Intracorporeal knot-tying for the thoracoscopic surgeon: a novel and simplified technique.

Thoracoscopic surgery has usually been limited by 2-dimensional vision and the limited space between ribs--problems that have been only partially overcome by the use of robotics. One of the technical challenges of any minimally invasive surgical approach is tying an intracorporeal knot. For the thoracoscopic surgeon, we describe an easier technique of knot-tying that involves using a right-angled dissector.

Continuous-flow cardiac assistance: effects on aortic valve function in a mock loop.

Background: As the use of left ventricular assist devices (LVADs) to treat end-stage heart failure has become more widespread, leaflet fusion--with resul-tant aortic regurgitation--has been observed more frequently. To quantitatively assess the effects of nonpulsatile flow on aortic valve function, we tested a continuous-flow LVAD in a mock circulatory system (MCS) with an interposed valve.

Materials And Methods: To mimic the hemodynamic characteristics of LVAD patients, we utilized an MCS in which a Jarvik 2000 LVAD was positioned at the base of a servomotor-operated piston pump (left ventricular chamber).

Clusterin induces CXCR4 expression and migration of cardiac progenitor cells.

Clusterin (CST) is a stress-responding protein with multiple biological functions, including the inhibition of apoptosis and inflammation and transport of lipids. It may also participate in cell traffic and migration. In the process of post-infarct cardiac tissue repair, stem cells migrate into the damaged myocardium under the influence of chemoattractive substances such as stromal cell-derived factor (SDF).

Clinical value of plasma hepatocyte growth factor measurement for the diagnosis of periampullary cancer and prognosis after pancreaticoduodenectomy.

Background: Previous studies suggest that serum hepatocyte growth factor (HGF) level may be a useful diagnostic and prognostic biomarker for various tumors. We investigated the utility of plasma HGF level measurements in diagnosing periampullary cancer (PAC).

Methods: Of the patients enrolled in this pilot study (n = 118), 57 had PAC, 21 had benign pancreatic tumor (BPT), 20 had chronic pancreatitis (CP), and 20 were healthy controls.

A novel surgical approach to cardiac autotransplantation in complex cardiac sarcoma resection.

A 28-year-old woman was admitted to our institution, reporting progressive dyspnea, cough, and weight loss of 14 kg. Two-dimensional echocardiography revealed a left atrial mass, and cardiac magnetic resonance imaging showed localized involvement of the mass with adjacent structures. These clinical signs and radiographic images were highly suggestive of cardiac sarcoma.

Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections.

Background: Perfusion through the right axillary artery is an alternative to aortic or femoral artery cannulation during surgery for ascending aortic dissections. The results of this strategy, particularly beyond the immediate postoperative period, are not well described.

Methods: Eighty-three patients (median age, 58 years) with acute or subacute ascending aortic dissection underwent surgical repair with right axillary artery perfusion through an interposition Dacron graft.

Delivery of negatively charged liposomes into the atheromas of Watanabe heritable hyperlipidemic rabbits.

Liposomes have been used as imaging and therapeutic agents in various tissues but only infrequently in the cardiovascular system. We prepared a liposome to target atheromas in a Watanabe heritable hyperlipidemic (WHHL) rabbit model. Liposomes labeled with rhodamine and nanogold were injected intra-arterially into the descending thoracic aortas of WHHL rabbits.

Totally percutaneous aortic aneurysm repair: methods and outcomes using the fully integrated IntuiTrak endovascular system.

Aim: A totally percutaneous approach to endovascular abdominal aortic aneurysm repair (PEVAR) has been shown in multiple reports to be feasible, but carries attendant risks that appear to increase with increasing sheath size. We report our methods and sequential PEVAR case experience using a new delivery system having an integrated 19Fr introducer sheath for treatment of patients with aortic necks up to 32 mm in diameter.

Methods: A single institution, prospective, controlled evaluation was conducted in 57 consecutive patients with abdominal aortic aneurysm who underwent PEVAR between December 2008 and April 2010.

A transthoracic, left ventricular vent facilitates challenging sternal reentry.

In this brief report, we describe a technique to facilitate hypothermic arrest before a redo sternotomy that is likely to require extensive dissection. This approach may be well-suited for patients with significant aortic insufficiency, as it allows control of left ventricular distention once hypothermic ventricular fibrillation ensues. The procedure entails inserting a second venous cannula through the left ventricular apex through a 7-cm left mini-thoracotomy.

Impella Recover 5.0 assisted coronary artery bypass grafting.

