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Background: Anxiety and delirium are prevalent complications in cardiac patients undergoing invasive procedures like coronary artery bypass surgery, with untreated symptoms potentially leading to enduring physical and psychological consequences. Benson's relaxation technique, a method of attention focusing, has demonstrated efficacy in alleviating various symptoms, although findings are conflicting. Thus, this study aimed to assess the influence of Benson's relaxation on anxiety and delirium severity in open-heart surgery candidates. Methods: Conducted in 2022 at Qaem Hospital in Mashhad, this randomized controlled trial involved 60 patients. The intervention group received Benson's relaxation training pre-surgery and practiced it twice daily for 72 h post-admission. Standard care was provided to controls. Anxiety and delirium were assessed using standardized scales before and after the intervention. Results: The demographic characteristics of both groups were comparable with no significant differences. Benson's relaxation significantly reduced delirium scores on the first and second days post-surgery (P < 0.001). However, the difference in delirium scores between the groups was not significant on the third day (P = 0.129). While the intervention led to a significant reduction in anxiety within the intervention group, no significant difference in anxiety reduction was observed between the intervention and control groups (P = 0.579). Conclusion: Incorporating Benson's relaxation technique, which showed significant effects in reducing early postoperative delirium, into postoperative care plans for open-heart surgery patients warrants consideration. However, given the lack of a significant effect on anxiety reduction compared to routine care, further research is necessary to evaluate its long-term effectiveness and broader impact on psychological outcomes. Trial Registration: This study was registered in the Iranian Registry of Clinical Trials (no. c IRCT20210903052365N1) on 2022-01-28. [ABSTRACT FROM AUTHOR]

Background: Daily activities have been recommended to minimize the long-term complications of coronary artery bypass as one of the strategies to return to the normal activity level, the effectiveness of which needs further investigation. This study aims to determine the quality of life and activities of daily living one year after CABG. Methods: This cross-sectional study was performed on 206 patients who had undergone CABG for more than one year in 2018 in the north of Iran. The research instrument was a questionnaire including five sections, Data were analyzed using descriptive statistics and Chi2, Mann–Whitney U, Kruskal–Wallis tests, and a Logistic regression model. Result: The mean score of quality of life was 31.7 ± 2.04 of 12 to 48 possible scores. About Activities of Daily Living results showed 99.5% and 84.7% of the samples needed help with many of these activities respectively. The mean score of quality of life was significantly different based on sex (p < 0.018) and instrumental activity of daily living (p < 0.0001). A logistic regression model was used to determine the factors related to quality of life. The final model showed cross-clamp duration (OR = 0.33,p = 0.014), length of stay(LOS)in the intensive care unit(OR = 0.42,p = 0.05), and instrumental activities of daily living (OR = 0.08,p = 0.001) predicted patients' quality of life one year after coronary artery bypass grafting. Conclusion: Although more than half of the samples had a good average quality of life score, due to the lack of definitive treatment for coronary artery disease, it is suggested to consider predictive variables to help plan to improve the quality of life of these patients. Highlights: • Daily activity is very important in patients undergoing heart bypass surgery. • The quality of life in these patients has a significant relationship with their daily activity level. Plain language summary: The quality of life (QoL) of patients after CABG depends on many variables, one of the effective variables is the daily activity of these patients, which can significantly affect their quality of life, so it seems that by creating low-cost programs to improve the activity level of these people, it is possible to help increase their quality of life. The results of this research showed that about half of the research samples had an average quality of life and the majority of them still needed help to perform daily life activities. Maybe the design of special tools to determine the quality of life of these patients after coronary artery bypass surgery can show a clearer picture of the quality of life of these patients after surgery. [ABSTRACT FROM AUTHOR]

Objective: Diffuse coronary artery disease remains a critical issue that heart surgeons continue to research in terms of treatment options. An alternative method applied during coronary bypass surgery to achieve complete revascularization is coronary artery endarterectomy. Since the reliability of this technique and its effects on mortality and morbidity are still debated in the literature. Our objective in conducting this study is to determine the mid-term patency rates in patients who underwent LAD endarterectomy and to explore its future applicability. Materials and Methods: This study reviewed 20 patients who underwent coronary endarterectomy during CABG in our clinic between January 2014 and December 2021. The data, including contrast imaging to check graft patency, were evaluated retrospectively by reviewing hospital archives and patient files. Patients without LAD endarterectomy were excluded from the study. Results: LAD endarterectomy and patch-plasty were performed on all patients in the study. In 17 patients, the LIMA graft was anastomosed onto the patch applied to the LAD. It was observed that 12 of the grafts anastomosed to the LAD (60%) were patent during a mean follow-up period of 32.8 ± 25.9 months. The average 4-year survival rate was found to be 95%. Perioperative myocardial infarction occurred in 5 patients (25%). There was no need for high-dose inotropic support, IABP, or ECMO in the postoperative period. Conclusion: Coronary artery endarterectomy should be considered a viable option for surgeons to achieve satisfactory revascularization in cases where suitable anastomosis sites on coronary arteries to ensure adequate outflow are not available. Our findings align closely with literature reports indicating that endarterectomy performed on the LAD, with LIMA used as the conduit, leads to promising outcomes. [ABSTRACT FROM AUTHOR]

The incidence and prognostic impact of major bleeding (MB) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) are unknown. The goal of this study was to investigate the rates and outcomes of MB after LMCAD revascularization. In the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with unprotected LMCAD were randomized to undergo PCI (n = 948) or CABG (n = 957) and followed up for 5 years. MB was defined as TIMI major or minor bleeding, BARC (Bleeding Academic Research Consortium) types 3 to 5 bleeding, or any overt bleeding requiring blood transfusion. The association between MB and subsequent mortality was assessed in time-adjusted Cox regression models. At 5 years, 217 patients (11.4%) had at least 1 MB event. Rates of 5-year MB were 7.9% after PCI vs 14.8% after CABG (OR: 0.48; 95% CI: 0.36-0.65; P < 0.0001). However, in-hospital MB was lower after PCI (3.8% vs 13.5%; OR: 0.25; 95% CI: 0.17-0.37), whereas postdischarge MB was lower after CABG (4.5% vs 2.0%; OR: 2.33; 95% CI: 1.33-3.09; P interaction < 0.0001). All 41 postdischarge MB events after PCI occurred in patients receiving dual antiplatelet therapy. MB events within 5 years were associated with a higher subsequent risk of all-cause mortality (adjusted HR: 2.71; 95% CI: 1.95-3.77; P < 0.0001), whether in-hospital or postdischarge (P interaction = 1.00) and after both PCI and CABG (P interaction = 0.95), driven both by increased cardiovascular and non-cardiovascular mortality. In the EXCEL trial, CABG resulted in higher 5-year rates of all MB and in-hospital MB, although postdischarge MB was more frequent after PCI. MB after both procedures was associated with increased cardiovascular and noncardiovascular mortality within 5 years. (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: Cardiac surgery with cardiopulmonary bypass (CPB) causes systemic inflammatory response and multiple organ dysfunction. The release of cytokines including tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interferon-gamma (IFN-γ) was reported to be the main reason of multiorgan failure after CPB. The aim of this study is to investigate the effects of cardiopulmonary bypass on the systemic inflammatory response and the relationship between cytokine responses and organ dysfunction in patients with poor left ventricles underwent coronary revascularization with cardiopulmonary bypass. Methods: Thirty patients who had depressed left ventricular function (EF≤35%) and underwent CABG surgery were included in this prospective observational study. The maintenance of anesthesia and CPB was performed in accordance with institutional standards. After induction of anesthesia, a thermodilution pulmonary artery catheter was placed via the right internal jugular vein. Peripheral blood samples for the assessment of TNF-α, IL-6, IL-8 and IL-10 levels were taken immediately after the induction of anesthesia (T0), at 30th minute (T1) after the beginning of CPB and at the 1st (T2), 3rd (T3), 6th (T4), and 24th (T5) hours after CPB. Hemodynamic parameters including mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), left ventricular end diastolic pressure (LVEDP) and cardiac index (CI) were also recorded in these time intervals. Multiorgan dysfunction score (MODS) was recorded daily for 3 days after the surgery. Results: IL-6 and IL-8 peaked at the 3rd hour after CPB and returned to the level of the first half hour at the 24th hour. IL-10 peaked at the 1st hour after CPB. TNF-α increased in the first half hour after the beginning of CPB, and this level was maintained. A significant positive correlation was found between IL-6 levels at the 3rd hour and pulmonary, cardiopulmonary and renal dysfunction (r=0.3, p=0.04; r=0.4, p=0.003; r=0.3, p=0.04, respectively). Also, there was a correlation between IL-10 levels at the 6th hour and renal dysfunction (r=0.5, p=0.001) and between IL-6 levels at the 6th hour (r=0.3, p=0.05) and IL-8 levels at the 3rd hour (r=0.3, p=0.03) and hematological dysfunction. Conclusion: IL-6 and IL-8 peaked at the 3rd hour after CPB; IL-10 peaked at the 1st hour after CPB. TNF-α reached its highest level in the first half hour. A positive significant correlation was found between IL-6 levels and pulmonary, cardiopulmonary and renal dysfunction in the early postoperative period. Also, there was a relationship between IL-8 levels and hematological dysfunction. The development of these studies may be valuable in developing medical treatment protocols that will prevent inflammatory systemic responses. [ABSTRACT FROM AUTHOR]

