Objectives: Clampless aortic anastomosis devices aim to lower stroke risk in off-pump coronary artery bypass grafting. Two main strategies for clampless anastomosis devices emerged with automated anastomosis punching and aortic sealing devices, prompting the question of perioperative outcome differences. Methods: All consecutive patients undergoing elective off-pump coronary artery bypass grafting with a clampless aortic anastomosis device between September 2014 and December 2021 in 2 centers were retrospectively included. Cohorts were divided by the use of an automated anastomosis punching device or an aortic sealing device to achieve proximal anastomosis on the ascending aorta. To reach group comparability propensity score matching was performed. The primary end point was defined as a composite of all-cause mortality, stroke and rethoracotomy. Secondary end points were perioperative outcome parameters. Results: A total of 3703 patients were enrolled of whom 575 and 3128 were included in the automated anastomosis punching and the aortic sealing device group, respectively. By propensity score matching a total of 1150 patients were included with 575 in each group. The primary composite endpoint showed no significant difference with 6.3% versus 5.9% events (odds ratio, 0.9; 95% confidence interval, 0.58-1.53, P = .81). All-cause mortality (P = .36), stroke (P = .81), and rethoracotomy (P = .89) also exhibit no disparity. Operation time was significantly longer in the aortic sealing device cohort with 220.0 +/- 50.8 minutes and 204.6 +/- 53.8 minutes (P < .01). Conclusions: Clampless aortic anastomosis strategies aortic sealing device and automated anastomosis punching did not differ in perioperative outcome parameters, whereas the implementation of aortic sealing devices were associated with a prolonged operation time without inducing any inferior clinical outcome.

Background: Postoperative Atrial Fibrillation (POAF) is a common complication in cardiac surgery. Despite its multifactorial origin, the left atrial (LA) size is closely linked to POAF, raising the question of a valid cut-off value and its impact on the long-term outcome. Methods: Patients without a history of AF who underwent coronary artery bypass grafting between 2014 and 2016 were selected for this retrospective study. LA size was preoperatively assessed using the left atrial anterior–posterior diameter (LAAPd). Correlation and logistic regression analyses were performed, following a receiver-operating characteristic (ROC) analysis. Propensity score matching (PSM) was applied to ensure group comparability, followed by a comparison analysis regarding the primary endpoint of POAF and the secondary endpoints of all-cause mortality and stroke during a five-year follow-up. Results: A total of 933 patients were enrolled in the study eventually revealing a significant correlation between LAAPd and POAF (cor = 0.09, p < 0.01). A cut-off point of 38.5 mm was identified, resulting in groups with 366 patients each after PSM. Overall, patients with a dilated LA presented a significantly higher rate of POAF (22.3% vs. 30.4%, p = 0.02). In a five-year follow-up, a slightly higher rate of all-cause mortality (9.8% vs. 13.7%, HR 1.4 [0.92–2.29], p = 0.10) was observed, but there was no difference in the occurrence of strokes (3.6% vs. 3.3%, p = 0.87). Conclusions: An LAAPd of >38.5 mm was found to be an independent predictor of POAF after coronary artery bypass grafting and resulted in a non-significant tendency towards a worse outcome regarding all-cause mortality in a five-year follow-up.

Die herzchirurgische Literatur des Jahres 2023 wurde zur Erstellung einer Übersichtsarbeit gesichtet. Schwerpunktarbeiten beschäftigten sich mit den mittel- und langfristigen Auswirkungen invasiver Behandlungsoptionen bei Patienten mit koronarer Herzkrankheit (KHK). Dabei wurde die interventionelle Therapie (PCI) mit der Bypass-Operation (CABG) verglichen. Die Literatur aus dem Jahr 2023 bestätigt dabei erneut die ausgezeichneten Langzeitergebnisse von CABG bei Patienten mit einer Hauptstammstenose im Vergleich zur PCI. Dies gilt ebenfalls bei komplexer Koronaranatomie, chronischer KHK und auch für ein älteres Patientenkollektiv. Die Resultate der Arbeiten bestätigen dabei die infarktpräventive Wirkung von CABG im Sinne eines prognostischen Effekts. Zudem deuten die erschienenen Daten zur Ad-hoc-PCI auf eine geringe Einhaltung der geltenden Leitlinien bei Patienten mit Hauptstammstenosen und Mehrgefäßerkrankungen hin. Diese Übersicht enthält Publikationen, die uns aus unserer Perspektive relevant erschienen. Der Fokus liegt dabei auf den chirurgisch relevanten Aspekten.

