Abstract Background Acute myocardial infarction (AMI) is associated with an increased rate of neurological events (NE). AMI patients, who undergo coronary artery bypass graft (CABG) surgery may be at an even greater risk for peri-operative NE, but detailed data is missing. Methods We conducted a retrospective, single-center data analysis of 1628 patients that underwent CABG within 48 h after being diagnosed with AMI. Between 01/2001 and 03/2023, 77 patients (4.7%) suffered from a peri-operative NE. This included 66 (4.0%) thromb-embolic strokes and 11 (0.7%) hypoxic brain damages. We compared the outcome between NE patients and those without (w/o) NE. Primary outcome parameters were 30-day mortality and long-term survival. Secondary outcome parameters included post-operative ICU length of stay, transfusion rates and need for renal replacement therapy (RRT). Results Median time from AMI diagnosis to CABG was 7.6 h (4.4–16.4 h). Significantly more NE patients were smokers (n = 36(46.8%) vs. n = 532(34.5%);p = 0.04) and presented with a severely reduced left ventricular function pre-operatively (n = 15(20.3%) vs. n = 161(11.1%);p = 0.02). NE patients had undergone CPR pre-operatively more often than patients w/o NE (n = 23(29.9%)vs n = 168(10.8%);p < 0.001). Accordingly, EuroScore II was significantly higher in NE patients compared to patients w/o NE (7.8 (4.2–14.3) vs. 4.9 (2.8–10.2); p < 0.001). Intra-operatively, bypass-time proved to be longer in NE patients (117 (94–149) vs. 107 (88–130)minutes; p = 0.02). Post-operatively, significantly more NE patients had to stay longer than 48 h in the ICU (n = 72 (94.7%) vs. n = 866 (55.8%); p < 0.001). Neither transfusion rates nor need for RRT differed between the groups. Thirty day mortality was higher in NE patients (n = 16 (20.8%) vs. n = 165 (10.7%); p < 0.01). Pre-operative diagnosis of peripheral artery disease (pad) and need for CPR were identified as independent predictors of 30-day mortality in NE patients. Ten-year survival of NE patients remained impaired compared to patients w/o NE (39% vs. 69%; p < 0.001). Conclusion AMI Patients undergoing CABG within 48 h are at an increased risk for neurological injuries. In particular, patients with generalized atherosclerosis and those that underwent CPR pre-operatively, seem to represent a vulnerable subgroup. Further studies have to clarify whether individualized peri-operative actions may reduce the stroke rates in this setting.

Bioresorbable stents (BRS) have been explored in cardiovascular intervention to provide temporary mechanical support while reducing long-term foreign material. The coronary experience has shown both the potential and the limitations of this strategy. First-generation polymeric stents demonstrated feasibility but were limited by thick struts, insufficient radial strength, delayed healing, and increased scaffold thrombosis. In contrast, metallic bioresorbable platforms improved mechanical performance, but each material system still faces trade-offs between strength, degradation rate, and biological response. Transcatheter pulmonary valve replacement (TPVR) may represent a clinically meaningful setting for renewed BRS development. Patients with congenital heart disease often require repeated pulmonary valve interventions over a lifetime, and permanent metallic frames may increase cumulative implant burden and complicate future treatment. However, TPVR imposes distinct requirements, including large-diameter expansion, stable anchoring, fatigue resistance, controlled degradation, and leaflet-frame integration. This review summarizes the lessons learned from coronary BRS, discusses material considerations for TPVR-oriented stent design, and evaluates current preclinical evidence for bioresorbable and regenerative pulmonary valve platforms. Particular attention is given to magnesium-zinc alloys as a tunable material strategy for future bioresorbable TPVR frames. Although direct evidence for fully bioresorbable metallic TPVR devices remains limited, this approach provides a rational framework for next-generation pulmonary valve intervention.

