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Objectives: Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis., Methods: This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases., Results: Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio  = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70)., Conclusions: Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.

Groin lymphocele is a serious complication of vascular and cardiac surgery as well as of interventional procedures that cannulate the femoral vessels, whose treatment lacks standardization because of high risk of failure. The aim of the technique we describe is the sealing of open lymphatic channels thanks to prolonged external compression of the groin by application of prolene or silk stitches tied upon plastic pledgets. We have used our technique, called 'packing of the groin', as first treatment in 10 patients affected by lymphocele of the groin: nine patients had complete resolution of the lymph leakage, followed by normal healing of the wound whereas one patient had infective complication with treatment failure. Our technique is simple and safe with appreciable results in terms of success and it does not require immobilization with positive effects on patient's management.

Use of the Foley catheter has been described in cardiac surgery over a wide range of applications. In recent years, the interest in minimally-invasive surgery has increased, providing several advantages in terms of mortality and morbidity. Unfortunately, challenging situations, such as re-do surgery may be encountered, and innovative strategies to reduce the invasiveness of the surgical approach need to be developed. External snaring of the caval veins in re-do patients is hazardous when a minimally-invasive approach is used because the tissues are usually fragile and sudden bleeding can be difficult to control. We propose a simple strategy using Foley catheters to provide 'internal snaring' of both caval veins, avoiding surgical dissection of the adhesions around the vessels. Three re-do patients were operated on for combined mitral/tricuspid surgery using internal snaring: the occlusion of the veins was satisfactory in all cases, with no complications reported so far. Even though the 'trick' described is not spectacular, it might be very helpful to be prepared to use this technique either on a routine basis or in special situations when the risk of injury to the atrial or caval structures appears to be increased.

A method for correcting the tube kinking after ascending aortic replacement for acute dissection is described. Its main advantage is the no need for cardiopulmonary by-pass (CPB) and aortic clamping to solve the problem.