Surgical mitral plasticity for chronic ischemic mitral regurgitation.

Background And Aim Of The Study: The outcome of mitral valve (MV) repair for chronic ischemic mitral regurgitation (IMR) is suboptimal, due to the high recurrence rate of moderate or severe mitral regurgitation (MR) during follow-up. The MV adapts to new MR increasing its area to cover the enlarged annular area (mitral plasticity). As this process is often incomplete, we aimed to evaluate if augmenting the anterior leaflet (AL) and cutting the second-order chords (CC) together with restrictive mitral annuloplasty, a strategy we call "surgical mitral plasticity," could improve the midterm results of MV repair for IMR.

Aortic stenosis and aortic regurgitation express different titin isoforms: Differences and relationships with functional and geometric characteristics.

Background-Titin represents an important biomechanical sensor which determines compliance and diastolic/systolic function of the left ventricle (LV). To assess the different titin-isoform expression and the relationships with functional and geometric patterns, we analyzed titin-isoform expression and cardiomyocytes contractile function in myocardial biopsy samples of patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS) and for aortic regurgitation (AR). Method -Specimens, collected from the LV of 35 with AS and 35 with AR undergoing AVR were analyzed for titin-isoform expression and cardiomyocytes force measurement.

Individualized strategy for clopidogrel suspension in patients undergoing off-pump coronary surgery for acute coronary syndrome: a case-control study.

Objective: An increasing number of patients presenting for urgent coronary surgery have been exposed to clopidogrel, which constitutes a risk of bleeding and related events. Based on the wide variability in clopidogrel response and platelet function recovery after cessation, we evaluated the role of point-of-care platelet function testing to define the optimal time for off-pump coronary artery bypass graft (CABG) surgery in a case-control study.

Methods: Three equally matched groups (300 patients in total) undergoing isolated off-pump CABG for acute coronary syndrome were compared.

B-type natriuretic peptide as a biochemical marker of left ventricular diastolic function: assessment in asymptomatic patients 1 year after valve replacement for aortic stenosis.

OBJECTIVES Left ventricular (LV) diastolic dysfunction after aortic valve replacement (AVR) carries a substantial risk of development of heart failure and reduced survival. In addition to echocardiography, B-type natriuretic peptide (BNP) provides a powerful incremental assessment of diastolic function. This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction.

Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery: results from the CRYSSA (prevention of Coronary arteRY bypaSS occlusion After off-pump procedures) randomised study.

Objective: To determine the individual variability in the response to aspirin and/or clopidogrel and its impact on graft patency after off-pump coronary artery bypass grafting.

Design: A single-centre prospective randomised controlled study designed according to the Consolidated Standards of Reporting Trials statement. Randomisation was obtained by a computer-generated algorithm.

Endothelial nitric oxide synthase expression in postmenopausal women: a sex-specific risk factor in coronary surgery.

Background: After coronary artery bypass graft surgery, older women have less favorable clinical outcome and lower conduit patency compared with men. This less favorable outcome can be in part ascribed to impaired endothelium-derived nitric oxide (eNOS) production. This study evaluated endothelial nitric oxide synthase expression in internal mammary artery from postmenopausal women undergoing coronary artery bypass graft surgery.

Previous percutaneous coronary interventions increase mortality and morbidity after coronary surgery.

Background: This multicenter study investigated the impact of previous percutaneous coronary interventions (PCI) on postoperative outcome and 5-year survival of subsequent coronary artery bypass grafting.

Methods: Among 7,855 patients who underwent isolated first-time coronary artery bypass grafting between January 2000 and December 2005, 6,834 (87%) had no previous PCI and 1,021 (13%) had previous PCI with stenting. Logistic multiple regression and propensity score analyses were used to assess the risk-adjusted impact of prior PCI on in-hospital mortality and major adverse cardiac events.

Preoperative intraaortic balloon pump for off-pump coronary arterial revascularization.

Background: Prophylactic intraaortic balloon pump (IABP) support showed better outcomes in critical patients undergoing coronary revascularization compared with intraoperative or postoperative insertion. We conducted a prospective, randomized study to determine the optimal timing for preoperative IABP insertion in high-risk patients undergoing off-pump coronary artery revascularization.

Methods: The study enrolled 230 consecutive high-risk patients (having a logistic European System for Cardiac Operative Risk Evaluation score of ≥10) undergoing off-pump coronary artery revascularization.

Serial evaluation of flow in single or arterial Y-grafts to the left coronary artery.

Background: It is unclear whether composite Y-grafts can withstand the flow demand of the coronary system at rest and under stress. This study compared the graft flow and flow reserve of the left internal mammary artery (LIMA) intraoperatively and over a 2-year follow-up in single or composite Y-graft configurations using the radial artery (RA).

