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Background Quantifying the fibrotic and calcific composition of the aortic valve at CT angiography (CTA) can be useful for assessing disease severity and outcomes of patients with aortic stenosis (AS); however, it has not yet been validated against quantitative histologic findings. Purpose To compare quantification of aortic valve fibrotic and calcific tissue composition at CTA versus histologic examination. Materials and Methods This prospective study included patients who underwent CTA before either surgical aortic valve replacement for AS or orthotopic heart transplant (controls) at two centers between January 2022 and April 2023. At CTA, fibrotic and calcific tissue composition were quantified using automated Gaussian mixture modeling applied to the density of aortic valve tissue components, calculated as [(volume/total tissue volume) × 100]. For histologic evaluation, explanted valve cusps were stained with Movat pentachrome as well as hematoxylin and eosin. For each cusp, three 5-µm slices were obtained. Fibrotic and calcific tissue composition were quantified using a validated artificial intelligence tool and averaged across the aortic valve. Correlations were assessed using the Spearman rank correlation coefficient. Intermodality and interobserver variability were measured using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results Twenty-nine participants (mean age, 63 years ± 10 [SD]; 23 male) were evaluated: 19 with severe AS, five with moderate AS, and five controls. Fibrocalcific tissue composition strongly correlated with histologic findings ( r = 0.92; P < .001). The agreement between CTA and histologic findings for fibrocalcific tissue quantification was excellent (ICC, 0.94; P = .001), with underestimation of fibrotic composition at CTA (bias, -4.9%; 95% limits of agreement [LoA]: -18.5%, 8.7%). Finally, there was excellent interobserver repeatability for fibrotic (ICC, 0.99) and calcific (ICC, 0.99) aortic valve tissue volume measurements, with no evidence of a difference in measurements between readers (bias, -0.04 cm 3 [95% LoA: -0.27 cm 3 , 0.19 cm 3 ] and 0.02 cm 3 [95% LoA: -0.14 cm 3 , 0.19 cm 3 ], respectively). Conclusion In a direct comparison, standardized quantitative aortic valve tissue characterization at CTA showed excellent concordance with histologic findings and demonstrated interobserver reproducibility. Clinical trial registration no. NCT06136689 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almeida in this issue.

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., (© 2024. The Author(s).)

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively ( p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter ( p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality ( p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.

Objectives: Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI., Methods: The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper., Results: A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048)., Conclusions: Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to compare the safety and clinical outcomes of transcarotid (TC) and transapical access (TA) transcatheter aortic valve implantation (TAVI) patients whom the transfemoral approach (TF) was not feasible., Methods: The analysis included consecutive patients with severe symptomatic aortic stenosis treated from 2017 to 2020 with TC-TAVI or TA-TAVI in two high-volume TAVI centers. The approach was selected by multidisciplinary heart teams after analyzing multislice computed tomography of the heart, aorta and peripheral arteries, transthoracic echocardiography and coronary angiography., Results: One hundred and two patients were treated with alternative TAVI accesses (TC; n = 49 and TA; n = 53) in our centers. The groups were similar regarding age, gender, New York Heart Association class, and echocardiography parameters. Patients treated with TC-TAVI had significantly higher surgical risk. The procedural success rate was similar in both groups (TC-TAVI 98%; TA-TAVI 98.1%; p = 0.95). The rate of Valve Academic Research Consortium-2 defined clinical events was low in both groups. The percentage of new-onset rhythm disturbances and permanent pacemaker implantation was similar in TC and TA TAVI (4.1% vs. 11.3%; p = 0.17 and 10.2% vs. 5.7%; p = 0.39, respectively). In the TA-TAVI group, significantly more cases of pneumonia and blood transfusions were observed (11% vs. 0%; p = 0.01 and 30.2% vs. 12.2%; p = 0.03). The 30-day mortality was similar in TC and TA groups (4.1% vs. 5.7%; p = 0.71, respectively)., Conclusions: Both TC and TA TAVI are safe procedures in appropriately selected patients and are associated with a low risk of complications.

