B Marty

Cantonal Hospital of Schwyz, Schwyz, Schwyz, Switzerland

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Publications (53)76.55 Total impact

  • Bettina Marty
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2010; 38(3):310. · 2.40 Impact Factor
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    Bettina Marty, Bernhard Egger
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 09/2009; 36(4):775. · 2.40 Impact Factor
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    ABSTRACT: : Intravascular ultrasound (IVUS) generates high definition circumferential cross-sectional images and provides real-time readout of vascular dimensions, including visualization of vessel branches. We have used it as an alternative to angiography in the endovascular thoracic aneurysm repair work-up. : Out of consecutive 203 patients with descending thoracic aortic aneurysm, 89 (43.8%) received endovascular treatment [mean age, 68 ± 8 years; range, 29-82; male, 79 (88.7%); female, 10 (11.3%)] without using angiography during the endovascular procedure. IVUS (6 F, 12.5 MHz probe or 10 F 9 MHz) coupled with fluoroscopy for the placement of radiopaque markers was used for target site identification, landing zone measurement, device positioning, and assessment of endovascular repair. : Hospital mortality was 4/89 (4.5%). Number of devices implanted in each patient was 1.2 (range, 1-3). X-ray exposure time was 12 ± 8 minutes. Median procedure time was 63 ± 20 minutes. Conversion to open surgery was necessary in one patient (1.1%) because of aortic dissection. In nine patients (10.1%) left subclavian artery was covered because of a short neck. Two patients (2.2%) had vascular access lesions and required surgical repair. One patient developed paraplegia (1.1%). Early endoleak was observed in eight patients (8.9%) and 4 (4.5%) required additional procedures (proximal or distal extensions). Late conversion was necessary in one patient (1.1%). : IVUS provides all information necessary for device selection, target site identification as well as safe and correct deployment of thoracic endoprostheses and makes periprocedural angiography unnecessary, thus avoiding the risk of renal failure because of contrast medium.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2009; 4(1):32-5.
  • Bettina Marty
    European Journal of Cardio-Thoracic Surgery 08/2008; 34(1):24-5. · 2.67 Impact Factor
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    ABSTRACT: Stents have a long history in traditional valve surgery as both, porcine biological valves as well as pericardial valves are mounted on stents prior to implantation. Recently stent-mounted biological devices have been compressed up to the point, where they can be passed through a catheter. Various routes can be distinguished for implantation: open access, the trans-vascular route in antegrade or retrograde fashion, as well as direct trans-apical or trans-atrial access. Direct access has the potentialforvideo-endoscopic valve replacement. In theory, as well as in the experimental setting, valved stents have been implanted in tricuspid and caval position respectively, as well as in pulmonary, mitral and aortic locations. The largest clinical experience has been achieved in pulmonary position whereas current efforts target the aortic position.
    Revue médicale suisse 04/2008; 4(150):805-9.
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    ABSTRACT: The hybrid treatment of aortic aneurysms is indicated in patients having the ostia of supra aortic or visceral branches taken in to the aneurysm. Indeed, these lesions are not eligible for classic endovascular treatment because the existing endoprostheses cannot provide perfusion of the side branches without inducing major endoleaks. The surgical technique consists of 2 steps: firstly, a by-pass between normal aorta and the major aortic branches involved in the aneurysm is performed to guarantee the perfusion of the organs such as brain, bowel, and after endoprosthesis deployment. Secondly, the endoprosthesis is deployed using the classical technique to isolate the aneurysm. The hybrid approach provides safe and reliable treatment of complex aortic aneurysms with mortality and morbidity rate far below the classical open surgery.
    Revue médicale suisse 04/2008; 4(150):793-6.
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    Bettina Marty
    European Journal of Cardio-Thoracic Surgery 03/2008; 33(2):149-51. · 2.67 Impact Factor
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    ABSTRACT: To review a single-institution experience with endovascular repair of acute traumatic aortic rupture (ATAR) performed on an emergency basis using intravascular ultrasound (IVUS) exclusively as the navigation tool for stent-graft implantation (no arteriography). Between September 1998 and November 2006, 26 consecutive patients (19 men; mean age 38+/-19 years, range 15 to 83) underwent endovascular repair of ATAR performed by a surgical team using IVUS and fluoroscopy for lesion characterization and stent-graft deployment guidance. Transesophageal echocardiography was routinely used in all patients to visualize the aortic lesion and rule out residual flow after device deployment. Sealing of the aortic tear was evaluated by postoperative contrast-enhanced computed tomography. IVUS