BackgroundLeft atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest.MethodsAll patients who underwent isolated coronary artery bypass grafting (CABG) between 2018 and 2021 at two high-volume centers were retrospectively included in the study. Patients were divided into two groups-the CABG and CABG + LAA groups-based on whether they underwent concomitant LAA amputation. Propensity score matching (PS matching) was applied to ensure comparability between the groups. The primary endpoint was defined as a composite outcome comprising of all-cause mortality, stroke, and reoperation. Secondary endpoints included the components of the primary endpoint, perioperative outcome parameters, transfusion rates, and laboratory parameters.ResultsA total of 3904 patients were included with 3038 and 866 in the CABG and CABG + LAA group, respectively. After PS matching each group consisted of 856 patients. The primary endpoint showed no significant differences between the CABG and CABG + LAA group (7.0% vs. 6.5% (OR 0.9 95% CI [0.64; 1.35], p = 0.70)). Similarly, there were no notable differences in the individual components of the composite endpoint: all-cause mortality (p = 0.84), stroke (p = 0.74), and reoperation (p = 0.50). Subgroup results did not show any relevant dissimilarity.ConclusionThe concomitant performance of LAA amputation is not associated with worse in-hospital outcomes, as measured by the composite endpoint of all-cause mortality, stroke, and reoperation.Graphical abstractPerioperative outcome of left atrial appendage amputation in coronary artery bypass grafting. 95% CI, 95% confidence intervals; CABG, coronary artery bypass grafting; EF, left ventricular ejection fraction; LAA, left atrial appendage amputation; OR, odds ratio

Background Recent data demonstrated the benefit of left atrial appendage (LAA)-amputation in patients with atrial fibrillation (AF). However, the long-term impact of LAA-amputation for patients with new-onset perioperative atrial fibrillation (POAF) is still unknown. Methods Patients with no history of AF undergoing coronary artery bypass grafting by off-pump technique (OPCAB) between 2014 and 2016 were retrospectively examined. Cohorts were divided by the concomitant execution of LAA-amputation. Propensity score (PS) matching was applied by all available baseline characteristics. The composite of all-cause mortality, stroke and rehospitalization in patients with POAF and patients maintaining sinus rhythm posed as the primary endpoint. Results A total of 1522 patients were enrolled, of whom 1208 and 243 were included in the control and the LAA-amputation group, respectively and were matched to 243 patients in each group. In total, patients with POAF without LAA-amputation showed a significantly higher rate of the composite endpoint (17.3% vs 32.1%, p = 0.007). However, patients with LAA-amputation showed no significant difference in the composite endpoint (23.2% vs 26.7%, p = 0.57). The significantly higher occurrence of the composite endpoint was driven by all-cause mortality (p = 0.005) and rehospitalization (p = 0.029). Subgroup analysis revealed a CHA 2 DS 2 -VASc-score of ≥ 3 to be associated with the high rate of the primary endpoint (p = 0.004). Conclusion POAF is associated with a higher rate of the combined endpoint of all-cause mortality, stroke and rehospitalization. The composite endpoint in patients with LAA-amputation concomitant with OPCAB surgery developing new-onset POAF in a 5-year follow-up was not increased compared to a control cohort maintaining sinus rhythm. Graphical abstract Five-year outcome of patients with POAF and LAA-amputation; 95% CI , 95% confidence interval, CPR, cardiopulmonary resuscitation, ECLS, extracorporeal life support, HR, hazard ratio, IABP , intra-aortic balloon pump, LAA , left atrial appendage, OPCAB , off-pump coronary artery bypass grafting, PAPs , systolic pulmonary artery pressure, SR , sinus rhythm, VT, ventricular tachycardia.

