Valvulogenesis of a living, innervated pulmonary root induced by an acellular scaffold

Heart valve disease is a major cause of mortality and morbidity worldwide with no effective medical therapy and no ideal valve substitute emulating the extremely sophisticated functions of a living heart valve. These functions influence survival and quality of life. This has stimulated extensive attempts at tissue engineering “living” heart valves. These attempts utilised combinations of allogeneic/ autologous cells and biological scaffolds with practical, regulatory, and ethical issues. In situ regeneration depends on scaffolds that attract, house and instruct cells and promote connective tissue formation. We describe a surgical, tissue-engineered, anatomically precise, novel off-the-shelf, acellular, synthetic scaffold inducing a rapid process of morphogenesis involving relevant cell types, extracellular matrix, regulatory elements including nerves and humoral components. This process relies on specific material characteristics, design and “morphodynamism”.</p

Assessment of left ventricular tissue mitochondrial bioenergetics in patients with stable coronary artery disease

Recurrent myocardial ischemia can lead to left ventricular (LV) dysfunction in patients with coronary artery disease (CAD). In this observational cohort study, we assessed for chronic metabolomic and transcriptomic adaptations within LV myocardium of patients undergoing coronary artery bypass grafting. During surgery, paired transmural LV biopsies were acquired on the beating heart from regions with and without evidence of inducible ischemia on preoperative stress perfusion cardiovascular magnetic resonance. From 33 patients, 63 biopsies were acquired, compared to analysis of LV samples from 11 donor hearts. The global myocardial adenosine triphosphate (ATP):adenosine diphosphate (ADP) ratio was reduced in patients with CAD as compared to donor LV tissue, with increased expression of oxidative phosphorylation (OXPHOS) genes encoding the electron transport chain complexes across multiple cell types. Paired analyses of biopsies obtained from LV segments with or without inducible ischemia revealed no significant difference in the ATP:ADP ratio, broader metabolic profile or expression of ventricular cardiomyocyte genes implicated in OXPHOS. Differential metabolite analysis suggested dysregulation of several intermediates in patients with reduced LV ejection fraction, including succinate. Overall, our results suggest that viable myocardium in patients with stable CAD has global alterations in bioenergetic and transcriptional profile without large regional differences between areas with or without inducible ischemia

Chirurgie conservatrice des anévrysmes de la racine aortique et de l'aorte ascendante par la technique de réimplantation (Opération de Tirone David) : expérience Rouennaise

La prise en charge chirurgicale des anévrysmes de la racine aortique et de l’aorte ascendante par la technique de réimplantation de Tirone David connaît une large expansion. L’objectif de ce travail est d’évaluer la morbimortalité de ces patients opérés de façon élective ou en urgence et d’évaluer le devenir de la fonction valvulaire aortique, de la fonction ventriculaire gauche et l’évolution de l’aorte thoracique en utilisant l’IRM cardiaque. Patients et méthodes : Entre 2003 et 2012, 121 patients ont bénéficié d’une chirurgie de Tirone David I, l’âge moyen était de 55±15 ans, 70% (n=84) était des hommes. Un syndrome de Marfan a était diagnostiqué chez 12% des patients (n =15), une bicuspidie aortique chez 15%(n=18) et une dissection aortique chez 20% (n =26). En peropératoire 30% des patients (n=40) ont bénéficié d’une plastie aortique associée et 25% (n=31) d’un tube type Valsalva. Le suivi clinique et échographique a concerné 92 patients pour une durée moyenne de 2,6±2 (10 mois, 10 ans), le suivi par IRM cardiaque a englobé 65 patients pour une durée moyenne de 4,2± 2,3 années. Résultats : La mortalité hospitalière était de 4,9% (n=6). Les décès précoces sont survenus chez les patients opérés en urgence pour une dissection aortique (p=0,007). Le suivi par échographie cardiaque révèle une IAO≥2 chez 19%(n=18) patients. L’analyse univariée n’a retrouvé aucun facteur de risque de survenue d’IAO≥2. Le suivi par IRM révèle une IAO≥2 chez 27%(18), une fonction ventriculaire gauche < 50% chez 9 patients, une masse ventriculaire gauche de 72±18 g/ m², un VTDVG de 83 ± 20ml/ m², un VTSVG de 36±17 ml/ m², aucune dilatation aortique ni dissection aortique n’est survenue sur le reste de l’aorte thoracique. Sept patients ont été réopérés, 3 pour insuffisance aortique sévère par prolapsus valvulaire, 3 pour endocardite aortique et un pour une infection précoce de prothèse. La survie sans ré-intervention chirurgicale était de 91%±3, 3 à 5ans et à10 ans. Ni le syndrome de Marfan, ni la bicuspidie aortique, ni le type de prothèse utilisée, ni la sévérité de l’IAO préopératoire, ni l’opération en urgence sont des facteurs de risque de ré-intervention chirurgicale. La survie globale était de 87%±3 à 5 ans et de 75%±9 à 10 ans. Conclusions : La technique de réimplantation de Tirone David est une technique sure, reproductible et durable car elle démontre d’excellents résultats à 5 et 10 ans. Les patients opérés en urgence pour une dissection aortique sont exposés à une surmortalité indépendante de la technique chirurgicale. Le suivi par IRM des patients asymptomatique avec une IAO modérée, par le calcul de la masse, des volumes

