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Currently, aortic valve (AV) disease is the most common reason for heart valve surgery. The gold standard of care for people with aortic pathology is thought to be AV replacement. The issue of prosthesis selection has always been important. Although mechanical prosthesis are robust, lifelong anticoagulation medication is necessary due to the significant risk of thromboembolic consequences. Biological prostheses have a flow structure that is similar to the physiological one, and as malfunction gradually sets in, scheduled recurrent surgery can be carried out. The purpose of this study is to evaluate the short- and long-term effects of biological prosthetic aortic valve replacement (AVR) in elderly individuals. The study included 198 patients with AV pathology [85 men (42.9%)/113 women (57.1%)]. The median age was 70 [66–73] years. There were 175 (88.4%) patients with degenerative AV, 5 (2.5%) with infective endocarditis, and 30 patients (15.2%) had bicuspid AV. The median follow-up period was 26.3±1.4 months. Hospital mortality was 4.5%. No wound complications were detected. Thirty-one patients died in the long-term period. The causes of lethality were: cardiovascular disease (13 patients), malignant neoplasm (5 patients), gastrointestinal disease (2 patients), urinary system disease (1 patient), COVID-19 (1 patient), unknown cause (9 patients). Thus, the five-year postoperative survival rate was 63%, respectively. Throughout the observation period, two patients (2.9%) underwent reoperation on AV. 97.1% of patients were free of reoperation after five years. The five-year survival rate was 63% due to the history of severe concomitant pathology and mean age of the patients of 70 years.

Background: The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. Materials and methods: We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. Results: In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0–13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. Conclusion: The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.

OBJECTIVES Extended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery. METHODS A systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020. RESULTS Our search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy. CONCLUSION XR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance., Extended reality (XR), encompassing both virtual (VR) and augmented reality (AR), allows the user to interact with a computer-generated environment based on reality.

BACKGROUND: The use of left ventricular assist devices (LVAD) in patients with advance heart failure is still associated with an important risk of immune dysregulation and infections. The aim of this study was to determine whether extracorporeal blood purification using the CytoSorb device benefits patients after LVAD implantation in terms of complications and overall survival.MATERIALS AND METHODS: Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation, of whom 72 underwent CytoSorb therapy and 135 did not. Overall survival, major adverse events, and laboratory parameters were compared between 112 propensity score-matched patients (CytoSorb: 72 patients; non-CytoSorb: 40 patients).RESULTS: WBC (p = .033), CRP (p = .001), and IL-6 (p < .001), significantly increased with LVAD implantation, while CytoSorb did not influence this response. In-hospital mortality and overall survival during follow-up were similar with CytoSorb. However, patients treated with CytoSorb were more likely to develop respiratory failure (54.2% vs. 30.0%, p = .024), need mechanical ventilation for longer than 6 days post-implant (50.0% vs. 27.5%, p = .035), and require tracheostomy during hospitalization (31.9% vs. 12.5%, p = .040). No other significant differences were observed with regard to major adverse events during follow-up.CONCLUSIONS: Overall, our results showed that CytoSorb might not convey a significant morbidity or mortality benefit for patients undergoing LVAD implantation.

Background: There is an ongoing debate about the influence of the female gender on postoperative outcomes after durable left ventricular assist device (LVAD) implantation. Despite the differences in pathophysiology of heart failure in females, therapy concepts are the same as in the male population. The aim of this study was to investigate the role of the female gender in surgical heart failure therapy. Materials and methods: Between August 2010 and January 2020, 207 patients were treated with durable LVAD at out institution. We matched 111 patients in two groups to compare the outcomes in male and female patients and to stratify the risk factors of mortality. Results: The groups were matched 2:1 and were comparable after matching. We found no difference in in-hospital and follow-up mortality between male and female patients. Postoperative adverse events and complications were found to be unvaried across male and female patients. Female patients had higher rates of postoperative LVAD-thrombosis compared to their male counterparts (13.5% vs 0, p = 0.001) and the rates of renal replacement therapy lasting over 90 days were also higher in the female group (33.8% vs 56.8%, p = 0.021). Furthermore, the female gender was not an independent predictor neither of in-hospital nor follow-up mortality. Conclusions: Durable continuous flow left ventricular assist devices as a bridge to transplantation or recovery in female patients are associated with a higher risk of acute kidney injury requiring RRT and are at a higher risk of LVAD-thrombosis. Nevertheless, survival rates between genders are similar.

