Balloon-Expandable Valve Geometry After Transcatheter Aortic Valve Replacement in Low-Risk Patients With Bicuspid Versus Tricuspid Aortic Stenosis.

Background: Prospective bicuspid low-risk transcatheter aortic valve replacement (TAVR) registries' data demonstrated encouraging short-term results. Detailed data on transcatheter heart valve (THV) geometry after deployment using contemporary devices are lacking. This study sought to examine valve geometry after TAVR in patients with bicuspid aortic stenosis (AS).

Randomized Trial of Aspirin Versus Warfarin After Transcatheter Aortic Valve Replacement in Low-Risk Patients.

Background: The optimal antithrombotic regimen after transcatheter aortic valve replacement remains unclear.

Methods: In this randomized open-label study, low-risk patients undergoing transfemoral transcatheter aortic valve replacement at 7 centers in the United States were randomized 1:1 to low-dose aspirin or warfarin plus low-dose aspirin for 30 days. Patients who could not be randomized were enrolled in a separate registry.

Implementing a protocol to optimize blood use in a cardiac surgery service: results of a pre-post analysis and the impact of high-volume blood users.

Background: Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests that a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality.

Study Design And Methods: A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit.

The effects of using a radial artery in patients already receiving bilateral internal mammary arteries during coronary bypass grafting: 30-day outcomes and 14-year survival in a propensity-matched cohort.

Objectives: Recent studies have demonstrated the superiority of bilateral internal mammary arteries (BIMAs) as conduit material for coronary artery bypass grafting (CABG) surgery. However, there is limited research on the effects of other graft conduits used in patients who require additional bypasses. The goal of this study was to evaluate the impact of the radial artery (RA) when used in conjunction with the BIMAs.

Effects of a protocol-based management of type A aortic dissections.

Background: Ascending aortic dissections (AADs) require prompt diagnosis and surgical treatment. We present the results of implementing a multidisciplinary aortic dissection protocol on the outcomes of AAD treatment at a nonteaching hospital.

Methods: From January 2002-December 2013, 54 patients with the diagnosis of AAD were treated at our institution.

Homograft subclavian interposition graft to left main coronary artery ostium in aortic root replacement.

Performing a reoperative root replacement in cases of prosthetic valve endocarditis (PVE) can often be challenging due to significant inflammation and scarring. During these cases, surgeons may decide to utilize an interpositional graft when mobilization of the coronary ostia becomes too hazardous. The authors describe their experience performing a reoperative root replacement on a patient with PVE.

Impact of pump status and conduit choice in coronary artery bypass: A 15-year follow-up study in 1412 propensity-matched patients.

Objective: Previous studies have demonstrated that bilateral internal mammary artery (BIMA) grafts lead to superior outcomes compared with single internal mammary artery grafts. This study examines whether cardiopulmonary bypass affects conduit-dependent outcomes of coronary artery bypass grafting (CABG) surgery.

Methods: From 1994 to 2013, a total of 6666 patients underwent isolated CABG surgery at our institution.

Perioperative predictors of midterm survival after aortic valve replacement.

Background: Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery.

Methods: From 2006 to 2010, 509 patients having aortic valve replacement or aortic valve replacement with coronary artery bypass were grouped according to age (<80 years and ≥80 years) and procedure (aortic valve replacement ± coronary artery bypass).

Comparative genome-wide transcriptional analysis of human left and right internal mammary arteries.

In coronary artery bypass grafting (CABG), the combined use of left and right internal mammary arteries (LIMA and RIMA) - collectively known as bilateral IMAs (BIMAs) provides a survival advantage over the use of LIMA alone. However, gene expression in RIMA has never been compared to that in LIMA. Here we report a genome-wide transcriptional analysis of BIMA to investigate the expression profiles of these conduits in patients undergoing CABG.

Epicardial surgical ligation of the left atrial appendage is safe, reproducible, and effective by transesophageal echocardiographic follow-up.

Objective: The left atrial appendage (LAA) is the source of 90% of thrombi in patients with atrial fibrillation. Our double LAA ligation (LLAA) technique was shown to be 96% successful in a small study. However, the outcomes of these patients have yet to be compared with a set of nonligated patients.

Blood transfusion in cardiac surgery does increase the risk of 5-year mortality: results from a contemporary series of 1714 propensity-matched patients.

Background: Studies have found that cardiac surgery patients receiving blood transfusions are at risk for increased mortality during the first year after surgery, but risk appears to decrease after the first year. This study compared 5-year mortality in a propensity-matched cohort of cardiac surgery patients.

Study Design And Methods: Between July 1, 2004, and June 30, 2011, 3516 patients had cardiac surgery with 1920 (54.

Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation.

Background: Jehovah's Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions.

Methods: A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011.

Impact of New York Heart Association classification, advanced age and patient-prosthesis mismatch on outcomes in aortic valve replacement surgery.

OBJECTIVES More elderly patients (>80 years of age) are being referred for aortic valve replacement (AVR) with or without CABG. Current risk stratification models may not accurately predict the preoperative risk in these patients. We sought to determine which perioperative variables were relevant in determining short-term (30-day to in-hospital) outcomes in our intuition's series of consecutive AVR and AVR+CABG surgeries.

Use of an objective tool to assess platelet inhibition prior to off-pump coronary surgery to reduce blood usage.

