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The ROMA trial is a large randomized clinical trial comparing single arterial grafting (SAG) and multiple arterial grafting (MAG) in coronary artery bypass surgery (CABG). The trial began in 2017 and is expected to conclude in 2023. It was initiated due to the inconclusive results of a previous trial. Challenges faced by the ROMA trial include high crossover rates and the impact of the COVID-19 pandemic. The trial's results are still pending but are anticipated to provide valuable insights into the effectiveness of MAG in CABG procedures. The success of the ROMA trial has led to the establishment of the ROMA network, which conducts other cardiac surgery trials. The trial involves multiple participating centers across different continents, including hospitals in Asia such as Jilin Heart Hospital, Fuwai Hospital, Teda Hospital, National Taiwan University Hospital, and Ruijin Hospital Shanghai Jiao Tong USM. The document also provides a list of hospitals and medical institutions from various countries involved in the trial. The ROMA trial is funded by the National Institutes of Health and the Canadian Institutes of Health and Research. [Extracted from the article]

Open in new tab Download slide OBJECTIVES Age-related atherosclerosis has been shown to cause aortic stiffness and wall rigidification. This analysis aimed to correlate age and dissection extension length in a large contemporary multicentre study. We hypothesize that younger patients suffer more extensive DeBakey type I dissection due to aortic wall integrity, allowing unhindered extension within the layers. METHODS The perioperative data of 3385 patients from the German Registry for Acute Aortic Dissection Type A were retrospectively analyzed with regard to postoperative outcomes and dissection extension. Patients with DeBakey type I aortic dissection (n  = 2510) were retrospectively identified and divided into 2 age groups for comparison: ≤69 years (n  = 1741) and ≥70 years (n  = 769). Patients with DeBakey type II dissection or connective tissue disease were excluded from the analysis. RESULTS In younger patients (≤69 years), aortic dissection involved the supra-aortic vessels significantly more often (52.0% vs 40.1%; P  < 0.001) and extended significantly further downstream the aorta: descending aorta (68.4% vs 57.1%; P  < 0.001), abdominal aorta (54.6% vs 42.1%; P  < 0.001) and iliac bifurcation (36.6% vs 26.0%; P  < 0.001). Consequently, younger patients also presented with significantly higher incidences of preoperative cerebral (P  < 0.001), spinal (P  < 0.001), visceral (P  < 0.001), renal (P  = 0.013) and peripheral (P  < 0.001) malperfusion. In older patients (≥70 years), dissection extent was significantly more often limited to the level of the aortic arch (40.9% vs 29.2%; P  < 0.001). No significant difference was found with regard to 30-day mortality (20.7% vs 23.6%; P  = 0.114). CONCLUSIONS Extensive DeBakey type I aortic dissection is less frequent in older patients ≥70 years than in younger patients. In contrast, younger patients suffer more often from preoperative organ malperfusion and associated complications. Postoperative mortality remains high irrespective of age groups. [ABSTRACT FROM AUTHOR]

Keywords: Coronary artery bypass grafting; Arterial grafting; Radial artery; Internal thoracic artery; Bilateral internal thoracic artery; Meta-analysis EN Coronary artery bypass grafting Arterial grafting Radial artery Internal thoracic artery Bilateral internal thoracic artery Meta-analysis 1 5 5 03/02/23 20230201 NES 230201 We are grateful for the opportunity to reply and comment on the Taggart I et al. i [[1]] and Freemantle I et al. i [[2]] pieces. Taggart I et al. i [[1]] raise the following points in their commentary: The mean age of the left internal thoracic artery (LITA) and radial artery (RA) group was younger than the other groups: this is incorrect. Apparent exclusion of the Radial Artery Patency and Clinical Outcomes (RAPCO) trial: RAPCO patients were excluded from the propensity score-matched analysis due to the high rate of missing baseline data which would have not allowed the application of a non-parsimonious model to calculate the propensity score. However, the RA effect is qualitatively consistent with the 30% mortality reduction with RA versus BITA at 15 years recently reported by the RAPCO trial and, despite all the described limitations, cannot be ignored or dismissed as implausible. [Extracted from the article]

