Search Results (450)

Background: Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) is a rare variant of tetralogy of Fallot marked by aneurysmal pulmonary artery dilatation and variable tracheobronchial compression. The identification of clinical indicators that predict perioperative risk in this patient population remains challenging. We aimed to review the surgical outcomes and reintervention requirements of patients with TOF-APVS over a 15-year single-center experience, with particular focus on two indicators of disease severity: preoperative mechanical ventilation (MV) and computed tomography (CT)-detected airway compression. Methods: We retrospectively reviewed 27 patients with TOF-APVS who underwent surgical repair at a single center between January 2010 and January 2025. Airway compression was assessed by CT in 20 patients. The primary outcome was the need for any reintervention during follow-up. Secondary outcomes comprised early and overall mortality and postoperative duration of intubation, ICU stay, and hospital stay. Subgroup comparisons were performed using the Fisher exact test and the Mann–Whitney U test. Results: The median age at surgery was 8 months (IQR, 4.5–16). Preoperative MV was required in 5 patients (18.5%), and CT revealed airway compression in 13 of 20 patients (65.0%). Early postoperative mortality was 7.4%, and overall mortality during follow-up was 18.5%. At least one reintervention was required in 9 patients (33.3%). Preoperative MV was significantly associated with early mortality (40.0% vs. 0%; p = 0.028) and with prolonged ICU stay (median 15 vs. 4 days; p = 0.008). CT-detected airway compression was not significantly associated with either mortality or reintervention. Conclusions: In this 15-year single-center experience with 27 patients, preoperative mechanical ventilation was associated with markedly higher early postoperative mortality and prolonged ICU stay, and may thus serve as a practical clinical indicator of disease severity in TOF-APVS. CT-detected airway compression was a frequent and often severe finding, but its association with early mortality and reintervention could not be statistically confirmed, likely reflecting the selective use of CT and small subgroup size. These findings support the integration of preoperative ventilation status into perioperative risk assessment and highlight the need for larger, preferably multicenter, studies with standardized airway assessment to clarify the prognostic role of anatomical airway compression. Full article

Background/Objectives: Idiopathic Carpal Tunnel Syndrome (CTS) can be an early manifestation of systemic amyloidosis, particularly transthyretin cardiac amyloidosis (ATTR-CA). The primary purpose of this retrospective case series was to describe the presence of amyloid deposits in tenosynovial tissue and explore potential cardiac involvement in patients undergoing carpal tunnel release surgery. Methods: From a cohort of 54 patients diagnosed with bilateral idiopathic CTS with surgical indication, 12 patients were selected for tenosynovial tissue samples, which were subsequently evaluated using Congo red staining and proteomic confirmation via mass spectrometry. Before the procedure, patients underwent a clinical assessment of medical history, electrocardiogram, and cardiac scintigraphy with Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD). Transthoracic echocardiogram and cardiac magnetic resonance were subsequently performed in all patients with positive scintigraphy, while a subset of scintigraphy-negative patients underwent an echocardiogram. Results: Congo red staining identified amyloid deposits in 3 of the 12 patients (25%). Proteomic analysis confirmed ATTR amyloidosis deposits in 2 of these patients (17%). One of these 2 patients presented Perugini grade 3 uptake on cardiac scintigraphy, suspicious for ATTR-CA. Complete concordance across histology, proteomics, and cardiac imaging was observed in only 1 patient (8.3%). Three discordances were noted: one case of tenosynovial ATTR without evident cardiac disease, one patient with a discordant Congo red result likely reflecting low amyloid burden or tissue heterogeneity, and one with imaging findings suspicious for ATTR-CA despite a negative tenosynovial biopsy. Conclusions: Tenosynovial biopsy obtained during CTS surgery can reveal early amyloid deposition, which may precede overt cardiac involvement. The variability observed across findings underscores the need for a multimodal diagnostic approach that integrates histological, proteomic, and imaging data, thereby mitigating the risk of amyloidosis misclassification. Full article

