Background: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large‐scale study aimed to retrospectively evaluate the long‐term outcomes of the patients who underwent reoperation or TC of PVLs. Methods and Results: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary end point was defined as the all‐cause death during follow‐up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P =0.549) and procedural success (73.7 versus 65.2%; P =0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in‐hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75–5.88]; P =0.001; and adjusted odds ratio (inverse probability‐weighted), 4.55 [95% CI, 2.27–10.0]; P <0.001). However, the long‐term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59–1.25]; P =0.435; and adjusted HR (inverse probability‐weighted), 1.11 [95% CI, 0.67–1.81]; P =0.679). Conclusions: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long‐term mortality rates compared with surgery.

Objective: This study aims to evaluate outcomes in nutcracker syndrome patients with tolerable symptoms and treated conservatively without invasive interventions. Methods: This prospective study included patients treated conservatively. Promoting weight gain, the endpoint of the study was spontaneous resolution of symptoms. Results: Sixteen patients (75% female and mean age 24.4 ± 3.5 years) underwent conservative management. Over a mean follow-up of 27.3 months [13–42, interquartile range (IQR)], the diameter ratio (5.5 [5–6.5, IQR] vs 4.3 [4.1–6], p = NS), the peak velocity ratio (6 [5–7, IQR] vs 4.8 [4.8–5.8], p = NS), beak angle (27° [24–30, IQR] vs 29° [24–32]; p = NS), and aortomesenteric angle (26° [23–29, IQR] vs 28° [24–30]; p = NS) exhibited no statistically significant changes. Complete resolution and improvement of symptoms were 28.5% and 31.4%, respectively, while 68.5% remained unchanged. Conclusions: This study shows that a conservative approach contributes to the spontaneous improvement or complete resolution in young adult patients with mild symptoms.

Background: In this study, we shared our experience with the minimal invasive extracorporeal circulation system for coronary artery bypass grafting patients. Methods: A total of 163 patients were included in the retrospective study, with 83 patients (63 males, 20 females; mean age: 61.9±8.9 years; range, 35 to 81 years) undergoing coronary artery bypass grafting with minimal invasive extracorporeal circulation and 80 patients (65 males, 15 females; mean age: 60.5±8.8 years; range, 43 to 82 years) undergoing coronary artery bypass grafting with conventional cardiopulmonary bypass between July 2021 and April 2023. Elective coronary bypass performed by same surgical team were included in the study. Mortality, major adverse cardiac and cerebrovascular event, hospital stays and transfusion requirements were evaluated. Results: There were no significant differences in sex distribution, age, comorbidities, and blood values between the two groups. Intraoperatively, the minimal invasive extracorporeal circulation group had a slightly higher number of distal anastomoses and comparable times for aortic cross-clamp and cardiopulmonary bypass. Postoperative outcomes such as tamponade, bleeding, atrial fibrillation, left ventricular ejection fraction improvement or reduction, and postoperative drainage were similar between the two groups. However, the minimal invasive extracorporeal circulation group had fewer transfusions of packed red blood cells and fresh frozen plasma and a shorter length of stay in the intensive care unit. Conclusion: The minimal invasive extracorporeal circulation system effectively preserves blood, works with lower activated clotting time values without additional complications in coronary artery bypass grafting, and could present a better option for patients with anemia or patients with a relatively high risk for high-dose heparinization.

Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is inevitable in a certain number of patients requiring IABP support, all alternative accesses should be added to the surgical armamentarium. Herein, we present our 27-year experience with different alternative accesses for IABP insertion following failed contraindication to femoral artery cannulation. The alternative techniques described below were: transthoracic insertion with a tube graft, transthoracic insertion – direct, transaxillary/subclavian insertion and transbrachial insertion.