Background To assess childhood neurocognitive outcomes in a contemporary Fontan cohort and to identify neurodevelopmental risk factors. Methods This retrospective cohort study enrolled patients with a single ventricle born between 2004 and 2019 receiving standardized neurocognitive testing with age‐appropriate Wechsler intelligence scales after staged univentricular palliation. Demographic, surgical, and perioperative data were collected to evaluate neurodevelopmental risk factors. Results Data from 204 patients assessed at 5.0 (interquartile range, 4.5–6.1) years of age were analyzed. Full‐scale IQ (FSIQ) was in the lower normal range (93.5±12.3) but below population norms (P<0.001). Severe cognitive impairment (FSIQ <70) was noted in 4% and moderate impairment (FSIQ 84–70) in 20.5%. FSIQ was not different between hypoplastic left heart syndrome (n=112) and other univentricular heart defects (93.7±12.6 versus 93.3±11.9, P=0.821). Use of cardiopulmonary bypass for neonatal palliation (n=142) was not related to lower FSIQ (93.7±12.8 versus 92.9±11.0, P=0.670). Microcephaly, lower parental education level, and complications before and length of postoperative stay after neonatal palliation were independently associated with FSIQ below average. Head circumference Z‐score, higher parental education, and shorter cumulative hospital stay were related with favorable outcome (FSIQ>100). Conclusions In this contemporary Fontan cohort, mean FSIQ was in the low normal range but with a higher proportion of patients with intellectual impairment. Hypoplastic left heart syndrome or use of cardiopulmonary bypass for neonatal palliation was not associated with lower FSIQ scores. Preoperative condition and patient‐related factors were more important determinants of cognitive function than variables related to surgical palliation.

Severe tricuspid regurgitation (TR) is a prevalent and challenging condition associated with poor survival outcomes and significant morbidity. Medical therapy alone often fails to provide adequate symptom relief, and stand-alone surgical intervention is linked to high mortality rates, making it a less favorable option unless combined with left-sided valve surgery. The advent of transcatheter tricuspid interventions has provided new therapeutic possibilities, particularly for high-risk patients who are ineligible for conventional surgery. However, many patients are still unsuited for transcatheter tricuspid repair or have only limited benefits from such procedures. In this context, Transcatheter tricuspid valve replacement (TTVR) has rapidly emerged as a promising alternative, offering the potential for more effective treatment outcomes. This review explores the latest advancements in TTVR devices, highlights key clinical findings, and discusses the challenges and limitations of this evolving strategy. Additionally, we address patient selection criteria, procedural outcomes, and future directions in the field, emphasizing the potential of TTVR to transform the management of severe TR.

OBJECTIVES:Patients with extensive coronary artery disease (CAD) have a higher risk of cardiovascular events. This post hoc analysis of the Ticagrelor in CABG (TiCAB) trial examined the association of ticagrelor monotherapy versus aspirin with clinical outcomes after coronary artery bypass grafting (CABG) in relation to the extent of CAD. METHODS:The TiCAB trial randomized CABG patients to ticagrelor (90 mg twice daily) or aspirin (100 mg daily) for 12 months. Patients were stratified by SYNTAX score terciles: low (≤22), intermediate (23-32) and high (≥33). The primary end-point was major adverse cardiac and cerebrovascular events (MACCE) at 12 months, including cardiovascular death, myocardial infarction, stroke or repeat revascularization. Secondary end-points included individual MACCE components and major bleeding events. Cox proportional hazards models were used to assess treatment effects. RESULTS:Among 752 patients, 33.4% had low, 36.0% intermediate and 30.6% high SYNTAX scores (median 26.5 [20.0-33.0]). MACCE rates were similar across groups (low: 7.8%; intermediate: 9.2%; high: 8.8%; P = 0.87), though the incidence of repeat revascularization differed significantly among SYNTAX score groups (P = 0.02). Ticagrelor did not show a significant MACCE benefit over aspirin in any SYNTAX score group (low: HR 2.27, 95% CI 0.87-5.94; intermediate: HR 1.02, 95% CI 0.46-2.27; high: HR 1.76, 95% CI 0.70-4.46; Pint=0.41). Secondary outcomes, including bleeding, aligned with overall trial results. CONCLUSIONS:This analysis did not find a differential benefit of ticagrelor versus aspirin across CAD complexity levels as measured by the SYNTAX score. Further studies are warranted to refine antiplatelet strategies for patients with complex CAD undergoing CABG.

