Search Results (596)

Background: Sex-related differences in outcomes following cardiac surgery are well documented, with females generally experiencing higher postoperative mortality rates than males. However, the underlying factors driving this disparity remain incompletely understood. This study aimed to compare the preoperative risk characteristics of female and male patients who died within one year after elective cardiac surgery with those who survived, in order to identify sex-specific risk profiles associated with postoperative mortality. Methods: In this retrospective single-centre cohort study, data were derived from a prospective quality assurance database at Amsterdam University Medical Centres (Amsterdam UMC), the Netherlands, covering January 2001 to December 2020. All adult patients (≥18 years) undergoing elective cardiac surgery were included. Descriptive and comparative analyses were performed to characterise sex-specific preoperative differences between survivors and non-survivors. Results: The study cohort comprised 10,614 patients, including 2804 females (26%; median age 72 years [IQR 65–77]) and 7810 males (74%; median age 67 years [IQR 59–73]). In both sexes, non-survivors more frequently had major comorbidities, including atrial fibrillation, history of reoperation, pulmonary hypertension, chronic obstructive pulmonary disease, cerebrovascular disease, and kidney dysfunction. Within one year post-surgery, 143 (5.1%) females and 299 (3.8%) males had died. Among females, non-survivors within one year of surgery more frequently had several preoperative risk factors compared with survivors, including moderately impaired left ventricular function (16% vs. 11%), pulmonary hypertension (12% vs. 3%), extracardiac arteriopathy (25% vs. 9%), and kidney dysfunction (46% vs. 21%) dependent on the type of surgery (combined valve + coronary artery bypass grafting (CABG) (29% vs. 15%) or aortic surgery (14% vs. 4%)). In male patients, however, different risk factors such as higher age (median 73 years [IQR 66–77] vs. 67 [⁵⁹,⁶⁰,⁶¹,⁶²,⁶³,⁶⁴,⁶⁵,⁶⁶,⁶⁷,⁶⁸,⁶⁹,⁷⁰,⁷¹,⁷²,⁷³]), lower Body Surface Area (mean 1.96 m² (SD ± 0.19) vs. 2.02 ± 0.18), hypercholesterolaemia (35% vs. 44%), severely impaired left ventricular function (14% vs. 6%), myocardial infarction (31% vs. 22%), and type of surgery (aortic surgery (9% vs. 3%), or combined valve + CABG (22% vs. 12%)) were preoperative predictors of mortality compared to non-survivors. Conclusions: Our study demonstrates that one-year mortality following elective cardiac surgery is driven by distinct preoperative risk profiles in females and males. Recognising that mortality in females is associated with systemic disease and males by direct cardiac damage is a critical step toward developing more equitable, precise, and effective perioperative management strategies. Full article

Ischemic heart disease (IHD), the leading causes of cardiovascular morbidity and mortality worldwide, is currently treated though revascularization strategies such as pharmacological thrombolysis, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI). However, the restoration of blood flow often induces cardiac dysfunction, known as myocardial ischemia–reperfusion injury (MIRI). The pathogenesis of MIRI involves a complex, multifactorial process characterized by the interplay of diverse pathophysiological mechanisms, including oxidative stress, intracellular calcium overload, inflammatory cascade activation, apoptosis, autophagy, and microvascular endothelial dysfunction. In recent years, modified RNA (modRNA) technology has emerged as a novel therapeutic strategy for MIRI due to its enhanced molecular stability, reduced immunogenicity, and controllable transient protein expression. Studies have demonstrated that optimized modRNA delivery systems enable efficient, localized expression of therapeutic genes (e.g., antioxidant, anti-apoptotic, and pro-angiogenic factors) at injury sites, significantly mitigating MIRI-associated pathological damage. Nevertheless, significant challenges remain in clinical translation, such as delivery system targeting, transfection efficiency and cytotoxicity. This review focuses on recent advances in the development and application of modRNA-based delivery systems for MIRI treatment. Understanding the molecular mechanisms of MIRI and the structural characteristics and application of modRNA may encourage researchers to explore promising therapeutic modalities for addressing reperfusion-related cardiac injury. Full article

