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The article in the journal "Thoracic & Cardiovascular Surgeon" discusses the histological characteristics and predictors of debris captured by the Sentinel cerebral embolic protection device during transcatheter aortic valve replacement. The study included 112 patients, with debris found in the filters of 96% of all patients. The most prevalent types of debris captured were endothelium/vascular wall, fibrin/thrombus, calcification, and foreign material. The study found differences in the size and number of captured debris among self- and balloon-expandable valves, with predilatation identified as a risk factor for embolic debris. [Extracted from the article]

This article in the journal "Thoracic & Cardiovascular Surgeon" examines the histopathologic findings of explanted MitraClip devices used in transcatheter edge-to-edge repair (TEER) of the mitral valve. The study analyzes the healing response and biocompatibility of the device on human mitral valve leaflets after failed TEER procedures. Results show that the device interaction with leaflet tissue leads to fibrous encapsulation, which adds structural stability to the repair but may reduce the likelihood of valve reconstruction, impacting treatment decisions, especially in low-risk and young patients. [Extracted from the article]

This article in the journal "Thoracic & Cardiovascular Surgeon" evaluates the performance of an open-source, offline-capable large language model in extracting data from unstructured electronic health records. The study found that the 405B model had a 100% accuracy rate, while the 70B and 8B models had slightly lower accuracy rates. The open-source model's performance was comparable to two closed-source models, suggesting its potential for use in processing health records. Further research is recommended to confirm these results with real health records. [Extracted from the article]

This article discusses the outcomes of complex surgery for Lusoria Artery in adults, a rare and surgically challenging disease. The study, conducted across multiple centers in Germany, Switzerland, and Belgium, analyzed patient data from 1993 to 2024. Results showed that surgical treatment for aberrant subclavian artery (aSA) pathology led to symptom improvement in most cases, with low mortality rates. The study highlights the importance of expertise in surgery centers for achieving successful outcomes in treating aSA. [Extracted from the article]

This article compares different strategies for arterial cannulation in minimally invasive mitral valve repair surgeries. The study analyzed data from 823 patients who underwent the procedure and examined the incidence of adverse outcomes such as mortality, stroke, vessel dissection, and infection. The three cannulation strategies studied were direct aortic cannulation, open cannulation of the femoral artery, and percutaneous cannulation of the femoral artery. The results showed that direct aortic cannulation was associated with fewer complications and a lower incidence of postoperative delirium compared to femoral artery cannulation. [Extracted from the article]

This article discusses a study that explores the use of GPT-4, a generative pre-trained transformer, as a tool for extracting data from unstructured medical records. The study involved drafting fifty fictitious patient records in German and providing GPT-4 with instructions on how to process each one. The accuracy, recall, precision, and F1-Score of GPT-4 were assessed for various variables, and it was found that GPT-4 exhibited excellent performance in both text-mining and classification tasks. The study concludes that reliable data extraction from unstructured medical records is possible with the GPT-4 chatbot. [Extracted from the article]

This article discusses the efficacy of mitral valve surgery after percutaneous edge-to-edge mitral valve repair using the MitraClip. The study conducted a retrospective analysis of patients who underwent mitral valve repair or replacement after failed MitraClip repair. The primary endpoints were all-cause mortality and postoperative morbidity, while secondary endpoints included freedom from severe mitral regurgitation and improved clinical and echocardiographic parameters. The results showed a high survival rate at 30 days and one year postintervention, along with improvements in functional class and stable mitral valve function. The study suggests the need for further research to better understand the long-term benefits and limitations of mitral valve surgery following MitraClip repair. [Extracted from the article]

This article discusses the impact of minimally invasive coronary artery bypass surgery (MICS CABG) as an alternative to traditional surgery. The study analyzes the short-term outcomes of this approach for single- and multi-vessel diseases. The results show that MICS CABG is a safe procedure with low mortality and morbidity rates. The study also found low rates of reoperations and graft-related complications. These findings support the use of MICS CABG as a standard of care in coronary surgery. [Extracted from the article]

