BackgroundCardiovascular diseases are the leading cause of mortality worldwide, with coronary artery bypass grafting being the most effective treatment for severe cases. While autografts are preferred, donor veins are often limited. Human umbilical arteries (hUAs) show promise as an alternative. However, to make vascular graft by decellularization, a traditional chemical method can damage tissue structure and function.ObjectiveThis study aims to evaluate the shortening of treatment time and the hUA decellularization efficiency of the perfusion bioreactor systems.MethodshUAs were perfused with 1% Triton X-100 for 6 h, followed by two different concentrations of (0.5% and 1%) SDS for 18 h, and subsequently subjected to a washing procedure. The decellularization process was evaluated using histological staining and DNA quantification, along with tests for cytotoxicity, cell adhesion and proliferation.ResultsThe 0.5% SDS protocol proved most effective, reducing residual DNA to below 50 ng/mg of dry weight while preserving collagen structure. It showed no cytotoxicity to L929 cells, SEM analysis confirmed human umbilical vein endothelial cell (HUVEC) attachment and CCK-8 testing showed promoted HUVECs proliferation.ConclusionThe decellularization protocol of perfusing through 1% TX for 6 h and 0.5% SDS for 18 h through the perfusion bioreactor system is efficient in the intact hUAs tissue. This sets the stage for future in vivo studies and potential clinical applications.

Fresh frozen plasma (FFP) is the standard treatment for severe bleeding following cardiac surgery. Despite increasing use of prothrombin complex concentrate (PCC) for coagulopathic bleeding in preference to FFP in the UK, the evidence comparing FFP versus PCC in this setting is lacking. In adults who develop severe bleeding, PCC is superior to FFP in reducing a composite of mortality, organ failure, or infection up to 90days following cardiac surgery, and is more cost-effective. Phase III pragmatic, multicentre, parallel group, superiority, non-blinded, open-label, two-stage group sequential randomised controlled trial with internal pilot embedded. Participants will be recruited by the research team at up to 20 hospitals in England and Wales. Those who have provided informed consent and who develop bleeding within 24 h of cardiac surgery (elective and urgent procedures) will be randomised to PCC (1500 IU if ≤70 kg or 2000 IU if >70 kg; a maximum of 2 doses) or FFP (4 units if ≤70 kg and 5 units if >70 kg; no maximum dose). Randomisation will be stratified by site and will allocate participants using minimisation, with a 1:1 ratio to receive PCC or FFP. Age (≥70 and <70 years) and planned type of surgery (valve only, major aortic surgery, coronary artery bypass graft + valve, and complex/combined procedure) will be the minimisation factors. The primary outcome is a composite of mortality or new onset of respiratory failure, myocardial injury, renal failure, liver injury, intestinal injury, focal neurological deficit, or infection at 90 days. Secondary outcomes will compare safety (transfusion-related reactions, thrombosis), quality of life, healthcare costs, and cost-effectiveness. A sample size of 496 participants will have a 90% power (with a 5% significance level) to detect a relative risk of 0.7 between the two groups at 90 days. The date of the 1st patient enrolled was 11th February 2025. This trial will provide evidence on the clinical/cost-effectiveness of PCC versus FFP in cardiac surgery patients who bleed post-surgery. Its outcome will provide high-quality evidence to inform the management of bleeding following cardiac surgery. ISRCTN 92114384. Registered on 16/04/2024. ISRCTN-ISRCTN92114384: PROthrombin complex concentrate versus fresh frozen Plasma for bleeding in adults undergoing HEart SurgerY (PROPHESY-2 trial).

Survival outcomes and predictors following coronary artery bypass grafting in patients with preoperative left ventricular dysfunction.