Background and Objectives: Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. However, postoperative cognitive decline (POCD) remains a significant concern, affecting a substantial proportion of patients. One of the pathogenic mechanisms underlying POCD involves inflammatory responses and oxidative stress. Dexamethasone, a corticosteroid with potent anti-inflammatory properties, has been proposed as a potential neuroprotective agent. This study aimed to assess the effect of a single perioperative dose of dexamethasone on postoperative cognitive function in patients undergoing CABG surgery. Materials and Methods: This retrospective cohort study was conducted at the Hospital of Lithuania. Inclusion criteria: elective CABG surgery, non-neurocognitive anamnesis, Minimal Mental State Examination score ≥25 before surgery, and age >50. Patients were divided into two groups: DEXA (those who received preoperative dexamethasone 0.1 mg/kg) and non-DEXA (those who did not). Cognitive functions were assessed with the Addenbrooke’s Cognitive Examination test (ACE-III) 7 days post operation. Results: The study enrolled 60 patients (DEXA = 30, non-DEXA = 30): male (85%), female (15%). The mean age of the study was 66.1 ± 8.1 and the education was 12 (12–30) years. The groups were similar in the evaluated preoperative characteristics (sex, age, education) (p > 0.05). Cognitive impairment (ACE-III score cut–off 88 points) was identified in 40% (n = 12) of participants in the DEXA and 69.3% (n = 21) in the non-DEXA group, with no statistically significant difference between groups (p = 0.073). However, the DEXA group had significantly better cognitive scores in attention (Z = 3.145, p = 0.002), fluency (Z = 2.25, p = 0.024), and spatial ability (Z = 4.444, p < 0.001) while language (Z = 1.167, p = 0.243) and memory scores (Z = 1.906, p = 0.057) showed no significant differences. Conclusions: These findings suggest that dexamethasone may provide neuroprotective benefit, reducing postoperative cognitive function domains, such as attention, fluency, and spatial ability, after CABG surgery. Further prospective studies are needed to confirm these findings. Full article

Background/Objectives: Various pathophysiological mechanisms play a role in the development of cardiovascular diseases (CVDs). There is a need for new biomarkers that can complement existing clinical findings, particularly in the early diagnosis and prognostic assessment of coronary artery disease (CAD) and that can also contribute to more effective management of the diagnosis and treatment process. Therefore, both blood and pericardial fluid samples can provide important diagnostic information. This study aims to investigate Stromal Cell-Derived Factor 4 (SDF4) levels and thiol/disulfide homeostasis in the blood and pericardial fluid of patients with established CAD undergoing open-heart surgery with cardiopulmonary bypass (CPB), in order to better characterize oxidative stress-related and redox-mediated pathophysiological processes associated with the development and progression of coronary heart disease. Comparisons with a healthy control group were performed to elucidate disease-related biochemical alterations rather than to propose these markers as diagnostic tools for CAD. Methods: In this study, intraoperatively collected venous blood and pericardial fluid samples from 45 patients undergoing on-pump coronary artery bypass grafting were analyzed. SDF4 levels were measured using enzyme-linked immunosorbent assay (ELISA), while thiol–disulfide homeostasis was assessed via spectrophotometric analysis. Results: The study revealed statistically significant differences in parameters such as SDF-4, native thiol, total thiol, disulfide, and disulfide/total thiol ratio among the control, patient serum, and pericardial fluid groups (p < 0.05). Notably, SDF-4 and disulfide levels were elevated, while thiol levels were reduced in the pericardial fluid group, suggesting increased oxidative stress and disrupted redox balance. Principal Component Analysis (PCA) and Variable Importance in Projection (VIP) analyses successfully demonstrated the discriminative power of these parameters among the groups. Conclusions: The increased SDF-4 levels and disturbances in the thiol–disulfide balance observed in this study indicate elevated oxidative stress and impaired cellular redox homeostasis in CAD. These findings suggest that SDF-4 and thiol–disulfide parameters may serve as important biochemical markers in the pathophysiology of CVD and hold potential as diagnostic and prognostic biomarkers. Full article

