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  1. Article ; Online: Sternal protection technique for open chest management.

    Pruna-Guillen, Robert / Morales-Rey, Ignacio / Quintana, Eduard / Sandoval, Elena

    Multimedia manual of cardiothoracic surgery : MMCTS

    2023  Volume 2023

    Abstract: On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to ...

    Abstract On some occasions, postoperative mediastinal bleeding or right ventricular failure forces surgical teams to pursue a strategy of open-chest management and delayed sternal closure. One notable source of postoperative bleeding is the sternum, either due to medullar bleeding or bone margin oozing, which may be difficult to control. Furthermore, in cases with right ventricular failure or dilatation needing an open-chest strategy, sternal margins might erode and injure the right ventricular anterior wall. We propose a simple but effective sternal protection technique during open-chest management and further delayed chest closure. Using leftover tubing from the cardiopulmonary bypass circuit or a mediastinal 32 Fr drain, both sternal margins are covered and secured with sutures. Moreover, in case of profuse bleeding, a thrombin-derived haemostatic agent can be applied between the bone marrow and the tube for an additional level of haemostasis. The sternal wound is isolated with a latex membrane and covered with transparent sterile adhesive sheets to achieve vacuum sealing.
    MeSH term(s) Humans ; Surgical Wound Infection/surgery ; Sternum/surgery ; Heart Failure/surgery ; Reoperation
    Language English
    Publishing date 2023-11-03
    Publishing country England
    Document type Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2023.058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A heart transplant under temporary paracorporeal biventricular circulatory support.

    Pruna-Guillen, Robert / Sandoval Martínez, Elena / Alcocer, Jorge / Quintana, Eduard

    Multimedia manual of cardiothoracic surgery : MMCTS

    2023  Volume 2023

    Abstract: Mechanical circulatory support as a strategy for a bridge to a heart transplant for patients with end-stage heart failure is increasing. A heart transplant following short-term support is a challenging procedure with many particularities. In this video ... ...

    Abstract Mechanical circulatory support as a strategy for a bridge to a heart transplant for patients with end-stage heart failure is increasing. A heart transplant following short-term support is a challenging procedure with many particularities. In this video tutorial, we present a 44-year-old patient who was bridged to a heart transplant with biventricular short-term paracorporeal support. The patient, who had dilated non-ischaemic cardiomyopathy, suffered an arrhythmic storm and was refractory to medical treatment and multiple ablation attempts. At the time the support was initiated, he was sarcopenic due to cardiac cachexia. He received a heart from a suitable donor after 10 days on mechanical circulatory support.
    MeSH term(s) Male ; Humans ; Adult ; Heart-Assist Devices ; Heart Transplantation ; Myocardial Ischemia ; Extracorporeal Membrane Oxygenation ; Tissue Donors ; Heart Failure/surgery ; Treatment Outcome
    Language English
    Publishing date 2023-03-21
    Publishing country England
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2023.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Open descending and thoracoabdominal aortic replacement: operative steps for patients with prior endovascular treatment.

    Pruna-Guillen, Robert / Adams, Benjamin / Ye Oo, Aung / Lopez-Marco, Ana

    Multimedia manual of cardiothoracic surgery : MMCTS

    2023  Volume 2023

    Abstract: Open surgery remains the gold standard for the treatment of the thoracoabdominal aorta. The rising number of endovascularly treated patients comes with an increase in the number of patients who require secondary open interventions due to the complex ... ...

    Abstract Open surgery remains the gold standard for the treatment of the thoracoabdominal aorta. The rising number of endovascularly treated patients comes with an increase in the number of patients who require secondary open interventions due to the complex nature of the aortic disease or to treat endovascular complications. We describe our current approach to secondary open extent II thoracoabdominal aortic repair in patients with prior endovascular repair. In this case report, we show two different cases that exemplify this scenario.
    MeSH term(s) Humans ; Aortic Dissection ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Aortic Diseases/surgery ; Aorta/surgery ; Endovascular Procedures/adverse effects ; Treatment Outcome ; Postoperative Complications/surgery ; Retrospective Studies
    Language English
    Publishing date 2023-02-06
    Publishing country England
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2022.118
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Root-commando operation with a modified self-assembled aortic root conduit for endocarditis after sutureless aortic valve replacement.

