OBJECTIVE: To compare the clinical efficacy and safety of intra-aortic balloon pump (IABP) and levosimendan in coronary artery bypass grafting (CABG).
METHODS: A systematic search of PubMed^®, Embase, Cochrane Library, and Google Scholar was conducted through July 2024. Outcomes analyzed included atrial fibrillation, postoperative mediastinitis, the requirement for inotropic support, in-hospital mortality, postoperative intensive care unit (ICU) stay, postoperative length of stay, ventilation time, and mean arterial pressure (MAP) levels.
RESULTS: The analysis included nine studies with 681 patients. Levosimendan presented advantage over IABP in CABG patients in terms of postoperative ICU stay, postoperative length of stay, and reduction in MAP levels, with effect sizes: mean difference (MD) = -0.83, 95% confidence interval (CI) -0.97 to -0.68, P < 0.00001 = -1.14, 95% CI: -1.33 to -0.95, P < 0.00001, and MD = -4.55, 95% CI: -6.14 to -2.96, P < 0.00001, respectively. Levosimendan had an advantage on subgroup analyses in terms of postoperative ICU stay and postoperative length of stay, with effect sizes: MD = -0.83, 95% CI: -0.93 to -0.72, P < 0.00001 and MD = -1.14, 95% CI: -1.28 to -1.01, P < 0.00001, respectively. However, the incidence of postoperative mediastinitis was higher in the levosimendan group (relative risk = 1.45, 95% CI: 0.88 to 2.38), though not statistically significant.
CONCLUSION: Levosimendan may improve recovery and hemodynamic outcomes in high-risk CABG patients compared to IABP but may be associated with a higher, though non-significant, risk of mediastinitis. Further high-quality studies are warranted.

We present a clinical case of mitral insufficiency in a 59-year-old patient with dextrocardia and complete transposition of the viscera. The patient underwent mitral valve posterior leaflet repair and annuloplasty. During the operation, a "mirror inversion” of the equipment and surgery team position was carried out. The special feature of the operation was due to the fact that the aorta and great vessels in the wound were mirror-image. The postoperative period proceeded without complications. Being aware of the patient's dextrocardia and hence organizing the surgical procedure appropriately, we could achieve good results in radical surgery for valvular heart disease.

INTRODUCTION: Despite advancements in technique and the increasing number of coronary artery bypass grafting (CABG) procedures, new-onset postoperative atrial fibrillation (POAF) is one of the most common complications following CABG and remains a major concern. The exact mechanism is unclear, but impaired diastolic function may predispose patients to POAF. Thus, this study aims to evaluate preoperative diastolic dysfunction (DD) and associated factors as predictors of new-onset POAF.
METHODS: This retrospective cohort study involved patients undergoing CABG surgery who met the inclusion criteria between January 2018 to August 2022. DD was measured through preoperative transthoracic echocardiogram, while new-onset POAF was assessed through continuous electrocardiogram.
RESULTS: A total of 191 patients who met the inclusion criteria were enrolled in this study. Data-analysis revealed no significant difference in DD between patients with and without POAF (P = 0.72). Multivariate analysis demonstrated left main coronary artery disease (LMCAD) (odds ratio [OR] = 2.51; 95% confidence interval [CI] [1.12 – 5.59]; P = 0.02), in-stent restenosis (ISR) ≥ 70% (OR = 6.34; 95% CI [1.68 – 23.92]; P < 0.01), reduced ejection fraction ≤ 50% (OR = 2.18; 95% CI [0.94 – 5.06]; P = 0.07), and electrolyte imbalance (OR = 2.14; 95% CI [2.91 – 24.75]; P < 0.01) as the independent predictors of new-onset POAF.
CONCLUSION: DD was not identified as a predictor of new-onset POAF in patients undergoing CABG. The independent predictors identified in this study included male sex, comorbid LMCAD and ISR ≥ 70%, reduced left ventricular ejection fraction ≤ 50%, and postoperative electrolyte imbalance.

