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The aim of the study was to detect the associations between heart rate variability (HRV) and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The study was performed in Kaunas, Lithuania, during 2008–2012. We used data of 220 patients. HRV was assessed by a 5-minute electrocardiogram. The data were collected at 1.5 months, 1 year, and 2 years after the surgery (495 measurements). A negative association of standard deviation of beat-to-beat interval (SDNN), very low frequency (VLF), low frequency, and high frequency (HF) powers with a decrease in air temperature (T) during a 3-day period in the range of T < 1°C wind speed >2.75 knots 2 days before, and the daily North Atlantic Oscillation indices were observed. The effect of wind speed on SDNN and VLF power was stronger in males. Two days after relative humidity >89%, a lower mean VLF and higher HF in normalized units were found; in females, this effect was stronger 1.5 months after the surgery. Among patients after open-heart surgery, the HRV variables may be related to specific weather changes and the effect of weather was different for males and females and at different times after the surgery. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether instantaneous wave – free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG). Background: Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency. Methods: In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome. Results: In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 – 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 – 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 – 0.96)) were occluded (p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded (p < 0.001). In terms of MACCE, no difference (p = 1.0) was found between all 3 groups divided according to iFR value. Conclusions: Instantaneous wave – free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period. [ABSTRACT FROM AUTHOR]

Background: To evaluate different aortic root surgery techniques and their contemporary clinical outcomes in patients with regurgitant aortic valve and aortic root aneurysm. Methods: The study consisted of 141 adult patients who underwent aortic valve reimplantation (David group = 73) or aortic valve replacement surgery (Bentall group = 68) for aortic valve regurgitation (AR) and dilatation of the aortic root at our institution within the same period (April 2004–October 2016). Kaplan–Meier method was used to estimate survival and other clinically relevant outcomes between the groups. Results: The completeness of clinical follow-up was 100%, with a mean time of 8.0 ± 3.8 years. Thirty-day (in-hospital) mortality rates were equivalent between groups (1.3 and 1.5%, p = 1.0). The overall survival rates at 10 years were significantly better for the David group patients comparing to Bentall group patients (95.3 ± 2.6% vs 79.7 ± 6.8%; p = 0.04) with similar freedom from AV related reoperation (94.4 ± 2.7% vs 98.5 ± 1.5%; p = 0.2). Freedom from bleeding events at 10 years was 90.7 ± 3.6% for Bentall group patients and none were observed among David group patients (p = 0.01). Conclusions: Aortic valve and root surgery can be performed with equivalent safety and efficacy using either valve-sparing (David procedure) or valve-replacing (Bentall procedure) techniques in selected patients. Furthermore, patients after the David procedure demonstrated significantly improved survival and low risk of bleeding in comparison to the Bentall procedure with an acceptable risk of reoperation at 10 years follow-up. [ABSTRACT FROM AUTHOR]

Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008–2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health. [ABSTRACT FROM AUTHOR]

Introduction: Patient-prosthesis mismatch (PPM) has been associated with numerous short- and long-term adverse events. This study aimed to evaluate the effect of PPM on early postoperative results after aortic valve replacement (AVR) in daily practice. Methods: In this single-centre retrospective study, 150 non-consecutive patients from March 2019 to January 2020 with clinically indicated AVR with/without concomitant surgery were analysed. The study protocol included operative mortality, complication rate, and pre- and postoperative echocardiographic data. PPM was considered severe with indexed effective orifice area at <0.65 cm2/m2, moderate at 0.65–0.85 cm2/m2 and none at >0.85 cm2/m2. Results: Moderate PPM was observed in 16 patients (10.6%). No patient had severe PPM. PPM was not related to early mortality (r = 0.40, p = 0.630), intra- (r = −0.076, p = 0.352) and postoperative (r = −0.0134, p = 0.102) events. Conclusion: In this study, moderate PPM was a frequent finding after AVR, whereas severe PPM was not observed. PPM did not affect the early results after AVR. A long-term follow-up study in a large patient population is required to assess the actual influence of residual PPM. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to evaluate the diagnostic value of global and regional myocardial deformation parameters derived from two-dimensional speckle-tracking echocardiography to detect functionally significant coronary artery stenosis. Methods: Dobutamine stress echocardiography and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) were performed on 145 patients with a moderate and high probability of coronary artery disease (CAD) and LVEF ≥ 55%. Significant CAD was defined as > 50% stenosis of the left main stem, > 70% stenosis in a major coronary vessel, or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by CMRMPI. Patients were divided in two groups: non-pathological (48.3%) vs pathological (51.7%), according to CAG and CMR-MPI results. Afterwards, off-line speckle-tracking analysis was performed to analyse myocardial deformation parameters. Results: There were no differences in myocardial deformation parameters at rest between groups, except global longitudinal strain (GLS) and global radial strain (GRS) were significantly lower in the CAD (+) group: -21.3 ± 2.2 vs.-16.3 ± 2.3 (P < 0.001) and 39.7 ± 23.2 vs. 24.5 ± 15.8 (P < 0.001). GLS and regional longitudinal strain rate (SR) had the highest diagnostic value at high dobutamine dose with AUC of 0.902 and 0.878, respectively. At early recovery, GLS was also found to be the best myocardial deformation parameter with a sensitivity of 78%, specificity 67%, AUC 0.824. Conclusion: Global and regional myocardial deformation parameters are highly sensitive and specific in detecting functionally significant CAD. The combination of deformation parameters and WMA provides an incremental diagnostic value for patients with a moderate and high probability of CAD, especially the combination with regional longitudinal SR. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the incidence rate of technical failure of graft patency while performing intra-operative angiography after coronary artery bypass grafting. Methods: This prospective pilot study included 50 patients with multi-vessel coronary artery disease who underwent coronary artery bypass grafting, in addition to intra-operative angiographic graft assessments, on open-chest. Overall, 144 grafts and 160 distal anastomoses were assessed in a hybrid operating room. Results: Intra-operative angiography allowed the identification of 23 angiographic defects (15.9% of all grafts) in 22 patients (44%): three graft defects (2% of all grafts), 17 anastomotic defects (10.6% of all distal anastomoses), and three target artery errors (1.8% of all grafted arteries). Ten re-interventions (43.4%) were performed based on the angiographic defects detected. During the follow-up period, computed tomography angiography of the attached grafts at a mean of 224 days (range, 80–318 days) showed that all repaired grafts were patent. During surgery, the total mean dose of radiation was 1.848 ± 0.54 mSv (range, 0.78–3.4 mSv) per patient and investigation time was 19.4 ± 4.94 minute (range, 9–31 minute). Conclusions: Intra-operative angiography is a powerful tool allowing the identification of graft defects, anastomotic defects and target vessel errors. Assuming relatively low level of exposure to radiation and short investigation time, intra-operative angiography could be included in routine practice as safe procedure improving surgery quality. [ABSTRACT FROM AUTHOR]

Aim: we choose to evaluate, whether type of cardioplegia is an important predictor to determine biventricular function changes after CABG. Methods: 81 patients who underwent CABG surgery and matched inclusion criteria were enrolled in this study. The exclusion criteria were acute MI within 30 days, impaired systolic left ventricle function (LVEF ⩽35%), atrial fibrillation.TTE was performed for all patients and echocardiographic parameters of biventricular geometry and function were assessed before CABG surgery, first postoperative day and 6 months after surgery. Cardioplegia type was randomly chosen. First group consisted of 49 patients (60.5%) when CC was performed and the others 32 patients (39.5%) formed the second - BC group. Results: Patients' demographic characteristics were similar in both groups, except the lower rates of AH and BSA in BC group (p = 0.015, p = 0.001 respectively). Longer duration of XCT and CBP time was observed in BC group (p = 0.019 and p = 0.028). BC group patients showed more efficient right heart chambers size reduction (p = 0.001 for RV diameter; p = 0.015 for RA diameter) and better improvement of longitudinal RV function (p = 0.02 for TAPSE; p = 0.001 for RV S') 6 months after surgery when compared with CC group patients. RV global systolic function diminished in both groups postoperatively, but the reduction was higher in CC group, although the difference was significant in comparing early postoperative measurements with the late after CABG surgery (p = 0.03). Changes of LV systolic function as well as diameter of LA did not differ between groups (p = 0.165 and p = 0.279, respectively), while diastolic function improved significantly in BC group patients at the late follow-up period: E/e' decreased (p < 0.001) and e' velocity of interventricular septum augmented significantly (p < 0.001). Conclusion: BC is associated with better RV reverse remodelling and improvement of longitudinal RV function, as well as LV diastolic function improvement after CABG surgery. