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In selected cases, aortic valve repair (RVAo) is an alternative to prostesic aortic valve replacement.To compare mid-term survival, need of reoperation and echocardiographic findings associated with RVAo.Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent RVAo between 2012 and 2017. A comparison was made with a group of patients who underwent mechanical aortic valve replacement (SVAo) in the same period. The groups were characterized and compared using Chi-Square and t-tests for independent samples and survival and reoperation were analyzed using Kaplan-Meier curves and Cox regressions.We included 72 patients submitted to RVAo. Mean follow-up time was 4 years, maximum 7. Although the mean age was relatively low (47±13 years), patients undergoing RVAo presented a lower prevalence of rheumatic etiology (3%). The cardiopulmonary bypass (148±74 minutes) and cross clamping aortic times (108±52 minutes) are the usual times for this type of surgery and similar to those of the comparing group (SVAo). In the echocardiographic follow-up (median of 3 months), we verified a left ventricular mass regression of 21% and a prevalence of aortic insufficiency of 4%. At 7 years, cumulative survival and freedom from reoperation of patients undergoing RVAo were 98.8% and 97.6%, respectively.RVAo can be a safe and effective alternative, with good mid-term results if patient selection is judicious.Introdução: Em casos selecionados, a reparação da válvula aórtica (RVAo) constitui uma alternativa à substituição por prótese. Objetivo: Avaliar a sobrevida e necessidade de reoperação a médio prazo, bem como o resultado funcional após RVAo. Métodos: Estudo de coorte retrospetivo, unicêntrico incluindo consecutivamente doentes com idade ≤70 anos, submetidos a RVAo por doença da válvula aórtica não-estenótica, entre 2012-2017. Os resultados foram comparados com os obtidos após substituição valvular aórtica por prótese mecânica (SVAo) no mesmo período. Os grupos foram caracterizados e comparados utilizando testes Qui-Quadrado e t para amostras independentes e a sobrevida e reoperações foram analisadas através de curvas de Kaplan-Meier e regressões de Cox. Resultados: Foram incluídos 72 indivíduos submetidos a RVAo. O follow-up médio foi de 4 anos, máximo de 7. Apesar da idade média relativamente baixa à data da intervenção (47±13 anos), os doentes submetidos a RVAo apresentam uma baixa prevalência de etiologia reumática (3%). Os tempos de circulação extracorporal (148±74 minutos) e de clampagem aórtica (108±52 minutos) são os habituais para este tipo de cirurgias e semelhantes aos do grupo SVAo. Durante o seguimento ecocardiográfico (mediano de 3 meses) verificou-se uma regressão de massa do ventrículo esquerdo de 21% e uma prevalência de insuficiência aórtica de 4%. Aos 7 anos, a sobrevida cumulativa e a sobrevida livre de reoperação dos doentes submetidos a RVAo foram, respetivamente, 96,4% e 94,4%. Conclusões: Com uma seleção adequada dos doentes, a RVAo pode ser uma alternativa segura e efetiva, com bons resultados a médio prazo.

