Pleiotropic effects of the HMG-CoA reductase inhibitors

The HMG-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia. They have also demonstrated a benefit in a variety of other disease processes. These secondary actions are known as pleiotropic effects. Our paper serves as a focused and updated discussion on the pleiotropy of statins and emphasizes the importance of randomized placebo-controlled trials to further elucidate this interesting phenomenon

The quest for the optimal surgical management of tricuspid valve endocarditis in the current era: A narrative review

Tricuspid valve endocarditis (TVE) is a growing concern with increasing rates and mortality burden. The currently changing etiology, the antibiotic resistance and the raise in iatrogenic causes as with implantable cardiac devices [cardiac implantable electronic device (CIED)], represent a challenge for the management of these patients. The progressively widespread use of CIEDs is adding to the more commonly known intravenous (IV) drug abuse in the list of causes. Treatment strategies include medical therapy alone or surgery. From the surgical standpoint tricuspid valve repair, replacement or the staged procedure of valvectomy as bridge to replacement are available options. Treatment of endocarditis related to implantable device is another expanding field which requires a coordinated action with microbiologists in consideration of the microorganism antibiotic resistance. This review summarizes the currently available evidences on TVE including surgical indications, timing of interventions and technical considerations. The conflicting results of the available observational evidences and the non-unanimous consensus on many aspects of TVE impede to reach a definitive conclusion regarding the best management strategy and demands for randomized studies in this field

Incidence of postoperative acute kidney injury in patients with chronic kidney disease undergoing minimally invasive valve surgery

BackgroundWe hypothesize that minimally invasive valve surgery in patients with chronic kidney disease (CKD) is superior to a conventional median sternotomy.MethodsWe retrospectively analyzed 1945 consecutive patients who underwent isolated valve surgery. Included were patients with CKD stages 2 to 5. In-hospital mortality, composite complication rates, and intensive care unit and total hospital lengths of stay of those who underwent a minimally invasive approach were compared with those who underwent a standard median sternotomy. Resource use was approximated based on intensive care unit and total hospital lengths of stay.ResultsThere were 688 patients identified; 510 (74%) underwent minimally invasive surgery, and 178 (26%) underwent a median sternotomy. There was no significant difference in mortality. Minimally invasive surgery was associated with fewer composite complications (33.1% vs 49.4%; odds ratio, 0.5; P ≤ .001), shorter intensive care unit (48 [interquartile range {IQR}, 33-74] hours vs 71 [IQR, 42-96] hours; P < .01), and hospital (8 [IQR, 6-9] days vs 10 [IQR, 8-15] days; P < .001) lengths of stay, and a lower incidence of acute kidney injury (8% vs 14.7%; odds ratio, 0.5; P = .01), compared with median sternotomy. In a multivariable analysis, minimally invasive surgery was associated with a 60% reduction in the risk of development of postoperative acute kidney injury.ConclusionsIn patients with CKD undergoing isolated valve surgery, minimally invasive valve surgery is associated with reduced postoperative complications and lower resource use

Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations

International audienc

Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach

Intermediate Results of Transaortic Edge-to-Edge Repair of the Mitral Valve in Patients Undergoing Aortic Valve Replacement

Background and aim of the study: The study aim was to evaluate the safety and efficacy of a transaortic edge-to-edge mitral valve repair in patients undergoing aortic valve replacement (AVR) who were considered to be at high risk for double-valve surgery. Methods: All patients deemed to be at high surgical risk for standard double-valve surgery, and who instead underwent AVR with transaortic edge-to-edge mitral valve repair between September 2008 and October 2012 at the authors' institution, were analyzed retrospectively. Intraoperative transesophageal and follow-up transthoracic echocardiography were performed to evaluate adequacy of the repair and to assess for any recurrence of mitral regurgitation (MR). Results: A total of 55 patients (mean age 78.4 +/-. 8.4 years) was identified (45 minimally invasive, 10 median sternotomy). All patients were in NYHA class The aortic valve lesion was classified as stenosis (n = 45), insufficiency (n = 6), or prosthetic valve insufficiency (n = 4), and the mitral valve lesion as functional (n = 16), degenerative calcification (n = 27), or rheumatic (n = 12). There were four deaths (7%). The median total hospital length of stay was 7 days (IQR 6-11 days). The median preoperative versus postoperative MR grade was moderate-to-severe (3+) (IQR 3-4+) versus 0 (IQR 0-1+) (p <0.001). The median time to follow up echocardiography was 6.5 months (IQR 0.8-12 months). The median preoperative and postoperative versus follow up MR grades were 3+ (IQR 3-4+) versus 1+ (IQR 0-1+) (p <0.001), and 0 (IQR 0-1+) versus 1+ (IQR 0-1+) (p = 0.004), respectively. Conclusion: In high-risk patients undergoing AVR with grade 3-4+ MR, a transaortic edge-to-edge mitral valve repair may be a safe and effective alternative to conventional double-valve surgery. However, longer-term data are needed to verify this proposal