Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts.

J Thorac Cardiovasc Surg. 2016 Apr;151(4):1081-9

https://www.ctsnet.org/jans/hybrid-coronary-revascularization-versus-coronary-artery-bypass-surgery-bilateral-or-single?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=JANS+1%2F20%2F2017

Suprise!!
We surgeon believe that BIMA is superior to SIMA and hybrid coronary revascularization (HCR= LIMA-LAD + PCI)


The authors also sought to better delineate preoperative patient selection criteria predictive of the use of HCR and found that older patients, patients with lower body mass index or prior percutaneous coronary intervention, and patients with stable 2-vessel disease were more likely to undergo HCR and that patients who underwent CABG with a single arterial conduit, compared with bilateral arterial conduits and HCR, had significantly higher Society of Thoracic Surgeons predicted risk of mortality with the highest rates of diabetes, peripheral arterial disease, prior myocardial infarction, and heart failure.

In light of these findings and with data showing that drugeluting stents are equivalent if not better than saphenous vein grafts,8 should we not be pushing the envelope and greatly expanding our use of HCR at the expense of traditional left internal thoracic artery–left anterior descending þ saphenous vein graft CABG regardless of whether or not they slot nicely into historical patient selection brackets?

 Although this study provides an excellent proofof-concept and suggests a change in clinical practice, it also highlights our need for aggressive multicenter randomized controlled trials to determine the optimal surgical coronary revascularization and patient-selection strategies in an all-comers fashion. Initial randomized control trial forays into HCR10 are a good start.

How Can We Treat Tricuspic Regurgitation?

By Miami Valves Featuring Brian O'Neill

https://www.vumedi.com/video/how-can-we-treat-tricuspic-regurgitation/

Percutanous caval stent valve implantation
For severe TR
IVC between liver vein and RA

Only one patient in 2014: NYHA 4 > 3, Ascites: no change fue to chirrosis

Surgical Repair of Regurgitant Quadricuspid Aortic Valve

Silvia Mariani
https://www.ctsnet.org/article/surgical-repair-regurgitant-quadricuspid-aortic-valve


A 32-year-old man with a quadricuspid aortic valve. The standardization principles of conservative aortic valve surgery by Lansac et al. were applied, addressing the three elements that support aortic valve physiology: cusps, root diameters (aortic annular base and sinotubular junction), and root dynamics. The annulus dilation was corrected by applying an expansible aortic ring in a subvalvular position. The authors remodeled the aortic root, reducing the sinotubular junction diameter and respecting the root dynamics with the Yacoub technique, and successfully performed the bicuspidization and re-suspension of the leaflets.

Care fo conduction system on annular ring sutures due to quadricuspid aortic valve which might have  another abnormal anatomic change.
Bicuspidication
 Pros: easy
 Cons: aortic valve stenosis in future

Should Off-Pump CABG Be Abandoned?

Joseph Sabik

https://www.ctsnet.org/article/should-pump-cabg-be-abandoned


Few differences.
OPCAB
Conversion risk: high!
Incomplete revascularization: high!  Especially Cx
# of grafts and graft patency: low!

If we could do same # and patency, we can get the same results.

九州心臓弁膜症カンファレンス2016 田中先生

Concomitant tricuspid valve repair with mitral surgery
Tronto (David):7-10%
NY(Adams): 65%

Valve Sparing Root Replacement for Aneurysm of Sinus Valsalva in Alagille Syndrome

Valve Sparing Root Replacement for Aneurysm of Sinus Valsalva in Alagille Syndrome
By J Andreas Hoschtitzky Featuring Bilal Kirmani

https://www.vumedi.com/video/valve-sparing-root-replacement-for-aneurysm-of-sinus-valsalva-in-alagille-syndrome/



Head camera
The video sound is terrible.
Standard David procedure.
1st row: 5-0 prolene x6

九州心臓弁膜症カンファレンス2016 川添先生

大動脈弁形成術
若い人ほど良い適応。
ARに対する三尖の二尖弁化手術は15年でASになる。
ここから先天性二尖弁に対して三尖弁化することを思いついた。

内側から弁下にフェルトストリップで弁輪縫縮（22mm決め打ち）。
弁が余剰になるのでCV-5（７は切れる）で釣り上げ
10年手術回避率80％


MR
アメリカのガイドラインは、重症なら無症状であっても手術してよいとなっているが疑問。
厳重な経過観察（アメリカでは医療事情でできない）で、その後症状が出てから手術しても同じ良好な成績。
アメリカのガイドラインは最近より引き上げられている。（手術成功期待率が90→95％）

僧帽弁が余剰な場合はいろいろなオプションがある。
少ない場合のほうが問題。オーグメンテーションするしかない。

尾辻先生
僧帽弁逸脱とは症候群
バーロー（突然死しやすい）と変性（突然死しにくい）がある。
バーローは不整脈が出る。左房拡大すると心不全が出にくくなる。心不全が出る頃には心筋変性が進んでいる。

九州心臓弁膜症カンファレンス2016 長崎大学内科 恒任先生

三尖弁エコー

三尖弁のエコーでの形態理解は思ったより難しい。

どの弁尖をみているのかはピットフォール。ちょっとした角度、個人差で変わってくる。

RVの大きさ、三尖弁のテザリングに関して

Up Grade形成術、PM Spiral suspension

ゴアテックス糸で三尖弁両乳頭筋と弁輪の間を縫縮

TRとディスシンクロニーが問題かもしれない。

単独TRに対する手術は危険なので適応が問題。

→症状が出たときには遅いという理論は、症状が出る前にすべきということに繋がるが、そもそも症状が出る前なら利尿剤でコントロールできてしまう。この検討はされていない。