OC-068 THE USE OF VAC IN THE SALVAGE OF INFECTED SYNTHETIC MESHES

Introduction

Mesh-related infections consist a major complication of hernia repair operations that can negatively affect postoperative outcomes. Until recently, surgical removal of the mesh was the only treatment option and it was related to increased morbidity. VAC devices are a proper alternative in treating such infections and can eliminate the need to remove the infected mesh. The negative pressure that is used, removes the exudate and enhances revascularization and granulation of the wound. Such devices promote quicker wound healing, compared to conventional wound dressings.

Aim

The aim of the study is to review current literature and present three relevant cases from our center.

Materials and Methods

During 2020–2021, we encountered three cases of synthetic mesh infection after incisional hernia repair. The patients were treated conservatively, with the application of VAC devices and targeted antimicrobial therapy. All three patients were discharged and continued to visit the hospital as outpatients in order to change the dressings.

Results and conclusions

In all three cases, complete wound healing was achieved and the infection was treated successfully, without removing the mesh. In conclusion, the use of VAC is an alternative therapeutic strategy of low risk that can contribute to the salvage of the infected mesh.

Heart rate turbulence as potential adjuvant index for optimal treatment guidance in severe pulmonary artery hypertension

Purpose

Despite significant progress achieved in the management of pulmonary arterial hypertension (PAH), the prognosis remains poor. Sudden cardiac death is one main cause of death in advanced disease. It is already known that in pts with PAH there is an alteration in cardiac autonomic nervous activity. Heart rate turbulence (HRT) is an ECG–related autonomic marker, helpful in risk stratification of proarrhythmia and sudden cardiac death. Aim of the study was to examine HRT in patients with severe idiopathic PAH (IPAH) and its relation to disease's progress.

Methods

The study population consisted of 46 pts, (32 men and 14 women), mean age 50±9 years, Group A 20 pts: NYHA III, III–IV diagnosed as severe IPAH and Group B 26 pts: NYHA II, II–III diagnosed as moderately severe IPAH. They underwent 24h Holter monitoring-HRT analysis with calculation of 2 parameters, turbulence onset (TO) and turbulence slope (TS) (Abnormal values: TO>0, TS<2.5msec/RR). Pts were defined as HRT(+) when TO and/or TS were abnormal and as HRT(−) when both TO and TS were normal or when HRT could not be calculated because of none or too few suitable PVCs. Reassessment of HRT was undertaken in 6 mo and 1 year in case of change in clinical status. Six pts from group A and 7 pts from group B underwent HRT reassessment because of change in clinical status.

Results

Initially abnormal HRT was found in 12 out of 20 pts (n=12, 60%) in group A and in none out of 26 (n=0, 0%) in group B (p=0,001). In 5 pts out of 8 with clinical improvement and 4 pts with clinical deterioration who had HRT reassessed, significant positive correlation was found between TS and change of clinical status (r=0,64, p=0,04). There was a tendency to greater normal TS mean values with clinical improvement even in group where TS was already normal (6,95±4,5 vs 3±0,3 p=0.077).

Conclusion

In severe IPAH cardiac autonomic system impairment was demonstrated mainly as abnormal TS in HRT. Significant positive correlation between normalization of TS and clinical improvement was revealed and that raises promises for use of HRT optimization as adjuvant index to guide optimal IPAH therapy and efficacy.

Funding Acknowledgement

Type of funding sources: None.

Diagnostic superiority of continuous-loop electrocardiographic recording over other testing in a patient with recurrent syncope and underlying coronary artery disease with severe left ventricular dysfunction

Dysrhythmic causes of syncope may elude diagnosis in postinfarction patients despite elaborate testing, including electrophysiologic study. For a correct diagnosis, capture of cardiac rhythm during patient's typical symptoms is crucial. This report describes a patient with coronary artery disease and decreased left ventricular ejection fraction who experienced recurrent syncopal episodes without obvious precipitating factors. The 12-lead electrocardiogram showed left bundle-branch block indicating a possible conduction abnormality as the underlying cause of syncope. Twenty-four-h Holter monitoring exhibited no sinus rhythm or conduction disturbances but revealed a nonsustained run of ventricular tachycardia. Findings at electrophysiologic testing led to a presumptive diagnosis of tachyarrhythmic cause of syncope; however, the correct diagnosis was only made with use of a loop monitor which documented a 15-s sinus pause during a syncopal episode.

Radiofrequency ablation for post infarction ventricular tachycardia. Report of a single centre experience of 112 cases

OBJECTIVES

This report presents the largest consecutive series to date of radiofrequency ablation in the treatment of post infarction ventricular tachycardia.

METHODS

One hundred and twelve consecutive patients were studied, with an average of 12 documented episodes of ventricular tachycardia in the month preceding the radiofrequency ablation. Seventy-four percent of the subjects had an ejection fraction of less than 35%; 84% had more than one morphology of ventricular tachycardia and 30% had haemodynamically unstable ventricular tachycardia. The mean follow-up period was 61 months.

