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The Aortic Valve
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
An oblique aortotomy is performed slightly higher than usual to facilitate closure. Aortic tear at the pulmonic side of the incision can be bothersome, mainly in low aortotomies. Therefore, a transverse arteriotomy should be avoided because of exposure difficulties in this area. Three 4-0 polypropylene sutures are passed in each commissure and tagged to the drapes. These sutures further bring the valve from the bottom of the incision upwards to the middle of the operative field (Figure 7.1.8).
Infection control procedures
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
David Andresen, Giulietta Pontevivo
Infectious risks of interventional cardiology procedures may be classified in several ways. We find it useful to consider separately the risk of blood-borne viruses, infections associated with vascular access or incision sites, and infections related to permanently retained devices. Blood-borne virus infections are uncommon so long as single-use devices are not reprocessed or reused. Such transmission events are generally either patient-to-healthcare-worker, or rarely, healthcare-worker-to-patient. Vascular access infections are uncommon in electrophysiology, due to predominantly venous catheterisation sites and short device dwell-times. Arterial vascular access sites are more prone to infection, particularly if arteriotomy closure devices are used. Infection of coronary stents is remarkably rare.
Management of Acute Intestinal Ischaemia
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Michael J. Stamos, John V. Gahagan
Once the SMA is adequately exposed, a portion of the SMA just proximal to the middle colic branch is identified and circumferentially cleared. The artery at this location is sufficiently large to accommodate a bypass procedure, if necessary. If systemic heparinisation was not started pre-operatively, it should be given now. Proximal and distal control is obtained with vessel loops. The artery can then be opened with a transverse arteriotomy. Alternatively, a longitudinal arteriotomy can be made if the vessel is diminutive and should subsequently be closed with a vein patch. The proximal control on the SMA can be released to allow for any clot to be removed. A 3-Fr or 4-Fr balloon catheter can then be inserted to retrieve any proximal embolus or residual clot. Once complete, brisk pulsatile flow will be noted. Proximal control is again obtained, and attention is turned to the distal SMA. A 2-Fr or 3-Fr balloon catheter can be used for distal embolectomy. The distal mesenteric vessels can be fragile, so it is important to perform this manoeuvre with great care so as not to rupture the vessel.
The effect of ticagrelor on microarterial thrombosis in an experimental model
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Mehmet İhsan Okur, Ahmet Çetinbaş, Serdar Altun, Mehmet Öztan, Aysun Yıldız Altun, İbrahim Özercan
The subjects were laid on their backs, and the fur in their right and left inguinal regions was shaved. The surgical site was disinfected with povidone/iodine solution (Batticon, ADEKA, Istanbul), and the surgery was started. Following skin incision, a blunt dissection was used for the identification of the femoral pedicle, and both femoral vessels were isolated and cross-clamped. The femoral artery was placed into a double microvascular clamp, and excess adventitia was trimmed. A 180-degree arteriotomy was formed using microscissors, and the repair was initiated. Afterwards, a 180-degree arteriotomy was formed. A 9-0 Prolene monofilament suture was used for to create a ‘tuck’ of adventitia into the lumen of the vessel using an operating microscope and microvascular instruments, as specified by Stepnick et al. [6] (Figure 1). The suture was placed through the vessel's distal end and brought out closer to the arteriotomy site, but still on the distal side. Afterwards, the suture was passed from within the lumen of the arteriotomy out through the proximal wall of the vessel. Additional sutures were placed to assure hemostasis. The cross-clamps were removed and blood flow was observed. Any small leaks observed in the suture line were stopped within 1–2 min after a was buffer made using the fat pad. Up-lift and milking tests were performed distal to the suture line. In these tests performed at the first and fifth and minutes after suturing, blood flow through the suture line was detected in all subjects. The surgery was completed by closing the incision with skin sutures.
Contribution of Human Trophoblast Progenitor Cells to Neurogenesis in Rat Focal Cerebral Ischemia Model
Published in Brain Injury, 2021
Kerem Yanar, Muge Molbay, Eylem Özaydın-Goksu, Gozde Unek, Emre Cetindağ, Ali Unal, Emin Turkay Korgun
After the animals were anesthetized with 4% isoflurane, a ventral midline incision was performed under a stereoscopic microscope and the surface connective tissue was dissected. After the glandular tissue was separated by blunt dissection, blunt dissection was continued until the carotid artery was found from the left side of the tracheal muscle. The two branches of the external carotid artery (ECA) were ligated with the occipital artery and the superior thyroid artery 6/0 suture and cut with a catheter. The ECA was tied as distally as possible with a 6/0 suture. The micro clamps were placed near the joints of the common carotid artery (CCA) and the internal carotid artery (ICA). Arteriotomy was performed between the two sutures at ECA. The 2.0–2.2 cm 4/0 monofilament nylon suture, a 2.0 mm long, 0.39 mm diameter silicon type, was pushed into the ECA lumen into the region where the micro clamp was toward CCA. The suture around the ECA was tightened and the location of the nylon suture was stabilized, and bleeding was prevented. The micro clamp in the ICA was then slowly removed and the nylon suture was pushed from the ECA to the ICA lumen until it reached the middle cerebral artery (MCA). After 90 minutes of occlusion, the micro clamp in CCA was removed and the skin was closed with a 3/0 suture. Under the red light, the animal was expected to wake up from anesthesia.
Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
J. James Edelman, Chistopher Meduri, Pradeep Yadav, Vinod H. Thourani
Some prefer the subclavian artery which is approached by an infraclavicular incision medial to the pectoralis minor, while others prefer the axillary artery in the deltopectoral groove lateral to pectoralis minor. Both techniques most often require division of pectoralis minor just distal to its origin at the coracoid process. Care must be taken to avoid injury to the cords of the brachial plexus, which lie adjacent (subclavian approach) to or over (axillary approach) the artery (Figure 2). Three techniques are utilized for puncture of the axillary and placing of the wire and sheath: 1) purse-string of the artery with monofilament suture and access using a Seldinger technique, 2) transverse arteriotomy of the artery and then placement of a 7–8 F sheath, or 3) suture of a Dacron synthetic graft to the artery through which the large sheath is placed. Once the artery is exposed, the patient is heparinized and 6–8 mm graft is sutured onto the subclavian/axillary artery. Using seldinger technique the appropriate sheath is placed within the sheath and into the ascending aorta. Once the procedure is completed, the graft is oversewn and a two-layer closure is performed.