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Mitral valve (MV) repair in children is challenging because of the broad spectrum of lesions and anticipated patient growth. The purpose of the study was to evaluate the outcome of MV repair in children below 10 years of age. We reviewed all MV repair procedures performed in children below 10 years of age. Endpoints of the study were survival after MV repair and cumulative incidence of reoperation. MV repair was performed in 40 patients with congenital MV disease (MVD) and in 10 patients with acquired MVD. Median age at time of repair for congenital MVD was 1.2 years (range, 14 days to 9.8 years) and for acquired MVD 1.9 years (range, 10 days to 9.9 years). Indication for MV repair was mitral regurgitation in 31 congenital MVD patients (77.5%) and in all acquired MVD patients. In patients with congenital MVD operative mortality was 5% and late mortality was 10%. No deaths occurred in patients with acquired MVD. Patients with congenital mitral regurgitation showed a better, yet not significant, 6-year survival than patients with congenital mitral stenosis (85.3% ± 8.2% vs 60% ± 18.2%, P =.1). In patients with congenital MVD cumulative incidence of reoperation at 6 years was 38.6% ± 8.3%. In children below 10 years of age, MV repair is an effective treatment option for MVD. However it often just delays the time to valve replacement. [ABSTRACT FROM AUTHOR]

Background Sternal dehiscence after median sternotomy is a challenging problem in situations of frail bone, fractures, or complete sternectomy. Plate osteosynthesis offers a promising approach to restore sternal integrity. However, there is only scarce data on mid-term outcome. Methods Mid-term data on 34 patients with unstable thorax after open heart operation, requiring sternal refixation with the Synthes Titanium Sternal Fixation System (Oberdorf, Switzerland) between 2005 and 2011, were analyzed. The Titanium Sternal Fixation System was used if conventional rewiring had failed or if failure of rewiring was expected because of risk factors. Follow-up examinations included clinical tests, computed tomographic scans, and pain assessment to evaluate sternal integrity and persistent pain. Results Median follow-up time was 1.4 years (range, 0.3 to 6.6 years). Clinical examination showed thoracic stability in all patients. Computed tomographic scans demonstrated complete bone consolidation in 25.8%, nearly complete in 38.7%, partial in 9.7%, and missing in 25.8% of patients. Pain assessment revealed no sternal pain in 16 patients (48.5%), mild pain in 9 (27.3%), moderate pain in 3 (9.1%), and severe pain in 5 patients (15.1%). Pain on movement was reported in 12 patients and 5 patients had chronic pain. A total of 13 patients (38%) required plate removal due to pain (n = 8) or infection (n = 5) after a median of 10.9 and 2 months, respectively. Conclusions With the use of plates, it was possible to achieve thoracic stabilization in complicated dehiscence. However, the rate of postoperative infection and pain is not negligible. Thus, we recommend plate reconstruction only in sternal high-risk patients, who are unsuitable for standard reclosure. [ABSTRACT FROM AUTHOR]

Background Mitral valve (MV) repair through a right minithoracotomy (RT) is technically more demanding than through a median sternotomy (MS) and has been cited for a higher rate of reoperation, increased postoperative bleeding, thromboembolic events, poor visualization, and longer operative times. Randomized studies are not available, however, and specific characteristics of patients who undergo operation with either technique are usually highly different. Therefore, a propensity matching study was performed to reduce selection bias. Methods A retrospective analysis was made of 745 patients, 501 in group RT (67%) and 244 in group MS (33%), who underwent isolated MV repair between 2000 and 2010. Propensity matching identified 97 matched patient pairs for comparison of functional outcome, survival, incidence of reoperation, and quality of life after MV repair. Results Propensity matched patients in group RT had longer cardiopulmonary bypass time (120 ± 28 versus 99 ± 30 minutes, p < 0.001) and cross-clamp time (86 ± 23.5 versus 74 ± 25 minutes, p < 0.001). Thirty-day mortality was similar for both groups (RT, 0%; MS, 1%; p = 0.13). There were no significant differences in other outcomes such as amount of red blood cell transfusion, ventilation time, and hospital stay. Five-year survival in group RT (93.5% ± 3.7%) versus group MS (87.4% ± 3.6%, p = 0.556) and freedom from MV reoperation (93.3% ± 2.9% versus 97.9% ± 1.5%, respectively; p = 0.157) were not different. Functional outcome and quality of life variables were similar. Conclusions Mitral valve surgery through a right minithoracotomy is a safe procedure associated with a very low operative mortality comparable to the standard sternotomy approach. In addition to improved cosmetics, minimally invasive MV surgery provides equally durable results as the standard sternotomy approach. [ABSTRACT FROM AUTHOR]

