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The prevalence and outcomes of the unicuspid aortic valve (UAV) in patients undergoing the Ross procedure have been strongly underreported in the current literature. We sought to evaluate this in comparison with bicuspid (BAV) and tricuspid valve (TAV) in our Ross cohort.This was a retrospective observational study of patients undergoing the Ross procedure at 2 dedicated centers between 2009 and 2020. Primary end points were the risks of midterm autograft reoperation and the onset of at least moderate aortic regurgitation during follow-up. The secondary end point was to compare the perioperative outcomes between the groups.Included in the analysis were 286 patients, of those 39% with UAV, 52% with BAV, and 9% with TAV. UAV patients were operated on at the youngest age (P.001) and more often for a combined hemodynamic aortic valve pathology (P = .02). They had the largest aortic root dimensions: annulus (P = .01), Valsalva sinuses (P = .11), sinotubular junction (P = .001), and ascending aorta (P.0001). The risks of reoperation (P = .86) and the onset of aortic regurgitation (P = .75) were comparable among the groups over the follow-up of 4.1 years. There was no difference in perioperative outcomes.UAV is a separate unit characterized by a distinct hemodynamic pathology and generated aortopathy. It is not associated with a higher risk of reoperation or new onset of aortic regurgitation after the Ross procedure in the midterm postoperatively. At the current state, UAV remains acceptable for the Ross procedure.

Climate-active gases, notably carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O), display fundamental absorption bands in the mid-infrared (mid-IR). The detection and monitoring of those gases could be enabled by the development of mid-IR optical sources. Broadband mid-IR on-chip light emission from rare-earth-doped chalcogenide photonic integrated circuits could provide a compact, efficient, and cost-effective gas sensing solution. Mid-IR photoluminescence of dysprosium-doped selenide ridge waveguides obtained under optical pumping at a telecommunication wavelength (∼1.3 µm) is investigated for Dy3+ ion concentrations in the 2500–10,000 ppmw range. CO2 detection at around 4.3 µm is then demonstrated based on absorption of this broadband mid-IR emission.

Personalized External Aortic Root Support (PEARS) is an evolving method of treatment for patients with a dilated aortic root or ascending aorta. This treatment is being adopted in an increasing number of centres. For the sake of the safety of the procedure a standardized surgical technique is necessary. The authors describe a surgical technique of implantation that is derived from their extensive experience.

Background Diabetes mellitus (DM) and malignancy are recognized among the most common complications increasing mortality in patients after heart transplantation (HTx). Clinical trials have shown a higher risk for different types of tumours in diabetic patients. This risk is potentiated by immunosuppressive therapy in transplant patients. Biguanide metformin has been shown to exhibit anti-tumour activity and we tried to find out whether this effect is valid for heart transplant patients. Methods We retrospectively analysed a group of 497 patients, who undergone HTx in our centre between 1998 and 2019. The primary outcome was any malignancy during the 15-year follow-up period and patient's survival. Results Out of the 497 patients enrolled in the study, 279 (56 %) had diabetes and 52 (19 %) were treated with metformin. Fifteen-year survival in treated patients without malignancy was 93 %, the remainder for the DM patients was 56 %, with survival in non-DM patients being 74 %. Untreated diabetic patients had 4.7 times higher chance of malignancy than those on metformin (p = 0.01). Fifteen-year survival in metformin treated patients was 53 %, in other DM patients 44 %, and in non-DM patients 51 %. Conclusion Our study showed a significantly lower incidence of malignancies in metformin-treated patients and slightly better overall survival (Tab. 2, Fig. 3, Ref. 19) Keywords: biguanide, heart graft, malignancy, diabetes mellitus, survival.

International audience; The mid-infrared (mid-IR) spectral region is of great interest to many areas of science and technology as it contains two important transparency windows (3-5 and 8-13 mu m) of the Earth's atmosphere and strong characteristic vibrational transitions displayed by a large number of molecules. Praseodymium (Pr3+) and dysprosium (Dy3+) ions feature characteristic transitions in the mid-IR and transmission range of chalcogenides-based materials spans a large part of the mid-IR. The combination of efficient waveguiding properties with mid-IR light emitters would therefore be a key enabler of the development of mid-IR sensors-on-a-chip for health, security and environmental applications. In this paper, RF magnetron co-sputtering is used to deposit a Dy3+/Pr-3 broken vertical bar-doped chalcogenides guiding layer based on the quaternary system composed of Ga, Ge, Sb and Se atoms on silica cladding layer. The fabrication process of straight ridge waveguides using photolithography and RIE/ICP dry etching is then described. Finally, Dy3+ and Pr3+ mid-IR guided photoluminescence around 2.5 and 4.5 mu m is demonstrated at room temperature using co-propagating pumping at telecommunication wavelengths ( respectively around 1.3 and 1.55 mu m).

