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Background: Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD. Methods: This is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFRCT analyzed by HeartFlow™. The correlation and agreement between QFR and FFRCT were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFRCT were evaluated. Results: Out of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFRCT and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFRCT (R ​= ​0.759; p ​< ​0.001), and the Bland-Altman analysis demonstrated a mean difference of −0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFRCT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P ​= ​0.026). Conclusion: In patients with complex CAD, QFR and FFRCT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFRCT.

PubMed displayed almost 37,000 hits for the search term “cardiac surgery AND 2022.” As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

BACKGROUND: Personalized long term vital prognosis plays a key role in deciding between percutaneous coronary intervention (PCI) and CABG in patients with complex coronary artery disease. The FASTTRACK CABG trial enrolls patients with the sole guidance of coronary computed tomographic angiography (CCTA) and fractional flow reserve CCTA (FFRCT). The feasibility/non-feasibility of this approach is determined by the surgeon request to have access to the invasive coronary angiography. METHODS: This interim analysis, which was requested by the Data and Safety Monitoring Board (DSMB), compared the treatment decision of the "on site" Heart team to the recommended treatment as per the SYNTAX Score II 2020 (SS-2020), which was prospectively assessed by the central core laboratory in the first 57 consecutive patients (half of the planned population) enrolled in this First in Man study. RESULTS: The average anatomical SYTAX Score is 35.6 ± 11.5. The SS-2020 predicted 5-year MACE and 10-year all-cause mortality are 14.7 % and 21.6 % following CABG, and 23.0 % and 30.4 % following PCI. Among the enrolled patients the SS-2020 predicts long-term PCI outcomes similar to CABG (absolute risk difference ≤0 % in favor of PCI) in only two patients whilst the remaining 55 patients had a predicted survival benefit with CABG. CONCLUSIONS: According to the SS-2020, the first 57 patients recruited into the FASTTRACK CABG trial received the appropriate modality of revascularization and the DSMB allowed the investigators to complete the study.

PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

Purpose The diagnostic performance of the SYNTAX score 2020 (SS-2020) when calculated using CCTA remains unknown. This study aimed to compare treatment recommendations based on the SS-2020 derived from coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA). Methods This interim analysis included 57 of the planned 114 patients with de-novo three-vessel disease, with or without left main coronary artery disease, enrolled in the ongoing FASTTRACK CABG trial. The anatomical SYNTAX scores derived from ICA or CCTA were evaluated by two separate teams of blinded core-lab analysts. Treatment recommendations were based on a maximal individual absolute risk difference in all-cause mortality between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) of 4.5% ([predicted PCI mortality] – [predicted CABG mortality]). The level of agreement was evaluated with Bland-Altman plots and Cohen’s Kappa. Results The mean age was 66.2±9.2 years and 89.5% of patients were male. Mean anatomical SYNTAX scores derived from ICA and CCTA were 35.1±11.5 and 35.6±11.4 (p=0.751), respectively. The Bland-Altman analysis showed mean differences of -0.26 and -0.93, with standard deviation of 3.69 and 5.23, for 5- and 10-year all-cause mortality, respectively. The concordance in recommended treatment for 5- and 10-year mortalities were 84.2% (48/57 patients) and 80.7% (46/57 patients), with Cohen’s κ coefficients of 0.672 and 0.551. Conclusion There was moderate to substantial agreement between treatment recommendations based on the SS-2020 derived using CCTA and ICA, suggesting that CCTA could be used as an alternative to ICA when making decisions regarding the modality of revascularization.

