In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan.

Background: Transcatheter aortic valve implantation (TAVI) is a new method for patients with severe aortic stenosis at high surgical risk, such as previous cardiac surgery. The presence of mechanical mitral prosthesis might complicate TAVI because of possible interference between both prostheses. Some reports have already demonstrated the feasibility of TAVI in such patients. Case Reports: We report 2 patients with severe symptomatic aortic stenosis who had prior mitral valve replacement that successfully underwent TAVI with Edwards Sapien and CoreValve aortic prosthesis, respectively. Computed tomographic angiography (CTA) was useful for the assessment of the distance between both aortic and mitral prosthesis annuli. Transesophageal echocardiography was crucial for precise positioning of TAV. There were no special technical tips besides precise positioning of the valve prosthesis. In case of Core Valve the goal was the positioning at "zero point" and in case of Edwards Sapien valve a "half-on-half" position according to natural aortic valve. We observed no deformation or dysfunction of aortic and mitral prosthesis in any of the patients. Balloon valvuloplasty prior to implantation helps to observe the mutual effect of the new aortic valve and pre-existent mitral prosthesis. Conclusions: We conclude that TAVI can be safely and successfully performed in patients with mechanical mitral prosthesis carefully considering the altered anatomical conditions. Skillfulness and TAVI experience of the operators should not be neglected.

Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.

Background: Transfemoral valve implantation is the most widely used approach for transcatheter aortic valve implantation (TAVI) and transapical approach is considered to be associated with increased morbidity and mortality. The aim of our study was to compare TAVI related complications in trasfemoral and transapical approach and to compare the long-term outcome in these two groups. Methods and results: We enrolled 171 patients who underwent transfemoral or transapical TAVI between October 2009 and January 2015 (143 transfemoral approach, 28 transapical approach). Patients with transapical approach were more often men and more of them had coronary artery disease and carotid stenosis. The most common complications were related to vascular damage that resulted in minor bleeding and were more common in transfemoral approach. There were no other significant differences in periprocedural complications between transfemoral and transapical site of implantation. We observed no statistical difference in 30 days survival between transfemoral and transapical approach, but long-term survival was better with the transfemoral approach (log Rank = 0.025). Conclusions: We observed comparable results with transfemoral and transapical TAVI approach. The long-term survival, which was better in transfemoral group, could be improved with valve and access route individualization to each patient's anatomy and general condition. aged, aortic valve stenosis, aortic valve replacement, transcatheter, postoperative complications/ mortality

Prikaz slučaja Percutaneous aoric valve implantaion (TAVI) is well established treatment opion for high risp paients with severe aoric stenosis. Transcatheter aoric valve implantaion (TAVI) is an atracive treatment opion for paients with failing bioprostheses (valve-in-valve concept), especially in elderly paients with high risk for reoperaion. Although clinical experience is sill limited for this of-label indicaion, the procedure has been shown to be feasible in stented as well as stentless bioprostheses. We report a case of of 71-years old woman were CoreValve 23 mm (Medtronic, Inc., Minneapolis, Minnesota, USA) was implanted inside a degenerated Sorin Freedom SOLO bioprosthesis using transfemoral approach. Freedom SOLO bioprosthesis stentless bioprosthesis is sutured in supra-annular posiion and presents a TAVI challenge due to its proximity to coronary osia. Careful pre-procedural planning with TEE and CTA is crucial. We decided for transfemoral approach with 23 m CoreValve implantaion. Balloon valvuloplasty before TAVI with contrast injecion may predict the inal result and is helpful for procedure success and risk reducion. The inal TAVR result was good. This case proves the ViV concept for stentless Freedom SOLO bioprosthesis.