Daniel Unić

One thousand minimally invasive valve operations: early and late results.

Objective:We sought to evaluate the potential benefits of minimally invasive approaches for treatment of isolated aortic and mitral valve disease. Methods:From 7/96 to 04/03, we performed 1000 minimally invasive valve operations: 526 aortic (AV) procedures (64 years; mean, 25–95) and 474 mitral (MV) procedures (58 years; mean, 17–90). Results:In the AV group, an upper ministernotomy was used in 492/526 patients (93%) and a right parasternal approach in 34 (7%). Sixty-three patients had reoperative aortic valve replacements. In the MV group lower sternotomy was used in 260/474 (55%), right parasternal in 200/474 (42%), and a right thoracotomy in 14 patients. MV repair was performed in 416 and MV replacement in 58 patients. Operative mortality was 12/526 (2%) in the AV and 1/474 (0.2%) in the MV group. Freedom from reoperation at 6 years was 99% and 95% in the AV and MV group, respectively. Late mortality was 5% in the AV and 3% in the MV group, respectively. Conclusions:Minimally invasive valve surgery can be performed at very low levels of morbidity and mortality, with results equal to or better than conventional techniques. All forms of valve repair and replacement operations can be performed. Long-term survival and freedom from reoperation are excellent.

Endoscopic Radial Artery Harvesting Reduces Postoperative Pain and Neurologic Complications

BACKGROUND Endoscopic radial artery harvest provides better cosmetic result without compromising the quality of the graft. We sought to compare postoperative harvesting site neurologic and vascular outcome. METHODS From 10/2002 until 10/2004, 50 patients were randomized to have their radial artery harvested for coronary bypass either endoscopically (group A, n = 25) or conventionally (group B, n = 25). Radial arteries were preoperatively evaluated by Doppler echocardiography. Neurologic and functional status was assessed by a self reporting questionnaire with a semiquantitative (1-5) scale. Vascular status of the forearm was assessed by control echocardiography. RESULTS At an average follow-up of 37 +/- 7 months, patients undergoing endoscopic radial artery harvesting had less overall neurologic complications (11 versus 17 patients, P = .023) and they were less severe (0.8 +/- 1.1 versus 2.2 +/- 1.2; P < .001). Ulnar flow increase was similar among the groups: 13.1 +/- 5.43 cm/s in group A versus 15.9 +/- 4.9 cm/s in group B (P = .147) as well as ulnar artery diameter increase 0.29 +/- 0.16 mm in group A versus 0.29 +/- 0.26 cm in group B (P = .914). CONCLUSION Endoscopic radial artery is safe and does not compromise graft quality or forearm and hand circulation postoperatively. Along with providing a better cosmetic result, endoscopic artery harvesting reduces postoperative harvesting site pain and neurologic complications.

Asymptomatic Calcifying Fibrous Pseudotumor Compressing Heart Cavities

Calcifying fibrous pseudotumor is a rare benign lesion composed mostly of dense hyalinized colagen with multiple dystrophic or psammomatous calcifications and variable lymphoplasmacytic infiltrate. Children and young adults are most commonly affected by this tumor of uncertain pathogenesis. This is a case of an asymptomatic young woman with calcifying fibrous pseudotumor of the pericardium compressing heart cavities. Partial resection and marsupialization of the mass was performed.

Isolated Tricuspid Valve Libman-Sacks Endocarditis in Systemic Lupus Erythematosus with Secondary Antiphospholipid Syndrome

Libman-Sacks endocarditis, one of the most prevalent cardiac presentations of systemic lupus erythematosus, typically affects the aortic or mitral valve; tricuspid valve involvement is highly unusual. Secondary antiphospholipid syndrome increases the frequency and severity of cardiac valvular disease in systemic lupus erythematosus. We present the case of a 47-year-old woman with lupus and antiphospholipid syndrome whose massive tricuspid regurgitation was caused by Libman-Sacks endocarditis isolated to the tricuspid valve. In addition, we discuss this rare case in the context of the relevant medical literature.

Impact of reduced creatinine clearance on early heart transplantation outcomes: A propensity score adjusted analysis

