Mind injuries after cardiac surgery.

After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage.

Short-term follow up with the 3f Enable aortic bioprosthesis: clinical and echocardiographic results.

Background And Aim Of The Study: High-risk patients referred for aortic valve replacement (AVR) may benefit from sutureless technology in order to reduce mortality and morbidity. Herein is described the authors' initial experience and short-term results of the sutureless 3f Enable aortic bioprosthesis.

Methods: A total of 28 patients (19 females, nine males; mean age 76.

Perceval S sutureless aortic valve prosthesis implantation via a right anterior minithoracotomy.

The rapid development and refinement of techniques over the past decade have led to the realization that a minimally invasive approach enables aortic valve surgery to be performed with results, at the very least, equivalent to those of traditional (open) valve surgery done in experienced centres. Minimally invasive aortic valve replacement (MIAVR) has now evolved into a safe, efficient treatment option providing greater patient satisfaction and fewer complications. For rapidly ageing population of industrialized countries, aortic valve replacement (AVR) has become the most frequent heart valve surgery.

Cross-sectional survey on minimally invasive mitral valve surgery.

Background: Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS.

Sutureless implantation of the perceval s aortic valve prosthesis through right anterior minithoracotomy.

Background: Many new, less invasive strategies are proposed for aortic valve operation in elderly patients. Rapid deployment sutureless aortic valve prosthesis has been recently introduced. We analyzed our experience with a sutureless valve implanted through a minimally invasive approach.

Three-dimensional sensitivity assessment of thoracic aortic aneurysm wall stress: a probabilistic finite-element study.

Objectives: In clinical practice, maximum diameter is used as a criterion to estimate aneurysm-rupture risk; however, it is only a general indicator and its value becomes difficult to estimate in the thoracic segment. Improved understanding of aortic aneurysm complexity and biomechanics is needed to achieve advancements in surgical repair techniques. The objective of this study was to determine the maximum wall stress by using imaging-derived data and a specific probabilistic design integrated into finite element (FE) analysis.

Minimally invasive and conventional aortic valve replacement: a propensity score analysis.

Background: The study aimed to compare the short-term results of aortic valve replacement through minimally invasive and sternotomy approaches.

Methods: This is a retrospective, observational, cohort study of prospectively collected data on 709 patients undergoing isolated primary aortic valve replacement between 2004 and 2011. Of these, 338 were performed through either right anterior minithoracotomy or upper ministernotomy.

Sutureless aortic valve implantation through an upper v-type ministernotomy: an innovative approach in high-risk patients.

Objective: Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients.

Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients.

Objectives: Recent studies have suggested an increased risk of stroke in patients undergoing minimally invasive mitral-valve surgery with retrograde perfusion when compared with antegrade perfusion. The aim of the present study was therefore to evaluate the impact on early outcome of retrograde arterial perfusion (RAP) strategy vs antegrade arterial perfusion strategy in a consecutive large cohort of patients who underwent minimally invasive mitral-valve surgery through a right minithoracotomy.

Methods: Between 2003 and 2012, 1280 consecutive patients underwent first-time minimally invasive mitral-valve surgery at our institution.

Severe mitral regurgitation in patients with postinfarction interventricular septal defect: a simple way of simultaneous valve repair.

Ventricular septal defect, a potentially deadly complication of transmural myocardial infarction, is often accompanied by ischaemic mitral regurgitation. It has been recognized that the presence and persistence of the latter negatively affect survival rates in patients after myocardial infarction. We present a simple endoventricular edge-to-edge technique of mitral repair using a single U-shaped stitch of polytetrafluoroethylene and a refined double-patch 'exclusion' technique of postinfarction interventricular septal defect (PVSD) closure in the treatment of two consecutive cases of PVSD and concomitant ischaemic mitral regurgitation.

Enhancing departmental quality control in minimally invasive mitral valve surgery: a single-institution experience.

Objectives: In recent years, there has been an increasing interest in monitoring the quality of cardiac surgical performance. The aim of the present study was to apply control charts (CUSUM curves) to monitor the performance of minimally invasive mitral valve procedures to enhance quality control for that operation.

