Changes in the Eyelids and Conjunctiva Caused by Ultraviolet Radiation

The aim of this study was to show the frequency, sex and age distribution of eyelids skin tumor changes and degenerative changes of the conjunctiva for the period of three years (2011–2013) at the Department of Ophthalmology in Split. We analyzed the eyelids skin lesions in biopsy material at the Department of Pathology and the same were compared with the profession of the patients. In this period there were found 131 tumor changes of the eyelids. The most common tumor was the basal cell carcinoma (118) with the higher frequency in women. There were 10 squamous cell carcinomas with the equal representation among sexes and three melanomas. There were 79 female and 52 male patients. There were 299 pterygiums operated with the higher frequency in women (68.2%). Exposure to UV radiation, particulary UVB radiation is the most common causative factor for genetic abnormalities in cells and provoked factor in oncogenesis of skin tumors. In our research we found a correlation between changes in the eyelids and conjunctiva caused by UV radiation with the professional interest of the respondents. Due to high incidence of eyelids skin tumor changes in the population professionally exposed to UV radiation, medical professionals should be aware of the importance of the public education on the etiology of these tumors and the importance of the UV protection

Changes in the Eyelids and Conjunctiva Caused by Ultraviolet Radiation

The aim of this study was to show the frequency, sex and age distribution of eyelids skin tumor changes and degenerative changes of the conjunctiva for the period of three years (2011–2013) at the Department of Ophthalmology in Split. We analyzed the eyelids skin lesions in biopsy material at the Department of Pathology and the same were compared with the profession of the patients. In this period there were found 131 tumor changes of the eyelids. The most common tumor was the basal cell carcinoma (118) with the higher frequency in women. There were 10 squamous cell carcinomas with the equal representation among sexes and three melanomas. There were 79 female and 52 male patients. There were 299 pterygiums operated with the higher frequency in women (68.2%). Exposure to UV radiation, particulary UVB radiation is the most common causative factor for genetic abnormalities in cells and provoked factor in oncogenesis of skin tumors. In our research we found a correlation between changes in the eyelids and conjunctiva caused by UV radiation with the professional interest of the respondents. Due to high incidence of eyelids skin tumor changes in the population professionally exposed to UV radiation, medical professionals should be aware of the importance of the public education on the etiology of these tumors and the importance of the UV protection

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Influence of different ratios of n6/n3 polyunsaturated fatty acids in food on cardiac diabetic neuropathy and connexin 37 and 43 expression in rat heart muscle

