Minimally Invasive Pectus Excavatum Correction and Endoscopic Port Access Mitral Valve Surgery.

This case study describes the successful short-term outcome of staged minimally invasive pectus excavatum correction and endoscopic mitral valve repair in a patient with severe mitral valve regurgitation and pectus excavatum.

Myocardial sodium-glucose cotransporter 2 expression and cardiac remodelling in patients with severe aortic stenosis: The BIO-AS study.

Aim: Cardiac remodelling plays a major role in the prognosis of patients with aortic stenosis (AS) and could impact the benefits of aortic valve replacement. Our study aimed to evaluate the expression of sodium-glucose cotransporter 2 (SGLT2) gene and protein in patients with severe AS stratified in high gradient (HG) and low flow-low gradient (LF-LG) AS and its association with cardiac functional impairments.

Methods And Results: Gene expression and protein levels of main biomarkers of cardiac fibrosis (galectin-3, sST2, serpin-4, procollagen type I amino-terminal peptide, procollagen type I carboxy-terminal propeptide, collagen, transforming growth factor [TGF]-β), inflammation (growth differentiation factor-15, interleukin-6, nuclear factor-κB [NF-κB]), oxidative stress (superoxide dismutase 1 [SOD1] and 2 [SOD2]), and cardiac metabolism (sodium-hydrogen exchanger, peroxisome proliferator-activated receptor [PPAR]-α, PPAR-γ, glucose transporter 1 [GLUT1] and 4 [GLUT4]) were evaluated in blood samples and heart biopsies of 45 patients with AS.

Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics.

Background: Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.

Objective: To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS).

Methods: Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre.

Aortic thoracic neuromodulation in heart failure with preserved ejection fraction.

The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device-based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance.

Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis.

Background: Development of left ventricle (LV) hypertrophy in aortic stenosis (AS) is accompanied by adaptive coronary flow regulation. We aimed to assess absolute coronary flow, microvascular resistance, coronary flow reverse (CFR) and microvascular resistance reserve (MRR) in patients with and without AS.

Methods: Absolute coronary flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and 29 controls, without AS, matched for age, gender, diabetes and functional severity of epicardial coronary lesions.

Importance of In-Hospital Prospective Registry and Infectious Endocarditis Heart Team to Monitor and Improve Quality of Care in Patients with Infectious Endocarditis.

Aim: To investigate the value of prospective in-hospital registry data and the impact of an infectious endocarditis heart team approach (IEHT) on improvement in quality of care and monitor outcomes in hospitalized patients with IE.

Methods: Between December 2014 and the end of 2019, 160 patients were hospitalized in one centre with the definite diagnosis of infectious endocarditis (IE) and entered in a prospective registry. From 2017, an IEHT was introduced.

Reasons for Conversion and Adverse Intraoperative Events in Robotically Enhanced Minimally Invasive Coronary Artery Revascularization.

Objective: The transition from sternotomy access to minimally invasive coronary artery bypass grafting is associated with steep learning curves. This study reports the reasons for sternotomy conversions from robotically enhanced minimally invasive direct coronary artery bypass grafting (RE-MIDCAB) and describes potential risk reduction strategies.

Methods: The perioperative data of 759 RE-MIDCAB patients (mean age 65.

Percutaneous Transfemoral TAVR With Direct Puncture and Successful Closure of Aortobifemoral Bypass Graft.

Two successful cases of percutaneous transfemoral transcatheter aortic valve replacement (TAVR) in patients with previous aortobifemoral bypass graft surgery are presented. Both cases demonstrate feasibility of this strategy after careful preprocedural planning and suggest transfemoral TAVR can also be considered for patients when alternative access and/or general anaesthesia is excluded.

Fractional flow reserve in patients with reduced ejection fraction.

Aims: Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes.

Methods And Results: From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50-70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion.

Six-Year Follow-Up of Fractional Flow Reserve-Guided Versus Angiography-Guided Coronary Artery Bypass Graft Surgery.

Background: Fractional flow reserve (FFR)-guided coronary artery bypass graft (CABG) surgery has been associated with lower number of graft anastomoses, lower rate of on-pump surgery, and higher graft patency rate as compared with angiography-guided CABG surgery. However, no clinical benefit has been reported to date.

Methods And Results: Consecutive patients (n=627) treated by CABG between 2006 and 2010 were retrospectively included.

Endoscopic port access surgery for isolated atrioventricular valve endocarditis.

Objectives: Our goal was to report the clinical and echocardiographic outcomes of endoscopic port access surgery for isolated active and convalescent atrioventricular valve endocarditis (AVVE).

Methods: Our current surgical team performed endoscopic port access surgery in 66 consecutive patients with isolated AVVE (mean age, 65.5 ± 12.

Reasons for conversion and adverse intraoperative events in Endoscopic Port Access™ atrioventricular valve surgery and minimally invasive aortic valve surgery.

Objectives: This study reports the factors that contribute to sternotomy conversions (SCs) and adverse intraoperative events in minimally invasive aortic valve surgery (MI-AVS) and minimally invasive Endoscopic Port Access™ atrioventricular valve surgery (MI-PAS).

