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Background: The impact of air bubbles into the cerebral circulation after open heart surgery has been a topic of discussion since the introduction of the heart-lung machine. The aim of the study was to evaluate whether the use of a dedicated commercial sponge diffuser is better than a custom-made narrow section cannula or the absence of CO2 in preventing neurological events after aortic valve replacement via J mini-sternotomy. Methods: Three cohorts of J-shaped mini-sternotomy performed at three different centers were prospectively compared: CO2 supplied via sponge diffuser, CO2 supplied via cannula, and no CO2 supply. Propensity matching was used to obtain comparable groups. The primary endpoints were postoperative stroke, transitory ischemic attack, convulsions, and dizziness. Secondary endpoints were 30-day mortality, duration of mechanical ventilation, and intensive care unit length of stay. Results: 275 patients were enrolled in the study. After propensity matching, the sponge diffuser cohort had a significantly lower duration of mechanical ventilation (P < 0.001) and 30-day mortality (P = 0.05) when compared to the cannula cohort and the no-CO2 cohort, a lower incidence of all neurological events (P = 0.03) and dizziness (P = 0.05) when compare to the no-CO2 cohort, and a lower intensive care unit length of stay when compared to the cannula cohort (P = 0.001). Conclusions: The sponge diffuser used to deliver the CO2 into the surgical field during aortic valve replacement via J mini-sternotomy has been demonstrated to guarantee better neurological outcomes compared to a custom-made narrow section cannula or the absence of CO2. [ABSTRACT FROM AUTHOR]

The article delves into the pivotal role played by Bernard J. Miller in the advancement of the Gibbon heart-lung machine, as recounted by his son, Stanton B. Miller. Through his collaboration with Dr. John Gibbon Jr., Bernard J. Miller made significant strides in biomedical engineering, particularly in the realm of the heart-lung machine. The text underscores Miller's innovative contributions that bridged the gap between engineering and clinical surgery, leading to critical advancements in the machine's development. It also sheds light on Miller's pioneering work in the field, including his involvement in the first successful case on May 6, 1953, and his subsequent research and clinical contributions that have had a lasting impact on modern cardiac surgery. [Extracted from the article]

Left ventricular assist devices (LVADs) are excellent therapies for advanced heart failure patients either bridged to transplant or for lifetime use. LVADs also allow for reverse remodeling of the failing heart that is often associated with functional improvement. Indeed, growing enthusiasm exists to better understand this population of patients, whereby the LVAD is used as an adjunct to mediate myocardial recovery. When patients achieve benchmarks suggesting that they no longer need LVAD support, questions related to the discontinuation of LVAD therapy become front and center. The purpose of this review is to provide a surgical perspective on the practical and technical issues surrounding LVAD deactivation. [ABSTRACT FROM AUTHOR]

The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up. Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models. For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF. Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF. [ABSTRACT FROM AUTHOR]

The hydraulic leveling system plays an important role in the crane load-bearing platform (Referred to as CBP). In recent years, a lot of work has been done to improve the performance of the leveling system. However, all these efforts are focused on control techniques and methods, while ignoring other comprehensive improvement options. This article takes the hydraulic legs subjected to the synchronous drive system of CBP (Referred to as CBP) as the research object, a set of hydraulic synchronous leveling system used for the valve-controlled cylinder was designed, and the mathematical model of transfer function for the valve-controlled cylinder and the theoretical solutions of main parameters in hydraulic oil circuit are obtained, then establish a mechanical model suitable for the attitude position of CBP. After that, a composite leveling strategy applied to the fuzzy PID (Proportional Integral Differential) synchronous leveling system with hydraulic legs driven synchronously was proposed, and a fuzzy PID controller was mapped out independently. Meanwhile, the above-designed sync-drive system coupling synchronous leveling process suitable for the CBP legs was carried out by AMESim and MATLAB/Simulink software. In addition, the correctness and robustness of the simulation model were verified by the leveling experiment, and the validity and reliability of the previously designed oil circuit scheme was proved. The results proposed in this paper improve the hydraulic leveling accuracy and response speed to optimize the performance of the hydraulic leveling system. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiogenic shock (CS) and mitral regurgitation (MI) have a prohibitive risk that contraindicates surgical treatment. Although the feasibility of transcatheter edge-to-edge therapy (TEER) has been demonstrated in this setting, the benefit of the combined use of TEER with mechanical circulatory support devices (MCS) has not been studied. The aim of this study was to evaluate the clinical outcomes of TEER in patients with MCS. Methods: The MITRA-ASSIST study is a retrospective multicentre Spanish registry that included patients with MR and CS who underwent TEER in combination with MCS. The primary endpoint was death from any cause at 12 months. The secondary endpoint was a composite of death from any cause or hospitalisation for heart failure at 12 months. Results: A total of twenty-four patients in nine high-volume Spanish centres (66.2 (51–82) years, 70.8% female, EuroSCORE II 20.4 ± 17.8) were included. Acute ST-elevation myocardial infarction was the main CS aetiology (56%), and the most implanted MCS was the intra-aortic balloon pump (82.6%), followed by ECMO (8.7%), IMPELLACP® (4.3%), or a combination of both (4.3%). Procedural success was 95.8%, with 87.5% in-hospital survival. At 12-month follow-up, 25.0% of patients died, and 33.3% had a composite event of death from any cause or hospitalisation for heart failure. Conclusions: TEER in patients with concomitant CS and MR who require MCS appears to be a promising therapeutic alternative with a high device procedural success rate and acceptable mortality and heart failure readmission rates at follow-up. [ABSTRACT FROM AUTHOR]

Background: The timing of treatment for chronic aortic valve regurgitation (AR), especially in asymptomatic patients, is gaining attention since less invasive strategies have become available. The aim of the present study was to evaluate left ventricular reverse remodeling after aortic valve replacement (AVR) for severe AR. Methods: Patients (n = 25) who underwent surgical AVR for severe AR with left ventricular ejection fraction (LVEF) less than 55% were included in this study. Preprocedural and follow-up clinical and echocardiographic measurements of LVEF and left ventricular (LV) diameters were retrospectively analyzed. Results: Mean LVEF increased significantly following surgical AVR (p < 0.0001). LV diameters showed a clear regression (p = 0.0088). Younger patients and those receiving a mechanical valve tended to have less improved LVEF on follow-up than patients over 60 years or the ones who were implanted with a biological prosthesis (p = 0.0239 and p = 0.069, respectively). Gender had no effect on the degree of LVEF improvement (p = 0.4908). Conclusions: We demonstrated significant LV reverse remodeling following AVR for AR. However, more data are needed on LV functional and geometrical improvement comparing the different types of valve prostheses to provide an optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Perioperative management of patients on dialysis is critical for controlling bleeding and thrombotic risk, in addition to infection control. Postoperative anticoagulation is often difficult to control, and different institutions have different policies. Therefore, in this study, we aimed to investigate factors associated with postoperative bleeding events and whether warfarin (WF) therapy affects the incidence of postoperative bleeding events, total mortality, and stroke. Methods: Patients who were admitted to the cardiovascular surgery department and underwent valve replacement or plasty were included, and those who underwent mechanical valve introduction were excluded. Thirty-nine patients were included in the study. The primary endpoint was to identify factors associated with the composite endpoint of postoperative bleeding events, and the secondary endpoint was to determine the effect size of WF therapy on postoperative bleeding events, all-cause mortality, and stroke and the strength of association between the crossed endpoints. The strength of the association between the crossed items was examined. Results: Low body weight (p = 0.038) was identified as a factor associated with the primary endpoint of postoperative bleeding events. The secondary endpoint of whether or not patients received WF therapy was largely unrelated to bleeding events, all-cause mortality, and postoperative stroke up to 90 days after surgery. Conclusions: Preliminary studies suggest that low body weight is a risk factor for postoperative bleeding events in patients on dialysis, although further exploration of other factors will be necessary with the accumulation of similar cases. [ABSTRACT FROM AUTHOR]