Methods: A total of 936 minimally invasive mitral valve procedures were performed from September 2003 to March 2011 by seven surgeons (range 26-401 procedures) at a single institution.

Delayed dislocation of a sutureless aortic bioprosthesis: the first case.

Sutureless aortic bioprosthesis implantation is an alternative technique in high-risk patients undergoing aortic valve replacement with a possible reduction in the extracorporeal circuit time and reliable haemodynamic features. A 3F Enable (ATS Medical-Medtronic, Inc., Minneapolis, MN, USA) has shown very good results.

Mitral and aortic valve endocarditis caused by a rare pathogen: Streptococcus constellatus.

Streptococcus constellatus endocarditis is associated with systemic embolism and frequently with a poor prognosis. We describe the first case reported in the literature of infective endocarditis by penicillin-resistant S. constellatus causing both mitral and aortic valve regurgitation, treated successfully with double-valve replacement.

Sutureless aortic bioprosthesis in severe aortic root calcification: an innovative approach.

Aortic valve replacement (AVR) in patients with severe aortic root calcification is technically a very difficult procedure which requires a long cardiopulmonary bypass (CPB) time, especially in patients undergoing complex procedures such as multivalve or valve and coronary surgery. We report a case of successful AVR with an innovative approach in a patient with an extensively calcified aortic root and concomitant tricuspid valve regurgitation who underwent mitral valve replacement 20 years ago.

Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement.

Objective: Cumulative sum (CUSUM) analysis, first developed to assess industrial quality control, was then used to monitor cardiac surgery performance more than 10 years ago. This analysis may be more sensitive than the standard statistical tools to analyse surgical results. The aim of this study is to assess a single surgeon's learning curve with right anterior minithoracotomy (RAMT) for aortic valve replacement (AVR) using risk-adjusted CUSUM curves and to compare the short- and medium-term results of these patients with a propensity-matched cohort of patients who had standard AVR (SAVR).

In adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In adult patients undergoing redo surgery for left atrioventricular valve regurgitation after atrioventricular septal defect correction, is replacement superior to repair?' Altogether more than 109 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, and results of these papers are tabulated.

Aortic arch replacement with prophylactic aortic arch debranching during type A acute aortic dissection repair: initial experience with 23 patients.

Objective: To improve the long-term results of acute type A dissection repair, we developed a technique that combines radical surgical resection, and, at the same time, creates a safe and long landing zone for subsequent endovascular procedure on the descending aorta.

Methods: Since November 2006, 23 patients (62 ± 13 years) underwent aortic arch replacement concomitant with prophylactic debranching of the supra-aortic vessels, with a specially designed arch graft. The technique consists of replacing the ascending aorta and the aortic arch, and, at the same time, relocating the origin of the supra-aortic vessels just above the sinotubular junction creating a long and safe proximal landing zone for subsequent stent-graft deployment.

Stentless aortic valve implantation through an upper manubrium-limited V-type ministernotomy.

In this piece of work, we attempt to highlight our approach and early experience with minimally invasive aortic valve replacement with aortic Freedom Solo stentless bioprosthesis performed through an upper manubrium-limited ministernotomy in the second intercostal space. The novel suturing technique is required for stentless aortic bioprosthesis implantation, and this, in its turn, will predetermine and influence the surgeon's choice for operative access. In our department, the feasibility of the approach was first assessed; aortic valve was replaced by stentless bioprosthesis in a total of 23 patients (mean age 57 ± 12 years).

A completely detachable aortic clamping instrument for minimally invasive cardiac surgery.

A minimally invasive cardiac surgery is becoming more popular and is still undergoing a refinement of surgical techniques and dedicated instrumentarium as well. New specifically designed instruments are quintessence of safe surgery with improving operative outcomes and comfortable operator-oriented working conditions. In this article, we attempt to present our early clinical experience with a new aortic clamping instrument specifically developed for limited single-access minimally invasive valve surgery.