Prophylactic Left Atrial Appendage Exclusion in Cardiac Surgery Patients With Elevated CHADS-VASc Score: Results of the Randomized ATLAS Trial.

Objective: Patients with elevated CHADS-VASc scores are at high risk for atrial fibrillation (AF) and thromboembolic events (TE) after cardiac surgery. Left atrial appendage exclusion (LAAE) is a permanent, continuous approach to stroke prevention in AF, overcoming limitations of oral anticoagulation (OAC). We report ATLAS trial results focused on LAAE technical success and perioperative safety and TE rates with and without LAAE in cardiac surgery patients who developed postoperative AF (POAF).

First Dedicated Minimally Invasive Right Atrial Retractor.

Introduction: The importance of correcting tricuspid valve insufficiency in patients with left-sided valve disease is clear. In the United States, up to 30% of mitral valve operations are minimally invasive, while the data for isolated tricuspid valve is not known. A minimally invasive approach to the tricuspid valve provides faster recovery with lower transfusion rates and lower length of stay.

Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair.

Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020.

Contractile Differences Detected by Speckle Tracking Echocardiography in Pediatric Patients with Mitral Valve Prolapse.

Mitral valve prolapse (MVP) is the most common valvar dysfunction in children. There is emerging evidence that MVP is not always a benign entity, hence identification of underlying mechanisms is pertinent to clinical management. Our group previously identified a ventricular contraction abnormality named end-systolic basal eversion (ESBE) in adults that contributed to MVP.

Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine.

Objective: Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations.

Methods: Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( = 12).

Imaging in Minimally Invasive Mitral Valve Repair.

Minimally invasive mitral valve (MV) repair and replacement techniques have evolved as increasingly used alternatives to open heart surgery especially in patients unsuitable for surgery or at high perioperative risk. The vast majority of these techniques are still under development, and only a limited number of devices are approved for clinical use; however, they do show promising results in terms of minimizing complications and improving clinical outcome. The complex anatomy of the MV and the annulus complicates not only the development of devices for minimally invasive MV repair or replacement but also complicates preprocedural planning, which is mandatory for minimization of postprocedural complications.

Outcomes of repeat mitral valve surgery in patients with pulmonary hypertension.

Objective: We sought to study the outcomes of redo-mitral valve surgery in patients with pulmonary hypertension.

Methods: We reviewed data on redo mitral valve surgery in patients with pulmonary hypertension measured by Swan-Ganz catheter (mean pulmonary artery pressure ≥ 25 mm Hg or systolic pulmonary artery pressure ≥ 40 mm Hg).

Results: Between 1996 and 2010, 637 patients underwent 658 redo mitral valve operations; 138 of them had pulmonary hypertension.

Left main disease progression following left branch vessel percutaneous intervention in patients who are referred for coronary artery bypass grafting.

Background And Aim Of The Study: We studied patients presenting for coronary artery bypass grafting (CABG) with significant left main coronary artery disease (LMD) despite previously documented minimal or no LMD at percutaneous coronary intervention (PCI) for left-sided branch coronary artery disease.

Methods: Patients undergoing CABG for LMD with previous PCI were separated into fast or slow stenosis progression using percent change in LMD from first PCI to CABG divided by time (progression velocity). Outcomes and Kaplan-Meier survival were compared between the two groups.

Aortic Root Replacement for Pseudoaneurysm Arising from Freestyle Aortic Bioprosthesis.

A 70-year-old female presented with a new systolic murmur and shortness of breath three years after undergoing aortic root replacement using a 27-mm Medtronic Freestyle® stentless full root bioprosthesis (Medtronic, Inc., Fridley, Minnesota, USA). A large complex aortic root pseudoaneurysm was identified on contrasted computed tomography of the chest and transesophageal echocardiogram.

Advances in transcatheter valve therapies.

The surgical treatment for valvular heart disease is well established with excellent long-term outcomes in appropriately selected patients. For patients at elevated risk for surgical intervention, options have traditionally been limited to medical therapy with disappointing results. The advent of transcatheter techniques of valvular repair or replacement has revolutionized treatment options for these patients at significantly elevated risk for surgery.

Thirty-five day Impella 5.0 support via right axillary side graft cannulation for acute cardiogenic shock.

We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction.