Background:Post-infarction ventricular septal defect (VSD) repair is in general performed on a cardioplegic heart. An alternative concept is VSD repair on a beating heart. Aim of the study was to identify possible differences in survival between the two strategies. Methods:The study was a retrospective, observational, single-centre cohort study of data from all patients who underwent post-infarction VSD repair at our institution between May 2012 and December 2022. VSD repair was performed either on an arrested heart with aortic cross-clamping [n = 28 (conventional subgroup)] or on a beating-heart [n = 18 (beating-heart subgroup)] using CPB without aortic cross-clamping. Primary end-point was survival at 1 year after surgery. Secondary endpoints included the analysis of perioperative variables, 30-day mortality and long-term survival. Results:Forty six consecutive patients underwent repair of post-infarction VSD (28 in the "conventional subgroup" and 18 in the "beating-heart subgroup"). The mean age of the patients was 66.4 ± 11.2 years and 63% were men. All-cause mortality during the first postoperative 30-days occurred in 12 of 28 patients (43%) in the "conventional subgroup" and in 4 of 18 patients (22%) in the "beating-heart subgroup"). Survival at one and five years was 34% and 27% for the "conventional subgroup", compared to 72% and 61% for the "beating-heart subgroup", respectively [hazard ratio, 2.3; 95% confidence interval (CI), 1.1-4.8; P = 0.0364]. Conclusions:The modified surgical approach performing VSD-repair on a beating heart was associated with a lower risk of postoperative death than the conventional surgical strategy.

In patients with a mechanical aortic valve in need of left ventricular assist device (LVAD) support, replacement with a biological valve should be considered. We present a case of partial mechanical valve explantation followed by direct transcatheter valve replacement during LVAD implantation. This approach offers a simpler and faster alternative to conventional valve replacement, with reduced cross-clamp time.

OBJECTIVES:The aim of this study was to evaluate the outcomes of transposition of the omentum into the mediastinum to support the replacement of infected aortic grafts or to cover infected aortic grafts that are not amenable for surgical replacement. METHODS:All patients with thoracic aortic graft infections who underwent mediastinal transposition of the omentum at our institution between 2005 and 2023 were included in this study. Mediastinal transposition of the omentum was performed either after replacement of the infected graft ('curative concept') or solely as bailout procedure by wrapping the infected graft ('palliative concept'). The diagnosis, including computed tomography scans during follow-up, was made according to the criteria of the Management of Aortic Graft Infection Collaboration. RESULTS:The patient cohort consisted of 31 patients. Both in-hospital and 1-year mortality were 0% (n = 0) for the curative concept (n = 9) compared to 23% (n = 5) and 41% (n = 9) for the palliative concept (n = 22), respectively. There was no graft infection-associated death or recurrence of infection after 3 years in the curative group. Survival was 52% at 3 years in the palliative group, with freedom of infection in 59% of the patients (n = 13). CONCLUSIONS:Transposition of the omentum and wrapping of the infected aortic prosthetic graft is a useful bailout strategy for patients who are ineligible for replacement of an infected aortic graft. However, mortality stays high. For radical treatment of aortic graft infections, it may prove an effective supportive therapy and represents an important tool in the armamentarium of cardiac surgeons.

Infective endocarditis caused by non-HACEK gram-negative bacilli (GNB-IE) is rare but associated with significant morbidity and case fatality. Evidence on optimal treatment and management is limited. We aimed to describe the characteristics and management of GNB-IE patients, investigating factors associated with disease acquisition and unfavorable outcomes. We conducted a retrospective descriptive single-center study (tertiary care and referral hospital) between 2015 and 2021, including adult patients with definite GNB-IE. We reviewed demographic, clinical and microbiological data, focusing on predisposing factors, clinical outcomes and 1-year mortality. Of 1093 patients with probable or definite IE, 19 patients (median age 69 years) had definite GNB-IE, with an increasing incidence throughout the study period. Median age-adjusted Charlson Comorbidity Index score was 4 points. Prosthetic valve IE (PVIE) was present in 7/19 (37

Background: Prosthetic graft infection of the ascending aorta and aortic arch requires in situ reconstruction due to close location to the heart. Transposition of the greater omentum into the mediastinum and coverage of the new graft with the omentum is an additional measure to protect the suture line from reinfection by enhancing microbiological resistance. In high-risk patients it may be a solely surgical treatment as a palliative therapy by wrapping the old, infected prosthetic graft. This surgical procedure is barely performed for the treatment of infected aortic graft prostheses.

