-The purpose of this study was to characterize changes in antioxidant and age-related gene expression in aorta and aortic valve with aging, and test the hypothesis that increased mitochondrial oxidative stress accelerates age-related endothelial and aortic valve dysfunction. Wildtype (MnSOD ϩ/ϩ ) and manganese SOD heterozygous haploinsufficient (MnSOD ϩ/Ϫ ) mice were studied at 3 and 18 mo of age. In aorta from wild-type mice, antioxidant expression was preserved, although there were age-associated increases in Nox2 expression. Haploinsufficiency of MnSOD did not alter antioxidant expression in aorta, but increased expression of Nox2. When compared with that of aorta, age-associated reductions in antioxidant expression were larger in aortic valves from wild-type and MnSOD haploinsufficient mice, although Nox2 expression was unchanged. Similarly, sirtuin expression was relatively well-preserved in aorta from both genotypes, whereas expression of SIRT1, SIRT2, SIRT3, SIRT4, and SIRT6 were significantly reduced in the aortic valve. Expression of p16 ink4a , a marker of cellular senescence, was profoundly increased in both aorta and aortic valve from MnSOD ϩ/ϩ and MnSOD ϩ/Ϫ mice. Functionally, we observed comparable age-associated reductions in endothelial function in aorta from both MnSOD ϩ/ϩ and MnSOD ϩ/Ϫ mice. Interestingly, inhibition of NAD(P)H oxidase with apocynin or gp91ds-tat improved endothelial function in MnSOD ϩ/ϩ mice but significantly impaired endothelial function in MnSOD ϩ/Ϫ mice at both ages. Aortic valve function was not impaired by aging or MnSOD haploinsufficiency. Changes in antioxidant and sirtuin gene expression with aging differ dramatically between aorta and aortic valve. Furthermore, although MnSOD does not result in overt cardiovascular dysfunction with aging, compensatory transcriptional responses to MnSOD deficiency appear to be tissue specific.aging; mitochondrial oxidative stress; endothelial function; aorta; aortic valve INCREASING AGE IS ASSOCIATED with increases in reactive oxygen species (ROS), which is thought to contribute to the development of age-related cardiovascular disease. Previous work in aged humans and animals has shown that NAD(P)H oxidase contributes to age-related endothelial dysfunction and vascular fibrosis and that reducing SOD1 (cytosolic), SOD2 (mitochondrial), or SOD3 (extracellular) worsens endothelial function with aging (3,4,12,13,19,25). Furthermore, we have previously shown that aortic valve calcification is strongly associated with increases in oxidative stress and reductions in antioxidant defense mechanisms in humans (27), and several studies have shown that the balance between oxidative stress and nitric oxide bioavailability is an important determinant of vascular and valvular calcification in vitro (27,39,41). Interestingly, emerging data from in vitro experiments also suggest that, once initiated, ROS production may self-perpetuate (ROS-induced ROS-release), accelerate development of endothelial dysfunction, and accelerate development of age-relate...

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Background and Objectives:The introduction of robotic surgery offers patients and surgeons new options for adrenalectomy. Whereas multiport adrenalectomies have been safely performed using the robot, we describe our experience with the novel technique of single-port robotic-assisted adrenalectomy.Methods:We performed a matched-cohort study comparing 16 single-port robotic-assisted adrenalectomies with 16 patients from a pool of 148 laparoscopic adrenalectomies, matched for age, gender, operative side, pathology, and body mass index. All were operated on by 1 surgeon.Results:The pathology included aldosteronoma in 44% of patients, adrenocorticotropic hormone–dependent Cushing syndrome (bilateral adrenalectomy) in 19%, pheochromocytoma in 13%, and other pathology in 24%. The operative time was 183 ± 33 minutes for single-port robotic-assisted adrenalectomy and 173 ± 40 minutes for laparoscopic adrenalectomy (P = .58). The total time in the operating room was 246 ± 33 minutes for single-port robotic-assisted adrenalectomy and 240 ± 39 minutes for laparoscopic adrenalectomy (P = .57). There was 1 conversion to open adrenalectomy (6%) in each group, both because of bleeding on the right side during bilateral adrenalectomy. Two right-sided single-port robotic-assisted adrenalectomy patients required conversion to laparoscopic adrenalectomy, one because of poor visualization. There were no deaths. Complications occurred in 2 patients in each group (intensive care unit admission, prolonged ileus). Both groups had similar pain scores (mean of 3.7 on a scale from 1 to 10) on postoperative day 1, and patients in the single-port robotic-assisted adrenalectomy group used less narcotic pain medication in the first 24 hours after surgery (43 mg vs 84 mg in laparoscopic adrenalectomy group, P < .001). The differences between the single-port robotic-assisted adrenalectomy group and laparoscopic adrenalectomy group in length of stay (2.3 ± 0.5 days vs 3.1 ± 0.9 days, P = .23), percentage of patients discharged on postoperative day 1 (56% vs 31%, P = .10), and hospital cost (16% lower in single-port robotic-assisted adrenalectomy group, P = .17) did not reach statistical significance.Conclusion:Single-port robotic adrenalectomy is feasible; patients require less narcotic pain medication whereas costs appear equivalent compared with laparoscopic adrenalectomy.

Hypertrophic cardiomyopathy (HCM) occurs in 1 of 500 adults and is considered to be one of the most common causes of death in young people under 35 years of age. Children with HCM are usually asymptomatic and the overall annual mortality beyond the first year of life is 1%. Septal myectomy is safe and effective in children with obstructive HCM and published data shows improved late survival compared to untreated HCM. Patient selection and surgical expertise remain critical components to ensuring successful outcomes of septal myectomy, particularly when considering prophylactic myectomy in a seemingly asymptomatic patient.

Patients with functioning and non-functioning tumors, along with those with obesity can safely be treated with RSS-A. The surgeon learning curve was associated with shortened operative times and not increased complication rates.