Search Results (971)

Off-pump coronary artery bypass grafting (OPCAB) represents one of the most significant technical innovations in contemporary cardiac surgery. Developed as an alternative to conventional on-pump coronary artery bypass grafting (ONCAB), OPCAB avoids cardiopulmonary bypass and its associated systemic inflammatory response, aiming to reduce perioperative morbidity and improve recovery. Over the past three decades, advances in stabilization devices, intracoronary shunts, anesthetic management, and surgical training have refined the procedure, making it safer and more reproducible. Despite these developments, OPCAB adoption remains inconsistent worldwide, reflecting ongoing debate about its relative benefits and limitations. Evidence from randomized controlled trials, meta-analyses, and large registries suggests that OPCAB achieves comparable early mortality to ONCAB, with potential advantages in reducing renal dysfunction, neurocognitive decline, and perioperative bleeding. These benefits appear most pronounced in high-risk subgroups, including elderly patients and those with significant comorbidities. However, concerns persist regarding long-term graft patency, completeness of revascularization, and variability in outcomes depending on surgeon experience and institutional expertise. Cost-effectiveness analyses have suggested potential resource savings, but these are offset by training requirements and the technical complexity of the procedure. Global practice variation highlights the influence of surgical culture, guideline ambiguity, and institutional resources. Barriers to universal adoption include technical challenges, inconsistent long-term outcomes, and limited exposure in training programs. In the future, robotic and minimally invasive OPCAB, as well as hybrid revascularization strategies, may expand its role. This review synthesizes current evidence, explores barriers to widespread implementation, and outlines future directions for integrating OPCAB into balanced, evidence-based clinical practice. Full article

Background and Objectives: Patients with a prior history of coronary artery bypass grafting (CABG) who present with non-ST-segment elevation myocardial infarction (NSTEMI) represent a complex, high-risk subgroup due to advanced comorbidity burden and challenging coronary anatomy. Whether an invasive strategy offers meaningful benefit over conservative management in this population remains unclear. Therefore, this study aimed to compare long-term outcomes of percutaneous coronary intervention (PCI) versus medical therapy in NSTEMI patients with previous CABG and to identify independent predictors of major adverse cardiovascular events (MACE) and all-cause mortality. Materials and Methods: This retrospective cohort study included 286 NSTEMI patients with prior CABG (PCI: 112; medical therapy: 174). Baseline demographic, clinical, laboratory, and angiographic characteristics were assessed. The primary endpoint was MACE, while the secondary endpoint was all-cause mortality. Kaplan–Meier analysis evaluated survival differences, and multivariable Cox regression identified independent predictors. Results: During follow-up, MACE rates were comparable between PCI and medical therapy (14.3% vs. 18.9%; p = 0.305). All-cause mortality was likewise similar (9.8% vs. 10.3%; p = 0.541). Kaplan–Meier analysis showed no survival benefit with PCI (log-rank p = 0.334). Hypoalbuminemia independently predicted both MACE and mortality, while CKD and HF were major determinants of long-term mortality. Conclusions: In NSTEMI patients with prior CABG, no long-term superiority of PCI over medical therapy was observed with respect to MACE or mortality. Prognosis appears more closely linked to hypoalbuminemia, CKD, and HF than to the chosen management strategy. These findings underscore the importance of individualized and risk-adapted clinical decision-making in this complex population. Full article

Cardiac rehabilitation is strongly recommended in secondary cardiovascular prevention. In patients after coronary artery bypass grafting, this intervention is suggested to reduce mortality, morbidity, and disability. In addition, rehabilitation programs improve quality of life and cardiorespiratory fitness. Modern cardiac rehabilitation programs include structured exercise training, education, nutritional counseling, psychosocial support, and management of cardiovascular risk factors, each tailored to the specific needs of post-coronary artery bypass grafting patients who often face a high burden of comorbidities and surgical recovery challenges. For these reasons, cardiac rehabilitation should be regarded as standard of care. Evidence supports early cardiac rehabilitation initiation and individualized multidisciplinary plans, which have shown to improve exercise capacity, health-related quality of life, and medication adherence. Long-term follow-up is essential, as studies have demonstrated a clear association between sustained cardiac rehabilitation engagement and decreased rates of rehospitalization and all-cause mortality. Therefore, this comprehensive review presents recent advances and updates on the management of patients after coronary artery bypass grafting during cardiac rehabilitation, with a focus on the core components and long-term follow-up. Full article

