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Background: Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)–derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. Methods: This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. Results: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041–1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P Conclusions: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02910349

Graphical abstract The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure. Supplementary Information The online version contains supplementary material available at 10.1007/s12265-021-10133-9.

Background Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7–80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. Methods This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. Discussion REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. Trial registration EU Clinical Trials Register, EUDRA CT No: 2016-002606-39. Registered on September 8, 2016.

This paper was formed by the Expert committee for congenital heart disease (CHD) in adults – a division of Czech Society of Cardiology (CKS). It was designed as an appendix to National cardiovascular programme CKS created in 2013 and was based on Recommendations for organization of care for adults with congenital heart disease and for training in the subspecialty of ‘Grown-up Congenital Heart Disease’ in Europe: a position paper of the Working Group on Grown-up Congenital Heart Disease of the European Society of Cardiology created in 2014 [1] . Aims of this paper are: To optimize medical care in all its aspects for adults with CHD in the Czech Republic, to facilitate easy transition between paediatric and adult medical care, to enable research in the field in order to create evidence based care, to support training of regional cardiologists and other specialists who are involved in monitoring adult patients with CHD, to help with communication with national institutions, to provide information for other medical workers and patients, to consolidate resources.

Uvod: Chirurgicka terapie fibrilace sini (FS) je běžnou a osvědcenou metodou lecby teto arytmie, a to buď jako samostatný výkon, nebo výkon spojený s kardiochirurgickou operaci z jine indikace (konkomitantni výkon). I přes vysokou ucinnost chirurgicke lecby dochazi k recidivam arytmii. Tyto arytmie jsou casto rezistentni k farmakoterapii (diky velkemu jizevnatemu substratu) a elektroanatomicke mapovani s katetrizacni ablaci je výrazně ucinnějsi. Arytmogenni jizevnatý substrat je nasledkem jednak primarniho srdecniho onemocněni (stojiciho za dilataci sini) a jednak přimo chirurgicke intervence (incize, mista vstupu kanyl, linie výkonu maze s obnoveným vedenim na těchto blocich).Metoda a soubor pacientů: Od ledna roku 2010 do listopadu roku 2015 jsme na nasem pracovisti provedli elektroanatomicke mapovani a ablaci u 92 pacientů s recidivou arytmie po konkomitantni chirurgicke lecbě fibrilace sini. Po radiofrekvencni ablaci byl u pacientů monitorovan rytmus v půlrocnich intervalech (24hodinove holterovske EKG monitorovani, sedmidenni smyckový rekorder, u casti pacientů i implantovanými kardiostimulatory nebo implantabilnim smyckovým zaznamnikem). Průměrna velikost leve sině (PLAX) byla 50 mm, 59 % pacientů mělo operaci mitralni chlopně, 54 % trikuspidalni chlopně, operaci vrozene vývojove vady podstoupilo 16 % pacientů, 17 % kardiochirurgickou reoperaci. Z uvedeneho vyplýva, že se jedna o pacienty s velkým jizevnatým substratem.Výsledky: Výkon maze vedl k organizaci rozsahleho jizevnateho siňoveho arytmogenniho substratu (recidivujici arytmie po maze jsou castěji pravidelne siňove tachykardie [AT], zatimco mezi arytmiemi, pro ktere byla maze u pacienta indikovana, převlada FS). Vsichni pacienti dosahli 12. měsicni kontroly, 80 % pacientů mělo 24. měsicni kontrolu. Casnou recidivu po ablaci (od výkonu do třetiho měsice) mělo 21 % pacientů. Casna recidiva po ablaci byla statisticky významně spojena s recidivou arytmie do 12 měsiců (p = 0,003) i s recidivou do 24. měsice (p = 0,003). Třiasedmdesat procent pacientů ve 12. měsici a 53 % ve 24. měsici nemělo rekurenci FS nebo siňove tachykardie. Celkem jsme ablovali 146 arytmii, tj. jedna třetina pacientů měla vice než jednu arytmii. Ve 24 % se jednalo o perzistentni FS, ve 13 % o paroxysmalni FS a v 53 % o pravidelnou siňovou tachykardii. Vice než polovina pravidelných siňových tachykardii pochazela z leve sině (LS) (větsinou perimitralni flutter sini). Zbytek arytmii pochazi z prave sině (v polovině připadů typický flutter sini). Sedmapadesat procent pacientů mělo obnovene vedeni na mitralnim isthmu (u jedne třetiny byla nutna ablace v koronarnim sinu). Žadna z plicnich žil nedominovala v poctu rekonexi. Nalez výrazne redukce amplitudy signalu v cele LS byl asociovan s vyssim rizikem akutniho selhani ablace (p = 0,001). Akutni selhani ablace bylo spojeno s trendem k vyssimu riziku recidivy ve 12. měsici (p = 0,07). Zjistili jsme trend vyssi cetnosti výskytu AT z prave sině u pacientů po operaci pro vrozenou srdecni vadu (VSV) (p = 0,06). Diagnoza arterialni hypertenze byla spojena s trendem k vyssimu riziku recidiv arytmii (p = 0,13). Nenasli jsme žadný vztah mezi typem arytmie na EKG před ablaci (EKG, dle ktereho byla u pacienta stanovena indikace k ablaci) a rizikem recidivy po ablaci.Zavěr: I přes rozsahlý arytmogenni substrat u pacientů po kardiochirurgickem výkonu je katetrizacni terapie recidiv arytmii ucinnou metodou nasledne lecby. Nemale množstvi AT pochazi z prave sině, a to hlavně u pacientů po operaci vrozených srdecnich vad. Nejsložitějsimi pacienty jsou ti s výrazně redukovaným signalem ve větsině sině pro obrovský arytmogenni substrat.

