Journal of Cardiovascular Development and Disease

16 pages, 563 KiB

Open AccessSystematic Review

Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review

by Eleni Delimanoli, Olav Muurlink, Pavlos Myrianthefs and Anna Korompeli

J. Cardiovasc. Dev. Dis. 2024, 11(11), 376; https://doi.org/10.3390/jcdd11110376 - 20 Nov 2024

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the [...] Read more.

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. Methods: A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. Results: The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Conclusions: Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach. Full article

(This article belongs to the Section Cardiac Surgery)

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13 pages, 1530 KiB

Open AccessArticle

Predictive Value of Preoperative Morphology Parameters in Patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Surgery

by Krzysztof Greberski, Jakub Batko, Paweł Bugajski, Maciej Łuczak, Maciej Brzeziński and Krzysztof Bartuś

J. Cardiovasc. Dev. Dis. 2024, 11(11), 375; https://doi.org/10.3390/jcdd11110375 - 20 Nov 2024

Abstract

Background: Coronary heart disease is the most common cause of death worldwide. It is responsible for almost a third of deaths in patients over the age of 35. Various biomarkers are currently being studied in detail for their value in predicting postoperative mortality [...] Read more.

Background: Coronary heart disease is the most common cause of death worldwide. It is responsible for almost a third of deaths in patients over the age of 35. Various biomarkers are currently being studied in detail for their value in predicting postoperative mortality in patients undergoing CABG. Aim: The aim of this study is to analyze the predictive value of certain blood morphological parameters in CABG and off-pump coronary artery bypass grafting (OPCAB). Methods: A total of 520 patients who underwent surgery in two consecutive years and underwent CABG (404) or OPCAB (116) were included in this retrospective study. Gender, age, comorbidities, five-year survival rate, detailed information on hospitalization, surgery, intensive care unit parameters and preoperative blood samples from the cubital vein were recorded. Inverse propensity treatment weighting was applied to adjust for confounding factors at baseline. Results: No differences were found between OPCAB and CABG as an isolated comparison. In the standardized population, patients with abnormal lymphocyte counts had an increased risk of death at one-year and five-year follow-up. In the standardized population, abnormal red blood cell distribution width (RDW-SD), neutrocyte-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were associated with increased mortality in each period analyzed. Conclusions: Abnormal PLR, RDW-SD and NLR are associated with increased early and late mortality in patients undergoing CABG and OPCAB. Abnormal lymphocytes are only associated with increased late mortality. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

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14 pages, 4605 KiB

Open AccessArticle

Different Proteins as Biomarkers for Sac Shrinkage After Endovascular Aortic Repair of Abdominal Aortic Aneurysms

by Alexander Zimmermann, Daniela Reitnauer, Yankey Yundung, Anna-Leonie Menges, Lorenz Meuli, Jaroslav Pelisek and Benedikt Reutersberg

J. Cardiovasc. Dev. Dis. 2024, 11(11), 374; https://doi.org/10.3390/jcdd11110374 - 20 Nov 2024

Abstract

Background: This study aims to identify circulating biomarkers by using proteomic analysis associated with sac shrinkage or expansion in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). Methods: Plasma samples were analysed from 32 patients treated with EVAR between 10/2009 [...] Read more.

Background: This study aims to identify circulating biomarkers by using proteomic analysis associated with sac shrinkage or expansion in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). Methods: Plasma samples were analysed from 32 patients treated with EVAR between 10/2009 and 10/2020. Patients were divided into two groups based on postoperative sac behaviour: sac shrinkage (≥5 mm reduction) and no shrinkage (stabilisation or expansion). Proteomic analysis was performed using high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS), with abundant protein depletion to enhance the detection of low-abundant proteins. Results: Of the 32 patients, 20 exhibited sac shrinkage, and 12 showed no shrinkage. Proteomic analysis identified 632 proteins, with significant differential abundance observed after adjusting for relevant clinical parameters. Notably, neurogranin (NRGN) levels were significantly associated with hypertension and smoking, while casein alpha S1 (CSN1S1) levels varied with statin use. Differentially abundant proteins related to aortic diameter included calpastatin, SCUBE3, and ubiquitin-conjugating enzyme E2, among others. Conclusions: Proteomic profiling revealed distinct biomarker patterns associated with sac behaviour in EVAR-treated AAA patients. These findings suggest potential therapeutic targets for enhancing EVAR outcomes and underscore the need for further investigation into the biological mechanisms underlying aneurysm sac shrinkage and stability. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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11 pages, 837 KiB