We used the Impella Recover LD 5.0 Left Ventricular Assist Device to support a 61-year-old woman with an acute myocardial infarction, compromised pulmonary function, and severe cardiovascular disease during coronary artery bypass grafting (CABG). Off-pump CABG or CABG with cardiopulmonary bypass would have been risky.

Short- and long-term outcomes of coronary artery bypass grafting or drug-eluting stent implantation for multivessel coronary artery disease in patients with chronic kidney disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), but no study has yet compared the short- and long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents for multivessel CAD among non-hemodialysis-dependent (HD) patients with CKD. In our institution's registry, we identified 812 patients with CKD (glomerular filtration rate <60 ml/min) who had undergone either CABG or PCI for multivessel CAD from May 2003 to December 2006. Of these patients, 725 had non-HD CKD, and 87 were hemodialysis-dependent.

Atorvastatin and cardiac hypertrophy and function in hypertrophic cardiomyopathy: a pilot study.

Background: Hypertrophic cardiomyopathy (HCM) is a genetic paradigm of cardiac hypertrophy. Cardiac hypertrophy is a major determinant of risk of sudden death and morbidity in HCM. Treatment with statins reverses hypertrophy in animal models of HCM.

Race/ethnicity and the incidence of new-onset atrial fibrillation after isolated coronary artery bypass surgery.

Background: Atrial fibrillation (AF) is more prevalent in Caucasians than in persons of other racial/ethnic groups.

Objective: The purpose of this study was to examine the association between race/ethnicity and new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).

Methods: Data from all patients with no history of AF who underwent isolated CABG at our institution from 2000 through 2008 were analyzed.

Endovascular repair of thoracic aortic pseudoaneurysms and patch aneurysms.

Pseudoaneurysms and patch aneurysms are life-threatening late complications after thoracoabdominal aortic aneurysm (TAAA) repair. We treated four patients who presented with a pseudoaneurysm or patch aneurysm involving the descending thoracic portion of a previously implanted TAAA graft. In each patient, stent grafts were placed within the existing graft to cover the aneurysm endoluminally.

Ventricular assist device outflow-graft site: effect on myocardial blood flow.

Background: Recent advances in left ventricular assist device (LVAD) technology have resulted in small, durable, energy-efficient, continuous-flow blood pumps that can support patients with end-stage heart failure. However, the effects of reduced or nonpulsatile flow on end-organ function are unclear. We performed a pilot study in calves with a continuous-flow LVAD to assess the effects of the pump's outflow-graft location (ascending versus descending aorta) on myocardial blood flow.

Programming antitachycardia pacing for primary prevention in patients with implantable cardioverter defibrillators: results from the PROVE trial.

Objectives: the PROVE trial was designed to determine if antitachycardia pacing (ATP) is clinically beneficial for primary prevention in patients who have implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds).

Background: use of ICDs and CRT-Ds reduces mortality in patients with ventricular dysfunction and mild to moderate heart failure. However, in studies of the primary prevention population, shock-only ICDs are predominantly used, without ATP programming for less painful termination of ventricular tachycardia (VT).

Experimental therapies in hypertrophic cardiomyopathy.

The quintessential clinical diagnostic phenotype of human hypertrophic cardiomyopathy (HCM) is primary cardiac hypertrophy. Cardiac hypertrophy is also a major determinant of mortality and morbidity including the risk of sudden cardiac death (SCD) in patients with HCM. Reversal and attenuation of cardiac hypertrophy and its accompanying fibrosis is expected to improve morbidity as well as decrease the risk of SCD in patients with HCM.

Two scimitar veins in an adult: repair through a right thoracotomy without cardiopulmonary bypass.

Scimitar syndrome is a rare but serious congenital condition that consists of anomalous pulmonary venous drainage of the right lung to the inferior vena cava. The appearance on chest radiography resembles a curved Turkish sword, or scimitar. Scimitar syndrome is associated with other anomalies, including hypoplasia of the right lung, dextroposition of the heart, anomalous systemic arterial supply to the right lung, and atrial septal defect.

Use of the IntuiTrak stent-graft delivery system for percutaneous abdominal aortic aneurysm exclusion: initial single-center experience.

The exclusion of abdominal aortic aneurysms by endovascular techniques has enabled the treatment of patients who have high-risk comorbidities that preclude safe surgical repair. Since the development of the unibody bifurcated endovascular stent-graft for abdominal aortic aneurysm exclusion, remarkable technological improvements have facilitated stent-graft delivery and reduced the required size of the access site. Our initial institutional experience with the use of the Endologix IntuiTrak Express Delivery System for the Powerlink stent-graft (in 7 patients) shows that the device is suited for percutaneous use without sequelae.