Background: The growing use of transcatheter aortic valve implantation (TAVI) has significantly changed treatment strategies for patients with aortic stenosis (AS), especially those with coexisting coronary artery disease (CAD). However, the impact of this shift on surgical aortic valve replacement combined with coronary artery bypass grafting (AVR + CABG) remains unclear. This study aimed to evaluate temporal trends, clinical characteristics, perioperative outcomes, and 5-year survival in patients undergoing AVR + CABG in the context of increasing TAVI adoption in Poland between 2014 and 2023. Methods: This retrospective, multicenter cohort study used data from the Polish National Cardiac Surgery Database. A total of 65,085 patients qualified for aortic valve intervention between 2014 and 2023 were analyzed. Baseline characteristics, procedural details, complication rates, and 5-year survival (Kaplan-Meier method) were assessed. AVR + CABG trends were compared to TAVI volumes over time. Results: The proportion of patients undergoing AVR + CABG decreased by 25% over the study period, while TAVI procedures increased fivefold. AVR + CABG patients became younger and predominantly male, with higher prevalence of hypertension and hyperlipidemia but improved functional status. Despite longer cross-clamp times and changes in prosthesis size, perioperative mortality and complication rates remained stable. Mid-term survival was not significantly affected. The growing use of percutaneous coronary intervention (PCI) with TAVI likely influenced these trends. Conclusions: Despite declining volumes, AVR + CABG remains an effective and safe option for selected patients. In the evolving landscape of valve disease treatment, multidisciplinary Heart Team decision-making and further comparative studies are essential.

Background The balance between thromboembolic complications and bleeding risk in anticoagulated patients with atrial fibrillation remains challenging, with left atrial appendage occlusion (LAAO) representing a potential alternative. Our prospective multicenter study aimed to evaluate the feasibility, safety, technical, and procedural outcomes of the contemporary practice of stand‐alone LAAO. Methods The SALAMANDER (Stand‐Alone Left Atrial Appendage Occlusion for Thromboembolism Prevention in Nonvalvular Atrial Fibrillation Disease) registry is a real‐world, multicenter, observational cohort study conducted at 16 cardiac centers in Europe between 2010 and 2024, evaluating the safety and efficacy of LAAO using contemporary devices. Results A total of 1660 patients were enrolled, with a median age of 76 (interquartile range, 70–81) years and 38% being women. The median CHA2DS2‐VASc score was 4 (interquartile range, 3–5). The most common indication for LAAO was significant bleeding (83.7% of patients), most frequently during treatment with direct oral anticoagulants (68.8%) more than vitamin K antagonists (24.9%). The predominant bleeding sites were the lower (27.9%) and upper (21.7%) gastrointestinal tracts, with 17.4% having a history of hemorrhagic stroke. The most common antithrombotic regimen before the procedure was direct oral anticoagulants (48.9%), while postprocedural therapy most often included dual antiplatelet therapy (50%). The technical success rate was 95.5%, with residual leak (2.2%) and tamponade (1.4%) as the main causes of failure. Procedural success was 90.5%, most often limited by vascular complications (3.7%), periprocedural death (1.1%), and major bleeding (0.7%). Technical and procedural success rates did not differ significantly between the devices used. Conclusions In this large prospective cohort, technical and procedural success rates were similar across all LAAO devices, suggesting comparable safety and efficacy. Postprocedural therapy typically involves dual antiplatelet therapy, with all patients requiring some pharmacological treatment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05144958.

OBJECTIVE:Atrial fibrillation (AF) is a common finding among patients with mitral valve disease, with a growing body of evidence showing survival benefits associated with surgical ablation (SA). However, a lack of data persists regarding the safety and survival after SA concomitant to minimally invasive mitral valve surgery (MIMVS). METHODS:We retrospectively collected data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych), searching for all adult patients with AF who underwent MIMVS between 2006 and 2021. Initially, 1,545 patients were identified; SA was performed on 512 patients (33.2%). Propensity score matching comparing MIMVS + SA versus MIMVS alone was performed. RESULTS:Matching resulted in 365 pairs with similar baseline characteristics (median age = 65 years, interquartile range [IQR]: 58 to 70 years; median EuroSCORE II = 2.2%, IQR: 1.4 to 3.4). We observed no differences in 24 h mortality for MIMVS + SA versus MIMVS alone (0.3% vs 0.0%, P = 0.99). Although there was no difference in in-hospital complications, neurologic complications were reported less frequently in the SA group (2.7% vs 8.2%, P = 0.002). Unadjusted survival analysis favored MIMVS+SA (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.40 to 0.69, P < 0.001). However, after adjustment for baseline risk factors, the effect was no longer significant (HR = 0.85, 95% CI: 0.56 to 1.32, P = 0.48). When stratified on baseline CHA2DS2-VASc score, a gradient of benefit was seen, with patients at higher thromboembolic risk gaining the most benefits from concomitant SA. CONCLUSIONS:Patients with a higher thromboembolic risk gain the most benefits from concomitant SA. SA was associated with fewer neurologic complications.

