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Di Eusanio M, Phan K, Bouchard D, Carrel TP, Dapunt OE, Di Bartolomeo R, Eichstaedt HC, Fischlein T, Folliguet T, Gersak B, Glauber M, Haverich A, Misfeld M, Oberwalder PJ, Santarpino G, Shrestha ML, Solinas M, Vola M, Alamanni F, Albertini A, Bhatnagar G, Carrier M, Clark S, Collart F, Kappert U, Kocher A, Meuris B, Mignosa C, Ouda A, Pelletier M, Rahmanian PB, Reineke D, Teoh K, Troise G, Villa E, Wahlers T, Yan TD. Sutureless Aortic Valve Replacement International Registry (SU-AVR-IR): design and rationale from the International Valvular Surgery Study Group (IVSSG). Ann Cardiothorac Surg 2015; 4:131-9. [PMID: 25870808 DOI: 10.3978/j.issn.2225-319x.2015.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SU-AVR) is an innovative approach which shortens cardiopulmonary bypass and cross-clamp durations and may facilitate minimally invasive approach. Evidence outlining its safety, efficacy, hemodynamic profile and potential complications is replete with small-volume observational studies and few comparative publications. METHODS Minimally invasive aortic valve surgery and high-volume SU-AVR replacement centers were contacted for recruitment into a global collaborative coalition dedicated to sutureless valve research. A Research Steering Committee was formulated to direct research and support the mission of providing registry evidence warranted for SU-AVR. RESULTS The International Valvular Surgery Study Group (IVSSG) was formed under the auspices of the Research Steering Committee, comprised of 36 expert valvular surgeons from 27 major centers across the globe. IVSSG Sutureless Projects currently proceeding include the Retrospective and Prospective Phases of the SU-AVR International Registry (SU-AVR-IR). CONCLUSIONS The global pooling of data by the IVSSG Sutureless Projects will provide required robust clinical evidence on the safety, efficacy and hemodynamic outcomes of SU-AVR.
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Affiliation(s)
- Marco Di Eusanio
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Denis Bouchard
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thierry P Carrel
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Otto E Dapunt
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Roberto Di Bartolomeo
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Harald C Eichstaedt
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Theodor Fischlein
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thierry Folliguet
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Borut Gersak
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Mattia Glauber
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Axel Haverich
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Martin Misfeld
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Peter J Oberwalder
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giuseppe Santarpino
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Malakh Lal Shrestha
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Vola
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Francesco Alamanni
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Albertini
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gopal Bhatnagar
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Michel Carrier
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Stephen Clark
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federic Collart
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Utz Kappert
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alfred Kocher
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Bart Meuris
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carmelo Mignosa
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Ahmed Ouda
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marc Pelletier
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Parwis Baradaran Rahmanian
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - David Reineke
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Teoh
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Emmanuel Villa
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thorsten Wahlers
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Tristan D Yan
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
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144
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Phan K, Tsai YC, Niranjan N, Bouchard D, Carrel TP, Dapunt OE, Eichstaedt HC, Fischlein T, Gersak B, Glauber M, Haverich A, Misfeld M, Oberwalder PJ, Santarpino G, Shrestha ML, Solinas M, Vola M, Yan TD, Di Eusanio M. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2015; 4:100-11. [PMID: 25870805 DOI: 10.3978/j.issn.2225-319x.2014.06.01] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/27/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. METHODS Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. CONCLUSIONS The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.
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Affiliation(s)
- Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Yi-Chin Tsai
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Nithya Niranjan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Denis Bouchard
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Thierry P Carrel
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Otto E Dapunt
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Harald C Eichstaedt
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Theodor Fischlein
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Borut Gersak
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Mattia Glauber
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Axel Haverich
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Martin Misfeld
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Peter J Oberwalder
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Giuseppe Santarpino
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Malakh Lal Shrestha
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Solinas
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Vola
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Di Eusanio
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
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