Nina Braunwald: a female pioneer in cardiac surgery

Nina Starr Braunwald, the first female cardiac surgeon, made headlines during a time when almost all specialty surgeons were men. Women have typically been deterred from entering surgical specialties, in part because of their traditional dual burden of managing their households and careers. Instead, female medical students and junior doctors have tended to be more attracted to medical specialties. This was the reality during Dr. Braunwald's venture into medicine in 1949. However, she never allowed negative ideas to keep her from joining a surgical training program. Under the mentorship of the prominent cardiac surgeons Charles Hufnagel and Andrew Morrow, Dr. Braunwald progressed in her career by conducting research that led to her development and implantation of the first prosthetic mitral valve. She was also a great teacher. Dr. Braunwald balanced her personal and professional activities admirably, and her example still inspires female doctors to consider careers in cardiothoracic surgery. In this report, we provide details of her impact on cardiac surgery and insights into her successes

Dust effect on optical transmittance of photovoltaic module glazing in a desert region

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The results of cardiac surgery during the COVID-19 pandemic compared with previous years:a propensity weighted study of outcomes at six months

OBJECTIVES: In addition to excess mortality due to COVID-19, the pandemic has been characterised by excess mortality due to non-COVID diagnoses and consistent reports of patients delaying seeking medical treatment. This study seeks to compare the outcomes of cardiac surgery during and before the COVID-19 pandemic. DESIGN: Our institutional database was interrogated retrospectively to identify all patients undergoing one of three index procedures during the first six months of the pandemic and the corresponding epochs of the previous five years. SETTING: A regional cardiothoracic centre. PARTICIPANTS: All patients undergoing surgery during weeks #13-37, 2015-2020. MAIN OUTCOME MEASURES: Propensity score weighted analysis was employed to compare the incidence of major complications (stroke, renal failure, re-ventilation), 30-day mortality, six month survival and length of hospital stay between the two groups. RESULTS: There was no difference in 30-day mortality (HR = 0.76 [95% CI 0.27-2.20], p = 0.6211), 6-month survival (HR = 0.94 [95% CI 0.44-2.01], p = 0.8809) and duration of stay (SHR = 1.00 (95% CI 0.90-1.12), p = 0.959) between the two eras. There were no differences in the incidence of major complications (weighted chi-square test: renal failure: p = 0.923, stroke: p = 0.991, new respiratory failure: p = 0.856). CONCLUSIONS: Cardiac surgery is as safe now as in the previous five years. Concerns over the transmission of COVID-19 in hospital are understandable but patients should be encouraged not to delay seeking medical attention. All involved in healthcare and the wider public should be reassured by these findings

Donor lung procurement by surgical fellow with an expectation of high rate of lung utilisation

There is an ever increasing demand for donor lungs in patients waiting for transplantation. Lungs of many potential donors will be rejected if the standard criteria for donor assessment are followed. We have expanded our donor lung pool by accepting marginal donors and establishing a donation after circulatory death program. We have achieved comparable results using marginal donors and accepting donor lungs following donation after circulatory death. We present our assessment and technical guidelines on lung procurement taking into consideration an increasingly complex cohort of lung donors. These guidelines form the basis of the lung procurement training program involving surgical Fellows at the Alfred Hospital in Melbourne, Australia

Transapical aortic valve implantation in Rouen: Four years’ experience with the Edwards transcatheter prosthesis

SummaryBackgroundThe first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department.AimsTo report 4-year outcomes of transapical implantation with the Edwards transcatheter bioprosthesis.MethodsWe prospectively evaluated consecutive patients who underwent transapical implantation with an Edwards transcatheter bioprosthesis between July 2007 and October 2011. Patients were not suitable for conventional surgery (due to severe comorbidities) or transfemoral implantation (due to poor femoral access).ResultsAmong 61 patients (59.0% men), mean logistic EuroSCORE was 27.5±14.9% and mean age was 81.0±6.8years. Successful valve implantation was achieved in 59/61 patients (96.7%) of patients. The other two patients required conversion to conventional surgery due to prosthesis embolization and died. Six additional patients died in the postoperative period. Causes of perioperative death were two septic shocks (one of peritonitis), two multi-organ failure, one ventricular fibrillation and one respiratory insufficiency. Intraprocedural stroke was not observed in any patient. The actuarial survival rates at 1, 2 and 4years were 73.8%, 67.2% and 41.0%. During this 4-year period, four patients died of cardiovascular events, but no impairment of transprosthesis gradient was observed.ConclusionOur series of 61 patients who underwent transapical implantation of the Edwards transcatheter bioprosthesis shows satisfactory results, similar to other reports, considering the high level of severity of patients referred for this method. Transapical access is a reliable alternative method for patients that cannot benefit from a transfemoral approach