WHAT THIS PAPER ADDSThere is no universally accepted aortic graft infection case definition and clinical approaches to this complex condition differ widely with variable outcomes. Here, the Management of Aortic Graft Infection Collaboration (MAGIC), involving clinicians from several English hospital National Health Service Trusts with large vascular services, propose a formal case definition, derived by a process of multidisciplinary, expert consensus. The definition is readily applied in routine practice and aids early recognition. Importantly and towards development of evidence-based clinical guidelines that are presently lacking, it provides a consistent diagnostic standard, essential for clinical trial design and meaningful comparison between diagnostic and therapeutic strategies.Objective/Background: The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI. Methods: A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition. Results: Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stentgraft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever 38 C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid ( 7 weeks and 3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source. Conclusion: This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database

Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.

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We investigate the existence and uniqueness of solutions to a coupled system of the hybrid fractional integro-differential equations involving φ-Caputo fractional operators. To achieve this goal, we make use of a hybrid fixed point theorem for a sum of three operators due to Dhage and also the uniqueness result is obtained by making use of the Banach contraction principle. Moreover, we explore the Ulam–Hyers stability and its generalized version for the given coupled hybrid system. An example is presented to guarantee the validity of our existence results.

The purpose of this paper is to introduce a new four-step iteration scheme for approximation of fixed point of the nonexpansive mappings named as S∗-iteration scheme which is faster than Picard, Mann, Ishikawa, Noor, Agarwal, Abbas, Thakur, and Ullah iteration schemes. We show the stability of our proposed scheme. We present a numerical example to show that our iteration scheme is faster than the aforementioned schemes. Moreover, we present some weak and strong convergence theorems for Suzuki’s generalized nonexpansive mappings in the framework of uniformly convex Banach spaces. Our results extend, improve, and unify many existing results in the literature.