Background: Robotically enhanced telemanipulation for totally endoscopic coronary artery bypass does not provide adequate tactile feedback., traction, or countertraction. The exposition of coronary target sites is difficult, the visual field is limited, and the epicardial stabilization may be troublesome. A fourth robotic arm for endothoracic instrumentation has been added to the da Vinci surgical system to facilitate totally endoscopic operations. The stereoendoscope was upgraded with a wide-angle feature. Methods: The procedure was performed in five patients. Four of these patients had left internal thoracic artery (LITA) to left anterior descending artery (LAD) grafting on the beating heart and the fifth had sequential bypass grafting (LITA to diagonal branch and LAD) on an arrested heart. The additional effector arm of the da Vinci surgical system was brought into the operative Held beneath the operating table and used as a second right arm. The wide-angle view was activated by either the console or the patient side surgeon. Results: The mean operative, port placement, and anastomotic times for a beating-heart totally endoscopic coronary artery bypass were 195 ± 58, 25 ± 10, and 18 ± 5 min. respectively. All procedures were free of morbidity and mortality, with satisfactory angiographic control. The sequential arterial bypass grafting procedure was fully completed in totally endoscopic technique. Conclusions: The additional instrumentation arm and wide-angle visualization are useful technical improvements of the da Vinci surgical system, solving the problem of traction, countertraction, and facilitated exposition of target sites as well as visualization of the surgical field. They provide potential for wider acceptance of totally endoscopic coronary artery bypass grafting in a larger surgical community. [ABSTRACT FROM AUTHOR]

Leukocyte filtration has evolved as an important technique in cardiac surgery with cardiopulmonary bypass to prevent pathogenic effector functions mediated by activated leukocytes. The underlying mechanisms that result in an improvement of laboratory variables as well as clinical outcome are not resolved yet. Moreover, the optimum strategy for the use of current filtration technology has not been systematically evaluated. This paper, therefore, reviews how activated leukocytes may lead to tissue damage, summarizes the known effects of leukocyte filtration on clinical outcome and laboratory parameters, and deals with current experimental and clinical efforts to further limit the pathogenic effects of leukocytes in cardiac surgery. [ABSTRACT FROM AUTHOR]

Introduction Young infants suffering from congenital or postoperative AV-block require life-long pacemaker stimulation. Due to the anatomical prerequisites initially epicardial electrodes are implanted and the generator is placed in the upper abdominal wall. The following study investigated modes of failure leading to reoperation in this group of technically challenging patients. Methods Between 10/2000 and 05/2005 a total of 21 infants (age 3 days to 5 years) underwent pacemaker implantation using a partial lower or complete median sternotomy. Nine had previous cardiac surgery for complex congenital defects. Different uni- and bipolar epicardial electrodes (Medtronic Capsure® epi) were fixed to the right ventricle, 15 had additional implantation of a bipolar atrial lead. The pacemaker generator (Medtronic Kappa® 701) was implanted into the right upper abdominal wall. A total of four reoperations occurred during the follow up period (19%), indications for revision were recorded. Results Three of the four revisions were caused by ventricular electrode fracture. At revision two electrodes were broken at the crossing between thorax and the abdominal wall, one bipolar lead at the division into the two tip electrodes. One reoperation was due to a pacemaker recall. All revisions could be performed by electrode or pacemaker change without complications. Pacing and sensing parameters remained stable during midterm follow-up. Conclusion Epicardial pacing in young infants is associated with a significant number of failures leading to reoperation, mainly due to electrode fracture caused by the muscular activity of this patient group. Reoperations can be performed at a low risk. [ABSTRACT FROM PUBLISHER]

A 74-year-old female was found hemiplegic in a public restroom. After arrival in our stroke unit, a computed tomography (CT) was performed, and she was diagnosed with bilateral carotid artery and right vertebral artery occlusion due to an acute type A aortic dissection. The patient deteriorated quickly to a GCS of 3 and was brought to the operating room, where a salvage replacement of the ascending aorta and the proximal aortic arch was performed with unilateral antegrade cerebral perfusion. Three days later, a significant decrease in left ventricular function and increase in cardiac biomarkers were observed. Coronary CT displayed residual dissection of the aortic root, extending into the left main coronary artery. The patient underwent an intravascular ultrasound-guided stenting of the left main, resulting in total recovery of heart function. She was extubated on the fourth postoperative day, with no residual neurological impairment. This case report advocates for the proper management of patients with ATAAD with severe neurological impairment, emphasizing the importance of a robust multidisciplinary approach in their care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2025 Bidovec, Risteski, Stähli, Dzemali, Hofmann and Stehli.)