The recently-described left atrial appendage (LAA) neck is a truncated cone-shaped structure that connects the LAA orifice to its lobe. It shows malformations in some cases, but their exact description and clinical significance are unknown. Therefore, the aim of this study was to provide a detailed anatomical and morphometric analysis of LAA neck malformations in clinical context. A total of 250 autopsied human hearts (20.0% women, 46.7 ± 18.2 years old) were examined for mural malformations: spikes and bulges. Endocardial roughness of the LAA neck with a depth <2 mm and no recognizable epicardial protrusion was defined as ectopic trabeculation. LAA neck malformations were found in 13.6%, bulges in 10.0% of the hearts examined, spikes in only 3.2%, and ectopic trabeculations in 24.8%. In one case, both a bulge and a spike were found in the LAA neck. Most LAA neck roughness was observed on the aortic and venous surfaces of the LAA neck. Those surfaces were the most common locations for malformations and ectopic trabeculations. The LAA wall was significantly thinner than the surrounding neck wall within the bulges and the ectopic trabeculations, but not in the spikes.

Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients. Results: In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure. Conclusion: Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery.

BACKGROUND:It is estimated that at least one third of the population will suffer from atrial fibrillation in their lifetime. In order to prevent strokes and thromboembolism, anticoagulation treatment should be administered. In addition, exclusion of the left atrial appendage should be considered in certain cases to prevent fatal ischemic complications. In patients at high risk of intervention, the devices available to close the left atrial appendage are not suitable. In addition, their use is limited by the anatomy of the left atrial appendage, which may not be suitable for any of the available exclusion devices. The aim of this study is to present the long-term results of the Sierra Aegis Left Atrial Appendage Ligation System - a new, exclusively epicardial system for closure of the left atrial appendage - for the first time in a human study. METHODS:This was a prospective, first-in-human study investigating the efficacy and safety of the Sierra Aegis Left Atrial Appendage Ligation System for epicardial closure of the left atrial appendage. 7 patients (mean age: 57.3 ± 10.6 years, 71.4 % male) who underwent left atrial appendage exclusion with the Sierra system were followed for up to 7 years. RESULTS:No strokes, leaks, or other complications were observed in the study group during the 7-year follow-up period. CONCLUSIONS:This 7-year follow-up of the first-in-human study of the Sierra Aegis Ligation System for left atrial appendage closure shows very good long-term results in terms of the efficacy and safety of this device when used in humans.

Patients with preoperative atrial fibrillation (AF) undergoing cardiac surgery face a heightened risk of complications and reduced survival. Concomitant surgical ablation (SA) has shown promise in mitigating the arrhythmic burden, prompting guideline upgrades by major scientific societies. However, SA remains underutilized, with performance rates varying between 22% and 48%, depending on the type of procedure. The goal of this narrative review is to summarize current evidence to aid physicians in decision making regarding AF management during cardiac surgery. This review examines existing literature on the prevalence, management and outcomes of AF in cardiac surgery. We assess epidemiological data, summarize trends in clinical practice and review the rationale and techniques for treating AF surgically. Emerging challenges, including barriers to implementation and novel therapeutic advancements, are also discussed. Evidence underscores the detrimental impact of preoperative AF on perioperative and long-term outcomes, including higher mortality, morbidity and thromboembolic risk. Concomitant SA, particularly the Cox-maze IV procedure, significantly improves sinus rhythm restoration, reduces mortality and mitigates complications like stroke. However, the procedure remains underperformed due to concerns about complexity, prolonged operative time and training gaps. Emerging hybrid techniques, novel mapping systems and technologies like pulsed field ablation may enhance outcomes and broaden SA adoption. Concomitant SA is an effective yet underutilized therapy that can improve survival and reduce AF-related complications in cardiac surgery patients. Addressing implementation barriers and integrating advancements in technology and surgical approaches are key to optimizing patient outcomes.

The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three-dimensional reconstructions of the heart chambers based on contrast-enhanced electrocardiography-gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone-shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2 . The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three-dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53-66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience.

