Preoperative serum LOXL2 levels are elevated in patients with pulmonary hypertension undergoing mitral valve surgery in a prospective observational cohort study.

Lysyl oxidase-like 2 (LOXL2) is associated with vascular remodeling associated in pulmonary hypertension (PH). This study evaluates the potential of serum LOXL2 levels as a clinical biomarker. We enrolled 158 patients undergoing mitral valve surgery.

Conservative Management of Left Atrial Dissection and Associated Complete Heart Block Following Cardiac Surgery.

Background: Left atrial (LA) dissection is a rare, but potentially serious, complication that most commonly arises following mitral valve surgery.

Case Summary: In this report, the authors describe an unusual case of a patient presenting with chest pain and presyncopal symptoms after cardiac surgery who ultimately received a diagnosis of LA dissection and associated complete heart block. Although permanent pacemaker placement was required as a result of recurrent episodes of complete heart block, the patient was otherwise managed safely using a conservative approach without surgical reintervention.

Fine-Mapping the Association of Acute Kidney Injury With Mean Arterial and Central Venous Pressures During Coronary Artery Bypass Surgery.

Background: Prior studies identified thresholds for mean arterial pressure (MAP <65 mm Hg) and central venous pressure (CVP >12 mm Hg) beyond which risk for cardiac surgery-associated acute kidney injury (AKI) increases. Optimal hemodynamic targets-that is, where active protection from AKI is observed-are unclear; however, current guidelines suggest maintaining MAP >65 and CVP 8 to 12. The aim of this study was to identify hemodynamic ranges associated with both increased and decreased risk of AKI by evaluating narrow ranges of MAP, CVP, and joint exposure to MAP and CVP concurrently.

Impact of donor obesity on outcomes of donation after circulatory death heart transplantation.

Background: In the setting of the obesity epidemic and donor organ shortage in the United States, there is a growing need to expand the donor organ eligibility criteria for orthotopic heart transplantation (OHT). Donation after circulatory death (DCD) has emerged as a promising solution, but the outcomes with obese donor hearts in DCD OHT remains unknown.

Methods: Using the United Network for Organ Sharing registry between 2019 and 2024, recipients of DCD OHT were stratified into 3 donor obesity categories by body mass index (BMI): underweight/normal (BMI <25 kg/m), overweight (BMI 25-30 kg/m), and obese (BMI >30 kg/m).

Reoperative approach after extra-anatomic ascending-to-descending aortic bypass graft.

Background: Extra-anatomic ascending-to-descending aortic bypass grafts have historically been utilized as a safe and effective solution for repairs of complex coarctation of the aorta. However, reports on reoperation in these patients remain rare. We present a case of an aortic valve replacement and coronary artery bypass grafting in a patient with an extra-anatomic ascending-to-descending aortic bypass graft.

The Impact of Silent Liver Disease on Hospital Length of Stay Following Isolated Coronary Artery Bypass Grafting Surgery.

Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.

Gastrointestinal complications after cardiac surgery.

Gastrointestinal complications after cardiac surgery are relatively rare entities but carry a high mortality. We identified over 70 articles written since 2010 using the PubMed database. We included 40 in our review.

Delayed CCL23 response is associated with poor outcomes after cardiac arrest.

Chemokines, a family of chemotactic cytokines, mediate leukocyte migration to and entrance into inflamed tissue, contributing to the intensity of local inflammation. We performed an analysis of chemokine and immune cell responses to cardiac arrest (CA). Forty-two patients resuscitated from cardiac arrest were analyzed, and twenty-two patients who underwent coronary artery bypass grafting (CABG) surgery were enrolled.

Bidirectional Circumferential Intimo-Intimal Intussusception in Acute Aortic Dissection.

Complete circumferential aortic dissection with bidirectional intimo-intimal intussusception is a rare occurrence in Stanford type A dissections. The antegrade dissection flap can obstruct the left ventricular outflow tract and coronary sinuses, whereas the retrograde flap can obstruct the aortic arch and branch vessels. Sequelae include aortic regurgitation, myocardial ischemia, and neurologic complications.

Intraoperative changes and prognostic implications of pulmonary hypertension in patients with hypertrophic obstructive cardiomyopathy undergoing surgical septal myectomy.

