IntroductionDelirium is common after cardiac surgery and is associated with long-term cognitive and psychological morbidity. Many patients later recall vivid, often frightening delusional experiences, but sustained delusional conviction in such memories long after delirium resolution is rarely reported.Case descriptionWe describe a woman in her late 60s with congenital aortic valve disease, three previous aortic valve operations and a recent tricuspid valve repair via right mini-thoracotomy. Her postoperative course was severely complicated by hemothorax, repeated thoracotomies, respiratory failure, sepsis, acute kidney injury, anemia and malnutrition, together with exposure to multiple centrally acting drugs (benzodiazepines, opioids, pregabalin, dexmedetomidine). While being treated on a general cardiothoracic ward she developed delirium, with disorientation, sleep-wake disruption and prominent persecutory and somatic delusions that staff were mocking her, taking humiliating photographs and “videos”, and forcing tablets into her throat. Delirium resolved with optimization of medical status, reduction of deliriogenic medications and short-term low-dose olanzapine, yet she retained a fixed belief that these ward events had truly occurred. For almost a year, including during a later admission for prosthetic valve endocarditis with paravalvular leak and an unsuccessful percutaneous closure attempt, she repeatedly reported these experiences as factual abuse despite psychotherapy and psychoeducation. Only during a subsequent elective admission, when reconsidering a high-risk redo valve operation that she ultimately declined, did she spontaneously reframe the memories as symptoms of “a mental disorder” and apologize to staff.ConclusionThis case highlights how delirium-related persecutory experiences can consolidate into persistent trauma-like autobiographical memories with prolonged delusional conviction, and underscores the need for structured delirium follow-up, explicit psychoeducation for patients and families, and close collaboration between cardiology, cardiac surgery, psychiatry and psychology.

Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic option for patients with severe aortic stenosis (AS) at high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-risk patients undergoing TAVI. Methods: Twenty seven patients with severe, symptomatic AS at high surgical risk were prospectively enrolled, who underwent treatment using the novel self-expanding NVT Allegra bioprosthesis via transfemoral approach (TF-TAVI). The primary end-point was all-cause mortality at 30 days. Results: Patients were elderly (83 years, range 75–89 years), and predominantly female (70.4%, n = 19). All patients were deemed to be at high surgical risk, with a mean logistic EuroSCORE of 12.4% (range, 2.8–31.8%). The bioprosthesis was successfully implanted in 96% of the cases (n = 25). The echocardiographic assessment confirmed good hemodynamic profile after implantation of the NVT Allegra bioprosthesis. Complications included cardiac tamponade (4%, n = 1) and the need for permanent pacemaker implantation (8%, n = 2). The analysis of procedural aspects showed a short learning effect related to the precise placement of the valve. A significant improvement in clinical symptoms were observed, and no patients died in-hospital or within 30 days of post-discharge observation. Conclusions: This prospective observation shows that the NVT Allegra bioprosthesis was associated with a satisfactory safety profile and a remarkable hemodynamic performance after implantation.

Background Acute respiratory distress syndrome (ARDS) is a serious complication after cardiac surgery with a variety of clinical risk factors. It was hypothesized that genome variants predispose these patients to it.

Background: There is still a lack of data on the nutritional status of older people with aortic stenosis (AS) and the effect of poor nutrition on the occurrence of complications and mortality after an aortic valve replacement (AVR) procedure. The aim of this study was to assess the impact of selected nutritional status parameters in elderly patients with severe AS on the occurrence of postoperative complications and one-year mortality after the AVR procedure. Methods: 101 elderly patients with AS aged 74.6 ± 5.2 years who qualified for surgical treatment (aortic valve area [AVA] 0.73 ± 0.2 cm2) were enrolled in the study. A nutritional status assessment was performed before AVR surgery, and the frequency of postoperative complications occurring within 30 days of surgery was assessed. The one-year mortality rate was also captured. Results: Adverse events (both major and minor) up to 30 days occurred in 49.5% (n = 50) of the study population. Low Mini Nutritional Assessment (f-MNA) and Subjective Global Assessment (7-SGA) scores and low concentrations of total cholesterol, LDL-cholesterol, and prealbumin were associated with a higher risk of postoperative complications. The risk of complications increased 1.22 times (95% CI; 1.030–1.453; p = 0.019) with an impaired nutritional status. The annual mortality rate in the study group was 7.9%. Unintentional weight loss of >2.8% in the six months preceding surgery proved useful for predicting death within the first year after AVR surgery. Conclusions: The results indicate that poor nutritional status is an important factor affecting the adverse outcomes in elderly patients with severe aortic valve stenosis undergoing an AVR procedure.

Transcatheter aortic valve replacement has become a standard therapeutic option for patients with severe aortic stenosis (AS) with high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-

Primary cardiac lymphomas (PCL) constitute about 1.3% of all primary neoplasms of the heart and 0.5% of all extranodal lymphomas [1–3]. PCL occur in elderly patients (median age at diagnosis is 63 ...

