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Transcatheter aortic valve implantation (TAVI) evolved to an established treatment for meanwhile moderate-risk surgical patients suffering from severe aortic stenosis. Due to its less invasiveness, avoiding the use of cardiopulmonary bypass, the procedure demonstrated to be an efficient and safe treatment option. However, long-term results regarding these new valve prostheses are still lacking. Potential prosthesis failure and/ or dysfunction would require either, if feasible, a transcatheter "valve in valve" procedure, or a conventional surgical valve replacement. In the literature, anecdotal reports are describing surgical removal techniques of the currently transcatheter-implanted prostheses. We herein propose a modified surgical removal technique of an infected Edwards SAPIEN 3 Transcatheter Heart Valve 18 months after its implantation.

Background: This study evaluates the impact of gender in dialysis-dependent patients undergoing cardiac surgery., Methods: We retrospectively identified 204 dialysis-dependent patients (68.6% male, aged 66.6 ± 9.9 years) with end-stage renal disease undergoing cardiac surgery and compared them to a propensity-score-pair-matched control collective., Results: A 30-day mortality was 13.2% (14/106) for coronary artery bypass grafting (CABG), 19.3% (6/31) for aortic valve replacement (AVR), and 23.8% (16/67) for combined procedures. Postoperative chest tube output was significantly higher in men (1,007 ± 946 mL) versus women (687 ± 598 mL, p = 0.014). Compared with a propensity-score-pair-matched control collective of 204 patients, we identified significant differences in terms of 30-day mortality: overall mortality revealed 17.6 versus 4.6% (p = 0.0001), 13.2 versus 3.4% (p = 0.014) for CABG, 19.3 versus 0% (p = 0.051) for AVR, and 23.8 versus 9.1% (p = 0.02) for combined procedures., Conclusion: Multivariate analysis identified preoperative myocardial infarction, prolonged extracorporeal circulation time, operation time, and surgical reexploration as independent predictors of 30-day mortality. There was a higher occurrence of bleeding complications in men that remained significant even after correction for body surface area., (Georg Thieme Verlag KG Stuttgart · New York.)

Background and Aim of the Study: The Mosaic bioprosthesis is a stented porcine aortic valve, which combines glutaraldehyde fixation with zero-pressure and root-pressure techniques and anti-mineralization treatment with amino-oleic acid for improved hemodynamics and tissue durability. The study aim was to collect intermediate-term data of the Mosaic bioprosthesis in the aortic position, the first device having been implanted in February 1994 at the authors' institution., Methods: A total of 100 patients (49 females, 51 males) underwent aortic valve replacement with the Mosaic bioprosthesis between February 1994 and May 1999. Mean age at implant was 73.4 +/- 7.3 years. Concomitant procedures were performed in 40.0% of cases. Patients were followed up within 30 days postoperatively, after six months, and at annual intervals thereafter. Mean follow up was 3.8 years (range: 0.1-7.1 years); total follow up was 383.1 patient-years (pt-yr) and 100% complete., Results: Early mortality (< or = 30 days) was 3.0%; late mortality was 4.6%/pt-yr, including a valve-related mortality of 0.6%/pt-yr. Freedom from event at seven years was 96.8 +/- 1.8% for thromboembolic events, 97.2 +/- 2.0% for thrombosed bioprosthesis, 96.6 +/- 2.6% for structural valve deterioration, 98.2 +/- 1.8% for nonstructural dysfunction, 95.9 +/- 2.0% for anti-thromboembolic hemorrhage, 98.9 +/- 1.1% for endocarditis, and 93.9 +/- 3.2% for reoperation/explant. After one year, the mean systolic pressure gradient was 15.3 +/- 6.7, 14.5 +/- 5.7, 12.7 +/- 4.1 and 12.9 +/- 4.8 mmHg for 21, 23, 25 and 27 mm valves respectively; the effective orifice area (EOA) was 1.4 +/- 0.4, 1.7 +/- 0.4, 1.8 +/- 0.4 and 2.6 +/- 0.4 cm2 for 21, 23, 25 and 27 mm valves respectively; and the EOA index was 0.8 +/- 0.3, 0.9 +/- 0.2, 0.9 +/- 0.2 and 1.3 +/- 0.1 cm2/m2 respectively. The mean left ventricular mass index was decreased significantly, from 159.7 +/- 56.8 g/m2 to 137.3 +/- 40.8 g/m2, for all valve sizes after one year., Conclusion: Clinical and hemodynamic performance of the Mosaic bioprosthesis was highly satisfactory during the first seven years after clinical introduction.