Background: The management of mitral valve disease in young children is challenging. Mechanical mitral valves could provide long-term durability; however, the need for anticoagulation increases the risk profile of mechanical valves. We report our experience in mechanical mitral valve replacement (MVR) in children under 2 years of age and evaluate factors affecting the outcomes. The study included all patients younger than 2 years who underwent mechanical MVR between 2000 and 2023. The study outcomes were mitral valve reoperation, bleeding, valve-related thrombosis, and survival. Results: Twenty-three patients were included, with a mean age of 10.2 ± 5.9 months. The mitral valve sizes ranged from 16 to 25 mm, and 6 (26%) were placed in the supra-annular position. Complete heart block occurred in seven patients (30%), and operative mortality occurred in three patients (13%). Postoperative warfarin was used in 17 patients (74%). After discharge, bleeding occurred in five patients (22%), four were managed conservatively, and one had intracranial hemorrhage treated with craniotomy. Nine patients (39%) had valve-related thrombosis; two underwent reoperation, while seven were treated with alteplase in 26 patients. Valve-related thrombosis was more common in patients with supra-annular valves (p < 0.001) and in those who were not on warfarin (p < 0.001). A total of seven patients (30%) underwent redo MVR, and redo was more common in young patients (p = 0.029) and in patients with supra-annular valves (p < 0.001). Survival of the whole cohort was 73% at 5 years. Among the annular position group, 5-year survival was 88%, while among the supra-annular position group, survival was 50% after 3 months and 25% after 14 months (p = 0.009). Conclusions: Mechanical MVR in children younger than 2 years is associated with high complication rates, including thrombosis and bleeding. The supra-annular valve position appears to be a risk factor for thrombosis and reoperation. Anticoagulation with warfarin remains challenging. However, further studies evaluating alternative options are needed. [ABSTRACT FROM AUTHOR]

Warfarin-related nephropathy (WRN) is defined as acute kidney injury subsequent to excessive anticoagulation with warfarin. Patients with mechanical prosthetic valves require long-term anticoagulant therapy. Nonetheless, warfarin remains the sole available option for anticoagulant therapy. Consequently, patients with mechanical prosthetic valves constitute a special group among the entire anticoagulant population. The present study recorded two cases of patients who had undergone mechanical prosthetic valve surgery and were receiving warfarin therapy. They presented to the hospital with gross hematuria and progressive creatinine levels. Notably, their international normalized ratio (INR) did not exceed three. Subsequent renal biopsies confirmed WRN with IgA nephropathy. The two patients continued to receive warfarin as anticoagulation therapy and were prescribed oral corticosteroids and cyclophosphamide, which resulted in improved renal function during the follow-up. Based on a review of all relevant literature and the present study, we proposed a new challenge: must elevated INR levels be one of the criteria for clinical diagnosis of WRN? Perhaps some inspiration can be drawn from the present article. [ABSTRACT FROM AUTHOR]

This article is an interview with Victor Poirier, a pioneer in the development of artificial heart technology. Poirier discusses his work with Dr. Edward Teller, a renowned nuclear physicist known for his contributions to the development of atomic and hydrogen bombs. Poirier explains how he ended up working with Teller and their involvement in developing nuclear-powered electrical systems. They later applied this technology to artificial heart systems, with Teller providing crucial information and recommending the use of Plutonium 238 as a fuel source. The proposed system was eventually accepted, and Poirier reflects on the honor and privilege of working with Teller on this project. [Extracted from the article]

Advanced heart failure (HF) is characterized by refractory symptoms and frequent rehospitalizations despite the optimal medical therapy. The prevalence of end-stage HF is increasing due to the increasing number of patients with risk factors for cardiovascular diseases and the ageing of the population, and it is a great clinical challenge and burden for the healthcare system. The prognosis of the disease is poor, with a one-year mortality rate of 25% to 75%. Given that the optimal medical therapy is of limited effect, advanced therapeutic methods which include heart transplantation and the mechanical circulatory support are being considered in the treatment of such patients. Heart transplantation is the gold standard for the treatment of end-stage HF, but due to the limited number of donor organs and certain contraindications, some patients will not be treated with this method. Short-term devices for mechanical circulatory support can be used in the treatment of cardiogenic shock and acute deterioration as a bridge to decision, recovery, upgrade or heart transplantation. Long-term devices for left ventricular support are implanted as a bridge to heart transplantation or as destination therapy in patients who are permanently ineligible for heart transplantation. The main challenge in the adequate use of heart transplantation is the disproportion between the need and the number of donors, which requires optimal screening of candidates and better rationalisation of resources. Despite advances in the technology of the devices for mechanical circulatory support, their full potential is limited due to the still underdeveloped long-term right ventricular support, the underdeveloped complete intracorporeal system, the cost (availability) and possible adverse events after implantation such as driveline infections, systemic thrombosis or bleeding. Application of advanced methods of treating HF in carefully selected patients is essential for a successful outcome. Delayed referral of such patients to transplant centres further limits therapeutic options. This paper presents the challenges in the treatment of patients with end-stage HF with reference to the disease itself, pharmacotherapy and the use of advanced treatment methods. [ABSTRACT FROM AUTHOR]

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are glucose-lowering agents used for the treatment of type 2 diabetes mellitus, which also improve heart failure and decrease the risk of cardiovascular complications. Epicardial adipose tissue (EAT) dysfunction was suggested to contribute to the development of heart failure. We aimed to elucidate a possible role of changes in EAT metabolic and inflammatory profile in the beneficial cardioprotective effects of SGLT-2i in subjects with severe heart failure. Methods: 26 subjects with severe heart failure, with reduced ejection fraction, treated with SGLT-2i versus 26 subjects without treatment, matched for age (54.0 ± 2.1 vs. 55.3 ± 2.1 years, n.s.), body mass index (27.8 ± 0.9 vs. 28.8 ± 1.0 kg/m2, n.s.) and left ventricular ejection fraction (20.7 ± 0.5 vs. 23.2 ± 1.7%, n.s.), who were scheduled for heart transplantation or mechanical support implantation, were included in the study. A complex metabolomic and gene expression analysis of EAT obtained during surgery was performed. Results: SGLT-2i ameliorated inflammation, as evidenced by the improved gene expression profile of pro-inflammatory genes in adipose tissue and decreased infiltration of immune cells into EAT. Enrichment of ether lipids with oleic acid noted on metabolomic analysis suggests a reduced disposition to ferroptosis, potentially further contributing to decreased oxidative stress in EAT of SGLT-2i treated subjects. Conclusions: Our results show decreased inflammation in EAT of patients with severe heart failure treated by SGLT-2i, as compared to patients with heart failure without this therapy. Modulation of EAT inflammatory and metabolic status could represent a novel mechanism behind SGLT-2i-associated cardioprotective effects in patients with heart failure. [ABSTRACT FROM AUTHOR]