Background: Aortic root aneurysms are traditionally treated by open surgery methods, which significantly increase the risk of postoperative complications. Elderly patients with a history of previous cardiac surgery have a higher risk of postoperative events and demand more careful supervision during hospitalization. Materials & Methods: We report a case of a 72‐year‐old female patient with aortic root aneurysm and a previous history of cardiac surgery (CABG) with a high risk for EuroSCORE II (15,52%). The postoperative period was uneventful. Discussion and Conclusion: We use this case to discuss the effectiveness and short‐term results of this procedure in patients with high risk. Keywords: aortic aneurysm, CABG, hemiarch reconstruction

Introduction Transcatheter aortic valve implantation (TAVI) techniques are increasingly being adopted into clinical routine for various risk groups. Coronary artery disease (CAD) is seen in up to 75% of patients with severe aortic valve stenosis (AS) presenting with typical angina pectoris. Due to high mortality rates and procedural complications in these patients, a hybrid concept of simultaneous transaortic TAVI and off-pump coronary artery bypass (OPCAB) can be a feasible treatment option. Methods Between April 2014 and July 2020, 10 consecutive high-risk patients underwent concomitant transaortic TAVI and OPCAB at our institution. All indications were discussed in Heart Team and decisions were made based on patients' comorbidities and complexity of CAD. The study endpoints were 30-day mortality, device success, and development of postoperative adverse events defined by the Valve Academic Research Consorium. Results The mean age of the patients was 77.9 ± 7.1 years old. All patients presented with multiple comorbidities (mean logistic EuroSCORE 26.5 ± 12.3%, median EuroSCORE II 5.13% [interquartile range 4.2-9.5], mean STS-Score 6.04 ± 1.6%). Five patients (50%) presented with porcelain aorta. No conversion to conventional procedures was needed. 30-day mortality occurred in one patient (10%). Complete revascularization was achieved in seven (70%) of the patients. Device success rate was 100%. No paravalvular leakage was detected. No stroke, myocardial infarction or vascular complications were observed. Conclusions A hybrid approach combining transaortic TAVI and OPCAB might be a safe and feasible method of treatment in high-risk patients presenting with severe AS and CAD who are not eligible for conventional surgical or interventional solutions.

Objectives The aim of this study was to evaluate early results of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) versus redo surgical aortic valve replacement (SAVR) fo...

In rare cases of extensive aortic root or mitral valve infective endocarditis (IE), severe calcification of the aortic and mitral valves, or double-valve procedures in patients with small aortic and mitral annuli, surgical reconstruction of the intervalvular fibrous body (IVFB) is required. A high mortality is generally associated with this procedure, and it is frequently avoided by surgeons due to a lack of experience. It is crucial to radically resect all tissues that are severely affected by IE to prevent recurrence in the patient. Our experience with the Commando procedure in patients with extensive double-valve IE involving the IVFB is presented in this article.