Background: The current standard of care is to delay coronary surgery 5-7 days after clopidogrel exposure to prevent bleeding complications. We sought to determine the utility of an objective tool (ie, the VerifyNow assay) to measure platelet inhibition (PI) in patients receiving preoperative clopidogrel prior to off-pump coronary artery bypass grafting surgery (OPCABG).

Patients And Methods: Between June 2007 and July 2009, a total of 482 isolated OPCABG procedures were performed at our institution.

Propensity matched analysis of bilateral internal mammary artery versus single left internal mammary artery grafting at 17-year follow-up: validation of a contemporary surgical experience.

Objectives: Bilateral internal mammary arteries (BIMA) remains widely underutilized in coronary artery bypass grafting (CABG). Although prior research has demonstrated a long-term benefit of the use of BIMA over left internal mammary artery (LIMA)-only, validation of these results is lacking in a contemporary surgical experience. We compared complications and survival at 17-year follow-up in a large series of consecutive CABG patients from a single institution that underwent BIMA grafting with a propensity-matched group where LIMA only was used.

Antiplatelet therapy, cardiac surgery, and the risk of bleeding: the surgeon's perspective.

Antiplatelet therapy is widely accepted in the contemporary management of patients with coronary syndromes. Effective platelet inhibition can cause an increased risk of bleeding, which is more evident when patients are referred to surgical coronary revascularization. The cardiac surgeon should be familiar with all new antiplatelet drugs.

Unexpected durability of a Björk-Shiley first-generation aortic valve after 40 years of implantation.

The case is reported of a patient who underwent aortic valve replacement (AVR) in 1969 and received a (first-generation) Björk-Shiley Delrin valve. Forty years later, the patient presented to the authors' hospital in congestive heart failure and with echocardiographic evidence of severe stenosis and mild aortic regurgitation. The patient underwent a redo sternotomy and AVR with a bioprosthesis.

Stroke-related mortality in coronary surgery is reduced by the off-pump approach.

Background: Stroke remains an important complication after coronary artery bypass graft surgery (CABG). We sought to determine the frequency and death-related incidence of stroke after on-pump and off-pump CABG.

Methods: We analyzed 4,869 consecutive isolated CABG performed in our institution.

Spontaneous rupture of a nonaneurismatic ascending thoracic aorta.

Spontaneous rupture of the ascending thoracic aorta without any history of aneurysm, trauma, infection, dissection, or previous surgery is a very rare and potentially lethal event. We report a case of spontaneous rupture of the ascending aorta treated successfully. While the etiology is still unclear, diagnosis with bedside transesophageal echocardiography prompted emergent surgical intervention.

Cardiogenic shock due to partial occlusion of the left coronary ostium in infective endocarditis: a case report.

The case is presented of chronic aortic valve endocarditis in a previously asymptomatic 54-year-old male. The main initial clinical manifestation was cardiogenic shock, but further examination revealed the presence of a large mobile mass attached to a bicuspid aortic valve, partially occluding the left coronary ostium. The patient underwent emergency surgery to excise the vegetative mass and preserve the aortic valve.

Acute mitral regurgitation requiring urgent surgery because of chordae ruptures after extreme physical exercise: case report.

Chordae rupture is the most common cause of severe acute mitral insufficiency. Many different mechanisms can cause an acute chordal rupture: degenerative mitral valve disease, infective endocarditis, myocardial infarction, or a posttraumatic event. We present 2 cases of acute mitral regurgitation requiring urgent surgery due to a posterior leaflet chorda rupture after extreme physical exercise.

Safe and complete exclusion of the left atrial appendage: a simple epicardial approach.

A standardized technique to permanently exclude the left atrial appendage during cardiac surgical procedures to potentially prevent stroke has never been established. We describe a simplified technique using a combination of endoloop occlusion with direct purse-string suturing supported with multiple teflon pledgets placed epicardially at the base of the appendage. The left atrial appendage is subsequently opened and decompressed to facilitate contraction and scarring, reducing or eliminating the possibility of recannalization.

Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue.

Objectives: To (1) determine frequency of occurrence and risk factors for intraoperative adverse events (IAE) during reoperative cardiac surgery, (2) characterize them with respect to structure injured, timing, and use of preventive strategies, and (3) identify the impact on outcome in terms of successful and unsuccessful rescue and cost.

Methods: Operative notes of 1847 patients undergoing reoperative cardiac surgery were reviewed to identify and characterize documented intraoperative adverse events. Logistic regression modeling was used to identify risk factors for intraoperative adverse events and outcomes.

Lung transplantation for idiopathic pulmonary fibrosis.

Background: Outcomes of lung transplantation for idiopathic pulmonary fibrosis (IPF) are thought to be worse than those for other indications, although the reasons are unknown. In addition, the choice of single versus double lung transplantation is unclear. To guide decision-making, we (1) compared survival of patients receiving transplantation for IPF with survival of patients receiving transplantation for non-IPF diagnoses, (2) identified risk factors for mortality after transplantation for IPF, and (3) ascertained whether double lung transplantation for IPF confers a survival advantage.

Surgical treatment of pseudoaneurysm of the thoracic aorta.

Objectives: To examine the clinical profiles, operative outcomes, and late results of patients with pseudoaneurysm of the thoracic aorta.

Methods: From 1990 to 2002, 60 patients underwent repair of aortic pseudoaneurysm: ascending aorta in 70%, ascending aorta and arch in 15%, descending aorta in 10%, and arch alone in 5%. Mean age was 53 +/- 15 years, and 70% were men.