The Heart Surgery Forum

The Days Are Just Packed: Learning Surgery on the Go…

Skylar Rodgers, Curt Tribble — Sun, 23 Jun 2024 00:00:00 -0700

No abstract present.

Novel Mechanism of SIRT3 Regulation in Cardiac Inflammatory Injury: The Key Role of MITOL

Ping Li, Lingzhi Wang — Wed, 19 Jun 2024 00:00:00 -0700

Background: Myocardial injury is a common heart disease that involves various forms of cell death, including pyroptosis. Lipopolysaccharide (LPS) can simulate the inflammatory response of cardiomyocytes, resulting in their damage. Sirtuin 3 (SIRT3), a mitochondrial deacetylase, has been shown to play a role in cardiac protection. This study aimed to investigate whether SIRT3 mitigates inflammation-induced cardiomyocyte pyroptosis and alleviates LPS-induced myocardial injury via the mitochondrial ubiquitin ligase (MITOL)-dependent mechanism. Methods: Mouse and H9C2 cardiomyocyte models were used to simulate myocardial inflammatory injury by LPS treatment. Cardiac ultrasound, protein expression analysis, mRNA expression detection, and serum biochemical indicators were used to assess the extent of myocardial injury. The EdU experiment was conducted to detect cell proliferation capacity. DCFH-DA fluorescence was used to measure Reactive Oxygen Species (ROS) levels. JC-1 probe analysis was used to assess the aggregate/monomer ratio in different treatment groups. Furthermore, SIRT3 treatment and MITOL silencing experiments were conducted to explore the impact of SIRT3 on cardiomyocyte pyroptosis and whether it functions through MITOL. Scanning electron microscopy experiments were conducted to assess the reversal of the protective effect of SIRT3 by silencing MITOL. Results: The experimental results showed that LPS treatment significantly impaired mouse cardiac function, increased the expression of pyroptosis-related proteins in cardiomyocytes, elevated serum myocardial injury indicators, and increased the mRNA expression of inflammatory factors (tumor necrosis factor-alpha (TNFα) and interleukin-1β (IL-1β)). SIRT3 treatment significantly reduced LPS-induced myocardial injury, improved cardiac function, reduced the expression of pyroptosis-related proteins, and decreased inflammatory factors. Silencing MITOL reversed the protective effect of SIRT3 on cardiomyocyte injury, suggesting that SIRT3 exerted its therapeutic effect through MITOL. Conclusion: This study revealed that SIRT3 mitigated inflammation-induced cardiomyocyte pyroptosis via a MITOL-dependent mechanism, thereby alleviating LPS-induced myocardial injury. This finding provides a new molecular target for the treatment of myocardial inflammation-related diseases and lays a theoretical foundation for the development of cardiac protection strategies. Future research can further explore the potential application of the SIRT3-MITOL axis in cardiac diseases, providing effective treatment methods for cardiac patients.

Using a Novel Machine-Learning Algorithm as an Auxiliary Approach to Predict the Transfusion Volume in Mitral Valve Surgery

Wed, 19 Jun 2024 00:00:00 -0700

Background: Blood transfusion is an indispensable supportive therapy. It plays a pivotal role in the perioperative management of cardiac surgery. The aim of this study was to develop a model for predicting the transfusion volume in isolated mitral valve surgery. Methods: We gathered data from 677 patients undergoing isolated mitral valve surgery with and without simultaneous tricuspid valve operation. The dataset was partitioned into a training dataset (70%) and a testing dataset (30%). We evaluated 18 machine-learning algorithms, incorporating inputs from 36 demographic and perioperative features. Additionally, the performance of multiple linear regressions was compared with machine-learning algorithms. CatBoost was selected for further analysis, and Shapley additive explanation (SHAP) values were employed to evaluate feature importance. Finally, we explored the impact of various features on the accuracy of CatBoost by analyzing the reasons for misjudgment. Results: CatBoost outperformed all 18 machine learning algorithms with an R-squared value of 0.420, mean absolute error of 0.702, mean squared error of 1.208, and root mean squared error of 1.090, surpassing multiple linear regression. The analysis of the testing group achieved 72.5% accuracy. SHAP identified 20 pertinent features influencing transfusion volume. No significant differences were observed between correctly and incorrectly predicted groups in tricuspid valve repair, American Society of Anesthesiologists classification, or platelet count. Conclusion: CatBoost effectively predicts the intraoperative transfusion volume in mitral valve surgery, aiding clinicians in transfusion decision-making and enhancing patient care.