Objectives: We aimed to evaluate the performance of multiple large language models (LLMs) in data extraction from unstructured and semi-structured electronic health records., Methods: 50 synthetic medical notes in English, containing a structured and an unstructured part, were drafted and evaluated by domain experts, and subsequently used for LLM-prompting. 18 LLMs were evaluated against a baseline transformer-based model. Performance assessment comprised four entity extraction and five binary classification tasks with a total of 450 predictions for each LLM. LLM-response consistency assessment was performed over three same-prompt iterations., Results: Claude 3.0 Opus, Claude 3.0 Sonnet, Claude 2.0, GPT 4, Claude 2.1, Gemini Advanced, PaLM 2 chat-bison and Llama 3-70b exhibited an excellent overall accuracy >0.98 (0.995, 0.988, 0.988, 0.988, 0.986, 0.982, 0.982, and 0.982, respectively), significantly higher than the baseline RoBERTa model (0.742). Claude 2.0, Claude 2.1, Claude 3.0 Opus, PaLM 2 chat-bison, GPT 4, Claude 3.0 Sonnet and Llama 3-70b showed a marginally higher and Gemini Advanced a marginally lower multiple-run consistency than the baseline model RoBERTa (Krippendorff's alpha value 1, 0.998, 0.996, 0.996, 0.992, 0.991, 0.989, 0.988, and 0.985, respectively)., Discussion: Claude 3.0 Opus, Claude 3.0 Sonnet, Claude 2.0, GPT 4, Claude 2.1, Gemini Advanced, PaLM 2 chat bison and Llama 3-70b performed the best, exhibiting outstanding performance in both entity extraction and binary classification, with highly consistent responses over multiple same-prompt iterations. Their use could leverage data for research and unburden healthcare professionals. Real-data analyses are warranted to confirm their performance in a real-world setting., Conclusion: Claude 3.0 Opus, Claude 3.0 Sonnet, Claude 2.0, GPT 4, Claude 2.1, Gemini Advanced, PaLM 2 chat-bison and Llama 3-70b seem to be able to reliably extract data from unstructured and semi-structured electronic health records. Further analyses using real data are warranted to confirm their performance in a real-world setting., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: Memo 4D is a semi-rigid ring with an exclusive saddle shape and progressive increased anteroposterior diameter. This preliminary analysis reports 30-day clinical and haemodynamic outcomes of the MANTRA Memo 4D sub-study., Methods: MANTRA is an 'umbrella' prospective, multicentre, worldwide post-market study to collect real-life safety and performance data on the Corcym devices. Clinical and echocardiographic outcomes were gathered preoperatively, at discharge and each follow-up. KCCQ-12 questionnaires were collected preoperatively and at 30 days. Echocardiographic studies were performed per a predefined protocol and assessed by an independent core laboratory., Results: In total, 166 patients (52, 31.3% female, mean age 60.7 ± 11.4 years) underwent mitral valve repair with Memo 4D in 17 international institutions between July 2021 and June 2023 (enrolment is still ongoing). Primary was the most common aetiology (157, 94.6%), of which 33 cases of Barlow's disease (19.9%); secondary mitral regurgitation was present in six cases (3.6%). Thirty-day mortality was 0.6% (1). One stroke event (0.6%), one acute kidney failure (0.6%), one myocardial infarction (0.6%) and two reoperations within 30 days were reported. Surgery marked improvement in the patient's NYHA class associated with a significant increase in KCCQ-12 summary score, from 69.1 (SD = 23.7) preoperatively to 83.9 (SD = 15.7) at 30 days. End-diastolic left ventricular diameters decreased from 55.19 (SD = 7.10) preoperatively to 52.70 (SD = 3.76) mm at 30 days, and left atrial volume decreased from 125.79 (SD = 46.33) preoperatively to 91.51 (SD = 37.20) ml at 30 days. Mitral regurgitation significantly reduced after the operation and up to 30-day follow-up., Conclusions: Mitral valve repair with Memo 4D is associated with good clinical and haemodynamic outcomes in the early period.MANTRA ClinicalTrials.gov number NCT05002543., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Among 3127 episodes of suspected infective endocarditis, the 2023 Duke-International Society for Cardiovascular Infectious Diseases clinical criteria showed an accuracy of 90% for infective endocarditis diagnosis. A new heart murmur was present in 690 (22%) episodes. Excluding imaging and surgical findings decreased the accuracy to 73%, while using the physical examination criterion slightly improved the accuracy to 78%., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Introduction:  Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after replacement of the aortic valve (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MPs) and LDH elevation after AVR. Thus, we analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAVs) or rapid deployment valves (RDVs)., Methods:  We retrospectively analyzed the data from patients who received an AVR with the RDV and TA-TAV groups between 2015 and 2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality., Results:  In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5-73.2, p  = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile ( p  = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05-1.65, p  = 0.635). The 30-day mortality was similar between groups., Conclusion:  Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: A significant proportion of patients with heart failure (HF) progress to an advanced stage, which is associated with a substantial increase in morbidity and mortality. These patients may be eligible for advanced treatment strategies such as mechanical circulatory support with ventricular assist devices (VAD). Vascular dysfunction is a hallmark of heart failure pathophysiology and prognosis. However, whether and to what degree the hemodynamic benefits of VADs influence vascular function remain unknown., Methods and Results: In this study, we evaluated endothelial vascular function with flow-mediated vasodilatation (FMD) and with flicker-light induced retinal vasodilatation (FID). 34 patients with a VAD (age 58 ± 10 years, 85% male, 74% ischemic heart disease, 26 continuous-flow (CF)-LVAD, and 8 pulsatile biventricular (bi)-VAD) were compared to 34 propensity-matched patients (mean age 62 ± 9 years, 68% male, 59% ischemic heart disease) with advanced HF (AdvHF). Endothelial function of larger arteries (FMD) was significantly better in patients after VAD implantation compared to matched AdvHF patients (7.2 ± 4.6% vs. 5.0 ± 3.2%, p = 0.03), whereas microvascular arteriolar function (FIDart) did not differ (0.99 ± 1.43% vs. 1.1 ± 1.7%, p = 0.78). The arterio-venous ratio (AVR) was higher in the VAD group (0.90 ± 0.06 vs 0.85 ± 0.09, p = 0.01), reflecting wider retinal arteriolar and narrower venular diameters. There was no difference in vascular function between patients with CF-LVAD and pulsatile Bi-VAD., Conclusion: In patients with advanced heart failure, VAD implantation was associated with better endothelial function at the level of large arteries, but not in the microcirculation., (© 2024. The Author(s).)

