Tissue-specific relaxin-2 is differentially associated with the presence/size of an arterial aneurysm and the severity of atherosclerotic disease in humans.

Circulating or tissue-related biomarkers are of clinical value for risk stratification in patients with abdominal aortic aneurysms. Relaxin-2 (RL2) has been linked to the presence and size of arterial aneurysms, and to the extent of atherosclerosis in human subjects. Here, we assessed the expression levels of RL2 in aneurysmal (AA, n = 16) and atherosclerotic (ATH, n = 22) arteries, and established the correlation between RL2 levels and the presence/size of AA and the clinical severity of atherosclerosis. The expression levels of metalloproteinases (MMPs) and endothelial nitric oxide synthetase (eNOS) were also detected for correlations with different phenotypes of atherosclerosis and AA. Temporal artery biopsy specimens (n = 6) and abdominal aortic tissues harvested from accident victims during autopsy (n = 10) were used as controls. Quantitative tissue biomarker analysis revealed that tissue-specific RL2 was increased in patients with larger or symptomatic AA compared to subjects with atherosclerotic disease and healthy controls. In situ RL2 levels were proportional to the size and the severity of aneurysmatic disease, and were substantially elevated in patients with symptomatic aneurysm of any diameter or asymptomatic aneurysm of a diameter >350% of that of the normal artery. In contrast, tissue RL2 was inversely associated with the clinical severity of atherosclerotic lesions. Correlation between RL2 and MMP2 was different between ATH1 and ATH2, depending on atherosclerosis grade. Overall, tissue RL2 is differentially associated with discrete phenotypes of arterial disease and might exert multipotent biological effects on vascular wall integrity and remodeling in human subjects.

Increased Serum KLF4 in Severe Atheromatosis and Extensive Aneurysmal Disease.

BACKGROUND: Krüppel-like factor 4 (KLF4) is known to preserve vascular homeostasis. In the present study, we sought to correlate serum KLF4 levels with arterial aneurysm size and their clinical presentation. We also explored the association between serum KLF4 levels and the severity of extracranial carotid and peripheral arterial disease. METHODS: Patients undergoing surgery for various forms of atheromatosis (ATH group) or for arterial aneurysm repair (AA group) were eligible for inclusion. KLF4 levels were measured via enzyme-linked immunosorbent assay. RESULTS: Patients in the atheromatic and aneurysmal groups had significantly higher serum KLF4 levels compared with controls. Patients with permanent end-organ damage (ATH3) had higher serum KLF4 (6.96 ± 0.75 pg/mL) compared with patients with asymptomatic internal carotid stenosis >70% or claudication (ATH1) (2.76 ± 0.68 pg/mL; mean difference [MD], -4.20; 95% confidence interval [95% CI], -5.35 to -3.04; P < 0.01) and those with transient ischemic attack or rest pain (ATH2) (4.47 ± 1.08 pg/mL; MD, -2.48; 95% CI, -3.76 to -1.21). Furthermore, patients with an asymptomatic aneurysm of a diameter 250-300% of that of the normal artery (AA1, 5.01 ± 1.08 pg/mL) had considerably lower serum KLF4 compared with those suffering from either a symptomatic aneurysm or an asymptomatic aneurysm of a diameter >350% of that of normal artery (AA3, 6.63 ± 1.92 pg/mL; MD, -2.61; 95% CI, -5.04 to -0.18; P < 0.01). CONCLUSIONS: Serum KLF4 levels are significantly increased in patients with end-organ damage related to atheromatosis as well as those with extensive aneurysmal disease.

Improving the storage quality of Tahitian limes (Citrus latifolia) by pre-storage UV-C irradiation.

UV-C (180-280 nm) has been shown to extend the postharvest shelf-life of many horticulture crops. In this study, Tahitian limes (Citrus latifolia) were exposed to 0, 3.4, 7.2 and 10.5 kJ m-2 UV-C then stored for 28 days in air at 10 °C and 80% RH. Weight loss, peel colour, calyx abscission, ethylene production, respiration rate, total soluble solids (TSS), titratable acidity (TA) and acceptability index were assessed. The results showed that UV-C treatment maintained lime peel green colour and retained calyx attachment after 28 days storage. UV-C treatment also affected endogenous ethylene production and respiration rate, where the highest UV-C treatment (10.5 kJ m-2) maintained low ethylene production and low respiration rates after 28 days storage with no differences between the different UV-C intensities. In terms of fruit acceptability, limes were exposed to 10.5 kJ m-2 UV-C had a 60% acceptability index after 28 days storage, while untreated control fruit retained acceptability of 39%. In general, the pre-storage UV-C treatments did not affect fruit weight loss, TSS or TA contents during storage.

