Postoperative recurrence of c-ros oncogene 1 ()-rearranged non-small cell lung cancer is rarely reported, and the role of tyrosine kinase inhibitors (TKIs) remains unclear. We retrospectively reviewed four patients with...Postoperative recurrence of c-ros oncogene 1 ()-rearranged non-small cell lung cancer is rarely reported, and the role of tyrosine kinase inhibitors (TKIs) remains unclear. We retrospectively reviewed four patients with completely resected -positive lung adenocarcinoma who developed recurrence, three receiving crizotinib. The median disease-free interval was 33.4 months, and the median overall survival from postoperative recurrence and initial surgery was 40.7 and 71.2 months, respectively. Brain metastases were the most common initial recurrence site (75%). Crizotinib showed limited efficacy with a median progression-free survival of 3.5 months. These findings highlight indolent disease behavior but limited TKI benefit, supporting the need for adjuvant trials.
Heeringa TJP, Hoogewerf M, Hegeman R
… +12 more, Wylick DV, Stecher D, Cramer MJ, De Zan G, Koop Y, Meijer RCA, Zuithoff NPA, Harst PV, Guglielmo M, Vaartjes I, Mokhles MM, van der Kaaij NP
This study evaluated the echocardiographic parameters and complication rates of surgical myectomy with concomitant anterior mitral leaflet extension (SM + AMLE) and isolated SM in hypertrophic obstructive cardiomyopathy...This study evaluated the echocardiographic parameters and complication rates of surgical myectomy with concomitant anterior mitral leaflet extension (SM + AMLE) and isolated SM in hypertrophic obstructive cardiomyopathy (HOCM) patients.All HOCM patients undergoing SM + AMLE (2006-2015) and isolated SM (2015-2020) in our centre were analysed. The primary outcome was left ventricular outflow tract (LVOT)-gradient and surgical reoperation (SM/mitral surgery). Secondary outcomes were aortic cross-clamping (ACC) time, iatrogenic ventricular septal defect (VSD), and mortality at 30-day and 3-year follow-up. Mixed-effects models assessed postoperative changes in LVOT-gradient measurements over time until a 3-year follow-up.This cohort ( = 59) consisted of 34 (58%) SM + AMLE and 25 (42%) isolated SM procedures. There were 32 (54%) males and 27 (46%) females with a mean age of 55 ± 13 years at the time of the intervention. Postoperatively, no differences were observed over time in the median LVOT-gradient ( = 0.34). In the SM + AMLE group, 6% ( = 2) required surgical reoperation (due to patch dehiscence) versus 0% in the SM group. In the SM + AMLE group, the ACC time was significantly higher (86 minutes [interquartile range [IQR]: 74-103]) than in the isolated SM group (48 minutes [IQR: 39-57]; < 001). In both groups, the VSD complication rate was 0%, and neither procedure led to death at 3-year follow-up.HOCM-patients who underwent SM + AMLE had comparable clinical and echocardiographic outcomes to patients who underwent isolated SM. This suggests that increasing procedural complexity may not improve outcomes. However, given potential confounding, this should be interpreted with caution, future prospective randomised controlled trials are necessary.
We describe a technique for concomitant coronary artery bypass grafting (CABG) and mitral valve (MV) replacement or annuloplasty with ring implantation performed through a single left anterior minithoracotomy (LAmT). Fou...We describe a technique for concomitant coronary artery bypass grafting (CABG) and mitral valve (MV) replacement or annuloplasty with ring implantation performed through a single left anterior minithoracotomy (LAmT). Four patients underwent combined MV and CABG surgery using peripheral cardiopulmonary bypass, a transseptal approach to the MV, and complete coronary revascularization. MV exposure was successfully achieved in all cases without conversion to sternotomy. No major complications such as stroke, reoperation for bleeding, or early mortality occurred. Our initial results demonstrate that single LAmT is a feasible sternum-sparing approach for patients requiring simultaneous coronary and mitral procedures.
Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, well-defined but limited datasets of all cardiac and vascular surgery procedures performed in 77 Germa...Based on a voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in 1980, well-defined but limited datasets of all cardiac and vascular surgery procedures performed in 77 German heart surgery departments are reported annually. For the year 2024, a total of 178,547 procedures were submitted to the registry. A total of 103,617 of these operations are defined as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 28,843 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 2.5:1) was 97.8%. A total of 97.2% for the 45,422 isolated heart valve procedures (24,957 transcatheter interventions included) and 99.3% for 20,114 pacemaker/implantable cardioverter defibrillator procedures, respectively. Concerning short- and long-term mechanical circulatory support, a total of 3,168 extracorporeal life support/extracorporeal membrane oxygenation implantations, and 809 ventricular assist device implantations (L-/R-/biventricular assist device, total artificial heart) were reported. In 2024, 348 isolated heart transplantations, 287 isolated lung transplantations, and 2 combined heart-lung transplantations were performed. This annually updated registry of the DGTHG represents nonrisk-adjusted voluntary public reporting encompasses actual data for nearly all heart surgical procedures in Germany, constitutes trends in heart medicine, and represents a basis for quality management (e.g., benchmark) for all participating institutions.
Concomitant cryoablation is routinely performed in patients with atrial fibrillation who undergo minimally invasive atrioventricular (AV) valve surgery. While biomarker thresholds for postoperative myocardial infarction...Concomitant cryoablation is routinely performed in patients with atrial fibrillation who undergo minimally invasive atrioventricular (AV) valve surgery. While biomarker thresholds for postoperative myocardial infarction (pMI) are established in coronary artery bypass surgery, no clear thresholds exist after concomitant cryoablation in endoscopic valve surgery. This study aimed to analyze the perioperative cardiac biomarker release patterns in this patient cohort and to evaluate the applicability of SCAI-defined pMI thresholds.We retrospectively analyzed patients who underwent endoscopic AV valve surgery from 2018 to 2024, comparing those with cryoablation ( = 165; mean age: 66.5 ± 9.5 years) to those without ( = 513; mean age: 62.4 ± 12.0 years). Perioperative creatine kinase-myocardial band (CK-MB) and troponin T (TnT) levels were measured before surgery, at 1 and 4 hours after surgery, and on postoperative day 1 (1POD). In-hospital outcomes were also assessed.Cryoablation significantly increased CK-MB (6.4 × ULN vs. 2.4 × ULN, < 0.001) and TnT (257 × ULN vs. 80 × ULN, < 0.001). Compared with SCAI pMI criteria (CK-MB > 10 × ULN; TnT > 70 × ULN), CK-MB remained below the threshold, while TnT exceeded it in most cases ( < 0.05). Despite these elevations, clinical pMI was rare (two cases vs. three cases). In-hospital mortality did not differ significantly between the groups (1.2% vs. 1.6%; = 1.000).Cryoablation during minimally invasive AV valve surgery markedly increases postoperative cardiac biomarkers without higher clinical pMI rates. Procedure-specific biomarker thresholds and validation of SCAI criteria are essential for accurate diagnosis and patient management.
Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right minithoracotomy offers a less invasive option for the treatment of tricuspid valve insufficiency compared with conventional ster...Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right minithoracotomy offers a less invasive option for the treatment of tricuspid valve insufficiency compared with conventional sternotomy approach.We present our postoperative results regarding the two different surgical approaches.From 2017 to 2021, 180 patients underwent isolated or combined tricuspid valve procedures in our heart center, either through median sternotomy ( = 152, group 1) or via MIC approach ( = 28, group 2). Mean age was 68 ± 11 years in group 1 and 69 ± 11 years in group 2. A propensity matching analysis was performed comparing 21 patients from each group. The majority of the patients in both groups received tricuspid valve repair (90% in unmatched group 1 and 79% in unmatched group 2). Tricuspid valve replacement was performed in 10% of group 1 versus 21% of group 2. The 30-day mortality was higher in matched group 1 patients (14%) in comparison to matched group 2 patients (5%; odds ratio [OR] = 3.00; [0.31, 28.84]; = 0.341). Mean required packed red blood cells was 9.43 ± 11.79 units in group 1, respectively, 3.57 ± 4.75 units in group 2 (OR = 1.12; [0.98, 1.29]; = 0.099). Postoperative echocardiography revealed excellent tricuspid valve function in both matched groups.Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right mini-thoracotomy is a good alternative to sternotomy approach. Our postoperative results demonstrate that MIC approach is safe and feasible.
