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In the last 20 years, mechanical circulatory supports (MCS) have overturned completely the outcomes and the clinical recovery of patients with isolated acute left ventricle failure (iALVF). This usually occurs more frequently than right-sided heart failure or biventricular dysfunction, and it mainly is caused by acute myocardial infarction. The primary role of MCS is to restore the tissue metabolism to preserve the vital organs' function but, on the other hand, they also have to relieve the workload stress on the heart. In this way, they allow not only the heart to recover from the acute event, but MCS also can stabilize the patient toward cardiac transplantation. The short-term MCS devices currently used in clinical practice are the intraaortic balloon pump, the Impella (Abiomed, Danvers, MA), and venoarterial extracorporeal membrane oxygenation (VA-ECMO), but the choice of the right and tailored device for each patient, as well as the timing to use it, is actually one of the most debated topics of MCS management. [ABSTRACT FROM AUTHOR]

The aims of this study were to analyse the incidence of visceral malperfusion syndrome (MPS) following Frozen Elephant trunk operations in patients affected by chronic aortic dissection and the associated risk factors. Between January 2007 and February 2019, 165 patients underwent surgery with FET for chronic aortic dissection. Post-operative computer tomography angiogram parameters (diameters, early post-operative false lumen enhancement and involving of aortic branches by the dissection) were collected and analysed to evaluate their impact on the occurrence of visceral malperfusion. Visceral (renal and mesenteric) MPS (with both clinical and radiological signs of MPS) was detected in 10 cases (6.1%). Post-operative visceral malperfusion was strongly related with in hospital mortality. The involvement of the visceral branches in the dissection was not a risk factor for visceral malperfusion occurrence, while a larger post-operative total aortic diameter at level of the coeliac trunk increased the risk of visceral MPS (OR 1.05; CI 1.002–1.102, p -value = 0.04). Furthermore, visceral MPS was associated to a complete thrombosis of the false lumen at level of the distal descending thoracic aorta. The development of post-operative MPS in frozen elephant trunk is strongly related to in-hospital mortality. The involvement of aortic branches by the dissection does not represent a real predictive risk factor for MPS, while early larger aortic diameters and false lumen thrombosis represent independent risk factors for MPS and in-hospital mortality. [Display omitted] • Post-operative malperfusion after frozen elephant trunk surgery significantly affects in-hospital mortality. • The involvement of aortic branches by the dissection does not represent a real predictive risk factor for malperfusion. • Larger diameters at level of the descending aorta and false lumen thrombosis are risk factors for malperfusion and early mortality. [ABSTRACT FROM AUTHOR]

Aberrant right subclavian artery is a relatively rare congenital anomaly of the aortic arch. A 74-year-old woman was referred to our cardiac surgery department for chest pain. Computed tomography angiography scan showed an acute aortic dissection and revealed an aberrant right subclavian artery routed behind the trachea. We performed supracoronary ascending aorta and total arch replacement with the frozen elephant trunk technique. The aberrant right subclavian artery was then anastomosed termino-terminal to one branch of the Thoraflex (Vascutek, Glasgow, Scotland) arch graft. Postoperative computed tomography scan indicated a successful reconstruction of the aortic arch, proving the open stent-grafting technique as a useful and effective approach for aortic disease with aberrant right subclavian artery. [ABSTRACT FROM AUTHOR]