Associations between serum relaxin 2, aneurysm formation/size and severity of atherosclerosis: a preliminary prospective analysis.

Serum relaxin 2 (RL2) is a pleiotropic hormone that acts on various organs and systems, particularly the cardiovascular system. Although RL2 seems to upregulate the synthesis of nitric monoxide (NO) and matrix metalloproteinase (MMP)-2 and -9, current literature on its role in atherosclerosis and aneurysm formation is scarce. The aim of this study was to investigate the levels of serum RL2 in patients with an arterial aneurysm as well as in atherosclerotic patients, and correlate them with the severity of their related vascular disease. A total of 53 subjects were enrolled in this study: 37 patients were scheduled to undergo surgery: 21 patients for different forms of atherosclerotic disease (ATH), 16 patients for an arterial aneurysm (AA), 6 patients for undergoing temporal artery biopsy (TAB), and 10 healthy blood donors (HBD) served as the control groups. RL2 was measured using enzymelinked immunosorbent assay. RL2 was significantly higher in AA patients compared to ATH (P<0.01), TAB (P<0.001) and HBD (P<0.01). No significant difference was found between the ATH and TAB groups (P>0.05). In addition, ATH and AA patients were further subdivided based on the severity of their disease. Serum RL2 was progressively increased in patients with arterial aneurysms, showing a positive relationship with the size of the aneurysmatic dilatation. By contrast, the RL2 level was inversely related to the severity of the atherosclerotic disease. Studies with a larger cohort incorporating a consistent study population are warranted to verify our results and shed light on the mechanistic background of these processes.

Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion.

This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries' "steal syndrome" from the inferior mesenteric artery unique.

The German Aortic Valve Registry (GARY): in-hospital outcome.

BACKGROUND: Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. METHODS AND RESULTS: A total of 13 860 consecutive patients undergoing repair for aortic valve disease [conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques] have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI). CONCLUSION: The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients.

Alternatives to DPA and ethoxyquin for preventing the development of superficial scald in apples: A review.

Apples are one of most economically important crops worldwide with a production of approximately 96 million tons in 2022. During postharvest storage, apple quality can decline due to the development of physiological disorders. Superficial scald is one of the main physiological disorders that develops in apples during cold storage and results in quality deterioration. Superficial scald is controlled by synthetic antioxidants such as diphenylamine (DPA) and ethoxyquin. Both chemicals have been banned from the EU due to their toxicity. The current review provides an update on superficial scald complicated development mechanism and summarizes studies investigating postharvest treatments as alternatives to DPA and ethoxyquin. Ethylene and oxygen are important factors that trigger the development of superficial scald in apples by regulating various metabolic pathways during cold storage. More studies are required to investigate alternatives to synthetic antioxidants and elucidate the contribution level of the different metabolites to superficial scald development.

The Artery of Adamkiewicz: Anatomy and Considerations in Spine Surgery - A Review of the Literature.

The artery of Adamkiewicz (AKA) provides blood supply to the thoracolumbar spinal cord. Any disruption of the AKA can lead to the anterior spinal artery (ASA) syndrome, with devastating systematic and neurologic complications for the patient. This is a narrative review of the anatomy of AKA, the characteristics of ASA syndrome and the role of radiologic techniques in diagnosis and treatment. A detailed search of the PubMed database was conducted from January 2000 until April 2020, to locate articles relevant to our study. The references of the included studies were also retrieved in order not to miss any information. The ASA syndrome can present as a possible post-operative complication after minimally invasive or open surgeries of multiple specialties that involve the field of spine. Risk factors associated with ASA syndrome include; kyphosis of the patient, corresponding spinal surgical approach, intraoperative hypotension, multiple ligations of the AKA, a left side approach and a 360-combined or revision surgery. The incidence varies among different operations. Many different imaging modalities have been used in preoperative plan, including but not limited to computed tomography angiography, magnetic resonance angiography, and subtraction angiography. The use of computed tomography angiography or magnetic resonance angiography preoperatively can play a major role in the prevention of the ASA syndrome. However, more research needs to be done before making any final assumptions.