revealed an extensive disruption of the tunica intima and media (>180 degrees ) in 46% (12/26) of patients; the disruption was circumferential in 3 cases, with pseudocoarctation. The aortic diameter at the site of rupture measured 24+/-4 mm. Primary technical success was 92% (24/26); 1 persistent but small proximal endoleak and an intraoperative death (4% in-hospital mortality) from abdominal bleeding in an octogenarian accounted for the failures. Procedure-related complications (2, 8%) included the aforementioned endoleak and a minor stroke secondary to cerebral embolization. There was no paraplegia associated with the repairs. Endovascular repair of acute traumatic aortic disruption yields promising results, with high technical success and minimal procedure-related morbidity. IVUS as the primary navigation tool for device implantation allows prompt endovascular setup, instant aortic measurements, and precise visualization of the aortic disruption.
    Journal of Endovascular Therapy 10/2007; 14(5):689-97. · 2.70 Impact Factor
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    ABSTRACT: Valved stents are new land for cardiac surgeons even though they are being used more frequently by interventional disciplines. This paper presents simple steps to build a patient-specific pulmonary valved stent and its delivery device. The design concept was tested by random participants at a med-tech meeting. The valved stent is constructed by linking an endoprosthetic graft with a valved-jugular-vein. The delivery device is made from a modified 5-ml syringe. Of 72 participants, 66 (92%) built and 60 participants implanted the device successfully into the targeted pulmonary position via a trans-infundibular access.
    Interactive Cardiovascular and Thoracic Surgery 09/2007; 6(4):430-2. · 1.11 Impact Factor
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    ABSTRACT: Zwischen 1995 und 2005 wuchs die Anzahl der jährlich von uns mit endovaskulären Techniken versorgten Aortenaneurysmen (EVAR) von 0 auf 50, und dies auf allen Stufen der Aorta. Zu unserer Organisation gehören ein breites Team von Chirurgen, ein Lager mit 3kompletten Familien von Endoprothesen (gerade Endoprothesen, konische Endoprothesen, und Bifurkationen), ein mobiler Wagen mit Zubehör (Einführungsbestecke, Führungsdrähte, Katheter, Ballone etc.) und ein Apparat auf Rädern für die intravaskuläre Ultraschalluntersuchung (IVUS). Letzterer erlaubt es zusammen mit einer mobilen Durchleuchtungsanlage (C-Bogen), in jedem Operationssaal unserer Institution endovaskulär Aneurysmen zu analysieren, und dies in der Regel ohne Angiographie bzw. Kontrastmittel. Deshalb sind wir nicht mehr auf eine ausgiebige bildgebende präoperative Abklärung potenzieller Kandidaten für eine endovaskuläre Sanierung von Aneurysmen angewiesen und können rupturierte Aneurysmen der Bauchaorta oder der thorakalen Aorta ohne Verzug behandeln. Bei der endovaskulären Sanierung von Aortenaneurysmen unterscheiden wir zwischen Prozessschritten (Indikationsstellung, Darstellung der Zugangsgefäße, Ausmessen mittels IVUS und Roadmapping mittels Durchleuchtung, Implantatwahl, Implantatinsertion, Positionierung, Implantatabwurf, Erfolgsbeurteilung, Rekonstruktion der Zugangsgefäße und Nachkontrolle) und Kompetenzstufen (Assistent, Oberarzt, Leitender Arzt). Unsere ultraschallgestützte Technik zur endovaskulären Sanierung von Aneurysmen wurde mittels IVUS-Transporter und Telementoring erfolgreich auch anderen Institutionen zur Verfügung gestellt. Between 1995 and 2005, the number of aortic aneurysms treated annually using endovascular techniques (EVAR) increased from 0 to 50, including all aortic stages. Our organization includes a large team of surgeons, a stock of three complete families of endoprostheses (straight, conical and bifurcated), a mobile trolley with accessories (arterial introducer/introducer sheath, guide wire, catheters, balloons, etc.) and an appliance on wheels for intravascular ultrasound examination (IVUS). This appliance, together with a mobile fluoroscopy device (c-arm), allows endovascular aneurysms analysis of every operating room in our institution, usually without angiography or the use of contrast medium. In general, we are therefore not depending on substantial preoperative imaging in order to identify candidates for endovascular aneurysms repair and can treat abdominal and thoracic aortic ruptures without delay. For endovascular aortic aneurysms repair we distinguish between process steps on the one hand (determining indications, imaging of the access vessels, measurement using IVUS and road mapping via fluoroscopy, selection of implant, implant insertion, positioning, setting the implant, determining success, reconstruction of the access vessel and follow-up) and the level of competence on the other (assistant, senior and directing physicians). Our ultrasound supported technique for endovascular aneurysms repair has been successfully brought to other hospitals using an IVUS transporter and telementoring.
    Gefässchirurgie 01/2007; 12(4):225-230. · 0.24 Impact Factor
  • B Marty, M Depairon
    Praxis 06/2006; 95(21):845-8.
  • European Journal of Cardio-Thoracic Surgery 01/2006; 28(6):896. · 2.67 Impact Factor
