Coronary ostium topography: an implication for transcatheter aortic valve implantation?

Objectives: Shorter distances from coronary ostia to the calcified aortic valve may result in occlusion with potential infarction during transcatheter aortic valve implantation. We hypothesized that preoperative CT-scan measurements might predict coronary occlusion.

Methods: Distances from the coronary ostia to the calcified aortic valve were measured during open heart aortic valve replacement in 60 consecutive patients.

Risk of aortic valve replacement in patients with aortic stenosis and chronic obstructive pulmonary disease.

Background And Aim Of The Study: Patients with aortic stenosis (AS) and chronic obstructive pulmonary disease (COPD) have been considered at high risk for aortic valve replacement (AVR), which results in some patients being denied this life-saving operation. Hence, the study aim was to assess the operative, 30-day, and long-term mortality in individuals with COPD undergoing AVR for AS in the modern surgical era.

Methods: This retrospective cohort of patients had documented COPD (FEV1/FVC < 70%), and underwent isolated AVR for severe AS between 1993 and 2007 at the Mayo Clinic in Rochester, MN.

Does metabolic syndrome influence bioprosthetic mitral valve degeneration and reoperation rate?

Background: Evidence suggests that metabolic syndrome (MbS) is associated with early senescence of bioprosthetic aortic valve prostheses. The purpose of this study was to determine whether MbS is also associated with accelerated failure of bioprosthetic valves prostheses in the mitral position.

Methods: Records of all patients undergoing bioprosthetic mitral valve replacement (MVR) from 1993 to 2000 were reviewed.

A prospective, randomized, double-blind trial of 3 regimens for sedation and analgesia after cardiac surgery.

Objective: The aim of this study was to evaluate cardiac risk as a consideration for selecting postoperative sedation and analgesia regimens used for cardiac surgical patients requiring cardiopulmonary bypass and early extubation.

Design: An observer-blind, randomized, controlled trial.

Setting: A tertiary referral medical center involving an intensive care unit.

Pericardial effusion after cardiac surgery: risk factors, patient profiles, and contemporary management.

Background: We aimed to review recent experience at our institution in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.

Methods: We searched our clinical database for patients 18 years or older who had cardiac surgery with cardiopulmonary bypass from 1993 through 2005. For patients with pericardial effusion (study group), medical records were reviewed to evaluate its manifestations and management.

Prosthetic valve endocarditis: clinicopathological correlates in 122 surgical specimens from 116 patients (1985-2004).

Background: Few studies have documented the clinicopathological features of prosthetic valve endocarditis independently of native valve endocarditis.

Study Design: Retrospective analysis of patients undergoing cardiac surgery for prosthetic valve endocarditis at our institution (1985-2004).

Methods: Medical records and microscopic slides were reviewed from 116 patients for demographics, infecting organisms, comorbidities, and pathologic features.

Management of mild aortic stenosis at the time of coronary artery bypass surgery: should the valve be replaced?

Background: General consensus favors aortic valve replacement (AVR) for patients with moderate aortic stenosis (AS) undergoing coronary artery bypass graft surgery (CABG); however, the management of similar patients with mild AS is controversial. We therefore investigated such patients to determine incremental risk of concomitant AVR, progression of AS among those undergoing CABG alone, and operative risk of AVR after prior CABG.

Methods: Between January 1993 and December 2003, 316 consecutive patients with mild AS (mean gradient >15, <30 mm Hg) underwent CABG only (107) or CABG plus AVR (209).

Safety and durability of mitral valve repair for anterior leaflet perforation.

Objective: We sought to evaluate mitral valve repair for anterior leaflet perforation.

Methods: Between October 1987 and October 2006, 26 patients with mitral valve anterior leaflet perforation underwent mitral valve repair (median age, 54 years; 18 [69%] were male).

Results: The indication for operation was severe mitral regurgitation only in 14 patients, both aortic regurgitation and mitral regurgitation in 11, and ventricular septal defect repair in 1.

