Minimally Invasive Valvular Surgery in the Elderly - Safety, Early Recovery, and Long-Term Outcomes.

Background: For elderly people, the benefit of minimally invasive cardiac surgery (MICS) is unclear, so we evaluated the safety, recovery, and long-term survival in elderly MICS patients.

Methods and results: 63 propensity score-matched pairs of 213 consecutive patients (≥70 years old) who underwent mitral and/or tricuspid valve surgery between 2010 and 2020 (121 right mini-thoracotomies vs. 92 full sternotomies) were compared.

Ulcer-like projections into the dilated false lumen after stent-graft placement for aortic dissection: A case report.

Rationale: Acute type A aortic dissection and chronic type B aortic dissection (TBAD) occurs simultaneously in rare cases. Although the development of ulcer-like projection (ULP) is associated with an increase in adverse aorta-related events, the false-lumen enlargement caused by the ULP progression is uncommon.

Patient Concerns: A 72-year-old female with chronic TBAD was admitted to our unit with back and chest pain.

David Operation for Insufficient Pulmonary Autograft After Ross-Konno Procedure.

We report the case of a 25-year-old woman who developed severe aortic regurgitation because of pulmonary autograft root dilatation late after Ross-Konno procedure. The geometric heights of all 3 cusps were relatively small, allowing for the David operation with a 24-mm straight graft. We carefully dissected the aortic root and, the dissection process was relatively straightforward, and the basal ring could be sutured properly.

"Leafletization" of Atrialized Ventricular Septum Endocardium in Ebstein Anomaly.

This case presentation of a 73-year-old man introduces a unique tricuspid valve repair with "endocardium leafletization" for Ebstein anomaly. In this procedure, an atrialized portion of the right ventricular endocardium was delaminated, starting from the level of the true tricuspid annulus, to create a neoleaflet in continuity with the displaced true leaflet. The obtained neoleaflet was then anchored to the true tricuspid annulus.

Tricuspidization by the raphe suspension technique in a unicuspid or bicuspid aortic valve.

Central plication to close a raphe is the most reproducible procedure in bicuspid aortic valve or unicuspid aortic valve repair; however, raphe plication is sometimes associated with systolic doming of the fused leaflet and narrowing of the valve orifice. We experienced a patient with a bicuspid aortic valve with a pliable raphe and commissure orientation close to 120°. Suspension of the raphe was performed instead of plication to create a functional commissure and achieve tricuspidization.

Mitral endocarditis in hypertrophic obstructive cardiomyopathy with leaflet perforation.

We present a case of mitral endocarditis in hypertrophic obstructive cardiomyopathy with systolic anterior motion of anterior leaflet. Perforated anterior leaflet was repaired and extended septal myectomy was concomitantly performed to control systolic anterior motion and mitral regurgitation.

Very long-term outcomes of twisted auto-pericardial mitral annuloplasty.

Objectives: During mitral annuloplasty, we twisted the harvested auto-pericardium to enable adequate ring sizing and implanted it to prevent ring-related complications. Indication for twisted auto-pericardial band (APB) was limited to patients with less than severe annular dilation to ensure high reproducibility and durability. The aim of this study was to investigate the long-term outcomes of twisted APB annuloplasty.

Impact of Lesion Localization on Durability of Mitral Valve Repair in Infective Endocarditis.

Background: Mitral valve (MV) repair for infective endocarditis (IE) is sometimes challenging. We investigated the durability of repair associated with the location of the infected lesion.

Methods: The study comprised 83 patients (55 ± 18 years; active, 66; healed, 17) who underwent MV repair at our institution.

[Successful Treatment of Ascending Aortic Graft Infection with a Rifampicin-soaked Vascular Prosthesis and Continuous Irrigation].

A 68-year-old woman underwent replacement of the ascending aorta for acute type A aortic dissection. She was then diagnosed with postoperative methicillin-resistant Staphylococcus aureus (MRSA) infection, and the infected aortic graft was replaced with a rifampicin-soaked vascular prosthesis, which was followed by continuous irrigation using a 0.1% povidone-iodine solution.

Mitral leaflet restoration using a billowing leaflet in active infective endocarditis.

A key to the success of mitral valve repair in patients with infective endocarditis is the technique used for reconstruction of the missing leaflet. We report the case of a 47-year-old man with active mitral infective endocarditis. After dissection of the infected segments of P3 and the posteromedial commissure, the defect was reconstructed using tissue from a billowing A2 medial and A3 segment.