Among 302 episodes with prosthetic valve endocarditis (PVE), one-year mortality was 31%. There was no evidence indicating that early-onset PVE within 6 months from valve surgery led to a worse outcome compared to late-onset PVE (21% versus 32%; p=0.126), despite similar redo valve surgeries across both categories., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objectives: Less invasive surgery has emerged as an option for aortic pathologies. The current study compared our experience on early postoperative results of patients with aortic surgery between partial upper sternotomy (PUS) and full sternotomy (FS)., Methods: We performed a retrospective analysis of the data of patients undergoing aortic root surgery with concomitant ascending aorta and hemiarch replacement. Exclusion criteria were type A aortic dissection and other concomitant major cardiac surgery. After propensity score matching, we compared the perioperative outcomes of patients undergoing surgery with PUS versus FS., Results: A total of 161 patients operated on between January 2013 and September 2022 met the inclusion criteria (PUS: n = 22, FS: n = 139). Propensity score matching yielded 22 pairs with a balanced distribution of propensity scores and covariates between the compared groups. There was no evidence that PUS affects cardiopulmonary bypass [108 (67-119) vs 113 (87-148) min, P = 0.154; PUS vs FS] and circulatory arrest duration [9 (7-10) vs 9 (8-13) min, P = 0.264; PUS vs FS]. There was a reduced cross-clamp duration in the PUS group [88 (58-96) vs 92 (71-122) min, P = 0.032]. Cumulative sum charts have shown consistently low cross-clamp and circulatory arrest duration for 2 experienced surgeons who performed 20 of the procedures in the PUS group (10 each). Perioperative mortality and morbidity were low, with no in-hospital mortality in the PUS group [0 vs 1(4.5%), P > 0.999] and absence of strokes in both groups., Conclusions: In summary, our initial experience suggests that less invasive aortic root, ascending aorta and hemiarch replacement via PUS could be performed in our patient cohort as safely as via full sternotomy. Advantages for the patient are reduced surgical trauma, improved cosmetic results and-presumably-less pain., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Background: Historically, the majority of patients admitted to inpatient exercise-based cardiac rehabilitation (EBCR) have undergone open heart surgery (OHS). However, with advances in minimally invasive cardiac surgery (MICS), these patient groups are also increasingly referred for inpatient EBCR. Herein, we aimed to compare the progress of these groups during rehabilitation., Methods: In this prospective, nonrandomized study, 403 inpatient EBCR patients were recruited from December 2022 until September 2023 and stratified into two groups: OHS, and MICS. Participants completed a 3-4-week certified EBCR program. The primary endpoint was defined as a change in the 6-minute walk test (6MWT). Moreover, a comprehensive panel of quality-of-life (QoL) assessments were performed at admission and discharge., Results: At baseline, patients with OHS were older (66 years [IQR 59 - 72]), more often male (83%), and underwent emergency/urgent procedures more often (20%) than patients with MICS. Furthermore, patients with MICS showed a better 6MWT at admission (426 meters [IQR 336 - 483]) compared to patients with OHS (381 meters [IQR 299 - 453]). While all patients were able to increase the distance in the 6MWT, regression analyses in fully adjusted models showed no difference in improvements between the two groups (β -5, 95% CI, -26 - 14, p = 0.58). Moreover, during EBCR, we observed significant improvements in all QoL measures in all groups., Conclusions: In this study, improvements in fitness, as assessed by the 6WMT were observed in all groups. Furthermore, multiple QoL measures improved equally across all groups. These encouraging results emphasize the importance of EBCR., (© 2024. The Author(s).)

