Objectives: Risk stratification in coronary artery bypass grafting (CABG) remains challenging despite existing models. The Endothelial Activation and Stress Index (EASIX), originally developed for hematological conditions, has shown promise in various medical fields as a predictor of adverse outcomes. EASIX, calculated from lactate dehydrogenase, creatinine, and platelet count, reflects endothelial dysfunction and systemic inflammation. This study investigates EASIX’s potential in predicting mortality and morbidity in patients undergoing CABG. Methods: A total of 475 patients undergoing isolated CABG between January 2017 and June 2020 were retrospectively analyzed. EASIX scores were calculated from pre-operative blood samples. Patients were stratified based on an EASIX cut-off value of 1.16. Results: Patients with EASIX ≥ 1.16 were older and had more comorbidities. They experienced higher 30-day mortality (5.0% vs. 0.8%, p = 0.004), increased wound infections (6.7% vs. 2.5%, p = 0.035), and more frequent prolonged ventilation (9.2% vs. 4.2%, p = 0.040). The long-term survival analysis showed significant differences at 3 years (p = 0.030) and 5 years (p < 0.001). EASIX demonstrated moderate discriminatory power for long-term survival (AUROC 0.669, 95% CI: 0.598–0.740, p < 0.001). Importantly, the multivariable analysis revealed EASIX as an independent risk factor for long-term mortality, even after adjusting for traditional risk factors and comorbidities (HR: 2.65, 95% CI: 1.59–4.42, p < 0.001). Conclusions: EASIX ≥ 1.16 was associated with postoperative morbidity and poorer long-term survival in patients undergoing CABG. This easily calculable score could enhance risk stratification and guide personalized postoperative management.

The aim of the study was to investigate the potential prognostic role of preoperative measurement of erector spinae myosteatosis with Hounsfield Unit Average Calculation (HUAC) as a marker for sarcopenia and frailty in patients undergoing coronary bypass surgery (CABG). Preoperative computer tomography (CT) derived measurements of 479 consecutive patients undergoing CABG between January 2017 and December 2019 were retrospectively performed. The erector spinae muscle at the level of the 12^th vertebra was manually outlined bilaterally on the axial CT slices and Hounsfield Unit Average Calculation (HUAC) was performed. The lower quartile of muscle density values was defined as myosteatotic and thus sarcopenic. Sarcopenic (n = 121) versus non-sarcopenic patients (n = 358) were compared regarding postoperative morbidity, short-term and long-term mortality. Results were adjusted for age, Body Mass Index (BMI), atrial fibrillation and hypertension using inverse probability weighting (IPW) Sarcopenia was associated with higher 30-day mortality (4.1% vs 0.8% p = 0.012), mid-term mortality after 1 year (9.3% vs 3.1% p = 0.047) and 2 years (10.8% vs 4.2% p = 0.047). Long-term mortality (5 years) was 20.8% for sarcopenic and 13.0% for non-sarcopenic patients but was not found to be significantly different (p = 0.089). Sarcopenia was associated with higher rates of reintubation (7.5% vs 1.1% p < 0.001), sternal wound infections (7.5% vs 2.8% p = 0.039) and acute kidney injury requiring hemodialysis (2.5% vs 0.4% p = 0.021). In patients undergoing coronary bypass surgery, sarcopenia was associated with increased short-term mortality, mid-term mortality and morbidity. The measurement of erector spinae myosteatosis could be an easy and useful parameter in preoperative risk assessment.

This report describes a technique to create a biologic Bentall from a pericardial tube and a rapid deployment valve. This technique facilitates reimplantation of the coronary arteries because the proximal anastomosis is sewn before valve implantation and allows suturing of the coronary ostia from inside and outside, given that there is no interference with the implanted valve. Indications for this technique include complex redo cases and patients with contraindications to a conventional Bentall procedure. This technique has been used in 2 patients with good results.

