Incidentally Discovered Anomalous Mitral Chordae at the Time of Mitral Valve Repair.

Anomalous supravalvular mitral chordae tendineae that originate from the mitral leaflet(s) and attach to the interatrial septum or dome of the left atrium are a rare congenital anomaly. These supravalvular chordae are often associated with severe mitral regurgitation and surgical experience has included resection of the anomalous chord as part of the repair. We describe an unusual presentation of an incidentally discovered anomalous supravalvular chord at the time of mitral valve repair for degenerative mitral regurgitation related to a flail posterior leaflet.

Is concomitant tricuspid valve repair in patients undergoing robotic mitral valve repair safe and effective?

Objectives: Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair.

Long-term Stroke and Mortality Risk in Nonagenarians After Transcatheter Aortic Valve Insertion.

Background: Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. This study investigated the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population.

Methods: A retrospective analysis was conducted of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020.

Single-Center Prospective Study of Cross-Clamp vs Balloon Occlusion in Robotic Mitral Surgery.

Background: Transthoracic aortic cross-clamp and endoaortic balloon occlusion have both been shown to have comparable safety profiles for aortic occlusion. Because most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion.

Methods: We changed our technique from aortic cross-clamp to balloon occlusion in November 2022.

Navigating missing link: innovative cannulation for robotic mitral valve repair in the absence of inferior vena cava.

Cardiac surgeries often require the use of cardiopulmonary bypass to allow visualization and manipulation of tissues. Vascular anomalies may impose challenges with access configuration. A patient was evaluated for robot-assisted mitral valve repair and found to have an atretic inferior vena cava secondary due to chronic occlusion.

A Case Series of Minimally Invasive Robotic-Assisted Resection of Cardiac Papillary Fibroelastoma: The Mayo Clinic Experience.

Papillary fibroelastomas (PFEs) are small, slowly growing benign cardiac tumors with clinically significant risk of embolization. Surgical excision is the definitive treatment of symptomatic PFE and is conventionally performed through a median sternotomy. In this study, we report a series of 12 patients, who underwent robotic-assisted PFE removal at the Mayo Clinic.

Does Minimally Invasive Mitral Valve Repair Mean Less Postoperative Pain?

Background: Rapid recovery after minimally invasive mitral valve (MV) repair has been demonstrated in many studies, but the issue of postoperative pain has not been fully elucidated. We evaluated pain scores and medication use in patients undergoing MV repair by minimally invasive surgery (MIS) and open sternotomy (OS).

Methods: Between 2008 and 2019, 1332 patients underwent isolated MV repair by OS, and 913 underwent minimally invasive MV repair.

Malignant Left Ventricular Outflow Tract Obstruction: A Reason to Operate?

A 57-year-old man with high-grade synovial sarcoma was found to have cardiac involvement of his malignancy. Intracardiac tumor resulted in dynamic left ventricular outflow tract obstruction and severe mitral regurgitation. He underwent mitral valve replacement and had no cardiovascular symptoms at 1-year follow-up.

Robotic vs. minimally invasive mitral valve repair: A 5-year comparison of surgical outcomes.

Background: Minimally invasive mitral valve repair (MVr) is commonly performed. Data on the outcomes of robotic MVr versus nonrobotic minimally invasive MVr are lacking. We sought to compare the short-term and mid-term outcomes of robotic and nonrobotic MVr.

Controversy pro: Mechanical AVR for better long-term survival of 50-70 years old.

Selection of the most appropriate type of aortic valve prosthesis (mechanical or biologic) for patients 50-70 years of age is a matter of frequent debate. The purpose of this article is to review overlooked concepts and misconceptions in valve-related complications, prosthesis durability, and late survival to aid decision making in contemporary practice. A trend favoring improved long-term survival was found among patients who receive a mechanical prosthesis compared to a biologic substitute.

Population-Based Trends in Amputations and Revascularizations for Peripheral Artery Disease From 1990 to 2009.

Objective: To determine trends in amputations and revascularizations for peripheral artery disease (PAD) in a well-defined population.

Methods: A population-based cohort study of Olmsted County, Minnesota, residents with PAD undergoing amputation or revascularization was conducted between January 1, 1990, and December 31, 2009. Population-level 5-year incidence trends for endovascular, open surgical, and hybrid revascularizations and major and minor amputations were determined.

Robotic Mitral Valve Repair: A Decade of Experience With Echocardiographic Follow-up.

Background: Surgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. Although the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution.

Massive intrathoracic solitary fibrous tumor of the right hemithorax.

Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal tumors that arise from visceral or parietal tissue. Surgical resection of massive SFTP can be complicated by airway collapse, vascular compression/hemodynamic instability, and hemorrhage. Patients with SFTP may also present with metabolic derangements secondary to paraneoplastic processes.

Impact of Hematologic Malignancies on Outcome of Cardiac Surgery.

Background: Previous studies suggest that patients with prior or current hematologic malignancy are at increased risk of intraoperative and postoperative complications when undergoing cardiac surgery. The aim of this review was to compare clinical outcomes of patients with a history of hematologic malignancy to those of similar patients with no known blood dyscrasia.

Methods: From January 1993 to June 2017, 37,839 patients underwent elective cardiac surgery at Mayo Clinic.

Bivalirudin for Maintenance Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation for COVID-19.

In its severe manifestation, coronavirus disease 2019 (COVID-19) compromises oxygenation in a manner that is refractory to maximal conventional support and requires escalation to extracorporeal membrane oxygenation (ECMO). Maintaining ECMO support for extended durations requires a delicately balanced anticoagulation strategy to maintain circuit viability by preventing thrombus deposition while avoiding excessive anticoagulation yielding hemorrhage-a task that is complicated in COVID-19 secondary to an inherent hypercoagulable state. Bivalirudin, a member of the direct thrombin inhibitor drug class, offers potential advantages during ECMO, including to its ability to exert its effect by directly attaching to and inhibiting freely circulating and fibrin-bound thrombin.

Open versus thoracoscopic thymectomy for juvenile myasthenia gravis.

Background: Juvenile myasthenia gravis (JMG) is an antibody mediated autoimmune disorder that manifests as progressive voluntary muscle weakness and fatigue. In medically refractory cases, thymectomy has been shown to abrogate symptoms and reduce glucocorticoid dependence. While transcervical or transsternal incisions have been the traditional approach, adult trends now favor thoracoscopic thymectomy.

Deliberate Practice and the Emerging Roles of Simulation in Thoracic Surgery.

In the current era of duty hour limitations and societal focus on cardiothoracic surgical outcomes, simulation and deliberate practice have emerged as valuable supplemental training options. Evidence supporting acquisition of technical skill, clinical transferability, and patient safety within the realm of simulation is mounting. This article provides a focused synthesis of evidence regarding the usefulness of simulation-based training and deliberate practice as a whole and within the subspecialty of cardiothoracic surgery.

The Need for Multiple Bypass Grafts in Repair of Right Coronary Artery-to-Coronary Sinus Fistulas.

Coronary artery fistulas are rare anomalies with controversial management strategies. The two main treatment options are surgical repair and catheter embolization. This case report describes successful treatment of a complex right coronary artery-to-coronary sinus fistula by using a less conventional approach: multiple coronary artery bypass grafting.