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Background: Degenerative aortic valve disease (DAVD) is a multifactorial process. We developed an animal model to analyze the isolated, local effect of reactive oxygen species (ROS) on its pathophysiology. Methods: We utilized a photodynamic reaction (PDR) as a source of ROS in the aortic valve by aiming a laser at the aortic valve for 60 min after the administration of a photosensitizer 24 h prior. ROS, laser, and sham groups (n = 7 each) for every observation period (t = 0; t = 8 d; t = 84 d; t = 168 d) were established. The amount of ROS generation; morphological changes; inflammatory, immune, and apoptotic reactions; and hemodynamic changes in the aortic valves were assessed using appropriate histological, immunohistological, immunohistochemical, and echocardiographic methods. Results: The ROS group displayed an increased amount of ROS (p < 0.01) and increased inflammatory activation of the endothelium (p < 0.05) at t = 0. In the ROS group, aortic valves were calcified (p < 0.05) and the transvalvular gradient was increased (p < 0.01) at t = 168 d. Conclusion: The small animal model employed here may serve as a platform for analyzing ROS's isolated role in the DAVD context. [ABSTRACT FROM AUTHOR]

Aim: Extracorporeal membrane oxygenation (ECMO) is resource-intensive, is associated with significant morbidity and mortality, and requires careful patient selection. This study examined whether the model for end-stage liver disease (MELD) score is a suitable predictor of in-hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively assessed patients with COVID-19 on ECMO at our institution from March 2020 to May 2021. MELD scoring was performed using laboratory values recorded prior to ECMO initiation. A multiple logistic regression model was established. Results: A total of 66 patients with COVID-19 on ECMO were included (median age of 58.5 years; 83.3% male). The in-hospital mortality was 74.2%. In relation to mortality, patients with MELD Na scores >13.8 showed 6.5-fold higher odds, patients aged >53.5 years showed 18.4-fold higher odds, and male patients showed 15.9-fold higher odds. The predictive power of a model combining the MELD Na with age and sex was significant (AUC = 0.883, p < 0.001). The findings in the COVID-19 patients were not generalizable to a group of non-COVID-19 patients on ECMO. Conclusions: A model combining the MELD Na, age, and sex has high predictive power for in-hospital mortality in patients with COVID-19 on ECMO, and it may be clinically useful for guiding patient selection in critically ill COVID-19 patients both now and in the future, should the virus widely re-emerge. [ABSTRACT FROM AUTHOR]

Objective Despite the recent trend of access miniaturization in minimally invasive cardiac surgery (MICS) surgical "cut down (CD)" for femoral cannulation remains the standard at many centers. Percutaneous vascular closure (PVC) devices have recently been introduced for minimizing invasiveness during interventional diagnostic and therapy. This report summarizes the initial experience with this new approach in the setting of MICS, with a special focus on safety and advantages. Methods Percutaneous cannulation with a standard protocol including preoperative computer tomography imaging and intraoperative point-of-care ultrasound guidance was performed in 93 consecutive patients from September 2018 until February 2020, while conventional "CD" procedure performed in 218 patients in the previous period. We analyzed patients' characteristics and compared access site complications of PVC group versus conventional "CD" group. Results As far as operative/postoperative outcome, the duration of intensive care unit stay as well as hospital stay was statistically shorter in PVC compared with CD (CD vs. PVC: 2.74 ± 3.83 vs. 2.16 ± 2.01 days, p < 0.01, 16.7 ± 8.75 vs. 13.0 ± 4.96 days, p < 0.001, respectively). Further, we found no femoral infection or lymphocele in the PVC group, whereas 4 cases of wound complications were observed in the CD group. Conclusion According to our results, percutaneous closure system for femoral vessels in MICS seems to be beneficial with the assist of preoperative computed tomography and intraoperative Doppler guidance. [ABSTRACT FROM AUTHOR]

Background With this study we aimed to analyze if the separate consideration of body mass index (BMI) could provide any superior predictive values compared with the established risk scores in isolated minimally invasive mitral valve surgery (MIMVS). This might facilitate future therapeutic decision-making, e.g., regarding the question surgery versus transcatheter mitral valve repair (TMVr). Methods We assessed the relevance of BMI in non-underweight patients who underwent isolated MIMVS. The risk predictive potential of BMI for mortality and several postoperative adverse events was assessed in 429 consecutive patients. This predictive potential was compared with that of European System for Cardiac Outcome Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons score (STS score) using a comparative receiver operating characteristic curve analysis. Results BMI was a significant numeric predictor of wound healing disorders (p = 0.001) and proved to be significantly superior in case of this postoperative adverse event compared with the EuroSCORE II (p = 0.040) and STS score (p = 0.015). Except for this, the predictive potential of BMI was significantly inferior compared with that of the EuroSCORE II and STS score for several end points, including 30-day (p = 0.029 and p = 0.006) and 1-year (p = 0.012 and p = 0.001) mortality. Conclusion Therefore, we suggest that, in the course of decision-making regarding the right treatment modality for non-underweight patients with isolated mitral valve regurgitation, the sole factor of BMI should not be given a predominant weight. [ABSTRACT FROM AUTHOR]

