The minithoracotomy approach: a safe and effective alternative for heart valve surgery.

Despite criticisms over the last decade, heart valve surgery through right anterior minithoracotomy (MT) proved excellent short-term and long-term-term results, becoming a feasible and popular alternative to the sternotomy approach. The rapid development and refinements of techniques have led to MT valve surgery being considered safe, effective, and durable. Minithoracotomy has been demonstrated to be a valid cost-effective and cost-saving strategy for valve surgery, being associated with reduced morbidity and mortality.

Outcome of redo surgical aortic valve replacement in patients 80 years and older: results from the Multicenter RECORD Initiative.

Background: Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort.

Methods: This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery.

Tongue flap to treat a severe case of Miescher's cheilitis granulomatosa.

Miescher's cheilitis granulomatosa is the monosymptomatic form of Melkersson-Rosenthal Syndrome. Severe macrocheilitis often causes a functional and esthetical impairment of the lip. Conservative treatment represents the first option to face this rare disease.

Bullous lung disease and neurofibromatosis type-1.

Lung interstitial diseases and bullae are described as possible complications of neurofibromatosis type-1 (NF-1), a genetic disorder inherited as a autosomal-dominant trait. We report the case of a 16-year-old male non-smoker with NF-1, who presented with pneumothorax caused by ruptured lung bullae. The case of this young patient, successfully treated by video-assisted thoracoscopic resection of bullae, supports the concept that pulmonary alterations may be part of the NF-1 syndrome, rather than as an unrelated complication.

Preoperative statin therapy is not associated with a decrease in the incidence of delirium after cardiac operations.

Background: Delirium after cardiac operations is associated with significant morbidity and death. Statins have been recently suggested to exert protective cerebral effects. This study investigated whether preoperative statins were associated with decreased incidence of postoperative delirium in patients undergoing coronary artery bypass grafting.

Acute kidney injury after composite valve-graft replacement for ascending aorta aneurysms.

Acute kidney injury (AKI) following cardiac surgery is a continuing source of morbidity and mortality. Although several studies have attempted to determine its etiology and prophylactic measures, limited data exist after thoracic aortic surgery. The aim of this study was to evaluate the incidence and predictors of AKI in patients undergoing aortic root replacement (ARR) with valve conduit for ascending aorta aneurysms.

Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study.

Background: Atrial fibrillation (AF) after thoracic surgery is a continuing source of morbidity and mortality. The effect of postoperative AF on long-term survival however has not been studied. Our aim was to evaluate the impact of AF on early outcome and on survival > 5 years after pulmonary lobectomy for lung cancer.

Optimal timing of discontinuation of clopidogrel and risk of blood transfusion after coronary surgery. Propensity score analysis.

Background: The optimal time delay between last clopidogrel dose and surgery is controversial. The aim of the present study was to analyze the impact of preoperative clopidogrel on the need for blood transfusions with reference to the proper timing of discontinuation.

Methods And Results: Between January 2005 and December 2010, 1,947 consecutive patients undergoing coronary surgery were enrolled.

Visceral artery aneurysms: management of 48 cases.

Aim: The purpose of this study was to review the outcomes of endovascular treatment and open repair of visceral artery aneurysms, and to compare their results.

Methods: Between January 1995 and January 2009, 42 patients (22 males) underwent surgical or endovascular treatment for visceral artery aneurysms. Mean age was 60 ± 13 (range, 35-85).

Bronchogenic cyst associated with pericardial defect: case report and review of the literature.

Partial defect of the pericardium combined with bronchogenic cyst is a very rare congenital anomaly. We describe the case of a 32-year-old man with a partial defect of the left pericardium and a bronchogenic cyst arising from the border of the pericardial defect. The cyst was successfully resected with the harmonic scalpel by three-port videothoracoscopic approach.

Endovascular repair of a celiac trunk aneurysm with a new multilayer stent.

Operative treatment of celiac trunk aneurysms has traditionally involved open repair using simple ligation, interposition graft, resection, and direct repair or antegrade bypass from the aorta; recently, endovascular techniques have been proposed in selected cases. We report a 60-year-old man presenting with a celiac trunk aneurysm that we treated with a new multilayer stent with the aim of preserving the parent vessels arising from the aneurysm. Computed tomography angiography at the 12-month follow-up visit confirmed the patency of the stents, the complete thrombosis of the sac without impairment of the main branches, and the regular perfusion of the liver and spleen.

Endovascular treatment of elective abdominal aortic aneurysms: independent predictors of early and late mortality.

Background: The purpose of this study was to review our personal experience with patients who underwent elective endovascular repair of abdominal aortic aneurysms so as to detect the predictors of early and late mortality.

Methods: Between November 2000 and June 2008, a total of 235 consecutive patients (218 men; mean age: 71.9 ± 8.

Imbalance between pro-angiogenic and anti-angiogenic factors in rheumatic and mixomatous mitral valves.

Background: A balance between angiogenic and anti-angiogenic factors is critical in tissue development, tissue repair and homeostasis. Aberrant angiogenesis has been implicated in several pathologic conditions, including valvular heart disease. The aim of this study was to ascertain the pathogenetic role of angiogenesis in rheumatic and mixomatous mitral valve diseases.

Preoperative n-3 polyunsatured fatty acids are associated with a decrease in the incidence of early atrial fibrillation following cardiac surgery.

Background: Atrial fibrillation (AF) after cardiac surgery is associated with increased mortality, morbidity, and expenditure. Controversial data exist on possible preventive effects of n-3 polyunsatured fatty acids (PUFAs) against postoperative AF. We investigated whether preoperative PUFA therapy is effective in reducing AF after cardiac surgery during the surgical hospitalization and/or the cardiac rehabilitation period.

Acute iatrogenic type A aortic dissection following thoracic aortic endografting.

Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.(1,2) However, depending on the different aortic pathologies, procedure related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).(3,4) One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).

Aortic endograft infection: A report of 2 cases.

Introduction: Endograft infection has received less attention than other complication, so that little is known about the general features, risk factors, and treatment. The purpose of this short series is to examine our experience of infective complications after EVAR.

Material And Methods: Between November 2000 and December 2008, 247 patients underwent endograft repair for abdominal aortic aneurysm.

Papillary fibroelastoma: insight to a primary cardiac valve tumor.

Papillary fibroelastomas are rare benign cardiac tumors. Although they have minimal hemodynamic effects, their propensity for embolization can result in serious morbidity. The pathophysiology and management of these tumors is the subject of this review.

Tako-tsubo cardiomyopathy complicated by ventricular septal perforation and septal dissection.

Tako-tsubo cardiomyopathy is a form of reversible left ventricular dysfunction, with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. The precise clinical features and etiologic basis of this syndrome remain unclear, although an association with emotional or stressful triggers has been recognized. We describe the first case of this syndrome complicated with a ventricular septal perforation and dissection.

Microdialysis assessment of peripheral metabolism in critical limb ischemia after endovascular revascularization.

Background: Critical limb ischemia is a chronic pathologic condition defined by the lack of blood flow in peripheral circulation. Microdialysis is a well-known and sensitive method for the early detection of tissue ischemia. The aim of the present study was to use microdialysis in order to analyse cellular metabolism changes after peripheral endovascular revascularization.

Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair.

Background: Cerebrovascular accidents are devastating and worrisome complications after thoracic endovascular aortic repair. The aim of this study was to determine cerebrovascular accident predictors after thoracic endovascular aortic repair.

Methods: Between January 2001 and June 2008, 76 patients treated with thoracic endovascular aortic repair were prospectively enrolled.