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Histidine–tryptophan–ketoglutarate (HTK) cardioplegia is one of the most widely used methods of cardioplegia. This solution is hyponatremic compared to blood, and the rapid infusion of a substantial volume of hyponatremic solution will result in a notable reduction in serum natrium (Na) levels. The aim of this study was to analyze changes in serum Na concentration following HTK cardioplegia infusion in aortic valve surgery, and to investigate the association between hyponatremia and postoperative outcomes in patients who underwent aortic valve replacement surgery.

Aortic dissection (AD) is a critical heart condition with potentially severe outcomes. Our study aimed to investigate the existence of a “weekend effect” in AD by examining the correlation between patient outcomes and whether their treatment occurred on weekdays versus weekends.

Background: Postoperative atrial fibrillation (AF) has a complex etiology, and beta-blockers are commonly recommended for its pharmacological prevention. This study aims to assess the impact of beta-blocker therapy on postoperative AF occurrence in patients undergoing aortic valve replacement, mitral valve replacement, surgical revascularization of the myocardium, or a combination of these procedures. Methods: The study encompassed 472 patients who received aortic valve replacement, mitral valve replacement, surgical revascularization, or their combination. We evaluated the efficacy of preoperative and one-month postoperative beta-blocker administration in preventing postoperative AF, and the associated risk factors involved in the development of postoperative AF. Results: Of the total patient population, 36% experienced postoperative AF. Our study demonstrated a significant reduction in postoperative AF incidence among patients receiving beta-blocker treatment (all p-values < 0.05). Additionally, one-month post-surgery, beta-blocker treatment exerted a protective effect by maintaining the sinus rhythm (p = 0.0001). Regarding the risk factors involved in the development of postoperative AF, both age and left atrium (LA) sizeassessed pre-and postoperatively--were positively correlated with the occurrence of postoperative AF (p = 0.006). No relationship was found between leukocyte counts and AF incidence. Notably, C-reactive protein (CRP) levels were significantly elevated on the fifth postoperative day in patients with AF (p < 0.007). The duration of ischemia was significantly longer in patients with AF (p = 0.009). Conclusions: This study establishes the efficacy of perioperative beta-blocker treatment in mitigating postoperative AF. One month post-surgery, most patients under beta-blocker therapy maintained sinus rhythm, suggesting a potential long-term protective effect of beta-blockers against late-onset AF. [ABSTRACT FROM AUTHOR]

The objective of this study is to demonstrate the safety and reproducibility of our surgical technique for implanting decellularized vascular xenografts in the carotid artery of sheep. Acellular porcine carotid arteries were implanted as interposition xenografts in seven sheep. An intravascular shunt was used for cerebral protection, and a flowmeter was utilized to assess graft performance. There were no intraoperative deaths or postoperative neurological complications observed. Acute graft thrombosis occurred in one sheep during surgery, but was successfully managed with thrombectomy to restore blood flow. Post-implantation flowmetry and Doppler ultrasound confirmed graft functionality. Our study demonstrates the successful application of our surgical method for implanting decellularized vascular xenografts in the carotid artery of sheep. The implanted grafts maintained patency, normal blood flow, and favorable wound healing and neurological outcomes post-surgery. [ABSTRACT FROM AUTHOR]