Background: Patients with aortic stenosis (AS) and small aortic annulus (SAA) who undergo surgical aortic valve replacement (SAVR) are more likely to receive smaller prostheses, predisposing them to prosthesis patient-mismatch (PPM). Since the Ozaki Procedure (aortic valve neocuspidization–AVNeo) has proved promising, we aimed to assess its immediate results in this scenario. Methods: AVNeo was performed in 106 consecutive patients from January 2017 to March 2019 at three centers. The records were prospectively collected and reviewed retrospectively. Most of the patients were older than 60 years and 97.2% had AS. Preoperative echocardiography showed average peak pressure gradient of 64.9±20.7mmHg and mean pressure gradient of 46.0±12.2mm Hg for patients with AS and an annular diameter of 19.8±1.1mm for all patients. EOA and iEOA averaged 0.7±0.2 cm2 and 0.4±0.2cm2/m2 before surgery, respectively. Results: There was no conversion to SAVR. Four patients needed reoperation for bleeding, but none needed reoperation due to early infective endocarditis. Median intensive care unit and hospital length of stay were 1.5±1.2 and 13.7± 5.1 days, respectively. There were 2 in-hospital deaths due to non-cardiac causes. Postoperative peak pressure gradient averaged 11.8±5.9mmHg and mean pressure gradient averaged 7.3±3.5mmHg, which means statistically significant average decreases of 58.1 and 38.7 mmHg, respectively. Postoperative EOA and iEOA averaged 2.5±0.4cm2 and 1.3±0.3cm2/m2, which means statistically significant average increases of 1.8cm2 and 0.9cm2/m2, respectively. Conclusions: AVNeo is feasible and reproducible with good immediate results. Our findings show that AVNeo produces immediate postoperative low-pressure gradients, larger EOA and minimal regurgitation of the aortic valve. CA extern

This review summarizes the pathophysiology of acute aortic dissection with recent findings and current strategies for diagnosis and treatment. The addition of clinical and laboratorial findings to radiologic classifications emerges as an approach to better stratify and treat patients with aortic dissection. Endovascular strategies grow in variety of treatment options, including for type A aortic dissection. Aortic dissection is a wide spectrum syndrome, generally posing a life-threating risk. Early identification can be the difference between life and death. Better imaging diagnosis made clear that accurately classification is crucial for choosing the optimal treatment. Mortality rates are still high, with the involvement of the ascending aorta being the most lethal type, despite a current trend toward better outcomes. Promising new developments in ascending aorta and aortic arch endovascular treatments are appealing for high surgical risk patients.

Background Mechanical complications of percutaneous coronary interventions are treated percutaneously in most cases. If the rescue intervention is unsuccessful, bailout bypass surgery is necessary to restore the coronary flow. The surgical risk in these cases is higher than that of patients operated on for other indications. The aim of our study was to characterize patients who underwent surgical treatment at our institution and to compare their long-term outcomes with patients who underwent emergency bypass surgery for other indications. Methods We analyzed 707 consecutive patients who underwent isolated emergency bypass surgery at our institution from 2007 to 2015. In 44 of these cases, the surgery was necessitated by mechanical complications of percutaneous coronary interventions. There were 31 coronary dissections, 5 entrapped guidewires, and 8 coronary perforations. We compared patients in these three groups with one another. Follow-up was performed to assess long-term outcomes. Results The median age of the cohort was 68 years (range 59–75 years), and 36 (81.8%) patients presented in cardiogenic shock. Thirty-seven (84.1%) patients had history of a percutaneous coronary intervention. The courses were typical for bypass patients. The long-term survival was similar in all three subgroups ( p = 0.16). The survival profiles within our sample did not differ significantly from that in patients who underwent emergency bypass surgery for other indications. Conclusions Surgical risk and short- and long-term outcomes of patients undergoing emergency bypass surgery due to mechanical complications of percutaneous coronary interventions are similar to those of patients receiving the same surgery for other indications.

