EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coronary artery bypass patients.

Background And Aim Of The Study: European system for cardiac operative risk evaluation (EuroSCORE) has been studied for its effectiveness in predicting operative mortality, and more recently, long-term mortality in a wide variety of cardiac surgical procedures. Combined coronary artery bypass and aortic valve replacement (AVR-CABG) carries increased perioperative risk, and tends to have higher-risk patients. Performance of the EuroSCORE system in patients undergoing concomitant AVR-CABG has not been well established.

The first open-heart repairs using extracorporeal circulation by cross-circulation: a 53-year follow-up.

Between March 26, 1954 and July 19, 1955, C. Walton Lillehei and colleagues operated upon 45 infants and children with previously uncorrectable cardiac anomalies using cross-circulation with a human donor. Late follow-up was obtained in all of the 28 patients discharged after the operation.

Alpha II-spectrin breakdown products serve as novel markers of brain injury severity in a canine model of hypothermic circulatory arrest.

Background: The development of specific biomarkers to aid in the diagnosis and prognosis of neuronal injury is of paramount importance in cardiac surgery. Alpha II-spectrin is a structural protein abundant in neurons of the central nervous system and cleaved into signature fragments by proteases involved in necrotic and apoptotic cell death. We measured cerebrospinal fluid alpha II-spectrin breakdown products (alphaII-SBDPs) in a canine model of hypothermic circulatory arrest (HCA) and cardiopulmonary bypass.

Inspiring medical students to pursue surgical careers: outcomes from our cardiothoracic surgery research program.

Background: The past several years have witnessed a dramatic decline in the number of general surgery residents pursuing cardiothoracic surgery residency training. We believe that attracting individuals to pursue surgical careers should begin during the formative years of medical education. We implemented a program to introduce first-year medical students to cardiothoracic surgery and laboratory research.

Aortic root replacement in 372 Marfan patients: evolution of operative repair over 30 years.

Background: We reviewed the evolution of practice and late results of aortic root replacement (ARR) in Marfan syndrome patients at our institution.

Methods: A retrospective clinical review of Marfan patients undergoing ARR at our institution was performed. Follow-up data were obtained from hospital and office records and from telephone contact with patients or their physicians.

Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures.

Background: We compared results of the Bentall procedure with valve-sparing aortic root replacement (VSRR) for aortic root aneurysm in Marfan syndrome.

Methods: Marfan syndrome patients who had the Bentall procedure or VSRR at our institution between April 1997 and September 2006 were identified. Follow-up information was obtained from hospital charts and contact with patients or their physicians.

Two thousand Blalock-Taussig shunts: a six-decade experience.

Background: The Blalock-Taussig shunt (BTS) remains valuable for palliation of congenital heart disease, but its role has evolved. We reviewed our total institutional experience with BTS to examine changes in its use and outcomes.

Methods: A retrospective review was performed of all patients undergoing BTS at our institution from November 1944 to May 2006.

Aortic valve replacement and concomitant coronary artery bypass: assessing the impact of multiple grafts.

Background: The impact of multivessel coronary artery disease and multivessel coronary artery bypass grafting on outcomes after combined aortic valve replacement and coronary artery bypass grafting (AVR-CABG) has not been sufficiently evaluated.

Methods: We retrospectively reviewed all patients who underwent AVR-CABG at our institution between January 2000 and December 2004. Patients with any previous or concomitant procedures were excluded.

Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease.

Background: Loeys-Dietz syndrome (LDS) is a recently described genetic aortic aneurysm syndrome resulting from mutations in receptors for the cytokine transforming growth factor-beta. Phenotypic features include a bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity, but risk of thoracic aortic rupture and dissection is the principle focus of management and exceeds that of most known connective tissue disorders. Our surgical experience with LDS was reviewed to assess outcomes and develop guidelines for management of this aggressive disease.

Critical role of physiologist John A. Johnson in the origins of Minnesota's billion dollar pacemaker industry.

Complete heart block developed in more than 10% of C. Walton Lillehei's early patients undergoing closure of ventricular septal defects, and hospital mortality was 100% in this group of patients. This problem of early fatality from heart block was completely eliminated with the use of a myocardial electrode in combination with an external plug-in electric stimulator.

