The document summarizes the Personalised External Aortic Root Support Project (PEARS), which developed an engineered external support sheath as an alternative to prosthetic valves or grafts for ascending aortic dilation. The PEARS team used imaging to create 3D models of patients' aortas, then manufactured bespoke textile supports. 64 patients have been treated with reduced risks compared to other surgeries. The technique aims to improve outcomes for various conditions causing aortic dilation and may reduce costs compared to lifetime anticoagulation from other procedures.
Surgical Management for a Stuck up and fracture angioplasty devices in Vivo during PCI in a Complex LAD Artery Lesion: A Case Report and Literature Review.
Md. Abir Tazim Chowdhury1, Sohail Ahmed2, Md. Zulfiqur Haider2
Abstract
Background: Stuck up and fracture of coronary angioplasty devices are uncommon complications of percutaneous coronary interventions (PCI) for which surgical rescue and management is once in a while needed.
Case description: Here, we present one case of a 59-year-old diabetic, a hypertensive gentleman, who attended the emergency room (ER) with central chest pain for several hours and, after physical and diagnostic evaluation, was diagnosed as a case of Acute ST-segment elevated Myocardial Infarction (AMI) with stable hemodynamic. The findings mentioned above were initially treated with the thrombolytic agent in the ER and followed by admission to the cardiac care unit for monitoring and further invasive coronary evaluation by coronary angiogram (CAG). It was demonstrated essentially Single Vessel Disease (SVD) with complex Left Anterior Descending (LAD) artery lesion, where PCI attempted but failed with unfortunate stuck up and broken of the delivery shaft, and left inside the coronary system. Immediate judgment and surgical retrieval of lost angioplasty device and correction of the coronary lesion with its revascularization save the patient life from grave complications. This article describes all the critical, challenging events and our management approaches to this very complex coronary artery lesion.
.
Conclusion: Coronary angioplasty hardware should be regulated gently, carefully, and precisely according to the manufacturers' instructions for use, and it should be inspected for its integrity once brought out of the patient's body. In vivo trap of angioplasty hardware, fracture, and retention during the PCI are infrequent. Percutaneous retrieval of specifically complex bifurcation lesions constantly presents limits and risks. In those cases, it will be crucial to thoroughly inform the patient concerning the hazard of the procedure and consider surgical revascularization.
Address of Correspondence:
Name: Dr. Md. Abir Tazim Chowdhury
Designation: Specialist, Department of Cardiothoracic and Vascular Surgery
Institution: Evercare Hospital Dhaka, Bangladesh.
e-mail: chowdhuryabir0@gmail.com
Devices and technology in interventional cardiologyRamachandra Barik
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
Surgical Management for a Stuck up and fracture angioplasty devices in Vivo during PCI in a Complex LAD Artery Lesion: A Case Report and Literature Review.
Md. Abir Tazim Chowdhury1, Sohail Ahmed2, Md. Zulfiqur Haider2
Abstract
Background: Stuck up and fracture of coronary angioplasty devices are uncommon complications of percutaneous coronary interventions (PCI) for which surgical rescue and management is once in a while needed.
Case description: Here, we present one case of a 59-year-old diabetic, a hypertensive gentleman, who attended the emergency room (ER) with central chest pain for several hours and, after physical and diagnostic evaluation, was diagnosed as a case of Acute ST-segment elevated Myocardial Infarction (AMI) with stable hemodynamic. The findings mentioned above were initially treated with the thrombolytic agent in the ER and followed by admission to the cardiac care unit for monitoring and further invasive coronary evaluation by coronary angiogram (CAG). It was demonstrated essentially Single Vessel Disease (SVD) with complex Left Anterior Descending (LAD) artery lesion, where PCI attempted but failed with unfortunate stuck up and broken of the delivery shaft, and left inside the coronary system. Immediate judgment and surgical retrieval of lost angioplasty device and correction of the coronary lesion with its revascularization save the patient life from grave complications. This article describes all the critical, challenging events and our management approaches to this very complex coronary artery lesion.
.
Conclusion: Coronary angioplasty hardware should be regulated gently, carefully, and precisely according to the manufacturers' instructions for use, and it should be inspected for its integrity once brought out of the patient's body. In vivo trap of angioplasty hardware, fracture, and retention during the PCI are infrequent. Percutaneous retrieval of specifically complex bifurcation lesions constantly presents limits and risks. In those cases, it will be crucial to thoroughly inform the patient concerning the hazard of the procedure and consider surgical revascularization.