Concomitant surgery for renal neoplasm with pulmonary tumor embolism.

Objective: Gross tumor pulmonary embolism from renal carcinoma is rarely diagnosed preoperatively. Individual cases of intraoperative embolization of tumor during radical resection of the kidney have been reported. We report on 9 patients who underwent pulmonary arterial tumor removal concomitant with nephrectomy.

Results of mitral valve annuloplasty with a standard-sized posterior band: is measuring important?

Objective: This study was undertaken to determine hemodynamic and clinical outcomes of annuloplasty with a standard-sized (63 mm) posterior band in adult patients undergoing mitral valve repair for degenerative valve disease.

Methods: We studied 511 patients who underwent isolated mitral valve repair for degenerative disease with a 63-mm posterior band used for annuloplasty. Operations were performed between 1994 and 2001, and average follow-up was 4.

Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse.

Objective: Recovery of ventricular function after surgical correction of mitral regurgitation is often incomplete. We studied clinical and echocardiographic factors influencing return of normal left ventricular ejection fraction after mitral valve repair or replacement for mitral regurgitation caused by leaflet prolapse.

Methods: We evaluated 1063 patients who had mitral valve repair or replacement between January 1, 1980, and December 31, 2000.

Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic valve regurgitation.

Background: Indications for valve replacement in patients with aortic regurgitation include diminished ejection fraction and increased left ventricular dimensions. Our objective was to examine the effect of preoperative ejection fraction and left ventricular dimensions on survival and return of normal systolic function (ejection fraction > or = 0.50) after valve replacement for aortic regurgitation.

Survival and reoperation risk following bicuspid aortic valve-sparing root replacement.

Background And Aim Of The Study: The mid-term outcome of aortic valve-sparing root replacement, reimplanting native bicuspid versus tricuspid aortic valves, is unclear.

Methods: The records of 84 consecutive patients (66 men, 18 women; mean age 46.6 years) who had undergone aortic valve-sparing root replacement using the reimplantation technique between January 1997 and July 2006, were reviewed.

Management of moderate functional mitral regurgitation at the time of aortic valve replacement: is concomitant mitral valve repair necessary?

Objective: The optimal management of moderate functional mitral regurgitation at the time of aortic valve replacement remains undefined.

Methods: We retrospectively identified 686 consecutive patients undergoing aortic valve replacement between 1993 and 2006 with at least moderate (grade 2 or more) functional mitral regurgitation. Patients with structural valve abnormalities or significant coronary artery disease were excluded, leaving 190 in the study.

Embolic potential of cardiac tumors and outcome after resection: a case-control study.

Background And Purpose: Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients.

Methods: From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.

Survival after resection of primary cardiac tumors: a 48-year experience.

Background: Primary cardiac tumors are rare but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. To date, however, there have been no studies examining survival characteristics of patients who undergo surgical resection.

Methods And Results: From 1957 to 2006, 323 consecutive patients underwent surgical resection of primary cardiac tumors; 163 (50%) with myxomas, 83 (26%) with papillary fibroelastomas, 18 (6%) with fibromas, 12 (4%) with lipomas, 28 (9%) with other benign primary cardiac tumors, and 19 (6%) with primary malignant tumors.

Is the European System for Cardiac Operative Risk Evaluation model valid for estimating the operative risk of patients considered for percutaneous aortic valve replacement?

Objective: The European System for Cardiac Operative Risk Evaluation has been used to define a particularly high-risk group of patients for aortic valve replacement in whom alternative procedures, such as stent-mounted percutaneous valve procedures, may be appropriate. Our objective was to assess the validity of this risk assessment at a large-volume, tertiary cardiac surgical center.

Methods: From January 1, 2000, to December 30, 2006, a total of 1177 patients underwent isolated aortic valve replacement at the Mayo Clinic.

Improving results of open arch replacement.

Background: The rapid evolution of endovascular approaches to arch reconstruction such as brachiocephalic debranching and endovascular stent grafting renders an accurate understanding of contemporary outcomes of conventional open arch surgery particularly relevant.

