Carotid artery atherosclerosis or stenosis is frequently present at the carotid bifurcation or the internal carotid artery, accounting for at least 20% of all ischemic strokes. High levels of serum total cholesterol and low-density lipoprotein cholesterol are established risk factors for genesis and progression of atherosclerotic lesions through various mechanisms. In addition, accumulating evidence has shown that a high level of triglyceride is associated with increased atherosclerosis risks. The so-called “vulnerable plaque” with a large lipid core, thin fibrous cap and intra-plaque hemorrhage tends to cause subsequent thromboembolic ischemic events. Statins are known not only to lower serum cholesterol levels but also to promote plaque stabilization via pleiotropic effects such as reducing subclinical systemic inflammation, endothelial activation, leukocyte intra-plaque infiltration, and increasing intimal smooth muscle cell migration. This article discusses the mechanisms of atherosclerosis formation induced by dyslipidemia and the role of lipid-lowering agents including statins in patients with symptomatic and asymptomatic atherosclerotic carotid artery stenosis.

High-density lipoprotein (HDL) plays a major role in reverse cholesterol transport (RCT) but also exhibits, anti-inflammatory, endothelial/vasodilatory, anti-thrombotic, antioxidant, anti-aggregating, anticoagulant and cytoprotective functions, which enhance its protective effect against cardiovascular disease. However, the function of HDL is dependent upon genetic, environmental and lifestyle factors. Modification of the protein or lipid components of HDL in certain conditions may convert the HDL particles from anti-inflammatory to pro-inflammatory and pro-atherogenic by limiting their ability to promote RCT and to prevent LDL modification. In our review, we will present the clinical and scientific data pertaining to the factors and conditions that impair HDL functionality and we will discuss the effects of dysfunctional HDL on atherogenesis.

Lipid accumulation in cells of subendothelial intima and the formation of foam cells is the earliest and the most noticeable manifestation of atherosclerosis at the cellular level. Generally, the foam cell formation is the result of interaction of cell with pro-atherogenic low-density lipoprotein providing cholesterol delivery and anti-atherogenic high-density lipoprotein providing its efflux. In this review, we discuss possible mechanisms of foam cell formation, the role of intracellular lipid deposition as a trigger of atherosclerotic lesion development, current approaches to diagnostics and strategies for preventing atherosclerosis based on recent knowledge of causes of foam cell formation.

Aortic valve stenosis is the most clinically relevant valvular heart disease in the elderlies. Surgical aortic valve replacement (SAVR) represented, for decades, the standard of care for the treatment of severe aortic stenosis. Although SAVR still represents a valid option in this clinical scenario, transcatheter aortic valve implantation proved to be superior to medical therapy and comparable to SAVR in several randomized trials in patients at high or intermediate operative risk. At the same time, the growing aging population carrying on greater morbidities and high risk profiles has led to the development of minimally invasive technologies, as rapid deployment aortic valve replacement or Sutureless, to minimize surgical impact on patients. The Heart Team is nowadays tasked to determine the best option tailored for each patient considering patient-related factors and mastering all the surgical options in terms of both different techniques and types of available valves. Nevertheless, some open issues need to be already answered as: which has the longest durability, which the lower complication rate and the lower overall mortality. The aim of this review is to briefly resume the main features of these different options and explore what kind of open questions these newer-generation prosthetic valves and delivery devices carry.

Aim: In left ventricular hypertrophy (LVH), the heart muscle thickens. One third of individuals with LVH never complain of heart problems. However, such patients have a high risk of sudden death. LVH can be caused by arterial atherosclerotic lesions. The linkage of mtDNA mutations 652insG, m.5178C>A, m.3336T>C, m.14459G>A, 652delG, m.14846G>A, m.1555A>G, m.15059G>A, m.3256C>T, m.12315G>A and m.13513G>A with atherosclerosis was described earlier by our laboratory. The aim of the study was to analyze the linkage of these mtDNA mutations with LVH.

Methods: DNA from white blood cells was isolated using a phenol-chloroform method. PCR-fragments of DNA contained the region of the investigated mutations. The heteroplasmy level of mtDNA mutations was analyzed using a pyrosequencing-based method developed by our laboratory.

Results: We investigated two groups of individuals. One hundred and ninety-four patients with LVH. Two hundred and ten were conventionally healthy. It was found that mtDNA mutation m.5178C>A was significantly associated with LVH. Single nucleotide replacement m.1555A>G was associated with LVH at the level of significance P ≤ 0.1. At the same time m.12315G>A and m.3336T>C were significantly associated with the absence of this pathology. Single nucleotide replacement m.14459G>A was associated with the absence of LVH at the significance level P ≤ 0.1.