Open AccessArticle

Mitral Transcatheter Edge-to-Edge Repair in INTERMACS 3–4 Profile Patients with Severe Mitral Regurgitation

by Simone Frea, Stefano Pidello, Filippo Angelini, Paolo Boretto, Pier Paolo Bocchino, Daniele Melis, Giuseppe Giannino, Elena Cavallone, Francesca Giordana, Sara Rettegno, Carol Gravinese, Giulia De Lio, Guglielmo Gallone, Veronica Dusi, Gianluca Alunni, Antonio Montefusco, Fabrizio D'Ascenzo, Massimo Boffini, Claudia Raineri, Mauro Rinaldi and Gaetano Maria De Ferrari Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2024, 11(11), 373; https://doi.org/10.3390/jcdd11110373 - 19 Nov 2024

Abstract

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a [...] Read more.

Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated. Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility. The primary endpoint was a composite of death, urgent heart transplantation and LVAD implantation at 12 months. Results: A total of 36 patients underwent TEER, while 27 patients received optimal medical therapy (MT) alone. In the intervention group, 35 patients (97%) were discharged alive. In the MT group, two in-hospital deaths occurred, two patients underwent urgent heart transplantation, and three patients were discharged on inotropes. At the 12-month follow-up, the incidence of the primary endpoint occurring was lower in the TEER group (25% vs. 70%, HR 0.25, 95% CI 0.11–0.60, p < 0.01) and the tolerance to neurohormonal therapy was higher (53% vs. 30%, p = 0.03). Conclusions: In advanced HF patients with INTERMACS profile 3 or 4 and severe FMR, TEER on top of optimal MT was associated with a lower incidence of death, urgent heart transplantation or LVAD implantation at 12 months compared to optimal MT alone. Full article

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9 pages, 944 KiB

Open AccessArticle

Sex Differences Among Patients Undergoing Transcatheter Tricuspid Valve Repair Using the Edge-to-Edge Technique

by Mhd Nawar Alachkar, Astrid Eichelsdörfer, Hesham Mady, Andrea Milzi, Rakan Saadoun, Lukas Krygier, Steffen Schnupp and Christian Mahnkopf

J. Cardiovasc. Dev. Dis. 2024, 11(11), 372; https://doi.org/10.3390/jcdd11110372 - 19 Nov 2024

Abstract

Introduction: Tricuspid valve regurgitation (TR) is more prevalent among females. Transcatheter tricuspid valve repair (TTVR) using the edge-to-edge technique represents an alternative to surgery in patients with severe TR and high surgical risk. This study aims to investigate sex differences among patients undergoing [...] Read more.

Introduction: Tricuspid valve regurgitation (TR) is more prevalent among females. Transcatheter tricuspid valve repair (TTVR) using the edge-to-edge technique represents an alternative to surgery in patients with severe TR and high surgical risk. This study aims to investigate sex differences among patients undergoing TTVR. Methods: All patients who underwent TTVR at our center were retrospectively included. We compared baseline characteristics, intra-hospital, and one-year outcomes between males and females. Results: A total of 105 consecutive patients underwent TTVR. Females were more prevalent in the study cohort (n = 63, 60%). Coronary artery disease (CAD) was more evident in males than females (71.4% vs. 47.6%, p = 0.016). Left ventricular ejection fraction (LVEF) was also worse in males (48.8 ± 13.4 vs. 58 ± 6.8, p < 0.001). Other clinical characteristics were similar between both groups. The Success of the procedure (88.1% vs. 95.2%, p = 0.177) and intra-hospital mortality (4.8% vs. 11.1%, p = 0.255) were similar among males and females. At one-year follow-up, mortality was similar between both groups (24.3% vs. 25.9%, p = 0.863). Furthermore, hospitalization due to acute heart failure was also similar between both groups (40.5% vs. 37.5%, p = 0.768), as was a composite endpoint of death or hospitalization. In patients with successful procedures and who survived one year, TR severity was comparable between both groups. Conclusions: In our real-world cohort, more females underwent TTVR than males. No difference was observed in outcomes between males and females at one-year follow-up. Full article

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11 pages, 1815 KiB

Open AccessArticle

Females at a Clear Disadvantage with Postoperative Myocardial Infarction Symptoms

by Sonja Guethoff, Rebekka Kraft, Matthias Riege, Carola Grinninger and Kara Krajewski

J. Cardiovasc. Dev. Dis. 2024, 11(11), 371; https://doi.org/10.3390/jcdd11110371 - 19 Nov 2024

Abstract

Background: Cardiovascular disease remains the leading cause of death in women. Gender bias and blindness are coming into focus as relevant risk factors for patients. To date, there have been no studies that target surgeons’ potential gender bias in recognizing postoperative myocardial infarction [...] Read more.