Methods: Cases of arch reconstruction were identified by search of the computerized cardiovascular surgical database. Perioperative (30-day) outcomes as per The Society of Thoracic Surgeons database were evaluated.

Determinants of early decline in ejection fraction after surgical correction of mitral regurgitation.

Objective: We sought to echocardiographically examine the early changes in left ventricular size and function after mitral valve repair or replacement for mitral regurgitation caused by leaflet prolapse.

Methods: Preoperative and early postoperative echocardiograms of 861 patients with mitral regurgitation caused by leaflet prolapse who underwent mitral valve repair or replacement (with or without coronary revascularization) were studied. Among the patients, 625 (73%) were men and 779 (90%) had mitral valve repair.

Mitral regurgitation surgery in heart failure due to ischemic cardiomyopathy: a 24-year experience.

Background And Aim Of The Study: The long-term benefits of mitral regurgitation (MR) surgery in ischemic cardiomyopathy (ICM) are controversial. Herein are reported the results and trends of this surgical approach over the past 24-year period.

Methods: Patients were identified in refractory heart failure due to ICM with NYHA functional class III/IV symptoms, left ventricular ejection fraction < or =35% and MR who underwent mitral surgery between 1979 and 2002.

Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery.

Background: Tricuspid regurgitation (TR) is common in patients undergoing mitral valve surgery, and atrial fibrillation (AF) can cause progression of TR. This study examined the hypothesis that correction of AF with the Maze procedure can prevent the late progression of TR after mitral valve surgery.

Methods: We compared severity of TR in 33 patients (January 1, 1993, to January 1, 2003) who underwent concomitant Maze procedure plus mitral valve surgery and converted to normal sinus rhythm postoperatively with case-matched control patients who underwent mitral valve surgery alone and remained in AF postoperative.

Analysis of benign ventricular tumors: long-term outcome after resection.

Objective: We sought to compare clinical and pathologic characteristics of ventricular tumors and to detect whether differences exist in short- and long-term survival after resection.

Methods: From 1964 to 2005, 323 patients had cardiac surgery for resection of primary cardiac tumors; 53 (16%) patients had primary ventricular tumors. We randomly sampled 53 characteristics of ventricular tumors.

Neuronal ceroid lipofuscinosis in a 31-year-old woman presenting as biventricular heart failure with restrictive features.

A 31-year-old woman presented with dyspnea and left-sided chest discomfort and was found to have biventricular heart failure with impaired ventricular filling. Clinically, she was thought to have restrictive cardiomyopathy or constrictive pericarditis. Transmission electron microscopy of myocardial tissue unexpectedly revealed crosshatched, curvilinear, and fingerprint depositions, which were characteristic for neuronal ceroid lipofuscinosis.

Aortic valve replacement in patients aged 50 to 70 years: improved outcome with mechanical versus biologic prostheses.

Objective: Improved durability of bioprostheses has led some surgeons to recommend biologic rather than mechanical prostheses for patients younger than 65 years. We compared late results of contemporary bioprostheses and bileaflet mechanical prostheses in patients who underwent aortic valve replacement between 50 and 70 years old.

Methods: In this retrospective study, patients received either St Jude bileaflet valves or Carpentier-Edwards bioprostheses.

Surgical management, complications, and outcome of radical nephrectomy with inferior vena cava tumor thrombectomy facilitated by vascular bypass.

Objectives: To describe the technique, complications, and outcomes of vascular bypass during radical nephrectomy and tumor thrombectomy for patients with renal cell carcinoma and venous tumor thrombus. The indications and results for venovenous bypass (VVB) versus cardiopulmonary bypass (CPB) were reviewed as well.

Methods: We identified 41 patients who had undergone radical nephrectomy and thrombectomy requiring VVB (n = 13) or CPB (n = 28) at our institution from 1970 to 2005 for renal cell carcinoma with venous tumor thrombus.