Background: Tight blood pressure control is a cornerstone of postoperative cardiac surgery patients. In addition, plasma lactate levels are frequently monitored in this setting as it is a marker for malperfusion, with early elevated levels being associated with increased morbidity and mortality. Elevations from malperfusion may be due to decreased cardiac output, hypovolemia, or persistent post-bypass vasoplegic response. Here, we investigate whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery. Methods: This is a retrospective cohort observational study of patients who have undergone coronary artery bypass graft (CABG) and valve replacement or repair surgeries at NYU Langone Long Island Hospital over a 6-month period. Postoperative blood pressures and lactate levels were examined over the first 16 h of care. Primary outcome: The relationship between blood pressure parameters and lactate clearance. Secondary outcomes: ICU length of stay, hospital length of stay, and mortality. Results: A total of 81 patients met inclusion criteria. The average pre-operative mean arterial blood pressure (MAP) was 95.4 mmHg and the average MAP in the first 6 h post-operatively was 78.4 mmHg. The average change in MAP from baseline was a decrease of 16.7%. The average cleared lactate fraction by 16 h postoperatively was 85.9%. Lactate clearance was associated in a statistically significant way only with the need for inotropic support on postoperative day 1, p = 0.03. There was a slight trend toward a delay in lactate clearance in those with lower early systolic blood pressures, p = 0.14. Conclusions: Lactate clearance appears to occur largely independently of postoperative blood pressures in the first 16 h after surgery but may be delayed in those requiring inotropic support through the morning or postoperative day one. Full article

Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured approach in which multimodality cardiovascular imaging plays a central role. Echocardiography remains the first-line modality, providing readily available assessment of ventricular function, valvular competence, and wall motion, while advanced techniques, such as strain imaging and myocardial work, enhance sensitivity for subclinical dysfunction. Coronary computed tomography angiography (CCTA) offers excellent diagnostic accuracy for graft patency and native coronary anatomy, with emerging applications of CT perfusion and fractional flow reserve derived from CT (FFR-CT) expanding its ability to assess lesion-specific ischemia. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization, quantifying scar burden, viability, and inducible ischemia, and stress CMR protocols have demonstrated both safety and independent prognostic value in post-CABG cohorts. Nuclear imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) remains essential for quantifying perfusion, viability, and absolute myocardial blood flow, with hybrid PET/CT approaches offering further refinement in patients with recurrent symptoms. In patients after CABG, multimodality imaging is tailored to the patient’s characteristics, symptoms, and pre-test probability of disease progression. In asymptomatic patients, imaging focuses on surveillance, risk stratification, and the early detection of subclinical abnormalities, whereas in symptomatic individuals, it focuses on establishing the diagnosis, defining prognosis, and guiding therapeutic interventions. Therefore, the aim of our review is to propose updated and comprehensive guidance on the crucial role of multimodality cardiovascular imaging in the evaluation and management of post-CABG patients and to provide a practical, evidence-based framework for optimizing outcomes. Full article

Background/Objectives: Long-term outcomes of patients with left main coronary artery (LMCA) disease and diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) are incompletely investigated. The aim of this study was to assess the 10-year clinical outcomes after PCI according to diabetic status and antidiabetic therapy in patients with LMCA. Methods: This study represents a pooled analysis of two randomized trials (n = 1257 patients) on LMCA PCI focused on the prespecified subgroups of diabetic patients. Patients were categorized in groups according to the diabetic status and antidiabetic therapy (oral drugs or insulin therapy). The primary endpoint was 10-year all-cause mortality. Results: Overall, 361 patients had DM (246 patients on oral antidiabetic drugs and 115 patients on insulin therapy) and 896 patients had no DM. At 10 years, 477 patients died: 291 nondiabetic patients (35.7%), 111 diabetic patients (49.5%) on oral antidiabetic drugs and 75 diabetic patients (70.0%) on insulin therapy (hazard ratio [HR] = 1.57, 95% confidence interval [1.26–1.96]; p < 0.001 for diabetic patients on oral antidiabetic drugs vs. nondiabetic patients; HR = 2.80 [2.17–3.61]; p < 0.001 for diabetic patients on insulin therapy vs. nondiabetic patients; HR = 1.78 [1.33–2.39]; p <0.001 for diabetic patients on insulin therapy vs. diabetic patients on oral antidiabetic drugs). The 10-year incidence of myocardial infarction was higher in diabetic patients on insulin therapy (10.0%) versus diabetic patients on oral antidiabetic drugs (3.0%). There were no significant differences between the groups regarding the 10-year incidence of definite stent thrombosis, coronary artery bypass graft surgery, repeat PCI or stroke. Conclusions: In patients with LMCA disease undergoing PCI, DM was associated with a higher 10-year incidence of all-cause mortality than patients without DM with the worst outcomes observed in diabetic patients on insulin therapy. Full article

