Use of longitudinal rigid sternal fixation in prevention and treatment of wound complications among high-risk patients after cardiac surgery.

Background: Traditionally, wire cerclage closure has been used to reapproximate the sternum after cardiac surgery. Recent evidence suggests that rigid sternal fixation may reduce the risk of wound complications. The aim of this study was to analyze our 10-year experience with longitudinal rigid sternal fixation (LRSF) for prevention and treatment of wound complications in high-risk patients.

Advantages of intraoperative implantation of Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with cardiogenic shock.

Background: Despite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA ( https://www.

Single-stage hybrid repair of a ruptured Kommerell diverticulum associated with dextrorotation, bovine arch, and bicuspid aortic valve.

Background: A strategy for the surgical repair of ruptured Kommerell diverticulum has not yet been established. The aim of this study is to demonstrate that this entity could be associated with a number of other cardiac anomalies and this lesion can be successfully treated by a hybrid approach.

Case Presentation: The patient, with a combination of ruptured Kommerell diverticulum, dextrorotation, bovine arch, and bicuspid aortic valve, underwent emergency surgery.

Should We Move Up the Clock on Preventive Intervention in Marfan's Disease?

Gradual dilatation of the ascending aorta is a common phenomenon in patients with Marfan's disease, which often leads to dissection and rupture. It is estimated that around two-thirds of the patients either die or require major surgery before the age of 42 years. In the mirror of the experience of 40 years with aortic wall reinforcement, the author forward the postulate that whenever the ascending aorta of an individual with proven Marfan's disease reaches adult size, that is, approximately 3.

Cause of Ascending Aortic Dilatation in Patients with Bicuspid Aortic Valves: The Final Link.

Background: This article discusses about the cause of dilatation of the ascending aorta in patients with congenitally bicuspid aortic valves (CBAVs). Some members of the profession believe that it is genetic, while others attribute it to turbulence. The author previously presented in vitro data proving that CBAVs are inherently morphological stenotic, even in the absence of measurable gradient and clinical symptoms.

Right Atrial Anomalous Muscle Bundle Presenting with Acute Superior Vena Cava Syndrome and Pulmonary Embolism: Surgical Management.

Background: An anomalous muscle bundle (AMB) crossing the right atrial cavity represents a pathologic finding with unproved clinical significance. This congenital anomaly may be difficult to recognize via echocardiography and could be confused with other intracavitary lesions.

Methods: We report the case of a 53-year-old woman presented to the cardiovascular service with acute superior vena cava (SVC) syndrome and submassive pulmonary embolism.

Early Surgical Reconstruction of Sternum with Longitudinal Rigid Polymer Plating after Acute Chest Trauma.

Purpose: The surgical management of the patients with traumatic sternal fractures remains controversial. The aim of this study was to evaluate the effectiveness of an early surgical reconstruction of a displaced sternal fracture utilizing longitudinal rigid polymer fixation in the settings of an acute chest trauma.

Methods: To perform the sternal fixation, we utilized a longitudinal rigid plating system.

Successful Repair of Acute Type B and Retrograde Type A Aortic Dissection With Kidney Ischemia.

Acute dissection of thoracic aorta carries a risk of renal ischemia followed by the development of a kidney failure. The optimal surgical and nonsurgical management of these patients, timing of intervention, and the factors predicting renal recovery are not well delineated and remain controversial. We present a case of acute type B thoracic aortic dissection with left kidney ischemia.

An Extrapericardial Minimally Invasive Approach for Implantable Cardioverter Defibrillator.

The indications for placement of an implantable cardioverter defibrillators (ICDs) have greatly expanded over the last years. However, standard transvenous approach is not suitable for a subset of patients who cannot benefit from ICD therapy. Here, we have demonstrated the feasibility and efficacy of extrapericardial ICD placement through a minimally invasive access in intact hearts as well as in postmyocardial infarction large animal models.

Dilatation of the ascending aorta in patients with congenitally bicuspid aortic valves.

Introduction: The cause of ascending aortic dilatation occurring in patients with congenitally bicuspid aortic valves was investigated.

Methods: Flow patterns through human aortic roots with congenitally bicuspid aortic valves as well as through porcine constricted aortas were studied in a left heart simulator. Vibration was recorded as a measure of turbulence in the post-stenotic segment.

Wilhelm Ebstein and the history of surgery for Ebstein's Disease.

In the mirror of the life-story of Wilhelm Ebstein, the discovery of "Ebstein's Disease" is presented. The readers are guided through the individual stages of the development of surgical treatment of the condition.

Hypoglycemia with intensive insulin therapy after cardiac surgery: predisposing factors and association with mortality.

Background: Intensive insulin therapy has become a major therapeutic target in cardiac surgery patients. It has been associated, however, with an increased risk of hypoglycemia compared with conventional insulin therapy. Our study sought to identify the factors predisposing to hypoglycemia with intensive insulin therapy and investigate its effect on early clinical outcomes after cardiac surgery.

Surgical correction of pectus excavatum. How did we get here? Where are we going?

The currently applied techniques recommended for the repair of pectus excavatum anomalies are discussed, set against a historical review of early clinical studies and surgical interventions. The issues of the future direction pectus excavatum surgery may take are analyzed in detail, with the reviewer expressing reservations in connection with the recent trend to closed repair and concern over the potential for serious complications associated with the application of this technique.

Does the technique of distal anastomosis influence clinical outcomes in acute type A aortic dissection?

The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups.

Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox?

Background: Numerous studies have documented an obesity paradox in which overweight and obese people with cardiovascular disease have a better prognosis compared with patients with normal body mass index (BMI). This study sought to quantify the effect of BMI on clinical outcomes after cardiac surgery and investigate the obesity paradox.

Methods: A concurrent cohort study of 2,440 consecutive patients undergoing cardiac surgery (coronary artery bypass grafting [CABG], valve, or CABG and valve surgery) from January 2004 to December 2008 was carried out.