Clinical outcomes of noninfectious sternal dehiscence after median sternotomy.

Background: Infectious complications of median sternotomy carry significant morbidity and mortality. However, the outcomes of noninfectious sternal dehiscence have not been addressed. We have identified the preoperative characteristics, postoperative complications, and long-term functional outcomes of patients after reoperation for noninfectious sternal dehiscence and compared these patients with a control group to determine risk factors for dehiscence.

Valve-sparing aortic root replacement: early experience with the De Paulis Valsalva graft in 51 patients.

Background: Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress.

Methods: Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft.

Valproic acid prevents brain injury in a canine model of hypothermic circulatory arrest: a promising new approach to neuroprotection during cardiac surgery.

Background: The anticonvulsant valproic acid (sodium valproate, Depacon) acts as a neuroprotectant in rodents, but has never been tested in larger animals. We used valproate in our canine model of hypothermic circulatory arrest to evaluate its neuroprotective benefit in complex cardiac surgical cases.

Methods: Thirteen dogs pretreated with valproate before 2 hours of hypothermic circulatory arrest survived for 24 hours (n = 7) or 72 hours (n = 6).

Noninvasive assessment of brain injury in a canine model of hypothermic circulatory arrest using magnetic resonance spectroscopy.

Background: Studies have confirmed the neuroprotective effect of diazoxide in canines undergoing hypothermic circulatory arrest (HCA). A decreased N-acetyl-asparate:choline (NAA:Cho) ratio is believed to reflect the severity of neurologic injury. We demonstrated that noninvasive measurement of NAA:Cho with magnetic resonance spectroscopy facilitates assessment of neuronal injury after HCA and allows for evaluation of neuroprotective strategies.

Early experience with valve-sparing aortic root replacement in children.

Background: Aortic valve-sparing root replacement has become an established treatment for adults with aneurysms of the ascending aorta, but there is limited experience in children, for whom the advantages of avoiding valve prostheses are particularly attractive.

Methods: A retrospective clinical study was undertaken to examine results of aortic valve-sparing operations in pediatric patients at a single institution. Clinical and echocardiographic data were obtained from chart review and outpatient follow-up examination.

Aortic valve replacement and concomitant mitral valve regurgitation in the elderly: impact on survival and functional outcome.

Background: The impact of mitral regurgitation (MR) on elderly patients (> or = 70 years) undergoing isolated aortic valve replacement (AVR) is not clearly defined. This study investigates the long-term effects of preoperative, moderate MR on survival and functional outcome in elderly AVR patients.

Methods And Results: A retrospective review identified 408 consecutive elderly patients who underwent isolated AVR from January 1983 to February 2004.

Lillehei, Lewis, and Wangensteen: the right mix for giant achievements in cardiac surgery.

The dawn of open-heart surgery occurred at the University of Minnesota on September 2, 1952, when Dr John Lewis and his surgical team closed an atrial septal defect using total-body hypothermia and inflow stasis. Eighteen months later on March 26, 1954, Dr C. Walton Lillehei and his surgical team used a parent as a biologic oxygenator to repair a ventricular septal defect in a 1-year-old boy.

A 32-year experience with surgical repair of sinus of valsalva aneurysms.

Introduction: Sinus of Valsalva (SoV) aneurysms are rare (0.15% to 1.5% CPB cases) and five times more frequent in Asians.

Determining the utility of temporary pacing wires after coronary artery bypass surgery.

Background: Temporary epicardial pacing wires are used routinely after coronary artery bypass graft (CABG) surgery and can cause rare, catastrophic complications. This study's purpose was to identify patient characteristics predicting the need for pacing after CABG surgery with the potential to limit their utilization.

Methods: This prospective observational study involved 290 consecutive patients undergoing CABG at our institution from August 2000 to January 2001.

Results of aortic valve-sparing operations: experience with remodeling and reimplantation procedures in 65 patients.

Background: Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes.

Methods: A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians.

Application of haptic feedback to robotic surgery.

Robotic surgical systems have greatly contributed to the advancement of minimally invasive endoscopic surgery. However, current robotic systems do not provide tactile or haptic feedback to the operating surgeon. Under certain circumstances, particularly with the manipulation of delicate tissues and suture materials, this may prove to be a significant irritation.