Background: With 1.4 billion people worldwide affected by elevated lipoprotein(a) [Lp(a)] concentrations, it has emerged as a critical player in the realm of cardiovascular health. Lp(a) is an established independent risk factor for coronary heart disease and became a recently recognized factor for aortic valve stenosis. This study aims to investigate the impact of elevated Lp(a) on the long-term outcomes following cardiac surgery.

Abstract Background Elevated levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) reflect cardiac status in heart failure patients and are independently associated with mortality and adverse cardiovascular outcomes in elective patients undergoing non-cardiac surgery. However, there is scarce evidence about the association between NT-proBNP and outcome after cardiac surgery in large patient populations. Purpose The aim of this study was to analyze the association of preoperative NT-pro-BNP levels with 30-day and five-year mortality after cardiac surgery. Methods A consecutive cohort of 6938 patients undergoing cardiac surgery was analyzed retrospectively. The relationship between preoperative NT-proBNP and 30-day and five-year mortality adjusted for EuroSCORE II was explored using a Cox proportional hazards model. The dynamics of preoperative NT-proBNP were analyzed by comparing the values at the time of diagnosis or assignment to surgery with the values on the day before surgery (n= 4739). Results were validated in an external cohort from the SWEDEHEART registry (n=3415). Results Median preoperative NT-proBNP was 552 ng/l. Death within 30 days occurred in 2.1% of the patients. High preoperative NT-proBNP levels were associated with a higher 30-dayand 5-yearmortality. Preoperative NT-proBNP thresholds to identify patients at high-risk (>4000 ng/l), intermediate-risk (2000-4000 ng/l) and low-risk (<2000 ng/l) for 30-day mortality were determined. Patients in the intermediate or high-risk category had a higher risk for prolonged ICU stay (OR 2.52), ultrafiltration (OR 3.68), ECMO (OR 3.63), 30-day mortality (HR 2.79), and 5-year mortality (HR 2.41) (p-value all <0.001). Patients who improved in the preoperative NT-proBNP risk had a significant 30-day and five-year survival benefit. Conclusions Preoperative NT-proBNP levels are independently associated with 30-day and five-year mortality after cardiac surgery. NT-proBNP reduction prior to surgery might decrease 30-day and five-year mortality after cardiac surgery.NTproBNP is associated with outcome

Background: We aimed to determine the relationship between postoperative high-sensitivity cardiac troponin T/creatine kinase MB and the risk of death (all-cause) within 30 days and 5 years after cardiac surgery.

Background: Despite numerous advantages of skeletonized left internal thoracic artery grafts, latest research shows adverse patency rates and clinical outcome of skeletonized versus pedicled left internal thoracic artery harvesting after coronary artery bypass grafting.

Background: Inflammation is a major trigger for the onset of calcific aortic valve disease (CAVD). Biglycan (BGN) is a proteoglycan responsible for the stability of the valvular extracellular matrix. It is released upon mechanical stress and acts as danger-associated molecular pattern activating the innate immune system. We aimed to (1) characterize the mechanism of innate immune activation and (2) explore it as potential therapeutic target.

Background: Ex situ heart perfusion (ESHP) enables the resuscitation and assessment of donor hearts. Therefore, a comprehensive analysis of myocardial function and metabolism is crucial. Currently, the only used assessment tool for quality control is sequential lactate measurement from the perfusate. The aim of this study was to investigate new assessment tools in ESHP.

Purpose Due to the high ATP demand of myocardium, cardiac function is highly dependent on an efficient mitochondrial respiration. Ischemia and reperfusion injury (I/R) has severe impact on the function of the mitochondrial respiratory system. In donation after circulatory death (DCD), extent of I/R damage is decisive for posttransplant graft function. We aimed to investigate the mitochondrial respiration using high-resolution respirometry (HRR) in a porcine ex-situ heart perfusion (ESHP) model. Methods 12 German domestic pigs (65-75kg) were used to simulate two different organ donation protocols: "donation after brain death" (DBD) (n=6) and DCD (n=6). ESHP was performed for 6 hours. Mitochondrial function in tissue homogenates of porcine myocardium was assessed by HRR. Samples were obtained at baseline (b), and after 1, 3, and 6 hours of ESHP. Comparison of repeated measurements were performed with two-way ANOVA followed by Sidak's post hoc test. Results The oxidative phosphorylation capacity after addition of NADH-generating substrates, fatty acids and succinate decreased slightly in the DCD group. A significant difference after 6 hours of perfusion was found (DBD 200.5±27.9 vs DCD 143.4±22.7 pmol−1·s−1·mL−1, p=0.038). The flux control ratio of the NADH-linked (Complex I) respiration declined in the DCD group (6h: DBD 0.16 vs DCD 0.05, p=0.007) (Figure 1). The mitochondrial outer membrane damage, assessed by cytochrome c addition was significantly lower after 6 hours of ESHP (p<0.001) without a difference between the groups. Conclusion We performed the first in-depth analysis of mitochondrial respiratory function during ESHP in a DCD model. Interestingly, mitochondrial respiration is preserved over 3 hours in DCD hearts with a decline in function after 6 hours. Importantly, the initial mitochondrial outer membrane damage recovered over time in both groups. Next, the predictive value of HRR might be evaluated in clinical practice to promote organ acceptance in the future.

Background: Coronary malperfusion in type A aortic dissection (AAD) is associated with high perioperative mortality. Depending on the type of lesion surgical repair reaches a higher complexity level. Aim of this study was to analyze if there is a certain myocardial injury pattern according to Neri classification and to investigate the impact on myocardial recovery during mid-term survival.

Background: SYNTAX Score II has been internally and externally validated according to predictive capability for mortality rates after coronary artery bypass grafting mainly in left-main and multivessel coronary artery disease.