Aims . The prevalence of obesity is rapidly increasing during the past decades. While previous research has focused on the early outcome after cardiac surgery or specific complications, the current study covers the whole burden of obesity in the field of cardiac surgery over short term and long term. Endpoints of the study were all‐cause mortality, perioperative outcome, and wound‐healing disorders (WHDs). Methods . 14.754 consecutive patients who underwent cardiac surgery over a 14 years’ time period were analyzed. BMI classifications were used according to the WHO definition. Results . Mean survival was 11.95 years ± 0.1; CI 95% [12.04–12.14]. After adjustment for clinical baseline characteristics, obesity classes’ I–III (obesity) did not affect 30‐day mortality or all‐cause mortality during the whole observational period. After adjustment for known risk factors, the risk for WHDs doubled at least in obesity patients as follows: obesity I (OR = 2.06; CI 95% [1.7–2.5]; p < 0.0001), obesity II (OR = 2.5; CI 95% [1.83–3.41]; p < 0.0001), and obesity III (OR = 4.12; CI 95% [2.52–6.74]; p < 0.0001). The same applies to the risk for sternal reconstruction that is substantially elevated in obesity I (OR = 2.23; CI 95% [1.75–2.83]; p < 0.0001), obesity II (OR = 2.81; CI 95% [1.91–4.13]; p < 0.0001), and obesity III (OR = 2.31; CI 95% [1.08–4.97]; p = 0.03). No significant correlation could be found between obesity and major adverse events in the perioperative course like renal failure, ventilation >24 h, re‐exploration, or cerebrovascular events. Conclusions . Cardiac surgery is safe in obesity as short‐ and long‐term mortality are not increased, and major adverse events during the perioperative course are similar to control patients. The burden of obesity lies in substantially increased rates of wound‐healing disorders and sternal reconstructions.

Objectives: The Geriatric Nutritional Risk Index (GNRI) was introduced to predict mortality in elderly people (age ≥ 65 years). In contrast to common risk scores for cardiac surgery, the GNRI relies on just 6 clinical parameters: age, height, weight, sex, albumin, and sodium. Methods: This study presents a large single-centre, retrospective analysis of all consecutive patients ≥ 65 years who underwent cardiac surgery using cardiopulmonary bypass (CPB) between 2010 and 2023. Patients were stratified according to GNRI risk classes: major risk (<82), moderate risk (82 to 98). Receiver operating risk analyses were performed to compare the predictive power of 30-day mortality of GNRI versus the EuroSCORE II. Results: In total, 6712 patients were included: 52 (0.8%) patients were at major risk, 233 (3.5%) patients were at moderate risk, 506 (7.5%) patients were at low risk, and 5921 (88.2%) patients were at minimal risk. The GNRI had the same predictive power for 30-day mortality as the EuroSCORE II (AUC = 0.75 vs AUC = 0.71, P = .051). Notably, when adjusted for the type of surgery, GNRI reached an AUC = 0.77 and did statistically not differ from the EuroSCORE II (P = .6). The Hosmer-Lemeshow test indicated good calibration for both the GNRI model (P = .301) and the adjusted GNRI model (P = .619) and revealed P < .0001 for the EuroSCORE II. Conclusions: The GNRI demonstrates predictive power for all-cause 30-day mortality comparable to the EuroSCORE II in a real-world patient cohort. GNRI offers a substantial simplification of risk estimation in patients undergoing cardiac surgery with CPB.