Background: In the population of patients with ischemic cardiomyopathy (IC) and reduced left ventricular ejection fraction, the benefits of prophylactic implantable cardioverter-defibrillator (ICD) therapy are not uniform. Identifying predictors of ventricular arrhythmias to estimate the risk of appropriate therapy is crucial. Methods: Patients with IC and an ICD for primary prevention implanted between 2006 and 2019 were retrospectively analyzed for appropriate therapy (ATh). The primary objective was to assess predictors of ATh development. The secondary objective was to assess the impact of ATh on survival. Results: Overall, 260 patients (age 67.3 ± 9.4 years, 15.4% female) were analyzed with a follow-up of 4.47 ± 3.02 years. ATh occurred in 79 patients (30.4% of the study group). Independent risk factors for ATh were as follows: non-sustained ventricular tachyarrhythmias (nsVTs) detected before ICD implantation, extensive area of ischemic left ventricular damage on echocardiographic assessment, left ventricular end-diastolic dimension (LVEDd) ≥ 68 mm, history of coronary artery bypass grafting (CABG), and presence of chronic total occlusion (CTO). A multiparameter logit model was created to estimate the probability of ATh. Patients with a score ≥ 0.6 had more than a six-fold higher risk of developing ATh compared with patients with a score < 0.6. Patients after ATh had significantly lower survival compared to patients without intervention (HR 1.69, p = 0.008). Conclusions: Patients with the independent risk factors listed above are at higher risk for ATh. A multiparameter logit model based on these risk factors is effective in estimating the risk of ATh. The occurrence of ATh was associated with a significantly higher risk of all-cause mortality. Full article

Ischemia–reperfusion injury (IRI) is a mechanism based on inflammatory mediators’ release and activation of effectors of damage. Studies showed a correlation between cytokine, severity of damage, and post-operative outcomes. Ex situ perfusion may work as a platform for the treatment of IRI mechanisms, such as the removal of cytokines using cytokine adsorption (CA). We assessed the safety and benefits of an integrated CA during ex situ dual-oxygenated hypothermic (D-HOPE) and normothermic perfusion (NMP). During the period of July 2021–December 2023, 84 octogenarian liver grafts, suitable for transplantation, were considered: 12 were randomized to D-HOPE or NMP with or without CA (D-HOPE + CA, D-HOPE, NMP + CA, NMP groups, n = 3 each) and compared to 72 performed using grafts preserved in static cold storage (SCS). IL-1, IL-6, IL-10, and TNF-a perfusate concentrations were evaluated together with perfusion parameters and post-operative outcomes. Perfusion procedures were unaffected by CA integration. In NMP, cytokine levels were 10–40 times higher than in healthy subjects and 20–50 times higher than D-HOPE. Cytokines were removed both in D-HOPE and NMP, but the concentration-dependent mechanisms of action of CA led to more remarkable removal in NMP. IL-10 and TNF-a concentrations were significantly lower in NMP + CA than in NMP. The application of CA was associated with significantly higher arterial flows both in D-HOPE and NMP, and reduced neutrophil infiltration in NMP. No differences in post-operative outcomes were found among groups. In conclusion, cytokine adsorption during ex situ machine perfusion of liver grafts from elderly donors is safe and feasible and is associated with modulation of inflammatory mediators and perfusion dynamics. These findings are hypothesis-generating, and larger studies are required to determine the clinical impact of this strategy. Full article