Early Enteral Nutrition Does Not Cause Excessive Inflammatory Response in Veno-Arterial Extracorporeal Membrane Oxygenation Patients

Shengnan Yang, Chen Wang, Feilong Hei, Anshi Wu — Tue, 18 Jun 2024 00:00:00 -0700

Background: To evaluate the safety between early enteral nutrition (EN) and parenteral nutrition (PN) by observing changes in inflammatory cytokines and gastrointestinal hormones in veno-arterial extracorporeal membrane oxygenation (VA ECMO) patients. Methods: This study was a prospective, observational study that enrolled patients receiving VA ECMO treatment from 1 January 2020 to 31 December 2023. Patients were enrolled in an EN group or a PN group according to the inclusion criteria. The concentration of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor α (TNF-α) on the first five days of VA ECMO treatement were tested in both groups. Serum concentrations of Motilin (MOT), Gastrin (GAS), Cholecystokinin (CCK), and Calcitonin gene-related peptide (CGRP) were measured for the EN group. Student t test or Fisher test was used to compare the difference between the two groups. Results: 28 patients were enrolled in this study; 16 in the EN group and 12 in the PN group. The baseline characteristics were comparable between the two groups. The concentration of IL-1β in the EN group was significantly lower than that of the PN group on day 3 and day 4 (day 3: 0.65 ± 0.17 pg/mL vs. 0.93 ± 0.09 pg/mL, p < 0.01, day 4: 0.52 ± 0.16 pg/mL vs. 0.74 ± 0.12 pg/mL, p < 0.01). The concentration of IL-6 and TNF-α in the EN group were also significantly lower than in the PN group on day 3 and day 4. There was no statistical difference in IL-10 serum concentration between the EN group and the PN group from day 1 to day 5. On day 3, the concentration of MOT, GAS and CCK reached the highest level and then gradually decreased. Conclusions: Implementation of early EN in patients receiving VA ECMO does not cause significant elevation of pro-inflammatory cytokines with an excessive inflammatory response.

Initial Clinical Experience with Implantation of a New Left Ventricular Assist Device HeartCon

Shan Guo, Shi-Fu Wang, Ling-Di Hou, Xiao-Cheng Liu, Guo-Wei He — Tue, 18 Jun 2024 00:00:00 -0700

Objective: Heart failure is a major health problem worldwide. We report the initial experience of a new left ventricular assist device (LVAD) Heartcon—a centrifugal pump of magnetic-fluid suspension rotor integrated with the pump and machine. From September 2020 to March 2023, HeartCon was implanted in a total of 78 cases throughout China, 27 were implanted in TEDA International Cardiovascular Hospital. Methods: The patient data collected from the medical record included patient demographics, surgical and cardiopulmonary bypass (CPB) data, doses of transfused red blood cells, mechanical ventilation time (h), intensive care unit (ICU) stay time (d), and cardiac function indices assessed by echocardiography, 6-minute walk tests, and N-terminal pro brain natriuretic peptide (NT proBNP) values. Results: All patients were in New York Heart Association (NYHA) grade IV before surgery and 21 had a dilated cardiomyopathy. All patients survived the surgery. One patient underwent heart transplantation 10 months after the implantation. Eight patients reported adverse event events. The duration of mechanical ventilation after operation was 37.8 ± 52.0 h. The incidence of hemorrhagic stroke was 7.4% and the incidence of mediastinal infection was 7.4%. At 90 day followup, 25 patients were in NYHA grade I and the other 2 patients were in grade II. Conclusion: We conclude that HeartCon implantation is a safe and useful LVAD for treatment of end-stage heart failure. It provides a shorter duration of mechanical ventilation time, and a lower incidence of hemorrhagic stroke and mediastinal infection.

A Retrospective Study of Whether Sacubitril–Valsartan Improves Cardiac Function in Patients with Acute Coronary Syndrome and Hypertension after Percutaneous Coronary Intervention

Fuzhong Liu, Jia Lu, Yongchao Dong, Yingjun Yang — Mon, 17 Jun 2024 00:00:00 -0700