Under proatherogenic conditions, epicardial (EAT) and pericardial adipose tissue (PAT) acquire inflammatory/pro-atherogenic phenotypes that contribute to coronary atherosclerosis. Recent data have highlighted a significant inverse relationship between levels of n-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in adipose tissue and risk of myocardial infarction. Our study aimed at investigating whether DHA/EPA supplementation of cardiac fat adipocytes attenuates cardiac adipose tissue inflammation. To this aim mature adipocytes and adipose stem cells were isolated from PAT samples collected from coronary artery disease (CAD) patients undergoing coronary artery bypass grafting, exposed to DHA/EPA ex vivo, and evaluated for pro-inflammatory gene expression and activity. PAT adipocytes and stem cell exposure to DHA led to a significant increase in the membrane ratio of omega-3 to omega-6 PUFAs and decreased mRNA expression levels of monocyte chemoattractant protein (MCP)-1, interleukin(IL)-6, matrix metalloproteinase(MMP)-9 and CXC motif chemokine ligand (CXCL)10 (p < 0.05). This downregulation was accompanied by increased expression of uncoupling proteins (UCP)1 and 2 and heme-oxygenase (HO)-1 and of the anti-inflammatory and pro-resolving lipid mediator resolvin D1. Mechanistically, this protective modulation appears to be driven by the upregulation of peroxisome proliferator-activated receptor gamma (PPAR)-γ and nuclear factor erythroid 2-related factor (NRF)2, leading to increased NRF2 activity and suppressed NF-κB signaling. Functionally, supernatants from DHA-conditioned adipocytes exhibited reduced monocyte-attracting activity in chemotaxis assays. While EPA conditioning produced effects similar to DHA, arachidonic acid (AA) showed no significant biological effects. In conclusion, DHA and EPA mitigated the PAT inflammatory profile, highlighting the potential therapeutic role of such PUFAs in reducing cardiac adipose tissue inflammation. These results may have implications for treatment of CAD patients.

This study developed a predictive model to identify the high-risk patients for sequential oxygen therapy (SOT) following the extubation from invasive mechanical ventilation (IMV) in patients with coronary artery bypass grafting (CABG). A total of 152 patients were included in this study. Both univariate and multivariate logistic regression analyses identified the potential risk factors associated with the need for SOT following the extubation from IMV in patients with CABG, including the timing of endotracheal extubation (OR = 0.40, 95%CI = 0.29-0.52), duration of IMV (OR = 7.37, 95%CI = 4.28-10.47), simple/combined CABG (OR = 4.31, 95%CI = 1.95-6.67), 1-hour postoperative creatine kinase (CK) levels (OR = 1.60, 95%CI = 1.17-2.02), oxygenation index (OI) (OR = 0.74, 95%CI = 0.63-0.85), and base excess (BE) (OR = 0.47, 95%CI = 0.36-0.57) at the time of extubation. The nomogram demonstrated a consistency index (C-index) and an area under the ROC curve of 0.700. The calibration curve indicated a high degree of agreement between predicted and observed values, and the DCA confirmed the practical utility of the identified indicators.

Single Arterial Versus Multiple Arterial Grafting in 3,164 Diabetic Patients Undergoing Coronary Artery Bypass Surgery: A Propensity-Matched Analysis.

Cognitive decline after coronary artery bypass graft (CABG) is common and affects morbidity, mortality, and quality of life. We systematically reviewed randomized CABG trial control arms to characterize cognitive assessments, testing frequency, attrition, and ability to detect perioperative change. We searched MEDLINE, Embase, Cochrane Library, and PsycINFO for randomized controlled trials of CABG surgery that included at least one arm of patients solely undergoing CABG and that reported at least one objective cognitive assessment, from January 2005 to February 2025. Trials with mixed cardiac surgery or only subjective measures were excluded. We summarized task frequency, cognitive domains, and attrition. For tasks assessed preoperatively and postoperatively in ≥3 trials, we reported control group means and SDs. Risk of bias was assessed using the Cochrane Risk of Bias tool among 6 bias domains. This study was supported by NIH-R01NS123639. Of 3494 screened studies, 2284 were CABG trials, and only 71 (3.1%) reported cognitive evaluation. These involved 15 925 patients (79% men; mean age, 64.2 years; median follow-up, 90 days) and used 145 unique cognitive tasks, with the Trail Making Test Part B (40 of 71; 56.3%) and Part A (38 of 71; 53.5%) being the most frequently administered. Among 7 tasks with sufficient data, none detected preoperative to postoperative changes. Attrition rates averaged 18.9%, with a broad range of 0 to 62%. Cognitive assessment is uncommon in CABG trials, and commonly used tests rarely detect change. Heterogeneity precluded meta-analysis, and high attrition raises concerns about selection and survivorship bias. To evaluate cognitive impact after CABG, trials need standardized, sensitive assessment strategies resilient to attrition and feasible for broad deployment.