Background: Although minimally invasive mitral valve surgery (MIMVS) has become the first choice for primary mitral regurgitation (MR) in recent years, clinical evidence in this field is yet limited. The main focus of this study was the analysis of preoperative (Pre), postoperative (Post), and 1‐year follow‐up (Fu) data in our series of MIMVS to identify factors that have an impact on the left ventricular ejection fraction (LVEF) evolution after MIMVS. Methods: We reviewed the perioperative and 1‐year follow‐up data from 436 patients with primary MR (338 isolated MIMVS und 98 MIMVS combined with tricuspid valve repair) to analyze patients' baseline characteristics, the change of LV size, the postoperative evolution of LVEF and its factors, and the clinical outcomes. Results: The overall mean value of ejection fraction (EF) slightly decreased at 1‐year follow‐up (mean change of LVEF: −2.63 ± 9.00%). A significant correlation was observed for preoperative EF (PreEF) und EF evolution, the higher PreEF the more pronounced decreased EF evolution (in all 436 patients; r = −.54, p <.001, in isolated MIMVS; r = −.54, p <.001, in combined MIMVS; r = −.53, p <.001). Statistically significant differences for negative EF evolution were evident in patients with mild or greater tricuspid valve regurgitation (TR) (in all patients; p <.05, odds ratio [OR] = 1.64, in isolated MIMVS; p <.01, OR = 1.93, respectively). Overall clinical outcome in New York Heart Association classification at 1 year was remarkably improved. Conclusions: Our results suggest an excellent clinical outcome at 1 year, although mean LVEF slightly declined over time. TR could be a predictor of worsened follow‐up LVEF in patients undergoing MIMVS. [ABSTRACT FROM AUTHOR]

Purpose: Activation of mitochondrial large-conductance Ca2+-sensitive potassium (mBKCa)-channels is a crucial step for cardioprotection by preconditioning. Whether activation of these channels is involved in levosimendan-induced preconditioning is unknown. We investigated if cardioprotection by levosimendan requires activation of mBKCa-channels in the rat heart in vitro.Methods: In a prospective blinded experimental laboratory investigation, hearts of male Wistar rats were randomized and placed on a Langendorff system, perfused with Krebs-Henseleit buffer at a constant pressure of 80 mmHg. All hearts were subjected to 33 min of global ischemia and 60 min of reperfusion. Before ischemia, hearts were perfused with different concentrations of levosimendan (0.03-1 μM) for determination of a dose-effect curve. In a second set of experiments, 0.3 μM levosimendan was administered in combination with the mBKCa-channel inhibitor paxilline (1 μM). Infarct size was determined by TTC staining.Results: In control, animal’s infarct size was 58 ± 7%. Levosimendan at a concentration of 0.3 μM reduced infarct size to 30 ± 7% (P < 0.05 vs. control). Higher concentrations with 1 μM levosimendan did not confer stronger protection. Paxilline completely blocked levosimendan-induced cardioprotection while paxilline alone had no effect on infarct size.Conclusions: This study shows that activation of mBKCa-channels plays a pivotal role in levosimendan-induced preconditioning. [ABSTRACT FROM AUTHOR]

Osteogenesis imperfecta (OI) is a syndrome that is often associated with dysfunction of the aortic valve. Because of the resultant fragile vessels and impaired hemostasis, surgical therapy to treat OI is challenging. Previous reports have suggested that transcatheter aortic valve implantation (TAVI) might be a suitable treatment for this condition. To the best of the authors' knowledge, the present case is the first to describe a young patient who underwent successful TAVI to treat osteogenesis imperfecta. The proposal of transfemoral TAVI serving as first-line therapy for aortic valve stenosis in patients suffering from osteogenesis imperfect was confirmed.

Transcatheter aortic valve implantation (TAVI) is an emerging treatment for high-risk patients with aortic stenosis. Aortic regurgitation is considered to be a relative contraindication for transcatheter procedures, as a non-calcified aortic annulus poses the risk of an insufficient anchoring of the transcatheter aortic valve prosthesis. Herein is described the case of a patient who suffered from recurrent aortic valve regurgitation after valve-sparing repair, and which was successfully treated by the transcatheter implantation of an Edwards SAPIEN 3™ prosthesis. This case report demonstrated the suitability of this prosthesis to treat pure aortic valve regurgitation, without excessive oversizing of the valve.