We study the effect of spatially correlated classical noise on both Anderson and many-body localization of a disordered fermionic chain. By analyzing the evolution of the particle density imbalance following a quench from an initial charge density wave state, we find prominent signatures of localization also in the presence of the time-dependent noise, even though the system eventually relaxes to the infinite temperature state. In particular, for sufficiently strong static disorder we observe the onset of metastability, which becomes more prominent the stronger the spatial correlations of the noise. In this regime we find that the imbalance decays as a stretched-exponential - a behavior characteristic of glassy systems. We identify a simple scaling behavior of the relevant relaxation times in terms of the static disorder and of the noise correlation length. We discuss how our results could be exploited to extract information about the localization length in experimental setups., Comment: 6 pages, 3 figures; v2 close to published version

To evaluate the safety and efficacy of a novel technique of preconditioning autologous blood with gold particles (GOLDIC®) and injection in patients with moderate to severe knee osteoarthritis (KOA). During this phase 2a, proof-of-concept (PoC) open label study, 83 consecutive patients that 64 patients met inclusion criteria (mean age: 64.8 years; 89 knees) with radiographically proven KOA, received four ultrasound guided intra-articular knee injections of GOLDIC® at three to six day intervals. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee injury and Osteoarthritis Outcome Score (KOOS) were evaluated at baseline, four weeks, three, six months, one, two and four years (T1–T6). The incidence of treatment related severe adverse events (SAEs) recorded. Intra-articular gelsolin level in patients with effusion was determined. KOOS and WOMAC scores improved for the full duration of the study (P < 0.05), minimal clinically important difference (MCID) was observed at all time points in all KOOS subscores, with no reported SAEs. Intra-articular gelsolin level increased after treatment with reduction of effusion. No statistically significant evidence of an association between patient demographics and outcome were identified. Nine patients failed treatment, with 32 months mean time to failure and underwent total knee arthroplasty. PoC study of GOLDIC® as a novel device for conservative management of moderate to severe KOA was confirmed. GOLDIC® produces rapid and sustained improvements in all indices after treatment, with no SAEs. § 13 Abs.2b AMG Bavaria (Protokol Reg OBB 5-16) (Ref 53.2-2677.Ph_3-67-2)—Date 3/20/2010 retrospectively registered.

Background The bicuspid aortic valve (BAV) frequently requires surgical intervention for aortic regurgitation (AR) and aneurysm. Valve-preserving surgery for BAV has evolved over the last 25 years. Methods This review summarized experience in BAV repair with a special focus on predictors of failure and specific surgical techniques addressing them. Results Excellent repair stability can be achieved if a standardized approach addressing all pathologic components of aortic valve and root is used. Anatomic variations must be addressed with special approaches. Conclusions Today, BAV repair leads to excellent stability if an anatomy-oriented concept is used. Further improvements of cinical results and reproducibility can be anticipated.

In 2020, nearly 30,000 published references appeared in the PubMed for the search term “cardiac surgery.” While SARS-CoV-2 affected the number of surgical procedures, it did not affect outcomes reporting. Using the PRISMA approach, we selected relevant publications and prepared a results-oriented summary. We reviewed primarily the fields of coronary and conventional valve surgery and their overlap with interventional alternatives. The coronary field started with a discussion on trial data value and their interpretation. Registry comparisons of coronary artery bypass surgery (CABG) and percutaneous coronary intervention confirmed outcomes for severe coronary artery disease and advanced comorbidities with CABG. Multiple arterial grafting was best. In aortic valve surgery, meta-analyses of randomized trials report that transcatheter aortic valve implantation may provide a short-term advantage but long-term survival may be better with classic aortic valve replacement (AVR). Minimally invasive AVR and decellularized homografts emerged as hopeful techniques. In mitral and tricuspid valve surgery, excellent perioperative and long-term outcomes were presented for structural mitral regurgitation. For both, coronary and valve surgery, outcomes are strongly dependent on surgeon expertise. Kidney disease increases perioperative risk, but does not limit the surgical treatment effect. Finally, a cursory look is thrown on aortic, transplant, and assist-device surgery with a glimpse into the current stand of xenotransplantation. As in recent years, this article summarizes publications perceived as important by us. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide up-to-date information for decision-making and patient information.