V poslednich deseti letech bylo na Kardiochirurgickem odděleni v Nemocnici Na Homolce (NNH) provedeno celkem 844 operaci u 805 dospělých s vrozenou srdecni vadou (VSV). Median věku operovaných byl 37 let (mezikvartilove rozpěti 25-49, celkove rozpěti 16-81 let). Operace komplexnich a vzacných VSV tvořily 47 %. Ve 44 % (u 354 pacientů) se jednalo o reoperaci po předchozi operaci v dětstvi ci dospělosti, ve 14 % (113 pacientů) se jednalo o opakovanou reoperaci. Kombinovane výkony byly provedeny v 70 % připadů.Celkova 30denni mortalita cinila v celem souboru 1,36 %; hospitalizacni mortalita 1,7 %. Průměrne pětilete přeživani po operaci VSV v NNH cinilo 97 %.Mezi významne rizikove faktory casneho i pozdniho umrti po operaci VSV patřily symptomy ve třidě NYHA III-IV (p < 0,0001; OR 30,8), anamneza městnaveho srdecni selhani (p = 0,001; OR 6,7), cyanoza (p < 0,0001; OR 60,5), pocet předchozich operaci (p = 0,00033), přitomnost mechanicke chlopenni protezy (p = 0,0032; OR 3,7) a univentrikularni cirkulace (p = 0,0276; OR 5,4). Statisticke významnosti pro riziko umrti nedosahly arytmie (p = 0,078), plicni hypertenze (p = 0,072), věk v době operace (p = 0,372) a pohlavi (p = 0,48).Centralizace pece o dospěle s VSV do center s vysokým poctem výkonů a zkusenostmi přinasi velmi dobre chirurgicke výsledky s nizkou casnou i pozdni mortalitou.Důležita je vcasna indikace operace a odstraněni vsech rezidualnich nalezů kombinovaným výkonem. Přitomnost dětskeho kardiochirurga je nezbytna u operaci komplexnich VSV.

Autoři prezentuji připad 48lete pacientky s malignim thymomem s rozsiřenim na pravou srdecni siň. Ackoliv invazivni thymomy větsinou infiltruji mediastinalni struktury, intrakardialni růst je vzacný. Pacientka podstoupila kardiochirurgickou operaci s kompletnim odstraněnim intrakardialni nadorove tkaně. Po operaci absolvovala adjuvantni chemo a radioterapii. Rok od operace je stale bez průkazu recidivy.

Kazuistika prezentuje připad 62leteho pacienta po aortalni nahradě a nahradě ascendentni aorty s rychlou progresi velikosti vaku protezy kolem ascendentni aorty. Překvapivý byl operacni nalez, který vyloucil aktivni infekci.