Conclusion: MtDNA mutations m.5178C>A and m.1555A>G can be used for molecular genetic assessment of the predisposition of individuals to the occurrence of left ventricular hypertrophy. They can also be used for the family analysis of this pathology. Mutations m.12315G>A, m.3336T>C and m.14459G>A can be used in the development of LVH gene therapy methods.

During pregnancy, physiologic hormonal changes provoke a significant increase in triglyceride levels. Genetic abnormalities of triglyceride metabolism and secondary factors may multiply the risk of severe lipid abnormalities. Although severe gestational hypertriglyceridemia can be a life-threatening condition for both mother and fetus, its optimal treatment has not been fully clarified. A 33-year-old woman at 37 weeks of her second pregnancy was admitted to our clinic. Her triglyceride level was 57.8 mmol/L. Abdominal pain, nausea, vomiting or any other complaints were not reported. She kept a fat-restricted diet, however her triglyceride level remained 41 mmol/L. Therefore we decided to perform plasmapheresis with a replacement of human albumin as a colloidal solution. Complications did not occur during the treatment. Plasmapheresis reduced her triglyceride level by 54.1% (to 18.8 mmol/L), and the patient delivered a healthy female neonate at 40 weeks. In case of significantly increased values, plasmapheresis is a fast, effective and safe method for decreasing triglyceride level even in the third trimester.

Type 2 diabetes mellitus characterized by chronic hyperglycaemia is caused by insulin resistance and β-cell dysfunction. Glycogen accumulation, due to impaired metabolism, contributes to this “glucotoxicity” via dysregulated biochemical pathways promoting β-cell dysfunction. Thus, long-term exposition of insulin-secreted cells or isolated islets together with increased free fatty acids (FFA) and glucose levels can cause insulin-induced glucose secretion depression, damage to insulin gene expression and apoptotic death of cells. It is known that, the main regulator of pancreatic β-cells functioning and regulator of insulin gene expression, synthesis and secretion of insulin is glucose. Glucose enters cells and progressively metabolizes, in particular, to pyruvate in a cycle of tricarboxylic acids, subjected to oxidative phosphorylation, during which formed adenosine triphosphate and reactive oxygen radicals (ROS). Although, when more glucose enters the cell, there are other ways in which extra glucose can be transferred to reserve and of the glucose molecules can form ROS. The release of excessive amounts of FFA leads to lipotoxicity, as lipids and metabolites produce ROS in the endoplasmic reticulum and mitochondria. This affects both adipose and non-fat tissue, making up its pathophysiology in many organs. This overview demonstrates that the insulin gene is expressed in pancreatic β-cells. Glucose is the main physiological regulator of insulin gene expression. It controls the effect of transcription factors, insulin mRNA stability, and transcription rate. Glucolipotoxicity mechanisms affect the transcription factors MafA and PDX-1. Important is the β-cells damaging, which is connected with the oxidative stress and the synthesis of ceramides.

Aim: Cardiac angina is a disease in which discomfort or retrosternal pain may occur. Atherosclerosis of coronary arteries is one of the main risk factors for cardiac angina. The aim of the investigation was to analyze the association of 11 mitochondrial genome mutations with cardiac angina. In our preliminary studies an association of these mutations with atherosclerosis, a risk factor for cardiac angina, was found.

Methods: We used samples of white blood cells collected from 192 patients with cardiac angina and 201 conventionally healthy study participants. DNA from blood leukocyte samples was isolated using a phenol-chloroform method. DNA amplicons containing the investigated regions of 11 mitochondrial genome mutations (m.12315G>A, m.652delG, m.5178C>A, m.14459G>A, m.3336T>C, 652insG, m.3256C>T, m.1555A>G, m.15059G>A, m.13513G>A, m.14846G>A) were pyrosequenced. The heteroplasmy level of mitochondrial DNA (mtDNA) mutations was analyzed using a method developed by our laboratory on the basis of pyrosequencing technology.

Results: According to the obtained data, three mitochondrial mutations of human genome correlated with cardiac angina. A positive correlation was observed for mutation m.14459G>A (P ≤ 0.05). One single nucleotide substitution m.5178C>A (P ≤ 0.1) had a trend for positive correlation. A negative correlation for mutation m.15059G>A with cardiac angina (P ≤ 0.05) was found.

