Combining stem cells and tissue engineering in cardiovascular repair -- a step forward to derivation of novel implants with enhanced function and self-renewal characteristics.

The use of stem and progenitor cells in cardiovascular therapy has been proposed as a feasible option to promote repair of tissue damage by ischemia, or to devise definitive artificial tissue replacements (valves, vessels, myocardium) to be surgically implanted in patients. Whereas in other medical branches such as dermatology and ophthalmology the use of ex vivo grown tissues is already accessible to a large degree, the use of bio-artificial implants in cardiovascular surgery is still marginal. This represents a major limitation in cardiovascular medicine at present.

Incidence and predictors of pacemaker placement after surgical ablation for atrial fibrillation.

Background: Bradyarrhythmia requiring pacemaker placement is a relatively common complication after surgical ablation for atrial fibrillation (AF). We report our experience with surgical ablation procedures using various energy modalities and lesion sets in an attempt to identify the risk factors associated with postoperative pacemaker requirement.

Methods: Intraoperative data were collected prospectively, and preoperative and postoperative data were collected retrospectively.

Quality, not volume, determines outcome of coronary artery bypass surgery in a university-based community hospital network.

Objectives: The present study examined the relationship between hospital and surgeon coronary artery bypass grafting procedural volume, mortality, morbidity, and National Quality Forum care processes in a university-based community hospital quality improvement program.

Methods: The study population consisted of 2218 consecutive patients undergoing isolated coronary artery bypass grafting from 2007 to 2009 in a university-based quality improvement program that emphasizes involvement of all surgeons in the academic quality endeavor. The endpoints included operative mortality, major morbidity, and National Quality Forum-endorsed process measures as defined by the Society of Thoracic Surgeons.

Optimal surgical management of severe ischemic mitral regurgitation: to repair or to replace?

Background: Ischemic mitral regurgitation, a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and is estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention.

A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery.

Objective: The aim of this study was to compare the cost and effectiveness of a minimally invasive (MI) versus traditional sternotomy (ST) approach for mitral valve surgery (MVS).

Methods: From January 1, 2003, to December 31, 2008, a total of 847 patients underwent isolated MVS at our institution. Propensity matching on 22 clinical variables was carried out to generate a study cohort of 434 patients (217 matched pairs).

The golden age of minimally invasive cardiothoracic surgery: current and future perspectives.

Over the past decade, minimally invasive cardiothoracic surgery (MICS) has grown in popularity. This growth has been driven, in part, by a desire to translate many of the observed benefits of minimal access surgery, such as decreased pain and reduced surgical trauma, to the cardiac surgical arena. Initial enthusiasm for MICS was tempered by concerns over reduced surgical exposure in highly complex operations and the potential for prolonged operative times and patient safety.

Designing comparative effectiveness trials of surgical ablation for atrial fibrillation: experience of the Cardiothoracic Surgical Trials Network.

Objective: Since the introduction of the cut-and-sew Cox maze procedure for atrial fibrillation, there has been substantial innovation in techniques for ablation. Use of alternative energy sources for ablation simplified the procedure and has resulted in dramatic increase in the number of patients with atrial fibrillation treated by surgical ablation. Despite its increasingly widespread adoption, there is lack of rigorous clinical evidence to establish this procedure as an effective clinical therapy.

On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial.

Objective: Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach.

Methods: Among a total of 13,819 patients with moderate- to high-risk acute coronary syndromes enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy trial, 1375 patients were triaged to isolated coronary artery bypass grafting.

Pathological healing response of explanted MitraClip devices.

Background: The safety and effectiveness of the MitraClip device (Abbott Vascular, Menlo Park, CA) is being evaluated in the Endovascular Valve Edge-to-Edge Repair Study (EVEREST) clinical studies. The healing response after device implantation has not previously been characterized in humans.

Methods And Results: A total of 67 explanted devices (implantation duration, 1 to 1878 days) from 50 patients were submitted for histological evaluation.

Percutaneous treatment of mitral regurgitation: current status and future directions.

The burgeoning field of catheter-based, percutaneous valve intervention takes an interdisciplinary approach to mitral valve regurgitation with the goal of maximizing clinical outcomes and minimizing procedure-associated morbidity. This exciting field continues to push the boundaries of technological innovation as it expands the armamentarium available to treat valvular disease. Around the world teams are working to create a catheter-based approach that is practical and durable.

Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis.

Background: Over the past decade, minimally invasive (MI) mitral valve surgery has grown in popularity. The purpose of this study was to compare both short- and long-term outcomes of mitral valve repair and replacement performed through a MI versus traditional sternotomy (ST) incision using a propensity analysis approach to account for differences in baseline risk.

