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Background: This is an investigation of complete arterial coronary artery bypass grafting (CACABG) using bilateral internal mammary arteries (IMA) and the T-graft technique either on- or off-pump as a routine approach to treat coronary artery disease. Methods: Between January 2000 and December 2012, 3,445 patients underwent on-pump (n = 2,216) or off-pump (n = 1,229) CACABG. A 30-day follow-up was performed prospectively, a long-term follow-up by a questionnaire, and coronary angiography in selected patients. Results: End points at 30 days were death, myocardial infarction, stroke, repeat revascularization, renal replacement, reoperation, sternal wound infection and atrial fibrillation. FitzGibbon A patency rates were 89.8 vs. 91.4% (p = 0.464) with consecutive percutaneous coronary intervention in the grafted area of 1.8 vs. 1.1% (p = 0.693) on- vs. off-pump, and no reoperation in the grafted area in both groups. Conclusion: CACABG by use of skeletonized bilateral IMA with the T-graft technique performed either on- or off-pump is a safe and effective approach.

OBJECTIVES Higher rates of mortality and morbidity have been reported in women undergoing coronary artery bypass grafting (CABG) compared with men. Different revascularization techniques (on-pump and off-pump) might influence this outcome. METHODS We retrospectively analysed 3445 consecutively recruited patients (all comers) undergoing complete arterial CABG (CACABG) at a single centre between January 2000 and December 2012. CACABG was performed in all patients using bilateral skeletonized internal mammary artery in T-graft technique, either on-pump (n = 2216) or off-pump (n = 1229). Early results (30-day) and long-term follow-up data were analysed with respect to gender-specific outcome. RESULTS Women were older than men in both groups (P

The Mosaic bioprosthesis (Medtronic, Minneapolis, MN) is a third-generation stented porcine bioprosthesis combining physiologic fixation and amino oleic acid antimineralization treatment to improve hemodynamic performance and durability. The findings of this single-center experience with this valve were evaluated to determine the clinical and hemodynamic performance.Between February 1994 and October 1999, we enrolled 255 patients with aortic valve replacement (AVR) with a mean age of 67 years (range, 23 to 82 years) and 47 patients with mitral valve replacement (MVR) with a mean age of 67 years (range, 41 to 84 years) in this post-United States Food and Drug Administration approval prospective and nonrandomized clinical trial. Patients were followed-up, including serial echocardiographic assessment, within 30 days, at 6 months, and annually thereafter. The cumulative follow-up was 1540 patient-years for AVR (mean, 6.1 years; maximum, 10 years) and 250 patient-years for MVR (mean, 5.4 years, maximum; 10 years).Early mortality after AVR (30 days) was 0.8%; late mortality per patient-year was 3.5%, including a valve-related/unexplained mortality of 1.1%. Early mortality after MVR (30 days) was 0.0%; late mortality per patient-year was 2.8%, including a valve-related/unexplained mortality of 1.2%. Median postoperative gradient and effective orifice area for all valves after AVR were (early, n = 252; 5 years, n = 161; 9 years, n = 43) 13.7, 12.3, and 11.7 mm Hg and 1.9, 1.8, and 1.8 cm2 at early, 5 years, and 9 years, respectively. With MVR respective data were (early, n = 46; 5 years, n = 25; 7 years, n = 13) 4.6, 4.1, and 3.9 mm Hg and 1.8, 2.2, and 2.3 cm2. At 10 years, freedom from adverse events in the AVR group and MVR group was, respectively, thromboembolism, 86.6% +/- 6.6% and 86.3% +/- 9.8%; permanent neurologic event, 91.2% +/- 6.8% and 90.9% +/- 8.7%; valve thrombosis, 98.2% +/- 0.8% and 100%; structural valve deterioration, 87.1% +/- 6.7% and 100%.Our midterm results demonstrate clinical safety and good performance of the Mosaic bioprosthesis. Continued follow-up will determine if this new design will provide increased durability.

The main advantage of bioprosthetic cardiac valves in comparison to mechanical prosthesis is the lower incidence of antithromboembolic-related hemorrhages. However, bioprostheses have limited durability due to progressive tissue degeneration and calcification resulting in structural valve deterioration (SVD) and suboptimal hemodynamic performances. The Medtronic Mosaic bioprosthesis is a supraannular third-generation stented porcine bioprosthesis which was introduced in 1994. It is built upon the historical durability of the Hancock II valve [1] and technical innovations were incorporated into the design in an attempt to improve hemodynamic performance and durability [2]. Tissue fixation with the Medtronic Physiologic Fixation™ process is performed with glutaraldehyde in order to minimize the consequences of antigenicity after porcine valve implantation [3]. Furthermore, the valve design includes predilatation of the porcine aortic root and using zero net pressure across the leaflets (Fig. 1a) [4]. By this treatment, natural leaflet morphology is generally preserved. The tissue is mounted on a low-profile flexible polymer stent (Fig. 1b) to minimize hemodynamic disturbance and to make it suitable for patients with small aortic root diameters. Open image in new window Fig. 1. Supraannular valve implantation technique

