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Open in new tab Download slide OBJECTIVES The Bentall procedure is the gold standard for patients with combined aortic root dilation and valve dysfunction. Over the past decade, fast-track (FT) perioperative anaesthetic management protocols have progressively evolved. We reviewed our results for selected patients undergoing Bentall surgery under an FT protocol. METHODS We retrospectively analysed a consecutive cohort of patients who underwent elective Bentall procedures at our institution between 2000 and 2018. Complex aortic root repair (i.e. David and Ross procedure, redo surgery, major concomitant procedures, emergency repair for acute dissections) was excluded. Patients who underwent conventional perioperative treatment and those treated according to our institutional FT concept were compared following 1:1 propensity score matching. RESULTS Of 772 patients who fit the in- and exclusion criteria, 565 were treated conventionally post-surgery, while 207 were treated using the FT protocol. Propensity score matching resulted in 197 pairs, with no differences in baseline characteristics after matching. In-house mortality, 30-day mortality and overall all-cause long-term mortality were comparable between the FT and the conventionally treated cohort. Postoperative anaesthetic care unit/intensive care unit length-of-stay (6.2 vs 20.6 h, P  = 0.03) and postoperative ventilation times (158.9 vs 465.5 min, P  < 0.001) were significantly shorter in the FT cohort. There were no differences in rates of postoperative adverse events. CONCLUSIONS In centres with experienced anaesthesiologists, perioperative FT management is non-inferior to conventionally treated patients undergoing elective Bentall procedures without compromising patient safety. [ABSTRACT FROM AUTHOR]

Aims Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging. Methods and results Patients with moderate to severeMRand high surgical risk underwent MitraClipTM-implantation andCMRimaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strainwas applied.Twenty patients (age: 76+8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33+16 underwent both successful MitraClipTM implantation and CMR imaging. MR fraction (36+10 vs. 19+12%; P , 0.001) and LV end-diastolic volume (115+36 vs. 105+41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42+15 vs. 41+16%, P = 0.8) and cardiac index (1.7+0.5 vs. 1.8+0.4 L/min/2, P = 0.4) remained unchanged. MitraClipTM implantation resulted in a significant impairment of circumferential (212.8+4.8 vs. 28.2+3.3; P = 0.002) and radial strain (15.4+7.7 vs. 9.6+5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83+19 vs. 84+18 mL/2, P = 0.8), ejection fraction (42+9 vs. 43+11%, P = 0.8), or tricuspid regurgitation fraction (24+17 vs. 25+19%, P = 0.7). MitraClipTM implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P , 0.001). Conclusion In severely compromised patients, marked reduction in MR by MitraClipTM implantation might not result in immediate improved cardiac output and effective biventricular forward flow. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the results of minimally invasive transapical aortic valve implantation (TA-AVI) in patients requiring redo surgery. Methods: Twenty-five high risk patients with symptomatic aortic valve stenosis and previous cardiac surgical interventions received TA-AVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN™) since February 2006. All valves were implanted in a hybrid operative theater. Patient age was 78 years, 60% were female, logistic EuroSCORE and STS score risk for mortality were 39% and 17%, respectively. Previous cardiac surgery was CABG in 17, valve surgery in 5 and other in 3 patients. Results: TA-AVI was performed successfully in 24 (96%) of the patients. One patient required early conversion to sternotomy and one patient required temporary ECMO support. A total of 21 patients (84%) were treated completely off-pump, one early patient was treated on-pump by intention and three patients required secondary cardiopulmonary bypass support. Echocardiography revealed good valve function in all but the converted patient, with trivial to mild (1°) paravalvular incompetence in 40%. Three patients died within 30 days of the procedure and during follow-up four patients died, all with good valve function at most recent echo. Thirty-day survival was 88% and one-year survival was 72%. There were no new-onset neurological events. Conclusions: TA-AVI can be performed with excellent results and minimal stroke risk in high risk patients requiring redo cardiac surgery. TA-AVI represents an important alternative to conventional surgery in elderly high risk patients requiring reoperative procedures. [Copyright &y& Elsevier]