The long-term safety, efficacy, and outcomes of low-intensity anticoagulation for mechanical heart valves remain unclear. This study aimed to evaluate the long-term outcomes of low-intensity anticoagulation therapy after aortic valve replacement (AVR) with a mechanical prosthesis. This retrospective cohort study consulted medical records and conducted a questionnaire to investigate 519 patients who underwent single AVR with the St. Jude Medical bileaflet valve and were in sinus rhythm. All patients were followed up with an international normalized ratio (INR) target of 1.6–2.5, and their INR values were checked throughout the follow-up period. The survival rate, incidence of major adverse cardiac and cerebrovascular events (MACCE), and risk factors for cardiac death and MACCE were investigated. The total follow-up was 9793 patient-years, and the follow-up periods were 19.9 (standard deviation [SD]: 7.9) years. The mean INR was 2.03 (SD: 0.54). Survival rates from cardiac death were 93.6% in 20 years and 85.2% in 30 years. Advanced age ≥ 70 years was the only significant risk factor for cardiac death and MACCE, and the INR < 2.0 was not significant risk factor for MACCE including thromboembolism or bleeding events. Low-intensity anticoagulation with an INR of 1.6–2.5 for patients with sinus rhythm after AVR with a bileaflet mechanical valve is safe and effective, even over 30 years. [ABSTRACT FROM AUTHOR]

No guidelines currently exist for the management of Candida auris bloodstream infection in patients with left ventricular assist devices (LVADs). We aim to share our management experience through this retrospective case series outlining 15 episodes of C auris candidemia identified in 7 patients over 18 months. The initial source of candidemia was central venous catheter in 5 patients, driveline exit site infection in 1 patient, and possible pump infection in 1 patient. All patients were initially treated with micafungin. Despite susceptibility to micafungin, 4 patients experienced recurrent C auris candidemia. All patients died within 1 year of their first episode of C auris candidemia. Source control is challenging in patients with LVADs, and strict infection prevention measures should be practiced. More studies are needed to evaluate the role of newer antifungal agents, use of combination antifungal regimens, and impact on morbidity in patients with LVADs. [ABSTRACT FROM AUTHOR]

Aortic stenosis is a heart valve disease that comprises one of the most common valvular lesions worldwide that can obstruct blood flow from the heart to the rest of the body leading to a significant mortality rate. In the present study, a sophisticated approach concerning the inspection of patient‐specific human heart conditions is proposed utilizing advanced computational and manufacturing methodologies. The suggested method exploits Digital Imaging and Communications in Medicine (DICOM) data that are retrieved via a computerized tomography scan process, and the corresponding 3D digital model of the heart is computed. In the next phase, the design the construction of an appropriate mechanical aortic valve is conducted considering the patient anatomical characteristics, which are derived directly from the heart's 3D model. Hereupon, additive manufacturing technologies are employed to accurately feature the customizable geometry of the native aortic valve. In addition, several experimental tests are performed in order to calculate the optimal process‐related parameters; presenting that way a mechanical behavior that resembles the mechanical properties of commercial artificial heart valves. Both the physical and digital 3D models can be used by healthcare professionals to identify potential defects prior to the cardiovascular operation. Finally, a numerical simulation is developed using computational fluid dynamics (CFD) modeling, which has emerged as an effective tool to explore the heart's hemodynamics pinpointing the efficiency of the aortic valve replacement. [ABSTRACT FROM AUTHOR]

This article discusses a case report of a patient who underwent repair of a ventricular septal defect (VSD) following a myocardial infarction (MI). The patient was initially supported with an Impella 5.5 device for two weeks before undergoing repair using a right ventriculotomy and implantation of a Heartmate 3 (HM3) device. The article highlights the effectiveness of pre-operative Impella 5.5 support in facilitating rehabilitation and myocardial remodeling, and demonstrates the successful use of a right ventriculotomy and the LV apical core for VSD repair. The case emphasizes the importance of timely VSD repair and the potential benefits of mechanical circulatory support in these cases. [Extracted from the article]

Objective: Reports on long-term outcomes of surgical aortic valve replacement (AVR) for patients aged < 60 years are scarce in Japan. Hence, we aimed to evaluate these outcomes in patients aged < 60 years. Methods: Between March 2000 and December 2020, 1477 patients underwent aortic valve replacement. In total, 170 patients aged < 60 years who underwent aortic valve replacement were recruited. Patients aged < 18 years were excluded. Patient data collected from the operative records and follow-up assessments were reviewed. Results: The mean age was 49 ± 9 years, and 64.1% of patients were male. One-hundred-and-fifty-two patients (89.4%) underwent aortic valve replacement with a mechanical valve and 18 (10.6%) with a bioprosthetic valve. The mean follow-up period was 8.1 ± 5.5 years. No operative mortality occurred, and in-hospital mortality occurred in one patient (0.6%). Ten late deaths occurred, with seven cardiac-related deaths. The overall survival rate was 95.4 ± 1.7%, 93.9 ± 2.3%, 90.6 ± 3.9%, and 73.2 ± 11.8% at 5, 10, 15, and 20 years, respectively. Freedom from major bleeding was 96.4 ± 1.6% at 5, 10, and 15 years, and 89.0 ± 7.3% at 20 years. Freedom from thromboembolic events was 98.7 ± 1.3%, 97.3 ± 1.9%, 90.5 ± 4.5%, and 79.0 ± 11.3% at 5, 10, 15, and 20 years, respectively. Freedom from valve-related reoperation was 99.4 ± 0.6% at 5 years, 97.8 ± 1.7% at 10 and 15 years, and 63.9 ± 14.5% at 20 years. Conclusions: Patients aged < 60 years undergoing aortic valve replacement with a high mechanical valve implantation rate had favorable long-term outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a study on the estimation of regurgitation in patients with percutaneous left ventricular assist devices (PLVAD) during full support. The study proposes an estimation system based on a regurgitation model and uses an unscented Kalman filter (UKF) as an estimation approach. The effectiveness of the algorithm is assessed using a mock circulatory loop experimental platform. The research findings demonstrate that the proposed system can accurately estimate regurgitation during PLVAD full support, providing valuable information for clinical practitioners to manage potential complications. [Extracted from the article]

