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Transcatheter technologies triggered the recent revision of the guidelines that progressively widened the indications for the treatment of aortic stenosis. On the surgical realm, a technology avoiding the need for sutures to anchor the prosthesis to the aortic annulus has been developed with the aim to reduce the duration of cardiopulmonary bypass and simplify the process of valve implantation. In addition to a transcatheter aortic valve replacement (TAVR)-like stent that exerts a radial force, these so-called "rapid deployment valves" or "sutureless valves" for aortic valve replacement also have cuffs to improve sealing and reduce the risk of paravalvular leak. Despite promising, the actual advantage of sutureless valves over traditional surgical procedures (surgical aortic valve replacement) or TAVR is still debated. This review summarizes the current comparative evidence reporting outcomes of "sutureless valves" for aortic valve replacement to TAVR and surgical aortic valve replacement in the treatment of aortic valve stenosis. • The comparative safety and efficacy of sutureless (SuAVR) vs conventional aortic valve replacement surgery is currently under investigation. • Potential candidates for SuAVR include those undergoing concomitant procedures, complex reoperations in patients with frail aortic root tissue, minimally invasive aortic valve replacement procedures, and high-risk patients for whom TAVR is not suitable. • The Heart Team should participate in shared decision making with patients in the selection of valve replacement modality for aortic stenosis. [ABSTRACT FROM AUTHOR]

Background: The current study presents a novel and precise surgical technique for complete reconstruction of the aortic valve using glutaraldehyde-treated autologous pericardium in a patient with aortic valve disease and endocarditis. The technique aims to provide a more effective and reproducible method for aortic valve repair, with the goal of improving outcomes and quality of life for patients with aortic valve disease. Case presentation: A 35-year-old Iranian male with aortic valve disease and endocarditis underwent aortic valve reconstruction surgery. Preoperative echocardiography showed a degenerative aortic valve with severe regurgitation, reduced left ventricular ejection fraction, and specific aortic root dimensions. The surgical technique involved precise measurements and calculations to design the size and shape of the new aortic valve cusps using autologous pericardium, with the goal of optimizing coaptation and function. The surgeon calculated the intercommissural distance based on the aortic annulus diameter to determine cusp size and shape. He tailored the pericardial cusps to have a height equal to 80% of the coaptation margin length. Detailed suturing techniques were used to ensure proper alignment and coaptation of the new cusps. Intraoperative evaluation of the valve function using suction and transesophageal echocardiography showed good coaptation and minimal residual regurgitation. At the 3-year follow-up, the patient had a well-functioning aortic valve with only trivial leak and was in satisfactory clinical condition. Conclusions: Glutaraldehyde-treated autologous pericardium is a validated leaflet alternative, and the causes of its failure are late annular dilatation and other technique breakdowns. Current evidence reveals that aortic valve reconstruction with glutaraldehyde-treated autologous pericardium is associated with many advantages with the potential to improve patient outcomes and quality of life. Further clinical studies are warranted to evaluate the long-term durability and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Background: Aortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical option that has become a common treatment for people unable to undergo open aortic valve replacement; despite the increase in TAVI offerings in the last decade, patient quality of life (QoL) outcomes postoperatively are poorly understood. Objective: The aim of this review was to determine whether TAVI is effective in improving QoL. Method: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, and the protocol was registered on PROSPERO (CRD42019122753). MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for studies published between 2008 and 2021. Search terms included "transcatheter aortic valve replacement" and "quality of life" and their synonyms. Included studies were evaluated, dependent on study design, using either the Risk of Bias-2 or the Newcastle-Ottawa Scale. Seventy studies were included in the review. Results: Authors of the studies used a wide variety of QoL assessment instruments and follow-up durations; authors of most studies identified an improvement in QoL, and a small number identified a decline in QoL or no change from baseline. Conclusion: Although authors of the vast majority of studies identified an improvement in QoL, there was very little consistency in instrument choice or follow-up duration; this made analysis and comparison difficult. A consistent approach to measuring QoL for patients who undergo TAVI is needed to enable comparison of outcomes. A richer, more nuanced understanding of QoL outcomes after TAVI could help clinicians support patient decision making and evaluate outcomes. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the rate and impact of post-pericardiotomy syndrome after native valve-sparing aortic valve surgery and the perioperative factors associated with its occurrence. Methods: All consecutive patients who underwent native valve-sparing aortic valve surgery (i.e., repair ± ascending aorta replacement, valve-sparing root replacement, Ross procedure ± ascending aorta replacement) at our institution between January 2021 and August 2023 served as our study population. Post-pericardiotomy syndrome was diagnosed if patients showed at least two of the following diagnostic criteria: evidence of (I) new/worsening pericardial effusion, or (II) new/worsening pleural effusions, (III) pleuritic chest pain, (IV) fever or (V) elevated inflammatory markers without alternative causes. A logistic regression model was calculated. Results: During the study period, 91 patients underwent native valve-sparing aortic valve surgery. A total of 21 patients (23%) developed post-pericardiotomy syndrome early after surgery (PPS group). The remaining 70 patients (77%) showed no signs of post-pericardiotomy syndrome (non-PPS group). Multivariate logistic regression revealed blood type O (OR: 3.15, 95% CI: 1.06–9.41, p = 0.040), valve-sparing root replacement (OR: 3.12, 95% CI: 1.01–9.59, p = 0.048) and peak C-reactive protein >15 mg/dl within 48 hours postoperatively (OR: 4.27, 95% CI: 1.05–17.29, p = 0.042) as independent risk factors. 73% (8/11) of patients displaying all three risk factors, 60% (9/15) of patients with blood type O and valve-sparing root replacement, 52% (11/21) of patients with blood type O and early postoperative peak C-reactive protein >15 mg/dl and 45% (13/29) of patients with early postoperative peak C-reactive protein >15 mg/dl and valve-sparing root replacement developed post-pericardiotomy syndrome. Conclusion: In summary, blood type O, valve-sparing root replacement and peak C-reactive protein >15 mg/dl within 48 hours postoperatively are significantly associated with post-pericardiotomy syndrome after native valve-sparing aortic valve surgery. Particularly, the presence of all three risk factors is linked to a particularly high risk of post-pericardiotomy syndrome. [ABSTRACT FROM AUTHOR]

Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (PMAIF) is a rare complication of infective endocarditis or aortic valve surgery. Surgical treatment is suggested, but the long-term follow-up of conservative management remains unclear. Case presentation: A 33-year follow-up of a patient who developed PMAIF six years after aortic valve replacement is reported. The patient presented to our center with dyspnea, and the echocardiography revealed an ejection fraction of 20% and a PMAIF measuring 7 × 10 mm. Despite being advised to undergo surgery, the patient declined due to fear of surgical outcomes. Consequently, conservative treatment with close observation but without surgery was initiated. During the 33-year follow-up period, the patient did not experience any adverse health effects. Conclusion: Surgical intervention should be considered whenever the PMAIF is diagnosed. However, in any case that the surgery was not applicable, conservative management might lead to long-term survival, based on this and similar case reports in the literature. [ABSTRACT FROM AUTHOR]

Background: Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting. Methods: This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events. Results: Out of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition (p = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group (p = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion (p = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding. Conclusions: Minimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT02272621. [ABSTRACT FROM AUTHOR]

Background: Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. Objective: We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. Methods: This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. Results: Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. Conclusions: The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation. [ABSTRACT FROM AUTHOR]