Objective: To test the German Aortic Valve (GAV) score at our university hospital in patients undergoing isolated aortic valve replacement (AVR). Methods: A total of 224 patients who underwent isolated conventional AVR between January 2015 and December 2018 were included. Patients with concomitant procedures and transcatheter aortic valve implantation were excluded. Patients’ data were collected and analyzed retrospectively. Patients’ risk scores were calculated according to criteria described by GAV score. Sensitivity, specificity, and accuracy (area under the ROC curve [AUC]) were also calculated. The calibration of the model was tested by the Hosmer-Lemeshow method. Results: The mortality rate was 8.04% (18 patients). The patients’ mean age was 58.2±19.3 years and 25% of them were female (56 patients). Mean GAV score was 1.73±5.86 (min: 0.0; max: 3.53). The GAV score showed excellent discriminative capacity (AUC 0.925, 95% confidence interval 0.882-0.956; P

This study aims to investigate the outcomes of venoarterial extracorporeal life support (VA-ECLS) in a large single-center patient cohort regarding survival and adverse events. Between June 2009 and March 2019, 462 consecutive patients received VA-ECLS. The mean age was 66.2 ± 11.9 years. Two patient groups were identified: Group 1-patients with ECLS due to postcardiotomy shock (PCS) after cardiac surgery (PCS, n = 357); Group 2-patients with ECLS due to cardiogenic shock (CS) without previous surgery (nonPCS, n = 105). The primary end point was overall in-hospital survival, while secondary end points were adverse events during the study period. Overall, the in-hospital survival rate was 26%. There was no statistically significant difference between the groups: 26.3% for PCS and 24.8% for nonPCS, respectively (P > .05). Weaning from VA-ECLS was possible in 44.3% for PCS and in 29.5% for nonPCS (P = .004). The strong predictors of overall mortality were postoperative hepatic dysfunction (OR = 14.362, 95%CI = 1.948-105.858), cardiopulmonary resuscitation > 30 minutes (OR = 6.301, 95%CI = 1.488-26.673), bleeding with a need for revision (OR = 2.123, 95%CI = 1.343-3.355), and previous sternotomy (OR = 2.077, 95%CI = 1.021-4.223). Despite its low survival rates, VA-ECLS therapy is the last resort and the only lifesaving option for patients in refractory CS. In contrast, there is still a lack of evidence for VA-ECLS in PCS patients. Future studies are warranted to evaluate the outcomes of VA-ECLS therapy after cardiac surgery.

Virtual and augmented reality can be defined as a three-dimensional real-world simulation allowing the user to directly interact with it. Throughout the years, virtual reality has gained great popularity in medicine and is currently being adopted for a wide range of purposes. Due to its dynamic anatomical nature, permanent drive towards decreasing invasiveness, and strive for innovation, cardiac surgery depicts itself as a unique environment for virtual reality. Despite substantial research limitations in cardiac surgery, the current literature has shown great applicability of this technology, and promising opportunities.

Aims To report the largest single-center experience in surgical aortic valve replacement (SAVR) using the Enable sutureless bioprosthesis concerning the clinical outcome and hemodynamic behavior. Material and methods From April 2010 to May 2017, a total of 432 patients (36.3% of them women) received the Enable sutureless prosthesis for aortic valve stenosis, regurgitation, and/or endocarditis. The endpoints were overall survival after operation for 30 days and adverse events. Results No intraoperative complications occurred; intraoperative mortality was 0%. The 30-day mortality rate was 3.5% overall and 0.9% for isolated procedure. No valve-related deaths were observed. There was a need for prosthesis replacement during the early postoperative period in eight patients (1.9%): seven patients (1.6%) had a significant paravalvular leak and one patient (0.2%) developed early postoperative endocarditis. The maximum and mean pressure gradients across the prosthesis were 19.2 ± 7.1 mmHg and 11.1 ± 4.6 mmHg, respectively. A permanent pacemaker was necessary in 6.5% of the patients. Conclusions The Enable sutureless prosthesis showed a reliable clinical outcome with low perioperative mortality and morbidity. The hemodynamic performance was satisfactory. Our data confirmed the safety of SAVR using the Enable bioprosthesis. However, a higher rate of pacemaker implantation (6.5%) has to be mentioned.