    Pechenenko, Anton / Rzhanyi, Maksym / Pruna-Guillen, Robert / Ascaso, María / Alcocer, Jorge / Quintana, Eduard

    Multimedia manual of cardiothoracic surgery : MMCTS

    2023  Volume 2023

    Abstract: We present a case of a Staphylococcus epidermidis early prosthetic valve endocarditis after minimally invasive sutureless aortic valve replacement. The patient developed a root abscess with a fistula, severe mitral and periprosthetic regurgitations, with ...

    Abstract We present a case of a Staphylococcus epidermidis early prosthetic valve endocarditis after minimally invasive sutureless aortic valve replacement. The patient developed a root abscess with a fistula, severe mitral and periprosthetic regurgitations, with a large mitral vegetation and a residual patent foramen ovale. The surgical approach consisted of a redo median sternotomy, explantation of a sutureless aortic prosthesis, resection of an intervalvular fibrosa and anterior mitral leaflet and debridement of an aortic root-left ventricle outflow tract abscess. These procedures were followed by a root-commando procedure with mitral and aortic root placement using a self-assembled mechanical aortic root conduit. The technique used is an alternative to a root-commando procedure performed with an allograft or a Medtronic Freestyle bioprosthesis. The same technique can be utilized with a commercially available stented bioprosthesis.
    MeSH term(s) Humans ; Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/surgery ; Aortic Valve/surgery ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis Implantation/methods ; Abscess/surgery ; Aorta, Thoracic/surgery ; Endocarditis/etiology ; Endocarditis/surgery ; Bioprosthesis/adverse effects
    Language English
    Publishing date 2023-11-06
    Publishing country England
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2023.073
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Postinfarction posterior ventricular septal defect repair: Infarct exclusion technique.

    Ascaso, María / Pruna-Guillen, Robert / Sandoval Martínez, Elena / Quintana, Eduard

    Multimedia manual of cardiothoracic surgery : MMCTS

    2021  Volume 2021

    Abstract: A 61-year-old man, an active smoker with associated chronic obstructive pulmonary disease on bronchodilator therapy, presented with acute inferior ST-elevation myocardial infarction. The right coronary artery was shown to be the infarct-related artery ... ...

    Abstract A 61-year-old man, an active smoker with associated chronic obstructive pulmonary disease on bronchodilator therapy, presented with acute inferior ST-elevation myocardial infarction. The right coronary artery was shown to be the infarct-related artery and was ultimately treated with a drug-eluting stent with an optimal angiographic result. Despite treatment, the patient continued to experience chest pain. Echocardiography showed an extensive posterior mid-ventricular septal defect. Given the scenario of an acute ventricular septal defect with impending hemodynamic repercussions, emergency surgery was pursued. After a median sternotomy and institution of cardiopulmonary bypass with bicaval cannulation, the inferior wall was exposed to assess the necrotic scar. After ventriculotomy, there was an irregular large septal defect with poorly defined margins. In this case, the posterior papillary muscle showed patchy areas of necrosis, requiring a mitral valve replacement. The ventricular septal defect was repaired using an oval-shaped bovine pericardial patch sutured with 3-0 polypropylene sutures, secured with Teflon pledgets, placed transmurally in healthy endocardium. The same patch was incorporated in the ventriculotomy closure.
    MeSH term(s) Animals ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Cattle ; Drug-Eluting Stents ; Heart Septal Defects, Ventricular/surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction
    Language English
    Publishing date 2021-11-29
    Publishing country England
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2021.078
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Extended septal myectomy and left ventricular outflow tract intervention for hypertrophic obstructive cardiomyopathy.

    Pruna-Guillen, Robert / Ascaso, María / Affronti, Alessandro / Quintana, Eduard

    Multimedia manual of cardiothoracic surgery : MMCTS

    2021  Volume 2021

    Abstract: Hypertrophic obstructive cardiomyopathy is the most common inherited cardiomyopathy. Septal myectomy is a low-risk operation and remains the first septal reduction therapeutic option. We present a patient with hypertrophic obstructive cardiomyopathy ... ...