A 66-year-old man presented with hemolytic anemia, which required frequent blood transfusion, 6 months after surgical repair of an ascending aortic pseudoaneurysm. Hemolysis was attributed to luminal stenosis caused by graft kinking by laboratory test, CT and four-dimensional magnetic resonance imaging. First, an Excluder cuff was placed at the stenotic site under rapid pacing, but it migrated distally. Thereafter a Palmaz XL stent was placed at the stenotic site, which led to resolution of anemia. In this case, a Palmaz XL stent was successfully used to treat hemolytic anemia caused by graft kinking following ascending aortic surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Observational studies have shown reduced perioperative bleeding in patients undergoing minimally invasive, compared with full sternotomy, aortic valve replacement. Data from randomized trials are conflicting. Methods This was a Swedish single center study where adult patients with aortic stenosis, 100 patients were randomly assigned in a 1:1 ratio to undergo either minimally invasive (ministernotomy) or full sternotomy aortic valve replacement. The primary outcome was severe or massive bleeding defined by the Universal Definition of Perioperative Bleeding in adult cardiac surgery (UDPB). Secondary outcomes included blood product transfusions, chest tube output, re-exploration for bleeding, and several other clinically relevant events. Results Out of 100 patients, three patients randomized to ministernotomy were intraoperatively converted to full sternotomy (none was bleeding-related). Three patients (6%) in the full sternotomy group and 3 patients (6%) in the ministernotomy group suffered severe or massive postoperative bleeding according to the UDPB definition (p = 1.00). Mean chest tube output during the first 12 postoperative hours was 350 (standard deviation (SD) 220) ml in the full sternotomy group and 270 (SD 190) ml in the ministernotomy group (p = 0.08). 28% of patients in the full sternotomy group and 36% of patients in the ministernotomy group received at least one packed red blood cells transfusion (p = 0.39). Two patients in each group (4%) underwent re-exploration for bleeding. Conclusions Minimally invasive aortic valve replacement did not result in less bleeding-related outcomes compared to full sternotomy. Clinical Trial Registration http://www.clinicaltrials.gov . Unique identifier: NCT02272621.

Abstract Background The extent of aortic valve inflammation in patients undergoing aortic valve replacement (AVR) is unsettled. The significance of aortic valve histopathology in patients undergoing AVR is undetermined. Methods A total of 145 resected aortic valves of consecutive patients undergoing surgery for a local aortic valve disease with or without ascending aorta were investigated for histopathology. The extent of inflammation and degeneration were investigated. Unadjusted survival was evaluated by Kaplan–Meier analysis. Median follow-up was 2.7 years (interquartile range 1.5–3.9). Results Mean patient age was 69 (SD 11) years. Though endocarditis was apparent in only six patients preoperatively, severe aortic valve inflammation was diagnosed histologically in 32 patients of whom 12 patients had acute, subacute or chronic endocarditis. Despite complete aortic valve resection, survival was decreased in patients with severe aortic valve inflammation as opposed to those without (log rank, P = 0.044), even after exclusion of patients with endocarditis, emergency and aortic surgery. Conclusions Aortic valve tissue analysis reveals severe inflammation that may require postoperative treatment. The association of severe but local aortic valve inflammation with patient outcome after aortic valve surgery merits further investigation.

Background: Blood shortage is a global challenge, impacting elective surgeries with high bleeding risk. Predicting intraoperative blood use, optimizing resource allocation, and ensuring safe elective surgery are vital. This study targets identifying key bleeding risk factors in Aortic Valve Replacement (AVR) through machine learning. Methods: Data from 702 AVR patients were split into 70% training and 30% test sets. Thirteen models predicted RBC transfusion. SHapley Additive exPlanations (SHAP) analyzed risk factors. Results: Logistic Regression excelled, with Area Under Curve (AUC) 0.872 and 81.0% accuracy on the test set. Notably, female gender, Hemoglobin (HGB) < 131.91 g/L, Hematocrit (HCT) < 0.41L/L, weight < 59.49 kg, age > 54.47 year, Mean Corpuscular Hemoglobin (MCH) < 29.15 pg, Total Protein (TP) > 69.7 g/L, FIB > 2.61 g/L, height < 160 cm, and type of operation is Surgical Aortic Valve Replacement (SAVR) were significant RBC transfusion predictors. Conclusions: The study's model accurately forecasts AVR-related RBC transfusions. This informs pre-surgery blood preparations, reducing resource waste and aiding clinicians in optimizing patient care. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (sSAS) who are at high- or intermediate-risk of surgical mortality. The PARTNER 3 trial showed clinical benefits with SAPIEN 3 TAVI compared with SAVR in patients at low risk of surgical mortality. Whether TAVI is also cost-effective compared with SAVR for low-risk patients in the Dutch healthcare system remains uncertain. This article presents an analysis using PARTNER 3 outcomes and costs data from the Netherlands to inform a cost-utility model and examine cost implications of TAVI over SAVR in a Dutch low-risk population. Methods: A two-stage cost-utility analysis was performed using a published and validated health economic model based on adverse events with both TAVI and SAVR interventions from a published randomized low risk trial dataset, and a Markov model that captured lifetime healthcare costs and patient outcomes post-intervention. The model was adapted using Netherlands-specific cost data to assess the cost-effectiveness of TAVI and SAVR. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses. Results: TAVI generated 0.89 additional quality-adjusted life years (QALYs) at a €4742 increase in costs per patient compared with SAVR over a lifetime time horizon, representing an incremental cost-effectiveness ratio (ICER) of €5346 per QALY gained. Sensitivity analyses confirm robust results, with TAVI remaining cost-effective across several sensitivity analyses. Conclusions: Based on the model results, compared with SAVR, TAVI with SAPIEN 3 appears cost-effective for the treatment of Dutch patients with sSAS who are at low risk of surgical mortality. Qualitative data suggest broader societal benefits are likely and these findings could be used to optimize appropriate intervention selection for this patient population. [ABSTRACT FROM AUTHOR]

