Abstract Postoperative inflammation contributes to organ dysfunction and complications after cardiac surgery. C-reactive protein (CRP) is a common marker of systemic inflammation. In this study, we assessed how postoperative CRP levels and their trajectories are associated with the CRP rs1800947 gene variant and perioperative dexamethasone use, and how these factors relate to postoperative morbidity. We analysed CRP levels in 484 adults who underwent cardiac surgery with cardiopulmonary bypass (CPB). CRP levels on postoperative day 1 (CRP1) were compared across the rs1800947 genotype and intraoperative dexamethasone dose: (1) none, (2) low (median 0.4 mg/kg), or (3) high (median 1.0 mg/kg). The 4-day CRP trajectories were evaluated in a subgroup of 174 patients with serial CRP measurements. The composite outcome of 30-day morbidity and mortality was analysed to reveal the association with CRP trajectories. Results: Adjusted analysis revealed an association between the GC genotype and a 15% reduction in CRP1 levels. Dexamethasone, regardless of dose, reduced CRP1 levels by ~ 30%. Morning surgery increased CRP1 levels by 27%. Elevated preoperative CRP levels increased postoperative CRP1 levels by 19%. CRP trajectories varied by genotype and dexamethasone exposure. Patients were grouped into four trajectory types, whose associations with postoperative complications differed significantly. Conclusions: Postoperative CRP levels and trends were associated with genetic and clinical factors. Low-dose dexamethasone is as effective as high-dose dexamethasone in limiting increases in CRP1 level. The CRP patterns associated with CRP genotypes and dexamethasone use potentially represent inflammatory endotypes linked to different morbidity risks. Trial registration: This study was registered in the US National Clinical Trial under the code NCT01020409 https://clinicaltrials.gov/ct2/show/study/NCT01020409. Registered on November 24, 2009.

Mitochondrial dysfunction plays a critical role in the pathogenesis of cardiovascular and metabolic diseases. However, direct assessment of mitochondrial respiration in human vascular tissue remains technically challenging. In this study, we present an ex vivo approach for real-time analysis of mitochondrial respiration in human left internal mammary artery (LIMA) grafts obtained during coronary artery bypass grafting (CABG). LIMA segment was collected intraoperatively and processed for bioenergetic assessment using the Seahorse XF Flex 3D Analyzer. Mitochondrial respiration was evaluated using the Mito Stress Test, enabling real-time measurement of oxygen consumption rate (OCR). In parallel, tissue nucleotide levels were quantified using high-performance liquid chromatography (HPLC), allowing complementary assessment of cellular energy status and redox balance. We demonstrate the feasibility of measuring mitochondrial respiration in intact human arterial tissue ex vivo. To our knowledge, this is the first application of the Seahorse XF Flex 3D platform for real-time bioenergetic analysis in intact human vascular tissue. Combined analysis of OCR and nucleotide levels enabled integrated assessment of vascular bioenergetic status. The applied protocol enabled reliable assessment of key bioenergetic parameters, including basal and maximal respiration. This study establishes a novel proof-of-concept workflow for ex vivo bioenergetic profiling of human vascular grafts, providing a platform for future investigations of vascular metabolism in cardiovascular and metabolic disorders.

Introduction: The search for the perfect cardioplegic solution continues. Although del Nido cardioplegia has achieved undeniable success in paediatric cardiac surgery, it has not gained comparable popularity in adult cases. Aim: This prospective randomised trial aimed to compare the cardioprotective properties and in-hospital clinical outcomes of two single-dose cardioplegic solutions: del Nido and Bretschneider HTK. Material and methods: One hundred adult patients scheduled for elective aortic valve replacement were randomly assigned to receive either del Nido or Bretschneider HTK cardioplegia. Details regarding cardiopulmonary bypass, the intra- and postoperative periods, and cardiac enzyme levels were collected. Results: Cardiac enzyme concentrations were similar between the two groups across all postoperative measurements. Only a correlation between cardiac markers and reperfusion time in the del Nido group was found. The Bretschneider HTK group showed a greater need for defibrillation after cross-clamp removal and lower pH values during cardiopulmonary bypass. No other significant differences in postoperative complications or laboratory results were observed. Conclusions: Del Nido and Bretschneider HTK cardioplegic solutions provide comparable cardioprotection and in-hospital clinical outcomes when used during elective aortic valve replacement. However, the use of Bretschneider HTK significantly increases the need for defibrillation and leads to greater intraoperative metabolic acidosis. Despite these findings, the cardiac enzyme levels in the postoperative period remain unaffected.