Background The triglyceride-glucose (TyG) index is a simple and reliable marker of insulin resistance and is associated with cardiovascular risk. Epicardial adipose tissue (EAT) volume reflects local visceral fat burden and also correlates with cardiovascular events. While both markers have been studied individually, their combined predictive value for major adverse cardiovascular events (MACE) after coronary artery bypass grafting (CABG) remains unclear. This study evaluated whether TyG index and EAT volume, alone or in combination, can improve risk prediction of MACE following CABG and assessed their potential interaction. Methods We retrospectively analyzed 304 patients who underwent CABG between 2018 and 2022. TyG index and EAT volume were measured preoperatively. Patients were stratified based on optimal cut-off values derived from ROC analysis. Cox regression models were used to estimate associations with MACE. Interaction was assessed using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). Model performance was evaluated using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Model fit was assessed with the Akaike information criterion (AIC), Bayesian information criterion (BIC). Results During follow-up of 44 months, 82 patients experienced MACE. Both TyG index and EAT volume were independently associated with increased risk. Patients with elevations in both markers had a significantly higher risk (adjusted HR = 7.62, 95% CI: 3.27–17.76). A significant additive interaction was observed (RERI = 3.81; AP = 0.50; SI = 2.34). Adding both variables improved model discrimination and fit. Conclusion TyG index and EAT volume are independent predictors of MACE after CABG. Their combined assessment provides additional information for risk stratification, but the findings are preliminary and require validation in larger, prospective, multi-center studies.

Aim To study the quantitative characteristics of cardiomyocyte mitochondrial ultrastructure using electron microscopy data of patients with chronic heart failure (CHF) and to analyze the association of these characteristics with CHF clinical parameters and severity.Material and methods The study analyzed a total of 180 micrographs of right atrial appendage cardiomyocytes from 30 patients with CHF and reduced or mid-range left ventricular ejection fraction (LVEF). Standard laboratory and instrumental tests, including echocardiography, a 6-minute walk test (6MWT), and a cardiorespiratory exercise test, were performed in all patients. Biopsy samples were collected during coronary artery bypass grafting. Electron microscopy was performed with a JEM-1400 transmission electron microscope. The total interfibrillar mitochondrial area (Smtx) was calculated at a magnification of ×5,000. Also, the ratio of the outer membrane length of an individual mitochondrion to the length of its inner membrane at a magnification of ×15,000 was calculated.Results The Smtx positively correlated with the exercise tolerance (r=0.593; p=0.033), peak oxygen consumption during exercise (r=0.395; p=0.012), and the distance covered in the 6MWT (r=0.483; p=0.002). A negative correlation was found between Smtx and the concentration of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) (r= -0.472; p=0.017). The ratio of the outer mitochondrial membrane length to the inner membrane length inversely correlated with LVEF (r= -0.593; p=0.033).Conclusion The total area of cardiomyocyte interfibrillar mitochondria correlated with exercise tolerance, peak oxygen consumption, and NT-proBNP concentration, while the mitochondrial membrane length ratio correlated with left ventricular ejection fraction. This suggests an association between quantitative parameters of mitochondrial ultrastructure and clinical manifestations of CHF.