AIMS:Evidence suggests that a high-dose statin loading before a percutaneous coronary revascularization improves outcomes in patients receiving long-term statins. This study aimed to analyse the effects of such an additional statin therapy before surgical revascularization. METHODS AND RESULTS:This investigator-initiated, randomized, double-blind, and placebo-controlled trial was conducted from November 2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635) with a long-term statin treatment (≥30 days) who were scheduled for isolated coronary artery bypass grafting (CABG) were randomly assigned to receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery using a web-based system. The primary outcome of major adverse cardiac and cerebrovascular events (MACCE) was a composite consisting of all-cause mortality, myocardial infarction (MI), and a cerebrovascular event occuring within 30 days after surgery. Key secondary endpoints included a composite of cardiac death and MI, myocardial injury, and death within 12 months. Non-statistically relevant differences were found in the modified intention-to-treat analysis (2406 patients; 1203 per group) between the statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.74-1.18; P = 0.562] or any of its individual components. Secondary endpoints including cardiac death and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69-1.12; P = 0.300), the area under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P = 0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable between treatment arms. CONCLUSION:Additional statin loading before CABG failed to reduce the rate of MACCE occuring within 30 days of surgery.

OBJECTIVES: Since recent data demonstrated the benefit of the amputation of the left atrial appendage (LAA) in patients with atrial fibrillation, the long-term impact of LAA amputation on stroke rate and mortality in patients with no history of atrial fibrillation is still unknown. METHODS: Patients with no history of atrial fibrillation who underwent coronary artery bypass grafting by the off-pump technique between 2014 and 2016 were examined retrospectively. Cohorts were divided by the concomitant execution of LAA amputation, and propensity score matching was applied by baseline characteristics. The stroke rate in a 5-year follow-up served as the primary end point. Secondary end points were the mortality rate and rehospitalization in the same time span. RESULTS: A total of 1,522 patients were enrolled, of whom 1,267 and 255 were included in the control group and in the LAA amputation group, respectively. These were matched to 243 patients in each group. In total, patients with an LAA amputation showed a significantly lower rate of stroke in a 5-year follow-up [7.0% vs 2.9%, hazard ratio, 0.41; 95% confidence interval (0.17; 0.98), p = 0.045]. However, there was no difference in all-cause mortality (P = 0.23) or rehospitalizations (P = 0.68). Subgroup analysis revealed LAA amputation in patients with a CHA(2)DS(2)VASc [congestive heart failure, hypertension, age >= 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female)] score of >= 3 to be associated with a reduction of stroke [9.4% vs 3.1%, hazard ratio, 0.33; 95% confidence interval [0.12; 0.92], P = 0.034]. CONCLUSIONS: LAA amputation concomitant with cardiac surgery reduces the stroke rate in patients with no history of atrial fibrillation and a high CHA(2)DS(2)VASc score (>= 3) in a 5-year follow-up.

In recent years coronary artery bypass grafting (CABG) has become established as the gold standard for the treatment of stable coronary artery disease (CAD) [1]. Even in 2022 this evidence has been continuously confirmed, especially in multivessel disease with high anatomical complexity and/or main stem stenosis. Worldwide, long-term survival appears to be better in patients after CABG than after percutaneous coronary intervention (PCI), regardless of geographic location [2] and even though PCI is less invasive and associated with a faster recovery, in the literature the 30-day mortality is the same as with CABG. Therefore, PCI is probably not less dangerous than CABG [3]. With respect to aspects of the surgical technique the evidence for the radial artery as the best second bypass graft increased and the patency rate of the right mammary artery has been questioned [4]. Patient selection for bypass surgery and surgical precision during bypass surgery currently appear to be the greatest modifiers of surgical success. The focus of this literature review is on the surgically relevant aspects. Further treatment-relevant information on diagnostics and drug treatment is briefly summarized.