Background: We investigated long-term outcomes, particularly later aorta operations and overall death in patients who underwent aortic valve replacement for bicuspid aortic valve without aortic surgery. Methods: Between January 2002 and December 2022, 274 patients underwent aortic valve replacement for bicuspid aortic valve at our institution. Of them, 181 patients who did not undergo aortic surgery, in accordance with current guidelines, were analyzed retrospectively. Results: The median follow-up duration was 6.1 (2.0–10.6) years, and follow-up was completed in 97.8% of pateints. There were 3 patients (1.7%) who underwent later aorta operation during follow-up period. The cumulative later aorta operation rate at 10 years adjusting overall death as competing risk was 16.3%, and the estimated rates of freedom from overall death at 10 years was 83.7%. Fine-Gray competing risk regression model showed that aortic valve stenosis was only the predictor of later aorta operation (hazard ratio 8.477; p = 0.012). In multivariable Cox models, predictors of overall death were aortic valve stenosis (hazard ratio: 8.270, 95% confidence interval: 1.082–63.235; p = 0.042) and operation time (hazard ratio: 1.011, 95% confidence interval: 1.004–1.017; p = 0.002). Conclusions: Patients with bicuspid aortic valve with ascending aortic diameter less than 45 mm are at low risk of later aorta operation after isolated aortic valve replacement. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta‐analyses identified preexisting right bundle branch block (RBBB), LAHB, and new‐onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self‐expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post‐TAVR, highlighting the need for further research and standardized treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Data on the postoperative outcomes for patients with infective endocarditis complicated by an aortic root abscess is sparse due to the condition's low incidence and high mortality rates. This systematic review and meta-analysis aims to evaluate existing data on the impact of aortic root abscesses on the postoperative outcomes and to inform optimal surgical approach. Methods: The online databases MEDLINE, EMBASE and Cochrane library were searched from 1990 to 2022 for studies comparing cohorts of surgically managed infective endocarditis patients with and without an aortic root abscess. Data was extracted by two independent investigators and aggregated in a random-effects model. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa scale. Results: Six clinical studies were included in the meta-analysis (n 1982). The abscess group was associated with increased in-hospital mortality (OR 1.74 95%: CI 1.18–2.56) and late mortality (HR 1.27 95% CI:1.03–1.58). The reoperation meta-analysis was complicated by high rates of heterogeneity (I2 = 59%) and found no significant differences in reoperation between abscess and no abscess groups (HR=1.48: 95% CI:0.92–2.40). Post-hoc scatter graph showed a strong linear relationship (r 0.998), suggesting hospitals with higher rates of aortic root replacement achieve lower rates of reoperation for aortic root abscess patients compared with patch reconstruction. Conclusions: The presence of an aortic root abscess in aortic valve endocarditis is associated with elevated early and late mortality despite modern standards of care. Additionally, aortic root replacement should be considered to have a favourable postoperative profile for use in this context. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Q fever is a contagious zoonotic disease which is caused by a gram-negative and intracellular Coccobacillus known as Coxiella burnetii ticks play a role in its transmission. Endocarditis is the most common consequence of chronic Q fever. Methods: Here we report a case of endocarditis caused by Q fever. The patient is a 67-year-old, and she had coronary artery bypass graft (CABG) and aortic valve replacement surgery. Results: The result of echocardiography showed a suspicious mass (Vegetation) on the implanted valve. Based on laboratory and clinical assessments, endocarditis caused by C. burnetii was the final diagnosis. Conclusion: Q fever is a tick-transmitted pathogen that has been known as an important cause of culture-negative endocarditis in Iran, and more attention needs to be paid to this disease in Iran by the healthcare system and physicians. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both. METHODS A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure. RESULTS Initially, 42 510 patients with preoperative AF were identified, and, after exclusion, 33 949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27 437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P  < 0.001). Mortality benefits were reflected when stratified by surgery type with the exception of aortic valve surgery where LAAO alone fare worse than no treatment. CONCLUSIONS Among patients with preoperative AF undergoing cardiac surgery, surgical management of AF, particularly SA + LAAO, was associated with lower 6-year mortality. These findings support the benefits of incorporating SA and LAAO in the management of AF during cardiac surgery. [ABSTRACT FROM AUTHOR]

Objective: Myocardial contraction fraction (MCF), a costless, easy-to-perform echocardiography measure, which estimates cardiac function through the volumetric measurement of myocardial shortening, may be a useful prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to evaluate MCF in patients who underwent TAVR at a public hospital in Rio de Janeiro, Brazil. Methods: This was a retrospective cohort study. Clinical and echocardiographic data were obtained from medical records. MCF was calculated as FDV in mL/FSV in mL x100, where FDV= final diastolic volume and FSV= final systolic volume. These were derived from the dimensions of the left ventricle. The FDV was estimated as 4.5 x (final diastolic diameter of the left ventricle) and the FSV was estimated as 3.72 x (final systolic diameter of the left ventricle). Patients were followed for 66 months, and all-cause mortality was registered. Results: Overall, 78 patients were studied. Median age was 78 years. Mortality was 56.4% over 9 years, with 29% of deaths in the first year. Pre-TAVR median MCF (45.9%) was low, while mean left ventricular ejection fraction (LVEF) was normal (57.0%). In patients who survived after the procedure, MCF increased post-TAVR, but in those who died, it decreased (49.3% vs 45.1%). Conclusions: MCF may demonstrate left ventricular dysfunction unrecognized by LVEF measurement in patients undergoing TAVR, and may be a prognostic marker in this patient population. [ABSTRACT FROM AUTHOR]

Aims Previous studies have demonstrated relatively slow rates of progression of early calcific aortic valve disease (CAVD), which encompasses aortic sclerosis (ASc) and mild aortic stenosis (AS). The potential evolution to clinically significant AS is unclear, and we therefore examined the long-term outcomes of patients with ASc and mild AS detected at the time of clinically indicated echocardiography. Methods and results Data from initial clinically indicated echocardiograms performed between 2010 and 2018 in patients aged ≥18 years were extracted and linked to nationally collected outcome data. Those with impaired right or left systolic ventricular function or other significant left-sided valve disease were excluded. A time to first event analysis was performed with a composite primary outcome of cardiovascular death and aortic valve intervention (AVI). Of the 13 313 patients, 8973 had no CAVD, 3436 had ASc, and 455 had mild AS. The remainder had moderate or worse stenosis. Over a median follow-up period of 4.2 (interquartile range 1.8–6.7) years (and after adjustment for age and sex), those with ASc were at greater risk of the primary outcome [hazard ratio (HR) 2.9, 95% confidence interval (CI) 2.1–4.0] and need for AVI (HR 26.8, 95% CI 9.1–79.1) compared with those with no CAVD. Clinical event rates accelerated after ∼5 years in those with mild AS. Conclusion Patients with ASc are >25 times more likely to require AVI than those with no CAVD, and follow-up echocardiography should be considered within 3–4 years in those with mild AS. [ABSTRACT FROM AUTHOR]

Background: Junctional epidermolysis bullosa is a rare skin and mucosal disorder characterized by blister formation in response to minor trauma and extracutaneous manifestations. There have been no reports of cardiac surgery and prognostication in patients with epidermolysis bullosa due to skin and mucosal fragility. Case presentation: A 55-year-old man presented with congenital junctional epidermolysis bullosa, hypertension, and vasospastic angina. He complained of dyspnea on exertion, and transthoracic echocardiography revealed severe aortic valve regurgitation, moderate aortic valve stenosis (tricuspid valve), and severe mitral valve regurgitation. Considering that the skin condition in the right chest wall was relatively healthy, the right thoracotomy approach was preferred and totally endoscopic concomitant mitral valve repair and aortic valve replacement were performed using a sutureless bioprosthetic valve (Perceval™ (Corcym, Group, Milan, Italy)). Polyurethane and silicon dressing foams were used to protect the skin at the site of contact with the bag valve mask, arterial pressure catheter, intravenous catheter, and the tracheal intubation tube. Vertical mattress sutures were used for the skin sutures. The postoperative course was uneventful, and the patient was discharged nine days after the operation. There was no indication for reoperation until three years follow-up period. Conclusions: The totally endoscopic concomitant aortic and mitral valve surgery using Perceval™ prosthesis can be performed safely in patients with junctional epidermolysis bullosa by adequate protection of the skin and mucosa. [ABSTRACT FROM AUTHOR]