Introduction: Destructive aortic root endocarditis is associated with high mortality rates. The objective of this article was to characterize the clinical and microbiological profiles of these patients, especially concerning an already implanted aortic valve prosthesis. We also focused on prognostic factors. Methods: Eighty patients underwent aortic root replacement due to destructive endocarditis from 1999 to 2018 in our institution. We analyzed their pre, intra, and postoperative data, outcomes, and predictors of mortality. Results: Thirty-one patients had native valve endocarditis (NVE), eight patients had early-onset prosthetic valve endocarditis (PVE), and 41 patients had late-onset PVE. Streptococcus was found in 19.4% of NVE cases and no PVE case. Coagulase-negative Staphylococcus was responsible for 62.5% of the cases of early-onset PVE. Thirty-four (42.5%) patients had received inappropriate antibiotics before admission. No microorganism was associated with higher risk of mortality. Aortoventricular dehiscence was identified as an independent risk factor of mortality along with PVE, concomitant bypass surgery, and delayed diagnosis. The incidence of postoperative complications was similar in all three groups. Rates of long-term survival (P=0.044) and freedom from the composite endpoint (P=0.024) defined as death, stroke, aortic valve reinfection, and aortic valve reoperation were the lowest within the NVE group and the highest among the PVE patients. Conclusion: In endocarditis, prolonged diagnostics, inadequate antimicrobial treatment, and late surgery led to destructive local complications and worsened the prognosis. PVE is associated with higher mortality than NVE.

BACKGROUND Aortic root and ascending aortic aneurysms are traditionally surgically treated through the deployment of a conduit with an artificial aortic valve, which significantly increases the risk of postoperative complications in the form of thrombosis. MATERIALS & METHODS We report a case of Wolfe procedure in a 78-year-old female patient with aortic root aneurysm at high risk for conventional Bentall surgery. DISCUSSION AND CONCLUSION We use this case to discuss the effectiveness and short-term results of this procedure.

Background Bronchial artery aneurysms (BAAs) are a rare vascular entity. They can have various presentations ranging from an incidental finding on radiological examination to life-threatening hemoptysis. Material and methods We report the case of a 60-year-old woman with three posterior mediastinal BAAs who presented with unilateral periscapular pain, shortness of breath, hoarseness, and dysphagia. The BAAs were removed successfully via thoracotomy, with excellent recovery and relief of the periscapular pain. Discussion and conclusion We use this case as a platform to discuss the treatment options for BAAs.

Objectives In many centers, training in cardiac surgery is considered to increase perioperative risk. This study aims to test whether a resident working as the main operator is a genuine risk factor. Methods We analyzed patients who underwent elective isolated aortic valve replacement, elective isolated coronary artery bypass grafting, or both, in our institution, from 2008 to 2016. Redo- and off-pump surgery, ejection fraction Results The times of surgery, cardiopulmonary bypass, and cross-clamp were longer if residents operated (p Conclusion Training in cardiac surgery is safe, and carefully selected patients can be operated by residents without increased risk of perioperative mortality and complications.

Objective The main purpose of this article is to evaluate an impact of epicardial ligation of the left atrial appendage (LAA) in patients with atrial fibrillation (AF) undergoing off-pump coronary artery bypass grafting (OPCAB) on the development of ischemic stroke and mortality. Methods From 2009 to 2013, a total of 125 patients (86.4% men, mean age 64 ± 7 years, 95% confidence interval: 61–65 years) received a combined OPCAB and LAA ligation because of coronary artery disease and AF. All the subjects were divided into two groups: group 1 (n = 57)—LAA ligation during OPCAB, group 2 (n = 68) without LAA ligation during OPCAB. Primary endpoints were postoperative incidence of ischemic stroke and mortality. Results No difference in the number of ischemic stroke (0 vs. 5.9%) and death (0 vs. 4.4%) in both groups during the hospital period (p > 0.05). Median overall follow-up was 41 (22–61) months: without difference for groups (p > 0.05). During follow-up, there was a difference in the number of ischemic stroke (0 vs. 17.6%, p 0.05). Conclusion Epicardial ligation of LAA during OPCAB in patients with AF may reduce the risk of ischemic stroke in long-term follow-up and does not affect the mortality.