Fruit, vegetables, and mushrooms for the preparation of extracts with α-amylase and α-glucosidase inhibition properties: A review.

The inhibition of the α-amylase and α-glucosidase activity facilitates the maintenance of circulating glucose levels by decreasing the rate of blood sugar absorption. Existing enzyme inhibitors such as acarbose, miglitol, and voglibose are used for inhibiting the activity of these enzymes, however, alternative solutions are required to avoid the side-effects of using these drugs. The current study aims to review recent evidence regarding the in vitro α-amylase and α-glucosidase inhibition activities of extracts derived from selected fruit, vegetables, and mushrooms. The mechanisms of action of the extracts involved in the inhibition of both enzymes are also presented and discussed. Compounds including flavonoids, phenolic acids, anthocyanins, saponins, carotenoids, terpenes, sugars, proteins, capsaicinoids, fatty acids, alkaloids have been shown to have α-amylase and α-glucosidase inhibition activities. Harvesting period, maturity stage, sample preparation, extraction technique, and solvent type are parameters that affect the α-amylase and α-glucosidase inhibition activities of the extracts.

Factors affecting the incidence of postoperative periprosthetic fractures following primary and revision hip arthroplasty: a systematic review and meta-analysis.

OBJECTIVES: The increasing number of hip arthroplasties (HA), due to the growing elderly population, is associated with the risk of femoral periprosthetic fractures (FPFs). The purpose of this study was to identify potential risk factors for the development of FPFs after HA. METHODS: A systematic review was conducted in five data bases (Medline, Embase, Cochrane, Cinahl, ICTRP) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines up to May 2019, using the key words "risk factor," "periprosthetic fracture," and "hip replacement or arthroplasty." Meta-analysis of the clinical outcomes of HA and subgroup analysis based on the factors that were implicated in FPFs was performed. RESULTS: Sixteen studies were included (sample size: 599,551 HA patients, 4253 FPFs, incidence 0.71%). Risk factors statistically associated with increased incidence of FPFs were female gender (+ 40%), previous revision arthroplasty surgery (× 3 times), and the presence of rheumatoid arthritis (× 2.1 times), while osteoarthritis (- 57%), cement application (- 59%), and insertion of Biomet (- 68%) or Thompson's prosthesis (- 75%) were correlated with low prevalence of FPFs. Obesity, cardiac diseases, advanced age, bad general health (ASA grade ≥ 3), and use of Exeter or Lubinus prosthesis were not linked to the appearance of FPFs. CONCLUSION: This meta-analysis suggested that female gender, rheumatoid arthritis, and revision arthroplasty are major risk factors for the development of FPFs after a HA. In those patients, frequent follow-ups should be planned. Further prospective studies are necessary to clarify all the risk factors contributing to the appearance of FPFs after HA.

Monitoring the effect of different microwave extraction parameters on the recovery of polyphenols from shiitake mushrooms: Comparison with hot-water and organic-solvent extractions.

The current study aimed to investigate the effect of different microwave-assisted extraction (MAE) parameters (i.e., particle size of the sample, solid-to-liquid ratio, microwave power, and extraction time) on the total phenolic content (TPC), antioxidant capacity (DPPH and CUPRAC), chlorogenic acid and caffeic acid contents of shiitake mushrooms. All the independent variables affected TPC and antioxidant capacity values. Only the sample particle size had no significant effect on phenolic acid contents. The highest TPC, DPPH, and CUPRAC values were obtained when a particle size of 1.75 mm, solid-to-liquid ratio of 1/40, microwave power of 600 W, and extraction time of 15 min were used. The extracts obtained by MAE were compared with those obtained after hot-water extraction (HWE) and organic-solvent extraction (OSE). Scanning electron microscopy (SEM) confirmed that MAE resulted in cell wall disruption which might be due to an increase in the pressure of the inner part of the cells.