We present the case of a 72-year-old male patient with a three-vessel coronary artery disease (CAD) and slight left main stenosis. The patient previously underwent percutaneous coronary intervention with the insertion of a drug-eluting stent to treat an ostial stenosis of the right coronary artery (RCA). However, the patient now presented with subtotal ostial restenosis and a 14 to 9-mm aneurysm in the proximal RCA

In den letzten Jahren hat sich die koronare Bypass-Operation („coronary artery bypass grafting“ – CABG) als Goldstandard zur Behandlung der stabilen koronaren Herzkrankheit (KHK) konsolidiert [1]. Auch 2022 findet diese Evidenz kontinuierlich Bestätigung, insbesondere bei Mehrgefäßerkrankungen hoher anatomischer Komplexität und/oder Hauptstammstenose. Patienten nach CABG zeigten im Vergleich zu PCI („percutaneous corornary intervention“) ein besseres Langzeitüberleben. Dieser Überlebensvorteil ließ sich unabhängig vom geografischen Standort weltweit nachweisen [2]. Hinsichtlich der 30-Tage-Sterblichkeit zeigte sich zwischen den beiden Therapieoptionen CABG und PCI kein Unterschied, obwohl PCI weniger invasiv und mit einer kürzeren Rekonvaleszenz verbunden ist. PCI ist damit wahrscheinlich nicht weniger gefährlich als CABG [3]. In Bezug auf chirurgisch-technische Aspekte steigt die Evidenz für die Radialarterie als bester zweiter Bypass-Graft und die Offenheitsraten der rechten Mammaria wurden infrage gestellt [4]. Die Patientenauswahl für und die chirurgische Präzision während einer Bypass-Operation scheinen derzeit die größten Modifikatoren des chirurgischen Erfolgs zu sein. Der Fokus dieser Literaturübersicht liegt auf den chirurgisch relevanten Aspekten. Weitere therapierelevante Informationen zu Diagnostik und medikamentöser Therapie sind kurz zusammengefasst.