Introduction: Acute type A aortic dissection (ATAAD) is a rare but potentially catastrophic complication following transcatheter aortic valve implantation (TAVI). Most reported cases occur during or shortly after the procedure and are attributed to procedural aortic injury. Very late presentations occurring years after successful TAVI are exceptionally uncommon, and evidence regarding their optimal management remains limited. Case Presentation: An 86-year-old man presented with acute chest pain four years after transfemoral implantation of a self-expanding Evolut R 29-mm transcatheter heart valve. Transthoracic echocardiography revealed pericardial effusion with signs of impending cardiac tamponade. Computed tomography angiography confirmed Stanford type A acute aortic dissection involving the ascending aorta. Emergency surgical repair was performed through replacement of the ascending aorta and hemiarch using a vascular graft. The previously implanted transcatheter valve was preserved because it remained structurally intact and functionally normal. The postoperative course was uneventful, and the patient was discharged on postoperative day 9 with preserved prosthetic valve function (mean gradient 11 mmHg, peak velocity of 2.1 m/s, EOA 1.8 cm², EF 50%, TAPSE 18 mm and no evidence of paravalvular or intraprosthetic regurgitation). Discussion: To better contextualize this rare presentation, a focused review of the literature on delayed and late ATAAD after TAVI was performed. Only a limited number of cases were identified, highlighting the exceptional rarity of this complication. Reported management strategies included conservative treatment, endovascular interventions, and open surgical repair, with considerable heterogeneity in outcomes. Compared with previously published reports, the present case is notable for the exceptionally long interval between TAVI and dissection onset and for the successful valve-preserving surgical repair. These findings suggest that emergency surgery with preservation of a functioning transcatheter valve may be a feasible option in carefully selected patients. Conclusions: Very late ATAAD after TAVI is an exceptionally rare but life-threatening condition. This case demonstrates that valve-preserving surgical repair can be successfully performed even in selected octogenarian patients. As the population of long-term TAVI survivors continues to expand, awareness of late aortic complications, prompt diagnosis, and referral to specialized aortic centers remain essential for achieving favorable outcomes. Full article

Wireless power transfer (WPT) has emerged as a promising technology for modern implantable medical devices (IMDs), providing a reliable alternative to traditional batteries and reducing the need for repeat surgical procedures. WPT-based IMDs are extensively employed in biomedical applications such as deep brain stimulators, endoscopic capsules, pacemakers, and cardiac monitoring systems, which are being commercialized. As the IMD market is expected to grow with the aging population, extensive research efforts are proceeding to address key design and implementation challenges. A key challenge lies in simultaneously achieving high power-transfer efficiency (PTE), high data rates, low power consumption, and low circuit complexity. This review paper thoroughly examines recent developments, design trends, and current research problems in simultaneous power and bidirectional data transmission over a single inductive link, as well as the associated modulation and demodulation techniques. We reviewed various uplink and downlink modulation techniques, focusing on key characteristics such as data rate, power consumption, circuit complexity, and health and safety considerations. Finally, future research directions toward efficient, compact, and reliable simultaneous wireless power and data transfer (SWPDT) for the next generation of IMDs are discussed. This review paper will hopefully guide ongoing research into more efficient, scalable, and safe SWPDT systems. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Infective endocarditis (IE) continues to represent a major challenge for global health systems. In 2019, its annual incidence was estimated at 13.8 cases per 100,000 individuals, contributing to approximately 66,300 deaths worldwide. Due to its high morbidity and mortality rates, enhancing preventive measures has become a priority in both clinical practice and ongoing research efforts. Since the publication of the 2015 ESC Guidelines for the management of IE, several pivotal studies have emerged, prompting a re-evaluation and potential update of the existing recommendations. One growing concern is the increasing antibiotic resistance among oral streptococci, particularly to macrolides such as azithromycin and clarithromycin, which now show higher resistance levels than penicillin. Changes in national antibiotic stewardship programs may have inadvertently contributed to a rise in IE incidence, in part due to altered prophylactic practices. At the same time, advances in diagnostic modalities—including more widespread and targeted use of echocardiography in patients with positive blood cultures for organisms like Enterococcus faecalis, Staphylococcus aureus, and various streptococci—have likely improved detection rates. Additionally, innovations in imaging, particularly computed tomography (CT) and nuclear medicine techniques, have enhanced the diagnosis of IE, especially among patients with prosthetic heart valves or implantable cardiac devices. This has allowed for better characterization of patient populations, aiding in the refinement of diagnostic criteria and therapeutic approaches. Furthermore, updated antibiotic treatment protocols, informed by EUCAST’s antimicrobial susceptibility data, have helped tailor antimicrobial regimens to current resistance trends. The combination of improved diagnostic sensitivity and evolving microbial resistance patterns has also led to an increased number of patients being considered for cardiac surgery as part of their treatment pathway. This review seeks to synthesize the latest findings and guideline revisions, offering an integrated overview of recent progress in the diagnosis, medical treatment, and surgical management of infective endocarditis. It will also explore current therapeutic strategies and operative indications in light of the most recent evidence. Full article