Background: Cardiovascular disease remains the leading cause of death in women. Gender bias and blindness are coming into focus as relevant risk factors for patients. To date, there have been no studies that target surgeons’ potential gender bias in recognizing postoperative myocardial infarction (MI). Methods: An online clinical vignette describing a patient with postoperative MI was randomized for gender. Possible diagnoses, the next steps in management, and questions on gender bias were assessed. Results: A total of 205 surveys were analyzed. MI was recognized in 55.6% of the male case studies vs. 32.0% of the female case studies in the first question (p < 0.005). Cardiac diagnostics were initiated significantly more in male case studies (94% vs. 76%, p = 0.001). Female surgeons listed MI as the first diagnosis twice as often as male surgeons overall (43% vs. 23%, p = 0.027). Female surgeons were also more likely to mention MI across the survey at all compared to male surgeons (89% vs. 67%, p = 0.0002). Board-certified surgeons diagnosed MI by the end of the survey significantly more (88.2%) than residents (75.0%) and medical students (75.0%, p = 0.047). Conclusions: Overall, this study was able to demonstrate the presence of both gender bias and gender blindness in surgeons’ assessment of postoperative myocardial infarction symptoms with a clear disadvantage for female patients and a superior awareness for female surgeons. Full article

(This article belongs to the Special Issue Women and Cardiovascular Disease: The Gender Gap)

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9 pages, 989 KiB

Open AccessArticle

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

by Fausto Biancari, Giorgio Mastroiacovo, Mauro Rinaldi, Luisa Ferrante, Timo Mäkikallio, Tatu Juvonen, Giovanni Mariscalco, Zein El-Dean, Matteo Pettinari, Javier Rodriguez Lega, Angel G. Pinto, Andrea Perrotti, Francesco Onorati, Konrad Wisniewski, Till Demal, Petr Kacer, Jan Rocek, Dario Di Perna, Igor Vendramin, Daniela Piani, Eduard Quintana, Robert Pruna-Guillen, Joscha Buech, Caroline Radner, Manoj Kuduvalli, Amer Harky, Antonio Fiore, Angelo M. Dell’Aquila, Giuseppe Gatti, Lenard Conradi, Mark Field, Arianna Galotta, Daniele Fileccia, Giuseppe Nanci and Sven Peterss Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2024, 11(11), 370; https://doi.org/10.3390/jcdd11110370 - 19 Nov 2024

Abstract

Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 [...] Read more.

Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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11 pages, 993 KiB

Open AccessArticle

Evolution of the Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) Indication and Mortality Rates in Spain from 2010 to 2019

by Óscar Gasulla, Antonio Sarría-Santamera, Ferran A. Mazaira-Font, Cielo García-Montero, Oscar Fraile-Martinez, Diego Cantalapiedra, Manuel F. Carrillo-Rodríguez, Belen Gómez-Valcárcel, Miguel Á. Ortega, Melchor Álvarez-Mon and Angel Asúnsolo

J. Cardiovasc. Dev. Dis. 2024, 11(11), 369; https://doi.org/10.3390/jcdd11110369 - 16 Nov 2024

Abstract

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main interventional treatments for coronary artery disease (CAD) patients. Both procedures are constantly being perfected and developed. This study aims to analyze the evolution of intervention mortality rates of PCI and [...] Read more.

