Abstract

Our institution has performed over 100 robot-assisted mitral valve repairs. The procedure has shown many advantages to conventional sternotomy-based repair. However, the robotic approach leads to longer cross-clamp and bypass times than conventional sternotomy. As a result of the increased risk of myocardial damage and arrhythmias from lengthy arrest times, nitinol U-clips have been used in the laboratory and currently in patients for the tissue-annuloplasty ring approximation. The technology replaces the time-consuming task of knot tying, as well as provides better visualization during placement of the annuloplasty ring. The animal studies show excellent tissue incorporation. Short-term echocardiographic imaging shows durability without evidence of mitral stenosis or regurgitation. Further studies are ongoing in our patient population, and the data suggest shorter, more efficient and effective robot-assisted mitral valve repairs.

Abstract

This study was a retrospective analysis of both the efficacy and long-term outcome of endovascular management of thoracic aortic disease. From March 1999 to August 2003, 129 patients (110 males; 19 females) were enrolled. They were divided into four groups: aneurysms (41, 5 of which acutely ruptured, Group A), post-traumatic lesions (24, 14 acute and 10 chronic, Group B) and complicated type B dissections (42, 23 acute and 19 chronic, Group C). Twenty-two of the 129 patients with chronic type B dissection, not suitable for endovascular treatment, received medical management only (Group D). All patients underwent computed tomography (CT) scan and angiography as preoperative assessment. Stent-graft systems were Talent -Medtronic, Excluder-Gore, Zenith-Cook and Endofit-Endomed, deployed by transesophageal echocardiography (TEE) monitoring. An optimal deployment with sealing of the graft was achieved in 95.3% (102/107) of the treated patients discharged in good condition within 6 days. Five patients (3 in Group A and 2 in Group C) underwent endovascular completion of the elephant trunk technique successfully. In 5 patients affected by atherosclerotic aneurysm, in a single-time procedure, we have also treated the abdominal aortic aneurysm by endovascular. No spinal cord injuries were observed. The follow up (average: 20.82+/-10.01 months), performed with serial chest CT scans, was 100% complete. No stent-graft related complications were detected. In 2 patients with chronic dissection, an asymptomatic type II endoleak was detected. A total of 4 hospital deaths resulted in an overall operative mortality rate of 3.7%. Seven patients (6.5%) died during the follow-up period, whereas a 31.8% (7/22) mortality rate (p < 0.001) was observed within the medical treatment group. Endovascular treatment of thoracic aortic diseases, even in the acute phase, may represent a valid option, especially when compared to medical therapy.

Abstract

The Bentall operation is preferred when a diseased aortic valve is associated with a dilated or dissected ascending aorta. Composite valved grafts have been devised to facilitate and expedite this procedure. The initial clinical results of the Bentall procedure using a vascular conduit modified to incorporate "pseudosinuses of Valsalva," with the aim of simplifying coronary button anastomoses and decreasing tension upon them, is described herein. Over a period of 40 months since its introduction, the novel conduit has been used, for a Bentall procedure in 37 consecutive patients. Of this group, 31 were men and 6 were women, with a mean age of 63.8+/-9.9 years. Five were Marfan patients, 8 were patients after acute or chronic dissection, and 8 were patients who required redo procedures. In 22 patients, the modified conduit was used in association with a biological valve (4 stentless valve) and in 15, with a mechanical valve. The mean durations of CPB and X-clamp time were 117+/-32 and 88+/-22 minutes, respectively. No operative or late deaths occurred after a mean follow-up period of 20+/-12 months. This study indicates that the new vascular prosthesis appears to facilitate implantation by maintaining a more natural shape of the reconstructed aortic root.

Abstract

Ischemic steal syndrome (ISS) is an uncommon complication of arteriovenous (AV) access placement. Distal revascularization interval ligation (DRIL) is an alternative to preserve AV access and resolve ISS simultaneously. This case illustrates the problem of ISS and tissue loss, and its successful treatment after undergoing the DRIL procedure. Other options for management of ISS also are reviewed.