Introduction: It is exceedingly uncommon for neoplasms to arise directly within the heart, with incidence rates in necropsy series reaching up to 0.4%. The vast majority of these tumors, roughly 75%, are benign and encompass a variety of types such as myxomas, rhabdomyomas, lipomas, fibromas, and teratomas. Among these, lipomas are prevalent on the walls of the right atrium or left ventricle, comprising nearly 10% of all primary cardiac tumors. Case Report: We present a case of a 65-year-old male known with monovascular coronary disease, NYHA class II heart failure, and grade II arterial hypertension, with a high cardiovascular risk. The patient was experiencing shortness of breath, tiredness, and fainting. A chest X-ray did not show any immediate changes, however, the echocardiography revealed a clearly defined, 40/60mm oval-shaped tumor mass that has a mixed hypo- and hyperechogenic appearance, with an area of 23mm and a weak Doppler signal, located at the pericardial level, postero-lateral to the right atrium. The tumor was compressing the left atrium, interatrial septum, and the ostium of the superior vena cava, causing turbulence at this level. As a result, the surgical treatment was chosen. Discussions : During the intraoperative inspection, a heart with preserved contractility is observed, as well as a 10/8/4 cm round-oval tumor formation in the vicinity of the right atrium, which is encapsulated, well delimited, and has an adherent base to the postero-lateral wall of the right atrium, at the level of the inferior vena cava and the right pulmonary veins, causing their partial collapse. The tumor was excised successfully, with no intraoperative complications. Conclusions: Cardiac lipoma is a benign primary tumor of the heart. Nonetheless, clinical symptoms range from slight discomfort to syncope. Overgrowth of a lipoma and infiltration into the heart may signal a more severe clinical presentation and a poor outcome. Accurate diagnosis and detailed evaluation of cardiac lipoma rely heavily on multimodal imaging. In symptomatic patients, radical lipoma excision is the most effective therapeutic option. Conservative treatment may be used for asymptomatic cardiac lipomas, and preventive excision should be investigated. [ABSTRACT FROM AUTHOR]

The inherent limitations of current heart valve substitutes create the premise for the Tissue Engineered Heart Valve (TEHV), considered the perfect substitute. We aimed to compare in vitro hemodynamic performances of our TEHV, the conventional prosthetic valve and similar porcine valves, by ultrasonography and geometry resulting in six valve models analysis. In a bioreactor, pulmonary and aortic physiology were replicated thus hemodynamic characteristics were tested. Using ultrasound, transvalvular pressure gradients and flow were measured and used to calculate their valvular functional area (VFA) and using a high-speed camera, the geometric peak opening area (GOA) was assessed. The obtained results were normalized to the diameter of the biological prosthesis in order to increase the measurement's accuracy. The ultrasound revealed normal function of all valves and physiologic transvalvular pressure gradients. The TEHV scaffold revealed absence of laceration or dehiscence, and performances in accordance with the control prostheses. The GOA was facile to obtain and the normalized values proved to be greater than the calculated functional area in all analyzed cases and the peak opening areas resulted lesser for the aortic conditions for all six used valves prototypes. To our knowledge, this is the first study to use bioreactors, for in vitro evaluation of heart valves. [ABSTRACT FROM AUTHOR]

Background: Acute aortic dissection is characterized by injury to the inner layer of the blood vessel, resulting in the formation of a false lumen within the aortic wall. Selective cerebral perfusion is crucial during surgery to protect the brain. Two methods are commonly used: antegrade and retrograde. Objective: The aim is to maintain sufficient cerebral blood flow via antegrade selective perfusion during surgery for acute type A aortic dissection. Over the past five to ten years, this method has become the standard in many centers due to its minimal impact on cerebral metabolic function and lesser visceral impairment compared to retrograde perfusion. Material and methods: We present a case of a 45-year-old hypertensive and smoker pacient, with no prior cardiovascular history, who presented to the emergency department with severe retrosternal pain. Acute ascending aortic dissection was suspected and confirmed via angio-CT and echocardiography. The surgical procedure consisted in replacing the ascending aorta with a 30mm dacron prosthesis and performing aortic valve commissuroplasty on cardiopulmonary bypass, utilizing right femoral arterial and central venous cannulation. Results: During surgery, deep hypothermia (25 degrees Celsius) was induced to provide additional cerebral protection. Right and left carotid cannulation was performed to ensure continuous cerebral perfusion. In contrast to unilateral cannulation, which allows a maximum ischemic time of 30 minutes, selective cerebral perfusion offers the advantage of being feasible for a more extended period without impacting the patient's postoperative neurological status. For this patient, a 25-minute duration was achieved, and subsequently, the postoperative course was favourable, being discharged neurologically intact, hemodynamically stable, and without respiratory complications. Conclusions: Hence, ensuring antegrade cerebral perfusion is crucial for the postoperative well-being of patients, reducing mortality rates, lowering the risk of permanent neurological deficits, and mitigating complications such as multiorgan failure, sepsis, and acute ischemic events. [ABSTRACT FROM AUTHOR]