Background: The extent of aortic valve inflammation in patients undergoing aortic valve replacement (AVR) is unsettled. The significance of aortic valve histopathology in patients undergoing AVR is undetermined. Methods: A total of 145 resected aortic valves of consecutive patients undergoing surgery for a local aortic valve disease with or without ascending aorta were investigated for histopathology. The extent of inflammation and degeneration were investigated. Unadjusted survival was evaluated by Kaplan–Meier analysis. Median follow-up was 2.7 years (interquartile range 1.5–3.9). Results: Mean patient age was 69 (SD 11) years. Though endocarditis was apparent in only six patients preoperatively, severe aortic valve inflammation was diagnosed histologically in 32 patients of whom 12 patients had acute, subacute or chronic endocarditis. Despite complete aortic valve resection, survival was decreased in patients with severe aortic valve inflammation as opposed to those without (log rank, P = 0.044), even after exclusion of patients with endocarditis, emergency and aortic surgery. Conclusions: Aortic valve tissue analysis reveals severe inflammation that may require postoperative treatment. The association of severe but local aortic valve inflammation with patient outcome after aortic valve surgery merits further investigation. [ABSTRACT FROM AUTHOR]

Aim: To assess risk factors for mortality in cardiac surgical adult patients. Methods: One thousand hundred adult patients who underwent cardiac surgery under cardiopulmonary bypass, aged 20 to 60 years of either gender were selected and parameters such as clinical profile, systolic and diastolic blood pressure, preoperative condition, type of operations performed and risk factors, etc. were recorded. Results: There were 620 males and 480 females. Age groups 20-30 years had 50, 30-40 years had 250, 40-50 years had 520, and 50-60 years had 280 patients. BMI showed healthy 660, overweight 370, obese 50, and severe obese 20 subjects. Preoperative conditions found were diabetes in 230, hypertension in 140, extracardiac arteriopathy in 60, intermittent claudication in 80, chronic renal insufficiency in 50, and chronic pulmonary disease in 20 patients. Operations performed were elective coronary artery bypass surgery in 600, aortic valve surgery in 250, mitral repair or replacement in 210, and ASD closure in 40. The difference was significant (P< 0.05). Out of 1100 patients, 30 (2.7%) died. Common risk factors were advancing age, female gender, extracardiac arteriopathy, chronic pulmonary disease, neurological dysfunction, serum creatinine >2.0, LVEF <30% and systolic pulmonary pressure > 60. Conclusion: Several risk factors contribute to cardiac surgical mortality such as systolic pulmonary pressure > 60, increasing age, female gender, extracardiac arteriopathy, chronic pulmonary disease, neurological dysfunction, serum creatinine >2.0, LVEF <30%. Using this data, a risk stratification method for estimating hospital mortality and evaluating the quality of care can be created. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P  = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37–1.05; P  = 0.1]. Age (OR 1.03, 95% CI 1.01–1.05; P  < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08–2.42; P  < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17–4.04; P  < 0.05) and endocarditis (OR 2.66, 95% CI 1.71–4.14; P  < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality. [ABSTRACT FROM AUTHOR]

Mitral valve surgery (MVS), with repair preferred to replacement, is a common procedure for the treatment of severe primary mitral regurgitation related to leaflet prolapse. Structural complications after MVS include left ventricular outflow obstruction, paravalvular leak and atrial septal defect. Intraoperative transoesophageal echocardiography and predischarge transthoracic echocardiography (TTE) specifically screen for these complications. Ventricular septal defect (VSD), a known complication after aortic valve surgery, is rarely reported after MVS. Recently, unsuccessful valvuloplasty prior to replacement was suggested as a risk factor. We present such a case and explore mechanisms with advanced cardiac imaging. In this case, the patient was found to have an elongated membranous septum that likely predisposed her to septal injury. Finally, we provide guidance on specific transoesophageal/transthoracic echocardiography views to avoid a missed diagnosis. [ABSTRACT FROM AUTHOR]

ObjectivesAlthough the Perceval sutureless aortic valve bioprosthesis presents a feasible alternative to conventional aortic valve prostheses, the extent of its applicability with respect to technical considerations for a real-world patient collective is still under debate.MethodsOne hundred patients received the Perceval prosthesis [males: 59; age: 72.5 (7.3–79) years] between December 2015 and February 2023 [EuroSCORE II: 2.8 (1.7–5.4)] for an aortic valve replacement (AVR), with additional concomitant procedures, for underlying severe aortic valve stenosis [n = 93 (93)], endocarditis [n = 5 (5)], and redo AVR [n = 7 (7)] including a prior surgical AVR [n = 4 (4)] and a failed transcatheter aortic valve implantation [n = 3 (3)]. Surgery was conducted primarily by median sternotomy [n = 71 (71)] and, alternatively, by the upper hemisternotomy approach [n = 29 (29)].ResultsOver a median follow-up time of 36.5 (16.5–53) months, eight patients (8%) underwent postoperative pacemaker implantation, with five (5%) due to high-grade atrioventricular block, while nine patients experienced a stroke (9%). The median values of maximum and mean gradients across all valve sizes were 22 (18–27.5) mmHg and 10 (13–18) mmHg, respectively. Two patients (2%) had moderate and one (1%) had severe paravalvular leakage, with the latter presenting the only case of underlying valve migration and induced redo AVR with valve explantation 2 days following initial surgery. Thirty-day mortality (and overall mortality) was 5% and 26%, respectively.ConclusionThe implantation of the Perceval bioprosthesis is feasible for a variety of indications, with excellent hemodynamic results and low complication rates in a real-world high-risk patient collective.

There is paucity of studies that focus on the composition of pericardial fluid under resting conditions. The purpose of this study is to determine the levels of inflammatory mediators in pericardial fluid and their correlation with plasma levels in patients undergoing elective cardiac surgery. We conducted a prospective cohort study on candidates for elective aortic valve replacement surgery. Pericardial fluid and peripheral venous blood samples were collected after opening the pericardium. Levels of interleukin 1α (IL-1α); interleukin 1β (IL-1β); interleukin 2 (IL-2) interleukin 4 (IL-4); interleukin 6 (IL-6); interleukin 8 (IL8); interleukin 10 (IL10); tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1) epidermal growth factor (EGF), soluble E-selectin, L-selectin, P-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) were determined in both pericardial fluid and serum samples. A total of 45 patients with a mean age of 74 years were included of which 66% were males. Serum levels of all study mediators were within normal limits. Serum and pericardial levels of IL-1 α, IL-1 β, IL-2, IL-4, and IL-10 were similar. Levels of VEGF, EGF, VCAM-2, ICAM 1, E-selectin, P-selectin, and L-selectin were significantly lower in pericardial fluid than in serum. However, levels of IL-6, IL-8, TNF-α, IFN-γ, MCP-1, and MCP-1 were significantly higher in the pericardial fluid than in serum. Under normal conditions, the pattern of distribution of different inflammatory mediators in the pericardial fluid does not reflect serum levels. This may either reflect the condition of the underlying myocardium and epicardial fat or the activity of the mesothelial and mononuclear cells present in pericardial fluid. [ABSTRACT FROM AUTHOR]

This article examines the incidence and risk factors of postoperative atrial fibrillation (POAF) in patients with aortic valve disease who undergo aortic valve surgery (AVS). The study included 264 patients without a history of atrial fibrillation at the time of surgery. The incidence of POAF after AVS was found to be 23.1%, with arterial hypertension, dyslipidemia, and aortic valve stenosis identified as independent risk factors. The study highlights the clinical challenge posed by POAF in individuals with aortic valve disease and suggests that future research should focus on reducing its prevalence. [Extracted from the article]