The Use of Upcycled Defatted Sunflower Seed Flour as a Functional Ingredient in Biscuits.

Defatted sunflower seed flour (DSSF) is an upcycled by-product of sunflower oil extraction, rich in protein, fibre and antioxidants. This study assessed the instrumental and sensory quality of biscuits enriched with DSSF at 18% and 36% w/w as a replacement for wheat flour. Measurements included colour, texture, total phenolic content (TPC) and antioxidant capacity. Sensory analysis was carried out with Quantitative Descriptive Analysis (QDA). The inclusion of DSSF significantly increased the protein content of the biscuits, as well as the TPC and antioxidant capacity of the biscuits. The resulting products were significantly darker, less red and less yellow with increasing DSSF levels, while hardness (measured instrumentally) increased. Sensory results agreed with colour measurements, concluding that DSSF biscuits were more "Brown" than the control, and with texture measurements where biscuits with 36% DSSF had a significantly firmer bite. In addition, DSSF biscuits at 36% inclusion had higher QDA scores for "Off-note" and the lowest scores for "Crumbly" and "Crumb aeration". DSSF biscuits at 18% inclusion were similar to the control in most parameters and should be considered for further developments. These results show the potential of the upcycled DSSF by-product as a novel, sustainable and healthy food ingredient.

The Odyssey of Bioactive Compounds in Avocado (Persea americana) and Their Health Benefits.

Persea americana, commonly known as avocado, has recently gained substantial popularity and is often marketed as a "superfood" because of its unique nutritional composition, antioxidant content, and biochemical profile. However, the term "superfood" can be vague and misleading, as it is often associated with unrealistic health claims. This review draws a comprehensive summary and assessment of research performed in the last few decades to understand the nutritional and therapeutic properties of avocado and its bioactive compounds. In particular, studies reporting the major metabolites of avocado, their antioxidant as well as bioavailability and pharmacokinetic properties, are summarized and assessed. Furthermore, the potential of avocado in novel drug discovery for the prevention and treatment of cancer, microbial, inflammatory, diabetes, and cardiovascular diseases is highlighted. This review also proposes several interesting future directions for avocado research.

Encapsulation of Citrus By-Product Extracts by Spray-Drying and Freeze-Drying Using Combinations of Maltodextrin with Soybean Protein and ι-Carrageenan.

The effect of different combinations of maltodextrin (MD) coating agents (MD, MD + soybean protein, and MD + ι-carrageenan) on the encapsulation of lemon by-product aqueous extracts using freeze-drying and spray-drying were investigated. The total phenolic content (TPC), total flavonoid content (TFC), and ferric ion reducing antioxidant power (FRAP) of the microparticles were evaluated. Freeze-drying with the mixture of MD + soybean protein resulted in the highest retention of TPC, TFC, and FRAP (1.66 ± 0.02 mg GAE/g d.b., 0.43 ± 0.02 mg CE/g d.b., and 3.70 ± 0.05 mM TE/g, respectively). Freeze-drying resulted in microparticles with lower moisture content (MC) and water activity (aw) than those produced by spray-drying. Specifically, the MC and aw of the microparticles produced by freeze-drying ranged from 1.15 to 2.15% and 0.13 to 0.14, respectively, while the MC and aw of the microparticles produced by spray-drying ranged from 6.06% to 6.60% and 0.33 to 0.40, respectively. Scanning electron microscopy revealed that spray-drying resulted in the formation of spherical particles of different sizes regardless of the type of coating agent. Although freeze-drying resulted in microparticles with amorphous glassy shapes, the mixture of MD + soybean protein resulted in the formation of spherical porous particles. X-ray diffraction revealed a low degree of crystallinity for the samples produced by both techniques.

Design and construction of an optimized transmit/receive hybrid birdcage resonator to improve full body images of medium-sized animals in 7T scanner.