Objective: Postoperative pulmonary complications (PPCs) remain a significant source of morbidity and mortality in patients undergoing minimally invasive cardiothoracic procedures. Noninvasive ventilation (NIV) is frequently employed as adjunctive therapy to manage respiratory insufficiency. This study evaluated the implementation of prophylactic NIV immediately following extubation after minimally invasive direct coronary artery bypass (MIDCAB) surgery. Methods: A total of 454 consecutive patients undergoing MIDCAB were included. In total, 139 patients received prophylactic NIV (P-NIV)—postoperative management, 315 patients formed a historical control group treated according to the previous standard of care. Clinical outcomes assessed postoperative pulmonary complications, in-hospital mortality, and one-year survival. Results: The incidence of PPCs was significantly lower in the P-NIV group compared with the control cohort (6.5% vs. 14.9%; p = 0.012). Unadjusted analyses demonstrated a significant reduction in the odds of PPCs with P-NIV (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.17–0.85). Using inverse probability of treatment weighting, prophylactic NIV was associated with an absolute reduction of 8.0 percentage points in PPC risk across the entire cohort (average treatment effect [ATE], −0.080; 95% CI, −0.136 to −0.024; z = −2.80; p = 0.005). Kaplan–Meier analysis demonstrated significantly improved one-year survival in the P-NIV group (log-rank p = 0.047). Conclusions: The implementation of prophylactic NIV following MIDCAB was associated with a greater than 50% reduction in the odds of PPCs in both unadjusted and adjusted analyses and improved one-year survival. These results support the adoption of routine prophylactic NIV in the postoperative management of patients undergoing minimally invasive coronary surgery. Full article

Background: Despite level-A evidence demonstrating superior long-term survival with bilateral internal mammary artery (BIMA) grafting, its global utilization remains dismally low (<10–15%), largely due to historical concerns over deep sternal wound infections (DSWI) and technical complexity. This underutilization persists even as multi-arterial grafting (MAG) adoption stagnates, with recent North American data showing only 16% of coronary artery bypass grafting CABG procedures utilize more than one arterial conduit. Objective: This review synthesizes contemporary evidence demonstrating that modern surgical refinements—particularly skeletonized “no-touch” harvesting—have effectively mitigated these concerns, enabling wider BIMA application. Methods & Results: Over two decades of institutional experience confirm that skeletonized harvesting preserves sternal perfusion and minimizes DSWI risk, even in high-risk patients. Propensity-matched analyses show significant survival benefits of BIMA grafting across age and comorbidity strata (8-year survival: 67.1% BIMA vs. 58.2% single internal mammary artery (SIMA), p < 0.05), rendering previous contraindications relative rather than absolute. Long-term outcomes demonstrate superior 10-year survival for in situ BIMA compared with SIMA (86.1% vs. 78.6%, p < 0.05). Advanced configurations such as sequential skeletonized grafting are safe and further enhance outcomes. In single-vessel left anterior descending artery (LAD) disease, skeletonized left internal mammary artery (LIMA) continues to outperform percutaneous coronary intervention (PCI), underscoring the unmatched durability of arterial conduits. Conclusions: The technical evolution of conduit harvesting has resolved the “BIMA paradox”. Contemporary evidence supports BIMA grafting as a standard of care for a broad CABG population, offering a durable, lifelong solution for coronary artery disease and warranting renewed guideline emphasis on multi-arterial revascularization. Full article

