H. Kirov

Cardiac surgery 2015 reviewed

For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term “cardiac surgery”. The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader “solid ground” for up-to-date decision-making in cardiac surgery.

Cardiac surgery 2016 reviewed

For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term “cardiac surgery”. Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader “solid ground” for up-to-date decision-making in cardiac surgery.

Cardiac surgery 2014 reviewed.

For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term “cardiac surgery”. The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with “solid ground” for up-to-date decision-making in cardiac surgery.

Deformation of a Transapical Aortic Valve After Cardiopulmonary Resuscitation: A Potential Risk of Stainless Steel Stents

![Figure][1] [![Graphic][3] ][3] We show autopsy images of a deformed Edwards Sapien XT (Edwards Lifesciences Corp., Irvine, California) valve from a patient requiring cardiopulmonary resuscitation (CPR) 5 days after uneventful transapical valve implantation. Postoperative

Cardiac surgery 2017 reviewed

For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term “cardiac surgery”. This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier. The field of coronary bypass surgery was primarily filled with confirmatory evidence for the beneficial role of coronary artery bypass grafting for complex coronary disease and equal outcomes for percutaneous coronary intervention for less complex disease including main stem lesions. For aortic valve treatment, the new guidelines provide an equal recommendation for surgical and transcatheter aortic valve replacement for high and intermediate risk giving specific check lists to individualize decision-making by the heart team. For low-risk aortic stenosis, surgical valve replacement remains the primary indication. For the mitral valve, the importance of surgical experience of the individual surgeon on short- and long-term outcome was presented and the prognostic impact of mitral repair for primary mitral regurgitation was emphasized. In addition, there were many relevant and interesting other contributions from the purely operative arena in the fields of tricuspid disease as well as terminal heart failure (i.e., transplantation and ventricular assist devices). While this article attempts to summarize the most pertinent publications, it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader “solid ground” for up-to-date decision-making in cardiac surgery.

Metabolomic profiling in patients undergoing Off-Pump or On-Pump coronary artery bypass surgery

BackgroundCoronary artery bypass surgery can be performed without (Off-Pump) or with cardiopulmonary bypass (On-Pump). Extracorporeal circulation and cardioplegic arrest may cause alterations in the plasma metabolome. We assessed metabolomic changes in patients undergoing On-Pump or Off-Pump coronary artery bypass surgery.MethodsWe assessed five analyte classes (41 acylcarnitines, 14 amino acids, 92 glycerophospholipids, 15 sphingolipids, sugars, lactate) using a mass-spectrometry-based kit (Biocrates AbsoluteIDQ® p150) in paired arterial and coronary sinus blood obtained from 10 consecutive On-Pump and 10 Off-Pump patients. Cardioplegia for On-Pump was warm blood Calafiore. On-Pump outcomes were corrected for hemodilution through crystalloid priming.ResultsDemographic data were equal in both groups with normal ejection fraction, renal and liver function. Patients received 2.25 ± 0.64 bypass grafts. All postoperative courses were uneventful. Of 164 measured metabolites, only 13 (7.9%) were altered by cardiopulmonary bypass. We found more long-chain acylcarnitines Off-Pump and more short-chain acylcarnitines On-Pump. Glycerophospholipids showed lower concentrations On-Pump and arginine (as the only different amino acid) Off-Pump. Interestingly, plasma arginine (nitric oxide precursor) concentration at the end of surgery correlated inversely with postoperative vasopressor need (r = −0.7; p < 0.001). Assessing arterial/venous differences revealed phosphatidylcholine-production and acylcarnitine-consumption. These findings were unaffected by cardiopulmonary bypass, cardioplegia or temporary vessel occlusion during Off-Pump surgery.ConclusionsCardiopulmonary bypass and warm blood cardioplegia cause only minor changes to the metabolomic profile of patients undergoing coronary artery bypass surgery. The observed changes affected mainly acylcarnitines. In addition, there appears to be a relationship between arginine and vasopressor need after bypass surgery.

Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis

Background Isolated tricuspid valve (TV) surgery is considered a high risk‐procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo‐MITS) or through sternotomy. Methods We retrospectively analyzed all patients with previous cardiac surgery who underwent redo‐MITS (n = 26) and compared them to redo‐Sternotomy (n = 17). A group of primary‐MITS (n = 61) served as control. Results The redo‐MITS approach consisted of a right anterolateral mini‐thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo‐MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo‐Sternotomy: 8.42 ± 7.33% versus primary‐MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo‐Sternotomy had the highest 30‐day mortality (24%), the poorest long‐term survival, and the highest perioperative complication rate. Redo‐MITS did not differ in perioperative outcome from primary‐MITS. Multivariable logistic regression analysis identified redo‐Sternotomy (odds ratio [OR] = 9.76; 95% confidence interval [CI] 1.88‐63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20‐54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02‐1.35) as independent predictors of 30‐day mortality. The Cox model revealed redo‐Sternotomy (hazard ratio [HR] = 2.67; 95% CI 1.18‐6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45‐7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04‐4.92) as risk factors for poor long‐term survival. TV surgery significantly reduces NYHA class. Conclusion Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome.

Transcatheter Harvest of a Dislocated Sapien Valve With an Inoue Balloon Through the Left Subclavian Artery

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5][![Graphic][6] ][6] An 85-year-old man with dyspnea on mild exertion underwent implantation of an Edwards Sapien valve (Edwards Lifesciences, Irvine, California) through the right femoral artery.