Search Results (758)

Background: Prolonged extubation and pain following cardiac surgery remain significant clinical challenges. The pecto-intercostal fascial plane block (PIFB) is an emerging regional anesthesia technique incorporated into multimodal analgesia protocols to reduce opioid consumption and facilitate early extubation. This study retrospectively evaluated extubation times, perioperative opioid consumption, and postoperative analgesic requirements in patients who underwent isolated open-heart surgery via median sternotomy, comparing those who received PIFB with those who did not. Methods: This retrospective single-center study included ninety-nine patients who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy between 1 June 2023 and 25 March 2024. The study included 46 patients who received PIFB (Group 1) and 53 patients who received no block (Group 2). Ultrasound-guided bilateral PIFB was performed after anesthesia induction, with a total of 40 mL administered to each side (30 mL 0.25% bupivacaine + 10 mL normal saline). Demographic data, perioperative data, extubation times, analgesic consumption, and complications were compared between groups. Results: Demographic data, EuroSCORE, body mass index, and ejection fraction were similar between groups. Perioperative opioid (fentanyl) consumption was statistically significantly higher in Group 2 (median 450 [IQR: 350–600] μg vs. 400 [IQR: 350–450] μg; p = 0.037). Extubation time was statistically significantly shorter in Group 1 compared to Group 2 (median 340 [IQR: 265–490] min vs. 495 [IQR: 420–555] min; p < 0.001). The number of patients requiring postoperative paracetamol and tramadol was statistically significantly lower in Group 1 (p = 0.015 and p < 0.001, respectively). No statistically significant difference was found between groups regarding chest drain removal, length of hospital stay, or ICU length of stay (p > 0.05). Mortality occurred in 1 patient in Group 1 and 2 patients in Group 2. Conclusions: PIFB application in isolated open-heart surgery performed via median sternotomy was associated with shorter extubation time and reduced perioperative fentanyl and postoperative analgesic consumption, without a statistically significant effect on hospital length of stay. Complication and mortality data are reported descriptively; the study does not have sufficient statistical power to draw inferences regarding safety outcomes. Full article

Cardiogenic shock secondary to acute myocardial infarction complicated by mechanical failure remains associated with high mortality despite advances in cardiac surgery and mechanical circulatory support. We report the case of a 42-year-old patient with posterior papillary muscle rupture leading to severe mitral regurgitation, managed with emergency surgical intervention and extracorporeal membrane oxygenation. The patient, with a history of Type I Bipolar Disorder under long-term lithium therapy and chronic Cannabis use, presented in critical condition with cardiogenic shock (Killip IV), acute pulmonary edema, and ST-segment elevation myocardial infarction in the infero-posterior territory. Coronary angiography revealed right coronary artery occlusion and involvement of an obtuse marginal branch. Emergency mitral valve replacement with a mechanical prosthesis and aortocoronary bypass were performed. Due to failure to wean from cardiopulmonary bypass, central veno-arterial ECMO was initiated. The postoperative course was complicated by hemodynamic instability and recurrent pericardial collections requiring repeated surgical interventions and conversion to peripheral ECMO. Multiorgan dysfunction developed, including hepato-renal failure requiring hemofiltration, neurological injury, respiratory impairment, and neuropsychiatric complications. Despite these challenges, progressive recovery was achieved under intensive multidisciplinary management. This case emphasizes the importance of early surgical correction and tailored ECMO support in managing post-infarction mechanical complications. Full article

Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017. Full article

Objectives: Coronary artery bypass grafting (CABG) remains a fundamental surgical treatment for advanced coronary artery disease. With the increasing use of large language models to obtain health information, patients are increasingly turning to these systems to understand surgical options. However, their performance in generating patient-oriented CABG information has not been sufficiently evaluated. Therefore, this study aimed to compare the responses generated by ChatGPT and DeepSeek-R1 to patient questions about CABG in terms of scientific accuracy, comprehensibility, and level of unnecessary detail. Methods: Forty patient-oriented questions were developed based on online sources and clinical experience. Responses were obtained from ChatGPT and DeepSeek under standardized conditions. A blinded panel of four cardiovascular surgeons evaluated the responses using a five-point Likert scale across three domains. Statistical analyses were performed using paired tests. Results: DeepSeek generated significantly longer responses than ChatGPT (212.88 ± 48.13 vs. 188.7 ± 50.34 words; p < 0.001). Accuracy scores were higher for DeepSeek (median 4.5 vs. 4.25; p = 0.004), whereas comprehensibility and unnecessary detail scores were similar between the models. Overall scores were high for both models (4.32 ± 0.28 vs. 4.27 ± 0.30; p = 0.34). Conclusions: The responses generated by both models were generally evaluated favorably by the expert panel, with only limited differences observed between them. DeepSeek demonstrated higher accuracy, whereas ChatGPT tended to produce shorter and more concise responses. However, given the variability observed at the individual-question level, these findings should be interpreted with caution. Large language models may support patient information delivery but should not be considered reliable stand-alone sources for clinical decision-making or patient counseling. Full article

