Preserving a Well-Functioning 33-Year-Old Starr-Edwards Aortic Prosthesis in Repeat Aortic Root Aneurysm Repair.

We report the case of a 61-year-old obese male patient in whom we found a well-functioning 33-year-old Starr-Edwards aortic prosthesis during repeat aortic surgery. Rather than explant the prosthesis, we remodeled the aortic root, almost completely removing the aortic sinuses and leaving only a pillar of aortic tissue around the coronary ostia. The proximal end of a Hemashield tube-graft was then scalloped to accommodate the remaining aortic tissue. The patient's heart function was excellent after his weaning from cardiopulmonary bypass. Simplifying the repeat aortic root repair, by preserving a well-functioning Starr-Edwards valve, might lead to a better outcome in similar cases. We also discuss other instances of this valve's durability.

Blood transfusion and the risk of atrial fibrillation after cardiac surgery.

BACKGROUND: Red blood cell transfusion (Tx) induces a proinflammatory state. Inflammatory mediators are associated with an increased risk of postoperative atrial fibrillation (AF). Therefore, in this study we determined the association between AF and Tx after isolated coronary artery bypass graft surgery (CABG). METHOD: Between January 2008 and December 2010, a total of 879 patients underwent CABG. Of these, 815 (92.7%) had complete data extracted from our institution's Society of Thoracic Surgeons (STS) database. Predictors of AF development among four levels of Tx versus nontransfused patients were examined. Multivariable logistic regression and propensity score matching models were used. RESULTS: The mean age was 65.8 years (±10.3), 77.4% were male, and 54.4% had an STS predicted risk score (mortality/morbidity) of ≥10%. A total of 564 (69.2%) had at least one unit of Tx. Adjusting for age, sex, time on pump, congestive heart failure, stroke, creatinine level (<1.5 mg per deciliter vs. ≥1.5), STS morbidity/mortality score, perioperative myocardial infarction (MI), cross-clamp time, medications, and hemoglobin level, the odds ratio (OR) of AF increased with increasing Tx (OR, 1.36; 95% confidence interval [CI], 1.11 to 1.68; p = 0.003). The odds of AF increased 61% with each increasing level of Tx (OR, 1.61; 95% CI, 1.15 to 2.26; p = 0.006, by propensity analysis). CONCLUSIONS: Perioperative Tx may be associated with excess AF following CABG. This risk increases with increasing number of Tx.

Use of fibrin sealants in cardiovascular surgery: a systematic review.

BACKGROUND: Fibrin sealants are used for hemostasis and tissue adherence. AIM OF STUDY: This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. METHODS: A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. RESULTS: Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. CONCLUSIONS: Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries.

Aorto-pulmonary artery disruption following acute type-A aortic dissection repair with the use of BioGlue®.

We report an extremely rare complication of a delayed aorto-pulmonary artery wall disruption with false aneurysm formation after repair of acute type-A aortic dissection with BioGlue®. The potential role of BioGlue® in this complication is the subject of this report.

Entrapment of an arterial pressure catheter by a previously deployed Starclose device.

Herein is a case report description of entrapment of an arterial pressure line by a previously deployed Starclose device. This device is widely used to control femoral artery puncture site following diagnostic catheterization.

A "double overlap" suture technique for the proximal attachment of a composite graft to the aortic annulus.

Repair of an aortic root aneurysm using a composite graft is sometimes complicated by proximal suture line bleeding, which may be very difficult to control. We adopted a previously described technique of "double overlap" sutures on the annulus and the prosthetic cuff, which has virtually eliminated this complication.

Diagnosis of Partial Anomalous Pulmonary Venous Connection with Intact Interatrial Septum by Echocardiography.

This case illustrates the complementary use of transthoracic echocardiography and transesophageal echocardiography in the diagnosis of partial anomalous pulmonary venous connection. The transthoracic echocardiogram suggested the presence of anomalous pulmonary venous return by demonstrating right heart volume overload and evidence of an intact atrial septum. Transesophageal echocardiography was required to confirm these findings and provide a firm anatomic diagnosis before surgery. This case also emphasizes that a high degree of clinical suspicion for this condition should occur in situations in which apparent right heart volume overload is otherwise unexplained.