Background: Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce., Objectives: This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR., Methods: Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke., Results: A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95% CI 1.01-11.8, p = 0.04). At a median of 3.5 years [interquartile range ( IQR ) 1.3-5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% ( HR 0.82, 95% CI 0.52-1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95% CI 0.81-3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95% CI 0.15-1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95% CI 0.45-7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95% CI 0.15-0.85, p = 0.02)., Conclusions: This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR., Visual Overview: A visual overview is available for this article., Registration: https://www.clinicaltrials.gov; Unique identifier: NCT04968977., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wańha, Bil, Kołodziejczak, Kowalówka, Kowalewski, Hudziak, Gocoł, Januszek, Figatowski, Milewski, Tomasiewicz, Kübler, Hrymniak, Desperak, Kuźma, Milewski, Góra, Łoś, Kulczycki, Włodarczak, Skorupski, Grygier, Lesiak, D'Ascenzo, Andres, Kleczynski, Litwinowicz, Borin, Smolka, Reczuch, Gruchała, Gil, Jaguszewski, Bartuś, Suwalski, Dobrzycki, Dudek, Bartuś, Ga̧sior, Ochała, Lansky, Deja, Legutko, Kedhi and Wojakowski.)

Introduction: Transcatheter aortic valve‑in ‑valve implantation (ViV‑TAVI) has emerged as an alternative to redo surgery in patients with failed surgical aortic bioprosthesis., Objectives: We evaluated the safety and efficacy of ViV‑TAVI in Polish patients after surgical aortic valve replacement., Patients and Methods: This was a nationwide multicenter registry of ViV‑TAVI procedures. Data were collected using an online form, and the clinical follow ‑up lasted 1 year., Results: From 2008 to 2020, 130 ViV‑TAVI procedures were performed (1.9% of all transcatheter aortic valve implantation [TAVI] cases). A considerable increase in ViV‑TAVI procedures since 2018 has been observed (n = 59, 45% of ViV‑TAVI cases). Hancock II, Freestyle, and homograft were the most frequently treated bioprostheses. The self ‑expanding supra ‑annular Corevalve / Evolut valve was used in 76% of cases. In 21% of cases, the mean postprocedural pressure gradient (PG) exceeded 20 mm Hg. All‑cause mortal‑ity at 1 year was 10.8%. Aortic valve stenosis was associated with a higher mean PG than aortic valve regurgitation or mixed disease (P = 0.004). Supra ‑annular transcatheter aortic valves were associated with lower mean PGs than intra ‑annular valves (P = 0.004). Second ‑generation devices were associated with shorter procedure time (120 min vs 135 min, P = 0.04), less frequent need for additional TAVI (2% vs 10%, P = 0.04), and lower 1‑year cardiovascular mortality (95% vs 82.8%, P = 0.03) than first‑generation valves., Conclusions: Transcatheter treatment of failed bioprostheses is increasingly common, with the best hemodynamic effect shown for supra ‑annular valves. The introduction of second‑generation valves has improved procedural and clinical outcomes.

Background: The treatment of aortic root aneurysm remains challenging for both cardiac surgeons and cardiologists., Aims: This study aimed to assess and compare the long-term outcomes of different approaches to aortic root replacement (ARR)., Methods: All elective patients operated for aortic root aneurysm with or without aortic regurgitation at our institution over a 10-year period were included. We excluded patients with any degree of aortic stenosis and with active endocarditis. We assessed mortality, freedom from reoperation, freedom from aortic valve regurgitation, and the rate of hemorrhagic and thromboembolic complications., Results: Two hundred and four patients underwent elective aortic root replacement: 107 (53%) valve-sparing aortic root replacement (VSARR), 35 (17%) mechanical Bentall procedure (MB), and 62 (30%) Bio-Bentall procedure (BB). Early mortality for VSARR, BB, and MB group was 2.8%, 4.8%, and 0%, respectively (P = 0.40). Estimated 5-year survival was: 90.2% vs. 78.4% vs. 94.2%, respectively (P = 0.12), 5-year freedom from reoperation: 97.8%, 96.6%, and 96.8%, respectively (P = 0.99). Estimat-ed 5-year freedom from complications was: 94.2%, 83.1% and 57.3% in the VSARR, BB and MB group, respectively (P <0.001). On last follow-up echocardiography, 90.5%, 98.4%, and 97.1% (P = 0.08) of patients were free from aortic regurgitation grade 2 or higher. The median (IQR) aortic valve peak gradient was 9 (6-12) mm Hg, 12 (10-18) mm Hg and 16 (14-22) mm Hg, respectively (P <0.001). Complications were predicted by mechanical Bentall (hazard ratio, 6.70 [2.54-17.63]; P <0.001)., Conclusion: With the same mortality, freedom from reoperation, and a minimal late complication rate in comparison with mechanical Bentall and Bio-Bentall, VSARR might be the preferred approach to aortic root aneurysm.

