Superior transseptal versus left atriotomy approaches in isolated mitral valve surgery.

Objective: The superior transseptal approach to mitral valve surgery offers improved exposure compared with left atriotomy; however, concerns remain regarding postoperative arrhythmias and pacemaker placement. This study investigates intraoperative parameters and postoperative outcomes in these approaches.

Methods: Retrospective review of 259 adults undergoing isolated mitral valve repair or replacement over a 10-year period was performed.

Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study.

Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients who underwent reoperation for a failed surgical aortic bioprosthesis. Long-term data on patients who underwent TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk who underwent TAV-in-SAV.

Stentless Freestyle Root Replacement: Distillation of Technique From a 30-Year Experience.

In 1968, Bentall introduced a composite valve-graft that became the "gold standard" for aortic root replacement. Since then, several alternatives have arisen; one is the Freestyle (Medtronic) stentless aortic root bioprosthesis. This porcine aortic valve has excellent results, and we describe the surgical technique we have developed during our 30-year experience.

Aortopulmonary Fistulous Communication Between Stentless Root Xenograft and Homograft.

Aortopulmonary fistulas are a rare complication of aortic root replacements associated with aortic aneurysms. We describe a patient with a sinus of Valsalva pseudoaneurysm associated with a Freestyle root replacement that fistulized to a distal pulmonary valve homograft after having 2 prior aortic and pulmonary valve surgeries. After a failed endovascular closure attempt, he underwent a third operation for repair.

Echocardiography and EuroSCORE II for the stratification of low-gradient severe aortic stenosis and preserved left ventricular ejection fraction.

The purpose of this study was to explore the utility of echocardiography and the EuroSCORE II in stratifying patients with low-gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF ≥ 50%) with or without aortic valve intervention (AVI). The study included 323 patients with LG SAS (aortic valve area ≤ 1.0 cm and mean pressure gradient < 40 mmHg).

Atrial appendage angiotensin-converting enzyme-2, aging and cardiac surgical patients: a platform for understanding aging-related coronavirus disease-2019 vulnerabilities.

Purpose Of Review: Hospitalizations for COVID-19 dramatically increase with age. This is likely because of increases in fragility across biological repair systems and a weakened immune system, including loss of the cardiorenal protective arm of the renin--angiotensin system (RAS), composed of angiotensin-converting enzyme-2 (ACE2)/angiotensin-(1--7) [Ang-(1--7)] and its actions through the Mas receptor. The purpose of this review is to explore how cardiac ACE2 changes with age, cardiac diseases, comorbid conditions and pharmaceutical regimens in order to shed light on a potential hormonal unbalance facilitating SARs-CoV-2 vulnerabilities in older adults.

Atrial angiotensin-(1-12)/chymase expression data in patient of heart diseases.

The data presented here are related to the research article entitled "Differential expression of the angiotensin-(1-12) [Ang-(1-12)]/chymase axis in human atrial tissue [1]. We have showed that chymase gene transcripts, chymase activity, and immunoreactive- Ang-(1-12) expression levels were higher in left compared to right atrial tissue, irrespective of cardiac disease. This article presents the echocardiographic characteristics of 111 patients undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation or ischemic heart disease.

Differential Expression of the Angiotensin-(1-12)/Chymase Axis in Human Atrial Tissue.

Background: Heart chymase rather than angiotensin (Ang)-converting enzyme has higher specificity for Ang I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. Herein, we address whether Ang-(1-12), chymase messenger RNA (mRNA), and activity levels can be differentiated in human atrial tissue from normal and diseased hearts and if these measures associate with various pathologic heart conditions.

Assessment of the prognostic significance of low gradient severe aortic stenosis and preserved left ventricular function requires the integration of the consistency of stroke volume calculation and clinical data.

Background: This study was to evaluate the prognostic significance of low gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF) with the integration of echocardiographic and clinical data.

Methods: The study included 172 patients with LG SAS (AVAi ≤ 0.6 cm /m , mean aortic pressure gradient < 40 mm Hg) and LVEF (≥ 50%).

Novel Cardiac Intracrine Mechanisms Based on Ang-(1-12)/Chymase Axis Require a Revision of Therapeutic Approaches in Human Heart Disease.

Purpose Of The Review: Drugs targeting the renin-angiotensin system (RAS), namely angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, are the most commonly prescribed drugs for patients with or at risk for cardiovascular events. However, new treatment strategies aimed at mitigating the rise of the heart failure pandemic are warranted because clinical trials show that RAS blockers have limited benefits in halting disease progression. The main goal of this review is to put forward the concept of an intracrine RAS signaling through the novel angiotensin-(1-12)/chymase axis as the main source of deleterious angiotensin II (Ang II) in cardiac maladaptive remodeling leading to heart failure (HF).