Objectives: This study aimed to explore the effect of sacubitril–valsartan on cardiac function in patients with acute coronary syndrome (ACS) and hypertension after percutaneous coronary intervention (PCI). Methods: The study was conducted on 166 patients with ACS and hypertension who underwent PCI at our hospital from July 2022 to June 2023. The patients were divided into two groups: an observation group and a control group, with 83 cases in each group. The observation group was given sacubitril–valsartan, and the control group was given enalapril. The treatment period was 3 months. The cardiac function indexes, biochemical indexes, adverse reactions, and the occurrence of new cardiovascular and cerebrovascular events were compared between the two groups before and after medication. Results: We found no statistically dramatic differences between the two groups in gender, age, body mass index, diabetes, hyperlipidemia, family history of ACS, family history of hypertension, smoking history, drinking history, regular exercise history, low-salt and low-fat diet, New York Heart Association cardiac function classification, number of vessels involved in coronary artery disease, stent length, stent inner diameter, number of stent implants, duration of hypertension, medication time, use of antihypertensive drugs, systolic blood pressure (SBP), and diastolic blood pressure (DBP). The observation group had lower left ventricular end-diastolic internal diameter (LVEDD) levels, higher left ventricular ejection fraction (LVEF) levels, and lower left ventricular end-systolic internal diameter (LVESD) levels compared with the control group. The levels of N-terminal pro-brain B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), and creatine kinase isoenzyme MB (CK-MB) in the observation group decreased compared with those in the control group. Compared with the pre-medication period, LVEDD levels decreased, LVEF levels increased, and LVESD levels decreased in the observation and control groups, whereas NT-proBNP, cTnI, and CK-MB levels decreased in the observation and control groups. The total incidence rates of adverse reactions and new cardiovascular and cerebrovascular events in the observation group were found to be lower than those in the control group. Conclusion: The application of sacubitril–valsartan in patients with ACS complicated with hypertension after PCI can effectively improve patients' cardiac function, reduce biochemical indexes related to myocardial injury, and lower the incidence of adverse cardiovascular events. It features good safety, providing a new treatment strategy and method for patients with ACS complicated with hypertension.

Outcomes of Obese Coronavirus 2019 Patients Treated with Extra Corporeal Membrane Oxygenation

Mon, 17 Jun 2024 00:00:00 -0700

Background: Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is used as salvage therapy in severe cases of acute respiratory distress syndrome (ARDS) caused by the coronavirus disease 2019 (COVID-19). Obesity has been linked to worse disease severity and poor outcomes in COVID-19, but there is also a hypothesized obesity survival paradox whereby obese patients fare better in severe illness than their non-obese complement. The effect of obesity on ECMO outcomes in patients with COVID-19 is not well understood. Methods: We performed a retrospective analysis of all patients admitted to our institution who underwent VV ECMO cannulation for COVID-19 in the span of one year. These were separated by body mass index (BMI) with a cutoff of 35 kg/m² (signifying class 2 obesity or higher) and compared with each other as well as a comparator group of patients with BMI >35 kg/m² who underwent VV ECMO cannulation for any cause between 2016 and 1 March 2021. Disease severity was categorized using established scoring systems including Apache-II, Charleson-Dayeo, and Murray. Primary endpoints were 30 day mortality, survival to decannulation, and survival to discharge. Results: The study groups were similar in all respects with the exception of BMI. Illness severity, as classified by Charleson-Dayeo, Apache II, and Murray scores not significantly different between groups. The primary outcomes (30-day mortality, survival to decannulation, and survival to discharge) were not significantly different between groups. There was a trend toward more delayed inititation of ECMO therapy in the obese group that was not statistically significant. There was also a trend toward shorter duration of ECMO therapy that did not reach the threshold for statistical significance. Conclusions: There was no significant difference in outcomes between obese and non-obese patients undergoing VV ECMO for COVID-19. Trends toward shorter duration of ECMO and shorter intensive care unit (ICU) and hospital length of stay could represent the “obesity survival paradox” that has been described. Given similar outcomes, obesity should not be a contraindication to ECMO therapy for COVID-19.

Association between Thrombocytopenia and Outcomes in Patients Undergoing Redo Valvular Surgery Utilizing Cardiopulmonary Bypass

