First two brazilian cases: correction of ascending aortic aneurysm and aortic valve stenosis with sutureless/rapid deployment aortic prosthesis

Abstract Ascending aortic aneurysm is usually associated with aortic valve diseases, especially aortic stenosis. The standard technique involves the substitution of the dilated aortic segment with a Dacron tube and replacement of the aortic valve with a regular prosthesis. The correction of ascending aortic aneurysm with aortic valve replacement using the new sutureless and rapid deployment prosthesis was performed by a minimally invasive approach and for the first time in a Brazilian Center.

Teoría Bifásica del Movimiento Dentario Aplicada Mediante Micro-Osteo-Perforaciones / Teeth Movement Bifasic Theory Applied by Micro-Osteo-Perforations

RESUMEN: Un desafío común en la ortodoncia es la realización de cierres de espacio en brechas largas con pérdida ósea significativa producto de extracciones tempranas, sitio de extracciones traumáticas o expansiones en adultos con tabla vestibular delgada. El propósito de este artículo es difundir una teoría del movimiento dental desarrollada a partir de una serie de investigaciones que intentan probarla en animales como seres humanos. Las dos fases de remodelación de hueso son la "activación - reabsorción" (proceso catabólico) y "activación-formación" (proceso anabólico) de las superficies del hueso, resultando en los cambios de tamaño, forma y posición del hueso. La inflamación es necesaria para el movimiento dentario. Se puede estimular ambas fases mediante pequeñas perforaciones del hueso que pueden ser realizadas de forma segura en la superficie vestibular o lingual de las tablas corticales pudiendo ser superficiales o profundas. Se muestran ejemplos clínicos de pacientes tratados con el enfoque de la Teoría bifásica mediante estimulación ósea transgingival. Se concluye que esta teoría bifásica permite explicar la favorable respuesta que se observa en situaciones clínicas complejas cuando se estimula el movimiento con micro-osteoperforaciones.

ABSTRACT: A common challenge in orthodontics is the task of space closures in long gaps with significant bone loss due to early extractions, site of traumatic extractions or expansions in adults with thin vestibular table. The purpose of this article is to disseminate a theory of dental movement developed from a series of investigations that try to test it in animals as human beings. The two phases of bone remodeling are the "activation - resorption" (catabolic process) and "activation-formation" (anabolic process) of bone surfaces, resulting in changes in bone size, shape and position. Inflammation is necessary for tooth movement. Both phases can be stimulated by small perforations of the bone that can be performed safely on the vestibular or lingual surface of the cortical boards, which may be superficial or deep. Clinical examples of patients treated with the biphasic theory approach by transgingival bone stimulation are shown. It is concluded that this biphasic theory allows to explain the favorable response observed in complex clinical situations when the movement is stimulated with micro-osteoperforations.

Thrombocytopenia after aortic valve replacement: comparison between sutureless perceval s valve and perimount magna ease bioprosthesis

Abstract Introduction: The incidence of postoperative thrombocytopenia after aortic valve replacement (AVR) with the Perceval S Sutureless bioprosthesis remains unclear. The aim of this study was to report thrombocytopenia associated with the use of sutureless AVR. Methods: The data was collected retrospectively for patients who had isolated AVR with sutureless Perceval S valve (Group A: 72 patients) and was compared with patients who underwent isolated sutured AVR with Perimount Magna Ease Bioprosthesis (Group B: 101 patients) in our institution between June 2014 and January 2017. Results: Cardiopulmonary bypass and cross-clamp time were significantly shorter in group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A versus 44% mean (day 1.7) in group B (P=0.0001). Absolute platelet count on postoperative day 1-6 in group A was significantly less than in group B (P≤0.05). Platelet count recovered to preoperative value in 44% patients in group B versus only in 26% patients in group A at discharge (P=0.018). Moderate thrombocytopenia occurs more often in group A (41% vs. 26%) (P=0.008) while severe thrombocytopenia (<50 x 109) was observed in 6% in group A but never in group B. Platelets (P=0.007) and packed red blood cells (P=0.009) transfusion was significantly higher in the group A. Conclusion: The implantation of sutureless Perceval aortic valves was associated with a significant drop in platelet count postoperatively with slow recovery and higher platelets and packed red blood cells transfusion requirements. A prospective randomised trial is needed to confirm our findings.

Aortic valve replacement with a conventional stented bioprosthesis versus sutureless bioprosthesis: a study of 763 patients

Abstract Objective: The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. Methods: From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). Results: Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.