The majority of patients who had their valve reimplanted in a graft with sinuses continue to perform well after 10 years.

Avoidance of aortic side clamping results in a significant reduction in the proportion of solid microemboli detected with transcranial Doppler. As solid microemboli are probably the most damaging, use of the Enclose and Heartstring devices may represent an important strategy for minimizing cerebral injury during proximal aortic anastomoses.

Patients undergoing on-pump, but not off-pump, surgery have a significant relative reduction in prefrontal activation, which correlates with intraoperative cerebral microembolic load. We hypothesize that this reduction in activation is related to subclinical functional impairments and that microembolic load is an important mechanism of perioperative cerebral insult.

Inadvertent paramedian sternomoty strongly affects postoperative chest wound stability independently from sternal size, requiring prompt reinforcement of chest closure.

In patients with severe mitral regurgitation due to Barlow's disease with multiple central jet and without chordal rupture, mitral annuloplasty is effective in restoring mitral valve function owing to profound changes in mitral valve and left ventricle geometry. At follow-up, stress echocardiography confirms the results and the stability of the repair.

These findings (i) confirm the hypothesis that the sinuses of Valsalva play a key role in optimizing the aortic haemodynamics during systole, minimizing energy losses; (ii) suggest that the sinuses of Valsalva are needed because of the complex nature of blood flow during ejection.

No abstract

Solid cerebral microemboli represent approximately one third of the total cerebral microembolic load after mechanical aortic valve replacement and are detectable in the majority of such patients both 5 days and 3 months after surgery. The neurofunctional consequences of this phenomenon should be carefully assessed.