Which type of secondary tricuspid regurgitation accompanying mitral valve disease should be surgically treated?

Purpose: The purpose of this study was to examine changes in severity of secondary tricuspid regurgitation (TR) accompanying mitral valve disease, and to identify factors predicting failure of improvement in TR after mitral valve surgery.

Methods: We studied 99 patients who had TR of grade ≥2+ preoperatively, 47 with tricuspid annuloplasty (TAP Group) performed concurrently, and 52 with mitral surgery alone (nTAP Group). Predictors of failure of improvement in TR in the nTAP Group were analyzed.

Surgical experience with chronic constrictive pericarditis.

Objective: Constrictive pericarditis is a disease characterized by marked thickening of the pericardium which causes restriction of diastolic cardiac function. The purpose of this report is to review the outcome of pericardiectomy for constrictive pericarditis and to discuss its problems.

Methods: Sixteen consecutive patients who underwent pericardiectomy for constrictive pericarditis in our institution between March 2000 and June 2011 were reviewed.

Twelve years of experience with the ATS mechanical heart valve prostheses.

Objective: The ATS Open Pivot mechanical heart valve has been implanted routinely at our institution since 1999. The objective of this study is to retrospectively analyze our 12-year clinical results with ATS prostheses.

Methods: ATS Open Pivot mechanical valves were implanted in 268 adult patients between May 1999 and August 2010.

Characteristics and treatment strategies of mitral regurgitation associated with undifferentiated papillary muscle.

Purpose: In this report we review our experience of operations on mitral regurgitation associated with abnormal papillary muscles/chordae tendineae of the mitral valves and discussed the clinical characteristics, operative findings, and treatment strategies.

Methods: Undifferentiated papillary muscle was defined as a hypoplastic chordae tendineae with anomalous formation of papillary muscles attached to the mitral valves directly. Consecutive 87 patients undergoing surgery for mitral regurgitation at our institution were reviewed and 6 of them had undifferentiated papillary muscle.

Time-dependent change in fresh autologous pericardium applied for posterior mitral annuloplasty: degree of calcification and its influence on the repaired mitral valve.

Objective: To investigate the degree of calcification of fresh autologous pericardium applied for posterior mitral annuloplasty and its influence on the repaired mitral valve.

Methods: Thirty-nine patients (31 degenerative and 8 infective endocarditis; mean age at surgery: 62 ± 11 years) were enrolled in this study. Sixteen-slice multi-detector computed tomography was performed to identify calcification of autologous pericardium.

Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes.

Purpose: Residual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair.

Methods: From April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures.

The efficacy of human atrial natriuretic peptide in patients with renal dysfunction undergoing cardiac surgery.

Objectives: The purpose of this study was to investigate the efficacy of carperitide (human atrial natriuretic peptide [h-ANP]) in perioperative management in patients with renal dysfunction, especially its kidney-protecting effects.

Patients And Methods: The subjects were 18 patients who underwent elective cardiac surgery using cardiopulmonary bypass (CPB) with a preoperative serum creatinine (Cr) level of 1.2 mg/dl or more.

Isolated undersized mitral annuloplasty for functional mitral regurgitation in non-ischemic dilated cardiomyopathy: reconsideration of the relationship between preoperative coaptation depth and persistent mitral regurgitation.

Background: A preoperative coaptation depth (CD) >or=11 mm is apparently a predictive factor for persistent mitral regurgitation (MR) after undersized mitral annuloplasty for functional MR. The results of studies of isolated undersized mitral annuloplasty in non-ischemic dilated cardiomyopathy (DCM) are reported, including the relationship between the preoperative CD and recurrent MR.

Methods And Results: Six patients (mean age, 61 years) with severe functional MR in non-ischemic DCM underwent isolated undersized mitral annuloplasty.

Comparison of the effects of aortic valve replacement using 19-mm Carpentier-Edwards Perimount bioprosthesis and 19-mm Medtronic Mosaic bioprosthesis.

Objective: Short (< or =3 months)- and middle (> or =4 months)-term results of aortic valve replacement (AVR) using 19-mm Carpentier-Edwards Perimount (CEP) bioprosthetic valves and 19-mm Medtronic Mosaic (MM) bioprosthetic valves in patients with small aortic annulus were compared.

Patients And Methods: At our facility, AVR was performed using bioprostheses in 110 patients from April 1999 to March 2006. Of these patients, 40 were treated using 19-mm CEP (Group C), and 9 using 19-mm MM (Group M).