Background: Vein grafts are commonly employed in revascularisation surgery for multivessel coronary artery disease, yet neointimal hyperplasia (NIH) remains a critical impediment to the long‐term patency of these grafts. Despite this, effective methods to precisely identify and target interventions for the neointima are still inadequate. Methods: In this study, Sprague–Dawley (SD) rats were used to establish an external jugular vein transplantation model, and the NIH pathophysiological process was tracked across 11 time points (0–35 days) using various histological stains. Spatial transcriptomics was performed on normal veins and 19‐day grafts to explore gene expression in neointimal regions. Immunohistochemical analysis identified neointima‐specific markers, while NIH progression was assessed in SD rats with four and a half LIM domains protein 1 (Fhl1) knockout and in human saphenous veins (HSV) with adenovirus‐mediated Fhl1 overexpression. Results: Typical neointimal formation commenced by day 11 postgrafting and peaked at day 19. Neointimal cells originated from newly generated α‐SMA(+) repair cells located outside the grafted vein, displaying a hybrid fibroblast‐smooth muscle cell phenotype. Spatial transcriptomics identified stable and sustained Fhl1 expression within the neointima throughout the entire NIH phase. Systemic knockout of Fhl1 in SD rats via the phosphoinositide 3‐kinase pathway exacerbated graft inflammation, heightened cell proliferation, and accelerated NIH. Conversely, FHL1 overexpression in cultured HSV suppressed NIH. Conclusion: These findings indicate that, following grafting into the arterial system, the newly formed repair cells external to the grafted vein play a pivotal role in NIH, with neointimal cells exhibiting stable and continuous Fhl1 expression. Fhl1 serves as a protective factor against NIH both in vivo and in HSV, likely due to its anti‐inflammatory and anti‐proliferative effects. Key points: This study firstly used spatial transcriptomics technique to analyse the neointima and generated a specific neointimal transcriptomic atlas.Fhl1 exhibits specific and stable expression in the spatial region of the neointima. It has thus far the highest enrichment of expression in the neointima in NIH phases, suggesting that it is a prominent molecular biomarker of neointima.We generated rats with a Fhl1 deletion and found that insufficient Fhl1 expression caused an increase in the severity of vascular inflammation and proliferation during neointimal hyperplasia. Adenovirus‐mediated FHL1 overexpression in human saphenous vein have beneficial effects in preventing neointimal hyperplasia. These highlight its potential as a therapeutic target for mitigating vein graft failure associated with cardiovascular procedures.Spatial transcriptomics profiles and morphological observations demonstrated that a newly generated cell population outside the grafted vein with hybrid phenotype between SMCs and fibroblasts contributes to neointimal formation. [ABSTRACT FROM AUTHOR]

The structural and functional integrity of conduits used for coronary artery bypass grafting is critical for graft patency. Disruption of endothelial integrity and endothelial dysfunction are incurred during conduit harvesting subsequent to mechanical or thermal injury and during conduit storage prior to grafting, leading to acute thrombosis and early graft failure. Late graft failure, in particular that of vein grafts, is precipitated by progressive atherogenesis. Intra-operative management includes appropriate selection of conduit-specific harvesting techniques and storage solutions. Arterial grafts are prone to vasospasm subsequent to surgical manipulation, and application of intra-operative vasodilatory protocols is critical. Post-operative management includes continuation of oral vasodilator therapy and selection of antithrombotic and lipid-lowering agents to attenuate atherosclerotic disease progression in conduits. In this review, the scientific evidence underlying the key aspects of intra- and post-operative management of conduits for coronary artery bypass grafting is examined. Clinical consensus statements for best clinical practice are provided, and areas requiring further research are highlighted. [ABSTRACT FROM AUTHOR]

Exosomes derived from bone marrow mesenchymal stem cells (BMSCs) exhibit considerable therapeutic potential for myocardial regeneration. In our investigation, we delved into their impact on various aspects of myocardial infarction (MI), including cardiac function, tissue damage, inflammation, and macrophage polarization in a murine model. We meticulously isolated the exosomes from TNF-α-treated BMSCs and evaluated their therapeutic efficacy in a mouse MI model induced by coronary artery ligation surgery. Our comprehensive analysis, incorporating ultrasound, serum assessment, Western blot, and qRT-PCR, revealed that exosomes from TNF-α-treated BMSCs demonstrated significant therapeutic potential in reducing MI-induced injury. Treatment with these exosomes resulted in improved cardiac function, reduced infarct area, and increased left ventricular wall thickness in MI mice. On a mechanistic level, exosome treatment fostered M2 macrophage polarization while concurrently suppressing M1 polarization. Hence, exosomes derived from TNF-α-treated BMSCs emerge as a promising therapeutic strategy for alleviating MI injury in a mouse model. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hemodynamic monitoring is crucial for managing critically ill patients and those undergoing major surgeries. Cardiac output (CO) is an essential marker for diagnosing hemodynamic deterioration and guiding interventions. The gold standard thermodilution method for measuring CO is invasive, prompting a search for non-invasive alternatives. This pilot study aimed to develop a non-invasive algorithm for classifying the cardiac index (CI) into low and non-low categories using finger photoplethysmography (PPG) and a machine learning model. Methods: PPG and continuous thermodilution CO data were collected from patients undergoing off-pump coronary artery bypass graft surgery. The dataset underwent preprocessing, and features were extracted and selected using the Relief algorithm. A CatBoost machine learning model was trained and evaluated using a validation and testing phase approach. Results: The developed model achieved an accuracy of 89.42% in the validation phase and 87.57% in the testing phase. Performance was balanced across low and non-low CO categories, demonstrating robust classification capabilities. Conclusions: This study demonstrates the potential of machine learning and non-invasive PPG for accurate CO classification. The proposed method could enhance patient safety and comfort in critical care and surgical settings by providing a non-invasive alternative to traditional invasive CO monitoring techniques. Further research is needed to validate these findings in larger, diverse patient populations and clinical scenarios. [ABSTRACT FROM AUTHOR]

Background/Objectives: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. Methods: In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic (n = 256) and non-diabetic (n = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. Results: Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, p < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; p < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients (p < 0.0001). Conclusions: Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies. [ABSTRACT FROM AUTHOR]

The use of revascularization (coronary artery bypass surgery [CABG] and percutaneous coronary intervention [PCI]) in the United States is declining, but they remain important procedures for the treatment of patients with coronary artery disease. There are large and long‐standing disparities in the use of revascularization among patients hospitalized with heart disease. In this article, we investigate whether the implementation of the Patient Protection and Affordable Care Act (ACA) is associated with a reduction in disparities in the use of revascularization. We use data from the Agency for Healthcare Research and Quality (AHRQ)'s National Inpatient Sample (NIP) of the Healthcare Cost and Utilization Project (HCUP) project to compare the use of revascularization among patients 45 years and older in the United States in 2012 and 2018. For both years, we conducted multiple logistic regression analysis to assess the factors associated with coronary revascularization among patients hospitalized with heart disease. Hospitalizations for heart disease and the use of revascularization both fell between 2012 and 2018 at a rate that was greater than the reduction in heart disease deaths in the country. These findings are consistent with the clinical literature on the growth of medical management of heart disease. Disparities in the use of revascularization, by gender, insurance status, neighborhood, and race/ethnicity, were just as large after the implementation of the ACA in 2014. The expansion of insurance by the ACA, alone, was insufficient to reduce disparities in the use of revascularization in patients with diagnosed coronary heart disease in the United States. Key points: Hospitalizations for heart disease and the use of revascularization both fell in the United States between 2012 and 2018 at a rate that was greater than the reduction in heart disease deaths in the country.Disparities in the use of revascularization, by gender, insurance status, neighborhood, and race/ethnicity, have remained large following the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014.The expansion of insurance by the ACA, alone, was insufficient to reduce disparities in the use of revascularization in patients with diagnosed coronary heart disease in the United States. [ABSTRACT FROM AUTHOR]