Background Marfan syndrome is a genetic connective tissue disorder that commonly affects the cardiovascular, skeletal, and ocular system. The increased risk of developing thoracic aortic aneurysms that can lead to aortic dissection and rupture is the main source of mortality in these patients. Pregnancy-induced changes can further increase the risk for aortic complications, especially in patients with an aortic root diameter > 45 mm. Case summary The case of a 26-year-old female with Marfan syndrome who was lost to follow-up for five years and presented to our department being pregnant at 21 weeks is presented. Echocardiography and cardiovascular magnetic resonance (CMR) showed an aortic root diameter of 55 mm and a large aneurysm of an aberrant right subclavian artery. Following multidisciplinary team discussion, valve-sparing aortic root and ascending aortic replacement was performed at 22 weeks of gestation without any complications. During the remaining pregnancy, the patient had frequent clinical and CMR follow-up investigations showing a mild increased size of the subclavian aneurysm. Uncomplicated caesarean delivery was performed at 35 weeks of gestation, and the subclavian artery aneurysm was successfully treated by interventional embolization. Discussion Although cardiovascular surgery in our patient during pregnancy was uncomplicated, the case illustrates that pre-pregnancy counselling in Marfan patients is recommended to reduce the risk for mother and child.

BackgroundDiabetic patients with coronary artery disease may benefit from elective coronary artery bypass graft (CABG) surgery. It is unknown whether this merit is transferable to patients with acute myocardial infarction (AMI) undergoing surgery.MethodA total of 1,427 patients underwent CABG within 48 hours of being diagnosed with AMI at the current institution between 2001 and 2019. Of these patients, 206 (14.4%) had insulin-dependent diabetes mellitus (IDDM) and 148 (10.4%) had non-insulin dependent diabetes mellitus (NIDDM). Retrospective data analysis was performed.ResultsPatients with NIDDM showed the highest perioperative risk profile, with a EuroScore II of 11.6 (±10.3) compared with 7.8 (±8.0) in non-diabetic patients and 8.4 (±7.8) in patients with IDDM (p<0.001). Sub-analysis demonstrated a higher proportion of non-ST-elevation myocardial infarction patients in the NIDDM cohort compared with the IDDM cohort (70.9% vs 56.8%; p=0.005). Postoperatively, NIDDM patients had more sepsis (p<0.01) and longer ventilation times (p<0.001) compared with non-DM and IDDM patients (p<0.01). Wound healing complications were rare, but almost twice as high in NIDDM patients compared with non-DM and IDDM patients (4.7% vs 0.9% vs 2.4%, respectively). The 30-day mortality was highest in the NIDDM cohort (18.3% vs 11.3% vs 7.8%; p=0.012). Analysis of survival for up to 15 years revealed a significantly reduced survival of diabetic patients compared with non-diabetic patients, with lowest survival rates in NIDDM patients (p<0.001).ConclusionsNon-insulin dependent diabetes mellitus patients undergoing CABG within 48 hours of being diagnosed with AMI are at increased risk of short-term and long-term complications. Therefore, this particular group should undergo a careful evaluation concerning the expected risks and benefits of CABG in this setting.