Objective: Mitral valve reconstruction (MVR) is the preferred treatment for regurgitant lesions. Clinical benefit is well documented, but comparative data scrutinising factors influencing survival and postoperative quality of life (QOL) in different subsets of patients are missing. We hypothesised that mitral valve reconstruction for mitral regurgitation benefits the patients, regardless of the valve pathology. Methods: In this study, 663 consecutive patients undergoing mitral valve reconstruction using Carpentier techniques were assigned to four different groups. Aetiology of mitral regurgitation was degenerative (DEG) in 372 (56.1%) patients and ischaemic (ISC) in 157 (23.6%). Cardiomyopathy (CMP) was presentin23(3.4%)cases andcombineddegenerativeregurgitationpluscoronaryarterydisease(DEG + CAD)in111(16.7%)patients.Survivalwas evaluated using a Cox proportional hazards model. Postoperative QOL was assessed using the short form (SF)-36 questionnaire in a multivariate analysis of covariance. Results: The overall 30-day mortality was 1.1% (0.3%, 1.9%, 0% and 2.7% for groups DEG, ISC, CMP and DEG + CAD, respectively). The median preoperative NYHA class and grade MI was 3 and evenly distributed between groups. After a mean follow-up of 4.1 3.4 years, MVR proved to be effective in all groups with 90.3% of patients in the NYHA classes I and II (p < 0.001). At 5 years, unadjusted survival was 90.3%, 69.7%, 50.5% and 86.2%. However, after correcting for age, ejection fraction, chronic obstructive pulmonary disorder (COPD), renal insufficiency and the preoperative NYHA class, survival in groups ISC and DEG + CAD was comparable. Group allocation was not a predictor for late death. Postoperative QOL was inferior in female patients in all SF-36 scales (p < 0.01) and was impaired by co-morbidities. QOL scores were best for patients in group DEG and worst in group CMP. In a multivariate model correcting for gender, age and co-morbidities (COPD, treated diabetes, renal insufficiency, subjective heart rhythm, preoperative NYHA class and previous myocardial infarction), postoperative QOL was comparable between groups. For the majority of patients with degenerative MR, postoperative life expectancy as well as QOL is similar to a normal population. Conclusions: MVR was safely and effectively accomplished in all groups. Survival and postoperative QOL was determined by left ventricular function and co-morbidities rather than MR aetiology. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Background: The Mosaic bioprosthesis is a third-generation stented porcine bioprosthesis combining physiologic fixation and alpha-amino oleic acid (AOA) antimineralisation treatment to improve haemodynamic performance and durability. This single-centre study reports the clinical results, including haemodynamic performance, of the Mosaic bioprosthesis after implant in aortic or mitral position.Methods:Between February 1994 and October 1999, 255 patients with aortic valve replacement (AVR; mean age: 67 years, range: 23—82 years) and 47 patients with mitral valvereplacement(MVR;meanage:67years,range:41—84years)wereenrolledinthisprospectivenon-randomisedclinicaltrial.Follow-upvisits were performed 30 days and 6 months after implant and annually thereafter. The cumulative follow-up was 1976.2 patient-years (pt-yrs) after AVR (median: 8.3 years, maximum: 14.0 years) and 336.9 pt-yrs after mitral valve replacement (MVR) (median: 8.2 years, maximum: 13.3 years). Results: After AVR, mean systolic gradient and effective orifice area at 4, 8 and 13 years follow-up were 13.3 5.6, 15.5 7.7 and 16.0 7.2 mmHg and 1.8 0.5, 1.8 0.5 and 1.7 0.4 cm 2 . After MVR, respective data were 4.7 2.1, 4.3 1.2 and 5.0 mmHg (only one recording) and 2.2 0.7, 2.3 0.6 and 1.8 cm 2 . Transvalvular regurgitation at 13-year follow-up was mild or less in both the AVR and MVR patients. Thirteen-year survival was 63.1 4.5% in the AVR group and 51.2 13.6% in the MVR group. Early mortality after AVR and MVR was 1.2% and 0.0%, respectively; late mortality was 3.2% pt-yr 1 and 3.3% pt-yr 1 , including a valve-related/unexplained mortality of 1.1% pt-yr 1 and 0.9% pt-yr 1 . Freedom from adverse events in the AVR and MVR group was permanent neurological event: 97.4 1.2% and 96.0 3.9%; valvular thrombosis: 97.8 1.1% and 100%; structural valve deterioration: 84.8 7.8% and 93.8 6.1%; explant: 73.3 7.3% and 89.3 6.5%. Conclusions: The Mosaic bioprosthesis demonstrates excellent clinical performance and safety after 13 years of follow-up. Continued follow-up will determine whether this new design will provide increased durability. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.