Core temperature reflects the temperature of the internal organs. Proper temperature measurement is essential to diagnose and treat temperature impairment in patients. However, an accurate approach has yet to be established. Depending on the method used, the obtained values may vary and differ from the actual core temperature. There is an ongoing debate regarding the most appropriate anatomical site for core temperature measurement. Although the measurement of body core temperature through a pulmonary artery catheter is commonly cited as the gold standard, the esophageal temperature measurement appears to be a reasonable and functional alternative in the clinical setting. This article provides an integrative review of invasive and noninvasive body temperature measurements and their relations to core temperature.

Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome., Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline., Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased -2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors' group ( p = 0.024), it increased 1.44 ± 6.41 mmol/L., Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.

Background: Conduction disturbances necessitating permanent pacemaker (PPM) implantation after cardiac surgery occur in 1% to 5% of patients. Previous studies have reported a low rate of late PPM dependency, but there is lack of evidence that it might be related to implantation timing. In this study, we sought to determine whether PPM implantation timing and specific conduction disturbances as indications for PPM implantation are associated with late pacemaker dependency and recovery of atrioventricular (AV) conduction., Methods: Patients with a PPM implanted after cardiac surgery were followed in an outpatient clinic. Two outcomes were assessed: AV conduction recovery and PPM dependency, defined as the absence of intrinsic rhythm on sensing test in VVI mode at 40 bpm., Results: Of 15,092 patients operated between September 2008 and March 2019, 185 (1.2%) underwent PPM implantation. One hundred seventy-seven of these patients met the criteria for inclusion into this study. Follow-up data were available in 145 patients (82%). Implantation was performed at ≤6 days after surgery in 58 patients (40%) and at >6 days after surgery in 87 patients (60%). The median time from implantation to last follow-up was 890 days (range, 416-1998 days). At follow-up, 81 (56%) patients were not PPM dependent. Multivariable analysis showed that PPM implantation at ≤6 days after surgery is a predictor of being not PPM dependent (odds ratio [OR], 5.40; 95% confidence interval [CI], 2.43-12.04; P < .001) and of AV conduction recovery (OR, 4.96; 95% CI, 2.26-10.91; P < .001). Sinus node dysfunction as indication for PPM implantation was predictive of being not PPM dependent (OR, 6.59; 95% CI, 1.67-26.06; P = .007)., Conclusions: We recommend implanting a PPM on postoperative day 7 to prevent unnecessary implantations and avoid prolonged hospitalization., (Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Open aortic arch surgery is a complex cardiac surgical procedure., Aim: We reviewed the 10-year outcomes of elective aortic arch aneurysm surgery in a single cardiac surgical center., Material and Methods: The analysis includes all patients who underwent elective aortic arch surgery at our institution between January 2010 and December 2020. The study population was divided into group A consisting of patients operated on during the first 5 years, and group B, including patients operated on during the subsequent 5 years. The groups were compared with regard to baseline characteristics, scope of the surgery, operative and postoperative data as well as morbidity and mortality., Results: Eighty-six elective aortic arch procedures were performed during the analyzed period, including 25 (29%) patients in group A and 61 (71%) patients in group B. The hemiarch procedure was more frequently performed in group A (17 patients, 68%) in comparison to group B (21 patients, 34%) ( p = 0.008). Stroke was recorded in 6 (20%) patients from group A and 5 (8.2%) patients from group B ( p = 0.002). Five-year survival was 60 ±9.8% for group A, and 81 ±6.2% for group B (log-rank test, p = 0.003)., Conclusions: After completion of the learning curve, open aortic arch surgery is associated with acceptable early mortality, low incidence of stroke, and a high 5-year survival rate., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Purpose: We propose a novel technique for reconstruction of the dissected aortic root with the use of TachoSil fibrin sealant patch., Methods: Patients with acute type A aortic dissection involving the aortic root were included. Appropriately prepared TachoSil fibrin sealant patch was placed between the dissected layers of the aortic root to achieve their durable fusion. Thus, the false lumen was eliminated, and the anatomical and functional structure of the aortic wall was restored., Results: In all, 13 patients mean aged 57 ± 10.3 years underwent surgery for acute type A aortic dissection with the use of TachoSil fibrin sealant patch. All patients survived the surgery. The mean follow-up time was 30.8 ± 16.4 months. Follow-up computed tomography angiography (CTA) scans confirmed no aortic root dissection in all patients., Conclusions: This technique ensures durable restoration of the aortic wall structure, eliminates the secondary aortic valve regurgitation, and allows for the preservation of patients' native aortic valve.