OBJECTIVE: Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short- and long-term stroke risk. This study evaluated the prognostic...OBJECTIVE: Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short- and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm. MATERIALS AND METHODS: Among 2094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m²) was determined via receiver operating characteristic (ROC) curve and Youden index. Patients were classified as low (≤21.2 mm/m²) or high (>21.2 mm/m²) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4±20.0 months using Cox proportional hazards modeling. RESULTS: Thirty patients (7.7%) experienced a CVE, including 8 in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared to the low LADI group (19.8% vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank p<0.001). CONCLUSION: In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.
Modern cardiovascular medicine and surgery enable the treatment of complex cardiovascular disease, even in elderly and multimorbid patients, through increasingly sophisticated procedures. Nevertheless, there are situatio...Modern cardiovascular medicine and surgery enable the treatment of complex cardiovascular disease, even in elderly and multimorbid patients, through increasingly sophisticated procedures. Nevertheless, there are situations in which surgical intervention appears medically inappropriate or is explicitly declined by the patient. Similarly, it may become necessary in the postoperative course to revise the original therapeutic goals-particularly when continued survival depends upon prolonged intensive care unit treatment, or when the anticipated quality of life, from the patient's perspective, appears inadequate. While established guidelines and position papers-most notably from the German Interdisciplinary Association for Intensive and Emergency Medicine-are already available in the field of intensive care medicine, a discipline-specific framework for cardiac surgery has been lacking thus far. This inaugural position paper issued by the German Society for Thoracic and Cardiovascular Surgery seeks to contribute to the definition of clinical and ethical standards in the context of therapeutic restraint (Section A) and to the redefinition of therapeutic goals (Section B) within our specialty. The aim is to promote a structured and multiprofessional approach that transparently integrates the core pillars of goal setting in therapy-namely, medical indication and patient autonomy-into a comprehensible decision-making framework. Achieving this objective requires close collaboration among physicians and nursing staff in cardiac surgery, cardiology, intensive care, anesthesiology, ethics consultation, and palliative care. The present recommendations are intended to serve as a foundation for patient-centered, appropriate, and transparent decision-making-always with the overarching aim of preserving the dignity and self-determination of the patients concerned.
The frozen elephant trunk (FET) and Ascyrus Medical Dissection Stent (AMDS) are hybrid techniques used in managing acute type A aortic dissection (ATAAD). This systematic review and meta-analysis compared their periopera...The frozen elephant trunk (FET) and Ascyrus Medical Dissection Stent (AMDS) are hybrid techniques used in managing acute type A aortic dissection (ATAAD). This systematic review and meta-analysis compared their perioperative outcomes, aortic remodeling, and incidence of distal anastomotic new entry (DANE).A comprehensive search yielded 611 studies; after screening, 68 were included-59 on FET and 9 on AMDS-covering 7,420 patients (7,070 FET; 350 AMDS). The primary outcome was DANE incidence. Secondary outcomes included operative time, false lumen thrombosis, ICU/hospital stay, and 30-day/in-hospital mortality.DANE incidence was 7% in both groups. FET was associated with shorter operative times (353-369 vs. 422 minutes), higher false lumen thrombosis rates (88-89% vs. 84%), and longer hospital stays (17-19 vs. 9-11 days). AMDS had longer ICU stays (7.7-8.5 vs. 5.3-7.5 days). Mortality rates were similar (FET: 8-9%; AMDS: 7-10%). Critically, neurological complication rates were substantially higher with AMDS (33% [15-53%]) compared with FET (13% [10-16%]). However, the evidence base for AMDS remains limited (9 studies) compared with FET (59 studies). Egger's test showed publication bias in FET studies for DANE and length of stay outcomes; bias assessment for AMDS was limited by study number.Limited available evidence suggests that FET and AMDS show similar DANE and mortality outcomes. FET may favor better remodeling and a safer neurological profile, but longer hospitalization, though high heterogeneity and limited AMDS data underscore the need for robust comparative trials.