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main interventional treatments for coronary artery disease (CAD) patients. Both procedures are constantly being perfected and developed. This study aims to analyze the evolution of intervention mortality rates of PCI and CABG in recent years in Spain. We use a database of all hospital discharges from CABG and PCI procedures in Spain during two periods, between the years 2010 to 2012 and 2016 to 2019. We elaborate two multivariate regression logistic models to test the differences in mortality between the two periods and the two procedures, adjusting the mortality rates by age, gender, and comorbidities. We find strong evidence that CABG significantly reduced mortality rates, especially in complex patients, while PCI remained almost constant. We also discuss how physicians incorporate the improvement in procedures’ performance into the decision-making for the recommendation of these two procedures in CAD patient management. Full article

(This article belongs to the Special Issue 2nd Edition: Interventional Therapies and Management in Coronary Artery Disease)

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12 pages, 1708 KiB

Open AccessArticle

Beyond the Obesity Paradox: Analysis of New Prognostic Factors in Transcatheter Aortic Valve Implantation Procedure

by Francesca Ricci, Leonardo Benelli, Monia Pasqualetto, Mario Laudazi, Luca Pugliese, Maria Volpe, Cecilia Cerimele, Carlo Di Donna, Francesco Garaci and Marcello Chiocchi

J. Cardiovasc. Dev. Dis. 2024, 11(11), 368; https://doi.org/10.3390/jcdd11110368 - 15 Nov 2024

Abstract

Scope: The main purpose of our study was to collect computed tomography (CT) measurements of fat parameters that are significantly related to body mass index (BMI) and evaluate the associations of these measurements and sarcopenia with early and long-term complications after transcatheter aortic [...] Read more.

Scope: The main purpose of our study was to collect computed tomography (CT) measurements of fat parameters that are significantly related to body mass index (BMI) and evaluate the associations of these measurements and sarcopenia with early and long-term complications after transcatheter aortic valve implantation (TAVI) in order to investigate the existence of the so-called ‘obesity paradox’ and the role of sarcopenia in this phenomenon. Materials and Methods: We analyzed the significance of fat CT measurements in 85 patients undergoing the TAVI procedure and compared these with each other, as well as with quantified CT BMI and fat density measurements. Secondly, we evaluated the associations of BMI, CT measurements of fat, and CT evaluations of skeletal muscle mass with early and long-term complications after 24 months of post-TAVI follow-up. Results: We found positive and significant relationships between fat CT measurements with each other and with BMI and a negative and significant relation between fat density and fat quantity. By comparing the CT measurements of fat and skeletal muscle mass with early and long-term complications after TAVI, we confirmed the existence of the ‘obesity paradox’ and the poor effect of sarcopenia after the TAVI procedure. Conclusions: We confirm that overweight and obesity are good prognostic factors, and sarcopenia is a poor prognostic factor for outcomes following the TAVI procedure. We focused on the scientific validation of an easy and fast way to measure fat and skeletal muscle mass using CT to better predict the outcomes of patients undergoing TAVI. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Imaging—Computed Tomography (CT) Focus Issue)

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26 pages, 14150 KiB

Open AccessArticle

New Insights on the Formation of the Mitral Valve Chordae Tendineae in Fetal Life

by Meghan Martin, Kate Gillett, Parker Whittick and Sarah Melissa Wells

J. Cardiovasc. Dev. Dis. 2024, 11(11), 367; https://doi.org/10.3390/jcdd11110367 - 15 Nov 2024

Abstract

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during [...] Read more.

There is an increasing understanding that some mitral valve pathologies have developmental origins. The time course of valvulogenesis varies by animal model; in cattle, the branched chordae tendineae architecture becomes fully developed at full term. The mechanism by which chordae tendineae bifurcate during fetal development remains unknown. The current study presents a detailed description of bovine chordae tendineae formation and bifurcation during fetal development. Analysis of Movat Pentachrome-stained histological sections of the developing mitral valve apparatus was accompanied by micro-CT imaging. TEM imaging of chordae branches and common trunks allowed the measurement of collagen fibril diameter distributions. We observed a proteoglycan-rich “transition zone” at the junction between the fetal mitral valve anterior leaflet and chordae tendineae with “perforations” lined by MMP1/2 and Ki-67 expressing endothelial cells. This region also contained clusters of proliferating endothelial cells within the bulk of the tissue. We hypothesize this zone marks a region where chordae tendineae bifurcate during fetal development. In particular, perforations created by localized MMP activity serve as a site for the initiation of a “split” of a single chordae attachment into two. This is supported by TEM results that suggest a similar population of collagen fibrils runs from the branches into a common trunk. A clear understanding of normal mitral valvulogenesis and its signaling mechanisms will be crucial in developing therapeutics and/or tissue-engineered valve replacements. Full article

(This article belongs to the Special Issue 10th Anniversary of JCDD—'Cardiac Development and Regeneration' Section — from Development to Regeneration)

