The mitral valve is conventionally accessed through a left atriotomy; however, adequate visualization may be challenging in selected patients, particularly those undergoing redo surgery, minimally invasive procedures, or with a small or non-compliant left atrium. In such cases, a transseptal interatrial approach can provide improved exposure of the mitral apparatus while facilitating concomitant tricuspid valve procedures. The limited transseptal (LTS) approach represents a partial, anatomy-preserving modification of the classic extended vertical transatrial septal incision. By confining the septal incision to the region of the fossa ovalis, and avoiding superior extension toward the atrial roof, this technique provides sufficient mitral valve exposure while minimizing the risk of injury to the sinus node artery and atrial conduction tissue. Alternative strategies, including the superior transseptal approach and the extended vertical transseptal incision have been associated with a higher incidence of atrial conduction disturbances and postoperative pacing requirements. In contrast, the LTS approach preserves atrial anatomy and reduces surgical trauma while maintaining excellent access to both atrioventricular valves. This video tutorial outlines the anatomical principles, indications and step-by-step surgical technique of the LTS approach, highlighting technical pearls and potential pitfalls to facilitate its safe and reproducible application in contemporary mitral valve surgery.
Introduction/Objective. Hyperhidrosis is a condition of pathological excessive sweating that exceeds the body’s physiological requirements for thermoregulation. Endoscopic thoracic sympathicotomy (ETS) is a commonly used treatment for primary focal hyperhidrosis (PFH); however, it may result in compensatory sweating (CS), which represents its most frequent postoperative complication. This study aimed to investigate whether heart rate variability (HRV) parameters could predict CS. Methods. A prospective single-center study was conducted in 100 patients with primary focal hyperhidrosis (PFH) who underwent ETS. Preoperatively, all patients underwent 24-hour Holter ECG monitoring to assess standard HRV parameters. ETS was performed by transection of the sympathetic chain at the level of the third (R3) and fourth rib (R4), including the accessory Kuntz fibers. One month after surgery, the presence and severity of CS were assessed. Results. CS was absent in 61% of patients (p=0.028). Mild CS was the most common form (p < 0.01). No statistically significant differences were observed in the analyzed preoperative HRV parameters between patients with and without CS (p > 0.05), including the low-frequency (LF)/high-frequency (HF) ratios, which represent balanced autonomic activity (LF/HF < 2) and sympathetic predominance (LF/HF ≥ 2). ROC curve analysis showed that age had significant predictive accuracy for CS (AUC 0.7333; 95% CI 0.634-0.833; p < 0.01), with an optimal cutoff of 23.5 years (sensitivity 0.82, specificity 0.47). Conclusion. HRV parameters cannot reliably predict CS following bilateral ETC in patients with PFH. The study confirmed that the optimal age for surgery is below 23.5 years.
Abstract Background Acute heart failure (AHF) remains a frequent cause of emergency admission and is associated with substantial in-hospital mortality. Readily available biomarkers and echocardiography may support early risk assessment in routine care Purpose To describe a real-world AHF emergency cohort and compare survivors vs non-survivors. Methods Observational study of consecutive emergency admissions with a primary diagnosis of AHF in 2025. Patients with acute myocardial infarction or severe aortic stenosis were excluded. Admission NT-proBNP and transthoracic echocardiography were collected (LVEF, E/e’, TAPSE, estimated RVSP) when available. Primary outcome was in-hospital death. Continuous variables are reported as median [IQR]; available-case comparisons used Mann–Whitney U. Results 519 patients were included (mean age 67.8±13.1 years; 64.4% male). Mean LVEF was 38.3±14.7% (n=417), mean E/e’ 16.9±7.2 (n=306), mean TAPSE 1.58±0.46 cm (n=215), and mean RVSP 42.8±12.2 mmHg (n=390). In-hospital mortality was 10.8% (56/519). Non-survivors were older (73.5 [68.0–80.2] vs 69.0 [60.0–76.0] years; p=0.00028) and had shorter length of stay (4 [1–12] vs 7 [5–12] days; p=0.00057). Admission NT-proBNP was markedly higher in non-survivors (19,003.7 [8,932.8–35,000] pg/mL; n=52) than survivors (6,051.6 [2,679–14,434] pg/mL; n=409; p=3.45×10⁻⁸). Between-group differences in LVEF (p=0.77), E/e’ (p=0.58) and RVSP (p=0.29) were not pronounced; interpretation is limited by missing echocardiography in early fatal cases. Conclusion(s) In a large real-world AHF emergency cohort, in-hospital mortality was 10.8%. Older age and markedly higher admission NT-proBNP characterized patients with fatal in-hospital outcomes, supporting NT-proBNP as a key early risk marker in routine practice.
Abstract Introduction Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. Purpose This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 μmol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 μmol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.
Background and Objectives: Drug-coated balloon (DCB) angioplasty represents an established stentless strategy in percutaneous coronary intervention (PCI), although bailout stenting (BOS) is frequently required in the presence of suboptimal angiographic results. The clinical impact of BOS following DCB remains incompletely defined. Materials and Methods: We performed a systematic review and single-arm meta-analysis of studies reporting clinical outcomes after BOS following DCB angioplasty, with quantitative synthesis restricted to studies reporting BOS-specific clinical outcomes. Pooled event rates for cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) were estimated using random-effects models. Heterogeneity was assessed using standard heterogeneity statistics. Results: Five studies were included in the systematic review; four studies reporting BOS-specific clinical outcomes contributed to the quantitative synthesis, whereas REC-CAGEFREE I was retained as strategy-level supportive evidence. BOS after DCB angioplasty was associated with low pooled rates of cardiac death (1%), MI (3%), TLR (5%) and TVR (5%), with minimal or moderate heterogeneity across analyses. Overall, pooled outcomes were within the range reported in contemporary drug-eluting stent (DES) trials. Conclusions: BOS following DCB angioplasty was associated with generally low short- to mid-term event rates that were broadly consistent with selected historical DES benchmarks. However, because these comparisons are indirect, comparable safety or efficacy cannot be inferred. BOS may therefore be considered a pragmatic contingency within DCB-based strategies rather than necessarily representing procedural failure.
