Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts.

INTRODUCTION: Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique. METHODS: This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis. RESULTS: The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p < .01), with a subdistribution hazard ratio (SHR) of 0.16 (p = .010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p < .01) with a SHR of 0.53 (p = .017). The short-term results were similar in both groups. CONCLUSIONS: Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG.

Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II.

BACKGROUND: Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG. METHODS: A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10-20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes. RESULTS: We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02). CONCLUSIONS: Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.

Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial.

BACKGROUND: Animal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG. METHODS AND FINDINGS: A prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG ± valve procedure and had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat. We studied 303 patients (age 74 ± 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 ± 5,396 ng/L versus 6,452 ± 5,215 ng/L; p = 0.086). One patient died ≤30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed. A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 ± 4,846 ng/L versus 6,824 ± 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data. The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation. CONCLUSIONS: Infusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation. TRIAL REGISTRATION: ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02592824. European Union Drug Regulating Authorities Clinical Trials Database (Eudra CT number 2011-006241-15).

Elective replacement of a 4-year-old leadless pacemaker: New approach for end-of-life management.

We report the first case of new technique of replacement of a Micra TPS, due to battery depletion. A 38-year-old patient was admitted due to battery depletion of a TPS, after 44 months of regular pacemaker functioning. After routine implantation of a new TPS, we use a snare loop inserted in the delivery system to capture the old TPS. We believe this approach a good option not to abandon the depleted device, to avoid possible electrical interference or space occupation in right ventricle. This new approach allows to change the strategy during procedure and does not increase significantly the procedure costs.

Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting: a systematic review and meta-analysis.

To investigate the results of percutaneous coronary intervention (PCI) in saphenous vein grafts after coronary artery bypass grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were searched for relevant articles published between 1 January 2000 and 29 February 2020. The PICO (population, intervention, comparison, outcome) model was applied in constructing the clinical question. Two independent researchers performed the literature search. Thirty-six articles were identified and subjected to a quality assessment. The primary outcomes of the meta-analysis were long-term in-stent restenosis and long-term major adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95% CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 ± 1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%; 95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE (15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in better outcomes at least in term of in-stent restenosis, while the benefit of using embolic protection devices was questionable. Conclusions. PCI of a stenosed or occluded saphenous vein graft is a challenge for interventional cardiologists, and is still associated with relatively high rates of restenosis, MACE, and procedural failure. All efforts to enhance the results are warranted, including improved quality of the venous grafts used during CABG.

Observation of Spin Superfluidity in a Bose Gas Mixture.

The spin dynamics of a harmonically trapped Bose-Einstein condensed binary mixture of sodium atoms is experimentally investigated at finite temperature. In the collisional regime the motion of the thermal component is shown to be damped because of spin drag, while the two condensates exhibit a counterflow oscillation without friction, thereby providing direct evidence for spin superfluidity. Results are also reported in the collisionless regime where the spin components of both the condensate and thermal part oscillate without damping, their relative motion being driven by a mean-field effect. We also measure the static polarizability of the condensed and thermal parts and we find a large increase of the condensate polarizability with respect to the T=0 value, in agreement with the predictions of theory.

The Modified Bentall Procedure: A Single-Institution Experience in 249 Patients with a Maximum Follow Up of 21.5 Years.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. METHODS: Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr). RESULTS: Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for early mortality. Actuarial survival at 15 and 20 years was 62% and 60%, respectively. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93%/pt-yr) was 82% at 15 years, and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yr), with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications was 0.32%/pt-yr, with actuarial freedoms of 94% at 15 and 20 years. CONCLUSIONS: The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason, it is considered to be a valid option for the treatment of aortic root disease, whenever valvesparing procedures are not indicated.

Observation of solitonic vortices in Bose-Einstein condensates.

We observe solitonic vortices in an atomic Bose-Einstein condensate (BEC) after free expansion. Clear signatures of the nature of such defects are the twisted planar density depletion around the vortex line, observed in absorption images, and the double dislocation in the interference pattern obtained through homodyne techniques. Both methods allow us to determine the sign of the quantized circulation. Experimental observations agree with numerical simulations. These solitonic vortices are the decay product of phase defects of the BEC order parameter spontaneously created after a rapid quench across the BEC transition in a cigar-shaped harmonic trap and are shown to have a very long lifetime.

Superior long-term patency of no-touch vein graft compared to conventional vein grafts in over 1500 consecutive patients.

OBJECTIVES: To evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique. METHODS: This was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel). RESULTS: The study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR = 1.8). CONCLUSIONS: The no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts. CLINICAL TRIAL REGISTRATION: NCT04656366, 7 December 2020.

Production and Multi-Parameter Live Cell Fluorescence Lifetime Imaging Microscopy (FLIM) of Multicellular Spheroids.

