RESULTS: The use of an arthroscopic suture passer precludes the need for rotation of a curved needle in a constrained working area. Deploying a nitinol needle through an arc delivers the suture through the fascia, thereby facilitating closure. Satisfactory lumbar fascia closures were achieved in 18 patients with elevated body mass indexes.

CONCLUSION: Application of existing technology in other surgical specialties

may address the shortcomings of current techniques in minimally invasive approaches to the spine. The use of a flexible arthroscopic suture passer is one example in which current technology in one discipline may be applied to minimally invasive approaches. Increasing the awareness of techniques and instruments in other surgical disciplines may expand the armamentarium of the minimally invasive spine surgeon.”
“Objective: C188-9 nmr Survival of high-risk patients with univentricular heart disease after Norwood palliation is reduced. We hypothesized that early goal-directed monitoring with venous oximetry and near-infrared spectroscopy would offset their increased vulnerability and selleckchem improve survival.

Methods: A prospective database of patients

undergoing stage 1 palliation was used to assess differences in outcomes across risk groups in the setting of a comprehensive, goal-directed monitoring program. High-risk criteria included gestational age 35 weeks or less, birth weight less than 2.5 kg, and additional cardiac or extracardiac

anomalies. Outcomes included survival to defined end points and measures Calpain of postoperative support.

Results: From September 2000 to September 2008, 162 patients underwent stage 1 palliation: 28% (45/162) high-risk and 72% (117/162) standard-risk patients. Lesions other than hypoplastic left heart syndrome were more common among high-risk patients (38%, 17/45, vs 15%, 18/117, P = .003). Operative survival was not statistically different(87%, 39/45, high risk vs 95%, 111/117, standard risk, P = .1). High-risk patients were more likely to receive inpatient treatment until stage 2 palliation (24%, 11/45, vs 10%, 12/117, P = .001) and had lower 1-year survival (78% vs 93%, P = .01) and survival to date (71% vs 92%, P = .001).

Conclusions: Intensive monitoring partially offset biologic vulnerability of high-risk patients, helping attain comparable early outcomes. Vulnerability persisted throughout the interstage period, however, and increased mortality beyond cavopulmonary shunt was seen only among high-risk patients. Although enhanced monitoring reduced early mortality, high resource use and attrition after stage 2 palliation suggest an ongoing need to evaluate our current palliative strategy for this subset of patients.