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Objectives: Despite the benefits of rapid deployment aortic valve prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly used in the treatment for aortic stenosis. Given the paucity of randomized studies, this study aimed to synthesize available data to compare both treatment options., Methods: A systematic search of Pubmed, OVID, and MEDLINE was conducted to retrieve comparative studies for RDAVR versus cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35 papers were used in the final analysis, including 1 randomized study, 1 registry study, 6 propensity-matched studies, and 28 observational studies, incorporating a total of 10,381 participants (RDAVR n = 3686; cAVR n = 6310)., Results: Random-effects meta-analysis found no difference between the two treatment groups in terms of operative mortality, stroke, or bleeding (p > .05). The RDAVR group had reduced cardiopulmonary bypass (standardized mean difference [SMD]: -1.28, 95% confidence interval [CI]: [-1.35, -1.20], p < .001) and cross-clamp times (SMD: -1.05, 95% CI: [-1.12, -0.98], p < .001). Length of stay in the intensive care unit was also shorter in the RDAVR group (SMD: -0.385, 95% CI: [-0.679, -0.092], p = .010). The risk of pacemaker insertion was higher for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p < .001) as was the risk of paravalvular leak (PVL) at midterm follow-up (OR: 2.52, 95% CI: [1.32, 4.79], p = .005). Effective orifice area and transvalvular gradient were more favorable in RDAVR patients (p > .05)., Conclusions: Despite the benefits of RDAVR in terms of reduced operative time and enhanced recovery, the risk of pacemaker insertion and midterm PVL remains a significant cause for concern., (© 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.)

Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ever more ingenious designs and manufacturing methods with parallel developments in cardiology and cardiovascular surgical treatments. This feat has only been possible through close collaboration of many scientific disciplines in the fields of engineering, material sciences, basic tissue biology, medicine and surgery. As the pace of change continues to accelerate, we ask the readers to go back with us in time to understand developments in design and function of pericardial heart valves. This descriptive review seeks to focus on the qualities of pericardial heart valves, the advantages, successes and failures encapsulating the evolution of surgically implanted pericardial heart valves over the past five decades. We present the data on comparison of the pericardial heart valves to porcine valves, discuss structural valve deterioration and the future of heart valve treatments., (Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Surgical aortic valve replacement is the treatment of choice in patients with severe symptomatic aortic valve stenosis because it provides excellent early and long-term clinical outcomes in terms of hemodynamics, valve durability, and freedom from valve-related complications. In recent years, the number of high-risk patients being referred for surgical aortic valve replacement has increased. A considerable proportion of these patients are deemed operable despite the high risk. In order to modify the risk predominantly associated with duration of cardiopulmonary bypass and cross clamp time sutureless aortic valve technology has been developed. Sutureless aortic bioprosthetic valves, introduced in clinical practice in 2009, contrary to the conventional surgical technique for implantation (interrupted or continuous sutures, after thorough annular decalcification) are not hand sewn. This technological modification reduces the implantation time with potential translation into improved outcomes for high-risk patients undergoing surgical aortic valve replacement. Currently, three sutureless bioprostheses are available and amongst these the largest published experience is available for the patented and CE marked truly sutureless PERCEVAL S valve (Sorin Group, Saluggia, Italy). This article provides an overview of the published literature for Perceval S valve with an attempt to better define the role of sutureless aortic valve replacement in the treatment of critical aortic valve stenosis.

Percutaneous pulmonary valve implantation (PPVI) has revolutionized the management of right ventricular outflow tract dysfunction after repaired congenital heart disease. Although the technology is considered to be safe with a relatively low complication rate, infection is a described complication, with five cases of culture-positive infective endocarditis of percutaneously implanted pulmonary valve having been reported to date worldwide. Herein is reported the first ever case of culture-negative endocarditis following PPVI, caused by Bartonella henselae, diagnosed five years after implantation in a 15-year-old patient with a repaired truncus arteriosus.

Surgical radiofrequency Maze procedure is a well-developed technology with an established safety profile. Clinical complications, albeit rare, have been described secondary to usage of unipolar radiofrequency devices. Bipolar radiofrequency devices have virtually eliminated the complications associated with unipolar devices, thereby combining safety with efficacy. We report a case of chylopericardial tamponade and chylothorax following radiofrequency Maze procedure using a bipolar device. , (© 2011 Wiley Periodicals, Inc.)