Study objective: To indicate predictors of witnessed hypothermic cardiac arrest. Methods: We conducted a retrospective analysis of 182 patients with severe accidental hypothermia (i.e., with core body temperature of <= 28( degrees)C) who presented with preserved spontaneous circulation at first contact with medical services. We divided the study population into two groups: patients who suffered hypothermic cardiac arrest (HCA) at any time between encounter with medical service and restoration of normothermia, and those who did not sustain HCA. The analyzed outcome was the occurrence of cardiac arrest prior to achieving normothermia. Hemodynamic and biochemical parameters were analyzed with regard to their association with the outcome. Results: Fifty-two (29%) patients suffered HCA. In a univariable analysis, four variables were significantly associated with the outcome, namely heart rate (p < 0.001), systolic blood pressure (p = 0.03), ventricular arrhythmia (p = 0.001), and arterial oxygen partial pressure (p = 0.002). In the multivariable logistic regression the best model predicting HCA included heart rate, PaO2, and Base Excess (AUROC = 0.78). In prehospital settings, when blood gas analysis is not available, other multivariable model including heart rate and occurrence of ventricular arrhythmia (AUROC = 0.74) can be used. In this study population, threshold values of heart rate of 43/min, temperature -corrected PaO2 of 72 mmHg, and uncorrected PaO2 of 109 mmHg, presented satisfactory sensitivity and specificity for HCA prediction. Conclusions: In patients with severe accidental hypothermia, the occurrence of HCA is associated with a lower heart rate, hypoxemia, ventricular arrhythmia, lower BE, and lower blood pressure. These parameters can be helpful in the early selection of high-risk patients and their allocation to extracorporeal rewarming facilities. (c) 2024 Elsevier Inc. All rights reserved.

Introduction: Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game -changer in transcatheter interventions. Aim: This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions. Material and methods: We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months. Results: A cohort of 83 patients (mean age: 72.1 +/- 8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 +/- 34.3 min, contrast medium usage averaged 33.7 +/- 22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 +/- 3.4 days. Adverse effects were rare, including mini- mal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates. Conclusions: This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures.

Background: The incidence of thoracic aortic aneurysms is estimated at 3.0-8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present the results of thoracic endovascular aortic repairs at a single medium-sized center performed exclusively by a cardiac surgeon. Methods: Ninety patients who had undergone aortic stent graft implantations for the treatment of thoracic aortic anomalies were comprehensively, retrospectively evaluated. The detailed preoperative, surgical, and postoperative parameters of the patients, including the survival rate up to five years, were recorded and further analyzed. Results: The patients' Euroscores were four (2.1-9). The 30-day mortality rate was 8.9%, the 1-year mortality rate was 15.6%, and the 5-year mortality rate was 38.9% for all causes. Postoperative complications were observed in 10% of the patients. Statistically significant differences were observed between the urgency of surgery at 30 days and survival at one year, but not at five years. The most common complications were related to respiratory (4.4%), renal (3.3%), and neurological (3.3%) dysfunction. Conclusions: Thoracic endovascular aortic repair can be safely performed in small- and medium-sized centers with optimal long-term results.

AbstractDespite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35–0.68);p < 0.001 and consistently reduced in vancomycin (0.34 [0.18–0.64];p < 0.001) and gentamicin (0.58 [0.39–0.86];p = 0.007) groups (psubgroup = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32–0.65];p < 0.001 and 0.60 [0.44–0.83];p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43–0.83];p = 0.003) and superficial SWIs (0.54 [0.32–0.91];p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations’ activity: vancomycin against gram-negative strains: 0.20 (0.01–4.18) and gentamicin against gram-positive strains: 0.42 (0.28–0.62);P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients.

Background: Spinal cord ischemia is one of the most serious complications after an aortic repair. To date, there is no evidence for arterial changes during an aortic dissection or for the observation of such arteries after an aortic repair. The aim of this study was to compare spinal-cord-supplying arteries in patients with an acute aortic dissection, preoperatively and postoperatively, with patients without an acute aortic dissection. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure to treat an aortic dissection and 25 patients who qualified for a transcatheter aortic valve replacement without an acute aortic dissection and atherosclerosis of the analyzed vessels, treated as a control group, were reconstructed and retrospectively analyzed with the detailed medical data of the patients. The aortic branches with the ability to supply blood to the spinal cord as described in the literature were further analyzed. Results: The preoperative arterial diameters of the left internal thoracic artery, the left musculophrenic artery, and the left and right supreme intercostal arteries were significantly larger compared to the postoperative measurements. In addition, the preoperative measurements of the diameters of the left vertebral artery, right internal thoracic artery, left lateral thoracic artery, and left common iliac artery were significantly larger than in the control group. Conclusions: The internal thoracic arteries and supreme intercostal arteries may play a crucial role in providing additional blood supply to the spinal cord.