RESULTS

Complete success defined as no inducible sustained monomorphic ventricular tachycardia was achieved in 38%. Modified result, defined as ventricular tachycardia only inducible by two stimuli more aggressive than at baseline was achieved in 34%. During follow-up, ventricular tachycardia recurred in 25 patients: 22 after a failed procedure, two following a modified result and one following a complete success. Twenty-five patients died: 13 of progressive cardiac failure and four of presumed arrhythmic causes, three after a failed procedure and one following a modified result. There were no procedure-related deaths. Procedural complications occurred in seven patients.

CONCLUSIONS

In this report, radiofrequency ablation of post infarction ventricular tachycardia is a successful procedure with a low complication rate. Acute procedural success accurately predicts long-term freedom from recurrent ventricular tachycardia.

Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction

OBJECTIVE

To determine whether radiofrequency (RF) ablation might have a role in haemodynamically unstable ventricular tachycardia.

METHODS

10 patients with a history of ventricular tachycardia producing haemodynamic collapse in whom drug treatment had failed and device therapy was rejected underwent RF ablation of ventricular tachycardia in sinus rhythm. The arrhythmogenic zone was defined on the basis of abnormal systolic movement, the presence of fragmentation (low amplitude, prolonged multiphasic electrograms), and pace mapping. RF lesions were delivered in power mode in linear fashion within the defined arrhythmogenic zone.

RESULTS

Success (no ventricular tachycardia inducible postablation or at retest) was achieved in six patients, possible success (a different ventricular tachycardia inducible at more aggressive stimulation) in three. In one patient, the procedure was abandoned because of poor catheter stability. There were no clinical events during a mean (SD) follow up period of 23 (10) months in any of the nine patients defined as definite or possible successes.

CONCLUSIONS

RF ablation for addressing haemodynamically unstable ventricular tachycardia opens the door for the wider use of catheter ablation for treating this arrhythmia.

Thoracoscopic mapping and cryoablation of right ventricular tachycardia

A 14-year-old girl with right ventricular dysplasia and recurrent drug refractory ventricular tachycardia underwent thoracoscopic mapping cryoablation. Good access to the right ventricular free wall was obtained. We suggest this technique may have an important role in the management of patients with right ventricular tachycardia.

Respiratory variation in mitral flow velocity in pericardial effusion and cardiac tamponade

It has been suggested that the presence of increased respiratory variation in mitral flow velocity (RVIMFV) in patients with pericardial effusion (PE) represents significant hemodynamic compromise regardless of the amount of PE or 2D-echo findings. Recent experimental data do not, however, support this aspect. The aim of this study was to evaluate the relation of RVIMFV to clinical, hemodynamic, and 2D-echo findings in patients with PE and cardiac tamponade (CT). Therefore, 11 patients with PE and CT were studied with right-heart, pericardial, and arterial pressure measurements in conjunction with 2D and Doppler echocardiography during three stages of gradually decreasing PE, ie, (1) before any PE drainage, (2) after partial PE drainage, and (3) after full drainage. A significant RVIMFV was noted during all three stages of our study. It was maximal at the early stage [respiratory difference in mitral flow velocity (delta MFV): 16.8 +/- 6.3 cm/sec, 24.1%, P = 0.0000026] coinciding with pulsus paradoxus, high pericardial pressure, and diastolic right heart collapse, and it decreased slightly after partial drainage when all signs of CT receded (delta MFV: 13.7 +/- 9.7 cm/sec, 18%, P = 0.00043). However, there was still some RVIMFV (delta MFV: 8.7 +/- 7.6 cm/sec, 13.9%, P = 0.0017) after full pericardial drainage. It is concluded that the presence and the magnitude of RVIMFV is not predictive of hemodynamic compromise in patients with PE.

Early exercise test in acute myocardial infarction treated with intravenous streptokinase

The aim of this study was to assess the value of the early exercise test (ET) in patients with acute myocardial infarction (AMI) treated with IV streptokinase (SK). The authors studied 70 patients with first AMI; 31 were treated with SK and 39 were not. Before discharge everyone was given early exercise up to 5-6 METs and catheterized within 22.9 +/- 7.2 days. There was no significant difference in the number of positive ETs between the two groups (11/31 and 14/39 respectively). There was significant difference in favor of: (1) the recanalization of the infarct-related artery in the SK group, (2) the negative ET in patients with recanalized vessels in both groups, (3) the positive ET in patients with multi-vessel coronary disease. It is concluded that the results of early ET in patients with AMI are related to the recanalization of the infarct-related artery and the coexistence of multi-vessel coronary artery disease, regardless of SK treatment. Patients with successful thrombolysis have negative ET more frequently.