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Background The purpose of this study was to evaluate the safety and performance of the Freedom Solo valve in aortic valve replacement by clinical and hemodynamic outcomes. Methods Six hundred sixteen patients underwent aortic valve replacement in 18 European centers; mean age was 74.5 ± 5.9 years, 54.1% of the patients were male, and concomitant procedures were performed in 43.2% of the patients. The majority (69%) of the implanted sizes were 23 mm and 25 mm. Results At 1 year, overall survival was 94.0%, whereas freedom from valve-related death was 98.6%. There were 9 (1.5%) early (≤30 days) and 27 (4.4%) late (>30 days) deaths. Early and late valve-related mortality was 0.3% (n = 2) and 1.1% (n = 7), respectively. Freedom from explant was 97.6%; 10 valves were explanted for endocarditis and 4 for paravalvular leak. There were 10 (1.6%) early and 5 (0.8%) late strokes. Atrioventricular block requiring pacemaker implant occurred in 8 (1.3%) and 1 (0.2%) patients in the early and late postoperative period, respectively. Thrombocytopenia was seen in 27 cases (4.4%) in the early postoperative period. Preoperatively, 93.8% of patients were in New York Heart Association functional classes II through IV, whereas at 1 year 96.9% of patients were in New York Heart Association functional classes I and II. At 1-year follow-up, mean and peak pressure gradients were 7.2 and 14.6 mm Hg, respectively. Indexed left ventricular mass decreased by 12% from 138 g/m 2 at discharge to 122 g/m 2 at 1 year. Conclusions At 1-year follow-up after Freedom Solo implantation, we found acceptable clinical results with low mortality and morbidity and good hemodynamic performance, confirming safety and effectiveness in this multicenter experience.

Background Hybrid coronary revascularization, meaning, left mammary artery on left anterior descending artery combined with non–left anterior descending artery percutaneous coronary intervention stenting, is considered a viable alternative to conventional coronary artery bypass graft surgery or to multivessel percutaneous coronary intervention, to perform a functionally complete revascularization. Methods One hundred consecutive patients underwent hybrid coronary revascularization. Coronary risk was assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score. Long-term outcomes, major adverse cardiac and cerebrovascular events (MACCE) rate, and repeated target vessels revascularization (TVR) rate were evaluated. Results Mean age was 66.3 ± 12.0 years. Mean SYNTAX score was 28.22 ± 7. Mean European System for Cardiac Operative Risk Evaluation II score was 4.05 ± 1.83. Percutaneous coronary intervention was performed in all patients (n = 100), in 75% of cases before and in 25% of cases after surgery (interval, 2.2 ± 1.3 months). No in-hospital mortality was reported. At follow-up, 1 cardiac death of acute MI occurred. At 3.5 ± 1.3 years follow-up, overall population freedom from MACCE rate was 82.6% (95% confidence interval [CI]: 79.5% to 85.7%) and the freedom from TVR rate was 86.1% (95% CI: 82.9% to 89.3%). MACCE and TVR rates were higher in patients with intermediate and high coronary risk than in patients with SYNTAX score of 22 or less, although not statistically significant ( p > 0.05). Cox regression analysis showed a significant increment of risk for TVR on overall population in patients with diabetes mellitus (OR 2.4, 95% CI 1.3-3.5, p = 0.03) and in patients with non–left anterior descending artery stented lesions (OR 4.5, with 95% CI 2.8-6.2, p = 0.02). Conclusions Hybrid coronary revascularization is a viable option to perform a minimally invasive, functionally complete revascularization in high-risk patients for conventional revascularization, with better results when performed on patients with a SYNTAX score of 22 or less.

Type I myocardial rupture due to atrioventricular discontinuity in the region of the posterior mitral annulus is a fearsome and nearly unpredictable complication of mitral valve replacement. We report a case of a 49-year-old patient who had been operated on for mitral valve replacement. The posterior mitral leaflet had heavy calcifications embedded through the annulus in the posterior ventricular wall. After removal of calcifications we avoided the risk of myocardial rupture by suturing a straddling pericardial patch on the atrioventricular junction. The operation resulted in complete recovery.