Sleeve valve-sparing procedure in bicuspid aortic valve: early and midterm clinical results.

Background: Patients with aortic root ectasia and bicuspid aortic valve benefit of the treatment with aortic valve sparing procedure, with excellent long-term results. The Sleeve-procedure is one of the options in patients with aortic root diseases and it might be suitable for patients with a bicuspid valve.

Methods: From October 2006 to December 2018, 42 consecutive patients with bicuspid aortic valve and aortic root ectasia/aneurysm, with or without aortic regurgitation, were surgically treated with the Sleeve-procedure.

Aortic Root Dynamics in Sleeve Aortic Sparing Procedure: Echocardiographic and Computational Studies.

In Sleeve procedure, the leaflets-sinus unit is maintained. We hypothesized that this feature partially preserves aortic root (AR) dynamics and leaflets kinematics and limits tensions in the leaflets. We tested our hypothesis based on in vivo and computational assessment of leaflets and AR dynamics.

Aortic root surgery with the CARDIOROOT vascular graft: results of a prospective multicenter post-market surveillance study.

Background: Sparing Aortic Valve procedure requires to reproduction of the geometry of the physiologic anatomy of the aortic root. Thus, the materials adopted may make a difference. CARDIOROOT is a one-piece collagen-coated woven vascular graft with pseudo-sinuses, which was designed for use in the treatment of aortic root disease.

Opening/closing pattern of Trifecta and Freestyle valves versus native aortic valve: Are stentless valves more physiologic than a stented valve?

Background: Stentless valves have long been considered the ideal valves in terms of hemodynamics. Recently, the Trifecta valve, a stented bioprosthesis with excellent fluid dynamic characteristics, has become available. The aim of the study was to compare the opening/closing pattern of the Freestyle stentless valve and the Trifecta valve with that of the native aortic valve.

Hydrodynamic and Geometric Behavior of Two Pericardial Prostheses Implanted in Small Aortic Roots.

Hydrodynamic performance of stented bioprostheses is far below that of the native valve. One of the reasons is that the internal diameter of the prosthesis is usually smaller than that of the native valve. However, other valve characteristics are also important in generating the pressure drop.

Unexpected Radiation-Induced Aortic Wall Thickening Requiring Composite Graft Technique during Off-Pump Coronary Artery Bypass Grafting.

Mediastinal radiation is commonly used to treat Hodgkin's and non-Hodgkin's lymphoma, lung and breast cancer. Cardiac complications after radiation therapy are well described, although rare. A large spectrum of injuries can occur, causing long term morbidity among survivors.

Aortic Root Biomechanics After Sleeve and David Sparing Techniques: A Finite Element Analysis.

Background: Aortic root aneurysm can be treated with valve-sparing procedures. The David and Yacoub techniques have shown excellent long-term results but are technically demanding. Recently, a new and simpler procedure, the Sleeve technique, was proposed with encouraging results.

Opening-closing pattern of four pericardial prostheses: results from an in vitro study of leaflet kinematics.

Pericardial and porcine stented aortic valves have different leaflet kinematics. To study the biomechanics of a prosthesis thoroughly, the in vitro setting is the most appropriate. The aim of our study was to find out whether the prosthesis design in which the pericardial sheet is outside the stent post might influence the opening and closing patterns of the leaflets.

Hemodynamic comparison between Trifecta and Freestyle valves implanted in small aortic roots. One-year echocardiographic results from a prospective randomized study.

Background And Aim Of The Study: Aortic valve replacement in patients with a small aortic root may be associated to high residual gradients. In such patients, both stentless valves and aortic annulus enlargement can reduce these residual gradients. Several studies have reported that Trifecta valves yield very good hemodynamic results.

St. Jude Medical Trifecta aortic valve: results from a prospective regional multicentre registry.

Background: The Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St.

Early hemodynamic evaluation of Trifecta and Freestyle bioprostheses in patients with a small aortic root: preliminary results from a prospective randomized study.

Background And Aim Of The Study: Aortic valve replacement (AVR) in patients with a small aortic root is often associated with some degree of obstruction and residual gradients. Stentless valves display better hemodynamic performance than stented valves, and might be ideal in patients with a small aortic annulus. A new stented bioprosthesis, the Trifecta valve, has recently become available and has yielded interesting early results.

Hemodynamic comparison between Trifecta and freestyle aortic valve during exercise in patients with small aortic root.

Background: Patients with a small aortic annulus, that is ≤ 23 mm, constitute a challenge for the surgeon, because they are at high risk of patient-prosthesis mismatch. Stentless valves provide better hemodynamic performance at rest and during exercise than stented valves, and are advocated in this group of patients. A new-generation stented valve, the Trifecta (St.

Early and medium term results of the sleeve valve-sparing procedure for aortic root ectasia.