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11 pages, 279 KiB

Open AccessArticle

Bleeding Risk of Anticoagulation Reversal Strategies Before Heart Transplantation: A Retrospective Comparative Cohort Study

by Antonio Prieto-Romero, Sara Ibañez-García, Xandra García-González, Javier Castrodeza, Beatriz Torroba-Sanz, Carlos Ortiz-Bautista, Cristina Pascual-Izquierdo, José María Barrio-Gutiérrez, Ángel González-Pinto, Ana Herranz-Alonso and María Sanjurjo-Sáez

J. Cardiovasc. Dev. Dis. 2024, 11(11), 366; https://doi.org/10.3390/jcdd11110366 - 13 Nov 2024

Abstract

Heart transplantation (HT) poses high bleeding risks, especially for patients on anticoagulation. This study evaluates the use of idarucizumab for dabigatran (DBG) reversal compared to vitamin K antagonist (VKA) strategies in HT. A retrospective analysis of HT patients from January 2018 to December [...] Read more.

Heart transplantation (HT) poses high bleeding risks, especially for patients on anticoagulation. This study evaluates the use of idarucizumab for dabigatran (DBG) reversal compared to vitamin K antagonist (VKA) strategies in HT. A retrospective analysis of HT patients from January 2018 to December 2022, excluding those requiring ECMO immediately before or after surgery, was conducted. Outcomes included transfusion needs, re-surgery due to bleeding, ICU stay lengths, and 30-day survival. A cost analysis compared the direct expenses of each strategy. Among 34 patients, 20 were on DBG and 14 on VKAs or not anticoagulated. Idarucizumab significantly reduced the number of patients requiring transfusion (p = 0.034) and ICU stay lengths (p = 0.014), with no significant impact on re-surgery rates (p = 0.259) or survival (p = 0.955). Despite higher initial costs, overall expenses for idarucizumab were comparable to VKA reversal due to reduced transfusion needs and shorter ICU stays. Idarucizumab offers a viable and potentially cost-neutral anticoagulation reversal option for HT patients on DBG, presenting an alternative to VKA strategies. However, due to the retrospective nature of the study and the small sample size, further prospective studies are needed to confirm these findings. Full article

10 pages, 869 KiB

Open AccessArticle

Empowering EVAR: Revolutionizing Patient Understanding and Qualification with 3D Printing

by Michał Kargul, Patryk Skórka, Piotr Gutowski, Arkadiusz Kazimierczak and Paweł Rynio

J. Cardiovasc. Dev. Dis. 2024, 11(11), 365; https://doi.org/10.3390/jcdd11110365 - 10 Nov 2024

Abstract

Background: This study addresses the need for enhanced patient education in the context of abdominal aortic aneurysm (AAA) and its treatment through endovascular aneurysm repair (EVAR). Effective patient education is essential for improving comprehension and engagement, particularly for those facing complex medical conditions. [...] Read more.

Background: This study addresses the need for enhanced patient education in the context of abdominal aortic aneurysm (AAA) and its treatment through endovascular aneurysm repair (EVAR). Effective patient education is essential for improving comprehension and engagement, particularly for those facing complex medical conditions. Methods: A total of 55 patients scheduled for EVAR participated in the study. Patient-specific three-dimensional (3D)-printed models of the participants’ aneurysms were created using computed tomography angiogram (CTA) scans. The educational intervention included a structured session utilizing these 3D models, with assessments conducted before and after the session, including the Mini-Mental State Examination (MMSE). Statistical analyses evaluated the knowledge gain and its correlation with cognitive function. Results: The results showed a significant increase in knowledge scores post-education (p < 0.001), with a mean knowledge gain of 2.36 points. Patients rated the effectiveness of the 3D models highly on a Likert scale, with a mean score of 4.64 for improving their understanding of the medical condition and procedural aspects. A weak correlation was observed between MMSE scores and knowledge test results. Conclusions: This study demonstrates the potential of patient-specific 3D models to enhance patient education in the context of EVAR, improving patients’ understanding of their medical condition and the procedure and thereby facilitating more informed decision-making. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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19 pages, 1641 KiB

Open AccessArticle

Effects of Sodium–Glucose Co-Transporter 2 Inhibitors on Serum Chloride Concentrations in Patients with Heart Failure

by Ivana Jurin, Vanja Ivanović Mihajlović, Zrinka Šakić, Marin Pavlov, Tomislav Šipić, Petra Vitlov, Hrvoje Falak, Danijela Grizelj, Šime Manola and Mario Udovičić

J. Cardiovasc. Dev. Dis. 2024, 11(11), 364; https://doi.org/10.3390/jcdd11110364 - 9 Nov 2024

Abstract

Background and aims: In the past few years, some reports have shown that serum chloride concentration is a more powerful prognostic predictor than serum sodium levels in heart failure (HF). Elevated Na/Cl ratio has shown to be independently associated with all-cause death in [...] Read more.