Methods: In total, 3780 consecutive patients with either aortic valve disease or atrioventricular valve disease underwent minimally invasive valve surgery (MIVS) at our institution between 1 February 1997 and 31 March 2016. MI-AVS was performed in 908 patients (mean age 69.

Endoscopic Port Access Surgery for Late Orthotopic Cardiac Transplantation Atrioventricular Valve Disease.

Background: The study aim was to present details of the perioperative and long-term outcomes of redo-endoscopic port access surgery (REPAS) for late atrioventricular valve disease (AVVD) in orthotopic cardiac transplant (OCT) patients.

Methods: Between February 2004 and October 2015, REPAS was performed for late AVVD in seven consecutive OCT patients (mean age 57.9 ± 17.

Robotic-enhanced coronary surgery in octogenarians.

Objectives: Robotic-enhanced minimally invasive direct coronary artery bypass grafting surgery (RE-MIDCAB) is based on the use of a robotic console and instrumentation for the dissection of the left internal thoracic artery (LITA). The LITA to left anterior descending (LAD) artery anastomosis is subsequently constructed through a mini thoracotomy. The purpose of this study is to present our experience of RE-MIDCAB outcomes in elderly patients.

Endoscopic atrioventricular valve surgery in adults with difficult-to-access uncorrected congenital chest wall deformities.

Objectives: This study presents the first report on in-hospital and long-term outcomes of endoscopic port access atrioventricular valve surgery (EPAAVVS) in adult patients with uncorrected congenital chest wall deformities (CCWDs).

Methods: Our current surgical team performed EPAAVVS in 7 consecutive adult patients (mean age 51.3 ± 16.

Fractional Flow Reserve-Guided Revascularization in Patients With Aortic Stenosis.

Fractional flow reserve (FFR) has never been investigated in patients with aortic stenosis (AS). From 2002 to 2010, we identified 106 patients with AS and coronary artery disease with at least one intermediate lesion treated according to FFR guidance. We matched 212 contemporary control patients with AS in which revascularization was decided on angiography only.

Clinical Outcome of Patients with Aortic Stenosis and Coronary Artery Disease Not Treated According to Current Recommendations.

We evaluated the clinical outcome of patients with moderate/severe aortic stenosis and significant coronary disease not treated according to guidelines, recommending combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). From 2002 to 2010, we assessed death up to 5 years in 650 patients with moderate/severe aortic stenosis and at least one coronary lesion (>50 %): 23 % were treated conservatively (MT), 17 % with percutaneous coronary intervention (PCI), 11 % with AVR, and 49 % with combined CABG and AVR. At a median follow-up of 58 months, overall death decreased over the groups (MT, 68 % vs.

Minimally-Invasive Mitral Valve Repair for Isolated Anterior Leaflet Cleft in a 66 Year Old Woman.

Mitral valve regurgitation caused by an isolated cleft of the anterior leaflet of the mitral valve is a rare condition, usually corrected early in life. We report the case of a 66 year old patient with an isolated cleft, which was successfully corrected through a minimally-invasive approach, demonstrating good visibility and direct closure of the cleft.

Late redo-port access surgery after port access surgery.

Objectives: This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS-PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease.

Methods: Our current surgical team performed redo-PAS-PAS in 26 consecutive patients who had previous port access surgery (mean age 65.8 ± 13.

Minimally invasive primary aortic valve surgery: the OLV Aalst experience.

Background: The purpose of this study was to evaluate our in-hospital outcomes with primary J-sternotomy aortic valve surgery since the initiation of our program in 1997.

Methods: Between October 1(st) 1997 and August 31(st) 2014, 768 patients (mean age: 69.1±11.

Unrecognized anomalous left circumflex coronary artery arising from right sinus of Valsalva: a source of perioperative complication.

: In this article we provide a very interesting and challenging PCI of unrecognized anomalous left circumflex coronary artery (LCx) arising from right sinus of Valsalva (RSV) after aortic valve replacement (AVR).This case presentation focuses the attention on important criteria for recognition of abnormal LCx coronary artery, that is the most frequent congenital coronary variant. Failure to demonstrate the anomaly can lead to erroneous interpretation of coronary anatomy with fatal complication in case of aortic valve replacement, as a consequence of accidental ligation or compression of the anomalous vessel.

Does a minimally invasive approach increase the incidence of patient-prosthesis mismatch in aortic valve replacement?

Background And Aim Of The Study: The impact of a minimally invasive approach on patient-prosthesis mismatch (PPM) in patients undergoing aortic valve replacement (AVR) remains unknown. The study aim was to identify the impact of a minimally invasive approach for AVR on the incidence of PPM.

Methods: The results of a single-center experience in 506 patients who underwent isolated AVR through a minimally invasive or conventional sternotomy were analyzed.

Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery.

Background: Fractional flow reserve (FFR) is well established for patients undergoing percutaneous coronary intervention, yet little is known about candidates for coronary artery bypass graft surgery.

Methods And Results: From 2006 to 2010, we retrospectively included in this registry 627 consecutive patients treated by coronary artery bypass graft surgery having at least 1 angiographically intermediate stenosis. In 429 patients, coronary artery bypass graft surgery was based solely on angiography (angiography-guided group).