Promatrali smo utjecaj eksperimentalno induciranog diabetes mellitus-a tipa 1 (DM1), u kombinaciji sa različitim omjerima n6/n3 višestruko nezasićenih masnih kiselina (PUFA, engl. polyunsaturated fatty acids) na različite tipove živčanih vlakana u srčanom mišiću štakora, kako bi otkrili da li bi protektivni/nepovoljni učinci koje različite PUFA imaju na funkciju miokarda u dijabetičnih pacijenata mogle biti (barem djelomično) posljedica njihovog utjecaja na promjene srčane inervacije, kao i izražaja najčešćih tipova koneksina, budući da je dokazan (iako nedovoljno istražen) utjecaj istih na inervaciju u drugim organima. Kontrolna skupina i dijabetična skupina su hranjene hranom s n6/n3 PUFA omjerom oko 7; hrana stz + n6 skupine je imala omjer n6/n3 60, dok je hrana stz + DHA skupine sadržavala 2,5% ribljeg ulja (koje sadrži 16% eikozapentaenoične kiseline – EPA i 19% dokozaheksaenoične kiseline – DHA), n6/n3 omjer bio 1. DM1 je induciran intraperitonealnom injekcijom streptozotocina (55 mg/kg) 14 dana nakon početka prehrane eksperimentalnom dijetom, a štakori su eutanizirani 30 dana nakon indukcije DM1. Korištena je imunohistokemija za detekciju i kvantifikaciju različitih tipova živčanih vlakana srčanog septuma i izražaj Cx 43 i Cx 37. Pronašli smo razlike u srčanoj inervaciji karakteristične za početnu fazu eksperimentalnog DM1, koja se manifestirala kao povećanje ukupnog broja i gustoće površine svih živčanih vlakana u subendokardijalnim područjima srčanog septuma, mjerenih putem PgP 9.5 imunoreaktivnosti. Detaljnom analizom, pronašli smo da je ovaj porast sastoji većinom od teških mijeliniziranih NF 200 imunoreaktivnih vlakana i TH imunoreaktivnih simpatičkih vlakana, dok se gustoća Chat imunoreaktivnih parasimpatičkih vlakana smanjila. U intramuralnom miokarda, gdje su pronađena rijetka vlakna (svih istraživanih tipova), značajne razlike nije bilo. Iznenađujuće, pronašli smo konzistentniji protektivni učinak n6 PUFA, u usporedbi s prehranom s n3 PUFAma. Suprotno rasporedu živčanih vlakana, u intramuralnom dijelu septuma također je nađen izražaj oba istraživana koneksina. Pokusni DM1 sam po sebi nije doveo do promjene izražaja Cx 43, ali je u kombinaciji sa suplementacijom s n3 PUFA-ma rezultirao porastom izražaja u intramuralnom i subendokardijalnim dijelovima srčanog septuma okrenutim lijevoj klijetci, dok je suplementacija s n6 PUFA-ma rezultira njihovim porastom samo u intramuralnom dijelu septuma. Pokusni DM1 sam po sebi dovodeo je do porasta izražaja Cx 37 u intramuralnom dijelu srčanog septuma štakora. Ova promjena još je naglašenija kod suplementacije n3 PUFA-ma. Subendokardijalno dolazi do promjena samo s lijeve strane septuma, gdje je DM1 u kombinaciji sa suplementacijom s n3 PUFA-ma dovoeo do porasta izražaja Cx37. Ovi rezultati pridonose boljem razumijevanju potencijalnog utjecaja različitih PUFA omjera u prehrani dijabetičnih pacijenata na srčanu inervaciju i genezu i rezultat dijabetičke autonomne kardiomiopatije.We investigated the effect of experimentally induced diabetes mellitus type 1 (DM1) in combination with different ratios of dietary n6/n3 polyunsaturated fatty acids (PUFA) on different types of nerve fibers in rat cardiac muscle to determine, whether the protective/unfavorable effects of different PUFAs on myocardial function in diabetics could be a (at least partial) backlash of their effect on the changes in cardiac innervation as well as on the expression of the most abundant connexin types (Cx), since their influence on the innervation of other organs has been demonstrated. The control (c) and diabetic (stz) groups were fed an n6/n3 ratio of 7. The diet of the stz+n6 group had an n6/n3 ratio of 60, whereas the diet of the stz+ DHA group contained 2.5% fish oil (containing 16% eicosapentaenoic acid - EPA and 19% docosahexaenoic acid - DHA) and an n6/n3 ratio of 1. DM1 was induced by i.p. Injection of streptozotocin (55 mg/kg), and rats were euthanized 30 days after induction. Immunohistochemistry was used to detect and quantify various types of neuronal fibers as well as Cx37 and Cx43 in the cardiac septum. In the initial phase of experimental DM1, we found changes in the characteristics of cardiac innervation manifested by an increase in the total number and areal density of all neuronal fibers as measured by PgP 9.5 immunoreactivity. On detailed analysis, we found that this increase consisted mainly of heavy myelinated NF200 immunoreactive fibers and TH immunoreactive sympathetic fibers, whereas the density of ChAT immunoreactive parasympathetic fibers decreased. No significant differences were found in the deep (middle) part of the myocardium, where rare fibers (of all types studied) were found. Surprisingly, we found a more consistent protective effect of n6-PUFAs compared with supplementation with n3-PUFAs. In contrast to the nerve fiber arrangement, expression of the two connexins studied was also found in the intramural part of the septum. Experimental DM1 alone did not alter the expression of Cx 43, but in combination with supplementation with n3- PUFAs, it led to an increase in expression in the intramural and subendocardial parts of the cardiac septum facing the left ventricle, whereas supplementation with n6-PUFAs led to an increase only in the intramural part of the septum. Experimental DM1 alone resulted in an increase in the expression of Cx 37 in the intramural part of the rat cardiac septum. This change is even more pronounced when supplemented with n3 PUFAs. Subendocardial changes occur only on the left side of the septum, where DM1 combined with supplementation with n3-PUFAs led to an increase in Cx37 expression. These results may contribute to a better understanding of the potential effects of different PUFA ratios in the diet of diabetic patients on cardiac innervation and the development and progression of diabetic autonomic cardiomyopathy