Conclusion: MtDNA mutations m.14459G>A and m.5178C>A can be used for evaluation the predisposition of individuals to atherosclerotic lesions. At the same time, mitochondrial genome mutation m.15059G>A may be used for gene therapy of atherosclerosis.

Aim: To assess the safety and efficiency of H.E.L.P.-apheresis and cascade lipid-filtration in the treatment of severe lipid disorders in high-risk patients.

Methods: From 2016 to 2018 we observed 6 patients hyperLDLemia and high Lp(a)emia (> 60 mg/dL). The first group with H.E.L.P.-apheresis (n = 74 sessions) included 3 patients who underwent revascularization (coronary, femoral arteries). In the second group with cascade lipid-filtration (n = 92 sessions) - one patients underwent revascularization, two patients received drug therapy. Despite the lipid-lowering conventional therapy, no targeted low density lipoprotein (LDL) was obtained.

Results: The patients of the 1st group had threefold decrease of LDL, in patients of the 2nd group LDL decreased by 68%. At the same time, in both groups, we noted a decrease in Lp(a) after the procedure by 65%-68%. Despite a decrease in high density lipoprotein (by 22%-29%) after lipid apheresis procedures, there was a positive trend in apoB100/apoA index (a decrease of 33% after HELP-apheresis procedures and 60% after cascade lipid-filtration) and a decrease in atherogenic index (38% and 53%, respectively). The changes in hematological and haemostatic parameters remained within physiological intervals.

Conclusion: We noticed the successful application of lipid apheresis in patients with multifocal atherosclerosis and its complications.

Circulating monocytes are recruited to tissues, where they differentiate to macrophages and take part in the inflammation process or tissue remodeling. According to the traditional concept, macrophages are classified into pro-inflammatory (M1), non-activated (M0) or anti-inflammatory (M2) subsets that play distinct roles in the initiation and resolution of inflammation. This heterogeneity exists already at the monocyte level since monocytes can also belong to pro- or anti-inflammatory phenotypes. Growth factors, such as granulocyte-macrophage colony-stimulating factor (GM-CSF) and M-CSF play a principal role in their activation: GM-CSF drives the differentiation of “pro-inflammatory” monocytes to M1 macrophages, while M-CSF regulates differentiation of the “anti-inflammatory” subset of monocytes to M0 macrophages that have M2-like phenotypic and functional properties. More recent experimental findings led to a substantial update of monocyte-macrophage nomenclature to include the nature of the polarizing signal. In response to pro-inflammatory stimuli, monocytes can be directly polarized into 3 subsets of macrophages with the pro-inflammatory M1-like phenotype; with macrophages induced by interferon-γ having the strongest pro-inflammatory properties. When exposed to various anti-inflammatory stimuli, monocytes can differentiate to at least 5 subsets of M2-like macrophages. Of those, a subset generated under exposure to IL-4 (IL-13) has the most typical M2-like characteristics. Both in humans and in mice, monocyte-to-macrophage differentiation involves global transcriptome changes that are tightly controlled by various transcriptional regulators and signaling mechanisms. In this review, we discuss monocyte-macrophage heterogeneity and signaling pathways regulating the differentiation at transcription level.

Percutaneous coronary interventions (PCI) in chronic total occlusion (CTO) have been for long time considered as “last frontier” in interventional cardiology. Among the different subset of complex targets for PCI, CTO lesions represent a challenge for the interventional cardiologist. CTO techniques and devices have evolved in last few years together with the training of specialized interventional cardiologist in such complex field. All these factors have markedly increased procedural success of CTO procedures and have the potential to be applied in other settings. In this paper, we provide an update on the technical aspects and the devices developed for CTO PCIs that can be applied in complex PCI on non-CTO lesions.

Aim: This paper aims to evaluate the effectiveness of MitraClip implantation as a solution to severe mitral regurgitation (MR) in the case of posterior leaflet prolapse due to hypertrophic obstructive cardiomyopathy and chordae rupture.

Methods: NX CAD software was used to create a surface geometric model for the mitral valve (MV). A hyperelastic material model, calibrated against experimental results, was used to describe stress-strain responses of the MV leaflets, and a spring element approach was used to describe chordae response. Abaqus CAE was employed to create a finite element model for diseased MV suffering from MR. The effectiveness of MitraClip implantation on valve function was investigated by simulating the deformation of diseased valve, with and without MitraClip repair, during peak systole and diastole. Leaflet deformation and stress distributions were used to assess the effectiveness of the procedure.

