Abstract:

Aortic root replacement is the procedure of choice for patients with ascending aortic aneurysms and diseased aortic valve leaflets. The increasing age of patients who undergo aortic root surgery, and data that support the use of a biological aortic valve in the younger population, have significantly increased the need for a composite biological valved conduit. The third-generation Triplex™ (Terumo Vascutek, Renfrewshire, Scotland, UK) Dacron conduit with its three-layer technology, can be stored in glutaraldehyde along with biological prostheses while maintaining a complete blood impermeability. As the result of this fundamental improvement, the ready-to-use composite biological valved graft is currently available for the first time in different sizes, which avoids the need of assembling it on the surgical table. The procedure is expedited and a better hemostasis achieved because of the intrinsic characteristics of the new three-layered conduit. The BioValsalva (Terumo Vascutek, Renfrewshire, Scotland, UK) has been obtained by suturing a stentless aortic valve (Elan, Kohler, Leeds, UK) inside a Triplex Valsalva graft and combining the advantages of a biological valved conduit with the advantages of better leaflets dynamics, less tension on coronary ostia, and improved coronary flow proper of the Valsalva conduit. The authors' preliminary clinical experience with the BioValsalva is reported herein and the technique is discussed.

Authors:

Ruggero De Paulis, M.D. , Associate Professor and Chief, Raffaele Scaffa, M.D., Junior Staff Surgeon, Daniele Maselli, M.D., Senior Staff Surgeon, Luca Weltert, M.D., Junior Staff Surgeon, Andrea Salica, M.D., Junior Staff Surgeon, Alessandro Bellisario, M.D., Senior Staff Surgeon, Division of Cardiac Surgery, European Hospital, Roma, ITALY

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Abstract:

In 2001, we described a new surgical technique of surgical ventricular restoration (SVR) in severe heart failure by papillary muscle re-alignment and volume reduction. This procedure has been offered in our institution to patients with severely impaired left ventricular function. Here we examine our mid-term results and also compare them with a similar cohort of patients who had coronary artery bypass grafting (CABG) only. Between 1998 and 2005, 30 patients underwent SVR by papillary muscle realignment with coronary artery revascularization at our institution. A subset of 20 patients had their left ventricular volume measured by echocardiogram and MRI scan, and a maximal cardiopulmonary exercise test was performed before and after the operation. An unselected consecutive cohort of patients with matching age, gender, and hemodynamic status who underwent CABG only without SVR was tested using the same protocol and the results were compared. We noticed that there was a significant advantage for patients who had additional SVR over patients who had CABG only. The observed improvement in those who had SVR may be due to reduced metabolic mismatch as a result of reduced wall tension and normalization of the apical twist of the left ventricle. We believe this would provide a form of surgical treatment for heart failure secondary to ischemic cardiomyopathy at a time of reduced donor organ availability for transplant.

Authors:

R. Unnikrishnan Nair, F.R.C.S., Consultant Cardiothoracic Surgeon, Department of Cardiac Surgery, Diane Barker, M.R.C.P., Cardiology Specialist Registrar, Department of Cardiology, Sanjay Kumar, F.R.C.S., Registrar in Cardiothoracic Surgery, Department of Cardiac Surgery, Kayala Javengula, F.R.C.S., Registrar in Cardiothoracic Surgery, Department of Cardiac Surgery, Lip Bun Tan, F.R.C.P., Consultant Cardiologist, Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK

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Abstract:

The pharmacological treatment of atrial fibrillation (AF) has proven to be wholly inadequate. Although highly successful, the surgical approach is too invasive and has not been widely adopted. Progress has been made with breathtaking speed over the last decade toward the creation of an ablative surgical procedure that retains a high cure rate yet solves the problem of invasiveness. This chapter will describe a procedure that uses microwave energy delivered via a thin, long, and flexible catheter through endoscopic ports to treat AF. As energy delivery methods, surgical techniques, and assessment procedures continue to improve, treatments such as this one will hopefully attract the largest number of patients who suffer with this arrhythmia to seek a safe and effective cure.

Authors:

Adam E. Saltman, M.D., Ph.D., Director, Atrial Fibrillation Center, Division of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York, USA

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