Early postoperative complications following cardiac surgery are critical determinants of long-term outcomes, increasing postoperative mortality, prolonging ICU and hospital stays, and raising healthcare costs. Notably, acute kidney injury (AKI) after cardiac surgery is a major concern due to its association with reduced survival rates and increased risk of chronic kidney disease (CKD). The incidence of post-operative AKI varies widely (5%–42%) and depends on various patient-specific factors as well as specific surgical interventions. This study aimed to develop a comprehensive risk assessment model for postoperative AKI/MAKE (major adverse kidney events), integrating clinical, laboratory, and genetic predictors. Specifically, the study explored whether single nucleotide polymorphisms (SNPs) in BBS9 rs10262995 and GRM7 rs13317787are associated with AKI following cardiac surgery with cardiopulmonary bypass (CPB) in adult Caucasians. A prospective, observational cohort study: INFLACOR (INFL-ammation, A-fter, C-ardiac, O-pe-R-ation) was conducted. It enrolled adult patients scheduled for planned open-heart surgery with CPB. Patients with off-pump procedures, reoperations, or emergency surgeries were excluded. Clinical data was collected preoperatively, intraoperatively, and postoperatively. Blood samples for biomarkers analysis were collected before and after 18 hours after surgery. The primary endpoint was the occurrence of AKI within first post-surgery day, defined by the KDIGO criteria. The secondary endpoint (MAKE) combined severe kidney function impairment, RRT necessity, and death. The statistical logistic regression models adjusted for potential confounders were created. Out of 561 patients screened, 503 were included in the final analysis. The mean age was 64.6 ± 11.6 years , and 55.9% were male. The postoperative AKI (stage 1 to 3) occurred in 61 patients (12.1%). Severe AKI (stage 3 according to KDIGO 2012) requiring renal replacement therapy manifested in 13 patients (2.6%). The composite outcome of MAKE was observed in 14.7% of the patients. Preoperative risk factors for AKI included older age (69 vs 65 years, P = 0.02), higher baseline serum creatinine levels (AKI and non-AKI group: 1.06 mg/dL vs. 0.89 mg/dL, respectively; P < 0.001), preexisting CKD (P < 0.001, OR 18, 95% CI 5.4–62.6), and comorbidities such as atrial fibrillation and chronic obstructive pulmonary disease (P < 0.05, OR 1.8 and 4.5 respectively). Intraoperative risk factors involved longer surgery duration (5 hours vs. 4.2 hours; P < 0.001), intraoperative transfusions, epinephrine and dopamine use and elevated lactate levels (>2 mmol/l) (Fig. 1). Postoperatively the correlation with AKI/MAKE was found for the increased white blood cell counts, high-sensitivity troponin I/CK-MB levels and higher APACHE III scores (AKI group 43 points vs non-AKI 32 points, P < 0.001). Furthermore longer time of mechanical ventilation or intra-aortic balloon pump were also identified to correlate with AKI/MAKE incidence. Genetic analyses of BBS9 and GRM7 SNPs revealed no significant associations with AKI or MAKE. This study identifies multiple preoperative, intraoperative, and postoperative risk factors for AKI in patients undergoing cardiac surgery with cardiopulmonary bypass. Despite the exploration of genetic markers, no significant association was found between BBS9 and GRM7 SNPs and postoperative kidney injury. The findings highlight the importance of preoperative screening for kidney function, comorbidities, and the careful management of surgical and postoperative factors to reduce the risk of AKI. Despite the lack of genetic markers predicting AKI, the study provides valuable insights into modifiable clinical factors that could guide the development of a risk model for early intervention in high-risk patients.

Obstructive sleep apnea (OSA) is associated with systemic inflammation and cardiovascular disease, including atherosclerosis. S100A8 and S100A9 are pro-inflammatory proteins involved in atherogenesis, but their expression in the aortic walls of OSA patients remains unknown. This study aimed to determine the relationship between OSA severity and S100A8/S100A9 expression in aortic tissue from patients undergoing coronary artery bypass grafting (CABG). This study included 46 patients who underwent CABG. OSA severity was assessed using the WatchPAT™ home sleep apnea test, classifying patients into control and mild (0 < AHI < 15), and moderate to severe (AHI ≥ 15) OSA groups. Aortic wall samples were collected intraoperatively, and S100A8 and S100A9 expression was evaluated using immunohistochemistry. Statistical analysis compared protein expression across OSA severity groups. Patients with moderate-to-severe OSA exhibited higher S100A8 and S100A9 expression in aortic tissue compared to control and mild OSA groups. The difference was statistically significant for S100A9 (p < 0.01), while S100A8 showed a non-significant increasing trend (p = 0.073). This study provides novel evidence that S100A8 and S100A9 are overexpressed in the aortic walls of patients with moderate-to-severe OSA. These findings suggest a potential role for these proteins in OSA-related vascular inflammation and atherosclerosis. Further research is needed to explore their potential as biomarkers or therapeutic targets in OSA-related cardiovascular disease.

