Biomechanical characteristics of different methods of neo-chordal fixation to the papillary muscles

Background and Aim of the Study Several techniques have been described for neo-chordal fixation to the papillary muscles without any reported clinical differences. The objective of this study is to compare in vitro the biomechanical properties of four of these common techniques. Methods We studied the biomechanical properties of expanded polytetrafluoroethylene neo-chordal fixation using four techniques: nonknotted simple stitch, nonknotted figure-of-eight stitch, knotted pledgeted mattress stitch, and knotted pledgeted stitch using commercially available prefabricated loops. Neo-chordae were submitted to a total of 20 traction-relaxation cycles with incremental loads of 1, 2, and 4 N. We calculated the elongation, the force-strain curve, elasticity, and the maximum tolerated load before neo-chordal failure. Results The elongation of the neo-chordae was lowest in the simple stitch followed by the figure-of-eight, the pledgeted mattress, and he commercially prefabricated loops (p < .001). Conversely, the elastic modulus was highest in the simple stitch followed by the figure-of-eight, the pledgeted mattress, and the prefabricated loops (p < .001). The maximum tolerated load was similar with the simple stitch (28.87 N) and with the figure-of-eight stitch (31.39 N) but was significantly lower with the pledgeted mattress stitch (20.51 N) and with the prefabricated loops (7.78 N). Conclusion In vitro, neo-chordal fixation by nonknotted simple or nonknotted figure-of-eight stitches resulted in less compliance as opposed to the use of knotted pledgeted stitches. Fixation technique seemed to influence neo-chordal biomechanical properties, however, it did not seem to affect the strength of the suture when subjected to loads within physiological rangesS

Restoring Epigenetic Reprogramming with Diet and Exercise to Improve Health-Related Metabolic Diseases

Epigenetic reprogramming predicts the long-term functional health effects of health-related metabolic disease. This epigenetic reprogramming is activated by exogenous or endogenous insults, leading to altered healthy and different disease states. The epigenetic and environmental changes involve a roadmap of epigenetic networking, such as dietary components and exercise on epigenetic imprinting and restoring epigenome patterns laid down during embryonic development, which are paramount to establishing youthful cell type and health. Nutrition and exercise are among the most well-known environmental epigenetic factors influencing the proper developmental and functional lifestyle, with potential beneficial or detrimental effects on health status. The diet and exercise strategies applied from conception could represent an innovative epigenetic target for preventing and treating human diseases. Here, we describe the potential role of diet and exercise as therapeutic epigenetic strategies for health and diseases, highlighting putative future perspectives in this field

Galectin-3 as a Predictor of Post Cardiac Surgery Atrial Fibrillation: A Scoping Review

Galectin-3 is associated with myocardial fibrosis, a known risk factor for developing re-entrant circuits associated with atrial fibrillation (AF). Previous studies have demonstrated increased galectin levels in AF patients. Whether preoperative galectin-3 levels can predict the incidence of postoperative atrial fibrillation (POAF) remains unknown.This scoping review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic searches were conducted in Medline, EMBASE, Cochrane, and Google Scholar databases using a predetermined strategy. Methodological variables, demographics and operative data were extracted. Data extraction was performed manually by 3 reviewers.The search yielded 620 citations, of which 74 underwent full text review, and 3 citations with 3 independent samples (n=1812) met full inclusion/exclusion criteria and were included. Of the 3 studies that reported on the association between preoperative galectin-3 levels and POAF, 2 studies compared median galectin levels in patients who developed POAF and those who did not. While Alexandre et al. reported a significant difference (P=0.002), Bening et al did not find a significant difference between POAF and non-POAF groups (P=0.3). A third study reporting on the association between galectin-3 and atrial fibrillation comparing third and first tercile galectin-3 levels found a significant association between preoperative galectin levels and POAF on univariate analysis (OR 1.54; 95% CI 1.14-2.09).Galectin-3 is an emerging biomarker that has been associated with the development of AF. However, there is currently not enough evidence to establish its prognostic role in postcardiac surgery atrial fibrillation.Fil: King, Morgan. Queens University; CanadáFil: Stambulic, Thomas. Queens University; CanadáFil: Kirupaharan, Sawmmiya. Queens University; CanadáFil: Baranchuk, Adrian. Queens University; CanadáFil: Rabinovich, Gabriel Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Payne, Darrin. Queens University; CanadáFil: El Diasty, Mohammad. Queens University; Canad

Severe bilateral isolated coronary ostial lesions as a rare manifestation of radiation-induced cardiac disease A case report

Rationale: With advances in contemporary radiotherapy techniques, and as cancer survival improves, severe isolated coronary ostial disease may develop many years following mediastinal radiotherapy, even in the absence of classical cardiovascular risk factors. Patient concerns: We describe the case of a 73-year-old woman with previous chest radiotherapy for breast cancer who underwent coronary artery bypass graft surgery for severe bilateral coronary ostial lesions. Diagnoses: Coronary angiography demonstrated severe, isolated bilateral coronary ostial lesions. Interventions: The patient underwent urgent coronary artery bypass graft surgery to treat her critical coronary artery disease. Outcomes: Intra-operatively, internal mammary arteries were not amenable to harvesting due to very dense mediastinal adhesions. Therefore, saphenous vein grafts were performed to the left anterior descending, distal left circumflex, obtuse marginal and distal right coronary arteries. The patient made a satisfactory in-hospital recovery, and was subsequently discharged back to her local hospital for rehabilitation. Lessons: Patients successfully treated with mediastinal radiotherapy require careful long-term follow-up for the assessment of radiation-induced coronary artery disease. Importantly, mediastinal irradiation may preclude internal mammary artery utilization, and thus alter the strategy for surgical myocardial revascularization

Supplemental Material - Effect of oxygen delivery during cardiopulmonary bypass on postoperative neurological outcomes in patients undergoing cardiac surgery: A scoping review of the literature

Supplemental Material for Effect of oxygen delivery during cardiopulmonary bypass on postoperative neurological outcomes in patients undergoing cardiac surgery: A scoping review of the literature by Abdelrahman Elsebaie, Ayesha Shakeel, Shetuan Zhang, Marianne Alarie, Mohamed El Tahan and Mohammad El-Diasty in Perfusion</p