Patients undergoing cardiac surgery are particularly vulnerable to infectious diseases, which may adversely affect perioperative outcomes and long-term prognosis both before and after the procedure. Moreover, those requiring heart transplantation must take immunosuppressive medications, further compromising their immunity. This narrative review aims to look for the sources of increased risk for infections as well as synthesize vaccination recommendations for these patient groups based on the available literature and guidelines. We considered the influence of age, comorbidities, length of hospitalization, procedure-related risks, and blood product transfusions on the increased risk of vaccine-preventable diseases. By comprehensively addressing these factors, healthcare providers can develop tailored vaccination strategies that maximize protection for cardiac surgical patients while minimizing potential complications and optimizing overall health outcomes. Full article

Introduction: Congenital heart defects (CHD) occur in 1% of live births, with an estimated at least 33% of affected infants having genetic defects. It has become standard to screen children with CHD for genetic findings that could aid clinical decision-making, yet modern testing yields large volumes of information without understanding clinical utility. Genome-wide studies have identified associations between large copy number variants and neurocognitive outcomes in patients with CHD. Still, little research exists on the prognostic power of screening tests such as microarrays. The goal of this study was to determine if abnormal microarray results in infants with CHD were associated with worse clinical outcomes in the cardiac intensive care unit (CICU). Method: This was a single-center retrospective cohort study. The Society of Thoracic Surgery (STS) and Pediatric Cardiac Critical Care (PCICU) registries (PC4) were queried for all surgical admissions of neonates and infants between 1 January 2014 and 31 December 2019. Patient demographics, surgical details, and post-operative outcomes were collected for surgical admissions related to the patient’s index operation. A chart review was performed to ascertain microarray results, further genetic testing, and longitudinal outcomes. Patients without microarray results or long-term institutional follow-up were excluded. Wilcoxon rank-sum and chi-square tests were used to compare outcomes defined and collected in the PC4 registry between patients with normal and abnormal microarray results. Subgroup analysis was then performed using the same outcome measures to compare normal and abnormal microarray groups in children who required cardiac surgeries within 30 days of life and in children who presented with ventricular septal defect (VSD), atrioventricular septal defect (AVSD), aortic stenosis (AS), or Tetralogy of Fallot (TOF). Results: Of the 412 infants with surgical admissions to the CICU between 2014 and 2019, 43 infants had no longitudinal follow-up, and 65 infants had no microarray results. Three hundred and four infants were included in this study, of which 196 children had normal microarrays and 108 infants had abnormal microarrays. Both groups had similar distributions of gestational age and birth weight, but fundamental diagnoses and primary procedures differed significantly between groups (p < 0.005). STS score, deep hypothermic circulatory arrest (DHCA) time, and bypass time were each significantly lower in children with abnormal microarrays than in those with normal microarrays across the study. The patients with abnormal microarrays had a higher incidence of gastrostomy (G)-tube placement during their lifetime than infants with normal microarrays. On subgroup analysis, despite the differences in fundamental diagnoses and the fact that primary procedures differed significantly between normal and abnormal microarray groups that required cardiac surgery within 30 days of life, there were no detectable differences in the surgical and PCICU outcomes. DHCA time was once again significantly lower in the abnormal microarray subgroup in the second subgroup analysis. Conclusions: Our data indicate that microarray results have limited value in predicting immediate post-operative outcomes, but children with copy number variants should be included in future CHD research. Full article

Background: Aortic insufficiency (AI) during long-term left ventricular assist device (LVAD) support creates a maladaptive recirculatory loop that impairs forward flow, increases left ventricular filling pressures, leading to progressive congestion, and accelerates right ventricular dysfunction. Surgical correction carries high risk, making transcatheter aortic valve implantation (TAVI) an alternative strategy, although outcomes are challenged by complex annular geometry and the absence of calcific anchoring. Methods: We performed a retrospective single-center analysis of consecutive LVAD-supported patients undergoing TAVI for native AI. Annular sizing was area-based with a predefined oversizing strategy of approximately 15–30%, adjusted to annular geometry. Balloon-expandable valves were implanted using controlled deployment under rapid pacing and temporary LVAD flow reduction. Outcomes were assessed according to VARC-3 definitions. Results: Fourteen patients underwent TAVI. The cohort demonstrated high anatomical complexity, including annular eccentricity (median 0.21 [IQR 0.19–0.23]), horizontal aorta (42.9%), and flared left ventricular outflow tract (LVOT) morphology (50%). Median annular area was 528 mm² (IQR 487–574), with area-derived diameter 25.9 mm (IQR 24.9–27.0). Mean oversizing was 21.9% (median 20.0%; range 15.1–30.3%). Technical and VARC-3 device success were achieved in 71.4%. Second valve implantation occurred in 28.6%. Procedural mortality was 0%. In-hospital mortality (21.4%) was related to low cardiac output and multi-organ dysfunction rather than device failure. No survivor had moderate or greater residual AI at discharge. Conclusions: In anatomically complex LVAD patients, an anatomy-driven balloon-expandable TAVI strategy achieved elimination of clinically significant AI with zero procedural mortality. In our interpretation, mortality reflected the advanced stage of heart failure at the time of intervention rather than acute device-related failure. Full article