Objectives: Undersized ring annuloplasty is the treatment of choice for functional mitral regurgitation. However, recurrence of mitral regurgitation within the first years is frequent. The aim of this study was to analyze the functional and clinical outcome after mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm (Edwards Lifesciences LLC, Irvine, Calif) annuloplasty ring in patients with ischemic mitral regurgitation. Methods: Between November 2006 and November 2012, 70 patients (mean age, 68 ± 10 years; mean left ventricular ejection fraction, 40% ± 15%) with functional mitral regurgitation due to ischemic cardiomyopathy underwent mitral valve repair with the Edwards GeoForm annuloplasty ring. Concomitant procedures, such as coronary artery bypass grafting (75.7%), tricuspid valve repair (25.7%), aortic valve replacement (8.6%), and the Maze procedure (4.3%), were performed in 92.9% of patients. Follow-up is 97% complete (mean, 3.0 ± 1.7 years). Transthoracic echocardiography was obtained 2.4 ± 1.7 years postoperatively. Results: Thirty-day mortality was 5.9%. Overall survival at 5 years was 71.3% ± 6.9%. At 4 years, overall freedom from recurrence of mitral regurgitation grade 3+ or greater was 92.5% ± 3.6%, and freedom from recurrence of mitral regurgitation grade 2+ or greater was 71.0% ± 8.7%. Three patients required a mitral valve–related reoperation for ring dehiscence. New York Heart Association functional class improved from 3.6 ± 0.6 to 1.6 ± 0.6 during follow-up (P < .05). Mean mitral valve pressure gradient was 3.3 ± 1.8 mm Hg across all ring sizes at the time of follow-up. Conclusions: Mitral valve repair with the 3-dimensional saddle-shaped Edwards GeoForm annuloplasty ring in case of ischemic mitral regurgitation shows a low rate of recurrent regurgitation at 4 years. Clinically relevant mitral stenosis was not detected. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent ring dehiscence. [Copyright &y& Elsevier]

Background: Patients aged 80 years and older who require cardiac surgical procedures are an increasing population and usually present with considerable comorbidity. Detailed operative risk stratification versus long-term survival and quality of life after surgery is mandatory. Methods: A retrospective analysis was performed on 1,003 patients aged 82.3 years (range, 80 to 94 years) who underwent aortic valve replacement (n = 303), coronary artery bypass grafting (n = 403), or aortic valve replacement with coronary artery bypass grafting (n = 297) between 1987 and 2006. Preoperative data, operative outcome, long-term survival, and predictors for early and late mortality were analyzed. Furthermore, the Short Form 36 Health Status questionnaire was used to evaluate the quality of life. Results: Overall in-hospital mortality was 7.1%. Overall actuarial survival at 1, 5, and 10 years was 81.6% ± 1.2%, 60.4% ± 1.9%, and 23.3% ± 2.6% (mean survival time, 6.25 ± 0.2 years) and showed no significant difference compared with an age- and sex-matched general population. Multivariate analysis showed that preoperative creatinine concentration greater than 1.3 mg/dL (p < 0.001), preoperative atrial fibrillation (p < 0.005), and postoperative prolonged ventilation (p < 0.001) were independent predictors for poor long-term survival. The physical health summarized score of the Short Form 36 Health Status questionnaire was significantly increased in the study population compared with a German standard population aged 80 years and older (p < 0.05). Conclusions: Despite an increased operative mortality, octogenarians showed a considerable quality of life and an excellent long-term survival. To further improve surgical outcome in octogenarians, patient selection should be done with consideration of the identified independent preoperative risk factors. [ABSTRACT FROM AUTHOR]

