Abramsmason8713

Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare lesion with wide anatomic variability. A rare variant exists, marked by right-sided dilatation, an Ebsteinoid tricuspid valve (TV), and severe tricuspid regurgitation. Neonatal cone valvuloplasty allows for a biventricular circulation and avoids complications of prosthetic valves; however, this technique inevitably requires reintervention to exchange the RV-PA conduit as the patient grows. We present a successful complete repair cone tricuspid valvuloplasty in a 9-day-old (2.8 kg) neonate with trisomy 21, PA/IVS, and an Ebsteinoid TV.

Valve-sparing root replacement (VSRR) is more challenging with eccentric aortic insufficiency (AI) due to cusp and root asymmetry, which may impact valve durability and survival. This study analyzed the effect of jet eccentricity on long-term outcomes in tricuspid (TAV) and bicuspid (BAV) valves.

From 2005-2019, 111 patients (65 TAV, 46 BAV) with >2+ AI underwent VSRR at an academic center. Pre- and post-operative echocardiograms were analyzed. Of these, 32 patients presented with concentric jets (29 TAV, 3 BAV) and 71 with eccentric jets (28 TAV, 43 BAV). Median (IQR) follow-up was 49 (12-93) months. Kaplan-Meier analysis and cumulative risk were used to compare long-term survival and valve-related reintervention.

The mean age was 44 ± 12 years. Compared to TAV, more BAV patients presented with eccentric jets (93.5% vs 43.1%, p<0.001). All BAV patients received cusp repair, compared to 52.3% of TAV patients (p<0.001). At 3-, 5-, and 10-years, the cumulative risk of AVR for TAV (4.7%, 6.4%, and 6.4%) versus BAV (5.8%, 7.8%, and 7.8%) patients (p=0.87) and concentric (0%, 0%, and 0%) versus eccentric (6.4%, 9.4%, and 9.4%) jets (p=0.98) were similar. Overall survival at 10-years was 71% for TAV and 97% for BAV (p=0.19) and 86% for concentric and 79% for eccentric jets (p=0.17).

In patients presenting for VSRR with >2+ AI, the risk of valve-related reintervention long-term is low after cusp repair in TAV and BAV. Current results suggest preoperative jet eccentricity does not impact long-term survival and valve durability.

2+ AI, the risk of valve-related reintervention long-term is low after cusp repair in TAV and BAV. Current results suggest preoperative jet eccentricity does not impact long-term survival and valve durability.We report three cases of functional tricuspid regurgitation (FTR) and demonstrate a novel tricuspid repair technique through the right atrioventricular groove without cardiopulmonary bypass or open heart surgery, which provides a new idea for the treatment of FTR.A 64-year-old man experienced persistent atelectasis of the right lung following right upper lobectomy. To simultaneously visualize the airways and lung parenchyma in real-time, chest computed tomography was performed while pneumatically splinting the lung open via insufflation through the working channel of a bronchoscope. The bronchi were patent but peripheral consolidations within the remaining right lung were visualized, representative of pneumonia. The patient fully recovered with antimicrobial therapy. CT during bronchoscopic pneumatic lung splinting is an advanced diagnostic for the investigation of persistent atelectasis.

Patient prosthesis mismatch (PPM) is associated with significant long-term morbidity and mortality after aortic valve replacement, but the role and outcomes of annular enlargement (AE) remains poorly defined. We hypothesized that increasing rates of AE may lead to improved outcomes for patients at risk for severe PPM.

Patients over age 65 undergoing surgical aortic valve replacement (SAVR) with or without coronary artery bypass grafting from 2008-2016 in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD) with matching Center for Medicare Services data were included (n=189,268). Univariate, multivariate, and time-to-event analysis was used to evaluate the association between AE and early and late outcomes. Patients were stratified by projected degree of PPM based on calculated effective orifice area index (EOAi).

A total of 5,412 (2.9%) patients underwent AE. STS predicted mortality was similar between AE and non-AE groups (2.97% vs 2.99%, p=0.052). Patients undergoing AE had higher risk-adjusted rates of 30-day complications and death (5.4% vs 3.4%, p<0.0001), but no differences in long-term rates of stroke, heart failure re-hospitalizations or aortic valve reoperation. Survival analysis demonstrated a higher risk of mortality with AE during the first 3 years after which the survival curves cross, favoring AE.

These data suggest annular enlargement during SAVR is associated with increased short-term risk in a Medicare population. Survival curves crossed after three years, which may portend a benefit in select patients. However, annular enlargement is still only done in the minority of patients who are at risk for PPM.

These data suggest annular enlargement during SAVR is associated with increased short-term risk in a Medicare population. Selleck JAK inhibitor Survival curves crossed after three years, which may portend a benefit in select patients. However, annular enlargement is still only done in the minority of patients who are at risk for PPM.

Historically, a glomerular filtration rate (GFR) <50ml/min/1.73m

has been considered a contraindication to lung transplantation. Combined or sequential lung-kidney transplantation is an option for those with GFR <30ml/min/1.73m

. Patients with GFR 30-50ml/min/1.73m

are provided with no options for transplantation. This study explores factors associated with improved survival in patients who undergo isolated lung transplantation with GFR 30-50ml/min/1.73m

.

The United Network for Organ Sharing database was queried for adult patients undergoing primary, isolated lung transplantation between January 2007 and March 2018. Regression models were used to identify factors associated with improved survival in lung recipients with preoperative GFR 30-50ml/min/1.73m

. The propensity score method was used to match "highly performing" patients (outpatient recipients under the age of 60) with GFR 30-50ml/min/1.73m

, with patients with GFR >50ml/min/1.73m

. Kaplan-Meier, Cox and Logistic regression analyses compared outcomes in matched populations.