Mitral valve repair rates in degenerative mitral valve disease correlate with surgeon and hospital procedural volume.

Study Aim: To determine the relationship between surgeon and hospital procedural volume, and mitral valve repair rates and 30-day mortality for degenerative mitral regurgitation (MR), in Australian cardiac surgical centers.

Methods: A total of 4420 patients who underwent elective surgery for degenerative MR between January 2008 and December 2017 in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database were retrospectively included. Univariate and multivariate regression analyses examined surgeon and hospital procedural volumes for associations with repair rate and mortality.

Predictors of Pacemaker Insertion Post-Sutureless (Perceval) Aortic Valve Implantation.

Introduction: The use of rapid deployment sutureless aortic valve replacement (AVR) has become a viable alternative to conventional AVR especially in intermediate and high-risk patients. However, sutureless AVR has been associated with increased rates of permanent pacemaker (PPM) implantation compared with conventionally implanted aortic valve prostheses. The aim of this study was to determine predictive factors for complete heart block requiring insertion of a PPM post-AVR with a Perceval S sutureless valve (LivaNova, London, UK).

Cardiovascular disease and COVID-19: Australian and New Zealand consensus statement.

Introduction: The coronavirus 2019 disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID-19, and COVID-19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed.

Early Outcomes of Sutureless Aortic Valve Replacement With the Perceval S Bioprosthesis.

Background: Sutureless aortic valve replacement (SU-AVR) offers an alternative to traditional aortic valve replacement (AVR) and is becoming widely performed in many hospitals. The aim of the current study was to evaluate the early experience in SU-AVR with the Perceval S bioprosthesis at Monash Medical Centre.

Methods: Fifty-two (52) patients who underwent SU-AVR were retrospectively analysed (mean age: 74.

Effects on cognition of conventional and robotically assisted cardiac valve operation.

Background: The effect of valve surgical procedures on cognition was investigated in patients undergoing conventional or robotically assisted techniques. The confounding factors of surgical procedure, mood state, preexisting cognitive impairment, and repeated experience with cognitive tests were controlled for.

Methods: Patients undergoing conventional valve procedures (n = 15), robotically assisted valve procedures (n = 15), and thoracic surgical procedures (n = 15), along with a nonsurgical control group (n = 15) were tested preoperatively, 1 week after operation, and 8 weeks after operation by use of a battery of cognitive tests and a mood state assessment.

Gastrointestinal complications after cardiac surgery: 10-year experience of a single Australian centre.

Background: Gastrointestinal (GI) complications after cardiac surgery are uncommon, but are associated with high morbidity and mortality as well as significant hospital resource utilization.

Methods: We analysed a prospectively collected database containing all adult cardiac surgery procedures performed from July 2001 to March 2011 at Monash Medical Centre and Jessie McPherson Private Hospital. Patients with post-operative GI complications were compared to patients without GI complications who were operated in the same period.

A cost-analysis study of robotic versus conventional mitral valve repair.

Background: Robotic mitral valve repair has been performed in Australia since 2004. The aim of this study was to perform a cost-analysis of robotic mitral valve repair (MVR) with direct comparison to conventional MVR surgery.

Methods: All isolated MVRs performed within one metropolitan hospital network, between June 2005 and June 2008, were retrospectively compared.

Echocardiographic measurement of mitral intertrigonal distance is an adjunct to annuloplasty ring sizing.

Background And Aim Of The Study: Annuloplasty sizing with standard valve sizers may be imprecise and difficult in minimally invasive procedures. It is hypothesized that a constant clinical conversion factor relates the echocardiographic aortic annulus diameter (AAD) and the intertrigonal distance (ITD) in patients with degenerative mitral regurgitation (MR). This may provide another method to size the annuloplasty ring required for mitral valve repair.

Epicardial high-intensity focused ultrasound cardiac ablation for surgical treatment of atrial fibrillation.

Background: The available alternatives to an effective but technically complex Cox maze procedure for surgical treatment of atrial fibrillation include ablation using radiofrequency, microwave, laser, cryotherapy or ultrasound energy sources. The purpose of this study was to evaluate the safety and efficacy profile of high-intensity focused ultrasound cardiac ablation for the surgical treatment of atrial fibrillation.

Methods: 14 patients underwent epicardial high-intensity focused ultrasound treatment for atrial fibrillation using the Epicor cardiac ablation system between August 2006 and August 2007.

Operative timing for absent pulmonary valve with obstructive sleep apnea.

Congenital absence of the pulmonary valve appears to have a prolonged fate, despite substantial regurgitation, thus the optimal timing of surgical correction remains unclear. A 53-year-old man with isolated pulmonary regurgitation accompanied by obstructive sleep apnea developed progressive heart failure after reopening of the foramen ovale. Closure of the interatrial shunt and pulmonary valve replacement with a 25-mm mechanical prosthesis relieved his refractory left heart failure.

Extra-aortic implantable counterpulsation pump in chronic heart failure.

Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality.

Managing deep sternal wound infections with vacuum-assisted closure.

Deep sternal wound infection is an uncommon but serious complication of cardiac surgery. Currently, there is no consensus on the optimal management. Vacuum-assisted closure (VAC) has been increasingly used to facilitate wound healing.

Parasternal intercostal block with ropivacaine for pain management after cardiac surgery: a double-blind, randomized, controlled trial.

Objective: The purpose of this study was to test the hypothesis that administration of a parasternal intercostal block using ropivacaine 0.75% improved analgesia in postoperative cardiac surgical patients.

Design: Randomized, controlled, double-blinded trial.

Pericardiectomy using the starfish heart positioner.

We describe the use of the Starfish 2 heart positioning device as an aid to performing pericardiectomy for constrictive pericarditis. Whilst mainly a tool for off-pump coronary artery surgery, the Starfish device allows excellent cardiac positioning and haemodynamic stability during pericadiectomy via median sternotomy, without the need for cardiopulmonary bypass.

Predictors of surgery after percutaneous mitral valvuloplasty.

Background: Percutaneous mitral valvuloplasty (PMV) is a minimally invasive treatment option for selected patients with mitral stenosis (MS). In general, the procedure is well-tolerated with a high success rate. However, relatively little is known about the predictors of surgical intervention after PMV.

Experience with unipolar radiofrequency ablation for atrial fibrillation.

Background: The cut and sew Cox maze procedure for atrial fibrillation (AF), although effective, is not widely used because of technical complexity, prolonged duration and significant risk of postoperative bleeding. This study reviews our experience with the unipolar radiofrequency ablation (RFA) procedure, which was used to create a modified maze to treat AF.

Methods: A retrospective review of 31 patients undergoing consecutive cardiac surgery who had concomitant RFA for AF over a 16-month period was carried out.

Urgent and emergency coronary artery bypass grafting for acute coronary syndromes.

Background: Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients.

Methods: A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out.