BACKGROUND: The purpose of this study was to report the use of a transvenous transseptal approach using a stent valve in patients with degenerated biological mitral valve prostheses, regurgitation after mitral repair, and native mitral stenosis.

METHODS: Ten patients (median age, 74 years; range, 20-89 years; 5 men and 5 women) with degenerated mitral bioprosthetic valves (n = 7), failed mitral repair (n = 1), or calcified native stenotic valves (n = 2) underwent transvenous implantation of a stent valve.

RESULTS: The procedure was initially successful in all patients. Predilation was performed for balloon sizing only in the 2 patients with native mitral stenosis. The stent valve was deployed during 1 period of rapid pacing. A guidewire, as a loop from the right femoral vein and through the left ventricular apex, facilitated a good angle and secure positioning of the stent valve. An ultrasonographically guided puncture of the apex was carried out in 6 patients, and in the other 4 we performed a minithoracotomy before apical puncture. All valves were implanted in a good position with improved function and without significant paravalvular leakage (PVL). There were no periprocedural deaths. The 30-day survival was 80% (8 of 10 patients), and 60% (6 of 10) of patients were still alive a median time of 290 days after the procedure.

CONCLUSIONS: Transvenous transseptal implantation of a stent valve was performed in 10 patients with mitral valve disease, with good early functional results. These high-risk patients must be carefully selected by a multidisciplinary team because the procedure carries a high mortality.

Vi redovisar här våra mång­åriga erfarenheter av uppbyggnaden och implementeringen av ett IT-processtöd (Carath) för specialiserad vård, i detta fall toraxkirurgi.

Kombinerade kvalitets- och processdata ur Carath har givit en unik möjlighet att följa för vårdprocessen relevanta nyckeltal.

Sjukvårdsprocesser är komplexa. Bristande detaljkunskap om dessa eller underskattning av tidsåtgång för planering leder till fel i databasen, vilka kan vara svåra att korrigera i efterhand.

Avsevärda resurser bör avsättas för att säkerställa en god validitet på data i ett kvalitetsregister.

Komplexiteten i att koppla ihop t ex kvalitetsregister och datajournal med varandra på ett tillförlitligt vis ska inte underskattas.

Carath is the name of a database and outcomes registry for cardiovascular surgery used and developed by four Swedish cardiothoracic centres in cooperation.  This report focuses on our experiences, positive and negative, of designing and implementing a “tailor made” database program for process control in mainly cardiac surgery. The system now provides valuable, and in some ways unique information on medical outcomes as well as administrative data. We have also become very aware of the difficulties involved in maintaining a good quality of data in multicentre medical registries. Several factors, not least the human factor, must be taken into account when building user friendly databases and quality registries. Variables must be well defined. Also, direct linking of data and outcomes directly from digitalised patient records has proved to be complicated - technically and due to the complexity of health care processes.

In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, Pless than0.001). There was no increase in the absolute incidence of aminoglycoside resistant agents. The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance.