Mitral Valve Repair Versus Replacement in Elderly With Degenerative Disease: Analysis of the STS Adult Cardiac Surgery Database.

Background: It has been postulated that mitral valve repair in the elderly does not confer short-term benefits over mitral valve replacement with complete preservation of the chordal apparatus. Our purpose was to test this hypothesis using data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).

Methods: Patients aged 70 years or more undergoing primary isolated elective mitral valve repair or mitral valve replacement for degenerative disease were obtained from the STS ACSD versions 2.

Anti-factor Xa assay is a superior correlate of heparin dose than activated partial thromboplastin time or activated clotting time in pediatric extracorporeal membrane oxygenation*.

Objective: To assess the utility of activated clotting time, activated partial thromboplastin time, and anti-Factor Xa assay for the monitoring and dosing of heparin in pediatric patients requiring support with extracorporeal membrane oxygenation.

Design: Retrospective chart review.

Setting: PICU in a single, tertiary care, academic children's hospital.

Congenitally corrected transposition of the great arteries and concomitant coronary artery and valvular disease in the adult patient.

Congenitally corrected transposition of the great arteries (ccTGA) accounts for less that 1% of cardiac anomalies, and is defined as ventriculoarterial and atrioventricular (AV) discordance. The double discordant connection allows for survival with the right ventricle performing as the systemic ventricle, and the left ventricle as the pulmonary ventricle. We report a case of ccTGA in a 35-year-old male with situs inversus totalis status post repair of a ventricular septal defect (VSD) with a residual VSD, severe systemic AV valve regurgitation, and coronary artery disease who presented with chest pain.

Increased incidence of gastrointestinal bleeding following implantation of the HeartMate II LVAD.

Background: The HeartMate II (HMII) Left Ventricular Assist System (Thoratec Corporation, Pleasanton, CA, USA), an axial continuous-flow left ventricular assist device (LVAD), has been approved for use in bridge-to-transplant patients and is under investigation for destination therapy. To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed.

How Informed is "Informed Consent" for Robotic Cardiothoracic Surgery?

Objective: : The education of patients in the informed consent process remains a challenge for many surgeons. In cardiothoracic surgery, emerging minimally invasive techniques including robotics add another level of complexity to the patient education process. We sought to evaluate our patients' perceptions and informed knowledge after robotic-assisted cardiothoracic surgery.