Objectives: Pulmonary valve regurgitation is a common problem after surgical or interventional relief of right ventricular outflow tract (RVOT) obstructions. Pulmonary valve replacement with a homograft or xenograft is the routine treatment. The longevity of biological valves and the availability of homografts are limited. This study presents intermediate-term results for pulmonary valve reconstruction (PVr) in patients with severe regurgitation. Methods: Perioperative data, preoperative and postoperative cardiac magnetic resonance imaging (MRI) studies, freedom from valve replacement and risk factors for pulmonary valve dysfunction were analyzed. Early postoperative results and effects on right ventricular volume development were compared to a matched group of patients who received pulmonary valve replacement with a homograft. Results: A PVr was performed in 24 patients. The median age was 18 years (14-24 years). The median follow-up after the operation was 8.0 years (4.7-9.7 years). Freedom from valve failure was 96% after 2 years and 90% after 5 years. Magnetic resonance imaging (MRI) before and 6 months after surgery showed a significant reduction in the median regurgitation fraction from 41% to 21% (p = 0.001) and a decrease of indexed right ventricular end-diastolic volume from 156 ml/m2 (149-177 ml/m2) to 117 ml/m2 (103-142ml/m2, p = 0.004). In comparison to a group of homograft patients the regurgitation fraction was significantly higher (21% vs. 8%, p = 0.003), indexed end-diastolic right ventricular volumes showed no significant differences with 117ml/m2 (103-142 ml/m2) vs. 116ml/m2 (102-133ml/m2), p = 0.759). Conclusion: A PVr can be carried out in certain patients with acceptable intermediate-term results and can delay pulmonary valve replacement.

Die Pulmonalklappeninsuffizienz (PI) ist ein häufiges Problem nach chirurgischer oder interventioneller Erweiterung des rechtsventrikulären Ausflusstraktes (RVOT). Die routinemäßige Behandlung besteht in einem Pulmonalklappenersatz (PVR). Die Lebensdauer biologischer Klappen und die Verfügbarkeit von Homografts sind begrenzt. Daher werden alternative Methoden evaluiert. Diese Studie präsentiert Zwischenergebnisse für Pulmonalklappenrekonstruktionen (PVr) bei Patienten mit schwerer PI. Perioperative Daten, prä- und postoperative kardiale magnetresonanztomographische (MRT-)Untersuchungen, Freiheit von Klappenersatz und Risikofaktoren für das Wiederauftreten einer PI wurden analysiert. Die frühen postoperativen Ergebnisse der PVr und die Auswirkungen auf die rechtsventrikulären Volumina wurden einer Vergleichsgruppe nach einem Klappenersatz mit einem Homograft gegenübergestellt. Eine PVr erfolgte bei 24 Patienten im medianen Alter von 18 (14 bis 24) Jahren. Die mediane Nachbeobachtungszeit war 8 (5 bis 10) Jahre. Die Freiheit von einem Klappenersatz betrug 96