Objectives: Multiple studies have shown that external stenting (ExSt) mitigates the progression of vein graft disease years after coronary artery bypass grafting (CABG). We used computed tomography to evaluate the effect of ExSt on perioperative vein graft patency., Methods: This study assessed graft patency rates of saphenous vein grafts (SVG) in consecutive patients with isolated coronary artery bypass grafting (CABG) between 2018 and 2021. Logistic regression analyses were conducted to compare the outcomes of supported and non-supported groups at both patient and graft levels, with age, EuroSCORE II, gender, diabetes and arterial grafts as covariates. Subgroup analyses were performed based on different covariates. The goal of the study was to provide valuable insights into the clinical outcomes of SVG in patients having CABG., Results: The study examined a total of 357 patients who met the inclusion criteria and evaluated 572 vein grafts. Of these, 150 patients (205 SVGs) received ExSt, whereas 207 patients (337 SVGs) did not receive ExSt. The study results indicated that the likelihood of overall SVG patency at discharge was higher in the stented group than in the non-stented group, both at the level of the grafts [93.8% vs 87.8%, odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0-4.5; P = 0.05] and at the patient level (90.1% vs 83.5%, OR 1.8; 95% CI 0.9-3.6; P = 0.1). It is worth noting that the difference between the stented and non-stented groups was most significant in the subgroup that received 2 arterial grafts (96.5% vs 89.6%, OR 3.2; 95% CI 1.2-8.4; P = 0.02) and in the subgroup with a higher EuroSCORE II (median >1.1) (98.6% vs 88.6%, OR 8.8; 95% CI 1.1-72.7; P = 0.04)., Conclusions: The ExSt is associated with improved perioperative SVG patency at both the graft and the patient levels. Moreover, SVGs to the right territory and high-risk patients appear to have an advantage using ExSt., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Background: Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting., Methods: A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms "cardiac surgery" and "hemoadsorption". The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view., Results: The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb ® therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability., Conclusions: The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy., (© 2024. The Author(s).)

