Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch

Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an ‘off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proo

Compression coil provides increased lead control in extraction procedures

Aims We investigated a new lead extraction tool (Compression Coil; One-Tie, Cook Medical) in an experimental traction force study. Methods and results On 13 pacemaker leads (Setrox JS53, Biotronik) traction force testing was performed under different configurations. The leads were assigned to three groups: (i) traction force testing without central locking stylet support (n = 5), (ii) traction force testing with the use of a locking stylet (Liberator, Cook Medical) and a proximal ligation suture (n = 4), (iii) traction force testing with the use of a locking stylet and a compression coil (n = 4). The following parameters were obtained for all groups: stress-strain curves, maximal forces, elastic modulus, post-testing lead length and lead elongation. In Groups 2 and 3 retraction of the locking stylet within the lead was measured [lead tip-locking stylet distance (LTLSD)]. Maximal forces for the three groups were: (i) 28.3 ± 0.3 N; (ii) 30.6 ± 3.0 N; (iii) 31.6 ± 2.9 N (1 vs. 2, P = 0.13; 1 vs. 3, P = 0.04; 2 vs. 3, P = 0.65). Elastic modulus was (i) 22.8 ± 0.1 MPa; (ii) 2830.8 ± 351.1 MPa; (iii) 2447.0 ± 510.5 MPa (1 vs. 2, P < 0.01; 1 vs. 3, P < 0.01; 2 vs. 3, P = 0.26). Mean LTLSD in Group 2 was 19.8 ± 3.2 cm and was 13.8 ± 1.7 cm in Group 3 (P = 0.02). The ratio of LTLSD/post-testing lead length was 0.37 ± 0.03 for Group 2 and 0.24 ± 0.03 for Group 3 (P < 0.01). Conclusion The application of a compression coil leads to an increased lead control expressed by less retraction of the locking stylet within the lead. This enables improved central support of extraction sheaths in the case of challenging extraction procedure

Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch

Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an 'off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proof

Increasing atmospheric temperature implicates increasing risk for acute type A dissection in hypertensive patients

Background: Acute type A aortic dissection (AAAD) is a life-threatening condition with high mortality within 24 hours. We hypothesized if there is a correlation between seasonal weather changes and the occurrence of AAAD. The aim of the present study was to identify seasonal specific weather and patient characteristics predicting the occurrence of AAAD. Methods: This is a retrospective analysis of all consecutive patients of our department with AAAD between January 1st 2006 and December 31st 2016. The national meteorological department provided the data of temperature, humidity and air pressure during the study period. The occurrence of AAAD, preoperative neurological impairment and mortality were analyzed in correlation with the obtained daily weather data within the entire cohort and in patients with and without hypertension separately. Results: A total of 517 patients were included. Mean age was 63.4±13 years, 69.4% were male and 68.8% had documented hypertension. In-hospital mortality was 17.7%. In the whole cohort, the occurrence of AAAD was significantly increased in March, October, December (P=0.016). In hypertensive patients, the occurrence was increased 34% with rising temperature (0.1-9.6 °C, OR1.34, 95% CI: 1.06-1.69, P=0.015). There was no correlation between weather variables and preoperative neurological impairment or mortality. Conclusions: Our data suggests a relation between an increasing number of events of AAAD and certain months within our catchment area and a significantly increased occurrence with rising temperatures (independent from absolute temperature at time of the event) in hypertensive patients

Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center

OBJECTIVES Aortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years. METHODS This is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists/primary care physicians. RESULTS Between 02/1996 and 11/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33-59), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade ≥3, 12% were in functional NYHA-class ≥III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation ≤2. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5% ± 2.4% and 87.0% ± 3.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation ≥3. However a preoperative left ventricular end diastolic diameter of ≥5.5 cm was associated with worse outcome. CONCLUSION David operations can be performed with excellent perioperative and 10-year follow-up outcomes in centers not running large AVSRR-programs

Repair of post-infarction left ventricular free wall rupture using an extracellular matrix patch

Several techniques for surgical treatment of acute or subacute left ventricular free wall rupture (LVFWR) have been described using a sutured or sutureless patch with different currently available materials. We present a case report of a 50-year-old male with acute LVFWR, who was treated with a simple surgical technique using an 'off-pump' epicardially sutured LV patch consisting of an acellular xenogeneic extracellular matrix (ECM). ECM patches are structurally more surgeon-friendly and have shown to be bioactive, and capable of activating remodelling and even tissue regeneration. Compared with conventional pericardial patches, the advantage of this material is excellent pliability and very easy stitching owing to the thin composition of the material. In addition, and most importantly, in case of complex structural reconstructions, the patch is highly tear-proof

From asymptomatic adult patient to cardiopulmonary resuscitation – treatment of ALCAPA with total arterial myocardial revascularisation and mitral valve repair

Abstract Background Anomalous left coronary artery originating from the pulmonary artery (ALCAPA), is a unique congenital anomaly, comprising only 0.24–0.46% of all congenital cardiac anomalies. Late presentations, ranging from asymptomatic cases to sudden cardiac arrest, are exceptionally rare. This unique case highlights the complexity of managing ALCAPA in adulthood and underscores the necessity of a comprehensive surgical approach addressing both coronary and valvular issues. Presentation A 34-year-old female patient, who had been diagnosed with ALPACA in her early childhood, suffered sudden cardiac arrest at work, followed by out-of-hospital resuscitation. The patient had been followed-up regularly until adolescence, however, she had refused surgery. In the diagnostic work-up following successful resuscitation severe mitral valve regurgitation was additionally revealed. Subsequently, the patient underwent surgery, involving coronary artery bypass grafting (CABG), using bilateral internal mammary arteries, and mitral valve repair, with an excellent postsurgical result. At 16-month follow-up, the patient was asymptomatic and quality of life had significantly improved. Conclusion This rare case initially presented as silent myocardial ischemia, resulting in reduced left ventricular function and secondary mitral incompetence. Surgical treatment of ALCAPA in adults poses greater challenges and a higher risk than in children. CABG procedure offers an excellent prognostic therapeutic strategy, since this procedure is a routine in adult cardiac surgery