Background: The aim of this retrospective study was to evaluate our experience of using a simplified aortic valve sleeve procedure to treat aortic root ectasia and aneurysms with or without aortic regurgitation. In experienced hands, 2 aortic valve-sparing procedures, ie, Yacoub and David, have yielded excellent long-term results in the treatment of aortic root aneurysms, with or without aortic regurgitation. However, these techniques are demanding and not widely used.

Does the type of suture technique affect the fluid-dynamic performance of bioprostheses implanted in small aortic roots? Results from an in vitro study.

Background: The in vivo hemodynamic performance of a bioprosthesis implanted in an aortic position is affected by the characteristics of the prosthesis and the sizing strategy adopted. Recently, it has been hypothesized that the type of suture used to implant the prosthesis might influence hemodynamics.

Methods: Bioprostheses with labeled sizes of 19 mm and 21 mm were implanted in 2 groups of 5 porcine aortic roots, with native annuli of 19 mm and 21 mm, by means of 2 different suture techniques: simple interrupted and noneverting mattress with pledgets.

Fluid-dynamic results of in vitro comparison of four pericardial bioprostheses implanted in small porcine aortic roots.

Objectives: Small-sized aortic bioprostheses may cause high postoperative gradients. In clinical practice, it is difficult to compare bioprostheses from different manufactures, owing to the discrepancy between the true size and the nominal size of the prosthesis and the inter-patient variability in aortic root characteristics. In vitro studies provide accurate data, and using a system in which it is possible to implant bioprostheses in a true aortic root should enable a fair comparison to be made.

Treatment of mediastinitis by ventrofil plates without sternal rewiring.

Mediastinitis is a serious complication of cardiac surgical procedures, with high rates of morbidity and mortality. We describe a new simple surgical technique to treat deep sternal infection based on the removal of all wires and deep sutures, and reapproximation of the sternum with four external plates without rewiring. Fourteen patients were treated with this technique.

[From the coronary care unit to the intensive cardiac care unit: the evolution of the Cardiovascular Department of a tertiary center].

Background: Substantial changes have occurred over time in the diagnoses, procedures and characteristics of patients admitted to coronary care units (CCU). Following the introduction of cardiac surgery activity in our hospital in December 2009, the aim of this study was to evaluate the changes in activity, processes of care and outcomes of patients consecutively admitted to our CCU after the reorganization of the Cardiovascular Department.

Methods: All 1674 consecutive patients admitted to the CCU from January 2009 to December 2010 were enrolled in this retrospective registry.

Usefulness of transcranial color Doppler ultrasonography in aortic arch surgery.

Background: Hypothermia in combination with selective cerebral perfusion is a well-documented technique for cerebral protection during aortic arch surgery. However, such complex surgery is still accompanied by a considerable incidence of neurological events.

Aim: This study describes the advantages of transcranial color Doppler ultrasound (TCDU) as a noninvasive real-time method for intraoperative monitoring of cerebral blood flow.

Heart transplantation in patients with previous Fontan operations.

Objective: The clinical features and outcomes of patients undergoing heart transplantation after a failed Fontan operation are still debated. The aim of this study was to retrospectively evaluate our experience in 14 patients undergoing heart transplantation after previous Fontan-type operations.

Methods: From 1990 to 2002, 14 patients underwent heart transplantation in our institution after a previous Fontan procedure.

Left main stem patch plasty and aortic root homograft in Takayasu's disease.

Takayasu's arteritis (TA) is a chronic large vessel vasculitis, first described in 1908 by the Japanese ophthalmologist Takayasu, affecting more frequently young women. The typical lesions represented by aneurysmatic dilatation or obliteration, and narrowing of the arterial lumen may pose technical difficulties as well as demanding decision making for treatment. Since Jarvell first described aortic regurgitation in TA in 1954, unresolved problems still remain for aortic valve replacement, particularly because of the young age of these patients.

Aortic valve disease with severe ventricular dysfunction: stentless valve for better recovery.

Background: Stentless bioprostheses and homografts show better hemodynamic profiles compared with conventional stented bioprostheses and mechanical valves. Few data are available on stentless aortic valve implantation for patients with severe left ventricular dysfunction. The aim of this retrospective study was to assess the potential benefits of stentless aortic valve implantation for patients undergoing isolated aortic valve replacement with left ventricular ejection fraction < or = 35%.

[Surgical correction with homograft in native or prosthetic aortic valve infective endocarditis].

Background: Aortic valve surgery for infective endocarditis is still a high-risk procedure and the optimal valve substitute remains controversial. The aim of this study was to evaluate the results of our experience using homografts in the treatment of native (NVE) or prosthetic valve endocarditis (PVE).

Methods: Between May 1992 and December 2000, 37 patients with NVE and 16 patients with PVE underwent aortic valve replacement with homografts for infective endocarditis.