Search Results (2,461)

Objective and Background: With the increasing use of catheter ablation for tachyarrhythmias, continuous evaluation of in-hospital complications is essential. This study aimed at analyzing complications associated with catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) using nationwide administrative data. Methods: We conducted a retrospective multicentric data analysis from large German ablation centers between 2018 and 2023. Patients were identified using ICD and OPS codes for AF, AFL, and VT regarding predefined in-hospital complications: mortality, stroke, pericardial tamponade, pulmonary embolism, and vascular complications requiring intervention. Results: Among 19,258 ablation procedures from 11 centers, AF was most common (n = 12,241), followed by AFL (n = 5582) and VT (n = 1435). Major complications occurred in 2.2% (n = 433) of cases. VT ablations had the highest complication rate (9.8%), followed by AF (1.6%) and AFL (1.7%). Pericardial tamponade occurred in 0.9% patients, most commonly in VT ablations (4.0%). Vascular complications requiring intervention were reported in 1.1%, while stroke (0.3%) and pulmonary embolism (0.05%) were rare. In-hospital mortality was highest in VT patients (2.4%), compared to AF (0.08%) and AFL (0.13%). Higher AFL mortality as compared to AF was associated with older age and more comorbidities. Upon exploratory analysis, no statistical association between hospital volume and complication rates could be seen. Conclusions: In this multicenter analysis, catheter ablation was associated with a low overall complication rate. VT ablations carried the highest risk, highlighting the impact of structural heart disease and comorbidities. Full article

Background and Objectives: Systemic inflammation and renal dysfunction play a central role in the progression and prognosis of type A aortic dissection (TAAD). This study evaluated the SCr score, a composite index combining the systemic inflammation response index (SIRI) and serum creatinine, to assess its prognostic value postoperatively. Materials and Methods: Clinical data from 299 surgically treated TAAD patients were retrospectively analyzed. SCr scores were stratified into three levels using optimal cutoffs. Survival differences were examined using Kaplan–Meier curves. Independent predictors of overall survival (OS) and in-hospital mortality (IHM) were identified through multivariable Cox and logistic regression, respectively. A prognostic nomogram integrating SCr and significant clinical variables was developed, and model performance was evaluated and compared with previously published models. Results: Higher SCr scores were associated with a progressively increased mortality risk. In multivariable Cox analysis, both SCr scores of 1 and 2 emerged as independent predictors of worse long-term survival, with SCr = 2 demonstrating a particularly strong association (hazard ratio (HR) = 4.408, 95% confidence interval (CI): 1.786–10.881; p = 0.001). In logistic regression analysis, SCr scores remained an independent predictor of IHM (SCr = 1: odds ratio (OR) = 3.066, 95% CI: 1.032–9.102; SCr = 2: OR = 4.811, 95% CI: 1.081–21.409; p < 0.05 for both). A prognostic nomogram based on the SCr score and other clinical variables achieved strong discrimination for OS (area under the curve [AUC]: 0.845) and IHM (AUC: 0.821). Conclusions: The SCr score was independently associated with preoperative risk in patients with TAAD. An SCr-incorporating nomogram demonstrated favorable discriminative performance for predicting overall survival and in-hospital mortality. These findings suggest that SCr-based assessment may provide complementary information and assist in the identification of high-risk patients within established clinical assessment frameworks. Full article

Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways. Case presentation: We present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission. Conclusions: This case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed. Full article