This article compares the quantitative and functional changes in the left and right ventricles after the Ross procedure, a surgical treatment for aortic valve diseases, to conventional aortic valve surgery. The study enrolled 38 patients who underwent the Ross procedure and matched them with 19 patients who underwent conventional surgery. The results showed that there were no significant differences in left ventricle function and structure between the two procedures. However, the Ross procedure showed improved left ventricle global longitudinal strain three months after surgery. The right ventricle function was comparable between the two procedures, except for a temporary reduction immediately after the Ross procedure. The authors suggest that the improved left ventricle function may be due to the favorable hemodynamics of the autograft used in the Ross procedure. [Extracted from the article]

This article discusses the outcomes of over 300 minimally invasive implantations of a rapid deployment valve for aortic valve replacement. The study found that the procedure was safe and had comparable results to other surgical and transcatheter procedures. The 30-day mortality rate was 2.8%, and postoperative neurologic events occurred in 1.7% of patients. The study also reported good follow-up outcomes and short procedural times, highlighting the importance of this technique in promoting minimal access aortic valve surgery. [Extracted from the article]

This article discusses the clinical outcomes of minimally invasive aortic valve replacement surgery via right anterior mini-thoracotomy (RAMT) in patients under 50 years of age. The study analyzed the data of 51 patients who underwent this procedure between April 2017 and September 2023. The results showed that the surgery was successful in all patients, with no postoperative complications or mortality. The authors conclude that RAMT can be safely and effectively performed in younger patients, offering rapid recovery and positive midterm outcomes. Surgeons performing aortic valve surgery should consider this technique as an option for selected nonelderly patients. [Extracted from the article]

This article discusses the use of transaxillary access as a new route for minimally invasive aortic valve surgery. The study analyzed data from a large cohort of 639 patients who underwent aortic valve replacement using this access method. The results showed that the transaxillary access had a high success rate, with low rates of complications and mortality. The authors suggest that this technique has the potential to replace traditional median sternotomy and become the standard access route for a wide range of patients. [Extracted from the article]

As the survival after heart transplantation (HTx) is steadily improving, an increasing number of patients with late cardiac pathologies such as valvular disease is expected to rise. Nevertheless, no guidelines for indication of redo cardiac surgery after HTx exists. The aim of the present systematic review is to describe the results reported in the literature of surgical management of severe aortic and/or mitral valve disease. A systematic review was conducted including studies reporting on adult patients with severe mitral or aortic valve pathology needing surgery after their previous HTx. Exclusion criteria consisted in surgery with no left heart valve surgery, concomitant valve surgery during heart transplant, transcatheter interventions, and heterotopic HTx. A total of 35 papers met our inclusion criteria out of 2755 potentially eligible studies with 44 mitral valve surgery patients and 20 aortic valve surgery patients. In the entire population, the mean time from HTx to reintervention was 6.19 ± 5.22 years. After a mean follow-up of 2.78 ± 3.54 years and 1.53 ± 2.26 years from reintervention, 65.6% mitral and 86.7% aortic patients were reported as alive, respectively. As guidelines on cardiac surgery after HTx are currently lacking, left-sided valvular cardiac reinterventions can be considered a possible therapeutic approach in carefully selected patients. These interventions may not only improve the patient's functional status and survival, but may ultimately reduce the need for re-transplantation due to the chronic shortage of donor hearts. However, the support of more robust data is warranted. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR. Methods: Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%). Results: The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings. Conclusion: When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients. [ABSTRACT FROM AUTHOR]

Background Midline sternotomy is consider as conventional approach for aortic valve replacement surgeries. However, sternum disruptions are responsible for increased rate of postoperative bleeding, pain and wound infection leading to longer hospital stay and patient discomfort. Right anterolateral thoracotomy with central cannulation is a minimal invasive approach can be used as an alternative over standard midline sternotomy procedure for aortic valve replacement (AVR) surgeries in developing or underdeveloped countries. Objective To compare and analyze the intraoperative and postoperative surgical outcomes of patients undergoing aortic valve replacement through right anterolateral thoracotomy by central cannulation with conventional midline sternotomy. To find out utility and cost effectiveness of thoracotomy for aortic valve replacement even in center's that are not dedicated for minimal invasive cardiac procedures. To find out advantage of limited anterolateral thoracotomy with central cannulation over midline sternotomy and other minimal invasive approaches which requires multiple incision with peripheral cannulation. Methods This is a facility based cross sectional study of 120 patients undergoing aortic valve replacement during the study period of 3 years in a tertiary care hospital. Patients with any co-morbidity or history of any previous surgery (mentioned in the main text) are excluded from the study. Very strict inclusion criteria are used in order to avoid any effect modifications. Based on the surgical approach, the study cohort was divided into right anterolateral thoracotomy group and midline sternotomy group with 60 patients in each respective group. A comparison of intraoperative and postoperative outcome was carried out. Results The mean age in the thoracotomy group was 26.03+6.014 years and in the midline sternotomy group was 56.07+10.03 years. The study cohort comprised of 92 (76.7%) males and 28 (23.3%) females. Mean body surface area in thoracotomy group and midline sternotomy group was 1.46+0.16 m2 and 1.62+0.27 m2 respectively. The mean bypass time, aortic cross clamp time and mean operating time in the midline sternotomy group was higher as compared to the thoracotomy group (p<0.05). Duration till mobilization, ICU stay and hospital stay was shorter in thoracotomy group (p=0.000). Wound infection, scar formation and readmission were observed to be higher among patients in the midline sternotomy group than the thoracotomy group (p<0.05). Conclusion Minimal invasive AVR by single incision such as right anterolateral thoracotomy with central cannulation is an excellent option when compared to conventional midline sternotomy approach. This not only exclude the issues related to midline sternotomy but also avoids multiple incisions and requirement of peripheral cannulation used currently for minimal invasive aortic valve replacement. [ABSTRACT FROM AUTHOR]

Background Midline sternotomy is consider as conventional approach for aortic valve replacement surgeries. However, sternum disruptions are responsible for increased rate of postoperative bleeding, pain and wound infection leading to longer hospital stay and patient discomfort. Right anterolateral thoracotomy with central cannulation is a minimal invasive approach can be used as an alternative over standard midline sternotomy procedure for aortic valve replacement (AVR) surgeries in developing or underdeveloped countries. Objective To compare and analyze the intraoperative and postoperative surgical outcomes of patients undergoing aortic valve replacement through right anterolateral thoracotomy by central cannulation with conventional midline sternotomy. To find out utility and cost effectiveness of thoracotomy for aortic valve replacement even in center's that are not dedicated for minimal invasive cardiac procedures. To find out advantage of limited anterolateral thoracotomy with central cannulation over midline sternotomy and other minimal invasive approaches which requires multiple incision with peripheral cannulation. Methods This is a facility based cross sectional study of 120 patients undergoing aortic valve replacement during the study period of 3 years in a tertiary care hospital. Patients with any co-morbidity or history of any previous surgery (mentioned in the main text) are excluded from the study. Very strict inclusion criteria are used in order to avoid any effect modifications. Based on the surgical approach, the study cohort was divided into right anterolateral thoracotomy group and midline sternotomy group with 60 patients in each respective group. A comparison of intraoperative and postoperative outcome was carried out. Results The mean age in the thoracotomy group was 26.03+6.014 years and in the midline sternotomy group was 56.07+10.03 years. The study cohort comprised of 92 (76.7%) males and 28 (23.3%) females. Mean body surface area in thoracotomy group and midline sternotomy group was 1.46+0.16 m2 and 1.62+0.27 m2 respectively. The mean bypass time, aortic cross clamp time and mean operating time in the midline sternotomy group was higher as compared to the thoracotomy group (p<0.05). Duration till mobilization, ICU stay and hospital stay was shorter in thoracotomy group (p=0.000). Wound infection, scar formation and readmission were observed to be higher among patients in the midline sternotomy group than the thoracotomy group (p<0.05). Conclusion Minimal invasive AVR by single incision such as right anterolateral thoracotomy with central cannulation is an excellent option when compared to conventional midline sternotomy approach. This not only exclude the issues related to midline sternotomy but also avoids multiple incisions and requirement of peripheral cannulation used currently for minimal invasive aortic valve replacement. [ABSTRACT FROM AUTHOR]

