Comparison of a full sternotomy with a minimally invasive approach for concomitant mitral and tricuspid valve surgery.

Objectives: The need for concomitant tricuspid surgery in patients who need mitral valve surgery casts doubt on its feasibility via a minimally invasive approach. Our goal was to evaluate the short-term outcomes of patients undergoing concomitant mitral and tricuspid valve surgery either with a standard full sternotomy (full-MTS) or a minimally invasive approach (mini-MTS).

Methods: The outcomes of patients who had combined mitral and tricuspid valve surgery in 11 centres were retrospectively evaluated.

Perceval Implantation and Ascending Replacement: Which Should Be Performed First?

The use of sutureless prostheses has expanded due to their ability to reduce surgical times, thus favoring their implantation in high-risk patients. It is not uncommon that these patients have an ascending aortic aneurysm requiring treatment with a vascular prosthesis; therefore, using a sutureless aortic valve may be associated. To date, however, little is known about the time sequence of this intervention, that is, if sutureless implantation should precede or follow that of the vascular prosthesis.

Sutureless versus transcatheter aortic valve replacement: A multicenter analysis of "real-world" data.

Background: Recent data suggested that transcatheter aortic valve replacement (TAVR) may be indicated also for low-risk patients. However, robust evidence is still lacking, particularly regarding valve performance at follow-up that confers a limitation to its use in young patients. Moreover, a literature gap exists in terms of 'real-world' data analysis.

[An unusual case of ischemic mitral valve].

Mechanisms leading to mitral regurgitation can be multiple and have different etiologies. We present the case of severe mitral insufficiency due to posterior papillary muscle rupture in a young man, with exertional dyspnea, but permanently asymptomatic for chest pain and without clinical and laboratory signs of myocardial ischemia at the time of our evaluation.

Minimally invasive aortic valve replacement: short-term efficacy of sutureless compared with stented bioprostheses.

Objectives: Sutureless aortic valve prostheses have been introduced to facilitate the implant process, speed up the operating time and improve haemodynamic performance. The goal of this study was to assess the potential advantages of using sutureless prostheses during minimally invasive aortic valve replacement in a large multicentre population.

Methods: From 2011 to 2019, a total of 3402 patients in 11 hospitals underwent isolated aortic valve replacement with minimal access approaches using a bioprosthesis.

A rare case of quadrileaflet mitral valve and ostium primum atrial septal defect.

A 60-year-old woman was referred to our clinic for evaluation of her rapidly progressive dyspnea, and she had no previous history of heart disease. A murmur was noted on her examination, and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left-to-right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with ostium primum ASD closure by a patch and double cleft repair by suture after right heart catheterization.

Right ventricular assessment can improve prognostic value of Euroscore II.

Background: The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery.

Methods: This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm.

Aortic valve endocarditis complicated by proximal false aneurysm.

Background: Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates.

Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach.

Background: Mitral valve surgery (MVS) is evolving. Compared to standard sternotomy (S-MVS), minimally invasive method (Mini-MVS) has been increasingly adopted in the last years with encouraging results for both repairs and replacements. We evaluated trends of surgical approaches and operative outcomes in a multicenter study involving 10 cardiac surgical centers in Italy.

Minimally invasive surgical versus transcatheter aortic valve replacement: A multicenter study.

Objectives: Treatment of aortic valve stenosis is evolving, indications for transcatheter approach (TAVI) have increased but also surgical valve replacement has changed with the use of minimally invasive approaches. Comparisons between TAVI and surgery have rarely been done with minimally invasive techniques (mini-SAVR) in the surgical arm. Aim of the present study is to compare mini-SAVR and TAVI in a multicenter recent cohort.

Sutureless Aortic Valve and Pacemaker Rate: From Surgical Tricks to Clinical Outcomes.

Background: Several studies reported high rates of postoperative permanent pacemaker (PPM) implantation, which has been described as the "Achilles' heel" of sutureless aortic valve replacement (AVR).

Methods: From July 2010 to December 2017, 3,158 patients with symptomatic, severe aortic valve stenosis were referred to the Department of Cardiac Surgery (Klinikum Nürnberg - Paraclesus Medical University, Nuremberg, Germany), and 512 received a Perceval sutureless bioprosthesis (LivaNova PLC, London, United Kingdom). Thirty-nine patients who had been discharged with concomitant PPM implantation were reevaluated.

Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database.

This study provides early results of re-operations after the prior surgical treatment of acute type A aortic dissection (AAD) and identifies risk factors for mortality. Between May 2003 and January 2014, 117 aortic re-operations after an initial operation for AAD (a mean time from the first procedure was 3.98 years, with a range of 0.

Surgery of the Ascending Aorta with or without Combined Procedures through an Upper Ministernotomy: Outcomes of a Series of More Than 100 Patients.

Background: Use of a minimally invasive approach for isolated aortic valve surgery is increasing. However, management of the root and/or ascending aorta through a mini-invasive incision is not so frequent. The aim of this study is to report our initial experience with surgery of the ascending aorta through a ministernotomy approach.

Development and results of Puglia adult cardiac surgery registry.

Aims: To evaluate the feasibility of a cardiac surgery registry and to describe patients' characteristics, type of procedures performed, incidence of postoperative complications with short and middle-term mortality.

Methods: A database with clinical information and details on cardiac surgical operations was implemented by Puglia Health Regional Agency to collect data of each cardiac surgery procedure performed in the seven adult cardiac surgery centres of the region. Health regional agency personnel guaranteed data accuracy and quality control procedures.

Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry.

Objectives: To evaluate performance of the European System for Cardiac Operation Risk Evaluation (EuroSCORE II), to assess the influence of model updating and to derive a hierarchical tree for modelling the relationship between EuroSCORE II risk factors and hospital mortality after cardiac surgery in a large prospective contemporary cohort of consecutive adult patients.

Methods: Data on consecutive patients, who underwent on-pump cardiac surgery or off-pump coronary artery bypass graft intervention, were retrieved from Puglia Adult Cardiac Surgery Registry. Discrimination, calibration, re-estimation of EuroSCORE II coefficients and hierarchical tree analysis of risk factors were assessed.

Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a propensity score study.

Background: The aim of this retrospective study was to compare the early and midterm clinical outcomes of aortic root replacement in elderly patients receiving the Freestyle stentless bioprosthesis (FSB) (Medtronic Inc, Minneapolis, MN) with younger patients receiving a mechanical valve conduit.

Methods: From January 2001 to December 2010, 185 consecutive patients underwent aortic root replacement. Of these, 79 (43%) patients received the Freestyle bioroot (Medtronic Inc, Minneapolis, MN) (group F) and 106 (57%) patients received a mechanical valve conduit (group M).