Results: Overall, significant improvement was achieved for the diseased valve after MitraClip implantation. Prior to the introduction of the clip, the diseased valve was subjected to posterior leaflet prolapse which would induce a jet of MR. Once the MitraClip was included in the simulation, the valve leaflets were able to close and seal off, almost entirely at peak systolic condition without a significant impact on the stress distribution of the valve leaflets.

Conclusion: The results in this study provide further evidence to support MitraClip repair as a viable treatment for high-risk patients suffering from severe MR, and also highlight the need for further research into such an advanced, minimally invasive surgery technique.

Aim: This study was undertaken to explore the relationship between metabolic syndrome (MetS) and atherosclerosis-related mitochondrial DNA (mtDNA) mutations, since MetS shares conventional and genetic risk factors with atherosclerosis.

Methods: The study involved 220 participants; the carotid ultrasonography followed by intima-media thickness (cIMT) measurement was used for quantitative diagnostics of carotid atherosclerosis. The diagnosis of MetS was set according to International Diabetes Federation criteria (IDF-2009). The level of mtDNA heteroplasmy in leukocytes was determined by qPCR. The severity of MetS was estimated on combination of serum HDL cholesterol, triglycerides and fasting glucose, systolic and diastolic blood pressure, and waist circumference measurements.

Results: MetS was present in 44 study participants. Ten mtDNA mutations were tested, and m.3336T>C and m.652delG heteroplasmy levels correlated with the clusterization of MetS symptoms, in particular the cardiovascular and metabolic risk factors, of triglyceride and fasting glucose levels. The other mtDNA mutations each only correlated with one symptom (i.e., m.652delG and m.12315G>A-with triglycerides; m.3256C>T, m.1555A>G, and m.15059G>A-with systolic blood pressure; m.14846G>A-with fasting glucose). There was no correlation between integral severity of MetS and cIMT.

Conclusion: In this study, the MetS phenotype was not explained directly by atherosclerosis-related mtDNA variants. It is possible to hypothesize that mtDNA-related mechanisms in atherosclerosis and MetS may be different, in spite of the similarity of several phenotypic characteristics.

Aim: To explore whether geographical location, genetic and environmental factors are associated with carotid atherosclerosis in high-risk individuals.

Methods: In Moscow 470 apparently healthy, asymptomatic volunteer subjects with a high cardiovascular disease risk were recruited to participate in a cross-sectional study. Carotid intima-media thickness (cIMT), a validated biomarker for present and future cardiovascular disease risk, was assessed by means of high resolution ultrasound scans in subjects.

Results: The total burden of conventional cardiovascular risk factors explained 21% of the cIMT variability; the mutational burden of mitochondrial genome defined by heteroplasmic mutations m.652delG, m.3256C>T, m.13513G>A, m.14459G>A, and m.15059G>A independently explained 23% variability; the combination of conventional and genetic risk factors increased explanatory level to 36%. Further exploratory statistical analyses showed air pollution as an independent risk factor for cIMT.

Conclusion: In our study we confirmed and expanded the existence of a European geographic gradient of atherosclerosis risk and its association with cardiovascular disease risk. Geographical, environmental (particularly, air pollution) - and genetic risk factors (particularly, mutant variants of mitochondrial genome) may interplay in the formation of susceptibility to atherosclerosis.

Aim: To determine the lipid profile patterns in children with different types of glycogen storage disease (GSD).

Methods: The study included 62 children with GSD (43 boys, 19 girls), mean age 8.29 years. All patients underwent anthropometry, assessment of physical development, lipid profile analysis.

Results: The children were divided into three groups depending on the type of GSD. Nineteen children (31%) had type I GSD (Group 1), 16 (26%) - type III (Group 2) and 27 (43%) - types VI and IX (Group 3). Dyslipidemia of varying severity was more specific to patients with type I and III GSD. Higher levels of triglycerides were associated with type I GSD, while higher levels of LDL cholesterol were common to type III GSD (P < 0.05) No changes in the lipid profile were observed in 18 (29%): one with type I, 4 with type III, and 13 with types VI and IX.

Conclusion: Lipid metabolism disorders were detected in 71% of children with GSD, especially with types I and III. The elevated levels of total cholesterol and LDL cholesterol are associated with the early progression of atherosclerosis and an increased cardiovascular risk in the general population. But there is a lack of evidence of a link between lipid metabolism disorders detected in childhood and an increased risk of cardiovascular diseases in patients with GSDs. More studies needed to investigate this issue.