Coronary artery bypass grafting (CABG) remains the gold standard for patients with advanced multivessel coronary artery disease. Optimal myocardial protection versus ischemia during reversible and controlled cardiac arrest is a cornerstone of successful outcomes. Myocardial ischemia represents a state of reduced coronary perfusion with oxygenated blood, insufficient to meet the metabolic demands of the myocardium. Conventional cardioplegic solutions offer controlled and reversible cardiac arrest while actively modulating the molecular and cellular mechanisms that mediate ischemia–reperfusion injury. Cardioplegia dramatically elongates the reversible period of ischemic injury and restricts cardiomyocyte death by shutting down electromechanical activity, lowering metabolic demand, stabilizing ionic homeostasis, protecting mitochondrial integrity, and slowing oxidative stress and inflammatory signaling. During ischemia, cardiomyocytes shift from aerobic to anaerobic metabolism, resulting in adenosine triphosphate (ATP) depletion, loss of ionic homeostasis and calcium overload that activate proteases, phospholipases and membrane damage. Reperfusion restores oxygen supply and prevents irreversible necrosis but paradoxically initiates additional injury in marginally viable myocardium. The reoxygenation phase induces excessive production of reactive oxygen species (ROS), endothelial dysfunction and a strong inflammatory response mediated by neutrophils, platelets and cytokines. Mitochondrial dysfunction and opening of the mitochondrial permeability transition pore (mPTP) further amplify oxidative stress and inflammation, and trigger apoptosis and necroptosis. Understanding these intertwined cellular and molecular mechanisms remains essential for identifying novel therapeutic targets aimed at reducing reperfusion injury and improving myocardial recovery after ischemic events, particularly in coronary surgery. Full article

Introduction: Graft and patient survival after kidney transplantation in children has increased in the past decade; however, post-transplant surgical complications occur in up to 15.4% of recipients and pose a significant threat to graft survival. Due to anatomic discrepancies in children, kidney transplantation in this population is nuanced and requires meticulous planning. This narrative review summarizes the most common postoperative surgical complications following kidney transplantation in children. Methods: PubMed and Google Scholar were queried for full-text articles that reported pediatric kidney transplantation surgical complications and their management following kidney transplantation. Results: Vascular complications can occur in approximately 1.3–13.8% of cases and are the leading cause of graft nephrectomy, with arterial stenosis and venous thrombosis being the most common. Urologic complications occur in 1.3–30% of patients and are more frequent in children due to pre-existing genitourinary abnormalities prior to transplantation. Vesicoureteral reflux is the most common urologic complication. Discussion: Surgical complications following kidney transplantation in children continue to significantly affect graft viability. Ultimately, meticulous surgical techniques and close postoperative surveillance are critical to mitigating the risk of allograft nephrectomy. Prospective studies focused on best surgical practice, techniques, prevention, and postoperative care in pediatric kidney transplant recipients are needed. Full article

Small-diameter synthetic grafts often fail from thrombosis, intimal hyperplasia, and compliance mismatch, highlighting the need for alternatives that better support endothelialization and remodeling. Here, we evaluated multilayer plant-based vascular grafts fabricated from decellularized leatherleaf viburnum reinforced with cross-linked gelatin, seeded with vascular smooth muscle cells and endothelial cells, and conditioned in a perfusion bioreactor to mimic physiological shear stress. Pre-implant assays confirmed effective decellularization, low residual detergent, and mechanical integrity suitable for surgical handling. In a rat abdominal aorta interposition model, plant-based grafts remained patent at 1, 4, and 24 weeks and showed higher survival than silicone controls. Ultrasound imaging demonstrated flow patterns and resistance indices similar to native vessels, and plant-based grafts maintained significantly higher endothelial cell coverage than silicone controls, reaching native-like density by 24 weeks. Histology and biochemical assays showed early collagen and elastin coverage comparable to native aorta and increased collagen by 24 weeks. Scanning electron microscopy showed smooth luminal surfaces with minimal thrombus formation, contrasting with the rougher, thrombus-prone surfaces of silicone grafts. These findings indicate that plant-based grafts support endothelialization, maintain long-term patency, and undergo favorable remodeling in vivo, supporting their potential as a biomimetic alternative for small-diameter arterial repair. Full article

