Management of Aortic Pseudoaneurysms: Evolving Concepts and Controversies.

Background:  Techniques to repair aortic pseudoaneurysms have been rapidly evolving. We present our results following open and endovascular repair of aortic pseudoaneurysms from 2009 to 2013.

Methods:  A total of nine patients underwent pseudoaneurysm repair from April 2009 to February 2013.

Alternative Access Transcatheter Aortic Valve Replacement in Nonagenarians versus Younger Patients.

Background:  Numerous studies have documented the safety of alternatives access (AA) transcatheter aortic valve replacement (TAVR) for patients who are not candidates for transfemoral or surgical approach. There is a scarcity of studies relating use of AA TAVR in nonagenarian patients, a high-risk, frail group. Our study sought to investigate the clinical outcomes of nonagenarians who underwent AA TAVR for aortic stenosis, with comparison of nonagenarians age ≥90 years with patients age <90 years.

Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis.

 Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery.

Predictors and outcomes of patient-prosthesis mismatch after transcatheter aortic valve replacement.

Background: Patient-prosthesis mismatch (PPM) has been shown to be associated with adverse outcomes after surgical aortic valve replacement. There is limited data on its risk and impact after transcatheter aortic valve replacement (TAVR), especially with the newer generation heart valves.

Objectives: The objective of this study is to investigate the incidence, predictors, and clinical outcomes of PPM after TAVR.

Predictors and outcomes of stroke after transcatheter aortic valve replacement.

Objectives: Stroke is a devastating complication of transcatheter aortic valve replacement (TAVR). Many studies have investigated risk factors for postoperative stroke, but reliable predictors are not yet well-established. The objective of this study was to further characterize the predictors and outcomes of stroke after TAVR.

Early Experience With Embolic Protection Devices During Transcatheter Aortic Valve Replacement.

Objectives: Embolic protection devices (EPDs) have been employed to combat the risk of cerebrovascular events during transcatheter aortic valve replacement (TAVR). The use of EPD has been shown in some studies to decrease periprocedural stroke incidence when compared with non-EPD TAVR. Our study aimed to compare the postoperative outcomes of TAVR with versus without EPD.

A Technique for 360-Degree Rigid Sternal Fixation with Sternal Plates and Wire Cerclage.

Sternal instability after cardiac surgery can lead to poor bony healing, as well as deep sternal wound infections and mediastinitis. Rigid plate fixation is associated with greater stability and fewer complications compared with wire cerclage, however, rigid plate fixation alone lacks posterior stability of the sternum and may be less effective in morbidly obese or osteoporotic patients. This article describes a surgical technique of combined rigid plate fixation and wire cerclage that provides 360-degree stabilization for sternotomies in high-risk patients.

Continuous Suture Technique for Aortic Valve Replacement: Technical Considerations and Controversies.

Continuous suture technique (CST) for aortic valve replacement (AVR) is a simple, secure, and fast surgical technique that has been shown to significantly decrease cross clamp time and cardiac bypass time, ultimately resulting in decreased myocardial ischemic injury, operation time, and hospital stay. However, previous studies have reported increased risk of periprosthetic regurgitation with CST for AVR. We describe our technique for AVR using CST in 100 patients with low complication rate and no perioperative paravalvular aortic insufficiency.

Transcatheter aortic valve in valve implantation with bioprosthetic valve fracture.

Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) has emerged as a preferable option for high surgical risk patients requiring redo aortic valve replacement. However, VIV TAVR may restrict flow, especially in small native aortic valves. To remedy this, bioprosthetic valve fracture has been utilized to increase the effective orifice area and improve hemodynamics.

Modified whole blood microplegia in high-risk patients.

Background: Numerous studies have documented the safety of whole blood cardioplegia on clinical outcomes after cardiac surgery. However, there is a paucity of studies investigating the outcomes of whole blood microplegia after cardiac surgery. Our protocol of whole blood microplegia includes removal of the crystalloid portion and utilizing the Quest Myocardial Protection System, for delivery of del Nido cardioplegia additives in whole blood.