Background: The main aim of the study is to investigate the etiology of different valvular pathologies, surgical approaches(minimally invasive vs open sternotomy). within 30 day mortality among different surgical valve replacement groups Methods: The present study is a retrospective cross sectional observational study with data from august 2016 to December 2021 undertaken in government general hospital Kurnool. The data considered includes the age echo reports, angiographic data, surgery details and post surgery status. The study included total 126 patients undergone surgical valve replacement. The patients who were undergone aortic valve replacement surgery were 10 cases (7.9%), patients who were undergone mitral valve replacement were 79 (62.7%) and double valve replacement were 37 (29.4%). (figure 1) of these 2 AVR cases and 1 MVR case had undergone cabg with valve replacement Results: The The mean age of patients was 40.3 ± 12.07 years with maximum age of 68 years and minimum age of 13 years The distribution of male population was male 57 (45.2%) and female population was 69 (54.8%) The persons with congenital heart disease are 6(4.8%),chronic rheumatic heart disease are 117 (92.9%), degenerative valvular heart disease are 3 (2.4%). The mean ejection fraction of the patients were 58.66 ± 6.2 with highest ejection fraction noted was 63 and lowest was 35. Patients with EF in the range of > 40 are 123 (97.6%), < 40 are 3 (2.4%) Out of 126 patients 7(5.5%) patients undergone minimally invasive surgery and 119(95.5%) patients undergone open surgical approach. Among 126 patients undergone procedure 12 patients died. Of the 12 patients 3 cases(25%) belong to AVR group, 4 cases (33.3%) belong to MVR group and 5 case(41.7%) belong to DVR group. Among 7 patients who underwent minimal invasive surgery non had mortality. The distribution of valve groups are 2 AVR cases and 5 MVR cases. Among age matched minimal access surgery mvr group and open surgical group no significant difference found Conclusion: The most common etiologies among valve replacement surgeries is chronic rheumatic heart disease. Double valve replacement had higher mortality followed by mitral valve replacement and then the aortic valve replacement. The patients who undergone minimally invasive surgery had no mortality but when compared to age matched and valve replacement match individuals no significant mortality difference found but had less hospital stay [ABSTRACT FROM AUTHOR]

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post spinal surgery, a coronary computed tomography angiography was performed. The coronary computed tomography angiography revealed unique findings, including the absence of the left main coronary artery, right coronary artery dominance, ectopic origin of the left circumflex artery from the right sinus of the valsalva, a coronary–pulmonary arterial fistula originating from the right sinus of the valsalva, and an additional right pulmonary vein. The patient was qualified for surgical treatment for an aortic bulb aneurysm, was informed about the high surgical risk, and is awaiting surgery. This case underscores the rarity of Ehlers–Danlos syndrome coexisting with multiple coronary artery anomalies. The presence of a coronary–pulmonary arterial fistula further emphasizes the need for specialized patient monitoring when Ehlers–Danlos syndrome and coronary anomalies converge. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular diseases have been increasing gradually each year, and their incidence has reached 80%. Mechanical ventilation (MV) is essential in the postoperative period of cardiac surgery (CS) due to anesthetic induction. The tidal volume (TV) is a parameter that depends on the conditions of the respiratory system mechanics, aiming at the reduction of dynamic hyperinflation. Objective: Analyze the effect of different TVs on blood gas analysis variables and respiratory mechanics in patients submitted to CS. Materials and methods: This was an uncontrolled randomized clinical trial. Patients were randomized by lottery into the following two groups: One group was ventilated with a TV of 6 mL/kg; while the other received a TV of 8 mL/kg. After 30 minutes of admission with the VT, blood gas analysis data were evaluated, such as pH, oxygen arterial pressure (PaO2), arterial pressure of carbon dioxide (PaCO2), and peripheral oxygen saturation (SpO2). The evaluation of respiratory mechanics was composed of static and dynamic compliance, airway resistance, and driving pressure. Results: A total of 78 patients were included, 58% of whom were males with a mean age of 55 ± 13 years. It was observed that there were no significant differences regarding respiratory mechanics, only the driving pressure presented statistical significance, the group 6 mL/kg was 8.3 ± 2.5 in the group 8 mL/kg 10.4 ± 2.1 presenting a value of (p < 0.001). Conclusion: Based on the findings of the present study, we conclude that different TVs do not significantly alter the blood gas variables and do not influence the respiratory mechanics of patients undergoing CS. [ABSTRACT FROM AUTHOR]

Background Pleura integrity is a significant parameter influencing the outcomes in conventional cardiac surgery interventions. The impact of pleural integrity preservation in minimally invasive surgery is still not widely investigated. This study aims to define the role of pleural integrity preservation (PPI) on short and long-term outcomes after minimally-invasive aortic valve replacement (MIAVR). METHODS Data from 2430 consecutive patients who underwent MIAVR between 1997-2022 were retrospectively collected. Patients were divided into two groups: patients with PPI versus not-pleura integrity preservation (not-PPI). PPI has considered the maintenance of the pleura closed without the need for a chest tube insertion at the end of the surgical procedure. The not-PPI group included patients treated by right anterior Mini-Thoracotomy (824) or Ministernotomy (154) requiring surgical pleural drainage. A propensity-matched analysis was used to compare the two groups (not-PPI vs PPI). The main outcome was all-cause incidence of postoperative respiratory complications. RESULTS After propensity-matching, 848 patients were included in each group (PPI and not-PPI). Mean followup time was 147.4 months. Post-operatively, not-PPI vs PPI patients had a longer intensive care unit stay (hours) (9.7 vs 17.3, p= 0.00003, respectively), and hospital length of stay (LOS) (days) (5.2 vs 8.9, p= 0.00002, respectively). The rate of respiratory complications, including incidence of pneumothorax and/or subcutaneous emphysema, pulmonary atelectasis, and pleural effusion events requiring thoracentesis/drainage, was significantly higher in the not-PPI vs PPI group. Thirty-day all-cause mortality was higher in not-PPI vs PPI (0.029 vs 0.010, p= 0.0028, respectively), (Table 1). CONCLUSIONS Not-PPI after MIAVR was associated with an increased incidence of postoperative complications, and increased LOS compared to PPI. Even long term survival was significantly better in the PPI group. Particularly, the not-PPI approach increased 4 folds the probability of long-term mortality. Therefore, a MIAVR-tailored patient-procedure approach to maintaining the pleura integrity seems positively impacts short- and long-term outcomes. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) is the most frequent form of valvular heart disease in developed countries, and severe AS is a major cause of morbidity and mortality in the elderly. Since many of these patients often have a high or prohibitive risk for surgical aortic valve replacement (SAVR), transcatheter aortic valve implantation (TAVI) has emerged as an established therapy and is now becoming a common practice, even in low-risk patients. As severe AS and coronary artery disease (CAD) are often concomitant, a matter of debate is whether, how, and when to treat coexisting CAD. The aim of this commentary is to analyze the rationale for the diagnostic evaluation and management of CAD in TAVI candidates, as proposed by the recent EAPCI/ESC consensus statement. [ABSTRACT FROM AUTHOR]