Hypothermia is defined as a decrease in body core temperature to below 35 °C. In cardiac surgery, four stages of hypothermia are distinguished: mild, moderate, deep, and profound. The organ protection offered by deep hypothermia (DH) enables safe circulatory arrest as a prerequisite to carrying out cardiac surgical intervention. In adult cardiac surgery, DH is mainly used in aortic arch surgery, surgical treatment of pulmonary embolism, and acute type-A aortic dissection interventions. In surgery treating congenital defects, DH is used to assist aortic arch reconstructions, hypoplastic left heart syndrome interventions, and for multi-stage treatment of infants with a single heart ventricle during the neonatal period. However, it should be noted that a safe duration of circulatory arrest in DH for the central nervous system is 30 to 40 min at most and should not be exceeded to prevent severe neurological adverse events. Personalized therapy for the patient and adequate blood temperature monitoring, glycemia, hematocrit, pH, and cerebral oxygenation is a prerequisite and indispensable part of DH.

Objectives: The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair., Methods: We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified., Results: From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44-56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96-37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99-9.58); P = 0.053]., Conclusions: BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Introduction: Transfemoral access (TF) is the preferred access for transcatheter aortic valve implantation (TAVI). Transcarotid TAVI (TC-TAVI) is an alternative for patients in whom TF-TAVI is impossible. Two types of valves - balloon-expandable (BE) and self-expandable (SE) - can be used in TC-TAVI procedures., Aim: Comparison of the short-term results of patients treated with TC-TAVI using BE and SE valves., Material and Methods: The retrospective registry included 39 patients in whom the TC-TAVI procedure was performed between 2017 and 2020 (BE-TAVI; n = 10, SE-TAVI; n = 29). Preoperative characteristics, operative and postoperative results, and 30-days mortality were compared., Results: Patients from the BE-TAVI group had higher surgical risk (EuroSCORE) (10.8% (6.2-14.0) vs. 5.5% (4.3-8.7); p = 0.027). The incidence of chronic obstructive pulmonary disease (COPD) was higher in the SE-TAVI group (34.5% vs. 0%; p = 0.040). In terms of other comorbidities, demographics, preprocedural laboratory results, transthoracic echocardiography (TTE), and multislice computed tomography (MSCT), the two groups were comparable. In both groups, we observed 100% procedural success. The median valve size was larger in the SE-TAVI group (29.0 (26.0-29.0) vs. 26.0 (23.0-26.0); p < 0.001). The hospitalization time was shorter in the BE-TAVI group vs. SE-TAVI (5.8 ±0.6 vs. 6.4 ±0.9; p = 0.043). We did not observe statistically significant differences between BE-TAVI and SE-TAVI in periprocedural and 30-day mortality, or the number of strokes/TIA. Also TTE parameters and NYHA class showed similar improvement at 30 days in both groups., Conclusions: TC-TAVI using balloon-expandable and self-expandable valves showed similar safety and efficacy in 30 days follow-up., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia Sp. z o. o.)