We aimed to determine the independent effect of preoperative creatinine clearance (CrCl) on HTx outcomes. Patients and Methods: 220 patients underwent HTx in Croatia from 2008 to 2014. Four patients were excluded due to missing data. Patients were dichotomized according to a CrCl cut-off value of 50 ml/ min (Group A: CrCl≤50 ml/min; Group B: CrCl>50 ml/min). Sixty-three patients (29%) had a CrCl≤50 ml/ min. Propensity score (PS) adjustment was performed by accounting for recipient age and gender, AF, smoking, ischemic time, CPB time, BMI, mechanical circulatory assistance (MCS) and reoperation. Results: Patients in Group A were older (56±11 vs. 49±12 years, P<0.001) and had longer donor ischemic times (197±65 vs. 162±62 min, P<0.001). No significant differences were noted in recipient gender (48/63 (76%) vs. 125/153 (82%) male, P=0.355), donor age (39±13 vs. 39±12 years, P=0.875), donor gender (46/63 (73%) vs. 100/153 (65%) male, P=0.338), PVR (213±107 vs. 188±96 dyn*s*cm −5 , P=0.145), diabetes (18/63 (29%) vs. 34/153 (22%), P=0.382), reoperation (18/63 (29%) vs. 34/153 (22%), P=0.382), CPB duration (175±62 vs. 158±56 min, P=0.06) or preoperative MCS (6/63 (10%) vs. 17/153 (11%), P=0.813). Six-month mortality was higher in patients with a CrCl≤50 ml/min (18/63 (29%) vs. 19/153 (12%); unadjusted OR 2.82 [95% CI 1.36-5.84]; P=0.009). Similarly, group A patients were more likely to require renal replacement therapy (RRT) (16/63 (25%) vs. 17/153 (11%); OR 2.72 (1.28-5.82); P=0.012). After PS adjustment these differences remained significant for both 6-month mortality and RRT (OR 2.44 [95% CI 1.09-5.49]; P=0.030 and OR 3.36 [95% CI 1.43-7.92]; P=0.005, respectively). Con Clusions: Patients with a CrCl≤50 ml/min undergoing isolated HTx had inferior 6-month survival and required RRT more commonly. The impact of CrCl remained significant after adjustment for multiple perioperative covariates. Hrvoje Gasparovic 1

Omentum flap as a salvage procedure in deep sternal wound infection

and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Therapeutics and Clinical Risk Management 2017:13 1495–1497 Therapeutics and Clinical Risk Management Dovepress

Ventricular tachycardia: ominous sign of devastating prosthetic aortic valve dehiscence

Prosthetic valve endocarditis (PVE) is the most feared complication after valve implantation. It usually results in substantial morbidity and mortality in the postoperative period. An adverse effect on the annulus can cause conduction disturbances in the atrioventricular (AV) node, resulting in a high-degree AV block. This study describes a case of PVE that predominantly presented with sustained monomorphic ventricular tachycardia, which indicated a severe clinical course of PVE caused by a significant displacement of the aortic valve prosthesis. In our opinion, a very pronounced flap valve motion of the dehisced valve probably caused, in the critical moment, coronary artery blood flow limitation by means of coronary microembolization, which produced temporary ischemia and provoked sustained ventricular tachycardia. Furthermore, disturbances of rhythm such as ventricular tachycardia in the setting of endocarditis indicate a high-risk condition and should mandate fast and thorough noninvasive diagnostic procedures to obtain correct diagnosis even in the case of mild, slowly progressing disease.

Left ventricular assist device, HeartMate II — our experience

Cardiologia CROATICA Mechanical support of circulation with a left ventricular assist device (LVAD) is a rapidly evolving field. In this article we present three patient cases that involve implantation of a LVAD called HeartMate II (HM II), and describe different strategies for treating patients with the terminal stage of heart failure (HF) and the indications for placement of a LVAD. Patient 1 — N. S. 66 y, M. The patient has a history of arterial hypertension (AH), diabetes mellitus type II (DM II), and a myocardial infarction in September 2011. Clinical suspicion for HF was confirmed by echocardiography, which showed global left ventricular hypertrophy, an ejection fraction of 20%, mitral regurgitation, and normal right ventricular dimensions. Coronary arteriography showed triple vessel disease and scintigraphy showed scar tissue without viable myocardium. In October 2011, HM II was indicated as destination therapy. The only incident worth nothing was an infection at the exit site of the cannula that occurred one year later and was treated without complications. The patient continues to perform laborious tasks on his farm and refuses to quit. Patient 2 — ©. J. 65 y, F. The patient has a history of AH, DM II, and terminal HF with LVAD implantation in April 2010. In October 2011, the heart transplantation was required due to a resilient infection at the HM II stoma that led to sepsis. In June 2012, a syncopal event subsequent to asystole indicated the need for implantation of a permanent pacemaker. The patient currently feels well and tolerates physical activity. Patient 3 — V. H. †63 y, F. The patient has a history of DM II, STEMI treated with primary PCI, triple vessel CAD, double CABG, femoral and iliac artery disease, renal and hepatic dysfunction, and vascular changes in the brain. Echocardiography showed left ventricular dilation, contractibility of only the base of the left ventricle, and an EF of ~15%. In December 2011, HM II was indicated as destination therapy. Due to anti-heparin antibodies implantation was postponed until May 2012, when it was performed alongside CABG (RCA-SVG). Three months later, the patient sustained NSTEMI. In February 2013, the patient was hospitalized for left ventricular failure due to partial papillary muscle rupture and resultant mitral insufficiency. Blood cultures at the time were negative. In April 2013, the patient died of multiorgan failure. Autopsy reports found a destroyed mitral valve without evidence of endocarditis.

Minimally invasive valve surgery: What the pathologist should know

Minimally invasive approaches in cardiac surgery have emerged as an alternative to standard techniques particularly in patients undergoing valvular surgery. Their established benefits for the patients are likely to cause their widespread use in the future. The purpose of this is to provide an overview of modern minimally invasive approaches in valvular surgery with an emphasis on aspects of the surgery relevant for cardiovascular pathologists.