Multicellular tumor spheroids are a popular 3D tissue microaggregate model for reproducing tumor microenvironment, testing and optimizing drug therapies and using bio- and nanosensors in a 3D context. Their ease of production, predictable size, growth, and observed nutrient and metabolite gradients are important to recapitulate the 3D niche-like cell microenvironment. However, spheroid heterogeneity and variability of their production methods can influence overall cell metabolism, viability, and drug response. This makes it difficult to choose the most appropriate methodology, considering the requirements in size, variability, needs of biofabrication, and use as in vitro 3D tissue models in stem and cancer cell biology. In particular, spheroid production can influence their compatibility with quantitative live microscopies, such as optical metabolic imaging, fluorescence lifetime imaging microscopy (FLIM), monitoring of spheroid hypoxia with nanosensors, or viability. Here, a number of conventional spheroid formation protocols are presented, highlighting their compatibility with the live widefield, confocal, and two-photon microscopies. The follow-up imaging to analysis pipeline with multiplexed autofluorescence FLIM and, using various types of cancer and stem cell spheroids, is also presented.

Reduction in platelet count after aortic valve replacement: comparison of three bioprostheses.

BACKGROUND AND AIM OF THE STUDY: Concerns have recently been raised regarding postoperative decreases in platelet count (PC) after aortic valve replacement (AVR) with the Sorin Freedom Solo (SFS) stentless bioprosthesis. In order to assess the relevance and the clinical impact of this phenomenon, variations in PC were monitored in patients with SFS valves, and compared to changes of PC in patients after AVR with two other bioprostheses, the Medtronic Mosaic (MOS) porcine valve and the Sorin Mitroflow (MIT) pericardial valve. METHODS: Three groups of patients (25 in each group) who had undergone AVR with a biological prosthesis were compared. The patients were similar in terms of their preoperative characteristics, including mean age, NYHA functional class, risk factors, EuroSCORE, and mean PC. The PC was monitored on postoperative days 1, 3, and 5, and again at discharge. Thrombocytopenia was considered to be 'present' when the PC was < 150,000/microl, and 'severe' when the PC was < 30,000/microl. RESULTS: No significant inter-group differences were observed in the duration of extracorporeal circulation or cross-clamp times. The mean postoperative PCs for MOS valves were 154,000 +/- 56,000/microl, 154,000 +/- 54,000/microl, 161,000 +/- 85,000/microl, and 228,000 +/- 95,000/microl at days 1,3, and 5, and at discharge, respectively. For MIT valves, these values were 126,000 +/- 37,000/microl, 113,000 +/- 38,000/microl, 130,000 +/- 46,000/microl, and 170,000 +/- 50,000/microl, respectively. For SFS valves, the values were 99,000 +/- 27,000/microl, 67,000 +/- 9000/microl, 78,000 +/- 54,000/microl, and 96,000 +/- 32,000/microl, respectively. Severe thrombocytopenia was never observed in any patient. A significant decrease in PC occurred with SFS when compared to MOS valves (on days 1, 3, 5, and at discharge, p < 0.001) and to MIT valves (on days 3, 5, and at discharge, p < 0.005). Multivariate analysis showed older age (p = 0.001) and the SFS valve (p = 0.0002) to be incremental risk factors for developing severe or moderate thrombocytopenia after AVR. CONCLUSION: A reduction in PC occurred with all bioprostheses on postoperative day 1, while a significant reduction in PC was continued for SFS valves on postoperative days 3 and 5, when compared to MOS and MIT valves. A normalization of PC at discharge was observed only with MOS valves. Thrombocytopenia after AVR with biological prostheses was not associated with any major postoperative complication.

Aortopulmonary fistula after a modified Bentall procedure.

A 68-year-old man presented with aortic pseudoaneurysm and aortopulmonary fistula, due to dehiscence of the left coronary button anastomosis, at three months after surgery for acute aortic dissection using a composite conduit. At reoperation, the pulmonary trunk was repaired by direct suture and the coronary ostial anastomosis with single sutures, reinforced with pericardial pledgets from inside the aortic graft. Aortopulmonary fistula due to pseudoaneurysm formation is an extremely rare complication of operations on the proximal aorta. Furthermore, pseudoaneurysm caused by dehiscence of a coronary anastomosis complicated by an aortopulmonary fistula, as in the present case, has been previously reported only twice. Patients with acute aortic dissection, due to tissue fragility, appear particularly prone to develop such complications, which can occur even in the early postoperative period. Therefore, after the repair of acute aortic dissection, particularly when the insertion of a composite conduit is required, continuous follow up is mandatory for the early detection of this rare, but potentially lethal, complication.

Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts.

OBJECTIVE: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft. METHODS: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM). RESULTS: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains. CONCLUSION: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?

