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Prosthetic replacement of the aortic arch requires a cardiopulmonary bypass and deep hypothermic circulatory arrest. Thus, it is associated with major perioperative risks, and custom-made devices have been developed. However, the time required for this procedure precludes emergency cases, and anatomical prerequisites limit the creation of appropriate devices. Here, we present a totally endovascular approach that allowed an exclusion of the aortic arch with the usual commercial devices. We explain, step by step, the procedure and the materials carefully selected for each step.

OBJECTIVES To investigate the long-term outcomes of concomitant suture bicuspidization to treat mild or moderate tricuspid regurgitation at the time of mitral valve surgery. METHODS Data from patients who underwent mitral valve surgery for degenerative mitral valve regurgitation with mild or moderate tricuspid regurgitation and annular dilatation between January 2009 and December 2017 were analyzed. The cohort was divided into 2 groups: mitral valve surgery alone and mitral valve surgery with concomitant tricuspid valve repair. RESULTS A total of 196 patients were included in the study. Mitral valve surgery alone and mitral valve surgery with concomitant tricuspid valve repair were performed in 91 (46.4%) and 105 (53.6%) patients, respectively. Propensity score matching analysis identified 54 pairs. In the matched cohort, 30-day mortality (0.0% vs 1.9%, P = 1.0) and new permanent pacemaker implantation (11.1% vs 7.4%, P = 0.740) did not differ significantly between groups. After a mean follow-up of 6.0 (2.8) years, mitral valve surgery with concomitant tricuspid valve repair was not associated with increased mortality risk compared to mitral valve surgery alone (hazard ratio 1.04, 95% confidence interval 0.47–2.28, P = 0.927) with 10-year overall survival rates of 69.9% and 77.2%, respectively. Furthermore, mitral valve surgery with concomitant tricuspid valve repair was associated with a significantly reduced progression of tricuspid valve regurgitation (P CONCLUSION Patients undergoing mitral valve surgery with concomitant tricuspid valve repair had similar 30-day and long-term survival, similar permanent pacemaker implantation rate, and reduced progression of tricuspid valve regurgitation compared to those undergoing mitral valve surgery alone.

Cardiac fiber direction is an important factor determining the propagation of electrical activity, as well as the development of mechanical force. In this article, we imaged the ventricles of several species with special attention to the intraventricular septum to determine the functional consequences of septal fiber organization. First, we identified a dual-layer organization of the fiber orientation in the intraventricular septum of ex vivo sheep hearts using diffusion tensor imaging at high field MRI. To expand the scope of the results, we investigated the presence of a similar fiber organization in five mammalian species (rat, canine, pig, sheep, and human) and highlighted the continuity of the layer with the moderator band in large mammalian species. We implemented the measured septal fiber fields in three-dimensional electromechanical computer models to assess the impact of the fiber orientation. The downward fibers produced a diamond activation pattern superficially in the right ventricle. Electromechanically, there was very little change in pressure volume loops although the stress distribution was altered. In conclusion, we clarified that the right ventricular septum has a downwardly directed superficial layer in larger mammalian species, which can have modest effects on stress distribution.

Background: Minimally invasive procedures have demonstrated their effectiveness in reducing the recovery times while ensuring optimal results and minimizing complications. Regarding the coronary artery surgical revascularization field, the evolution of techniques and technology is permitting new surgical strategies that are increasingly precise and suitable for each patient. We present an initial single center experience with a case series of patients successfully treated with combined robotic harvesting of the left internal mammary artery (LIMA) and minimally invasive direct coronary artery bypass graft (MIDCAB) for the anastomosis. Methods: We retrospectively reviewed the records of patients who underwent minimally invasive coronary artery revascularization with the use of two combined techniques at our Institution between January 2021 and October 2022. Results: A total of 17 patients underwent coronary artery bypass grafting with the described approach. The median cardiopulmonary bypass (CPB) and cross-clamp times were 83 min (76–115) and 38 min (32–58), respectively. The median intensive care unit (ICU) and hospital stay were 2 days (1–4) and 8 days (6–11), respectively. The procedure’s success was achieved in 100% of patients. The 30-day mortality was 0%. Conclusions: Considering all the limitations related to the small sample, the presented results of a hybrid approach for minimally invasive coronary artery bypass grafting (CABG) appears to be encouraging and acceptable. The main advantage of this approach is related to the reduction of postoperative pain and pulmonary complications.