Today, isolated repair of the regurgitant aortic valve is an increasingly accepted alternative to replacement. Since its first description more than 2 decades ago (1), marked progress in understanding of normal function and configuration of aortic valve and root has been made. Different predictors for repair failure have been identified, such as dilatation of the basal ring (2,3), in particular in bicuspid aortic valve (BAV) repair (2). This was supported by experimental studies focusing on the interrelation of annular diameter and valve competence (4). In addition, the definition of the aortic annulus is inconsistent and anatomically challenging. There is a discrepancy between the anatomic aortoventricular junction, that is, the transition of ventricular myocardium and aortic wall, and the virtual basal ring at the level of nadirs of the sinuses (5). A high aortoventricular junction with myocardium extending into the sinus is a frequent finding in the presence of a BAV, but is also found in unicuspid (UAV) and tricuspid aortic valves (TAV). From a surgical perspective the basal ring should be considered as the aortic annulus and should be addressed by any annuloplasty device. We have applied a suture annuloplasty (6) at the level of the basal in ring in addition to isolated aortic valve repair over the last 10 years.

BACKGROUND: Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling. METHODS AND PATIENTS: Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8). RESULTS: All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003). CONCLUSION: In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.

Valve preservation or repair of the regurgitant bicuspid aortic valve (BAV) minimizes valve-related complications. The purpose of the current analysis was to determine the proportion of BAVs than can be repaired. Between 2000 and 9/2018, 1168 operations for BAV without stenotic pathology were performed. Of these, 103 underwent isolated aortic valve replacement, the remaining 1055 individuals underwent valve repair. Reasons for replacement were analyzed. The proportion of repaired BAVs remained constant at 85% over the years. The most frequent reasons for replacement were cusp calcification or active endocarditis. In only 2 instances, replacement was performed as intraoperative conversion after failed repair. The vast majority of BAVs can be repaired with good durability as long as cusp substance is preserved.

OBJECTIVES Cardiac biomarkers are indicators of irreversible cell damage. Current myocardial infarction (MI) definitions require concomitant clinical characteristics. For perioperative MI, a correlation of biomarker elevations and mortality has been suggested. Definitions emerged relying on cardiac biomarker release only. This approach is questionable as several clinical and experimental scenarios exist where relevant biomarker release can occur apart from MI. METHODS We reviewed the clinical and basic science literature and revealed important aspects regarding the use and interpretation of cardiac biomarker release with special focus on their interpretation in the perioperative setting. RESULTS Ischaemic biomarkers may be released without cell death in multiple conditions, such as after endurance runs in athletes, temporary inotropic stimulation in animal models and flow variations in in vitro cell models. In addition, access through atrial tissue during cannulation or concomitant valve procedures adds sources of enzyme release that may not be related to ventricular ischaemia (i.e. MI). Such non-cell death-related mechanisms may explain the lack of poor correlations of enzyme release and long-term outcomes in recent trials. In addition, the 3 main biomarkers, troponin T, I and creatine kinase myocardial band, differ in their release kinetics, which may differentially trigger MI events in trial patients. CONCLUSIONS The identification of irreversible myocardial injury in cardiac surgery based only on biomarker release is unreliable. Cell death- and non-cell death-related mechanisms create a mix in the perioperative setting that requires additional markers for proper identification of MI. In addition, the 3 most common ischaemic biomarkers display different release kinetics adding to the confusion. We review the topic.