Background and aims: In the past few years, some reports have shown that serum chloride concentration is a more powerful prognostic predictor than serum sodium levels in heart failure (HF). Elevated Na/Cl ratio has shown to be independently associated with all-cause death in acute HF. We evaluated changes in serum chloride concentrations and Na/Cl ratio in correlation with various clinical factors during 12 months of follow-up in patients in whom SGLT2is were initiated as part of HF therapy. Patients and methods: This was a prospective observational study conducted at University Hospital Dubrava and involving patients with HF. We included 241 participants between May 2021 and April 2023. All data were obtained before the introduction of SGLT2is, and the same parameters were obtained at 6 and 12 months of follow-up as well. Results: The results show that higher chloride concentration at both 6 and 12 months is an independent predictor of lower NT-proBNP levels. The chloride concentrations did not differ significantly between these groups in the follow-up period. There were no statistically significant differences in the Na/Cl ratio at different timepoints. The presence of cardiovascular risk factors did not significantly affect the increase in chloride concentration. Conclusions: Our results suggest that hypochloremia could be a potentially modifiable risk factor, given the influence of SGLT2is on chloride concentration, but also an ominous sign of a poor outcome in patients with HF. We believe that the determination of chloride concentrations should become routine in the monitoring of patients with HF. Full article

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10 pages, 458 KiB

Open AccessArticle

Associations of Left Atrial Volume Index to Left Ventricular Ejection Fraction Ratio with Clinical Outcomes in Transthyretin Cardiac Amyloidosis

by Yeabsra K. Aleligne, Machelle D. Wilson, Martin Cadeiras, Michael Gibson, Shirin Jimenez, Stella Yala, Pablo E. Acevedo, David A. Liem, Julie T. Bidwell and Imo A. Ebong

J. Cardiovasc. Dev. Dis. 2024, 11(11), 363; https://doi.org/10.3390/jcdd11110363 - 8 Nov 2024

Abstract

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) affects all cardiac chambers to cause left ventricular (LV) deformation as well as left atrial (LA) remodeling and functional impairment. We investigated the associations of the LA volume index (LAVI):LV ejection fraction (LVEF) ratio with the increased risk [...] Read more.

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) affects all cardiac chambers to cause left ventricular (LV) deformation as well as left atrial (LA) remodeling and functional impairment. We investigated the associations of the LA volume index (LAVI):LV ejection fraction (LVEF) ratio with the increased risk of death, heart transplant, or LV assist device implantation (LVAD) in patients with ATTR-CM. Methods: This was a retrospective cohort study involving 69 heart failure (HF) patients with ATTR-CM at an academic medical center between 1 November 2008 and 31 March 2024. ATTR-CM was diagnosed using a technetium–diphosphonate/pyrophosphate scan or an endomyocardial biopsy. The LAVI and LVEF were measured by echocardiography. Cox proportional hazards models were used for the analysis. Results: The mean (SD) age of the participants was 77.5 (9.3) years. Over a median (IQR) follow-up period of 1.96 (0.67–2.82) years, we observed 24 composite events that included twenty-two deaths, two heart transplants, and two LVAD implantations (who subsequently died). In multivariable-adjusted analyses that accounted for age and the glomerular filtration rate, a one-unit increase in the LAVI:LVEF ratio was associated with a doubling of the risk (HR, 95% CI: 2.06, 1.11–3.82) of experiencing the composite outcome. Conclusions: A one-unit increase in the LAVI:LVEF ratio was associated with an increased risk of death, heart transplant, or LVAD implantation in patients with ATTR-CM. Full article

(This article belongs to the Section Cardiovascular Clinical Research)