Background The coronary sinus reducer (CSR) is a therapeutic option for patients with coronary artery disease who are not eligible for further revascularization and experience refractory angina. Cardiac resynchronization therapy (CRT) improves symptoms and prognosis in heart failure with reduced ejection fraction, but the presence of a CSR may complicate left ventricular lead placement. Only four cases have been reported so far in this context. This case report introduces a novel technique for left ventricular lead implantation in such patients. Case summary A 73-year-old man with a history of chronic coronary syndrome, coronary artery bypass surgery, angioplasties, and CSR implantation presented with heart failure symptoms. His ECG showed sinus rhythm and left bundle branch block (QRS 160 ms), and echocardiography revealed severe systolic dysfunction (ejection fraction 20%). During Cardiac Resynchronization Therapy-Defibrillator (CRT-D) implantation, venography revealed a suitable proximal tributary branch near the CSR, which was successfully used for lead placement without complications. Discussion The CSR has shown promise in relieving refractory angina. As ischaemic heart disease progresses, CRT may become necessary in patients with CSR. The CSR's design can reduce the vascular lumen and complicate lead placement. Previous reports have confirmed the technical feasibility of CRT with CSR but lack long-term safety data. This case highlights that, under favourable anatomical conditions, proximal tributaries of the coronary sinus can be used for lead placement, potentially avoiding complications from reduced venous outflow. [ABSTRACT FROM AUTHOR]

Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available technologies. The object of the present review is to analyze the reluctance of surgeons toward the adoption of assessment methods. Materials and Method: A thorough literature review was carried out on Google Scholar based on the results obtained from AI's answer to the question about the reasons for that reluctance. We took advantage of using ChatGPT-4 since the research based on PubMed Central alone was not able to return a detailed response, maybe because the reasons for the reluctance are veiled in the text of the published papers. Through the items suggested by AI and taken from the literature, we deepened the research, pointing attention to the issues published so far about the various technologies. Results: There are many convincing pieces of evidence about the utility of intraoperative graft control in coronary surgery, involving improved clinical outcome, efficacy and safety, and social cost saving. The opinion that arose through this analysis is that, beyond the objective difficulties in utilizing some technologies and the equally objective limitations of an economic and organizational nature, the reluctance is the result of a real unwillingness based on the various implications that the discovery of the technical error entails. Conclusions: This negative attitude, in light of the convincing scientific and clinical evidence published up to now, appears to overwhelm the benefits for patients. [ABSTRACT FROM AUTHOR]

Background: Octogenarians constitute the fastest-growing segment within contemporary cardiac surgery, yet precise risk assessment in this age group remains challenging. Aims: This study aimed to evaluate EuroSCORE II reliability in octogenarians undergoing isolated coronary surgery and to create an adjustment formula if necessary. Patients and Methods: All octogenarians who had isolated coronary surgery in Poland from January 2012 to December 2023, recorded in the Polish National Registry of Cardiac Surgical Procedures (KROK registry), were retrospectively assessed. EuroSCORE II's reliability was measured using the ROC curve area and observed-to-predicted mortality ratio, differentiating on-pump and off-pump cases. A nomogram was developed to enhance predictive accuracy. Results: Among 5771 octogenarians, 2729 (47.3%) underwent on-pump and 3042 (52.7%) underwent off-pump surgery. EuroSCORE II demonstrated reliability in off-pump patients (AUC:0.72, O/E ratio:0.98) but underestimated mortality for on-pump cases (AUC:0.73, O/E ratio:1.62). The lowest predicted mortality group (0.50–1.82%) showed the greatest discrepancies. Calibration was improved by adding a coefficient and creating a nomogram. Conclusions: EuroSCORE II was dependable in predicting outcomes for Polish octogenarians undergoing isolated coronary surgery. Observed mortality following on-pump surgeries was higher than expected, which was corrected by adding a coefficient to the initial EuroSCORE II calculation. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have explored the effects of L-arginine, whether administered in the form of a supplement or through infusion during cardioplegia, on cardiac and inflammatory markers in individuals undergoing coronary artery bypass grafting (CABG). However, these studies presented contradictory findings. Consequently, the objective of this study was to investigate the impact of l-arginine on these markers by analyzing available randomized controlled trials (RCTs). Methods: We performed an extensive search across various databases, including Embase, Medline/PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, covering research published until December 2023. To analyze the mean changes in inflammatory and cardiac markers between the L-arginine and control groups, we calculated the weighted mean difference (WMD) along with the corresponding 95% confidence interval (CI) using a random-effects model. Results: A total of 393 RCTs were identified during the initial search. After screening and selection, 7 trials were included. In a meta-analysis of three trials that reported troponin T levels, we found a significant impact of L-arginine on reducing troponin T levels (WMD = -0.61 ng/ml; 95% CI: -1.07, -0.15). Our analysis also showed that L-arginine had a noticeable impact on decreasing interleukin-6 (IL-6) levels (WMD = -7.72 pg/ml; 95% CI: -15.05, -0.39). However, we found no considerable impact of L-arginine treatment on creatine phosphokinase-MB (CPK-MB), tumor necrosis factor-alpha (TNF-α), and troponin I compared to the placebo groups. Conclusions: Our findings suggest that L-arginine may benefit patients undergoing CABG, as it helps reduce inflammatory reactions and limits myocardial ischemia. This study registered in the PROSPERO database (Registration No. CRD42024508341). [ABSTRACT FROM AUTHOR]

OBJECTIVES Average treatment effects from randomized trials do not reflect the heterogeneity of an individual's response to treatment. This study evaluates the appropriate proportions of patients for coronary artery bypass grafting, or percutaneous intervention based on the predicted/observed ratio of 10-year all-cause mortality in the SYNTAX population. METHODS The study included 1800 randomized patients and 1275 patients in the nested percutaneous (n  = 198) or surgical (n  = 1077) registries. The primary end point was 10-year all-cause mortality. The SYNTAX score II-2020 was validated internally in the randomized cohort and externally in the registry cohort. Proportions of patients with survival benefits from coronary artery bypass grafting or percutaneous intervention were determined using SYNTAX score II-2020. RESULTS Ten-year mortality was 23.8% for coronary artery bypass grafting, 28.6% for percutaneous intervention in the randomized cohort, 27.6% for coronary artery bypass grafting and 55.4% for percutaneous intervention in the registries. In the coronary artery bypass grafting registry, the SYNTAX score II-2020 predicted 10-year mortality with helpful calibration and discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The proportion of patients deriving a predicted survival benefit from coronary artery bypass grafting over percutaneous intervention was 82.4% (2143/2602) and 17.7% (459/2602) for the entire SYNTAX trial population, translating into a 4.7 to 1 appropriate ratio of treatment allocation to coronary artery bypass grafting and percutaneous intervention. CONCLUSIONS Choosing a revascularization modality should depend on an individual's long-term prognosis rather than average treatment effects. Additionally, patients should be informed about their predicted prognosis. Trial registration Registered on clinicaltrial.gov SYNTAXES NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050) SYNTAX NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972) [ABSTRACT FROM AUTHOR]