Background: Transfemoral access is the preferred approach for transcatheter aortic valve implantation (TAVI), as it is characterized by the lowest complication rate. In the majority of patients ineligible for transfemoral access, the transcarotid approach can be used., Aims: This study aimed to compare short‑term outcomes in 2 groups of patients treated with transcarotid or transfemoral TAVI., Methods: A retrospective comparison included 265 patients in whom the TAVI procedure was performed between 2017 and 2019 (transcarotid TAVI, n = 33; transfemoral TAVI, n = 232). Preoperative characteristics, procedural and postprocedural outcomes, as well as 30‑day mortality were assessed., Results: Compared with the transfemoral TAVI group,patients undergoing transcarotid TAVI presented with a higher New York Heart Association (NYHA) functional class (median [interquartile range (IQR)], 3 [3-3] vs 2 [2-3]; P <0.001), a higher surgical risk (median [IQR] EuroSCORE II, 6 [4.8-10.7] vs 4.8 [2.8-7.9]; P = 0.003), and a higher incidence of peripheral artery disease (36.4% vs 18.1%; P = 0.035). The median (IQR) procedure duration in the transcarotid TAVI group was shorter than in patients undergoing transfemoral TAVI (65 [60-80] min vs 90 [80-110] min; P <0.001, respectively). In both study groups, we noted a high percentage of procedural success (transcarotid vs transfemoral TAVI, 96.9% vs 97.2%; P = 0.66). We found no significant differences between transcarotid TAVI and transfemoral TAVI in terms of periprocedural and 30‑day mortality as well as the number of strokes. Regardless of the access route chosen, echocardiographic parameters and the NYHA class similarly improved compared with preprocedural data., Conclusions: Despite posing a higher baseline risk and presenting a greater anatomic complexity, transcarotid access is safe and associated with 30‑day outcomes similar to those observed for transfemoral access. Importantly, procedural time was short and no periprocedural strokes or vascular complications were reported.

Background: Valve-sparing aortic root replacement (VSARR) techniques are an alternative to the classic Bentall procedure when aortic root aneurysm is not accompanied by aortic valve stenosis, and the regurgitant aortic valve is amenable to repair., Aims: The aim of the study was to assess long -term outcomes of valve sparing aortic root replacement using the David technique and the Yacoub technique., Methods: A total of 101 consecutive, elective VSARR procedures were performed from January 2010 to April 2020 including 52 David procedures (51.5%) and 49 Yacoub procedures (48.5%). We analyzed mortality, freedom from reoperation, and freedom from aortic valve regurgitation. The analysis was performed for the entire study cohort and for 2 subgroups: the David technique and the Yacoub technique., Results: The mean (SD) age was 50.2 (16.1) years; 90 (89.1%) patients were male. The median (interquartile range [IQR]) EuroScore II was 3.7 (2.7‒5.8). At 1, 5, and 8 years after surgery, survival (SE) was 98% (3%), 91.8% (8%), and 91.8% (8%), respectively, whereas freedom from reoperation (SE) was 100%, 97% (3%), and 97% (3%), respectively. Follow‑up echocardiography performed at a median (IQR) of 18.7 (2.5‒36.7) months postsurgery revealed freedom from aortic valve regurgitation in 90.8% of patients. No significant differences in mortality, freedom from reoperation, and freedom from aortic valve regurgitation were noted between the David and Yacoub subgroups., Conclusions: VSARR is a safe and effective surgical technique in patients with aortic root aneurysm, as the associated mortality, reoperation rate, and aortic valve regurgitation recurrence are low.

