Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.

Tricuspid valve (TV) disease most often occurs secondary to left-sided heart disease, particularly mitral valve (MV) regurgitation or stenosis. Appropriate treatment, even when TV regurgitation is secondary to left-sided heart disease, can improve long-term outcome. Valvuloplasty is the most common procedure for TV disease, and has received an increasing amount of attention, as right-sided heart failure combined with TV regurgitation is associated with poor long-term outcome. Although some controversies exist regarding the indication and timing of the TV operation, concomitant surgical repair of TV regurgitation at the time of MV surgery should be considered, as this procedure improves perioperative outcomes, functional class, and survival. Importantly, TV repair does not increase operative mortality. In our experience, both suture annuloplasty and partial ring annuloplasty give satisfactory results, and bioprosthetic valves can be used when leaflets are damaged and the TV annulus is extremely dilated.

Our meta-analysis of observational studies demonstrates that early mortality is lower after SU-AVR than after TAVI in selected patients. The rates of stroke and pacemaker implant are comparable between procedures; however, the incidence of paravalvular leak is higher after TAVI.

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.

In conclusion, pedicled flap antropyloroplasty is an alternative surgical option for corrosive antral stricture. It can effectively widen the narrowed antrum and restore gastric tube length span for subsequent esophageal reconstruction.

We retrospectively evaluated early outcome and conducted this study to determine the predictive factors for percutaneous cardiopulmonary support (PCPS) weaning and hospital discharge. From January 2004 to December 2006, 92 patients diagnosed as cardiac or respiratory failure underwent PCPS using the Capiox emergent bypass system (Terumo, Tokyo, Japan). The mean+/-S.D. age was 56+/-18 (range, 14-85) years and 59 (64%) were male. The mean duration of PCPS was 90.9+/-126.0 h and that of cardiopulmonary resuscitation (CPR) was 51.1+/-27.8 min. The rate of weaning was 59/92 (64%) and the rate of survival to discharge was 39/92 (42%). The results indicated that the etiologic disease (myocarditis) and the cause of PCPS (cardiopulmonary arrest) are significantly correlated with weaning, whereas cardiopulmonary arrest and a shorter CPR duration (<60 min) are considerably correlated with survival. On the contrary, elderly patients (>75 years) have similar rates of weaning and survival compared with younger patients. PCPS provides an acceptable survival rate and outcome in patients with cardiac or respiratory failure. Prompt application and selection of patients with a specific disease (myocarditis) provides good results. It is also effective in elderly patients, providing hospital survival similar to that for younger patients.

The Nuss procedure for pectus excavatum is a well-known technique. Although there are numerous reports on the Nuss procedure, the reports on its removal are few. Removal has been done with many variations in the supine position, which involves bending the bar or bringing the bar beneath the operating table, which can prove to be troublesome and dangerous. Our simple technique allows easy removal of the substernal bar without bar bending. This technique was used in 21 patients without complication.

Finding 2 primary benign lesions at 2 extremes of the mediastinum is a rare event. A minimal invasive operation performed in a single-staged procedure can prove to be difficult, especially when the procedure is performed with a robot. We discuss the positioning and details of the procedure carried out in a 52-year-old woman with acute pancreatitis.