There is increasing evidence that genetic variability influences patients' early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFLAmmation in Cardiac OpeRations) cohort. In a prospectively recruited cohort of 518 adult Polish Caucasians, who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFα, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their association with 30-day and 5-year mortality. The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. Serum levels of IL-6 and ICAM-1 measured three hours after the operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance. Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should account for the identified chronic and perioperative risk factors.

Leaflet tumor is a rare manifestation of mitral valve endocarditis [1Subban V. Krishnamurthy V. Mohanraj A. Ajit M.S. Posterior mitral leaflet aneurysm - a rare cause of mitral regurgitation.Indian Heart J. 2012; 64: 402-403Abstract Full Text Full Text PDF Scopus (4) Google Scholar]. Valve repair with use of autologous tissues is currently a standard in valve regurgitation resulting from endocarditis [2Dreyfus G. Serraf A. Jebara V.A. et al.Valve repair in acute endocarditis.Ann Thorac Surg. 1990; 49: 706-711Abstract Full Text PDF PubMed Scopus (185) Google Scholar]. We present a case of a 59-year-old woman with a history of diabetes mellitus, chronic renal disease, stroke, and symptoms including dyspnea at rest, fever, and general malaise. Echocardiography showed large posterior mitral leaflet tumor (Fig 1) with severe mitral regurgitation and severe aortic stenosis with suspected bacterial vegetation. Blood culture confirmed bacteremia with Streptococcus spp. Antibiotic therapy was introduced, and the patient was referred for surgery. Aortic valve replacement with Biointegral bioprosthesis and mitral valve repair was performed. Intraoperatively, the tumor appeared to be a leaflet abscess in P3 region (Fig 2, Fig 3, arrow), penetrating to the annulus. After excision of the involved tissues, a 4 × 4-cm cavity was repaired with an autologous pericardium patch. Rigid mitral ring was used. The echocardiographic effect was good. On postoperative day 38, the patient was discharged home in good condition. The use of pericardium coated bioprosthesis and autologous material for valve surgery is highly effective in the treatment of endocarditis, which was confirmed in the outstanding result in a complicated case.Fig 2View Large Image Figure ViewerDownload (PPT)Fig 3View Large Image Figure ViewerDownload (PPT)

BACKGROUND:Temporary atrioventricular (AV) conduction disturbances are a common complication following cardiac surgery, especially involving the aortic valve. Permanent complete AV block is a serious and rare complication. Its prevalence has been estimated at 3-6% of all patients undergoing aortic valve replacement. Identification of factors that affect the occurrence of complete AV block requiring permanent pacemaker implantation might help reduce the risk of this problem in the future.AIM:To evaluate clinical, anatomical and surgical factors that might affect occurrence of complete AV, resulting in the need for permanent pacemaker implantation.METHODS:In our prospective study, we analysed clinical data of consecutive 159 patients operated due to isolated aortic valve disease between February 2011 and March 2012. Patients with a pacemaker implanted before that time were excluded from the study. The main indication for surgery was aortic stenosis (n = 114, 71.7%). Infectious endocarditis was an indication in 6 (3.8%) cases. Mean patient age was 65.3 ± 11.4 years, and the proportion of males to females was 56.6%/43.4%. Overall, 135 (84.9%) patients had sinus rhythm preoperatively. All operations were performed using median sternotomy, cardiopulmonary bypass, and hypothermia at 30-32°C. A biological prosthesis was implanted in 120 (70.4%) patients. Patients who needed an additional procedure such as another valve surgery, aortic surgery or coronary artery bypass grafting were excluded from the study.RESULTS:Permanent pacemaker implantation was required in 11 (6.9%) patients. The pacemaker was implanted after at least 7 days of complete AV block which was then considered permanent. Univariate analysis showed that permanent pacemaker implantation was associated with prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, and the occurrence of electrolyte disturbances. Univariate logistic regression revealed that the need for permanent pacemaker implantation depended on 5 factors including prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, larger size of the implanted valve prosthesis, endocarditis as the indication for surgery, and electrolyte disturbances. In both backward and forward stepwise multivariate regression models, two parameters, prolonged aortic cross-clamp time and the presence of electrolyte disturbances, correlated with the occurrence of complete AV block.CONCLUSIONS:Permanent complete AV block is a serious complication after aortic valve surgery. Of all analysed clinical, anatomical and surgical factors, prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time, larger size of the implanted valve prosthesis, endocarditis as the indication for surgery, and electrolyte disturbances were found to be statistically significant predictors of permanent pacemaker implantation.

P>A 55-year-old woman underwent elective mitral valve replacement due to severe rheumatic mitral valve stenosis. After valve replacement with a mechanical prosthesis, the patient failed to wean from the cardiopulmonary bypass. An aortotomy was performed and thrombotic embolic material was removed from the left coronary ostia with a Fogarty catheter allowing for successful discontinuation from cardiopulmonary bypass. Peripheral emboli are a known complication in patients undergoing mitral valve surgery for rheumatic mitral stenosis. In this report, we describe the case of a patient who sustained an intraoperative coronary embolus during a mitral valve replacement for rheumatic mitral stenosis. (J Card Surg 2010;25:658-660).