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Background/Objectives: Infective endocarditis (IE) often requires surgical intervention, with postoperative acute kidney injury (AKI), posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with IE scheduled for valve surgery. Methods: This single-center study enrolled 130 consecutive IE patients from 2013 to 2021 undergoing valve surgery. The creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence; the relevance of creatinine levels for AKI detection; and the association of AKI with 30-, 60-, and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the second postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dL on the second day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the second day were robust predictors for short-term mortality at 30, 60, and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 h postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical IE patients. A specific threshold (1.35 mg/dL) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population. [ABSTRACT FROM AUTHOR]

Sutureless aortic bioprostheses have been developed for use in high-risk patients undergoing surgical aortic valve replacement due to severe aortic stenosis. These devices are mounted on a stent and are self-anchoring within the aortic annulus with no need for sutures, resulting in shorter operative and, hence, ischemic times. The use of these devices makes therefore valve implantation easier and faster, which seems to improve postoperative outcomes. At present, there are two commercially available sutureless aortic valves: the Perceval S (LivaNova Group, Milan, Italy) and the Intuity (Edwards Lifesciences, Irvine, CA, USA). In this paper the studies published to date evaluating these two bioprosthesis models are reviewed, along with future directions and indications for the target patient population.

Aortic valve bioprostheses are commonly implanted in the current era (also in younger patients) as they may obviate the need for anticoagulation while providing better hemodynamic performance and a more favorable quality of life. The steady increase in the use of biological valves has prompted the development of several different models of conventional stented bioprostheses. At present, there are four main types of stented aortic bioprostheses that compete in the market: the LivaNova Crown PRT (LivaNova Group, Burnaby, Canada), the St. Jude Medical Trifecta (St. Jude Medical, St. Paul, MN, USA), the Carpentier-Edwards Perimount Magna Ease (Edwards Lifesciences, Irvine, CA, USA), and the Medtronic Mosaic Ultra (Medtronic, Inc., Minneapolis, MN, USA). The purpose of this review is to describe the features of these bioprosthetic valve models and to compare the data provided by the manufacturers with those derived from the available literature.

Objective: : Surgical pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) blocks trigger stimulation from PVs and partially disconnects the atria from sympathetic and parasympathetic neural stimulation. This study describes long-term changes in heart rate variability (HRV) and autonomic activity (AA) after successful bipolar radiofrequency PVI., Methods: : Twenty-seven patients who underwent coronary artery bypass grafting and successful (defined as stable sinus rhythm for 1 year) off-pump bipolar radiofrequency PVI for PAF were prospectively followed 3, 6, and 12 months after surgery including 24 hours Holter electrocardiogram. The following HRV and AA parameters were calculated: mean NN-interval, SD of NN-intervals, SD of averaged NN-intervals, root mean square of successive differences, low frequency (LF) power (0.04-0.15 Hz; a parameter specific for sympathetic activity), high frequency (HF) power (0.15-0.4 Hz; a parameter specific for parasympathetic activity), and the LF:HF ratio., Results: : Preoperatively, high HRV and AA parameters were recorded. In 3-, 6-, and 12-month time, a progressive reduction of HRV and AA was observed, reaching significance after 12 months. Respective rates before surgery and 12 months after it were: for SD of averaged NN-intervals (122.4 ± 113; 80.5 ± 42 milliseconds; P = 0.046), for root mean square of successive differences (79.2 ± 93; 45 ± 20 milliseconds; P = 0.04). The LF:HF ratios were 1.22 and 0.73 before and 12 months after surgery, respectively. The statistically significant continuous reduction in LF:HF ratio (P = 0.02) is suggestive of a progressive parasympathetic dominance 12 months after surgery., Conclusions: : Successful PVI for PAF results in HRV and sympathetic activity reduction with preoperative sympathetic dominance and oncoming vagal dominance after 1 year from surgery. Despite preoperative sympathetic dominance, successful PVI for PAF results in HRV and a reduction in sympathetic activity with emerging parasympathetic dominance 12 months after surgery.

