Echocardiographic and Computed-tomographic Evaluation of the Fate of Bovine Pericardial Patch as a Pericardial Substitute in Bentall’s Procedure: Twenty-year’ Results

Objective: The study was designed to ascertain the influence of usage of bovine pericardial patch in patients undergoing Bentall’s procedure with respect to reexploration for bleeding, mediastinal infection, avoidance of conduit adhesions, late development of pericardial constriction and calcification. Materials and Methods: We reviewed 150 patients (79 males) aged between 22 to 68 years (mean±SD 49.25±12.9 years) receiving a composite aortic conduit between January 1998 to December 2020 for annuloaortic ectasia (n=100), aortic dissection (n=49), and dilated aortic root in repaired tetralogy of Fallot (n=1). Twenty-five patients had Marfan’s syndrome. Modified “button technique” was performed by interposing a glutaraldehyde treated pericardial strip at the graft coronary anastomoses, and proximal aortic conduit suturing using interlocking interrupted, pledgeted mattress suture. On completion, the pericardial cavity was reconstructed using St. Jude Medical Biocor pericardial patch. To detect evidence of pericardial constriction, survivors underwent echocardiography and computed tomography. The Kaplan-Meier curve was drawn to show the probability of survival over a period of follow-up time. Results: Seven (4.7%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output, and 87.1% had spontaneous return of sinus rhythm. The average 12-hour postoperative drainage was 245±70 ml and there was no mediastinal infection. At a mean follow-up of 172.4 (SD± 58.9) months, the actuarial survival was 94.2±0.04% (95% CI: 88.5-96.8), and there was no pericardial constriction or calcification. Conclusion: Reconstruction of pericardial cavity using Biocor bovine pericardial patch minimizes diffuse oozing of blood, graft infection, and is not associated with later development of pericardial constriction, or calcification.

Technical Details of Redo Aortic Valve Replacement using St. Jude Medical Mechanical Prosthesis in a Patient with Thrombosed Aortic Mechanical Prosthesis: A Video Presentation

Current consensus guidelines of the AHA and ESC, uniformly recommend either type of prosthetic valve for patients aged 60 to 70 years and mechanical prosthesis for patients aged less than 60 years

Redo Mitral Valve Replacement using St. Jude Medical Mechanical Prostheses in a Patient with Degenerated Mitral Perimount Bioprosthesis: A Video Presentation

Current consensus guidelines of the American Heart Association and European Society of Cardiology, uniformly recommend either type of prosthetic mitral valve for patients aged 60 to 70 years, and mechanical prosthesis for patients less than 60 years.

Early-Term Hemodynamic Performance And Clinical Results of 19-mm st. Jude Medical Regent Valve In Patients With Small Aortic Annulus Undergoing Dual Valve Replacement: A Retrospective Study

Background: The prosthesis selection in patients with small aortic annulus undergoing aortic valve replacement (AVR) has always been a challenge, especially in dual valve replacement (DVR, combined aortic and mitral valve replacement). The present study aimed to analyze early-term hemodynamic parameters of 19-mm St. Jude Medical Regent ( SJMR19 ) valve in patients with small aortic annulus undergoing DVR. Methods: Between January 2015 to December 2020, 54 patients with small aortic annulus who underwent DVR were divided into two groups: SJMR19 valve group (n=30) and 21-mm mechanical (M21) valve group (n=24). The perioperative and early-term hemodynamic data were collected and analyzed. Results: A significant difference in terms of maximum transaortic flow velocity (Vav max), maximum transaortic pressure gradient (PGav max), left ventricular mass index (LVMi) and left ventricular mass (LVM) was observed postoperatively in both groups. The postoperative left ventricular ejection fraction (LVEF) was significantly higher while the LVM and LVMi was evidently decreased in the SJMR19 group, compared with the M21 group. In order to confirm the influencing factors on postoperative LVEF, a multiple linear regression analysis model was established by including all candidate variables and the implanted valve type was identified in the multivariate analysis as an independent predictor for postoperative LVEF. Conclusions: The postoperative cardiac function and hemodynamic parameters was improved both in the SJMR19 and M21 groups. The postoperative LVEF, LVM and LVMi were better in the SJMR19 group compared with those of the M21 group. And the implanted valve type might possess the predictive value of postoperative LVEF in patients with small aortic annulus undergoing DVR.