Methods: One hundred patients who underwent off-pump myocardial revascularization with a composite Y-graft (group 2) were compared with a homogeneous group of 100 patients treated with a single independent LIMA graft on the left anterior descending artery (LAD) (group 1).

Coronary perfusion: impact of flow dynamics and geometric design of 2 different aortic prostheses of similar size.

Background: Aortic valve replacement leads to improvement of coronary flow but not to complete normalization. Coronary hypoperfusion contributes to higher left ventricular mass persistence, arrhythmias, congestive heart failure and sudden death. This prospective study compares 2 similarly sized aortic prostheses (mechanical and porcine) regarding coronary flow and hemodynamic performances in patients who underwent surgery for pure aortic stenosis.

Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch.

Objective: This study evaluated the impact of patient-prosthesis mismatch on myocardial function and high-energy phosphate metabolism after aortic valve replacement for pure aortic stenosis. Patients with and without patient-prosthesis mismatch were compared using magnetic resonance techniques.

Methods: Thirty patients who had undergone aortic valve replacement with Medtronic Mosaic bioprosthesis were evaluated.

Randomized flow capacity comparison of skeletonized and pedicled left internal mammary artery.

Background: The preferential harvesting technique of the internal mammary artery has been periodically debated. This randomized study evaluated the flow outcome of the skeletonized versus pedicled left internal mammary artery.

Methods: Two hundred patients undergoing surgery for left anterior descending coronary artery revascularization were enrolled and randomized to pedicled (n=100) or skeletonized (n=100) harvesting.

The association of acute aortic dissection with Helicobacter pylori virulence specific serotypes: Distinct diversity of systemic antibodies to CagA and VacA genotypes.

Background: Previous studies reported an association between chronic Helicobacter pylori infection and cardiovascular disease; however, controversy still exists regarding the presence of bacterial genomic material in atherosclerotic plaques. Currently, the genetic polymorphisms of H. pylori have been investigated and many virulence factors have been identified.

Influence of prosthesis-patient mismatch on exercise-induced arrhythmias: a further aspect after aortic valve replacement.

Objectives: The influence of prosthesis-patient mismatch on outcome after aortic valve replacement is controversial. This study analyzed the impact of prosthesis-patient mismatch on survival, the extent of left ventricular mass, and physical capacity after replacement with a small-size prosthesis.

Patients And Methods: A total of 157 patients who underwent valve replacement for pure aortic stenosis were reviewed.

Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial.

Objective: Myocardial disease without evidence of myocardial infarction is a frequent complication after cardiac surgery during cardiopulmonary bypass. Statins might be protective, but their efficacy has not been established in randomized trials.

Methods: Two hundred patients undergoing coronary surgery were enrolled.

Impact of blood coagulation and fibrinolytic system changes on early and mid term clinical outcome in patients undergoing stent endografting surgery.

Objectives: Blood coagulation and fibrinolytic system changes after endovascular repair (EVAR) of aortic pathologies are of great interest. We have examined the risk for consumption coagulopathy and its clinical implications early, and at a mid-term follow-up, in a prospective study.

Methods: From June 2002 to June 2004, 41 patients for abdominal aortic aneurysm (AAA), 16 for thoracic aortic aneurysm (TAA) and 13 for acute type-B dissection underwent EVAR.

A single-stage procedure for carotid endarterectomy and myocardial revascularization: early and late results.

Cardiac events are some of the most frequent postoperative complications of carotid endarterectomy, while cerebrovascular accidents frequently occur in patients who have undergone coronary artery bypass grafting. The strategy for treatment of combined carotid and coronary artery disease is still controversial. We report our experience with a single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass; then we evaluate our early and late results.

Elevated myocardial and lymphocyte GRK2 expression and activity in human heart failure.

Aims: The G protein-coupled receptor kinase-2 (GRK2 or beta-ARK1) regulates beta-adrenergic receptors (beta-ARs) in the heart, and its cardiac expression is elevated in human heart failure (HF). We sought to determine whether myocardial levels and activity of GRK2 could be monitored using white blood cells, which have been used to study cardiac beta-ARs. Moreover, we were interested in determining whether GRK2 levels in myocardium and lymphocytes may be associated with beta-AR dysfunction and HF severity.

Right luxation of the heart after pericardial rupture caused by blunt trauma.

Rupture of the pericardium with luxation of the heart after blunt trauma is a fairly rare condition but carries a high mortality rate. In this report, we describe our experience with a case of right luxation of the heart in a young patient with multiple injuries due to an automobile accident. The patient, who was in hemodynamic failure, underwent successful emergency surgical treatment to replace the heart in its anatomic site.