Minimally invasive type A aortic dissection repair: aortic valve resuspension with neomedia creation and the Ascyrus Medical Dissection Stent.

Type A aortic dissection is a life-threatening condition that requires immediate surgical intervention. The goal of traditional approaches is to treat the disease promptly, regardless of invasiveness, in order to achieve the quickest surgical outcome. This strategy has been shown to be associated with significant morbidity, extended recovery and postoperative complications.

Case report: Infective endocarditis after transcatheter aortic valve implantation surgically treated with sutureless prosthesis and ascending aorta replacement.

Infective endocarditis on transcatheter aortic valve implantation (TAVI) represents an increasingly frequent challenge for cardiac surgeons. Patients undergoing TAVI usually have high mortality risk scores and unsuitable anatomy for the traditional surgical approach. Therefore, surgical planning is crucial, albeit sometimes intraoperative findings can be unexpected and arduous.

Comparison of minimally invasive versus conventional thoracic aortic operations: Early and midterm results in a series of 624 patients.

Objective: Despite minimally invasive techniques having gained wider application in cardiac surgery, current evidence on minithoracic aortic surgery is still limited. The aim of this study was to compare early and midterm outcomes of patients undergoing operations of the proximal thoracic aorta through ministernotomy (MS) versus full sternotomy (FS).

Methods: Data from 624 consecutive patients who underwent proximal aortic repair through MS (n = 214, 34.

Successful early surgical treatment of a post-MINOCA ventricular septal defect.

Background: Acquired ventricular septal defect (VSD) is a life-threatening condition that occurred after a myocardial infarction (MI). The timing of the intervention remains very debated but it is crucial to choose the right surgical technique to obtain a stable and complete repair.

Methods: We report the case of an acquired VSD that occurred after a MI without obstructions of coronary arteries (MINOCA).

Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool.

Background: Pericardial pathology still has challenging diagnostic and treating issues. To reduce surgical trauma and pain for the patient, the authors developed a totally endoscopic echo-guided approach for both diagnostic and operative pericardioscopy.

Methods: Three steps moved from animal model (8 pigs) through concomitant open-chest interventions (7 patients) to closed-chest interventions for 10 patients with a diagnosis of severe pericardial effusion.

Aortic dissection: diagnosis, state-of-the-art of imaging and new management acquisitions.

A prompt diagnosis is the cornerstone of effective treatment of aortic dissection and it is the single most important determinant of survival in this patient population. New imaging modalities such as transesophageal echocardiography, magnetic resonance imaging, helical computed tomography and electron-beam computed tomography have been introduced during the last decade. These new imaging techniques allow for a better and earlier diagnosis of aortic diseases even in emergency situations.

Off-pump coronary surgery improves in-hospital and early outcomes in octogenarians.

Background: A retrospective study on octogenarians who underwent off-pump (OPCAB) or conventional (CCAB) coronary artery bypass surgery undertaken to evaluate the in-hospital and early outcomes in terms of survival and cardiac and neurological events.

Methods: The design of the study was single-institutional, retrospective and comparative. Between January 1997 and May 2003, 114 patients were included and 73 underwent OPCAB, while 41 underwent CCAB.

Improving hemostasis during replacement of the ascending aorta and aortic valve with a composite graft.

The use of a composite graft is an established treatment for patients with aortic valve disease and ascending aortic aneurysms. Since bleeding from suture lines is a potential complication of this procedure, we modified the technique and evaluated the effect on hemostasis. From January 1994 through December 1998, 35 patients underwent composite aortic graft replacement for chronic aortic disease.

Concomitant aortic valve replacement and surgical angioplasty of left main coronary ostium.

The association of calcific aortic valve disease and isolated coronary ostial stenosis is rare. A 80-year-old woman was found to have severe aortic stenosis with critical narrowing of the ostium of the left main coronary artery. She was successfully managed by simultaneous aortic valve replacement and patch angioplasty of the left main coronary artery, using a patch of autologous pericardium fixed in glutaraldehyde.

Mitral valve annuloplasty for degenerative disease: assessment of four different techniques.

Background And Aim Of The Study: Mitral valve repair (MVR) is the treatment of choice in patients with degenerative valve disease. However, controversy persists as to whether mitral valve annuloplasty should always be included as part of the reconstructive procedure.

Methods: The records of 62 consecutive patients undergoing MVR for degenerative disease between January 1994 and December 1996 were reviewed.

Performance of 21-mm size perimount aortic bioprosthesis in the elderly.

Background: Aortic valve replacement in elderly patients with a small aortic annulus may pose difficult problems in terms of prosthesis selection. We have evaluated the hemodynamic performance of the 21-mm Carpentier-Edwards Perimount bioprosthesis implanted in elderly patients.

Methods: From July 1996 to June 1998, 19 patients (17 women and 2 men, mean age 76+/-4 years and mean body surface area 1.

Prospective evaluation of frequency and nature of transcranial high-intensity Doppler signals in prosthetic valve recipients.

Background And Aim Of The Study: In asymptomatic prosthetic valve recipients, high-intensity transient signals (HITS) observed with transcranial Doppler (TCD) are a phenomenon of obscure clinical relevance which nature has not yet been elucidated convincingly.

Methods: Eighty-three patients without carotid disease, history of cerebrovascular accidents, and with negative preoperative TCD undergoing either valve replacement (mitral, n = 11; aortic, n = 56; mitral + aortic, n = 6; 40 mechanical prostheses, 29 biological prostheses, 10 homografts) or mitral repair (n = 10) were evaluated prospectively by means of TCD at discharge, three months and one year after surgery, to analyze the presence, incidence and characteristics of HITS. Furthermore, in 12 patients positive for HITS, TCD was repeated during a 30-min period of 100% O2 inhalation.

[High-intensity transcranial Doppler signals in patients wearing heart valve prostheses: a prospective study].

Background: Transcranial Doppler sonography (TCD) of the middle cerebral arteries in patients with prosthetic heart valves reveals high-intensity transient signals (HITS) and can detect asymptomatic cerebrovascular microemboli. Both the nature of the underlying embolic material (either gaseous or corpuscular) and its clinical significance remain uncertain.

Methods: Seventy-one patients undergoing heart valve replacement (n = 63) or repair (n = 8) from June 1996 to June 1998 were prospectively evaluated preoperatively and one week, 3 months and 12 months after valve replacement using TCD.

[Myocardial revascularization with arterial conduits: comparison of bilateral internal mammary artery and single internal mammary artery].

The use of bilateral internal mammary artery (BIMA) grafting for myocardial revascularization has been demonstrated to provide long-term benefits compared to revascularization using single left internal mammary artery (SIMA) and venous conduits. However, it is still controversial whether the use of BIMA is associated with a higher hospital mortality and morbidity. The present study retrospectively evaluated the possible advantages related to the use of BIMA at 3-year follow-up and whether the presence of operative risk factors in patients with BIMA could limit the application of the procedure in myocardial revascularization.

[Myocardial revascularization with both internal mammary arteries].

Background: The excellent results obtained with the use of the left internal mammary artery (IMA) for myocardial revascularization have led to the simultaneous use of other arterial conduits, particularly the right IMA.

Methods: The present study includes the first 100 consecutive patients with ischemic heart disease who underwent myocardial revascularization with in situ bilateral IMA grafted to branches of the left coronary artery, performed at our center. Ninety-six (96%) were males and four (4%) were females, with a mean age of 58 +/- 8 years (range, 35-75 years).