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24 pages, 4268 KiB

Open AccessArticle

Sex-Specific Changes in Cardiac Function and Electrophysiology During Progression of Adenine-Induced Chronic Kidney Disease in Mice

by Valentina Dargam, Anet Sanchez, Aashiya Kolengaden, Yency Perez, Rebekah Arias, Ana M. Valentin Cabrera, Daniel Chaparro, Christopher Tarafa, Alexandra Coba, Nathan Yapaolo, Perony da Silva Nogueira, Emily A. Todd, Monique M. Williams, Lina A. Shehadeh and Joshua D. Hutcheson

J. Cardiovasc. Dev. Dis. 2024, 11(11), 362; https://doi.org/10.3390/jcdd11110362 - 7 Nov 2024

Abstract

Chronic kidney disease (CKD) and cardiovascular disease (CVD) often co-exist, with notable sex-dependent differences in manifestation and progression despite both sexes sharing similar risk factors. Identifying sex-specific diagnostic markers in CKD-induced CVD could elucidate why the development and progression of these diseases differ [...] Read more.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) often co-exist, with notable sex-dependent differences in manifestation and progression despite both sexes sharing similar risk factors. Identifying sex-specific diagnostic markers in CKD-induced CVD could elucidate why the development and progression of these diseases differ by sex. Adult, C57BL/6J male and female mice were fed a high-adenine diet for 12 weeks to induce CKD, while control mice were given a normal diet. Adenine-treated males showed more severe CKD than females. Cardiac physiology was evaluated using electrocardiogram (ECG) and echocardiogram markers. Only adenine-treated male mice showed markers of left ventricular (LV) hypertrophy. Adenine males showed markers of LV systolic and diastolic dysfunction throughout regimen duration, worsening as the disease progressed. Adenine males had prolonged QTc interval compared to adenine females and control males. We identified a new ECG marker, S_peak-J duration, which increased with disease progression and appeared earlier in adenine-treated males than in females. We identified sex-dependent differences in cardiac structure, function, and electrophysiology in a CKD-induced CVD mouse model, with adenine-treated males displaying markers of LV hypertrophy, dysfunction, and electrophysiological changes. This study demonstrates the feasibility of using this model to investigate sex-dependent cardiac differences resulting from CKD. Full article

(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)

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17 pages, 1531 KiB

Open AccessReview

Sternal Wound Reconstruction Following Deep Sternal Wound Infection: Past, Present and Future: A Literature Review

by Arwa Khashkhusha, Sundas Butt, Mariam Abdelghaffar, William Wang, Asveny Rajananthanan, Sakshi Roy, Bakht Noor Khurshid, Mohamed Zeinah and Amer Harky

J. Cardiovasc. Dev. Dis. 2024, 11(11), 361; https://doi.org/10.3390/jcdd11110361 - 7 Nov 2024

Abstract

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site [...] Read more.

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site preparation, are crucial in reducing the incidence of DSWI. Effective management necessitates a multidisciplinary approach encompassing surgical debridement, drainage, and sternum repair utilising diverse procedures in conjunction with antibiotic therapy. Traditional approaches to managing DSWI involved closed irrigation and drainage techniques. While these methods exhibited certain advantages, they also exhibited limitations and varying degrees of success. The current care paradigms emphasise prophylactic antibiotic administration and surgical interventions like closed suction and irrigation, vacuum-assisted closure, and flap reconstruction. Future advancements in surgical techniques and technology hold promise for further enhancing sternal wound reconstruction. This review separates and emphasises the distinct roles of prophylaxis, antibiotic treatment, and reconstructive techniques, each relevant specifically to DSWI management. Collaborative efforts between cardiac and plastic surgeons, supported by ongoing research and innovation, are indispensable to advance sternal wound restoration and achieve superior outcomes in terms of patient welfare, morbidity and mortality reduction, and surgical efficacy. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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12 pages, 1137 KiB

Open AccessArticle

Patient-Level Pericoronary Adipose Tissue Mean Attenuation: Associations with Plaque Characteristics

by Katrine Schultz Overgaard, Thomas Rueskov Andersen, Roda Abdulkadir Mohamed, Sebastian Villesen Kristensen, Helle Precht, Jess Lambrechtsen, Søren Auscher and Kenneth Egstrup

J. Cardiovasc. Dev. Dis. 2024, 11(11), 360; https://doi.org/10.3390/jcdd11110360 - 7 Nov 2024

Abstract

Pericoronary adipose tissue attenuation (PCAT_a), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCAT_a and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted [...] Read more.