Background The “UFO procedure” was initially developed as a surgical option to enlarge the aortic annulus in patients requiring valve replacement. This technique can be employed to treat extensive endocarditis located in the intervalvular fibrous body (IVFB). One of the indications for a "UFO procedure" is massive aortic and mitral valve calcification. It is a challenging surgical procedure with a high risk of intraoperative complications. Case summary We present a 76-year-old male patient with massive aortic and mitral valve calcification involving the left atrium, the left ventricle and the left ventricular outflow tract. Both valves exhibited severe stenosis and moderate to severe regurgitation. The left ventricle was hypertrophic and the left ventricular ejection fraction was > 55%. The patient was prediagnosed with persistent atrial fibrillation. The risk of death following heart surgery (EuroSCORE II) was calculated as 9.21%. We successfully performed a so-called “UFO procedure” including replacement of both valves without annular decalcification to avoid atrioventricular dehiscence. We enlarged the IVFB and replaced the non-coronary sinus of Valsalva with doubled bovine pericardium. The left ventricular outflow tract was decalcified. The patient was transferred to a local hospital on the 13th postoperative day. Conclusion Successful surgical treatment to this extent was demonstrated for the first time. Due to the high perioperative mortality, the surgical treatment of patients with this constellation would be refused in most cases. In our patient, the preoperative imaging showed extreme calcification of both valves and the surrounding myocardium. Excellent preoperative planning and a highly experienced surgical team is necessary.

Ischaemic ventricular septal defect is a serious complication of acute myocardial infarction with poor outcome. We present the 'beating-heart butterfly' technique to close the ventricular septal defect with a double-layered pericardial patch sewn to the intact septum under beating-heart cardiopulmonary bypass in 4 highest-risk patients. This technique combined with a liberal postoperative mechanical circulatory support and open-chest treatment allowed excellent results with 12 months of survival in all patients.

A 68-year-old female patient underwent redo surgery for structural valve deterioration of a biological aortic valve prosthesis (19 mm) which was implanted 3 years ago. Preoperative coronary angiography and intraoperative transesophageal echocardiography revealed subtotal obstruction of the left coronary ostium which was in close proximity to the prosthetic ring (Panels A, B and Supplementary material online, Video 1 and Video 2). Intraoperative inspection confirmed this finding and revealed that the obstruction was caused by chronic ingrowth of neo-intima originating from the prosthetic ring of the implanted bioprosthesis (Panel C). The neo-intima was completely removed leaving the intact native intima (Panel D). A sutureless biological valve was implanted in order to increase the distance between the prosthetic valve ring and the ostium of the left coronary artery (Panel E). The postoperative course was uneventful. A postoperative echocardiography showed a free left ostium without...

Abstract Background The UFO procedure was initially developed as a surgical option to enlarge the aortic annulus in patients requiring valve replacement. This technique can be employed to treat extensive endocarditis located in the intervalvular fibrous body (IVFB). One of the indications for a UFO procedure is massive aortic and mitral valve calcification. It is a challenging surgical procedure with a high risk of intraoperative complications. Case summary We present a 76-year-old male patient with massive aortic and mitral valve calcification involving the left atrium, the left ventricle and the left ventricular outflow tract. Both valves exhibited severe stenosis and moderate to severe regurgitation. The left ventricle was hypertrophic and the left ventricular ejection fraction was > 55 %. The patient was prediagnosed with persistent atrial fibrillation. The risk of death following heart surgery (EuroSCORE II) was calculated as 9.21 %. We successfully performed a so-called UFO procedure including replacement of both valves without annular decalcification to avoid atrioventricular dehiscence. We enlarged the IVFB and replaced the non-coronary sinus of Valsalva with doubled bovine pericardium. The left ventricular outflow tract was decalcified. The patient was transferred to a local hospital on the 13th postoperative day. Conclusion Successful surgical treatment to this extent was demonstrated for the first time. Due to the high perioperative mortality, the surgical treatment of patients with this constellation would be refused in most cases. In our patient, the preoperative imaging showed extreme calcification of both valves and the surrounding myocardium. Excellent preoperative planning and a highly experienced surgical team is necessary.

