Intraoperative management Patients will be monitored with arterial and central venous catheterizations. All patients will be considered at high risk for postoperative bleeding as they will receive at least one antiplatelet agent and therefore will be administered tranexamic acid (Exacyl®, Sanofi-Aventis, Paris, France) according to the following standardized protocol: infusion of 10 mg/kg for 20 minutes during anaesthesia induction, followed by a continuous infusion until the end of surgery, according to renal function of patients as described by Nuttall et al. (8) (See table below). The rest of intraoperative management will be the same as previously described by Ouattara and al. (5). Briefly, before aortic cannulation, an initial loading dose of heparin will be directly administered by the surgeon into the right atrium and then anticoagulation will be maintained by additional bolus during the extracorporeal circulation. Non-pulsatile cardiopulmonary bypass will be ensured at a flow of 2.4 L/min/m2. The temperature of systemic perfusion during cardiopulmonary bypass (hypothermia <32°C, mild hypothermia 32-36°C, and normothermia >36°C) will be left to the discretion of the attending surgeon. After discontinuation of the cardiopulmonary bypass, heparin will be neutralized by protamin sulfate (0.008-0.01 mg/IU of total heparin dose intraoperatively used). Intraoperative cell salvage will be systematically used (Electa, Dideco, Mirandola, Italy). The use of inotropes for difficult weaning from cardiopulmonary bypass will be left to the discretion of the attending anaesthesiologist. Discontinuation of the cardiopulmonary bypass will be done when central body temperature (estimated by vesical temperature) will be above 35°C.