Replacement of a Calcified Aortic Valve in a Porcine Aortic Root with the Perceval Sutureless Bioprosthesis.

We report a 79-year-old patient who had aortic valve replacement (AVR) using a porcine aortic root. Due to degeneration of the porcine aortic valve, he required reoperation during which a heavily calcified porcine root and aortic annulus prevented insertion of any traditional bioprosthesis. AVR was achieved using a sutureless bioprosthesis, combined with mitral valve replacement.

Aortic valve-sparing procedure-a durable choice in liver transplantation recipient.

A 44-year old man with aortic regurgitation and aneurysm of the ascending aorta underwent an aortic valve-sparing procedure as a durable treatment before liver transplantation. Since patients with chronic liver failure are at high risk of hemorrhagic complications at time of major surgery, while management of warfarin administration may still represent a concern, the choice of a cardiac procedure which avoids any anticoagulant treatment appeared justified.

Early aortic dissection after aortic valve replacement with a Perceval sutureless bioprosthesis.

We report a patient who developed ascending aorta dissection after aortic valve replacement with a Perceval sutureless pericardial bioprosthesis, a previously not reported complication with this device. At reoperation, the intimal tear was located at the aortotomy suture line; the tips of the nitinol stent were far from the aortic lesion which therefore was not attributable to the presence of this specific prosthetic model. Nevertheless, a previous report of aortic dissection due to erosion of the aortic wall by the strut of a transcatheter prosthesis may raise the suspicion that such complication could also occur with sutureless prostheses of similar design.

Transthyretin-related amyloid in a saphenous vein. Histological diagnosis in a patient undergoing coronary artery bypass surgery.

Amyloidosis is an underdiagnosed and challenging disease with clinical and etiologic heterogenicity, requiring amyloid subtyping because of the distinctive prognostic and therapeutic impact. Transthyretin amyloidosis is more common in elderly patients, and in such population undergoing cardiovascular surgery, it could be worthy to be investigated. We herein describe an unusual case of transthyretin-related vascular amyloidosis in an 81-year-old man undergoing coronary artery bypass surgery.

Syphilitic Aortic Aneurysm in the Third Millennium.

A 69-year-old man presented with precordial pain and a dilated ascending aorta with the suspicion of an intramural hematoma. At emergency operation, the aorta appeared grossly thickened with diffuse intimal scarring. Retrospectively, the patient tested positive to serologic screening for syphilis with histologic findings also compatible with a syphilitic aortitis.

Excellent Durability of the Mosaic Porcine Aortic Bioprosthesis at Extended Follow Up.

Background: Biological prostheses are widely employed for aortic valve replacement (AVR). The study aim was to evaluate the performance of the Mosaic porcine bioprosthesis in the aortic position over two decades.

Methods: Between November 1995 and December 2016, a total of 254 patients (194 males, 60 females; mean age 74 ± 9 years) underwent AVR with a Mosaic bioprosthesis at the authors' institution.

Incidence of Aortitis in Surgical Specimens of the Ascending Aorta Clinical Implications at Follow-Up.

The objectives of this study are to evaluate the incidence of aortitis on a surgical population, establish any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression of the disease and influencing late outcome. From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histologic evaluation, providing adequate data in 178 (75%) for a clinical and pathologic correlation.

Repair of a giant left ventricular pseudoaneurysm with rupture of the interventricular septum.

Presence of two combined mechanical complications of acute myocardial infarction is extremely rare and still associated with a high-operative mortality. We describe a 73-year-old male patient who presented with a giant left ventricular pseudoaneurysm associated with rupture of the interventricular septum. Surgical repair of both lesions was successfully accomplished.

Intraoperative displacement of a Perceval sutureless prosthesis.

We describe a patient with mitral incompetence and aortic stenosis who underwent mitral valve repair and aortic valve replacement using a Perceval sutureless bioprosthesis. After weaning from cardiopulmonary bypass, repeated mitral valve repair was required due to residual mitral regurgitation. During this procedure, the aortic prosthesis was displaced, most likely by undue inadvertent traction on the atrial retractor, requiring its removal and reinsertion.

Surgical Treatment of Annuloaortic Ectasia - Replace or Repair?

Background: Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures.

Methods: A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015.

The Modified Bentall Procedure: A Single-Institution Experience in 249 Patients with a Maximum Follow Up of 21.5 Years.

Background And Aim Of The Study: The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit.

Methods: Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases.

Micro-RNA-21 (biomarker) and global longitudinal strain (functional marker) in detection of myocardial fibrotic burden in severe aortic valve stenosis: a pilot study.