Patient: Male, 66 Final Diagnosis: Ischemic cardiomyopathy Symptoms: Angina pectoris • dyspnoea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: We report a 66-year-old patient who received implantation of HeartMate II LVAD (St. Jude Medical, Minneapolis, MN, USA) as destination therapy 10 years ago. Case Report: Preoperatively, the patient developed acute heart failure due to transmural myocardial infarction requiring catecholamine therapy and intra-aortic balloon pump. Echocardiography revealed a left ventricular ejection fraction of 15%. We saw an indication for left ventricular assist device (LVAD) implantation. The intraoperative course was uncomplicated. The operation time was 153 minutes and the cardiopulmonary bypass time was 69 minutes. The procedure was performed in normothermia, and no further combined procedures were necessary. Only one re-hospitalization, due to driveline infection, was required. Once a month, the patient visited our heart failure outpatient clinic for laboratory control, echocardiographic examination, and device measurement. There was always a normal LVAD function. During the 10 years of follow-up, the patient did not have any other complications. Conclusions: Patients with a strict indication for LVAD and fewer risk factors can show a relatively uncomplicated postoperative course. Our case report demonstrates the opportunity to care for a patient for years using LVAD. Modern LVADs are reliable cardiac support systems as destination therapy from the long-term perspective. Careful patient selection, timely decision on LVAD implantation, and structured patient care are critical.

Patient: Male, 50 Final Diagnosis: Coronary artery disease in a patient with situs inversus totalis Symptoms: Angina pectoris Medication: — Clinical Procedure: Coronary artery bypass grafting Specialty: Cardiac surgery Objective: Rare disease Background: We report a rare case of total arterial coronary artery bypass grafting (CABG) in a patient with situs inversus totalis (SIT). SIT is a rare variant of biologically normal anatomy, in which the main internal organs are mirrored compared to normal localization. Case Report: A 50-year-old patient with SIT and severe coronary stenosis of the left anterior descending artery (LAD) and the ramus circumflexus (RCX) was admitted to our hospital. CABG was performed promptly using 2 conduits. After medial sternotomy, both mammary arteries were isolated by the skeletal method. Next, the cannulation of the aorta and the physiologically right atrium was performed. Custodiol cardioplegia was performed antegrade in a single shot. The left internal mammary artery (LIMA) was anastomosed to the LAD and the right internal mammary artery (RIMA) to the RCX. The aortic clamping time was 29 minutes. The operation was completed without complications. The patient was extubated 6 hours after surgery. On the first postoperative day, the patient was transferred to a regular ward. Postoperative therapy was performed without complications. Conclusions: Surgical correction is indicated for many patients with SIT in combination with coronary heart disease. Performing a CABG operation on these patients requires the operating team to have certain skills. Surgeons face a number of problems and issues: preoperative preparation of the patient, the position of the surgeon to the left or right during the operation, the choice of conduit for anastomosis, and the tactics of the operation.

