Indications, complications, and outcomes of cardiac surgery after heart transplantation: results from the cash study

[Abstract] Background: Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods: We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion: Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure

The role of CRP in the prognosis and diagnosis of the uncomplicated aneurysms of the thoracic aorta

Background: The role of CRP and IL-6 as a marker in the prognosis of asymptomatic TAA patients has not been well established. Therefore we evaluated a possible association between serum CRP and IL-6 and aneurysm dimension in this group of patients. Methods and Results: Serum CRP and IL-6 were determined and aneurismal size was measured in 26 patients with TAA. Mean (SD) CRP and IL-6 were 0,58 (1,07) mg/dl and 7,47(17,78) pg/ml respectively. Serum CRP and IL-6 did not correlate with aneurismal dimension. Moreover there was significant correlation between values of the ratio above 0,8 and aneurismal dimension (r=0,78485). Secondly there is also significant association smoking, age group of 69-80 years old and dyslipidemia and aneurysm dimension (p=0,0023, p=0,0607 and p=0,0704 respectively). Conclusions: This report shows that values of the ratio CRP/IL-6 above 0,8 are associated with aneurismal dimensions. The clinical significance of this finding is early to be established. Further studies with larger groups of patients with longer follow-up are needed to evaluate the usefulness of the serum CRP and IL-6 as markers of the disease progression.Σκοπός: Ο ρόλος των CRP και IL-6 ορού στην ανευρυσματική νόσο της θωρακικής αορτής σε ασυμπτωματικούς ασθενείς ως δεικτών πρόγνωσης και εξέλιξης της νόσου δεν ερευνάται επαρκώς μέσα από την παγκόσμια βιβλιογραφία. Μέσα από αυτή την εργασία προσπαθούμε να αξιολογήσουμε μία πιθανή συσχέτιση ανάμεσα στις CRP και IL-6 ορού και το μέγεθος του ανευρύσματος σε αυτή την ομάδα ασθενών. Μέθοδος και Αποτελέσματα: Σε 26 ασυμπτωματικούς ασθενείς με ανεύρυσμα της θωρακικής αορτής, προσδιορίστηκαν οι τιμές των CRP και IL-6 ορού και μετρήθηκε και το μέγεθος του ανευρύσματος. Οι μέσες τιμές (τυπική απόκλιση) των CRP και IL-6 ορού είναι 0,58 (1,07) mg/dl και 7,47 (17.78) pg/ml αντίστοιχα. Από τα αποτελέσματα φαίνεται ότι δεν προκύπτει κανένας συσχετισμός ανάμεσα στις τιμές των CRP και IL-6 ορού και το μέγεθος του ανευρύσματος. Σημαντικό εύρημα είναι ότι σε τιμές του λόγου CRP/IL-6 άνω του 0.8 προκύπτει σαφής και δυνατός γραμμικός συσχετισμός (r=0,78485) ανάμεσα στις τιμές αυτές και το μέγεθος του ανευρύσματος. Επιπλέον προκύπτει σημαντική σχέση ανάμεσα στο κάπνισμα, την ηλικιακή κατηγορία 69-80 έτη και την υπερλιπιδαιμία και το μέγεθος του ανευρύσματος (p= 0.0023, p=0,0607 και p=0,0704 αντίστοιχα). Συμπέρασμα: Σ’ αυτή την εργασία, οι τιμές του λόγου CRP/IL-6 που είναι άνω του 0,8 σχετίζονται με το μέγεθος του ανευρύσματος. Η κλινική σημασία αυτού του ευρήματος είναι νωρίς για να καθοριστεί. Περισσότερες μελέτες χρειάζονται να γίνουν με μεγαλύτερα δείγματα πληθυσμού και με μεγαλύτερο χρόνο παρακολούθησης για να εκτιμηθεί επαρκώς η χρησιμότητα των CRP και IL-6 ορού ως δεικτών πρόγνωσης και εξέλιξης της ανευρυσματικής νόσου

Bentall operation in a patient with an anomalous left circumflex artery: Case report and review

Anomalous origin of a left circumflex artery from the right coronary sinus represents a technical challenge in patients who require aortic valve/root procedures. This case report describes a patient who presented with bicuspid aortic valve, anomalous origin of the circumflex artery, severe aortic regurgitation, and aneurysm of the ascending aorta as well as aortic root that was safely managed following the Bentall procedure with the combined button technique