Objective: Atrioventricular (AV) conduction impairment represents an infrequent complication following aortic valve replacement (AVR). Although several conditions have been considered as potential risk factors for such a postoperative event, the role of the surgical technique has not been evaluated. The aim of this study was to investigate if the suture technique for implantation of the prosthetic valve is a potential risk factor need of pacemaker (PM) implantation after AVR. Methods: One hundred twenty‐four patients undergoing AVR were enrolled in this study. A “continuous” suture technique was performed in 72 patients (58%; Group A), whereas an “interrupted” suture technique was used in 52 patients (42%; Group B). The incidence of “major,” requiring PM implantation, as well as “minor,” without PM implantation, impairment of the AV conduction was evaluated and compared in the two groups by means of univariate and multivariate analyses. Results: The patients of the two groups were homogenous for all preoperative parameters except patient age. A longer clamp time was present in the patients of group B than those of group A (73 ± 24 minutes and 60 ± 24 minutes, respectively; p < 0.01). Postoperatively, hospital mortality consisted of four patients (3.2%) with no statistical importance between the two groups. Eleven patients of group A (17.5%) and one patient of group B (2.2%) required PM implantation (p < 0.05). Prolonged P‐R interval was recorded in 15 patients of group A and in 5 patients of group B (p < 0.05). Conclusions: We showed that the continuous suture technique increases the need for postoperative PM implantation after AVR. No major differences have been observed, however, regarding in‐hospital mortality and length of hospital stay, regardless of the type of prosthetic suture technique.

OBJECTIVES Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (−35.4%) and operating rooms (−29.2%), along with healthcare personnel reallocation to COVID departments (nurses −15.4%, anaesthesiologists −7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P &lt; 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)]. CONCLUSIONS This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency is over.

BackgroundHepatocellular carcinoma (HCC) with the presence of tumor thrombus in hepatic veins and vena cava, until the atrium (RATT), is correlated with poor prognosis and with risk of tricuspid valve occlusion, congestive heart failure, and pulmonary embolism.MethodsThree patients with HCC on cirrhotic liver with RATT were studied. Operative technique, pre-operative and post-operative liver function tests, blood loss and transfusions, post-operative morbidity and mortality, and the overall survival and the disease free survival were analyzed.ResultsMean operative time was 336 ± 66 min. Intra-operative blood loss was 926.6 ± 325.9 ml. No major complications occurred. The times of hospital stay were 10, 21, and 19 days, respectively. The survival times were 90, 161, and 40 days, and the disease-free survival times were 30, 141, and 30 days, respectively.ConclusionsThe complete removal of HCC with RATT may be achieved with cardiopulmonary by-pass (CPB) and total hepatic vascular exclusion (THVE). Adding the hypothermic cardiocirculatory arrest (HCCA) to the use of CPB allowed us to have minimal blood loss and hemostasis of the resectional plane. So the use of CPB and HCCA should be considered a good therapeutic alternative to the normothermic CPB with THVE.

The possibility to progress to overt aortic dissection may explain the need to an early diagnosis in the treatment of acute IMHs. Immediate surgical treatment is, in our experience, the preferred therapeutic option.

The other 2 patients had recurrence of mild regurgitation at the third and 30th months. Freedom from mitral regurgitation was 86.9%.

A case of a 67-year-old woman with cardiac tamponade caused by toothpick ingestion is presented. At clinical presentation, it mimicked postinfarction ventricular free wall rupture and the diagnosis was not made until the operation. Ingested toothpicks have often been reported as a cause of intestinal injuries, but in this rare case the toothpick migrated into the pericardium and caused laceration of the right coronary artery.

Intravenous leiomyomatosis (IVL) is an uncommon condition characterized by an intraluminal growth of benign smooth muscle cells in venous vessels. While IVL confined within the inferior vena cava usually causes few symptoms-including pelvic pain and edema of the lower extremities-the tumor may extend to the heart, causing intermittent obstruction of the tricuspid valve or right ventricular obstruction outflow, and subsequently right-sided heart failure or death. The present article reports a case of IVL extending to the heart that was treated in a single-stage operation involving cardiopulmonary bypass and hypothermic circulatory arrest.A 43-year-old patient was referred to Careggi University Hospital complaining of dyspnea and intermittent episodes of tachycardia; the patient had a previous history of uterine leiomyoma excision. Echocardiogram confirmed the presence of a right atrium intracardiac mass. MRI revealed a uterine mass measuring 8 cm in diameter with

Objectives To highlight short‐ and long‐term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. Methods We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta‐analysis, and gray literature. Results Fourty‐five clinical studies with 12.714 patients were included in the analysis. Thirty‐day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%−6.9% for SB. Long‐term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%−3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%−0.7% and Perceval 0%−1%), endocarditis (Intuity 0.2%−0.7% and Perceval 1.6%−6.6%), stroke (Intuity 0.36%−1.4% and Perceval 0%−0.8%), MI (Intuity 0.07%−0.26%), and SVD (Intuity 0.12%−0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%−2.1% for SFS. Hospital costs outcomes ranged from $37,187−$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short‐term mortality ranged between 0.9% and 12.4% while long‐term mortality ranged between 2.6% and 20%. Conclusions This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.