Background: Frailty and impaired muscle quality are strong determinants of adverse outcomes after coronary artery bypass grafting (CABG), yet conventional risk scores overlook this biological dimension. The Hounsfield Unit Average Calculation (HUAC) obtained from routine preoperative computed tomography (CT) scans quantifies skeletal muscle attenuation, reflecting intramuscular fat infiltration and metabolic reserve. This study evaluated the prognostic value of HUAC measured at two thoracic levels and explored sex-specific differences in its predictive performance. Methods: In this retrospective single-center study, 479 patients (382 men, 97 women) undergoing isolated CABG with available preoperative CT scans were analyzed. Mean HUAC was measured bilaterally at the fourth (TH4) and twelfth (TH12) thoracic vertebral levels. Sex-specific HUAC quartiles were generated, with the lower quartile defining low thoracic muscle attenuation, representing a radiographic phenotype of impaired muscle quality. Associations with 1-, 3-, and 5-year mortality were assessed by Kaplan–Meier analysis, receiver-operating-characteristic (ROC) curves, and sex-stratified Cox regression models incorporating inverse probability weighting (IPW). Incremental prognostic value beyond EuroSCORE II was assessed by comparing Harrell’s C-statistics of Cox models with and without low HUAC. Results: Patients with low HUAC showed reduced survival at all time points. HUAC measured at TH4 demonstrated higher discriminative ability compared with TH12. In women, TH4 yielded area under the curve (AUC) of 0.773 and 0.807 for 1- and 3-year survival, respectively, compared with 0.670 and 0.640 in men. In sex-specific Cox analyses, women in the lower HUAC-TH4 quartile had markedly increased mortality risk (unweighted HRs 6.6, 9.5, and 6.4 for 1-, 3-, and 5-year follow-up; all p ≤ 0.03), which remained significant after IPW adjustment. In men, the association was weaker and lost significance after weighting. Formal interaction testing demonstrated significant sex × low-HUAC interactions at TH4 for 3- and 5-year mortality (p interaction = 0.046 and 0.045, respectively), whereas no significant interaction was observed at TH12. Addition of low TH4 HUAC to EuroSCORE II improved model discrimination in the overall cohort, with C-statistics increasing from 0.665 to 0.711 at 3 years and from 0.658 to 0.690 at 5 years (both likelihood-ratio p < 0.001); the largest incremental gains were observed in women (ΔC = +0.115 and +0.081, respectively). Conclusions: Low thoracic muscle attenuation, particularly HUAC at TH4, independently predicts long-term mortality after CABG. Formal interaction testing supports an exploratory sex-dependent prognostic association at TH4, with a stronger association of low muscle attenuation with mortality in women than in men. HUAC represents a simple, objective biomarker of physiological reserve that can be derived from existing preoperative CT scans and may enhance individualized risk stratification in contemporary cardiac surgery.

Background and Clinical Significance: We report an exceptionally rare case of mechanical aortic valve replacement necessitated by self-inflicted needle penetration with aortic valve and left ventricular involvement in a patient with recurrent self-harm behavior. Case Presentation: A 24-year-old female with post-traumatic stress disorder and emotionally unstable personality disorder, borderline type, presented with dyspnea two weeks after self-inserting multiple needles into her thorax. Computed tomography revealed a needle lodged in the aortic root and an intramyocardial needle with hemorrhagic pericardial effusion. Emergency sternotomy revealed inflammatory destruction of the right coronary aortic cusp with complete perforation. Following failed reconstruction attempts, mechanical aortic valve replacement was performed. The patient survived the immediate postoperative period but demonstrated recurrent non-adherence to oral anticoagulation, including multiple episodes of over- and under-anticoagulation. More than six years after surgery, she presented with cardiogenic shock due to prosthetic valve thrombosis after discontinuing warfarin for two weeks. Despite venoarterial ECMO and fibrinolytic therapy, she died from refractory left ventricular failure. Conclusions: This case highlights critical challenges in managing patients with severe psychiatric disorders requiring mechanical valve prostheses and suggests that bioprosthetic valves may warrant careful consideration in patients with major concerns regarding long-term anticoagulation adherence.