Percutaneous femoral venoarterial ECMO decannulation at the bedside using the Manta vascular closure device.

A case of peripheral venoarterial extracorporeal membrane oxygenation decannulation using the Teleflex Manta vascular closure device is presented.

Bilateral pulmonary septic embolectomy in the setting of multivalvular acute infective endocarditis surgery.

We report a case of multivalvular acute infective endocarditis associated with a bilateral septic pulmonary embolism. The patient underwent aortic and tricuspid valve replacement, mitral valve anterior leaflet debridement and bilateral pulmonary septic embolectomy, followed by a 6-week intravenous antibiotic treatment. We present our multidisciplinary approach for the management of such complex cases.

Comprehensive management of late mediastinitis involving an aortic Dacron graft.

We present a case of late mediastinitis following surgery for type A aortic dissection. After a thorough preoperative workup, the patient underwent a redo sternotomy, removal of all prosthetic material, and replacement of the aortic root with a homograft. The patient required venoarterial extracorporeal membrane oxygenation and delayed sternal closure for post-postoperative biventricular failure as well as prolonged antibiotic treatment.

Diagnostic and surgical management of HeartMate 3 outflow graft obstruction due to two different mechanisms.

Outflow graft obstruction is a potentially catastrophic complication of left ventricular assist devices that may occur secondary to different mechanisms. Two cases of Heartmate 3 outflow graft obstruction associated with two different pathophysiological mechanisms are presented. The first one was a 70-year-old man who developed outflow graft obstruction secondary to kinking.

Intraoperative Collateral Drainage Evaluation Before Superior Caval Interruption in Partial Anomalous Pulmonary Venous Connection Repair.

A superior sinus venosus atrial septal defect and partial anomalous pulmonary venous connection was corrected by a minimally invasive approach by permanently ligating the superior vena cava and a single pericardial patch for rerouting the flow through the enlarged interatrial communication. The patient had persistency of the left superior vena cava draining in the coronary sinus but no innominate vein. This anatomy poses a risk of developing right-sided superior vena cava syndrome.

Direct true lumen cannulation for type A aortic dissection (Samurai technique) in emergency scenarios.

Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the possible problems that may arise.

Surgery for Hypertrophic Obstructive Cardiomyopathy: Comprehensive LVOT Management beyond Septal Myectomy.

Hypertrophic cardiomyopathy (HCM) is a complex, underestimated, multifaceted disease frequently associated with left ventricular outflow tract (LVOT) obstruction. It is clearly demonstrated that this is due not only to septal hypertrophy but also to systolic anterior motion (SAM) of mitral valve leaflets secondary to mitral valve/subvalvular apparatus abnormalities. Surgical treatment involves performing an extended septal myectomy, eventually followed by ancillary procedures to those structures responsible for maintaining LVOT obstruction, if necessary.

Impact of Bedside Re-Explorations in a Cardiovascular Surgery Intensive Care Unit Led by Surgeons.

Surgical re-explorations represent 3-5% of all cardiac surgery. Concerns regarding mortality and major morbidity of re-explorations in the intensive care unit (ICU) setting exist. We sought to investigate whether they may have different outcomes compared with those performed in the operating room (OR).

Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures.

Introduction And Objectives: Septal myectomy remains the first septal reduction therapy for hypertrophic obstructive cardiomyopathy in young patients and those requiring concomitant procedures. Its role in advanced ages is questioned due to perceived increased risk. We assess the outcomes of surgical relief of obstruction in patients beyond 65 years old.

Extended septal myectomy and left ventricular outflow tract intervention for hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy is the most common inherited cardiomyopathy. Septal myectomy is a low-risk operation and remains the first septal reduction therapeutic option. We present a patient with hypertrophic obstructive cardiomyopathy requiring extended septal myectomy and concomitant left ventricular outflow tract intervention.

Extracorporeal Membrane Oxygenation for COVID-19 Respiratory Distress Syndrome: An Italian Society for Cardiac Surgery Report.

An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed.

Levosimendan to facilitate weaning from cardiorespiratory support in critically ill patients: current evidence and future directions.