Background and Objectives: The optimal timing for surgical intervention in acute aortic valve infective endocarditis (IE) remains debated. Although European guidelines distinguish emergency, urgent, and delayed indications, some centres postpone surgery, concerned that operating before sufficient antibiotic sterilization could increase IE relapse risk. Materials and Methods: This retrospective, observational, multicenter study included patients with acute aortic valve IE. Patients who were not operated, had non-aortic valve IE, or underwent emergency surgery were excluded. Surgery within 7 days of starting targeted antibiotics was classified as “early”; surgery between 7 and 30 days as “late.” Primary outcomes were in-hospital mortality and 30-day permanent pacemaker implantation. Secondary endpoints included reinfection, reoperation for IE relapse, and mid-term survival. Results: A total of 203 patients included: 104 early and 99 late. In-hospital mortality was comparable (early: 16 patients, 15.4%; late: 16 patients, 16.2%; p = 0.90). Permanent pacemaker implantation was higher in the late group (early: 9 patients, 8.7%; late: 18 patients, 18.2%; p = 0.046). Mid-term survival at four years was similar (early: 67.1 ± 5.8%; late: 59.7 ± 8.1%; p = 0.71). Recurrence of IE (early: 5.7%; late: 4.8%; p > 0.9) and reoperation for recurrent IE (early: 5.7%; late: 4.8%; p > 0.9) did not differ. Conclusions: Delaying surgery for acute aortic valve IE does not improve procedural safety, as in-hospital mortality is similar. Early intervention does not increase reinfection or reoperation risk, and may reduce permanent pacemaker implantation, likely by preventing progressive fibrosis of the cardiac conduction system caused by infection and prolonged antibiotic exposure. Full article

Background: Invasive coronary angiography has historically been the reference standard for coronary, valvular, and structural heart disease. Over the past decade, coronary computed tomography angiography (CCTA), CT-derived fractional flow reserve (CT-FFR), photon-counting detector computed tomography (PCCT), and cardiac magnetic resonance (CMR) have expanded the range of clinical questions answerable without an intra-arterial catheter, but this shift has been uneven across clinical domains. Methods: We performed a narrative review and synthesis of randomized trials, registries, society guidelines, and consensus documents (2009–2026) identified through PubMed and major cardiovascular guideline databases, written from a joint cardiology and cardiac-surgical standpoint. Results: The boundary has shifted asymmetrically, by which we mean a domain-dependent rather than uniform displacement of invasive angiography. Non-invasive imaging is now established as the first-line approach for stable chest pain at low-to-moderate pretest probability, for pre-transcatheter aortic valve replacement (TAVR) and structural procedural planning, and for aortic disease. It remains contested for stable multivessel disease and pre-coronary artery bypass grafting (CABG) planning, where CCTA- or CT-FFR-only planning is still investigational. Invasive angiography stays first-line for ST-elevation myocardial infarction (STEMI), cardiogenic shock, and complex percutaneous coronary intervention (PCI), where diagnosis and therapy are inseparable. Conclusions: Invasive and non-invasive modalities are complementary rather than competing. The appropriate first-line investigation depends on the disease domain, pretest probability, anatomical complexity, imaging quality, and whether diagnosis and treatment can be separated. We propose a complexity-stratified, heart-team framework and identify the surgical research gaps that remain. Full article

This narrative review critically summarizes the literature on the associations of Type A and Type D personality, together with related personality traits, with cardiovascular disease (CVD) onset, prognosis, cardiac surgery, and rehabilitation outcomes. For the past half a century, there has been a consistent interest in the question of whether or not there is a connection between personality qualities and CVD. At the same time as individuals with a Type A personality who were angry, competitive, and excessively motivated were overrepresented among patients seeking treatment for CVD, it was also noted that these individuals were more likely to acquire coronary artery disease or syndrome. Anger and animosity were among the unfavorable impacts that were found to be connected with worse cardiovascular outcomes, according to the findings of research. After that, a new personality entity was brought into existence, which was referred to as the type D “distressed” personality. This personality type coupled negative affectivity and social inhibition. Type D personality subsequently became a major focus of research, and several studies reported associations with poorer patient-reported health and adverse cardiac outcomes. However, these findings have not been consistently replicated, and the stability, incremental predictive value, and independence of Type D personality from depression, disease severity, and other psychosocial factors remain debated. As a result, there are a number of criticisms that pertain to the current knowledge of the connection between personality construct and the risk of developing cardiovascular diseases as well as the outcome of these diseases. This review provides a critical narrative synthesis of supportive and conflicting evidence and highlights the methodological limitations that currently prevent definitive causal or prognostic conclusions. Full article