Since its introduction in 1992, multiple variations of the aortic valve-sparing David procedure technique have been described. Here, we present the short- and midterm outcomes of 2 centers using the straight tube graft (David-I) and the Valsalva prosthesis in patients who underwent isolated David procedure. Between March 2002 and October 2015, 232 patients underwent the David procedure at 2 European centers. Patients received either a straight tube graft (David-I, group A, n = 103, 74% men) or Valsalva graft (group B, n = 129, 85% men). Mean age was 47 ± 17 years in group A and 48 ± 17 years in group B (P =.916). There were significantly more cusp repairs in group B (n=28, 22%) compared with group A (n = 4, 4%, P <.001). The 30-day mortality rate was 1% (n = 1) in group A and 2% (n = 2, P =.698) in group B. Postoperative echocardiography showed aortic insufficiency ≥II in 0% (n = 0) of group A and 17% (n = 21) of group B (P <.001). Follow-up comprised 1530 patient-years, and survival was comparable between the 2 groups (P =.799). Follow-up echocardiography showed aortic insufficiency ≥II in 22% (n = 15) of group A and 39% (n = 33) of group B (P <.026). The rates for aortic valve-related reoperation were 8% (n = 8) in group A and 13% (n = 16) in group B (P =.241). Logistic Cox regression analysis identified bicuspid aortic valve (odds ratio, 3.435; 95% confidence interval, 1.459-8.083, P =.005) and postoperative aortic insufficiency ≥II (odds ratio, 5.988; 95% confidence interval, 2.545-14.088, P <.001) as risk factors for aortic valve-related reoperation. The aortic valve-sparing David procedure has acceptable midterm results. Our results show that the David-I procedure with straight tube graft is not inferior to those performed with Valsalva prosthesis. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe single-center intraoperative details and early outcome of the new GORE TAG conformable stent graft with ACTIVE CONTROL (C-TAG ACTIVE CONTROL; W. L. Gore & Associates, Flagstaff, Ariz). Between September 2017 and June 2018, a consecutive 30 patients underwent thoracic endovascular aortic repair with C-TAG ACTIVE CONTROL. This new system provides an intermediate deployment step at 50% and optional angulation control of the proximal part of the stent graft. Indications for thoracic endovascular aortic repair varied widely, including chronic postdissection and degenerative aneurysms, complicated acute dissections, and intramural hematomas, among others, in an elective (63.3%), urgent (13.3%), or emergent (23.3%) setting. The proximal landing zone (LZ) was LZ 2 in 23.3%, LZ 3 in 43.3%, and LZ 4 in 33.3%. Data were collected retrospectively and analyzed for technical and clinical success. In all patients, the stent graft was successfully introduced and deployed at the intended position, with complete exclusion of aortic disease and without intraoperative mortality (primary technical success, 100%). One emergent patient died at 2 days of ongoing septic shock (clinical success at 30 days, 96.6%). Median follow-up was 107 days (range, 33-271 days); late mortality was 3.4% (one patient died of stent graft infection at 40 days). Freedom from type I and type III endoleak at the early follow-up was 100%. No patients required other surgical or endovascular procedures for the primary treated aortic disease. Our reported initial experience in 30 patients with the C-TAG ACTIVE CONTROL showed excellent early results, with high deployment accuracy and conformability. The additional features of staged deployment and angulation control may be of great help in challenging aortic arch diseases, allowing precise positioning and preventing bird-beak effect. [ABSTRACT FROM AUTHOR]

Despite optimal hemodynamics at rest, the performance of the aortic valve under stress conditions long after David I procedure is still debated. From 2001-2014, 73 patients underwent reimplantation with David I technique. Aortic valve function of 13 patients (age 61.2 ± 8.72) with a follow-up of at least 5 years (6.3 ± 0.9 years) was assessed at exercise echocardiographic stress test on a stationary cycle. Patients who had undergone concomitant procedure, with recurrent aortic insufficiency or mitral valve incompetence, were excluded. In all, 8 healthy volunteers served as controls. Transvalvular gradients progressively increased during the steps in both groups (P-within < 0.001), being higher in David patients (P-between < 0.001), but never reaching a clinical significance (David Peak gradient 23.8 ± 9.3 mmHg; Mean gradient 13.2 ± 5.1 mmHg). Effective orifice area (EOA) and EOA index did not change during the test in David patients, whereas Controls showed a progressive increase of functional valve area to a peak at 50 W (Controls EOA 4.0 ± 0.5 cm(2); EOA index 2.0 ± 0.3 cm(2)/m(2)). In conclusion, David I procedure ensures good hemodynamics during high-flow conditions at long-term follow-up. The reimplantation of the functional aortic annulus inside a rigid tube determines a paradoxical reduction of functional aortic valve area, secondary to the increased stroke volume, without any clinically relevant increase in transvalvular gradients. These data confirm the reliability of David I in the long term, even under physical stress conditions. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate the immediate and late outcome of emergency coronary artery bypass grafting (CABG) in a multicenter setting. Design Multicenter, retrospective study. Setting Four university hospitals. Participants 596 patients were included in this study. Interventions Included patients underwent isolated, emergency CABG. Measurements and Main Results Sixty patients (absolute rate: 10.1%, pooled rate: 8.7%) died during the in-hospital stay period. Increasing emergency CABG classes (p<0.0001), recent myocardial infarction (p = 0.019), left ventricular ejection fraction≤30% (p = 0.034), on-pump surgery (p = 0.012), and participating centers (p<0.0001) were independent predictors of in-hospital mortality. Survival rates at 1, 3, and 5 years were 86.4%, 81.6%, and 76.1%, respectively. Extracorporeal membrane oxygenation was used in 6 patients and 3 of them (50.0%) survived the immediate postoperative period. Patient populations of participating centers differed significantly in most of baseline characteristics. The preoperative use of intra-aortic balloon pump (8% to 51%) and off-pump surgery (2.8% to 56.3%) varied significantly between institutions. In-hospital mortality (2.8%, 5.9%, 7.7% and 19.8%, p<0.0001), as well as midterm survival, significantly differed between institutions (at 3 years, 90.6%, 89.8%, 81.2%, and 67.2%, p<0.0001). Conclusions The outcome after emergency CABG is satisfactory despite a significant operative risk. However, the results of emergency CABG significantly differed between the participating institutions, likely due to differences in the referral pathways and perioperative treatment strategies. Evaluation of these factors is crucial for implementation of treatment in centers with suboptimal results. [ABSTRACT FROM AUTHOR]

