Method Of Reimplantation Research Articles

Clinical implementation of simplification of biliopancreatic duct re-implantation method when performing transduodenal ampullectomy.

Clinical implementation of simplification of biliopancreatic duct re-implantation method when performing transduodenal ampullectomy.

Comparison of reconstruction methods used during liver transplantation in case of a graft with replaced or accessory right hepatic artery: A retrospective study.

Variations in graft arterial anatomy can increase the risk of postoperative hepatic arterial thrombosis (HAT), especially in presence of a replaced or accessory right hepatic artery (RHA). We retrospectively analyzed 223 cases of liver transplantations with the presence of an RHA on the graft. Patient outcomes were compared according to the four different reconstruction methods used: (i) the re-implantation of the RHA into the splenic or gastroduodenal artery (n= 106); (ii) the interposition of the superior mesenteric artery (SMA) (n= 83); (iii) dual anastomosis (n= 24); (iv) use of an aortic patch including the origins of both the SMA and the coeliac trunk (n= 10). A competing risk analysis and Inverse Probability Weighting (IPW) were used. We found that the interposition of the SMA method was associated with a significantly lower incidence of HAT, at 4.8% compared to the re-implantation method at 17.9%, dual anastomosis at 12.5%, and aortic patch at 20%, p= .03. In the competing risk analysis with IPW, the only risk factor for RHA thrombosis was the type of reconstruction. Taking the SMA interposition group as the reference, the sub-hazard ratio (sHR) was 5.05 (CI 95 [1.72; 14.78], p< .01) for the re-implantation group, sHR=2.37 (CI 95 [0.51; 11.09], p= .27) for the dual anastomosis group and sHR=2.24 (CI 95 [0.35; 14.33], p= .40) for the aortic patch group. There were no differences for intraoperative transfusion, hospitalization duration (p= .37) or incidence of severe complications (p= .1). The long-term graft (p= .69) and patient (p= .52) survival was not different. In conclusion, the SMA interposition method was associated with a lower incidence of RHA thrombosis.

Comparison of hemodynamics and root configurations between remodeling and reimplantation methods for valve-sparing aortic root replacement: a pulsatile flow study

PurposeTo compare the characteristics of reimplantation (RI) using grafts with sinuses and remodeling (RM) with/without external suture annuloplasty using a pulsatile flow simulator.MethodsPorcine aortic roots were obtained from an abattoir, and six models of RM and RI with sinuses were prepared. External suture annuloplasty (ESA) was performed in the RM models to decrease the root diameter to 22 mm (RM-AP22) and 18 mm (RM-AP18). Valve models were tested at mean pulsatile flow and aortic pressure of 5.0 L/min and 120/80 (100) mmHg, respectively, at 70 beats/min. The forward flow, regurgitation, leakage, backflow rates, valve-closing time, and mean and peak pressure gradient (p-PG) were evaluated. Root configurations were examined using micro-computed tomography (micro-CT).ResultsThe backflow rate was larger in the RM models than in the RI models (RI: 8.56% ± 0.38% vs. RM: 12.64% ± 0.79%; p < 0.01). The RM-AP and RI models were comparable in terms of the forward flow, regurgitation, backflow rates, p-PG, and valve-closing time. The analysis using a micro-CT showed a larger dilatation of the sinus of the Valsalva in the RM groups than in the RI group (Valsalva: RI, 26.55 ± 0.40 mm vs. RM-AP22, 31.22 ± 0.55 mm [p < 0.05]; RM-AP18, 31.05 ± 0.85 mm [p < 0.05]).ConclusionsRM with ESA and RI with neo-sinuses showed comparable hemodynamics. ESA to RM reduced regurgitation.