OBJECTIVES Age is an important factor weighing on revascularization decisions. We analysed long-term health outcomes of young patients with low-complexity coronary anatomy suitable for both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), according to revascularization strategy. METHODS Patients 60 years old or less, undergoing invasive coronary angiography between January 2007 and December 2015, presenting with proximal left anterior descending artery involvement, left main or multivessel disease and a SYNTAX Score ≤22 were retrospectively selected. An inverse probability of treatment weight methodology generated a pseudopopulation with well-balanced characteristics, which was used to estimate the average treatment effect between PCI (n  = 374) and CABG (n  = 173). RESULTS Mean age was 53 ± 7 years old, 27% had diabetes mellitus and 48% presented with an acute coronary syndrome. Mean SYNTAX score was 13.6 ± 4.9 and 68% underwent PCI as index revascularization strategy. In the weighed population, the adjusted hazard of the primary end-point of all-cause death at total follow-up (median 9.3 years; interquartile range 6.9–11.7) was 0.40 (95% confidence interval 0.19–0.7) for CABG vs PCI (incidence rate 5.8 vs 14.0 deaths/1000-person-years). Accounting for death as competing risk, the cumulative hazard of new revascularization (sub-distribution hazard ratio 0.72; 95% confidence interval 0.32–1.25) and any cause hospital readmission (sub-distribution hazard ratio 0.70; 95% confidence interval 0.41–1.07) were lower in CABG patients, as opposed to death/stroke rates at 30 days which were higher with CABG (0.3% vs 1.7%; risk ratio = 5.84). CONCLUSIONS In this quasi-experimental analysis of young patients with coronary artery disease and an equivalent indication for both PCI and CABG, long-term health outcomes were favourably associated with CABG, as compared to PCI. These observations support the need for dedicated randomized trials with longer follow-up in order to better inform lifetime treatment options. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Patients with hemophilia A can safely undergo cardiac surgery. Combining continuous infusion and boluses of factor VIII is both safe and cost‐effective. Interdisciplinary approach and meticulous planning are crucial in the prevention of bleeding complications. [ABSTRACT FROM AUTHOR]

Background: as transcatheter technologies have advanced, the patient population that is referred to open heart surgeries has shifted. This study's objective was to evaluate recent trends in the characteristics of patients undergo surgical valvular interventions and coronary revascularizations (CABG) in our center over a period of 14 years. Methods: this is a retrospective analysis of ecological trends in the age, sex, and risk profile (Charlson comorbidity index—CCI) of patients who, from January 2010 to December 2023, underwent CABG, aortic valve replacement (AVR), or mitral valve repair or replacement (with or without tricuspid valve intervention). The data were extracted from electronic clinical files using MD-Clone software. Results: for the CABG procedures, the respective data for 2010 and 2023 were: mean ages 68.0 and 64.6 years; 79.7% and 83.1% males; and mean CCI scores 3.16 and 2.51. The p-values for the cumulative differences over the study period were 0.001, 0.005, and 0.013, respectively. The respective data for isolated AVR were mean ages of 69.2 and 62.9 years; 64.1% and 59.1% males; mean CCI 3.64 and 2.32; p-values: <0.001, 0.229, and 0.019. The respective data for mitral valve procedures were mean ages of 63.6 and 59.8 years, 71.4% and 65.5% males; mean CCI 2.90 and 1.79; p-values: 0.84, 0.422, and 0.318. Conclusions: over a 14-year period, changes were evident in the age, sex distribution, and CCI for operations performed in our center. These changes most likely resulted from accumulated data regarding the advantages and detriments of treatment strategies, mostly of CABG vs. percutaneous coronary intervention; major advancements in transcatheter technologies, mostly in transcatheter AVR; and clinical guidelines facilitating a more collaborative decision-making, open-minded, and personalized approach. [ABSTRACT FROM AUTHOR]

The article in Acta Cardiologica delves into the correlation between the thumb-palm test and ascending aortic diameter and aortic regurgitation, aiming to predict aortic dilatation and insufficiency in adult patients. The study reveals that a positive thumb-palm test is linked to an increase in ascending aortic diameter and aortic regurgitation grades, even after adjusting for various factors. It emphasizes the potential of the thumb-palm test in foreseeing aortic aneurysm and regurgitation during routine evaluations, drawing on research on aortic root size in hypertensive and normotensive individuals, as well as insights into giant cell arteritis, the Framingham Heart Study, and aortic root dilatation in hypertensive patients. [Extracted from the article]

Background In transcatheter aortic valve implantation, the transfemoral approach is commonly used, but challenging access and procedural difficulties are sometimes encountered. Among alternatives, the transcarotid approach is increasingly used. We present a case of transcatheter aortic valve implantation in which a left common carotid approach achieved favourable outcomes in a patient with low cardiac function and dialysis. Case summary The patient was a 67-year-old woman with a history of coronary artery bypass surgery and dialysis. Heart failure secondary to aortic stenosis and hypotension during dialysis required surgery. Echocardiography indicated severe aortic stenosis with low-flow low-gradient. Access was problematic, with 4.0 mm diameter calcified external iliac arteries. Severe calcific stenosis was observed in the left subclavian artery, and the presence of right internal thoracic artery bypass rendered the bilateral subclavian artery approach unsuitable. Given the history of open-heart surgery and reduced left ventricular function, the carotid approach was chosen; however, both internal carotid arteries showed moderate stenosis. Carotid compression magnetic resonance angiography confirmed intracranial communication, so we chose access through the more severely stenosed left common carotid artery. Under preoperative extracorporeal membrane oxygenation and general anaesthesia, transcatheter aortic valve implantation was performed with a Sapien3 Ultra RESILIA 23 mm valve. Postoperatively, there was no symptomatic cerebral infarction, and the dialysis-related hypotension resolved. Discussion Even with intracranial carotid stenosis, flow evaluations, such as Matas test magnetic resonance imaging assessments, can reduce the cerebral infarction risk during transcarotid-transcatheter aortic valve implantation, providing a potentially safe and minimally invasive alternative access. [ABSTRACT FROM AUTHOR]

Objective: Calafiore and modified del Nido cardioplegic solutions are currently being used during coronary artery bypass surgery. This study aims to compare myocardial ischemic stress associated with both solutions by studying the changes in cardiac metabolites during cardioplegic ischemic arrest and early reperfusion. Methods: Biopsy specimens were taken from the left ventricles of 20 patients undergoing routine coronary artery bypass grafting using Calafiore or modified del Nido cardioplegic solutions. Biopsies were taken immediately after the beginning of extracorporeal circulation (basal biopsy), 30 min after application of the aortic cross‐clamp (ischemic biopsy), and 20 min following the removal of aortic cross‐clamp (reperfusion biopsy) and were analyzed for their amino acid and lactic acid contents using amino acid analyzer and appropriate kits. Peripheral blood samples were also collected for the determination of blood concentrations of cardiac proteins (CK‐MB and troponin I) using an immunofluorescence scanner. Results: Both CK‐MB and troponin I increased significantly 12 h postoperatively and were associated with an increase in myocardial lactic acid, but there were no significant differences in markers of myocardial injury between the two groups. Comparison of amino acid concentrations between the two groups according to sampling time showed that glutamic acid concentrations were significantly lower in the Calafiore cardioplegia group compared to the del Nido cardioplegia group, but there were no other significant differences in markers of metabolic stress (taurine and alanine/glutamate ratio) between the two groups. Moreover, there were no significant differences in changes in amino acid concentrations regardless of the type of cardioplegic solution used. Conclusions: Cardioplegic ischemic arrest and early reperfusion are associated with a rise in myocardial metabolic stress. Both Calafiore and modified del Nido cardioplegic solutions are effective in attenuating myocardial substrate derangements and confer equal myocardial protection during routine coronary artery bypass surgery. Trial Registration: ClinicalTrials.gov identifier: NCT06287372 [ABSTRACT FROM AUTHOR]

The article explores the need to redefine perioperative myocardial infarction (PMI) after cardiac surgery. It discusses different definitions of PMI and their implications for patient outcomes. The authors argue for updating the criteria for PMI diagnosis, particularly in non-coronary artery bypass graft surgeries, and emphasize the importance of considering the dynamics of cardiac biomarkers over time. They also highlight the challenges of using cardiac troponin to diagnose PMI and propose that a better definition should take into account the amount of myocardial injury associated with different procedures. Further research is needed to develop a more accurate and comprehensive definition of PMI. [Extracted from the article]