Appropriate weaning is of crucial importance for critically ill patients requiring respiratory support. However, a remarkable proportion of them are difficult to wean. Levosimendan is a positive inotropic agent characterized by vasodilatory properties, which is used for the treatment of acute decompensated heart failure or in patients needing inotropic treatment, including cardiogenic shock, septic shock, pulmonary hypertension and right ventricular dysfunction, needed for hemodynamic support in patients with diuretic resistance, and weaning either from ventilator or from extracorporeal membrane oxygenation.

Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery?

Purpose Of Review: The debate on the second best conduit for CABG is still intense. In this review, we discuss the role of the radial artery and the right internal thoracic artery (RITA) compared with saphenous vein grafts (SVG).

Recent Findings: The recent RADIAL STUDY has been the first evidence based on randomized trials of a clinical benefit using a second arterial graft in CABG.

Emergency Surgery for Iatrogenic Injuries attributable to Percutaneous Coronary Interventions: When Planning and Time Matter.

See Article by Verevkin et al.

Early Versus Late Tracheostomy in Cardiac Surgical Patients: A 12-Year Single Center Experience.

Objectives: To evaluate whether early tracheostomy is associated with better outcomes in mechanical ventilation-dependent patients after cardiac surgery compared with a late tracheostomy.

Design: Retrospective, observational study.

Setting: Cardiac surgical intensive care unit (ICU) of a tertiary care center.

Nine years' experience with the chordal cutting technique in ischemic mitral regurgitation.

Objectives: The optimal surgical management of chronic ischemic mitral regurgitation has not yet been clearly defined. Among the various approaches proposed, the excision of strut (or main) chordae, along with complete annuloplasty to relieve tethering, has been the one preferred by our institution to treat this particular subset of mitral disease.

Methods: Between October 2004 and May 2013, 11 patients underwent surgery for chronic ischemic mitral regurgitation.

Cardiac tamponade caused by a migrating sewing needle.

: Penetrating injuries of the heart caused by migrating needles have been rarely described. They usually occur accidentally or are self-inflicted in the setting of an underlying psychiatric disorder. We present an unusual case of cardiac tamponade caused by a sewing needle that migrated to the heart from the chest wall through the lung.

Levosimendan may improve weaning outcomes in venoarterial ECMO patients.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support in patients with refractory cardiogenic shock, allowing time for cardiac recovery. Levosimendan is a calcium sensitizer with inotropic and vasodilatory effects used in the treatment of severe heart failure. It does not increase myocardial oxygen consumption.

[Case report of a patient on extracorporeal memebrane oyxgenation for cardiogenic shock not suitable for weaning in a peripheral center. Just a "problem" or is it feasible a treatment before patient transfer to a Hub center?].

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is the treatment of choice for cardiogenic shock unresponsive to inotropes or intra-aortic balloon pumping. It provides a temporary mechanical circulatory support and blood oxygenation allowing time for cardiac recovery. If this is not the case, the patient may become suitable for heart transplantation or left ventricular assist device (LVAD) implantation and must be transferred to a referral center.

Obstruction of the tricuspid valve orifice by a huge right atrial myxoma associated with the Carney complex: a case report.

Carney complex (CNC) is an inherited autosomal dominant disorder associated with multiple neoplasms. Myxomas associated with CNC differ from their sporadic forms because the former usually develop at a younger age and they may be multicentric and have a tendency to recur. Furthermore, their localization may be atypical.

Postinfarction septal dissection and rupture evolved as an inferobasal pseudoaneurysm: a specific anatomical pattern.

In rare cases of posterior myocardial infarction, septal rupture is the consequence of a dissecting interventricular hematoma that evolves as a fibrotic septal chamber with two separate communications, towards left and right ventricle. This unusual anatomical pattern is generally unsuspected and described as a normal interventricular defect associated with a basal left ventricular aneurysm or pseudoaneurysm. We present a case where echocardiography and ventricular angiography did not detect this situation.

Repair of posterior left ventricular aneurysm through transatrial approach.

Repair of posterior left ventricular ischemic aneurysms implies an extracardiac approach to reshape the ventricular geometry frequently associated with mitral surgery. A transatrial technique was described for lesions following mitral surgery or for subvalvular idiopathic cases. A transmitral approach was used for ischemic or traumatic pseudoaneurysm.