Pediatric heart transplantation (HT) is nowadays the standard of care for children with end-stage heart failure and >700 pediatric HT are performed worldwide per year with an average survival rate exceeding 90% at 1 y, and for infants, a median survival of >20 y is possible.1 Despite these excellent results, pediatric HT requires lifelong systemic immunosuppression to prevent organ rejection and enable allograft and patient survival. However, systemic immunosuppression is associated with numerous complications, including increased rates of infection and malignancy and toxic side effects from the drugs themselves.2 Particularly for children, with immature and developing immune system, the "ideal immunosuppressive regimen" after HT still needs to be found and most probably will need to be tailored for the individual patient.3 In this context, corticosteroid therapy has been associated with a variety of adverse long-term effects such as poor growth, short stature, and osteopenia in children. Its use also results in altered glucose and lipid metabolism, both important pathways with regard to cardiovascular health and potential influence on long-term graft survival in HT recipients. Therefore, current trends in immunosuppression protocols include more use of induction therapy and steroid-avoidance or withdrawal protocols.3 In this issue of Transplantation, Hartje-Dunn et al4 reported the results of a 14-y experience using a steroid-avoidance immune suppression regimen at a single large pediatric HT center. HT recipients were included when they did not have evidence of donor-specific antibodies (DSAs), and immunosuppression included a 5-d thymoglobulin/steroid induction followed by a tacrolimus-based, steroid-free regimen. The majority of the little HT recipients (150/181) were eligible for a steroid-free immunosuppressive regimen, their median age was 8.7 y, 41% had congenital heart disease (CHD), 23% were sensitized, and 35% were on mechanical support. The median follow-up was 6.1 y. Eleven patients (8%) were on maintenance steroids at discharge and 13% of the patients at 1 y. The authors can show that graft survival was excellent, with 87% of the patients alive at 5 y and that comparatively few patients faced allograft rejection, posttransplant lymphoproliferative disease, or cardiac allograft vasculopathy (CAV) at this time point. Taken together, this study provides convincing evidence that a steroid-free regimen in pediatric HT patients at low risk for antibody-mediated rejection is associated with excellent survival for up to 5 y and freedom from acute rejection, posttransplant lymphoproliferative disease, and CAV.4 Some "Caveats" do exist because survival in pediatric recipients younger than 1 y at the time of transplant was significantly lower compared with older pediatric patients. One explanation may be the presence of complex CHD in a majority of infant recipients who tend to be sicker at the time of transplant. This view is also supported by previous registry analyses when comparing infant recipients with CHD and cardiomyopathy because after the early posttransplant period, survival curves run fairly parallel.1 Therefore, in this rather complex patient group, a steroid-free regimen should only be started the first year post-HT. Interestingly, a very recent study supports this view and suggests that pediatric patients can even be switched to monotherapy with only 1 immunosuppressant after HT after the first year posttransplant, which was found to be safe in the medium term.5 Steroid-avoidance regimens have also been associated with leukopenia in pediatric patients, and mycophenolate mofetil can be responsible for low white blood counts. Although the mycophenolate mofetil doses seem to be fairly variable in both pediatric patient cohorts, there is a trend to more leukopenia in the steroid-avoidance group of pediatric recipients. This is also supported by the fact that 10 patients in the steroid-free patient group developed severe neutropenia and required treatment with granulocyte colony–stimulating factor during the first year posttransplant, suggesting that these parameters should be closely monitored when using a steroid-avoidance regimen. CAV still remains a significant barrier to long-term cardiac allograft survival in the pediatric patient population, but there was no negative effect on CAV using a steroid-avoidance regimen in this pediatric patient cohort after 5 y. However, a word of caution should be added because the clinical (noninvasive) diagnosis of CAV is difficult and a 5-y follow-up with regard to the timeline of CAV development is not particularly long. Again, this finding is supported by a recent study5 in which monotherapy with only 1 immunosuppressive drug was even associated with a protective effect regarding the development of CAV. Possible explanations for these findings in both studies could be confounding factors such as fewer complications after HT, lower preexisting risk factors (eg, donor age) for the development of CAV, or simply a better immunologic "match." There may also be an interaction between immunosuppressive compounds and CAV in children that is not yet fully understood. Finally, nonadherence and consequently underimmunosuppression are prevalent, in particular, among adolescents going through puberty. This entity has been associated with the development of DSAs, but the effect of weaning or minimizing immunosuppression on the development of DSAs has not been investigated in detail.6 Therefore, careful patient selection will be paramount in choosing who would benefit from a steroid-free regimen. Taken together, the study by Hartje-Dunn et al4 added a new chapter to the multifaceted subject of "how much immunosuppression is necessary for an individual child after heart transplantation." The authors can demonstrate that treating children with a steroid-free regimen results in very good midterm survival and the safety profile of this strategy seems very acceptable. However, immunosuppression in pediatric patients probably does not follow the simplified title of this commentary "the leaner the better," and to achieve ultimate graft survival in the long term, more sophisticated protocols will be needed and tailored for the individual pediatric patient.