Background Bicuspid aortic valve (BAV) is a common anatomical variation that the aortic valve possesses two functional cusps. Sternal cleft is a rare congenital malformation which is caused by failed fusion of sternal bones. Early surgical repair is advised; otherwise, alternative surgical techniques should be performed. Due to their biocompatibility and elasticity, 3D-printed polyether ether ketone (PEEK) implants can be used. Complete sternal cleft coexistence with BAV is infrequent. Case summary A 49-year-old man with a 6-month history of paroxysmal shortness of breath and exertional chest tightness presented to our hospital. The man was diagnosed with BAV with severe aortic valve regurgitation and a complete sternal cleft. He underwent aortic valve replacement surgery using the bovine pericardial aortic valve. Concurrently, a 3D-printed PEEK implant surgery was performed to address the sternal cleft. The patient's postoperative recovery was uneventful. Discussion In this case, 3D-printed PEEK implants were used for high biocompatibility and elastic modulus. However, because PEEK material inherently lacks biological activity, enhancing this aspect remains a focal point of clinical research. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear. Methods We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Acquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. Results We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P =.01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P <.001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality. Conclusions Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist. [ABSTRACT FROM AUTHOR]

Background and Aims Bicuspid aortic valve (BAV) is the most common congenital heart anomaly. Lifetime morbidity and whether long-term survival varies according to BAV patient-sub-groups are unknown. This study aimed to assess lifetime morbidity and long-term survival in BAV patients in the community. Methods The authors retrospectively identified all Olmsted County (Minnesota) residents with an echocardiographic diagnosis of BAV from 1 January 1980 to 31 December 2009, including patients with typical valvulo-aortopathy (BAV without accelerated valvulo-aortopathy or associated disorders), and those with complex valvulo-aortopathy (BAV with accelerated valvulo-aortopathy or associated disorders). Results 652 consecutive diagnosed BAV patients [median (IQR) age 37 (22–53) years; 525 (81%) adult and 127 (19%) paediatric] were followed for a median (IQR) of 19.1 (12.9–25.8) years. The total cumulative lifetime morbidity burden (from birth to age 90) was 86% (95% CI 82.5–89.7); cumulative lifetime progression to ≥ moderate aortic stenosis or regurgitation, aortic valve surgery, aortic aneurysm ≥45 mm or z-score ≥3, aorta surgery, infective endocarditis and aortic dissection was 80.3%, 68.5%, 75.4%, 27%, 6% and 1.6%, respectively. Survival of patients with typical valvulo-aortopathy [562 (86%), age 40 (28–55) years, 86% adults] was similar to age-sex-matched Minnesota population (P =.12). Conversely, survival of patients with complex valvulo-aortopathy [90 (14%), age 14 (3–26) years, 57% paediatric] was lower than expected, with a relative excess mortality risk of 2.25 (95% CI 1.21–4.19) (P =.01). Conclusion The BAV condition exhibits a high lifetime morbidity burden where valvulo-aortopathy is close to unavoidable by age 90. The lifetime incidence of infective endocarditis is higher than that of aortic dissection. The most common BAV clinical presentation is the typical valvulo-aortopathy with preserved expected long-term survival, while the complex valvulo-aortopathy presentation incurs higher mortality. [ABSTRACT FROM AUTHOR]

Introduction: Permanent pacing indications are common after cardiac surgery and transcatheter structural valve interventions. Leadless pacemakers (LPs) have emerged as a useful alternative to transvenous pacemakers. However, current commercially available LPs are unable to provide atrial pacing or cardiac resynchronization and relatively little is known about LP outcomes after cardiac surgery and transcatheter valve interventions. Methods: This retrospective study included patients who received a Micra VR (MicraTM MC1VR01) or Micra AV (MicraTM MC1AVR1) (Medtronic) leadless pacemaker following cardiac surgery or transcatheter structural valve intervention between September 2014 and September 2022. Device performance and clinical outcomes, including ventricular pacing burden, ejection fraction, and need for conversion to transvenous pacing systems, were evaluated during follow‐up. Results: A total of 78 patients were included, of whom 40 received a Micra VR LP implant, and 38 received a Micra AV LP implant. The mean age of the cohort was 65.9 ± 17.9 years, and 48.1% were females. The follow‐up duration for the entire cohort was 1.3 ± 1.1 years: 1.6 ± 1.3 years for the Micra VR group and 0.8 ± 0.5 years for the Micra AV group. Among the cohort, 50 patients had undergone cardiac surgery and 28 underwent transcatheter structural valve interventions. Device electrical performance was excellent during follow‐up, with a small but clinically insignificant increase in ventricular pacing threshold and a slight decrease in pacing impedance. The mean right ventricle pacing (RVP) burden significantly decreased over time in the entire cohort (74.3% ± 37.2% postprocedure vs. 47.7% ± 40.6% at last follow‐up, p <.001), and left ventricle ejection fraction (LVEF) showed a modest but significant downward trend during follow‐up (55.0% ± 10.6% vs. 51.5% ± 11.2% p <.001). Patients with Micra VR implants had significantly reduced LVEF during follow‐up (54.1% ± 11.9% vs. 48.8% ± 11.9%, p =.003), whereas LVEF appeared stable in the Micra AV group during follow‐up (56.1% ± 9.0% vs. 54.6% ± 9.7%, p =.06). Six patients (7.7%) required conversion to transvenous pacing systems, four who required cardiac resynchronization for drop in LVEF with high RVP burden and two who required dual‐chamber pacemakers for symptomatic sinus node dysfunction. Conclusion: Leadless pacemakers provide a useful alternative to transvenous pacemakers in appropriately selected patients after cardiac surgery and transcatheter structural valve interventions. Device performance is excellent over medium‐term follow‐up. However, a significant minority of patients require conversion to transvenous pacing systems for cardiac resynchronization or atrial pacing support, demonstrating the need for close electrophysiologic follow‐up in this cohort. [ABSTRACT FROM AUTHOR]

Objective • This study aims to compare patient data from two different surgical approaches for minimally invasive valve surgery: hemi-sternotomy and right anterolateral thoracotomy. The primary objective is to determine the safety and efficacy of both surgical incisions. Methods • Between December 2019 and December 2022, a total of 90 patients underwent minimally invasive valve surgery at our center. Among them, 36 patients received the hemi-sternotomy incision with an average age of 45.86 ± 14.83, and 54 patients received the right anterolateral thoracotomy with an average age of 56.77 ± 14.83 years. In the hemi-sternotomy group, 21 patients underwent aortic valve surgery, and 15 had mitral valve surgery, while in the right anterolateral thoracotomy group, 30 patients underwent aortic valve surgery, and 15 patients had mitral valve surgery. Results • No deaths or significant bleeding occurred in the hemi-sternotomy group. However, in the right anterolateral thoracotomy group, one patient died from continuous low cardiac output syndrome after surgery, and one patient suffered a femoral artery dissection. All other patients were discharged without complications. The aortic clamp time and the cardiopulmonary bypass time were significantly lower in the hemi-sternotomy group compared to the right anterolateral thoracotomy group. Conversely, the two groups had no significant differences in intubation time, 24-hour drainage, hospitalization time, and blood transfusion. On the second day after surgery, serum c-TNT and NT-PROBNP levels significantly increased in both groups, but they were significantly higher in the right anterolateral thoracotomy group than in the hemi-sternotomy group. However, on the fifth day after surgery, serum c-TNT and NT-PROBNP levels decreased significantly in both groups, with no significant differences between them. Conclusions • Minimally invasive valve surgery, whether performed with right anterolateral thoracotomy or hemisternotomy, is safe and effective after the learning curve. Patients can benefit from these advances in minimally invasive cardiac surgery, and surgeons can easily master these techniques. [ABSTRACT FROM AUTHOR]

