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Complete Repair (complete + repair)

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Medical Sciences85%

Selected Abstracts

Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:

JOURNAL OF CARDIAC SURGERY, Issue 2 2004
Literature Review, Our Experience
Materials and Methods: Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 ± 1.9 years. Mean gradient across the right ventricular outflow tract was 63 ± 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. Results: Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 ± 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 ± 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 ± 0.4 versus 1.7 ± 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 ± 6 mmHg, significantly lower than preoperatively (p < 0.001). Conclusions: Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice. (J Card Surg 2004;19:175-183) [source]

Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp-Patch for Reconstruction of the Right Ventricular Outflow Tract

JOURNAL OF CARDIAC SURGERY, Issue 6 2008
D.Sc., Guo-Wei He M.D., Ph.D.
Methods: From 2001 through 2005, 74 patients (50 male, 24 female; mean age of 13.6 ± 0.8 years, ranging from four to 34 years) with TOF (67) or double outlet RV (DORV)-type-TOF (seven) underwent complete repair. The resection of RVOT stenosis ± pulmonary valvotomy was principally through RA. A new two-patch technique to create a folded mono-cusp valve by using autologous pericardium was applied since August 2004. Results: The repair was through RA in 52 patients and through RA + RVOT/PA in 22 patients (18/4). TAPR was performed in 17 patients (23%, eight non-valved and nine valved). The aortic cross-clamp time was 130.1 ± 6.8 min in TAPR group and 85.8 ± 4.6 min in non-TAPR group (p < 0.0001). The operative mortality was 4.0% (3/74) in all and 2.9% (2/67) in TOF patients (due to low output, uncontrollable bleeding, and repeated bleeding from the pulmonary collateral vessels late) and was similar in TAPR or non-TAPR. The valved patch-repaired patients had mild PI and good RV function postoperatively up to eight to 12 months. Conclusions: Repair of TOF in older children/adults should include low rate of TAPR of RVOT. If indicated, the new folded monocusp-patch technique is recommended. It is an effective and simple way to markedly reduce postoperative PI with no additional cost. [source]

Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:

JOURNAL OF CARDIAC SURGERY, Issue 2 2004
Literature Review, Our Experience
Materials and Methods: Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 ± 1.9 years. Mean gradient across the right ventricular outflow tract was 63 ± 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. Results: Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 ± 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 ± 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 ± 0.4 versus 1.7 ± 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 ± 6 mmHg, significantly lower than preoperatively (p < 0.001). Conclusions: Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice. (J Card Surg 2004;19:175-183) [source]

Evaluation of articular cartilage repair using biodegradable nanofibrous scaffolds in a swine model: a pilot study

JOURNAL OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE, Issue 1 2009
Wan-Ju Li
Abstract The aim of this study was to evaluate a cell-seeded nanofibrous scaffold for cartilage repair in vivo. We used a biodegradable poly(,-caprolactone) (PCL) nanofibrous scaffold seeded with allogeneic chondrocytes or xenogeneic human mesenchymal stem cells (MSCs), or acellular PCL scaffolds, with no implant as a control to repair iatrogenic, 7 mm full-thickness cartilage defects in a swine model. Six months after implantation, MSC-seeded constructs showed the most complete repair in the defects compared to other groups. Macroscopically, the MSC-seeded constructs regenerated hyaline cartilage-like tissue and restored a smooth cartilage surface, while the chondrocyte-seeded constructs produced mostly fibrocartilage-like tissue with a discontinuous superficial cartilage contour. Incomplete repair containing fibrocartilage or fibrous tissue was found in the acellular constructs and the no-implant control group. Quantitative histological evaluation showed overall higher scores for the chondrocyte- and MSC-seeded constructs than the acellular construct and the no-implant groups. Mechanical testing showed the highest equilibrium compressive stress of 1.5 MPa in the regenerated cartilage produced by the MSC-seeded constructs, compared to 1.2 MPa in the chondrocyte-seeded constructs, 1.0 MPa in the acellular constructs and 0.2 MPa in the no-implant group. No evidence of immune reaction to the allogeneically- and xenogeneically-derived regenerated cartilage was observed, possibly related to the immunosuppressive activities of MSCs, suggesting the feasibility of allogeneic or xenogeneic transplantation of MSCs for cell-based therapy. Taken together, our results showed that biodegradable nanofibrous scaffolds seeded with MSCs effectively repair cartilage defects in vivo, and that the current approach is promising for cartilage repair. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Bounding the optimal burn-in time for a system with two types of failure

NAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 8 2004
Ji Hwan Cha
Abstract Burn-in is a widely used method to improve the quality of products or systems after they have been produced. In this paper, we consider the problem of determining bounds to the optimal burn-in time and optimal replacement policy maximizing the steady state availability of a repairable system. It is assumed that two types of system failures may occur: One is Type I failure (minor failure), which can be removed by a minimal repair, and the other is Type II failure (catastrophic failure), which can be removed only by a complete repair. Assuming that the underlying lifetime distribution of the system has a bathtub-shaped failure rate function, upper and lower bounds for the optimal burn-in time are provided. Furthermore, some other applications of optimal burn-in are also considered. © 2004 Wiley Periodicals, Inc. Naval Research Logistics, 2004 [source]

Morphometric evaluation of the repair of critical-size defects using demineralized bovine bone and autogenous bone grafts in rat calvaria

CLINICAL ORAL IMPLANTS RESEARCH, Issue 8 2008
Rodrigo Cardoso de Oliveira
Abstract Objective: To evaluate the repair of critical-size bone defects in rats treated with demineralized bovine bone (DBB) compared with autogenous bone (AB). Material and method: A bone defect of 8 mm in diameter was created in the calvaria of 50 Rattus norvegicus, treated either with DBB or AB. Sub-groups of five rats of each group were killed at 7, 14, 21, 30 and 90 days post-operatively, and the skulls were removed and processed histologically. Histological sections were stained with hematoxylin and eosin. Result: Histological analysis showed complete closure of the defects with new bone at 90 days in group AB, and substitution of the biomaterial by fibrotic connective tissue in the DBB group at 21 days. Morphometric analysis showed that DBB was rapidly absorbed at 14 days, with its volume density decreasing from 47%±0.8% at 7 days to 1.2%±0.41% at 14 days. Subsequently, volume densities of the connective tissue and neoformed bone increased from 51.1%±11.17% to 86.8%±7.92% and from 1.9%±1.13% to 12%±8.02%, respectively, for the same time interval. The volume density of AB particles did not change throughout the experimental periods, but the amount of new bone increased markedly between 7 and 90 days, from 4.5%±1.57% to 53.5%±6.42% (P<0.05). Conclusion: DBB did not provide complete repair of the defects, with significantly less new bone formation than in the AB group. [source]