Journal of Cardiac SurgeryVolume 37, Issue 10 p. 3448-3448 LETTER TO THE EDITOR UFO procedure: Two small surgical details Leonhard Wert MD, Corresponding Author Leonhard Wert MD wert@dhzb.de orcid.org/0000-0002-2840-8724 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany Correspondence Leonhard Wert, MD, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Email: wert@dhzb.deSearch for more papers by this authorMiralem Pasic MD, PhD, Miralem Pasic MD, PhD orcid.org/0000-0003-3990-5141 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, GermanySearch for more papers by this author Leonhard Wert MD, Corresponding Author Leonhard Wert MD wert@dhzb.de orcid.org/0000-0002-2840-8724 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany Correspondence Leonhard Wert, MD, Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Email: wert@dhzb.deSearch for more papers by this authorMiralem Pasic MD, PhD, Miralem Pasic MD, PhD orcid.org/0000-0003-3990-5141 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, GermanySearch for more papers by this author First published: 12 July 2022 https://doi.org/10.1111/jocs.16763Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume37, Issue10October 2022Pages 3448-3448 RelatedInformation

We present the case of a patient with infective endocarditis anesthetized for replacement of severely regurgitant aortic valve. Intraoperative transesophageal echocardiography revealed a new diagnosis of severe secondary mitral regurgitation. After aortic valve replacement and tricuspid valve repair, severe mitral regurgitation resolved rapidly without any intervention. In multivalvular disease, instant spontaneous resolution of secondary mitral regurgitation is possible after surgical correction of an aortic regurgitation causing left ventricular volume overload.

Objectives We aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) approaches on mortality and identify effect modifiers and predictors for mortality. Background Alternative access routes to transfemoral (TF) TAVI include the surgical intra-thoracic direct-aortic (DA) and transapical (TA) approach. TA TAVI has been associated with a higher mortality rate. We hypothesized that this is related to effect modifiers, in particular the left ventricular ejection fraction (LVEF). Methods This multicentre study derived its data from prospective registries. To adjust for confounders, we used propensity-score based, stabilized inverse probability weighted Cox regression models. Results In total, 5,910 patients underwent TAVI via TF (N = 4,072), DA (N = 524), and TA (N = 1,314) access. Compared to TF, 30-day mortality was increased among DA (HR 1.87, 95%CI 1.26-2.78, p = .002) and TA (HR 3.34, 95%CI 2.28-4.89, p < .001) cases. Compared to TF, 5-year mortality was increased among TA cases (HR 1.50, 95%CI 1.24-1.83, p < .001). None of the variables showed a significant interaction between the approaches and mortality. An impaired LVEF (<= 35%) increased mortality in all approaches. Conclusions The surgical intra-thoracic TA and DA TAVI are both associated with a higher 30-day mortality than TF TAVI. TA TAVI is associated with a higher 5-year mortality than TF TAVI. The DA approach may therefore have some advantages over the TA approach when TF access is not feasible.

Abstract Funding Acknowledgements Type of funding sources: None. Background Surgical ventricular repair (SVR) is an established treatment option in patients with heart failure (HF) due to left ventricular (LV) aneurysms, whereby LV volume reduction is the principal therapeutic target. Precise planning therefore is essential for postoperative improvement of HF symptoms. Purpose In this study we evaluated the potential of cardiac computed tomography (CCT) to estimate the aneurysm volume and to predict the achievable residual LV volume. Methods 205 patients (11/2005-01/2016, m:w = 151:54, median 63.4 years; mean NYHA class 3.03) with anteroapical LV aneurysm underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%), and LV thrombectomy (19%). CCT was performed before and 7 days after surgery. Volumetric assessment was made using dedicated software (syngo.via Cardiac Function, Siemens AG). Preoperative CCT data of 48 consecutive patients were analyzed and then matched with effectively achieved postoperative volumes. To separate the aneurysm volume in the systole and diastole a plane determined by three landmarks on borders of scared to intact LV myocardium (antero-septal, lateral and inferior) was used. In this way ensued the retrospective estimation of the aneurysm volume (AnV/AnVI) and anticipated LV end diastolic and end systolic volume (LVEDVI, LVESVI). Results Mean diastolic and systolic estimated AnV were 92 ± 56.6 ml and 83.5 ± 61.6 ml respectively. Relation of AnV to LVEDV and to LVESV was 29.2% and 38.2%, correspondingly. There was significant correlation between anticipated and effectively achieved LVEDV and LVESV (r = 0.87 and r = 0.88, respectively, p < 0.0001), and their indexed values (r = 0.83 and r = 0.83, respectively, p < 0.0001). Anticipated LVEDVI was only 10.3 ± 22.5 ml/m2 greater than achieved LVEDVI (p = 0.003), and anticipated LVESVI was only 2.4 ± 20.3 ml/m2 greater than achieved LVESVI (p = 0.433). Conclusions Estimation of aneurysm volume and anticipated postoperative LV volume allows to predict if the therapeutic targets can be successfully achieved in individual patients. Based on the CCT assessment we propose an approach for surgical planning in anterior LV aneurysms.