Coronary artery bypass grafting (CABG) using the autologous saphenous vein (SV) remains widely performed for obstructive atherosclerosis; however, vein graft disease drives recurrent ischaemia through early thrombosis and progressive intimal hyperplasia, and accelerated atherosclerosis developing within the grafts. Extracellular vesicles (EVs) are membrane-bound particles that transfer proteins, lipids, and microRNAs between cells. They modulate endothelial dysfunction, vascular smooth muscle cell phenotypic switching, inflammation, and coagulation, which are core processes in vein graft remodelling. Arterialisation exposes the vein to abrupt rises in shear stress, cyclic stretch, and intraluminal pressure. These forces increase EV release and reshape EV cargo in experimental systems, suggesting a potential mechanism for amplifying early graft injury which warrants direct investigation in vein tissue. This review synthesises current evidence for cell-specific EV contributions from ECs, vascular smooth muscle cells, platelets, and macrophages, and appraises EV-associated microRNAs with biomarker potential relevant to graft failure pathways. We also review therapeutic strategies that may modulate EV signalling including antiplatelet therapy, statins, KCa3.1 inhibition, and pro-reparative mesenchymal stromal cell-derived EVs. No published clinical studies evaluate EV-based biomarkers specifically for saphenous vein graft patency, and none prospectively predict saphenous graft failure. CABG provides a well-defined time zero event that enables longitudinal sampling and risk stratification. Prospective studies linking EV phenotypes and miRNA signatures to imaging-defined graft outcomes are needed to support clinical translation. Full article

Background/Objectives: Post-sternotomy mediastinitis and sternal osteomyelitis are serious complications of cardiac surgery associated with substantial morbidity and mortality. Computed tomography (CT) is widely used to evaluate suspected infection, but the frequency with which CT reports suggest infection in clinically uninfected post-sternotomy patients is poorly characterized. Methods: A retrospective observational study was conducted at a tertiary cardiac surgery center. Using an institutional data warehouse, all adult patients undergoing cardiac surgery via median sternotomy between 2010 and 2020 were identified. Patients with documented mediastinitis, sternal osteomyelitis, other postoperative infections, antibiotic treatment, or infectious disease consultation were excluded, as were patients without postoperative CT, those with coronary CT angiography only, and those whose CT scans were performed within 14 days or more than 1 year after surgery. CT reports of the remaining clinically uninfected patients were reviewed and categorized as either showing no evidence of mediastinitis/sternal osteomyelitis or containing findings interpreted as suspicious for these complications. Results: Among 4019 patients who underwent cardiac surgery during the study period, 92 highly selected clinically uninfected adults met the inclusion criteria and had eligible postoperative CT scans. Of these, 60 had coronary artery bypass grafting, 6 had mitral valve replacement, 17 had aortic valve replacement, and 9 had ascending aortic replacement. Four patients (4.4%; 95% CI, 1.2–10.9%) had CT reports describing findings suggestive of mediastinitis and/or sternal osteomyelitis despite the absence of concomitant clinical or laboratory evidence of infection. All four were post-coronary artery bypass grafting patients and had common radiologic features reported in postoperative infection, including sternal edge irregularity/erosion, sclerosis, retrosternal fluid collections, and mediastinal or presternal fat stranding. Conclusions: In this single-center retrospective series, CT reports suggesting mediastinitis or sternal osteomyelitis were observed in a small proportion of carefully selected, clinically uninfected post-sternotomy patients. These findings support the need to interpret CT abnormalities after cardiac surgery in close conjunction with clinical and laboratory data to avoid unnecessary invasive interventions in patients without true infection. Full article

