Elevated Lipoprotein(a) Levels and Massive Ruptured Root and Ascending Aortic Aneurysm.

Background: Rupture of a root and ascending aortic aneurysm is a rare, life-threatening condition requiring prompt recognition and surgical intervention. Elevated lipoprotein(a) levels have been implicated in vascular pathology but are less studied in thoracic aneurysms.

Case Summary: A 61-year-old man who presented with severe dyspnea and chest tightness was found to have a 7.

Safety and efficacy of empagliflozin in heart failure among patients with a history of valvular heart disease: Insights from EMPEROR-Pooled.

Background: Valvular heart disease (VHD)-associated heart failure (HF) remains an important and growing cause of morbidity and mortality. There are no contemporary data on the efficacy and safety of SGLT2 inhibitors in patients with a history of VHD.

Methods: The EMPEROR-Pooled trial analyzed 9718 patients with HF who were enrolled in the randomized trials of empagliflozin versus placebo in HF with reduced left ventricular ejection fraction (HfrEF; EMPEROR-Reduced) and HF with preserved left ventricular ejection fraction (HFpEF; EMPEROR-Preserved).

Contemporary Prevention and Management of Postoperative Delirium in Cardiac Surgery Patients.

This review examines the prevention and management of postoperative delirium in cardiac surgery patients, a frequent complication linked with significant mortality, morbidity, prolonged hospitalization, and cognitive decline. The aim was to consolidate current evidence on postoperative delirium pathophysiology, risk factors, diagnostic approaches, and pharmacologic and non-pharmacologic interventions. A PubMed/MEDLINE database review was conducted through October 2024, identifying studies that evaluated the relationship between cardiac surgery and the occurrence of postoperative delirium.

Emerging Implications of Elevated Lipoprotein(a) Levels in Coronary Artery Bypass Graft Surgery.

Background: Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease (CAD). In nonurgent surgical revascularization cases, preoperative optimization of modifiable risk factors can improve outcomes. There is increasing interest in the relationship between lipoprotein(a) levels and the risk for ischemic cardiovascular disease, particularly how CABG outcomes are in turn affected.

Right Atrial and Bicaval Reconstruction for Cardiac Sarcoma.

Sarcomas represent the most common primary cardiac malignancy. A poor prognosis can be improved with multimodal management including aggressive surgical reconstruction in combination with neoadjuvant or adjuvant therapy. We present the case of a primary cardiac sarcoma to describe our approach to a more radical right atrial and bicaval reconstruction.

When Is Resection of a Cardiac Tumor With Metastatic Disease Acceptable?

Metastatic disease is a relative contraindication for resection of malignant cardiac tumors. However, certain situations may present themselves when primary cardiac resection may be warranted. We present a 21-year-old male diagnosed with metastatic epithelioid hemangioendothelioma with right ventricular outflow tract involvement for whom surgical resection was successfully performed and discuss strategies.

High-Risk Features and Utility of Computed Tomography-Fluoroscopy-Guided Biopsy as a Diagnostic Tool.

Left atrial masses are most commonly diagnosed as myxomas. When clinicians doubt the diagnosis, a biopsy is warranted. However, this can be very difficult with left-sided tumors.

Primary Cardiac Diffuse Large B-Cell Lymphoma: Diagnostic Journey of Undifferentiated Right Atrial Mass.

Undifferentiated cardiac tumors represent a diagnostic dilemma that requires meticulous workup. We present the case of a 67-year-old woman with a right atrial mass that was investigated with multiple modalities before being diagnosed as a cardiac lymphoma. The role of transvenous and/or percutaneous biopsy for guiding diagnosis and management is emphasized.

Surgical and multimodal approaches to right-sided cardiac tumours.

Purpose Of Review: Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques.

Recent Findings: Management of cardiac tumours can be categorized into three key phases.

Disparities in mortality rates from aortic aneurysm and dissection by country-level income status and sex.

Objective: To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole.

Methods: Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated.

Obesity/cardiometabolic phenotype of heart failure with preserved ejection fraction: mechanisms to recent trials.

Purpose Of Review: Heart failure with preserved ejection fraction (HFpEF) is a leading and growing cause of morbidity and mortality globally. Of the various phenotypes identified, the obesity (or cardiometabolic) phenotype appears to be most common. The purpose of this review is to provide the clinician with an abridged understanding of recent developments that have elucidated obesity/visceral adiposity as a central mechanism linking inflammation/immune dysregulation to the development of the HFpEF syndrome.

Efficacy and Safety of Empagliflozin According to Background Diuretic Use in HFrEF: Post-Hoc Analysis of EMPEROR-Reduced.

Background: The EMPEROR-Reduced (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction) trial established the efficacy of empagliflozin in reducing heart failure (HF) outcomes among patients with heart failure with reduced ejection fraction (HFrEF).

Objectives: The authors examined the outcomes of EMPEROR-Reduced as a function of background diuretic therapy.

Methods: The EMPEROR-Reduced trial was a double-blind, randomized controlled trial of placebo vs empagliflozin 10 mg among 3,730 HFrEF patients.

A big STEP for treatment of heart failure with preserved ejection fraction.

In the STEP-HFpEF trial, 2.4 mg semaglutide produced marked improvements in heart failure-related symptoms, physical limitations, and exercise function, and reduced inflammation and body weight in individuals with obesity HFpEF phenotype. These data usher in a new paradigm of targeting obesity as a therapeutic strategy in HFpEF.

Age period cohort analysis of rheumatic heart disease in high-income countries.

Introduction: Rheumatic heart disease is considered well-controlled in high-income countries; however, its actual trends in mortality remain unclarified. We analyzed trends in mortality from rheumatic heart disease in association with age, period, and birth cohort.

Methods: We analyzed the WHO mortality database to determine trends in mortality from rheumatic heart disease in the UK, Germany, France, Italy, Japan, Australia, USA, and Canada from 2000 to 2020.

Chronic heart failure management in adult patients with congenital heart disease.

Purpose Of Review: A growing number of adult patients with congenital heart disease (ACHD) are entering the healthcare system as a result of advances in the diagnosis and management of congenital heart defects. Heart failure is a common final pathway for this diverse patient population, representing the leading cause of mortality in ACHD patients. Herein, we review present guideline-directed management of heart failure in ACHD patients.

Cardiopulmonary bypass and cardiac surgery associated pulmonary hypertension: The need for proactivity and reactivity.

Pulmonary hypertension remains an important postcardiac surgical problem requiring prompt identification and management. In this edition of the Journal of Cardiac Surgery, Fayad and colleagues provide a detailed review of this topic, including epidemiology, mechanistic underpinnings, and available treatment options. In addition to responding to postoperative pulmonary hypertension, however, proactive measures including optimal timing of intervention are paramount to preventing the development of pulmonary hypertension and its associated complications.