Background: During the past decade, the Perimount Magna Ease (PME) bioprosthesis has been implanted worldwide for aortic valve replacement (AVR). Recently, the INSPIRIS Resilia (IR) valve has been introduced as the newest generation of pericardial bioprostheses. However, few data have been reported about patients ≤70 years, and no comparisons in terms of hemodynamic performance between these two bioprostheses have been ever reported. Methods: Patients aged <70 years undergoing AVR were considered for comparison between PME (n = 238) and IR (n = 192). Propensity score (PS) matching was performed by logistic regression with adjustment for eight key baseline variables. The two prostheses were compared in terms of hemodynamic performances up to 3 years postoperatively. Sub-analysis according to prosthetic size-category was accomplished. Results: A total of 122 pairs with similar baseline characteristics were obtained from the PS-matching. The two prostheses showed comparable hemodynamic performances at one year (Gmean: 11.3 ± 3.5 mmHg vs. 11.9 ± 5.4 mmHg; p = 0.8) and at 3 years postoperatively (Gmean: 12.2 ± 7.9 mmHg vs. 12.8 ± 5.2 mmHg for; p = 0.3). The sub-analysis of size-category confirmed no statistical differences concerning the hemodynamic performances for each annulus size. Conclusions: This first PS-matched analysis demonstrated that the newly developed IR valve achieves the same safety and efficacy of the PME valve during mid-term follow-up in patients aged <70 years.

OBJECTIVES: The goal was to evaluate gender authorship in 2 cardio-thoracic surgical journals. METHODS: We performed a bibliometric analysis of all articles published from 2017 to 2022 in the European Journal of Cardio-Thoracic Surgery and the Interdisciplinary Cardiovascular and Thoracic Surgery. For each article, the gender and academic rank of the first, senior and corresponding authors were verified by Internet search, email contact or use of the application Genderize.io. Articles were categorized based on topic, type and country of origin. The Cochran-Armitage test was used to evaluate gender authorship trend over time. RESULTS: A total of 5243 articles were included in the analysis. Women represented 18% of first authors, 7% of senior authors and 13% of corresponding authors; no trend was seen over time. Women represented 16% of first authors and 7% of senior authors in adult cardiac surgery, 23% of first authors and 9% of senior authors in congenital cardiac surgery and 19% of first authors and 8% of senior authors in thoracic surgery. Male first authors were more frequently full professors (17% vs 5%) and associate professors (16% vs 8%), and male senior authors were more frequently full professors (48% vs 31%) and associate professors (16% vs 8%) compared to female senior authors. CONCLUSIONS: The proportion of female authors is significantly lower than that of male authors in highest-impact European cardio-thoracic surgery journals, and no significant increase in female authorship has been demonstrated in recent years. Increasing awareness of gender disparities is essential to facilitate equal career opportunities and academic advancement for women in cardio-thoracic surgery.

Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning.

Background: The transfemoral approach represents the optimal access for TAVI due to its low invasiveness; however, up to 10–15% of TAVI candidates are considered unsuitable for femoral access because of significant peripheral vascular disease and need alternative access. Methods: This is a single-center retrospective observational study including all consecutive adult patients undergoing transcatheter procedures through a TA approach from March 2015 to April 2024. Results: 213 patients underwent transcatheter aortic or mitral valve implantation through a TA approach and were enrolled in this study. The mean age of the patients was 79.5 ± 5.7 years, and 54% of the patients were males. The mean Euroscore II was 7.9 ± 6.4%. One-third of the patients had previous cardiac surgery. The overall mean survival time was 5.3 ± 0.3 years. Nine (4%) patients developed infective endocarditis (IE) during the follow-up. Conclusions: The transapical approach for transcatheter procedures is a safe and effective procedure for patients unsuitable for TF access with low periprocedural mortality and a low rate of post-procedural complications when performed by experienced surgeons and cardiologists.

