Routine early postoperative computed tomography angiography after coronary artery bypass surgery: clinical value and management implications.

Objectives: Computed tomography angiography (CTA) is broadly used for long-term follow-up of graft patency after coronary artery bypass graft surgery (CABG). However, its clinical value in the early postoperative setting has not been established yet. We evaluated the benefit of adding CTA to the routine clinical work-up after CABG on patient management.

Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial.

Background: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFR) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFR on heart team's treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease.

Reduced-order modeling of blood flow for noninvasive functional evaluation of coronary artery disease.

We present a novel computational approach, based on a parametrized reduced-order model, for accelerating the calculation of pressure drop along blood vessels. Vessel lumina are defined by a geometric parametrization using the discrete empirical interpolation method on control points located on the surface of the vessel. Hemodynamics are then computed using a reduced-order representation of the parametrized three-dimensional unsteady Navier-Stokes and continuity equations.

Feasibility of planning coronary artery bypass grafting based only on coronary computed tomography angiography and CT-derived fractional flow reserve: a pilot survey of the surgeons involved in the randomized SYNTAX III Revolution trial.

Objectives: Invasive coronary angiography has been the preferred diagnostic method to guide the decision-making process between coronary artery bypass grafting (CABG) and percutaneous coronary intervention and plan a surgical revascularization procedure. Guidelines recommend a heart team approach and assessment of coronary artery disease (CAD) complexity, objectively quantified by the anatomical SYNTAX score. Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFRCT) are emerging technologies in the diagnosis of stable CAD.

Sternal Anomalies in Asymptomatic Patients after Median Sternotomy and Potential Influencing Factors.

Background: We aimed to assess asymptomatic patients who had open-heart surgery with median sternotomy for potential sternal anomalies (SA), their related patient-specific risk factors, and treatment options for the prevention of SA.

Methods: Multiplanar CT scans (CTs) from 131 asymptomatic consecutive patients were analyzed retrospectively. Of these, 83 underwent CABG (63.

Long-Term Outcomes after Minimally Invasive Aortic Valve Surgery through Right Anterior Minithoracotomy.

 Minimally invasive aortic valve surgery (MIAV) through a right anterior minithoracotomy evolved to an accepted procedure with favorable short- and mid-term outcomes, whereas long-term results lack. The aim of this study was to evaluate the long-term outcomes.  All our MIAV patients were included ( = 225).

Computed Tomography Angiography of Coronary Artery Bypass Grafts: Low Contrast Media Volume Protocols Adapted to Tube Voltage.

Objective: The aim of this study was to evaluate the potential of contrast media (CM) reduction in computed tomography angiography (CTA) of coronary artery bypass grafts (CABGs) when adapting CM volume to automatically selected tube voltages.

Material And Methods: Sixty consecutive patients (mean age, 71 ± 14.5 years) with a total of 176 CABGs (692 bypass segments) underwent contrast-enhanced prospectively electrocardiography-gated high-pitch CTA with automated, attenuation-based tube voltage selection (100 ref.

Optimizing radiation dose by using advanced modelled iterative reconstruction in high-pitch coronary CT angiography.

Purpose: To evaluate the potential of advanced modeled iterative reconstruction (ADMIRE) for optimizing radiation dose of high-pitch coronary CT angiography (CCTA).

Methods: High-pitch 192-slice dual-source CCTA was performed in 25 patients (group 1) according to standard settings (ref. 100 kVp, ref.

Use of extracellular matrix patches in cardiac surgery.

A noncellular xenogeneic extracellular matrix derived from the porcine small intestinal submucosa can be used as a new patch material with potential advantages. We review the literature on the use of this material in cardiac surgery.

The Potential Impact of Functional Imaging on Decision Making and Outcome in Patients Undergoing Surgical Revascularization.

Objective: Coronary angiography (CA) remains the standard for preoperative planning for surgical revascularization. However, besides anatomical imaging, current guidelines recommend additional functional imaging before a therapy decision is made. We assess the impact of functional imaging on the strategy of coronary artery bypass grafting (CABG) with particular regards on postoperative patency and myocardial perfusion.

Acute, subacute, and long-term evaluation of a novel endovascular occlusion system in a large animal model.

Objectives: Endovascular occlusion of blood vessels represents a key component of interventional therapy. While coils are most commonly used, vessel occlusion is generally not achieved immediately and may necessitate a large number of devices. It has been suggested that endovascular plugs may overcome these limitations; however, immediate and durable occlusion remains a challenge with plugs as well.

Does body mass index impact the early outcome of surgical revascularization? A comparison between off-pump and on-pump coronary artery bypass grafting.