This report reviews an Ethiopian patient who underwent cardiac surgery and had a mechanical heart valve implanted on the mitral valve with tricuspid valve repair for rheumatic heart disease via a local non-profit organization donation later complicated by cardio-embolic stroke, and aims to describe the challenges faced by patients from rural Ethiopia who require cardiac surgery for rheumatic heart disease and narrate the importance of careful follow-up. The lessons to be drawn from this case are that careful follow-up and adherence to prescribed Vitamin K antagonists after surgery for mechanical heart valves are critical and, when such patients are lost to follow-up as was witnessed in this case, it can induce lifelong morbidity. Morbidity that could have been avoided with strict and meticulous follow-up and with standardized patient tracing or contact systems. When patients are lost to follow-up it needs to be top priority to trace them after cardiac surgery and this report highlights the pivotal role of the health education in such populations. Unless we utilize this opportunity to unlock the door and embrace a systemic approach to reforming our risk assessment, referral chain system, and integration of various healthcare professionals in patient follow-up, as well as enhancing health education among our patients in rural Ethiopia and other low-income countries, the consequences could prove to be significant. Preventing such fatal complications is far superior to managing them afterwards, as it not only saves on expenses but also saves lives and enhances quality-of-life. [ABSTRACT FROM AUTHOR]

This article explores the use of stem cells to study valvular heart disease (VHD), a significant cause of cardiovascular morbidity and mortality, particularly among older individuals. While animal models have provided some insights into VHD, they do not fully replicate human valvulogenesis and phenotypes. The article introduces a novel approach to generate human-induced pluripotent stem cell-derived valvular endothelial cells and valvular interstitial cells, which are crucial for understanding VHD. This research has the potential to enhance our understanding of VHD and improve treatment strategies. The article also discusses the use of single-cell multiomics to study the development and progression of heart valves, emphasizing the importance of understanding the origins and trajectories of endocardial cells to create an in vitro cellular model that accurately replicates the pathophysiology of human heart valves. The authors also explore potential applications of this research, including the development of patient-specific engineered heart valves for autologous replacement. They stress the need for further research to enhance the applicability of iPSC-derived valve cells and improve outcomes of valve replacement surgeries. [Extracted from the article]

Background: Hemophilic arthropathy usually affects the knees bilaterally. In order to reduce costs and improve rehabilitation, bilateral simultaneous total knee arthroplasty (TKA) can be performed. However, pharmacological prophylaxis for deep venous thrombosis (DVT) remains controversial in patients with severe hemophilia. The purpose of this study was to establish the incidence of DVT in severe hemophilia A patients undergoing bilateral simultaneous TKA without pharmacological thromboprophylaxis. Methods: Consecutive patients with severe hemophilia A undergoing bilateral simultaneous TKA at a single center between January 2015 and December 2020 were retrospectively reviewed. All patients received a modified coagulation factor substitution regimen. Tranexamic acid (TXA) was used for hemostasis in all patients during surgery. All patients followed a standardized postoperative protocol with routine mechanical thromboprophylaxis, and none received anticoagulation. D-dimer was measured preoperatively, on the day of the operation and on postoperative days 1, 7 and 14. Ultrasound (US) of the lower extremities was performed before (within 3 days of hospitalization) and after surgery (days 3 and 14) to detect asymptomatic DVT. Patients were followed up until 2 years after surgery for the development of symptomatic DVT or pulmonary embolism (PE). Results: 38 male patients with severe hemophilia A underwent 76 simultaneous TKAs. Mean (± standard deviation) age at the time of operation was 41.7 (± 17.1) years. Overall, 47.3% of patients had D-dimer concentrations above the threshold 10 µg/mL on day 7 and 39.5% on day 14. However, none of the patients had DVT detected on postoperative US, nor developed symptomatic DVT or PE during the 2-year follow-up. Conclusions: The risk of DVT in patients with severe hemophilia A after bilateral simultaneous TKA is relatively low, and routine pharmacological thromboprophylaxis may not be needed. [ABSTRACT FROM AUTHOR]

Recognizing that cells "feel" and respond to their mechanical environment, recent studies demonstrate that many cells exhibit a phenomenon of "mechanical memory" in which features induced by prior mechanical cues persist after the mechanical stimulus has ceased. While there is a general recognition that different cell types exhibit different responses to changes in extracellular matrix stiffening, the phenomenon of mechanical memory within myocardial cell types has received little attention to date. To probe the dynamics of mechanical memory in cardiac fibroblasts (CFs) and cardiomyocytes derived from human induced pluripotent stem cells (iPSC-CMs), we employed a magnetorheological elastomer (MRE) cell culture substrate with tunable and reversible stiffness spanning the range from normal to diseased myocardium. In CFs, using increased cell area and increases in α-smooth muscle actin as markers of cellular responses to matrix stiffening, we found that induction of mechanical memory required seven days of stiff priming. Both induction and maintenance of persistent CF activation were blocked with the F-actin inhibitor cytochalasin D, while inhibitors of microtubule detyrosination had no impact on CFs. In iPSC-CMs, mechanical memory was invoked after only 24 h of stiff priming. Moreover, mechanical memory induction and maintenance were microtubule-dependent in CMs with no dependence on F-actin. Overall, these results identify the distinct temporal dynamics of mechanical memory in CFs and iPSC-CMs with different cytoskeletal mediators responsible for inducing and maintaining the stiffness-activated phenotype. Due to its flexibility, this model is broadly applicable to future studies interrogating mechanotransduction and mechanical memory in the heart and might inform strategies for attenuating the impact of load-induced pathology and excess myocardial stiffness. [ABSTRACT FROM AUTHOR]

Aims: The determinants and relevance of right ventricular (RV) mechanical dyssynchrony in heart failure with reduced ejection fraction (HFrEF) are poorly understood. We hypothesized that increased afterload may adversely affect the synchrony of RV contraction. Methods and results: A total of 148 patients with HFrEF and 36 controls underwent echocardiography, right heart catheterization, and gated single‐photon emission computed tomography to measure RV chamber volumes and mechanical dyssynchrony (phase standard deviation of systolic displacement timing). Exams were repeated after preload (N = 135) and afterload (N = 15) modulation. Patients with HFrEF showed higher RV dyssynchrony compared with controls (40.6 ± 17.5° vs. 27.8 ± 9.1°, P < 0.001). The magnitude of RV dyssynchrony in HFrEF correlated with larger RV and left ventricular (LV) volumes, lower RV ejection fraction (RVEF) and LV ejection fraction, reduced intrinsic contractility, increased heart rate, higher pulmonary artery (PA) load, and impaired RV–PA coupling (all P ≤ 0.01). Low RVEF was the strongest predictor of RV dyssynchrony. Left bundle branch block (BBB) was associated with greater RV dyssynchrony than right BBB, regardless of QRS duration. RV afterload reduction by sildenafil improved RV dyssynchrony (P = 0.004), whereas preload change with passive leg raise had modest effect. Patients in the highest tertiles of RV dyssynchrony had an increased risk of adverse clinical events compared with those in the lower tertile [T2/T3 vs. T1: hazard ratio 1.98 (95% confidence interval 1.20–3.24), P = 0.007]. Conclusions: RV dyssynchrony is associated with RV remodelling, dysfunction, adverse haemodynamics, and greater risk for adverse clinical events. RV dyssynchrony is mitigated by acute RV afterload reduction and could be a potential therapeutic target to improve RV performance in HFrEF. [ABSTRACT FROM AUTHOR]

