Left ventricular rupture after mitral surgery: repair by patch and sealing

Mortality Rates of Surgical Techniques for Correcting Atrioventricular Disjunction

We compared the mortality rates of two surgical techniques for correction of atrioventricular disjunction in 10 out of 720 patients who underwent mitral valve replacement from 2005 to 2012. In group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a 'patch' of bovine pericardium was sutured and extended from the base of the lateral and medial papillary muscles, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring. The group II technique showed a lower mortality.

Polyethylene Glycol-Based Synthetic Hydrogel Sealant for Filtration Bleb Leaks: An In Vivo and Histologic Study

Purpose

To evaluate the efficacy of polyethylene glycol (PEG)-based synthetic sealant for closing bleb leaks after glaucoma filtration surgery.

Methods

Tube shunt surgery that included implantation of a 22-gauge indwelling catheter and intraoperative mitomycin C was performed in the left eyes of 11 New Zealand white rabbits. Seven days postoperatively, all filtration blebs were perforated with an 18-gauge needle to create a bleb hole. In six rabbits, the holes were covered with the sealant and irradiated with blue-green light for 60 seconds; in the five control rabbits, the holes were untreated. For 3 weeks after the tube shunt surgery, the eyes were checked for bleb leaks, and the intraocular pressure (IOP) was measured in both eyes. Finally, the operated eyes were enucleated for histologic examination.

Results

The bleb leaks stopped in the eyes in which sealant was used and persisted in the other eyes. The sealant preserved the bleb function; the IOPs in these eyes were significantly (P < 0.05) lower than the right eyes that did not undergo surgery. Hematoxylin and eosin staining showed that the holes were closed and covered with conjunctival epithelial cells in the eyes in which sealant was applied; the holes were open in the control eyes. Immunohistochemical staining showed that the bleb holes in which the sealant was applied had fewer inflammatory cells.

Conclusions

The PEG sealant has the potential to seal bleb leaks effectively.

Translational Relevance

Application of the PEG sealant can be used as adjunct therapy for bleb leaks in glaucoma surgery.

Epicardial Tachosil Patch Repair of Ventricular Rupture in a 90-Year-Old After Mitral Valve Replacement

We report our experience with emergent treatment of ventricular rupture following a mitral valve replacement in a 90 year-old male. The repair was performed using a Tachosil patch (Baxter Health Care Corporation, Westlake Village, California), a fibrin sealant coated on an equine collagen sponge, and BioGlue (Cryolife, Kenneson, GA) and bovine pericardium (Edwards Lifesciences, Irvine, CA). Aside from early ventricular dysfunction requiring a low-dose dopamine infusion, this patient's recovery was uneventful. Follow-up echocardiograms demonstrated no gross anatomic abnormality at the repair site, and steady improvement in his ventricular function.

Use of Bovine Pericardium and Sutureless Biological Glue in Left Ventricular Rupture After Mitral Valve Replacement, Five Years of Follow-up

Rupture of the left ventricular wall after mitral valve replacement is an infrequent but lethal complication. Reporting correction technique of ventricular rupture with bovine pericardium patch secured with glue and without suturing: a 51 years-old female patient, with double rheumatic mitral lesion, severe stenosis and discrete insufficiency, who had a mitral valve replacement. During surgery, the patient presented a ventricular rupture of the posterior wall (atrioventricular disruption), which was successfully repaired using bovine pericardium with sutureless biological glue over the epicardium of the damaged area. Sixty months after surgery the patient has no symptoms.

On-demand and negative-thermo-swelling tissue adhesive based on highly branched ambivalent PEG-catechol copolymers

A series of well-designed highly branched PEG-catechol based thermo-responsive copolymers were synthesized via a one-pot RAFT polymerization. A varying degree of photocrosslinkable (meth)acrylate moieties were incorporated within the 3D structure to allow on-demand photocuring (strong cohesion, unlike conventional PEG adhesives). At the same time, multitudes of free catechol groups inspired from adhesive proteins of marine mussels were also introduced in the hyperbranched structure, giving rise to adherence to skin and cardiac tissue. The resulting ambivalent PEG-catechol based copolymers were systematically studied to investigate the effects of polymer composition on tissue bioadhesive and swelling properties, comparing acrylates to methacrylates and PEG to 2-hydroxyethyl acrylamide (HEAA). It was proved that DOPA played a major role in the adhesion performance as it significantly enhanced the adhesion performances on varied substrates. The highly branched PEG-catechol copolymers demonstrate the great potential in the design of novel surgical glues, sealants or drug delivery vectors.