Simplifying Mitral Valve Repair with Novel Premeasured Chordal Loops.

The "respect" approach to surgical mitral valve repair, which involves implanting artificial neochordae, is gaining increased adoption. Surgeons are possibly prone to error in the manual construction of neochordae, which can lead to prolonged cross-clamp times. Novel systems such as Chord-X Pre-Measured Loops (On-X Life Technologies, Inc.

Cardiac surgery for radiation associated heart disease in Hodgkin lymphoma patients.

Much of the modern focus of Hodgkin's Lymphoma (HL) treatment involves the prevention of secondary organ injury. Despite rationalisations of radiotherapy fields, many patients still develop late radiation-related cardiotoxicity that is severe and requires interventional management. No guidelines exist to direct management of these complex patients who often present with multiple concurrent cardiac pathologies.

Multifocal primary intrapulmonary thymoma successfully resected via robotic-assisted thoracoscopic surgery.

Primary intrapulmonary thymoma (PIT) represents a rare subset of ectopic thymoma that arises solely from inside the pulmonary parenchyma. Multifocal PIT, where multiple isolated PIT origins coexist in the lungs, has only been confirmed in one previous case report, in which the patient died before surgical resection. These tumours are difficult to diagnose as imaging findings are non-specific, and non-invasive biopsy often yields inaccurate results.

Coronary Artery Bypass Grafting in Dialysis-Dependent Patients - Key Peri-Operative Considerations.

Cardiovascular disease represents the leading cause of mortality in dialysis-dependent (DD) patients, with the great majority of these patients afflicted by severe coronary artery disease. As rates of end-stage renal disease increase worldwide, DD patients represent a growing proportion of the coronary artery bypass grafting (CABG) cohort. Yet, these patients are complex, with crucial changes in their haemodynamic and physiologic profiles that complicate revascularisation surgery.

The role of cardiac surgery in radiation-associated heart disease: a scoping review.

Background: Thoracic irradiation is an important tool in the treatment of breast cancer, non-Hodgkin's lymphoma, and other cancers of the chest. The heart is commonly involved in these radiation fields, and young patients can present with severe cardiac pathologies requiring surgical intervention. However, this population poses a high surgical risk due to involvement of mediastinal tissues, and there are no consensus guidelines on best practice management.

Improving survival after pulmonary metastasectomy for sarcoma: analysis of prognostic factors.

Background: Metastatic sarcoma confers a grave prognosis to patients and poses a management dilemma for clinicians. Pulmonary metastasectomy is frequently performed for the recurrence of sarcomatous tumours in the lung, but the evidence-base is poor. No guidelines exist to inform clinicians on appropriate patient selection and surgical technique.

Review of bioprosthetic structural valve deterioration: Patient or valve?

Background: With guidelines progressively recommending bioprosthetic aortic valves in younger patients, a greater emphasis is placed on structural valve deterioration (SVD) as an important clinical endpoint for both transcatheter and surgically implanted valves. However, SVD of bioprosthetic valves is a complex entity with varying definitions in the literature and a multifaceted pathogenesis.

Aim: This review first aims to establish the most updated definitions of SVD as per the literature.

Application of a computational model in simulating an endovascular clot retrieval service system within regional Australia.

Introduction: The global demand for endovascular clot retrieval (ECR) has grown rapidly in recent years creating challenges to healthcare system planning and resource allocation. This study aims to apply our established computational model to predict and optimise the performance and resource allocation of ECR services within regional Australia, and applying data from the state of South Australia as a modelling exercise.

Method: Local geographic information obtained using the Google Maps application program interface and real-world data was input into the discrete event simulation model we previously developed.

Geographic Service Delivery for Endovascular Clot Retrieval: Using Discrete Event Simulation to Optimize Resources.

Background: Endovascular clot retrieval (ECR) is the standard of care for acute ischemic stroke caused by large vessel occlusion. Reducing stroke symptom onset to reperfusion time is associated with improved functional outcomes. This study aims to develop a computational model to predict and identify time-related outcomes of community stroke calls within a geographic area based on variable parameters to support planning and coordination of ECR services.

CODE STROKE ALERT-Concept and Development of a Novel Open-Source Platform to Streamline Acute Stroke Management.

Effective, time-critical intervention in acute stroke is crucial to mitigate mortality rate and morbidity, but delivery of reperfusion treatments is often hampered by pre-, in-, or inter-hospital system level delays. Disjointed, repetitive, and inefficient communication is a consistent contributor to avoidable treatment delay. In the era of rapid reperfusion therapy for ischemic stroke, there is a need for a communication system to synchronize the flow of clinical information across the entire stroke journey.

Free flap failure secondary to dual thrombophilia.

Much has been learned over the past several decades regarding thrombophilic conditions. Thrombotic complications, such as deep venous thrombosis, pulmonary embolus, myocardial infarction, and stroke, are sometimes attributed to a diagnosable thrombophilia. Less has been written with regard to their effect on reconstructive outcomes.

Rapamycin-coated expanded polytetrafluoroethylene bypass grafts exhibit decreased anastomotic neointimal hyperplasia in a porcine model.

Objective: We tested the hypothesis that rapamycin coated onto, and eluted from, expanded polytetrafluoroethylene (ePTFE) grafts would diminish neointimal hyperplasia in a porcine model.

Methods: Rapamycin (also called sirolimus) was coated onto the luminal surface of 6-mm-internal-diameter thin-walled ePTFE grafts by using an adhesive polymer that allows timed release of the drug. An adhesive polymer that allows timed release of rapamycin from ePTFE was developed with commercially available chemicals and applied on 6-mm ePTFE grafts.

Comparison of small-intestinal submucosa and expanded polytetrafluoroethylene as a vascular conduit in the presence of gram-positive contamination.

Objective: As a vascular conduit, expanded polytetrafluoroethylene (ePTFE) is susceptible to graft infection with Gram-positive organisms. Biomaterials, such as porcine small-intestinal submucosa (SIS), have been successfully used clinically as tissue substitutes outside the vascular arena.

Summary Background Data: In the present study, we compared a small-diameter conduit of SIS to ePTFE in the presence of Gram-positive contamination to evaluate infection resistance, incorporation and remodeling, morphometry, graft patency, and neointimal hyperplasia (NH) development.

Small intestinal submucosa for vascular reconstruction in the presence of gastrointestinal contamination.

Introduction: Surgical options for vascular reconstruction in a contaminated field are limited and include prosthetic reconstruction or ligation with extra-anatomic bypass. With prosthetic insertion, rates of graft infection and failures (pseudoaneurysms and thrombosis) are high. In the emergent situations, extra-anatomic bypass is time-consuming and complex, and it produces marginal long-term results.