Background: Cell therapy can protect cardiomyocytes from hypoxia, primarily via paracrine secretions, including extracellular vesicles (EVs). Since EVs fulfil specific biological functions based on their cellular origin, we hypothesised that EVs from human cardiac stromal cells (CMSCLCs) obtained from coronary artery bypass surgery may have cardioprotective properties. Objectives: This study characterises CMSCLC EVs (C_EVs), miRNA cargo, cardioprotective efficacy and transcriptomic modulation of hypoxic human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). C_EVs are compared to bone marrow mesenchymal stromal cell EVs (B_EVs) which are a known therapeutic EV type. Methods: Cells were characterised for surface markers, gene expression and differentiation potential. EVs were compared for yield, phenotype, and ability to protect hiPSC-CMs from hypoxia/reoxygenation injury. EV dose was normalised by both protein concentration and particle count, allowing direct comparison. C_EV and B_EV miRNA cargo was profiled and RNA-seq was performed on EV-treated hypoxic hiPSC-CMs, then data were integrated by multi-omics. Confirmatory experiments were carried out using miRNA mimics. Results: At the same dose, C_EVs were more effective than B_EVs at protecting CM integrity, reducing apoptotic markers, and cell death during hypoxia. While C_EVs and B_EVs shared 70–77% similarity in miRNA content, C_EVs contained unique miRNAs, including miR-202-5p, miR-451a and miR-142-3p. Delivering miRNA mimics confirmed that miR-1260a and miR-202/451a/142 were cardioprotective, and the latter upregulated protective pathways similar to whole C_EVs. Conclusions: This study demonstrates the potential of cardiac tissues, routinely discarded following surgery, as a valuable source of EVs for myocardial infarction therapy. We also identify miR-1260a as protective of CM hypoxia. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the relationship between advanced glycation end product (AGE) levels in patients with saphenous vein graft (SVG) failure and in patients without SVG failure. Subjects and Methods: In our study, 55 patients with a history of previous coronary artery bypass grafting (CABG) surgery, who subsequently underwent coronary angiography for any reason and were found to have either SVG occlusion or significant lesions, were included as study patients. Additionally, 55 patients who have had CABG surgery without SVG failure for at least 1 year served as the control group. AGE values of the patients were measured using the skin autofluorescence method. Results: In our study results, we observed a significant difference in AGE levels between the two groups of patients with similar demographic characteristics (SVG failure groups AGE 3.2 [2.8–3.6] vs. control groups AGE 2.4 [2.1–2.7] p < 0.001). In the receiver operating characteristic curve analysis, we determined the ability of AGE levels to detect SVG failure with an area under the curve of 0.869. We found that in patients with AGE >3, it could detect SVG failure with a sensitivity of 70.9% and a specificity of 87.3%. Conclusions: Our results demonstrate that AGE levels can predict SVG failure risk inexpensively, easily, and quickly. [ABSTRACT FROM AUTHOR]

OBJECTIVES The threshold to perform concomitant tricuspid valve (TV) repair during primary mitral valve (MV) surgery has decreased, based on recent randomized evidence. Based on these developments, the indication for TV repair during MV surgery is expected to increase further. However, concerns have been raised regarding the risk of permanent pacemaker implantation (PPI) during a concomitant procedure. Therefore, we aim to assess the incidence of PPI in combined MV and TV surgery in a nationwide registry. METHODS The current study uniquely cross-linked the Cardiothoracic and Pacemaker/ICD registry of the Netherlands Heart Registration. Patients undergoing primary MV and TV surgery (± atrial septal defect closure, rhythm surgery, coronary artery bypass grafting) between 1 January and 31 December2021 were included. The primary outcome was PPI within 30 days after surgery. Subgroup analyses were performed for isolated MV and TV surgery and MV repair. The association between concomitant TV surgery and PPI was assessed using multivariable binary logistic regression analyses. RESULTS A total of 1060 patients (n  = 833 MV, n  = 227 MV + TV) were included. The overall incidence of PPI was 4.3%. No significant difference in PPI between MV and MV + TV surgery were found (3.7% vs 6.6%, P  = 0.06). Concomitant TV surgery was not an independent risk factor for PPI after surgery after adjustment for covariates. These results were robust after sensitivity analyses. CONCLUSIONS The current study was not able to find a statistical difference between the PPI rate in MV surgery patients and MV + TV surgery patients. Extension of the waiting period prior to PPI, may result in decreased PPI rates. [ABSTRACT FROM AUTHOR]

Background: Graft occlusions are commonly present in symptomatic patients after coronary artery bypass surgery (CABG). The aim of this study was to evaluate the diagnostic accuracy of coronary computed tomography angiography (CCTA) and stress single photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) for detecting graft disease in symptomatic post-CABG patients. Methods: This was a prospective, single centre study of 100 symptomatic post-CABG patients with native coronary artery/graft occlusions on invasive angiography (CAG). Grafts were evaluated for degree of stenosis qualitatively on CCTA. Reversible perfusion defects were graded using summed difference score (SDS) on MPI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CCTA and MPI were evaluated against CAG. Results: CCTA identified 17/31 (55%), 30/43 (70%) and 18/19 (95%) patients with ≥50% stenosis of arterial, venous and both grafts respectively with specificity and PPV of 100%. Reversible perfusion defects were present in 81% of the patients with a mean SDS score of 5.4 ± 3.39 and sensitivity of 84%. Accuracy of CCTA and MPI for detection of graft occlusions were 99% and 84% respectively. 63/65 (97%) patients with ≥50% stenosis of grafts had ≥ 5 SDS score (moderate to severe grade ischemia) and 64% patients were revascularized. Conclusion: CCTA has a comparable diagnostic accuracy to CAG and can be used as an initial investigation in symptomatic post-CABG patients. Reversible perfusion defects on stress MPI help to risk stratify symptomatic post-CABG patients and guide further treatment. Hemodynamically significant occlusions may benefit from revascularization. [ABSTRACT FROM AUTHOR]

A 51‐year‐old woman presented with recurring palpitations. Electrocardiography revealed narrow QRS tachycardia with short RP configuration. Computed tomography showed coronary sinus (CS) ostial atresia along with a small persistent left superior vena cava (PLSVC). Electrophysiological study identified the retrograde earliest atrial activation site (EAAS) at the CS ostium without decremental properties, and para‐Hisian pacing suggested retrograde atrioventricular nodal conduction. Using a 1.6‐Fr microelectrode catheter distally placed in the CS via the PLSVC, EAAS was confirmed within the left atrium, not the CS ostium. Transseptal approach revealed a left lateral accessory pathway, which was successfully eliminated. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the beneficial effects of N-acetylcysteine (NAC) in the treatment of contrast-induced nephropathy (CIN). Materials and Methods A prospective study was conducted in the department of cardiology of a tertiary health care hospital. A sample of 100 patients who had developed CIN through coronary angioplasty were categorized into two groups: one group treated with intravenous fluids (IVF) monotherapy and the other group treated with the combination of IVF and NAC therapy. Statistical Analysis The data were analyzed using statistical software SPSS software version 26 and statistical significance was set at p < 0.05. Independent t -test and paired t -test were used to analyze the parameters. Results The rate of incidence of CIN was found to be 10%. We observed that the IVF + NAC combination therapy significantly decreases the serum creatinine compared to IVF monotherapy (p = 0.004). Both therapies show similar treatment outcomes with no significant difference (p = 0.556) in the case of estimated glomerular filtration rate (eGFR). Based on creatinine clearance, the results show adding NAC does not impact any additional benefits (p = 000). The duration of hospital stay of the NAC group was reduced significantly (p = 0.000). Conclusion At present, we found that the treatment outcomes which we analyzed based on factors such as serum creatinine, eGFR, and creatinine clearance, are too inconsistent to conclude the beneficial effect of NAC in the management of CIN. [ABSTRACT FROM AUTHOR]

Background: There are no clear recommendations for optimal transfusion thresholds for patients with coronary artery disease who undergo noncardiac surgery. By comparing restrictive and liberal transfusion strategies for coronary artery disease combined with hip surgery, this study hopes to provide recommendations for transfusion strategies in this special population. Methods: A total of 805 patients from the FOCUS trial (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) with coronary artery disease combined with hip surgery were divided into two groups based on transfusion thresholds: restricted transfusion (a hemoglobin level of 8 g/deciliter) and liberal transfusion (a hemoglobin threshold of 10 g/deciliter). The primary outcome of this study was a composite endpoint including in-hospital death, myocardial infarction, unstable angina, and acute heart failure. The secondary endpoints included other in-hospital adverse events and 30- and 60-day follow-up events. Analyses were performed by intention to treat. Results: Except for the proportion of congestive heart failure patients, the baseline levels of the two groups were comparable. The median number of transfusion units in the liberal transfusion group was 2 units, and the median transfusion volume in the restricted transfusion group was 0 units. The primary outcome was not significantly different between the two groups (9.2% vs. 9.4%, p = 0.91). The incidence of in-hospital myocardial infarction events was lower in the liberal transfusion group than in the restricted transfusion group (3.2% vs. 6.2%) (OR = 0.51, P = 0.048). The remaining in-hospital endpoint events, except for myocardial infarction, were not significantly different between the two groups. The 30-day and 60-day endpoints of death and inability to walk independently were not significantly different between the two groups, with ORs (95% CI) of 1.00 (0.75–1.31) and 1.06 (0.80–1.41), respectively. We also found no interaction between transfusion strategies and factors such as age, sex, or multiple underlying comorbidities at the 60-day follow-up. Conclusions: There was no significant difference in the in-hospital, 30-day or 60-day outcome endpoints between the two groups. However, this study demonstrated that a liberal transfusion strategy tends to reduce the incidence of in-hospital myocardial infarction events in patients with coronary artery disease combined with hip surgery compared to a restrictive transfusion strategy. More high-quality studies should be designed to investigate the optimal transfusion threshold in patients with coronary artery disease treated without cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Bentall surgery is the main method for treating aortic root lesions, but traditional Bentall method is very difficult for patients with mild aortic sinus dilation to directly anastomose the coronary artery orifice with graft. Case presentation: A 41-year-old man was admitted to hospital after severe chest pain. Computed tomography angiography(CTA)revealed a type A aortic dissection. Echocardiography showed moderate aortic valve regurgitation and an aortic sinus diameter of 38 mm(mm). The patient underwent emergency Bentall surgery (using a preset coronary artery orifice patch), total arch replacement, and implantation of a graft into the descending aorta. Follow-up echocardiography showed the patient cardiac function was good, and there was no residual leakage at the coronary artery orifice. Conclusions: This method is an alternative to traditional Bentall surgery and is suitable for all aortic root lesions, especially those with mild aortic sinus dilation or concomitant aortic dissection. [ABSTRACT FROM AUTHOR]