Fodop SGJ, Femi-Lawal VO, Anyinkeng AB
… +11 more, Akumbom AH, Chukwuebuka A, Majani E, Phiri EC, Mohamed A, Emhemed MS, Demilade AF, Paile K, Lawal SA, Heiden MV, Pingpoh C
Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide, with Sub-Saharan Africa (SSA) facing a severe shortage of cardiac surgeons (0.12 per million people) and limited access to cardi...Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide, with Sub-Saharan Africa (SSA) facing a severe shortage of cardiac surgeons (0.12 per million people) and limited access to cardiac surgical care. This study explores the career aspirations of African medical students and examines the factors influencing their interest in pursuing various career paths and cardiac surgery in particular.A cross-sectional study was conducted among 807 medical students from various African medical schools. Data were collected using a validated online questionnaire available in English, French, and Arabic. Sociodemographic characteristics, career aspirations, specialty preferences, and factors influencing career choices were analyzed using descriptive and bivariate statistical methods.The mean age of participants was 22.79 ± 2.99 years, with a nearly equal gender distribution (51.2% male, 48.8% female). Surgery was the most preferred specialty (34.3%), cardiac surgery was chosen by 11.8% of participants, and 0.5% chose cardiothoracic surgery. The inclusion of cardiac surgery in the curriculum ( = 0.046) and exposure to cardiac patients ( = 0.034) positively influenced career interest. However, the presence of functional cardiac surgery units in teaching hospitals was negatively associated with pursuing the specialty ( = 0.032). Additionally, hospital-based exposure to cardiac surgery significantly reduced interest in cardiac surgery ( < 0.001) as specialty choice. A majority (71.4%) intended to pursue postgraduate studies abroad, citing limited local opportunities.The level of interest in cardiac surgery among African medical students highlights the need for targeted interventions, including curriculum reforms, improved training environments, and structured mentorship programs to translate this interest into cardiac surgical workforce. Strengthening local postgraduate training capacity and addressing systemic barriers are crucial steps in building a sustainable cardiac surgery workforce in Africa, ultimately helping to reduce the burden of cardiovascular diseases across the continent.
This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in poststernotomy mediastinitis (PSM) patients.A single-center retrospective case-control study in 198 cardiac sur...This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in poststernotomy mediastinitis (PSM) patients.A single-center retrospective case-control study in 198 cardiac surgery patients with PSM and consecutive NPWT were retrospectively divided into two groups. Group I consisted of patients whose NPWT was successful ( = 117/198; 59.1%), while in Group II treatment, failure occurred ( = 81/198; 40.9%). The primary endpoint was treatment failure, defined as recurrence of wound infection requiring surgical treatment within 30 days after secondary wound closure.Body mass index (BMI) >30 kg/m ( = 0.04; odds ratio [OR] 1.07), diabetes mellitus (DM; = 0.03; OR 1.94), and the number of sponge changes ( = 0.01; OR 1.57) showed an association with the occurrence of NPWT failure. During the study period, 10/198 (19.8%) patients died after secondary wound healing. In group I, 1/117 (0.9%) patient died versus group II with 9/81 (12.7%) patients. About 70% patients died from septic multiple organ failure.This study confirms that variables associated with treatment failure after NPWT in PSM are BMI >30 kg/m, diabetes mellitus (DM), and the "number of sponge changes," respectively. However, this does not mean that sponge changes increase the risk; rather, sponge changes are associated with more resistant germs, incomplete wound healing, and more aggressive infection. This implies that management should be in the hands of cardiac surgeons with extensive experience in septic surgery and at centers with expertise in order to minimize the duration of NPWT and thus the number of sponge changes.
