Laura Rings

Background: Outcome data for the Gemini S bipolar radiofrequency clamp are almost absent; the only indexed report being a three‐patient case series. We describe 1‐year outcomes in a consecutive cohort. Methods: We retrospectively analyzed all consecutive patients treated with the Gemini S clamp between January 2021 and August 2024. Epicardial box isolation was combined with left atrial appendage (LAA) exclusion; completeness was confirmed by entry and exit block on epicardial three‐dimensional mapping. The primary outcome was freedom from AF recurrence at 12 months, on and off antiarrhythmic drugs (AADs) after a 90‐day blanking period. Results: Twenty‐three patients were included (mean age 64.4 ± 8.0 years; 82.6% male). AF was paroxysmal in 34.8%, persistent in 26.1%, and long‐standing persistent in 39.1%; 60.9% had prior catheter ablation and 69.6% had failed or were intolerant to a Class I or III agent. A complete block‐verified box lesion was achieved in 95.7% and LAA exclusion in 91.3%. Three patients (13.0%) required conversion to sternotomy for bleeding, exceeding larger series. There was no death, stroke, phrenic nerve palsy, or pacemaker implantation. At 1 year, 87.0% (95% CI 67.9–95.5) were in sinus rhythm, all off Class I/III AADs. Conclusions: Sinus rhythm was achieved in 87.0% of patients at 1 year. As the largest reported experience with this device, the series provides device‐level evidence where little existed, but it is descriptive, not powered for comparison, and the conversion rate needs confirmation.

Patients with severely impaired left ventricular ejection fraction (LVEF) undergoing surgical coronary revascularization face elevated perioperative risk. We retrospectively analyzed all consecutive patients who underwent off-pump coronary artery bypass (OPCAB) surgery under prophylactic Impella 5.0/5.5 support at a single center between 2020 and 2023. The primary endpoint was 30-day all-cause mortality; secondary endpoints were the change in LVEF to discharge, early graft patency on computed tomography angiography, duration of support, and device- and access-related complications. Twenty-one patients were included. Median age was 63 years (IQR 59–74), 19 (90.5%) were male, and median EuroSCORE II was 10.8% (IQR 7.8–17.8). Median preoperative LVEF was 20% (IQR 20–28). Complete revascularization was achieved in all patients, and none required intraoperative conversion to cardiopulmonary bypass. Median duration of Impella support was 4 days (IQR 2–7). Median LVEF at discharge was 38% (IQR 34–40), with a median within-patient change of +16 percentage points (IQR 10–20). Predischarge computed tomography angiography showed early graft failure in one patient (4.8%). Two patients (9.5%) required postoperative escalation to veno-arterial extracorporeal membrane oxygenation, and 30-day mortality was 4.8% (n = 1). Impella 5.0/5.5-assisted OPCAB appears feasible in selected patients, with a complication profile that warrants further evaluation given the low number of patients enrolled. This uncontrolled series cannot establish a benefit attributable to Impella; prospective controlled evaluation is required.

This study compared surgical aortic valve replacement (SAVR) via partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) with central aortic cannulation regarding intraoperative perfusion parameters, transfusion requirements, and early postoperative outcomes. We retrospectively analyzed 380 patients who underwent isolated SAVR via PUS or RALT. Propensity score matching yielded 107 matched pairs. All patients underwent central aortic and peripheral venous cannulation. Cardiopulmonary bypass, aortic cross-clamp, and total operative times were longer in the RALT group, whereas reperfusion time was shorter (all p < 0.001). Transfusion requirements for packed red blood cells, fresh-frozen plasma, and platelet concentrates did not differ between groups. Cell salvage volume was generally lower in the RALT group after matching. Intubation times were comparable between groups. Intensive care unit (ICU) length of stay and total postoperative hospital stay were shorter in the RALT group (p < 0.001 and p = 0.008, respectively). Peak catecholamine requirements were lower in the RALT group (p = 0.005). Rates of permanent pacemaker implantation and pulmonary, wound, and urinary tract infections did not differ. In-hospital mortality was 0.9% in the PUS group; no deaths occurred in the RALT group. Both approaches achieved low in-hospital mortality and comparable complication rates. Despite longer operative times, RALT was associated with shorter ICU and hospital stays and lower vasopressor requirements. RALT with central aortic cannulation is a safe and feasible alternative to PUS for minimally invasive aortic valve surgery.

