[Dilation of the ascending aorta: diagnosis, clinical presentation, and indication for surgery. The crucial role of the cardiologist].

The diagnosis of ascending aortic aneurysm, its precise assessment criteria and indications for surgery represent a chapter of great stimulus and interest for the clinical cardiologist. There are many factors influencing the classification of patients, but it is the contemporary evolution of knowledge in this field that contributes to a more global view of the aorta. The approach is increasingly multidisciplinary, both in clinical and genetic terms, and multimodal imaging is a crucial support for therapeutic decisions and monitoring.

Optimizing CO2 field flooding during sternotomy: In vitro confirmation of the Karolinska studies.

Although CO2 field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the "safe" quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO2 concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements.

Resection of thymic carcinoma after induction therapy and reconstruction of right ventricular outflow tract with pulmonary homograft.

Treatment of malignant epithelial thymic tumours, including thymoma and thymic carcinoma, is based on surgical resection, whenever possible. Mainstay of surgical treatment is complete resection with clear margins. This may require resection of adjacent structures, even major vessels.

Ten-Year Experience with Transapical and Direct Transaortic Transcatheter Aortic Valve Replacement to Address Patients with Aortic Stenosis and Peripheral Vascular Disease.

Objective: Transcatheter aortic valve replacement (TAVR) through alternative access routes is indicated in patients with severe aortic valve stenosis and diseased peripheral arteries. We analysed and compared the outcome of patients undergoing transapical (TA) and direct transaortic (TAO) TAVR procedures. Methods: Preoperative characteristics, procedural details, and thirty-day outcome of patients undergoing transapical (TA-TAVR group) and direct transaortic (TAO-TAVR group) TAVR procedures were prospectively collected and retrospectively analysed.

Cardiac surgery simulation - part 1: Step-by-step David procedure in a preclinical model.

We performed this operation on a preclinical model (porcine heart) that has been positioned and fixed inside a plastic mannequin that simulates the human anatomy. This simulation allows surgical operations to be performed at almost the same depth and orientation at which they would be performed on a patient in an operating room. The preclinical model allows the exact simulation of most of the key movements and steps of major coronary and valve surgery.

Transcatheter mitral valve replacement in native mitral valve with severe mitral annular calcification: Skirting the Sapien 3 to reduce the risk of paravalvular leaks.

Background: Mitral annular calcification (MAC) may represent a significant challenge for heart surgeons with an extremely high perioperative risk during mitral valve (MV) surgery. The risk is further increased when patients fail to be eligible for any percutaneous treatment, particularly because circumferential calcifications involving the anterior leaflet suggest a critical obstruction of the left ventricular outflow tract (LVOT).

Objectives: The objective of this study was to evaluate residual mitral regurgitation (MR) after surgical mitral valve replacement using a Sapien 3 Ultra (Edwards Lifesciences, CA, USA) transcatheter aortic valve implantation (TAVI) prosthesis, reinforced with a pericardial skirt, in high-risk selected patients with severe MAC.

Patient tilt improves efficacy of CO field-flooding in minimally invasive cardiac surgery.

Objective: Space limitations during minimally invasive cardiac surgery impede consistent use of CO field-flooding. We compared different gas delivery methods, flow rates and the effect of patient inclination.

Methods: A gastight model of MICS surgery with internal organs and right thoracotomy wound was created from a mannequin and equipped with a CO concentration sensor in the left ventricle.

Percutaneous Venous Cannulation for Minimally Invasive Cardiac Surgery: The Safest and Effective Technique Described Step-by-Step.

The current cardiac surgical landscape, with the expansion of minimally invasive operations, ECMO, and some interventional therapies, requires a thorough knowledge of peripheral cannulation techniques. In particular, venous cannulation may appear trivial and complication-free, but this does not reflect the reality. A venous cannulation which is not perfectly performed can lead to serious life-threatening complications in several steps.

The use of balloon-expandable Sapien-3 valve in redo aortic valve replacement and the potential risk of left main stem occlusion.

Redo aortic valve surgery for the failure of a previously implanted valve is always challenging. In case of small-sized implanted valves, the use of a balloon-expanding Sapien-3 valve can enhance the final effective orifice area, avoid annulus enlargement complex techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19 mm St.

Gaseous Microemboli in the Cardiopulmonary Bypass Circuit: Presentation of a Systematic Data Collection Protocol Applied at Istituto Cardiocentro Ticino.

Air emboli are reported to enter the cardiovascular system during cardiac surgery despite air-bubble filters in the arterial line of the cardiopulmonary bypass (CPB). A potential association with stroke, covert cerebral insults and cognitive decline after cardiac surgery has been hypothesized. Although most of the previous studies failed to prove it, this hypothesis cannot be rejected because the situation in the operating room (OR) is multifactorial and complex.

Embedded Computational Heart Model for External Ventricular Assist Device Investigations.

Purpose: External cardiac assist devices are based on a promising and simple concept for treating heart failure, but they are surprisingly difficult to design. Thus, a structured approach combining experiments with computer-based optimization is essential. The latter provides the motivation for the work presented in this paper.

Efficacy of Intraoperative Vein Graft Storage Solutions in Preserving Endothelial Cell Integrity during Coronary Artery Bypass Surgery.

(1) Introduction: Intraoperative preservation solutions for saphenous vein grafts may influence the endothelial structure and increase the risk of graft failure after coronary surgery. The aim of the study was to compare the efficacy of three solutions in maintaining the endothelial cell integrity of venous segments. (2) Methods: We tested the efficacy of physiological saline solution (PSS), heparinized autologous blood (HAB) and DuraGraft in preserving the endothelium of vein segments by evaluating the degree of endothelial cell apoptosis.

Development of a Gastight Thoracotomy Model for Investigation of Carbon Dioxide Field-Flooding Efficacy.

Carbon dioxide (CO) field-flooding during cardiac surgery is a prevention technique to avoid blood-air contact and subsequent embolization. Although it was first used more than 60 years ago, there is still some perplexity around its efficacy, mainly because the gas is invisible and air embolization is difficult to quantify. An accurate assessment of field-flooding can, therefore, best be performed in models where various methods can be tried in a controlled environment and evaluated with industrial-grade sensors.