Aortic Valve Disease: State of the Art

Aortic valve replacement is the most commonly performed valve operation. It has been shown to be an effective therapy in all age groups, including the very elderly (age > 90 years). The most common etiologies for aortic stenosis are calcific degeneration, rheumatic disease, and congenital bicuspid valves. The most common causes of pure aortic regurgitation include annuloaortic ectasia and associated dilation of the aortic root, endocarditis, aortic dissection, and rheumatic disease. The indications for surgery depend on the pathophysiology and symptoms. The choice of the prosthesis can be difficult and depends on multiple clinical and lifestyle considerations. Early and late outcomes are generally quite good, even in high-risk patients

Low copper levels measured in the aortic wall of New Zealand patients with non-syndromic ascending thoracic aortic aneurysm

OBJECTIVES: Studies in animals have shown causal relationships between copper (Cu) deficiency and the development of thoracic aortic aneurysms (TAAs) [1, 2]. Cu deficiency is widespread in New Zealand (NZ) soils; the high soil pH from the use of lime fertilizers reduces the bioavailability of Cu for grazing animals and growing plants; this, in turn, reduces Cu availability in the NZ human food chain. Our study is a pilot study to explore associations between Cu and TAA. We measured Cu levels in aneurysmal aortic tissues in patients undergoing Bentall procedures and non-aneurysmal aortic tissue from coronary artery bypass graft patients. METHODS: Aortic samples were collected from 2 groups of patients during elective open-heart surgery over 4 months between November 2017 and February 2018. The groups were a TAA group, patients with non-syndromic aortic aneurysm and without the bicuspid aortic valve or known infectious or inflammatory condition (ANEURYSM; n = 13), and a control coronary artery bypass graft group (CONTROL; n = 44). Standardized digested dry tissue weighed samples were analysed from both groups. Tissue extraction of trace elements was carried out using HCl-H2O2 digestion and a highly sensitive analytical technique, inductively coupled plasma mass spectrometry-used to measure elemental concentrations. RESULTS: Cu concentration (mean ± SD) was significantly lower in ANEURYSM (3.34 ± 0.16 µg/g) when compared to the CONTROL group tissues (4.33 ± 0.20 µg/g) (dry weight; mean ± SD; Student's t-test, P < 0.05). Over 46% of the Aneurysm patients were Maori and live in a geographically Cu-deficient NZ territory. CONCLUSIONS: Cu deficiency may play a role in the development or progression of non-syndromic ascending aortic aneurysms in NZ. Maori patients are more at risk as they commonly live in rural NZ, dependent on locally grown nutritional sources. Further studies are required to confirm this exciting finding and to establish cause and effect relationship

Outcomes of long left coronary endarterectomy in patients with diffuse coronary artery disease

Aim: Historically the outcome of left coronary artery endarterectomy (LCAE) has been associated with increased morbidity and mortality when surgeons performed it with coronary artery bypass grafting (CABG). We aim to review outcomes after open LCAE-CABG in patients managed with aggressive dual antiplatelet therapy.Methods: From 1999 to 2007 open LCAE with CABG was performed in 87 patients. We compared the short and long-terms outcomes of 75 propensity-matched conventional CABG patients. Both groups were operated on by a single surgeon.Results: Sixty-six percent (66%; n = 58/87) of LCAE group had diffuse atheroma in Left anterior descending artery (LAD); 31% (n = 27/87) involved both LAD and branches of the circumflex artery (Cx); 3%; (n = 3/87) involved the Cx in isolation. Cross clamp time (43.29 vs. 59.04, P = 0.019) and bypass time (57.29 vs. 74.04, P = 0.007) were significantly higher in the LCAE group. There was no significant difference in early (1% vs. 1.3%) and late mortality (4% vs. 4.5% at 10 years). The hospital length of stay (5.58 vs. 6.67, P = 0.03), was higher in the LACE group when compared with the CABG group. The freedom from angina and long-term survival were not significantly different between the two groups.Conclusion: Patients undergoing CABG with Left-sided coronary endarterectomy had increased cross-clamp and bypass times with prolonged stay in hospital and increased blood transfusion rates. The mortality, morbidity, long-term survival and freedom from angina are not different when compared to CABG alone. The use of retrograde blood cardioplegia and aggressive antiplatelets may have contributed to the excellent outcome

Acute shortness of breath due to reoccurrence of an intrapericardial bronchogenic cyst

A 71‐year‐old woman presented with dysphagia and acute shortness of breath. Surgical history included a prior thoracotomy overseas for a bronchogenic mesothelial cyst 19 years before. Computed tomography demonstrated a mass within the posterior mediastinum measuring 69 × 70 × 74 mm. A median sternotomy was performed, and after removal of the cyst, repair of the left atrium and pulmonary vessels was undertaken due to the invading nature of the cyst. Intrapericardial bronchogenic cysts are a rare form of congenital cysts arising from the primitive foregut. The cardiac primordia are in close proximity to the foregut and primitive tracheobronchial tree, and thus, abnormal budding of the tracheobronchial tree can arise in a myocardial location. Irrespective of the method of approach in redo surgery, complete resection must be performed in order to minimize the chance of recurrence, relieve symptoms, eliminate risk of infection, and prevent malignant degeneration