Recent experiments with ultracold quantum gases have successfully realized integer-quantized topological charge pumping in optical lattices. Motivated by this progress, we study the effects of static disorder on topological Thouless charge pumping. We focus on the half-filled Rice-Mele model of free spinless fermions and consider random diagonal disorder. In the instantaneous basis, we compute the polarization, the entanglement spectrum, and the local Chern marker. As a first main result, we conclude that the space-integrated local Chern marker is best suited for a quantitative determination of topological transitions in a disordered system. In the time-dependent simulations, we use the time-integrated current to obtain the pumped charge in slowly periodically driven systems. As a second main result, we observe and characterize a disorder-driven breakdown of the quantized charge pump. There is an excellent agreement between the static and the time-dependent ways of computing the pumped charge. The topological transition occurs well in the regime where all states are localized on the given system sizes and is therefore not tied to a delocalization-localization transition of Hamiltonian eigenstates. For individual disorder realizations, the breakdown of the quantized pumping occurs for parameters where the spectral bulk gap inherited from the band gap of the clean system closes, leading to a globally gapless spectrum. As a third main result and with respect to the analysis of finite-size systems, we show that the disorder average of the bulk gap severely overestimates the stability of quantized pumping. A much better estimate is the typical value of the distribution of energy gaps, also called mode of the distribution., 14 pages, 15 figures. Revised version essentially as published. Additional references, updated figures and extended discussions. Data partially available as ancillary files

IntroductionThe previously published SYNTAX III REVOLUTION trial demonstrated that clinical decision-making between coronary artery bypass graft (CABG) and percutaneous coronary intervention based on coronary CT angiography (CCTA) had a very high agreement with the treatment decision derived from invasive coronary angiography (ICA). The study objective of the FASTTRACK CABG is to assess the feasibility of CCTA and fractional flow reserve derived from CTA (FFRCT) to replace ICA as a surgical guidance method for planning and execution of CABG in patients with three-vessel disease with or without left main disease.Methods and analysisThe FASTTRACK CABG is an investigator-initiated single-arm, multicentre, prospective, proof-of-concept and first-in-man study with feasibility and safety analysis. Surgical revascularisation strategy and treatment planning will be solely based on CCTA and FFRCT without knowledge of the anatomy defined by ICA. Clinical follow-up visit including CCTA will be performed 30 days after CABG in order to assess graft patency and adequacy of the revascularisation with respect to the surgical planning based on non-invasive imaging (CCTA) with functional assessment (FFRCT) and compared with ICA. Primary feasibility endpoint is CABG planning and execution solely based on CCTA and FFRCT in 114 patients. Primary safety endpoint based on 30 day CCTA is graft assessment and topographical adequacy of the revascularisation procedure. Automatic non-invasive assessment of functional coronary anatomy complexity is also evaluated with FFRCT for functional Synergy Between percutaneous coronary intervention With Taxus and Cardiac Surgery Score assessment on CCTA. CCTA with FFRCT might provide better anatomical and functional analysis of the coronary circulation leading to appropriate anatomical and functional revascularisation, and thereby contributing to a better outcome.Ethics and disseminationEach patient has to provide written informed consent as approved by the ethical committee of the respective clinical site. Results will be submitted for publication in peer-reviewed journals and will be disseminated at scientific conferences.Trial registration numberNCT04142021.

To evaluate the safety and efficacy of a novel technique of preconditioning autologous blood with gold particles (GOLDIC®) and injection in patients with moderate to severe knee osteoarthritis (KOA).During this phase 2a, proof-of-concept (PoC) open label study, 83 consecutive patients that 64 patients met inclusion criteria (mean age: 64.8 years; 89 knees) with radiographically proven KOA, received four ultrasound guided intra-articular knee injections of GOLDIC® at three to six day intervals. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee injury and Osteoarthritis Outcome Score (KOOS) were evaluated at baseline, four weeks, three, six months, one, two and four years (T1-T6). The incidence of treatment related severe adverse events (SAEs) recorded. Intra-articular gelsolin level in patients with effusion was determined.KOOS and WOMAC scores improved for the full duration of the study (P0.05), minimal clinically important difference (MCID) was observed at all time points in all KOOS subscores, with no reported SAEs. Intra-articular gelsolin level increased after treatment with reduction of effusion. No statistically significant evidence of an association between patient demographics and outcome were identified. Nine patients failed treatment, with 32 months mean time to failure and underwent total knee arthroplasty.PoC study of GOLDIC® as a novel device for conservative management of moderate to severe KOA was confirmed. GOLDIC® produces rapid and sustained improvements in all indices after treatment, with no SAEs.§ 13 Abs.2b AMG Bavaria (Protokol Reg OBB 5-16) (Ref 53.2-2677.Ph_3-67-2)-Date 3/20/2010 retrospectively registered.