Introduction: Over the last two decades transcatheter aortic valve replacement (TAVR) has been approved for clinical use. The anaesthetic choice for this procedure is evolving. General anaesthesia was the predominant anaesthetic technique. Growing experience and advances in technology and economic considerations have led to an increasing interest in performing TAVR under monitored sedation., Aim: The assessment of monitored sedation, called cooperative sedation, involves pharmacologically mediated suppression of consciousness and preservation of verbal contact in response to stimulation as a safe method of anaesthesia for TAVR., Material and Methods: Sixty out of 63 TAVR patients with femoral access received monitored sedation. Dexmedetomidine was administered in most of such cases (46 patients). A questionnaire was also carried out by staff involved in performing TAVR procedures, with more than 5 years of experience in it, concerning the method of anaesthesia and perioperative care., Results: Conversion to general anaesthesia was required in 10% of patients (6 cases), only one as a patient-related complication (hypercarbia). The questionnaire carried out showed that anaesthesia and postoperative care after TAVR are underestimated., Conclusions: The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed., Competing Interests: The authors report no conflict of interest., (Copyright: © 2021 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Background: Over the last years, aortic valve repair has evolved from being a random and irreproducible procedure to a standardized technique yielding durable long‑term results., Aims: The aim of the study was to assess long‑term outcomes of aortic valve repair and aortic valve sparing procedures., Methods: We analyzed the outcomes of all consecutive patients who underwent aortic valve repair and/ or aortic valve sparing root replacement till the end of 2019. We assessed mortality, freedom from reoperation, and freedom from at least moderate aortic valve regurgitation., Results: A total of 504 patients underwent aortic valve repair and/or aortic valve sparing root replacement over 17 years, including 452 (89.7%) elective and 52 (10.3%) emergency surgeries for acute type A aortic dissections. Median (interquartile range) age was 59 (35-66) years, 72.4% were male. Median follow‑up time was 35 months. Estimated 5‑year survival was 83%, and 10‑year survival was 73%. In 452 patients after elective surgery, the estimated actuarial 5‑year and 10‑year survival was 86% and 75%, respectively. In patients after emergency surgery for acute type A aortic dissection, actuarial 5‑year survival was 62%, and 10‑year survival was 62%. Estimated 5- and 10‑year freedom from reoperation was 96% and 87%, respectively. The comparison of both subgroups did not reveal differences (P = 0.42). Freedom from at least moderate aortic valve regurgitation was confirmed in 86.6% of patients., Conclusions: Aortic valve repair is a durable and effective surgical procedure associated with low early and late mortality. Aortic valve reconstruction in patients with acute type A aortic dissection yields good long‑term results.

Background: The aim of the study was to assess safety TAVI procedure through the common carotid artery in high-vascular-risk patients., Methods: The approach was selected by a multidisciplinary (cardiologists and cardiac surgeons) heart team after analyzing preoperative coronary angiography, transthoracic echocardiography and multislice contrast computed tomography of the peripheral arteries. Patients with the following conditions were qualified to the transcarotid access: severe peripheral artery disease (stenotic, heavily calcified), tortuous or small diameter <6 mm iliofemoral arteries, descending and abdominal aortic disease., Results: Ten transcarotid transcatheter aortic valve implantation procedures were performed in our hospital from September 2017 to May 2018. There were no in-hospital deaths or strokes. The procedural success rate defined as the implantation of the valve with no coronary obstruction and less than moderate paravalvular leak was 100%. Parameters of regional cerebral oximetry were symmetrical on the left and right side in all cases and only during rapid ventricular pacing transiently decreased below the value of 50%. Postoperative cerebrovascular complications and myocardial infarctions were not observed. Statistically significant reduction of the echocardiographic parameters (PGmax and PGmean, Vmax) were observed. Mild paravalvular leaks occurred in 4 patients. Additionally, the heart failure symptoms diminished after the procedure from a median class III to class II. In the 3-month follow-up, mortality is 10% (unknown cause of death of one patient). The mean NYHA class of the other patients is II. Echocardiographic parameters are comparable to postoperative day 4., Conclusions: The pilot registry showed the safety of transcarotid approach in patients with the anatomy precluding the transfemoral approach.