Background: Transcatheter aortic valve implantation (TAVI) has been introduced to offer a new treatment option for patients who are not eligible for conventional aortic valve replacement. Especially in this subset of patients, the expected improvement of quality of life (QoL) after valve implantation will be critical for decision-making for TAVI. Methods: We performed a prospective analysis of 99 patients (41 male) aged 82 years (range 57-94 years) who underwent TAVI. For assessment of QoL, the Short Form 36 Health Survey Questionnaire was used preoperatively and 3 months after TAVI. Results: Thirty-day mortality rate was 10.1%. The Short Form 36 Health Survey Questionnaire scores for physical functioning (34.7 ± 2.8 vs 48.5 ± 3.4, P < .001), bodily pain (61.7 ± 3.1 vs 73.2 ± 2.9, P < .01), general health (47.1 ± 1.9 vs 54.1 ± 2.3, P < .01), and vitality (37 ± 2.8 vs 46.1 ± 2.7, P < .01) increased significantly 3 months after TAVI compared with preoperative scores. No significant changes were found for role-physical (21.7 ± 4.1 vs 31.1 ± 5.1, P < .08), social functioning (74.6 ± 3.4 vs 74.6 ± 3.1, P = 1), and mental health (63 ± 2.9 vs 67.4 ± 2.2, P = .17) 3 months after TAVI. Only the score for role-emotional (69.3 ± 5.6 vs 51.7 ± 6, P = .02) decreased significantly 3 months after TAVI compared with the preoperative score. Corresponding to these results, the physical health summarized score (31.2 ± 1.2 vs 38.6 ± 1.6, P < .001) was significantly increased 3 months after TAVI compared with the preoperative score, whereas the mental health summarized score (48.5 ± 1.8 vs 47.3 ± 1.7, P = .5) showed no changes. Conclusion: In patients who are not eligible for conventional aortic valve replacement, TAVI leads to a considerable QoL improvement within 3 months after valve implantation. [ABSTRACT FROM AUTHOR]

Background: In the past, chordal replacement techniques with expanded polytetrafluoroethylene sutures have been primarily reserved for anterior leaflet pathology, whereas the more frequent posterior leaflet prolapse was treated by resection. This study reports midterm results of isolated posterior prolapse repair with chordal replacement without resection as opposed to the quadrangular resection. Methods: An analysis was made of 397 consecutive patients who underwent mitral valve repair for isolated posterior leaflet prolapse between 2000 and 2007. Of them, 205 patients (52%) underwent quadrangular resection (group R, “resection”) and 192 patients (48%) underwent a neochordal repair (group NR, “no resection”). The follow-up is 98% complete (mean follow-up of 383 survivors is 1.9 ± 1.4 years). Results: Overall 30-day mortality was 1.0% (4 of 397). Ten patients (2.5%) died late. Actuarial survival at 4 years for group R and group NR was 94% ± 3% and 98% ± 1%, respectively (p = 0.99). Ten patients (2.5%) required a mitral valve–related reoperation after an average of 1.9 ± 2 months. Freedom from reoperation at 4 years was 96% ± 1% for group R and 99% ± 1% for group NR (p = 0.08). Generally, in patients of group NR, a larger annuloplasty ring could be implanted (mean size 32 ± 2.5 versus 30 ± 2, p < 0.001). At latest follow-up, 94% of the patients showed no or grade I regurgitation, with no difference between groups. Conclusions: Repair of posterior mitral leaflet prolapse by chordal replacement is equally effective as classic quadrangular resection, permits the use of larger annuloplasty rings, offers a potentially more physiological repair with preserved leaflet mobility, and can be performed with excellent midterm results and a low incidence of reoperation. [Copyright &y& Elsevier]

Background: The benefit of cardiac surgery in octogenarians is well described. Today, nearly every second patient who undergoes cardiac surgery is older than 70 years. The time between primary cardiac surgery and reoperation is 7 to 13 years. Therefore, in the future we can expect to see an increasing number of reoperations in octogenarians. Methods: We studied 71 patients (41 male) with a mean age of 83 ± 2.8 years, who underwent cardiac reoperation between 1994 and 2006. These patients were compared with 71 octogenarians who underwent primary cardiac operation. Patients were matched for age, sex, year of operation, and surgical procedure. Demographic profiles, operative data, long-term survival, and quality of life by the Short-Form 36-Item Health Survey questionnaire were analyzed. Results: Average time between previous operation and reoperation was 10.8 ± 5.6 years (range: 1.7 to 30.6). The 30-day mortality rate was 14.7% in the reoperation group and 8.5% (p = 0.43) in the control group. Actuarial survival at 1, 3, and 6 years was 71% ± 5.5%, 60.5% ± 6.1%, and 30% ± 8.1% for patients who underwent cardiac reoperation; and 77.2% ± 5%, 58.3% ± 6.3%, and 36.3% ± 7.8% for matched octogenarians who underwent primary cardiac surgery (p = 0.68). No significant differences were found between groups regarding the physical health summarized score (40.7 ± 9.4 versus 39.1 ± 10; p = 0.55) and the mental health summarized score (51.9 ± 10.9 versus 48 ± 12.9; p = 0.24) of the Short-Form 36-Item Health Survey questionnaire. Conclusions: Octogenarians exhibit a similar long-term survival and quality of life after primary and redo cardiac surgery. Therefore, cardiac reoperation should not be a contraindication per se in octogenarians. [Copyright &y& Elsevier]

