Month: January 2026

Interdiscip Cardiovasc Thorac Surg. 2025 Nov 6;40(12):ivaf275. doi: 10.1093/icvts/ivaf275.

ABSTRACT

Root enlargement via traditional transverse or oblique aortotomy disrupts the anatomical features of smooth continuity and symmetry from the aortic root to the proximal ascending aorta. A straight longitudinal aortotomy, extended vertically into nadir of noncoronary aortic annulus, achieves smooth continuity and symmetrical enlargement from the aortic root to the proximal ascending aorta with a tear-drop-shaped bovine pericardial patch. Herein, we report successful symmetrical root enlargement following straight longitudinal aortotomy via right anterior minithoracotomy.

PMID:41270797 | PMC:PMC12668772 | DOI:10.1093/icvts/ivaf275

JACC Case Rep. 2025 Oct 29;30(34):105585. doi: 10.1016/j.jaccas.2025.105585.

ABSTRACT

OBJECTIVE: To describe the case of a 52-year-old man who developed severe mitral regurgitation 4 years after undergoing aortic valve replacement, maze procedure, and mitral vegetation removal during surgery for infective endocarditis; the mitral regurgitation was due to a perforation of the anterior mitral leaflet (A2) identified on transthoracic echocardiography.

KEY STEPS: Key procedural steps included: 1) right minithoracotomy access; 2) adhesiolysis and wedge resection of pleural perforations; 3) leaflet perforation repair with bovine pericardial patch; and 4) annuloplasty ring implantation.

POTENTIAL PITFALLS: Patch repair can fail if the patch is undersized, poorly positioned, or not well integrated, leading to residual regurgitation or early breakdown. Anterior leaflet repairs also carry a risk of systolic anterior motion, and prior surgery may complicate access owing to adhesions.

TAKE-HOME MESSAGES: Mitral valve repair using a pericardial patch is a reasonable option for anterior leaflet perforation, even in complex reoperative settings. Early recognition and a tailored, minimally invasive approach may offer favorable outcomes in selected patients.

PMID:41173632 | PMC:PMC12665858 | DOI:10.1016/j.jaccas.2025.105585

Acta Biomater. 2025 Nov 26:S1742-7061(25)00882-7. doi: 10.1016/j.actbio.2025.11.046. Online ahead of print.

ABSTRACT

Aortic stenosis (AS) is characterised by the narrowing and stiffening of the aortic valve, which restricts blood flow from the heart to the rest of the body. Severe AS is a life-threatening condition which affects 1.48 % of individuals aged 55 and older, with a four-year mortality rate of 44.9 % if left untreated. Minimally invasive treatment for AS involves the implantation of a bioprosthetic valve with porcine or bovine pericardium leaflets, which frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage. The relationship between these two durability-limiting processes is debated, and the influence of device crimping on both factors is not comprehensively understood. This study aims to explore the relationship between calcification and structural damage and determine if device crimping affects these processes. First, porcine pericardium (PP) tissue was exposed to either in vitro calcification in unloaded conditions (calcification) or cyclic bulge loading in saline, without calcification (structural damage). Subsequently, PP was simultaneously calcified and cyclically loaded for 30 million cycles. Simultaneous calcification and loading led to dramatically increased calcification and structural damage, including tissue rupture. Device crimping was not found to have a significant impact on calcification or structural damage. However, fibre architecture was found to affect rupture location, and dramatically affect the rate of rupture of PP. This finding has implications for future bioprosthetic valve leaflet anti-calcification strategies, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification. STATEMENT OF SIGNIFICANCE: Porcine pericardium (PP) is a commonly used biomaterial, most frequently in the leaflets of bioprosthetic valves. These devices frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage of their leaflets. This work shows that calcification and structural damage work together to accelerate failure of PP, with dramatically increased calcification and structural damage of PP, including rupture, when the tissue is exposed to both simultaneously. Fibre architecture of PP was found to affect rupture location, and dramatically affect rate of rupture. This finding has implications for bioprosthetic leaflet durability, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification and maximise valve durability.

PMID:41314445 | DOI:10.1016/j.actbio.2025.11.046

Acta Biomater. 2025 Nov 26:S1742-7061(25)00882-7. doi: 10.1016/j.actbio.2025.11.046. Online ahead of print.

ABSTRACT

Aortic stenosis (AS) is characterised by the narrowing and stiffening of the aortic valve, which restricts blood flow from the heart to the rest of the body. Severe AS is a life-threatening condition which affects 1.48 % of individuals aged 55 and older, with a four-year mortality rate of 44.9 % if left untreated. Minimally invasive treatment for AS involves the implantation of a bioprosthetic valve with porcine or bovine pericardium leaflets, which frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage. The relationship between these two durability-limiting processes is debated, and the influence of device crimping on both factors is not comprehensively understood. This study aims to explore the relationship between calcification and structural damage and determine if device crimping affects these processes. First, porcine pericardium (PP) tissue was exposed to either in vitro calcification in unloaded conditions (calcification) or cyclic bulge loading in saline, without calcification (structural damage). Subsequently, PP was simultaneously calcified and cyclically loaded for 30 million cycles. Simultaneous calcification and loading led to dramatically increased calcification and structural damage, including tissue rupture. Device crimping was not found to have a significant impact on calcification or structural damage. However, fibre architecture was found to affect rupture location, and dramatically affect the rate of rupture of PP. This finding has implications for future bioprosthetic valve leaflet anti-calcification strategies, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification. STATEMENT OF SIGNIFICANCE: Porcine pericardium (PP) is a commonly used biomaterial, most frequently in the leaflets of bioprosthetic valves. These devices frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage of their leaflets. This work shows that calcification and structural damage work together to accelerate failure of PP, with dramatically increased calcification and structural damage of PP, including rupture, when the tissue is exposed to both simultaneously. Fibre architecture of PP was found to affect rupture location, and dramatically affect rate of rupture. This finding has implications for bioprosthetic leaflet durability, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification and maximise valve durability.

PMID:41314445 | DOI:10.1016/j.actbio.2025.11.046

J Surg Case Rep. 2025 Nov 19;2025(11):rjaf920. doi: 10.1093/jscr/rjaf920. eCollection 2025 Nov.

ABSTRACT

Nutcracker syndrome is a rare condition caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. This results in increased venous pressure, leading to haematuria, flank pain, and pelvic discomfort, particularly in individuals with low body mass index. Diagnosis is often challenging due to nonspecific symptoms and overlap with other pelvic disorders. We report a case of a 49-year-old woman with persistent left flank pain, dysmenorrhea, and recurrent vaginal bleeding. Imaging confirmed compression of the left renal vein. A conservative approach with nutritional support was initially attempted, but due to ongoing symptoms, the patient underwent surgical transposition of the vein with patch angioplasty using bovine pericardium. This case underscores the need to consider Nutcracker syndrome in patients with unexplained haematuria and flank pain, especially in underweight women. We also review current diagnostic tools and treatment options for this uncommon vascular condition.

PMID:41268427 | PMC:PMC12628186 | DOI:10.1093/jscr/rjaf920

J Clin Med. 2025 Oct 31;14(21):7736. doi: 10.3390/jcm14217736.

ABSTRACT

Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40-198.8]) compared to the felt group (315 mL [IQR 285-445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes.

PMID:41227132 | PMC:PMC12609355 | DOI:10.3390/jcm14217736