Left atrial appendage occlusion affects systemic coagulation parameters, leading to additional patient-related benefits. The aim of this study was to investigate the differences in coagulation factor changes 6 months after epicardial left atrial appendage occlusion in patients with different LAA morphometries. This is the first study to analyze these relationships in detail. A prospective study of 22 consecutive patients was performed. Plasminogen, fibrinogen, tPA concentration, PAI-1, TAFI and computed tomography angiograms were performed. Patients were divided into subgroups based on left atrial appendage body and orifice diameter enlargement. The results of blood tests at baseline and six-month follow-up were compared. In a population with normal LAA body size and normal orifice diameter size, a significant decrease in analyzed clotting factors was observed between baseline and follow-up for all parameters except plasminogen. A significant decrease between baseline and follow-up was observed with enlarged LAA body size in all parameters except TAFI, in which it was insignificant and plasminogen, in which a significant increase was observed. Occlusion of the left atrial appendage is beneficial for systemic coagulation. Patients with a small LAA may benefit more from LAA closure in terms of stabilizing their coagulation factors associated with potential thromboembolic events in the future.

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53–66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience.

Background: Spinal cord ischemia is one of the most serious complications after an aortic repair. To date, there is no evidence for arterial changes during an aortic dissection or for the observation of such arteries after an aortic repair. The aim of this study was to compare spinal-cord-supplying arteries in patients with an acute aortic dissection, preoperatively and postoperatively, with patients without an acute aortic dissection. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure to treat an aortic dissection and 25 patients who qualified for a transcatheter aortic valve replacement without an acute aortic dissection and atherosclerosis of the analyzed vessels, treated as a control group, were reconstructed and retrospectively analyzed with the detailed medical data of the patients. The aortic branches with the ability to supply blood to the spinal cord as described in the literature were further analyzed. Results: The preoperative arterial diameters of the left internal thoracic artery, the left musculophrenic artery, and the left and right supreme intercostal arteries were significantly larger compared to the postoperative measurements. In addition, the preoperative measurements of the diameters of the left vertebral artery, right internal thoracic artery, left lateral thoracic artery, and left common iliac artery were significantly larger than in the control group. Conclusions: The internal thoracic arteries and supreme intercostal arteries may play a crucial role in providing additional blood supply to the spinal cord.

Minimally invasive aortic valve replacement through a right anterior thoracotomy is limited by prolonged operative times. We assessed whether a rapid-deployment prosthesis reduces those times and improves early outcomes when surgical access, team and era are held constant. Single-centre retrospective cohort study of 204 consecutive isolated aortic valve replacements performed through a right anterior thoracotomy by one surgical team between 2023 and 2025. Patients receiving a mechanical prosthesis (n = 5) or a 29 mm sutured valve (n = 7, a size not manufactured for the study device) were excluded, leaving 192 patients: 70 received the Edwards Intuity rapid-deployment valve and 122 a conventional sutured bioprosthesis. Prosthesis choice was at the surgeon’s discretion. Primary endpoints were aortic cross-clamp and cardiopulmonary bypass time. Groups were compared by multivariable regression adjusted for age, sex, EuroSCORE II, NYHA class, ejection fraction and implanted valve size, with robust standard errors for continuous outcomes and Firth-penalised logistic regression for binary outcomes. Aortic cross-clamp time was shorter with the Intuity (median 61.0 [54.0–75.0] versus 91.0 [76.0–108.5] min; adjusted difference −26.9 min, 95% CI −33.7 to −20.1; p < 0.001), as was cardiopulmonary bypass time (103.5 [84.2–115.0] versus 131.0 [115.0–153.0] min; adjusted difference −29.4 min, −38.7 to −20.2; p < 0.001). Mean and peak transvalvular gradients were lower (adjusted differences −5.52 mmHg, −6.80 to −4.25, and −11.50 mmHg, −13.90 to −9.10; both p < 0.001) and hospital stay was shorter by 1.4 days (−2.4 to −0.4; p = 0.009). In-hospital mortality was 1/70 versus 1/122 (p = 1.000). Permanent pacemaker implantation occurred in 6/70 (8.6%) versus 2/122 (1.6%) (unadjusted p = 0.053) and paravalvular leak of any grade in 7/69 (10.1%) versus 8/121 (6.6%); with eight and fifteen events respectively, neither endpoint could be estimated with useful precision; these non-significant comparisons should not be read as evidence of comparable safety. Within a single access, team and era, the rapid-deployment prosthesis was associated with substantially shorter operative times, lower gradients and shorter hospital stay, with similar observed in-hospital mortality (1/70 versus 1/122); with only two deaths overall this comparison cannot establish equivalence. These findings describe operative efficiency rather than demonstrated clinical superiority, and the safety comparisons remain underpowered.

Background: The region of the tricuspid valve is an important area for various cardiac interventions. In particular, the spatial relationships between the right coronary artery and the annulus of the tricuspid valve should be considered during surgical interventions. The aim of this study was to provide an accurate description of the clinical anatomy and topography of this region. Methods: We analyzed 107 computed tomography scans (44% female, age 62.1 ± 9.4 years) of the tricuspid valve region. The circumference of the free wall of the tricuspid valve annulus was divided into 13 annular points and measurements were taken at each point. The prevalence of danger zones (distance between artery and annulus less than 2 mm) was also investigated. Results: Danger zones were found in 20.56% of the cases studied. The highest prevalence of danger zones and the smallest distances were found at the annular points of the tricuspid valve located at the posterior insertion of the leaflets, without observed sex-specific differences. Conclusion: The highest risk of iatrogenic damage to the right coronary artery is in the posterior part of the tricuspid valve annulus.

Cardiac surgery carries substantial risk of early postoperative complications including postoperative atrial fibrillation (POAF, 30–50%), periprocedural myocardial infarction (PMI), acute kidney injury (AKI, 3.8–54.4%), bleeding (3–5%), stroke, and cognitive dysfunction. This narrative review synthesizes 30+ studies on circulating microRNAs (miRNAs) as perioperative biomarkers, identifying strongest evidence for cardiac-enriched miR-499 (AUC 0.93, sensitivity 85.7%, specificity 93.3%) and miR-133a (peaks 1–3 h post-declamping) in PMI diagnosis -outperforming troponins’ 6h kinetics. POAF prediction favors preoperative miR-483-5p (AUC 0.78), while AKI, bleeding (miR-223), and neurological injury show emerging but less validated candidates (miR-21, miR-210-3p). We critically analyze limitations across studies and outline clinical translation barriers (3–6 h assay times, heparin inhibition, lacking standardization) with solutions for point-of-care implementation.