Background: Microcirculation within the ascending aortic wall, supplied by the vasa vasorum, is increasingly recognized as a potential factor in the pathogenesis of aortic aneurysms. However, in vivo assessment remains challenging. This pilot study aimed to evaluate ascending aortic microcirculation intraoperatively using Laser Doppler Perfusion Monitoring (LDPM). Material and methods: Twenty-four patients (18 males, 6 females) undergoing elective cardiac surgery were enrolled. LDPM was performed on the exposed ascending aorta prior to surgical manipulation. A probe was sutured to the aortic wall and perfusion was recorded in Perfusion Units (PU). A brief probe compression test was conducted to evaluate perfusion response. Results: The mean LDPM value was 281.58 PU (males: 339.94 PU; females: 139.86 PU). In males, LDPM negatively correlated with age (r = -0.593, p = 0.0121), whereas a moderate but non-significant correlation was noted with BMI (r = -0.303, p = 0.2366). No significant associations were observed with hypertension, diabetes, smoking, or aortic dilation. A paradoxical increase in PU during probe compression occurred in 54% of patients. Conclusions: LDPM provides real-time intraoperative assessment of aortic microcirculation. Age-related decline in perfusion may contribute to aortic wall vulnerability. Further studies with larger cohorts are needed to validate these findings.

Surgical coronary artery bypass grafting (CABG) is the standard procedure in coronary revascularization.Compared to on-pump CABG, the off-pump CABG (OPCABG), or beating heart surgery without cardiopulmonary bypass, provides a less invasive technique as it does not

Human bitter taste receptors (TAS2Rs) are G protein-coupled receptors primarily associated with bitter taste perception, in the oral cavity. Many dietary compounds and drugs function as TAS2Rs agonists, activating their intracellular signaling pathways. Emerging evidence indicates TAS2Rs expression in extraoral tissues, including the cardiovascular system, where their functional role remains underexplored.. This study investigates TAS2Rs expression in primary human aortic and coronary artery endothelial cells. Using digital PCR (dPCR), we confirmed the mRNA expression of all 25 TAS2R subtypes in both cell lines. The expression levels were substantially higher in human coronary artery endothelial cells compared to human aortic endothelial cells. We confirmed the protein expression of TAS2R10 and TAS2R38 proteins using Western blot. These findings mark the first identification of TAS2Rs in these endothelial cells, suggesting a potential role in vascular physiology. These findings suggest a potential role for TAS2Rs in vascular physiology, prompting further research into their impact on endothelial function in cardiovascular health and pathology. ### Competing Interest Statement The authors have declared no competing interest.

Objective: Preoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant with other heart surgery remains low. In the current study we aimed to address the long-term mortality after SA concomitant with cardiac surgery.Methods: This report pertains to the HEart surgery In atrial fibrillation and Supra-ventricular Tachycardia (HEIST) registry. We identified 20,765 adult patients (62% male) with preoperative AF who underwent conventional sternotomy heart surgery between 2010 and 2021 in 8 tertiary centers in Poland, Netherlands, and Italy. We used Cox proportional hazards models for computations and propensity score matching to minimize differences in baseline characteristics.Results: Of included patients, 2755 (13.4%) underwent SA for AF. The highest rates of SA were observed for mitral interventions (mitral valve repair or replacement and tricuspid intervention, 25.2%), lowest for isolated coronary artery bypass graft-ing (6.2%). Patients in the SA group were younger (mean age 64.5 +/- 9.0 years vs 68.7 +/- 16.0 years; P < .001) and lower risk (mean European System for Cardiac Operative Risk Evaluation [EuroSCORE] II, 4.1 vs 5.7; P < .001). During the 11-year study period, there was a mortality reduction associated with SA (hazard ratio, 0.57; 95% CI, 0.52-0.62; P <.001). After propensity matching, 2750 pairs with similar baseline characteristics were identified. SA was associated with 16% mortality decline (hazard ratio, 0.84; 95% CI, 0.75-0.94; P = .003).Conclusions: In this multicenter, retrospective, propensity matched study, SA concomitant with other cardiac surgery was associated with improved long-term sur-vival regardless of baseline surgical risk. (J Thorac Cardiovasc Surg 2023;166:1656-68).

