Marco Gennari

Composite graft using an Edwards Intuity Elite rapid deployment bioprosthesis for aortic root replacement

We describe a technique using an Edwards Intuity Elite rapid deployment bioprosthesis to construct a composite graft for an aortic root replacement.

Retrograde type A aortic dissection from a distal aortic arch stent graft

Retrograde type A aortic dissection is a known complication of endovascular stent grafts used to treat type B thoracic dissections. A 46-year-old male developed acute chest pain 6 months following endovascular stent grafting (34 × 20mm Gore®Tag® endoprosthesis made of expanded polytetrafluoroethylene on a self-expanding nitinol stent (W. L. Gore & Associates, Inc, Newark, DE) and a 30-mm Zenith AlphaTM thoracic endovascular graft distal extension (Cook Medical, Inc, Bloomington, IN) for a type B aortic dissection. A computed tomography angiogram showed a dissection flap in the aortic arch just proximal to the attachment of the stent graft, which extended retrograde to just above the right coronary artery (Figure 1). A femoro-femoral cannulation was performed as previously described beca`use of dense adhesions, the cardio-pulmonary bypass (CPB) was peripherally instituted and the patient cooled to a 20°C

Ascending aorta pseudo-aneurysm due to proximal and distal suture dehiscence

Aortic pseudoaneurysms are commonly seen following aortic surgery in young patients with connective tissue disorders. We present images of a young patient with no history of any connective tissue diseases who developed suture line pseudoaneurysms following ascending aortic surgery. A 25-year-old male was admitted with a 2 day history of chest pain. Eight years prior to admission, he underwent ascending aortic replacement with a #28 Dacron graft (Gelweave, Vascutek, Inchinnan, UK) and an aortic valve repair at another institution for a posttraumatic ascending aortic aneurysm following a motor vehicle accident. He had no history of any connective tissue disorders. A chest computed tomography (CT) scan revealed a 10 × 8-cm pseudoaneurysm of the ascending aorta involving both the proximal and distal graft suture lines (Figures 1A and 1B). The pseudoaneurysm was immediately posterior to the sternum (Figures 1C and 1D). A transthoracic echocardiogram showed severe aortic regurgitation. At the time of surgery, the patient was initially placed on cardiopulmonary bypass by cannulating the right axillary artery and right femoral vein and placing a

Saphenous vein cannulation in re-redo cardiac surgery.

Abstract  The widely used peripheral vein site of cannulation (i.e., the femoral vein) cannot always be employed in the setting of re‐redo procedures. We propose a safe and simple surgical technique for a femoral vein cannulation using the greater saphenous vein as the inflow tract for the venous drainage in the setting of redo cardiac surgery. (J Card Surg 2012;27:676‐677)

Repair of a pseudoaneurysm following a Yacoub procedure

Thoracic aortic pseudoaneurysms are a known life-threatening complication following all aortic procedures. We present images from a procedure to repair a pseudoaneurysm of a proximal suture line following a Yacoub procedure. A 77-year-old male underwent a Yacoub procedure for an aortic root aneurysm and severe aortic insufficiency (AI). He developed recurrent AI 9 months later and underwent an aortic valve replacement with a # 23 Carbomedics mechanical valve (LivaNova, London, UK) at which time the walls of the non-coronary sinus of Valsalva were left intact. Eight years later, he underwent repair of a pseudoaneurysm of the distal suture line using a Dacron graft. He now returned with superior vena cava (SVC) syndrome and hepatic failure and was found to have an 8.7 × 7.7-cm pseudoaneurysm of the proximal suture line which compressed the right atrium and the SVC (Figure 1). At the time of surgery, cannulas were inserted into the femoral artery and vein and a left apical vent was inserted via a limited left anterolateral thoracotomy. The patient was placed on cardiopulmonary bypass (CPB) and cooled to 30 degrees centigrade, at which time the chest was entered via a resternotomy. The ascending aorta as cross-clamped and the aorta opened transversally and a cold blood cardioplegia infused in a selective coronary anterograde fashion. The aortotomy revealed a large pseudoaneurysm at the level of the proximal suture line at the non-coronary sinus (Figure 2). Multiple

Superficial femoral artery access for transcatheter aortic valve replacement.

Different vascular accesses have been described for the delivery of a transcatheter aortic bioprosthesis. We report the use of the superficial femoral artery (SFA) as the arterial site of puncture with surgical cut-down. It may be a reasonable access alternative to the other classical routes, especially in the setting of either obese patients with elevated body mass index or in the presence of high femoral artery bifurcation. This route seems to be feasible with a low-profile risk.

Acute ascending aortic dissection associated with chronic intramural hematoma.

1Department of Cardiovascular Disease, Development and Innovation Cardiac Surgery Unit, IRCCS Centro Cardiologico Monzino, Milan, Italy 2Department of Emergency, IRCCS Centro Cardiologico Monzino, Milan, Italy *Correspondence Marco Gennari, M.D., Department of Cardiovascular Disease, Development and Innovation Cardiac Surgery Unit, IRCCS Centro Cardiologico Monzino, Via Parea 4, Milan 20138, Italy. Email: marcogennari.md@gmail.com or marco.gennari@ccfm.it

Cavo-atrial metastases from cutaneous melanoma.

resonance imaging, which revealed that the mass now occupied almost the entire right atrium and was attached to the superior cavo-atrial junction and prolapsed into the right ventricle (Fig. 1A). Following a median sternotomy and double right atrial cannulation, themasswas noted to infiltrate the anterolateral wall of Conflict of interest: The authors acknowledge no conflict of interest in the submission.

Acute Aortic Insufficiency due to Rupture of an Aortic Valve Commissure

Myxomatous degeneration generally involves the atrioventricular valves (mitral and tricuspid). Rarely, it may affect the aortic or pulmonary valve. We report a case of an acute severe aortic insufficiency due to a rupture of a commissure of the aortic valve in a patient who had previously undergone mitral valve surgery for myxomatous mitral valve prolapse. doi: 10.1111/jocs.12276 (J Card Surg 2014;29:497–498)

Coronary artery disease associated with severe mitral and tricuspid valve regurgitation after left pneumonectomy: report of a successful hybrid procedure

The literature concerning heart surgery after pneumonectomy is still poor. Moreover, there is still a lack of a standardized approach to such a patient in the decision-making process. Here, we report a case of a patient who had previously had left pneumonectomy for malignancy and who had coronary artery disease and mitral and tricuspid regurgitation treated with a hybrid procedure.