Persistent reduction of mitral regurgitation by implantation of a transannular mitral bridge: durability and effectiveness of the repair at 2 years-results of a prospective trial†.

Objectives: Ring annuloplasty reduces the septal-lateral diameter (SLD) indirectly by circumferential annular cinching and frequently results in the recurrence of mitral regurgitation (MR) in patients with functional MR (FMR). Our goal was to report the results from the trial and the 2-year post-trial surveillance data. We evaluated whether direct reduction of the SLD with a transannular mitral bridge could achieve significant and durable MR reduction in patients with FMR.

Does dual antiplatelet therapy affect blood loss and transfusion requirements in robotic-assisted coronary artery surgery?

Objective: Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting.

A step toward nonrobotic total endoscopic coronary bypass grafting: 40 coronary anastomoses in a biomechanical beating heart model.

Objective: Nonrobotic total endoscopic coronary bypass grafting is commonly considered as technically too difficult. After endoscopic practicing in a simple box model, we questioned this statement in a more sophisticated training model.

Methods: In a handmade chest model containing a mechanically actuated porcine heart, anastomoses between homologous vein and shunted anterior coronary artery were performed using Prolene 7-0 sutures or U-clips in 20 anastomoses each.

Does body mass index affect outcomes in robotic-assisted coronary artery bypass procedures?

Objective: Obese patients pose unique technical challenges for minimal-access cardiac surgery. We sought to examine the effect of body mass index on short-term outcomes in robotic-assisted coronary surgery.

Methods: From January 2010 to November 2011, a total of 110 consecutive patients underwent robotic-assisted coronary surgery at our institution.

Increasing surgical experience with off-pump coronary surgery does not mitigate the morbidity of emergency conversion to cardiopulmonary bypass.

Objective: Emergency conversion during off-pump coronary artery bypass (OPCAB) confers significant morbidity. We sought to determine whether the outcomes in these patients have changed as our experience with off-pump techniques has increased.

Methods: Between January 1999 and December 2010, 4763 patients underwent coronary artery surgery.

Hybrid minimally invasive extraction of atrial clot avoids redo sternotomy in Jehovah's Witness.

We report the novel use of the AngioVac device in a percutaneous hybrid approach to remove a large right atrial clot as an effective and potentially lifesaving alternative to a very high-risk redo-sternotomy in a Jehovah's Witness patient.

Triple left ventricular outflow tract obstruction.

A 59-year-old man had, over a period of 5 years, three different clinical scenarios which led to dynamic left ventricular outflow tract obstruction (LVOTO). Initially, this man who suffered from hypertrophic cardiomyopathy presented with asymmetric septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral leaflet, along with mitral regurgitation. He was treated by septal myectomy and mitral valve repair with insertion of an artificial mitral ring.

Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve).

Objective: Functional ischemic mitral regurgitation is a complication of ventricular remodeling; standard therapy is reduction annuloplasty and coronary artery bypass grafting. Unfortunately, outcomes are retrospective and contradictory. We report a multicenter study that documents the outcomes of reduction annuloplasty for functional ischemic mitral regurgitation.

Outcomes of the RESTOR-MV Trial (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve).

Objectives: we sought to determine whether patients with functional mitral regurgitation (FMR) would benefit from ventricular reshaping by the Coapsys device (Myocor, Inc., Maple Grove, Minnesota).

Background: FMR occurs when ventricular remodeling impairs valve function.

Long-Term Survival After Minimal Invasive Direct Coronary Artery Bypass (MIDCAB) Surgery in Patients With Low Ejection Fraction.

Objective: : The long-term survival after minimal invasive direct coronary artery bypass (MIDCAB) surgery to any coronary territory in patients with ejection fraction of ≤30% was investigated for the first time in literature.

Methods: : Seventy-three patients with primary MIDCAB and 89 patients with reoperative MIDCAB were studied including preoperative risk factors, operative details, early postoperative complications, and survival up to 10 years postoperatively.

Results: : Despite the high-risk profile of the patients, the MIDCAB approach for targeted revascularization resulted in excellent short-term results.

Off-pump Coronary Bypass Surgery in Patients With Low Ejection Fraction: Is There a Long-Term Survival Advantage?

Objective: : Long-term survival after off-pump surgery in patients with low ejection fraction was investigated.

Methods: : Three hundred forty-six patients with ejection fraction 30% or less with isolated off-pump coronary artery bypass surgery (OPCAB) were compared with a propensity matched historical group operated on-pump (ONCAB) and with data from literature after percutaneous coronary intervention and OPCAB surgery.

Results: : The lower invasiveness of OPCAB contributed to a significantly better 30-day survival, shorter postoperative length of stay, and fewer in-hospital complications.

Minimally invasive direct coronary artery bypass as a primary strategy for reoperative myocardial revascularization.