(1) Background: Our aim was to evaluate left atrial (LA) volumes and function in patients with newly diagnosed, treatment-naive type 2 diabetes mellitus (T2DM) using Four-Dimensional Automated Left Atrial Quantificative (four-dimensional auto LAQ) analysis and to explore the independent factors influencing left atrial function in diabetic patients. (2) Method: A total of 62 treatment-naive, newly diagnosed T2DM patients without hypertension or obesity and 50 healthy controls were prospectively enrolled in the study. All participants underwent laboratory analyses, routine echocardiography and 4D LAQ assessment. The parameters were compared between the two groups, and independent factors influencing left atrial function in diabetic patients were investigated through univariate and multivariate linear regression analyses. (3) Results: Despite no significant difference in LA end-systolic anteroposterior diameter between groups, LA volume parameters (LAVmax, LAVmin, LAVpreA, and LAVmaxI) were significantly increased in T2DM patients (all p < 0.05). Regarding LA strain, reservoir and conduit function were significantly impaired in T2DM patients, as reflected by lower LASr, LAScd, LASr-c, and LAScd-c (all p < 0.05). Conversely, circumferential contractile strain (LASct-c) was significantly higher in the T2DM group (p = 0.029), while longitudinal contractile strain (LASct) did not differ significantly between groups (p = 0.146). Multivariate analysis revealed that HbA1c and E/e’ ratio were independently associated with multiple LA strain parameters (all p < 0.05). (4) Conclusion: Newly diagnosed, treatment-naive patients with T2DM exhibited increased LA volumes, decreased left atrial ejection fraction (LAEF), and impaired reservoir and conduit functions, accompanied by a compensatory increase in contractile function. Furthermore, HbA1c and E/e’ demonstrated an independent correlation with 4D strain parameters. 4D Auto LAQ echocardiography may serve as a sensitive tool for early detection of diabetic atrial myopathy. Full article

Background: Despite advances in reperfusion strategies, long-term major adverse cardiac and cerebrovascular events (MACCE) remain frequent after ST-elevation myocardial infarction (STEMI). Practical risk stratification tools applicable at presentation are therefore needed. We investigated the prognostic value of a simple composite index integrating age, blood urea nitrogen, and left ventricular ejection fraction (Age×BUN/LVEF) for predicting long-term MACCE in STEMI patients treated with primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center cohort study included 313 consecutive STEMI patients undergoing primary PCI between 2020 and 2024. The Age×BUN/LVEF (AGEBUNeFR) index was calculated using age and admission blood urea nitrogen values and left ventricular ejection fraction assessed during index hospitalization. The primary outcome was long-term MACCE, defined as a composite of all-cause mortality, recurrent myocardial infarction, repeat revascularization, stroke, and heart failure hospitalization. The median follow-up was 2.24 years (interquartile range 1.40–3.06). Results: During follow-up, 93 patients (29.7%) experienced MACCE. The AGEBUNeFR index was independently associated with MACCE after multivariable adjustment (adjusted HR 1.028 per unit increase, 95% CI 1.016–1.040; p < 0.001). Time-varying analyses demonstrated a dynamic prognostic effect, with significant associations in the early post-PCI period (p = 0.002) and a pronounced re-emergence of risk during late follow-up (>36 months; p < 0.001). Conclusions: The AGEBUNeFR index is a simple, readily available, and powerful predictor of long-term MACCE in STEMI patients undergoing primary PCI. By integrating age, renal/hemodynamic stress, and cardiac function, this composite index provides dynamic and incremental prognostic information beyond conventional clinical models, supporting its potential role as a practical tool for long-term risk stratification after STEMI. Full article

Inhaled Treprostinil is the primary treatment of pulmonary hypertension related to interstitial lung disease (PH-ILD). Despite treatment effectiveness in clinical trials, the real-world safety and tolerability of this therapy remains unclear. We conducted a multicenter, retrospective review of adults with PH-ILD who were prescribed inhaled treprostinil. We assessed clinical outcomes, 6 min walk distance (6MWD) and changes in natriuretic peptides (BNP, NT-proBNP), as well as medication tolerance. Eighty-three patients met the inclusion criteria. The 6MWD data was collected but a limited number of patients had results within close proximity to initiation of inhalational treprostinil with only seven patients having assessments within the 3 months prior to initiation as well as 3 months post therapy. Limited 6MWD data is likely due, in part, to coinciding with the COVID pandemic, limiting face-to-face interactions and exercise testing. The majority of our subjects, 63%, had an absolute improvement in their BNP level, over a mean duration of 170 days. However, no significant difference was detected between baseline and follow-up natriuretic peptide levels. Adherence was assessed and the majority (77%) of patients remained on therapy at the time of censoring, with three-quarters (75%) meeting the target dose. Of the 15 patients intolerant to nebulized treprostinil who were transitioned to a dry powder inhaler, the majority (87%) were able to tolerate the other formulation. The medication was well-tolerated with a large percentage of patients remaining on therapy indefinitely and reaching the targeted therapeutic dose. Full article