Percutaneous pulmonary valve implantation (PPVI) has revolutionized the management of right ventricular outflow tract dysfunction after repaired congenital heart disease. The technology is considered to be safe, with a relatively low complication rate. Infection is one of the described complications of PPVI, and to date five cases of culture-positive infective endocarditis of percutaneously implanted pulmonary valve have been reported worldwide. Herein is reported the first ever case of culture-negative endocarditis of a percutaneously implanted pulmonary valve, caused by Bartonella henselae, five years after implantation in a 15-year-old patient with a repaired truncus arteriosus.

A best evidence topic in cardiac surgery was written, according to a structured protocol. The question addressed was: in young patients with rheumatic aortic regurgitation compared to non-rheumatics is a Ross operation associated with increased incidence of autograft failure? The pulmonary autograft with its inherent advantages of viable autologous transplant, central laminar flow, freedom from prosthetic valve complications, side effects of anticoagulation, and growth potential is considered a well-accepted option for aortic valve replacement in young patients. However, the use of a pulmonary autograft in young patients with rheumatic aortic valve disease is controversial. We analyse existing evidence to determine the suitability of the pulmonary autograft as a substitute for the diseased aortic valve in patients with rheumatic disease. Altogether 901 papers were found using the reported search terms, from which eight represented the best evidence to answer the clinical question. In addition, a meta-analysis also superficially addressed this issue. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All eight publications were from two institutions with one reporting outcomes for a Ross operation vs. mechanical valve implantation and two compared results of the Ross operation in rheumatic vs. non-rheumatic aortic valve disease. We conclude that the current available evidence suggests that pulmonary autograft is susceptible to rheumatic involvement. Use of pulmonary autograft in young patients (<30 years) with rheumatic aortic regurgitation and concomitant mitral regurgitation requires a cautious approach as there is an impaired autograft durability in this subgroup of patients.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether, in patients with mitral regurgitation secondary to degenerative mitral valve disease requiring mitral valve repair with an annuloplasty ring, a flexible ring is superior to a semi-rigid or rigid ring in terms of improvement in symptoms and survival. Using the reported search 478 papers were identified. Twelve papers of which seven were echocardiographic studies and five clinical studies, including two randomised controlled trials (RCTs), represented the best evidence on the subject. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated for these. We conclude that current best available evidence suggests that, in patients with a flexible annuloplasty ring compared to patients with a semi-rigid/rigid annuloplasty ring, the improvement in LV systolic function as reported by all the seven sophisticated echocardiographic studies with a total of 266 patients does not translate into better clinical outcomes as five clinical studies with a total of 941 patients, including two RCTs, report comparable clinical outcomes for patients with mitral regurgitation secondary to degenerative mitral valve disease requiring mitral valve repair with an annuloplasty ring.

A variety of congenital cardiac anomalies with severe right ventricular outflow tract (RVOT) obstruction or RVOT interruption require surgical reconstruction from the infundibulum up to the pulmonary artery bifurcation or even into the branches of the pulmonary arteries. Ideally, the conduit or valve required for such reconstruction has to be formed of autologous tissue that grows, resists infection, lasts for the life span of the patient and is readily available in all sizes. Such conduits, however, are not available and although several alternatives have been used, none of which are without potential drawbacks. Contegra valved bovine internal jugular vein conduit (Medtronic Inc., MN, USA) has recently emerged as a promising option for pediatric RVOT reconstruction and has been advocated for its 'off-the-shelf' availability in sizes ranging from 12 to 22 mm, surgical pliability and encouraging short- and mid-term success in experimental animal, as well as clinical studies. This review focuses on the current outcomes of Contegra conduit and highlights some of the major concerns related to the use of this conduit and strategies to tackle these concerns.

Past four decades have seen a gradual evolution in aortic valve replacement surgery. The ideal valve substitute should combine central flow, low transvalvular gradient, low thrombogenicity, durability, easy availability, resistance to infection, freedom from anticoagulation, and easy implantability. Although there are several types of valves available to replace the diseased aortic valve-autograft, allograft, xenograft, mechanical, and bioprosthetic valves-none is ideal. On one end of the spectrum is the pulmonary autograft, which comes closest to achieving these goals, but creates a double valve procedure for single valve disease, while on the other end are the mechanical valves and stented tissue valves, which allow easy "off the shelf" availability as well as easy implantability but are limited by the potential drawback of causing intrinsic obstruction to some extent because of the space occupied by the stent and sewing ring. Stentless xenograft aortic valves have been developed as a compromise between these ends of the valve spectrum. Stentless aortic valves have been reported to provide more physiologic hemodynamic behavior and cause more timely and thorough regression of ventricular hypertrophy. This review article attempts to evaluate current best available evidence from randomized controlled trials to assess the impact of stentless aortic valves on left ventricular function and hypertrophy.