Objectives: Patients with hypertrophic cardiomyopathy often have concomitant pulmonary hypertension, which has a negative prognostic effect in patients undergoing myectomy. Our objective was to investigate the effect of myectomy on pulmonary artery pressure obtained via Swan-Ganz catheter and characterize how changes in pulmonary artery systolic pressure may indicate outcomes in these patients.

Methods: We performed a single-center retrospective analysis of 271 patients with recordings of intraoperative pulmonary artery pressures during surgical myectomy.

Multicenter experience with valve-in-valve transcatheter aortic valve replacement compared with primary, native valve transcatheter aortic valve replacement.

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) offers an alternative to reoperative surgical aortic valve replacement. The short- and intermediate-term outcomes after ViV TAVR in the real world are not entirely clear.

Patients And Methods: A multicenter, retrospective analysis of a consecutive series of 121 ViV TAVR patients and 2200 patients undergoing primary native valve TAVR from 2012 to 2017 at six medical centers.

Decreased expression of ErbB2 on left ventricular epicardial cells in patients with diabetes mellitus.

We investigated the cell surface expression of ErbB receptors on left ventricular (LV) epicardial endothelial cells and CD105 cells obtained from cardiac biopsies of patients undergoing coronary artery bypass grafting surgery (CABG). Endothelial cells and CD105 non-endothelial cells were freshly isolated from LV epicardial biopsies obtained from 15 subjects with diabetes mellitus (DM) and 8 controls. The expression of ErbB receptors was examined using flow cytometry.

Myocardial Bridge or Something Else?

In this E-Challenge, the authors report on a patient with symptoms of exertional dyspnea and angina, scheduled to have surgical unroofing of an identified myocardial bridge (MB). An MB is very common in patients with hypertrophic cardiomyopathy (HCM). Intraoperative transesophageal echocardiography with provocative maneuvers revealed the patient had a systolic anterior motion of the mitral valve with septal contact and resulting outflow tract obstruction despite the notable absence of significant basal septal hypertrophy.

Repair of Spontaneous Left Atrial Dissection Resulting in Severe Paravalvular Native Mitral Valve Regurgitation.

A 54-year-old male with history of end-stage renal disease secondary to hypertension on hemodialysis with moderate aortic valve insufficiency presented with progressive exertional dyspnea and lower extremity edema over several weeks. Relevant history included hospitalization for bacteremia secondary to dialysis catheter line infection 6 months prior. ().

Protective role of ErbB3 signaling in myeloid cells during adaptation to cardiac pressure overload.

Background: Myeloid cells play an important role in a wide variety of cardiovascular disorders, including both ischemic and non-ischemic cardiomyopathies. Neuregulin-1 (NRG-1)/ErbB signaling has recently emerged as an important factor contributing to the control of inflammatory activation of myeloid cells after an ischemic injury. However, the role of ErbB signaling in myeloid cells in non-ischemic cardiomyopathy is not fully understood.

Comparative effectiveness of revascularization strategies for early coronary artery disease: A multicenter analysis.

Objectives: The goal of this analysis was to examine the comparative effectiveness of coronary artery bypass grafting versus percutaneous coronary intervention among patients aged less than 60 years.

Methods: We performed a multicenter, retrospective analysis of all cardiac revascularization procedures from 2005 to 2015 among 7 medical centers. Inclusion criteria were age less than 60 years and 70% stenosis or greater in 1 or more major coronary artery distribution.

Comparison of intraoperative tranexamic acid and epsilon-aminocaproic acid in cardiopulmonary bypass patients.

Objective: To compare tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: Over a consecutive 2-year period, 824 adult cardiac surgery patients who received TXA during an EACA shortage were compared with 778 patients who received EACA postshortage. Patient characteristics and process and outcome variables were collected through chart review and database queries.

High ErbB3 activating activity in human blood is not due to circulating neuregulin-1 beta.

Neuregulin-1β (NRG-1) is a membrane-bound or secreted growth and differentiation factor that mediates its action by binding to ErbB receptors. Circulating levels of NRG-1 are characterized by large inter-individual variability with the range of absolute values covering two orders of magnitude, from hundreds to tens of thousands of picograms per milliliter of blood. NRG-1 signaling via ErbB receptors contributes to the cell survival and downregulation of the inflammatory response.