Long-Term Follow-up of Standard and Small Diameter Implantable Cardioverter Leads

Background: Small-diameter implantable cardioverter-defibrillator (ICD) leads have been introduced into clinical practice to facilitate the implantation procedure. Despite their expected benefits, the reliability of these leads has proven to be questionable. The main purpose of our study is to investigate the impact of ICD lead diameter (≤8 F versus >8 F) on long-term lead durability. Methods: Overall, 206 consecutive patients implanted with a right ventricular ICD lead in the Electrophysiology and Cardiac Pacing Unit of our department from January 2008 to December 2013 were included in this analysis. ICD leads were defined, according to their diameter, as small (≤8 F) and standard (>8 F).The small-diameter leads (n=106) included Linox (Biotronik; n=58) and Durata (St. Jude Medical/Abbot; n=48). The standard-diameter ICD leads (n=100) consisted of Sprint Quattro (Medtronic; n=64) and Endotak (Boston Scientific; n=36). Results: After a median follow-up of 7.3 years, lead failure rate was significantly increased for small-diameter leads compared with standard-diameter leads (6.6% vs 1%; P=0.035). No difference in lead survival probability has been observed between Linox and Durata small-diameter leads (93% vs 92.7%; P=0.71). The majority of lead failures presented as noise (87.5%), without detectable abnormalities on fluoroscopic evaluation. Conclusion: Our single-centre study showed that both Linox and Durata small-diameter ICD are associated to be more susceptible to a greater risk of lead failure as compared to standard-diameter ICD leads. In this perspective, a comprehensive vigilance strategy including home monitoring is warranted for early detection of lead failure.

Enhanced detection of atrial tachyarrhythmias with pacing devices by using more accurate atrial sensing

Purpose Cardiac pacing devices can detect and monitor atrial tachyarrhythmias (ATA) which increase the risk of thromboembolic complications. The aim of this study was to compare (1) two different atrial leads and (2) standard and optimized settings to detect ATA and reject far-field R-wave signal (FFRW). Methods This was a prospective, randomized multi-center trial comparing St. Jude Medical OptiSense lead (tip-to-ring spacing 1.1 mm) and Tendril lead (tip-to-ring spacing 10.0 mm), having programmed atrial sensitivity at 0.2 mV and post-ventricular atrial blanking at 60 ms. We measured intra-atrial amplitudes of FFRW, intrinsic atrial signals, the amount of FFRW oversensing, and other inappropriate mode switching. Results One hundred and ten patients were enrolled. The mean amplitude of sensed and paced FFRW bipolar signal was 0.13 mV vs. 0.21 mV (p < 0.001) and 0.13 mV vs. 0.26 mV (p < 0.001) with OptiSense and Tendril lead, respectively. The mean amplitude of the atrial bipolar signal was 2.84 mV with OptiSense and 3.48 mV with Tendril lead, p = 0.014. With the optimized settings with OptiSense lead, one patient out of 20 (5%) had FFRW oversensing, none had undersensing of ATAs due to 2:1-blanking of atrial depolarizations, and the concordance of the ATAs by Holter and pacemaker memory was high (Spearman’s rank correlation coefficient = 0.90). In the Tendril group, 12 out of 25 patients (48%) had oversensing and 4 had atrial undersensing (p < 0.001). Conclusions The technique with an atrial lead with short tip-to-ring spacing combined with optimized pacemaker programming resulted in reliable and accurate atrial arrhythmia detection. Trial registration ClinicalTrials.gov number NCT01074749.

