Background: Clopidogrel application before diagnostic or therapeutical percutaneous coronary intervention has become the standard for stent thrombosis prevention. Irreversible platelet inhibition causes increasing bleeding complications if urgent coronary artery bypass grafting is necessary. This study evaluates the effect on bleeding complications of clopidogrel in urgent CABG using bilateral internal thoracic artery (ITA) and saphenous veins in all patients. Methods: We retrospectively analyzed 128 patients (operated between January 2000 and September 2002) undergoing urgent or emergent CABG using both ITAs, and compared 64 patients with previous clopidogrel and aspirin application (within 5 days) to 64 patients without clopidogrel. We evaluated chest tube output, re-exploration rate and necessity of blood products, ventilation time and ICU stay. Results: Both groups were comparable in age, gender, number of performed anastomoses (mean 4/patient). Chest tube output (24 h) was higher in the clopidogrel group at 977 ± 628 ml vs. 788 ± 389 ml (p = 0.046), as was re-exploration rate with 7.81 % (5 of 64) vs. 0 % (0 of 64) (p < 0.005). The number of blood products amounted to 2.7 ± 1.9 U in the clopidogrel group vs. 1.9 ± 1.6 U (p = 0.013) for red cells, 0.05 ± 0.9 U vs. 0.03 ± 0.25 (p = 0.0003) for platelets, and 0.5 ± 1.3 U vs. 0.2 ± 1.0 U (p = 0.14) for fresh frozen plasma. Mechanical ventilation time was 11.9 ± 9.7 h vs. 9.6 ± 5.9 h (p = 0.10), ICU stay 32.6 ± 22.1 h vs. 27.8 ± 18.2 h (p = 0.19). Conclusions: Previous application of clopidogrel in combination with aspirin before urgent CABG induces increased chest tube output, re-exploration rate and necessity of blood products, especially platelets. Nevertheless, routine use of both ITAs in patients after clopidogrel exposure can be performed with acceptable bleeding complications.

In recent times, there have been notable changes in cardiovascular medicine, propelled by the swift advancements in artificial intelligence (AI). The present work provides an overview of the current applications and challenges of AI in the field of heart failure. It emphasizes the “garbage in, garbage out” issue, where AI systems can produce inaccurate results with skewed data. The discussion covers issues in heart failure diagnostic algorithms, particularly discrepancies between existing models. Concerns about the reliance on the left ventricular ejection fraction (LVEF) for classification and treatment are highlighted, showcasing differences in current scientific perceptions. This review also delves into challenges in implementing AI, including variable considerations and biases in training data. It underscores the limitations of current AI models in real-world scenarios and the difficulty in interpreting their predictions, contributing to limited physician trust in AI-based models. The overarching suggestion is that AI can be a valuable tool in clinicians’ hands for treating heart failure patients, as far as existing medical inaccuracies have been addressed before integrating AI into these frameworks.

Background: The occurrence of severe carotid artery disease in more than 12 % of patients requiring CABG results in a discrepancy concerning the best treatment for both diseases. We reviewed the early outcome of patients with CABG and/or valve replacement and simultaneous carotid endarterectomy (CEA). Methods: We evaluated retrospectively 244 patients operated simultaneously between 7/94 and 10/2001. 209 patients received CABG; 35 patients CABG and/or valve replacement. Mean age was 68 years. 188 patients were male. We analyzed risk factors, morbidity, incidence of neurological complications and 30 day mortality. Results: Perioperative stroke with hemiplegia occurred in 3.3 % (8 patients). 4 of these patients showed contralateral carotid artery occlusion, 2 contralateral severe stenosis. 2 patients (0.8 %) experienced prolonged reversible ischemic neurological deficit (PRIND), 4 patients (1.6 %) transient ischemic attack (TIA). 30-day lethality was 4.5 %. 3 patients died due to low cardiac output, 6 patients due to extracardial reasons, 2 patients (0.8 %) developed a cerebral death. Conclusions: Simultaneous CEA and cardiac surgery can be performed with an acceptable risk for neurological complications and mortality. Occlusion of contralateral carotid artery could be identified as an evident predictor for increased neurological complications. Compared to two-stage procedures, combined operations yield a reduction of hospital costs.

Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

To evaluate the impact of paravalvular abscess in the surgical management and outcome of infective endocarditis. Retrospective review of 35 patients with paravalvular abscess due to active endocarditis operated on at 1 institution from September 1996-August 2007. Patients' mean age was 59.4 +/- 12.1 years; 80% were men. 31 patients suffered from native- and 4 from prosthetic valve endocarditis. In 23 cases the affected valve was the aortic, in 7 cases the mitral, in 4 cases both (mitral and aortic), and in 1 patient the tricuspid; no abscess presence was noticed by pulmonal annuluses. Surgical procedures included radical lesion-resection as well as reconstruction of the annulus with pericardial patches. Most of the patients were preoperatively in New York Heart Association (NYHA)-class III-IV. Follow-up was 100% complete with a maximum of 11.25 years. Early mortality (30 days) was 11.4% (n = 4). The 11-year overall survival rate was 68.7 +/- 9% (76.1% for aortic valve patients and 26.9% for mitral valve patients (P = .15). With regard to the type of prosthetic devices, the survival rates at 11.25 years were 74.2% for mechanical, 80% for biological, and 45.6% for other/reconstructive (P = .6). There were no episodes of recurrent endocarditis; hence freedom of recurrent endocarditis at 11 years was 100%. Causative microorganisms were approximately 30% Staphylococci, and MRSA seems to induce more frequent destructive lesions like paravalvular abscess. Considering the severity of the onset, a radical surgical treatment delivers acceptable long-term results by acceptable operative mortality. The choice of the prosthetic device seems not to be influential in long-term survival and morbidity.