OBJECTIVES In patients supported by a durable left ventricular assist device (LVAD), infections are a frequently reported adverse event with increased morbidity and mortality. The purpose of this study was to investigate the possible association between infections and thromboembolic events, most notable cerebrovascular accidents (CVAs), in LVAD patients. METHODS An analysis of the multicentre European Registry for Patients Assisted with Mechanical Circulatory Support was performed. Infections were categorized as VAD-specific infections, VAD-related infections and non-VAD-related infections. An extended Kaplan–Meier analysis for the risk of CVA with infection as a time-dependent covariate and a multivariable Cox proportional hazard model were performed. RESULTS For this analysis, 3282 patients with an LVAD were included with the majority of patients being male (83.1%). During follow-up, 1262 patients suffered from infection, and 457 patients had a CVA. Cox regression analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.90 [95% confidence interval (CI): 1.55–2.33; P CONCLUSIONS Infection during LVAD support is associated with an increased risk of developing an ischaemic or haemorrhagic CVA, particularly in the setting of VAD-related or VAD-specific infections. This suggests the need of a stringent anticoagulation management and adequate antibiotic treatment during an infection in LVAD-supported patients.

International audience; In this work, the kinetics of photoinduced changes in sputtered ternary Ge29Sb8Se63 chalcogenide thin films with different thicknesses is studied. The optical bandgap energy of virgin thin films is 1.87 +/- 0.02 eV and the refractive index at 1 550 nm is 2.55 +/- 0.01 as determined by spectroscopic ellipsometry using Cody-Lorentz oscillator model. An annealing treatment caused bleaching of thin films resulting in optical bandgap energy increase to 1.96 +/- 0.02 eV accompanied with refractive index decrease down to 2.54 +/- 0.01. Subsequently, the photoinduced shift of the absorption edge was determined by the analysis of transmission data obtained by fibre-coupled high-resolution spectrometer. The irradiation of virgin thin films by near-bandgap light coming from continuous-wave diode-pumped solid-state laser leads to a fast photodarkening (PD) followed by slow photobleaching (PB) effect. The PB effect persists in virgin films and the maximum magnitude of this effect was found in film with the thickness of similar to 350 nm. Rise of the optical bandgap energy was similar to 0.04 +/- 0.02 eV using optical intensity of 125.0 +/- 5.0 mW center dot cm(-2). On the other hand, in annealed thin films, only PD occurs under the same conditions indicating that the PB component of the photoinduced change disappears when the film is annealed. Maximum decrease in optical bandgap energy due to the PD effect in annealed films was about similar to 0.05 +/- 0.02 eV found in film with the thickness of similar to 650 nm. An influence of the thickness and laser optical intensity onto the kinetics of photoinduced changes is discussed.

OBJECTIVES Implantation of a personalized external aortic root support (PEARS) can prevent dilatation of the aortic root and ascending aorta in patients with aortopathy of various aetiologies. Because PEARS is an emerging technology, all aspects concerning indications, surgical technique and safety should be elucidated. Our goal was to summarize all of these aspects so that physicians and patients would have sufficient information to evaluate this alternative approach. METHODS Between April 2004 and March 2020, 317 patients underwent PEARS operations at 25 surgical centres in 9 countries. RESULTS The most common indication was Marfan syndrome (57%). The single perioperative death represented a mortality of 0.3%. The long-term experience comprises 871 patient/years with 1 patient living for 15 years and 19 patients living for more than 10 years. CONCLUSIONS PEARS seems to be a promising method of treatment of dilatation of the aortic root and/or ascending aorta. Multicentre observational studies are needed to gain more experience because this operation is still uncommon and the number of operations per surgeon/centre is low.

Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61–9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.