BACKGROUND: Predicting an accessory pathway location is extremely important in pediatric patients. AIMS: We designed a study to compare previously published algorithms by Arruda, Boersma, and Chiang. METHODS: This multicenter study included patients who had undergone successful ablation of one accessory pathway. Analysis of resting 12-lead electrocardiograms was carried out. An aggregated prediction score was constructed on the basis of algorithm agreement, and a structured workflow approach was proposed. RESULTS: The total population was 120 patients (mean age, 12.7 [± 3.6] years). The algorithm by Boersma had the highest accuracy (71.7%). The inter-rater agreement among the 3 reference algorithms, according to left-sided accessory pathway (AP) identification, was good between Boersma and Chiang (κ = 0.611; 95% confidence interval [CI], 0.468-0.753) but moderate between Arruda and Chiang and between Arruda and Boersma (κ = 0.566; 95% CI, 0.419-0.713 and κ = 0.582; 95% CI, 0.438-0.727, respectively). Regarding locations at risk of atrioventricular (AV) block, agreement was fair between Arruda and Chiang and between Boersma and Chiang (κ = 0.358; 95% CI, 0.195-0.520 and κ = 0.307; 95% CI, 0.192-0.422, respectively) but moderate between Arruda and Boersma (κ = 0.45; 95% CI, 0.304-0.597). On applying a first-step diagnostic evaluation, when concordance was achieved, we were able to correctly identify left-sided or non-left-sided ablation sites in 96.4% (n = 80) of cases. When concordance was achieved, correct prediction of risk/no risk of AV block was achieved in 92.2% (n = 59) of cases. CONCLUSIONS: An aggregated prediction score based on 3 reference algorithms proved able to predict an accessory pathway location very precisely and could be used to plan safely invasive procedures.

Challenges in the remote monitoring of cardiac implantable electronic devices in 2021.

Patients with cardiac implantable electronic devices have usually been scheduled for routine in­hospital visits. In addition, they are now monitored remotely. The remote monitoring of cardiac implantable electronic devices is a valuable tool to screen and triage patients at very high risk of deterioration. The continuous expansion of remote monitoring in real­world settings brought a substantial increase of published evidence on the topic. Therefore, this review aims to summarize challenges and knowledge gaps in the field. Challenges that were identified as issues to be solved comprise warranty of data security and accessibility, integration with clinical repositories, patient selection and persistence, and resource availability. Future improvements of telemedicine will need to face these significant residual challenges.

Generating green to red light with semiconductor lasers.

Diode lasers enable one to continuously cover the 730 to 1100 nm range as well as the 370 to 550 nm range by frequency doubling, but a large part of the electro-magnetic spectrum spanning from green to red remains accessible only through expensive and unpractical optically pumped dye lasers. Here we devise a method to multiply the frequency of optical waves by a factor 3/2 with a conversion that is phase-coherent and highly efficient. Together with harmonic generation, it will enable one to cover the visible spectrum with semiconductor lasers, opening new avenues in important fields such as laser spectroscopy and optical metrology.

Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts

ABSTRACT Objective: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft. Methods: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM). Results: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains. Conclusion: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

Aortic valve replacement in systemic sclerosis.

Systemic sclerosis (scleroderma) is a chronic systemic autoimmune disease of the connective tissue, which can involve the cardiac valves, the mitral valve being more frequently affected, although involvement of the aortic valve has been rarely described. We report a patient with aortic stenosis and systemic sclerosis who required aortic valve replacement. Awareness of this rare association may help to provide adequate management of such patients and prevent complications related to the underlying disease.

Single center experience with the Sorin Bicarbon prosthesis: a 17-year clinical follow-up.

OBJECTIVE: To evaluate the long-term results of aortic valve replacement (AVR) and mitral valve replacement (MVR) with the Sorin Bicarbon prosthesis (SBP). METHODS: Five hundred seven patients (306 men, 201 women), mean age 62±10 years (range, 21-86 years), received an SBP between 1994 and 2000; AVR was performed in 344 (67%) and MVR in 163 (33%). The main concomitant procedure was coronary artery grafting in 79 patients (16%). Follow-up was 99% complete; mean follow-up was 12.7±4.0 years with a cumulative duration of follow-up of 6475 patient-years in the entire group (4348 patient-years for AVR and 2124 patient-years for MVR). RESULTS: Hospital mortality was 2.7% (AVR, 2.03%; MVR, 4.3%). There were 169 late deaths (AVR, 128; MVR, 41). Actuarial survival at 17 years is 49.7%±5.3% for AVR and 62.0%±6.1% for MVR. At the last follow-up, 310 survivors (199 AVR, 111 MVR) are in New York Heart Association functional class I or II. At 17 years, actuarial freedom from valve-related deaths, embolism, and bleeding is 89.8%±4.8%, 85.8%±5.4%, and 96.2%±1.2% after AVR, and 91.9%±3.9%, 96.3%±1.8%, 95.0%±2.9% after MVR. Reoperation was required in 5 patients with AVR (thrombosis in 4 and perivalvular leak in 1). Actuarial freedom from reoperation is 98.1%±0.8% after AVR and 100% after MVR; freedom from endocarditis is 100% after AVR and 99.2%±0.7% after MVR. No cases of intrinsic structural valve failure were observed. CONCLUSIONS: The SBP has shown excellent results in terms of clinical improvement and freedom from valve-related complications, even up to 17 years after AVR and MVR. It therefore seems to be a safe option whenever a mechanical prosthesis is needed.