full sternotomy (FS) is the gold standard approach to perform surgical aortic valve replacement (AVR). However, potential advantages of a less traumatic approach fomented the development of so-called minimally invasive procedures, which include upper mini-sternotomy (MS).to compare immediate postoperative clinical results and mid-term mortality after AVR through MS and FS.single-centre retrospective study including all patients who underwent isolated AVR through MS between January 1, 2011 and July 31, 2017. These were then matched with patients who underwent the same procedure through FS and by the same surgeons who performed MS, using coarsened exact matching for the variables age, gender, body mass index and diabetes mellitus. Groups were later characterized and compared regarding postoperative results using Qui- -squared and Mann-Whitney tests and regarding mid-term mortality through Kaplan-Meier curves.we included 82 patients (n=41 in each group). Aortic cross clamp [78 vs. 63 minutes, p=0.001] and cardiopulmonary bypass times [107 vs. 90 minutes, p=0.002] were significantly longer in the MS group vs. FS group, respectively. Although without reaching statistical significant difference, a smaller percentage of patients from the MS group required red blood cells transfusions during surgery (39.0% vs. 53.7%, p=0.184). Similar results were found regarding mechanical ventilation, inotropic support, morphine infusion, intensive care unit length of stay and incidence of de novo atrial fibrillation. Cumulative survival at 6 years was 86.7% after MS and 88.5% after FS (p=0.650).Aortic valve replacement through MS seems to be a safe alternative to the gold standard FS.Introdução: a esternotomia completa (EC) é a abordagem gold standard da cirurgia de substituição valvular aórtica (SVA). Contudo, as potenciais vantagens de uma abordagem menos traumática promoveram o desenvolvimento de procedimentos minimamente invasivos, incluindo a mini-esternotomia (ME). Objetivo: comparar resultados clínicos no pós-operatório imediato e mortalidade, após SVA por ME e EC. Métodos: estudo retrospetivo unicêntrico incluindo todos os doentes submetidos a SVA isolada por ME, de 1 de janeiro de 2011 a 31 de julho de 2017, emparelhados com doentes submetidos ao mesmo procedimento, pelos mesmos cirurgiões por EC. Utilizou-se o método de emparelhamento coarsened exact matching para as variáveis idade, género, índice massa-corporal e diabetes mellitus. Os grupos foram caracterizados e comparados quanto aos resultados no pós-operatório imediato através de testes Qui-quadrado e Mann-Whitney e quanto à sobrevida através de curvas de Kaplan-Meier. Resultados: foram incluídos 82 doentes (n=41 em cada grupo). Os tempos de clampagem aórtica [78 vs. 63 minutos, p=0,001] e de circulação extracorporal [107 vs. 90 minutos, p=0.002] foram significativamente superiores no grupo ME vs. EC, respetivamente. Embora a frequência de transfusões sanguíneas durante a cirurgia fosse menor no grupo ME, essa diferença não foi estatisticamente significativa (39,0% vs. 53,7%, p=0,184). Os resultados foram semelhantes relativamente ao tempo de ventilação mecânica, suporte inotrópico, infusão de morfina, tempo de permanência em unidade de cuidados intensivos e incidência de fibrilação auricular de novo. A sobrevida cumulativa aos 6 anos foi de 86,7% após ME e 88,5% após EC (p=0,650). Conclusões: a SVA por ME parece ser uma alternativa segura comparativamente ao gold standard EC.

To compare stentless Freedom Solo and stented Trifecta aortic bioprostheses regarding hemodynamic profile, left ventricular mass regression, early and late postoperative outcomes and survival.Longitudinal cohort study of consecutive patients undergoing aortic valve replacement (from 2009 to 2016) with either Freedom Solo or Trifecta at one centre. Local databases and national records were queried. Postoperative echocardiography (3-6 months) was obtained for hemodynamic profile (mean transprosthetic gradient and effective orifice area) and left ventricle mass determination. After propensity score matching (21 covariates), Kaplan-Meier analysis and cumulative incidence analysis were performed for survival and combined outcome of structural valve deterioration and endocarditis, respectively. Hemodynamics and left ventricle mass regression were assessed by a mixed- -effects model including propensity score as a covariate.From a total sample of 397 Freedom Solo and 525 Trifecta patients with a median follow-up time of 4.0 (2.2- 6.0) and 2.4 (1.4-3.7) years, respectively, a matched sample of 329 pairs was obtained. Well-balanced matched groups showed no difference in survival (hazard ratio=1.04, 95% confidence interval=0.69-1.56) or cumulative hazards of combined outcome (subhazard ratio=0.54, 95% confidence interval=0.21-1.39). Although Trifecta showed improved hemodynamic profile compared to Freedom Solo, no differences were found in left ventricle mass regression.Trifecta has a slightly improved hemodynamic profile compared to Freedom Solo but this does not translate into differences in the extent of mass regression, postoperative outcomes or survival, which were good and comparable for both bioprostheses. Long-term follow-up is needed for comparisons with older models of bioprostheses.

To compare survival and safety of BIMA versus SIMA CABG between males and females at our tertiary care center.Single-center retrospective cohort including consecutive patients with at least 2 left coronary system (LCS) vessel disease who underwent isolated CABG with at least 1 IMA conduit and a minimum of 2 conduits targeting the LCS between 2004 and 2013. All-cause mortality was the primary outcome, secondary outcomes were in-hospital mortality and reoperation due to sternal wound complications (SWC). Kaplan-Meier analysis after inverse probability weighting using propensity score (IPW) was used to compare BIMA and SIMA CABG amongst genders. Results were confirmed by subgroup analysis.BIMA CABG was performed in 39% out of 2424 eligible procedures and in 27% of 460 females. No differences were found in survival after BIMA and SIMA CABG (median and maximum follow-up of 5.5 and 12 years, respectively) but a statistical interaction was observed with gender (P0.001). Females who underwent BIMA CABG showed higher mortality (weighted HR in females subset: 3.16; 95%CI: 1.56-6.29, P=0.001). BIMA CABG showed a higher incidence of reoperations due to SWC (IPW adjusted model OR: 1.74; 95% CI: 1.16-2.60) that were mostly ascribable to males (weighted OR in males: 3.10; 95%CI: 1.74-5.51, P0.001).Females may experience higher mortality after BIMA CABG which should be further explored.