Clinical Outcomes of Mitral Valve Reoperations in the United States: An Analysis of The Society of Thoracic Surgeons National Database.

Background: This study evaluated outcomes of reoperative mitral valve surgery (MVS) in the United States.

Methods: Adults undergoing isolated MVS with prior open-heart operation in The Society of Thoracic Surgeons (STS) National Database between July 2011 and September 2016 were included. Urgent or emergent operations as well as all indications and causes for MVS were included.

Burden of Cancer Among Syrian Refugees in Jordan.

The Syrian crisis, which started in 2011, has had a profound impact on the entire region. Jordan, with its limited resources, now has the second highest ratio of refugees to inhabitants in the world (89 to 1,000). The actual number of Syrians in Jordan is hotly contested: more than 630,776 refugees registered in November 2015 compared with 1,265,514 reported by the national census conducted at the same time.

Antibiotics, Resistome and Resistance Mechanisms: A Bacterial Perspective.

History of mankind is regarded as struggle against infectious diseases. Rather than observing the withering away of bacterial diseases, antibiotic resistance has emerged as a serious global health concern. Medium of antibiotic resistance in bacteria varies greatly and comprises of target protection, target substitution, antibiotic detoxification and block of intracellular antibiotic accumulation.

Aortic root replacement with cryopreserved homograft for infective endocarditis in the modern North American opioid epidemic.

Objective: To study mid-term survival in patients with infective endocarditis as a result of IV drug use undergoing aortic root replacement with cryopreserved aortic homograft.

Methods: Patients undergoing aortic root homograft replacement from 2011-2017 were studied retrospectively. Aortic root replacement was performed using a modified Bentall technique.

Outcomes of mitral valve surgery during concomitant aortic valve replacement.

Background: This study evaluates outcomes of mitral valve surgery (MVS), replacement (MVR), and repair (MVr), during concomitant aortic valve replacement (AVR).

Methods: Patients undergoing MVS with concomitant AVR between 2011 and 2017 at a single center were reviewed. Patients were stratified into MVR versus MVr with concomitant AVR.

Short-Term Circulatory and Right Ventricle Support in Cardiogenic Shock: Extracorporeal Membrane Oxygenation, Tandem Heart, CentriMag, and Impella.

Severe right ventricular (RV) failure is a significant cause of morbidity and mortality, with an in-hospital mortality rate up to 70% to 75%. Medical management is employed and is successful for most of these patients. However, a small percentage of patients will continue to have persistent RV failure, for which mechanical support is used for management.

A running suture line for aortic valve replacement does not increase the rate of postoperative complete heart block.

Background: Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker.

Methods: 374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017.

Prevalence and diversity of TEM, SHV and CTX-M variants among multidrug resistant spp. from an urban riverine environment in India.

In the present study, we have investigated prevalence and diversity of ESBL genes among isolates obtained from highly polluted stretch of river Yamuna, India. Phenotypic screenings of 116 isolates revealed ~30% were positive for ESBL production. Antibiotic profiling showed multidrug resistance phenotype among 90% isolates.

Management of thoracic aortic graft infections.

Aortic graft prostheses are susceptible to infection that can have catastrophic consequences with an operative mortality of nearly 50%. Management options include graft excision and replacement, aortic re-routing, and graft preservation techniques. This review summarizes the management of thoracic aortic graft infections.

Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection.

Background: The aim of this study was to evaluate the impact of medical student placement of Foley catheters on rates of postoperative catheter-associated urinary tract infection (CAUTI).

Study Design: We included adult surgical patients in our institutional National Surgical Quality Improvement Program (NSQIP) database, and defined CAUTI according to NSQIP criteria. A multivariable model risk-adjusting for patient and operative variables associated with CAUTI in univariate analysis (exploratory p < 0.

Right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation.

Objectives: To evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI).

Background: RV function and pulmonary hypertension (PH) are both prognostically important in patients receiving TAVI. RV-PA coupling has been shown to be prognostic important in patients with heart failure but not previously evaluated in TAVI patients.

Hospital readmission rates are similar between patients with mechanical versus bioprosthetic aortic valves.

Background: The aim of this study was to evaluate hospital readmission rates and clinical outcomes between bioprosthetic (bAVR) and mechanical (mAVR) aortic valve replacements (AVR).

Methods: Adults aged 50 years or older undergoing isolated or concomitant AVR between 2011 and 2017 were included. The primary outcome was 5-year hospital readmission.

Nonoperative Management of Brachiocephalic Artery Dissection.