Background/Objectives: Previous studies evaluated the prognostic role of hematological parameters in predicting outcome in patients with infective endocarditis (IE). However, only a few studies evaluated the role of hematological parameters in patients undergoing surgery for IE. The aim of this study was to review our 20-year experience with the treatment of native (NVE) and prosthetic (PVE) valve endocarditis and to evaluate the role of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to monocyte ratio (NMR), and systemic inflammatory index (SII) on early and long-term outcomes of patients undergoing surgery for NVE and PVE. Methods: All adult patients undergoing surgery for NVE and PVE at our institution between January 2001 and December 2022 were included in the study. Preoperative NLR, NPR, PLR, MLR, NMR, and SII were calculated using hemograms with complete blood count. Results: During the study period, 503 patients, 371 (74%) males, median age 65 (52–73) years, underwent surgery for NVE (n = 337, 67%) or PVE (n = 166, 33%). Patients with PVE had significantly more aortic annulus abscess (95 (57%) vs. 51 (15%); p < 0.001), longer CPB (180 (131–235) vs. 105 (84–145) min; p < 0.001) and aortic cross-clamping times (129 (96–175) vs. 82 (64–114) min; p < 0.001), and received more aortic homografts (47 (28%) vs. 28 (9%); p < 0.001) and postoperative pacemaker implantation (25 (15%) vs. 20 (6%); p < 0.001 compared to patients with NVE. Preoperative NLR was 3.7 (2.4–6.1), NPR was 23 (16–37), PLR was 159 (106–210), NMR was 8.4 (6.6–12), MRL was 0.41 (0.29–0.62], and SII was 790 (485–1396). NLR, NPR, and MLR were significantly lower in patients with NVE compared to patients with PVE and in survivors compared to non-survivors. Overall mean survival time was 12.2 ± 0.5 years, with patients with NVE having better early and late survival compared to patients with PVE. Patients with preoperative NLR < 3.8, NPR < 30.9, and MLR < 0.4 had significantly better mean survival time compared to patients with preoperative NLR > 3.8, NPR > 30.9, and MLR > 0.4, respectively. Conclusions: In patients undergoing surgery for IE, preoperative higher NLR, NPR, and MLR are associated with increased early and long-term mortality.

Background: Neonates born with hypoplastic left heart syndrome (HLHS) or complex (HLHC), who undergo stage I palliation with Norwood operation or Damus-Kaye-Stansel (DKS), still carry substantial mortality and morbidity even in the modern era of cardiac surgery. Mortality varies from 10% up to 40% in some Institutions, remaining still one of the highest in pediatric cardiac surgery. In order to reduce mortality and morbidity, we have developed a strategy of selective cerebro-myocardial perfusion (sCMP), allowing to perform the entire operation on the beating heart. The aim of the presents report is to describe our results with such an innovative approach. Methods: Between December 2016 to December 2024, 12 consecutive patients underwent Norwood-Brawn/double-barrel DKS stage I palliation for single ventricle (SV) palliation associated with ascending aorta and severe arch hypoplasia. All patients were managed with a 3.5 mm modified Blalock-Taussig (mBT) shunt, except one 5-month infant who had a 4 mm shunt. The operation was performed under mild hypothermia with selective constant coronary and cerebral perfusion provided by 2 separate pump rotors. Results: There were 6 male and 6 female patients, with a median age of 4.5 days [interquartile range (IQR), 2.75–5.25 days] and median body weight of 3.2 kg (IQR, 3.075–3.55 kg). Median cardiopulmonary bypass (CPB) time was 200 min (166–306 min), the median time of myocardial perfusion 80 min (67.5–90 min), the median time of cerebral perfusion time was 160 min (150–176.25 min) and the median time of splanchnic ischemia during cerebro-myocardial perfusion was 47 (40.75–53.5 min). In the series only 2 patients required veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for failure to wean from bypass. The mean peak troponin T (TnT) was 5,973 (IQR, 1,775.5–8,971) ng/L, while the mean peak lactate level was 8.9 (5.55–11.95) mmol/L. Acute kidney injury, requiring a transient period of peritoneal dialysis was observed in 9 of 12 (75%) patients, while no patients developed liver dysfunction. Postoperative death occurred in 2 patients affected by one of the most severe forms of HLHS (mitro-aortic atresia) due to cardiac dysfunction and failure to wean from VA ECMO support. There was one interstage mortality (between stage I and II) due to progressive heart failure and sepsis. During a median follow-up of 52 months (13–73 months) all late survival were in good clinical conditions without signs of cardiac dysfunction and trivial systemic valve regurgitation. Nine patients completed II stage and six of them stage III palliation of the univentricular heart. Conclusions: The present experience suggests that a strategy of cerebro-myocardial perfusion is safe, versatile, and feasible in high-risk neonates with HLHC. Encouraging outcomes were noted in terms of cardiac and neurological function, with limited end-organ morbidity.