Marek Jasiński

Aortic valve repair is a complex and evolving field that requires multidisciplinary teamwork among heart specialists to diagnose and treat various causes and mechanisms of aortic regurgitation and proximal thoracic aortic aneurysms across all age groups. From a surgical standpoint, aortic valve repair includes all procedures aimed at restoring or maintaining native valve function. This European Association for Cardio-Thoracic Surgery (EACTS) Expert Consensus Document critically evaluates the current evidence on the common causes and mechanisms of aortic regurgitation, the use of echocardiographic parameters in patient selection, intraoperative assessment, and prognostic evaluation as well as the surgical techniques in practice. It outlines fundamental surgical principles shared across different repair methods and provides consensus statements to guide clinical practice. These statements are intended for a broad audience, including paediatric and adult cardiologists, echocardiographers, cardiovascular imaging specialists, and cardiac surgeons. Where high-quality evidence is unavailable, the guidance relies on the collective experience and expert judgement of the multidisciplinary author team. This document presents the official stance of the EACTS and aims to promote standardized, evidence-based decision-making in the management of patients undergoing aortic valve repair.

Objectives: Patients with advanced-stage chronic renal failure have poor outcomes following cardiac surgery. Our registry study aimed to compare postoperative and follow-up data between patients who underwent isolated coronary artery surgery with preoperative chronic dialysis and patients with preoperative severe renal impairment who did not require chronic dialysis. Methods: We analyzed 157,948 consecutive adult patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry) scheduled for isolated coronary artery surgery between January 2010 and December 2023. Overall, in this cohort 938 patients underwent chronic dialysis (CD group), and 13,253 patients had severe renal impairment but did not undergo CD (SRI group). Patients in these groups constituted 0.6% and 8.4% of the entire population, respectively. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were compared among patients in CD group and SRI group. Results: Mean age of patients CD group and SRI group was 63.3 ± 9.5 years vs 71.9 ± 8.4 years, respectively (p<0.001), while the mean EuroSCORE II score in these groups was 4.85 ± 7.03% vs 5.82 ± 7.76%, respectively (p<0.001). In-hospital mortality among patients in the CD and SRI groups were 10.9% and 6.3%, respectively (p<0.001). Patients with preoperative CD had more frequent respiratory complications and reoperations for bleeding. The long-term mortality was also significantly higher in CD group (p<0.001) Conclusion: Patients with CD had higher in-hospital and long-term mortality rates than those with a preoperative SRI. It is possible that the EuroSCORE II underestimates the risk of coronary bypass grafting in a group of patients with chronic dialysis. It is possible that the coagulation disorders may play role in the higher mortality rates in patients undergoing chronic dialysis

Background and Aim of the Study: An incompetent bicuspid aortic valve (BAV) can be treated through valve replacement or repair using various surgical techniques. This study presents the outcomes of a 13-year single-surgeon experience in BAV repair and compares two annuloplasty techniques: external and subcommissural aortic annuloplasty. Materials and Methods: A total of 150 consecutive patients (111 males; mean age: 43.2 ± 17.5 years) with BAV insufficiency, with or without aortic dilatation, underwent valve repair at three institutions. Multivariable logistic regression was used to identify associations between risk factors and major adverse events. Among these, 50 patients were prospectively assigned to one of two groups based on the annular stabilization technique: Group EA received external annuloplasty, while Group SCA underwent subcommissural annuloplasty. All patients in both groups were evaluated by transthoracic echocardiography before surgery and two years postoperatively. Results: There was no in-hospital mortality, and all patients survived throughout the follow-up period. Nine patients (6%) developed moderate to severe postoperative insufficiency and required reoperation. The Kaplan–Meier estimated freedom from reoperation at eight years was 100% in patients who did not undergo subcommissural annuloplasty, compared to 81% in those who did (p = 0.037). External annuloplasty was associated with a significantly smaller postoperative aortic annulus diameter (24.1 ± 2.6 mm vs. 25.8 ± 2.1 mm, p < 0.05), and lower mean and peak transvalvular gradients (7 ± 4 mmHg vs. 13 ± 4 mmHg, p = 0.02; and 15.3 ± 9.7 mmHg vs. 20.7 ± 5.6 mmHg, p = 0.03, respectively). Aortic root or ascending aorta replacement was also found to be a predictor of repair durability (p = 0.0039). Conclusions: Bicuspid aortic valve repair provides favorable short- and midterm outcomes. External annuloplasty offers superior annular stabilization and hemodynamic performance compared to subcommissural annuloplasty. Additionally, concomitant aortic replacement further improves the long-term durability of the repair.