Methods: From January 2000 to December 2008, a total of 1,121 isolated mitral valve operations were performed at our institution (548 ST, 573 MI).

Surgical versus percutaneous revascularization for multivessel disease in patients with acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.

Objectives: The aim of this study was to evaluate outcomes of patients with moderate- and high-risk acute coronary syndromes (ACS) and multivessel coronary artery disease managed with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG).

Background: There is uncertainty about the preferred revascularization strategy for high-risk patients with multivessel disease.

Methods: Among 13,819 moderate- and high-risk ACS patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, 5,627 had multivessel disease (including left anterior descending artery involvement) and were managed by PCI (n = 4,412) or CABG (n = 1,215).

Long-term outcomes with a minimally invasive approach for resection of cardiac masses.

Background: Minimally invasive cardiac surgery has been used with increased frequency in all areas of cardiac surgery. The purpose of this study was to compare the effectiveness of a minimally invasive (MI) versus traditional sternotomy approach for the resection of cardiac masses.

Methods: From January 1, 2000 to December 31, 2007, 74 patients (36 traditional sternotomy, 38 MI) underwent surgery for isolated resection of a cardiac mass.

Right Atrial Isolation After Maze Procedure Discovered at the Time of Pacemaker Implantation.

This article describes the case of a gentleman who required a permanent pacemaker after mitral valve replacement and a modified maze procedure, with an unusual observation after right atrial lead insertion.

Retroperitoneal hematoma with abdominal compartment syndrome during minimally invasive mitral valve replacement.

Although retroperitoneal hematomas most often occur secondary to trauma, they are a reported complication of ruptured aneurysms, anticoagulation therapy, and femoral vascular access. In the cardiovascular literature, retroperitoneal hematomas have occurred after percutaneous coronary interventions; however, these hematomas rarely bleed to the extent that they cause abdominal compartment syndrome. The present report describes the case of an adult patient who had a retroperitoneal hematoma develop during minimally invasive mitral valve replacement with intraoperative abdominal compartment syndrome requiring emergent surgical decompression.

Surgical revision after percutaneous mitral repair with the MitraClip device.

Background: Percutaneous mitral repair with the MitraClip device (Evalve, Menlo Park, CA) has been reported. Preserving conventional surgical options in the event of percutaneous treatment failure is important. We describe surgical treatment at varying intervals after the MitraClip procedure in 32 patients.

Posttransplant survival is not diminished in heart transplant recipients bridged with implantable left ventricular assist devices.

Background: The purpose of this study was to compare posttransplantation morbidity and mortality in orthotopic heart transplant recipients bridged to transplant with a left ventricular assist device with nonbridged recipients. To account for potential differences across device types, we stratified bridge-to-transplant recipients by type of ventricular assist device: extracorporeal (EXTRA), paracorporeal (PARA), and intracorporeal (INTRA).

Methods: The United Network for Organ Sharing provided de-identified patient-level data.

A comparison of atrial arrhythmias after heart or double-lung transplantation at a single center: insights into the mechanism of post-operative atrial fibrillation.

Objectives: We compared the incidence of atrial arrhythmias in double-lung transplant patients versus heart transplant patients to gain insight into factors that contribute to post-operative atrial fibrillation (AF).

Background: Atrial fibrillation is a common complication after thoracic surgery. Pulmonary vein isolation is an effective treatment for AF.

Eight-year experience with minimally invasive cardiothoracic surgery.

Background: Over the past decade, minimally invasive cardiac surgery (MICS) has emerged as an accepted approach for the management of cardiac disease that requires a surgical solution. We report the results of an 8-year, single-institution experience with MICS.

Methods: Between January 1, 2000 and December 31, 2007, a total of 910 patients underwent MICS.

Aortic valve replacement: reliability of EuroSCORE in predicting early outcomes.

EuroSCORE algorithms were developed to predict perioperative mortality in cardiac surgery. This study was designed to evaluate the reliability of EuroSCORE algorithms and to analyze the predicting role of the scoring system's factors on patients that undergo isolate AVR. 339 patients underwent aortic valve replacement.

Matching high-risk recipients with marginal donor hearts is a clinically effective strategy.

Background: The purpose of this study is to determine the clinical outcomes associated with alternate listing transplantation, which utilizes "marginal" donor organs by transplanting them into high-risk recipients who fail to meet the standard criteria for transplantation.

Methods: The United Network for Organ Sharing provided de-identified patient-level data. Analysis focused on patients undergoing heart transplantation between January 1, 1999, and December 31, 2005 (n = 13,024).