Novel Teaching Points•The Lipton R-IP classification is the rarest SCA configuration, with the left coronary system originating from the right coronary periphery.•Percutaneous coronary intervention of the left coronary system may be very challenging in cases of Lipton’s R-IP classification.•Surgical revascularization is a reasonable strategy, especially when the coronary periphery is in the typical location.•An in-depth heart team approach is crucial to ensure the performance of “in-time” lifesaving treatments in such critical and complex cases. •The Lipton R-IP classification is the rarest SCA configuration, with the left coronary system originating from the right coronary periphery.•Percutaneous coronary intervention of the left coronary system may be very challenging in cases of Lipton’s R-IP classification.•Surgical revascularization is a reasonable strategy, especially when the coronary periphery is in the typical location.•An in-depth heart team approach is crucial to ensure the performance of “in-time” lifesaving treatments in such critical and complex cases. Coronary anomalies are a rare phenomenon. One of the most observed coronary anomalies is the single coronary artery (SCA) originating from one coronary ostium and dividing into the coronary arteries in various configurations,1Angelini P. Coronary artery anomalies: an entity in search of an identity.Circulation. 2007; 115: 1296-1305Crossref PubMed Scopus (569) Google Scholar classified by Lipton’s classification.2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (437) Google Scholar A 38-year-old male patient was admitted to a community hospital with typical signs of non-ST-elevation myocardial infarction (NSTEMI) but without any known comorbidities. Urgent coronary angiography revealed a rare anomaly (incidence of 0.008%3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Scopus (1700) Google Scholar,4Mohanty A. Chandra S. A rare case of 'superdominant' single coronary artery.Indian Heart J. 2015; 67: 389-391Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar) of an SCA, with the left coronary system originating from the right coronary periphery, posterior to the great vessels (Lipton’s classification R-IP, Table 1), and occlusion of the circumflex artery (CX; Fig. 1, A and B ; Video 1 , view video online). A culprit-lesion percutaneous coronary intervention was attempted. However, despite the use of various flexible guidewires and angled microcatheters (90°), CX passage through the left main artery equivalent was not achieved (Video 2 , view video online) and resulted in ST elevation. A prompt control demonstrated a dissection of the left main artery (Figure 1C; Video 3 , view video online). Further interventional approaches were waived, and the patient was transferred for surgical revascularization.Table 1Lipton’s single coronary artery classification2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (437) Google ScholarCriterionCodeDescriptionOstial locationRRight sinus of valsalvaLLeft sinus of valsalvaAnatomic distributionIThe solitary domain vessel follows the course of either a normal right or left coronary arteryIIOne coronary artery arises from the proximal part of the normally located other coronary arteryIIILAD and CX arise separately from a common trunk originating from the right sinus of valsalvaCourse of the transverse trunkAAnterior to the great vesselsBBetween the aorta and the pulmonary arteriesPPosterior to the great vesselsSSeptal type: a part of the route passes through the interventricular septumCCombined type: combination of diverse routesLAD, left anterior descending artery; CX, circumflex artery. Open table in a new tab LAD, left anterior descending artery; CX, circumflex artery. Intraoperatively, coronary dissection was confirmed, whereas the left anterior descending artery and the CX were identified in the typical locations. Coronary revascularization was performed by anastomosis of the left internal mammary artery to the left anterior descending artery, and a saphenous vein graft to the CX was performed using the perfusion-assisted beating heart technique. The postoperative course remained uneventful, and the patient was discharged on the 10th postoperative day. The main issue in SCA remains the dependency on one system, with fatal results in the case of proximal occlusion. Given that the overall incidence of coronary anomalies is very low,3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Scopus (1700) Google Scholar the treatment strategy for acute coronary syndromes in patients with anomalous coronary anatomy remains unclear. In particular, an interventional approach in cases of complex coronary anatomy can result in coronary injury. Given that timing is critical in cases of myocardial infarction, an in-depth—even interhospital—heart team approach is crucial to ensure the performance of “in-time” lifesaving treatments. The authors have no funding sources to declare.

Patients suffering retrograde type A aortic dissection after TEVAR for type B dissection are at higher risk of mortality than their spontanous counterparts and the kind of optimal therapy remains obscure. We present a case of successful open surgical repair where distal open anastomosis was accomplished by cutting off the un-covered stent portion and suturing a vascular prosthesis to the dissected distal aortic arch including the covered stent part. The clinical course was regular. Immediate and radical repair in the aortic arch may be the adequate response in such instances.

OBJECTIVES:Recent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort.METHODS:A total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis.RESULTS:In the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87-1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32-0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47-0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87-1.08; P = 0.59 and HR 1.01, 95% CI 0.90-1.13; P = 0.91, respectively).CONCLUSIONS:Data do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.