INTRODUCTION: Despite the prevalence of cardiac fibrosis, there are currently no effective treatments to reverse it. A major obstacle is the lack of reliable in vitro models. An increase in angiotensin II and collagen occurs in cardiac fibrosis. Therefore, we hypothesized that the combination of angiotensin II with ascorbic acid and dextran sulfate could induce fibrosis in neonatal rat cardiac fibroblasts (nrCFs) and be used as an in vitro model of cardiac fibrosis.
METHODS: nrCFs were treated with angiotensin II, ascorbic acid, and dextran sulfate. Key features of cardiac fibrosis were evaluated using Alizarin Red, Picrosirius Red, Masson's trichrome staining, quantitative reverse transcription polymerase chain reaction, and immunocytochemistry and scratch assay.
RESULTS: Although dextran sulfate increased the expression of alpha-smooth muscle actin (α-SMA), it did not increase collagen deposition and cell migration. Therefore, it seems that the combination of 500 nM angiotensin II with 100 μM ascorbic acid would be effective in induction of cardiac fibrosis in vitro, which increased (1) the expression of collagen, α-SMA, and vimentin at protein level, (2) the expression of collagen type I alpha 1 chain, collagen type III alpha 1 chain, matrix metalloproteinase 2, and transforming growth factor-beta 1 at ribonucleic acid level, and (3) cell proliferation and migration.
CONCLUSION: In this study, 72 hour-treatment of nrCFs with 500 nM angiotensin II and 100 μM ascorbic acid was effective in the creation of an in vitro model of cardiac fibrosis. It is hoped that this model will be useful for screening antifibrotic treatments.

OBJECTIVE: This study aimed to investigate whether hsa_circ_0076767 exacerbates mitochondrial injury during myocardial ischemia/reperfusion injury (MI/RI) by targeting miR-140-3p and directly inhibiting the hypoxia-inducible factor (HIF)-1α/β-catenin pathway.
METHODS: MI/RI and hypoxia/reoxygenation (H/R) cell models were established. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was performed to determine hsa_circ_0076767 expression in both the MI/RI models and to detect the subcellular localization of hsa_circ_0076767 and its responsiveness to ribonuclease R in HL-1 cells. A loss-of-function assay was performed to examine the function of hsa_circ_0076767 in cardiomyocyte mitochondrial and cardiac tissue injury following MI/RI. Hematoxylin-eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labeling staining were used to assess myocardial tissue injury and apoptosis of myocardial tissues in mice, respectively. hsa_circ_0076767 was assayed for cell viability using Cell Counting Kit-8, for apoptosis using flow cytometry, for mitochondrial membrane potential using JC-1, and for cellular adenosine triphosphate content using commercial kits. RT-qPCR and protein blotting were performed to detect gene expression. Dual-luciferase, ribonucleic acid pull-down, and fluorescence in situ hybridization co-localization assays were used to validate the interaction between hsa_circ_0076767 and miR-140-3p. Finally, the regulatory relationship between hsa_circ_0076767 and the HIF-1α/β-catenin pathway was verified.
RESULTS: hsa_circ_0076767 was upregulated in myocardial tissues of MI/RI mice and H/R HL-1 cells. Silencing hsa_circ_007676767 ameliorated myocardial tissue injury, apoptosis, and mitochondrial damage in cardiomyocytes. hsa_circ_0076767 targets miR-140-3p. Moreover, hsa_circ_0076767 promoted mitochondrial injury by inhibiting the HIF-1α/β-catenin pathway.
CONCLUSION: hsa_circ_0076767 targets miR-140-3p and directly inhibits the HIF-1α/β-catenin pathway, exacerbating mitochondrial damage in cardiomyocytes during MI/RI.

INTRODUCTION: Median sternotomy can cause postoperative adhesions, raising bleeding and organ damage risks during resternotomies. Computed tomography angiography (CTA) and extended reality (XR) are increasingly used to enhance surgical planning and minimize these risks. This study aims to assess the benefits of integrating XR technology into resternotomy planning
METHODS: This multi-center study, conducted at the Sheba and Wolfson Medical Centers in Israel, evaluated the utility of three-dimensional imaging in surgical resternotomy planning in 24 cases. Pediatric and adult patients selected for resternotomy underwent routine CTA, and those with adequate image quality were used to generate virtual three-dimensional segmentation. The images were evaluated preoperatively.
RESULTS: The findings indicated no significant benefit of XR over CTA in terms of resternotomy anatomical data. However, the accuracy of the XR models varied with medical experience: senior physicians rated the XR as less accurate for adult patients than did residents, but the ratings were high in both groups for pediatric cases. The XR models improved the surgeons' understanding of chest anatomy in pediatrics more than in adult patients, whereas for surgical decision-making, XR was seen as more beneficial in pediatric cases, particularly by senior surgeons. Overall, senior physicians reported that XR influenced their surgical decisions more, suggesting that the utility of XR varies with physician experience and patient age.
CONCLUSION: XR technologies have shown considerable potential in enhancing visualization and contributing to determining surgical strategies. However, the extent of their influence in terms of reducing operative durations and minimizing intraoperative complications requires further investigation.