Matthias Thielmann

Background: Despite several registries explored sex differences in patients underwent acute myocardial infarction (AMI), data concerning mechanical complications following AMI are still to be described. Aims: We aimed to investigate sex-related differences in the outcomes following surgical treatment for post-acute myocardial infarction mechanical complications. Methods and Results: Using the CAUTION study database, we examined sex differences patients with post-infarction mechanical complications undergone surgical treatment. The primary outcome was in-hospital mortality. Secondary outcomes included long-term mortality, between sex differences in characteristics, and predictors of in-hospital and overall mortality for either sex group. From a total of 805 patients, women (34.9%) were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02–1.06, P < .001], were more likely to have diabetes mellitus (OR 1.59, 95% CI 1.05–2.43, P = .031), more often presented with anterior myocardial infarction (OR 0.50, 95% CI 0.33–0.74, P = .001) and had higher in-hospital mortality (OR 1.75, 95% CI 1.02–3.02, P = .044) than men. Overall, the median follow-up period was 3.6 years. Survival rates at 1, 5, and 10 years were 50.2%, 45.7%, and 39.4% for women, and 59.1%, 52.7%, and 44.7% for male patients, respectively (log-rank P = .035). Long-term survival of hospital survivors stratified by gender at 1-, 5-, and 10-year survival was 84.5%, 76.9%, and 66.4% for women, and 85.8%, 76.7%, and 65.0% for men, respectively (log-rank P = .901). Conclusions: Women have higher in-hospital mortality rate and worse overall survival than men after surgical treatment for post-infarction mechanical complications.

Introduction: Blood purification techniques are being investigated as adjunctive options in critically ill patients not only to treat severe inflammation but also to remove harmful substances such as myoglobin in rhabdomyolysis. Yet, the available evidence is limited, and further research is needed to clarify their clinical benefits. Methods: The international prospective COSMOS Registry (NCT05146336, 23 Nov 2021) tracks CytoSorb® (CS) utilization patterns and outcomes in critical care settings. Clinical assessment was performed before, during, and after CS treatment, with a 90-day follow-up. Device-related adverse effects were reported by investigators as the safety evaluation. Data were analyzed according to a pre-specified statistical plan using descriptive statistics and paired tests to compare pre- and post-treatment values, with subgroup and safety analyses performed. Results: A total of 300 adult patients (30.3% female, mean age 59 ± 15 years) from 22 sites were included in this analysis. The most common indications for CS therapy (multiple indications possible per patient) were septic shock (48.3%), rhabdomyolysis (12.8%), cardiogenic shock (11.5%), liver failure (11.5%), and acute respiratory distress syndrome (ARDS; 5.0%). On average, each patient received 3.3 ± 3.3 adsorbers, with 27.9% of patients receiving 4 or more adsorbers. CS was integrated in conjunction with kidney replacement therapy (75.6%), standalone hemoperfusion (7.1%), intermittent hemodialysis (IHD; 10.6%), extracorporeal membrane oxygenation (ECMO; 3.9%), and sustained low-efficiency daily dialysis (SLEDD; 4.9%). At baseline, median (interquartile range, IQR) APACHE II and SOFA scores were 24 [18, 30] and 12 [9, 15], respectively. Fluid balance improved from +1675 [141, 3348] mL pre-CS to +115 [−1100, 1495] mL post-CS, and norepinephrine requirements decreased from 0.21 [0.09, 0.40] µg/kg/min to 0.08 [0.02, 0.22] µg/kg/min ( p < 0.0001 for both). Ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (P/F ratio) improved from 120 [72, 208] to 176 [115, 255] ( p < 0.0001). Platelet counts decreased from 123 [76, 185] to 72 [42, 118] × 10 ⁹ /L ( p < 0.0001), while albumin levels remained stable from 2.6 [2.3, 3.1] to 2.5 [2.3, 3.0] g/dL ( p = 0.112). ICU mortality was 33.1%, which was lower than mortality estimates historically associated with comparable APACHE II and SOFA scores. No serious adverse effects related to the device or device deficiencies were reported. Conclusions: Real-world CytoSorb® use as part of standard care in critically ill patients was associated with improvements in several clinical and laboratory parameters; however, these findings should be interpreted cautiously given the observational design and absence of a control group. Observed mortality was lower than mortality estimates historically associated with established severity scores.