Influence of different ratios of n6/n3 polyunsaturated fatty acids in food on cardiac diabetic neuropathy and connexin 37 and 43 expression in rat heart muscle

Promatrali smo utjecaj eksperimentalno induciranog diabetes mellitus-a tipa 1 (DM1), u kombinaciji sa različitim omjerima n6/n3 višestruko nezasićenih masnih kiselina (PUFA, engl. polyunsaturated fatty acids) na različite tipove živčanih vlakana u srčanom mišiću štakora, kako bi otkrili da li bi protektivni/nepovoljni učinci koje različite PUFA imaju na funkciju miokarda u dijabetičnih pacijenata mogle biti (barem djelomično) posljedica njihovog utjecaja na promjene srčane inervacije, kao i izražaja najčešćih tipova koneksina, budući da je dokazan (iako nedovoljno istražen) utjecaj istih na inervaciju u drugim organima. Kontrolna skupina i dijabetična skupina su hranjene hranom s n6/n3 PUFA omjerom oko 7; hrana stz + n6 skupine je imala omjer n6/n3 60, dok je hrana stz + DHA skupine sadržavala 2,5% ribljeg ulja (koje sadrži 16% eikozapentaenoične kiseline – EPA i 19% dokozaheksaenoične kiseline – DHA), n6/n3 omjer bio 1. DM1 je induciran intraperitonealnom injekcijom streptozotocina (55 mg/kg) 14 dana nakon početka prehrane eksperimentalnom dijetom, a štakori su eutanizirani 30 dana nakon indukcije DM1. Korištena je imunohistokemija za detekciju i kvantifikaciju različitih tipova živčanih vlakana srčanog septuma i izražaj Cx 43 i Cx 37. Pronašli smo razlike u srčanoj inervaciji karakteristične za početnu fazu eksperimentalnog DM1, koja se manifestirala kao povećanje ukupnog broja i gustoće površine svih živčanih vlakana u subendokardijalnim područjima srčanog septuma, mjerenih putem PgP 9.5 imunoreaktivnosti. Detaljnom analizom, pronašli smo da je ovaj porast sastoji većinom od teških mijeliniziranih NF 200 imunoreaktivnih vlakana i TH imunoreaktivnih simpatičkih vlakana, dok se gustoća Chat imunoreaktivnih parasimpatičkih vlakana smanjila. U intramuralnom miokarda, gdje su pronađena rijetka vlakna (svih istraživanih tipova), značajne razlike nije bilo. Iznenađujuće, pronašli smo konzistentniji protektivni učinak n6 PUFA, u usporedbi s prehranom s n3 PUFAma. Suprotno rasporedu živčanih vlakana, u intramuralnom dijelu septuma također je nađen izražaj oba istraživana koneksina. Pokusni DM1 sam po sebi nije doveo do promjene izražaja Cx 43, ali je u kombinaciji sa suplementacijom s n3 PUFA-ma rezultirao porastom izražaja u intramuralnom i subendokardijalnim dijelovima srčanog septuma okrenutim lijevoj klijetci, dok je suplementacija s n6 PUFA-ma rezultira njihovim porastom samo u intramuralnom dijelu septuma. Pokusni DM1 sam po sebi dovodeo je do porasta izražaja Cx 37 u intramuralnom dijelu srčanog septuma štakora. Ova promjena još je naglašenija kod suplementacije n3 PUFA-ma. Subendokardijalno dolazi do promjena samo s lijeve strane septuma, gdje je DM1 u kombinaciji sa suplementacijom s n3 PUFA-ma dovoeo do porasta izražaja Cx37. Ovi rezultati pridonose boljem razumijevanju potencijalnog utjecaja različitih PUFA omjera u prehrani dijabetičnih pacijenata na srčanu inervaciju i genezu i rezultat