Background: An increasing number of patients are receiving left ventricle assist devices as a bridge to heart transplantation. The aim of this study was to determine the difference between patients who received transplants from a left ventricle assist device and those who underwent heart transplantation without a prior left ventricle assist device implantation. Material and methods: The study included patients who underwent heart transplantation in our institute between January 2010 and November 2018. The following clinical variables were evaluated: donor characteristics, patient’s pre-transplant demographical data, post-transplant data, and patient survival. Cardiac allograft vasculopathy progression was prospectively examined (after 1 month and 12 months after heart transplantation) by coronary optical coherence tomography. We were interested in the difference in 1- and 5-year survival between the left ventricle assist device and non-left ventricle assist device groups. Results: A total of 248 patients were identified; out of them, 48 patients received a left ventricle assist device before heart transplantation, whereas 200 had transplants with no prior left ventricle assist device implantation. There were no significant differences in any donor characteristics. The mean duration of cardiopulmonary bypass time in the non-left ventricle assist device group was 156 versus 175 min in the left ventricle assist device group ( p = 0.009), blood loss was 650 versus 1045 mL ( p Conclusion: Our results indicate that patients undergoing heart transplantation from left ventricle assist devices suffer significantly more from intraoperative and post-operative complications; however, only insignificant cardiac allograft vasculopathy progression and survival differences between the two groups were observed.

Quenching of CuMnAs was recently discovered using electrical and train of optical pulses. In this contribution, we report the single laser pulse quench switching and erasing using different pulse parameters to improve the response.

For the surgical field to be peaceful and bloodless, the majority of cardiac surgery patients are operated on using the cardioprotective technique called ischaemic cardioplegic arrest. The current myocardial protection relies on the hyperkalaemic arrest, reinforced with hypothermia, a number of additives and mixing the cardioplegic solution with the patient’s blood. Cardiac surgery patients are now more risky in terms of age, comorbidities and the need for complex procedures. These groups of patients have a higher incidence of postprocedural complications and mortality. One factor to consider involves the current limits of intraoperative cardioplegia. It brings about reperfusion injury, which leads to dysfunction and/or loss of part of the myocardium. Also in the cardiology, acute myocardium infarction patients treated with contemporary mechanical revascularization principles, going onto develop post-infarct heart failure, which is now on the rise. Thus it is obvious that any reduction of periprocedural myocardial injury is important for the prognosis of the patient. One way of augmenting myocardial protection is the phenomenon of ischaemic conditioning, elicited with brief non-lethal episodes of ischaemia-reperfusion. In addition, drugs are being tested (and attracting great attention) that mimic ischaemic conditioning. Such cardioprotective techniques are mainly focused on reperfusion injury, a complex response of the organism to the restoration of coronary blood flow in ischaemic tissue, that can eventually lead to cell death. Extensive research over the last three decades has revealed the basic mechanisms of reperfusion injury and myocardial conditioning, suggesting its therapeutic potential. But despite the enormous efforts and resources that have been expended in preclinical studies, almost all cardioprotective therapies have failed in the third phase of clinical trials. One reason is that evolutionary young cellular mechanisms of protection against oxygen handling are not very robust. Ischaemic conditioning, which is among these, is also limited by this. At present, the prevailing belief is that such options of treatment exist, but their full employment will not occur until subquestions and methodological issues with the transfer into clinical practice have been resolved.

Background: Complex cardiovascular procedures may initiate a systemic inflammatory response syndrome (SIRS) with a massive cytokine release, which is involved in postoperative myocardial injury. Intraoperative cytokine hemoadsorption (HA) mitigates the inflammatory response. Micro ribonucleic acids (miRNAs) are emerging as a marker of myocardial injury. Methods: This study evaluated if intraoperative cytokine reduction by HA modulates SIRS and affects myocardial injury as measured by miRNA-126, 223 and miRNA-1, 133a, respectively. Twenty-eight patients were assigned into HA (n = 15) and control (C) (n = 13) groups. HA was performed by integrating CytoSorb™ into the extracorporeal circuit. Results: MiRNA-133a plasma levels were increased postoperatively in both groups but were much higher in the HA group than in the C group at 3 h (P = 0.037) and 18 h (P = 0.017) after reperfusion. MiRNA-1 and miRNA-223 plasma levels were significantly increased postoperatively, but did not differ between groups. The vascular miRNA-126 was not affected. Conclusion: Intraoperative cytokine HA in cardiovascular operations increased the plasma levels of miRNA-133a, suggesting higher myocardial injury. J Clin Med Res. 2019;11(12):789-797 doi: https://doi.org/10.14740/jocmr3989