Energy savings, albeit very small, are of great importance for devices whose use has become indispensable. In this study, an optimization based on sustainability and energy saving was aimed at designing the valve used in a white goods company's mass production of dishwashers. One significant factor that affects the overall efficiency of a dishwasher is pressure loss within the mechanical valve system. By optimizing the system, it is possible to minimize pressure loss and increase overall efficiency. To this end, 4th-order Bézier curves, which are used to model the blades of the impeller, were obtained using MATLAB R2023a software. Using Bézier curves, solid models of impellers with different blade profiles and numbers were created with SOLIDWORKS 2021 software. Fifty different models with six different blade numbers and five different materials were considered. In the numerical analyses, pressure losses were determined using ANSYS Fluent 2023R2 software. In addition to numerical analysis, blades were produced using the additive manufacturing method, and outlet pressures were measured experimentally. The experimental results were compared with the computational fluid dynamics analysis findings to evaluate the performance of different impeller designs. To determine the optimal design, the design of experiments and response optimizer approaches are applied, which enables the systematic evaluation of different design parameters. Furthermore, using numerical results, an artificial neural network model was created, and efficiency was predicted for the optimum parameters. Experimental and numerical results show that the optimum blade design enables the least pressure loss. [ABSTRACT FROM AUTHOR]

Mechanical load is one of the main determinants of cardiac structure and function. Mechanical load is studied in vitro using cardiac preparations together with loading protocols (e.g., auxotonic, isometric). However, such studies are often limited by reductionist models and poorly simulated mechanical load profiles. This hinders the physiological relevance of findings. Living myocardial slices have been used to study load in vitro. Living myocardial slices (LMS) are 300‐μm‐thick intact organotypic preparations obtained from explanted animal or human hearts. They have preserved cellular populations and the functional, structural, metabolic and molecular profile of the tissue from which they are prepared. Using a three‐element Windkessel (3EWK) model we previously showed that LMSs can be cultured while performing cardiac work loops with different preload and afterload. Under such conditions, LMSs remodel as a function of the mechanical load applied to them (physiological load, pressure or volume overload). These studies were conducted in commercially available length actuators that had to be extensively modified for culture experiments. In this paper, we demonstrate the design, development and validation of a novel device, MyoLoop. MyoLoop is a bioreactor that can pace, thermoregulate, acquire and process data, and chronically load LMSs and other cardiac tissues in vitro. In MyoLoop, load is parametrised using a 3EWK model, which can be used to recreate physiological and pathological work loops and the remodelling response to these. We believe MyoLoop is the next frontier in basic cardiovascular research enabling reductionist but physiologically relevant in vitro mechanical studies. What is the central question of this study?Can cardiac tissues be cultured under conditions that do not simulate the mechanical load the heart is exposed to in vivo?What is the main finding and its importance?A culture bioreactor was developed that can keep living heart tissue alive in vitro under continuous electromechanical stimulation. The device, MyoLoop, simulates the cardiac cycle on a beating slice during culture, recreating the in vivo workload of the heart in vitro. MyoLoop is a novel translational platform for cardiac studies. [ABSTRACT FROM AUTHOR]

Direct oral anticoagulants (DOACs) have revolutionized the field of antithrombotic treatments, challenging the dominance of warfarin. DOACs have provided a viable alternative to warfarin, eliminated the need for regular laboratory testing, and surpassed regulatory constraints. The uptake of DOACs has been hindered by budget impacts and restrictive reimbursement policies, as well as social determinants of health. However, DOACs have advantages such as fixed dosing without monitoring, improved coverage of anticoagulation use, and simplified perioperative management. There are still gaps in evidence regarding the use of DOACs in certain patient populations, and further research is needed to guide selection among different DOACs and assess their safety in specific conditions. [Extracted from the article]

Timely and accurate referral of end-stage heart failure patients for advanced therapies, including heart transplants and mechanical circulatory support, plays an important role in improving patient outcomes and saving costs. However, the decision-making process is complex, nuanced, and time-consuming, requiring cardiologists with specialized expertise and training in heart failure and transplantation. In this study, we propose two logistic tensor regression-based models to predict patients with heart failure warranting evaluation for advanced heart failure therapies using irregularly spaced sequential electronic health records at the population and individual levels. The clinical features were collected at the previous visit and the predictions were made at the very beginning of the subsequent visit. Patient-wise ten-fold cross-validation experiments were performed. Standard LTR achieved an average F1 score of 0.708, AUC of 0.903, and AUPRC of 0.836. Personalized LTR obtained an F1 score of 0.670, an AUC of 0.869 and an AUPRC of 0.839. The two models not only outperformed all other machine learning models to which they were compared but also improved the performance and robustness of the other models via weight transfer. The AUPRC scores of support vector machine, random forest, and Naive Bayes are improved by 8.87%, 7.24%, and 11.38%, respectively. The two models can evaluate the importance of clinical features associated with advanced therapy referral. The five most important medical codes, including chronic kidney disease, hypotension, pulmonary heart disease, mitral regurgitation, and atherosclerotic heart disease, were reviewed and validated with literature and by heart failure cardiologists. Our proposed models effectively utilize EHRs for potential advanced therapies necessity in heart failure patients while explaining the importance of comorbidities and other clinical events. The information learned from trained model training could offer further insight into risk factors contributing to the progression of heart failure at both the population and individual levels. [ABSTRACT FROM AUTHOR]

Background: Complete atrioventricular septal defect is a complicated congenital heart malformations, and surgical correction is the best treatment, the severe tricuspid stenosis is a rare long-term complication after the surgery. Case presentation: We report a case with the complication of severe tricuspid stenosis 7 years after the surgical correction of complete atrioventricular septal defect in a child. Then the patient underwent tricuspid mechanical valve replacement, Glenn, atrial septostomy, and circumconstriction of the right pulmonary artery. Conclusions: The patient recovered successfully with good short-term. [ABSTRACT FROM AUTHOR]

Sleep‐disordered breathing, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is common in severe heart failure (HF) patients. There is limited data on the effect of left ventricular assist devices (LVAD) on sleep apnea. We performed a retrospective review of 350 durable LVAD patients and found 5 with a history of pre‐ and post‐LVAD sleep studies. All five patients had OSA, and three had concomitant CSA. We observed reduced apnea‐hypopnea index following LVAD placement. This was due to a near abolishment of CSA in three mixed sleep apnea patients—as seen by a central apnea index improvement from an average of 25.9 ± 13.1 to 1.4 ± 2.5 events per hour (p = 0.063). LVAD placement was associated with an increase in thermodilution cardiac output from 2.7 ± 0.6 to 4.1 ± 1.1 L/min (p = 0.014). These findings support chemoreception physiology seen in patients with poor circulation and the effect of restoring this circulation with LVAD support. [ABSTRACT FROM AUTHOR]