Long-term transthoracic echocardiogram (TTE) follow-up guidelines after muscular ventricular septal defect (mVSD) device closure are vague. The primary goal of this study was to perform a literature search to characterize the type and timing of complications that occur after mVSD device placement. The search was performed in Medline (PubMed) with English language and publication date (1983 to 2024) filters applied. Studies were included if they reported on patients who underwent mVSD device closure. Studies were excluded if they reported on other types of ventricular septal defect (VSD) device closures, were review papers, or did not report outcomes after the device procedure. A total of 139 articles met the criteria (retrospective, n = 63; prospective, n = 10; case reports, n = 66), encompassing 1668 patient cases. Age at the time of mVSD closure was 10.6 + 2.7 years. Incidence of complications was 17.9% (299/1668). Maximum follow-up was 160 months. Most complications were residual shunts (40.8%, 122/299), followed by valve dysfunction (13.7%, 41/299) and arrhythmias (13.7% 41/299). The vast majority of complications occurred ≤12 months post-device placement 98.0% (293/299). Only 1.3% (4/299) of complications occurred at >12 months (mild tricuspid regurgitation, n = 2; left bundle branch block, n = 1; atrial fibrillation, n = 1). Time until complication was not reported in 0.7% (2/299) of patients (residual shunts, n = 2). All clinically significant complications diagnosed via TTE occurred <12 months post-mVSD device procedure. The utility of repeat TTE beyond one year after mVSD device closure should be reassessed if no clinical concerns are present. Full article

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, which can result in severe complications such as cardiac arrhythmia, heart failure, and sudden cardiac death. Genetic factors contribute to MI etiology and have been studied through genome-wide association studies (GWAS). This systematic review aims to summarize all GWAS of MI reporting single-nucleotide polymorphisms (SNPs) reaching genome-wide significance (p < 5 × 10⁻⁸) and elucidate on their biological relevance and potential clinical utility. A systematic review following PRISMA guidelines was conducted using PubMed and the GWAS Catalog to identify eligible studies. This review included nine GWAS published between 2007 and 2023, conducted in both European and non-European cohorts. GWAS have identified multiple loci associated with MI, pinpointing potential biological pathways underlying MI, and potential therapeutic targets and enhancing risk prediction. Nonetheless, significant challenges remain, particularly the underrepresentation of diverse ancestries and the need for functional follow-up studies to define causal variants and clarify the mechanisms linking genetic variation to MI pathogenesis. Full article

Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use. Methods: Using national data from the German Statistical Office, all pregnant women diagnosed with PPCM and hospitalized between 2009 and 2022 were included. Patients were categorized into groups based on levosimendan treatment. Demographics, treatment modalities, peripartum complications, and transfusion rates were analyzed. Results: The prevalence of PPCM in Germany is 0.01%; 3.60% of patients received levosimendan, mostly after childbirth (61.76%). Peripartum complications and the use of mechanical circulatory support devices were significantly higher in the levosimendan group (p < 0.0001). Women in the levosimendan group suffered significantly more often from intrapartum bleeding and increased rates of blood transfusion compared to women in the non-levosimendan group. Conclusions: PPCM is a rare disease in Germany with a prevalence of 0.01%. Despite higher complication rates in women with levosimendan treatment, further studies are necessary to help determine the role and timing of levosimendan in the treatment of women with PPCM. Full article

