Ten-year follow-up of unreplaced Valsalva sinuses after aortic valve replacement in bicuspid aortic valve disease.

Background: Aortopathy is common in patients with bicuspid aortic valve (BAV).

Aim: To evaluate the fate of unreplaced Valsalva sinuses in patients with BAV, 10 years after aortic valve replacement (AVR) with or without replacement of the ascending aorta (RAA).

Methods: We retrospectively reviewed all surgical patients with BAV who were operated on between January 2005 and December 2007.

Multiple reoperations on the aortic valve: outcomes and implications for future potential valve-in-valve strategy.

Objectives: Surgical mortality and long-term outcomes are important considerations when determining strategies for multiple reoperations on the aortic valve (AV). With the rise of percutaneous valve-in-valve, we sought to evaluate the current outcomes of conventional surgery for AV reoperation, focusing first on the effect of the number of previous AV interventions with a subsequent analysis of the risk factors for adverse outcomes.

Methods: From January 2007 to December 2016, 316 consecutive patients underwent an open redo operation (replacement) on their AV at a single centre.

Technical Aspects of Open Repair for Degenerative Aneurysmal Evolution Despite Early Thoracic Endovascular Repair of Type B Aortic Dissection.

Background: Closure of the proximal tear by thoracic endovascular aortic repair (TEVAR) at the acute phase appears to be a safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoracoabdominal aneurysm despite early closure proximal tear by TEVAR.

New estimate of valvuloarterial impedance in aortic valve stenosis: A cardiac magnetic resonance study.

Purpose: Valvuloarterial impedance (Z ), estimating left ventricle (LV) afterload, has been proposed in transthoracic echocardiography (TTE) as a predictor of mortality in aortic valve stenosis (AVS). However, its calculation differs from arterial characteristic impedance (Z ). Our aim was to apply the concept of Z calculation to estimate Z from MR with carotid tonometry and to evaluate these indices through their associations with symptoms, LV diastolic function and aortic stiffness.

Three-Year Outcomes With the Multilayer Flow Modulator for Repair of Thoracoabdominal Aneurysms: A Follow-up Report From the STRATO Trial.

Purpose: To evaluate midterm outcomes of endovascular repair of types II and III thoracoabdominal aortic aneurysms (TAAA) using the Multilayer Flow Modulator (MFM) in patients unsuitable for open surgery or fenestrated stent-grafts.

Methods: In the prospective, multicenter, nonrandomized STRATO trial (EudraCT registration: 2009-013678-42; ClinicalTrials.gov identifier NCT01756911), 23 patients (mean age 75.

Conduction disorders after tricuspid annuloplasty with mitral valve surgery: Implications for earlier tricuspid intervention.

Objective: Tricuspid valve repair has been recently advocated in patients undergoing mitral valve surgery who have mild to moderate secondary tricuspid regurgitation. However, the incidence of heart conduction disorders after combined mitral valve and tricuspid valve interventions has not been evaluated. We sought to analyze the incidence of permanent pacemaker implantations and heart conduction disorders in patients undergoing mitral valve surgery with and without tricuspid valve annuloplasty.

Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain.

Background: Chronic mesenteric ischemia is a rare disease with nonspecific clinical symptoms, such as chronic postprandial abdominal pain and weight loss. Diagnostic modalities and revascularization techniques have evolved during the past 20 years. The significance of stenosis in a single splanchnic vessel remains unclear.

Determinants of Transcutaneous Ear Lobe CO2 Tension (PtCO2) at 37°C During On-Pump Cardiac Surgery.

Objective: There are no available criteria for determining the optimal flow rate and mean arterial pressure level in patients undergoing cardiopulmonary bypass (CPB). Transcutaneous carbon dioxide tension (PtCO2) has been proposed for microcirculation monitoring and it could be useful for guiding hemodynamic optimization under CPB. The goal of this exploratory study was to determine the factors that influence PtCO2 variations during CPB.

Rupture of mitral valve chordae in hypertrophic cardiomyopathy.