Activation of JAK/STAT and MAPK/ERK1,2 signalling pathways has been shown to increase the production of reactive oxygen species (ROS) in multiple cell types involved in cardiovascular diseases (CVDs), including vascular smooth muscle cells (VSMCs). However, these have not yet been studied in human saphenous vein SMCs (HSVSMCs) responsible for the maladaptive remodelling leading to saphenous vein graft failure (VGF), to which patients with type 2 diabetes mellitus (T2DM) are more susceptible. Therefore, this study aimed to evaluate the contributions of the JAK/STAT and MAPK/ERK1,2 pathways towards production of mitochondrial ROS (mROS) in HSVSMCs from T2DM patients versus non-diabetic controls. HSVSMCs explanted from surplus HSV tissues from consenting patients undergoing coronary artery bypass graft surgery were stimulated in vitro with mitogenic stimuli known to be involved in neointimal hyperplasia (NIH) and VGF, which are known activators of the JAK/STAT and the MAPK/ERK1,2 signalling pathways. Flow cytometry was then used to analyse the production of mROS (superoxide) in MitoSOX-stained HSVSMCs. Additionally, we examined the effect of ruxolitinib and trametinib, selective inhibitors of JAK1/2 and MEK1/2 signalling pathways, respectively, on mROS levels in these cells. From our findings, mROS production was significantly higher in HSVSMCs from T2DM patients versus non-diabetic controls. Activation of either the JAK/STAT or MAPK/ERK1,2 signalling pathways did not significantly alter the production of mROS in HSVSMCs from both T2DM and non-diabetic patients. However, inhibition of JAK/STAT and MAPK/ERK1,2 signalling pathways with ruxolitinib and trametinib, respectively, resulted in a significant reduction in mROS in HSVSMCs from both T2DM and non-diabetic patients. Our findings demonstrate a JAK/STAT- and MAPK/ERK1,2-mediated production of mROS in HSVSMCs. Hence, they are potential targets for drug development to limit ROS production in ROS-driven proliferation and migration of HSVSMCs responsible for VGF. Full article

Background: Hemodialysis access dysfunction can lead to missed treatments and increased mortality. Traditional monitoring methods, such as physical examination and ultrasound, have limitations, emphasizing the need for a more efficient approach. This study investigates the use of digitized acoustic data to identify and monitor vascular access dysfunction. Methods: This prospective study involved patients undergoing hemodialysis with either arteriovenous fistulas (AVF) or arteriovenous grafts (AVG) between June 2023 and February 2025. All patients underwent vascular imaging (either angiography or ultrasound) to confirm the degree of stenosis. Acoustic data were recorded using a standardized procedure at various puncture sites. Pre- and post-angioplasty data were also collected to assess the effects of vascular intervention. The digitized acoustic data were analyzed for changes in relative loudness, peak-to-valley ratios, and frequency distribution. Results: A total of 157 patients with 236 audio recordings (mean age: 67 ± 11 years; 58% male) were included. Significant acoustic differences were found at the arterial puncture and anastomosis sites in AVF patients with dysfunction, particularly in venous site dysfunction, which exhibited a more pronounced reduction in sound volume and an increased peak-to-valley ratio. After angioplasty, acoustic changes were observed in both arterial and venous sites, with values moving toward normal levels. However, no significant acoustic changes were observed in AVG patients. Additionally, frequency distribution ratios showed minimal clinical relevance. Conclusions: Digitized acoustic data, particularly from the arterial puncture and anastomosis sites, can be an effective tool for detecting and monitoring hemodialysis access dysfunction. These findings suggest potential for acoustic analysis in clinical practice, especially when integrated with AI models for better diagnostics. Full article