Modified Technique to Control the Eutachian Valve During Transcatheter Closure of Atrial Septal Defect/Patent Foramen Ovale

Objective to describe an approach to perform safe transcatheter closure of Atrial Septal Defect (ASD)/Patent Foramen Ovale (PFO) associated with large redundant Eustachian Valve. Background Transcatheter device closure of ASD/PFO is feasible in a great majority of patients. However, the presence of a huge mobile Eustachian Valve can compromise device placement. Patients and Methods Six patients (3 PFO and 3 ASD patients) with a huge redundant Eustachian valve were included. Two patients had PFO with long tunnel and were closed with Occlutech FigullaFlex II PFO occluders sized 23/25 and 27/30 respectively. The other PFO patient had an associated atrial septal aneurysm (ASA) and was closed with a 25 mm Amplatzer Multi-Fenestrated Septal Occluder “cribriform” device (St. Jude Medical – Abbott Vascular). The three ASDs were closed by regular ASD occluders (2 Flex II ASD Occluders sized 30 and 33 mm and 1 Amplatzer ASD Occluder sized 24 mm). Eustachian valve was successfully held with a steerable ablation catheter to deflect it against the lateral right atrial wall, keeping it away from the inter-atrial septum to prevent its entrapment or interference with the cable, the sheath or the device. Results All ASDs/PFOs have been successfully closed with no complications with free inferior vena cava (IVC) flow, with no residual inter-atrial shunt and the eustachian valve is not interfering with the device. Conclusions Safe percutaneous ASD/PFO closure can be achieved with proper control of a large redundant Eustachian valve.

Salvage endovascular embolization of the left pulmonary artery for recurrent pseudoaneurysm

Background Pulmonary pseudoaneurysm (PPA) is a potentially lethal complication of lung resection with a high risk of recurrence after endovascular coiling. Case presentation We report a case in which recurrent hemoptysis due to PPA after left lower lobe sleeve resection was treated by endovascular embolization of the left main pulmonary artery as a salvage treatment. The first hemoptysis was managed by endovascular coil embolization with extracorporeal membrane oxygenation, but refractory hemorrhage occurred 3 months later due to penetration of the endovascular coil into the bronchial anastomosis site. Because left completion pneumonectomy was considered too high risk, the left main pulmonary artery was palliatively embolized using an Amplatzer vascular plug (St. Jude Medical, MN, USA) to totally disrupt the left pulmonary arterial flow. Conclusions Total embolization of the left main pulmonary artery for repeated PPA rupture may be useful as a palliative treatment in patients unable to tolerate pneumonectomy.

A new leadless pacemaker with atrioventricular synchronous pacing replacing a still working VVI leadless pacemaker: a case report

Background A new intracardiac leadless pacemaker (ILP) has been developed to ensure atrioventricular synchrony during ventricular pacing. Recent studies have shown feasibility and safety of accelerometer-based atrial sensing and an improvement in atrioventricular synchrony among patients with atrioventricular block implanted with the Micra AV ILP (Medtronic Inc, Minneapolis, Minnesota, US). However, no data exists about the benefits of a VDD ILP in patients wearing a still working VVI Nanostim ILP (St Jude Medical, St Paul, Minnesota, US). We describe the feasibility of the procedure and the absence of device-related adverse events in the short-term follow-up. Case summary We present the case of a 72-year-old man implanted with a VVI ILP (Nanostim, St Jude Medical, St Paul, MN) on May 2014, who has developed symptomatic high percentage of VVI asynchronous pacing and was treated with an upgrade to synchronous AV PM ILP—Micra AV (Medtronic Inc, Minneapolis, Minnesota, US), which has improved symptoms and functional class. Discussion ILPs represent the best current option for patients requiring pacemaker implantation who are at high risk of infection and bleeding. Our case shows that the new AV synchronous ILP is a good alternative to VVI ILP in patients with sinus rhythm and a strong need for ventricular pacing.

Redo Aortic and Mitral Valve Replacement using St. Jude Medical Mechanical Prosthesis in a Patient with Degenerated Mitral Bioprosthesis and Severe Aortic Regurgitation: A Video Presentation

The American College of Cardiology/American Heart Association practice guidelines suggest bioprosthetic aortic and mitral valve replacement is a reasonable option for patients older than 65 years and for selected patients younger than 65 years according to patients’ preference. However, routine use of bioprosthetic valves in younger patients remains controversial. Patients prevalence to avoid anticoagulation, decreasing operative risks for valve reoperations, and the availability of catheter valve-in-valve techniques have created a need to reexamine bioprosthetic valve durability, particularly in young patients undergoing valve replacements