dijabetičke autonomne kardiomiopatije.We investigated the effect of experimentally induced diabetes mellitus type 1 (DM1) in combination with different ratios of dietary n6/n3 polyunsaturated fatty acids (PUFA) on different types of nerve fibers in rat cardiac muscle to determine, whether the protective/unfavorable effects of different PUFAs on myocardial function in diabetics could be a (at least partial) backlash of their effect on the changes in cardiac innervation as well as on the expression of the most abundant connexin types (Cx), since their influence on the innervation of other organs has been demonstrated. The control (c) and diabetic (stz) groups were fed an n6/n3 ratio of 7. The diet of the stz+n6 group had an n6/n3 ratio of 60, whereas the diet of the stz+ DHA group contained 2.5% fish oil (containing 16% eicosapentaenoic acid - EPA and 19% docosahexaenoic acid - DHA) and an n6/n3 ratio of 1. DM1 was induced by i.p. Injection of streptozotocin (55 mg/kg), and rats were euthanized 30 days after induction. Immunohistochemistry was used to detect and quantify various types of neuronal fibers as well as Cx37 and Cx43 in the cardiac septum. In the initial phase of experimental DM1, we found changes in the characteristics of cardiac innervation manifested by an increase in the total number and areal density of all neuronal fibers as measured by PgP 9.5 immunoreactivity. On detailed analysis, we found that this increase consisted mainly of heavy myelinated NF200 immunoreactive fibers and TH immunoreactive sympathetic fibers, whereas the density of ChAT immunoreactive parasympathetic fibers decreased. No significant differences were found in the deep (middle) part of the myocardium, where rare fibers (of all types studied) were found. Surprisingly, we found a more consistent protective effect of n6-PUFAs compared with supplementation with n3-PUFAs. In contrast to the nerve fiber arrangement, expression of the two connexins studied was also found in the intramural part of the septum. Experimental DM1 alone did not alter the expression of Cx 43, but in combination with supplementation with n3- PUFAs, it led to an increase in expression in the intramural and subendocardial parts of the cardiac septum facing the left ventricle, whereas supplementation with n6-PUFAs led to an increase only in the intramural part of the septum. Experimental DM1 alone resulted in an increase in the expression of Cx 37 in the intramural part of the rat cardiac septum. This change is even more pronounced when supplemented with n3 PUFAs. Subendocardial changes occur only on the left side of the septum, where DM1 combined with supplementation with n3-PUFAs led to an increase in Cx37 expression. These results may contribute to a better understanding of the potential effects of different PUFA ratios in the diet of diabetic patients on cardiac innervation and the development and progression of diabetic autonomic cardiomyopathy

Influence of different ratios of n6/n3 polyunsaturated fatty acids in food on cardiac diabetic neuropathy and connexin 37 and 43 expression in rat heart muscle

