Oxidative Stress in the Pathogenesis of Aorta Diseases as a Source of Potential Biomarkers and Therapeutic Targets, with a Particular Focus on Ascending Aorta Aneurysms

: Aorta diseases, such as ascending aorta aneurysm (AsAA), are complex pathologies, currently defined as inflammatory diseases with a strong genetic susceptibility. They are difficult to manage, being insidious and silent pathologies whose diagnosis is based only on imaging data. No diagnostic and prognostic biomarkers or markers of outcome have been known until now. Thus, their identification is imperative. Certainly, a deep understanding of the mechanisms and pathways involved in their pathogenesis might help in such research. Recently, the key role of oxidative stress (OS) on the pathophysiology of aorta disease has emerged. Here, we describe and discuss these aspects by revealing some OS pathways as potential biomarkers, their underlying limitations, and potential solutions and approaches, as well as some potential treatments

A promising therapeutic peptide and preventive/diagnostic biomarker for age-related diseases: The Elabela/Apela/Toddler peptide

Elabela (ELA), Apela or Toddler peptide is a hormone peptide belonging to the adipokine group and a component of apelinergic system, discovered in 2013-2014. Given its high homology with apelin, the first ligand of APJ receptor, ELA likely mediates similar effects. Increasing evidence shows that ELA has a critical function not only in embryonic development, but also in adulthood, contributing to physiological and pathological conditions, such as the onset of age-related diseases (ARD). However, still little is known about the mechanisms and molecular pathways of ELA, as well as its precise functions in ARD pathophysiology. Here, we report the mechanisms by which ELA/APJ signaling acts in a very complex network of pathways for the maintenance of physiological functions of human tissue and organs, as well as in the onset of some ARD, where it appears to play a central role. Therefore, we describe the possibility to use the ELA/APJ pathway, as novel biomarker (predictive and diagnostic) and target for personalized treatments of ARD. Its potentiality as an optimal peptide candidate for therapeutic ARD treatments is largely described, also detailing potential current limitations

A rare localization of papillary fibroelastoma

Papillary fibroelastoma is a benign cardiac tumor, generally small and with papillary fronds, third in frequency after cardiac myxoma and lipoma, with a prevalence of about 10% of all cardiac tumors [1, 2]. Its localization, similarly to other benign cardiac tumors, prefers the endothelium of the valve leaflets, most commonly the aortic valve (44% to 59%), less frequently the mitral (13% to 35%) and tricuspid (4% to 15%) valves [3–5]. It is discovered occasionally or following symptoms due to systemic or coronary embolization. Symptoms due to obstruction of the ventricular flow tract are rare. Surgical excision is curative and its recurrence rare if the resection of margins are disease-free

How Refined Surgical Technical Solutions Can Make Bentall Operation a Low-Risk Procedure: 20-Year Personal Experience at the “Root” of the Aortic Diseases—It Is Time to Change Surgical Guidelines

(1) objective: twenty years' experience of bentall-de bono operations by one surgeon. (2) methods: from January 2003 to september 2023, four-hundred-and-two patients aged 65.9 +/- 15 years underwent a bentall operation. the euroScore-2 was 5.0% +/- 3.8%. associated procedures were performed on 113 patients (28.1%). results: operative mortality was 1.2% (n = 5), in particular 0.69% (n = 2/289) for isolated bentall operation, 2.65% (n = 3/113) for combined procedures (p < 0.05). postoperative acute heart failure occurred in 38 patients (9.45%). preoperative pulmonary hypertension (44 +/- 14 vs. 33 +/- 7 mmHg), cardiopulmonary bypass time (169 +/- 61 min. vs. 124 +/- 42 min.) and aortic cross-clamp time (133 +/- 45 min. vs. 107 +/- 34 min.) have been recognized as independent predictors of mortality and cardiac complications (p < 0.05). conclusions: In our experience, the bentall operation was associated with low operative mortality and low rate of complications. for this reason, in agreement with the patients, we have modified surgical indication for ascending aortic aneurysms and now we think that it is time to change surgical guidelines

Endocarditis: Cardiac Surgery Treatment/A Thrilling Challenge in Cardiac Surgery

Infective endocarditis is a rare but life-threatening disease that has a major impact on healthcare resources. It is heterogeneous in etiology, clinical manifestations, and course. The timing of surgery remains a topic of debate. Some authors promote an early surgical approach to improve the outcomes. There are different points of view between American and European guidelines regarding the relative priority of surgery over medical treatment. Anyway, multidisciplinary teams and multimodality strategies are advocated in order to optimize the treatment according to the individual needs of the patients. The early surgical approach may represent a valuable treatment option for high-risk patients. In this chapter, we discuss the latest evidence on surgical approaches, potential pitfalls, and the controversial issues in the contemporary practice of infective endocarditis

The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

Background: data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. we evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome. methods: between december 2014 and march 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. the mean follow-up was 40±27 (median 38) months. Logistic and cox model analysis regressions were used to assess the risk of female gender and other variables, kaplanMeier estimates to assess survival rates. results: women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). there was no difference in the use of left internal mammary artery (97.5% vs. 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41). conclusions: women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women

Transcatheter aortic valve replacement in the management of aortic insufficiency secondary to left ventricular assist device implantation: a case report

background: left ventricular assist device (LVAD) is considered either a destination therapy for patients with end-stage heart failure or heart transplantation bridging. LVAD implantation often causes aortic insufficiency (AI), which requires aortic valve repair. however, severe acute aI does not respond well to medication, and re-operation means higher risk to the patients; the most effective therapeutic strategies for LVAD-induced AI still need further exploration. In this report, we present the first described case of new-onset, severe LVAD-induced aI in china with a patient who underwent transcatheter aortic valve replacement (TAVR) and achieved significant improvement in functional capacity and symptoms with lower operation risk. case description: a 55-year-old male patient was diagnosed with dilated cardiomyopathy for 14 years. The effect of the medication gradually deteriorated, LVAD (HeartCon®) was implanted one year earlier. the patient complained of intermittent chest tightness for one week, which had been aggravated for two days before hospitalization. echocardiographic findings revealed new-onset, severe LVAD-induced AI. TAVR was performed with a self-expandable stent-valve (TAV30, vitaflow Liberty). within minutes, the patient recovered with rapid disappearance of chest tightness and stable vital signs. before discharge, the position of the artificial valve was fixed without incomplete closure nor thrombus attachment, yielding a left ventricular ejection fraction (LVEF) of 35%. the patient was hospitalized for 38 days, and followed up with outpatient treatment, the condition was stable until 19 June 2023. conclusions: TAVR could be an effective, safe, and less invasive means of restoring ejection fraction for patients with a LVAD who develop severe AI

Risk of aortic dissection in patients with ascending aorta aneurysm: a new biological, morphological, and biomechanical network behind the aortic diameter

Thoracic aortic aneurysm represents a deadly condition, particularly when it evolves into rupture and dissection. Proper surgical timing is the key to positively influencing the survival of patients with this pathology. According to the most recent guidelines, ascending aorta size ≥ 55 mm and a rate of growth ≥ 0.5 cm per year are the most important factors for surgical indication. Nevertheless, a lot of evidence show that aortic ruptures and dissections might occur also in small size ascending aorta. In this review, we sought to analyze a new biological and morphological network behind the aortic diameter that need to be considered in order to identify the portion of patients with thoracic aortic aneurysm who are at increased risk of aortic complications, despite current aortic guidelines not advising surgical intervention in this group