Small aortic annulus: the hydrodynamic performances of 5 commercially available bileaflet mechanical valves.

Objective: Hemodynamic performances of mechanical valve prostheses in patients with aortic valve stenosis and a small aortic annulus are crucial. We analyzed the in vitro hydrodynamics of 5 currently available bileaflet mechanical prostheses that fitted a 21-mm-diameter valve holder of a Sheffield pulse duplicator.

Methods: Three samples of 5 high-performance production-quality prostheses, including the sewing ring cuffs, were tested in the aortic chamber of a Sheffield pulse duplicator.

First Italian robot-enhanced coronary bypass.

This case report presents the first totally endoscopic coronary artery bypass performed with a robotic system in Italy at the Department of Cardiovascular Surgery of Padua University in December 2001. A 66-year-old male, with an indication to a single bypass of the left anterior descending coronary artery using the left mammary artery, was considered eligible for a robot-assisted myocardial revascularization using the da Vinci robotic system. The left internal mammary artery takedown was performed through three 1 cm ports on the thoracic wall.

Hemodynamic and clinical outcomes with the Biocor valve in the aortic position: an 8-year experience.

Objectives: The aim of this study was to analyze the 8-year experience, survival, prosthetic complications, and hemodynamics of patients who received the Biocor valve, a new-generation tissue valve, in the aortic position.

Methods: From May 1992 through May 2001, 257 consecutive patients (129 women and 128 men; mean age, 75 +/- 6 years; age range, 45-91 years) received 258 aortic Biocor porcine prostheses. One female patient who received 2 Biocor valves in the aortic position during 2 consecutive operations was entered twice in the statistical analysis.

Double crisscross sternal wiring and chest wound infections: a prospective randomized study.

Objective: We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability.

Methods: Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T.

Hancock II bioprosthesis: a glance at the microscope in mid-long-term explants.

Background And Objectives: The Hancock II bioprosthesis is a second-generation porcine valve xenograft treated with the detergent sodium dodecyl sulphate (T6) to retard calcification. The aim of this investigation was to study the gross and microscopic features in Hancock II explants to assess the structural changes occurring with time.

Methods: Among 1382 Hancock II bioprostheses (701 isolated aortic, 421 isolated mitral, 130 double) implanted from 1983 to 1997 in 1252 patients, 22 (16 mitral, 6 aortic) were removed at reoperation until 1999 and were available for pathological investigation: infective endocarditis occurred in 5 and structural deterioration in 8, whereas in the remaining 9 xenografts reoperation was performed for nonstructural valve deterioration (paravalvular leak in 4 and prophylactic replacement in 5).

Long-term durability of the Hancock II porcine bioprosthesis.

Background: Survival and prosthetic complications of patients receiving the Hancock II second-generation bioprosthesis (Medtronic, Inc, Minneapolis, Minn) in the aortic, mitral, mitral-aortic, and tricuspid positions were analyzed at 15 years' follow-up.

Methods: Between May 1983 and December 1993, 212 patients (104 men and 108 women; mean age, 63 +/- 9 years; age range, 29-81 years) received 66 aortic, 114 mitral, 26 mitral-aortic, and 6 tricuspid Hancock II valves. Thirty-one percent of patients had previous valve operations, 15% had concomitant cardiac procedures, and 87% were in New York Heart Association class III or IV.

Leaflet escape in a new bileaflet mechanical valve: TRI technologies.

Background: Leaflet escape is a mode of structural valve failure for mechanical prostheses. This complication previously has been reported for both monoleaflet and bileaflet valve models. We report 2 leaflet escape occurrences observed in 2 patients who underwent valve replacement with a TRI Technologies valve prosthesis.

Radiofrequency ablation through a right atrium incision in congenital atrial septal defect.

Background: The incidence of atrial fibrillation is similar in the clinical history of patients with atrial septal defect, either surgically corrected and uncorrected. We present an unpublished technique for treating atrial fibrillation by left endocardial radiofrequency ablation through the lone right atrium incision, coupled to atrial septal defect septum primum and secundum closure, thus reducing the surgical trauma related to paraseptal left atrium incision.

Patients And Methods: We treated 2 patients through a lone right atrium incision by radiofrequency ablation because of congenital atrial septal defect and chronic atrial fibrillation.

Cell characterization of porcine aortic valve and decellularized leaflets repopulated with aortic valve interstitial cells: the VESALIO Project (Vitalitate Exornatum Succedaneum Aorticum Labore Ingenioso Obtenibitur).

Background: Heart valve bioprostheses for cardiac valve replacement are fabricated by xeno- or allograft tissues. Decellularization techniques and tissue engineering technologies applied to these tissues might contribute to the reduction in risk of calcification and immune response. Surprisingly, there are few data on the cell phenotypes obtained after cellularizing these naturally-derived biomaterials in comparison to those expressed in the intact valve.

Left main trunk ostial stenosis and aortic incompetence in Takayasu's arteritis.

A 41-year-old woman with recent onset of heart failure and angina due to aortic valve incompetence and critical left coronary ostium stenosis in the setting of Takayasu's arteritis is reported. The patient was successfully surgically treated by aortic valve replacement and coronary artery bypass with saphenous vein graft, showing a cardiac event-free 17 months follow-up. Takayasu's arteritis must be included among the possible causes of coronary artery disease and aortic valve incompetence in young female patients.

Mid-term follow-up in patients with Biocor porcine bioprostheses.

Background: Prosthetic cardiac valves have increased life expectancy of patients (pts) with valvular heart disease. Bioprosthetic complications required devices replacements within 10 years of implantation; structural valve deterioration (SVD) has emerged as the major cause of reoperation. We reviewed survival and prosthetic complications of Biocor porcine bioprostheses implanted in mitral, aortic and mitro-aortic position.

Case report: fibroelastoma of the papillary muscle of the mitral valve: diagnostic implications and review of the literature.

A 77-year-old woman was found accidentally to be in atrial fibrillation. Two-dimensional echocardiography revealed the presence of a mass attached to the anterior papillary muscle of the mitral valve. She was mildly symptomatic for dyspnea and asthenia.

Coronary artery bypass with glycerol-preserved saphenous vein allografts.

Over a 2-year period, 19 patients whose autologous saphenous veins were either unsuitable or unavailable underwent myocardial revascularization with saphenous vein allografts (SVAs) at our institution. All SVAs had been preserved in 98% glycerol at room temperature for at least 3 weeks (average, 7 weeks); before use, they were rinsed with saline and antibiotic solution. One operative death (5.