Extracellular matrix for repair of type IV laryngotracheo-esophageal cleft.

Type IV laryngotracheo-esophageal cleft (LTEC) extending to the level of the carina presents unique challenges to operative repair, particularly with respect to soft tissue durability. This is the first report of CorMatrix(®) extra-cellular matrix (ECM) material use as an interposition graft in a four-layered LTEC repair. At day seven post-operatively, there was epithelialization along the surface of the trachea.

Differential expression of the angiotensin-(1-12)/chymase axis in human atrial tissue.

Objective: Heart chymase rather than angiotensin converting enzyme has higher specificity for angiotensin (Ang) I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. We address here whether Ang-(1-12) and chymase gene expression and activity are detected in the atrial appendages of 44 patients (10 females) undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation or ischemic heart disease.

Papillary fibroelastoma of the mitral valve chordae with systemic embolization.

Papillary fibroelastoma (PFE) is a rare benign tumor that most commonly involves heart valves. Cardiac PFE involving the mitral chorda is rarer. Most papillary PFE are asymptomatic; rarely, they are diagnosed because of cardiac symptoms or after an embolic event.

Angiotensin-(1-12): a chymase-mediated cellular angiotensin II substrate.

The classical view of biochemical pathways for the formation of biologically active angiotensins continues to undergo significant revision as new data uncovers the existence of important species differences between humans and rodents. The discovery of two novel substrates that, cleaved from angiotensinogen, can lead to direct tissue angiotensin II formation has the potential of radically altering our understanding of how tissues source angiotensin II production and explain the relative lack of efficacy that characterizes the use of angiotensin converting enzyme inhibitors in cardiovascular disease. This review addresses the discovery of angiotensin-(1-12) as an endogenous substrate for the production of biologically active angiotensin peptides by a non-renin dependent mechanism and the revealing role of cardiac chymase as the angiotensin II convertase in the human heart.

Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis.

Background: The Freestyle stentless aortic root bioprosthesis has excellent hemodynamics and durability through 10 years. The purpose of this report is to present clinical outcomes in a large multicenter cohort through 15 years.

Methods: The multicenter evaluation of the Freestyle valve began in 1992 at 21 centers in North America and Europe.

Factor IX complex for the treatment of severe bleeding after cardiac surgery.

Background: Previous reports have been published on the use of recombinant Factor VIIa for intractable bleeding after cardiac surgery; however, there is limited information on the use of Factor IX Complex in this population.

Methods: A retrospective cohort study of adult patients who underwent cardiac surgery and experienced severe postoperative bleeding, defined as a mean chest tube output ≥300 mL/h. Primary outcomes were changes in chest tube output and blood product usage pre- and post-Factor IX Complex administration.

Imaging of infective endocarditis with cardiac CT angiography.

Infective endocarditis (IE) is a disease characterized by high rates of morbidity and mortality that can present with a spectrum of clinical and imaging findings. Cardiac-gated computed tomographic angiography (CTA) has been shown to be highly accurate in evaluation of both coronary artery disease and structural heart disease and is now considered an appropriate preoperative imaging modality in patients undergoing noncoronary cardiac surgery. This review discusses the use of cardiac-gated CTA in preoperative evaluation of patients with IE, with emphasis on imaging findings of valvular and perivalvular complications.

Anomalous left coronary artery from the pulmonary arteryin an adult.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect that usually presents before the age of 1 year. Several surgical options exist for the correction of ALCAPA; however, debate continues regarding the optimal repair technique in adult populations. We report the case of successful surgical repair of ALCAPA with a direct aortic implantation technique in a 44-year-old mother of 4 children.

Effect of a dexmedetomidine substitution during a nationwide propofol shortage in patients undergoing coronary artery bypass graft surgery.

Study Objective: To assess the effect of substituting dexmedetomidine for propofol during a nationwide propofol shortage on postoperative time to extubation and opioid requirements in patients who underwent coronary artery bypass graft (CABG) surgery.

Design: Retrospective case-control study.

Setting: Single-center cardiothoracic intensive care unit (ICU) in a tertiary academic medical center.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a delayed complication of aortic root replacement.

A 41-year-old male with prior history of aortic root replacement for infectious endocarditis was found to have a pseudoaneurysm in the fibrous continuity between the aortic and mitral valves: the so called "mitral-aortic intervalvular fibrosa." Preoperative cardiac-gated computed tomographic angiography and intraoperative transesophageal echocardiography imaging findings used to guide surgical repair are presented.