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare blood flow velocity changes in the middle cerebral artery before, during and after heart surgery with cardiopulmonary bypass for patients with and without postoperative cognitive dysfunction. Materials and methods: A total of 100 patients, undergoing elective coronary artery bypass grafting or/and valve surgery enrolled in the study. A neurocognitive test evaluation included Adenbrooke, Mini-Mental State Examination and Trial Making test before and 7-10 days after surgery. Middle cerebral artery mean blood flow velocity was evaluated 1 day before the surgery, after anaesthesia induction, before cardiopulmonary bypass, at the beginning, ending and after cardiopulmonary bypass, and post surgery in intensive care unit. Blood samples for glial fibrillary acidic protein were measured after anaesthesia induction, 24 hours and 48 hours after surgery. According to neurocognitive tests results patients were divided in to two groups: patients with and without postoperative cognitive dysfunction. Results: Of the 100, 86 patients completed investigation. After induction, blood flow velocity of the middle cerebral artery was lower in postoperative cognitive dysfunction group (41.2; min 27.91, max 49.47) than in the H group (41.2, min 21.9, max 84.3) p = 0.034, and during cardiopulmonary bypass, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (37.35, min 26.6, max 44.02) than the H group (42.3, min 20.1, max 86.5), p = 0.001. After the surgery, blood flow velocity of the middle cerebral artery was lower in the postoperative cognitive dysfunction group (40.7, min 29.7, max 50.4) than in the H group (45.3, min 34.12, max 59.88), p = 0.05. Results of cognitive tests had weak correlation (rho, 0.391) with middle cerebral artery's blood flow velocity after anaesthesia induction (p = 0.001) and during bypass (p = 0.018). The receiver operating characteristic analysis showed that the blood flow velocity of the middle cerebral artery during bypass (area under the curve = 0.735) was a fair predictor for postoperative cognitive dysfunction (p = 0.001). No significant correlations were found among glial fibrillary acidic protein, middle cerebral artery blood flow velocity, and cognitive tests results. Conclusion: Middle cerebral artery's blood flow velocity was decreased after anaesthesia induction and during cardiopulmonary bypass for patients with postoperative cognitive dysfunction comparing with their blood flow velocity preoperatively. Blood flow velocity during bypass has diagnostic value for postoperative cognitive dysfunction. Brain biomarker glial fibrillary acidic protein is not helpful in diagnosing postoperative cognitive dysfunction. [ABSTRACT FROM AUTHOR]

Objective: Surgical management of infective endocarditis continues to be challenging and is associated with significant morbidity and mortality. The objective of our study was to determine the risk factors and conditions associated with poor early infective endocarditis surgical treatment outcomes—30-day postoperative mortality. Methods: A total of 124 patients who underwent surgery for infective endocarditis at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from January 2010 to December 2017 were retrospectively included in this study. The primary endpoints were 30-day postoperative mortality and identification of risk factors associated with it. Secondary endpoints were early postoperative outcomes and complication rates. Results: During the study period, 124 patients with infective endocarditis underwent cardiac surgery, presenting an overall 30-day postoperative mortality rate of 10.48%. Mean age was 58 ± 14.4 years with 95 (76.61%) males. Independent predictive factors of early mortality were age >63 years (odds ratio = 6.4, 95% confidence interval = 1.66-24.66, p = 0.003), body mass index >30 kg/m² (odds ratio = 7.74, 95% confidence interval = 2.20-27.27, p = 0.003), and ischemic heart disease (odds ratio, 6.6, 95% confidence interval = 1.62-26.90, p = 0.003), as well as intraoperative parameters—prolonged aortic cross-clamp >84.5 minutes (odds ratio = 3.79, 95% confidence interval = 1.10-13.08, p = 0.03) and cardiopulmonary bypass time >107.5 minutes (odds ratio = 10.0, 95% confidence interval = 1.26-79.58, p = 0.023). Staphylococcus aureus infection (odds ratio = 5.04, 95% confidence interval = 1.29-19.64, p = 0.012), infective endocarditis–related intracardiac complication such as paravalvular abscess detected by transesophageal echocardiography (odds ratio = 4.32, 95% confidence interval = 1.31-14.25, p = 0.01), and infective endocarditis complicated by septic or cardiogenic shock (odds ratio, 18.43, 95% confidence interval = 4.59-73.98, p = 0.001) were statistically significant factors for increased risk of 30-day postoperative mortality. Conclusion: Surgical treatment of infective endocarditis showed good results in our center. The independent predictors of 30-day postoperative mortality for patients who underwent cardiac surgery for infective endocarditis were age, body mass index, ischemic heart disease, prolonged aortic cross-clamp and cardiopulmonary bypass time, Staphylococcus aureus infection, paravalvular abscess, and septic or cardiogenic shock. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate early and long-term clinical outcomes following aortic valve sparing aortic root reimplantation surgery in patients with leaking bicuspid and tricuspid aortic valves. Methods: The study consisted of 92 consecutive adult patients (tricuspid aortic valve group = 63 and bicuspid aortic valve group = 29) who underwent aortic valve sparing aortic root reimplantation surgery with or without aortic cusp repair for dilatation of the aortic root and/or aortic valve regurgitation at our institution from April 2004 to October 2016. Clinical outcomes were investigated using Kaplan–Meier and log-rank tests between groups. Results: The follow-up was 100% complete with a mean time of 5.3 ± 3.3 years. The 30-day in-hospital mortality was 3.1% in tricuspid aortic valve group and 3.4% in bicuspid aortic valve group patients. The overall survival rates at 10 years did not differ between bicuspid aortic valve and tricuspid aortic valve patient groups (96.6 ± 3.3% vs. 90.3 ± 4.2%, p = 0.3). Freedom from recurrent aortic valve regurgitation (>2+) at 10 years was 90.5 ± 4.1% in tricuspid aortic valve group and 75.7 ± 8.7% in bicuspid aortic valve group (p = 0.06). Freedom from aortic valve reoperation at 10 years was 100% in tricuspid aortic valve group and 83.9 ± 7.4% in bicuspid aortic valve group (p = 0.002). Conclusion: Aortic valve sparing aortic root reimplantation surgery is a safe and efficient technique, providing acceptable long-term survival with low rates of valve-related complications in both tricuspid aortic valve and bicuspid aortic valve patient groups. However, aortic valve reoperation rates at 10 years follow-up were higher in bicuspid aortic valve group patients compared to tricuspid aortic valve group patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the impact of concomitant tricuspid valve (TV) repair on the right ventricular (RV) function postoperatively and within the 6 months following degenerative mitral valve (MV) repair. Methods: The prospective study included 37 patients (mean age 57.32 ± 2.13 years) with severe MV regurgitation due to primary MV prolapse. Nineteen underwent successful MV repair (TV(−) group). Additional TV repair due to moderate-to-severe TV regurgitation was performed in 18 (TV(+) group). Two-dimensional (2D) speckle-tracking and tissue Doppler echocardiography was performed for all patients before surgery and 7 days and 6 months after surgery. Results: Preoperative dimensions and indices of RV longitudinal function did not differ between the groups (right ventricle end-diastolic diameter (RVEDD) was 33.53 ± 0.94 mm vs. 34.67 ± 1.72 mm, tricuspid annular systolic motion (S') was 15.06 ± 0.85 cm/s vs. 16.0 ± 1.27 cm/s, tricuspid annular plane systolic excursion (TAPSE) was 24.02 ± 1.06 mm vs. 22.4 ± 1.36 mm, respectively; p>0.05). RVEDD decreased significantly and did not change within the follow-up in the TV(−) group. In the TV(+) group, RVEDD decreased early after surgery and more markedly six months later in comparison to the TV(−) group. Indices of RV systolic longitudinal function decreased early after surgery and had a tendency to increase after six months in both groups. Regional longitudinal strains of the lateral RV wall decreased early after surgery and improved within the six months in the TV(−) group and did not change significantly in the TV(+) group. Conclusions: Additional TV repair in degenerative MV repair more markedly reduces RV dimensions and does not have a negative impact on RV systolic function in comparison to an isolated MV repair although these conclusions are of limited value due to the lack of a control group. [ABSTRACT FROM AUTHOR]

Background: Most epidemiological studies have shown that the prevalence of high blood pressure (BP) has significantly increased among children and adolescents in various countries of the world. The aim of this study was to examine the associations between overweight, obesity, abdominal obesity and prehypertension and hypertension among Lithuanian adolescents aged 12-15 years. Methods: The subjects with increased BP (≥90th percentile) were screened on two separate occasions. Data on the body mass index (BMI), waist circumference (WC), and BP were analysed in 7,457 adolescents aged 12-15 years. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. Results: After two screenings, the study participants were categorised as prehypertensive (12.8%), hypertensive (22.2%), and normotensive (65%). The overall prevalence of overweight, obesity, and abdominal obesity (if WC was in the ≥75th percentile) were 12.1%, 2.4%, and 9%, respectively. After adjusting for age and sex, significant associations were found between overweight and obesity and high BP, namely, prehypertension (overweight: aOR = 2.62; 95% CI 2.13-3.23; obesity: aOR = 4.81; 95% CI 3.08-7.52) and hypertension (overweight: aOR = 3.56; 95% CI 3.02-4.19; obesity: aOR = 6.64; 95% CI 4.65-9.49). Prehypertension was found to be significantly associated with WC in the 75th- < 90th percentiles (aOR = 3.16; 95% CI 2.43-4.10) and WC in the ≥90th percentile (aOR = 4.08; 95% CI 2.35-7.10). For hypertension, significant associations were detected with WC in the 75th- < 90th percentiles (aOR = 3.92; 95% CI 3.18-4.82) and WC in the ≥90th percentile (aOR = 7.41; 95% CI 4.97-11.05). Conclusions: Overweight, obesity, and abdominal obesity were associated with prehypertension and hypertension. [ABSTRACT FROM AUTHOR]