OBJECTIVES The choice of optimal surgical treatment for young and middle-aged adults with aortic valve disease remains a challenge. Mechanical aortic valve replacement (mAVR) is generally preferred despite promising recent outcomes of the Ross procedure. Our goal was to compare the strategies at a nationwide level. METHODS This study was a retrospective analysis of prospectively recorded data from the National Registry of Cardiac Surgery of the Czech Republic. Using propensity score matching, we compared the outcomes of patients undergoing the Ross procedure in 2 dedicated centres with all mAVRs performed in country between 2009 and 2020. RESULTS Throughout the study period, 296 adults underwent the Ross procedure and 5120 had an mAVR. We found and compared 291 matched pairs. There were no in-hospital deaths, and the risk of perioperative complications was similar in both groups. Over the average follow-up period of 4.1 vs 6.1 years, the Ross group had a lower all-cause mortality (0.7 vs 6.5%; P = 0.015). This result remained significant even when accounting for cardiac- and valve-related deaths only (P = 0.048). Unlike the Ross group, the mAVR group had a significantly lower relative survival compared with the age- and sex-matched general population. There was no difference in the risk of reoperation (4.5 vs 5.5%; P = 0.66). CONCLUSIONS The Ross procedure offers a significant midterm survival benefit over mAVR. The procedures have a comparable risk of perioperative complications. Patients after mAVR have reduced survival. Thus, the Ross procedure should be the preferred treatment option for young and middle-aged adults with aortic valve disease in dedicated centres.

Aims In the randomized GRAFFITI trial, surgeons drew their strategy based on coronary angiography. When patients were randomized to fractional flow reserve (FFR)-guidance, surgeons were informed of the FFR values and asked to redraw their strategy. The aim of this study was to investigate the changes induced by FFR knowledge. Methods and results The intended and performed strategy (before and after FFR) were compared. Among 172 patients, 84 with 300 lesions were randomized to the FFR-guided group. The intended strategy was to bypass 236 stenoses:108 with a venous and 128 with an arterial graft. After disclosing FFR, a change in strategy occurred in 64 lesions (21.3%) of 48 (55%) patients. Among 64 lesions for which the intended strategy was medical therapy, 16 (25%) were bypassed after disclosing FFR. The number of procedures with >1 venous graft planned was significantly reduced from 37 to 27 patients (p = .031). The proportion of on-pump surgery was significantly reduced from 71 to 61 patients (p = .006). The rates of clinical events at 1 year were similar between patients with or without at least one change in strategy. Discussion FFR-guided CABG is associated with a simplified surgical procedure in 55% of the patients, with similar clinical outcomes.

Patient: Female, 49-year-old Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Dynpnea Medication: — Clinical Procedure: — Specialty: Anatomy • Critical Care Medicine • General and Internal Medicine • Pathology Objective: Rare disease Background: Takotsubo cardiomyopathy (TTC) is a cardiac syndrome characterized by transient left ventricle (LV) dysfunction, typically showing apical ballooning due to apical akinesis with preserved basal segment contractility. The inverted form is very uncommon and is characterized by basal segment hypokinesis or akinesis and normal LV apical segment contractility. Case Report: We describe the case of a 49-year-old woman who developed inverted TTC after orthotopic liver transplantation. On day 1 (D1), dyspnea and oliguria suddenly appeared. A chest X-ray showed pulmonary edema, and echocardiography showed severe systolic LV dysfunction with an estimated ejection fraction of approximately 25% and akinesis of basal and midventricular LV segments, normal apical segment contractility, and mild mitral regurgitation. Elevated troponin T, creatine kinase-MB, and N-terminal pro B-type natriuretic peptide were found in the blood sample. Suspected inverted takotsubo cardiomyopathy was confirmed by left ventriculography, with normal apical part motion, akinesis in the other LV parts, and negative coronary angiography. The echocardiographic findings returned to normal on D14, and the patient was discharged from the hospital on D19 with normal LV motion and an ejection fraction of 65%. The transplanted liver function was excellent. Conclusions: Organ transplantation is connected with a great emotional stress because the patient’s life depends on the death of another person. Therefore, we have to think about the possibility of stress cardiomyopathy even after liver transplantation, because early diagnosis and treatment can be life-saving for the patient. To our knowledge, this is the first described case of inverted takotsubo cardiomyopathy after liver transplantation.