Background In our institution, we developed a modification of the standard implantation technique of the Perceval sutureless aortic prosthesis (LivaNova, London, United Kingdom) that involves the usage of snuggers for the guiding sutures during valve deployment. The technique has been described elsewhere. In this article, we present the results of our initial case series comprising 128 consecutive patients. Methods From September 2016 to June 2018, 128 patients received a sutureless Perceval prosthesis (mean age 72.2 ± 8.5 years, 66 males). The data of the patients were prospectively collected in our general database and retrospectively analyzed using the SPSS software version 25 (IBM SPSS Inc., Chicago, Illinois, United States). Primary end points were primary implantation success and 30-day mortality. All patients underwent transthoracic echocardiography on discharge. Results Our cohort consisted of real-world scenario patients with infective endocarditis, bicuspid aortic valves and one patient with left ventricular assist device. However, we had 100% primary implantation success with no need for valve explantation or paravalvular leaks. All-cause 30-day mortality was 2.3% (3 patients) with no cardiac deaths. Two patients (1.6%) had a permanent neurological deficit, three patients (2.3%) had new-onset renal dialysis, and four patients (3.1%) needed a permanent pacemaker postoperatively. Conclusion To our knowledge, this is the first case series to report on a modified implantation technique of the Perceval prosthesis. The Perceval valve prosthesis produces excellent outcome in most pathologies, so that current contraindications should be revised.

Patient: Male, 26 Final Diagnosis: Pulmonary valve replacement Symptoms: No symptom Medication: — Clinical Procedure: — Specialty: Surgery Objective: Congenital defects/diseases Background: One of the most common complications after repair of Fallot’s tetralogy is pulmonary valve regurgitation (PR). There are many concepts of treatment, such as surgical, percutaneous, or hybrid pulmonary valve repair. Surgical pulmonary valve replacement is associated with low operative morbidity and mortality and shows very good long-term results. For that reason, it remains the standard of treatment. Case Report: We present a case of a 26-year-old male patient who underwent a successful emergent surgical pulmonary valve replacement after a failed percutaneous pulmonary valve intervention, which was performed due to pulmonary regurgitation. Conclusions: Despite the modern (interventional and hybrid) procedures in the treatment of pulmonary valve regurgitation after repair of Fallot’s tetralogy, surgical treatment for pulmonary regurgitation still remains the gold standard for young adult patients.

Background: To investigate whether preoperative short-term extracorporeal life support therapy in patients undergoing continuous-flow left ventricular assist device implantation has an impact on the outcome regarding survival and adverse events. Methods: Between January 2011 and May 2018, 100 consecutive patients received HeartMate II, HeartWare, or HeartMate III for end-stage heart failure. Mean age was 64.2 ± 10.3 years. Three patient groups were identified: without preoperative extracorporeal life support (non-extracorporeal life support group, n = 80), with preoperative extracorporeal life support due to postcardiotomy shock after conventional cardiac surgery (postcardiotomy shock group, n = 9), and with preoperative extracorporeal life support without previous surgery (non-postcardiotomy shock group, n = 11). The primary endpoint was overall survival after device implantation. Secondary endpoints were adverse events during the follow-up period. Results: Survival was significantly different between the groups (p Conclusion: Continuous-flow left ventricular assist device implantation with prior extracorporeal life support appears to have a worse outcome regarding survival, right heart failure, renal and respiratory dysfunction (p

Our aim was to analyse the hospital outcome for the worldwide largest series of stentless bioroot xenografts (Medtronic Freestyle) as full root replacement in a single centre over a period of 18 years. Retrospective data analysis was performed for the entire cohort of patients undergoing aortic root surgery with the Medtronic Freestyle valve prosthesis. Logistic regression analysis was performed to analyse predictors of in-hospital mortality. 971 patients underwent aortic full root replacement with the Medtronic Freestyle valve in the period from 1999–2017, with an average age of 68.8 ± 10.3y and gender distribution of 608:363 (male:female). Concomitant surgery was performed in 693 patients (71.4%). In-hospital all-comers mortality was 9.8% (95 patients), with the respective highest risk profiles including dissections (6.4%), endocarditis (5.6%) and re-do procedures (12.5%). In-hospital mortality for elective patients was 7.6% while isolated aortic root replacement demonstrated a mortality of 3.6%. Logistic regression analysis demonstrated age (OR 1.05, p = 0.005), dissection (OR 5.78, p

Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p 3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

