Association of HbA1c and utilization of internal mammary arteries with wound infections in CABG.

Background: Deep sternal wound infection (DSWI) remains a serious complication after coronary artery bypass grafting (CABG). We herein aimed to stratify diabetic patients who underwent CABG using bilateral internal mammary artery (BIMA) for levels of glycated hemoglobin A1C (HbA1c) and compare postoperative outcomes.

Methods: Between January 2010 and August 2020, 4,186 consecutive patients underwent isolated CABG at our center.

Right ventricular and pulmonary artery pulse pressure variation and systolic pressure variation for the prediction of fluid responsiveness: an interventional study in coronary artery bypass surgery patients.

Purpose: Predicting fluid responsiveness is essential when treating surgical or critically ill patients. When using a pulmonary artery catheter, pulse pressure variation and systolic pressure variation can be calculated from right ventricular and pulmonary artery pressure waveforms.

Methods: We conducted a prospective interventional study investigating the ability of right ventricular pulse pressure variation (PPV) and systolic pressure variation (SPV) as well as pulmonary artery pulse pressure variation (PPV) and systolic pressure variation (SPV) to predict fluid responsiveness in coronary artery bypass (CABG) surgery patients.

Rise of cGMP by partial phosphodiesterase-3A degradation enhances cardioprotection during hypoxia.

3',5'-cyclic guanosine monophosphate (cGMP) is a druggable second messenger regulating cell growth and survival in a plethora of cells and disease states, many of which are associated with hypoxia. For example, in myocardial infarction and heart failure (HF), clinical use of cGMP-elevating drugs improves disease outcomes. Although they protect mice from ischemia/reperfusion (I/R) injury, the exact mechanism how cardiac cGMP signaling is regulated in response to hypoxia is still largely unknown.

Impella 5.0 therapy as a bridge-to-decision option for patients on extracorporeal life support with unclear neurological outcomes.

Objectives: Peripheral venoarterial extracorporeal life support (ECLS) for the treatment of cardiogenic shock has shown to improve survival but is associated with complications. However, if the patient cannot be weaned from ECLS, their therapy options are limited. Although durable left ventricular assist device implantation might be an option in such cases, an unclear neurological outcome is often a contraindication.

Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A Randomized Clinical Trial.

Background And Purpose: The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of synchronous combined carotid endarterectomy and CABG as compared with isolated CABG.

Methods: Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET [North American Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG.

Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm.

Purpose: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach.

Technique: The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta.

Reduction of clinically irrelevant alarms in patient monitoring by adaptive time delays.

The problem of high rates of false alarms in patient monitoring in anesthesiology and intensive care medicine is well known but remains unsolved. False alarms desensitize the medical staff, leading to ignored true alarms and reduced quality of patient care. A database of intra-operative monitoring data was analyzed to find characteristic alarm patterns.

Trends in Surgical Aortic Valve Replacement in More Than 3,000 Consecutive Cases in the Era of Transcatheter Aortic Valve Implantations.

Objectives Biological prostheses for surgical aortic valve replacement (sAVR) are increasingly being considered in patients < 60 years of age. Likely, preserving the option of performing a transcatheter valve-in-valve (ViV) procedure in cases of structural valve deterioration has contributed to this development. We assessed the use pattern in sAVR over an 11-year period.

Distinction of non-ischemia inducing versus ischemia inducing coronary stenosis by fluorescent cardiac imaging.

Intraoperative fluorescent cardiac imaging (FCI) can quantitatively assess myocardial perfusion abnormalities produced by graded flow-limiting coronary stenosis (FLS), but there are no data to distinguish FLS from non flow-limiting stenosis (NFLS) to determine their functional significance. The aim of the study was to evaluate whether non-ischemia inducing NFLS can be quantified and differentiated from FLS by FCI technology. Data are compared to gold standard fluorescent microspheres (FM).

Initial experience of pacemaker and implantable cardioverter defibrillator lead extraction with the new GlideLight 80 Hz laser sheaths.

Objectives: Laser lead extraction is a challenging procedure, especially in patients with old or multiple pacemaker (PM) or implantable cardioverter defibrillator (ICD) leads. The mechanical force is a leading cause of complications during the extraction procedure. Use of new laser sheaths, which deliver a rate of 80 pulses per second, may probably reduce intraoperative adverse events by reduction of extraction force.

Transcutaneous lead implantation connected to an externalized pacemaker in patients with implantable cardiac defibrillator/pacemaker infection and pacemaker dependency.

Aims: Systemic cardiac implantable electronic device (CIED) infection is a serious complication, especially in patients with pacemaker (PM) dependency. In those patients after infectious device removal temporary pacing is necessary, to obtain adequate haemodynamics. In this study, a new therapy option with temporary pacing by ipsilateral implantation of a new active-fixation right ventricular (RV)-lead was evaluated.

Customized transapical thoracic endovascular repair for acute type A dissection.

A 67-year-old patient with severe comorbidities and acute type A aortic dissection with pericardial tamponade was treated with an endograft introduced through a mini-thoracotomy and puncture of the left ventricular apex. Final angiography showed complete coverage of the dissection. Early and 6-month follow-up computed tomography showed full apposition of the endograft without residual dissection.

Myeloperoxidase deficiency preserves vasomotor function in humans.

Aims: Observational studies have suggested a mechanistic link between the leucocyte-derived enzyme myeloperoxidase (MPO) and vasomotor function. Here, we tested whether MPO is systemically affecting vascular tone in humans.

Methods And Results: A total of 12 135 patients were screened for leucocyte peroxidase activity.

First successful use of the new ab5000 portable circulatory support console as bridge to recovery in a case of dilated cardiomyopathy.

Introduction: Growing clinical experience and improved technology have led to more widespread use of ventricular assist devices in patients with end-stage heart failure.

Methods: We report the case of a patient with preexisting cardiomyopathy who arrived at our center in cardiogenic shock and received a biventricular assist device.

Results: The new compact Abiomed Portable Circulatory Support Console facilitated mobilization of the patient which was particularly advantageous in the face of transient hemiparesis.

Ten-year follow up after autologous rectus abdominis fascia sheath patch repair of aortic root abscess.

The infection of aortic annular tissue is a life-threatening complication of aortic valve endocarditis, the survival of which is usually with immediate surgical intervention. Optimal surgical techniques include aortic valve replacement with an aortic or pulmonary homograft, and reconstruction of cardiac structures with autologous pericardium. Here, two cases are reported with extensive aortic root infection and partial left ventricular-aortic dehiscence, who underwent left ventricular outflow tract reconstruction using a rectus abdominis fascia patch and aortic valve replacement with a Carpentier-Edwards porcine bioprosthetic graft.

Surgical revision of an uncommonly dislocated self-expanding Amplatzer septal occluder device.

Open heart surgery is the standard procedure for closure of ostium secundum atrial septal defects. Recently, percutaneous transcatheter procedures emerged as therapeutic alternatives for closure of both atrial septal defects and patent foramen ovale. Unfortunately, however, such percutaneous procedures may require surgical intervention for early or late complications.

Functional and biochemical analysis of endothelial (dys)function and NO/cGMP signaling in human blood vessels with and without nitroglycerin pretreatment.

Background: In experimental animal models, long-term in vivo treatment with nitroglycerin (NTG) induces both endothelial dysfunction and tolerance to nitrates. However, it is still controversial whether nitrate tolerance in humans is associated with both endothelial dysfunction and impaired vascular response to nitrovasodilator-derived NO.

Methods And Results: Patients undergoing elective bypass surgery were randomized to receive 48 hours of continuous NTG infusion (NTG group) or no nitrate therapy (control group).