Treatment of neuromuscular dysplasia of the vesicoureteral segment of the ureters in children

Aim. To optimize conservative and surgical treatment of neuromuscular dysplasia of the vesicoureteral segment in children.Materials and methods. Study included 84 operated children with neuromuscular dysplasia of the vesicoureteral segment of the ureters. Megaureter antenatally diagnosed in 28 (25.4%) children: Ι degree - in 5, II degree - in 9, III degree - in 10, IV degree - in 4 children. The main criteria for diagnosing a megaureter in the perinatal period are an expansion of the anterior-posterior size of the pelvis, visualization of the dilated ureter, and in СFM - identification of weakening of the renal blood flow in the affected side.Results and discussion. As a result of the conservative and minimally invasive therapy – stenting of the ureters for up to 2 years, urodynamics were restored and the phenomena of ureterohydronephrosis were eliminated in 30 (27.2%) patients. In 32 (29%) patients, percutaneous puncture nephrostomy was performed, aimed at reducing the collecting system of the kidney, and ureter, as well as preparing for surgical treatment. The operated patients (84) were divided into 3 groups: Group I - operated according to the Politano-Ledbetter method (29); Group II - according to Cohen (20); Group III operated according to the method of extravesical reimplantation of the ureter with antireflux protection, developed in the clinic of pediatric surgery (35). Complications were noted in 8 (27.5%) patients after the Politano-Ledbetter operation; in 4 (20%) cases after the Cohen method operation; and in 5 (14.2%) cases after the extravesical reimplantation with antireflux protection.Conclusion. The method of ureteral reimplantation, developed and tested at the Clinic of Pediatric Surgery, is a fairly effective way to treat megareteral disease in children. This technique is highly effective in children older than 1-3 years, which makes 85.8%.

Outcomes of Surgical Reimplantation for Anomalous Origin of One Pulmonary Artery From the Aorta

Anomalous origin of one pulmonary artery from the ascending aorta (AOPA) is a rare and potentially deadly anomaly. Little research, aside from case reports on APOA, has been published, especially for patients with late referrals. This study was a retrospective review of 57 patients with AOPA who underwent reimplantation of the pulmonary artery (PA) from 2009 to 2019. Two different reimplantation methods were used to correct the anomaly, including direct anastomosis in 36 patients and angioplasty with autologous tissue in 21 patients. The median age at repair was 2.8 months (range, 8 days to 3.6 years). In-hospital death occurred in 2 patients (3.5%). Five patients (9.1%) with a median age of 9.3 months (range, 5.2 months to 3.6 years) experienced a pulmonary hypertensive crisis. Patients older than 4.9 months were more likely to have a pulmonary hypertensive crisis (P= .001). The 2-year freedom from postoperative PA stenosis rate was 75.3% in patients who underwent direct anastomosis and 46.8% in patients who underwent autologous tissue angioplasty (χ2= 4.878; P= .027). Angioplasty with autologous tissue (hazard ratio, 5.03; 95% confidence interval, 1.61 to 15.71; P= .005) and an innately smaller diameter of the aberrant PA (hazard ratio, 0.65; 95% confidence interval, 0.45 to 0.92; P= .015) were 2 independent risk factors for postoperative PA stenosis. Surgical reimplantation of the PA in patients with AOPA has resulted in favorable early and midterm outcomes. Pulmonary hypertensive crisis occurs more commonly in patients who receive a diagnosis after the age of 4.9 months. Reimplantation with autologous tissue augmentation and an intrinsically smaller diameter in affected PAs are 2 independent risk factors for postoperative PA stenosis.

Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients.

To investigate the frequency of vesicoureteral reflux, and the relationship of pretransplant decreased bladder capacity and post-transplant vesicoureteral reflux in children undergoing kidney transplantation. A voiding cystourethrography was carried out in 172 pediatric kidney transplantation recipients before, and 4months after, transplantation to evaluate bladder capacity and vesicoureteral reflux. The correlation of post-transplant vesicoureteral reflux with pretransplant bladder capacity, vesicoureteral reflux in the native kidney and the method of ureteral reimplantation (intravesical/extravesical) was analyzed. Atrophic bladder was defined as having ≤50% functional bladder capacity (age in years+2)×25 (mL) or ≤150mL in patients aged >10years. Bladder capacity increased remarkably after transplantation in both post-transplant vesicoureteral reflux- group (from 180 to 253mL) and vesicoureteral reflux+ group (from 82 to 171mL). Voiding cystourethrography showed vesicoureteral reflux in 12 cases of kidney transplantation (7%; grade1: 2, grade2: 3, grade3: 7). Pretransplant atrophic bladder was an independent risk factor of post-transplant vesicoureteral reflux (P=0.004, hazard ratio 9.5). There was no difference in renal function between the vesicoureteral reflux- group and vesicoureteral reflux+ group at 4months to 5years post-transplantation. Pretransplant atrophic bladder is a risk factor of post-transplant vesicoureteral reflux in pediatric patients. However, bladder capacity can remarkably increase after transplantation, and kidney function in the post-transplant vesicoureteral reflux+ group is stable.

