In heart failure (HF), implantable haemodynamic monitoring devices have been shown to optimize therapy, anticipating clinical decompensation and preventing hospitalization. Direct left‐sided haemodynamic sensors offer theoretical benefits beyond pulmonary artery pressure monitoring systems. We evaluated the safety, usability, and performance of a novel left atrial pressure (LAP) monitoring system in HF patients.

Session 08:15 Young Investigator Awards 212 Cardiac 13:30 Surgical videos 111 Congenital 13:30 Defining good outcomes after aortic root surgery 113 Vascular 15:15 Arch and descending aortic pathology 113 Vascular Abstract Rapid ResponseRapid Response 15:15 Congenital Rapid Response – Miscellaneous 211 Congenital 15:15 Trends in Aortic valve replacement 212 Cardiac Training in Research Session 08:15 Preparing your scientific breakthrough: from abstract to paper 122 & 123 All Domains 13:30 Statistics from scratch: finding your way through the forest of options... 122 & 123 All Domains

Background Transcatheter aortic valve-in-valve implantation (ViV) is increasingly used to treat failed bioprostheses (BP), but elevated gradients remain a challenge. In-vitro studies suggest transcatheter heart valves (THV) with supra-annular position improve haemodynamic results compared to THV with intra-anular position. Methods We compared haemodynamic performance. Methods: Since 2008, 71 patients underwent ViV using the Medtronic CoreValve /Evolut-R (CV) or Edwards Sapien /XT/3 THV (ES). Patients were matched regarding true internal diameter (ID) and mode of degeneration (MoD) (CV=22, ES=19). Results In the total group, CV were implanted into smaller BP than ES (true ID: 19.0 ± 2.1mm vs. 21.4 ± 2.7mm, p < 0.01). After matching, true ID was 19.4 ± 2.0mm in both groups, p = 0.92. MoD, BSA and left ventricular function were not significantly different. Baseline mean gradients (CV: 39.0 ± 17.2mmHg vs. ES: 38.0 ± 19.5mmHg, p = 0.86) and indexed effective orifice areas (iEOA; CV: 0.79 ± 0.11cm²/m² vs. ES: 0.80 ± 0.10cm²/m², p = 0.64) were comparable. At discharge, mean gradients were 22.0 ± 7.7mmHg (CV) vs. 20.0 ± 7.8 (ES, p = 0.43) and iEOA: 0.77 ± 0.14 cm²/m² (CV) vs 0.84 ± 0.21cm²/m² (ES, p = 0.28). In CV, 54.5% had a mean gradient ≥20mmHg, compared to 52.6% in ES, p = 1.0. There was no paravalvular regurgitation >1. Conclusion In retrospect, haemodynamic performance of either CV or ES for ViV was not different and superiority of supra-annular THV remains to be proven. Other factors, such as implantation depth of THV, may be more relevant for haemodynamic outcome and need further investigation.

Introduction: A consensus regarding the ideal graft material in presence of acute native or prosthetic aortic valve endocarditis is still missing. Aortic allograft replacement has been the policy in our institution. We are reporting on our experience.