Open in new tab Download slide OBJECTIVES Following cardiac surgery, postoperative cognitive decline (POCD) is a common complication that can impair the quality of life and increase mortality. The aim of this study was to investigate whether early postoperative cognitive training can decrease POCD after cardiac surgery. METHODS The study was a multi-centred, two-arm, randomized (1:1 ratio), controlled trial involving older patients undergoing elective heart valve surgery with extracorporeal circulation. Recruitment took place at the Department of Cardiac Surgery of the Kerckhoff-Clinic in Bad Nauheim (Germany) and the University-Hospital in Giessen (Germany). The patients were randomized to either a paper-and-pencil-based cognitive training group or a standard rehabilitation care control group. The cognitive training started 1 week after surgery and lasted about 3 weeks until discharge from rehabilitation. To detect POCD, neuropsychological functions were assessed prior to surgery, upon discharge from rehabilitation (primary outcome), and 3 months after discharge (secondary outcome). Data were primarily analysed in a per-protocol fashion. RESULTS The frequency of POCD at discharge from rehabilitation (training group, n  = 37; control group, n  = 44) was 50% in the control group and 19% in the training group (χ2[1] = 8.45, P  = 0.004; odds ratio = 4.29, 95% confidence interval [1.56–11.80]). Three months after the cognitive training (training group, n  = 33; control group, n  = 34), POCD frequency was 29% in the control group and 6% in the training group (χ2[1] = 6.21, P  = 0.013; odds ratio = 6.46, 95% confidence interval [1.29–32.28]). CONCLUSIONS Since our cognitive training showed beneficial effects, it could be a promising method to prevent POCD. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Clinical studies have indicated minor beneficial effects of the calcium sensitizer levosimendan on clinical outcomes in patients undergoing cardiac surgery. Here, the influence of levosimendan administered 24 h before cardiac arrest on myocardial function was examined in rat hearts perfused in a Langendorff model. METHODS Levosimendan (Levo group) or NaCl (control group) was administered to 53 rats via drinking water 24 h prior to mounting excised hearts on a Langendorff apparatus. Cardiac arrest with or without cardioplegia was induced in both groups; another set of hearts was perfused continuously. During 90-min reperfusion at 36°C, functional parameters were measured and normalized to baseline values. Troponin I was quantified in coronary sinus effluent, and the functionality of isolated cardiomyocytes was studied. RESULTS Oral application of levosimendan showed therapeutic efficacy. Baseline values were similar in the Levo and NaCl groups except for coronary flow. After ischaemia and reperfusion, Levo hearts did not recover better than NaCl hearts {left ventricular derived pressure: 63 [standard deviation (SD): 36.2] vs 46 (SD: 41.8)% baseline; P = 0.386}, In hearts exposed to cardioplegia, functional recovery only slightly differed in the Levo and NaCl groups [left ventricular derived pressure: 69.96 (SD: 12.7) vs 51.89 (SD: 28.1)% baseline; P = 0.09]. Cell shortening of cardiomyocytes isolated from hearts exposed to ischaemia or perfusion was better in Levo groups [cell shortening: 7.65 (SD: 1.95) %; 7.8 (SD: 1.79)% vs 6.28 (SD: 1.67)%; 6.5 (SD: 1.87)%, P < 0.001]; this benefit was absent in cardioplegia-treated hearts. CONCLUSIONS Levosimendan applied orally before ischaemia/reperfusion improves functional recovery, but this effect is only moderate when cardioplegia is included. Differences between hearts exposed to cardioplegia or to global ischaemia may indicate why levosimendan-related beneficial effects do not directly translate into better clinical outcome. