Type-A acute aortic dissection: combined operation plus stent management.

When the port of entry of acute type-A aortic dissection is at the level of the horizontal portion of the aortic arch, the latter should be replaced by a prosthesis. To avoid performing this difficult procedure in an emergency situation, we place a stent in the aortic arch. Then we replace the ascending aorta by a prosthesis.

Treatment of a fistula at the distal anastomosis after Bentall operation with endoluminal covered stent.

A 25-year-old Marfan patient was operated on for an acute type A aortic dissection that was complicated twice by false aneurysms at the distal suture line. At the third episode a covered endoprosthesis was inserted in the ascending aorta between the coronary ostia and the inominate artery. The postoperative course was uneventful and a control computed tomographic scan showed complete occlusion of the false aneurysm. This attractive technique should be considered versus an open-heart operation in selected patients.

Mitral valve and short-term ventricular assist devices; potential mechanical complications.

Mechanical complications of ventricular assist devices (VADs) are rare but serious. The authors describe two cases of different mechanical complications of VADs that can affect the mitral valve. Attention should be paid to the position of the inflow/outflow cannula after off-loading of the ventricle, especially in acute heart failure and normal atrial dimensions. Complete off-loading of the left ventricle in the presence of a bioprosthetic mitral valve might cause fusion of the valve leaflets leading to mitral stenosis, which will call for another intervention.

Operative Myocardial Protection in Patients with Left Ventricular Hypertrophy: The Role of Systemic Hypothermia.

OBJECTIVES: Myocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR). METHODS: Twenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5-8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23-26 °C. (Group II) also received CRBC but their body temperature was kept at 32-34 °C. RESULTS: No operative morality (30 days) was noted in both groups. Postoperative reduction in ejection fraction (EF) was seen in nine patients of group I and in twelve patients of group II (P < 0.05). The need for multiple inotropes was more in group II (eight patients) than in group I (two patients) (P < 0.001). IABP was needed in three patients of group II and non in group I (P < 0.01). CONCLUSION: Moderate systemic hypothermia might have a role in protecting hypertrophied myocardium in patients undergoing AVR.

What has happened to multiple arterial grafting in coronary artery bypass grafting surgery?

Coronary artery bypass grafting (CABG) is a well-established therapy for patients with multivessel coronary artery disease, with excellent short- and medium-term results. This is best illustrated by studies comparing percutaneous coronary interventions (PCIs) with CABG surgery, where CABG continues to offer better event-free survival. However, there has been increasing concern about the long-term patency of vein grafts utilized for CABG when compared with arterial grafts. Some have suggested that revascularization with arterial grafts rather than vein grafts may result in improved outcomes following CABG. This is particularly important when one considers that graft occlusion can result in recurrence of disabling angina, rehospitalization, reintervention and death. To date, however, multiple arterial grafts have yet to become the standard approach for patients undergoing CABG. This is best exemplified by reports from large registries suggesting that the use of multiple arterial grafting is limited to approximately 10% of all patients undergoing CABG. In this article, we will provide some of the evidence outlining the risk and benefits of multiple arterial grafting, but more importantly, begin to explore why the utilization of multiple arterial grafting does not appear to be increasing significantly.

Homograft replacement of the calcified aortic root in familial hypercholesterolemia.

A 39-year-old woman with a known history of homozygous familial hypercholesterolemia was admitted with chest discomfort. Preoperative echocardiography and coronary angiography showed a heavily stenotic aortic valve as well as a calcific hypoplastic aortic root. Aortic root replacement using an aortic homograft was done.