BACKGROUND: It remains unknown how often, and to which extent, patients with diabetes and non–ST-segment–elevation myocardial infarction are revascularized. This study aimed to identify practice patterns and clinical outcomes in patients with diabetes and non–ST-segment–elevation myocardial infarction according to completeness of revascularization. METHODS: All patients with diabetes and multivessel disease hospitalized for non–ST-segment–elevation myocardial infarction in Ontario, Canada, between April 2009 and March 2020 and undergoing coronary angiography were included. Patients with previous coronary artery bypass grafting (CABG) at any time, percutaneous coronary intervention (PCI) in the previous 90 days, or an ST-segment–elevation myocardial infarction in the previous 90 days were excluded, as were patients with hemodynamic instability at hospital admission. Patients were classified into 4 groups, from the most to the least complete revascularization strategy: CABG, complete revascularization with PCI, incomplete PCI, or no revascularization. The primary outcome was all-cause death at 5 years. Cox regression adjusted for multiple baseline characteristics was used to compare outcomes between groups. RESULTS: We included 14 511 patients (mean age: 68.7±11.5 years; 69.6% males); 4525 (31.2%) were treated with CABG, 3008 (20.7%) with complete PCI, 3624 (25.0%) with incomplete PCI, and 3354 (23.1%) did not receive any revascularization procedure. Adjusted 5-year risks of all-cause death after CABG, complete PCI, incomplete PCI, and no revascularization were progressively increased: 25.9%, 29.8%, 32.2%, and 39.4% respectively. Compared with no revascularization, a 46% reduction in all-cause death was observed after CABG (hazard ratio, 0.54 [95% CI, 0.50–0.58]), 35% after complete PCI (hazard ratio, 0.65 [95% CI, 0.60–0.71]), and 27% after incomplete PCI (hazard ratio, 0.73 [95% CI, 0.68–0.79]), over a median follow-up of 5.8 years (interquartile range, 3.3–8.6). CONCLUSIONS: Almost a quarter of the patients with diabetes and non–ST-segment–elevation myocardial infarction did not receive any revascularization procedure. There was an incremental mortality reduction associated with CABG or complete revascularization with PCI, compared with incomplete revascularization with PCI or no revascularization.

BackgroundDespite timely reperfusion, 7-9% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) experience major adverse cardiac and cerebrovascular events (MACCE) within the index hospitalization.PurposeTo develop and temporally validate machine-learning (ML) models that predict in-hospital MACCE after primary PCI in STEMI admissions using a nationally representative dataset.MethodsWe analyzed the Nationwide Inpatient Sample (2016-2022). After survey weighting, 822 980 STEMI admissions treated with PCI were included. Predictors comprised demographics, socioeconomic factors, hospital characteristics, and 29 Elixhauser comorbidities. MACCE was defined as a composite of in-hospital mortality, ischemic stroke, coronary artery bypass grafting, cardiogenic shock, or cardiac arrest. Five models—Extreme Gradient Boosting (XGBoost), LightGBM, random forest, multilayer perceptron, and logistic regression—were trained on 2016-2021 data and temporally validated on 2022 admissions. Performance metrics included discrimination (area under the receiver operating characteristic curve [AUROC], 95% confidence intervals [CI] via 1,000 bootstraps), calibration (Brier score), pairwise model comparison (bootstrap test, n=1,000), and interpretability analysis (Shapley Additive Explanations values). Sex- and race-stratified AUROCs evaluated fairness. Sex- and race-stratified AUROCs evaluated fairness.ResultsIn-hospital MACCE occurred in 8.8% of admissions. In the 2022 test set, XGBoost achieved the highest discrimination (AUROC 0.846, 95% CI 0.839–0.853; Brier 0.062), outperforming LightGBM (0.842, 95% CI 0.835–0.850), logistic regression (0.840, 95% CI 0.833–0.848; p < 0.001 vs XGBoost), random forest (0.838, 95% CI 0.830–0.846), and multilayer perceptron (0.821, 95% CI 0.812–0.829). Calibration was preserved across models (all Brier ≤ 0.066). AUROC drift was minimal across sex (men 0.847 vs women 0.839) and race (Black 0.848, White 0.847, Hispanic 0.837; largest gap = 0.011) [Figure 1]. SHAP interpretation showed that patients at lowest risk for MACCE typically presented without cardiac arrhythmias, electrolyte abnormalities, or neurological comorbidities.ConclusionAn explainable gradient-boosted model trained on routinely captured admission data provided superior prediction of in-hospital MACCE after primary PCI for STEMI compared with logistic regression and other ML approaches, while maintaining equitable performance across sex and racial groups. These findings need to be validated using prospective data to confirm generalizability and clinical utility.Figure 1

The study's aim was to validate artificial intelligence (AI)-assisted discharge education material for patients undergoing coronary artery bypass graft (CABG) surgery. The discharge training material was prepared with the assistance of the consensus GPT. The material was then subjected to a thorough evaluation by a panel of 12 experts in terms of content validity, readability, comprehensibility, and actionability. The material demonstrated a content validity ratio of 0.88. The readability of the material was evaluated using the Ateşman readability formula, which yielded a score of 76.5, indicating that the material was easy to read. In addition, the readability of the material was assessed using the Bezirci-Yilmaz readability formula, which yielded a score of 18.52, indicating an academic level of readability. The comprehensibility and actionability scores obtained from the Patient Education Materials Assessment Tool for Printable Materials were 73.24 and 69.04, respectively, indicating moderate levels of comprehensibility and actionability. This study presents an innovative approach to addressing the educational needs of patients undergoing CABG surgery regarding discharge. It demonstrates for the first time the strategic role of AI in enhancing efficiency, accessibility, and patient engagement, while also providing a foundation for future research through guidance on integrating AI into discharge education materials.

