Internal aortic annuloplasty remodeling ring in bicuspid aortic valve repair: different phenotypes.

We describe our approach, which is based on using an internal bicuspid annuloplasty ring not only to provide annular reduction but also to routinely achieve 180° valve symmetry. The HAART 200 ring has a circular base geometry with 180° subcommissural posts. It is sized according to the intercommissural diameter and keeps that dimension unchanged. The non-fused leaflet serves as a reference, and its free-edge length is measured with a ball sizer that predicts the required ring diameter (D): D =free-edge diameter/1.5 with transannular suturing. The ring brings the sinus-to-sinus dimension centrally to improve leaflet coaptation. More importantly, the ring remodels the fused and nonfused sinuses into equal annular segments, thereby increasing the mobility of the fused segment, facilitating its later plication. In this way, the ring establishes 180° valve geometry.

Bicuspid aortic valve repair: outcomes after 17 years of experience.

OBJECTIVES: This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS: Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS: There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01-60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7-23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01-64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2-13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS: The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

Mature mediastinal teratoma with somatic type malignancy including neuroblastoma and intestinal type of adenocarcinoma: A Case Report.

INTRODUCTION AND IMPORTANCE: The majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth. CASE PRESENTATION: We present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment. DISCUSSION: Mediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient. CONCLUSION: Radiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.

The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance.

BACKGROUND: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodelling using cardiac magnetic resonance (CMR) and compare the results of external and subcommissural annuloplasty. METHODS: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). RESULTS: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period (median: 12.6 months (first quartile: 6.6; third quartile: 14.1). CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r = 0.62; p = 0.003) as well as left ventricular ejection fraction (r = -0.53; p = 0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5 (2.5; 4.0) vs. 2.5 cm2 (2.0; 3.4); p = 0.04). In both EA and SCA group, aortic valve area below 3.5 cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10 (6; 17) vs. 21 mmHg (15; 27); p = 0.04). CONCLUSIONS: The repair of the bicuspid aortic valve provides significant postoperative reverse remodelling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. EA is associated with lower transvalvular gradients and higher aortic valve area assessed by CMR, compared to SCA.

Can a trainee perform endovascular aortic repair as effectively and safely as an experienced specialist?

OBJECTIVES: Endovascular aortic repair (EVAR) is a technically demanding procedure usually carried out by highly experienced surgeons. However, in this era of modern endovascular surgery with growing numbers of patients qualifying for the procedure, the need to enhance surgical training has emerged. Our aim was to compare the technical results of EVAR in patients operated on by trainees to that of those operated on by an endovascular expert. METHODS: Between 2016 and 2018, a total of 119 patients diagnosed with an abdominal aorta disease requiring EVAR were admitted to our clinic. Overall, we included 96 patients who underwent preoperative and postoperative computed tomography angiography and EVAR performed either by an endovascular expert (N = 51) or a trainee (N = 45). RESULTS: We detected no difference in the baseline characteristics, indication for EVAR and preoperative anatomy between patients operated on by trainees and our endovascular expert. We noted the same incidence of endoleak type Ia occurrence (n = 2 vs n = 2, P = 1.00), reintervention rate (n = 0 vs n = 0, P = 1.00) and in-hospital mortality (n = 0 vs n = 1, P = 1.00) for operations done by trainees and the expert, respectively. There was no difference in X-ray doses or time between the 2 groups. Despite longer median operation times [112 (first quartile: 84; third quartile: 129) vs 89 (75-104) min; P = 0.03] and in-hospital stays [10 (8-13) vs 8 (7-10) days, P = 0.007] of the patients operated on by trainees, the overall clinical success of EVAR was satisfactory in both groups. CONCLUSIONS: An EVAR planned and performed by a trainee need not raise the cumulative risk of the procedure. Trainees who have undergone both mind and hand skills training can therefore carry out EVAR under the supervision of an experienced specialist as effectively and safely as experts do.

Effect of Perioperative Optimization of Arterial Oxygen Content and Perfusion Pressure on the Function of the Transplanted Kidney in the Retrospective Study of Excretory Function and Assessment of New Markers of Kidney Damage: IL-18, Neutrophil Gelatinase-Associated Lipocalin, and Clusterin.

INTRODUCTION: The concept of anesthesia, in which kidney perfusion is optimized, the use of nephrotoxic drugs is avoided, and general anesthesia with protective and preconditioning properties of the graft is applied, is a key element of the therapeutic strategy in kidney transplantation (KTx). MATERIAL AND METHOD: A total of 86 patients (mean age: 49.4 ± 14.0 years, 66% men) with end-stage renal disease who underwent KTx between 2012 and 2015 were included in this retrospective study. Our aim was to assess the effect of oxygen content in arterial blood and selected hemodynamic parameters on the graft function and the occurrence of delayed graft failure. RESULTS: No differences were found in baseline characteristics, indication for transplantation, and surgical technique used among study population. No correlation was found between oxygen delivery exponents and both standard markers of renal function and new biochemical markers (eg, IL-18, clusterin, and neutrophil gelatinase-associated lipocalin [NGAL]). DISCUSSION: In our study, hemodynamic parameters measured at scheduled intervals did not exceed the physiological range, which might have been the reason for the lack of correlation between the function of graft and the described hemodynamic conditions. At the same time, in the observed ranges of perfusion pressure during optimization of the oxygen content, no correlations were found with the postoperative function of the transplanted kidney. That observation could be a valuable conclusion for reducing the tendency of maintaining high blood pressure with the abuse of catecholamines, especially vasoconstrictors, and volume therapy, whose negative effect on tissue perfusion is unequivocal.