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.

Objective: The role of the frozen elephant trunk technique in the treatment of acute aortic dissections is currently based on results from high-volume centers only. We investigated the patient selection process, intraoperative data, the evolution of surgical practice and outcomes from a low-volume center. Methods: A retrospective analysis was conducted on 202 acute aortic dissection (AAD) patients treated between October 2014 and December 2023. Patients were categorized into those receiving less invasive open aortic repair (group 1, n = 136) and those undergoing frozen elephant trunk procedures (FETs) (group 2, n = 66). Data on demographics, surgical procedures, and outcomes were analyzed. Results: Overall 30-day mortality was 16% (13% vs. 23%; p = 0.068). Rates of postoperative disabling stroke were similar (9% vs. 8%, p = 0.190). FET procedures required longer cardiopulmonary bypass (195 min vs. 234 min, p = 0.011), hypothermic circulatory arrest (26 min vs. 43 min, p < 0.001), and selective cerebral perfusion times (26 min vs. 47 min, p < 0.001). Follow-up indicated that 17% of FET patients received completion thoracic endovascular aortic repair (TEVAR) versus 4% in non-FET patients (p = 0.002), whereas no difference was seen in open surgical reintervention. Median follow-up at 33 months showed an overall mortality of 27%, with no significant difference between groups (23% in group 1 vs. 35% in group 2, p = 0.123). Conclusions: The FET technique is feasible in low-volume centers, yielding outcomes comparable to high-volume centers. FET proximalization and a liberal use of extra-anatomical left subclavian artery (LSA) grafts ease the learning curve. Completion treatments can be effectively conducted following FET implantation to further induce positive aortic remodelling.

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.