A modified relief of unilateral ureteral obstruction model

Objectives: To improve the mouse model of relief for unilateral ureteral obstruction (RUUO) and explore the pathological process of renal fibrosis after the obstruction was relieved.Methods: C57BL/6 mice in model group were randomly divided into RUUO group, improved RUUO group, and UUO group. After leaving Unilateral Ureteral Obstruction (UUO) for 3 days, the obstruction was released by reimplantation way in RUUO group and in reimplantation + catheter way in improved RUUO group. C57BL/6 mice in observation group were randomly divided into 1d RUUO group, 3d RUUO group, 7d RUUO group, and 14d RUUO group. Three days after UUO, the obstruction was released by reimplantation + catheter in four groups. We detected the renal volume, H&E, Masson staining, and immunohistochemistry of kidney pathology on the seventh day after RUUO in model group and on the 1st, 3rd, 7th, and 14th day after RUUO in observation group.Results: Comparing with mice in RUUO group, mice in improved RUUO group had lower renal volume, tubular damage score, and collagen area percentage. After the obstruction was relieved, the renal volume decreased gradually within 2 weeks. The tubular damage score in 7d RUUO group was lower than that in 1d RUUO and 3d RUUO group. However, the tubular damage score in 14d RUUO group was higher than that in 7d RUUO group. The tendency of collagen area percentage and α-SMA IOD value were consistent with the tubular damage score.Conclusions: Using the method of reimplantation + catheter, a reliable mice model of RUUO can be got. After RUUO, the de-obstructed kidneys are still in damage and fibrosis state.

Transient Multiple Removal and Subsequent Reimplantation of Abdominal and Retroperitoneal Organs with Multisystemic Neoplastic Lesions

The aim of the study was to develop simple, minimally invasive method of transient multiple removal and subsequent reimplantation of abdominal and retroperitoneal organs with multisystemic neoplastic lesions, allowing subsequent reimplantation of the organ block after extracorporeal surgery. Material and Methods. Ten human cadavers of subjects who died of causes unrelated to pathology of the abdominal organs were used in this study. The anatomical experiment involved transient multiple removal of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions and their subsequent reimplantation. Surgery was performed using the method developed at the Department of Operative Surgery and Topographic Anatomy of I.M. Sechenov First Moscow State Medical University (Patent RU 2601100). Results. The proposed method showed several advantages: consistency of cold perfusion in deep hypothermia of the patient,hypothermic circulatory arrest of the abdominal organs (up to 4–6 h); feasibility of insertion and subsequent removal of arterial and venous shunts, reimplantation of the abdominal organs; restoration of arterial and venous blood flow in the patient (cadaver) and preserved integrity of the transected anatomical structures. Conclusion. The proposed method of transient multiple removal and subsequent reimplantation of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions provides sustained viability of the organs and can be recommended as a suitable model for further application in clinical practice.

Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus

IntroductionTraditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy. ObjectiveThis study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design. MethodsConsecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I “Bony wall reimplantation method” was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II “bone removal method” was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled buccal fat pad after lesion removal and all cases were without inferior meatal antrostomy. ResultsA total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1–3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images. ConclusionsSinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled buccal fat pad is enough for drainage and inferior meatal antrostomy is not necessary.

Modified ureteral orthotopic reimplantation method for managing infant primary obstructive megaureter: a preliminary study.

To describe a modified ureteral orthotopic reimplantation method in infant with primary obstructive megaureter (POM) and report our initial experience. Thirteen children with POM (range 1-7months) underwent modified transvesical ureteral implantation surgery. Treatment consists of transecting the ureter proximal to the obstruction and performing orthotopic reimplantation in end freely fashion with distal ureter protruding into the bladder, providing dilated ureteral diameter: ureteral exposure length in bladder ratio of 1:1.5-2. All patients underwent repeat ultrasound, radionuclide imaging and voiding cystourethrography. Cystoscopy was conducted in patients at 6months after surgery. The mean operating time was 40min. There were one redo this procedure for recurrent obstruction and one Cohen reimplantation for Grade 5 vesico-ureteral reflux in one bilateral POM. Hydroureteronephrosis improved in other 11 patients, and the ureter diameter was significantly reduced from preoperative measurements. At the time of cystoscopy, thick and large volcanic-shaped ureteral orifice was found and urine ejected intermittently. The proposed 'modified ureteral orthotopic reimplantation' with no tapering or advancement for POM in infants is a simple, feasible and less invasive procedure that had good success rates in this small series. Further, larger studies are required to support or negate the usefulness of this technique.