Introduction: Transcatheter paravalvular leak closure (TPVLC) has become an established treatment option but is mostly performed with off-label use of different non-dedicated occluders. The first one specifically designed for TPVLC is the paravalvular leak device (PLD - Occlutech)., Aim: We present initial short-term results of a prospective registry intended to assess the safety and efficacy of TPVLC with PLD., Material and Methods: We screened patients with paravalvular leak (PVL) after surgical valve replacement (SVR). Heart failure symptoms and/or hemolytic anemia were indications for TPVLC. Patients were selected according to PVL anatomy by RT 3D TEE. Only those considered appropriate for closure with a single PLD were enrolled. The procedures were performed via transvascular or transapical access using type W (waist) PLDs only., Results: Thirty patients with 34 PVLs (18 aortic, 16 mitral) were included. We implanted 35 PLDs with a total device success rate of 94.3% (100% for aortic, 88.2% for mitral). The procedural success rate, encompassing device success without in-hospital complications, was 94.1% (100% for aortic, 93.8% for mitral). During the follow-up period we recorded an increase of hemoglobin concentration (3.9 to 4.1 g/dl), red blood count (11.6 to 12.2 M/mm(3)) and functional improvement by NYHA class., Conclusions: Paravalvular leak device type W is a promising TPVLC device, but meticulous preselection of patients based on imaging of PVL anatomy is a prerequisite. A PLD should only be chosen for channels shorter than 5 mm. Size of the device should match the PVL cross-sectional area without any oversizing. Such an approach facilitates high device and procedural success rates.

Introduction: Paravalvular leak (PVL) may complicate cardiac valve replacement surgery. Radical treatment is required if a PVL produces heart failure (HF) symptoms or severe hemolysis. Even though transcatheter PVL closure (TPVLC) has become a valid alternative to reoperation, a number of anatomical conditions may prove technically challenging for transvascular access. We intended to verify the utility of transapical access in such settings., Methods: We report a prospective series of 7 patients with mitral PVLs who underwent transapical TPVLC. The Heart Team made the choice of treatment and Amplatzer Vascular Plug III devices were used off-label as occluders., Results: Transapical TPVLC enabled excellent sealing of mitral PVL in 6 cases. This resulted in HF symptom reduction and decreased NT-proBNP plasma concentration. No procedure-related complications occurred., Conclusions: Transapical access seems to be an efficient and safe alternative for transvascular approach for mitral TPVLC, but further technical development is still needed.

Objective: This trial was undertaken to determine the safety and efficacy of preoperative aspirin administration in a contemporary cardiac surgical practice setting., Methods: This randomized, double-blind, parallel-group, single-center trial involved patients with stable coronary artery disease who were assigned to receive either 300 mg of aspirin or placebo the night before coronary bypass surgery. Using a random digit table, patients were allocated to receive the tablet from 1 of the 40 coded bottles containing either aspirin or placebo. Patients, surgeons, anesthetists, and investigators were all masked to treatment allocation. The primary safety end points were as follows: more than 750 mL of bleeding during the first postoperative 12 hours and more than 1000 mL of total discharge from the chest drains. The secondary efficacy end point was a composite of cardiovascular death, myocardial infarction, or repeat revascularization., Results: A total of 390 patients were allocated to aspirin (387 analyzed) and 399 to placebo (396 analyzed). The follow-up median was 53 months. Fifty-four placebo recipients and 86 aspirin recipients bled more than 750 mL in the first 12 hours (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25-2.63), while total chest drain discharge was above 1000 mL in 96 placebo and 131 aspirin recipients (OR, 1.60; 95% CI, 1.17-2.18). Preoperative aspirin decreased the long-term hazard of nonfatal coronary event (infarction or repeat revascularization)-hazard ratio (HR), 0.58 (95% CI, 0.33-0.99)--and tended to decrease the hazard of a major cardiac event (cardiovascular death, infarction, or repeat revascularization--HR, 0.65 [95% CI, 0.41-1.03])., Conclusions: Performing coronary grafts on aspirin is associated with increased postoperative bleeding but may decrease the long-term hazard of coronary events., (Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)