Can Zhao, Yaqiong Xiao, Jianping Xu — Sun, 16 Jun 2024 00:00:00 -0700

Objective: To figure out the incidence of postoperative thrombocytopenia among adult cases undergoing redo valvular surgery with cardiopulmonary bypass (CPB) and to discern its ramifications on early postoperative outcomes. Methods: A cohort comprising 188 cases undergoing redo valvular surgery with CPB between March 2018 and July 2023 was analyzed. It was attempted to stratify cases into two groups on the basis of presence of thrombocytopenia that was defined as a nadir platelet count <71 × 10³/μL within 72 hours (n = 45), or absence of thrombocytopenia (n = 143). Comparative evaluation was performed concerning postoperative mortality and morbidity. Logistic regression models were employed to unveil the relationship of thrombocytopenia with clinical outcomes. Results: Thrombocytopenia manifested in 45 (23.94%) cases. Univariate analysis disclosed a significant association of percent change in platelet count with mortality (odds ratio (OR), 1.039, 95% confidence interval (CI), 1.005 to 1.074, p = 0.024), postoperative pneumonia (OR, 1.058, 95% CI, 1.023 to 1.095, p = 0.001), prolonged mechanical ventilation (OR, 1.048, 95% CI, 1.026 to 1.071, p < 0.001), extended intensive care unit (ICU) stay (OR, 1.029, 95% CI, 1.010 to 1.049, p = 0.003), protracted post-operative hospitalization (OR, 1.031, 95% CI, 1.011 to 1.051, p = 0.002), postoperative renal replacement therapy (OR, 1.042, 95% CI, 1.017 to 1.069, p = 0.001), and re-thoracotomy attributable to hemorrhage (OR, 1.040, 95% CI, 1.000 to 1.080, p = 0.047). Multivariate analysis demonstrated that thrombocytopenia, regarded as a categorical variable, was independently correlated with an escalated likelihood of prolonged postoperative hospital stay (OR, 4.926, 95% CI, 1.740 to 13.948, p = 0.003). Conclusions: Thrombocytopenia appeared to be closely linked to escalated in-hospital mortality and postoperative morbidity rates among cases undergoing redo valvular surgery employing CPB. Further investigations with larger, prospective cohorts are essential to validate these outcomes and unravel potential underlying mechanisms.

Effect of Early Heparin Anticoagulation on Blood Flow and Cardiac Function in Patients with Acute ST Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Xiaohua Huang, Xiaobo Jiang, Mingyang Tang, Li Deng, Xia Wei, Mingjian Lang — Sun, 16 Jun 2024 00:00:00 -0700

Objective: This study aimed to investigate the effect of early administration of heparin anticoagulation on blood flow and cardiac function in patients with acute ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: A retrospective analysis was conducted on 730 patients with STEMI who underwent PPCI at the Department of Cardiology of the Chengdu Fifth People's Hospital of Chengdu from December 2017 to May 2023. According to the timing of heparin administration. The patients were divided into two groups based on the timing of heparin administration: the early group (3000 U unfractionated heparin administered immediately after the diagnosis of STEMI) and the delayed group (Intravenous injection of ordinary heparin 3000 U after successful interventional catheterization following the diagnosis of STEMI). The study compared general clinical data, myocardial injury markers (initial troponin, peak troponin, and tmax troponin), interventional related indicators (preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, stent length, and thrombus aspiration), and postoperative indexes ST segment resolution (STR), left ventricular ejection fraction (LVEF), n-terminal pro-brain natriuretic peptide (NT-proBNP), major adverse cardiovascular events (MACE), and bleeding events. Results: The early group had a lower proportion of TIMI 0–1 grade and a higher proportion of TIMI 2–3 grade compared to the delayed group (p < 0.05). The early group showed better ST segment resolution (p < 0.05). There was no significant difference in LVEF and NT-proBNP classification between the two groups (p > 0.05). Subgroup analysis suggested an interaction between early heparin anticoagulation and left anterior descending infarct-related artery (IRA) on cardiac function. There was no significant difference in the incidence of MACE and bleeding events between the two groups (p > 0.05). Logistic regression analysis revealed that early heparin anticoagulation was a predictor of immediate TIMI grade 2–3 flow, and TIMI grade 2–3 flow was negatively correlated with early heparin anticoagulation. Conclusions: Early heparin anticoagulation can improve the patency of the IRA and myocardial perfusion in patients with STEMI. Additionally, it can reduce myocardial injury and improve cardiac function without increasing the risk of in-hospital bleeding.

