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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.

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.

Abdominal aortic aneurysm (AAA) represents the increase of the diameter of the aorta by more than 50% in the absence of surgical or endovascular intervention. The risk of rupture and, therefore, mortality is increased significantly in AAA. The role of the mechanical characteristics of the AAA wall is poorly studied.

Autologous vascular arterial or venous graft are not available in 10-40% of patients, due to vascular pathologies, and the utility of decellularized biological scaffolds would be a solution for those cases. The purpose of this research was to obtain a functional acellular xenograft, prior to in-vivo testing as a vascular graft in an experimental animal.

In vascular reconstruction in arterial trauma, ruptured abdominal aortic aneurysm or ruptured aneurysmal arteriovenous fistula, the challenge no longer lies in the surgical procedure itself, but rather the prevention of intimal hyperplasia, thrombosis and aneurysm formation, in parallel with extending as long as possible the patency of the grafts.

An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment.

Postoperative coronary vasospasm is a well-known cause of angina that may lead to myocardial infarction if not treated promptly. We report a case of a 70-year-old female with severe mitral regurgitation submitted to mitral valve replacement, and a history of diabetes mellitus type II, stroke, idiopathic thrombocytopenic purpura on steroid therapy, and previous percutaneous coronary intervention (PCI) for severe obstruction of the circumflex coronary artery, 4 months prior to surgery. Immediately after intensive care unit admission, the patient developed pulseless electrical activity which required extracorporeal membrane oxygenation for hemodynamic support. The coronary angiography showed diffuse occlusive coronary artery vasospasm, ameliorated after intra-coronary administration of nitroglycerin. The following postoperative evolution was marked by cardiogenic shock and multiple organ dysfunction syndrome. Subsequent echocardiographic findings showed an increase in left ventricular function with an EF of 40%, and extracorporeal membrane oxygenation (ECMO) support was weaned after seven days. However, after a few hours, the patient progressively deteriorated, with cardiac arrest and no response to resuscitation maneuvers. Hemodynamic instability following the surgical procedure in a patient with previous PCI associated with an autoimmune disease and diabetes mellitus should raise the suspicion of a coronary artery vasospasm.

Background: We hypothesized that an ideal heart valve replacement would be acellular valve root scaffolds seeded with autologous stem cells. To test this hypothesis, we prepared porcine acellular pulmonary valves, seeded them with autologous adipose derived stem cells (ADSCs) and implanted them in sheep and compared them to acellular valves.

Genetic factors play a significant role in the pathogenesis of mitral valve diseases, including mitral valve prolapse (MVP) and mitral valve regurgitation. Genes like Fibrillin-1 (FBN1), Filamin A (FLNA), matrix metalloproteinase 2 (MMP2), and SRY-box transcription factor 9 (SOX9) are known to influence mitral valve pathology but knowledge of the exact mechanism is far from clear. Data regarding serum parameters, transesophageal echocardiography, and genetic and histopathologic parameters were investigated in 54 patients who underwent cardiovascular surgery for mitral valve regurgitation. The possible association between Fibrillin-1, Filamin A, MMP2, and SOX9 gene expressions was checked in relationship with the parameters of systemic inflammatory response. The mRNA expression levels (RQ—relative quantification) were categorized into three distinct groups: low (RQ < 1), medium/normal (RQ = 1–2), and high (RQ > 2). Severe fibrosis of the mitral valve was reflected by high expression of FBN1 and low expression of MMP2 (p < 0.05). The myxoid degeneration level was associated with the mRNA expression level for FBN1 and a low lymphocyte-monocyte ratio was associated with an increased mRNA expression of FBN1 (p < 0.05). A high number of monocytes was associated with high values of FBN1 whereas the increase in the number of lymphocytes was associated with high levels of MMP2. In addition, we observed that the risk of severe hyalinization was enhanced by a low mRNA expression of FLNA and/or SOX9. In conclusion, a lower FLNA mRNA expression can reflect the aging process that is highlighted in mitral valve pathology as a higher risk for hyalinization, especially in males, that might be prevented by upregulation of the SOX9 gene. FBN1 and MMP2 influence the inflammation-related fibrotic degeneration of the mitral valve. Understanding the genetic base of mitral valve pathology can provide insights into disease mechanisms, risk stratification, and potential therapeutic targets. [ABSTRACT FROM AUTHOR]

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]

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]

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: achieving a pulmonary valve xenograft with no hemodynamic impact. Methods: In the Tissue Engineering and Regenerative Medicine Laboratory at the University of Medicine and Pharmacy Tîrgu-Mureş, acellular scaffolds were created from decellularized porcine pulmonary valves using mechanical, chemical and enzymatic methods. Those were included in a decellularized bovine pericardium conduct and placed in extra-anatomic position between the right ventricle outflow tract and the pulmonary trunk. 7 juvenile sheep about 4-5 months (22-25 kg) were selected as animal model. Right ventricle and pulmonary artery invasive pressures were measured intra-operatorily, before and after the ligature of the native pulmonary trunk. Systemic blood pressure, heart rate and oxygen saturation were also monitored. Results: The physiologic average of the right ventricle mean pressure was 20.14 mmHg (interval between 17 and 22) and in the pulmonary artery, it was 23.42 mmHg (interval between 21 and 26). Redirecting the blood flow through the valvular conduit, by ligating the pulmonary trunk origin produced similar values: 21.42 mmHg (19 to 23) in the right ventricle and 23.14 mmHg (21 to 26) in the pulmonary artery. The new means were not significantly different from the native values, as shown by the two-tailed p values of the paired t-test (p = 0.06, respectively 0.77, at a 95% confidence level). Arterial blood pressures were maintained between 110-130/70-80 mmHg, heart rate below 100/min and oxygen saturation above 94%. Conclusions: Our pulmonary valve xenograft implantation technique did not modify intraventricular and pulmonary pressures. Systemic blood pressure, heart rate and oxygen saturation were also stable. Long term follow-up is necessary to evaluate the xenograft performance. [ABSTRACT FROM AUTHOR]

Background: In the present days cardiovascular surgery is embrancing minimally invasive techniques in a growing number. It consists of small incisions and the divergence of median sternotomy. This leads to shorter duration of hospitalization, decreased blood loss, less postoperative pain and scarring, and faster recovery. Objective: The aim of the study is to conduct minimally invasive surgical closure of an atrial septal defect under femoro-femoral cardiopulmonary bypass. A supplementary cannula that is inserted straight through the thoracic aperture drains the superior vena cava. We offer a present approach wherein a single two-stage femoral cannula is used to drain both vena cavae. Material and methods: The cannula is inserted through the femoral vein, its proximal holes remain in the IVC while the distal ones are directed into the SVC. To increase the venous return, a centrifugal pump is installed on the venous line between the cannula and the venous reservoir. The right atrium is isolated using clamps on the IVC and SVC cannula before the atrium is opened and the ASD is fixed. Results: We recently used this method on a 60-year-old male patient. Passive venous drainage was 2.6 l/min, while the perfusion theoretical flow was 5.4 l/min. However, adding the centrifugal pump boosted the flow to 5.4 l/min, resulting in an ideal perfusion flow. The CPB duration was 38 minutes, and the operative time was 140 without complications. The patient was discharged on postoperative day 5. Conclusions: Minimally invasive procedure is a great alternative to the transcatheter treatment,avoiding sternotomy. Administering a single venous catheter to drain both vena cavae streamlines the procedure and adds to the development of minimally invasive cardiac surgery. [ABSTRACT FROM AUTHOR]