The main complication of aortocoronary reconstruction with vein grafts is restenosis in the course of time. The aim was to assess the effect of a periadventitial polyester mesh releasing sirolimus on intimal hyperplasia of autologous grafts. We implanted v. jugularis ext. into a. carotis communis in rabbits. The vein graft was either intact, or was wrapped with a pure polyester mesh, or with a sirolimus-releasing mesh. Three and six weeks after surgery, the veins were subjected to standard histological staining and the thicknesses of the tunica intima, the media and the intima-media complex were measured. Wrapping the vein with a mesh releasing sirolimus or with a pure mesh decreased the thickness of the intima in comparison with a vein graft by 73 ± 11% or 73 ± 8% after 3 weeks, and by 73 ± 9% or 59 ± 12% after 6 weeks, respectively. Sirolimus-releasing meshes reduced the thickness of the media by 65 ± 9% and 20 ± 12% after 3 and 6 weeks. The thickness of the intima-media complex in grafts with sirolimus-releasing meshes decreased by 60 ± 6% and 30 ± 13% in comparison with pure PES meshes, after 3 and 6 weeks, respectively. A periadventitial polyester mesh releasing sirolimus has the potential to become an effective device in preventing vein graft restenosis.

Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m²) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m²), p

Autologous vein grafts used as aortocoronary bypasses are often prone to intimal hyperplasia, which results in stenosis and occlusion of the vein. The aim of this study was to prevent intimal hyperplasia using a newly developed perivascular system with sustained release of sirolimus. This system of controlled drug release consists of a polyester mesh coated with a copolymer of L-lactic acid and ε-caprolactone that releases sirolimus. The mesh is intended for wrapping around the vein graft during surgery. The mesh releasing sirolimus was implanted in periadventitial position onto arteria carotis communis of rabbits, and neointimal hyperplasia was then assessed. We found that implanted sirolimus-releasing meshes reduced intima thickness by 47±10 % compared to a vein graft after 3 weeks. The pure polyester mesh decreased vein intima thickness by 35±9 %. Thus, our periadventitial system for controlled release of sirolimus prevented the development of intimal hyperplasia in autologous vein grafts in vivo in rabbits. A perivascularly applied mesh releasing sirolimus is a promising device for preventing stenosis of autologous vein grafts.

Srdecni resynchronizacni lecba se stala neoddělitelnou soucasti lecby pacientů s pokrocilým chronickým srdecnim selhanim a srdecni dyssynchronii definovanou jako rozsiřeni komplexu QRS. Koncept metody vychazi z resynchronizace porusene synchronie atrioventrikularni, interventrikularni a intraventrikularni v myokardu leve komory. Jednou z významných determinant výsledku resynchronizacni lecby je poloha jednotlivých použitých elektrod, jmenovitě levokomorove, pravokomorove a teoreticky i siňove. V přehledovem clanku jsou diskutovany prakticke aspekty hledani optimalni polohy jednotlivých elektrod a možnosti hodnoceni systemu pro resynchronizacni lecbu s ohledem na klinickou odpověď u individualnich pacientů.

Chronický expandujici intraperikardialni hematom je vzacný. Literatura uvadi ojediněle připady po kardiochirurgických operacich, traumatech hrudniku, poraněnich osrdecniku ci perkutannich koronarnich intervencich (PCI)1. Uvadime kasuistiku 64leteho muže s expandujicim hematomem v perikardu s klinickým obrazem konstriktivni perikarditidy. Tři roky před stanovenim diagnozy chronickeho hematomu v perikardu nemocný prodělal aortokoronarni bypass a nasledně opakovane PCI. Hematom byl chirurgicky odstraněn. Rok po exstirpaci doslo k recidivě nalezu s nutnosti reoperace. V nasledujicich dvou letech byl již pacient bez znamek recidivy onemocněni.

Pulmonary hypertension (PH) unresponsive to pharmacological intervention is considered a contraindication for orthotopic heart transplantation (OHTX) due to risk of postoperative right-heart failure. In this prospective study, we describe our experience with a treatment strategy of improving severe PH in heart transplant candidates by means of ventricular assist device (VAD) implantation and subsequent OHTX. In 11 heart transplantation candidates with severe PH unresponsive to pharmacological intervention we implanted VAD with the aim of achieving PH to values acceptable for OHTX. In all patients we observed significant drop in pulmonary pressures, PVR and TPG (p