Periodically driven quantum systems are currently explored in view of realizing novel many-body phases of matter. This approach is particularly promising in gases of ultracold atoms, where sophisticated shaking protocols can be realized and interparticle interactions are well controlled. The combination of interactions and time-periodic driving, however, often leads to uncontrollable heating and instabilities, potentially preventing practical applications of Floquet engineering in large many-body quantum systems. In this work, we experimentally identify the existence of parametric instabilities in weakly interacting Bose-Einstein condensates in strongly driven optical lattices through momentum-resolved measurements, in line with theoretical predictions. Parametric instabilities can trigger the destruction of weakly interacting Bose-Einstein condensates through the rapid growth of collective excitations, in particular in systems with weak harmonic confinement transverse to the lattice axis. Understanding the onset of parametric instabilities in driven quantum matter is crucial for determining optimal conditions for the engineering of modulation-induced many-body systems., SCOPUS: ar.j, info:eu-repo/semantics/published

Quasicrystals are long-range ordered but not periodic, representing an interesting middle ground between order and disorder. We experimentally and numerically study the localization transition in the ground state of noninteracting and weakly interacting bosons in an eightfold symmetric quasicrystalline optical lattice. In contrast to typically used real space in situ techniques, we probe the system in momentum space by recording matter wave diffraction patterns. Shallow lattices lead to extended states whereas we observe a localization transition at a critical lattice depth of ${V}_{0}\ensuremath{\approx}1.78(2){E}_{\mathrm{rec}}$ for the noninteracting system. Our measurements and Gross-Pitaevskii simulations demonstrate that in interacting systems the transition is shifted to deeper lattices, as expected from superfluid order counteracting localization. Quasiperiodic potentials, lacking conventional rare regions, provide the ideal testing ground to realize many-body localization in 2D.

Valve-preserving aortic root replacement has become an attractive alternative to composite replacement leading to better quality of life and minimal valve-related complications. Root remodeling requires less surgical dissection and has been shown to lead to more physiological hemodynamics compared to valve reimplantation. Over the last 2 decades, improvements have been made regarding assessment of cusp and root configuration. Aggressive correction of cusp prolapse extended the application of root remodeling to a larger patient population and has markedly improved valve stability, even in patients with connective tissue disorders. In the presence of annular dilatation, the addition of an annuloplasty has been shown to be beneficial for valve competence and repair durability. Aortic root remodeling combined with cusp repair and correction of annular dilatation leads to excellent valve stability and minimal valve-related complications.

Structurally bound upwelling and outflowing hot fluids in the city of Wiesbaden suggest an interesting geothermal potential at the northern margin of the permo-carboniferous Saar-Nahe basin (SNB), Germany. The SNB in the Wiesbaden area was previously not a target for intensive geophysical prospecting of the deeper underground. We present new geophysical exploration data of the SNB to investigate potential geothermal reservoirs near Wiesbaden for heat and power production. The main goal was to explore the local geometry and internal structure of the SNB. Exploration encompasses analysis of LIDAR data, a dense grid gravity survey as well as 2D and 3D seismic surveys. The geophysical data revealed for the first time the deep structure of the Mainz and Saar-Nahe basins near Wiesbaden down to a depth of c. 4000m. The SNB is strongly segmented and comprises deep reaching active faults. An essential element of the exploration concept was the definition of those structures as geothermal drilling targets which promise high permeability at a low risk of induced or triggered seismicity. For this reason numerical simulations of the local stress field were used to evaluate the geomechanical characteristics of the identified faults zones and their fault reactivation tendency. Geomechanical ensemble modelling helped to characterise the influence of uncertain input parameters and boundary conditions. The results of the geomechanical simulations together with temperature estimates and the reservoir characterization were used to identify a number of promising drilling targets. This article is protected by copyright. All rights reserved