Objective: Various devices have been proposed for ring stabilization in patients with mitral valve disease. This study reports the intermediate-term results of mitral valve repair with a new semirigid partial annuloplasty ring in a large series of patients. Methods: A total of 437 consecutive patients were analyzed who underwent mitral valve reconstruction with annuloplasty using the Colvin–Galloway Future band at the German Heart Center in Munich between 2001 and 2005. A total of 237 patients (54.2%) underwent isolated mitral valve repair, and 200 patients (45.8%) underwent a combined procedure. The follow-up is 97% complete (mean follow-up of 405 survivors 2.1 ± 1.1 years). Results: Overall 30-day mortality was 2.7%. Twenty patients (4.6%) died later after an average of 1.1 ± 1.1 years. Actuarial survival at 4 years after isolated mitral valve reconstruction and combined procedures was 91% ± 4% and 87% ± 2.5%, respectively (P < .001). Twelve patients (2.7%) required a mitral valve reoperation after an average of 4.5 ± 4.3 months. Five of these reoperations were required for band dehiscence, and 1 reoperation was required for band fracture. Freedom from reoperation at 4 years was 97% ± 0.9%. At the latest follow-up, 93.5% of the patients showed trivial or mild mitral valve regurgitation, and 86.4% of the patients showed New York Heart Association functional class I or II. Conclusion: Mitral valve annuloplasty with the Colvin–Galloway Future band can be performed with a low early and late mortality and an excellent functional outcome. The low incidence of reoperation demonstrates that the Colvin–Galloway Future band is a safe and effective device. The importance of secure anchoring of the device in the mitral annulus has to be emphasized to prevent band dehiscence. [Copyright &y& Elsevier]

Sternal dehiscence after median sternotomy can be a challenging problem in case of multiple fractures or infection. For sternal refixation, the principles of rigid plate and screw osteosynthesis gained from orthopedic surgery have been recommended by several authors. We present a new system for sternal reconstruction consisting of reconstruction plates, steel cables, and cannulated screws. [Copyright &y& Elsevier]

To date, closure of a patent foramen ovale (PFO) by the transcatheter technique is the preferred method, and an operation with cardiopulmonary bypass is reserved for special indications. Although different closure devices are used with high efficacy, adverse events after transcatheter PFO closure have been reported. We describe an unusual case of a cardiac perforation occurring 10 years after transcatheter PFO closure. The device was explanted surgically, and the interatrial communication was closed with a polytetrafluoroethylene patch. [ABSTRACT FROM AUTHOR]

Highlights • Deposit formation leads to a strong increase of the initial apparent contact angle. • Deposits lead to surface heterogeneities and, increase the drop pinning phase. • For lower temperatures brown films are seen, which are washed to the substrate edge. • Close to saturation deposition is strong and concentrated at the substrate center. • The drop evaporation can be described with an effective diffusive transport. Abstract The evaporation and deposit formation process of a hydrocarbon drop on a heated aluminium surface is experimentally investigated and compared to a physico-mathematical model. To analyze the effect of wall temperature on deposit formation, the experiments are conducted for three substrate temperatures below, one temperature close to and one temperature above the saturation point for atmospheric pressure. In each experimental run 500 single drops with constant volume are deposited and evaporated successively. The shape evolution of the drops is recorded with a monochrome camera sidewards. The deposited mass is evaluated as well as the contact angle evolution and drop lifetime. The experiments show a strong dependency of the contact angle on the deposit formation and on the wall temperature. With higher wall temperatures and an ongoing deposit formation, the initial contact angles increase and drop lifetime is reduced. The appearing deposits vary from light yellow and highly viscous films to dark brown solid layers and black particles, depending on the applied substrate temperatures. The model based calculations show a possibility to describe the evaporation process with effective diffusive transport. [ABSTRACT FROM AUTHOR]