Background/Objectives: Coronary collateral circulation (CCC) reduces ischemic damage in patients with chronic total occlusion (CTO), yet collateral development varies considerably among individuals. Endothelial stress and systemic inflammation are key biological processes involved in collateral vessel formation. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine, and platelet count, is a simple marker reflecting endothelial dysfunction and inflammatory status. However, evidence regarding its relationship with angiographic coronary collateral development in CTO remains limited. Therefore, this study aimed to evaluate the association between EASIX and CCC grades in patients with CTO. Methods: This retrospective study included 186 patients with CTO who underwent coronary angiography. CCC was evaluated using the Rentrop–Cohen classification and categorized as poorly developed (grades 0–1) or well-developed (grades 2–3). Clinical and laboratory data, including EASIX, were collected. Univariate and multivariate binary logistic regression analyses were performed to identify factors associated with poorly developed CCC. EASIX was standardized (z-score), and odds ratios were reported per 1-standard deviation increase. The predictive performance of EASIX was assessed using receiver operating characteristic (ROC) curve analysis. Results: Poorly developed CCC was observed in 70 patients (37.6%). Patients with well-developed CCC had significantly lower EASIX values (median 0.44 vs. 0.67, p < 0.001) and higher HDL cholesterol levels (p = 0.043). Neutrophil-to-lymphocyte ratio was also higher in the poorly developed CCC group (median 2.59 [2.19–3.59] vs. 2.41 [1.59–3.49], p = 0.028). In multivariate analysis, standardized EASIX remained independently associated with poorly developed CCC (OR 2.536 per 1-SD increase, 95% CI 1.734–3.710, p < 0.001). ROC analysis showed that EASIX provided moderate discrimination for poorly developed CCC (AUC 0.718), with 72.9% sensitivity and 62.1% specificity at a cutoff of >0.51. Conclusions: Higher EASIX values were independently associated with poorly developed CCC in patients with CTO. These findings support a link between systemic endothelial stress and impaired collateral vessel formation. EASIX may serve as a simple, practical, and low-cost biomarker to support risk stratification in CTO patients; however, prospective studies are needed to confirm these results and clarify clinical implications. Full article

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. The primary outcomes included operative mortality, stroke, conversion to sternotomy, major aortic bleeding, and dissection; the secondary outcomes included delirium, reoperation, infection, ICU stay, and hospitalization. The descriptive statistics were reported as means ± SD or median (interquartile range [IQR]). Results: The mean age of the patients was 57.2 ± 9.8 years, with 72% of these being male. The most frequent comorbidities observed in the study population were hypertension (62%), diabetes (52%), and peripheral artery disease (28%). The mean cross-clamp time was found to be 63 ± 27 min, and the mean CPB time was 118.6 ± 41.6 min. The occurrence of stroke, aortic dissection, major bleeding, and sternotomy conversions was not observed. One patient died from severe pneumonia on the ninth post-operative day. The mean ICU stay was 1.2 ± 0.4 days, and the mean hospital stay was 5.3 ± 1.1 days. Conclusions: Central aortic cannulation appears to be a safe and feasible procedure for TCRAT, providing physiological antegrade flow and eliminating the complications associated with peripheral cannulation. The preliminary findings suggest that central arterial cannulation may be a safe and practical alternative for the TCRAT technique, but prospective comparative studies are required to confirm its benefits over the femoral and axillary approaches. Full article

