David operation: single center 10-year experience.

AIM: Aortic valve-sparing operation has been progressively widely performed for the treatment of aortic root aneurysm. Nowadays, this procedure has been proposed even in presence of a bicuspid aortic valve, severe aortic regurgitation or in primary aortic dissection repair. We present our ten-year experience focusing on mid-term echocardiographic follow-up. METHODS: Between June 2002 and February 2012, 139 patients (mean age of 61±12 years) underwent aortic valve-sparing operation with valve reimplantation. Twenty-seven patients (19%) had bicuspid aortic valve; in eighteen cases (13%) cusp motion or anatomical abnormalities concurred in determining aortic regurgitation and needed an adjunct cusp repair. A Gelweave Valsalva™ graft was implanted in all the patients. RESULTS: The mortality pre-discharge was 0.7% (1 patient). The cumulative 1-year, 5-years and 8-years survival rates were 99%, 93% and 87% respectively. Postoperative aortic regurgitation more than mild degree (>2+/4+) was the only significant risk factors for redo aortic valve surgery Freedom from reoperation due to aortic valve regurgitation was 96% at 1 year, 90% at 5 years and 86% at 8 years. When comparing freedom from reoperation in patients with bicuspid vs tricuspid aortic valve, no differences were found (P=0.31) and the rate of aortic valve reoperation was significantly higher (P<0.001) in patients who received leaflet's repair. CONCLUSION: The durability of valve reimplantation was found to be excellent in patients with tricuspid aortic valve and normal or nearly normal cusps. Cusp prolapse and complication after cusp repair turned out to be the main causes for early failure.

Intracerebellar hematoma following thoracoabdominal aortic repair: an unreported complication of cerebrospinal fluid drainage.

Cerebrospinal fluid (CSF) drainage is a routinely used adjunct in thoracoabdominal aortic aneurysm (TAAA) surgery which may reduce the incidence of perioperative paraplegia by improving the spinal cord perfusion. However, a small but evident complication rate of lumbar drainage should be considered. We present two rare cases of intracerebellar hematoma possibly due to excessive CSF drainage after TAAA repair.

Fibrin sealant coated stents compared with non-coated stents in a porcine carotid artery model. Preliminary study report.

BACKGROUND: Balloon expandable metal stents (BEMS) are used to treat restenosis following percutaneous transluminal angioplasty (PTA) and as primary treatment. Intimal proliferation (IP) and resultant restenosis occurs in 25-50% of patients despite all preventive measures. OBJECTIVE: to test the intra-arterial response to the insertion of a fibrin sealant (FS) coated BEMS vs an uncoated BEMS by measuring endothelization and IP. HYPOTHESIS: that a BEMS coated with FS will lead to rapid endothelization and prevent or reduce IP. RATIONALE: FS consists of fibrinogen and thrombin. Thrombin affects endothelial cell proliferation and reduces smooth muscle proliferation, the forerunner of IP and restenosis. Normal endothelium also releases substances that promote vascular relaxation and normal smooth muscle tone regulation. METHODS: Thirty-40 kg pigs (EA), Palmaz-Shatz BEMS (Cordis), FS Tissucol (Baxter Immuno). Stents were uniformly coated with FS in a special mold. Both coated and uncoated stents were mounted on balloon catheters and deployed caudad in the carotid arteries via an arteriotomy. Angiograms were obtained postdeployment. All specimens were examined grossly, photographed then fixed for histology and in some cases, scanning electron microscopy (SEM). RESULTS: Fifteen animals form this preliminary report. Sacrifice at five days as per original protocol showed insufficient stent incorporation. Thereafter 1/2 of the animals were sacrificed at 15 days and 1/2 at 30 days. PATENCY: coated stents: 6 patent, 9 thrombosed. UNCOATED: 7 patent, 8 thrombosed. Of five EA given postoperatively low molecular weight heparin (LMWH) 4 animals had patent stents 80%. HISTOLOGY: varying degrees of IP were seen in all specimens. In general the coated stents showed a greater degree than the uncoated. STENOSIS: presacrifice angiography revealed that where the stents were patent no stenosis was present, in fact, some demonstrated mild dilatation. This was particularly the case with the coated stents. CONCLUSIONS: Coating stents with FS is not detrimental. IP in these EA at 30 days did not produce stenosis. Postoperative LMWH appears helpful in maintaining patency in a thrombogenic experimental animal. Further study maintaining EA for 6-12 months should resolve whether the IP seen had achieved its maximum expression or would progress and produce stenosis.