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Homograft heart valves may have significant advantages and are preferred for the repair of congenital valve malformations, especially in young women of childbearing age, athletes and in patients with active endocarditis. A growing problem, however, is the mismatch between tissue donation and the increasing demand. The aim of this paper is to describe the initiation process of a homograft procurement program to attenuate the shortage of organs. A comprehensive description of the infrastructure and procedural steps required to initiate a cardiac and vascular tissue donation program combined with a prospective follow-up of all homografts explanted at our institution. Between January 2020 and May 2022, 28 hearts and 12 pulmonary bifurcations were harvested at our institution and delivered to the European homograft bank. Twenty-seven valves (19 pulmonary valves, 8 aortic valves) were processed and allocated for implantation. The reasons for discarding a graft were either contamination (n = 14), or morphology (n = 13) or leaflet damage (n = 2). Five homografts (3 PV, 2 AV) have been cryopreserved and stored while awaiting allocation. One pulmonary homograft with a leaflet cut was retrieved by bicuspidization technique and awaits allocation, as a highly requested small diameter graft. The implementation of a tissue donation program in cooperation with a homograft bank can be achieved with reasonable additional efforts at a transplant center with an in-house cardiac surgery department. Challenging situations with a potential risk of tissue injury during procurement include re-operation, harvesting by a non-specialist surgeon and prior central cannulation for mechanical circulatory support.

The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of “typical” microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a “Living Document.”, The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of "typical"microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the Duke-ISCVID Criteria available online as a "Living Document."

Aquest document descriu la metodologia seguida per a dissenyar una màquina recol·lectora de fruits secs; tenint en compte tots els aspectes implicats, des de l’anàlisi de l’estat de l’art, passant per la definició de les especificacions de la màquina i l’estructura funcional, la proposta d’alternatives i la selecció de la millor alternativa, finalitzant amb el disseny de la màquina, protocols d’assaig i estudis econòmic, mediambiental i social i d’igualtat de gènere del projecte. Així doncs, el projecte està englobat en el món de l’agricultura, concretament en la recol·lecció de fruits secs i encara més específicament, de la recol·lecció d’ametlles. El projecte pretén buscar una solució econòmica i simple per una tasca que actualment es realitza de forma manual i amb la necessitat de més d’un operari. L’objectiu principal del treball és la creació d’un primer disseny d’una màquina recol·lectora de fruits secs que s’adapti a un conreu sense accés per a maquinària pesant. Es valoraran les solucions existents al mercat, patents i normativa vigent per tal de definir el disseny de la màquina i es definiran les especificacions de la màquina segons els requisits establerts. Es plantejaran diferents solucions i considerant els factors més crítics per al funcionament de la màquina s’escollirà una solució final. A partir d’aquí, es desenvolupa un disseny tenint en compte els materials utilitzats, pes, robustesa i fiabilitat. Durant aquest treball es farà una proposta dels protocols d’assaig per tal de validar el correcte funcionament dels subconjunts de la màquina i de les hipòtesis preses durant el desenvolupament del projecte. Els assajos cobreixen validacions funcionals, de durabilitat i de muntatge i validació del muntatge. Finalment, l’escrit inclou una planificació del projecte tenint en compte les tasques executades i una hipotètica fabricació d’una primera unitat, un estudi econòmic complet analitzant el cost de cada subconjunt de la màquina i els màxims contribuïdors, Este documento describe la metodología seguida para diseñar una máquina recolectora de frutos secos; teniendo en cuenta todos los aspectos implicados, desde el análisis del estado del arte, pasando por la definición de las especificaciones de la máquina y la estructura funcional, la propuesta de alternativas y la selección de la mejor alternativa, finalizando con el diseño de la máquina, protocolos de ensayo y estudios económico, medioambiental y social y de igualdad de género del proyecto. Así pues, el proyecto está englobado en el mundo de la agricultura, concretamente en la recolección de frutos secos y todavía más específicamente, de la recolección de almendras. El proyecto pretende buscar una solución económica y simple por una tarea que actualmente se realiza de forma manual y con la necesidad de más de un operario. El objetivo principal del trabajo es la creación de un primer diseño de una máquina recolectora de frutos secos que se adapte a un cultivo sin acceso para maquinaria pesada. Se valorarán las soluciones existentes al mercado, patentes y normativa vigente para definir el diseño de la máquina y se definirán las especificaciones de la máquina según los requisitos establecidos. Se plantearán diferentes soluciones y considerando los factores más críticos para el funcionamiento de la máquina se escogerá una solución final. A partir de aquí, se desarrolla un diseño teniendo en cuenta los materiales utilizados, peso, robustez y fiabilidad. Durante este trabajo se hará una propuesta de los protocolos de ensayo para validar el correcto funcionamiento de los subconjuntos de la máquina y de las hipótesis tomadas durante el desarrollo del proyecto. Los ensayos cubren validaciones funcionales, de durabilidad y de montaje y validación del montaje. Finalmente, el escrito incluye una planificación del proyecto teniendo en cuenta las tareas ejecutadas y una hipotética fabricación de una primera unidad, un estudio económico completo analizando el coste de cada subconj, This document describes the methodology used to design a dry fruit collecting machine; considering all aspects involved, from analysis of the art state, defining machine specifications and functional structure, proposing alternatives and selecting the best alternative, ending with machine design, test protocols and economic, environmental and social studies and gender equality studies of the project. Thus, the project is encompassed in the world of agriculture, specifically in the collection of dry fruit and even more specifically, in the collection of almonds. The project aims to seek an economic and simple solution for a task that is currently performed manually and with the need for more than one operator. The primary goal of the work is the creation of a first design of a dry fruit harvesting machine that adapts to a crop without access for heavy machinery. Existing market solutions, patents and regulations in force will be evaluated to define the design of the machine and the specifications of the machine will be defined according to established requirements. Different solutions will be considered and considering the most critical factors for the operation of the machine a final solution will be chosen. From there, a design is developed taking into account the materials used, weight, robustness and reliability. During this work, a proposal for test protocols will be made to validate the correct functioning of the subsets of the machine and the hypotheses taken during the development of the project. The essays cover functional validations, durability and mounting and validation of the mount. Finally, the writing includes a project planning considering the tasks performed and hypothetical manufacture of a first unit, a full economic study analysing the cost of each subset of the machine and the maximum contributors at its price, an environmental study of the machine's materials and a social study and gender equality study

