The remodeling and reimplantation aortic valve-sparing root replacement techniques provided excellent long-term survival. Although the number of patients was relatively small, we provide some hints that in the second decade after the operation, especially in bicuspid aortic valve patients, the risk of reoperation may be increased, needing further evaluation.

In our specific model, in noncalcified as well as calcified conditions, TAVI-ViV is feasible with either SAVB (Trifecta or Perimount Magna Ease) without an increased risk of coronary obstruction. Nevertheless, before clinical application of these results, thorough preoperative assessment, considering the different limitations of this model, is mandatory.

In our study, ascending aorta intervention could be performed with low hospital mortality and obviously did not add to the overall mortality compared with no intervention. Ascending aorta replacement was the most definite intervention. The multifactorial decision for ascending aorta intervention including the z score of the ascending aorta was more liberal in younger patients compared to the simple aortic size guidelines and provided excellent results. However, generalizability needs further data.

Bicuspid aortic valve related aortopathy is known to significantly increase the risk for catastrophic aortic events and, therefore, represents a considerable health burden. Albeit of ongoing research in this field including genetic, molecular, hemodynamic and morphologic aspects, bicuspid aortic valve related aortopathy still represents an imperfectly understood disorder. This lack in knowledge results in a lack of consistency considering different therapeutic approaches. Recent studies have provided new insights into the etiology and clinical impacts of bicuspid aortic valve related aortopathy in different clinical settings, leading to a growing body of opinion towards a more individualized surgical approach than currently provided by the guidelines. Especially valvular hemodynamics-stenosis and regurgitation-seem to have significant impact on the development of bicuspid aortic valve related aortopathy. In this context, there is evidence that regurgitation of bicuspid aortic valves is the more fatal pathomechanism. Furthermore, "age" represents an aspect that should be taken into account when deciding whether to replace the aorta or not, because the diameter depends mainly on a patients age. The same diameter of the aorta in a 70-year old and a 20-year old patient has to be interpreted differently and should, therefore, result in different therapeutic strategies.

Platelet accumulation in vascular prostheses: 1. F. Lane et al. Wilkinson AR, Hawker RJ, Hawker LM. "'Indium labelledCrookston JH. Blood platelet survival. A case of spontaneous rupture of the left common iliac vein is reported and the possible aetiological findings discussed. Case reportA previously healthy 79-year-old woman was admitted to Ashington Hospital, having collapsed in the street. She described a 12 h history of swelling of the left leg associated with lower abdominal pain. The pain became severe and whilst walking she became dizzy and fainted. There was no history of trauma and she was not taking any medication. On admission, she was pale and sweaty. Her blood pressure was 100/45 mmHg and pulse regular at 80 min-'. Abdominal examination revealed the presence of a large, tender non-pulsatile mass in the left iliac fossa approximately 12 x 10 cm. Femoral pulses were both present and there were n o bruits. The left leg was warm and oedematous up to the groin. Rectal examination revealed a boggy swelling in the Pouch of Douglas. The haemoglobin was 6 g/dl and haematocrit 0224.Her condition rapidly improved on the administration of plasma expanders and blood. She was taken to theatre where she was found to have an extensive retroperitoneal haematoma which extended into the broad ligament, the anterior abdominal wall and up to the posterior abdominal wall as far as the left kidney. Exploration of the haematoma revealed normal iliac arteries but a 4cm tear in the anteromedial aspect of the left common iliac vein. The vein contained fresh thrombus but otherwise appeared healthy. After thrombectomy, there was satisfactory bleeding from the distal end but none from the proximal end of the vein. The proximal portion of the vein appeared to be compressed between the overlying right common iliac artery and the sacral promontory. By lifting the artery from the vein, free back bleeding was obtained and mobilization of the artery improved back bleeding to a lesser degree. The tear in the vein was sutured with 4/0 Ethibond.She was anticoagulated initially with heparin and then with warfarin but her recovery was complicated by atrial fibrillation and on the thirteenth day by a small pulmonary embolus. A venogram performed 4 weeks after operation showed that the common iliac vein still contained a thrombus with an extensive collateral circulation. Since then, the oedema of the left leg has resolved and she is now mobile and active.