Background: Altered autonomic regulation after cardiac operations precipitates cardiac arrhythmias, affects repolarization, and increases the risk of sudden cardiac death. We sought to clarify how the 2 different techniques of coronary artery bypass grafting (CABG), namely conventional CABG using cardiopulmonary bypass (on-pump) and beating-heart CABG without cardiopulmonary bypass (off-pump), affect cardiac autonomic regulation and arrhythmic disturbances postoperatively., Methods: We included 57 consecutive patients, 28 in the on-pump group and 29 in the off-pump group. The electro-cardiographic recordings were performed on the preoperative day and the fourth, seventh, and twenty-eighth day after operation. Fifteen-minute digital recordings were taken; one channel was used to record electrocardiogram and the other breathing. Detailed analyses of arrhythmia, heart rate, and heart rate variability indices were performed on respective days to assess sympathetic and parasympathetic modulation of the heart and relate it to detected arrhythmic disturbances., Results: Total power, low-frequency power, which indicates baroreceptor-mediated sympathetic modulation, and high-frequency power, indicating parasympathetic vagal modulation, declined significantly in both groups after CABG (P < .001); however, 7 days after CABG, total and high-frequency power were better preserved in the off-pump group. Mean RR interval was longer in the off-pump group at 7 (P= .006) and 28 days (P= .008) after surgery. The total incidence of arrhythmic events was higher in the on-pump group on the seventh day (P = .017, adjusted odds ratio = 8.6, 95% confidence interval 1.4-80.3)., Conclusions: The results show profound impairment of cardiac autonomic regulation after CABG, showing better preserved cardiac autonomic modulation 7 days after beating-heart revascularization. Evidence suggests that slower restoration of heart rate and increased incidence of arrhythmic events after CABG using cardiopulmonary bypass are the result not only of impaired cardiac autonomic regulation but also of the involvement of additional factors of nonautonomic origin.

Background: Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death. This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting (CABG) affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG., Methods: Forty-two patients (mean age, 61.9 +/- 9.3 years; mean EURO score 2.6 +/- 1.9) were electively admitted for off-pump CABG. The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis. Total power of spectra was defined in the range of 0.01 to 0.40 Hz, high-frequency power within 0.15 to 0.40 Hz, and low-frequency power within 0.04 to 0.15 Hz. Normalized power was defined as a ratio of power in each band/total power. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. Ventricular repolarization was assessed using QT interval, QT interval variability, and QT-RR interdependence analysis. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. Pearson correlation between length of RR and QT interval was applied to study QT-RR characteristics. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P <.05 was considered significant., Results: The frequency of arrhythmic events and heart rate increased from the fourth to the seventh postoperative day and returned to preoperative levels 4 weeks after CABG. Heart rate variability measures indicating autonomic modulation remained depressed even 4 weeks after the procedure. QT variability index increased from -1.2 +/- 0.5 to -0.8 +/- 0.4 on the fourth day after the operation (P <.05) and returned to -1.0 +/- 0.5 4 weeks after CABG (P = not significant). QT-RR correlation decreased from 0.41 to 0.23 (P <.05) and remained significantly impaired as long as 4 weeks after CABG., Conclusions: Observed faster heart rates until 1 week after off-pump CABG imply excessive adrenergic activation, which is comparable to on-pump CABG procedure rates. The results indicate profound autonomic derangement and loss of rate-dependent regulation after off-pump CABG even 4 weeks after operation. Restituted repolarization as assessed by QT variability index 4 weeks postoperatively corresponded with decreased frequency of rhythm disturbances 4 weeks after CABG. The loss of coupling between QT and RR intervals shows increased electrical instability postoperatively, which may serve as an additional promoter for postoperative arrhythmias, especially at higher heart rates.