Despite their medical importance, rupture properties of ascending thoracic aortic aneurysms (ATAA) subjected to biaxial tension were inexistent in the literature. In order to address this lack, our group developed a novel methodology based on bulge inflation and full-field optical measurements. Here we report rupture properties obtained with this methodology on 31 patients. It is shown for the first time that rupture occurs when the stretch applied to ATAAs reaches the maximum extensibility of the tissue and that this maximum extensibility correlates strongly with the elastic properties. The outcome is a better detection of at-risk individuals for elective surgical repair.

A single bolus of etomidate blunts the hypothalamic-pituitary-adrenal axis response for more than 24 h in patients undergoing elective cardiac surgery, but this was not associated with an increase in vasopressor requirements.

Late results of abdominal aortic surgery in children, in our experience, are encouraging. Quality of life in adulthood was excellent. Insofar as possible, correction should be deferred until the child is 8 to 10 years old so that a prosthesis of sufficient diameter can be used.

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Less invasive aortic valve operations through a partial sternotomy or minithoracotomy can be performed with conventional bioprostheses. 1,2 Totally endoscopic aortic valve replacement (TEAVR) has not previously been feasible, because the currently available designs of stented tissue valves do not allow them to fit through a trocar. The recent advent of sutureless bioprostheses, mounted on a compressible self-expanding nitinol stent, has made this possible. We report the first TEAVR procedures in 2 patients through conventional thoracoscopic trocars. FIGURE 1. A, Preoperative computed tomographic images of patient 2 demonstrate how to assess and apply the selection criteria. It is recommended to avoid patients with insufficient periaortic working space (<2 cm between the inferior margin of the sternum and the aortic anterior wall; top left). To keep a comfortable distance between the aortic clamp, the cardioplegia needle, and the aortotomy, and consequently safe placement of the aortic closing sutures, very short aortas should also be excluded (the central line of the ascending aorta should be longer than 5 cm; top right). Vertical aortas without physiologic curvature should be avoided; the central axis of the proximal aortic root (bottom left, red line), together with the operative axis of the third intercostal space (bottom left, blue line), should create an angle not exceeding 45 , to avoid any traction onto the margins of the aortotomy when instruments are inserted in the aortic root through the trocars. The last panel (bottom right) shows a 3-dimensional reconstruction of the computed tomographic scan. B, Patient 1's aortotomy can be seen on the screen. C, Intraoperative photograph of patient 2 shows operating field and trocar positioning. The main working trocar (20 mm) is in the second intercostal space, a second operative trocar (15 mm) is in the third, a percutaneous transthoracic aortic clamp is in the first, a 5-mm 30 optic is in the second (7 mm trocar), and a right pulmonary vein venting line and purse-string with carbon dioxide insufflation line are in the fifth (both with a 7 mm trocar). D, Patient 2 is shown on postoperative day 4.

Alteration of tissue perfusion is a main contributor of organ dysfunction. In cardiac surgery, the importance of organ dysfunction is associated with worse outcome. Central venous-arterial difference in CO tension (ΔCO) has been proposed as a global marker of the adequacy of tissue perfusion in shock states. We hypothesized that ΔCO could be increased in case of postoperative organ failure or worse outcome. In this monocentric retrospective cohort study, we retrieved, from our database, 220 consecutive patients admitted in intensive care after an elective cardiac surgery. Four time points were formed: ICU admission, and 6, 24 and 48 h after. A ΔCO below 6 mmHg defined the normal range values. The SOFA score, intensive care unit and hospital length of stay, hospital and 6-month mortality rate were recorded. We compared patient with low ΔCO (<6 mmHg) and high ΔCO (≥6 mmHg). We included 55 (25 %) and 165 patients in low and high ΔCO groups, respectively. The SOFA score, the hospital and 6 months mortality rate were higher in patients with low ΔCO. Surprisingly, we did not find results previously published in other surgical settings. In cardiac surgery, ΔCO has a low predictive value of outcome.

This study confirms, through a non-invasive technology, a significant but transient alteration of the microcirculation during elective cardiac surgery. However, as these microvascular alterations were not correlated with patient's outcome, NIRS-derived parameters seem to be of limited interest in the cardiac surgery setting.