Promatrali smo utjecaj eksperimentalno induciranog diabetes mellitus-a tipa 1 (DM1), u kombinaciji sa različitim omjerima n6/n3 višestruko nezasićenih masnih kiselina (PUFA, engl. polyunsaturated fatty acids) na različite tipove živčanih vlakana u srčanom mišiću štakora, kako bi otkrili da li bi protektivni/nepovoljni učinci koje različite PUFA imaju na funkciju miokarda u dijabetičnih pacijenata mogle biti (barem djelomično) posljedica njihovog utjecaja na promjene srčane inervacije, kao i izražaja najčešćih tipova koneksina, budući da je dokazan (iako nedovoljno istražen) utjecaj istih na inervaciju u drugim organima. Kontrolna skupina i dijabetična skupina su hranjene hranom s n6/n3 PUFA omjerom oko 7; hrana stz + n6 skupine je imala omjer n6/n3 60, dok je hrana stz + DHA skupine sadržavala 2,5% ribljeg ulja (koje sadrži 16% eikozapentaenoične kiseline – EPA i 19% dokozaheksaenoične kiseline – DHA), n6/n3 omjer bio 1. DM1 je induciran intraperitonealnom injekcijom streptozotocina (55 mg/kg) 14 dana nakon početka prehrane eksperimentalnom dijetom, a štakori su eutanizirani 30 dana nakon indukcije DM1. Korištena je imunohistokemija za detekciju i kvantifikaciju različitih tipova živčanih vlakana srčanog septuma i izražaj Cx 43 i Cx 37. Pronašli smo razlike u srčanoj inervaciji karakteristične za početnu fazu eksperimentalnog DM1, koja se manifestirala kao povećanje ukupnog broja i gustoće površine svih živčanih vlakana u subendokardijalnim područjima srčanog septuma, mjerenih putem PgP 9.5 imunoreaktivnosti. Detaljnom analizom, pronašli smo da je ovaj porast sastoji većinom od teških mijeliniziranih NF 200 imunoreaktivnih vlakana i TH imunoreaktivnih simpatičkih vlakana, dok se gustoća Chat imunoreaktivnih parasimpatičkih vlakana smanjila. U intramuralnom miokarda, gdje su pronađena rijetka vlakna (svih istraživanih tipova), značajne razlike nije bilo. Iznenađujuće, pronašli smo konzistentniji protektivni učinak n6 PUFA, u usporedbi s prehranom s n3 PUFAma. Suprotno rasporedu živčanih vlakana, u intramuralnom dijelu septuma također je nađen izražaj oba istraživana koneksina. Pokusni DM1 sam po sebi nije doveo do promjene izražaja Cx 43, ali je u kombinaciji sa suplementacijom s n3 PUFA-ma rezultirao porastom izražaja u intramuralnom i subendokardijalnim dijelovima srčanog septuma okrenutim lijevoj klijetci, dok je suplementacija s n6 PUFA-ma rezultira njihovim porastom samo u intramuralnom dijelu septuma. Pokusni DM1 sam po sebi dovodeo je do porasta izražaja Cx 37 u intramuralnom dijelu srčanog septuma štakora. Ova promjena još je naglašenija kod suplementacije n3 PUFA-ma. Subendokardijalno dolazi do promjena samo s lijeve strane septuma, gdje je DM1 u kombinaciji sa suplementacijom s n3 PUFA-ma dovoeo do porasta izražaja Cx37. Ovi rezultati pridonose boljem razumijevanju potencijalnog utjecaja različitih PUFA omjera u prehrani dijabetičnih pacijenata na srčanu inervaciju i genezu i rezultat dijabetičke autonomne kardiomiopatije.We investigated the effect of experimentally induced diabetes mellitus type 1 (DM1) in combination with different ratios of dietary n6/n3 polyunsaturated fatty acids (PUFA) on different types of nerve fibers in rat cardiac muscle to determine, whether the protective/unfavorable effects of different PUFAs on myocardial function in diabetics could be a (at least partial) backlash of their effect on the changes in cardiac innervation as well as on the expression of the most abundant connexin types (Cx), since their influence on the innervation of other organs has been demonstrated. The control (c) and diabetic (stz) groups were fed an n6/n3 ratio of 7. The diet of the stz+n6 group had an n6/n3 ratio of 60, whereas the diet of the stz+ DHA group contained 2.5% fish oil (containing 16% eicosapentaenoic acid - EPA and 19% docosahexaenoic acid - DHA) and an n6/n3 ratio of 1. DM1 was induced by i.p. Injection of streptozotocin (55 mg/kg), and rats were euthanized 30 days after induction. Immunohistochemistry was used to detect and quantify various types of neuronal fibers as well as Cx37 and Cx43 in the cardiac septum. In the initial phase of experimental DM1, we found changes in the characteristics of cardiac innervation manifested by an increase in the total number and areal density of all neuronal fibers as measured by PgP 9.5 immunoreactivity. On detailed analysis, we found that this increase consisted mainly of heavy myelinated NF200 immunoreactive fibers and TH immunoreactive sympathetic fibers, whereas the density of ChAT immunoreactive parasympathetic fibers decreased. No significant differences were found in the deep (middle) part of the myocardium, where rare fibers (of all types studied) were found. Surprisingly, we found a more consistent protective effect of n6-PUFAs compared with supplementation with n3-PUFAs. In contrast to the nerve fiber arrangement, expression of the two connexins studied was also found in the intramural part of the septum. Experimental DM1 alone did not alter the expression of Cx 43, but in combination with supplementation with n3- PUFAs, it led to an increase in expression in the intramural and subendocardial parts of the cardiac septum facing the left ventricle, whereas supplementation with n6-PUFAs led to an increase only in the intramural part of the septum. Experimental DM1 alone resulted in an increase in the expression of Cx 37 in the intramural part of the rat cardiac septum. This change is even more pronounced when supplemented with n3 PUFAs. Subendocardial changes occur only on the left side of the septum, where DM1 combined with supplementation with n3-PUFAs led to an increase in Cx37 expression. These results may contribute to a better understanding of the potential effects of different PUFA ratios in the diet of diabetic patients on cardiac innervation and the development and progression of diabetic autonomic cardiomyopathy