Aortic aneurysms are complex, predominantly asymptomatic vascular diseases with distinct incidence patterns depending on anatomical localisation. The incidence of thoracic aortic aneurysms (TAAs) has moderately increased, whereas that of abdominal aortic aneurysms has declined, primarily due to public health measures. Undiagnosed or poorly managed aneurysms are at significant risk of progression to acute aortic syndrome, with high associated mortality. The embryological origins of the aorta may have a substantial impact on its structural, cellular, and functional heterogeneity. Specifically, smooth-muscle cells (SMCs) in the thoracic aorta are derived from cardiac neural crest and mesodermal cells, whereas abdominal aortic SMCs originate from the paraxial and splanchnic mesoderm. To explore these developmental and regional distinctions, we conducted a narrative review based on targeted literature retrieval and expert curation, highlighting how these distinctions might potentially influence susceptibility to aneurysms and their clinical presentation. Histological differences, such as the number of lamellar units and the presence or absence of vasa vasorum, could further explain regional vulnerability. Molecular mechanisms underlying aneurysm formation include inflammation, oxidative stress, extracellular matrix degradation, phenotypic switching, and dysregulated signalling pathways, notably transforming growth factor-beta (TGF-β) and angiotensin II. Genetic mutations significantly contribute to TAAs, with genes involved in the elastin–contractile unit and TGF-β signalling pathways playing pivotal roles. However, the complex interplay between genetic susceptibility and risk factors explains why some patients develop aneurysms while others do not. Clinical management strategies have evolved, emphasising early risk stratification, surveillance, and timely surgical intervention, guided increasingly by genetic profiling and segment-specific molecular understanding. Advances in genomic technologies, biomarker identification, and computational modelling promise to enhance individualised care. Bridging developmental biology, molecular genetics, and clinical practice is crucial for improving outcomes in patients with aortic aneurysms, thereby reinforcing a multidisciplinary approach to patient-centred cardiovascular medicine.

Lactate dehydrogenase (LDH) is a standard postoperative marker for hemolysis in the presence of paravalvular leakage (PVL) after replacement of the aortic valve (AVR). LDH is elevated in certain valves by a fluttering phenomenon. Previous studies suggested a correlation between microparticles (MPs) and LDH elevation after AVR. Thus, we analyze the postoperative relevance of LDH after AVR with transapical transcatheter aortic valves (TA-TAVs) or rapid deployment valves (RDVs). We retrospectively analyzed the data from patients who received an AVR with the RDV and TA-TAV groups between 2015 and 2018. We compared PVL and LDH levels before and after surgery, transvalvular gradients, heart block that required pacemaker implantation, and 30-day mortality. In total, 138 consecutive patients were selected for the study: 79 patients in the RDV group (37 Sorin Perceval valve, 42 Edwards Intuity valve) and 59 in the TA-TAV group (Edwards Sapien valve). TA-TAV group was older (median 10 years) and had a higher incidence of PVL (odds ratio 11, 95% confidence interval [CI] 2.5–73.2, p = 0.04)). Interestingly, the TA-TAV group showed lower levels of LDH despite higher rates of PVL. Of note, the Perceval valve trended toward higher LDH values. Additionally, the RDV group showed an increased arrhythmia profile (p = 0.0041); however, the results show lower incidence in pacemaker implantation (95% CI 0.05–1.65, p = 0.635). The 30-day mortality was similar between groups. Our data do not support the association between hemolysis and PVL despite elevated LDH in suture-free valves. Our results suggest that LDH could be a marker of extreme heart muscle output or fluttering phenomenon and not a marker of hemolysis after sutureless AVR.