Off‑pump coronary artery bypass grafting (OPCAB) has undergone significant evolution since its introduction as an alternative to conventional on‑pump CABG. By avoiding cardiopulmonary bypass (CPB) and minimizing aortic manipulation, OPCAB aims to reduce perioperative morbidity, neurological complications, and systemic inflammatory responses. Despite these theoretical advantages, its adoption has varied widely across institutions due to concerns regarding graft patency, completeness of revascularization, and operator dependency. This state‑of‑the‑art review provides a comprehensive SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of OPCAB, integrating evidence from randomized trials, meta‑analyses, and large observational studies. The strengths of OPCAB include reduced stroke risk, lower perioperative morbidity in high‑risk populations, decreased bleeding and transfusion requirements, and compatibility with anaortic total arterial revascularization. Weaknesses include technical complexity, variability in surgeon experience, concerns regarding long‑term graft patency, and inconsistent evidence from randomized trials. Emerging opportunities include the expansion of anaortic no‑touch techniques, integration with minimally invasive and robotic platforms, advances in intraoperative imaging, and the potential for subspecialty training to standardize outcomes. Threats include declining surgeon experience, competition from percutaneous coronary intervention and hybrid revascularization strategies, persistent skepticism regarding patency and completeness of revascularization, and economic or technological barriers to widespread adoption. Through a structured SWOT framework, this review synthesizes contemporary evidence to clarify OPCAB’s current role and future trajectory in coronary surgery. The analysis highlights the importance of surgeon expertise, institutional commitment, and technological integration in optimizing outcomes. OPCAB remains a valuable strategy for selected patients, particularly those at elevated risk for neurological complications or adverse effects of CPB.

Reevaluating Internal Thoracic Artery Use in Octogenarians Undergoing Multivessel Coronary Artery Bypass Grafting.

IntroductionContinuous retrograde cardioplegia worsens surgeon's vision while performing distal anastomosis in coronary artery bypass grafting operations. We investigated whether intermittent retrograde cardioplegia, which provides a bloodless surgical field by interrupting cardioplegia flow during distal anastomosis, poses a disadvantage in terms of myocardial protection.MethodsThis retrospective study was conducted in two different heart centres between January 2013 and July 2023. A total of 234 patients who underwent ≥2 target vessel revascularization under cardiopulmonary bypass were examined. Isothermic, potassium-enriched blood cardioplegia was used and induction was performed antegrade in all patients. In addition to antegrade, we routinely gave retrograde cardioplegia. Retrograde cardioplegia was applied continuously with the force of gravity in the continuous group (n = 167), and intermittently with pressure in the intermittent group (n = 167).ResultsThe volume of cardioplegia solution administered was significantly higher in the intermittent group compared to the continuous group (4070 ± 760mL vs 3190 ± 575mL; p = 0.001). However, no significant differences were observed between the groups regarding postoperative clinical outcomes or early mortality rates.ConclusionsIntermittent retrograde cardioplegia offers superior operative conditions by ensuring a bloodless surgical field and improved procedural comfort, while maintaining equivalent efficacy in myocardial protection compared with the continuous method.

