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Residual aortic regurgitation after transcatheter aortic valve replacement under the echocardiographic microscope
Transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis has expanded dramatically in patients deemed suboptimal for surgical aortic valve replacement (SAVR). The explosive growth of TAVR has been supported by unparalleled clinical trial data in specifically defined patient subsets, with equal or superior survival and stroke rates,1-3 improved early quality of life,4 lower major adverse clinical events,1 and improved systolic flow parameters,1 including lower rates of patient prosthetic mismatch5 when compared with SAVR.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 27, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Michael J. Reardon, Jeffrey J. Popma Tags: Editorial commentary Source Type: research

The Risk and Extent of Neurological Events Are Equivalent for High-Risk Patients Treated With Transcatheter or Surgical Aortic Valve Replacement
This study demonstrates equivalent neurologist-adjudicated stroke risk and extent following TAVR or SAVR in a high risk population, and it defines several risk factors for stroke.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 12, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Thomas G. Gleason, John T. Schindler, David H. Adams, Michael J. Reardon, Neal S. Kleiman, Louis R. Caplan, John V. Conte, G. Michael Deeb, G. Chad Hughes, Sharla Chenoweth, Jeffrey J. Popma Source Type: research

Mitral valve repair using robotic technology: Safe, effective, and durable
The most recent American College of Cardiology/American Heart Association heart valve guidelines recommend that prompt surgical correction of severe degenerative mitral valve regurgitation, ideally mitral valve repair, should be performed to decrease the risks of long-term mortality and heart failure risks associated with this condition. Mitral valve repair performed using a minimally invasive robotic approach can now be successfully carried out in nearly all cases of degenerative disease with very low risks of stroke or death.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 22, 2016 Category: Cardiovascular & Thoracic Surgery Authors: Rakesh M. Suri, Joseph A. Dearani, Tomislav Mihaljevic, W. Randolph Chitwood, Douglas A. Murphy, Alfredo Trento, Hoda Javadikasgari, Harold M. Burkhart, Wiley L. Nifong, Richard C. Daly, A. Marc Gillinov Tags: Expert opinion Source Type: research

Trans-aortic, Video-Assisted Removal of a Mobile Left Ventricular Apical Thrombus in a Patient with Aortic Stenosis and Severe Left Ventricular Dysfunction
We describe the removal of a mobile and protruding left ventricular thrombus using a video-assisted technique during an aortic valve replacement and coronary artery bypass procedure.
Source: The Journal of Thoracic and Cardiovascular Surgery - September 27, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Christina Williamson, Lori B. Sheehan, David M. Venesy, Richard S. D’Agostino Source Type: research

Treating valvular heart disease has never been one size fits all
The case report by Capestro and colleagues in this issue of the Journal illustrates the many therapeutic options cardiac surgeons now have at their disposal to treat complex valvular heart disease.1 Capestro and colleagues have described a difficult patient scenario that occurs commonly after homograft implantation. The rate of structural valve deterioration with homografts approaches nearly 40% at 10 years, and the accompanying extensive calcification of these prostheses complicates reoperative aortic valve replacement surgery by predisposing toward paravalvular leaks, the implantation of small prostheses, and perioperative stroke.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 5, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Hersh Maniar Tags: Editorial commentary Source Type: research

In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective
Stroke is a widely recognized complication after aortic valve replacement (AVR), especially among elderly patients. The literature contains substantial variability in reports of the actual incidence of stroke after AVR among high-risk patients. Our objective was to define risk of stroke in patients undergoing surgical AVR, using a large national database.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 4, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Shikhar Agarwal, Aatish Garg, Akhil Parashar, Lars G. Svensson, E. Murat Tuzcu, Jose L. Navia, Stephanie Mick, Samir R. Kapadia Tags: Acquired cardiovascular disease Source Type: research

In-hospital Mortality and Stroke Following Surgical Aortic Valve Replacement: A Nationwide Perspective
Stroke is a widely recognized complication following aortic valve replacement (AVR), especially among elderly patients. Significant heterogeneity exists in the current literature around the actual incidence of stroke following AVR among high-risk patients. Our objective was to define risk of stroke in patients undergoing surgical AVR from a large national database.
Source: The Journal of Thoracic and Cardiovascular Surgery - June 4, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Shikhar Agarwal, Aatish Garg, Akhil Parashar, Lars G. Svensson, E. Murat Tuzcu, Jose Navia, Stephanie Mick, Samir R. Kapadia Source Type: research

The paradox of surgical management of patients with low-flow, low-gradient aortic stenosis
In this issue of the Journal, Parikh and colleagues1 elegantly analyze the institutional outcomes of aortic valve replacement (AVR) at the Cleveland Clinic to illustrate the potential impact of low-flow, low-gradient aortic stenosis (LFLGAS) on 5-year post-AVR mortality. Despite quite acceptable initial operative outcomes, a fifth of their 875 consecutive patients who underwent surgical AVR for severe stenosis during a 2-year period were dead at 5 years. Preoperative left ventricular stroke volume index (LVSVI) was used to identify both LFLGAS with low ejection fraction (EF) and paradoxic LFLGAS with an EF of 50% or greater.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 21, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Vinay Badhwar, John S. Ikonomidis, Jeffrey P. Jacobs Tags: Editorial commentary Source Type: research