Introduction: Catheter‐based radiofrequency (RF) ablation is generally regarded as the standard approach for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drug therapy and may be considered as a first‐line approach when there is a preference to avoid these agents. Patients with a history of cardiac surgery may have VT substrate inaccessible to catheter ablation due to intervening prosthetic materials or scar. Methods and Results: This article describes a 55‐year‐old patient with a history of surgically repaired subvalvular aortic stenosis and subsequent valve‐sparing root replacement who presented with sustained VT. After RF ablation failed due to VT substrate "guarded" by graft material, retrograde coronary venous ethanol ablation (RCVEA) was employed to successfully treat the clinical VT. Conclusion: RCVEA ablation can be useful for treating VT when conventional ablation is limited by inaccessible substrate due to prior cardiac surgery. [ABSTRACT FROM AUTHOR]

We studied the relationship of inotropic responses of the isolated myocardium to stimulation of β1-and β2-adrenergic receptors (β-AR) with echocardiography parameters in 28 patients with coronary heart disease (CHD). Myocardial fragments (trabeculae of the right atrial appendage) were obtained during coronary artery bypass surgery. The inotropic response of the trabeculae was assessed in an isometric mode. Stimulation of β1-and β2-AR with agonists was performed against the background of preliminary α-AR blockade. In case of preserved ejection fraction, significant inotropic response of the trabeculae (135 (112; 154)% from the initial contraction amplitude) was observed after β1-AR stimulation, while in reduced ejection fraction, its significant increase was observed after β1-AR stimulation (126 (112; 170)% from the initial contraction amplitude). In patients with preserved and reduced ejection fraction, the correlations between the inotropic responses of the trabeculae to β1-and β2-AR stimulation and echocardiography parameters were different. The revealed differences reflect the degree of cardiac remodeling under condition of the studied pathology. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of ling gui shen fu decoction (LGSFD) on cardiac injury and cardiomyocyte apoptosis in rats with ischemic heart disease (IHD), and to elucidate the underlying molecular mechanism. Methods: An IHD rat model was established by performing coronary artery occlusion surgery on the left anterior descending (LAD) of rats. The rats were assigned equally to 5 groups: sham-operated group (sham group), IHD group, IHD + perindopril group, IHD + low-dose LGSFD group (IHD + LGSFD-L group), and IHD + high-dose LGSFD group (IHD+LGSFD-H group). The LGSFD was given via gavage. A hypoxia-induced cardiomyocyte model was established by subjecting H9C2 cells to hypoxia. Then, LGSFD-containing serum or blank serum was used to treat the hypoxic rat cardiomyocytes (H9C2). The severity of cardiac injury and extent of apoptotic changes in cardiomyocytes was determined using hematoxylin-eosin (H&E) staining and TUNEL staining, while immunoblotting was used to measure the protein expressions of ANP32A, p-AKT, AKT, HIF-2a, p-mTOR, mTOR and HMGB1. Results: The cardiac injury of rats in the LGSFD groups was significantly reversed, relative to the IHD group (p < 0.05). Moreover, LGSFD reduced the level of apoptosis in hypoxia-induced H9C2 cells and upregulated the concentrations of ANP32A, p-AKT, HIF-2a and p-mTOR. However, the expression levels of HMGB1 were decreased in the heart tissues of IHD rats and hypoxic H9C2 cells. Silencing of ANP32A with ANP32A siRNA (siANP32A) down-regulated ANP32A, p-AKT, HIF-2a and p-mTOR, but up-regulated apoptosis and expression levels of HMGB1 in hypoxic H9C2 cells. Conclusion: LGSFD ameliorates cardiac injury in IHD rats by inhibiting cardiomyocyte apoptosis via the ANP32A/HIF-2a/HMGB1 axis. Further investigations are recommended into the specific mechanism of LGSFD effect using clinical samples, in order to facilitate its clinical development. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery is considered a contraindication in patients with advanced liver cirrhosis (LC) due to increased mortality and morbidity. There are limited data on the treatment strategy and management of this population. We aimed to present our strategy and evaluate the clinical outcome of cardiac surgery in patients with LC. Methods: Our strategy was (i) to list patients for liver transplant (LT) at the time of cardiac surgery; (ii) to maintain high cardiopulmonary bypass (CPB) flow (index up to 3.0 L/min/m2) based on hyper‐dynamic states due to LC; and (iii) to proceed to LT if patients' liver function deteriorated with an increasing model for end‐stage liver disease Na (MELD‐Na) score after cardiac surgery. Thirteen patients (12 male and 1 female [mean age, 63.0]) with LC who underwent cardiac surgery between 2017 and 2024 were retrospectively analyzed. Results: Six patients were listed for LT. Indications for cardiac surgery included coronary artery disease (N = 7), endocarditis (N = 2), and tricuspid regurgitation (N = 1), tricuspid stenosis (N = 1), mitral regurgitation (N = 1), and hypertrophic obstructive cardiomyopathy (N = 1). The Child–Pugh score was A in five, B in six, and C in one patient. The procedure included coronary artery bypass grafting (N = 6), single valve surgery (mitral valve [N = 2] and tricuspid valve [N = 1]), concomitant aortic and tricuspid valve surgery (N = 2), and septal myectomy (N = 1). Two patients had a history of previous sternotomy. The perfusion index during CPB was 3.1 ± 0.5 L/min/m2. Postoperative complications include pleural effusion (N = 6), bleeding events (N = 3), acute kidney injury (N = 1), respiratory failure requiring tracheostomy (N = 2), tamponade (N = 1), and sternal infection (N = 1). There was no in‐hospital death. There was one remote death due to COVID‐19 complication. Preoperative and postoperative highest MELD‐Na score among listed patients was 15.8 ± 5.1 and 19.3 ± 5.3, respectively. Five patients underwent LT (1, 5, 8, 16, and 24 months following cardiac surgery) and one patient remains on the list. Survival rates at 1 and 3 years are 100% and 75.0%, respectively. Conclusion: Cardiac surgery maintaining high CPB flow with LT backup is a feasible strategy in an otherwise inoperable patient population with an acceptable early and midterm survival when performed in a center with an experienced cardiac surgery and LT program. [ABSTRACT FROM AUTHOR]

Background: The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. Methods: In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Results: Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; p < 0.001), a longer HLOS (13 days (10–19) vs. 12 days (9–16); p < 0.001), and a longer VT (33 h (11–124) vs. 28 h (9–94); p < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; p < 0.001), a shorter HLOS (12 days (9–16) vs. 13 days (10–19); p < 0.001) and a shorter VT (20 h (10–69) vs. 36 h (11–135); p < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51–2.29, p < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91–1.97, p < 0.001), and a longer VT (33.67 h; 95% CI: 18.67–48.66, p < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; p < 0.001) and a shorter VT (20 h (10–69) vs. 65 h (29–210); p < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42–9.51, p < 0.001). Conclusions: COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this. [ABSTRACT FROM AUTHOR]

