DOUBLE TRANS-APICAL ACCESS DURING NEOCHORD IMPLANTATION

Mitral valve repair using trans-apical off-pump beating-heart neochordae implantation is a relatively new procedure with promising early and mid-term results in selected patients. However early failures few days after the procedure, requiring surgical reintervention, have been described. We describe a case of intraoperative acute procedural failure treated with a second procedure through a different trans-apical access adjacent to the first one. The final result was excellent with trivial residual regurgitation and the subsequent hospitalization was uneventful. This case demonstrates that a second trans-apical mitral neochordae implantation is feasible and should be considered in case of intraoperative acute procedural failure

Total Endovascular Aortic Arch Repair: From Dream to Reality

The gold-standard therapy for the treatment of aortic arch pathologies is conventional open surgery. Recently, total endovascular aortic arch replacement with branched stent-grafts has been introduced into clinical practice with the aim of reducing invasiveness especially in selected high-risk patients. The aim of this review is to describe the two most commonly used branched devices for endovascular arch stent-grafting: Nexus (Endospan, Herzlia, Israle) and RelayBranch (Terumo Aortic, Glasgow, United Kingdom). Nexus is a CE-certified off-the-shelf, single branch, double stent graft system. It consists of two different components: a main module for the aortic arch and the descending aorta with a side-branch for the brachiocephalic artery (BCA), and a curved module for the ascending aorta that lands into the sino-tubular junction and connects to the main module through a side-facing self-protecting sleeve. Nexus may be used in urgent-emergency cases and also in patients with only one suitable supra-aortic target vessel but, on the other hand, it makes cerebral blood flow dependent on one source vessel only. The RelayBranch Thoracic Stent-Graft System is a custom made, double branched endograft with a wide window on its superior portion to accommodate two inner tunnels for BCA and left common carotid artery connection; bilateral cervical accesses are generally used to advance guidewires for catheterization of the inner tunnels in a retrograde fashion. RelayBranch can be customized on every patient’s specific anatomy and provides a double blood source for the brain, but it cannot be used in urgent-emergency conditions. Therefore, in order to optimize outcomes, the choice of the most appropriate device should be made considering pros and cons of each system and patient’s anatomy by an experienced aortic team. In conclusion, total endovascular aortic arch exclusion is a promising reality in selected high-risk patients

Aortic dissection during heart transplant: when a nightmare comes true

: Although heart transplant is a simple surgical procedure, it is actually considered challenging to perform this procedure in patients with a long-term left ventricular assist device assistance. We present the case of a patient who was bridged to the transplant by using a Jarvik 2000 left ventricular assist device. During the debridement, an acute type A aortic dissection occurred and the surgical strategy was suddenly replanned. The acute aortic dissection is one of the most feared complications, but it could be well managed, thanks to a rapid replanning of the surgical strategy

Aortic dissection during heart transplant: when a nightmare comes true

: Although heart transplant is a simple surgical procedure, it is actually considered challenging to perform this procedure in patients with a long-term left ventricular assist device assistance. We present the case of a patient who was bridged to the transplant by using a Jarvik 2000 left ventricular assist device. During the debridement, an acute type A aortic dissection occurred and the surgical strategy was suddenly replanned. The acute aortic dissection is one of the most feared complications, but it could be well managed, thanks to a rapid replanning of the surgical strategy

Colore e materia: i gialli di piombo, stagno, antimonio

The aim of this work is to investigate the methods used for producing artificial yellow pigments (‘type I’ and ‘type II’ lead-tin yellow, lead antimonate yellow or Naples yellow, and lead-tin-antimony yellow), starting from various recipes and the more recent literature, and to characterize the materials produced by utilising different analytical techniques. The artificial yellow pigments were obtained from pure chemicals (PbO, Pb3O4, SnO2, Sb3O4). The effects produced were tested by varying the stoichiometric ratios, melting temperatures and times, and crucible typologies. The powders obtained were characterized by means of SEM-EDS, XRD, XRF and DTA analyses. In order to evaluate the colour changes due to different melting temperatures and stoichiometric ratios, the colour measurements were taken using CIExy 1931 and CIE 1976Lab coordinates

A New and Unexpected Complication after Arch Stent Grafting For Residual Dissection

This report describes an unreported complication after stent-grafting of the aortic arch for residual dissection following ascending aorta and aortic arch replacement for acute type A dissection. The patient developed, one year later, a pseudoaneurysm originating from the proximal suture line and therefore far from the stent-graft landing zone, that fistulized into the pulmonary artery. Possible causes are: suture damage during stent deployment or change of system forces after stent placement leading to high-tension on the suture line. Emergency surgery was performed. Aortic arch stent grafting is a new promising technique but its complications are still not completely known

Conduction disorders after aortic valve replacement with rapid-deployment bioprostheses: early occurrence and one-year evolution

Rapid-deployment bioprostheses represent one of the newest aortic valve substitutes introduced into clinical practice. The aim of this retrospective single-center study was to evaluate the occurrence of conduction disorders (CDs) after rapid-deployment aortic valve implantation at discharge and at 1-year follow-up, and to identify risk factors for CDs and permanent pacemaker implantation (PPI)

Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection

none9The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices.noneD'Onofrio, Augusto; Cibin, Giorgia; Antonello, Michele; Battocchio, Piero; Piazza, Michele; Caraffa, Raphael; Dall'Antonia, Alberto; Grego, Franco; Gerosa, GinoD'Onofrio, Augusto; Cibin, Giorgia; Antonello, Michele; Battocchio, Piero; Piazza, Michele; Caraffa, Raphael; Dall'Antonia, Alberto; Grego, Franco; Gerosa, Gin