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Often times, in mitral valve repair techniques, the height of the newly placed Gore-Tex sutures needs correction to achieve better mitral valve leaflet coaptation or to correct systolic anterior motion (SAM). Herein, a less challenging "Hornet" technique to accurately adjust artificial chordal length is described. This technique describes a way to adjust/shorten the Gore-Tex chords, should they need revision. Ideally, this should not be needed, however due to the circumstances for mitral valve repair, this is sometimes necessary. With the annuloplasty band already in place, it is somewhat harder to reinsert new chords and hence, this technique may be beneficial., (© 2019 Wiley Periodicals, Inc.)

Aorto-pulmonary fistula (APF) due to an eroding pseudoaneurysm of the ascending aorta (AOP) is rare and can be life threatening. We report an 83-year-old male with multiple comorbidities who presented with an AOP, which was successfully treated with an endovascular exclusion device. doi: 10.1111/jocs.12758 (J Card Surg 2016;31:453-455)., (© 2016 Wiley Periodicals, Inc.)

In the small aortic root, extremely weakened tissue and extensive calcification predispose toward the implantation of small prostheses, anastomotic bleeding, and paravalvular leaks. We describe a procedure in which a "homemade" composite mechanical prosthesis-conduit is implanted in a supra-annular position in two patients with a small aortic root. This technique facilitates the placement of a larger prosthesis, thus avoiding patient-prosthesis mismatch. doi: 10.1111/jocs.12741 (J Card Surg 2016;31:309-310)., (© 2016 Wiley Periodicals, Inc.)

Background: Red blood cell transfusion (Tx) induces a proinflammatory state. Inflammatory mediators are associated with an increased risk of postoperative atrial fibrillation (AF). Therefore, in this study we determined the association between AF and Tx after isolated coronary artery bypass graft surgery (CABG)., Method: Between January 2008 and December 2010, a total of 879 patients underwent CABG. Of these, 815 (92.7%) had complete data extracted from our institution's Society of Thoracic Surgeons (STS) database. Predictors of AF development among four levels of Tx versus nontransfused patients were examined. Multivariable logistic regression and propensity score matching models were used., Results: The mean age was 65.8 years (±10.3), 77.4% were male, and 54.4% had an STS predicted risk score (mortality/morbidity) of ≥10%. A total of 564 (69.2%) had at least one unit of Tx. Adjusting for age, sex, time on pump, congestive heart failure, stroke, creatinine level (<1.5 mg per deciliter vs. ≥1.5), STS morbidity/mortality score, perioperative myocardial infarction (MI), cross-clamp time, medications, and hemoglobin level, the odds ratio (OR) of AF increased with increasing Tx (OR, 1.36; 95% confidence interval [CI], 1.11 to 1.68; p = 0.003). The odds of AF increased 61% with each increasing level of Tx (OR, 1.61; 95% CI, 1.15 to 2.26; p = 0.006, by propensity analysis)., Conclusions: Perioperative Tx may be associated with excess AF following CABG. This risk increases with increasing number of Tx., (© 2014 Wiley Periodicals, Inc.)

This report describes an effective cerebral perfusion method using an additional 4th side limb graft sewn to a trifurcated graft in patients undergoing redo aortic root reconstruction combined with total aortic arch replacement. This method is useful in cases where the origin of the innominate artery is unsuitable for clamping or when axillary perfusion is not employed, and assures continuous brain protection and minimizes circulatory arrest time., (© 2013 Wiley Periodicals, Inc.)

The intervalvular fibrosa, the structure that connects the mitral and the aortic valves, can be injured during aortic valve replacement. Although this complication is rare, it may require complex and extensive repair. Herein, we describe management of a damaged aortic-mitral curtain and fibrous body during tissue aortic valve replacement in a patient with mixed connective tissue disorder. A "U" suture repair combining an external and internal reinforcement repair technique via the aorta, without explanting the prosthetic valve technique, is described. The purpose of using the "externalized" buttressed U-stitch was to obliterate any residual cavity and to assure control of hemorrhage externally. Repair of damaged fibrous body during aortic valve replacement (AVR) is challenging. We managed this difficult situation in a satisfactory surgical approach without explanting the aortic prosthesis. , (© 2011 Wiley Periodicals, Inc.)