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    ABSTRACT: Five years of experience with endovascular infrarenal aneurysm repair at our institution is reviewed. Implantation of endoprostheses in 88 patients has been performed by surgeons using exclusively intravascular ultrasound (IVUS) and fluoroscopy. IVUS identified the target site of deployment in all cases. In-hospital morbidity was 22% (19/88). Two percent mortality (2/88) and 5% early conversion (4/88) as a consequence of type I endoleaks were noted only in the first 53 patients with early devices (NS). Early endoleaks were present in 36% (32/88) including twenty-two type I, five type II and five type III endoleaks. Proximal endoleaks were associated with early devices (P<0.001), and technical difficulties with deployment. Tube grafts used in the beginning, performed poorly with 54% (7/13) type I endoleaks. Endoleaks diminished to 10% (9/88) by spontaneous closure and secondary endovascular procedures that were necessary in 24% (21/88) and consisted of coil embolization/cuff extension (9), late conversion (6), and limb recanalization or femoral cross-over bypass (6). Endovascular aneurysm repair using IVUS is a valid alternative technique. Improved devices and systematic use of bifurcated endoprostheses for infrarenal aneurysms reduce the occurrence of type I endoleaks.
    Interactive Cardiovascular and Thoracic Surgery 06/2005; 4(3):275-9. · 1.11 Impact Factor
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    ABSTRACT: To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair (EVAR). According to a prospectively designed study protocol, 48 patients underwent EVAR: the first 12 patients (group A) were treated at a secondary care center by an experienced interventionist, who was training the local team; a further 12 patients (group B) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite; and the last 24 patients (group C) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center. Telementoring was performed using 3 video sources; images were transmitted using 4 ISDN lines. EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches, as well as for identifying the origins of the renal arteries, assessing the aortic neck, and monitoring the attachment of the stent-graft proximally and distally. Average duration of telementoring was 2.1 hours during the first 12 patients (group B) and 1.2 hours for the remaining 24 patients (group C). There was no difference in procedural duration (127+/-59 minutes in group A, 120+/-4 minutes in group B, and 119+/-39 minutes in group C; p=0.94) or the mean time spent in the ICU (26+/-15 hours in group A, 22+/-2 hours in group B, and 22+/-11 hours for group C; p=0.95). The length of hospital stay (11+/-4 days in group A, 9+/-4 days in group B, and 7+/-1 days in group C; p=0.002) was significantly different only for group C versus A (p=0.002). Only 1 (8.3%) patient (in group A: EVAR performed by the experienced operator) required conversion to open surgery because of iliac artery rupture. This was the only conversion (and the only death) in the entire study group (1/12 in group A versus 0/36 in groups B + C, p=0.31). Telementoring for EVAR is feasible and shows promising results. It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine.
    Journal of Endovascular Therapy 05/2005; 12(2):200-5. · 2.70 Impact Factor
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    ABSTRACT: The advent of stents has profoundly changed percutaneous transluminal coronary angioplasty (PTCA), peripheral transluminal artery angioplasty (PTA), and treatment strategies of numerous other problems. Similar developments can be observed for stent applications in peripheral vascular lesions, cerebro-vascular disease, and many other fields. With the advent of covered stent-grafts, aneurysm surgery, has been put up for competitive treatment approaches. Such new approaches are perceived as less invasive, and draw significant attention. Endovsacular aneurysm repair (EVAR) is here to stay. In addition new developments are coming in many ways and stent derived devices can by now be found everywhere in the cardio-vascular system. This includes stenosed vessels, aneurysmal vessels, diseased valves, all sorts of congenital heart defects, and even cardiopulmonary bypass. The key technologies and know-how for EVAR are available or can be made available in most cardio-vascular surgical units. Special interest in this field (clinical and/or experimental) can enhance recruitment of patients. The opposite is also true...
    European Journal of Cardio-Thoracic Surgery 01/2005; 26 Suppl 1:S14-7; discussion S17-8. · 2.67 Impact Factor