    Abstract Hypertrophic obstructive cardiomyopathy is the most common inherited cardiomyopathy. Septal myectomy is a low-risk operation and remains the first septal reduction therapeutic option. We present a patient with hypertrophic obstructive cardiomyopathy requiring extended septal myectomy and concomitant left ventricular outflow tract intervention. In addition to septal reduction therapy, this patient also underwent anterior mitral valve plication, trigonal release, and secondary chordal division to relieve the obstruction. A tailored approach to hypertrophic obstructive cardiomyopathy with a comprehensive left ventricular outflow tract intervention is necessary to ensure the best hemodynamic outcome. Preoperative heart failure and recurrent syncope fully resolved after this intervention.
    MeSH term(s) Cardiac Surgical Procedures/methods ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/surgery ; Heart Septum/surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Ventricular Outflow Obstruction/etiology ; Ventricular Outflow Obstruction/surgery
    Language English
    Publishing date 2021-03-02
    Publishing country England
    Document type Case Reports ; Journal Article ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2021.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Intraoperative Collateral Drainage Evaluation Before Superior Caval Interruption in Partial Anomalous Pulmonary Venous Connection Repair.

    Affronti, Alessandro / Sandoval, Elena / Quintana, Eduard / Pruna-Guillen, Robert / Pereda, Daniel

    Innovations (Philadelphia, Pa.)

    2022  Volume 17, Issue 3, Page(s) 244–246

    Abstract: A superior sinus venosus atrial septal defect and partial anomalous pulmonary venous connection was corrected by a minimally invasive approach by permanently ligating the superior vena cava and a single pericardial patch for rerouting the flow through ... ...

    Abstract A superior sinus venosus atrial septal defect and partial anomalous pulmonary venous connection was corrected by a minimally invasive approach by permanently ligating the superior vena cava and a single pericardial patch for rerouting the flow through the enlarged interatrial communication. The patient had persistency of the left superior vena cava draining in the coronary sinus but no innominate vein. This anatomy poses a risk of developing right-sided superior vena cava syndrome. In this article, we describe our intraoperative strategy to assess the safety of this approach in such cases, which facilitates minimally invasive repair and avoids the most important complications of conventional repair.
    MeSH term(s) Drainage ; Heart Septal Defects, Atrial/complications ; Heart Septal Defects, Atrial/diagnostic imaging ; Heart Septal Defects, Atrial/surgery ; Humans ; Pulmonary Veins/abnormalities ; Pulmonary Veins/surgery ; Scimitar Syndrome/diagnostic imaging ; Scimitar Syndrome/surgery ; Superior Vena Cava Syndrome/complications ; Vena Cava, Superior/diagnostic imaging ; Vena Cava, Superior/surgery
    Language English
    Publishing date 2022-05-13
    Publishing country United States
    Document type Journal Article
    ISSN 1559-0879
    ISSN (online) 1559-0879
    DOI 10.1177/15569845221097790
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Direct true lumen cannulation for type A aortic dissection (Samurai technique) in emergency scenarios.

    Pruna-Guillen, Robert / Ascaso, María / Affronti, Alessandro / Quintana, Eduard / Sandoval Martínez, Elena / Pereda, Daniel

    Multimedia manual of cardiothoracic surgery : MMCTS

    2021  Volume 2021

    Abstract: Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the ... ...