This study investigated the effect of preoperative fat mass index (FMI), fat-free mass index (FFMI), fat mass ratio (FMR), and fat-free mass ratio (FFMR) on postoperative morbidity and mortality in coronary artery bypass grafting (CABG) patients.About 120 patients were included in this prospective study. The patients' FMI, FFMI, FMR, and FFMR were evaluated preoperatively along with other clinically significant data. The postoperative morbidities were recorded. Receiver operating characteristic (ROC) curve analyses were made to determine threshold values of FMR, FFMR, and FMI for wound dehiscence. The multivariate logistic regression analysis was made to assess the independent risk factors for infection site leakage.ROC analysis yielded threshold values of FMR 0.26, FFMR 0.73, and FMI 7.46. FMI, FMR, and FFMR were associated with parameters including body mass index (BMI), diabetes, and wound dehiscence (80.7% sensitivity and 87.3% specificity [area under the curve = 0.600, 95% CI: 0.789-0.919, p < 0.001]). FMR >0.26 and FFMR <0.73 were associated with high pulmonary embolism risk. Patients with FFMI (men: 18.7-21 kg/m2, women: 14.9-17.2 kg/m2) had significantly less postoperative atrial fibrillation and wound dehiscence. Patients with FMR >0.26 and FMI >7.46 are at a 3- to 38-fold increased risk of wound dehiscence, irrespective of their BMI. Fat mass measurements were not associated with mortality.Our study demonstrates that preoperative fat mass measurements can effectively predict postoperative morbidity in CABG patients. Fat mass measurements are valuable for risk prediction, especially in non-obese patients.

Changes in Vascular Cell Adhesion Molecule-1 in Conventional Versus Robotic Bypass Graft Surgery.

Objective To assess the knowledge, attitudes, and practices (KAP) of patients with coronary artery disease (CAD) and their families regarding coronary artery bypass grafting (CABG), multimodal imaging examinations, and postoperative daily management. Methods A cross-sectional study was conducted on patients with CAD and their families between January and April 2025, at TEDA International Cardiovascular Hospital, using a self-designed, validated questionnaire. Results A total of 512 (96.24%) valid responses were obtained. Among the participants, 338 (66.0%) were CAD patients and 174 (34.0%) were family members. A total of 322 (62.9%) participants were male, and 205 (40.0%) had undergone coronary stenting prior to the current hospitalization. The mean scores for knowledge, attitudes, and practices were 6.26 ± 5.34 (range: 0–26), 28.89 ± 4.10 (range: 8–40), and 32.49 ± 6.23 (range: 10–50), respectively. Multivariable analysis revealed that among patients, higher education, retirement/self-employment, higher income, prior MI hospitalization, and longer CAD duration (&amp;gt;3 years) were associated with better knowledge, which correlated with attitude. Among family members, higher income predicted better knowledge. Better practice was associated with attitude in patients and with attitude, knowledge, female sex, absence of hypertension, and prior MI in family members. Conclusion Significant knowledge deficits and suboptimal practices were identified among CAD patients and their families regarding CABG and postoperative management, despite generally positive attitudes. Clinicians and radiologists should prioritize educational programs that address gaps in knowledge and emphasize the interplay between attitudes and practices to enhance postoperative management and long-term outcomes for CAD patients and their families.

Impact of atrial fibrillation status on clinical outcomes in patients admitted with heart failure

Purpose The modified Bentall procedure utilizing the Carbomedics Carbo-Seal Valsalva™ graft can be employed to address aortic root pathologies. In this study, we examined the performance of this conduit specifically for treating isolated annuloaortic ectasia. Our objective was to evaluate the long-term outcomes of these surgeries. Methods A total of 48 consecutive patients with annuloaortic ectasia underwent aortic root replacement using the Carbomedics Carbo-seal Valsalva™ graft between 2012 and 2024. In 7 patients, additional cardiac procedures were performed: two underwent mitral valve annuloplasty, and five had coronary artery bypass grafting. The mean cardiopulmonary bypass time and aortic clamp time during the modified button-Bentall operations were 151 ± 37 min and 128 ± 14 min, respectively. Results The operative mortality rate was 2.1% ( n = 1). Late mortality was 6.3% ( n = 3), with causes including chronic heart failure (2.1%; n = 1), cerebral hemorrhage (2.1%; n = 1), and pulmonary complications (2.1%; n = 1). Major late complications included cerebral hemorrhage (4.2%; n = 2), pulmonary bleeding (2.1%; n = 1), and gastrointestinal hemorrhage (2.1%; n = 1). The Kaplan–Meier estimated survival rates were 96.22% at 5 years and 95.20% at 10 years. Additionally, the Kaplan–Meier curves showed event-free survival rates of 98% at 5 years and 82% at 12 years (95% CI). Conclusions Modified button-Bentall operations for annuloaortic ectasia, with Carbomedics Carbo-Seal Valsalva™ graft, can be performed with a low mid- and long-term mortality and morbidity.