Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished. To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery. Retrospective, single-center. Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. 448 patients older than 75 years who had undergone isolated, elective heart valve surgery. Patients were divided into low (GNRI≥92; 346 patients) and moderate-to-high (GNRI<92; 102 patients) risk groups of nutrition-related complications. Demographic, clinical, and biological variables were retrieved from the institutional Heart Valve Database. GNRI was calculated as follows: [1.489 × serum albumin (g/dL)] + [41.7 × actual body weight (kg) / ideal body weight (kg)]. Operative and postoperative outcomes were compared between GNRI groups. Survival at 3 years follow-up was analyzed using the Kaplan-Meier method and log-rank test. Cox regression was used to identify variables associated with survival. Mortality at 30 days did not differ between groups (0.98% vs 0.58% for GNRI < 92 and GNRI ≥ 92, respectively; p=0.54). Those with a GNRI < 92 required more frequently dialysis (2.9% vs 0.3%, p=0.04), inotropes (33.3% vs 22.8%, p=0.04), red blood cells transfusions (63.7% vs 19.9%, p<0.01), and longer mechanical ventilation support (12 ± 2 vs 6 ± 1.5 hours, p=0.03). Intensive care unit (4.7 ± 0.9 vs 1.6 ± 0.8 days, p=0.05) and total postoperative hospital (11.1 ± 1.9 vs 5.2 ± 1.5 days, p=0.05) stays were significantly longer in the GNRI < 92 group. A poor nutritional status may increase morbidity and prolong hospitalization after cardiac surgery. GNRI might improve risk assessment and should be integrated into traditional surgical risk models to offer tailored care to older patients.

Infective endocarditis (IE) is a complex and often misunderstood disease, carrying a substantial burden of morbidity and mortality. Over the past two decades, its incidence has risen steadily, accompanied by a growing predominance of highly virulent pathogens. Despite substantial advances in diagnostic tools, surgical techniques and perioperative management, IE continues to present major clinical challenges. In-hospital mortality remains extremely high, ranging from 15 to 30%, with a one-year mortality exceeding 40% in specific patient groups. In addition to its clinical impact, IE imposes a substantial economic burden, primarily due to prolonged hospitalization, extensive diagnostic work-ups, complex surgical interventions and long-term antibiotic therapy and follow-up. In such a complex scenario, delays in diagnosis and treatment are unfortunately common, often leading to fragmented and inefficient healthcare pathways, resulting in suboptimal patient management and compromised clinical outcomes. In response to these challenges, a dedicated Clinical Pathway (CP) for IE patients has been implemented to enhance interdisciplinary collaboration and ultimately improve patient outcomes.

Objectives: The treatment of secondary mitral regurgitation (MR) is still controversial. In 2019, a new conceptual framework was introduced, distinguishing between patients with a degree of MR “proportionate” to the left ventricular (LV) dilatation and patients in whom the severity of MR is “disproportionate” to the LV dilatation. The aim of this study was to compare the long-term outcome of patients with disproportionate vs. proportionate secondary MR who underwent mitral valve (MV) surgery. Methods: From January 2012 to June 2022, 96 patients with a preoperative diagnosis of pure secondary MR and LV dysfunction underwent MV surgery. The patients were divided in two groups, disproportionate vs. proportionate MR, according to echocardiographic parameters. A 5.2 (3.5–7.5) years complete clinical and echocardiographic follow-up was performed. Results: In the study period, 61 patients with disproportionate and 35 patients with proportionate MR underwent surgical MV repair or MV replacement. The thirty-day outcome was comparable in the two groups. At long-term follow-up, mortality was 5% in the disproportionate group vs. 11% in the proportionate group (p = 0.2), and cardiovascular mortality was 3% vs. 9%, respectively (0.5). Rehospitalization for heart failure was 6% vs. 20% (p = 0.04), and the rate of patients with New York Heart Association (NYHA) functional class ≥ III was 8% vs. 26%, respectively (p = 0.01). LV volumes were significantly higher in the proportionate group, thus presenting a lower LV ejection fraction (p < 0.001 and p = 0.03, respectively). No cases of recurrent MR have been observed. Conclusions: In this first exploratory analysis, patients with disproportionate secondary MR seem to present a possible benefit in terms of mortality and cardiovascular mortality, although not ones reaching statistical significance. Nevertheless, significant advantages were observed in terms of rehospitalization for heart failure, clinical status and symptoms, LV volumes, and LV function. Among patients referred to cardiac surgery, identifying the subset of patients with functional MR, who may obtain more significant advantages from surgery, seems relevant for patient selection, risk stratification, and to predict long-term outcomes.

Cardiac impantable electronic device infective endocarditis (CIED-IE) is a life-threatening condition. We report 2 cases of large infective endocarditis in which differences in surgical timing affected outcomes. Patients with CIED-IE should be referred to a hub center with experienced specialists and undergo early complete device extraction without unnecessary delay.

Objectives: This study aimed to define the learning curve required for cardiac surgery residents to acquire basic technical and interpretive skills in transit-time flow measurement (TTFM) and high-resolution epicardial ultrasonography (HRUS) during coronary artery bypass grafting (CABG). Methods: Prospective, observational, single-center study evaluating performance using a novel scoring system combining functional (TTFM) and anatomical (HRUS) assessment criteria. This study was registered on ClinicalTrials.gov (Identifier: NCT06589323). Nine cardiac surgery residents without prior hands-on experience in TTFM or HRUS were enrolled. Twenty-seven elective CABG patients (67 grafts) were analyzed. Each measurement was compared with those obtained by an expert benchmark surgeon (N.T.) under standardized hemodynamic conditions. Results: Residents achieved the predefined primary endpoint (combined TTFM + HRUS score/number of grafts ≥ 11) after a median of 3 cases (IQR 2–4) and 7 anastomoses (IQR 7–10). Kaplan–Meier analysis showed a progressive increase in the probability of success, with a sharp rise after the seventh anastomosis. A shorter interval between attempts (<30 days) was significantly associated with earlier achievement of the endpoint (p < 0.05). Median acquisition time for TTFM was 25 s, with 90% of cases, though slightly lower success rates were observed for lateral and inferior wall targets. No resident- or procedure-related variable was independently associated with performance improvement. Conclusions: Mastery of basic TTFM and HRUS skills requires only a few cases and anastomoses, demonstrating a short and attainable learning curve. These findings challenge the perception of a steep learning process and support the routine use of intraoperative graft verification techniques in all CABG procedures.

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made.