Objectives: Aortic arch or aortic root replacement is not performed in all cases of acute type A aortic dissection (ATAD), and a second aortic procedure will become necessary over time for some patients. Indications and outcomes, of second aortic procedures have not been studied extensively., Methods: Characteristics and in-hospital outcomes of all patients undergoing surgical repair for type A acute aortic dissection were analysed and patients needing second aortic procedure during follow-up were identified. The latter group was divided in 2 subgroups: on-pump includes patients operated on using cardiopulmonary bypass and off-pump without cardiopulmonary bypass., Results: A total of 638 patients underwent surgery for ATAD; 8% required a second aortic procedure. The most frequent indication for the second aortic procedure was dehiscence of suture lines (44%), followed by arch dilatation (24%). In-hospital mortality was 12%. Isolated ascending aorta replacement at the first surgery was associated with higher incidence of second aortic procedure (P = 0.006). Most patients in the on-pump group underwent a proximal reoperation (75%), with a mortality rate of 14.2%. In-hospital mortality of patients in the off-pump group was 7.7%. Long-term survival analysis showed no difference between groups (P = 0,526), Off-pump patients have greater likelihood of a second intervention during follow-up (P  = 0.004)., Conclusions: Extended aortic root surgery and customized aortic arch repair in ATAD could be reasonable to reduce the incidence and mortality of high-risk second aortic procedures., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Background:  Several studies have reported high rates of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) with the Mosaic prosthesis. This work assesses the incidence of PPM after AVR with a modified version of the Mosaic prosthesis, the Mosaic Ultra., Methods:  We performed a retrospective analysis of the data of 532 patients who underwent AVR with implantation of the Mosaic Ultra prosthesis in the period 2007-2016 in our institution. Patients were classified according to their indexed effective orifice area (EOAi) to severe (EOAi < 0.65 cm 2 /m 2 ), moderate (EOAi 0.65-0.85 cm 2 /m 2 ), and absent/mild PPM (EOAi > 0.85 cm 2 /m 2 ). In-hospital postoperative outcomes and the impact of PPM on mean transvalvular pressure gradient after stratification by prosthesis size were assessed., Results:  Overall, 3 (0.6%) patients had severe, 92 (17.3%) moderate, and 437 (82.1%) absent/mild PPM. There was a significant difference in PPM proportions (moderate/severe vs absent/mild PPM) across different prosthesis sizes overall ( p  < 0.0001), observing gradually increasing rates of PPM with decreasing prosthesis sizes. Patients with moderate/severe PPM had higher mean transvalvular pressure gradients (19 [13-25] vs 13 [10-17] mm Hg, p  < 0.0001) than patients with absent/mild PPM. There was a significant difference in mean transvalvular pressure gradient between the different aortic valve prosthesis sizes overall ( p  < 0.0001), observing gradually increasing gradients with decreasing prosthesis sizes., Conclusion:  Patients undergoing AVR with the smaller sized (19, 21, and 23 mm) Mosaic Ultra aortic valve prostheses exhibit a higher risk for moderate/severe PPM and higher mean aortic transvalvular pressure gradients than patients receiving the larger sized (25, 27, and 29 mm) prostheses., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Situs inversus totalis (SIT) is a rare condition, where all the organs in the body are mirrored. Atrial fibrillation occurs in patients with SIT. We describe the case of pulmonary vein isolation (PVI) in SIT., Case Summary: A patient with atrial fibrillation was referred to our hospital due to palpitations. Diagnosis of atrial fibrillation was made by electrocardiogram. The patient reported to have a SIT that was confirmed. Meticulous preparation was done including a three-dimensional model and radiofrequency PVI was performed successfully. No recurrence of atrial fibrillation was detected until last follow-up 2 years after PVI., Discussion: Pulmonary vein isolation in SIT can be performed successfully and with excellent long-term result., Competing Interests: Conflict of interest: RJ reports grants to the Institution: Abbott, Amgen, AstraZeneca, Bayer, Biosense Webster, Biotronik, Boston Scientific, Bristol-Myers Squibb, Cardionovum, Cordis, Daiichi Sankyo, Edwards Lifesciences, GE Medical Systems, MCM Medsys, Medtronic, Novartis, Pfizer, Terumo, Vascular Medical GmbH. AM reports fellowship and training support from Biotronik, Boston Scientific, Medtronic, Abbott/St. Jude Medical, and Biosense Webster. Speaker honoraria from Biosense Webster, Medtronic, Abbott/St. Jude Medical, AstraZeneca, Daiichi Sankyo, Biotronik, MicroPort, Novartis. Consultant for Biosense Webster, Medtronic, Abbott/St. Jude Medcal, and Biotronik., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases., Methods: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints., Results: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4)., Conclusions: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.