Background: Coronary artery perforation is a potentially life-threatening complication in 0.2–0.6% of all patients undergoing percutaneous coronary intervention. Despite the ongoing development of technical skills and coronary devices, severe recalcitrant calcified coronary lesions remain a challenge for interventional cardiologists and can carry a potential risk for life-threatening complications, including coronary perforation. Discussion and Conclusion: The algorithm for cardiac vessel perforation could be more comprehensive and cover preventive and predictive measures. It is necessary to take into consideration prompt recognition, implement actions to restabilize the hemodynamic status, understand the source and mechanism of bleeding, and classify the cause of bleeding into proximal, distal, coronary artery bypass graft and collateral vessel, pericardial, myocardial extravasation, and vessel-chamber perforation, as each causality would necessitate a different management strategy for a successful outcome. Imaging information about cardiac vessel injury is useful for a better understanding of the spatial orientation of the coronary vessels. It also helps to detect a hematoma that deteriorates the hemodynamic status without effusion “dry tamponade” and could have a particular role in cardiac interventions to predict and prevent this complication. Full article

Aspirin has been the default backbone of antiplatelet therapy after percutaneous coronary intervention (PCI) for over two decades, anchored by landmark trials that established 12-month dual antiplatelet therapy (DAPT) as the standard of care. Three developments have prompted reassessment of this paradigm: the markedly lower thrombotic risk of contemporary drug-eluting stents, the greater potency and consistency of potent P2Y₁₂ inhibitors (ticagrelor, prasugrel), and increasing recognition that major bleeding independently worsens outcomes after PCI. Recent randomised trials have systematically tested aspirin withdrawal at varying time points. Immediate aspirin-free strategies (NEO-MINDSET, STOPDAPT-3) demonstrated an early signal of excess ischaemic events in the ACS component of enrolled populations, suggesting that aspirin remains important during the earliest post-PCI period in ACS. One-month strategies (T-PASS, ULTIMATE-DAPT, TARGET-FIRST) and three-month strategies (TWILIGHT, TICO, DUAL-ACS) showed that transition to P2Y₁₂ monotherapy after an initial DAPT period significantly reduces bleeding without increasing ischaemic events in selected populations. Beyond one year, long-term randomised trials including the HOST-EXAM 10-year follow-up (Lancet 2026) and the STOPDAPT-2 5-year landmark analysis (Circ Cardiovasc Interv 2026), together with study-level meta-analyses (PANTHER) and recent individual patient data meta-analyses, provide converging evidence that clopidogrel monotherapy outperforms aspirin for chronic secondary prevention without excess bleeding. The choice of P2Y₁₂ agent is critical: clopidogrel monotherapy in ACS during the first post-procedural year carries excess thrombotic risk owing to CYP2C19 pharmacogenomic variability, whereas ticagrelor and prasugrel provide more reliable protection. This review synthesises the mechanistic rationale, trial evidence across all time points, special clinical contexts (oral anticoagulation, coronary artery bypass grafting, high bleeding risk), guideline evolution, and methodological considerations, providing a practical framework for individualising post-PCI antiplatelet therapy. Full article

Computational fluid dynamics (CFD)-based simulation of coronary blood flow provides valuable hemodynamic markers, such as pressure gradients, for diagnosing coronary artery disease (CAD). However, CFD is computationally expensive, time-consuming, and difficult to integrate into large-scale clinical workflows. These limitations restrict the availability of labeled hemodynamic data for training AI models and hinder the broad adoption of non-invasive, physiology-based CAD assessment. To address these challenges, we develop an end-to-end pipeline that automates coronary geometry extraction from coronary computed tomography angiography (CCTA), streamlines simulation data generation, and enables efficient learning of coronary blood pressure distributions. The pipeline reduces the manual burden associated with traditional CFD workflows while producing consistent training data. Furthermore, we introduce a diffusion-based regression model. Specifically, the inverted conditional diffusion (ICD) model is designed to predict coronary blood pressure directly from CCTA-derived features, thereby bypassing the need for computationally intensive CFD during inference. The proposed model is trained and validated on two CCTA datasets using the Adam optimizer with a weight decay of $1\times {10}^{-3}$, a learning rate of $1\times {10}^{-5}$, a batch size of 100, and Huber loss. It is then evaluated on a test set of ten simulated coronary hemodynamic cases. Experimental results demonstrate state-of-the-art performance. Compared with Long Short-Term Memory (LSTM), the proposed model improves the $R^2$ score by 19.78%, reduces the root mean squared error (RMSE) by 19.44%, and lowers the normalized root mean squared error (NRMSE) by 18%. Compared with a multilayer perceptron (MLP), it improves the $R^2$ score by 8.38%, reduces RMSE by 4.3%, and reduces NRMSE by 5.4%. This work represents a first step toward a scalable and accessible framework for rapid, non-invasive, CFD-based blood pressure prediction, with the potential to support CAD diagnosis. Full article

