The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Hemodynamics of the Edwards Sapien XT transcatheter heart valve in noncircular aortic annuli.
During implantation of transcatheter aortic valves into severe calcified aortic annuli, misdeployments due to asymmetric shapes of the target region were reported. Whether the resultant stent deformations influence valve performance has not been quantified. The objective of this study was to investigate in vitro hemodynamics of the Edwards Sapien XT (Edwards Lifesciences, Irvine, Calif) after valve deployment in noncircular aortic annuli. ⋯ Implantation of the Edwards Sapien XT transcatheter valve into non-circular-shaped aortic annuli leads to increased leakage. Annulus shape and relative position of the prosthesis are main determinants of leakage. Implantation into elliptical annuli, as found in bicuspid aortic valves, seems feasible.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Surgical strategies for anomalous origin of coronary artery from pulmonary artery in adults.
Limited data are available regarding the surgical strategies for an anomalous origin of the coronary artery from the pulmonary artery (ACAPA) in adulthood. We reviewed our surgical experience with ACAPA in adults. ⋯ Establishment of a dual coronary artery system with coronary transfer is preferred, even if an interposition graft is required. Coronary artery bypass grafting with closure of ACAPA should be reserved for when coronary transfer is not feasible. Surgical correction of ACAPA should be considered before the onset of left ventricular dysfunction.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Early experience with off-the-shelf endografts using a zone 0 proximal landing site to treat the ascending aorta and arch.
Acute type A aortic syndromes and its chronic complications are fatal diseases traditionally treated by open surgery, with high mortality rates. An endovascular approach to the ascending aorta could reduce the morbidity and mortality associated with open surgery. Our aim was to report our initial experience in treating ascending aortic pathology using commercially available descending thoracic endografts. ⋯ Endovascular treatment of the ascending aorta is feasible. We had 4 good mid-term results in 7 patients who had presented with penetrating ulcers or aneurysm formation. Acute dissections seem to be more unstable, and additional research is mandatory.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Transapical neochord implantation: is tension of artificial chordae tendineae dependent on the insertion site?
Transapical chordae tendineae replacement is a promising new approach for mitral leaflet prolapse. However, animal studies have raised concerns that the tension of the transapically fixated artificial neochordae might be greater than the tension in the neochordae attached to papillary muscle tips, thereby reducing repair durability. ⋯ Overall, the chordal insertion site had little influence on the tension in the artificial neochordae compared with the interindividual variation. However, abnormal tension fluctuations in the transapically fixated neochordae might predispose to leaflet tears and early repair failure.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery.
Minimally invasive valve surgery has been associated with increased cerebrovascular complications. Our objective was to evaluate the incidence of cerebrovascular accidents in patients undergoing minimally invasive valve surgery. ⋯ Minimally invasive valve surgery was associated with an acceptable stroke rate, regardless of the cannulation technique.