The Use of Unilateral Erector Spinae Plane Block in Minimally Invasive Cardiac Surgery.

Objectives: To examine the efficacy of continuous unilateral erector spinae plane (ESP) blocks in minimally invasive cardiac surgery patients.

Design: A retrospective nonrandomized study.

Setting: At a single-center, tertiary academic institution.

Advanced experience allows robotic mitral valve repair in the presence of extensive mitral annular calcification.

Objective: Mitral annular calcification is underdiagnosed in patients with mitral regurgitation. After excision, it may require reconstruction of the atrioventricular groove and decreases the probability of valve repair. We reviewed the safety and efficacy of totally endoscopic robotic mitral valve repair in the presence of mitral annular calcification, with an emphasis on pathology and repair techniques.

Aggressive tissue aortic valve replacement in younger patients and the risk of re-replacement: Implications from microsimulation analysis.

Objective: Advances in transcatheter aortic valve replacement have led to the consideration of tissue aortic valve replacement in younger patients. Part of this enthusiasm is the presumption that younger patients would have more flexibility in future treatment options, such as a primary surgical aortic valve replacement followed later by transcatheter aortic valve replacement(s) (valve-in-valve), vice versa, or other permutations. We created a microsimulation model using published longevity of tissue valves to predict the outcomes of patients after primary tissue surgical aortic valve replacement.

Ninety-Day Readmissions of Bundled Valve Patients: Implications for Healthcare Policy.

Medicare's Bundle Payment for Care Improvement (BPCI) Model 2 groups reimbursement for valve surgery into 90-day episodes of care, which include operative costs, inpatient stay, physician fees, postacute care, and readmissions up to 90 days postprocedure. We analyzed our BPCI patients' 90-day outcomes to understand the late financial risks and implications of the bundle payment system for valve patients. All BPCI valve patients from October 2013 (start of risk-sharing phase) to December 2015 were included.

Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin.

There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy.

Permanent Pacemaker Implantation After Rapid Deployment Aortic Valve Replacement.

Background: Expandable, rapid deployment aortic valves may interfere with the cardiac conduction system, which can lead to permanent pacemaker implantation (PPI). We sought to characterize PPI after rapid deployment aortic valve replacement with the Edwards Intuity valve system (Edwards Lifesciences, Irvine, CA) and investigate associated factors.

Methods: We analyzed 708 patients from 29 centers in the Multicenter Experience With Rapid Deployment Edwards Intuity Valve System for Aortic Valve Replacement (TRANSFORM) trial undergoing rapid deployment aortic valve replacement with or without coronary artery bypass graft surgery without preexisting pacemakers.

Del Nido cardioplegia for minimally invasive aortic valve replacement.

Background: We analyzed the impact and safety of del Nido Cardioplegia (DNC) in patients undergoing minimally invasive aortic valve replacement (MIAVR).

Methods: We analyzed all isolated MIAVR replacements from 5/2013-6/2015 excluding re-operative patients. The approach was a hemi-median sternotomy in all patients.

A Contemporary Approach to Reoperative Aortic Valve Surgery: When is Less, More?

Objective: Although the benefits of minimally invasive valvular surgery are well established, the applicability of extending these techniques to reoperative aortic valve surgery is unknown. We evaluated our experience with a minimally invasive approach to this patient population.

Methods: From January 2010 to September 2015, 21 patients underwent reoperative isolated aortic valve replacement via a minimally invasive approach by a single surgeon.

Reengineering valve patients' postdischarge management for adapting to bundled payment models.

Background: Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare in an effort to reduce expenditures while preserving quality of care. Payment model 2 reimburses based on a target price for 90-day episode of care postprocedure. The challenge for valve patients is the historically high (>35%) 90-day readmission rate.

Caregiver status and outcomes after durable left ventricular assist device implantation.

Objectives: To determine the relationship between caregiver status and outcomes after durable left ventricular assist device (LVAD) implantation.

Background: The absence of a caregiver is a relative contraindication to durable LVAD support.

Methods: Forty-three patients that underwent primary LVAD implantation were divided into three groups: those with caregivers that retained their roles for the duration of LVAD support (CG group), those with caregivers that resigned their roles (CG-QUIT group), and those implanted without an assigned caregiver (No-CG group).

Robotic Transcatheter Mitral Valve Replacement Using the Sapien XT in the Setting of Severe Mitral Annular Calcification.

We describe the use of the Sapien XT, placed in the mitral position using a totally endoscopic robotic approach in a 76-year-old man with extensive circumferential mitral calcifications and severe stenosis. The patient was at high risk for traditional open surgery and a large mitral valve annulus prevented safe transcatheter deployment due to size mismatch. Our novel approach offered a minimally invasive technique for native mitral valve replacement in a high-risk patient with anatomical constraints prohibitive to conventional approaches.

Residency characteristics that matter most to plastic surgery applicants: a multi-institutional analysis and review of the literature.

Purpose: The National Residency Matching Program Match is a very unique process in which applicants and programs are coupled to each other based on a ranking system. Although several studies have assessed features plastic surgery programs look for in applicants, no study in the present plastic surgery literature identifies which residency characteristics are most important to plastic surgery applicants. Therefore, we sought to perform a multi-institutional assessment as to which factors plastic surgery residency applicants consider most important when applying for residency.

Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is commonly used as a means of support for acute cardiopulmonary failure. In the setting of severe left ventricular (LV) dysfunction, VA-ECMO may be complicated by LV distension, which can lead to pulmonary edema and compromise myocardial recovery. Traditional decompression methods carry significant risk.

Composite scaffold provides a cell delivery platform for cardiovascular repair.

Control over cell engraftment, survival, and function remains critical for heart repair. We have established a tissue engineering platform for the delivery of human mesenchymal progenitor cells (MPCs) by a fully biological composite scaffold. Specifically, we developed a method for complete decellularization of human myocardium that leaves intact most elements of the extracellular matrix, as well as the underlying mechanical properties.

Use of ventricular assist devices in patients with mitral valve prostheses.

Background: Use of ventricular assist devices (VADs) in patients with prosthetic valves may carry an increased risk of thromboembolism; however, clinical information is lacking. The aim of this study was to report our experience of the use of VADs in patients with prosthetic mitral valves.

Methods: A retrospective analysis of 747 VAD patients from January 1995 to May 2010 was performed.

Force generated by actomyosin contraction builds bridges between adhesive contacts.

Extracellular matrices in vivo are heterogeneous structures containing gaps that cells bridge with an actomyosin network. To understand the basis of bridging, we plated cells on surfaces patterned with fibronectin (FN)-coated stripes separated by non-adhesive regions. Bridges developed large tensions where concave cell edges were anchored to FN by adhesion sites.

Percutaneous cell delivery into the heart using hydrogels polymerizing in situ.

Heart disease is the leading cause of death in the US. Following an acute myocardial infarction, a fibrous, noncontractile scar develops, and results in congestive heart failure in more than 500,000 patients in the US each year. Muscle regeneration and the induction of new vascular growth to treat ischemic disorders of the heart can have significant therapeutic implications.