Recently, it has been demonstrated that transcatheter aortic valve implantation (TAVI) can result in significant improvement in patients'' quality of life (QOL) in the short term. At present, however, little is known about the long-term improvements in QOL after TAVI. Thus, our aim was to prospectively assess the 1-year QOL outcome of patients undergoing TAVI. We performed a prospective analysis of 186 patients with symptomatic severe aortic valve stenosis ineligible for conventional aortic valve replacement, who underwent TAVI with either the Medtronic CoreValve or Edwards Sapien device. A total of 106 patients completed the 1-year follow-up protocol. The QOL was measured using the Medical Outcomes Study 36-item short-form health survey questionnaire at baseline and at 3 months and 1 year of follow-up. At 1 year of follow-up, significant improvements in the Medical Outcomes Study 36-item short-form health survey questionnaire scores for physical functioning (baseline 34.6 ± 2.3 vs 1 year of follow-up 45.6 ± 2.7; p <0.001), role physical (20 ± 3.0 vs 34.2 ± 4.4; p <0.001), bodily pain (59.9 ± 3 vs 70 ± 2.7; p <0.01), general health (47.3 ± 1.5 vs 55.2 ± 2.1, p <0.001), vitality (35.9 ± 2 vs 48.5 ± 2; p <0.001), and mental health (62.2 ± 2.2 vs 67.3 ± 1.8; p <0.05) were observed compared to baseline. No significant improvement could be detected for social functioning (75.4 ± 2.5 vs 76.5 ± 2.6; p = 0.79) and role emotional (61.1 ± 4.3 vs 66.5 ± 4.7; p = 0.29). At 1 year of follow-up, the various physical and mental scores were comparable to an age-matched standard population. In conclusion, the present study has demonstrated that TAVI can improve the QOL status of high-surgical risk patients with severe aortic valve stenosis that can be maintained for ≤1 year postproceduraly in survivors. Although the mental subscales improved slightly, the mental component summary score failed to reach statistical significance in our study population. [Copyright &y& Elsevier]

Objectives: The purpose of this study was to investigate the evolution of patient selection criteria for transcatheter aortic valve implantation (TAVI) and its impact on clinical outcomes. Background: Anecdotal evidence suggests that patient selection for TAVI is shifting toward lower surgical risk patients. The extent of this shift and its impact on clinical outcomes, however, are currently unknown. Methods: We conducted a single-center study that subcategorized TAVI patients into quartiles (Q1 to Q4) defined by enrollment date. These subgroups were subsequently examined for differences in baseline characteristics and 30-day and 6-month mortality rate. The relationship between quartiles and mortality rate was examined using unadjusted and adjusted (for baseline characteristics) Cox proportional hazard models. Results: Each quartile included 105 patients (n = 420). Compared with Q4 patients, Q1 patients had higher logistic EuroSCORES (25.4 ± 16.1% vs. 17.8 ± 12.0%, p < 0.001), higher Society of Thoracic Surgeons scores (7.1 ± 5.5% vs. 4.8 ± 2.6%, p > 0.001), and higher median N-terminal pro–B-type natriuretic peptide levels (3,495 vs. 1,730 ng/dl, p < 0.046). From Q1 to Q4, the crude 30-day and 6-month mortality rate decreased significantly from 11.4% to 3.8% (unadjusted hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.11 to 1.01; p = 0.053) and from 23.5% to 12.4% (unadjusted HR: 0.49; 95 CI: 0.25 to 0.95; p = 0.07), respectively. After adjustment for baseline characteristics, there were no significant differences between Q1 and Q4 in 30-day mortality rate (adjusted HR ratio: 0.29; 95% CI: 0.08 to 1.08; p = 0.07) and 6-month mortality rate (HR: 0.67; 95% CI: 0.25 to 1.77; p = 0.42). Conclusions: The results of this study demonstrate an important paradigm shift toward the selection of lower surgical risk patients for TAVI. Significantly better clinical outcomes can be expected in lower than in higher surgical risk patients undergoing TAVI. [ABSTRACT FROM AUTHOR]