The 2017 and 2021 ESC/EACTS guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as a treatment option for severe symptomatic aortic valve stenosis (AS) in pati...The 2017 and 2021 ESC/EACTS guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as a treatment option for severe symptomatic aortic valve stenosis (AS) in patients ≥75 years of age. However, surgical aortic valve replacement (SAVR) remains a viable option for elderly patients, particularly in specific anatomical or clinical subsets. The objective of this study was to analyze indications for SAVR and postoperative outcomes in patients ≥75 years of age.Heart team protocols were reviewed to determine indications for SAVR. The adjudication of acute procedural and early clinical outcomes was conducted in accordance with the standardized VARC-3 definitions. Furthermore, cardiovascular mortality and rate of aortic valve re-intervention were assessed at latest follow-up with a median duration of 5.5 years (1.9-7.1 years).A total of 43 patients ≥75 years of age (51% male) underwent isolated SAVR at our center between 2017 and 2022. STS/EuroSCORE II was 1.7 ± 0.6%/1.7 ± 0.4%. The age distribution of patients was as follows: 75 to 76 years in 32.5% (14/43), 77 to 79 years in 46.5% (20/43), and 80 to 83 years in 21% (9/43) of patients. Indications for SAVR included low operative risk according to STS (1.6 ± 0.3%) and EuroSCORE II (1.4 ± 0.3%) in 51.2% (22/43), unicuspid/bicuspid aortic valve in 21% (9/43), patient preference in 13.9% (6/43), large aortic annulus in 9.3% (4/43), and massive calcification of the left ventricular outflow tract in 4.6% (2/43) of patients. Mean aortic cross clamp and cardiopulmonary bypass times were 67.1 ± 18.2 minutes and 98.6 ± 25.1 minutes. All-cause 30-day mortality was 0% (0/43). Technical success, device success, and early safety were 100% (43/43), 100% (43/43), and 81.4% (35/43). Bleeding complications and the need for permanent pacemaker implantation (PPM) were observed in 9.3% (4/43) and 4.6% (2/43) of patients. Mean ICU and hospital stay were 2.9 ± 2.1 days and 12.5 ± 3.6 days. Post-procedural echocardiography demonstrated absence of paravalvular leakage (PVL) in all but one patient, who exhibited moderate PVL. The mean transvalvular pressure gradient was 11.4 ± 4.5 mmHg. Latest follow-up was at median 5.5 years (1.9-7.1 years). Aortic valve re-intervention at follow-up was 2.3% (1/43) and cardiovascular mortality was 4.6% (2/43).In the current era, SAVR is rarely performed in patients ≥75 years of age. Despite the highly selective nature of the patient cohort studied, the results are excellent, with a 30-day mortality of 0% and a low cardiovascular mortality at 5 years. SAVR should still be considered a valid option in elderly patients, evaluated by a heart team, which considers each patient's unique clinical, anatomic, and procedural characteristics.
Prognostic heterogeneity may exist among T3 nonsmall cell lung cancers depending on specific T3 descriptors. Our study aimed to evaluate the survival differences among T3 subgroups in patients with resected lung cancer.T...Prognostic heterogeneity may exist among T3 nonsmall cell lung cancers depending on specific T3 descriptors. Our study aimed to evaluate the survival differences among T3 subgroups in patients with resected lung cancer.This retrospective cohort study included 381 patients with pathologically confirmed (p)T3N0/1 nonsmall cell lung cancer. Patients with mediastinal lymph node metastases or superior sulcus tumors were excluded. Patients were classified into three subgroups; the T3-ordinary group (only tumor diameter >5 cm but ≤7 cm, or only an additional tumor nodule in the same lobe as the primary tumor, = 246), the T3-invasion group (the primary tumor directly invades any of the structures; only the phernic nerve, pericardium, parietal pleura or the chest wall, = 57), and the T3-multiple group (the tumor had at least two T3 descriptors, = 78).The 5-year overall survival rate was 52% (median survival time: 63 months; 95% CI: 53-72 months). A significant difference was observed between the three groups in terms of median survival time (T3-ordinary, 70 months; T3-invasion, 58 months; T3-multiple, 43 months; chi-square = 5.86, = 0.04-log rank). Moreover, the 5-year survival rate was significantly higher in the T3 single group than in the T3 multiple group (54.5% vs. 40.4%, = 0.03). Multivariate analysis showed that lymph node status ( = 0.007), adjuvant treatment ( < 0.001), major surgical complications ( < 0.001), and T3-subgroups ( = 0.02) were independent prognostic factors.Patients with two or more pT3 descriptors or tumors exhibiting invasion have the worst survival rates. Stage migration can be discussed in these patients.
