Zone 0 frozen elephant trunk for type A retrograde acute aortic dissection following endovascular stenting of the arch.

A 70-year-old man underwent the frozen elephant trunk (FET) procedure with zone 0 debranching following a failed endovascular repair for type B aortic dissection and a stent-graft deployment in zone 1 for a retrograde type A aortic dissection. Zone 0 deployment is a novel approach that is valuable as a bailout strategy in urgent cases and it can potentially improve the technical feasibility of the FET while minimizing its ischemic complications.

Combined Minimally Invasive Surgical and Percutaneous Catheter Ablation of Atrial Fibrillation: JACC Review Topic of the Week.

Hybrid ablation is a novel therapy in the invasive management of patients with atrial fibrillation (AF) which combines minimally invasive surgical and percutaneous catheter-based techniques. The evidence is mainly based on observational studies from experienced centers, with success rates of approximately 70% and risks that are 2.0-fold to 3.6-fold higher than catheter-based ablation. Hybrid ablation is offered typically to patients with persistent or longstanding persistent AF which, by design, requires 2 procedures (epicardial surgical and endocardial catheter-based ablation). One randomized trial demonstrated that hybrid ablation was more effective than catheter-based ablation, but with higher complication rates. The incidence of the most serious complications has decreased in contemporary studies of hybrid ablation. At present, hybrid ablation should be performed by experienced centers on selected patients with persistent or longstanding persistent AF. Additional randomized trials are needed to define the risks, benefits, and cost effectiveness of hybrid ablation to identify its most appropriate application in clinical practice.

Is It Feasible to Implant Sutureless Valves in Presence of Diseased Aortic Root and Aortic Aneurysm?

Sutureless bioprosthetic valves are typically used in patients with a normal-sized aortic root and annulus because of concerns that the stent portion of the valve will not be properly anchored. This report describes an initial case series of sutureless valve implantation in the setting of a diseased aortic root and ascending aortic aneurysm, and it shows that the use of the Perceval valve (LivaNova PLC, London, UK) is feasible in these complex situations.

Three-Dimensional Imaging Improves Accuracy in Clip Sizing During Thoracoscopic Left Atrial Appendage Exclusion.

The AtriClip is an epicardially applied occlusion device for the left atrial appendage. Accurate sizing and placement of the device is essential to its success. We describe the use of 3-dimensional computed tomography imaging to aid in accurate sizing of the AtriClip device during thoracoscopic surgical ablation. This technique reduces the risk of improper sizing of the device and thus mitigates the risk of malpositioning and potential damage or compression to surrounding structures such as the circumflex coronary artery.

Improved Safety of Endoscopic Vessel Harvesting During the COVID-19 Pandemic.

The COVID-19 pandemic has necessitated that operating room procedures be modified to ensure the safety of staff and patients. Specifically, procedures that have the potential to create aerosolization must be reassessed, given the risk of viral transmission via aerosolization. We present the use of a nonsealed endoscopic vessel harvesting approach during coronary surgery that does not necessitate the use of CO2 insufflation and utilizes suction through an ultra low particulate filter, thus mitigating the risk of possible viral transmission via aerosolization or surgical smoke production. This approach is technically feasible and can minimize the risk of viral transmission during endoscopic vessel harvesting.

Facilitated Coupling of Magnetic Introducers During Thoracoscopic Ablation of Atrial Fibrillation.

A 51-year-old man with long-standing persistent atrial fibrillation underwent a hybrid ablation procedure with right thoracoscopic epicardial ablation. Fluoroscopy was utilized in a novel way to visualize the magnetic tip catheters of the linear ablation surgical device and allow easier coupling of the tips, making this procedure more efficient and reducing the risk of improper positioning of the ablation device.

Zone 1 Debranching for Frozen Elephant Trunk and Whole-Body Perfusion.

A 65-year-old man with chronic type A aortic dissection underwent zone 1 debranching and frozen elephant trunk with whole-body perfusion. This approach has the potential to improve technical feasibility of the frozen elephant trunk procedure and reduce its ischemic complications.