Background: Failure of mechanical prothesis after mechanical valve replacement is a dreadful complication. Pannus and thrombosis are common causes of dysfunction. Different strategic plans for management are available but current approach still needs more evidence. Methods: Retrospective study analysis data of patients operated secondary to mechanical valve obstruction (MVO) from July 2014 to December 2019. Preoperative, operative and post operative are collected and analyzed. Results: 27 patients were operated secondary to MVO. Mean age was 31±12 years. Majority of patients were female 15 (55.5 %) and most of patients in NYHA class III. TTE data showed persevered EF (50 ± 11). MVO differ according to obstructed valve, 15 patients with mitral valve thrombus, and 5 of them thrombus and pannus. In aortic valve obstruction, 12 patients were with pannus and 3 of them with thrombus. The commonest preoperative rhythm was sinus rhythm in 17 patients while AF in 10 patients. Mean bypass time was 117 ± 11 per/min while aortic cross clamp was 99 ± 12 per/min. Mitral valve replacement was done in 12 patients and, valve thrombectomy in 5 patients. In Aortic valve obstruction, 9 valve replacement were done and 3 excisions of the pannus. In the present study, the total bleeding was 635 ± 325 ml, and no cases re-explored. One case needed permeant pacing. Total ICU stay was 43 ± 12 hours while total hospital stay was 9.07 ± 1.5 days. Mortality was 2 patients; one patient was early secondary to NYHA status and acute heart failure. The 2 nd was late secondary to endocarditis. Early and mid-term follow up showed no pannus formation or reintervention with mean follow up period up to 36 months. Conclusions: MVO is serious and life-threatening complications. Urgent intervention is the clue. Conservative or surgical approach should be directed for each patient. Thrombolysis has limited role and restricted indications and should directed to critically ill and high-risk patient, while open thrombectomy and pannus excision has good early and mid-term outcome but still lack long term outcome and more evidence still needed. Surgery is the definitive treatment with documented good long-term outcome. [ABSTRACT FROM AUTHOR]

Background: Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in‐hospital outcomes and resource utilization in the setting of cardiogenic shock (CS). Hypothesis: Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients. Methods: The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD‐9 and ICD‐10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in‐hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p <.05). Results: We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints. Conclusions: These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under‐diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long‐term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations. Key points: Unhoused patients hospitalized with cardiogenic shock (CS) have fewer traditional comorbidities however similar in‐hospital outcomes compared to housed patients.Unhoused patients with CS receive left and right heart catheterization and mechanical circulatory support less frequently than housed patients, however, undergo endotracheal intubation with greater frequency.A multidisciplinary approach along with strong community partnerships may result in improved access to care for this vulnerable population. [ABSTRACT FROM AUTHOR]

Introduction: Out‐of‐hospital cardiac arrest (OHCA) is defined as the loss of functional mechanical activity of the heart in association with an absence of systemic circulation, occurring outside of a hospital. Immediate coronary angiography (CAG) with percutaneous coronary intervention is recommended for OHCA with ST‐elevation. We aimed to evaluate the effect of early CAG on mortality and neurological outcomes in OHCA patients without ST‐elevation. Methods: This meta‐analysis and systemic review was conducted as per principles of Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) group. A protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, Ref No. = CRD42022327833). A total of 674 studies were retrieved after scanning several databases (PubMed Central, EMBASE, Medline, and Cochrane Central Register of Controlled Trials). Results: A total of 18 studies were selected for the final analysis, including 6 randomized control trials and 12 observational studies. Statistically, there was no significant difference in primary outcome, i.e., mortality, between early and delayed CAG. In terms of the grade of neurological recovery as a secondary outcome, early and delayed CAG groups also showed no statistically significant difference. Conclusion: Early CAG has no survival benefits in patients with no ST elevations on ECG after OHCA. [ABSTRACT FROM AUTHOR]

For most patients, direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists for stroke prevention in atrial fibrillation and for venous thromboembolism treatment. However, randomized controlled trials suggest that DOACs may not be as efficacious or as safe as the current standard of care in conditions such as mechanical heart valves, thrombotic antiphospholipid syndrome, and atrial fibrillation associated with rheumatic heart disease. DOACs do not provide a net benefit in conditions such as embolic stroke of undetermined source. Their efficacy is uncertain for conditions such as left ventricular thrombus, catheter-associated deep vein thrombosis, cerebral venous sinus thrombosis, and for patients with atrial fibrillation or venous thrombosis who have end-stage renal disease. This paper provides an evidence-based review of randomized controlled trials on DOACs, detailing when they have demonstrated efficacy and safety, when DOACs should not be the standard of care, where their safety and efficacy are uncertain, and areas requiring further research. [Display omitted] • Target-specific (or direct) oral anticoagulants are preferred for prevention or treatment of thromboembolism in most patients with atrial fibrillation or venous thromboembolism. • DOACs should not be the standard treatment for patients with mechanical heart valves, atrial fibrillation with rheumatic mitral stenosis, or antiphospholipid syndrome. • The efficacy and safety of DOACs remain uncertain for several other clinical conditions and subgroups, and future studies should address those situations. [ABSTRACT FROM AUTHOR]

The hemodynamics in the aorta as well as the durability of aortic valve prostheses vary greatly between different types of devices. Although placement and sizing of surgical aortic valve prostheses are excellent, the valve geometry of common devices cannot be customized to fit the patient's anatomy perfectly. Similarly, transcatheter aortic valve implantation (TAVI) devices are not customizable and may be orientated unfavorably during implantation. Imperfect fit of an aortic valve prosthesis may result in suboptimal performance and in some cases the need for additional surgery. Leveraging the advent of precision, multi-material 3D-printing, a bioinspired silicone aortic valve was developed. The manufacturing technique makes it fully customizable and significantly cheaper to develop and produce than common prostheses. In this study, we assess the hemodynamic performance of such a 3D-printed aortic valve and compare it to two TAVI devices as well as to a severely stenosed valve. We investigate the blood flow distal to the valve in an anatomically accurate, compliant aorta model via three-dimensional particle tracking velocimetry measurements. Our results demonstrate that the 3D-printed aortic valve induces flow patterns and topology compatible with the TAVI valves and showing similarity to healthy aortic blood flow. Compared to the stenosis, the 3D-printed aortic valve reduces turbulent kinetic energy levels and irreversible energy losses by over 75%, reaching values compatible with healthy subjects and conventional TAVIs. Our study substantiates that the 3D-printed heart valve displays a hemodynamic performance similar to established devices and underscores its potential for driving innovation towards patient specific valve prostheses. [ABSTRACT FROM AUTHOR]

This article discusses the potential use of machine learning algorithms to analyze data from cardiopulmonary bypass during cardiac surgery. The authors evaluate the technical aspects of the heart-lung machine and data recording parameters, identifying missing and incorrectly recorded data that could be important for analysis and control of the bypass. They suggest that the current technology and data recording methods are not well-suited for evaluation and analysis using machine learning algorithms, and propose improvements to the sensor technology of the heart-lung machine to achieve complete and accurate data recording. [Extracted from the article]