Background: Cardiothoracic surgery is among the most technologically advanced and resource-intensive medical specialties, placing it at the intersection of rapid digital innovation and growing demands for environmental sustainability. Addressing these parallel pressures requires integrated strategies that reconcile clinical excellence with ecological responsibility. Methods: This narrative review synthesizes PubMed-indexed literature published over the past two decades, supplemented by relevant policy documents and guidelines. The review examines digital transformation and sustainability initiatives in cardiothoracic surgery through the lens of the twin transformation framework, which conceptualizes digitalization and sustainability as interdependent and mutually reinforcing processes. Results: Key domains of digital transformation include artificial intelligence and big data-driven decision-making, robotic and minimally invasive surgical techniques, digital twins and simulation-based training, telemedicine and remote monitoring, and interoperable electronic health records. Sustainability-related themes encompass the substantial environmental burden of operating rooms, green surgical practices, sustainable procurement, and hospital-level decarbonization strategies. Emerging evidence suggests that aligning digital technologies with sustainability objectives can improve clinical outcomes, enhance operational efficiency, and reduce environmental impact. However, current evidence is largely derived from pilot studies and single-center experiences. Conclusions: Twin transformation offers a coherent and forward-looking framework for the future evolution of cardiothoracic surgery, demonstrating that digital innovation and sustainability can be synergistic rather than competing goals. While significant challenges remain—including high implementation costs, limited long-term data, and fragmented regulatory frameworks—integrating digital health technologies with sustainable practices represents a promising pathway toward high-quality, efficient, and environmentally responsible cardiothoracic care. Full article

Background: Neonates and young infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) are highly vulnerable to pulmonary dysfunction, systemic inflammation, capillary leak, and fluid overload, which may lead to acute kidney injury (AKI) and the need for peritoneal dialysis (PD). Lung ultrasound (LUS) is a bedside, radiation-free tool that allows real-time assessment of lung aeration and pulmonary congestion. However, its role in predicting postoperative renal support remains limited. This study aimed to evaluate whether early postoperative LUS scores could predict the need for PD in neonates after congenital heart surgery with CPB. Methods: In this prospective single-center study, 53 neonates undergoing cardiac surgery with CPB between June 2025 and January 2026 were included. LUS was performed preoperatively and at 0–2 h, 24–48 h, 72 h, 120 h, and 168 h postoperatively using a standardized six-zone scoring system (0–18). The primary outcome was postoperative PD requirement. ROC analysis assessed predictive performance, and multivariable logistic regression identified independent predictors. Results: Total LUS scores significantly increased in the early postoperative period, remained elevated for 24–72 h, and gradually declined by days 5–7. Infants requiring PD (n = 16) had significantly higher LUS scores at 0–2 h, 24–48 h, and 72 h (p < 0.05). The 24–48 h (AUC = 0.784; sensitivity 87%, specificity 62% at cut-off ≥ 11.5) LUS score showed the best predictive value for PD (AUC = 0.831; sensitivity 86%, specificity 74% at cut-off ≥ 13). In multivariable analysis, higher LUS scores at 0–2 h (OR 1.625, p = 0.048) and 24–48 h (OR 1.621, p = 0.048) independently predicted PD. Conclusion: Postoperative LUS is a reliable, noninvasive tool that can aid in predicting the need for PD in neonates undergoing cardiac surgery with CPB, supporting timely fluid and renal management. Full article

Introduction: Selective brain hypothermia has been investigated to improve neurological outcomes in patients with cardiac arrest; however, an optimal clinical method has not yet been established. This study aimed to evaluate the feasibility of a technique combining transnasal evaporative cooling with simultaneous endovascular temperature management to achieve selective brain hypothermia while preventing systemic hypothermia. Methods: Three adult male Göttingen swine were anesthetized and mechanically ventilated. Transnasal cooling was initiated at maximum output while endovascular warming preserved systemic temperature. Brain parenchymal and rectal temperatures, mean arterial pressure (MAP), heart rate (HR), and cardiac output (CO) were continuously monitored for 60 min. Temperature differences between brain and rectum at 60 min were analyzed. Results: A brain–rectal gradient ≥1.0 °C was achieved in all swine at 25, 40, and 30 min, respectively, and maintained at 1.0–1.5 °C thereafter. Brain temperature (34.5 ± 0.34 °C) was significantly lower than rectal temperature (35.8 ± 0.35 °C) at 60 min after initiation of the selective cooling procedure (p = 0.0048). MAP, HR, and CO showed no deviations from baseline. Conclusions: The combination of transnasal cooling and endovascular warming reliably induced selective brain hypothermia of 1–1.5 °C without adverse effects on hemodynamic parameters in swine. Full article