A 68-year-old man presented with complaints of right-sided neck and chest pain with systolic blood pressure greater than 200 mm Hg but denied any recent blunt trauma or whiplash events. A computed tomography angiography demonstrated an acute dissection involving the origin of the right brachiocephalic artery that extended into the right common carotid and right subclavian arteries. The patient was neurologically intact and computed tomography angiography of the brain demonstrated a stable arachnoid cyst and a brain perfusion scan demonstrated homogenous perfusion.

Bare Metal Stent Use in Type B Aortic Dissection May Offer Positive Remodeling for the Distal Aorta.

Background: Thoracic endovascular aortic repair is increasingly used in acute complicated type B aortic dissection. The objective of this study was to demonstrate evidence of aortic remodeling by using a Proximal ExTension to Induce COmplete ATtachment (PETTICOAT) system in patients with acute complicated type B aortic dissections.

Methods: From 2013 to 2016, 213 patients with type B aortic dissection were seen at our institution.

Mitral valve surgery for acute papillary muscle rupture.

Background: Papillary muscle rupture (PMR) is a rare complication of a myocardial infarction. The aim of this study was to review our results of mitral valve surgery for acute PMR.

Methods: Data from patients undergoing emergent mitral valve surgery for acute PMR between 2011 and 2017 at our institution were reviewed.

Conversion of Left- to a Right-Sided Aortic Arch: A Radical Approach for Select Indications.

Thoracic aortic graft infections, anomalous arch anatomy, and vascular rings may cause tracheal and/or esophageal compression. These circumstances often create challenging clinical dilemmas such that anatomical repair either does not eliminate the pathologic process completely or poses a measurable risk of recurrence. We describe a novel approach that facilitates complete relocation of the thoracic aorta to either prevent graft placement in an infected field or prevent tracheal and/or esophageal compression that effectively converts left-sided to right-sided arch anatomy.

Cutaneous melanoma in adolescents and young adults.

Cutaneous melanoma is rare in children, but has greater incidence in adolescents and young adults (AYAs). Diagnosis may be challenging due to its rarity in these age groups. Few studies have specifically addressed the topic of AYA melanoma.

Evolving trends in aortic valve replacement: A statewide experience.

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

Methods: The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017.

The predictive value of magnetic resonance imaging of retinoblastoma for the likelihood of high-risk pathologic features.

Purpose:: To evaluate the predictive value of magnetic resonance imaging in retinoblastoma for the likelihood of high-risk pathologic features.

Methods:: A retrospective study of 64 eyes enucleated from 60 retinoblastoma patients. Contrast-enhanced magnetic resonance imaging was performed before enucleation.

Empirical treatment with parenteral acyclovir in a child with herpes simplex virus hepatitis and acute lymphoblastic leukemia.

Introduction: Hepatitis secondary to Herpes Simplex Virus (HSV) infection is a complication that often leads to fatal hepatic failure. Early treatment with the anti-viral drug, acyclovir, is life-saving. In view of the non-specific nature of the signs and symptoms associated with HSV hepatitis, diagnosis is often made late during the course of the disease; a factor that largely contributes to the high mortality rate of this treatable disease complication.

Hemiarch Reconstruction Versus Clamped Aortic Anastomosis for Concomitant Ascending Aortic Aneurysm.

Background: Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating another cardiac disease to avoid increased risk of morbidity and mortality. We hypothesized that the use of DHCA with retrograde cerebral perfusion (RCP) does not add incremental risk to ascending aortic replacement alone in the setting of concomitant cardiac surgery.

Methods: A total of 408 ascending aortic ± hemiarch replacements and aortic (root), mitral, or tricuspid valve(s); coronary artery bypass grafting; or MAZE procedures were performed for concomitant cardiac disease.

Tricuspid valve endocarditis in the era of the opioid epidemic.

Background And Aim: We reviewed our institutional experience with tricuspid valve endocarditis to understand the impact of the opioid epidemic on the incidence of right heart endocarditis.

Methods: We retrospectively reviewed all cases of tricuspid endocarditis managed surgically from January of 2011 to May of 2017. There were no exclusion criteria.

Surgical cut down for vascular access with conscious sedation for transcatheter aortic valve replacement: the best of both worlds?

Objectives: Despite the established efficacy of transcatheter aortic valve replacement for aortic valve replacement, vascular complications remain a major cause of procedural morbidity and mortality. In this study, we evaluate the use of femoral artery cut down with conscious sedation and report outcomes and complications associated with this approach.

Methods: Our study included 282 patients undergoing transcatheter aortic valve replacement with conscious sedation and surgical cut down for femoral access between 2015 and 2017.