Objectives: Infective endocarditis (IE) with visible vegetations often requires urgent surgical treatment. However, in some cases due to recent cerebral infarction, patients have an increased risk of cerebral hemorrhage during extracorporal circulation. No suitable guideline exists in order to clarify the best surgical timing after cerebral embolization/hemorrhage, but neurosurgeons usually recommend to wait a couple of weeks due to heparinization during surgery. We evaluated endocarditis patients with urgent surgical indication and recent cerebral infarction directly postsurgically by CCT scan, evaluating the risk of subsequent hemorrhage due to complete heparinization.

The Trifecta aortic valve has excellent hemodynamic performance as result of an expansive valve design with a bovine pericardial sheet externally mounted on a titanium stent. We report 2 cases of early Trifecta valve degeneration, both caused by partial rupture of one of the leaflet cusps 3 and 4 years post-implant. Post discharge, both patients had routinely performed echocardiography check-ups, without signs of valve failure. Transesophageal echocardiography performed during emergency hospital readmission due to severe dyspnea revealed transvalvular aortic regurgitation without signs of endocarditis. Urgent redo-surgery was successful in both cases, replacing the Trifecta prosthesis with a different bovine bioprosthesis.

Objectives: An 84-year-old female with severe aortic stenosis and dyspnea NYHA class III underwent a transcatheter aortic valve implantation with a 27 mm Lotus valve (Boston Scientific, Marlborough, MA, USA) with no residual valvular or paravalvular regurgitation (PAR). After discharge the patient was asymptomatic with freedom from dyspnea (NHYA I) and in good health condition. Three months later she felt breathless again and was readmitted to our hospital with cardiac decompensation and NYHA class IV.

OBJECTIVES: In infective endocarditis (IE), identification of the causative organism and consecutive treatment are crucial for patient survival. Although the macroscopic aspect resembles infected tissue, standard diagnostic tests often fail to allow one to identify bacteria. Fluorescence in situ hybridization (FISH) is a molecular, culture-independent technique that allows one to identify and visualize microorganisms within tissue and to recognize their morphology, number and activity. We analysed the diagnostic benefit of FISH/polymerase chain reaction (PCR) by comparing its results to those of standard diagnostic tests. METHODS: From September 2015 to April 2018, 128 patients underwent first-time or redo valve surgery to treat IE. Patients were designated according to the modified Duke criteria as definite (n=61), possible (n=34) or rejected (n=33) IE. Tissue specimens obtained intraoperatively were analysed using FISH/PCR in addition to undergoing standard diagnostic testing and PCR alone. RESULTS: We used blood cultures to detect microorganisms in 67/128 patients; valve cultures, in 34/128; PCR, in 67/128; histopathological diagnosis showed IE in 72/128 cases. We were able to detect microorganisms in 103/128 cases using FISH/PCR, with 55/61 in definite IE. Furthermore, we were able to identify 26 cases of bacterial biofilm using FISH/PCR, despite antibiotic treatment of 61 in the definite, 13 in the possible and 1 in the rejected group, including 8/33 patients in the rejected group with active bacteria. In all cases, the patient's therapy was altered. CONCLUSIONS: FISH/PCR was used to identify microorganisms in cases in which standard diagnostic tests failed to provide sufficient results for various reasons. Furthermore, FISH/PCR enabled us to identify bacterial biofilms and to differentiate between active versus degraded bacteria, thus indicating the impact of treatment. Therefore, we suggest FISH/PCR as an additional diagnostic tool in IE alongside standard diagnostic tests.

Objectives: Complications during transcatheter aortic valve implantation (TAVI) might require surgical intervention and in severe cases cardiopulmonary bypass (CPB). Therefore, it is still mandatory to perform TAVI-procedures in a heart team, consisting of a heart surgeon and interventional cardiologist to increase patient survival. We aim to look at the management and outcome of TAVI complications requiring surgical intervention at our institution.