    Abstract Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the possible problems that may arise. In this video tutorial, we present a patient with acute type A aortic dissection who, after cardiopulmonary bypass with axillary arterial cannulation, developed a major complication: intraoperative malperfusion due to pressurization of the false lumen. The patient developed occlusion of the right coronary artery with electrocardiogram changes, inferior akinesia, and ventricular arrhythmias. Cerebral saturation was also significantly decreased. This scenario of acute malperfusion calls for immediate action.  We proceeded to switch the cardiopulmonary bypass configuration from axillary to direct true lumen cannulation. This technique, also known as the Samurai technique, is feasible in most cases and advantageous in this emergency situation, allowing prompt reestablishment of adequate perfusion of the true lumen . Some authors even advocate more widespread use of this technique because it may ensure antegrade perfusion while avoiding progression of the dissection flap and reduce the rate of the most common complications of other cannulation sites such as plexus injury during axillary cannulation or cerebral embolization through mobilization of thrombi or calcification from femoral retrograde perfusion. This technique is useful in cases of circumferential dissection and in patients with relative contraindications for peripheral cannulation such as morbid obesity or peripheral arterial occlusion by atherosclerosis or by the dissection itself.
    MeSH term(s) Aneurysm, Dissecting/surgery ; Axillary Artery ; Cardiopulmonary Bypass ; Catheterization ; Femoral Artery ; Humans
    Language English
    Publishing date 2021-11-09
    Publishing country England
    Document type Case Reports ; Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2021.073
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Infective endocarditis of a native quadricuspid aortic valve.

    Ascaso, María / Pruna-Guillen, Robert / Hernández-Meneses, Marta / Sandoval, Elena / Quintana, Eduard

    Asian cardiovascular & thoracic annals

    2021  Volume 30, Issue 2, Page(s) 202–204

    Abstract: Quadricuspid aortic valve complicated with infective endocarditis is an uncommon clinical scenario. The indications for surgery and medical management do not differ from other types of aortic valve endocarditis. Commonly present structural abnormalities ... ...

    Abstract Quadricuspid aortic valve complicated with infective endocarditis is an uncommon clinical scenario. The indications for surgery and medical management do not differ from other types of aortic valve endocarditis. Commonly present structural abnormalities pose an increased risk of complete heart block and coronary occlusion during valve replacement. We present a case of quadricuspid aortic valve complicated with infective endocarditis, with surgical images of the valve.
    MeSH term(s) Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Insufficiency/diagnostic imaging ; Aortic Valve Insufficiency/etiology ; Aortic Valve Insufficiency/surgery ; Endocarditis/surgery ; Endocarditis, Bacterial/diagnosis ; Endocarditis, Bacterial/diagnostic imaging ; Heart Valve Prosthesis/adverse effects ; Heart Valve Prosthesis Implantation/adverse effects ; Humans ; Quadricuspid Aortic Valve ; Treatment Outcome
    Language English
    Publishing date 2021-01-14
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1400468-9
    ISSN 1816-5370 ; 0218-4923
    ISSN (online) 1816-5370
    ISSN 0218-4923
    DOI 10.1177/0218492321989208
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Venovenous extracorporeal life support circuit exchange: Tips and pitfalls.

    Pruna-Guillen, Robert / Fernández-Cisneros, Alejandro / Martin Calabuig, Alexis / Gispert Martinez, Mireia / Chordà Sánchez, Marina / Sandoval Martínez, Elena

    Multimedia manual of cardiothoracic surgery : MMCTS

    2022  Volume 2022

    Abstract: Extracorporeal life support is a well-known therapy for acute respiratory failure. Its use has increased exponentially in recent years, even more since the beginning of the SARS-CoV-2 pandemic. Patients with COVID-19 may need long-term extracorporeal ... ...

    Abstract Extracorporeal life support is a well-known therapy for acute respiratory failure. Its use has increased exponentially in recent years, even more since the beginning of the SARS-CoV-2 pandemic. Patients with COVID-19 may need long-term extracorporeal life support runs. They also suffer coagulation derangements that cause a prothrombotic state. Both situations may increase the need for exchanges of extracorporeal life support circuits. Extracorporeal life support circuit exchange should be performed as quickly and as safely as possible because patients may be completely dependent on it.
    MeSH term(s) COVID-19 ; Extracorporeal Membrane Oxygenation ; Humans ; Respiratory Distress Syndrome ; Retrospective Studies ; SARS-CoV-2
    Language English
    Publishing date 2022-02-17
    Publishing country England
    Document type Video-Audio Media
    ZDB-ID 2280156-X
    ISSN 1813-9175 ; 1813-9175
    ISSN (online) 1813-9175
    ISSN 1813-9175
    DOI 10.1510/mmcts.2022.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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