Currently, guidelines for appropriate donor sizing in recipients mostly focuses on donor–recipient body weight matching. The purpose is to retrospectively determine the impact of predicted heart mass (pHM)–based size matching on heart transplant (HT) outcomes. According to our institutional registry, 512 consecutive adult patients underwent HT between January 2000 and August 2020. For each patient, pHM and donor-recipient pHM ratio were calculated. Patients were partitioned into quintiles in terms of pHM ratio: undersizing 2, undersizing 1, reference, oversizing 1, and oversizing 2, with mean pHM donor–recipient ratio of 0.81, 0.96, 1.04, 1.12, and 1.28, respectively. Severe early graft failure and 30-day, 90-day, 1-year, and 10-year mortality were analyzed as outcomes. Recipients of the most oversized group were mostly female (P <.001), had higher preoperative pulmonary vascular resistance (P =.009), had higher rate of mechanical circulatory support (P <.05), and showed a lower United Network for Organ Sharing score (P =.041); the respective donors were younger and more frequently male (P =.001). Ischemic time was similar in all groups (P =.358). Pulmonary vascular resistance (P =.023; odds ratio [OR], 2.38), preoperative mechanical circulatory support (P =.05; OR, 3.06), and United Network for Organ Sharing score (P =.033; OR, 1.76) were identified as risk factors for early mortality. Donor-recipient pHM ratio did not impact early graft failure (P =.871) and early mortality (P =.526). Survival analysis after adjustment for pHM ratio subgroups did not show any difference in outcomes. A wide range of pHM ratios seems to be safe. A careful allocation of organs, by considering a pHM ratio mismatch, may balance rescue preoperative clinical profiles and preserve HT outcomes. [ABSTRACT FROM AUTHOR]