Myocardial protection is one of the most important factors ensuring patient safety during cardiac surgery with the application of cardiopulmonary bypass. Infusion of cardioplegic solution into the coronary circulation protects the heart and provides a standstill operating field for the surgeon. Cold blood cardioplegia and crystalloid cardioplegia are the two main types of solutions with a long history of use and a large amount of research proving their efficacy and safety. Relatively new del Nido cardioplegia seems to be an interesting alternative. We reviewed the literature comparing del Nido cardioplegia with two other types of cardioplegic solutions. We took into consideration many different clinical and biochemical aspects may indicate the quality of cardioprotection.

Background: Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) and is associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population. Aim:The current analysis aimed to determine whether total arterial revascularization (TAR) is asso-ciated with improved long-term outcomes in patients with preoperative AF. Methods: We analyzed patients' data from the HEIST (HEart surgery In atrial fibrillation and Supra-ventricular Tachycardia) registry. The registry, to date, involves five tertiary high-volume centers in Poland. Between 2006 and 2019, 4746 patients presented with preoperative AF and multivessel coronary artery disease and underwent CABG. We identified cases of TAR and used propensity score matching to determine non-TAR controls. Median follow-up was 4.1 years (interquartile range [IQR], 1.9-6.8 years). Results: Propensity matching resulted in 295 pairs of TAR vs. non-TAR. The mean (standard deviation [SD]) number of distal anastomoses was 2.5 (0.6) vs. 2.5 (0.6) (P = 0.94), respectively. Operative and 30-day mortality was not different between TAR and non-TAR patients (hazard ratio [HR] and 95% confidence intervals [CIs], 0.17 (0.02-1.38); P = 0.12 and 0.74 [0.40-1.35]; P = 0.33, respectively). By contrast, TAR was associated with nearly 30% improved late survival: HR, 0.72 (0.55-0.93); P = 0.01. This benefit was sustained in subgroup analyses, yet most pronounced in low-risk patients (<70 years old; EuroSCORE II <2; no diabetes) and when off-pump CABG was performed. Conclusions: TAR in patients with preoperative AF is safe and associated with improved survival, with particular survival benefits in younger low-risk patients undergoing off-pump CABG.

Objectives:Although endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied. Methods:We analyzed patients' data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality. Results:Median follow-up was 4.7 years [interquartile range (IQR) 2.3-6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + -0.6 vs. 1.7 + -0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46-3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59-1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71-0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed. Conclusion:Complete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG.

OBJECTIVES:Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates midterm survival in low-risk patients undergoing elective surgical AV replacement (SAVR) versus TAVI. METHODS:The Aortic Valve Replacement in Elective Patients From the Aortic Valve Multicenter Registry (AVALON) compared isolated elective transfemoral TAVI or SAVR with sternotomy or minimally invasive approach in low-risk individuals performed between 2015 and 2019. Propensity score matching was conducted to determine SAVR controls for TAVI group in a 1-to-3 ratio with 0.2 caliper. RESULTS:A total of 2393 patients undergoing elective surgery (1765 SAVR and 629 TAVI) with median European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) score 1.81 (interquartile range [IQR], 1.36 to 2.53]) were initially included. Median follow-up was 2.72 years (IQR, 1.32-4.08; max 6.0). Propensity score matching returned 329 TAVI cases and 593 SAVR controls. Thirty-day mortality was 11 out of 329 (3.32%) in TAVI and 18 out of 593 (3.03%) in SAVR (risk ratio, 1.10; 95% CI, 0.52-2.37; P = .801) groups, respectively. At 2 years, survival curves began to diverge in favor of SAVR, which was associated with 30% lower mortality (hazard ratio, 0.70; 95% CI, 0.496-0.997; P = .048). CONCLUSIONS:Our data did not demonstrate a survival difference between TAVI and SAVR during the first 2 postprocedure years. After that time, SAVR is associated with improved survival. Extended observations from randomized trials in low-risk patients undergoing elective surgery are warranted to confirm these findings and draw definitive conclusions.