Evaluation of Mathisen's technique for ureteral reimplantation in children with primary vesicoureteral reflux

Although cross-trigonal ureteral reimplantation (Cohen) is a commonly used technique in children, it represents a non-physiological transfer of the ureteral orifices and may prove challenging with regard to endoscopic ureteral operations in later life. In 1964, Mathisen described an alternative method of ureteral reimplantation with lateralization of the neohiatus, creating an orthotopic course of the submucosal ureter. We have evaluated success and complication rates of both techniques that were applied sequentially at our departments. Forty-eight consecutive patients (83 ureters, 24 males/24 females) following Mathisen reimplantation were compared with 53 consecutive patients (98 ureters, 30 males/23 females) following Cohen reimplantation. Inclusion criteria were primary vesicoureteralreflux (VUR) and no previous intervention. Reflux grades (Mathisen 58 ureters/69.9% VUR ≥ III; Cohen 66 ureters/66.7% VUR ≥ III) and the occurence of other complicating factors (ureteroceles, megaureters, posterior urethral valves) in both groups were comparable. After Cohen's reimplantation there were no immediate complications requiring intervention; during follow-up (mean 28.2 months) three patients (5.6%) suffered febrile urinary tract infections (UTIs), of which one (1.8%) was diagnosed with a persisting VUR. Persistent hydronephroses (≥II SFU) were recorded in six patients (13.2%). After reimplantation using Mathisen's technique, two patients (4.1%) suffered significant intravesical bleeding; during follow-up (mean 23.06 months) four patients (8.3%) suffered febrile UTIs, and seven patients (14.5%) were diagnosed with persisting VUR after a mean follow-up of 10.8 months. The patients with persistent VUR had more commonly high-grade (IV and V) VUR initially, compared to the whole group. Two patients (4.1%) had persistent hydronephroses (≥II SFU). Mathisen's technique for ureteral reimplantation yielded a significantly (p=0.0256 patients, p=0.006 ureterorenal units) lower success rate (85.5% patients, 89.2% ureterorenal units) in comparison with Cohen's technique (98.2% patients, 99% ureterorenal units). Although there was no intervention for obstruction, persistent hydronephrosis was more common in the Cohen group (13.2% vs. 4.1%, n.s.). Despite the advantages of an orthotopic ureteral orifice close to the bladder neck, as achieved by Mathisen's reimplantation, cross-trigonal ureteral reimplantation proved more reliable for VUR correction. As regards optimizing the results, patient selection for either technique could prove essential. Nevertheless, as regards the difficulties with ectopic ureteral orifices in the Cohen technique in the long-term follow-up, the concept of anatomic, orthotopic ureteral reimplantation should be pursued and the technique should be further refined.

Robot-assisted technique for Boari flap ureteric reimplantation: replicating the techniques of open surgery in robotics.

To describe our robot-assisted Boari flap ureteric reimplantation (RA-BFUR) technique, Please see Video S1. The RA-BFUR technique is based on the open surgical technique of Übelhör, and the experience includes 11 cases. Excellent results were achieved after a mean follow-up period of >12 months. The RA-BFUR technique could be considered a safe and effective method of ureteric reimplantation for long distal ureteric strictures.

Rationale and results of the Stanford modification of the David V reimplantation technique for valve-sparing aortic root replacement

