Ibrahim Sultan

Management of coronary obstruction following transcatheter aortic valve replacement

Although occlusion of the coronary arteries during transcatheter aortic valve replacement is rare, the mortality is high. In this review, we discuss the prevention and management of this complication. Occlusion of coronary ostia is a very rare, but serious, complication of transcatheter aortic valve replacement (TAVR). Although reported as only occurring in <1% of TAVR cases, it carries a high risk of fatality, with some series reporting a mortality rate as high as 40%. We present the management of an occluded left coronary artery after a self‐expanding TAVR, and review the incidence, prevention, and management of this complication.

Hybrid Techniques for Aortic Arch Aneurysm Repair

Open repair of the aortic arch remains the gold standard for aortic aneurysms and dissections. However, in elderly patients with comorbidities, and in patients where prolonged cardiopulmonary bypass time and circulatory arrest may pose a significant risk, hybrid techniques in repairing the aortic arch have become quite attractive. Hybrid arch surgery includes a combination of endovascular and open surgery that allows surgeons to operate on the arch in a safe and expeditious manner with potential decrease in morbidity and mortality.

How I Teach a Valve-Sparing Root Replacement

The historic operation of choice for patients with sinus of Valsalva aneurysms is a Bentall operation, which involves replacement of the aortic valve and sinus segment with reimplantation of the coronary arteries. This operation has proven excellent long-term results [1]. However, in a select group of patients who have repairable or normal aortic valves with a sinus of Valsalva aneurysm, a valve-sparing root replacement (VSRR) is an appealing alternative. The ability to preserve a patient’s valve, obviating the need for anticoagulation therapy, makes it attractive because the disease tends to affect young patients who would otherwise need mechanical valves. The two most common procedures to address the pathology include the root remodeling technique by Magdi Yacoub and the reimplantation technique described by Tirone David and Christopher Feindel [2]. We prefer the latter in most patients because the operation has the added benefit of stabilizing the annulus. Teaching the VSRR operation is something we have done for more than a decade. It requires familiarity and mastery of the operation as the attending surgeon in addition to patience and the ability to teach, understand, and perform the operation from the “left side of the table.” Moreover, not all VSRRs are the same. Teaching a VSRR operation in a patient with normal left ventricular function and no aortic insufficiency (AI) is clearly not the same as teaching a VSRR operation in a patient with eccentric trileaflet AI with abnormal left ventricular function. For the sake of simplicity, we will describe how we teach a VSRR procedure in a trileaflet valve without any leaflet pathology.

Evolving trends in aortic valve replacement: A statewide experience

Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

The role of extracorporeal membrane oxygenator therapy in the setting of Type A aortic dissection

Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post‐cardiotomy shock. We sought to determine the utility of ECMO implementation post‐TAAD repair.

Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling

Concomitant endovascular stent grafting of the descending thoracic aorta during open repair for acute DeBakey I aortic dissection can be performed in patients with extensive dissection and malperfusion. We analyzed the effects of this strategy on distal aortic remodeling.

Routine use of hemiarch during acute type A aortic dissection repair.

Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, USA *These authors contributed equally to this work. Correspondence to: Wilson Y. Szeto. Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Penn Presbyterian Medical Center, 51 N 39th St, Heart & Vascular Pavilion 2A, Philadelphia, PA 19104, USA. Email: wilson.szeto@uphs.upenn.edu.

Tricuspid valve endocarditis in the era of the opioid epidemic

We reviewed our institutional experience with tricuspid valve endocarditis to understand the impact of the opioid epidemic on the incidence of right heart endocarditis.

Concomitant aortic valve replacement with orthotopic heart transplantation

From the Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Sept 20, 2016; revisions received Sept 30, 2017; accepted for publication Oct 30, 2017; available ahead of print Jan 2, 2018. Address for reprints: Ibrahim Sultan, MD, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Pittsburgh, PA 15232 (E-mail: sultani@upmc.edu). J Thorac Cardiovasc Surg 2018;155:e151-2 0022-5223/

Intercostal artery reimplantation with saphenous vein during thoracoabdominal aortic replacement

36.00 Copyright 2017 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2017.10.125