Aortic arch pathologies are possible life-threatening conditions with demanding management caused, in general, by anatomic aspects as well as patient’s age and comorbidities. We present the case of a 59-year old male with dissected aortic aneurysm involving the aortic arch and descending thoracic portion. Hybrid intervention was performed, more precisely aortic arch debranching using polyester prosthesis and subsequently stent implantation at the level of aortic arch and descending thoracic aorta with excellent results. This method of approach is safer considering the elimination of cardiopulmonary bypass and deep hypothermic circulatory arrest. [ABSTRACT FROM AUTHOR]

Generalised atheromatosis is the leading cause of mortality and morbidity in Western Europe and the United States. The main determinations are cardiac, cerebral and lower limbs. Usually, they require serial surgical procedures. We report a case of a 65 year-old patient with severe tricoronary stenosis and high abdominal aorta occlusion. The impossibility of using the abdominal aorta as an inflow source for revascularisation of the lower limbs and the severity of symptoms required concomitant myocardial and lower limb revascularisation using the ascending aorta as an inflow source for both procedures. The postoperative outcome was favourable, without complications, the patient being discharged at 9 days postoperatively. At first and 6 month postoperative follow-up, the patient was asymptomatic. In conclusion, the ascending aorta is a good inflow source to the lower limb revascularisation, and the combination of the two procedures can be performed in selected cases with good results. [ABSTRACT FROM AUTHOR]

The association o f an acute ventricular septal defect (VSD) and left ventricular aneurysm (LVA) is a rare, life-threatening complication of acute myocardial infarction (AMI). We present the case o f an apical VSD and LVA after anterior AMI, in a 71-year-old male patient with a history of aortic valve replacement, arterial hypertension and atrial fibrillation. An emergency percutaneous coronary intervention (PCI), with a BMS stent on the left anterior descendent coronary artery was performed. 3rd day echocardiographic reevaluation revealed LVA and apical VSD. After 35 days of cardiologic management, the patient underwent ventriculotomy for VSD repair using a bovine pericardial patch followed by endoventricular patch remodelling of the LVA. He was discharged 16 days after surgery and presented good clinical and echocardiographic evolution during follow-up. [ABSTRACT FROM AUTHOR]

Background: Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients., Methodology: Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes., Results: Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery., Conclusions: The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Committee of Emergency Institute for Cardiovascular Disease and Transplantation, Tîrgu Mures issued approval 3240, 15.04.2024. The study was conducted in accordance with the Declaration of Helsinki. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ghiragosian et al.)

Introduction: Left ventricular aneurysm is a severe complication of acute myocardial infarction, which contributes significantly to mortality and morbidity associated with this pathology. Despite the progress of correction techniques, there are still controversies about the optimal approach addressing this pathology., Aim: The aim of this study was to analyse short and medium term outcomes of left ventricular reconstruction for ischemic left ventricular aneurysm using two surgical techniques (endoventricular patch plasty and liniar suture) in order to determine if one of these techniques has supperior results., Method: 117 patients were included in the study, 48 patients (41%) underwent left ventricular reconstruction with endoventricular patch (Group 1), 69 patients (59%; Group 2) had linear reconstruction. 113 patients (96.5%) required associated procedures: 108 surgical myocardial revascularization, 18 mitral valvuloplasty and 8 ventricular septal defect closure. Short and medium term morbidity, mortality, alteration of ejection fraction and NYHA class were analysed., Results: Perioperative mortality was 11.11%, 4.2% in the endoventricular patch group, and 15.9% in the linear suture group (p = 0.03). The overall 5-year survival was 78.5% (88.7% in Group 1 and 71.2% in Group 2). The left ventricular ejection fraction and NYHA functional class improved in both groups, with greater improvement in the endoventricular patch group., Conclusions: Surgical ventricular reconstruction is a procedure performed for the correction of ischemic left ventricular aneurysm with good early and medium-term results, but with better results with the endoventricular patch technique regarding early and medium-term mortality, ejection fraction and NYHA functional class improvement. Orv Hetil. 2018; 159(51): 2167-2174.