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Endovascular repair has been introduced to decrease the morbidity and mortality associated with open surgical repair of aortic arch pathology. This case illustrates a 71-year-old male patient with an asymptomatic saccular aortic arch aneurysm treated by total endovascular aortic repair using 3-vessel inner branch stent graft. Postoperative course was unremarkable, and the patient was discharge home on postoperative day 3. Total endovascular aortic arch repair is a suitable alternative in higher-risk patients with aortic arch aneurysms who are not ideally suited for open surgical repair.

Freedom from structural valve deterioration (SVD) at 15 years with the Carpentier-Edwards (CE) Perimount pericardial valve in the aortic position was 60% in patients aged60 years compared to 90% and 99% in patients aged 60-70 years and70 years, respectively. The study aim was to focus on the causes of SVD requiring valve explant according to three different age groups:60 years, 60-70 years, and70 years. The short- and longterm clinical results of the patient cohort, followed for 25 years, are presented.A retrospective review was made of 89 patients among 2,405 who had undergone elective aortic valve replacement (AVR) with CE pericardial valves between November 1981 and March 2011, and in whom the prosthesis explant was secondary to degeneration of the valve.Patients aged70 years experienced more late complications such as endocarditis (p = 0.02) and mortality (p = 0.02). Following surgery for prosthesis explant and replacement, 39 of the 89 patients (44%) died. The average time to postoperative mortality in that population was 2.8 ± 3.6 years. On combining all causes of SVD, earlier dysfunction was noted in patients aged60 years, and late dysfunction in patients aged60 years (p = 0.003). However, there was no significant difference between groups in the process of degeneration (either calcification, pannus, tear, thrombus, endocarditis) (p = NS). No predictors were found of early and late dysfunction.Patients aged60 years in whom a CE Perimount valve was implanted in the aortic position were more prone to early degeneration of their valve and related mortality. However, no predictors were found of early degeneration of the valve in that patient population.

Several methods of aortic clamping have been described for minimally invasive mitral valve surgery (MIMVS). The aim of this study was to compare the endoaortic balloon occlusion technique with the transthoracic clamp approach in terms of perioperative outcomes.Between May 2006 and October 2011, a total of 259 patients underwent MIMVS through a 4 to 5 cm right anterolateral minithoracotomy. In 243 (93.8%) of these, the aorta was clamped using either the endoaortic balloon occlusion technique (endoballoon, n = 140) or the transthoracic clamp technique (transthoracic, n = 103).Patients in the endoballoon group had significantly longer operating time (4.3 ± 1.0 hours vs 3.2 ± 0.8 hours, p0.001), cardiopulmonary bypass time (143 ± 44 minutes vs 111 ± 29 minutes , p0.001), and cross-clamp time (114 ± 38 minutes vs 86 ± 23 minutes , p0.001). Perioperative blood loss was higher in the endoballoon group (287 ± 239 mL vs 213 ± 189 mL, p = 0.008) as was the mean postoperative creatinine kinase-MB level (36 ± 44 μg/L vs 26 ± 12 μg/L, p = 0.011). The repair rate was 99% or greater in both groups (p = 0.99). All patients left the operating room with no or trivial residual mitral regurgitation on transesophageal echocardiographic evaluation. In the endoballoon group there was 1 stroke (1%) and 5 myocardial infarctions (4%), compared with 2 strokes (2%) in the transthoracic group (p = not significant). There were 4 cases of postoperative cardiogenic shock, all of which occurred in the endoballoon group (p = 0.14). In-hospital mortality occurred in 2 patients from each group (p = 0.99).Minimally invasive mitral valve surgery can be performed successfully using either the endoaortic balloon technique or the transthoracic clamp approach. However, the transthoracic technique results in shorter operation time, less perioperative bleeding and better myocardial protection.

Background We describe the case of a 57-year-old woman who developed right heart failure after a second orthotopic bicaval cardiac transplant. Case Report Perioperative transesophageal echocardiogram showed a left atrial mass consisting of redundant tissue at the atrial suture line in the left atrium that did not have a significant hemodynamic effect under general anesthesia. Conclusions After discharge from the intensive care unit, she developed right heart failure that required excision and left atrial patch augmentation.