The purpose of this work was to develop an optimized transmit/receive birdcage coil to extend the possibilities of a 7T preclinical MRI system to conduct improved full body imaging in medium-sized animals, such as large New Zealand rabbits. The coil was designed by combining calculation and electromagnetic simulation tools. The construction was based on precise mechanical design and careful building practice. A 16-leg, 20 cm long, 16 cm inner diameter, shielded quadrature hybrid structure was selected. Coil parameters were assessed on the bench and images were acquired on phantoms and rabbits. The results were compared to simulations and data obtained with an available commercial coil. An inexpensive assembly with an increase of 2 cm in useful inner diameter and 50 Ω matching with larger animals was achieved. A reduction in radiofrequency (RF) power demand of 31.8%, an improvement in image uniformity of 18.5 percentage points and an increase in signal-to-noise ratio of up to 42.2% were revealed by phantom image acquisitions, which was confirmed by in vivo studies. In conclusion, the proposed coil extended the possibilities of a preclinical 7T system as it improved image studies in relatively large animals by reducing the RF power demand, and increasing image uniformity and signal-to-noise ratio. Shorter scans and time under anesthesia or reduced RF exposure, resulting in better images and lower animal health risk during in vivo experiments, were achieved.

A purpose-built neck coil for black-blood DANTE-prepared carotid artery imaging at 7T.

Atherosclerotic plaques in the bifurcation of the carotid arteries can pose a significant health risk due to possible plaque rupture and subsequent stroke. The assessment of plaques, and evaluation of the risk they pose, can be performed with Black-Blood (BB) vessel wall magnetic resonance imaging. However, resolution at standard clinical field strengths (up to 3T) is limited, hampering reliable assessment and diagnosis. The aim of this study was to investigate the benefits of 7T MRI using a BB application that has been successful at clinical field strengths. Therefore, for BB imaging, each sequence was preceded with 'Delay Alternating with Nutation for Tailored Excitation' (DANTE) preparation pulses for blood signal suppression. A coil comprising a 4-channel Tx array was designed and built to provide the required excitation coverage for the DANTE train; and a 4-channel Rx array was constructed to target the carotid bifurcation. Human and phantom results showed satisfactory blood suppression and comparable SNR and CNR to 3T, therefore demonstrating the feasibility of the application at 7T. However, the imposed SAR restrictions led to long scan times and subsequent motion artifacts. Thus, more accurate local SAR supervision schemes are required which could lead to a further improvement of BB DANTE vessel wall imaging at 7T.

In-hospital outcome of transcatheter vs. surgical aortic valve replacement in patients with aortic valve stenosis: complete dataset of patients treated in 2013 in Germany.

BACKGROUND: Transvascular (TV-AVI) or transapical (TA-AVI) aortic valve implantation (TAVI) is a treatment option for patients with aortic stenosis being at high or prohibitive risk for surgical aortic valve implantation (SAVR). Randomized data demonstrated that these subgroups can safely been treated with TAVI. However, a comparison of SAVR and TAVI in intermediate and low-risk patients is missing. Therefore, the aim of the analysis was to compare TAVI and SAVR in all patients who were treated for aortic valve stenosis in Germany throughout 1 year. METHODS: The mandatory quality assurance collects data on the in-hospital outcome from all patients (n = 20,340) undergoing either SAVR or TAVI in Germany. In order to compare the different treatment approaches patients were categorized into four risk groups using the logistic EuroScore I (ES). In-hospital mortality and peri- and postprocedural complications were analyzed. RESULTS: The in-hospital mortality did not differ between TV-AVI and SAVR in the low risk group (ES <10 %: TV-AVI 2.4 %, SAVR 2.0 %, p = 0.302) and was significantly higher for SAVR in all other risk groups (ES 10-20 %: TV-AVI 3.5 %, SAVR 5.3 %; p = 0.025; ES 20-30 %: TV-AVI 5.5 %, SAVR 12.2 %, p < 0.001; ES >30 %: TV-AVI 6.5 %, SAVR 12.9 %, p = 0.008). TA-AVI had a significantly higher mortality in all risk groups compared to TV-AVI. In comparison to SAVR, TA-AVI had a higher mortality in patients with ES <10, comparable mortality in ES 10-20 %, and lower mortality in patients with an ES >20 %. The overall stroke rate was 2.3 %. It occurred more frequently in patients with an ES <10 % treated with a transapical approach (SAVR 1.8 %, TV-AVI 1.9 %, TA-AVI 3.1 %, p < 0.01). There were no statistically significant differences in all other comparisons. CONCLUSIONS: This study demonstrates that TAVI provides excellent outcomes in all risk categories. Compared with SAVR, TV-TAVI yields similar in-hospital mortality among low-risk patients and lower in-hospital mortality among intermediate and high-risk patient populations.