The use of three-dimensional echocardiography, both in the clinical cardiology and perioperative settings, has increased thanks to its ability to add important information to the standard bi-dimensional exam and to evaluate structures without geometric assumptions. Both real time three dimensional (3D) transesophageal echo and offline quantitative measurements from 3D acquisitions have become integral for qualitative and quantitative analysis of structures and for surgical and procedural guidance. This review aims to provide an overview on the applications of 3D echo, with particular reference to the perioperative settings.

Cardiovascular diseases remain the main cause of death and morbidity in women. Despite the active preventive measures and the reduction in the total number of morbidity and mortality rates, the rate of cardiovascular morbidity remains high in the population, moreover cardiovascular morbidity is increased in women of 35-54 years. Cardiovascular morbidity has several unique characteristics for women; pregnancy, gestational hypertension, preeclampsia/eclampsia are gender-specific risk-factors for further cardiovascular morbidity in women, it's possible to detect these risk-factors in younger age groups and start prevention as early as possible. Arterial hypertension, which is characterized by genetic polymorphism, is an important and a powerful risk factor for development of both acute and chronic cardiovascular diseases; association of arterial hypertension with different metabolic disorders suah as metabolic syndrome, diabetes seems particularly dangerous in pregnancy in terms of peri-pregnancy and life-long morbidity. Preeclampsia shares some common features with atherogenesis and metabolic changes and atherogenesis and metabolic changes, so presence of hypertension during pregnancy increases the risk of cardiovascular diseases and diabetes later in the life. Is pregnancy revealing or predisposing factor of development cardiovascular diseases is not still clear and to answer these questions more and more studies are required.

In recent times the outcome of chronic total occlusion (CTO) percutaneous coronary interventions (PCI) in dedicated centers has steadily gained high success rate (> 80%) and low rate of coronary complications. Nevertheless comparing with non-CTO PCI the complications rate is higher, due to the higher lesion and technical complexity. Among the complications Type III coronary perforations remain the most troublesome events of CTO PCI and still carry a significant risk of death for the patients. The management of Type III coronary perforations has been extensively described as a flow chart of interventions and techniques to obtain rapid cessation of the blood extravasation and sealing of the ruptured vessel. Several techniques have been described to obtain bleeding cessation also in small vessel (< 2 mm) perforations.In this paper we will describe two cases of CTO PCI with Type III small vessel coronary perforations treated with percutaneous Cyanoacrylate/(NBCA-MS)-based glue infusion through a conventional CTO microcatheter. This technique is fast and straightforward and can be applied to any conventional CTO microcatheter.

We describe a right coronary artery (RCA) chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedure in a very high risk patient, in whom a complex PCI with the support of Impella CP device plus Rotablator rotational atherectomy was performed 6 months ago to revascularize a very calcified left anterior descendent. This was an unusual approach because it was performed through a very rare connection by retrograde technique. It was performed through a third distal septal branch connecting with the moderator band artery. Reverse controlled antegrade and retrograde tracking technique was then successfully performed. After RCA CTO PCI, there was an improvement in the patient symptoms and quality of life. This case highlights the important role of this unusual and rare source of collateral circulation in RCA CTO.

The increasing number of minimally invasive procedures prompted the quest for a simple and effective single shot cardioplegia to allow the surgeons to focus on their workflow. The originally pediatric Del Nido solution was successfully tested in several centers and gradually extended to regular coronary and valvular cases. In the present review we report the current evidence on the use of the Del Nido solution in adult patients.

Choice of conduit remains the Achilles heel of coronary artery bypass grafting. Conduit choice is crucial as it is deemed to influence the long-term outcomes. While the important survival advantage of a left internal mammary artery graft over vein grafts is universally accepted, controversy reigns supreme regarding the next best conduit. There is plenty of evidence to suggest that arterial grafts are not only superior in terms of patency and survival, but they also protect the native coronary arteries against further progression of atherosclerotic disease. Total arterial coronary grafting, utilizing various configurations of bilateral internal mammary arteries, radial artery and occasionally right gastroepiploic artery is a safe and reproducible strategy. However, concerns about additional operative time, enhanced technical complexity, graft spasm with hypoperfusion, competitive flow, increased risk of bleeding, deep sternal wound infection, and most importantly lack of randomized trial data have prevented the universal adoption of total arterial coronary grafting. This review evaluates the currents outcomes of total arterial coronary grafting and summarizes the concerns and controversies associated with this strategy.

