Transcatheter Mitral-Valve Repair in Patients With Heart Failure

Transcatheter Mitral-Valve Repair in Patients With Heart Failure

https://www.ctsnet.org/jans/transcatheter-mitral-valve-repair-patients-heart-failure?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+9%2F28%2F2018

This multicenter RCT study evaluated the efficacy of medical therapy plus transcatheter valve repair (MitraClip) to medical therapy alone for heart failure accompanied by secondary moderate to severe mitral regurgitation.

The device group experienced significantly fewer hospitalizations and lower mortality at 24 months follow-up.

Neither surgical repair nor surgical replacement of the mitral valve has been shown to lower the rate of hospitalization or death associated with secondary mitral regurgitation, and both procedures confer a substantial risk of complications.

Why are there the difference between surgery and MitraClip?

If surgery is too invasive, the mortality of surgical survivor must be improved.

According to MR improvement, MVR must be better than MVP and Mitraclip. But there were no differences between MVR and MVP.

I doubt some limitations affect the results.
1. Abbot's trial  It might cause COI.
2. F/U doctors know who are MitraClip patients due to XP.

Combined Transaortic and Transapical Approach to Septal Myectomy for Complex Long-Segment Hypertrophy

Combined Transaortic and Transapical Approach to Septal Myectomy for Complex Long-Segment Hypertrophy

https://www.ctsnet.org/article/combined-transaortic-and-transapical-approach-septal-myectomy-complex-long-segment?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=Pulse+9%2F25%2F2018

Standard Morrow's myectomy + myectomy through LV apex 5cm incision

Aortic Valve Replacement With Right Anterior Thoracotomy, Sutureless Valves, and Ultrafast-Track Anesthesia: A Truly Minimally Invasive Approach in Ancona

https://www.ctsnet.org/article/aortic-valve-replacement-right-anterior-thoracotomy-sutureless-valves-and-ultrafast-track?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=Pulse+9%2F25%2F2018

MICS-AVR
Need the disrtance between Aortomy and aortic valve over 7cm
Standard antegrade CP x1
Sutureless valve Perceval (crimp)
Every Nadia 1 suture

Right Coronary Aneurysm With Coronary Arteriovenous Fistula to Right Atrium

https://www.ctsnet.org/article/right-coronary-aneurysm-coronary-arteriovenous-fistula-right-atrium

The fistula between the proximal of RCA and SVC

They had some choices
1 Open the fistula, and close the entry and exit through the fistula ( or through the SVC). No need bypass.
2 Close the proximal RCA and the exit through the fistula ( or through the SVC). need bypass.

They chose 2. Why? I am afraid that SVG long term patancy. maybe too close.

Minimally Invasive Aortic Valve Replacement by Thoracotomy: Step-by-Step Guide

https://www.youtube.com/watch?time_continue=3&v=nIRL52PpM-E

Preop
Assessment of incision level:  CT Coronal view, Aortic cross clamp above PA
4-0 prolene sutures on FA and FV.
FV cannulation: Valsalva manuever
FA cannulation: 15Fr (BSA<1 .6="" 17fr="" 19fr="">2.1)
Remove excess pericardial fat to visualize

Right Anterior Minithoracotomy AVR Intuity Valve for Bicuspid Aortic Stenosis

https://www.youtube.com/watch?time_continue=1&v=ckiAlZc0A_4

Intuity Valve  (Suture-less valve)
Very small incision 6cm?
Difficult even for valve sizers to enter thoracic space.
Use tourniquets for three valve sutures.

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

http://onlinelibrary.wiley.com/doi/10.1111/jocs.13250/abstract

Aspirin is of benefit to patients following CABG.
Continuation or administration of preoperative aspirin before CABG or any cardiac surgical procedure remains controversial.

12 randomized controlled trials and 28 observational studies

Result
1
The use of preoperative aspirin in patients undergoing CABG at any dose is associated with reduced early mortality as well as a reduced incidence of postoperative acute kidney injury.
2
Low-dose aspirin (≤160 mg/d) is associated with a decreased incidence of perioperative myocardial infarction (MI).
3
Administration of preoperative aspirin at any dose in patients undergoing cardiac surgery increases postoperative bleeding. It did not increase the rates of surgical re-exploration due to excessive postoperative bleeding nor did it increase the rates of packed red blood cell transfusions (PRBC).

Bayaspirin　１T = 100mg