Objective: False lumen (FL) thrombosis plays a key role in aortic remodeling after Frozen Elephant Trunk (FET) surgery, yet current imaging assessments are limited to categorical classifications. This study aimed to evaluate an unsupervised artificial intelligence (AI) algorithm based on a variational autoencoder (VAE) for automated, continuous quantification of FL thrombosis using serial computed tomography angiography (CTA). Methods: In this retrospective study, a VAE model was applied to axial CTA slices from 30 patients with aortic dissection who underwent FET surgery. The model encoded each image into a structured latent space, from which a continuous “thrombus score” was developed and derived to quantify the extent of FL thrombosis. Thrombus scores were compared between postoperative and follow-up scans to assess individual remodeling trajectories. Results: The VAE successfully encoded anatomical features of the false lumen into a structured latent space, enabling unsupervised classification of thrombus states. A continuous thrombus score was derived from this space, allowing slice-by-slice quantification of thrombus burden across the aorta. The algorithm demonstrated robust reconstruction accuracy and consistent separation of fully patent, partially thrombosed, and completely thrombosed lumen states without the need for manual annotation. Across the cohort, 50% of patients demonstrated an increase in thrombus score over time, 40% a decrease, and 10% remained unchanged. Despite these individual differences, no statistically significant change in overall thrombus burden was observed at the group level (p = 0.82), emphasizing the importance of individualized longitudinal assessment. Conclusions: The VAE-based method enables reproducible, annotation-free quantification of FL thrombosis and captures patient-specific remodeling patterns. This approach may enhance post-FET surveillance and supports the integration of AI-driven tools into personalized aortic imaging workflows.

Objectives: Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear. Methods: Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors. Results: The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001). Conclusions: MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival. Clinical Registration Number: Clinicaltrials.gov, NCT03848429.

New technologies enabling access to high-sensitivity cardiac troponin (hs-cTn) assays at the point of care (POC) are available for routine use. POC technology can accelerate cardiac troponin testing within the hospital setting and support testing in other healthcare environments. Pre-analytical and analytical issues unique to POC testing are discussed. The opportunities and the evidence needed to support the routine use of hs-cTn POC assays in clinical care are outlined. Based on recent developments, the potential impact of hs-cTn at the POC in multiple clinical settings is described, and a roadmap of the steps required for successful implementation is provided.

The 72nd Annual International Congress of the European Society for Cardiovascular and Endovascular Surgery (ESCVS) 2024 in Istanbul, Turkey, marks a significant milestone in the advancement of cardiovascular surgery. As the main event in the cardiovascular surgery community calendar, this congress serves as a platform for leading experts, clinicians, and researchers to exchange information on the latest innovations, research results, and clinical procedures. This dedicated supplement to Proceedings provides a curated collection of abstracts presented at the congress, highlighting breakthrough contributions and fostering collaboration across the European and global cardiovascular surgery communities. The topics presented in this supplement represent a wide range of innovative advances in the fields of both cardiovascular and endovascular surgery. These include novel and minimally invasive surgical techniques, technological innovations, updates to clinical recommendations and guidelines, and new therapeutic strategies and procedures. Through the knowledge conveyed in these abstracts, the congress aims to advance the continuous evolution of patient care and outcomes in cardiac and vascular surgery. By showcasing the vibrant research and collaborative spirit of the ESCVS, this supplement provides valuable insights into the future directions of the field, emphasizing the importance of interdisciplinary approaches and innovation in addressing the complexities of cardiovascular disease. As cardiovascular care continues to evolve, the research and discussions presented at this congress will play a critical role in shaping the next generation of cardiac and vascular surgeons, promoting better patient outcomes, and improving the overall quality of cardiovascular health in Europe and worldwide.

Objective: To develop an unsupervised artificial intelligence algorithm for identifying and quantifying the presence of false lumen thrombosis (FL) after Frozen Elephant Trunk (FET) operation in computed tomography angiographic (CTA) images in an interdisciplinary approach. Methods: CTA datasets were retrospectively collected from eight patients after FET operation for aortic dissection from a single center. Of those, five patients had a residual aortic dissection with partial false lumen thrombosis, and three patients had no false lumen or thrombosis. Centerlines of the aortic lumen were defined, and images were calculated perpendicular to the centerline. Lumen and thrombosis were outlined and used as input for a variational autoencoder (VAE) using 2D convolutional neural networks (2D CNN). A 2D latent space was chosen to separate images containing false lumen patency, false lumen thrombosis and no presence of false lumen. Classified images were assigned a thrombus score for the presence or absence of FL thrombosis and an average score for each patient. Results: Images reconstructed by the trained 2D CNN VAE corresponded well to original images with thrombosis. Average thrombus scores for the five patients ranged from 0.05 to 0.36 where the highest thrombus scores coincided with the location of the largest thrombus lesion. In the three patients without large thrombus lesions, average thrombus scores ranged from 0.002 to 0.01. Conclusions: The presence and absence of a FL thrombus can be automatically classified by the 2D CNN VAE for patient-specific CTA image datasets. As FL thrombosis is an indication for positive aortic remodeling, evaluation of FL status is essential in follow-up examinations. The presented proof-of-concept is promising for the automated classification and quantification of FL thrombosis.