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    ABSTRACT: Determine the usefulness of endovascular surgery for repair of aortic lesions late after open surgical repair. A retrospective analysis of our databank (Patient Analysis and Tracking System, Dendrite, UK) for 2000-2002 showed 286 descending thoracic and/or abdominal aortic aneurysms: 60/286 (21%) descending thoracic, and 255/286 abdominal (89%). Endovascular surgery was planned in 98 patients (17/60 (28%) for thoracic lesions, and 81/255 (32%) for abdominal lesions). 13/98 patients (13%) underwent endovascular surgery late after failed open aortic repair: 4/13 at the level of distal aortic arch (3/4 for false aneurysms post-coarctation repair), 4/13 at the level of the descending thoracic aorta (3/4 for false aneurysms proximal to the previous graft), and 5/13 at the level of the infrarenal abdominal aorta (4/5 for false aneurysms proximal to the previous graft). Endovascular surgery included per procedural target site identification (previous graft) with intravascular ultrasound (IVUS) under fluoroscopic control (no angiographies), controlled hypotension (partial inflow occlusion with a right atrial balloon introduced through a femoral vein) for unloading of covered endoprostheses in the thoracic aorta, as well as in situ introducer sheath dilatation in case of complex access to the aorta. There were no hospital deaths and no parapareses or paraplegias in this small series of patients who underwent endovascular surgery for aneurismal lesions occurring late after open repair. An endoleak type I was documented in 2/13 patients (15%) requiring a proximal extension in 1 patient. For the second patient with a minor endoleak, a control examination is planned at 6 months of follow-up. Endovascular surgery is an elegant approach for repair of recurring aortic lesions late after open aortic surgery. IVUS is a precious instrument for per procedural identification of the previous implants. However, long-term follow-up is mandatory after endovascular surgery.
    European Journal of Cardio-Thoracic Surgery 10/2004; 26(3):614-20. · 2.67 Impact Factor
  • Revue medicale de la Suisse romande 08/2004; 124(7):380-2.
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    ABSTRACT: In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways
    Revue medicale de la Suisse romande 08/2004; 124(7):395-9.
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    ABSTRACT: The aim of the present study is to evaluate a new self-expanding valved stent design for minimal invasive aortic valve implantation and its interference with coronary flow. An equine pericardial valve mounted onto a self-expanding nitinol stent (3F Therapeutics trade mark, CA, USA), outer diameter 23 mm, was evaluated (A) in vitro in a dynamic pulsatile mock loop and (B) in vivo in six calves (75+/-2.5 kg). In four animals valve stents were implanted on-pump and in two animals off-pump after induction of ventricular fibrillation. Target site for deployment was the orthotopic aorta, over the native valves. In vivo assessment was performed with intracardiac (AcuNav) and intravascular ultrasound including leaflet motion, planimetric valve orifice and residual-coronary\sinus-stent-index (RCSSI, distance stent to aortic wall/coronary diameter) calculations, coronary blood flow characteristics, transvalvular gradient, regurgitation and paravalvular leaking, in combination with continuous cardiac output measures. Macroscopic analysis was performed at necropsy. Two-dimensional intracardiac ultrasound showed good leaflet motion, with full valvular opening and closing in five of six valves. Planimetric valve orifice was 1.75+/-0.4 cm(2). There were no signs of coronary flow impairment with an RCSSI of 1.8+/-1.2. The implanted valved stents showed a low transvalvular gradient of 5.3+/-3.9 mmHg (mean, peak-to-peak) on invasive measurements and 4.7+/-2.5 mmHg in two-dimensional intracardiac sonography. One of six valves showed mild to moderate regurgitation and one of six valves a minor to moderate paravalvular leak due to size mismatch. This new self-expanding valved stent design allows for on- and off-pump aortic valve implantation in the orthotopic aorta, over the native valves without interference of the coronary blood flow and excellent acute valve function in properly sized devices.
    European Journal of Cardio-Thoracic Surgery 06/2004; 25(5):754-9. · 2.67 Impact Factor
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    ABSTRACT: We designed an animal study to determine the feasibility of videoendoscopic thoracic aorta to iliac artery bypass using a sutureless anastomotic device for proximal anastomosis construction. In 12 pigs the descending thoracic aorta was exposed using the thoracoscopic technique. A 4 mm PTFE thin wall graft was used as conduit. The proximal anastomosis was constructed using a mechanical device for sutureless anastomosis inserted through the camera port incision. The prosthesis was passed through the diaphragm in the retroperitoneal space and the distal anastomosis was done with running suture. The operation was successfully completed in 11 animals. One animal died due to hemorrage during anastomosis construction. Mean graft flow was 144 ml/min (range 88-167 mmHg). The angiogram showed no graft kinking or stenosis. Total operative time was 58 min (range 47-68 min). This approach allows quick and excellent exposure of the entire descending thoracic aorta. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demands of this procedure and could avoid an aortic clamp.
    European Journal of Vascular and Endovascular Surgery 06/2004; 27(5):498-500. · 2.82 Impact Factor

Publication Stats

260 Citations
76.55 Total Impact Points

Institutions

  • 2009
    • Cantonal Hospital of Schwyz
      Schwyz, Schwyz, Switzerland
  • 1996–2009
    • University Hospital of Lausanne
      • Service de chirurgie cardio-vasculaire (CCV)
      Lausanne, VD, Switzerland
  • 1995–1997
    • Schulthess Klinik, Zürich
      Zürich, Zurich, Switzerland
  • 1992
    • Pathologie Institut Enge
      Zürich, Zurich, Switzerland