Background: Acute Stanford Type A aortic dissection (ATAAD) is a devastating disease requiring immediate surgery. A life-threatening complication hereby represents organ malperfusion. Lactate is a product of anaerobic glycolysis indicating organ malperfusion. The current study analyzes preoperative lactate acidosis as a surrogate marker for patients’ outcome after surgery for ATAAD over a 15-year period. Methods: In a single-center setting, 306 consecutive patients, who underwent surgery for ATAAD between 2000 and 2016, were analyzed retrospectively. Serum lactate measurements were taken before surgery. To define a simple cut-point of the predictor lactate, the maximally selected rank statistics method was used. Results: Median survival was 9.3 ± 0.5 and CI 95% [8.3–10.2] years. Mean lactate levels were 1.95 mmol/L ± 2.19 mmol/L (range: 0.15–19.27 mmol/L). Patients with a lactate level > 3.71 mmol/L had a higher 30-day mortality compared to patients with lactate levels ≤ 3.71 mmol/L (51.5% versus 18.7%). In a logistic regression model adjusted for clinical baseline characteristics at index procedure, lactate levels > 3.71 mmol/L reached the highest Odd for 30-day mortality of all tested risk factors (OR = 7.292; CI95% [3.029–17.555]; p < 0.0001). Analyzing the overall mortality, the early effect of lactate level > 3.71 mmol/L persists. The HRs for overall mortality, however, revealed substantially lower effects (HR = 2.772; (CI95% [1.689–4.550]; p < 0.0001). In patients who survived the first 30 days postoperatively, no clinical parameter other than age had a significant impact on survival, including lactate > 3.71 mmol/L (p = 0.494). Conclusions: In patients with ATAAD, preoperative lactate represents an easily obtainable surrogate marker for organ malperfusion. A preoperative lactate level > 3.71 mmol/L depicts the strongest marker for early mortality after surgery.

Objectives: Pronounced mitral annular disjunction (pMAD ≥8 mm) in myxomatous mitral valve disease has been associated with ventricular arrhythmias in selected cohorts, whereas minor degrees of mural separation are frequently observed in structurally normal hearts. Its clinical relevance after mitral valve surgery remains unclear. We investigated whether pMAD is associated with postoperative symptom burden and rhythm outcomes. Methodsv: In this retrospective cohort with prospective follow-up, 246 adults undergoing mitral valve surgery for Barlow’s disease were classified intraoperatively as pMAD (≥8 mm) or non-pMAD (<8 mm). The primary end point was patient-reported postoperative palpitations. Propensity score–based inverse probability weighting was applied to adjust for baseline differences. Structured follow-up in pMAD patients included transthoracic echocardiography (TTE) and 24-hour Holter monitoring. Results: pMAD was present in 103 patients (41.9%). Surgery effectively reduced disjunction distance. At follow-up, palpitations were more frequent in pMAD compared with non-pMAD patients (40.8% vs 18.9%, P = .011), remaining significant after adjustment. In the pMAD follow-up cohort, atrial fibrillation prevalence decreased significantly after surgery. Holter monitoring did not demonstrate sustained malignant arrhythmias. Survival and major adverse events were comparable between groups. Conclusions: After mitral valve surgery for Barlow’s disease, pMAD is independently associated with increased postoperative palpitations despite anatomical correction. This association was not accompanied by excess malignant arrhythmias or adverse clinical end points, suggesting persistent symptom susceptibility rather than overt electrical instability.

Background: Risk scoring prior TAVR is based on the EuroSCORE II (European System for Cardiac Operative Risk Evaluation) and the STS-score (Society of Thoracic Surgeons) which are complex, and partly prone to investigator bias. The geriatric nutritional risk index (GNRI) can be calculated by five parameters via publicly available formula (age, height, weight, sex, serum albumin), whereas EuroSCORE II and the STS-score require 21 and 69 variables, respectively. The study compares the efficiency of GNRI in predicting 30-day mortality compared to the EuroSCORE II and the STS-score. Furthermore, GNRI risk classes were analysed in the long-term. Methods: 3.470 consecutive patients who underwent TAVR between 2010 and 2023 at our institution were analysed. GNRI calculation produces a linear parameter that can be divided in four risk groups. Results: ROC (receiver operating characteristic) curve analysis demonstrated no difference in predicting 30-day mortality between GNRI vs. EuroSCORE II (AUC = 0.72 vs. 0.69, p = 0.3) and GNRI vs. STS-score (AUC = 0.72 vs. 0.72, p = 1.0). The Hosmer-Lemeshow test indicated good calibration for the GNRI model ( p = 0.3793). After adjustment for preoperative demographic characteristics, Cox regression analysis for overall survival after TAVR reveals for the major risk group [21 patients; HR = 4.624; CI95%(2.881–7.422); p < 0.0001], the moderate risk group [198 patients (5.7%), HR = 2.201; CI95%[1.821–2.660]; p < 0.0001], and the low risk group [452 patients (13.0%); HR = 1.831; CI95%[1.597–2.1]; p < 0.0001], respectively. Conclusions: The GNRI is an objective publicly available score that simplifies risk assessment prior TAVR without any loss of precision compared to the EuroSCORE II and the STS-score.