Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease.

Objectives: The study objective was to correlate the degree of tricuspid regurgitation with clinical indicators of right-sided heart failure and both qualitative and quantitative measures of right-sided heart morphology and function in patients with degenerative mitral valve disease.

Methods: From 2001 to 2007, 1833 patients with degenerative mitral valve disease, structurally normal tricuspid valve, and no coronary artery disease underwent surgery. Right-sided heart morphology (right ventricular base-to-apex length, tethering distance and area, and right atrial systolic area) and right ventricular function (tricuspid annular plane systolic excursion, myocardial performance index, and tricuspid valve annular shortening) were measured on preoperative transthoracic echocardiograms for 100 randomly selected patients from each of tricuspid regurgitation grades 0, 1+, and 2+, and for all 93 patients with tricuspid regurgitation grade 3+/4+.

Growing single-center experience with lung transplantation using donation after cardiac death.

Background: Early experience with lung transplantation (LTx) using organs from donors after cardiac death (DCD) has been promising, although widespread adoption has been slow because of the perception of diminished organ quality. Some centers have even suggested that use of DCD lungs is high risk and have recommended ex vivo evaluation before transplantation. We analyzed our growing single-center experience with DCD lungs procured and transplanted using protocols established for brain-dead donors.

Donor lungs with pulmonary embolism evaluated with ex vivo lung perfusion.

Acute pulmonary embolism (PE) compromises oxygenation and is typically considered a contraindication to lung donation for transplantation. We report the use of ex vivo lung perfusion (EVLP) to evaluate and possibly improve a pair of donor lungs with PE and poor oxygen exchange to a condition that might have been suitable for subsequent transplantation. A pair of donor lungs was procured for research after being declined for clinical use and placed on the EVLP circuit for 7 hours.

Effect of changes in postoperative spirometry on survival after lung transplantation.

Objective: The decline in normalized forced 1-second expiratory volume after lung transplantation is inevitable; however, the effect of this change on survival is unknown. Additionally, the benefit of double versus single lung transplant is debated, particularly because pulmonary function is only slightly better after double lung transplant. Our goal was to determine the effect of the temporal pattern of post-transplant forced 1-second expiratory volume (percentage of predicted) on the risk of death after transplant and the differences in the sensitivity of single and double lung transplant to this relationship.

Successful surgical repair of iatrogenic pulmonary vein stenosis.

Pulmonary vein stenosis can complicate ablation procedures for atrial fibrillation and often presents with severe respiratory symptoms. Described in this case report is a 21-year-old male who underwent a bilateral surgical augmentation of the pulmonary veins for severe occlusive pulmonary vein stenosis. The occluded left lower and right upper lobe veins were surgically modified to regain flow to the left atrium.

Pediatric donor lungs for adult transplant recipients: feasibility and outcomes.

Background: There is a limited experience using pediatric organs for adult lung transplantation (LTx), with size matching the major concern. We reviewed our experience transplanting pediatric donor lungs into adult recipients with endpoints of post-LTx complications and overall patient survival.

Methods: From 2/1990 to 12/2007, 609 adults underwent primary LTx at our institution.

Outcomes after surgical treatment of native and prosthetic valve infective endocarditis.

Background: The risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes.

Spontaneous coronary artery dissection in Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders with type IV, the vascular subtype, behaving as the most severe largely due to spontaneous arterial aneurysm and dissection. In this case report we describe a spontaneous left anterior descending coronary artery dissection treated with coronary artery bypass graft in a patient with Ehlers-Danlos syndrome type IV.

Reoperations after the ross procedure in adults: towards autograft-sparing/Ross reversal.

Background And Aim Of The Study: The risk of reoperation and loss of a second native valve is a major drawback of the Ross operation. The study aim was to examine the indications, pathologies, procedures, and outcomes for reoperation after the Ross procedure, emphasizing the potential for autograft salvage.

Methods: Between 1994 and 2009, a total of 60 reoperations was performed on 55 patients who previously had undergone the Ross procedure.

Pretransplant gastroesophageal reflux compromises early outcomes after lung transplantation.

Objectives: Gastroesophageal reflux disease (GERD) is implicated as a risk factor for bronchiolitis obliterans syndrome after lung transplantation, but its effects on acute rejection, early allograft function, and survival are unclear. Therefore, we sought to systematically understand the time-related impact of pretransplant GERD on graft function (spirometry), mortality, and acute rejection early after lung transplantation.