Background: While occasional reports of mitral valve chordal rupture have been described in hypertrophic cardiomyopathy, the exact prevalence and characteristics of this event in a large medical cohort have not been reported.

Aim: To assess the prevalence of mitral valve chordal rupture in hypertrophic cardiomyopathy and the clinical, echocardiographic, surgical and histological profiles of those patients.

Methods: We searched for patients with mitral valve chordal rupture diagnosed by echocardiography among all electronic files of patients admitted to our centre for hypertrophic cardiomyopathy between 2000 and 2010.

Atrial fibrillation at mid-term after bioprosthetic aortic valve replacement – implications for anti-thrombotic therapy.

Background: Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy.

Methods And Results: During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days).

Economic Impacts of Treatment for Type II or III Thoracoabdominal Aortic Aneurysm in the United States.

Background: Current treatment for extensive thoracoabdominal aortic aneurysms (TAAAs) involves high-risk surgical and endovascular repairs, with a hospital mortality exceeding 20%, and a postoperative paraplegia rate beyond 10.5%.

Objectives: The aim of this study was to present an estimation of the economic impacts of surgical and endovascular treatments of types II and III TAAAs in the US as well as the economic consequences of the elimination of spinal cord injury and mortality via an endovascular repair of extensive TAAAs (1).

Chimney stent graft for endovascular sealing of a pararenal aortic aneurysm.

Chimney endovascular aneurysm repair is still a controversial treatment of complex aortic aneurysms. Stent-graft patency and type-I endoleaks are the main challenges that temper this bailout technique. Endovascular aneurysm sealing (EVAS) consists of anchoring and sealing the device within the aneurysm sac.

One-year outcomes following repair of thoracoabdominal aneurysms with the multilayer flow modulator: report from the STRATO trial.

Purpose: To evaluate endovascular repair of type II and III thoracoabdominal aortic aneurysms (TAAA) using the Multilayer Flow Modulator (MFM) in patients with contraindications for open surgery and fenestrated stent-grafts.

Methods: In this prospective, multicenter, nonrandomized trial (EudraCT registration: 2009-013678-42; ClinicalTrials.gov identifier NCT01756911), 23 patients (19 men; mean age 75.

Experience of the Zenith Dissection Endovascular System in the emergency setting of malperfusion in acute type B dissections.

Objective: This study evaluated the safety and effectiveness of the Zenith Dissection Endovascular System (Cook Medical, Bloomington, Ind) in the urgent treatment of acute type B aortic dissections complicated by organ malperfusion.

Methods: Between June 2011 and June 2013, we prospectively enrolled all patients with acute type B dissection (<14 days) complicated by visceral malperfusion and treated by the Zenith Dissection Endovascular System, including a proximal covered stent and a distal noncovered stent. Organ malperfusion was diagnosed during the clinical, biological, and morphologic follow-up of patients admitted to a dedicated intensive care unit (SOS Aorta).

Reinterventions for type 2 endoleaks with enlargement of the aneurismal sac after endovascular treatment of abdominal aortic aneurysms.

Background: Type 2 endoleaks after the endovascular treatment (EVAR) of abdominal aorta aneurysms (AAAs) remain a concern for vascular surgeons, especially when they are associated with an enlargement of the persistent aneurysmal sac. The purpose of this study is to evaluate the effectiveness of secondary reinterventions for type 2 endoleaks associated with enlargement of the aneurysmal sac after EVAR.

Methods: The incidence of endoleaks, aneurysmal sac diameters, and reinterventions were collected from the clinical and radiologic data of the patients treated by EVAR for AAA with >1 year of follow-up.

Incidence, risk factors and prediction of post-operative acute kidney injury following cardiac surgery for active infective endocarditis: an observational study.

Introduction: Cardiac surgery is frequently needed in patients with infective endocarditis (IE). Acute kidney injury (AKI) often complicates IE and is associated with poor outcomes. The purpose of the study was to determine the risk factors for post-operative AKI in patients operated on for IE.