Background Hemodynamic stability is crucial during coronary artery bypass grafting (CABG) surgery to reduce perioperative complications. Dexmedetomidine, an alpha-2 adrenergic agonist, has been increasingly used for its sedative, analgesic, and sympatholytic properties. This study aims to evaluate the effects of intraoperative dexmedetomidine administration on hemodynamic parameters during CABG surgery. Materials and Methods A randomized controlled trial was conducted on 120 patients undergoing elective CABG surgery. Patients were randomly assigned into two groups: Group D (dexmedetomidine, n=60) and Group C (control, n=60). Group D received a loading dose of dexmedetomidine (0.5 μg/kg) followed by a maintenance infusion of 0.4 μg/kg/h until the end of surgery. Group C received an equivalent volume of saline as placebo. Hemodynamic parameters, including heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO), were recorded at baseline, after induction, during cardiopulmonary bypass, and postoperatively. Statistical analysis was performed using ANOVA and t-tests. Results The administration of dexmedetomidine significantly reduced HR and MAP compared to the control group. At the end of surgery, Group D showed a 15% reduction in HR (p<0.001) and a 20% decrease in MAP (p<0.001) compared to baseline. Additionally, CO was better maintained in Group D, with an average CO of 5.5 L/min compared to 4.8 L/min in Group C (p=0.03). The incidence of intraoperative hypotension was lower in Group D (10%) compared to Group C (25%) (p=0.02). Postoperative recovery was also smoother in Group D, with a lower requirement for vasoactive drugs. Conclusion Intraoperative administration of dexmedetomidine during CABG surgery significantly improves hemodynamic stability, reducing the incidence of intraoperative hypotension and maintaining cardiac output. Dexmedetomidine may be a valuable adjunct in managing patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Diabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery. A total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed. Patients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p<0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p<0.01) and longer ventilation times (p<0.001) compared with non-DM and IDDM patients (p<0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p<0.001). Non-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting. [ABSTRACT FROM AUTHOR]

Background: Ticagrelor, used in acute coronary syndrome (ACS), can be administered via nasogastric tube when oral intake is impossible. We investigated platelet inhibition and pharmacokinetics in resuscitated ACS patients and those undergoing semi-urgent coronary artery bypass graft (CABG) surgery. Our study aimed to assess platelet inhibition with use of the Platelet Function Analyser (PFA) and measured plasma concentrations of ticagrelor and its active metabolite in these ACS patients. Methods: We included resuscitated cardiac arrest patients (STEMI/NSTEMI) and semi-urgent CABG patients. Crushed ticagrelor tablets were administered using a nasogastric tube. PFA closure time (CT) was determined with CT longer than 113 s as reference range. Plasma concentrations of ticagrelor and its active metabolite were measured after protein precipitation, by using liquid chromatography with mass spectrometry detection. Results: In 20 resuscitated patients, 89% showed platelet inhibition at 24 h and 92% at day 4. For semi-urgent CABG patients, 85% exhibited platelet inhibition at 24 h and 84% at day 4. For ticagrelor in resuscitated patients, the median time to peak plasma concentration (Tmax) was 100 h [8; 100] for a median maximal concentration (Cmax) of 615.5 ng/mL [217.5; 1385.0]. For AR-C124910XX median Tmax was 100 h [8; 100] for a Cmax of 131.0 ng/mL [52.1; 177.7]. Among 20 patients undergoing semi-urgent CABG, Tmax for ticagrelor was 100 h [100; 100] for a median Cmax of 857.0 ng/ml [496.8; 1157.5]. For AR-C124910XX, median Tmax was 100 h [43; 100] for a Cmax of 251.0 ng/ml [173.0; 396.5]. Conclusion: Crushed ticagrelor via nasogastric tube achieved targeted platelet inhibition. Pharmacokinetics aligned with previous studies. EudraCT number: 2013-004191-35; Study protocol code: AGO/2013/011; EC/2014/1061; ClinicalTrial.gov identifier: NCT02341729 [ABSTRACT FROM AUTHOR]

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Background: Millions of patients undergo cardiac surgery each year. The red blood cell distribution width (RDW) could help predict the prognosis of patients who undergo percutaneous coronary intervention or coronary artery bypass surgery. We investigated whether the RDW has robust predictive value for the 30-day mortality among patients in an intensive care unit (ICU) after undergoing cardiac surgery. Methods: Using the Medical Information Mart for Intensive Care-IV Database, we retrieved data for 11,634 patients who underwent cardiac surgery in an ICU. We performed multivariate Cox regression analysis to model the association between the RDW and 30-day mortality and plotted Kaplan-Meier curves. Subgroup analyses were stratified using relevant covariates. Receiver operating characteristic (ROC) curves were used to determine the predictive value of the RDWs. Results: The total 30-day mortality rate was 4.2% (485/11,502). The elevated-RDW group had a higher 30-day mortality rate than the normal-RDW group (P <0.001). The robustness of our data analysis was confirmed by performing subgroup analyses. Each unit increase in the RDW was associated with a 17% increase in 30-day mortality when the RDW was used as a continuous variable (adjusted hazard ratio=1.17, 95% confidence interval, 1.10-1.25). Our ROC results showed the predictive value of the RDW. Conclusions: An elevated RDW was associated with a higher 30-day mortality in patients after undergoing cardiac surgery in an ICU setting. The RDW can serve as an efficient and accessible method for predicting the mortality of patients in ICUs following cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to investigate whether the use of antegrade perfusion with terminal non-cardioplegic warm blood (TNWB) before aortic unclamping in single-clamp technique coronary artery bypass has a positive impact on intraoperative heartbeat recovery. Methods: Between December 2022 and May 2023, 40 consecutive patients undergoing coronary artery bypass using single-clamp technique were randomized into one of two groups: the TNWB group received an antegrade perfusion with TNWB before removing the aortic cross-clamp (n = 20), while the control group did not receive (n = 20). The time intervals between coronary perfusion and the onset of the first heartbeats and sinus rhythms, occurrences of spontaneous sinus rhythm, intraoperative defibrillation requirements, as well as postoperative CK-MB and troponin T levels were recorded and subjected to analysis. Results: In the TNWB group, the median onset of the first heartbeats after the initiation of coronary perfusion was 34 s (4-100), while in the control group, it was 90 s (15–340) (p < 0.001). The median onset of the sinus rhythms was 100 s (28–290) in the TNWB group and was 132 s (45–350) in the control group (p = 0.023). The occurrence of intraoperative arrhythmias was 15% in the TNWB group compared to 50% in the control group (p = 0.018), and the incidence for internal defibrillation was 5% in the TNWB group and was 30% in the control group (p = 0.037). The TNWB group showed the median CK-MB levels at 6 h postoperative was 14.10 ng/mL (9.78–19.26), compared to 18.31 ng/mL (13.98–23.80) in the control group (p = 0.045). Conclusions: During single clamp coronary artery bypass, administration TNWB into the aortic root before aortic unclamping has the potential to enhance heartbeat recovery, as evidenced by the shortened time to the initial heartbeat and the establishment of sinus beats following coronary perfusion. Trial registration: Trial registration number (Study ID): TCTR20231002003. [ABSTRACT FROM AUTHOR]

Aims. We described our advancement in the field of robotic cardiac surgery, particularly in the context of coronary revascularization. We will outline how the application of the Da Vinci® X Surgical System in coronary surgery is safe, feasible, and reproducible after an adequate familiarization with the docking system, that could come from a previous mitral valve robotic program, and after a sufficient learning time period. Methods. Between February 2021 and December 2023, a cohort of 33 patients underwent coronary artery revascularization surgery, involving robotic harvesting of the left mammary artery and off‐pump hand‐direct bypass to the left descending coronary artery or marginal coronary artery. In cases of hybrid revascularization, percutaneous coronary intervention with drug‐eluting stent placement was performed either before or after surgery. Results. There were no mortalities within 30 days and at 1 year of follow‐up after surgery. Notably, 70% of patients were extubated in the operating room immediately following the surgical procedure. The median postoperative mechanical ventilation time was 0 [0–4] hours, and the median length of stay in the intensive care unit was 21 [20–48] hours. A progressive reduction of the console and instrumental Da Vinci® X Surgical System was underling after the 21st patient. Conclusion. The promising outcomes observed in this series highlight that robotic‐assisted coronary artery bypass represents a well‐established technique that could be reproducible, especially when integrated into a hybrid strategy. Initiating a program in robotic‐assisted coronary artery bypass surgery can be effectively attained in particularly when a well‐established background in Da Vinci® X Surgical System utilization is achieved. [ABSTRACT FROM AUTHOR]