Pericoronary adipose tissue attenuation (PCAT_a), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCAT_a and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted on 466 patients with suspected chronic coronary syndrome who underwent clinically indicated CCTA. PCAT_a was measured along the proximal 40 mm of the coronary arteries and averaged to represent the patient’s level. Plaque type was assessed, compositional plaque volumes were measured, and plaque burdens were quantified. The coronary calcification scores (CCSs) were categorized into groups. Statistical methods included t-tests, ANOVA, and multivariate regression analysis. PCAT_a differed significantly between calcified (−81.7 Hounsfield units (HU)) and soft (−77.5 HU) plaques. PCAT_a was positively associated with total plaque burden (β = 3.6) and non-calcified plaque burden (β = 7.0), but negatively correlated with calcified plaque burden (β = −3.5), independent of clinical factors and tube voltage (p < 0.05). The effect of PCAT_a was stronger when plaques of a different composition were absent. No significant differences in PCAT_a were found among different CCS groups. PCAT_a increased for calcified compared to soft plaques. The non-calcified plaque burden was associated with a higher PCAT_a, while the calcified plaque burden was associated with a lower PCAT_a. Full article

(This article belongs to the Section Acquired Cardiovascular Disease)

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13 pages, 2308 KiB

Open AccessReview

Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies

by Mariagrazia Piscione, Valeria Cammalleri, Giorgio Antonelli, Valeria Maria De Luca, Myriam Carpenito, Dario Gaudio, Nino Cocco, Antonio Nenna, Carmelo Dominici, Antonio Bianchi, Francesco Grigioni and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2024, 11(11), 359; https://doi.org/10.3390/jcdd11110359 - 7 Nov 2024

Abstract

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing [...] Read more.

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing valvular heart disease. Cardiac imaging plays a critical role in the management of CHD, so the final diagnosis can be performed through multimodal imaging techniques and the measurement of biomarkers. Moreover, in observational studies, surgical treatment of carcinoid-induced valve disease has been found to improve outcomes. Despite advancements in pre-operative preparation in recent years, mortality rates remain high in elderly patients and those with multiple comorbidities due to the risk of intra-operative carcinoid crisis and high post-operative bleeding. In this comprehensive review, we will analyze the causes of carcinoid syndrome and how it can result in severe right heart failure. The role of different imaging modalities in detecting heart valve disease will be discussed together with the therapeutic options at our disposal, such as medical treatment, surgery, and the novel role of transcatheter intervention. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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8 pages, 1095 KiB

Open AccessArticle

Endo-Aortic Clamp for Minimally Invasive Redo Mitral Valve Surgery: Early Outcome

by Cristina Barbero, Marco Pocar, Andrea Costamagna, Cecilia Capozza, Valentina Aloi, Erik Cura Stura, Stefano Salizzoni and Mauro Rinaldi

J. Cardiovasc. Dev. Dis. 2024, 11(11), 358; https://doi.org/10.3390/jcdd11110358 - 6 Nov 2024

Abstract

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde [...] Read more.

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde femoral arterial perfusion and endo-aortic clamping avoids re-entry injuries and reduces the requirement for dissection of adhesions and the risk of damage to cardiac structures. The aim of this study is to analyze redo patients undergoing mitral valve surgery with retrograde arterial perfusion and endo-aortic clamping setting. Methods: A retrospective analysis was performed on patients undergoing surgery from 2006 to 2022. Exclusion criteria were more than mild aortic regurgitation, moderate-to-severe peripheral vascular disease, dilated ascending aorta, and a lack of preoperative vascular screening. The primary outcome was perioperative mortality. Results: Two hundred eighty-five patients were analyzed. Mean age was 63.8 ± 13.3 years, mean EuroSCORE was 16.5 ± 14.5%, and one quarter of the patients had undergone two or more previous procedures via sternotomy. Perioperative mortality was 3.9% (11/285). Stroke was reported in six (2.1%) patients. Median intensive care unit and hospital length of stay were 1 and 8 days, respectively. Conclusions: Endo-aortic clamping setting in redo MV surgery avoids re-entry injuries and allows the surgeon to clamp the aorta and deliver the cardioplegia with minimal dissection of adhesions. In high-volume and experienced centers, this approach can be applied safely and effectively and may in the near future become the standard of care for redo mitral valve surgery. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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