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES There are disparities in the adherence to guideline-recommended therapies after coronary artery bypass graft (CABG). We therefore sought to evaluate the effect of guideline-adherent medical secondary prevention on 1-year outcome after CABG. METHODS Data were taken from the randomized 'Ticagrelor in CABG' trial. From April 2013 until April 2017, patients who underwent CABG were included. For the present analysis, we compared patients who were treated with optimal medical secondary prevention with those where 1 or more of the recommended medications were missing. RESULTS Follow-up data at 12 months were available in 1807 patients. About half (54%) of them were treated with optimal secondary prevention. All-cause mortality [0.5% vs 3.5%, hazard ratio (HR) 0.14 (0.05–0.37), P < 0.01], cardiovascular mortality [0.1% vs 1.7%, HR 0.06 (0.01–0.46), P = 0.007] and major adverse events [6.5% vs 11.5%, HR 0.54 (0.39–0.74), P < 0.01] were significantly lower in the group with optimal secondary prevention. The multivariable model for the primary end point based on binary concordance to guideline recommended therapy identified 3 independent factors: adherence to guideline recommended therapy [HR 0.55 (0.39–0.78), P < 0.001]; normal renal function [HR 0.99 (0.98–0.99), P = 0.040]; and off-pump surgery [HR 2.06 (1.02–4.18), P = 0.045]. CONCLUSIONS Only every second patient receives optimal secondary prevention after CABG. Guideline adherent secondary prevention therapy is associated with lower mid-term mortality and less adverse cardiovascular events after 12 months. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES We used individual patient data from 4 of the largest contemporary coronary bypass surgery trials to evaluate differences in long-term outcomes when radial artery (RA), right internal thoracic artery (RITA) or saphenous vein graft (SVG) are used to complement the left internal thoracic artery-to-left anterior descending graft. METHODS Primary outcome was all-cause mortality. Secondary outcome was a composite of major adverse cardiac and cerebrovascular events (all-cause mortality, myocardial infarction and stroke). Propensity score matching and Cox regression were used to reduce the effect of treatment selection bias and confounders. RESULTS A total of 10 256 patients (1510 RITA; 1385 RA; 7361 SVG) were included. The matched population consisted of 1776 propensity score-matched triplets. The mean follow-up was 7.9 ± 0.1, 7.8 ± 0.1 and 7.8 ± 0.1 years in the RITA, RA and SVG cohorts respectively. All-cause mortality was significantly lower in the RA versus the SVG [hazard ratio (HR) 0.62, 95% confidence interval (CI): 0.51–0.76, P  = 0.003] and the RITA group (HR 0.59, 95% CI 0.48–0.71, P  = 0.001). Major adverse cardiac and cerebrovascular event rate was also lower in the RA group versus the SVG (HR 0.78, 95% CI 0.67–0.90, P  = 0.04) and the RITA group (HR 0.75, 95% CI 0.65–0.86, P  = 0.02). Results were consistent in the Cox-adjusted analysis and solid to hidden confounders. CONCLUSIONS In this pooled analysis of 4 large coronary bypass surgery trials, the use of the RA was associated with better clinical outcomes when compared to SVG and RITA. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare. METHODS Retrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data. RESULTS A total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57–73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7–23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22–32%) before WCD prescription to 35% (IQR 28–42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD. CONCLUSIONS The risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF. [ABSTRACT FROM AUTHOR]

Aims Data suggest that women have worse outcomes than men after coronary artery bypass grafting (CABG), but results have been inconsistent across studies. Due to the large differences in baseline characteristics between sexes, suboptimal risk adjustment due to low-quality data may be the reason for the observed differences. To overcome this limitation, we undertook a systematic review and pooled analysis of high-quality individual patient data from large CABG trials to compare the adjusted outcomes of women and men. Methods and results The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization (major adverse cardiac and cerebrovascular events, MACCE). The secondary outcome was all-cause mortality. Multivariable mixed-effect Cox regression was used. Four trials involving 13 193 patients (10 479 