We investigated if the occurrence of preoperative right ventricular dysfunction is capable of influencing heart transplant results in terms of in-hospital mortality, incidence of primary graft dysfunction, and follow-up mortality. We retrospectively analyzed 517 patients who underwent heart transplant between January 2000 and December 2020. We defined right ventricular dysfunction (RVD), as central venous pressure (CVP) > 15 mm Hg and CVP/pulmonary capillary wedge pressure ratio > 0.63. We identified 2 subgroups in our population: 33 patients with preoperative RVD and 484 patients without RVD. In-hospital mortality was 7.9%. Severe early graft failure occurred in 6.6% of patients, with 26 patients (5.1%) needing intra-aortic balloon pump and 17 patients (3.3%) needing extracorporeal membrane oxygenation support. Clinical variables that significantly influenced in-hospital mortality were age, peripheral artery disease, and bilirubin > 1.5 mg/dL, while hemodynamic variables influencing in-hospital mortality were CVP (odds ratio [OR], 1.09 [confidence interval {CI}, 1.03-1.15], P =.004], pulmonary artery systolic pressure (OR, 1.02 [CI, 1.00-1.04], P =.05), CVP/pulmonary capillary wedge pressure ratio (OR, 2.78 [CI, 1.14-6.80], P =.025), pulmonary vascular resistance (OR, 1.15 [CI, 1.01-1.32], P =.042), transpulmonary gradient (TPG) (OR, 1.11 [CI, 1.03-1.18], P =.003) , diastolic transpulmonary gradient (OR, 1.10 [CI, 1.02-1.20], P =.015], together with right ventricular dysfunction (OR, 3.56 [CI, 1.44-8.80], P =.011). On the other hand, clinical variables influencing the incidence of early graft failure were body mass index (calculated as weight in kilograms divided by height in meters squared) > 30, peripheral artery disease, bilirubin > 1.5 mg/dL, Model for End-Stage Liver Disease score excluding international normalized ratio before transplant, and preoperative extracorporeal membrane oxygenation support, while hemodynamic variables were pulmonary arterial systolic pressure (OR, 1.03 [CI, 1.00-1.05], P =.016), TPG (OR, 1.08 [1.01-1.17], P =.03), and right ventricular dysfunction (OR, 3.00 [CI, 1.07-8.40] P =.046). On the multivariable analysis, RVD and TPG were independent predictors of in-hospital mortality, while only TPG was a predictor of early graft failure. Follow-up mortality was 38.7% and was influenced by recipient age, recipient body mass index, and preoperative diabetes. Moreover, 1-, 5-, and 10-year survival of patients with preoperative RVD was significantly worse than patients without RVD (log-rank = 0.001). In our population, RVD influenced both in-hospital and long-term results after heart transplant. For these reasons, it appears crucially important to optimize preoperative right ventricular function to improve these patients' outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The Štajerska region in north-eastern Slovenia and the Styria region in southern Austria have a long tradition of growing pumpkins (Cucurbita pepo L.) as an oil crop. GC-MS determination of the free and esterified minor compounds in oil of roasted pumpkin seeds from the Slovenian C. pepo L. variety ‘Slovenska golica’ revealed the presence of two previously unreported compounds: alpha-tocomonoenol and gamma-tocomonoenol. Using the GC-MS data, reference samples (Crude Palm Oil) and tocopherol and tocotrienol standards it was possible to assign and quantify alpha-tocomonoenol (17.6±0.6μg/g) and gamma-tocomonoenol (118.7±1.0μg/g) compounds in roasted ‘S. golica’ seed oil using HPLC. The concentrations of alpha-tocopherol and gamma-tocopherol were 77.9±1.9μg/g and 586.0±4.6μg/g, respectively. Surprisingly the gamma-tocotrienol concentration found was only 6.9±0.2μg/g. Analysis of the seeds from which the oil was pressed showed the initial gamma-tocotrienol amount was even lower (1.6±0.1 and 2.2±0.1μg/g in the ground and roasted seeds, respectively) than in the roasted seed oil. [Copyright &y& Elsevier]

The occurrence of early graft failure (EGF) after heart transplantation (Htx) often requires a mechanical circulatory support (MCS) therapy. The aims of our study were to identify risk factors of mechanically supported severe EGF and evaluate their impact on both early and late outcomes. Between January 2000 and December 2019, 499 consecutive adult patients underwent Htx at our institution. Severe EGF was defined as the need for extracorporeal life support (ECLS) within 24 hours after surgery. All available recipient and donor variables were retrospectively analyzed. Overall, EGF occurred in 58 (11.6%) patients. Post-Htx peripheral or central ECLS was necessary in 32 (6.4%) cases. Independent predictors of severe EGF were, in the recipient group, preoperative transpulmonary gradient (TPG) >12 mm Hg (odds ratio [OR] 4.1, P =.013), preoperative inotropic score >10 (OR 7.3, P =.0001), and pre-Htx ECLS support (OR 5.2, P =.015), while in the donors, a Eurotransplant donor score ≥17 (OR 8.5, P =.005). The absence of EGF was related with a better survival at 1 year and 5 years (94% and 85%, respectively) compared with EGF requiring ECLS population (36% and 28% at 1 year and 5 years, respectively; P <.001). A five-year conditional survival rate did not differ significantly (85% no EGF vs 83% EGF requiring ECLS). Both donor and recipient factors may influence EGF occurrence. Post-Htx ECLS may impact negatively early; however, patients weaned from ECLS eventually benefit from such a rescue treatment with outcomes comparable with Htx patients who did not suffer EGF. [ABSTRACT FROM AUTHOR]