Renal denervation: current status and future applications.

Despite the variety of antihypertensive agents that are available, resistant hypertension remains a significant clinical problem and a substantial economic burden. Over the past several years, renal sympathetic denervation has been introduced as a potential therapeutic option for this clinical problem. It is a catheter-based procedure that is showing promising results and appears to be associated with minimal or low risk. Thus far, two completed clinical trials have demonstrated excellent safety and encouraging outcomes. A review of these trials is the focus of this article, in addition to the analysis of ongoing studies, and the possible future applications of this technique.

Minimally invasive approach for isolated tricuspid valve surgery.

BACKGROUND AND AIM OF THE STUDY: Isolated tricuspid valve surgery has been associated with a high morbidity and mortality. The study aim was to analyze the feasibility of a minimally invasive approach for isolated tricuspid valve surgery. METHODS: A total of 2,945 heart operations performed at the authors' institution between January 2009 and April 2013 was retrospectively reviewed to identify patients who had undergone isolated, minimally invasive tricuspid valve surgery via a right mini-thoracotomy approach. Details of operative times, intensive care unit (ICU) and hospital lengths of stay, postoperative complications, and mortality were analyzed. RESULTS: A total of 12 patients (eight females, four males; mean age 68 +/- 18 years) was identified. The median left ventricular ejection fraction was 58% (IQR 47-64%), and prior valve or coronary artery bypass graft surgery was noted in four patients (33%) and two patients (17%), respectively. Most of the patients underwent tricuspid valve repair (92%), with a median cardiopulmonary bypass time of 106 min (IQR 82-122 min). The median ICU and total hospital lengths of stay were 84 h (IQR 47-157 h) and 7 days (IQR 6-12 days), respectively. Postoperative complications included prolonged ventilation (50%), reintubation (17%), atrial fibrillation (17%), and acute kidney injury (8%). There were no postoperative cerebrovascular accidents, myocardial infarctions, reoperations for bleeding, or deep wound infections. The 30-day mortality rate was 17%, and two-year survival 67%. CONCLUSION: A minimally invasive approach for isolated tricuspid valve surgery is feasible, with a high rate of valve repair.

Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis.

OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm(2)/m, 0.85-0.66 cm(2)/m(2), and <0.65 cm(2)/m(2), respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41%, 42, and 16%, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82%). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3%, 6.1%, and 8%, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49% of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.

Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis

OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm²/m, 0.85-0.66 cm²/m², and <0.65 cm²/m², respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41 percent, 42, and 16 percent, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82 percent). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3 percent, 6.1 percent, and 8 percent, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49 percent of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.