Address of Correspondence:
Name: Dr. Md. Abir Tazim Chowdhury
Designation: Specialist, Department of Cardiothoracic and Vascular Surgery
Institution: Evercare Hospital Dhaka, Bangladesh.
e-mail: chowdhuryabir0@gmail.com
Devices and technology in interventional cardiologyRamachandra Barik
In the past 2 to 3 decades, the field of pediatric
interventional cardiology has experienced significant
growth. Technological innovations have greatly advanced treatment of cardiovascular disease in both children and adults with congenital heart disease (CHD). Interventional therapy has become an acceptable alternative treatment for many CHD, including closure of atrial defects,muscular ventricular septal defects (VSDs), patent ductus arteriosus (PDA), dilation of stenotic valves (aortic and pulmonary), and dilation of stenotic vessels (branch pulmonary arteries, coarctation of the aorta [COA]). In some cases where the percutaneous approach is difficult or the patient still
requires repair of other associated cardiac anomalies,
a hybrid approach can be implemented with its obvious advantages to the patient
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
Transverse Aortic Constriction: The Importance of Monitoring Surgical OutcomesScintica Instrumentation
This free webinar hosted by Scintica Instrumentation reviewed with the viewer the importance of monitoring their surgical outcomes, specifically following transverse aortic constriction (TAC)
Join Tonya Coulthard as she discussed some background information about the TAC surgery, variability in the surgical outcomes and how to monitor those, as well as the importance of stratifying animals based on severity of constriction prior to initiating any form of intervention.
View more here https://www.scintica.com/webinar-transverse-aortic-constriction-the-importance-of-monitoring-surgical-outcomes/
Freedom: The Promise of Telemetry Revisited - Stellar Telemetry Webinar (TSE ...InsideScientific
The innovative Stellar Telemetry System allows individual recording of key physiological parameters in freely roaming and socially active animals. In this webinar we will discuss added capabilities of such a system, in particular flexibility and freedom for both scientist and subject. In one 'subtropical' setting we will learn how such a system can be used in a colony of primates that are free to roam, without traditional geographical or data management limitations. In the other setting we return to the lab and see how a system like this can enhance measurement capabilities in a traditional rodent model.
An educational material describing the Indications for Tracheostomy-Complications of Tracheostomy-Timing of Tracheostomy-Tracheostomy Technique-Tracheostomy Decannulation and types of Tracheostomy Tubes.
Dr Jonathan B Perlin President, Clinical Services and Chief Medical Officer, HCA (USA) on 'Learning healthcare and clinical leadership in an accountable environment'
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Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
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Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
1. Patient driven surgery:
The PEARS Project
A Question of Quality
ETC Venues, St Pauls London,
25 February, 2016
Tal Golesworthy C Eng MEI MRSC
Personalised External Aortic Root Support Project (PEARS)
2. Disease produces patients
Patient-need stimulates therapies
The medical profession develops to provide
those therapies
So patients’ therapeutic needs are the central
focus of the medical profession………..?
Personalised External Aortic Root Support Project (PEARS)
3. What is an R&D engineer doing in surgery?
3
3.5
4
4.5
5
1992 1994 1996 1998 2000 2002 2004
Time (Calendar Years)
AorticRootDia.(cm)
Personalised External Aortic Root Support Project (PEARS)
4. PROJECT TEAM - Technical
Personalised External Aortic Root Support Project (PEARS)
5. CULTURE?
Tal: “You know what the problem with you surgeons
is?”
Tom: “What’s that?”
Tal: ”You are facing engineering problems but you’re
NOT engineers”
Tom: ”Yes, you’re right……………”
Bob Anderson’s lab, Gt Ormond St, summer 2000
Personalised External Aortic Root Support Project (PEARS)
8. Dilation of the Ascending Aorta –
valve malfunction / dissection / rupture
Personalised External Aortic Root Support Project (PEARS)
9. PROJECT AIM
To prove the feasibility of an engineered, bespoke
external support sheath for the ascending aorta
retaining all of the patient’s native tissues thus
avoiding the need for prosthetic components in
contact with the blood and anti-coagulation
therapy.
Personalised External Aortic Root Support Project (PEARS)
10. STEP 1: Functional Specification
1. What MUST the external “stent” do?
2. What must the external stent NOT do?
3. What will the impact of the stent be on the
aortic/pericardial environment?
4. What will the impact of the aortic/pericardial
environment be on the stent?