Effects of Mindfulness Meditation on Anxiety, Self-Efficacy, and Quality of Life in Patients after Coronary Artery Bypass Transplantation

Shuyuan Wei, Ji Wang, Hua Xie, Yanshuang Cheng — Thu, 13 Jun 2024 00:00:00 -0700

Objective: This study aimed to determine the effects of mindfulness meditation on the anxiety, self-efficacy, and quality of life of patients after coronary artery bypass grafting (CABG). Methods: Data of 124 patients who underwent CABG in our hospital from May 2020, to May 2022, were collected. In accordance with the presence or absence of mindfulness meditation, the patients were divided into control group (n = 64, conventional cardiac rehabilitation) and observation group (n = 60, conventional cardiac rehabilitation + mindfulness meditation). The Hamilton Anxiety Scale (HAMA), General Self-Efficacy Scale (GSES), quality of life, and postoperative complications were compared between the two groups. Results: No significant difference was observed in the HAMA, GSES, and quality-of-life scores between the two groups after operation (p > 0.05). After the intervention, the HAMA score of the observation group was lower than that of the control group (p < 0.05), and the GSES and quality of life scores of the observation group were higher than those of the control group (p < 0.05). The total incidence of postoperative complications in the observation group (5.00%) was lower than that in the control group (7.81%), without significant difference (p > 0.05). Conclusions: The use of mindfulness meditation for patients undergoing CABG is beneficial to relieve anxiety and improve their self-efficacy and quality of life, hence worthy of adoption.

Influence of Serum Apelin and CD40L Expression Levels on Adverse Cardiovascular Events after PCI

Jie Zhang, Yanjun Liu, Ning Liu — Thu, 13 Jun 2024 00:00:00 -0700

Objective: This study aimed to investigate the effects of serum levels of apelin and CD40L on major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Methods: A case–control study was conducted to select patients undergoing PCI in our hospital from June 2020 to June 2022. Patients were divided into the occurrence group and the non-occurrence group according to whether MACEs occurred during the 12-month follow-up after surgery. Enzyme-linked immunosorbent assay was used to detect the expression levels of serum apelin and CD40L in the two groups, and the correlation between the expression of apelin and CD40L and prognosis was analyzed. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the prognosis of PCI. Results: Compared with the non-occurrence group, the occurrence group had a significantly lower level of apelin and a significantly higher level of CD40L (p < 0.001). Apelin was negatively correlated with the occurrence of MACEs after PCI (r = –0.583, p < 0.001), and CD40L was positively correlated with the occurrence of MACEs after PCI (r = 0.569, p < 0.001). Logistic regression analysis showed that apelin was a protective factor for MACEs after PCI (odds ratio (OR) = 0.248, p < 0.001); CD40L, age, hypertension, and the number of diseased vessels were risk factors for MACEs after PCI (OR = 8.684, 0.018, 0.003, 0.020, p < 0.05). The area under curve (AUC) of apelin combined with CD40L was large, and the predictive value was higher than that of apelin and CD40L alone (AUC values were 0.956, 0.857, 0.905, p < 0.001; p < 0.001; p < 0.001). Conclusions: This study showed that the levels of apelin and CD40L were correlated with MACEs after PCI. Clinicians should pay close attention to the levels of apelin and CD40L in patients after PCI and be alert to the occurrence of MACEs.

Safety and Effectiveness of Transthoracic Echocardiography and Transesophageal Echocardiography in the Interventional Closure of Atrial Septal Defects in Children: A Systematic Review and Meta-Analysis

Haiyan Lu, Jindong Wang, Lingjuan Zhou, Lian Liu — Wed, 19 Jun 2024 00:00:00 -0700

Objective: Through this meta-analysis, a systematic review was conducted on the effects of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the interventional closure of atrial septal defects (ASDs) in children. Methods: We searched papers in the PubMed, Web of Science, Cochrane Library, Google Scholar, CNKI, Wanfang, Embase, and VIP databases. The search time limit was from the establishment of the database to May 2023. Randomized controlled trials on the effect of TTE and TEE in the interventional closure of ASD in children were screened. The included results were integrated and analyzed, and ReviewManager 5.4 was used for the meta-analysis. Results: Six studies with a total of 253 patients with ASD were included in this meta-analysis. Results showed that the surgical success rate in each study was more than 90%, with no difference between TEE and TTE (p = 0.11; risk ratio (RR) = 0.96, 95% confidence interval (CI): 0.89 to 1.04). The surgery time of TTE was significantly shorter than that of TEE (standard mean difference (SMD) = –1.52, 95% CI: –2.30 to –0.74). The fluoroscopy time of TTE was shorter than that of TEE (SMD = –0.69, 95% CI: –1.08 to –0.30). We found no significant difference in complication rates (RR = 0.36, 95% CI: 0.09 to 1.39). Conclusion: The combination of TTE and TEE is important during surgery, and postoperative complications are relatively small. The surgery time and fluoroscopy time of TTE are shorter than those of TEE.