OBJECTIVES:Left atrial appendage (LAA) amputation concomitant to coronary artery bypass grafting (CABG) has become an increasingly performed technique in patients with atrial fibrillation (AF) or with sinus rhythm and a CHA2DS2-VASc score ≥2. However, LAA amputation has come under suspicion to cause postoperative atrial fibrillation (POAF) due to left atrial (LA) dilation. This study aims to assess this assumption in patients undergoing CABG in off-pump technique with and without amputation of the LAA. METHODS:Patients who underwent isolated CABG in off-pump technique without history of AF were retrospectively examined. Cohorts were divided according to the concomitant execution of LAA amputation. LA volume was measured by transthoracic echocardiography and rhythm was analyzed by electrocardiography, medication protocol, and visit documentation. Propensity score (PS) matching was performed based on 20 preoperative risk variables to correct for selection bias. RESULTS:A total of 1,522 patients were enrolled, with 1,267 in the control group and 255 in the LAA amputation group. Occurrence of POAF was compared in 243 PS-matched patient pairs. Neither the unmatched cohort (odds ratio [OR] 0.82; 95% confidence interval or CI [0.61; 1.11], p = 0.19) nor the PS-matched cohort (OR 0.94; 95% CI [0.62; 1.41], p = 0.75) showed significant differences in POAF occurrence. Subgroup analysis of sex, use of β-blockers, pulmonary disease, ejection fraction, and CHA2DS2-VASc-Score also showed no tendencies. LA volume did not change significantly (p = 0.18, 95% CI [-0.29; 1.51]). CONCLUSION:Surgical amputation of the LAA concomitant to CABG did not lead to LA dilation and has no significant impact on the occurrence of POAF.

Our report presents a 73-year-old female patient with severe aortic stenosis who was admitted to our department for a surgical aortic valve replacement. After an uneventful surgery, a worsening low cardiac output syndrome with signs of myocardial ischemia occurred. Immediate angiography revealed a diffuse left coronary dissection starting from the ostium extending to the periphery of the left coronary system. The diffuse nature of the dissection ruled interventional management out and thus has been treated with urgent coronary bypass surgery. However, after an antecedent favorable course, the patient died 2 months later due to pneumonia resulting in septic shock.

Advanced glycation endproducts (AGEs) are formed in a series of non-enzymatic reactions between reducing sugars and the amino groups of proteins and accumulate during aging, diabetes mellitus, chronic kidney disease and other chronic diseases. Accumulation of AGE-modifications alters protein structure and function, transforming these molecules into potential targets of the immune system, presumably triggering the production of autoantibodies against AGEs. In this study, we detected autoantibodies against AGE-modified proteins with ELISA in plasma samples of 91 patients with documented coronary artery disease (CAD), who underwent coronary artery bypass grafting (CABG) surgery. Patients with high levels of autoantibodies had a higher body mass index (BMI 28.6 vs 27.1 kg/m2; p = 0.046), were more likely to suffer from chronic obstructive pulmonary disease (COPD 30% vs 9.8%; p = 0.018), and more likely to need dialysis after the surgery (10% vs 0%; p = 0.037). Our findings show a weak link between the levels of autoantibodies against AGEs and diabetes mellitus (DM 44% vs 24.4%; p = 0.05). In a small subpopulation of patients, antibodies against native bovine serum albumin (BSA) were detected. A growing body of research explores the potential role of antibodies against AGE-modified proteins in pathogenesis of different chronic diseases; our data confirms the presence of AGE-autoantibodies in patients with CAD and that in parallel to the AGEs themselves, they may have a potential role in concomitant clinical conditions in patients undergoing CABG surgery. Further research is necessary to verify the molecular role of these antibodies in different pathological conditions.

Mechanical circulatory support gained a significant value in the armamentarium of heart failure therapy because of the increased awareness of the prevalence of heart failure and the tremendous advances in the field of mechanical circulatory support during the last decades. Current device technologies already complement a heart transplant as the gold standard of treatment for patients with end-stage heart failure refractory to conservative medical therapy. This article reviews important aspects of mechanical circulatory support therapy and focuses on currently debated issues.

Observational studies indicate a positive association between circulating 25-hydroxyvitamin D (25OHD) and testosterone (T) concentrations. Because low 25OHD concentrations and T deficiency are considered to be a generalized phenomenon in patients with advanced heart failure (HF), we aimed to investigate whether vitamin D supplementation has beneficial effects on T indices in these patients.