Objectives: To investigate the effects of body mass index (BMI) on early outcomes after revascularization using either on-pump or off-pump surgery.

Methods: Data for 3714 of 4314 patients who underwent surgical revascularization at our institution between 1999 and 2008 were analysed. Patients were divided into two groups [off-pump coronary artery bypass (OPCAB); n = 1958 and on-pump coronary artery bypass (ONCAB); n = 1756] and further assigned into five classes according to their BMI (underweight <20 kg/m(2), normal 20-24.

Complete Recovery From Severe Tachycardia-Induced Cardiomyopathy in a Patient With Ebstein's Anomaly.

We report the case of a young patient with repaired Ebstein's anomaly who developed severe tachycardia-induced cardiomyopathy and a large apical thrombus as a consequence of sustained atrial flutter with a 2:1 conduction. In spite of a dramatic course in hospital with prolonged mechanical resuscitation and extracorporeal membrane oxygenation, she survived and made a rapid and full recovery. This remarkable case underlines that atrial arrhythmias, the most common complication in adults with congenital heart disease, may have devastating outcomes when timely recognition is missed and treatment delayed-thus, emphasizing the importance of good patient education.

A physiological controller for turbodynamic ventricular assist devices based on a measurement of the left ventricular volume.

The current article presents a novel physiological control algorithm for ventricular assist devices (VADs), which is inspired by the preload recruitable stroke work. This controller adapts the hydraulic power output of the VAD to the end-diastolic volume of the left ventricle. We tested this controller on a hybrid mock circulation where the left ventricular volume (LVV) is known, i.

Evaluation of calcium loss after transcatheter aortic valve implantation.

Objectives: Aortic valve calcification and changes after transcatheter aortic valve implantation (TAVI) were specifically assessed by computed tomography (CT). The main difference between TAVI and the conventional technique is the compression of the cusps of the calcified native valve against the aortic wall before implantation. The objective of this study was to quantify the segmented calcification in the area of the basal annular plane before and after TAVI.

The endovascular occlusion system for safe and immediate peripheral vessel occlusion during vascular interventions.

Endovascular occlusion of blood vessels is an important part of interventional therapy concepts. Here, we evaluate the feasibility, procedural safety and efficacy of the novel endovascular occlusion system (EOS) in the arterial system in a porcine model. Thirteen devices were deployed in the iliac and femoral arteries (diameter: 4-5 mm) of five adult swine.

A new occlusion device: application of the ArtVentive endoluminal occlusion system (EOS)--first in human clinical trial.

Purpose: The purpose of this study was to determine the safety and efficacy of a new endoluminal occlusion device, ArtVentive endoluminal occlusion system (EOS), to occlude the spermatic vein in symptomatic males with varicoceles.

Methods: The ArtVentive EOS device has been developed for percutaneous, peripheral occlusion of the peripheral arterial and venous vasculature. The system is comprised of an implantable occlusion device and a delivery catheter.

Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: first long-term results from a prospective device trial.

Objectives: Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery.

Methods: Forty patients with AF were enrolled in this prospective 'first-in-man' trial.

A novel interface for hybrid mock circulations to evaluate ventricular assist devices.

This paper presents a novel mock circulation for the evaluation of ventricular assist devices (VADs), which is based on a hardware-in-the-loop concept. A numerical model of the human blood circulation runs in real time and computes instantaneous pressure, volume, and flow rate values. The VAD to be tested is connected to a numerical-hydraulic interface, which allows the interaction between the VAD and the numerical model of the circulation.

Stenosis quantification in coronary CT angiography: impact of an integrated circuit detector with iterative reconstruction.

Objectives: The objective of this study was to assess the value of an integrated circuit (IC) detector, potentially improving spatial resolution by means of reduced cross talk between detector channels, in coronary computed tomographic (CT) angiography regarding image quality and stenosis quantification compared with conventional detector technology.

Materials And Methods: In the ex vivo part of the study, a coronary phantom including 63 defined stenoses and 7 plaque densities (degree of stenosis, 10%-90%; plaque densities, -100 to 1000 Hounsfield unit [HU]) was loaded with contrast agent diluted to 300 HU and placed in an anthropomorphic chest phantom. The phantom was scanned in 0-, 45-, and 90-degree orientations to the z-axis of the CT scanner table.

Incidence of sternal wound infection after reexploration in the intensive care unit and the use of local gentamycin.

Background: Reoperation for bleeding is a known emergency complication after cardiac operations. When performed in the intensive care unit (ICU), sterility issues arise. Our aim was to examine the incidence of sternal wound infection (SWI) after reexploration in the ICU for bleeding with routine use of local gentamycin.