Objectives: This study aimed to define the learning curve required for cardiac surgery residents to acquire basic technical and interpretive skills in transit-time flow measurement (TTFM) and high-resolution epicardial ultrasonography (HRUS) during coronary artery bypass grafting (CABG). Methods: Prospective, observational, single-center study evaluating performance using a novel scoring system combining functional (TTFM) and anatomical (HRUS) assessment criteria. This study was registered on ClinicalTrials.gov (Identifier: NCT06589323). Nine cardiac surgery residents without prior hands-on experience in TTFM or HRUS were enrolled. Twenty-seven elective CABG patients (67 grafts) were analyzed. Each measurement was compared with those obtained by an expert benchmark surgeon (N.T.) under standardized hemodynamic conditions. Results: Residents achieved the predefined primary endpoint (combined TTFM + HRUS score/number of grafts ≥ 11) after a median of 3 cases (IQR 2–4) and 7 anastomoses (IQR 7–10). Kaplan–Meier analysis showed a progressive increase in the probability of success, with a sharp rise after the seventh anastomosis. A shorter interval between attempts (<30 days) was significantly associated with earlier achievement of the endpoint (p < 0.05). Median acquisition time for TTFM was 25 s, with <10% inter-observer variability across all flow parameters. HRUS images of adequate quality were obtained within 60 s in >90% of cases, though slightly lower success rates were observed for lateral and inferior wall targets. No resident- or procedure-related variable was independently associated with performance improvement. Conclusions: Mastery of basic TTFM and HRUS skills requires only a few cases and anastomoses, demonstrating a short and attainable learning curve. These findings challenge the perception of a steep learning process and support the routine use of intraoperative graft verification techniques in all CABG procedures. Full article

Background: High residual platelet reactivity (HRPR) and persistent dyslipidemia remain important unmet needs in cardiovascular risk management, particularly in patients undergoing coronary revascularization. Despite intensive lipid-lowering and antiplatelet therapy, a substantial proportion of patients fail to reach recommended low-density lipoprotein cholesterol (LDL-C) targets or exhibit inadequate platelet inhibition. Inclisiran, a PCSK9-targeting small interfering RNA, represents an emerging approach for long-term LDL-C reduction. Methods: A narrative review of the literature published between 2009 and 2025 was performed using PubMed, Scopus, Web of Science, and MEDLINE. Studies evaluating the addition of inclisiran to standard lipid-lowering therapy in patients with dyslipidemia and HRPR, assessed using the VerifyNow assay, were included. Illustrative clinical cases from Kazakhstan were analyzed to demonstrate real-world changes in LDL-C levels and platelet reactivity following insufficient response to conventional treatment. The review had a descriptive design. Results: Available evidence indicates that a significant proportion of high- and very-high-risk patients do not achieve LDL-C targets or are unable to tolerate high-intensity statin therapy. Inclisiran consistently induces sustained reductions in LDL-C and circulating PCSK9 levels. Emerging data suggest a potential indirect modulation of platelet reactivity associated with intensive lipid lowering. In patients at extreme cardiovascular risk—including those after coronary artery bypass grafting (CABG) and with long-standing multivessel coronary artery disease—inclisiran therapy was associated with marked LDL-C reduction and a trend toward normalization of platelet reactivity. Conclusions: Assessment of platelet function using the VerifyNow assay may improve identification of residual thrombotic risk in patients with advanced atherosclerotic disease. Inclisiran appears to be a promising adjunctive therapy for dyslipidemic patients with persistently elevated cardiovascular risk and HRPR despite standard treatment. Further prospective studies are warranted to clarify the relationship between intensive LDL-C lowering, platelet reactivity, and clinical outcomes, and to optimize integrated lipid-lowering and antiplatelet strategies. Full article