Aims: Myocardial fibrosis (MF) is a deleterious consequence of aortic valve stenosis (AVS). Global longitudinal strain (GLS) is a novel left ventricular (LV) functional parameter potentially useful to non-invasively estimate MF. MicroRNAs (miRNAs) are non-coding small ribonucleic acids (RNA) modulating genes function, mainly through RNA degradation.

Splenectomy and Valve Replacement in Patients With Infective Endocarditis and Splenic Abscesses.

In patients with infective endocarditis (IE), splenic involvement is a rare but well-known adverse event. The treatment of patients with IE and splenic abscesses is still challenging and controversial. We report 3 patients with IE and splenic abscesses who underwent successful valve replacement and splenectomy.

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up.

We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation.

Aortic valve replacement in systemic sclerosis.

Systemic sclerosis (scleroderma) is a chronic systemic autoimmune disease of the connective tissue, which can involve the cardiac valves, the mitral valve being more frequently affected, although involvement of the aortic valve has been rarely described. We report a patient with aortic stenosis and systemic sclerosis who required aortic valve replacement. Awareness of this rare association may help to provide adequate management of such patients and prevent complications related to the underlying disease.

Reduction in platelet count after aortic valve replacement: comparison of three bioprostheses.

Background And Aim Of The Study: Concerns have recently been raised regarding postoperative decreases in platelet count (PC) after aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis. In order to assess the relevance and the clinical impact of this phenomenon, variations in PC were monitored in patients with SFS valves, and compared to changes of PC in patients after AVR with two other bioprostheses, the Medtronic Mosaic (MOS) porcine valve and the Sorin Mitroflow (MIT) pericardial valve.

Methods: Three groups of patients (25 in each group) who had undergone AVR with a biological prosthesis were compared.

Lipid insudation as a cause of structural failure of a stentless pericardial bioprosthesis.

The Sorin Pericarbon Freedom (SPF) valve is a stentless bioprosthesis made from bovine pericardium, with a peculiar design aimed at preventing the mechanical failures observed with old models of stented pericardial bioprostheses. Herein, the case is described of a patient who presented with severe regurgitation of a SPF six years after aortic valve replacement, caused by commissural dehiscence. Both, microradiographic and histologic investigations, revealed mild calcific deposits and massive lipid infiltration, thus confirming that a patient-related mechanism such as 'atheromasia' can account for structural valve deterioration also in recipients of pericardial bioprostheses.

Recurrent mitral regurgitation due to ruptured artificial chordae: case report and review of the literature.

The use of expanded polytetrafluoroethylene (ePTFE) sutures has become an established method to correct mitral regurgitation due to elongated or ruptured mitral chordae. Mitral valve repair using artificial chordae has demonstrated excellent long-term results, particularly as ePTFE retains its flexibility with time and is highly resistant to mechanical stress. On conducting a literature review, four cases were found of recurrent mitral regurgitation due to the late (6-14 years postoperatively) rupture of ePTFE chordae.

Long-term durability of a St. Jude medical X-cell bioprosthesis.

An 82-year-old female had undergone aortic valve replacement with a 23-mm St. Jude Medical X-Cell porcine bioprosthesis (XCB), a glutaraldehyde-fixed valve subjected to a decellularization process. More than 13 years later, she required a repeated operation because of XCB structural failure.

Aortic valve replacement with the Medtronic Mosaic bioprosthesis: a 13-year follow-up.

Background: This study evaluated the long-term clinical performance of the Mosaic bioprosthesis (Medtronic Inc, Minneapolis, MN) after aortic valve replacement.

Methods: From 1995 to 2008, 178 patients (48 women; mean age, 74±6 years) had aortic valve replacement. Mean functional class was 2.

Unusual complication after aortic valve replacement with the Freedom Solo stentless bioprosthesis.

The case is presented of an unusual complication after aortic valve replacement with a Freedom Solo bioprosthesis. Excision of the aortic valve created a discontinuity of the aortic annulus that was missed intraoperatively and left uncorrected after supra-annular placement of the bioprosthesis; this created a pseudoaneurysm with direct communication to the pericardial cavity. When implanting the Freedom Solo bioprosthesis, care must be taken to exclude the presence of any aortic annular discontinuity.

Transmyocardial laser revascularization 12 years later.

We report the long-term follow-up of 34 patients who underwent transmyocardial laser revascularization (TMLR) from 1995 to 1999. At 12 years the actuarial survival is 24%±8%, actuarial freedom from cardiac deaths is 36%±10% and actuarial freedom from major adverse cardiac events 13%±8%. Mean angina class of nine current survivors is 2.