The potential role of fractional flow reserve (FFR) in coronary artery bypass grafting (CABG) planning and post-CABG patency assessment are currently under intense investigation to determine whether the favourable outcomes reported with FFR-guided percutaneous coronary intervention can be translated to surgical practice. This review provides an overview of the principles that guide FFR measurement, the clinical evolution of FFR in CABG practice, the much anticipated outcomes of recent investigations that compare FFR-guided and angiography guided CABG and outlines the potential of alternative technology that may assist in ensuring ongoing improvement in surgical revascularization outcomes.

Coronary artery bypass surgery is recommended for the patients with symptomatic coronary artery disease or patients having critical left main trunk stenosis. From the inception of the procedure it has undergone several modifications during different time periods evolving into the safe, durable and effective procedure that is to-day. Complete myocardial revascularization (CR) restores blood supply to all the territories in the myocardium that are ischemic because of narrowed blood vessels. Earlier clinical studies from the1980s showed that patients who had CR had better quality of life free of angina with less major adverse coronary events and had survival benefit when followed at 5 years and 10 years compared to the patients who had incomplete myocardial revascularization. According to the coronary artery surgery study registry the benefit is more pronounced when patients had severe triple vessel disease, class III-IV angina and decreased ejection fraction.

Chronic total occlusions (CTO) are frequently encountered during coronary angiography, and are generally regarded as the most challenging coronary lesions for percutaneous coronary intervention (PCI). Despite great technical advancements and greatly improved reported procedural success rates during previous years, data on clinical benefit of these procedures still remain scarce and controversial. Data from observational trials suggested that PCI for CTO could be linked to improvements both in symptoms and hard cardiovascular outcomes, while randomized controlled trials showed symptomatic improvement only, without improvement in patient’s prognosis. This is in parallel with findings for non-CTO PCI in patients with stable angina. Having in mind complexity of these interventions, high costs, greater volume of contrast, and radiation exposure, appropriate patient selection is crucial for optimizing treatment effectiveness. There are few important factors that should be taken into consideration before planning and attempting PCI for CTO. These are: severity of patient’s symptoms despite optimal medical therapy, presence of inducible myocardial ischemia and/or viability in the territory of occluded coronary artery.

Aim: Traditionally, transcatheter aortic valve implantation (TAVI) was performed under general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE). Recently, minimalist TAVI with monitored anesthesia care (MAC) and transthoracic echocardiography (TTE) has gained popularity. However, TTE imaging quality may be suboptimal compared to TEE and may increase the risks of paravalvular leak (PVL). We sought to compare TTE to TEE for PVL (primary outcome) and secondary safety outcomes in a study-level meta-analysis.

Methods: Ovid versions of Medline and Embase were searched from 1946 to 2018 for studies comparing TTE to TEE in TAVI directly or MAC to GA in TAVI (must also specify echocardiography usage) and meta-analyzed in a random effects model.

Results: Sixteen studies (n = 3,510) were included in the meta-analysis. The rate of any PVL was not significantly different between TTE-TAVI and TEE-TAVI groups (18.4% vs. 21.4%, risk ratio: 1.01, 95%CI: 0.83 to 1.23, P = 0.92, I2 = 36%). Similarly, there were no significant differences in secondary safety outcomes. Resource utilization was lower with TTE-TAVI; hospital LOS [mean difference (MD): -1.55 days, 95%CI: -2.27 to -0.83, P < 0.01], contrast volume (MD: -24.75 mL, 95%CI: -49.48 to -0.03, P = 0.05) and procedure time (MD: -31.09 min, 95%CI: -54.77 to -7.40, P < 0.01) were significantly lower.

Conclusion: The use of TTE-TAVI in conjunction with MAC was not associated with an increased risk of PVL and was associated with lower hospital resource utilization. However, other factors, such as mode of anesthesia, may have influenced these findings.

Hybrid coronary revascularization incorporates a surgical anastomosis of the left internal mammary artery to the left anterior descending coronary artery through a thoracotomy and percutaneous implantation of drug eluting stents in diseased non-left anterior descending coronary arteries. Hybrid coronary artery revascularization can be performed as a 1-stage procedure in a hybrid operating room or as a tightly scheduled 2-stage procedure. Hybrid coronary artery revascularization is seldom the selected modality for coronary revascularization due to the lack of a hybrid operating room in many hospitals, the recommended thoracotomy approach for bypass, or the rigid schedule of surgical and endovascular revascularization. A 2-stage approach, using a sternotomy as compared to standard thoracotomy, and a flexible schedule between surgical and endovascular procedures may facilitate the adoption of hybrid coronary revascularization with non-complex multi-vessel stable coronary artery disease.

Percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTO) still represents a challenge in the field of interventional cardiology. Despite the rate of peri-procedural complications has decreased over the years, it remains higher than in non-CTO PCI. Coronary perforations are among the most common and serious complications. Furthermore CTO recanalization carries a risk of unique and specific complications such as donor vessel injury and equipment loss or entrapment. Other infrequent complications of non-CTO PCI such as contrast induced renal dysfunction and radiation skin injury, assume more relevance in this subset given the length and complexity of these procedures. Operators facing CTO percutaneous treatment should be aware of the potential complications and the available strategies for prevention and management, to achieve procedural success.

In the last years procedural success rate of chronic total occlusions (CTOs) percutaneous coronary intervention has improved primarily for two reasons: the evolution in materials and the new techniques and skills acquired by dedicated CTOs operators. In the last decade a lot of complex and advanced CTO techniques have been introduced. The hybrid algorithm allows to standardize the experience shared by CTO operators. The aim of the algorithm is to help the operators to choose the best strategy for the single case, in order to improve procedural success rate, to fasten the procedure, shortening failure modes, and to reduce X ray exposure and contrast load. The aim of our review is to highlight the most recent scientific evidence about the use of the hybrid algorithm for the treatment of CTO.

The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD’s, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the Amplatzer^TM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX^TM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM^TM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy.

Characterizing the physical properties of the aortic wall is essential to understanding the causes of cardiovascular diseases, such as aneurysms. Modelling compliant, anisotropic, multilayered tubes such as the aorta has proven to be a challenge. In vitro studies of the mechanical properties of arteries incorporate a variety of testing methods; however, the majority of these tests fail to replicate the complex, transmural loading conditions arising from pulsatile flow. These methods include typical tensile tests, both in uniaxial and biaxial set-ups, bulge inflation tests and extension-inflation tests. Bulge-inflation tests grant material information in response to biaxial loading but still do not mimic proper cylindrical loading conditions. Extension-inflation tests capture the cylindrical loading but have only been performed with static pressurization and with rigid boundary conditions in effect. This review aims to present the current state of the biomechanical characterization of arterial walls, particularly the aorta, through discussion of testing methods and their findings. We emphasize literature that focuses on prediction of aneurysm rupture risk. Moreover, overarching concepts such as histological effects, age dependent effects, segmental effects, hemodynamic effects, viscoelastic modelling and torsion will be briefly explored. An understanding of the current limitations of testing will hopefully lead to the development of more robust in vitro test methods that will further elucidate the relationship between changing vessel wall mechanics and cardiovascular disease.

Postoperative pulmonary dysfunction is a multifactorial complication in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Numerous risk factors including individual, surgery- and anesthesia-related have been identified. Exacerbated systemic and pulmonary inflammatory response to CPB is one of the most studied mechanisms of lung injury in this patient setting. However, current literature lacks specific intraoperative mechanical ventilation (MV) strategies associated with a significant improvement in patients’ outcomes. We reviewed the randomized clinical trials and other reports published within the last 5 years involving patients undergoing cardiac surgery with CPB in order to summarize the existing MV strategies used in these patients and their associated outcomes. Moreover, we described the pathophysiological mechanisms involved in post- CPB lung injury and the mechanistic effects of protective ventilation.

This review will outline cell-based therapy for heart failure focusing on tissue engineering to deliver cells to the damaged heart. We will present an overview of the central approaches focusing on pluripotent stem cell-derived cells, mechanisms of action, autologous vs. allogeneic cell approaches, immunologic modulation, and safety considerations. We will outline the progress that has been made to-date and define the areas that still need to be investigated in order to advance the field.

Aim: This research paper aims to modeling and finite element analysis of PEEK 450G biomaterial used as cardiovascular stent implant.

Methods: Commercially available CATIA V5 and ABAQUS 6.0 software were used for modeling and finite element analysis of cardiovascular stent implant to evaluate the radial displacement, stress distribution, and plastic strain in the proximal area of PEEK 450G biomaterial under pressure load conditions of 0.8, 1.0, and 1.2 MPa.

Results: The results show that, both in non-linear bending analysis and non-linear pressure analysis, that PEEK 450G stent exhibits very good radial expansion and lowest stress concentration in plaque and also which is well below the yield level (100 MPa), however plastic strain is quite high.

