The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2013
Case ReportsAnnular rupture leading to fatal complications in an elderly patient with calcified aortic and mitral annulus undergoing transapical aortic valve implantation.
This case illustrates the awareness that must be taken of the high morphological risk due to the calcifications of both, the aortic and mitral annulus in elderly patients when performing transapical aortic valve implantation. In an 86-year-old, multimorbid woman (logistic EuroSCORE = 27%) with symptomatic aortic stenosis (annular diameter = 23.4 mm) and severe mitral annular calcification, the implantation of a 26-mm Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve in aortic position was primary successful, with no paravalvular leakage, valve instability, or coronary malperfusion. Second, a persisting transmural bleeding led to hypovolemic shock, which could not be stabilized even after going on cardiopulmonary bypass, and the patient died in the operation room. The autopsy showed a subvalvular ventricular rupture due to a transmural perforation of the calcified fibrotic annulus during valvuloplasty.
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Thorac Cardiovasc Surg · Aug 2013
Left atrial radiofrequency ablation associated with valve surgery: midterm outcomes.
Left atrial ablation is a surgical standard technique for the treatment of persistent or chronic atrial fibrillation (p-AF and c-AF, respectively).Objective The aim of the study is to evaluate midterm results of left atrial ablation according to modified Maze procedure in patients affected by p-AF or c-AF and concomitant mitral or aortic valve disease requiring surgical treatment. ⋯ Left atrial Maze procedure for p-AF offers better chances to conversion in sinus rhythm as compared with long-standing c-AF. Survival, functional status, and quality of life are superior in patients who benefit from sinus rhythm.
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Thorac Cardiovasc Surg · Aug 2013
Vascular complications of the intra-aortic balloon pump in patients undergoing open heart surgery: 10 years' experience.
The most encountered complications with intra-aortic balloon pump (IABP) use are seen within the vascular system. The purpose of our study is to evaluate vascular complications of the sheathless IABP in patients undergoing open heart surgery. ⋯ Incidence of vascular complications in IABP counterpulsation is still a problem despite improvements in catheter design and techniques. The presence of peripheral arterial disease and diabetes mellitus is important risk factors for ischemic complications.
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Thorac Cardiovasc Surg · Aug 2013
Role of tricuspid valve repair for moderate tricuspid regurgitation during minimally invasive mitral valve surgery.
The aim of this study was to investigate the impact of short- and mid-term survival of tricuspid valve (TV) repair versus conservative therapy in patients with preoperative moderate functional tricuspid regurgitation (TR) undergoing minimally invasive mitral valve (MV) surgery. ⋯ Patients undergoing MV surgery with moderate functional TR do not experience increased perioperative complication rates when a concomitant TV repair is performed. Our observations, combined with those of other groups, support current recommendations to perform concomitant TV repair in such patients, particularly if tricuspid annular dilation is present.
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Thorac Cardiovasc Surg · Jun 2013
Case ReportsAortic root replacement in a patient with bicuspid pulmonary valve late after arterial switch operation.
Mild to moderate neoaortic root dilatation late after arterial switch operation (ASO) is a well-documented morbidity, but rarely needs surgical replacement. Here, we report on a 22-year-old man, who developed marked dilatation of neoaortic root and needed an aortic root replacement with mechanical conduit. ⋯ Only three cases have been reported for surgical replacement of aortic root after ASO, and two of them had bicuspid neoaortic valves. We suspect that a bicuspid neoaortic valve may be a risk factor for marked dilatation of the aortic root late after ASO.