Surgical procedure
The surgical procedures were done using cardiopulmonary bypass (CPB),
and cardioplegic arrest was achieved using a cold crystalloid
cardioplegic solution. Standard median sternotomy, upper mini-sternotomy
through the fourth intercostal space or anterior mini-thoracotomy were
used for the surgical approach. The following mechanical prostheses were
used: St. Jude Regent, St. Jude Masters (Abbott, Chicago, IL), ATS Open
Pivot (Medtronic, Minneapolis, MN), ONX (CryoLife Inc., Kennesaw, GA)
and Carbomedics (LivaNova, London, UK). The biological prostheses used
in the study were as follows: Hancock (Medtronic, Minneapolis, MN),
Epic, Trifecta (Abbott, Chicago, IL), Crown (LivaNova, London, UK), Solo
Smart (LivaNova, London, UK) and sutureless Perceval S valve (LivaNova,
London, UK). The choice of the implant procedure was made according to
the current guidelines and the surgeon’s discretion alongside the fully
informed patient.