The left atrial appendage is well recognized as the site of thrombus formation in patients with atrial fibrillation. However, in patients who are either unsuitable for long-term oral anticoagulation or in whom this therapy is inefficient, left atrial occlusion has emerged as a mechanical strategy option to diminish stroke risk. Minimally invasive percutaneous and standalone surgical thoracoscopic techniques are appearing as viable options for left atrial appendage exclusion, each with distinct procedural risk profiles and characteristics, as well as evidence from trials or registers. We suggest that the choice between percutaneous and thoracoscopic left atrial appendage occlusion should be individualized, ideally within the multidisciplinary heart team, considering left atrial appendage anatomy, patient bleeding and thromboembolic risk profile, comorbidities, prior cardiac interventions, and institutional expertise and resources. We aim to present in this review the value of multimodality imaging in patient selection for minimally invasive left atrial appendage occlusion to minimize the possibility of complications, and to compare technical advancements and indications for percutaneous and standalone thoracoscopic left atrial appendage occlusion. Full article

Vasoplegic syndrome is a common and potentially life-threatening complication following cardiac surgery with cardiopulmonary bypass. It is characterized by profound hypotension due to persistently reduced systemic vascular resistance despite preserved or increased cardiac output. The reported incidence ranges from 8% to 44%, and severe, catecholamine-resistant forms are associated with markedly increased mortality. In this retrospective study, 3937 cardiac surgical patients treated at the University Hospital Frankfurt between 2017 and 2021 were analyzed. Postoperative vasoplegic syndrome occurred in 17.5% of the cases and was classified as mild to moderate or severe according to vasopressor requirements. Preoperative, intraoperative, and postoperative variables were assessed using descriptive statistics as well as univariate and multivariable regression analyses to identify independent risk factors. Advanced age, elevated body mass index, EuroSCORE II > 10%, arterial degenerative diseases, preoperative dialysis dependence, atrioventricular valve surgery, emergency procedures, prolonged cardiopulmonary bypass and operative times, blood loss or transfusion and elevated preoperative hematocrit were identified as independent risk factors. Postoperatively, impaired renal function, increased inflammatory markers, and low hemoglobin levels were associated with vasoplegic syndrome. Severe vasoplegic syndrome was associated with increased mortality, prolonged intensive care unit stay, and extended hospitalization. Further research is required to establish standardized definitions and optimize prevention and treatment strategies. Full article

Electrical storm (ES) is a life-threatening clinical condition characterized by recurrent ventricular arrhythmias within a 24 h period, carrying a high mortality rate. Despite conventional therapies, including hemodynamic optimization, antiarrhythmic drugs, implantable cardioverter-defibrillator (ICD) reprogramming, and catheter ablation, a subset of patients develop refractory ventricular arrhythmias. In this setting, cardiac sympathetic neuromodulation can interrupt arrhythmic circuits by reducing efferent sympathetic outflow to the myocardium. Stellate ganglion block (SGB) with local anaesthetic (LA) is a temporary pharmacological blockade used as rescue therapy; in the largest prospective series (the STAR study), 92% of treated patients achieved at least a 50% reduction in arrhythmic events in the 12 h following the procedure. Because the effect of anaesthetic blockade is transient, more durable interventions have been explored, including percutaneous radiofrequency or chemical neurolysis and surgical cardiac sympathetic denervation (CSD), although current evidence is largely confined to small, uncontrolled case series. This narrative review synthesizes the available evidence on cardiac sympathetic neuromodulation—spanning SGB, percutaneous neurolysis, and surgical CSD—in refractory ES, positioning these interventions primarily as a means of stabilizing patients and bridging to definitive therapy rather than as established survival-modifying treatments. Furthermore, this review describes the primary anatomical foundations of the cervicothoracic sympathetic nervous system and the various techniques for SGB, along with their most relevant clinical indications. The risks and complications associated with these interventions are also addressed. Finally, clinical implications and potential future research directions in this field are discussed, with the aim of providing guidance for the comprehensive management of critically ill patients with refractory ES. Full article