Background and Objectives: Perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG) remains difficult to diagnose due to varying biomarker thresholds and ECG criteria. This study aimed to evaluate the predictive value of ECG changes and cardiac biomarkers for identifying pathological findings in repeat coronary angiography after CABG. Materials and Methods: This retrospective study included 137 patients who underwent repeat coronary angiography due to suspected PMI. ECG changes and serial measurements of CK, CK-MB, and hsTnT were analyzed at 4, 8, and 18 h postoperatively. The primary endpoint was the identification of graft-related complications or new coronary lesions. Results: Pathological angiographic findings were detected in 85.4% (n = 117) of cases, predominantly graft-related complications (96.6%). ST-segment elevation (p < 0.01) and ST-segment depression (p = 0.02) were significantly associated with pathological findings. The combination of ST-segment elevation and CK-MB > 1.0 µkat/L also showed a high predictive accuracy (p < 0.01). HsTnT demonstrated the strongest diagnostic performance, with a threshold of 1231 ng/L at 18 h (AUC = 1.0; p < 0.01). Earlier postoperative biomarker elevations did not show significant discriminatory value. Conclusions: ECG remains the most accessible and fastest predictive tool for PMI detection. However, cardiac biomarkers only gain diagnostic relevance beyond 8 h postoperatively. A multimodal approach integrating biomarker kinetics and ECG changes may enhance early decision-making and improve patient outcomes, as ST-segment elevation in combination with CK-MB > 1.0 µkat/L serves as a relevant predictor. Notably, hsTnT levels > 1231 ng/L at 18 h reliably identified patients with pathological angiographic findings. These findings were derived from a highly selected cohort (~2% of all CABG patients) referred for coronary angiography and should therefore be interpreted as hypothesis-generating rather than directly generalizable to the broader surgical population. Full article

Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years. Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease. Results: In the group of octogenarians, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20–55%), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4%), chronic lung disease (7.3%), prior PCI (23.2%), and peripheral vascular disease (78.5%). The mean follow-up (100%) was 9.1 months. Left internal thoracic artery was used in 98.8% and radial artery was used in 43.9%. A mean of 3.0 ± 0.9 (range 2–5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164–480). In-hospital mortality was 1.2%, stroke rate was 1.2%, myocardial infarction rate was 0%, and repeat revascularization rate was 1.2%. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke were 4.9%, 0%, 2.4%, and 1.2%, respectively. The overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3% at follow-up. Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to reported contemporary outcomes of conventional CABG in elderly patients. Full article

Background: The aim of this study was to investigate the effect of preoperative statin use on postoperative bleeding and related complications in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: Between 2023 and 2025, 627 patients who underwent isolated CABG were evaluated. The patients were divided into two groups: Group A (n = 241, received preoperative statins) and Group B (n = 386, did not receive preoperative statins). All preoperative, intraoperative parameters, and postoperative outcomes were compared. Results: Patient demographics, comorbidities, laboratory parameters, EuroSCORE II, echocardiographic findings, operative data, cross-clamp times, and cardiopulmonary bypass times were similar. Intraoperative and postoperative blood product use were comparable between the groups. Postoperative total bleeding was higher in Group A than in Group B, but no statistical difference was found. The postoperative exploration rate was higher in Group A than in Group B, but no statistically significant difference was found. There were no significant differences between the groups in terms of gastrointestinal bleeding. Postoperative atrial fibrillation (POAF) was significantly lower in Group A than in Group B (21 (8.7%)–74 (19.2%), p < 0.001). Mortality was higher in Group B than in Group A, but no statistically significant difference was found (3 (1.2%)–14 (3.6%), p = 0.07). Intensive care unit stay was longer in Group B than in Group A. A significant negative association was found between statin usage and POAF (p = 0.001, OR = 0.418). Conclusions: We found no statistically significant increase in postoperative bleeding or blood product use with preoperative statin therapy in isolated CABG patients. However, we found that preoperative statin therapy was protective against POAF. Full article

Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output > 5 mL/kg/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol/L, p < 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation. Full article