males; 2714 females) were included. Over 5 years of follow-up, women had a significantly higher risk of MACCE [adjusted hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04–1.21; P  = 0.004] but similar mortality (adjusted HR 1.03, 95% CI 0.94–1.14; P  = 0.51) compared to men. Women had higher incidence of MI (adjusted HR 1.30, 95% CI 1.11–1.52) and repeat revascularization (adjusted HR 1.22, 95% CI 1.04–1.43) but not stroke (adjusted HR 1.17, 95% CI 0.90–1.52). The difference in MACCE between sexes was not significant in patients 75 years and older. The use of off-pump surgery and multiple arterial grafting did not modify the difference between sexes. Conclusions Women have worse outcomes than men in the first 5 years after CABG. This difference is not significant in patients aged over 75 years and is not affected by the surgical technique. [ABSTRACT FROM AUTHOR]

OBJECTIVES There is an ongoing discussion about how to treat coronary stents during bypass surgery: Should patent stents be left alone and the stented vessels be ungrafted, or should every stented coronary artery receive a bypass graft? This study aims to determine the relevance of perioperative stent stenosis or occlusion on postoperative outcomes up to 3 years postoperatively. METHODS Patients undergoing coronary artery bypass grafting surgery (CABG) (±concomitant procedures) with previous percutaneous coronary intervention from 4 centres were prospectively included in this observatory study between April 2015 and June 2017. A coronary angiography was conducted between the fifth and seventh postoperative days. The preoperative and postoperative angiograms were assessed in a core laboratory, assessing the patencies of coronary stents and bypass grafts. The core lab investigators were blinded to the patients' characteristics and perioperative course. RESULTS A total of 107 patients were included in the study. In the postoperative coronary angiography, 265 bypass grafts and 189 coronary stents were examined angiographically. Ninety-seven percent of preoperatively patent stents remained patent. New coronary stent stenoses were observed in 5 patients (4.7%). All 5 patients were asymptomatic and managed conservatively. Bypass stenoses were observed in 12 patients (11%), of whom were managed conservatively, 4 underwent percutaneous coronary intervention and 1 underwent redo-CABG. Two years postoperatively, 97% of patients were alive. Patients with new stent stenosis tended to have a better survival compared with patients with bypass stenosis (100% vs 73%; P  = 0.09) up to 3 years postoperatively. CONCLUSIONS Perioperative coronary stent stenosis occurs rarely. It is safe to leave a patently stented coronary vessel without bypass grafting. [ABSTRACT FROM AUTHOR]

Aims The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing coronary artery bypass grafting (CABG) is unclear. We prospectively compared the efficacy of ticagrelor and aspirin after CABG. Methods and results We randomly assigned in double-blind fashion patients scheduled for CABG to either ticagrelor 90 mg twice daily or 100 mg aspirin (1:1) once daily. The primary outcome was the composite of cardiovascular death, myocardial infarction (MI), repeat revascularization, and stroke 12 months after CABG. The main safety endpoint was based on the Bleeding Academic Research Consortium classification, defined as BARC ≥4 for periprocedural and hospital stay-related bleedings and BARC ≥3 for post-discharge bleedings. The study was prematurely halted after recruitment of 1859 out of 3850 planned patients. Twelve months after CABG, the primary endpoint occurred in 86 out of 931 patients (9.7%) in the ticagrelor group and in 73 out of 928 patients (8.2%) in the aspirin group [hazard ratio 1.19; 95% confidence interval (CI) 0.87–1.62; P  = 0.28]. All-cause mortality (ticagrelor 2.5% vs. aspirin 2.6%, hazard ratio 0.96, CI 0.53–1.72; P  = 0.89), cardiovascular death (ticagrelor 1.2% vs. aspirin 1.4%, hazard ratio 0.85, CI 0.38–1.89; P  = 0.68), MI (ticagrelor 2.1% vs. aspirin 3.4%, hazard ratio 0.63, CI 0.36–1.12, P  = 0.12), and stroke (ticagrelor 3.1% vs. 2.6%, hazard ratio 1.21, CI 0.70–2.08; P  = 0.49), showed no significant difference between the ticagrelor and aspirin group. The main safety endpoint was also not significantly different (ticagrelor 3.7% vs. aspirin 3.2%, hazard ratio 1.17, CI 0.71–1.92; P  = 0.53). Conclusion In this prematurely terminated and thus underpowered randomized trial of ticagrelor vs. aspirin in patients after CABG no significant differences in major cardiovascular events or major bleeding could be demonstrated. ClinicalTrials.gov Identifier NCT01755520. View large Download slide View large Download slide [ABSTRACT FROM AUTHOR]

