Background and Objectives: The treatment of choice for aortic valve stenosis in patients with low and intermediate risk is still debated. In this study, we compared the outcomes of low-to-intermediate surgical risk patients who underwent surgical versus transcatheter aortic valve replacement for severe aortic valve stenosis (AS). Methods: Between 2015 and 2019, 326 consecutive patients with severe AS underwent transcatheter aortic valve implantation (TAVI), while 341 patients underwent surgical aortic valve replacement (SAVR). The two populations were propensity score matched by age, gender and Euroscore II. The survival rate of patients during median 5-year follow-up between SAVR and TAVI patients was evaluated. Results: After propensity score matching, 94 pairs of patients were compared and the mean standard deviation age of patients, sex (female) and Euroscore II were 77.5 (6.6) versus 76.6 (6.5) years, 51.1% versus 51.1% and 3.3 (1.88)% versus 3.0 (1,84)%, respectively. Permanent pacemaker implantation was higher in transcatheter group (21.3% versus 1.1%, p < 0.001). No difference in length of ICU and in-hospital stay was observed, p = 0.08 and p = 0.12, respectively. During follow-up the presence of more than moderate insufficiency of the prosthetic valve postoperatively was significantly less frequent in the surgical versus transcatheter (0% versus 14.3%). Survival rates over 1, 3 and 5 years did not differ in surgical versus transcatheter group (93.6%, 81.9% and 62.8% versus 86.2%, 69.1% and 59.6%, respectively (p = 0.16)). Conclusions: Short- and long-term survival rates were similar in patients who underwent transcatheter versus surgical aortic valve replacement, whereas SAVR showed superior results concerning the postoperative detection of residual regurgitation and need for PPM. It is extremely important to personalize the choice of treatment according to patients’ age, clinical status and life expectancy.

Mitral valve disease is the most common heart valve disease worldwide. Surgical mitral valve replacement or repair has been an established therapy in patients with severe mitral valve disease for many years. On the other hand, many patients with advanced mitral valve disease and severe comorbidities are treated conservatively and are excluded from the surgical procedure. Furthermore, in patients with severe comorbidities, transcatheter mitral valve repair by edge-to-edge technique with MitraClip or transcatheter mitral valve repair with a non-absorbable ring have been added as therapeutic options over the last few years. Alternative procedures for the treatment of patients with advanced prosthetic or native mitral valve diseases include transcatheter access for replacement or implantation of a new prosthetic valve in the diseased mitral valve. Promising results were published about short-term outcomes of patients who underwent the transcatheter mitral valve replacement. The current view and results of the transcatheter mitral valve implantation in patients with advanced native or prosthetic mitral valve disease are briefly discussed.

We are presenting here a case of a 45-year-old physically active man who underwent aortic valve replacement with a stentless biological valve by means of minimally invasive Heartport technique. Access was gained via a midline incision of 4 cm at the upper part of the sternum and a midline manubriotomy with one-sided extension into the third intercostal space. Cardiopulmonary bypass was established with a Heartport straightshot arterial cannula and two venous cannulae inserted into superior vena cava (SVC) and via femoral vein into inferior vena cava (IVC). The long instruments supplied for minimal access surgery were used for the standard stentless valve implantation technique. The patient had a speedy and uneventful recovery, discharged from hospital on the third postoperative day and resumed full activities within 2 weeks. Minimally invasive stentless tissue valve replacement is presented as a safe and feasible treatment option for the young/middle-aged group of patients.

Introduction: Acute type A aortic dissection (ATAAD) repair is associated with high morbidity postoperatively. The aim of this study is to evaluate the incidence and risk factors for acute kidney injury in patients who underwent ATAAD repair. Patients and Methods: Two hundred and twenty-three patients underwent ATAAD repair. Postoperative acute kidney injury (AKI) was evaluated according to the Kidney Disease—Improving Global Outcomes (KDIGO) criteria. Results: Postoperative AKI was observed in 140 patients (62.8%). The patients with postoperative AKI classified by KDIGO stages: 1 = 53 (23.8%), 2 = 36 (16.1%), and 3 = 51 (22.9%) patients. Twenty-eight patients (12.6%) underwent replacement renal therapy due to severe renal impairment (KDIGO stage 3). Multivariable logistic regression analysis (adjusted to risk factors) showed that preoperative eGFR was the risk factor for postoperative RRT (odds ratio (OR) = 0.95, 95% CI: 0.92–0.97, p < 0.01). The lengths of hospital and intensive care-unit stay differed between the patients with and without postoperative RRT (p < 0.001 for both). Postoperative RRT was associated with 30-day mortality (10.3% versus 35.7%, p < 0.001). Conclusions: Postoperative AKI was associated with high morbidity and mortality rate in patients after ATAAD repair.