Mathias H. Aazami Cipriano Abad Shinichiro Abe Noriyuki Abe Yasir Abu-Omar Niv Ad Rajeshwara Krishna Prasad Adluri Prasad S. Adusumilli Salvatore Agati Seyedhossein Aharinejad Anders Ahlsson Hyuk Ahn Diana Aicher Clemens Aigner Koray Ak Ahmet Ruchan Akar Payam Akhyari Zohair Al Halees Nawwar Al-Attar Johannes M. Albes José Albors Ivan Aleksic Ottavio Alfieri Cem H. Alhan Ayyaz A. Ali Khaled M. Al-Kattan Mark Allen G. Hossein Almassi Jorge Almeida Nelson Alphonso Ahmed A. Alsaddique Bahaaldin Alsoufi Nasser Altorki Antonio Alvarez Cristiano Amarelli Vincenzo Ambrogi Marcello Carlo Ambrogi Gabriel Amir Mario Amorim Luca Ampollini Kyriakos Anastasiadis Nicholas D. Andersen Robert H. Anderson Makoto Ando Masahiko Ando Martin Andreas Claudio Andreetti Udo Christian Anegg Emanuela Angeli Gianni D. Angelini Dimitrios C. Angouras Marco Anile Amedeo Anselmi Martine Antoine Polychronis Antonitsis Juan L. Anton-Pacheco Manuel J. Antunes Anelechi Anyanwu Jehangir Appoo Amr A. Arafat Hirokuni Arai Jose I. Aramendi Jose Luis Aranda Sary F. Aranki Francesco Ardissone Claudia Arenz Olgun Kadir Aribas Rakesh Arora José M. Arribas Sinan Arsan Yucesin Arslan Latif Arusoglu Elena Ashikhmina Thanos Athanasiou Constantine L. Athanasuleas Pavan Atluri Nizar Attallah Rizwan Q. Attia Tim Attmann Erle H. Austin Rüdiger Autschbach Vassilios S. Avlonitis Adel Khader Ayed Jacques F. Azorin Nobuyoshi Azuma

BACKGROUND:Patients with complex coronary artery disease (CAD) may benefit from surgical myocardial revascularization but weighing the risk of peri-operative complications against the expected merit is difficult. Minimally invasive direct artery bypass (MIDCAB) procedures are less invasive, provide the prognostic advantage of operative revascularization of the left anterior descending artery and may be integrated in hybrid strategies. Herein, the outcomes between patients with coronary 1-vessel disease (1-VD) and patients with 2-VD and 3-VD after MIDCAB procedures were compared in this single-center study. METHODS:Between 1998 and 2018, 1363 patients underwent MIDCAB at the documented institution. 628 (46.1%) patients had 1-VD, 434 (31.9%) patients 2-VD and 300 (22.0%) patients suffered from 3-VD. Data of patients with 2-VD, and 3-VD were pooled as multi-VD (MVD). RESULTS:Patients with MVD were older (66.2 ± 10.9 vs. 62.9 ± 11.2 years; p < 0.001) and presented with a higher EuroScore II (2.10 [0.4; 34.2] vs. 1.2 [0.4; 12.1]; p < 0.001). Procedure time was longer in MVD patients (131.1 ± 50.3 min vs. 122.2 ± 34.5 min; p < 0.001). Post-operatively, MVD patients had a higher stroke rate (17 [2.3%] vs. 4 [0.6%]; p = 0.014). No difference in 30-day mortality was observed (12 [1.6%] vs. 4 [0.6%]; p = 0.128). Survival after 15 years was significantly lower in MVD patients (p < 0.01). Hybrid procedures were planned in 295 (40.2%) patients with MVD and realized in 183 (61.2%) cases. MVD patients with incomplete hybrid procedures had a significantly decreased long-term survival compared to cases with complete revascularization (p < 0.01). CONCLUSIONS:Minimally invasive direct coronary artery bypass procedures are low-risk surgical procedures. If hybrid procedures have been planned, completion of revascularization should be a major goal.