Outcomes of surgical aortic valve replacement for severe aortic stenosis: Incorporation of left ventricular systolic function and stroke volume index
We sought to a) assess predictors of mortality in consecutive patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR) and b) determine if there are differences in mortality, separated on the basis of different AS subtypes and left ventricular stroke volume index (LV-SVI).
Source: The Journal of Thoracic and Cardiovascular Surgery - March 11, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Roosha Parikh, Andrew L. Goodman, Tyler Barr, Joseph F. Sabik, Lars G. Svensson, L Leonardo Rodriguez, Bruce W. Lytle, Richard A. Grimm, Brian P. Griffin, Milind Y. Desai Source Type: research

Protecting the aorta during transcatheter aortic valve replacement: Have we found the answer?
Neurologic injury ranging from transient cognitive dysfunction to catastrophic permanent stroke constitutes the single main morbidity of cardiac surgery and largely affects modern transcatheter aortic valve replacement (TAVR).1-3 Today, the incidence of cerebrovascular events after TAVR ranges from 3% to 7%.4 In the current report, Samim and colleagues5 have explored one of the novel embolic protection devices (EPDs) aimed at reducing these extremely pervasive complications that often carry surmountable challenges to the patient in terms of a reduction in functional status and quality of life, and the healthcare provider i...
Source: The Journal of Thoracic and Cardiovascular Surgery - December 6, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Hanna A. Jensen, Amjad Syed, Vinod H. Thourani Tags: Editorial commentary Source Type: research

Impact of concurrent surgical valve procedures in patients receiving continuous-flow devices
Conclusions: Patients frequently require concurrent VPs at the time of LVAD placement; these patients are sicker and have higher early mortality. Furthermore, right ventricular dysfunction is increased in these patients. Further studies to develop selection criteria for concurrent valve interventions are important to further improve clinical outcomes.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 14, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Ranjit John, Yoshifumi Naka, Soon J. Park, Chittoor Sai-Sudhakar, Christopher Salerno, Kartik S. Sundareswaran, David J. Farrar, Carmelo A. Milano Tags: Acquired Cardiovascular Disease Source Type: research

The impact of unilateral versus bilateral antegrade cerebral perfusion on surgical outcomes after aortic arch replacement: A propensity-matched analysis
Conclusions: Using unilateral antegrade cerebral perfusion in a pressure-controlled manner during mild systemic hypothermia is a safe protection strategy in elective aortic arch surgery, associated with similar morbidity and mortality in comparison with bilateral antegrade cerebral perfusion, even if total arch replacement is required. Bilateral antegrade cerebral perfusion reveals a trend of higher incidence of stroke, probably due to manipulation on the arch vessels.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 6, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Andreas Zierer, Petar Risteski, Ali El-Sayed Ahmad, Anton Moritz, Anno Diegeler, Paul P. Urbanski Tags: Acquired Cardiovascular Disease Source Type: research

Effect of severe left ventricular systolic dysfunction on hospital outcome after transcatheter aortic valve implantation or surgical aortic valve replacement: Results from a propensity-matched population of the Italian OBSERVANT multicenter study
Objective: Despite demonstration of the superior outcomes of transcatheter aortic valve implantation (TAVI) versus optimal medical therapy for severe left ventricular systolic dysfunction, studies comparing TAVI and surgical aortic valve replacement (AVR) in this high-risk group have been lacking.Methods: We performed propensity matching for age, gender, baseline comorbidities, previous interventions, priority at hospital admission, frailty score, New York Heart Association class, EuroSCORE, and associated cardiac diseases. Next, the 30-day mortality and procedure-related morbidity of 162 patients (81 TAVI vs 81 AVR) with ...
Source: The Journal of Thoracic and Cardiovascular Surgery - November 21, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Francesco Onorati, Paola D’Errigo, Claudio Grossi, Marco Barbanti, Marco Ranucci, Daniel Remo Covello, Stefano Rosato, Alice Maraschini, Gennaro Santoro, Corrado Tamburino, Fulvia Seccareccia, Francesco Santini, Lorenzo Menicanti, OBSERVANT Research Gro Tags: Acquired Cardiovascular Disease Source Type: research

Reoperative aortic valve replacement in the octogenarians—minimally invasive technique in the era of transcatheter valve replacement
Conclusions: Octogenarians who undergo re-AVR are thought to be high-risk surgical candidates. The present single-center series revealed acceptable in-hospital outcomes and operative mortality. Mre-AVR was associated with better survival compared with Fre-AVR and might benefit this population.
Source: The Journal of Thoracic and Cardiovascular Surgery - November 4, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Tsuyoshi Kaneko, Dan Loberman, Igor Gosev, Fadi Rassam, Siobhan McGurk, Marzia Leacche, Lawrence Cohn Tags: Acquired Cardiovascular Disease Source Type: research

Repair of retrograde ascending dissection after descending stent grafting
Conclusions: Retrograde ascending dissection can present as an early or a late complication after descending stent grafting because of aortic instability or disease progression and has usually been associated with descending dissection or intramural hematoma. It is a life-threatening complication that can be managed safely with early recognition and rapid delivery of open or hybrid repair.
Source: The Journal of Thoracic and Cardiovascular Surgery - October 21, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Jahanzaib Idrees, Amr Arafat, Douglas R. Johnston, Lars G. Svensson, Eric E. Roselli Tags: Acquired Cardiovascular Disease Source Type: research

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