Treatment of obstructive thrombosed prosthetic heart valve.

Obstructive thrombosed prosthetic heart valve (OTPHV) is a serious complication of heart valve replacement. There are no generally accepted criteria for management of these patients. Therefore, in September 2012, a literature survey of studies published after 1995 was performed to analyze the data regarding clinical outcomes of patients with OTPHV treated with thrombolytic agents and with surgery since 1996.

A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion.

Introduction: Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain.

The IRAD classification system for characterizing survival after aortic dissection.

Background: The classification of aortic dissection into acute (<14 days from symptom onset) versus chronic (≥14 days) is based on survival estimates of patients treated decades before modern diagnostic and treatment modalities were available. A new classification of aortic dissection in the current era may provide clinicians with a more precise method of characterizing the interaction of time, dissection location, and treatment type with survival.

Methods: We developed separate Kaplan-Meier survival curves for Type A and Type B aortic dissection using data from the International Registry of Aortic Dissection (IRAD).

Extent of preoperative false lumen thrombosis does not influence long-term survival in patients with acute type A aortic dissection.

Background: Partial thrombosis of the false lumen has been related to aortic growth, reoperations, and death in the chronic phase of type B and repaired type A aortic dissections. The impact of preoperative false lumen thrombosis has not been studied previously. We used data from a contemporary, multinational database on aortic dissections to evaluate whether different degrees of preoperative false lumen thrombosis influenced long-term prognosis.

Patients with type A acute aortic dissection presenting with major brain injury: should we operate on them?

Objectives: The management strategy remains controversial for patients presenting with type A acute aortic dissection with cerebrovascular accident or coma. The present study aimed to help guide surgeons treating these high-risk patients.

Methods: Of 1873 patients with type A acute aortic dissection enrolled in the International Registry for Acute Dissection, 87 (4.

Indications for aortic aneurysmectomy: too many variables and not enough equations?

Endografting for treatment of thoracic aortic pathology continues to gain popularity; in some countries, endovascular aortic repair numbers now exceed open surgery cases. The skills and understanding of open surgical teams are not always translated into endovascular interventions, which may be led by a cardiologist or vascular surgeon with little knowledge of thoracic pathology. The indications for intervention on the dilated aorta continue to be debated despite volumes of literature and multisocietal guidelines.

How good is "good enough"?

Context: The safety and durability of endoscopic vein graft harvest in coronary artery bypass graft (CABG) surgery has recently been called into question.

Objective: To compare the long-term outcomes of endoscopic vs open vein-graft harvesting for Medicare patients undergoing CABG surgery in the United States.

Design, Setting, And Patients: An observational study of 235 394 Medicare patients undergoing isolated CABG surgery between 2003 and 2008 at 934 surgical centers participating in the Society of Thoracic Surgeons (STS) national database.

A prospective, randomized comparison of 3 contemporary bioprosthetic aortic valves: should hemodynamic performance influence device selection?

Objective: Latest generation biologic aortic valve prostheses were designed to improve hemodynamic performance. We sought to determine whether there are clinically important early differences among these devices.

Methods: Three hundred adults with severe aortic valve stenosis undergoing aortic valve replacement were randomized to receive the Edwards Magna, Sorin Mitroflow, or St.

Pseudocoarctation of the aorta secondary to aortic intimal sarcoma.

We describe a case of a 66-year-old woman who presented with upper extremity hypertension and a pseudocoarctation-like picture secondary to an aortic arch intimal sarcoma.

Aortic dissection and recurrence both precipitated by sexual activity.

Risk factors for aortic dissection include: hypertension, connective tissue disorders, chronic obstructive pulmonary diseases, and severe physical and emotional stress. Although dissection associated with extreme physical activity has been reported, to date, there have been no reports in the literature to our knowledge of acute dissection and recurrence both occurring during sexual activity. We report a case of a 34-year-old male who underwent emergency replacement of his aortic root and hemiarch for an aortic dissection precipitated by sexual intercourse.

Percutaneous therapeutic approaches to closure of cardiac pseudoaneurysms.

Cardiac and aortic pseudoaneurysms are rare complications following myocardial infarction or cardiac surgery. They are characterized by a contained cardiac or aortic rupture within surrounding tissue and have a high mortality rate if left untreated. Percutaneous treatment of cardiac pseudoaneurysms might be a feasible treatment option in patients who are at high risk of reoperative surgery.

Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD.

Aim: In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included.

Do pericardial bioprostheses improve outcome of elderly patients undergoing aortic valve replacement?

Background: Pericardial bioprostheses have favorable echocardiographic hemodynamics in the aortic position compared with porcine valves; however, there are few data comparing clinical outcomes. Our objective was to assess the late results of the two valve types.

Methods: We reviewed 2,979 patients aged 65 years or older undergoing aortic valve replacement with pericardial (n=1,976) or porcine (n=1,003) prostheses between January 1993 and December 2007.

Aortic valve stenosis in community medical practice: determinants of outcome and implications for aortic valve replacement.

Objective: To define the objective and subjective measures of aortic stenosis (AS) severity linked to survival after diagnosis in community practice.

Methods: All 360 Olmsted County, Minnesota residents (74 ± 14 years; 44% men) with AS diagnosed from 1988 to 1997 by echocardiography and without life-threatening comorbid conditions were enrolled. The presentation at first diagnosis, outcomes (mortality, heart failure, cardiac surgery), and coherence of guideline-based criteria for severe AS were analyzed.

Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study.

Background: Postoperative pain and anxiety are common in cardiac surgery patients. Studies have suggested that music can decrease anxiety in hospitalized patients. Primary Study Objective This study focused on the efficacy and feasibility of special music, which included nature sounds, for pain and anxiety.

Human factors and operating room safety.

A human factors model is used to highlight the nature of many systems factors that affect surgical performance, including the OR environment, teamwork and communication, technology and equipment, tasks and workload factors, and organizational variables. If further improvements in the success rate and reliability of cardiac surgery are to be realized, interventions need to be developed to reduce the negative impact that work system failures can have on surgical performance. Some recommendations are proposed here; however, several challenges remain.

Contemporary results of open aortic arch surgery.

Objectives: The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery.

Methods: The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database.

Comprehensive hemodynamic assessment of 305 normal CarboMedics mitral valve prostheses based on early postimplantation echocardiographic studies.

Background: Two-dimensional (2D) and Doppler-derived echocardiographic data on normal CarboMedics (CM) mechanical mitral valve prosthesis function have been reported but are limited.

Methods: Comprehensive retrospective 2D and Doppler echocardiographic assessment of 305 normal CM mechanical mitral valve prostheses (272 Standard and 33 Optiform) was performed early after implantation. The early postimplantation hemodynamic profiles of 80 patients were compared with profiles obtained by follow-up transthoracic echocardiography performed <1 year after implantation.

Coronary artery spasm after Cryo Maze III procedure.

The Cox Maze III procedure has been simplified with the availability of tissue ablation devices; however, complications related to their use are recognized. We report a case of 45-year-old woman who underwent mitral valve repair and concomitant Cryo-Maze procedure. She had reversible right coronary artery spasm develop after the procedure demonstrated by ST-segment elevation changes and coronary angiography, which was reversed with intracoronary nitroglycerin.