The extent to which patients with an abdominal aortic aneurysm (AAA) should exercise remains unclear, given theoretical concerns over the perceived risk of blood pressure‐induced rupture, which is often catastrophic. This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom‐limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring ‘myth’ that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with ‘methodological’ recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short‐term risks posed by potential AAA rupture.

Vascular graft/endograft infection (VGEI) is a constant in cardiovascular surgery with published rates between 1 and 5%. Every graft type and anatomical location is a potential target for infectious complications. These patients are sick patients with high frailty burden. Management of VGEI entails a multidisciplinary and multimodality approach. Here we review some aspects of the problem of VGEI including prevention, diagnosis, and surgical therapy with focus on recent developments in the field.

OBJECTIVES Aortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years. METHODS This is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists/primary care physicians. RESULTS Between 02/1996 and 11/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33-59), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade ≥3, 12% were in functional NYHA-class ≥III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation ≤2. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5% ± 2.4% and 87.0% ± 3.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation ≥3. However a preoperative left ventricular end diastolic diameter of ≥5.5 cm was associated with worse outcome.

Introduction: This study was conducted to evaluate the efficacy of postoperative computed tomography (CT) measurements of aortic lumen volumes in predicting aortic-related complications following acute type A aortic dissection (ATAAD) repair. Methods: We conducted a single-institution retrospective aortic volumetric analysis of patients after ascending aorta replacement performed during 2001-2015. The volumetric measurements of total lumen (total-L), true lumen (TL), false lumen (FL), as well as the TL:FL ratio from the first and second postoperative computer angiograms were obtained. A generalised structural equation model was created to analyse the predictive utility of TL:FL ratio. Results: One hundred and twenty-five patients underwent surgical intervention, of whom 97 patients were eventually discharged and analysed for postoperative complications. A total of 19 patients were included in the final analysis. Patients with late postoperative aortic complications had a significantly higher FL volume and total-L volume on the first (FL volume P = 0.041, total-L volume P = 0.05) and second (FL volume P = 0.01, total-L volume P = 0.007) postoperative scans. The odds of having aortic complications were raised by 1% with a 1 cm3 increase in total-L volume and by 2% with a 1 cm3 increase in FL volume. The TL:FL ratio was significantly lower in patients who developed complications. Conclusion: Postoperative CT volumetric measurements in patients who developed complications are characterised by a significant increase in the FL volume and total-L volume from the first postoperative scans. Patients with disproportionately expanded FL presenting with TL:FL ratios less than 1 were associated with aortic complications. Hence, the TL:FL ratio may be a reliable and useful parameter to monitor postoperative disease progression and to evaluate the risk of late complications in ATAAD patients.

INTRODUCTION Around 25% of patients with left-sided infective endocarditis and operative indication do not undergo surgery. Baseline characteristics and outcomes are underreported. This study describes characteristics and outcomes of surgical candidates with surgical intervention or medical treatment only. METHODS Retrospective analysis of ongoing collected data from a single-center from an observational cohort of patients with infective endocarditis (ENVALVE). Kaplan-Meier estimates for survival was calculated. Factors associated with survival were assessed using a bivariable Cox model. To adjust for confounding by indication, uni- and multivariable logistic regression for the propensity to receive surgery were adjusted. RESULTS From January 2018 and December 2021, 154 patients were analyzed: 116 underwent surgery and 38 received medical treatment only. Surgical candidates without surgery were older (70 vs. 62 years, p = 0.001). They had higher preoperative risk profile (EuroSCORE II 14% (7.2-28.6) vs. 5.8% (2.5-20.3), p = 0.002) and more comorbidities. One patient was lost-to-follow-up. Survival analysis revealed a significant higher one-year survival rate among patients following surgery (83.7% vs. 15.3% in the non-surgical group; log-rank test <0.0001). In the final multivariable adjusted model, surgery was less likely among patients with liver cirrhosis [OR = 0.03 (95% CI 0.00-0.30)] and with hemodialysis [OR = 0.014 (95% CI 0.00-0.47)]. CONCLUSION Patients with left-sided infective endocarditis who do not undergo surgery despite an operative indication are older, have more comorbidities and therefore higher preoperative risk profile and a low 1-year survival. The role of the Endocarditis Team may be particularly important for the decision-making process in this specific group.

Purpose: Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE. Methods: We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol. Results: The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered. Conclusions: Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible. Keywords: Antibiotic prophylaxis prior dental procedure; Dental procedure; Endocarditis guidelines; Endocarditis prophylaxis; High-risk patients; Infective endocarditis.