OBJECTIVES:There are disparities in the adherence to guideline-recommended therapies after coronary artery bypass graft (CABG). We therefore sought to evaluate the effect of guideline-adherent medical secondary prevention on 1-year outcome after CABG.METHODS:Data were taken from the randomized 'Ticagrelor in CABG' trial. From April 2013 until April 2017, patients who underwent CABG were included. For the present analysis, we compared patients who were treated with optimal medical secondary prevention with those where 1 or more of the recommended medications were missing.RESULTS:Follow-up data at 12 months were available in 1807 patients. About half (54%) of them were treated with optimal secondary prevention. All-cause mortality [0.5% vs 3.5%, hazard ratio (HR) 0.14 (0.05-0.37), P < 0.01], cardiovascular mortality [0.1% vs 1.7%, HR 0.06 (0.01-0.46), P = 0.007] and major adverse events [6.5% vs 11.5%, HR 0.54 (0.39-0.74), P < 0.01] were significantly lower in the group with optimal secondary prevention. The multivariable model for the primary end point based on binary concordance to guideline recommended therapy identified 3 independent factors: adherence to guideline recommended therapy [HR 0.55 (0.39-0.78), P < 0.001]; normal renal function [HR 0.99 (0.98-0.99), P = 0.040]; and off-pump surgery [HR 2.06 (1.02-4.18), P = 0.045].CONCLUSIONS:Only every second patient receives optimal secondary prevention after CABG. Guideline adherent secondary prevention therapy is associated with lower mid-term mortality and less adverse cardiovascular events after 12 months.

AIMS:Patients with pulmonary embolism (PE) and contraindications for or failed thrombolysis are at the highest risk for PE-related fatal events. These patients may benefit from surgical embolectomy, but data concerning this approach are still limited. METHODS:The method used here was retrospective data analysis of 103 patients who underwent surgical embolectomy from 2002 to 2020 at our department. RESULTS:Mean age was 58.4 (±15.1) years. Fifty-eight (56.3%) patients had undergone recent surgery; the surgery was tumor associated in 32 (31.1%) cases. Thirty (29.1%) patients had to be resuscitated due to PE, and 13 (12.6%) patients underwent thrombolysis prior to pulmonary embolectomy. Fifteen (14.5%) patients were placed on extra corporeal membrane oxygenation (ECMO) peri-operatively. Five patients (4.9%) died intra-operatively. Neurological symptoms occurred in four patients (3.9%). Thirty-day mortality was 23.3% ( n  = 24). Re-thoracotomy due to bleeding was necessary in 12 (11.6%) patients. This parameter was also identified as an independent risk factor for mortality. CONCLUSION:Surgical pulmonary embolectomy resulted in survival of the majority of patients with PE and contraindications for or failed thrombolysis. Given the excessive mortality when left untreated, an operative approach should become a routine part of discussions concerning alternative treatment options for these patients.

Objective:Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with a high rate of mortality and disabling morbidity. Coronary artery bypass grafting (CABG) is seldom considered in this setting due to the fear of peri-operative complications. Here, we analysed the outcome of CS patients undergoing CABG within 48 hours after diagnosed with AMI. Methods:A single-center, retrospective data analysis was performed in 220 AMI patients with CS that underwent CABG within 48 hours between 01/2001 and 01/2018. Results:141 patients were diagnosed with ST-elevation myocardial infarction (STEMI), 79 with non-STEMI (NSTEMI). Median age was 67 (60; 72) for STEMI, and 68 (60.8; 75.0) years for NSTEMI patients (p = 0.190). 52.5% of STEMI patients and 39.2% of NSTEMI patients had suffered from cardiac arrest (CA) pre-operatively (p = 0.049). Coronary 3-vessel disease was present in most patients (78.0% STEMI vs 83.5% NSTEMI; p = 0.381). Percutaneous coronary interventions (PCI) were performed in 32.6% STEMI and 27.8% NSTEMI patients (p = 0.543) prior to surgery. Time from diagnosis to surgery was shorter in STEMI patients (3.92 (2.67; 5.98) vs 7.50 (4.78; 16.74) hours; p < 0.001). A complete revascularization was achieved in 82.3% of STEMI and 73.4% of NSTEMI cases (p = 0.116). Post-operative low cardiac output occurred in 14.2% of STEMI vs 8.9% of NSTEMI patients (p = 0.289). The rate of cerebrovascular injury-including hypoxic brain damage was 12.1% for STEMI and 10.1% among NSTEMI patients. (p = 0.825). 30-day mortality was 32.6% after STEMI vs 31.6% in NSTEMI cases (p = 0.285). Conclusions:In contrast to the discouraging data concerning the role of PCI in AMI patients with CS and complex coronary artery disease, CABG may represent a treatment option worth considering.