Even though the concept of valve-sparing aortic root replacement was introduced 35 years ago, confusion still exists about the strengths and weaknesses of the different surgical procedures used when relatively normal aortic cusps call for replacing the aortic root and preserving the regurgitant aortic valve rather than replacing the valve with a composite valve graft. Valve-sparing aortic root replacement operations are subdivided into 2 general families: (1) the Yacoub ‘‘remodeling’’ technique used since 1979 and (2) the David ‘‘reimplantation’’ technique performed since 1988. Innumerable individual modifications of the David reimplantation procedure have been described, but many surgeons are still unclear about the rationale behind these different approaches and what they strive to accomplish. At the base, all reimplantation methods firmly anchor the aortic graft proximally at theventriculoaortic junction below the leaflets in the left ventricular outflow tract with the commissures sewn inside the polyester fabric graft. This is unphysiologic because it abolishes the pronounced 3-dimensional dynamicmotion of the normal aortic annulus, but the annulus cannot dilate postoperatively, causing recurrent aortic regurgitation (AR). To Tirone David’s chagrin, in 2003 I attempted to track the evolution of his personal surgical valve-sparing techniques. The ‘‘David I’’ is the original reimplantation procedure, which uses a 26to 30-mm cylindrical tube graft. The ‘‘David II’’ and ‘‘David III’’ are variations of Yacoub’s remodeling procedure (the David III incorporated a strip of polytetrafluoroethylene felt externally across the base of the noncoronary sinus from trigone to trigone of themitral valve tominimize subsequent annular

Midterm experience with modified Cabrol procedure: Safe and durable for complex aortic root replacement

To evaluate the early and late outcomes of the modified Cabrol technique as a method of coronary reimplantation during complex composite graft replacement of the ascending aorta. Between 1995 and 2012, 348 patients (mean age, 56 ± 14 years; 283 males and 65 females) underwent composite graft replacement of the ascending aorta, 40 of whom (mean age, 60 ± 12 years; 35 males and 5females) had one or both coronary ostia reimplanted using a modified Cabrol technique with an 8- to 10-mm Dacron interposition graft. The mean clinical and radiologic (computed tomographic scan) postoperative follow-up was 39 months (range, 1-171 months), via our aortic database, patient interviews, and Social Security Death Index. Cabrol reimplantation was necessitated by reoperations with anatomically fixed coronary ostia (n=16, 40%), severely displaced coronary arteries (n=15, 37.5%), button calcification (n=4, 10%), coronary anomalies (n=3, 7.5%), and coronary aneurysm (n=2, 5%). Of the operations, 20% (8 patients) were urgent interventions. Early mortality was 3 (7.5%) of 40, none related to the Dacron interposition graft. Total late mortality was 16.2%, also not related to the coronary graft. Actuarial survivals were 0.88 ± 0.05, 0.79 ± 0.07, and 0.73 ± 0.08 at 1, 3, and 6 years, respectively. Radiologic follow-up was available for 31 (83.8%) of the surviving patients and revealed that the interposition graft was widely patent in all. The modified Cabrol technique using a Dacron interposition graft showed good survival rates and excellent durability over time, confirmed radiographically. These data confirm that it is appropriate to use the Cabrol technique when technical complexity prevents bringing coronary buttons to the main aortic graft.

Easily Removable Ureteral Catheters for Internal Drainage in Children: A Preliminary Report

PurposeWe review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction.Materials and MethodsBetween April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded.ResultsOf the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter.ConclusionOur new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.

Impact à long terme des complications chirurgicales sur la survie du transplant rénal

To determine the incidence of surgical complications of renal transplantation at one institution, relate this to donor and recipient factors and to long-term graft survival. A consecutive series of 145 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Barry-Sarramon anastomosis was the most used method of ureteric reimplantation. Lich-Gregoir anastomosis was used in 28.9% of cases. The mean follow-up time was 14.4 ± 6.23 years. There were 67 surgical complications including ten vascular, 39 urological and 18 parietal complications. Among urological complications, 13 were urinary leaks, four distal ureteric necrosis, 13 symptomatic ureteric reflux, six primary ureteric obstructions, and one ureteric stone at some time after transplantation. The overall incidence of urological complications was 26.2%. There was no association with recipient or donor age, cold ischaemic times before organ reimplantation, dialysis duration before transplantation, operating times, or ureteric stenting. Overall surgical complications had a significant pejorative impact on graft survival (Hazard Ratio [HR]=1.805; P=0.32), but as we studied them separately, we highlighted that in fact only vascular complications had an impact on long-term graft survival (HR=17.442, P<5E-10). There was no association between urological (P=0.566) or parietal (P=0.797) complications and long-term graft outcome. The onset of a urological or a parietal complication had no impact in this series on long-term graft survival. Vascular complications dramatically increase the rate of graft loss.