As the Ross operation is gaining popularity, reinterventions for autograft failure are gaining importance. Patients with this problem are usually younger adults who would be facing lifelong anticoagulation if the autograft were to be replaced with a mechanical conduit. On the other hand, a biologic valve is not a suitable alternative. Because many of these patients have macroscopically normal or nearly normal valve leaflets, a valve-sparing root reimplantation appears most suited to meet their need for a reintervention that would maintain the promised benefits of the initial Ross procedure. These are the lack of a need for anticoagulation, nearly physiologic hemodynamics, and presumed longevity of repair, provided that the long-term results are comparable to those of root reimplantation for aneurysms of the ascending aorta. We report a case of autograft failure 4 years after a Ross operation that was successfully managed by valve-sparing root reimplantation and concomitant leaflet reconstruction. A 33-year old man who had undergone a Ross operation with a subcoronary implantation technique because of an incompetent bicuspid aortic valve 4 years previously was seen with a moderate to severe insufficiency of the autograft. Follow-up echocardiography had shown signs of progressive volume overload, with a left ventricular diastolic dimension of 62 mm, a left ventricular systolic dimension of 43 mm, and a left atrial dimension of 38 mm, as well as a mild reduction of the ejection fraction (50%). The aortic root had a diameter of 35 mm. Clinically, the patient was in New York Heart Association functional class II. Because of his young age and previous Ross operation, the mutual decision (the patient himself was a physician) was for a valve-sparing operation. Intraoperatively, we found a subcoronary positioned autograft with two tears of 2 mm at the inflow suture line, which had led to a paravalvular leakage. One tear lay between the right coronary and noncoronary commissures and the other between the right and left coronary commissures. In addition, there was a minute hole in the base of the left coronary leaflet and a 2-mm long hole close to the free margin of the left coronary leaflet. A valve-sparing procedure (reimplantation technique David I) was performed with a 28-mm Dacron polyester fabric graft and reconstruction of the leaflets with 7-0 interrupted Prolene sutures (Ethicon, Inc, Somerville, NJ). A remaining mild prolapse of the left coronary leaflet was corrected by a triangular plication of the free margin with interrupted 5-0 Prolene sutures. Intraoperative transesophageal echocardiography revealed no residual valve insufficiency and no paravalvular leakage. The remaining hospital stay was uneventful. The patient was discharged on the sixth postoperative day. At the first follow-up at 1 month, the patient was free of symptoms (New York Heart Association functional class 0), with echocardiography showing a left ventricular diastolic dimension of 50 mm, a left ventricular systolic dimension of 36 mm, and an ejection fraction of 60%. The valve was completely competent, and the valve gradient was measured at a mean of 9 mm Hg. At the last communication at 21 postoperative months, the patient remained symptom free (New York Heart Association functional class 0), and echocardiography showed a stable valve function (aortic insufficiency grade 0-I). Although short-term results appear to confirm this procedure as a good choice, long-term follow-up in the literature is lacking. Leyh and colleagues1Leyh R.G. Kofidis T. Fischer S. Kallenbach K. Harringer W. Haverich A. Aortic root reimplantation for successful repair of an insufficient pulmonary autograft valve after the Ross procedure.J Thorac Cardiovasc Surg. 2002; 124: 1048-1049Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar were the first to report on a valve-sparing root reimplantation after a Ross operation because of autograft dilatation and concomitant valve insufficiency. At 14 postoperative months, the autograft showed normal valve function with no signs of regurgitation or stenosis. Masetti and associates,2Masetti P. Davila-Roman V.A. Kouchoukos N.T. Valve-sparing procedure for dilatation of the autologous pulmonary artery and ascending aorta after the Ross operation.Ann Thorac Surg. 2003; 76: 915-916Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar reporting on a patient similar to that of Leyh and colleagues1Leyh R.G. Kofidis T. Fischer S. Kallenbach K. Harringer W. Haverich A. Aortic root reimplantation for successful repair of an insufficient pulmonary autograft valve after the Ross procedure.J Thorac Cardiovasc Surg. 2002; 124: 1048-1049Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar but instead choosing the remodeling technique for sparing the valve, mentioned that their patient was free of symptoms and of regurgitation at 6 months of follow-up. Ishizaka and associates3Ishizaka T. Devaney E.J. Ramsburgh S.R. Suzuki T. Ohye R.G. Bove E.L. Valve sparing aortic root replacement for dilatation of the pulmonary autograft and aortic regurgitation after the Ross procedure.Ann Thorac Surg. 2003; 75: 1518-1522Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar reported similar results with a similar follow-up in 4 patients in whom they preserved the valve with a root-remodeling technique. When one considers that the Ross procedure is chosen for its promise of lack of anticoagulation, near-physiologic hemodynamics, and longevity of repair, valve-sparing operations appear well-suited to a compatible promise at reoperation. This is especially true if long-term outcomes prove to be similar to those seen after valve-sparing operations in patients with aortic aneurysms and aortic regurgitation. Although the Ross operation has gained popularity, the number of patients undergoing similar reoperative procedures in a single center will remain small for some time. As a result, we see an important role of similar case reports in establishing a better understanding of this problem and how best to deal with it.

Introduction: Despite substantial improvements in the diagnosis and management of infective endocarditis the choice of the appropriate graft material in presence of native or prosthetic endocarditis is still lacking. We are reporting our experience with allograft aortic root replacement.