The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement (redo-MVR) at our institution. Forty-nine patients (24 males) underwent redo-MVR with either bioprosthetic (n = 24) or mechanical valves (n = 25) between January 2000 and 2010. Median age of patients was 63 years (range 21-80 years), and the mean additive EuroSCORE was 12 ± 4. Median time to re-operation was 8.2 ± 6.6 years for first time redo-MVR and 6.4 ± 5.6 years for second-time redo-MVR. Indications included prosthetic endocarditis (n = 22), para-prosthetic leak (n = 12), structural valve degeneration (n = 8), prosthetic valve thrombosis (n = 6) and malignancy (n = 1). The mean follow-up was 47.5 ± 37.0 months (range 0.1-112.3 months). In-hospital mortality was 12% (n = 6). Mean hospital stay was 17 ± 11 days (range 8-50 days). Actuarial survival at 1 and 5 years was 81 ± 5% and 72 ± 6%, respectively. Three patients required re-intervention: two for prosthetic valve endocarditis and one for para-prosthetic leak. Multivariate analysis showed that overall survival was associated with the LVEF < 50% (P < 0.001), concomitant AVR (P < 0.001) and urgent surgery (P = 0.03).

No abstract

Numerous studies have shown the presence of high levels of growth factors during the process of healing. Growth factors act by binding to the cell surface receptors and contribute to the subsequent activation of signal transduction mechanisms. Wound healing requires a complex of biological and molecular events that includes attraction and proliferation of different type of cells to the wound site, differentiation and angiogenesis. More specifically, migration of various cell types, such as endothelial cells and their precursors, mesenchymal stem/stromal cells (MSCs) or skin fibroblasts (DFs) plays an important role in the healing process. In recent years, the application of platelet rich plasma (PRP) to surgical wounds and skin ulcerations is becoming more frequent, as it is believed to accelerate the healing process. The local enrichment of growth factors at the wound after PRP application causes a stimulation of tissue regeneration. Herein, we studied: (i) the effect of autologous PRP in skin ulcers of patients of different aetiology, (ii) the proteomic profile of PRP, (iii) the migration potential of amniotic fluid MSCs and DFs in the presence of PRP extract in vitro, (iv) the use of the PRP extract as a substitute for serum in cultivating AF-MSCs. Considering its easy access, PRP may provide a valuable tool in multiple therapeutic approaches.

Oversizing the homograft at the time of the initial repair can lead to a homograft lasting more than 12 years. During long-term follow-up, 20% of patients require truncal valve replacement.

Complex atrioventricular valve surgery in the context of AVVE can be endoscopically performed in experienced centres and should not deter surgeons from offering patients with AVVE the potential benefits of minimally invasive cardiac surgery.

We describe a case of osteogenesis imperfecta in a 52-year-old man who underwent successful repair of aortic root dilatation and aortic valve insufficiency, using a bioprosthetic aortic valve anastomosed to an interposition graft.

A 62-year-old man with a history of hypertension was admitted with unstable angina. Three years earlier, he had presented with a non-ST-segment-elevation myocardial infarction and had undergone percutaneous coronary intervention with a paclitaxel-eluting stent (3.0×20 mm; Taxus, Boston Scientific, Boston, MA) to the proximal left anterior descending coronary artery ( Figure 1A). His initial ECG was normal, and his biomarkers were not elevated. Eight hours into his admission, he became pyrexial and developed chest pain associated with transient anterior ST-segment elevation. Emergency coronary angiography demonstrated aneurysmal dilatation at the proximal edge of the previous stent ( Figure 1B). Because he had normal flow (Thrombolysis in Myocardial Infarction grade 3), his pain had settled spontaneously, and there was no evidence of a left ventricular regional wall motion abnormality (Movie I in the online-only Data Supplement) on transthoracic echocardiography, the supervising cardiologist elected to treat him medically in the first instance, pending administration of antibiotics and discussion about coronary artery bypass graft surgery. He was treated with dual antiplatelet therapy and antibiotics. Multiple blood cultures subsequently grew Staphylococcus aureus (methicillin sensitive) sensitive to flucloxacillin.A few hours later, having continued to have a high temperature, he developed further chest pain and ST-segment elevation with hypotension. An emergency echocardiogram demonstrated a pericardial effusion. Repeat emergency coronary angiography confirmed rupture of the left anterior descending artery aneurysm ( Figure 1C), and he was transferred for emergency surgery. At surgery, the left anterior descending artery was exposed (Figure 2A), and the diseased area, including the stent, was resected ( Figure 2B-2D). The left internal mammary artery was then grafted to the left anterior descending artery. Postoperative transthoracic echocardiography demonstrated anterior hypokinesia with mild left ventricular systolic impairment (Movie II in the online-only Data Supplement). Tissue cultures confirmed the presence of methicillin-sensitive S aureus sensitive to flucloxacillin. The patient recovered well and was discharged home once he completed a 6-week course of antibiotic treatment, which consisted of intravenous flucloxacillin 2 g every 4 hours and peros fucidic acid 500 mg 3 times a day.Percutaneous stent deployment is the commonest modality for coronary revascularization. Infective complications are rare. The first coronary stent infection was described in 1993, 1 and since then, <30 cases have been reported.2 Most cases describe early infection, with onset between 2 days and 4 weeks after percutaneous coronary intervention.3 Late infection is rare, with 1 report of stent infection 3 years after intervention associated with stent fracture.2 These cases of stent infection share similar clinical features: fever usually accompanied with an episode of chest pain. 4 Diagnosis of stent infection can be challengin...

The role of cardiac magnetic resonance (CMR) in coronary artery disease is prominent. CMR provides functional and structural heart disease assessment with high accuracy. It allows accurate cardiac volume and flow quantification and wall motion analysis both at rest and at stress. CMR myocardial perfusion studies detect myocardial ischemia and provide insights into the morphology of the myocardial tissue. CMR imaging noninvasively differentiates causes of myocardial injury such as ischemia or inflammation; stages of myocardial injury, such as acute or chronic; grade of myocardial damage, such as reversible or irreversible; myocardial fibrosis or scar. There is an emerging role of CMR in patients with acute chest presentation since it can demonstrate causes of chest pain other than coronary artery disease such as myocarditis, pericarditis, aortic dissection and pulmonary embolism. CMR is noninvasive and radiation-free. It's combined approach of functional and structural cardiac assessment makes it unique compared with other imaging modalities.