In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed to show a benefit of prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims to redefine the effects of this treatment modality in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists of relevant articles were searched for full-text articles of RCTs in English or German. Assessments for eligibility, relevance, study validity and data extraction were performed by two reviewers independently using prespecified criteria. The primary outcome was hospital mortality. A total of nine eligible RCTs with 1171 patients were identified: 577 patients were treated preoperatively with intra-aortic balloon pump (IABP) and 594 patients served as controls. The pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629; P < 0.001). The pooled analyses of five RCTs including only patients undergoing isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] = 347) also showed a statistically significant improvement in mortality for preoperative IABP implantation (fixed-effects model: OR 0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital mortality from two randomized off-pump trials was 0.556 (fixed-effects model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic counterpulsation was associated with a significant reduction in low cardiac output syndrome (LCOS) in the total population (fixed-effects model: OR 0.330, 95% CI 0.214-0.508, P < 0.001) as well as in the subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI 0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238). Preoperative IABP implantation was associated with a reduction of intensive care unit (ICU) stay in all investigated populations with a greater effect in the total population [fixed-effects model: standard mean difference (SMD) -0.931 ± 0.198, P < 0.001] as well as in the subgroup of CAGB patients (fixed-effects model: SMD -1.240 ± 0.156, P < 0.001), compared with the off-pump group (fixed-effects model: SMD -0.723 ± 0.128, P < 0.001). Despite contradictory results from recent trials, the present study confirms the findings of previous meta-analyses that prophylactic aortic counterpulsation reduces hospital mortality, incidence of LCOS and ICU requirement in high-risk patients undergoing on-pump cardiac surgery. However, owing to small sample sizes and the lack of a clear-cut definition of high-risk patients, an adequately powered, prospective RCT is necessary to find a definite answer to the question, if certain groups of patients undergoing cardiac surgery benefit from a prophylactic IABP insertion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study is to evaluate the safety and efficacy of a novel 30° end-to-side coronary anastomotic coupler (Converge Medical, Inc., Sunnyvale, CA) that facilitates a non-penetrating, sutureless vein graft to coronary artery anastomosis. Material and methods: The Coupler utilizes a set of concentric mating frames approximating adjacent vessel tissue allowing for biological healing of the anastomosis. The frames are manufactured from Nitinol, a nickel titanium super-elastic metal alloy. The Nitinol frames attach the bypass graft to the coronary artery in a 30° end-to-side configuration. Between November 2002 and March 2003 a total of 46 patients (44 male) with a mean age of 63.6±7.5 years were admitted for coronary artery revascularization and included in the study. The mean LVEF was 60.6±12.4%. Results: Thirty-three patients were successfully treated with the Coupler. Nine patients did not meet the intraoperative inclusion criteria, and were excluded from the study due to small (≤2.0mm) or severely calcified coronary vessels, or small vein grafts. Hemostasis could not be achieved with the Coupler in 3 patients, and in one patient the graft flow measured intraoperative was low. In these instances the Coupler was removed and the anastomosis was sutured without complication. Average mean flow rate using transit time method through the Coupler attached bypasses was 54±26ml/min. In a control angiography 2 months after surgery, 29 (96.7%) of the 30 connector grafts were patent. One stenosis of 50% occurred on the site of a connector anastomosis. Angiographic patency assessments for 81 hand sewn grafts revealed 73 (90.1%) patent grafts. Conclusion: Initial results indicate that the Converge Coupler can be used to create a safe and effective 30° vein graft to coronary artery anastomosis under suitable conditions. [Copyright &y& Elsevier]

