Transapical access for thoracic endovascular aortic repair to elephant trunk completion.

The 2-stage elephant trunk procedure is widely used to treat extensive disease of the aortic arch and descending thoracic aorta. The 2nd stage of the procedure can be accomplished with both a standard surgical procedure and a retrograde transfemoral endovascular approach using the dangling graft as proximal landing zone. However, in some patients, severe disease of iliofemoral vessels can prevent standard retrograde thoracic endovascular aortic repair (TEVAR). In such cases, an alternative route to gain endovascular access must be used. Herein, we report a case of anterograde cardiac transapical approach for TEVAR as a 2nd stage of an elephant trunk procedure

Non-A non-B aortic dissection: a systematic review and meta-analysis

OBJECTIVES: Non-A non-B aortic dissections are rare, and little is known about their natural history, indications for surgery and operative results. We aim to examine the literature to summarize what is known of the natural history of non-A non-B dissections and evaluate the outcomes of the therapeutic options available

Early Coronary Thrombosis without ST-Segment Elevation Following Repair of Acute Aortic Dissection.

Acute coronary thrombosis after emergent surgery for acute Type A aortic dissection is a rare event that can remain undiagnosed in absence of typical electrocardiogram readings. We report a case of left anterior descending artery thrombosis without ST-segment elevation three days after surgical repair, which was successfully treated with angioplasty and stenting

A rare case of giant lipomatous hypertrophy of the atrial septum.

Benign lipomatous lesion of the heart includes an heterogeneous group of entities including neoplastic, congenital and reparative phenomena. Among these lipomas and lipomatous hypertrophy of the atrial septum ( LHIS) represent the most common lesion. Patients suffering from LHIS are often asymptomatic, however atrial fibrillation, congestive heart failure and supraventricular tachycardia are typical findings. Here we present a rare case of LHIS symptomatic for asthenia and dyspnea

The role of genetic testing in the prevention of acute aortic dissection

Although much has been learned about disease of the thoracic aorta, most diagnosis of thoracic aortic aneurysm (TAA) is still incidental. The importance of the genetic aspects in thoracic aortic disease is overwhelming, and today different mutations which cause TAA or alter its natural history have been discovered. Technological advance has made available testing which detects genetic mutations linked to TAA. This article analyses the genetic aspects of TAA and describes the possible role of genetic tests in the clinical setting in preventing devastating complications of TAA

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

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The worst MitraClip Scenario: acute mitral regurgitation due to papillary muscle rupture

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Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?

Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years

Edge-to-Edge Technique Used as a Bailout for Suboptimal Mitral Repair: long-term results

BACKGROUND: In case of initial sub-optimal mitral valve repair the edge-to-edge (EE) technique has been used as a bail-out procedure. However, the long-term durability of those rescued mitral valves is currently unknown. With this study we aim to evaluate the long term clinical and echocardiographic results of the EE technique used to rescue patients with initial sub-optimal conventional mitral valve repair. METHODS: A retrospective review of our institutional database was carried on querying for patients who had undergone mitral valve repair with EE used as a bailout procedure. Cumulative Incidence Function using death as competitive event was used to estimate cardiac death and REDO for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with random intercept for correlated data. RESULTS: 81 patients were selected. The median follow-up was 9.1 years [IQR 6.7-12.1], maximum: 22.6 years. At 15 years the estimated Kaplan-Meier overall survival was 63.2 ± 8.69%, 95% CI [43.76-77.46] and the predicted rate of moderate to severe MR recurrence was 16.67%. At 15 years the CIF for REDO for mitral valve replacement with death as competing event was 2.5 %; 95% CI [0.48-7.84] No case of more than mild mitral stenosis was detected. CONCLUSIONS: The EE technique can be effectively used as a bailout procedure in patients with sub-optimal conventional mitral valve repair with very satisfactory long term results