Propensity-score matched comparison between minimally invasive and conventional aortic valve replacement

Aim: To evaluate the impact of minimally invasive aortic valve replacement (mini-AVR) on clinical outcomes in comparison with the gold standard. ----- Methods: We retrospectively reviewed the records of all patients who underwent isolated AVR at the University Hospital Center Zagreb from 2010 to 2020. Patients undergoing mini-AVR were compared with patients undergoing conventional AVR (fs-AVR). The primary outcome measure was blood product consumption. Propensity score matching was used to create a balanced covariate distribution across treatment groups. Additionally, we compared the contemporary outcomes with a historical control. ----- Results: The final sample consisted of 1088 patients. In the unmatched cohorts, mini-AVR patients were younger (65±12 vs 68±10 years, P<0.001) and had lower risk profiles (EuroSCORE2 2.8±2.0 vs 3.5±3.1, P=0.003). After matching, mini-AVR patients required less blood transfusion than fs-AVR patients (270 [0-790] vs 510 [0-970] mL, P=0.029). The incidences of stroke, dialysis, new AV block, and mortality were comparable. Cross-clamp times were longer in the mini-AVR group (71 [60-87] vs 66 [53-83] minutes, P=0.013). Outcomes were improved in the contemporary mini-AVR era compared with our early mini-AVR experience across multiple metrics. Blood product consumption was reduced in the latter tercile of experience (0 [0-520] vs 500 [0-1018] mL, P<0.001), and the operation was performed more expeditiously (cross-clamp times: 63 [54,80] vs 74 [62,88] minutes, P<0.001) in comparison with earlier periods. ----- Conclusions: We showed that mini-AVR was associated with less blood product requirement than conventional surgery. Our data supports wider adoption of minimally invasive techniques in dedicated centers of excellence