Abstract: Objective: This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential. Methods: Between 1996 and 2006, 493 consecutive octogenarians with symptomatic aortic stenosis underwent AVR with and without (51%) concomitant coronary artery bypass grafting (CABG). To identify high-risk patient groups, risk factors of 6-month mortality were determined using multivariable logistic regression. Results: The 30-day mortality rate was 8.4% and it increased up to 15.2% until 6 months after AVR. Independent risk factors of 6-month mortality were patients older than 84 years (odds ratio (OR): 2.2 (1.29–3.61)), left ventricular ejection fraction <60% (OR: 2.5 (1.35–4.61)), body mass index (BMI) <24 (OR: 2.0 (1.22–3.36)), creatinine (OR: 1.6 (1.04–2.53)) and blood glucose (OR: 1.01 (1.001–1.009)). High-risk groups were patients older than 84 years with an ejection fraction <60% (6-month mortality 28%) and patients younger than 84 years with an ejection fraction <60% and a BMI <24 (6-month mortality 23.2%). These high-risk groups comprised 37% of the patient population. After isolated AVR, the 30-day mortality and survival at 1 and 5 years was 11.6%, 69% and 35% in this high-risk group, respectively. In octogenarians with an STS score >10 and an EuroScore >20, the 30-day mortality and survival at 1 year was 10.5% and 80%, 11.6% and 77%, respectively. Conclusions: In most octogenarians, AVR is a safe and beneficial procedure. In high-risk octogenarians, identified by STS score >10, EuroScore >20 and by simple three risk factors (age >84 years, ejection fraction <60% and BMI <24), the mortality after surgical AVR was no different from the currently reported outcome after transcatheter AVI. [Copyright &y& Elsevier]

Abstract: Objective: After transluminal endovascular implantation of a new valved stent, the aim of this study was to evaluate the feasibility of using a high-pressure water stream to endovascularly resect human calcified aortic valves. Methods: First, human calcified aortic valves were excised and then resected in vitro to determine optimal water jet parameters. Second, healthy porcine aortic valves were ablated in vitro to evaluate possible destruction to the surrounding anatomy. Third, resection was performed endoluminally by introducing microsystemic tools into the descending aorta, passing them through the arch and ascending aorta to the aortic valve in an in vitro porcine model. Macro- and micropathology of specimens were analyzed. Results: First, resection of human calcified valves took a mean of 6.0±2.4min per three leaflets at 150bar (n=17). The maximum size of the cut leaflets was 7.1±1.7mm. Second, resection of healthy porcine aortic valves at 60bar took 2.3±0.3min per three leaflets (n=10). Only the aortic annulus was moderately affected in six cases. Third, endoluminal resection via the descending aorta took 12.2±0.8min per three leaflets at 60bar (n=10). The aortic wall was affected in four cases, the aortic annulus and the coronary ostia only once. Microscopic analysis also revealed superficial lesions with a maximum lesion depth of 1200μm in one case, and an average of 580±145μm in subsequent lesions. The mitral valve and the left ventricular outflow tract were not affected. Conclusions: Percutaneous resection of heart valves is emerging as a promising auxiliary method for the resection of calcified aortic heart valves because they can be cut endoscopically. Nonetheless, before this resection tool can be clinically applied by surgeons to perform a true percutaneous valve replacement, an additional aortic valve resection chamber (already at the prototype stage) designed for capturing all debris, has to be established. [Copyright &y& Elsevier]