Background: Perfect heart valve prostheses have optimized hemodynamics, reduced surgical morbidity, long-lasting durability, and extended patient survival with greater quality of life. Mechanical valves are recommended; however, young children may need anticoagulant medication for life. In this study, we looked at the success rate and viability of aortic valve neocuspidization (AVNeo) surgery for a variety of aortic disorders. Methods: A methodical search strategy was used to fully evaluate the AVNeo results. Boolean operators were used to combine important words like “Ozaki Procedure,” “Aortic Valve Neocuspidization,” “AVNeo,” and associated terms. Reputable databases such as PubMed, MEDLINE, Embase, Web of Science, and Scopus were the focus of our search. Study quality was assessed using a critical evaluation created with the Critical Appraisal Skills Programme tool. Results: The findings are summarized in the ”Results” section that contains descriptive and critical analysis, ramifications, and explanations. According to research, AVNeo improved valve function and had few side effects. Aortic valve neocuspidization has a lower mean pressure gradient and a larger mean efficient orifice area than Trifecta. Aortic valve neocuspidization surgery reduces aortic valve regurgitation and pressure gradients. Postoperative echocardiograms indicated a decrease in peak and a rise in mean pressure gradient. Conclusion: The Ozaki method restores a healthy laminar flow pattern while preventing bivalvular disease. Ozaki procedure should be explored for valve repair in infants with truncal valve and congenital aortic disease. Aortic valve tricuspidization with glutaraldehyde-treated autologous pericardium results in considerable effective orifice area, modest pressure gradients, and little regurgitation. [ABSTRACT FROM AUTHOR]

Background: Aortic valve replacements (AVRs) are being conducted with minimal risk of complications. Reduced blood loss, shorter hospital stays, preservation of lung function, and lower incidence of atrial fibrillation are all benefits of less invasive techniques created for the benefit of patients. We aimed in this work to compare the outcome of patients undergoing aortic valve replacement in open heart surgeries via standard and mini sternotomy maneuvers (J-shaped). Methods: We conducted a retrospective cohort study for twenty-four cases who had aortic valve disease that necessitates aortic valve surgery at the Cardiothoracic surgery department of Zagazig University Hospital. Twelve patients underwent aortic valve replacement by standard sternotomy and the other twelve patients by mini sternotomy (J shaped to the right third intercostal space). Results: All the total bypass, aortic cross-clamp times, as well as operative times, were significantly longer in the mini-sternotomy group (P< 0.001). Mechanical ventilation (MV) duration as well as hospital stay were significantly shorter in the mini (p values=0.04 and 0.001 respectively) while total drain was significantly higher in the standard group (p=0.001). Post-operative pain score and pethidine dose were significantly higher in the standard sternotomy group. Incidence of infection as well as blood transfusion were significantly higher among the standard group (p=0.02 and 0.007 respectively). Conclusions: Mini sternotomy appears advantageous due to shorter mechanical ventilation times, potentially facilitating quicker postoperative recovery. It may also offer improved postoperative pain control. The patient's preferences, risk considerations, and intended outcomes should all be considered in making the decision. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Aortic valve stenosis (AVS) shares many risk factors with coronary disease, the latter being strongly and inversely associated with physical activity (PA) and cardiorespiratory fitness (CRF). However, the relationship between PA, CRF and AVS needs to be established. We explored whether PA habits and estimated CRF affect the risk of developing AVS demanding aortic valve replacement (AVR) and how these factors affect postoperative mortality. METHODS Participants from the second and third waves of Trøndelag Health Study were cross-linked with a local heart surgery registry and the Norwegian Cause of Death Registry. Estimated CRF was calculated through a developed algorithm based on clinical and self-reported data. Fine-Gray competing risk analyses were used to investigate how PA habits and estimated CRF were associated with the risk of AVR across CRF quintiles, PA groups and per 1-metabolic equivalent task (MET) (3.5 ml/min/kg). RESULTS In a study population of 57 214 participants, we found a 15% [95% confidence interval (CI) 1–27] reduced risk of AVR per 1-MET estimated CRF increment. Those in the highest CRF quintile had a 56% (95% CI 14–77) lower risk of surgery compared to the lowest quintile. Analyses on PA groups did not show significant results. Finally, we found a 37% (95% CI 17–53) lower risk of postoperative mortality per 1-MET increased estimated CRF. CONCLUSIONS Our findings indicate a strong and inverse relationship between estimated CRF and incidence of AVR due to AVS. Higher estimated CRF was associated with lower mortality after surgery. [ABSTRACT FROM AUTHOR]

The complicated interaction between a fluid flow and a deformable structure is referred to as fluid–structure interaction (FSI). FSI plays a crucial role in the functioning of the aortic valve. Blood exerts stresses on the leaflets as it passes through the opening or shutting valve, causing them to distort and vibrate. The pressure, velocity, and turbulence of the fluid flow have an impact on these deformations and vibrations. Designing artificial valves, diagnosing and predicting valve failure, and improving surgical and interventional treatments all require the understanding and modeling of FSI in aortic valve dynamics. The most popular techniques for simulating and analyzing FSI in aortic valves are computational fluid dynamics (CFD) and finite element analysis (FEA). By studying the relationship between fluid flow and valve deformations, researchers and doctors can gain knowledge about the functioning of valves and possible pathological diseases. Overall, FSI is a complicated phenomenon that has a great impact on how well the aortic valve works. Aortic valve diseases and disorders can be better identified, treated, and managed by comprehending and mimicking this relationship. This article provides a literature review that compiles valve reconstruction methods from 1952 to the present, as well as FSI modeling techniques that can help advance valve reconstruction. The Scopus, PubMed, and ScienceDirect databases were used in the literature search and were structured into several categories. By utilizing FSI modeling, surgeons, researchers, and engineers can predict the behavior of the aortic valve before, during, and after surgery. This predictive capability can contribute to improved surgical planning, as it provides valuable insights into hemodynamic parameters such as blood flow patterns, pressure distributions, and stress analysis. Additionally, FSI modeling can aid in the evaluation of different treatment options and surgical techniques, allowing for the assessment of potential complications and the optimization of surgical outcomes. It can also provide valuable information on the long-term durability and functionality of prosthetic valves. In summary, fluid–structure interaction modeling is an effective tool for predicting the outcomes of aortic valve surgery. It can provide valuable insights into hemodynamic parameters and aid in surgical planning, treatment evaluation, and the optimization of surgical outcomes. [ABSTRACT FROM AUTHOR]