Background/Objectives: Body Protection Compound-157 (BPC 157) is a stable gastric pentadecapeptide with cytoprotective, pro-angiogenic, and nitric oxide (NO)-modulating properties that has gained increasing attention for its therapeutic potential. Although vasodilatory effects have been demonstrated in animal models, functional evidence in human arterial tissue remains limited. This study investigated the effects of BPC 157 on vascular tone in human internal mammary artery (IMA) rings and evaluated the contribution of endothelial NO signaling. Methods: Residual IMA segments obtained from elective coronary artery bypass graft surgeries (n = 12) were dissected into endothelium-intact and endothelium-denuded rings. Following equilibration, the rings were challenged by phenylephrine (PheE; 3 × 10⁻⁶ M) to induce contraction. Cumulative concentration–response curves of BPC 157 (0.01–1 mg/mL) for five consecutive doses were constructed. The involvement of NO was assessed by BPC 157 dose–response curves in the nitric oxide synthase (NOS) inhibitor Nω-nitro-L-arginine methyl ester (L-NAME; 10⁻⁶ M) pre-incubated rings. Maximum force of contraction, area under the curve, maximum response (Emax), and negative logarithm of the half-maximal effective concentration (pEC50) values were analyzed. Results: BPC 157 produced a concentration-dependent reduction in PheE-induced contraction in both groups, with significantly greater relaxation in endothelium-intact rings (p < 0.05). L-NAME increased contractile responsiveness in intact rings and attenuated BPC 157-induced relaxation. Under NOS inhibition, differences between groups progressively diminished and concentration–response curves converged at higher concentrations. Emax analysis demonstrated that endothelial integrity markedly enhanced maximal vasorelaxation, whereas this advantage was largely abolished after NOS inhibition. Conclusions: BPC 157 induces concentration-dependent vasorelaxation in human arterial tissue, predominantly mediated via an endothelium-dependent NO pathway. Endothelial integrity primarily enhances maximal efficacy, while residual effects indicate additional mechanisms. These findings provide early mechanistic evidence for the vascular activity of BPC 157, although further molecular and in vivo studies are required to clarify its clinical relevance. Full article

Patients with left ventricular dysfunction undergoing cardiac surgery face a heightened risk of perioperative complications, including postcardiotomy shock (PCS). Conventional management with inotropes and vasopressors can exacerbate end-organ dysfunction, underscoring the need for alternative strategies. The planned use of mechanical circulatory support (MCS) devices, such as the Impella, offers a proactive approach to mitigating PCS in high-risk patients. This study presents our early experience at Johns Hopkins with planned Impella utilization in high-risk cardiac surgery. We detail our risk stratification methodology, patient selection criteria, and perioperative management strategies. Our proposed risk stratification scoring system incorporates surgical intent, preoperative myocardial function, anticipated postoperative course, and exit strategy to identify optimal candidates for perioperative MCS. We describe the intraoperative central placement technique for the Impella 5.5, perioperative management protocols—including anticoagulation strategies and weaning protocols—and postoperative device extraction. A retrospective review of our first 11 consecutive patients with severely reduced left ventricular ejection fraction (<30%) who underwent Impella-assisted cardiac surgery demonstrated favorable outcomes, with no postoperative mortality and a two-year follow-up. Our findings suggest that planned Impella use in high-risk cardiac surgery is both feasible and beneficial. However, further studies are necessary to validate these results, assess long-term outcomes, and evaluate cost-effectiveness. Full article