AIM: The effect of salvianolic acid B on myocardial ischemia-reperfusion injury (MIRI) and its possible mechanism of action. METHODS: In this experiment, human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) were used to establish a myocardial injury model by hypoxia for 6 hours and reoxygenation for 24 hours. Salvianolic acid B (7. 5, 15, 30, 60, 120 μg/mL) was selected Study the effects of 5 dose groups on the impedance and field potential of hiPSC-CMs and hiPSC-CMs myocardial injury models. Subsequently, animal experiments were conducted and divided into sham surgery group, myocardial ischemia-reperfusion model group, salvianolic acid B low (15 mg/kg), medium (30 mg/kg), high (60 mg/kg) dose group, and positive control propranolol (2. 5 mg/kg) group. After 4 days of gastric administration, left anterior descending coronary artery ligation surgery (ischemia for 30 minutes, reperfusion for 24 hours) was performed to establish a rat MIRI model, and the ischemic area of the rat heart was observed using TTC staining method. HE staining method was used to observe the pathological morphology of rat myocardial structure. Exploring the protective effect of salvianolic acid B on MIRI by measuring serum central muscle enzyme activity using a fully automated biochemical analyzer. Use a reagent kit to detect the possible antioxidant mechanisms involved in the protection of MIRI by salvianolic acid B. RESULTS: Salvianolic acid B has the effect of enhancing the contractility of hiPSC CMs, reducing myocardial injury, and improving field potential function. And it can effectively reduce the myocardial ischemic area of the rat MIRI model, improve myocardial structural damage, reduce myocardial enzyme activity, and protect the heart. In addition, it can also reduce the content of malondialdehyde (MDA) in the serum of MIRI rats, enhance the activity of superoxide dismutase (SOD) and reduced glutathione (GSH), and play an antioxidant role in improving myocardial injury. CONCLUSION: Salvianolic acid B can effectively reduce MIRI and play a role in improving the physiological function of myocardial cells and protecting the heart. Its mechanism of action may be related to reducing MDA levels, increasing SOD activity, and enhancing GSH activity of the serum [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Myocardial ischaemia following coronary artery bypass grafting (CABG) is a potentially devastating complication. Nevertheless, the incidence, aetiology and prognostic relevance of unplanned coronary angiography (uCAG) remain understudied. We aimed to investigate the prevalence and outcome of patients undergoing urgent, uCAG in the postoperative period following CABG. METHODS We screened all patients undergoing isolated elective CABG in an academic referral centre between 2016 and 2021 and identified patients undergoing uCAG within 30 days of surgery. For uCAG patients, a distinction was made between patients undergoing re-revascularization (REV) and patients receiving conservative management (CON). The primary outcomes were 30-day mortality and unadjusted and adjusted long-term survival. Secondary outcomes were the indication for and prevalence of uCAG and urgent revascularization. RESULTS Of the 1918 patients undergoing isolated CABG, 78 individuals needed uCAG (4.1%), of whom 45 underwent immediate revascularization (REV group; 2.3% overall, 57% within the uCAG group, median age 69.9 years) and 33 were treated conservatively (CONS group; 1.7% overall, 42% within the uCAG group, median age 69.1 years). Patients undergoing uCAG (n  = 78) had a higher 30-day mortality than patients not undergoing uCAG (n  = 1840, 30-day mortality: 9.0% vs 0.4%, P  < 0.001). Long-term survival was significantly decreased in patients undergoing uCAG in both unadjusted (hazard ratio 2.20, 95% confidence interval 1.30–3.73) and EuroSCORE-, age- and sex-adjusted models (hazard ratio uCAG 2.03, 95% confidence interval 1.16–3.56). CONCLUSIONS Unplanned postoperative coronary angiography is performed in 4.1% of isolated CABG procedures, and patients in need of such urgent invasive evaluation are subjected to decreased short- and long-term survival. [ABSTRACT FROM AUTHOR]

OBJECTIVES The aim of the study was to investigate the potential prognostic role of preoperative measurement of erector spinae myosteatosis with Hounsfield unit average calculation as a marker for sarcopenia and frailty in patients undergoing coronary bypass surgery. METHODS Preoperative computer tomography-derived measurements of 479 consecutive patients undergoing coronary bypass surgery between January 2017 and December 2019 were retrospectively performed. The erector spinae muscle at the level of the 12th vertebra was manually outlined bilaterally on the axial computer tomography slices and Hounsfield unit average calculation was performed. The lower quartile of muscle density values was defined as myosteatotic and thus sarcopenic. Sarcopenic (n  = 121) versus non-sarcopenic patients (n  = 358) were compared regarding postoperative morbidity and short- and long-term mortality. Results were adjusted for age, body mass index, atrial fibrillation and hypertension using inverse probability weighting. RESULTS Sarcopenia was associated with higher 30-day mortality (4.1% vs 0.8%; P  = 0.012), mid-term mortality after 1 year (9.3% vs 3.1%; P  = 0.047) and 2 years (10.8% vs 4.2%; P  = 0.047). Long-term mortality (5 years) was 20.8% for sarcopenic and 13.0% for non-sarcopenic patients but was not found to be significantly different (P  = 0.089). Sarcopenia was associated with higher rates of reintubation (7.5% vs 1.1%; P  < 0.001), sternal wound infections (7.5% vs 2.8%; P  = 0.039) and acute kidney injury requiring haemodialysis (2.5% vs 0.4%; P  = 0.021). CONCLUSIONS In patients undergoing coronary bypass surgery, sarcopenia was associated with increased short-term mortality, mid-term mortality and morbidity. The measurement of erector spinae myosteatosis could be an easy and useful parameter in preoperative risk assessment. [ABSTRACT FROM AUTHOR]

OBJECTIVES Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue for refractory cardiac arrest, of which acute coronary syndrome is a common cause. Data on the coronary revascularization strategy in patients receiving ECPR remain limited. METHODS The ECPR databases from two referral hospitals were screened for patients who underwent emergent revascularization. The baseline characteristics were matched 1:1 using propensity score between patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI). Outcomes, including success rate of weaning from extracorporeal membrane oxygenation (ECMO), hospital survival, and midterm survival in hospital survivors, were compared between CABG and PCI. RESULTS After matching, most of the patients (95%) had triple vessel disease. Compared with PCI (n  = 40), emergent CABG (n  = 40) had better early outcomes, in terms of the rates of successful ECMO weaning (71.1% vs 48.7%, P  = 0.05) and hospital survival (56.4% versus 32.4%, P  = 0.04). After a mean follow-up of 2 years, both revascularization strategies were associated with favourable midterm survival among hospital survivors (75.3% after CABG vs 88.9% after PCI, P  = 0.49), with a trend towards fewer reinterventions in patients who underwent CABG (P  = 0.07). CONCLUSIONS In patients who received ECPR because of triple vessel disease, the hospital outcomes were better after emergent CABG than after PCI. More evidence is required to determine the optimal revascularization strategy for patients who receive ECPR. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To predict the possibility of postoperative atrial fibrillation (AF) with mitral annular plane systolic excursion (MAPSE) measurement, which is a cheap, reproducible echocardiographic method and to monitor these patients more closely and to evaluate them more effectively postoperatively. MATERIAL AND METHODS: 247 patients scheduled for coronary artery bypass surgery were evaluated and 200 patients were included in the study.The enrolled patients were classified into the two groups according to the occurrence of postoperative AF or maintained sinus rhythm after coronary artery bypass surgery (normal sinus rhythm [NSR] group vs. AF group).The clinical and demographic data of all the patients were recorded on admission. Two-dimensional transthoracic echocardiography (TTE) was performed prior to elective surgery. RESULTS:Postoperative new onset AF occurred in 37 (18.5%) patients. In the multivariate logistic regression analysis carried out after the formation of the model based on the parameters related to AF development, the relationships with white blood cell count, LAd and MAPSE were observed to be prevalent.When MAPSE, which is a parameter used to predict the development of postoperative atrial fibrillation, was compared in the ROC analysis, the area under the curve was found to be 0.831, 95% CI lower-95% CI upper (0.761-0.901) (p<0.001). The distinguishing MAPSE value in predicting postoperative atrial fibrillation development was found to be 11.6 (sensitivity: 90%, specificity: 81%). CONCLUSIONS: We showed that MAPSE could play a role in determining postoperative atrial fibrillation development after coronary artery bypass surgery [ABSTRACT FROM AUTHOR]