Objective Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials (RCTs) are conflicting. Methods On-line databases were screened for studies comparing LAAC vs no-LAAC concomitant to other heart surgery. Endpoints assessed were all-cause mortality and stroke at early and longest available follow-up. Subgroup analyses stratified on pre-op AF were performed. Risk ratios (RR) with 95% Confidence Intervals (CIs) served as primary statistics. Results Electronic search yielded 25 studies (N=660,158 patients). There was no difference between LAAC and no-LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR 0.86, 95%CIs 0.74-1.00, P=0.05, I2=88%), reduced early stroke risk by 19% (RR 0.81, 95%CIs 0.72-0.93, P=0.002, I2=57%) and late stroke risk by 13% (RR 0.87, 95%CIs 0.84-0.90, P<0.001, I2=58%). Subgroup analysis showed lower mortality (RR 0.85, 95%CIs 0.72-1.01, P=0.06, I2=91%), short- and long-term stroke risk reduction only in patients with pre-op AF (RR 0.81, 95%CIs 0.71-0.93, P=0.003, I2=71% and RR 0.87, 95%CIs 0.84-0.91, P<0.001, I2=70%, respectively). No benefit of LAAC in patients without AF was found. Conclusions Concomitant LAAC was associated with reduced stroke rates at early- and long-term and possibly reduced all-cause mortality at long-term but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF setting.

AMA Burysz M, Batko J, Bartuś K, Ogorzeja W, Litwinowicz R. Hybrid treatment of penetrating aortic trauma. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):65-66. doi:10.5114/kitp.2024.138374. APA Burysz, M., Batko, J., Bartuś, K., Ogorzeja, W., & Litwinowicz, R. (2024). Hybrid treatment of penetrating aortic trauma. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), 65-66. https://doi.org/10.5114/kitp.2024.138374 Chicago Burysz, Marian, Jakub Batko, Krzysztof Bartuś, Wojciech Ogorzeja, and Radosław Adam Litwinowicz. 2024. "Hybrid treatment of penetrating aortic trauma". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 21 (1): 65-66. doi:10.5114/kitp.2024.138374. Harvard Burysz, M., Batko, J., Bartuś, K., Ogorzeja, W., and Litwinowicz, R. (2024). Hybrid treatment of penetrating aortic trauma. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 21(1), pp.65-66. https://doi.org/10.5114/kitp.2024.138374 MLA Burysz, Marian et al. "Hybrid treatment of penetrating aortic trauma." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 21, no. 1, 2024, pp. 65-66. doi:10.5114/kitp.2024.138374. Vancouver Burysz M, Batko J, Bartuś K, Ogorzeja W, Litwinowicz R. Hybrid treatment of penetrating aortic trauma. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2024;21(1):65-66. doi:10.5114/kitp.2024.138374.

Background:In the era of percutaneous aortic valve implantation, biological valves are the preferred prostheses implanted in patients undergoing surgical aortic valve replacement (sAVR). The aim was to present a real-life analysis of mid-term sAVR outcomes for the four aortic bioprostheses: the Hancock II, the Carpentier-Edwards Perimount Magna, the Carpentier-Edwards Perimount Magna Ease and the Trifecta valve. Methods:This is a retrospective study based on data from the Polish National Cardiac Surgery Database. The study population comprised of 1,589 consecutive patients, of whom 432 were in the Hancock II group, 356 in the Carpentier-Edwards Perimount Magna group, 427 in the Carpentier-Edwards Magna Ease group, and 374 in the Trifecta group. A comparison of the four groups was performed using analysis of variance (ANOVA) or Kruskal-Wallis test with appropriate post hoc tests (Tukey HSD or Steel-Dwass, respectively). Results:Patients in the Hancock II group were older, had higher New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) classes, had lower prevalence of hypertension and hyperlipidemia but higher prevalence of diabetes. The lowest mean valve size was observed in Trifecta group and the highest was in the Magna group (P<0.001). Survival analysis showed no significant differences in in-hospital mortality: 3.9% in Hancock II, 3.1% in Perimount, 3.3% in Magna and 2.1% in Trifecta group. Five-year mortality was significantly higher in Hancock II group (25.7%) compared to the other bioprostheses: 12.1% in Perimount, 9.1% in Magna and 10.70% in Trifecta group respectively. Conclusions:The 5-year mortality rate was significantly higher in the Hancock II group compared to the other bioprostheses. In contrast, Trifecta, Perimount Magna, and Magna Ease had similar 5-year mortality rates.

Objective:Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting. Methods:On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics. Results:Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; P = .05; I 2 = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; P = .002; I 2 = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; P < .001; I 2 = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; P = .06; I 2 = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; P = .003; I 2 = 71% and RR, 0.87; 95% CI, 0.84-0.91; P < .001; I 2 = 70%, respectively). No benefit of LAAC in patients without AF was found. Conclusions:Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.