Background: Outcomes of single-ventricle patients undergoing the Fontan operation improved over the past decades. Survival into adulthood is expected. We aimed to evaluate survival and morbidity after the modified Fontan operation in a large single-center cohort.

Background: The arterial switch operation (ASO) is the treatment procedure of choice in patients with transposition of the great arteries (TGA). Although survival is excellent, adverse long-term sequelae are known. Especially coronary artery occlusion or stenosis are of concern. The study aimed to evaluate the long-term outcomes after ASO at a single institution with regard to survival, freedom of reoperations, and catheter interventions and frequency of coronary complications

Background: The status of the systemic right ventricular coronary microcirculation in hypoplastic left heart syndrome (HLHS) is largely unknown. It is presumed that the systemic right ventricle’s coronary microcirculation exhibits unique pathophysiological characteristics of HLHS in Fontan circulation. The present study sought to quantify myocardial blood flow by cardiac magnetic resonance imaging and evaluate the determinants of microvascular coronary dysfunction and myocardial ischemia in HLHS. Methods: One hundred nineteen HLHS patients (median age, 4.80 years) and 34 healthy volunteers (median age, 5.50 years) underwent follow-up cardiac magnetic resonance imaging ≈1.8 years after total cavopulmonary connection. Right ventricle volumes and function, myocardial perfusion, diffuse fibrosis, and late gadolinium enhancement were assessed in 4 anatomic HLHS subtypes. Myocardial blood flow (MBF) was quantified at rest and during adenosine-induced hyperemia. Coronary conductance was estimated from MBF at rest and catheter-based measurements of mean aortic pressure (n=99). Results: Hyperemic MBF in the systemic ventricle was lower in HLHS compared with controls (1.89±0.57 versus 2.70±0.84 mL/g per min; P <0.001), while MBF at rest normalized by the rate-pressure product, was similar (1.25±0.36 versus 1.19±0.33; P =0.446). Independent risk factors for a reduced hyperemic MBF were an HLHS subtype with mitral stenosis and aortic atresia ( P =0.017), late gadolinium enhancement ( P =0.042), right ventricular diastolic dysfunction ( P =0.005), and increasing age at total cavopulmonary connection ( P =0.022). The coronary conductance correlated negatively with systemic blood oxygen saturation (r, −0.29; P =0.02). The frequency of late gadolinium enhancement increased with age at total cavopulmonary connection ( P =0.014). Conclusions: The coronary microcirculation of the systemic ventricle in young HLHS patients shows significant differences compared with controls. These hypothesis-generating findings on HLHS-specific risk factors for microvascular dysfunction suggest a potential benefit from early relief of frank cyanosis by total cavopulmonary connection.

Dieser Übersichtsbeitrag beschreibt die zunehmende Bedeutung von Herzrhythmusstörungen auf die Langzeitprognose von Erwachsenen mit einem angeborenen Herzfehler (EMAH). Tachykarde Herzrhythmusstörungen sind die häufigste Ursache für eine notfallmäßige Aufnahme von EMAH in eine Klinik. Mit zunehmendem Lebensalter kommt es zum deutlich erhöhten Auftreten von supraventrikulären und ventrikulären Tachyarrhythmien bei diesen Patienten. Generell ist festzustellen, dass bei den Betroffenen ein im Vergleich zur Normalbevölkerung um den Faktor 2 erhöhtes Risiko für schwerwiegende Komplikationen wie einen Schlaganfall und eine Herzinsuffizienz sowie für die Notwendigkeit operativer oder katheterinterventioneller Eingriffe besteht. Bei ventrikulären Tachyarrhythmien besteht das Risiko des plötzlichen Herztods.