Impact of different solvents on the recovery of bioactive compounds and antioxidant properties from lemon (Citrus limon L.) pomace waste.

The effects of different solvents on the recovery of (i) extractable solids (ES), (ii) total phenolic compounds (TPC), (iii) total flavonoid content (TFC), (iv) vitamin C, and (v) antioxidant activity from lemon pomace waste were investigated. The results revealed that solvents significantly affected the recovery of ES, TPC, TFC, and antioxidant properties. Absolute methanol and 50% acetone resulted in the highest extraction yields of TPC, whereas absolute methanol resulted in the highest extraction of TFC, and water had the highest recovery of vitamin C. 50% ethanol, and 50% acetone had higher extraction yields for TPC, and TFC, as well as higher antioxidant activity compared with their absolute solvents and water. TPC and TFC were shown to be the major components contributing to the antioxidant activity of lemon pomace.

Enhancing the Total Phenolic Content and Antioxidants of Lemon Pomace Aqueous Extracts by Applying UV-C Irradiation to the Dried Powder.

Several studies have shown that UV-C (ultraviolet C) irradiation promotes the bioactive compounds and antioxidants of fresh fruits and vegetables. The aim of this study was to apply UV irradiation in dried lemon pomace powder for enhancing its phenolic content and antioxidant properties, thus more bioactive compounds should be available for extraction and utilization. Lemon pomace dried powder was placed under a UV lamp and treated with dosages of 4, 19, 80 and 185 kJ·m-2, while untreated powder was used as a control. UV-C irradiation significantly affected the total phenolic content, total flavonoid content, proanthocyanidins, and antioxidant capacity measured by cupric reducing antioxidant capacity (CUPRAC) and ferric reducing antioxidant power (FRAP) of the lemon pomace dried powder, while it did not affect the vitamin C content. UV-C irradiation of 19 kJ·m-2 resulted in 19% higher total phenolic content than the control, while UV-C irradiation of 180 kJ·m-2 resulted in 28% higher total flavonoid content than the control. The antioxidant capacity was reduced when UV-C irradiation more than 4 kJ·m-2 was applied. The results of this study indicate that UV-C treatment has the potential to increase the extraction of bioactive compounds of dried lemon pomace at relatively high dosages.

Current Results of Surgical Aortic Valve Replacement: Insights From the German Aortic Valve Registry.

BACKGROUND: Conventional aortic valve replacement (AVR) remains the therapy of choice for many patients with severe aortic valve disease. The unique German Aortic Valve Registry (GARY) allows the comparison of contemporary outcomes of AVR with those of transcatheter AVRs. We report here real-world, all-comers outcomes of AVR, including combined AVR and coronary bypass grafting (AVR+CABG). METHODS: A total of 34,063 patients who received AVR (22,107 patients, 39% female; mean age 68.0 ± 11.3 years, mean logistic European System for Cardiac Operative Risk Evaluation, 8.6%) or AVR+CABG (11,956 patients, 28% female; mean age 72.6 ± 7.8 years, mean logistic European System for Cardiac Operative Risk Evaluation, 10.7%) between 2011 and 2013 were analyzed and followed up to assess the 1-year outcome. RESULTS: In-hospital mortality was 2.3% for AVR and 4.1% for AVR+CABG. Other important outcome variables include stroke (AVR, 1.2%; AVR+CABG, 1.9%) and new pacemaker implantation (AVR, 4.4%; AVR+CABG, 3.6%). Survival at 1 year was 93.2% for AVR and 89.4% for AVR+CABG. Total stroke rates at 1 year were 1.6% for AVR and 2.0% AVR+CABG. Quality of life assessment indicated that most patients were in New York Heart Association Functional Classification I or II (AVR, 86%; AVR+CABG, 84%) and that they were satisfied with the overall postoperative course (AVR, 88%; AVR+CABG, 87%). CONCLUSIONS: Contemporary surgical AVR yields excellent outcomes with low in-hospital mortality, a low overall complication rate, and good 1-year outcome for all risk groups. Accordingly, conventional AVR remains an important therapeutic option for many patients.