Personalised External Aortic Root Support Project (PEARS)
11. CT scanner – Cardiac gated to ventricular diastole –
contrast agent enhanced – LVOT to top of arch.
STEP 2: Imaging the Ascending Aorta
Personalised External Aortic Root Support Project (PEARS)
18. STEP 5: Manufacturing an ExoVasc
Textile mesh shaped on former – cleaned, sterilised and packed
Personalised External Aortic Root Support Project (PEARS)
19. Textile Technology
Implant type T/VSRR PEARS
Polymer type PET / Polyester
Yarn (mono/multi filament) Multi filament
Textile type Woven Knitted
Textile stiffness High Low
Textile porosity V.Low High
Textile edges hard/sharp soft/pliant
Textile incorporation Partial Total
Personalised External Aortic Root Support Project (PEARS)
20. STEP 6: Surgical implantation
No circ. break-in, cardiac arrest/body cooling, and optional CPB
Personalised External Aortic Root Support Project (PEARS)
21. Pre – Op Apr 04 Post – Op Sep 04
Personalised External Aortic Root Support Project (PEARS)
23. Patient demographic: Feb 2016
• 64 patients treated (38 M + 26 F)
• A cumulative total of 266 post–operative patient years
• P1 @ 11.75 years, 23 patients @ >5 years post-op
• 14 x patients treated in their teens
• 17 x patients treated in their 20s
• 16 x patients treated in their 30s
• 13 x patients treated in their 40s
• 4 x patients treated in their 50s
Personalised External Aortic Root Support Project (PEARS)
24. Surgical
SummaryA method for installing the ExoVasc has been developed:
• 64 patients have been treated
• 1 patient suffered a left main stem injury during surgery
that led to a cranial bleed from which he did not recover
• 3 patients had peri-operative problems. 2 fully resolved
in hospital, 1 subject to a redo operation (+ 6 years)
• Operating time has been demonstrated at ~ 2 hours
• Routine CardioPulmonary Bypass has been demonstrated
as unnecessary during the implantation procedure
Personalised External Aortic Root Support Project (PEARS)
25. Project Summary
• Skilled Multi Disciplinary Team, has achieved project aim
• A technically superior solution to TRR and VSRR for
aortic dilation has been developed and demonstrated
• Patient operative stress is reduced wrt time in surgery,
no circulatory break-in, no total body cooling and no
CardioPulmonary bypass
• Healthcare costs for the surgery, and follow-up anti
coagulation/re-operation are also reduced
Personalised External Aortic Root Support Project (PEARS)
26. ExoVasc: Applications
• Aortic dilation associated with:
Marfan Syndrome / Loeys-Dietz Syndrome
Bicuspid aortic valve Disease
Transposition of the great arteries /ASO
Tetrallogy of Fallot
• Recovery of dilation-induced aortic regurgitation
• Pulmonary Autograft support in the Ross procedure
Long-term LVAD use? EDS patients?
Personalised External Aortic Root Support Project (PEARS)
27. Aortic surgical options
TRR VSRR PEARS
Operation time (h) 4 - 6.5 4.5 - 7 2 - 3
Heart/Lung bypass (h) 2 – 3 2.5 – 4.5 Optional
Total body cooling Yes Yes No
Circulatory break-in Yes Yes No
Anti-coagulation Yes No No
Re-operation (%/yr) 0.3 1.3 ?
Fallback redo redo/TRR VSRR/TRR
Personalised External Aortic Root Support Project (PEARS)
28. A patient’s charter?
Every patient is entitled, should he or she wish, to:
1. A clear definition / explanation of what is wrong and the
risks associated with this disease / condition (if left
untreated) including likely quality of life and life expectancy.
2. A clear, unbiased explanation of ALL the available surgical
interventions including the immediate AND long-term risks
and benefits.
3. An open and candid discussion with all facts, opinions and
conflicts of interests identified and declared.
4. An appropriate interval for reflection and decision on which
surgical option to adopt.
29. Acknowledgements
Engineers: Warren Thornton, Peter Gibson
Medical imagers: Raad Mohiaddin, Mike Rubens et al
Surgeons: Tom Treasure, John Pepper, Mario
Petrou, Filip Rega, Ulrich Rosendahl,
Conal Austin, David Anderson, Jan Pirk
, Jiri Maly, & Pavel Zacek
And various others whose contributions were greater or
lesser…………..
Personalised External Aortic Root Support Project (PEARS)