This article explores the differences in the proteome composition of cardiac adipose tissue (cAT) and perigonadal adipose tissue (pAT) using immune-competent adipoids (Ad). The study found that cAT and pAT have distinct phenotypes, with cAT containing multilocular lipid droplets similar to beige adipose tissue and pAT containing monolocular lipid droplets typical of white adipose tissue. Proteomic analysis revealed significant differences in the quantities of key lipid biosynthesis proteins between cAT and pAT, suggesting disparities in fat depot lipid metabolism. These findings have implications for understanding the role of cAT in cardiovascular disease and developing targeted therapies and prevention strategies. [Extracted from the article]

Prosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis associated with a high mortality rate. Whether PVE affects biological and mechanical aortic valves to the same extent remains controversial. This study aimed to compare the incidence of re-intervention because of PVE between bioprosthetic and mechanical valves. Patients undergoing isolated surgical aortic valve replacement (AVR) or combined AVR in a single cardiac surgery centre between January 1998 and December 2019 were analysed. All patients who underwent re-intervention because of PVE were identified. The primary endpoint was the rate of explants. Freedom from re-intervention and variables associated with re-intervention were analysed using Cox regression analysis including correction for competing risk. During the study period, 5,983 aortic valve prostheses were implanted, including 3,620 biological (60.5%) and 2,363 mechanical (39.5%) prostheses. The overall mean follow-up period was 7.3±5.3 years (median, 6.5; IQR 2.9–11.2 years). The rate of re-intervention for PVE in the biological group was 1.5% (n=54) compared with 1.7% (n=40) in the mechanical group (p=0.541). Cox regression analysis revealed that younger age (HR 0.960, 95% CI 0.942–0.979; p<0.001), male sex (HR 2.362, 95% CI 1.384–4.033; p=0.002), higher creatinine (HR 1.002, 95% CI 0.999–1.004; p=0.057), and biological valve prosthesis (HR 2.073, 95% CI 1.258–3.414; p=0.004) were associated with re-intervention for PVE. After correction for competing risk of death, biological valve prosthesis was significantly associated with a higher rate of re-intervention for PVE (HR 2.011, 95% CI 1.177–3.437; p=0.011). According to this single-centre, observational, retrospective cohort study, AVR using biological prosthesis is associated with re-intervention for PVE compared to mechanical prosthesis. Further investigations are needed to verify these findings. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES This population-based cohort study investigated mid-term outcome after surgical aortic valve replacement with a bioprosthetic or mechanical valve prosthesis in patients aged <50 years in a European social welfare state. METHODS We analysed patient data from the main social insurance carriers in Austria (2010–2020). Subsequent patient-level record linkage with national health data provided patient characteristics and clinical outcome. Survival, reoperation, myocardial infarction, heart failure, embolic stroke or intracerebral haemorrhage, bleeding other than intracerebral haemorrhage and major adverse cardiac events were evaluated as outcomes. RESULTS A total of 991 patients were analysed. Regarding demographics, no major differences between groups were observed. Multivariable Cox regression revealed no significant difference in overall survival (P  = 0.352) with a median follow-up time of 6.2 years. Reoperation-free survival was decreased (hazard ratio = 1.560 [95% CI: 1.076–2.262], P  = 0.019) and the risk for reoperation was increased (hazard ratio = 2.770 [95% CI: 1.402–5.472], P  = 0.003) in patients who received bioprostheses. Estimated probability of death after reoperation was 0.23 (CL: 0.08–0.35) after 2 years and 0.34 (CL: 0.06–0.53) after 10 years over both groups. Regarding further outcomes, no significant differences between the two groups were observed. CONCLUSIONS In patients below 50 years of age receiving aortic valve replacement, implantation of bioprostheses when compared to mechanical heart valve prostheses was associated with a significantly higher rate of reoperations and reduced reoperation-free survival. Nevertheless, we could not observe a difference in overall survival. However, long-term follow-up has to evaluate that a significantly lower rate of reoperations may translate in consistently improved long-term survival. [ABSTRACT FROM AUTHOR]

Purpose: Aortic root and ascending aortic aneurysms are rarely encountered in pediatric patients. Our aim in this study was to compare our surgical approach and results in this patient group with similar studies in the literature. Materials and Methods: This study retrospective in design and its cohort consists of pediatric patients who were operated on due to the diagnosis of aortic root and/or ascending aortic aneurysm. The etiologies of the patients that caused the aneurysm were investigated preoperatively, and the severity of the disease in the aortic valve and ascending aorta and surgical indications were revealed with detailed imaging methods. Operative data was then retrieved and early postoperative morbidity and mortality, as well as post-discharge aortic valve functions were evaluated. The obtained data was compared with those of similar articles in the literature. Results: A total of eight pediatric patients were operated on with the diagnosis of aortic root and ascending aortic aneurysm. The average age of the patients was eleven (±4.03) years. The underlying cause of three (37.5%) patients was Marfan syndrome, two (25%) had bicuspid aortic valve and one (12.5%) had Wiscott-Aldrich Syndrome, previously operated sinus valsalva aneurysm and operated truncus arteriosus. There was 3rd degree aortic valve insufficiency in six patients (75%). The average aortic annulus diameter, mean sinus of valsalva diameter and ascending aorta diameter of the patients were 26.7 mm (±5.3), 40.9 mm (±9.7) and 37.8 mm (±9.2), respectively. The David I procedure was performed in three (37.5%) patients, while the Bentall procedure or aortic valve and ascending aorta replacement was performed on the other five patients. Non-cardiac mortality was observed in one (12.5%) patient, whereas native and mechanical valve dysfunction was not observed in any patient after discharge. Conclusion: Both valve-sparing surgical procedures and other replacement techniques can be used safely in pediatric patients with aortic root and ascending aortic aneurysms. [ABSTRACT FROM AUTHOR]

