In selected cases, the utilization of branched endografts for the treatment of aortic arch aneurysms could be a safe and advantageous alternative to high-risk procedures such as open total aortic arch replacement or hybrid arch repair. We present the case of a 70-year-old man with saccular aneurysm of a bovine aortic arch which was endovascularly treated using a double-branched custom-made aortic endoprosthesis based on the Relay NBS (Non-Bare Stent) Plus platform intended for zone 0 deployment. The postoperative clinical course was uneventful. The postoperative computed tomography scan showed a good result of the implant. The patient was discharged 6 days after the procedure.

Current guidelines for the care of heart transplantation recipients recommend routine endomyocardial biopsy and invasive coronary angiography as the cornerstones in the surveillance for acute rejection (AR) and coronary allograft vasculopathy (CAV). Non-invasive tools, including coronary computed tomography angiography and cardiac magnetic resonance, have been introduced into guidelines without roles of their own as gold standards. These techniques also carry the risk of contrast-related kidney injury. There is a need to explore non-invasive approaches providing valuable information while minimizing risks and allowing their application independently of patient comorbidities. Echocardiographic examination can be performed at bedside, serially repeated, and does not carry the burden of contrast-related kidney injury and procedure-related risk. It provides comprehensive assessment of cardiac morphology and function. Advanced echocardiography techniques, including Doppler tissue imaging and strain imaging, may be sensitive tools for the detection of minor myocardial dysfunction, thus providing insight into early detection of AR and CAV. Stress echocardiography may offer a valuable tool in the detection of CAV, while the assessment of coronary flow reserve can unravel coronary microvascular impairment and add prognostic value to conventional stress echocardiography. The review highlights the role of Doppler echocardiography in heart transplantation follow-up, weighting advantages and limitations of the different techniques.

Introduction and aims: Malnutrition is associated with increased morbidity and mortality in patients who undergo cardiac surgery. Nevertheless, objective assessment of malnourished patients undergoing heart transplantation (HT) is limited. We aimed to analyze the relationship between the malnutrition status and the early and late clinical outcomes of patients undergoing HT using a novel semi-quantitative tool. Methods: All patients aged ≥18 years who underwent HT between January 2015 and July 2020 in a single center were retrospectively evaluated and included in the study. The semi-quantitative Malnutrition Universal Screening Tool (MUST) score (already validated in heart failure) was calculated for each patient at the time of transplantation to assess their nutritional status. A propensity score weighting approach was performed to evaluate the association between the increase in MUST score and the risk of early complications and in-hospital mortality. A Cox regression analysis was performed to assess follow-up mortality. Results: A total of 168 HT patients (median age 58.4 years, IQR 49.5–65.2, men n = 128, 76%) were included within the study period. Their median preoperative BMI was 24.0 kg/m² (IQR 21.2–27.9). Preoperative MUST scores of 0, 1, and ≥2 were found in 92 (55%), 24 (14%), and 52 (31%) patients, respectively. The median preoperative eGFR was 64.3 mL/min (IQR 49.0–83.2). An increase in MUST score (from 0 to 2) was not significantly related to major postoperative complications or in-hospital mortality. An analogous increase in MUST score was associated with increased follow-up mortality risk (hazard ratio 1.28, 95% CI 1.04–1.83, p = 0.024). Conclusions: Malnutrition assessed with the MUST score seems not to be associated with increased in-hospital mortality or major postoperative complications in patients who undergo HT, but according to our preliminary data it is related to patients’ long-term mortality.