Background: Acute coronary syndrome (ACS) continues to be a major contributor to morbidity and mortality worldwide. While percutaneous coronary interventions (PCIs) have significantly evolved, coronary artery bypass grafting (CABG) has retained a role in emergency revascularization. Nevertheless, ongoing debate persists about how to select candidates for surgery, when to operate, and which surgical techniques offer the greatest safety and efficacy. Methods: A comprehensive literature search was conducted, yielding 2302 records, of which 25 studies met predefined screening criteria and were included for detailed analysis. Given that timing remains one of the most controversial issues in the management of ACS, our primary aim was to determine the optimal timing for CABG in this patient population. Additionally, we examined how preoperative antiplatelet therapy and the presence of cardiogenic shock influence clinical outcomes, and what revascularization strategy may be most appropriate for these patients. Results: Of the 2302 initially identified studies, 25 were selected for a detailed analysis, supplemented by 28 additional key references. Among the included studies, 17 focused primarily on the effects of surgical timing and 8 on comparisons between the outcomes of CABG and PCI. The analysis comprised 15 database or multicentre retrospective cohort studies, 8 single-centre retrospective studies, and 2 prospective investigations. Conclusion and limitations: Although the topic of non-elective coronary surgery has been with us for several decades, a number of inherent biases hinder thorough statistical investigation in this complex population. Although a number of contradictory findings hinder drawing simple conclusions, being reluctant to perform early surgery solely based on poorer unfiltered outcomes might miss a point. Full article

Objectives: This study evaluated the anatomical suitability of two single-branched thoracic stent grafts—the Castor (Endovastec, China) and the Thoracic Branch Endoprosthesis (TBE, Gore, USA)—for proximal landing in aortic arch zone 2, including the left subclavian artery (LSA), in patients with acute type B aortic dissection (TBAD). While the TBE is currently available as an off-the-shelf device (26 main bodies, 8 branch configurations), the study also aimed to define the minimal number of configurations needed to treat most patients. The same approach was applied to the Castor stent graft, currently only available as a custom-made device (CMD), to assess its potential for off-the-shelf adaptation. Methods: A retrospective analysis was performed on computed tomographic angiographies of TBAD patients treated between 2004 and 2023. Exclusion criteria included type A or non-A-non-B dissections, isolated abdominal dissections, intramural hematomas, and lack of consent. Morphometric measurements were conducted using centerline analysis software. Suitability was defined per manufacturers’ criteria and reported with 95% confidence intervals. Results: Among 100 TBAD cases, 82% (95% CI: 73.3–88.3%) were suitable for the Castor CMD with 74 configurations. Main causes of exclusion were short landing zones and atypical arch anatomies. With adjunctive procedures, 13 Castor configurations covered all morphologies; 34% could be treated off-the-shelf, and 48% required additional interventions. For the TBE, off-the-shelf suitability was 22%, increasing to 78% with adjunctive procedures (six main bodies, five branches). Conclusions: Both stent grafts are promising for proximal extension in TBAD. Reduced configuration availability necessitates more adjunctive procedures, impacting efficiency and cost. Full article

Background: Chronically non-healing thoracic wounds after cardiac and non-cardiac thoracotomy, including cases when coronary artery bypass grafting (CABG) is performed, represent a great clinical challenge. It is often that a conservative treatment of the wounds does not provide effective regeneration of the damaged tissues. It is especially critical in patients with infected wounds, in patients owning a systemic infection, and in elderly people. Methods: The article presents a case report of successful treatment of a 63-year-old man with refractory chronic osteomyelitis of the sternum and mediastinitis four years after CABG, complicated by COVID-19 at the time of reconstructive surgery. Due to the low effectiveness of conservative treatment methods, a two-stage approach was applied: radical surgical wound debridement followed by infiltration of the wound with allogenic mesenchymal stromal cells (MSCs) of Wharton’s jelly (WJ-MSCs). Results: This double-stage therapy successfully modulated the inflammatory environment and stimulated granulation, facilitating final thoracoplasty and osteosynthesis. The patient achieved complete healing of the sternum, demonstrating benefits of WJ-MSCs in treating conservative treatment-resistant infections in the surgical wound. Conclusions: The advantages of using perinatal mesenchymal stem cells, with WJ-MSCs as a type of this class of MSCs, were demonstrated in treating chronically infected sternal surgical wounds. We also compared their regenerative properties to other stem cell types like bone marrow MSCs. Full article