Heart failure is a chronic and progressive condition characterized by the heart's inability to pump sufficient blood to meet the body's metabolic demands. It is a significant public health concern worldwide, associated with high morbidity, mortality, and healthcare costs. For advanced heart failure cases not responding to medical therapy, heart transplantation or mechanical circulatory support with ventricular assist devices (VADs) can be considered. In the specific case of bi-ventricular heart failure a replacement of both ventricles is required. In this context a Total Artificial Heart (TAH) may be proposed as a bridge to transplant solution. Additionally, bi-ventricular assist devices (BiVADs) are available to support both ventricles simultaneously. However Bi-ventricular heart failure management is difficult with poor outcomes. New surgical procedures appear to propose solutions after both ventricle failure. One of these intervention uses two continuous-flow VADs as a total artificial heart after cardiac explantation due to myocardial sarcoma. Unfortunately, this procedure makes patient management very difficult as pulmonary pressures and flow rate are no longer measurable after the surgical procedure. The setting of both pumps is hence a complex task for patient management. This article aims at helping clinicians on patient management undergoing double assistance after cardiac explantation by predicting the different outcomes on the vascular grid for all the possible rotational speed combination using a lumped model. Results provide a range of both pump operating conditions suitable for delivering a physiologically adapted flow to the vascular grid when combined with hypotensive treatments. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is the most common valvular pathology after heart transplantation (HTx) and endomyocardial biopsy (EMB) remains responsible for the majority of cases due to the high probability of structural valve damage. The aim of the present review was to describe the results of surgical management of severe tricuspid regurgitation through tricuspid valve replacement (TVR) after a previous HTx. A systematic review was conducted by searching Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane databases until June 2023 for publications reporting patients undergoing TVR surgery after a previous HTx. If no right heart valve surgery was undertaken, or a heterotopic heart transplant was performed, or if the concomitant procedure was performed during the transplant itself, the paper was excluded. Twenty articles met our inclusion criteria out of 1532 potentially eligible studies, with a total of 300 patients. Mean age was 55.1 ± 9.6 years, and 85.1% were male. The mean number of EMB per patient was 31.1 ± 5.5 with a mean time between HTx and TVR of 7.64 ± 3.31 years. Bioprostheses were used in 83.3% of cases and 75.0% of patients with a bioprosthesis were reported as alive at last follow-up. Tricuspid valve repair is a valuable option, but these patients will be susceptible to recurrent TR after EMB. TVR with a bioprosthesis may provide the optimal solution for this subset of patients, as EMB is not feasible with a mechanical valve. [ABSTRACT FROM AUTHOR]

Objective. The adoption of transcatheter aortic valve replacement (TAVR) has changed the profile of patients referred for surgical aortic valve replacement (SAVR) and drawn more attention to valve sizing and durability. We examined the influence of TAVR on SAVR practice. Methods. Using a statewide database, we evaluated all isolated SAVRs, categorized into three eras: pre-TAVR (2008 to 2011), early TAVR (2012 to 2015), and current-TAVR (2016 to 2022). The primary outcomes of interest were changes in prosthetic valve size and the percentage of mechanical valves used between time periods. Results. There were 6,445 patients included. SAVR volume declined in the current era. Valve size increased over time. In the pre-TAVR era, 41% of patients received a valve smaller than 23 mm, which declined to 33% in the early TAVR era, then to 22% in the current era (p < 0.001 for all). The year of surgery was significantly associated with larger valve selection even after controlling for patient characteristics. Annular enlargement rose in the current-TAVR era (p < 0.001). The use of mechanical valves rose in the current era (p < 0.001 compared to early TAVR). Regression analysis showed that the year of surgery was not predictive of mechanical valve use, suggesting that changes in practice were driven by patient characteristics. Conclusion. Surgical valve choice since the adoption of TAVR has changed, with less frequent use of smaller valves. Increases in mechanical valve usage are likely a reflection of changing patient population. [ABSTRACT FROM AUTHOR]

Transcatheter pulmonary valve replacement is a minimally-invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly evolving over the past years. Heart valve prostheses currently available still have major limitations. Therefore, one of the significant challenges for the future is the roll out of transcatheter tissue engineered pulmonary valve replacement to more patients. In the present study, biodegradable poly-ε-caprolactone (PCL) nanofiber scaffolds in the form of a 3D leaflet matrix were successfully seeded with human endothelial colony-forming cells (ECFCs), human induced pluripotent stem cell-derived MSCs (hMSCs), and porcine MSCs (pMSCs) for three weeks for the generation of 3D tissue-engineered tri-leaflet valved stent grafts. The cell adhesion, proliferation, and distribution of these 3D heart leaflets was analyzed using fluorescence microscopy and scanning electron microscopy (SEM). All cell lineages were able to increase the overgrown leaflet area within the three-week timeframe. While hMSCs showed a consistent growth rate over the course of three weeks, ECFSs showed almost no increase between days 7 and 14 until a growth spurt appeared between days 14 and 21. More than 90% of heart valve leaflets were covered with cells after the full three-week culturing cycle in nearly all leaflet areas, regardless of which cell type was used. This study shows that seeded biodegradable PCL nanofiber scaffolds incorporated in nitinol or biodegradable stents will offer a new therapeutic option in the future. [ABSTRACT FROM AUTHOR]

Background: Hemoperfusion is a technique for the extracorporeal elimination of endogenous and exogenous toxins and harmful mediators by adsorption. It can be used as a stand-alone device, as part of a heart-lung machine or extracorporeal membrane oxygenation (ECMO) or, as is currently the case, integrated into a kidney replacement procedure. In the meantime, various suppliers offer devices with different technologies. Objective: The aim of this work was to evaluate the benefits, risks and evidence of the different systems, how they work and for which indications they are approved in Germany. Method: To achieve this goal, a narrative assessment of the existing literature and guidelines for different indications was performed. The focus was on in vivo studies. Results: In principle, a distinction must be made in adsorption techniques between pure adsorption and the combination as adsorption and kidney replacement therapy. The adsorbers available in Germany include Cytosorb®, HA-330, Seraph®-100 and Toraymyxin. Combined procedures (adsorption and kidney replacement) are offered with coupled plasma filtration and adsorption (CPFA) and oXiris®. Most adsorbers have been developed for cytokine and endotoxin removal in patients with sepsis; however, to date, no randomized controlled trial (RCT) has demonstrated a survival benefit when using hemoperfusion. Therefore, the S3 guidelines for treatment of sepsis and the surviving sepsis campaign guidelines advise against its routine use. When the corona pandemic began, hemoperfusion was considered as a promising therapeutic approach. Cytosorb®, Seraph®-100, and oXiris® received emergency approval by the FDA to be used in critically ill patients with COVID-19, so questions arose about the appropriateness and importance of its use; however, the data generated did not show positive results, so its use cannot be recommended routinely either. In addition, they are not mentioned as a treatment option in the current guidelines. The use of adsorption procedures in patients with liver failure and rhabdomyolysis has only been rudimentarily studied, so any evidence is currently lacking. The only adsorber that has CE approval in Germany for both applications is Cytosorb®. In the next few years, studies will have to follow that investigate the efficacy and thus either justify or refute the use in clinical routine. Hemoperfusion procedures are used in the heart-lung machine as part of cardiac surgery for either cytokine or anticoagulant adsorption. No congruent data are available to support the use for the elimination of cytokines. If emergency cardiac surgery is required in a patient with pre-existing anticoagulation, hemoperfusion procedures can be used to prevent bleeding complications. Cytosorb® has CE approval for this indication. All available techniques are nonselective adsorption processes, so that adsorption of known and unknown substances can occur. Unintentional adsorption of drugs, such as various anti-infective agents is a relevant risk, especially when used in patients with sepsis. Discussion: Various adsorption systems can eliminate different known and unknown substances. Currently, there is a lack of evidence for all indications and systems to justify their routine use except in clinical trials. Future clinical trials should evaluate the potential benefits but also dangers, so that in the meantime the routine use can be justified or a recommendation against the use can be given. [ABSTRACT FROM AUTHOR]