In our cohort, CR-Kp colonization was an important predictor of CR-Kp infection after open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp.

Background: Ministernotomy and right minithoracotomy are well-known minimally invasive approaches for aortic valve replacement (AVR); however, controversial opinions exist for their utilization in obese patients. The aim of this study is to check a potential positive role of minimally invasive surgery in this population. Methods: From January 2010 to November 2019, 613 obese patients (defined by a body mass index ≥30) underwent isolated AVR at our institution. Surgical approach included standard median sternotomy (176 patients), partial upper sternotomy (271 patients), or right anterior minithoracotomy (166 patients). Intra-and postoperative data were retrospectively collected. Results: Patients treated with minimally invasive approaches had shorter cardiopulmonary bypass time (p = .012) and aortic cross-clamp time (p = .022), mainly due to the higher utilization of sutureless valve implantation. They also presented advantages in terms of reduced postoperative ventilation time (p = .010), incidence of wound infection (p = .009), need of inotropic support (p = .004), and blood transfusion (p = .001). The univariable logistic regression showed the traditional full sternotomy approach as compared with ministernotomy (p = .026), active smoking (p = .009), peripheral vascular disease (p = .003), ejection fraction (p = .026), as well Logistic European system for cardiac operative risk evaluation (EuroSCORE; p = .015) as factors associated with hospital mortality. The multivariable logistic regression adjusted for the logistic EuroSCORE revealed that surgical approaches do not influence hospital mortality. Conclusions: Obese patients with severe aortic valve pathology can be treated with minimally invasive approaches offering a less biological insult and reduced postoperative complications, but without impact on hospital mortality.

PPM after AVR does not affect survival, functional status, and QoL in patients aged at least 75 years. Surgical procedures, often time-consuming, contemplated to prevent PPM, may therefore be not justified in this patient subgroup.

Aim Aortic valve replacement (AVR) using sutureless prosthesis is a reasonable alternative in those patients with aortic stenosis who would benefit from reduced cross clamp time, such as elderly and high-risk patients. Actually, excellent performances have been demonstrated in hemodynamic outcomes and safety, but some questions remain open regarding long-term durability and the need for postoperative pacemaker implantation. Methods Between January 2014 and August 2019, all 436 patients [male 40.6%, median age 78 years interquartile range (73–82)] treated with sutureless AVR with a Perceval prosthesis were included in our analysis. Results The univariate logistic regression showed previous aortic valve surgery [P = 0.028; odds ratio (OR) 3.248], dialysis (P = 0.036; OR 6.435), renal insufficiency (P = 0.021; OR 2.75), EuroSCORE II (P = 0.016; OR 1.051) and year of operation (P < 0.01; OR 0.658) as factors associated with the development of atrioventricular type II or type III block or junctional block requiring pacemaker implantation. The overall incidence of pacemaker implantation after sutureless AVR was 7.1% in the current study, but it dropped to 3.8 and 4.7%, respectively, in 2018 and 2019. Conclusion The Perceval aortic valve is associated with encouraging postoperative results. The incidence of pacemaker implantation is strictly linked to the surgeons’ experience, decreasing year by year after an adequate sizing, reaching a percentage comparable with sutured valve.

Post-sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound-healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complica-

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F ollowing on from the success of mitral valve repair, aortic valve (AV) repair is now recognized as a recommended treatment for selected patients with aortic insufficiency (AI) or proximal aorta aneurysm. In recent years, the main schools of aortic valve (AV) repair have standardized the approaches and techniques to enhance the reproducibility of AV repair. International guidelines now recommend a "heart team discussion" for selected patients with "pliable, non-calcified tricuspid or bicuspid" AI "in whom aortic valve repair may be a feasible alternative to valve replacement" (Class I C indication). 1 We have developed a standardized technique for aortic valve repair that is reproducible, and consists of a systematic approach to allow the surgeon to safely and competently embark on the correct strategy for valve repair. We have taught these techniques at our international courses, with many surgeons having learned to perform these operations using these standardized steps. The technique addresses the valve cusps as well as the annulus and sinotubular junction (STJ). 2 The physiologic ratio of STJ/annulus is 1.2, 3 and we restore root geometry back to this ratio using a double subvalvular and supravalvular annuloplasty. We also perform systematic effective height assessment and resuspension. This is the fourth and final article of the series, which are deep dives into how we teach the standardized techniques of aortic root and valve repair, including root replacement in tricuspid aortic valves (TAV) and bicuspid aortic valves (BAV), as well as isolated repair of TAV and BAV (Figure 1). Previously, we have described root remodeling and annuloplasty in both TAV and BAV, as well as isolated AV repair in TAV. [4][5][6] In this fourth article, we describe our approach to teaching isolated AV repair using double subvalvular and supravalvular annuloplasty in BAV.

Background: Current guidelines recommend root replacement when diameter of the sinuses of Valsalva are superior to 45 mm particularly for bicuspid valve. However, in case of tubular aorta aneurysms with moderate root dilatation (40-45 mm diameter), the approach is still debated regarding the increased risk of coronary reimplantation.We present a modified hemi-remodeling aortic repair technique that includes the replacement of the noncoronary sinus, ascending aorta, and valve repair with external ring annuloplasty in patients with bicuspid aortic valve (BAV) and moderately dilated aortic root. Methods: Between 2003 and 2017, 18 patients presenting with left-right BAV and an aortic root diameter at 42.3+/−3.3 mm underwent hemi-root and ascending aorta replacement and aortic valve repair with external annuloplasty.Results: Postoperatively, 16 (88.9%) had no aortic insufficiency (AI) and 2 (11.1%) had grade I AI, no patients had grade III or grade IV AI. Overall survival and freedom from grade II AI at 4 years and freedom from aortic valve-related reoperation were 100%. Conclusion:The standardized modified hemi-remodeling technique we present is a safe and reproducible procedure, with satisfactory durability at follow-up. This technique represents an interesting alternative to full valve sparing root replacement, as it avoids the operative risk of coronary reimplantation, allows shorter crossclamping time and a better exposition on the valve for a symmetrical repair, placing the commissure at 180°, compared with valve sparing root replacement.aneurysm of the ascending aorta, annuloplasty, aortic valve repair, bicuspid aortic valve, valve sparing root replacement | INTRODUCTIONPatients presenting with bicuspid insufficient aortic valve (aortic insufficiency [AI]) and aortic root aneurysms are usually surgically treated by either valve sparing procedures or root replacement when diameter exceeds 45 mm according to the guidelines. 1 In case of tubular aorta aneurysms with moderate root dilatation (between 40 and 44 mm diameter), the approach is still debated, as coronary reimplantion increase operative mortality particularly for the most frequent RL fusion where root dilation is predominant in the Non-Coronary (NC) sinus while right and left sinuses are often not dilated.In this regard, the position of the coronary ostia needs accurate observation, as if the origin of the coronary arteries is above the sinotubular junction (STJ), the aortic root is considered dystrophic and valve sparing operations are indicated. If the coronary ostia is normally positioned, so at the STJ or just below, the replacement of