Objective: : Conventional reoperative coronary artery bypass grafting is associated with risk of sternal re-entry, injury to patent grafts, and embolization from diseased grafts. Sternal sparing minimally invasive direct coronary artery bypass (MIDCAB) avoids such risks in cases where it is technically feasible. We sought to examine in-hospital outcomes of reoperative MIDCAB surgery.

Non-typhoid Salmonellae and prosthetic valve endocarditis: more than a rare coincidence? A review of the literature.

Non-typhoid Salmonellae (NTS) commonly cause gastroenteritis but are rarely found pathogens in prosthetic heart valve endocarditis. The details of two patients from the authors' institution and 15 published cases are reviewed in terms of their risk factors, clinical findings and outcomes. Only two of eight patients with paravalvular leakage or abscess--the most serious local complications--survived, both with surgery.

Evaluation of the PAS-Port Proximal Anastomosis System in coronary artery bypass surgery (the EPIC trial).

Objective: During coronary surgery, proximal vein graft anastomoses have been performed by using an aortic partial occlusion clamp to allow for a hand-sewn anastomosis. The purpose of this multicenter, prospective, randomized trial was to evaluate the efficacy of the PAS-Port device (Cardica, Inc, Redwood City, Calif), which allows an automated proximal anastomosis to be performed without aortic clamping.

Methods: Between June 22, 2006, and March 22, 2007, 220 patients requiring coronary artery bypass grafting with at least 2 vein grafts were enrolled.

Less invasive intracardiac surgery performed without aortic clamping.

Background: Aortic clamping and cardioplegia delivery add complexity to performing intracardiac procedures through a right minithoracotomy. Recent publications have shown excellent patient outcomes after mitral valve (MV) procedures undertaken through thoracotomy on the fibrillating heart. We reviewed our experience with this approach.

Minimally invasive coronary artery bypass grafting.

Limited access, off-pump coronary artery bypass grafting for revascularization of all the various coronary arteries is an acceptable alternative to standard on-pump coronary bypass grafting through sternotomy. A variety of small, targeted incisions are used to approach various coronary locations. Technical advances in conduit harvesting, stabilization, cardiac positioning devices, and anastomotic connectors have made these procedures more standardized and replicable.

Robotic assisted multivessel minimally invasive direct coronary artery bypass with port-access stabilization and cardiac positioning: paving the way for outpatient coronary surgery?

Background: Minimimal access multivessel coronary artery bypass grafting with same day hospital discharge remains the ultimate goal. We evaluated the feasibility for achieving multivessel coronary bypass through minimal access.

Methods: From January to July 2003, 30 patients under went off-pump minimally invasive multivessel coronary bypass.

Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality.

Objective: We sought to evaluate outcomes and predictors of emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery.

Methods: From January 1999 through July 2002, 1678 consecutive isolated coronary artery bypass operations were performed at Lenox Hill Hospital, with the intention to treat all patients with off-pump coronary bypass surgery. Fifty (2.

Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk?

Background: Restriction of volume-based referral for CABG surgery to high-risk patients has been suggested, and earlier studies have reached different conclusions regarding volume-based referral for low-risk patients.

Methods And Results: Patients who underwent isolated CABG surgery in New York from 1997 through 1999 (n=57 150) were separated into low-risk and moderate-to-high-risk groups with a predicted probability of in-hospital death of 2% as the cutoff point. The provider volume-mortality relationship was examined for both groups.

First robotic endoscopic epicardial isolation of the pulmonary veins with microwave energy in a patient in chronic atrial fibrillation.

The pulmonary veins have been demonstrated to play an important role in generating atrial fibrillation. We report the first successful endoscopic epicardial isolation of the pulmonary veins in a patient with permanent atrial fibrillation, along with a 1-year follow-up. The procedure consisted of making a conduction block around the pulmonary veins with a flexible microwave energy delivery probe.

Sternal wound reconstruction: 252 consecutive cases. The Lenox Hill experience.

The authors report on a personal experience of 252 consecutive secondary sternal wound closures resulting from a series of 11,601 median sternotomies at a single institution performed over a 14-year period. Protocols for treatment are described from the time of initial consultation with the plastic surgeon through the period of postoperative care. The patients and wounds were diverse and complex, with each factor requiring careful analysis before a treatment course was selected.

A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy.

Objectives: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk.

Background: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small.

Methods: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9135 patients) and on-pump CABG surgery (59044 patients) with median sternotomy from 1997 to 2000 in the state of New York.

Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease.

Background: Coronary artery bypass grafting can now be performed with or without cardiopulmonary bypass. Our objective was to determine whether off-pump coronary artery bypass grafting is associated with better early outcomes compared with conventional coronary artery bypass grafting.

Methods: In 4 centers with off-pump coronary surgery experience, a retrospective analysis of all coronary artery bypass grafting in a 3-year period was performed.