Left thoracotomy approach for implantation of the Abiomed left ventricular assist device.

We describe a left thoracotomy approach for implantation of the Abiomed AB5000 left ventricular assist device (LVAD). The technique is easily performed and spares the patient a sternotomy in anticipation of future transplantation or LVAD exchange.

Avoiding technical pitfalls in left ventricular assist device placement.

Left ventricular assist device (LVAD) placement is a serious surgical procedure. At our center, we accumulated a very large experience with the Novacor LVAD from the very first clinical trial, as well as from more recent experiences with the Jarvik 2000 and the HeartMate II. This article discusses technical issues that are common to all durable LVAD devices, with special emphasis on strategy and technical considerations aimed at avoiding surgical pitfalls.

Novel intracranial brain cooling catheter to mitigate brain injuries.

Background: The neuroprotective effects of cooling the spinal cord in a sheep model by a self-contained intrathecal catheter was reported recently by the authors. The present study was designed to determine if cooling catheters in the lateral ventricles of the brain can effectively cool the CSF and thereby reduce brain temperature while maintaining systemic normothermia.

Methods: The cooling catheter is a self-contained system that circulates a cold fluid and cools the CSF that circulates in the brain.

Management of type A aortic dissections: a meta-analysis of the literature.

The authors reviewed all published series of type A iatrogenic aortic dissections and performed meta-analyses to investigate the management and outcomes of this complication. The majority of type A iatrogenic aortic dissections occurred during cardiac surgery, but the incidence of iatrogenic aortic dissection was considerably higher during thoracic endovascular aortic repair. Intraoperative diagnosis of iatrogenic aortic dissection was made in 69% of patients, and surgical repair of the dissection was performed in 88%.

Biomarkers for diagnosis in thoracic aortic disease: PRO.

Identification of biomarkers for thoracic aortic aneurysm (TAA) disease is important because complications of TAAs are common. Preemptive operative repair of TAAs is effective in improving survival. However, elective surgical repair for asymptomatic aneurysms remains a clinical decision that must be based on the patient's operative risk and the risk that a given TAA will rupture.

Indications for the treatment of thoracic aortic aneurysms.

In an era of increasingly common and detailed imaging of the thorax, thoracic aortic aneurysms are being discovered in their precomplicated state with increasing frequency. At the same time, the list of potential treatments for thoracic aneurysms is beginning to expand. Deciding which treatment method to employ and which aneurysm to treat is often difficult.

Why are the intramyocardial portions of the coronary arteries spared from arteriosclerosis? Clinical implications.

Experienced cardiac surgeons are aware that the intramyocardial portions of the coronary arteries are rarely affected by arteriosclerosis. This is a striking and reliable finding in the operating room that is present even when the preceding and subsequent segments of the arteries are diseased. The present review describes the published evidence of embryological, anatomical and physiological differences between intramyocardial coronary arteries and their epicardial counterparts.

Thoracic Surgery Directors Association Award. What is the optimal management of late-presenting survivors of acute type A aortic dissection?

Background: Although type A aortic dissections represent a surgical emergency, some patients present late after the onset of symptoms. Optimal management of this cohort has not been defined.

Methods: Data on 195 patients with type A dissections followed up at a single institution between 1985 and 2005 were collected prospectively.

Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve.

Background: Patients with bicuspid aortic valve (BAV) are at risk for valvular disease and ascending aortic aneurysms and dissections. Although others have investigated the need for concomitant repair, the natural history of aortic disease has not been addressed.

Methods: A review of our institutional clinical database identified 514 patients (326 male, 188 female) with unrepaired ascending aortic aneurysms followed from 1985 to 2005.

Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms.

Background: Optimal operative decision making in thoracic aortic aneurysms requires accurate information on the risk of complications during expectant management. Cumulative and yearly risks of rupture, dissection, and death before operative repair increase with increasing aortic size, but previous work has not addressed the impact of relative aortic size on complication rates.

Methods: Our institutional database contains data on 805 patients followed up serially with thoracic aortic aneurysms.