Varela Barca L, De Antonio Antón N, Auquilla Luzuriaga H
… +5 more, Gomez Alonso E, Roldan Martinez M, Monguió Santín E, Alfonso Manterola F, Reyes Copa G
Postoperative atrial fibrillation (POAF) is a frequent entity after cardiac surgery. However, its potential relationship with adverse outcomes and permanent arrhythmias remains uncertain. We sought to assess the relation...Postoperative atrial fibrillation (POAF) is a frequent entity after cardiac surgery. However, its potential relationship with adverse outcomes and permanent arrhythmias remains uncertain. We sought to assess the relationship between the occurrence of atrial fibrillation (AF) in the postoperative period and its long-term recurrence.Patients who underwent aortic valve replacement (AVR) with a biological prosthesis between 2005 and 2023 were analyzed at our center. The incidence of atrial fibrillation in the postoperative period and the factors associated with its occurrence, as well as its long-term recurrence and related risk factors, were analyzed.The incidence of POAF was 22%. Postoperative renal insufficiency ( < 0.001) and chronic obstructive pulmonary disease (COPD) ( = 0.047) were identified as risk factors. During long-term clinical follow-up (mean 6.5 ± 4.5 years), 20.4% of patients without any previous arrhythmia episodes developed AF, whereas the incidence was 40.4% in those with atrial fibrillation in the postoperative period (Hazard Ratio [HR] = 2.18 [1.33-3.56]; = 0.002). AF during follow-up was independently associated with age (HR = 1.05), COPD (HR = 3.22), and POAF (HR = 1.9). In addition, there was an apparent association between permanent AF during follow-up and long-term mortality, which approached statistical significance (HR = 1.4 [95% CI: 0.9-1.8]; = 0.06).POAF is a frequent complication following AVR and is significantly associated with an increased risk of developing permanent AF during long-term follow-up. Multivariate analysis identified renal insufficiency and COPD as independent predictors of POAF, while age and COPD were independently associated with long-term AF. Additionally, there was a trend toward an association between permanent AF and increased long-term mortality.
Different techniques allow implantation of biological aortic valve prostheses larger than associated with classic annulus sizing. We described a replica-based technique (upsizing) before that utilizes the patient's root...Different techniques allow implantation of biological aortic valve prostheses larger than associated with classic annulus sizing. We described a replica-based technique (upsizing) before that utilizes the patient's root anatomy. We here evaluate the safety and efficacy of upsizing compared with standard sizing using the Epic Supra bioprosthesis.We assessed 958 patients undergoing aortic valve replacement with the Epic Supra bioprosthesis between 2010 and 2023. Upsizing was defined as implantation of a prosthesis larger than the measured annular size without enlarging the annulus. We assessed hemodynamic and standard outcome parameters. Mean follow-up was 44.5 ± 31.2 months. Propensity score matching was used to adjust for baseline differences.Patient anatomy allowed upsizing in 62% of patients. Demographics and outcomes (perioperative mortality, reoperation, bleeding, and pacemaker implantation) were comparable between the matched groups. Immediate postoperative and long-term pressure gradients were consistently and significantly lower in the upsizing groups across all annular sizes (upsizing vs. control: 23 mm; 12.9 ± 8.2 vs. 14.0 ± 5.6 mm Hg, = 0.029; 25 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, < 0.001; 27 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, < 0.001). Differences persisted at long-term follow-up but were less pronounced for the 25-mm annular size and greatest in the 27-mm group (8.5 ± 4.5 vs. 12.5 ± 5.5 mm Hg; < 0.001). Long-term survival was numerically higher in the upsizing groups with statistical significance in annular size 25 mm.Implanting a larger Epic Supra prosthesis than classically recommended ("upsizing") is safe and associated with improved immediate- and long-term hemodynamics without increasing pacemaker, perioperative, or long-term mortality risks.