Conclusion: The blood circulation will be appropriate and also chances of vessel damage may be reduced more. Hence the study reveals that PEEK 450G can be best alternate biomaterial appropriate for cardiovascular stent implant.

Aim: Historically the outcome of left coronary artery endarterectomy (LCAE) has been associated with increased morbidity and mortality when surgeons performed it with coronary artery bypass grafting (CABG). We aim to review outcomes after open LCAE-CABG in patients managed with aggressive dual antiplatelet therapy.

Methods: From 1999 to 2007 open LCAE with CABG was performed in 87 patients. We compared the short and long-terms outcomes of 75 propensity-matched conventional CABG patients. Both groups were operated on by a single surgeon.

Results: Sixty-six percent (66%; n = 58/87) of LCAE group had diffuse atheroma in Left anterior descending artery (LAD); 31% (n = 27/87) involved both LAD and branches of the circumflex artery (Cx); 3%; (n = 3/87) involved the Cx in isolation. Cross clamp time (43.29 vs. 59.04, P = 0.019) and bypass time (57.29 vs. 74.04, P = 0.007) were significantly higher in the LCAE group. There was no significant difference in early (1% vs. 1.3%) and late mortality (4% vs. 4.5% at 10 years). The hospital length of stay (5.58 vs. 6.67, P = 0.03), was higher in the LACE group when compared with the CABG group. The freedom from angina and long-term survival were not significantly different between the two groups.

Conclusion: Patients undergoing CABG with Left-sided coronary endarterectomy had increased cross-clamp and bypass times with prolonged stay in hospital and increased blood transfusion rates. The mortality, morbidity, long-term survival and freedom from angina are not different when compared to CABG alone. The use of retrograde blood cardioplegia and aggressive antiplatelets may have contributed to the excellent outcome.

Acute mechanical complications following acute myocardial infarction have an incidence less the 1% in the era post coronary and systemic thrombolysis. However, the early mortality is still high even after surgical therapy, reaching 70%. Left ventricle free wall rupture, ventricular septal defect and papillary muscle rupture represent the most challenging complications after myocardial infarction. Prompt diagnosis, appropriate medical therapy and mechanical support, such as intra-aortic balloon pump and extracorporeal membrane oxygenation, and urgent or emergency surgical operation may favor to obtain encouraging results and acceptable long-term outcome.

Cardiac Surgery is a Specialty undergoing profound changes. Since its inception, innovation has been at the forefront of activities seeking for the best of the patients. The introduction of the heart-lung machine in clinical practice in the 1950s of the twentieth century allowed for the correction of intra- and extracardiac defects. The recent past two decades have seen the progressive incorporation of transcatheter therapies to treat a variety of heart defects. Multimodality imaging approach has become a fundamental tool in the pre- intra- and postoperative assessment of patients. The future in Cardiac Surgery contemplates redesigning training programs with the mandatory acquisition of catheter skills, the knowledge of the different imaging modalities and allocation of resources and timing for basic and translational research.

Aim: Retinoic acid-related orphan receptor γ (RORγ) functions as a ligand-dependent transcription factor and its loss has been shown to affect the circadian expression of lipid metabolism genes. However, its effect on body weight gain and hepatic lipids is not well understood. In this study, we investigated the impact of Rorγ gene deletion on changes in body weight and hepatic lipids.

Methods: Body weight and lipids were analyzed in the plasma and liver. Expression of lipid metabolism genes in the liver was evaluated in wild type and Rorγ knockout mice.

Results: We show that deletion of RORγ results in reduced body weight and fewer lipids in the liver. Analysis of gene expression showed that deletion of Rorγ resulted in an overall lower expression of genes and transcription factors involved in lipid biosynthesis. We observed a decrease in the gene expression of cholesterol biosynthesis, efflux, and esterification but an increase in bile acid synthesis. There was a decrease in fatty acid and triglycerides biosynthesis genes and an increase in the fatty acid uptake genes. The decrease in the expression of lipid biosynthesis genes was accompanied by the decrease in the sterol response element binding protein (Srebp) genes. We observed an increase in the expression of peroxisome proliferator-activated receptor alpha (Ppara) and a decrease in the expression of acetyl-CoA carboxylase 2 (Acc2) genes.

Conclusion: Our data suggest that RORγ regulates body weight and lipid metabolism genes and its modulation may be beneficial for the management of obesity and related lipid metabolic disorders.