Role of mitral valve plication in the surgical management of hypertrophic cardiomyopathy.

Background: We have previously reported our 3-step repair for obstructive hypertrophic cardiomyopathy (HCM) consisting of resection of the septum, horizontal plication of the anterior mitral leaflet (AML), and release of abnormal papillary muscle attachments. This article reviews our complete experience with surgical management of HCM to better understand the role and relevance of mitral plication.

Methods: From 1997 to 2011, 132 patients with HCM underwent surgical treatment at our institution.

Anesthesia management of patients with hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy presents a challenge to the anesthesiologist. Because the condition is relatively prevalent, it is important for anesthesiologist to be aware of the pathophysiology. In this review, we draw upon case reports and studies of the anesthesia management of patients with hypertrophic obstructive cardiomyopathy to enhance medical decision making.

Lack of effectiveness of the pulmonary artery catheter in cardiac surgery.

Background: The pulmonary artery catheter (PAC) continues to be used for monitoring of hemodynamics in patients undergoing coronary artery bypass graft (CABG) surgery despite concerns raised in other settings regarding both effectiveness and safety. Given the relative paucity of data regarding its use in CABG patients, and given entrenched practice patterns, we assessed the impact of PAC use on fatal and nonfatal CABG outcomes as practiced at a diverse set of medical centers.

Methods: Using a formal prospective observational study design, 5065 CABG patients from 70 centers were enrolled between November 1996 and June 2000 using a systemic sampling protocol.

Resection-plication-release for hypertrophic cardiomyopathy: clinical and echocardiographic follow-up.

Background: Abnormal positioning and size of the mitral valve contribute to the systolic anterior motion and mitral-septal contact that are important components of obstructive hypertrophic cardiomyopathy (HCM). The RPR repair (resection of the septum, plication of the anterior leaflet, and release of papillary muscle attachments) addresses all aspects of this complex pathology. This study reports outcomes regarding effectiveness of the RPR repair.

Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery.

Context: Acute safety concerns have been raised recently regarding certain hemorrhage-sparing medications commonly used in cardiac surgery. However, no comprehensive data exist regarding their associations with long-term mortality.

Objective: To contrast long-term all-cause mortality in patients undergoing coronary artery bypass graft (CABG) surgery according to use of 2 lysine analog antifibrinolytics (aminocaproic acid and tranexamic acid), the serine protease inhibitor aprotinin, or no antibleeding agent.

Beyond extended myectomy for hypertrophic cardiomyopathy: the resection-plication-release (RPR) repair.

Background: Extended myectomy for left ventricular outflow tract obstruction (LVOTO) due to hypertrophic cardiomyopathy (HCM) has good long-term results. In addition to the midseptal resection (R) for HCM, our group has introduced a novel variation in anterior leaflet plication (P) and release (R) of papillary muscle attachments. We sought to investigate the medium-term success of this three-step repair that addresses all aspects of complex HCM pathology.

Robotically assisted left ventricular epicardial lead implantation for biventricular pacing.

Objectives: Ventricular resynchronization might be achieved in a minimally invasive fashion using a robotically assisted, direct left ventricular (LV) epicardial approach.

Background: Approximately 10% of patients undergoing biventricular pacemaker insertion have a failure of coronary sinus (CS) cannulation. Rescue therapy for these patients currently is limited to standard open surgical techniques.