Surgical Repair of Giant Dissecting Pulmonary Artery Aneurysm Associated with Atrial Septal Defect and Pulmonary Arterial Hypertension: A Case Report

Wen Xie, Jianrui Ma, Haiyun Yuan, Yong Zhang, Jian Zhuang, Shusheng Wen — Thu, 06 Jun 2024 00:00:00 -0700

Pulmonary artery aneurysm (PAA) and pulmonary artery dissection (PAD) are rare and potentially fatal conditions that may lead to pulmonary artery (PA) rupture and cardiac tamponade. PAA is often associated with other cardiac and congenital heart diseases, such as atrial septal defect (ASD). We report a case of a patient with ASD and a giant dissecting PAA who underwent surgical repair to prevent potentially fatal outcome and discuss the probable etiologies of this case. We present a rare case of a 50-year-old woman with a secundum ASD and severe pulmonary arterial hypertension (PAH) who developed a giant PAA of 114 mm with dissection. The PAA caused extrinsic compression of the left main coronary artery (LMCA), which was misdiagnosed as coronary artery disease (CAD) at local hospital. Right heart catheterization revealed PAH of 73 mmHg and she was referred to our center for further treatment. After 4 months of lowering PAH treatment, she underwent successful surgical repair of the PAA to release the compression of LMCA, as well as mechanical valve replacement, fenestrated ASD closure and tricuspid valvuloplasty. She had an uneventful recovery and showed significant improvement in pulmonary hemodynamics and clinical symptoms at one-year follow-up. PAA with dissection is a rare complication of ASD and PAH that can potentially be fatal. Patients with large or symptomatic PAA and PAD may require early surgical intervention, particularly if they experience compression of nearby structures or are at risk of rupture. It is crucial to promptly refer and consult with specialists and ensure optimal preoperative hemodynamic management to enhance patient outcomes.

Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta in a 10-Day-Old Boy: A Case Report

Lin Luo, Yulan Luo, Qi An, Mei Feng — Thu, 06 Jun 2024 00:00:00 -0700

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare anomaly, comprising approximately 0.1% of all congenital heart diseases. Patients suffered congestive heart failure in infancy, and some patients will experience progressive pulmonary vascular disease without surgical repair. In patients of this disease, early surgical intervention is generally advised and has demonstrated a high level of safety and efficacy, yielding excellent outcomes. We report a unique case involving a 10-day-old boy, characterized by the rare anomalous origination of the right pulmonary artery from the ascending aorta. This case is further complicated by the presence of a patent ductus arteriosus (PDA) and a right descending aorta. The ligation of the PDA and reimplantation of the right pulmonary artery (RPA) were successfully performed. The patient exhibited a favorable recovery trajectory postoperatively.

Hybrid Coronary Revascularization in Multivessel Disease: The Ideal Strategy for Challenging Scenarios

Sun, 23 Jun 2024 00:00:00 -0700

The treatment of coronary artery disease (CAD) has considerably evolved over the last three decades thanks to innovations in percutaneous and surgical revascularization techniques. The demographic shift towards an aging population with complex coronary anatomy and multiple comorbidities necessitates a personalized approach. A primary challenge for Heart Teams is to integrate new strategies into their decision-making process. Hybrid coronary revascularization (HCR) combines the long-term benefits of coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) to treat complex coronary artery disease. Selection of the ideal candidate for HCR requires careful evaluation of anatomic challenges and risk profiles. Although recent evidence demonstrates the safety and efficacy of HCR and makes it a viable alternative to conventional methods, further large-scale randomized controlled trials (RCTs) are needed to establish its role in routine practice. In this manuscript, we have provided an overview of the major advances in both percutaneous and surgical techniques. In addition, we have addressed the innovative implications of robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) and described the surgical procedure and postoperative care in detail. Finally, we have outlined the key principles that guide our clinical practice in selecting the appropriate approach for hybrid coronary revascularization.

Development of Dyslipidemia in Atherosclerosis and Modern Approaches to its Treatment

Sun, 23 Jun 2024 00:00:00 -0700

Dyslipidemia is one of the key features in the pathogenesis of atherosclerosis, however, many points in the progression of this pathological phenomenon remain unclear. In this review, we will consider the significance of various lipoproteins in the progression of atherosclerosis, the general pattern of dyslipidemia development and its role in the pathogenesis of atherosclerosis, as well as new approaches to the treatment of dyslipidemia, which will potentially reduce the disadvantages of existing therapies and increase drug efficacy.