BACKGROUND:Among patients referred for cardiac surgery, atrial fibrillation (AF) is a common comorbidity and a risk factor for postoperative arrhythmias (eg, sinus node dysfunction, atrioventricular heart block), including those requiring permanent pacemaker (PPM) implantation.OBJECTIVE:The purpose of this study was to evaluate the prevalence and long-term survival of postoperative PPM implantation in patients with preoperative AF who underwent valve surgery with or without concomitant procedures.METHODS:Presented analysis pertains to the HEIST (HEart surgery In atrial fibrillation and Supraventricular Tachycardia) registry. During the study period, 11,949 patients underwent valvular (aortic, mitral, or tricuspid valve replacement or repair) surgery and/or surgical ablation (SA) and were stratified according to postoperative PPM status.RESULTS:PPM implantation after surgery was necessary in 2.5% of patients, with significant variation depending on the type of surgery (from 1.1% in mitral valve repair to 3.3% in combined mitral and tricuspid valve surgery). In a multivariate logistic regression model, tricuspid intervention (P <.001), cardiopulmonary bypass time (P = .024), and endocarditis (P = .014) were shown to be risk factors for PPM. Over long-term follow-up, PPM was not associated with increased mortality compared to no PPM (hazard ratio 0.96; 95% confidence interval 0.77-1.19; P = .679). SA was not associated with PPM implantation. However, SA improved survival regardless of PPM status (log rank P <.001).CONCLUSION:In patients with preoperative AF, the need for PPM implantation after valve surgery or SA is not an infrequent outcome, with SA not affecting its prevalence but actually improving long-term survival.

Background Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce. Objectives This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR. Methods Consecutive patients who underwent PCI or CABG for unprotected LM-ISR were enrolled. The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stroke. Results A total of 305 patients were enrolled, of which 203(66.6%) underwent PCI and 102(33.4%) underwent CABG. At 30-day follow-up, a lower risk of cardiac death was observed in the PCI group, compared with the CABG-treated group (2.1% vs. 7.1%, HR 3.48, 95%CI 1.01–11.8, p = 0.04). At a median of 3.5 years [interquartile range (IQR) 1.3–5.5] follow-up, MACCE occurred in 27.7% vs. 29.6% (HR 0.82, 95%CI 0.52–1.32, p = 0.43) in PCI- and CABG-treated patients, respectively. There were no significant differences between PCI and CABG in cardiac death (9.9% vs. 18.4%; HR 1.56, 95%CI 0.81–3.00, p = 0.18), MI (7.9% vs. 5.1%, HR 0.44, 95%CI 0.15–1.27, p = 0.13), or stroke (2.1% vs. 4.1%, HR 1.79, 95%CI 0.45–7.16, p = 0.41). TVR was more frequently needed in the PCI group (15.2% vs. 6.1%, HR 0.35, 95%CI 0.15–0.85, p = 0.02). Conclusions This analysis of patients with LM-ISR revealed a lower incidence of cardiac death in PCI compared with CABG in short-term follow-up. During the long-term follow-up, no differences in MACCE were observed, but patients treated with CABG less often required TVR. Visual overview A visual overview is available for this article. Registration https://www.clinicaltrials.gov; Unique identifier: NCT04968977.

348 (0.72 μg/ml; reference range, <0.5 μg/ml) levels. The patient underwent computed tomography angiography, which showed a large hypodense mass in the right atrium and the pulmonary trunk (PT). Transthoracic echocardiography showed that both atria and the right ventri‐ cle (RV) were enlarged, indicating RV pressure A 47‐year ‐old man was admitted to the hospi‐ tal with a 2‐month history of increasing dys‐ pnea and fatigue and a 2‐week history of ede‐ ma of the right leg. He denied weight loss, fe‐ ver, and signs of infection. Laboratory tests showed slightly elevated C ‐reactive protein (8.9 mg/l; reference range, <5 mg/l) and D ‐dimer Correspondence to: Alicja Genc, MD, 1st Department of Cardiology, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland, phone: +48 58 349 25 00, email: alicja.genc@gumed.edu.pl Received: December 17, 2020. Revision accepted: January 20, 2021. Published online: January 27, 2021. Kardiol Pol. 2021; 79 (3): 348-349 doi:10.33963/KP.15787 Copyright by the Author(s), 2021 C L I N I C A L V I G N E T T E

Background Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). Results The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. Conclusions The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.

Acute aortic syndrome (AAS) continues to be a major clinical problem due to the need for urgent diagnosis and complex surgical management. We present a case that was not only surgically demanding, but also caused many difficulties in the preoperative diagnostic process. Typical clinical symptoms of AAS did not correlate with imaging study results, including computed tomography (CT) angiography and transthoracic echocardiography (TTE). A 64-year-old female patient was admitted to the hospital due to tearing, excruciating chest pain lasting for 18 hours and radiating to the interscapular area. Pain tended to slightly decrease with time. Other symptoms were transient numbness of the left lower extremity (a few hours) and amblyopia, lasting for several minutes. She had a history of poorly controlled hypertension, nicotinism, nephrectomy due to renal cell carcinoma, peptic ulcer disease, anxiety, depressive disorder, and addiction to clonazepam.

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.