Elective treatment of abdominal aortic aneurysm is reasonable in patients >85 years of age.

Background: The numbers of patients >85 years of age referred for abdominal aortic aneurysm (AAA) repair have increased in recent decades. With the population aging, increased screening of AAA, and introduction of less invasive surgical techniques, vascular surgeons will be treating more elderly patients. Few data are available for estimating the risks and benefits of prophylactic repair among those with such an advanced age.

Applicability and mid-term results of endovascular treatment for descending thoracic acute aortic syndromes.

Background: Descending thoracic acute aortic syndromes (DTAASs) are life-threatening pathologies in which thoracic endovascular aortic repair (TEVAR) is an attractive therapeutic option. There are few data in the literature on the survival and morbidity rates of TEVAR in such indications. We provide the results of TEVAR from our single-center cohort of DTAASs: ruptured aneurysms (RAs), acute symptomatic dissections (ADs), and traumatic ruptures (TRs).

Pathologic classification of antibody-mediated rejection correlates with donor-specific antibodies and endothelial cell activation.

Background: Humoral immune responses during heart transplantation may result in antibody-mediated rejection (AMR), which is now taken into account on endomyocardial biopsy (EMB) specimens and ranked according to the pathologic AMR (pAMR) grades of the International Society for Heart and Lung Transplantation classification. This classification might benefit from new immunohistological markers and validation by others biomarkers, namely donor-specific antibodies (DSA).

Methods: From the 293 protocol EMBs performed in 113 patients in our institution during a 1-year period for this prospective study, 280 EMB specimens were available with both histology and immunohistochemistry.

Deep hypothermia and low flow for surgery for abdominal or extraperitoneal tumors with cavoatrial extension.

Background: Surgical treatment of retroperitoneal tumors with cavoatrial involvement can be challenging. Completeness of resection of the cava tumor extension is crucial for the patient's survival. We report a monocentric experience with the use of cardiopulmonary bypass and deep hypothermic low flow for the surgical resection of caval and atrial involvement of retroperitoneal tumors.

Spot stenting of the tear in type B aortic dissection.

Background: In selected type B acute aortic dissection with aortic growth and patent false lumen, an intervention may be required to prevent aortic rupture. Apart from stent grafting of the thoracic aorta, aimed at occluding the primary intimal tear, some have advocated closure of reentry tears by stent grafting of the aortic true lumen after hybrid revascularization of the excluded viscera or by branched aortic endografts.

Methods: We describe a simple technique for occluding a major reentry tear in the visceral abdominal aorta, using on-the-shelf covered stent grafts, arising from the aortic true lumen, crossing the dissection septum tear and aortic false lumen, and being distally anchored in the visceral branch vessel, acting as a rivet on the dissection septum tear, achieving aortic false lumen thrombosis.

Elliptical shape of a SAPIEN XT prosthesis deployed in a patient with bicuspid aortic valve stenosis.

Transcatheter aortic valve implantation (TAVI) has been shown as an effective procedure in patients considered at high risk for surgery. Aortic valve bicuspidy, as encountered in up of 50% of patients with severe aortic stenosis, has been considered a contraindication to TAVI. One reason for this is that stent deformation is likely to occur after prosthesis deployment, but this has been refuted by recent observations with the SAPIEN prosthesis.

Mechanisms of the vasorelaxing effects of CORM-3, a water-soluble carbon monoxide-releasing molecule: interactions with eNOS.

The purpose of the present work was to elucidate the mechanisms underlying the endothelium-dependent and endothelium-independent components of the vascular relaxation induced by a water-soluble and ruthenium-based carbon monoxide (CO)-releasing agent, tricarbonylchloro(glycinato)ruthenium(II) (CORM-3). Changes in isometric tension and cyclic guanosine monophosphate (cGMP) production were measured in isolated aortic rings from normotensive Wistar-Kyoto rats. Nitric oxide (NO) generation was assessed in cultured human umbilical vein endothelial cells (HUVEC) by electron spin resonance.