Personalized External Aortic Root support (PEARS) is an evolving method of treatment for patients with dilated aortic root or ascending aorta. The treatment is adopted in still more centres. For the sake of the safety of the procedure a standardized surgical technique is necessary. The authors describe surgical technique of the implantation that is derived from their extensive experience.

A $1\times 2$ multimode interferometer beam splitter based on mid-infrared emitting chalcogenides waveguides is designed. This device multiplexes mid-infrared light in two channels whose respective passbands overlap either CO2 or CO absorption bands, respectively between 4.20- $4.32~\mu \text{m}$ and 4.50- $4.86~\mu \text{m}$ . The proposed device offers a low-cost solution for monolithic combination of broadband on-chip mid-infrared light emission with dispersive spectroscopic element devoted to mid-IR multigas sensing applications. Based on restrictive interference mechanism in a $1\times 2$ multimode interferometer, the multimode section dimensions (width and length) are engineered to increase the imbalance between the two ports for the two passbands and consequently to increase the output contrast ratio. Tolerances to variations from the optimum device design resulting from processing conditions (materials fabrication and sputtering, photolithography and dry etching steps) are assessed. In particular, the $1\times 2$ multimode interferometer diplexer spectral transmission is investigated as a function of deposited film refractive index and multimode section dimensions (width and length) deviation from designed values. Input and output ports tapering is introduced to reduce the device insertion loss.

Abstract We describe the association of Becker muscular dystrophy (BMD) derived heart failure with the impairment of tissue homeostasis and remodeling capabilities of the affected heart tissue. We report that BMD heart failure is associated with a significantly decreased number of cardiovascular progenitor cells, reduced cardiac fibroblast migration, and ex vivo survival. Background Becker muscular dystrophy belongs to a class of genetically inherited dystrophin deficiencies. It affects male patients and results in progressive skeletal muscle degeneration and dilated cardiomyopathy leading to heart failure. It is a relatively mild form of dystrophin deficiency, which allows patients to be on a heart transplant list. In this unique situation, the explanted heart is a rare opportunity to study the degenerative process of dystrophin-deficient cardiac tissue. Heart tissue was excised, dissociated, and analyzed. The fractional content of c-kit+/CD45− cardiovascular progenitor cells (CVPCs) and cardiac fibroblast migration were compared to control samples of atrial tissue. Control tissue was obtained from the hearts of healthy organ donor’s during heart transplantation procedures. Results We report significantly decreased CVPCs (c-kit+/CD45−) throughout the heart tissue of a BMD patient, and reduced numbers of phase-bright cells presenting c-kit positivity in the dystrophin-deficient cultured explants. In addition, ex vivo CVPCs survival and cardiac fibroblasts migration were significantly reduced, suggesting reduced homeostatic support and irreversible tissue remodeling. Conclusions Our findings associate genetically derived heart failure in a dystrophin-deficient patient with decreased c-kit+/CD45− CVPCs and their resilience, possibly hinting at a lack of cardioprotective capability and/or reduced homeostatic support. This also correlates with reduced plasticity of the explanted cardiac tissue, related to the process of irreversible remodeling in the BMD patient’s heart.

Orthotopic heart transplantation is a well-established therapy for end-stage heart failure patients. The median survival of adult patients transplanted after the year 2000 exceeds 12 years, for those who survive the first posttransplantation year is expected to reach 15 years (Stehlik et al., 2018). This text will describe morphological changes of electrocardiogram following heart transplantation with special attention to QT interval where the sex-related differences are most pronounced. Then particular types of arrhythmias will be commented. In the end, the phenomenon of sudden cardiac death in the specific population of posttransplantation patients is discussed.

Deep sternal wound infection is a challenging aspect of modern cardiac surgery. The considerable mortality rate, devastating morbidity and, negative impact on long-term survival has driven cardiac and plastic surgeons to seek a more advantageous treatment solution. This review summarizes progress in the field of deep sternal wound infection treatment after cardiac surgery. Emphasis is placed on outcomes analysis of contemporary treatment strategy based on negative pressure wound therapy followed by sternotomy wound reconstruction, and its comparison with conventional treatment modalities used afore. Furthermore, complications and drawbacks of treatment strategies are critically evaluated to outline current options for successfully managing this life-threatening complication following cardiac surgery.