Introduction Redo surgical mitral valve replacement (SMVR) remains the gold standard treatment in patients with a history of mitral valve surgery presenting with recurrent mitral valve pathologies. Whilst this procedure is demanding, it is an inevitable intervention for some indications, such as infective endocarditis, thrombosis, or multivalve procedures. In this study, we aim to evaluate our institutional experience with SMVR on a real-life cohort, identifying the factors that contribute to poor surgical outcomes whilst avoiding selection bias. Methods Between March 2012 and November 2020, 58 consecutive high-risk patients underwent a redo SMVR at our institution. The primary endpoints of this study were 30-day and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events. We analyzed and compared the survival in patients undergoing an isolated SMVR and in those that required at least one concomitant procedure. Results The overall operative, 30-day, and 1-year mortality were 3.4%, 22.4%, and 25.9%, respectively. The mortality in patients undergoing isolated SMVR was significantly lower than in patients requiring concomitant procedures. The multivariable regression model showed that NYHA Class IV, infective endocarditis, and postoperative dialysis were significantly associated with 30-day mortality. Society of Thoracic Surgeons Score, infective endocarditis, concomitant procedures, and mechanical valve implantation appeared to predict long-term mortality. Conclusion This study illustrates that SMVR after prior mitral valve surgery presents a demanding procedure with high operative risk, significant mortality, and morbidity. Whilst this procedure is inevitable for some indications, a careful patient selection and risk stratification provides acceptable surgical results in this cohort.

Background: We sought to evaluate the outcomes of transapical transcatheter mitral valve replacement in patients with degenerated mitral bioprostheses or failed mitral ring annuloplasty and high surgical risk for redo mitral valve procedure. Methods: Between August 2012 and December 2020, 41 consecutive high-risk patients underwent transcatheter mitral ‘valve-in-valve' (TM-ViV, n=25) or ‘valve-in-ring' (TM-ViR, n=16) implantation at our institution. All procedures were performed in a hybrid operating theater using the SAPIEN XT/3™ or the DIRECT FLOW MEDICAL™ prostheses. Data was collected prospectively according to MVARC criteria. Results: The logistic EuroSCORE-I was 42.3%±20.5% (mean ± SD), the Society of Thoracic Surgeons (STS) score was 11.9%±10.8%, and the STS/ACC-score was 7.6%±4.2%. Transcatheter mitral valve implantations were successful in all patients (100%). Early echocardiographic examinations showed no obstruction of the left ventricular outflow tract (LVOT), no paravalvular leakage, and only trace transvalvular leakage in eight patients. There was no operative mortality; thirty-day mortality was 9.8%. Survival was 72% at one year and 63% at three years. At two-year follow-up, transvalvular mean pressure gradients were 4.6±1.4 mmHg. Conclusions: Transapical transcatheter mitral valve-in-valve or valve-in-ring implantation represents a true minimally invasive alternative to surgical redo procedures, especially in high-risk patients with failed bioprosthetic mitral valves or annuloplasty and favorable anatomy. CA Zubarevich

Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

Introduction: The benefit of total arterial revascularization (TAR) in coronary artery bypass grafting (CABG) remains a controversial issue. This study sought to evaluate whether there is any difference on the long-term results of TAR and non-TAR CABG patients. Methods: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Clinical Trials. gov, Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Google Scholar databases were searched for studies published by October 2020. Randomized clinical trials and observational studies with propensity score matching comparing TAR versus non-TAR CABG were included. Random-effects meta-analysis was performed. The current barriers to implementation of TAR in clinical practice and measures that can be used to optimize outcomes were reviewed. Results: Fourteen publications (from 2012 to 2020) involving a total of 22,746 patients (TAR: 8,941 patients; non-TAR: 13,805 patients) were included. The pooled hazard ratio (HR) for long-term mortality (over 10 years) was lower in the TAR group than in the non- TAR group (random effect model: HR 0.676, 95% confidence interval 0.586-0.779, P