1159 99M TECHNETIUM DIMERCAPTO-SUCCINIC ACID RENAL SCINTIGRAPHY ABNORMALITIES FOLLOWING URINARY DIVERSION LONG TERM FOLLOW UP AFTER ORTHOTOPIC BLADDER SUBSTITUTION WITH EXTRAMURAL SEROUS LINED URETERAL REIMPLANTATION

INTRODUCTION AND OBJECTIVES: To determine the incidence and associated characteristics of renal abnormalities utilizing 99m Technetium Dimercapto-succinic acid (DMSA) renal scintigraphy in patients who completed minimal 10 year follow up after extramural serous-lined ureteral reimplantation METHODS: Between January 1992 and June 1998, 311 consecutive patients underwent an ileal w neobladder orthotopic urinary diversion with extramural serous-lined uretero-ileal anastomosis. Utilizing our prospectively maintained database, patients who were living free of malignancy and completed 10 years of follow up were identified (113Patients). All patients were radiologically evaluated by an ultrasound scan, ascending pouchogram. Patients with evidence of pouchoureteric reflux were evaluated by MAG 3 Renogram and 99mTc-DMSA scan. RESULTS: Ascending pouchogram revealed pouchoureteric reflux in 27 patients [30 renal units (13.6%) ]. These patients were evaluated by 99mTc-DMSA scan [52 renal units] Reflux grade was IV or V, II or III and I in 5, 18 and 7 of the 30 refluxing renal units, respectively. 99mTc-DMSA renal scintigraphy revealed parenchymal abnormalities in 22 renal units [(17 of the 30 refluxing renal units (54.1%)]. We noted differential uptake less than 40% with and without cortical defects in 10 and 7 refluxing units. Ultrasound showed pyelonephritic changes in 7 of the 17 patients (41%) in whom 99mTc-DMSA scintigraphy was abnormal. On multivariable analysis, risk factors significantly associated with 99mTc-DMSA scan renal parenchymal abnormalities (Grade III or more) were Diabetes, nephroithiasis, history of pyelonephritis and Grade III or more pouchoureteric reflux (p 0.05). CONCLUSIONS: After minimal 10 year follow up, around 35 % of the renal units develop renal parenchymal abnormalities detected by 99mTc-DMSA. Pouchoureteic reflux is a significant predictor of renal scarring on the long term.

Aortic Valve-Sparing Operations: Dealing With the Coronary Artery That is Too Close to the Aortic Annulus

During aortic root surgery, one of the coronary ostia is sometimes found to lie too close to one of the commissures to allow its safe detachment as a button while still preserving the native aortic valve. In the past, this has prevented aortic valve-sparing root replacement in cases of aortic root aneurysm. We describe a technique pertaining to the reimplantation method of aortic valve-sparing root replacement to deal with such a displaced coronary artery.

Pre- and Postoperative Imaging of the Aortic Root for Valve-Sparing Aortic Root Repair (V-SARR)

Valve-sparing aortic root repair (V-SARR) using the David reimplantation method is an increasingly popular alternative to composite valve graft aortic root replacement in patients with aortic root aneurysms or dissections who wish to avoid anticoagulation. Computed tomography (CT) with retrospective electrocardiograph (ECG)-gating has become routine before and following V-SARR at Stanford. CT allows accurate measurement of aortic dimensions and provides unprecedented three-dimensional (3D) images of the sinuses, the aortic valve cusps, and coronary arteries in patients with the Marfan syndrome (MFS), with a bicuspid aortic valve (BAV), or other aortic diseases. This helps the surgeon to conceptualize the size of the aortic grafts required and how much reduction is necessary proximally (aortic annulus) and distally. These maneuvers are used to reduce the aortic annular diameter (when necessary) and replace the sinuses and ascending aorta (T. David-V, Stanford modification V-SARR). Postoperative ECG-gated CT confirms the reconstructed geometry and reliably detects coronary or other anastomotic problems.

MP-14.12: Long-term functional results of the implementation of the serous-lined extramural tunnel technique of ureterointestinal reimplantation in ileal neobladders and rectosigmoid urinary reservoirs

There still exists an ongoing debate regarding the optimal method of ureterointestinal reimplantation in continent urinary diversion. The main objective of the present study was to analyze the long-term functional results after the construction of orthotopic ileal neobladders and rectosigmoid urinary reservoirs, based on the antireflux serous-lined extramural tunnel technique.