Methods: From January 2005 to July 2008, 215 patients underwent lung transplantation; 114 had preoperative pH testing, and 32 (28%) had objective evidence of GERD.

Predictors of acute rejection after lung transplantation.

Background: Acute rejection (AR) after lung transplantation (LTx) impacts survival and quality of life. The objective of this study, therefore, was to identify risk factors for AR after LTx, focusing on donor- and recipient-specific factors, operative variables, and immunologic issues, including pretransplant panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen (HLA) mismatch.

Methods: From March 1996 to November 2007, 481 adults undergoing LTx had 3237 serial transbronchial biopsy specimens that were evaluated for perivascular rejection (grade A0 to A4).

Surgery for anomalous aortic origin of the coronary artery.

Background: Anomalous aortic origin of the coronary artery (AAOCA) has been associated with coronary ischemia, myocardial infarction, and sudden death. Advances in echocardiography and computed tomography have identified at-risk patients. Treatment options include unroofing strategies in symptomatic and asymptomatic patients.

Long-term outcome and impact of surgery on adults with coronary arteries originating from the opposite coronary cusp.

Background: An anomalous coronary artery from the opposite sinus of Valsalva may increase sudden death risk in children and young adults, and surgical intervention is often recommended. The impact of this lesion when recognized in the adult and its management are ill defined.

Methods And Results: We reviewed 210 700 cardiac catheterizations performed over a 35-year period at a single institution and identified 301 adults with an anomalous coronary artery from the opposite sinus of Valsalva, either anomalous right coronary artery from the left cusp or anomalous left main coronary artery from the right cusp.

Deep hypothermia with circulatory arrest to aid in the management of suprahepatic vena cava stenosis after liver transplantation.

Liver transplantation is the treatment of choice for many liver diseases in the pediatric population. Complications involving late suprahepatic vena cava obstructions after liver transplantation are not common, but they tend to be more frequently seen in pediatric recipients. When such complications have occurred, approaches involving direct abdominal surgery or interventional radiology guidance have been used with satisfactory results.

Bronchial artery revascularization in lung transplantation: techniques, experience, and outcomes.

Purpose Of Review: Lung transplantation (LTX) is routinely performed ignoring the bronchial arteries. In this article, we review the published world experience, including our own, of LTX with direct bronchial artery revascularization (BAR) and describe the anatomy of the bronchial arteries and our surgical technique.

Recent Findings: The published experience of LTX with BAR consists of only a few small single-institution series, all with good success rates and outcomes.

Lessons learned from balloon aortic valvuloplasty experience from the pre-transcatheter aortic valve implantation era.

Background: Balloon aortic valvuloplasty (BAV) has been used as a bridge to surgical aortic valve replacement (SAVR) in high-risk patients with severe symptomatic aortic stenosis (AS). Such patients are now being referred for transcatheter aortic valve implantation (TAVI). We sought to study the indications and outcomes of BAV in patients with severe AS in the pre-TAVI era.

Guidelines for donor lung selection: time for revision?

Background: Few data support current guidelines for donor selection in lung transplantation. We determined degree of compliance with current donor guidelines, effect of these and variances on survival, and other donor factors predicting survival.

Methods: From July 1999 to June 2008, 10,333 primary transplants were performed in the US, with United Network for Organ Sharing data available for age, ABO type, chest radiograph, arterial difference in partial pressure of oxygen (PaO(2)) greater than 300 on 100% fraction of inspired oxygen, smoking, absence of aspiration/sepsis, and purulent secretions.

Repair of bicuspid aortic valve with severe regurgitation.

To improve the success rate and reproducibility of bicuspid aortic valves, we apply a systematic segmental approach to their repair. A segmental analysis of the morphology is followed by corresponding pathology specific corrections of each morphological abnormality contributing to regurgitation.

Should lung transplantation be performed for patients on mechanical respiratory support? The US experience.

Objective: The study objectives were to (1) compare survival after lung transplantation in patients requiring pretransplant mechanical ventilation or extracorporeal membrane oxygenation with that of patients not requiring mechanical support and (2) identify risk factors for mortality.

Methods: Data were obtained from the United Network for Organ Sharing for lung transplantation from October 1987 to January 2008. A total of 15,934 primary transplants were performed: 586 in patients on mechanical ventilation and 51 in patients on extracorporeal membrane oxygenation.