Perioperative airway management strategy and posttransplant successful tracheal resection and reconstruction in a heart transplant candidate with post-intubation stenosis.

Post-intubation tracheal stenosis (PTS) is an important clinical situation. It is estimated to occur in approximately 5% to 20% of intubated or tracheostomized patients. PTS most commonly occurs after prolonged intubation, and the treatment options have been well discussed in the literature. However, in solid organ transplantation, the necessity of administering high doses of corticosteroids as well as immunosuppressive therapies may compromise the healing processes following tracheal resection and reconstruction, requiring different treatment strategies for simultaneous PTS. We present a patient suffering from end-stage heart failure and post-intubation tracheal stenosis along with our treatment strategy.

Factorial design optimization and in vivo feasibility of poly(epsilon-caprolactone)-micro- and nanofiber-based small diameter vascular grafts.

Because of the severe increase of mortality by cardiovascular diseases, there has been rising interest among the tissue-engineering community for small-sized blood vessel substitutes. Here we present small diameter vascular grafts made of slow degradable poly(epsilon-caprolactone) nanofibers obtained by electrospinning. The process was optimized by a factorial design approach that led to reproducible grafts with inner diameters of 2 and 4 mm, respectively. Fiber sizes, graft morphology, and the resulting tensile stress and tensile strain values were studied as a function of various parameters in order to obtain optimal vascular grafts for implantation after gamma-sterilization. The influence of polymer concentration, solvent, needle-collector distance, applied voltage, flow rate, and spinning time has been studied. Consequently, an optimized vascular graft was implanted as an abdominal aortic substitute in nine rats for a feasibility study. Results are given following up a 12-week implantation period showing good patency, endothelization, and cell ingrowth.

Matching the diameter of ePTFE bypass prosthesis with a native artery improves neoendothelialization.

BACKGROUND AND AIM: The undersizing of the bypass graft diameter compared to native artery changes blood flow characteristics and velocity which may affect conduit neo-endothelialization, intimal hyperplasia reaction and patency. The aim of this study was to evaluate conduit neoendothelialization, intimal hyperplasia reaction and patency results between undersized and matched ePTFE grafts. MATERIAL AND METHODS: In 16 male Sprague-Dawley rats, undersized (1-mm internal diameter) and matched (2-mm internal diameter) ePTFE grafts were anastomosed end-to-end in the infrarenal abdominal aorta. Blood flow volume per minute was measured and wall shear stress was calculated for each group. After 3 weeks of follow-up, angiography was performed via the left carotid artery just before sacrifice. Conduit neoendothelialization and intimal hyperplasia reaction were measured by computer-assisted morphometry. RESULTS: Wall shear stress was 8 times higher for the undersized group (840.56 vs. 105.07 mPa). Three weeks after implantation, conduit neoendothelialization was better in matched grafts compared to undersized grafts (441 vs. 574 microm, p = 0.008). Intimal hyperplasia reaction was similar for both groups (8.7 vs. 6.7 microm(2)/microm for undersized and matched grafts, respectively). Patency rate was 7/8 for undersized and 8/8 for matched ePTFE grafts. CONCLUSION: Although the graft patency and the intimal hyperplasia reaction were not different between the two groups after 3 weeks, matched grafts had a significantly better endothelialization compared to undersized grafts. This short-term beneficial effect may influence long-term patency results.

Initial clinical experience with a novel biodegradable ring in patients with functional tricuspid insufficiency: Kalangos Biodegradable Tricuspid Ring.

BACKGROUND: Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. METHODS: Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. RESULTS: Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P < 0.0001). The right atrial diameter and tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. CONCLUSIONS: Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.