Background: Melatonin has antioxidant and anti-inflammatory properties that may attenuate ischemia-reperfusion injury, but randomized cardiovascular trial data remain inconsistent. Objectives: This study sought to evaluate the association of melatonin supplementation with cardiovascular outcomes across randomized trials. Methods: We performed a systematic review and meta-analysis of randomized trials comparing melatonin with placebo, usual care, or no melatonin in patients with cardiovascular disease. PubMed, Embase, and CENTRAL were searched from inception to 1 January 2026. Random-effects models with Hartung–Knapp–Sidik–Jonkman confidence intervals were used. Prespecified outcomes included left ventricular ejection fraction (LVEF), change in LVEF, troponin, infarct size by cardiac magnetic resonance, heart failure outcomes, inflammatory and oxidative stress biomarkers, and adverse events. Results: A total of 14 randomized controlled trials involving 1027 participants were included. Melatonin significantly improved change in LVEF from baseline to follow-up (mean difference: 3.95 percentage points; 95% CI: 1.70–6.20; p < 0.001), with the most consistent signal in coronary artery bypass grafting studies (mean difference: 4.65 percentage points; 95% CI: 2.56–6.74). Final LVEF was numerically higher with melatonin but not statistically significant. Troponin reduction was not significant. Narrative synthesis suggested lower inflammatory and oxidative stress markers after coronary artery bypass grafting and improvement in heart failure symptoms and quality of life, whereas infarct size findings in ST-segment elevation myocardial infarction were mixed and timing-dependent. Conclusions: Melatonin was associated with improved LVEF change, particularly in coronary artery bypass grafting settings, but benefit was not consistently demonstrated across final LVEF, troponin, or infarct size outcomes. Full article

Background/Objectives: Restenosis following coronary artery bypass grafting (CABG) remains a major long-term complication that adversely affects patient prognosis. Although prior studies have investigated clinical features, imaging parameters, and circulating biomarkers for restenosis risk stratification, the metabolic mechanisms underlying long-term restenosis—particularly those reflecting both the local cardiac microenvironment and systemic circulation—remain poorly defined. Therefore, this study aims to identify restenosis-associated metabolic alterations and develop a risk prediction model based on integrated targeted metabolomic profiling of pericardial fluid (PF) and serum in patients undergoing isolated CABG. Methods: Patients undergoing isolated CABG were prospectively enrolled. Paired PF and serum samples were collected during surgery or the perioperative period for targeted metabolomic analysis. Differential metabolite (DM) analysis was performed between patients with and without restenosis. Key metabolites were selected to construct a restenosis risk prediction model, which was subsequently evaluated in training and validation cohorts. Results: Compared with patients without restenosis, those who developed restenosis exhibited two key differential metabolites identified in PF and serum: 7α-Hydroxy-4-cholesten-3-one and Phenoxyacetic acid (PAA). A logistic regression-based prediction model incorporating these metabolites was developed and evaluated using receiver operating characteristic (ROC) analysis, integrated discrimination improvement (IDI), and decision curve analysis (DCA). The model demonstrated robust predictive performance in both training and validation cohorts. Kaplan–Meier survival analysis further revealed that higher model scores were significantly associated with an increased risk of long-term restenosis in the training cohort (HR = 1.44, p = 0.047) and validation cohort (HR = 1.83, p = 0.012). Conclusions: This study provides the first evidence that integrated metabolomic signatures derived from PF and serum are associated with long-term restenosis after CABG. By capturing complementary metabolic information from the local cardiac microenvironment and systemic circulation, this integrated approach enhances current understanding of restenosis biology and supports the potential clinical utility of targeted metabolomics for long-term restenosis risk prediction following CABG. Full article

Background: Acute type A aortic dissection (ATAAD) is a life-threatening condition that may be complicated by malperfusion, particularly in patients with prior aortic interventions such as Thoracic Endovascular Aortic Repair (TEVAR). Management becomes increasingly complex when the dissection involves supra-aortic branches and compromises previously placed stents. Methods: We report the case of a 58-year-old male presenting with ATAAD and left lower limb paralysis, with a history of prior TEVAR. Imaging demonstrated an entry tear in the ascending aorta with extension into the distal left main and supra-aortic branches, resulting in a dissection flap obstructing the proximal end of the TEVAR stent. The patient underwent emergency surgical intervention including a Bentall procedure, coronary artery bypass grafting (CABG), and deployment of a small Ascyrus Medical Dissection Stent (AMDS) distally within the TEVAR stent. Pre-operatively, the patient had severe lower limb ischemia due to near-complete obstruction of distal flow. Results: Following surgical intervention, there was restoration of true lumen perfusion with resolution of malperfusion. The patient was successfully weaned from cardiopulmonary bypass, extubated on post-operative day 4, and discharged on day 7 with stable hemodynamics and intact bilateral lower limb perfusion. Post-operative computed tomography (CT) demonstrated a well-seated AMDS with no evidence of ongoing false lumen perfusion. At 30-day follow-up, there was no clinical or biochemical evidence of organ malperfusion. Conclusions: The use of an AMDS deployed within a pre-existing TEVAR stent may represent an effective strategy for managing complex ATAAD with malperfusion, particularly in cases requiring combined surgical interventions. Full article