Background: Empagliflozin and dapagliflozin are the most widely prescribed sodium–glucose cotransporter-2 inhibitors (SGLT2i) with established cardioprotective benefits across the spectrum of heart failure (HF). However, direct comparative data remain limited, particularly in patients with a history of coronary revascularization—a population at persistently high cardiovascular (CV) risk. This study aimed to compare the long-term cardiovascular outcomes of empagliflozin versus dapagliflozin in revascularized HF patients who had undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: This retrospective cohort study included 631 HF patients who had undergone coronary revascularization (CABG or PCI) and were treated with an SGLT2 inhibitor (353 dapagliflozin, 278 empagliflozin) between 2014 and 2022 at a tertiary cardiovascular center. Patients were stratified by left ventricular ejection fraction (LVEF ≥ 50%: HFpEF; LVEF < 50%: HFrEF/HFmrEF). The primary outcomes were all-cause mortality, cardiac mortality, major adverse cardiovascular events (MACE), cardiac MACE, and HF-related hospitalization. Cox regression analyses—including time-dependent covariates—were performed to identify independent predictors of cardiac MACE. Results: Baseline demographic, clinical, and biochemical characteristics were comparable between groups. During a mean follow-up of 19.6 ± 1.5 months, there were no significant differences between dapagliflozin and empagliflozin in all-cause mortality (19.3% vs. 19.8%), cardiac mortality (11.0% vs. 12.2%), MACE (25.8% vs. 26.3%), cardiac MACE (23.8% vs. 21.9%), or hospitalization (23.8% vs. 23.7%) (all p > 0.05). Subgroup analyses by LVEF yielded consistent findings. In time-adjusted Cox modeling, age (HR = 2.089; 95% CI: 1.723–2.533; p < 0.001) and atrial fibrillation (AF) (log-rank p = 0.030) were identified as significant predictors of cardiac MACE, while creatinine and NT-proBNP lost significance after adjustment. Both age and AF showed time-varying hazard effects, with risk attenuation over time. Conclusions: In this real-world cohort of revascularized HF patients, empagliflozin and dapagliflozin demonstrated comparable long-term cardiovascular outcomes, supporting a class effect of SGLT2 inhibitors in this high-risk population. Beyond pharmacologic comparison, age and AF emerged as dynamic predictors of cardiac MACE, highlighting the importance of longitudinal, time-dependent risk assessment in heart failure management following coronary revascularization. Full article

Background/Objectives: Surgical ablation for atrial fibrillation (AF) during cardiac surgery decreases perioperative morbidity and mortality and improves long-term patient outcomes. Because of these benefits, it has been designated a Class I surgical society recommendation. As surgical ablation techniques have evolved, so too have ablation tools such as radiofrequency and cryothermal devices. In this study, we evaluated real-world evidence (RWE) of concomitant surgical ablation featuring an epicardial left atrial encircling lesion created by a novel bipolar radiofrequency clamp. Methods: Thirteen centers in the observational Tracking Results of Ablation to Combat AF (TRAC-AF) Registry (NCT05111015) contributed data used in this analysis. Included patients had AF and received the epicardial encircling lesion during cardiac surgery. Additional ablation and follow-up were per institutional standard of care. Freedom from AF/atrial tachycardia (AT)/atrial flutter (AFL) and survival were evaluated using the Kaplan–Meier method. Safety was evaluated within 30 days of the procedure. Results: Among 327 patients, 70% were male with a median age of 69 years. Sixty-nine percent had paroxysmal AF. Median left atrial diameter was 4.1 cm, and CHA₂DS₂-VASc score was 3. Isolated coronary artery bypass graft and aortic valve surgery were performed in 51% and 11% of patients, respectively. One- and two-year survival rates were 95.3% (95% CI, 91.7–97.3%) and 88.1% (95% CI, 81.5–92.5%). Through 12- and 24-months freedom from AF/AT/AFL was 87.4% (95% CI, 81.3–91.6%) and 79.9% (95% CI 72.0–85.8%). Mortality within 30 days of the index procedure was 1.5%. No serious adverse events were related to the epicardial cardiac ablation procedure or device. Conclusions: RWE from the TRAC-AF Registry demonstrates surgical ablation including an epicardial left atrial encircling lesion made by a novel bipolar RF clamp was safe and resulted in favorable long-term rhythm outcomes. Full article