Successful acute type A aortic dissection repair in a nonagenarian.

Surgical repair in older patients with acute type A aortic dissection (ATAAD) evokes a higher peri- and postoperative mortality, it therefore remains controversial in nonagenarians. The authors present a case of a surgically managed ATAAD in a nonagenerian, a 94-year-old man presented with an uncomplicated ATAAD, necessitating emergency surgical repair. The subsequent postoperative course was uneventful, and the patient was discharged after uncomplicated recovery. Aggressive surgical approach should be feasable in select nonagenarian patients with ATAAD, depending on the clinical presention and prior patient history.

Four-chamber pacing in patients with poor ejection fraction but normal QRS durations undergoing open heart surgery.

BACKGROUND: Poor ejection fraction (EF) comprises a critical risk factor in cardiac bypass surgery (CABG). It has been unclear, whether biventricular or four-chamber pacing confers benefit upon patients with intact atrioventricular and interventricular conduction especially following surgery. METHODS: Twenty-one consecutive patients with an EF

First clinical results with a 30 degrees end-to-side coronary anastomosis coupler.

OBJECTIVE: The purpose of this study is to evaluate the safety and efficacy of a novel 30 degrees end-to-side coronary anastomotic coupler (Converge Medical, Inc., Sunnyvale, CA) that facilitates a non-penetrating, sutureless vein graft to coronary artery anastomosis. MATERIAL AND METHODS: The Coupler utilizes a set of concentric mating frames approximating adjacent vessel tissue allowing for biological healing of the anastomosis. The frames are manufactured from Nitinol, a nickel titanium super-elastic metal alloy. The Nitinol frames attach the bypass graft to the coronary artery in a 30 degrees end-to-side configuration. Between November 2002 and March 2003 a total of 46 patients (44 male) with a mean age of 63.6+/-7.5 years were admitted for coronary artery revascularization and included in the study. The mean LVEF was 60.6+/-12.4%. RESULTS: Thirty-three patients were successfully treated with the Coupler. Nine patients did not meet the intraoperative inclusion criteria, and were excluded from the study due to small (

In vivo model for cross-species porcine endogenous retrovirus transmission using tissue engineered pulmonary arteries.

OBJECTIVE: Acellularised porcine scaffolds have been successfully used for cardiovascular tissue engineering. However, there is concern about the possibility of porcine endogenous retrovirus (PERV) transmission. In this study we developed an in vivo model for cross-species PERV transmission. METHODS: In vitro autologous repopulated porcine pulmonary arteries (n=6) were implanted in sheep in orthotopic position. Blood samples were collected regularly up to 6 months after implantation and tested for PERV by means of polymerase chain reaction and reverse transcriptase-polymerase chain reaction. Explanted tissue engineered pulmonary arteries were tested for PERV sequences. RESULTS: PERV DNA was detectable in acellularised porcine scaffolds. No PERV sequences were detectable 6 months after implantation of in vitro repopulated acellularised porcine pulmonary arteries and in all tested peripheral blood samples. CONCLUSIONS: Acellularised porcine matrix scaffolds can be used for cardiovascular tissue engineering of autologous grafts without risk of PERV transmission.