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Aim: Transcatheter aortic valve implantation is increasingly presented as an alternative to aortic valve replacement in the high risk surgical candidate. We review the outcomes of isolated aortic valve replacement to identify contemporary results of aortic valve replacement in such high risk patients., Methods: Retrospective analysis of 846 patients (mean age 68.7 ± 11.8 years) who underwent aortic valve replacement in a single institution from 1999 to 2008. We considered 10 risk factors as follows: female gender (395 patients, 46.7%), age, left ventricular ejection fraction, New York Heart Association Class, preoperative creatinine clearance, body mass index, peripheral vascular disease (49 patients, 5%), cerebrovascular disease (42 patients, 4.9%), chronic obstructive pulmonary disease (87 patients,10.2%), and redo surgery (53 patients, 6.2%)., Results: Twenty-five patients died (2.9%). Age (P=0.032; OR 1.07 per each year increase) was the only significant independent predictor of mortality. Length of stay in the hospital was correlated with age (P<0.0001), New York Heart Association Class (P<0.0001) creatinine clearance (P=0.005) and redo surgery (P=0.006)., Conclusion: Contemporary aortic valve replacement is a low risk procedure for most patients. Historical risk factors which have been used to define high risk and inoperability, such as pulmonary disease, reoperations, decreased left ventricular ejection fraction and vascular disease, may not be relevant in the current era. This observation should be considered if such criteria are used to define patients for transcatheter aortic valve implantation.

Background: Annulo-aortic ectasia is a dilation of the aortic root with the involvement of the Valsalva sinuses. In 1968 Bentall and DeBono proposed to replace the aortic valve, the Valsalva sinuses and the ascending aorta with a composite tube graft containing aortic valve prosthesis. Consequently coronary ostia had to be reimplanted on the prosthetic tube. Recently the use of new materials has resulted in a more acceptable operative risk, and postoperative bleeding and late mortality have been reduced., Methods: From January 1991 to December 1998, 44 out of 241 patients were operated on with the Bentall-DeBono procedure, affected by dissecting or expansive aneurysm of the ascending aorta. Of the 44 patients (35 males, 9 females, mean age 53.7 years), 3 presented with acute aortic dissection, 5 were asymptomatic, 10 were in NYHA functional class II, 14 in class III, 9 in class IV, and 2 in CCS class 4; 1 patient had dysphonia; 37 patients presented with isolated aortic regurgitation, and 7 associated aortic valvular stenosis. The diagnosis of acute dissection was made by transesophageal echocardiography and that of expansive aneurysm by thorax helical computed tomographic scanning and/or magnetic resonance imaging and cardiac catheterization. Follow-up was obtained in 100% of the patients for an average of 23 +/- 20.9 months (range 4-79 months)., Results: Four patients (9%) died; in 4 patients (9%) postoperative bleeding needed reoperation, in 5 (11.4%) a permanent pacemaker for atrioventricular block was implanted, and 1 patient (2.3%) had transient hemiparesis. At univariate analysis predictive factors for operative risk were NYHA functional class IV (p < 0.005) and atherosclerotic etiology (p < 0.05). At follow-up 7 late deaths occurred for an actuarial survival at 24 months of 75 +/- 9%. Causes were sudden death in 3 patients, cardiac failure in 3 and stroke in 1 patient; 31 surviving patients (94%) were in NYHA functional class I and 2 patients in class II (6%)., Conclusions: The Bentall-DeBono procedure involves moderate risk with good results; clinical presentation and associated valvular pathology influence early and mid-term results.

An abstract of the article "A simple and reliable tool to quantify calcium burden of ascending aorta" by E. Gatta and colleagues is presented.