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.

Hybrid coronary revascularization combines minimally invasive surgical coronary artery bypass grafting with percutaneous coronary intervention. This case report describes a 72-year-old male with multivessel coronary artery disease treated using a hybrid approach: robot-assisted bilateral internal mammary artery grafting followed by percutaneous coronary intervention. This method leverages the strengths of both modalities, offering tailored treatment for specific coronary lesions. The patient's postoperative course was uneventful, and follow-up demonstrated excellent outcomes.

This review discusses the morphological characteristics of the human great saphenous vein (SV) harvested for coronary artery bypass grafting (CABG). It focuses on the vein's luminal intima, which was examined using laser confocal microscopy (LCM), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Summarised findings are: (1) LCM observations revealed that the vessel-like profiles, formed by the intima of the peripheral parts of SV luminal folds, may create a false impression that these are vasa vasorum vessels terminating at the vein lumen. (2) The SV luminal intima displays openings ranging from about 5 μm to 20 μm. Among these, larger openings (> 10 µm) are recognized as openings of small tributary branches rather than vasa vasorum vessels donating to SV lumen. It is suggested that these vessel openings are involved in the retrograde blood flow into the SV graft wall after CABG. In contrast, openings < 10 µm, or even those < 5 µm, did not show obvious vascular characteristics, suggesting these structures might have another physiological function. (3) In addition to the abovementioned openings, narrow, elongated intimal openings approximately 3 μm by 30 μm in size can be seen at the SEM level; these likely represent the entrances to the small folds detected by TEM in the inner media of the SV. Communication between the SV lumen and the vein vasa vasorum seems crucial for the anti-ischaemic protection of the vein as coronary graft. This issue, including the role of intimal openings, may require further investigation.

The saphenous vein is the most commonly used conduit in patients undergoing coronary artery bypass surgery. Graft patency is improved using the no-touch technique where the vein is harvested with minimal trauma, avoiding high pressure distension and maintaining normal vessel architecture. Various cells that are damaged when using conventional harvesting are preserved using the no-touch technique and are a source of nitric oxide. The no-touch technique is becoming accepted more widely as is the role of nitric oxide in improved saphenous vein graft patency. However, there are conflicting views regarding the tissue sources of nitric oxide.

INTRODUCTION: The Charlson Comorbidity Index (CCI) is used for assessing comorbidities and estimating risk of adverse outcomes in surgical patients. In cardiac surgery, the burden of comorbidities can significantly influence incidence of postoperative complications and mortality. This study evaluates the utility of CCI in predicting perioperative complications in patients undergoing cardiac surgery.
METHODS: Observational cross-sectional study with retrospective data including 483 adult patients who underwent cardiac surgery with cardiopulmonary bypass at the Instituto Nacional de Cardiología Ignacio Chávez from June 2022 to December 2023. Patients were grouped by preoperative CCI: mild (0 – 1), moderate (2), and severe (≥ 3). Statistical analyses (chi-square, Mann-Whitney U, logistic regression) assessed the association between CCI and postoperative complications, adjusting for age and sex.
RESULTS: Patients with severe comorbidity had higher rates of postoperative complications, including delirium (27.3% vs. 9.4%, P = 0.00), stroke (P = 0.03), transfusion (69.7% vs. 47.2%, P = 0.04), and renal replacement therapy (18.2% vs. 5.3%, P = 0.02). Median Sequential Organ Failure Assessment scores at 24 hours were significantly higher (P = 0.00). Logistic regression adjusted for age, sex, and coronary artery bypass grafting identified delirium (odds ratio [OR]: 3.13), nosocomial pneumonia (OR: 3.10), acute kidney injury (OR: 2.28), and renal replacement therapy (OR: 4.10) as independent predictors of severe comorbidity.
CONCLUSIONS: The CCI is a valuable tool for predicting postoperative complications in patients undergoing cardiac surgery. Early identification of comorbidities is essential for perioperative planning and optimizing clinical outcomes. Integrating the CCI into routine clinical practice is recommended to enhance patient management.

INTRODUCTION: Heart transplantation is a crucial therapeutic modality for patients with advanced heart failure. For satisfactory results, acceptable ischemic times are essential. This study aims to investigate the relationship between cold ischemic time > 4 hours and mortality in the first month after heart transplantation.
METHODS: Retrospective and observational analysis of medical records of patients who underwent heart transplantation between January 2019 and December 2023. The inclusion criteria were patients who underwent heart transplantation using the histidine-tryptophan-ketoglutarate preservation solution during organ retrieval and immediately before organ implantation. Recipient variables, etiology of heart failure, procedural variables, and 30-day mortality were studied.
RESULTS: During the study period, 62 patients underwent heart transplantation. There were a predominance of males (79%) and an average age of 51 years. Seven patients had a cold ischemic time ≥ 4 hours, with three dying (43%) before 30 days. Among the 55 patients with cold ischemic times < 4 hours, 17 died (31%) before 30 days. Statistical analysis using the chi-square test revealed no statistically significant association between cold ischemia and mortality in the first 30 days after transplantation (P = 0.835).
CONCLUSION: The study found no difference in 30-day mortality between patients who underwent heart transplantation with cold ischemic times > 4 hours and those with cold ischemic times < 4 hours. Thus, there may be new strategies to increase the number of donors with a safe rebalance of the relationship between the number of available allografts and patients on the waiting list.

INTRODUCTION: Postoperative bleeding increases morbidity and mortality. We aimed to review the scoring systems used to predict massive bleeding after isolated coronary artery bypass grafting in diabetic patients and determine the parameters of the new scoring system — the Optimum Risk Score for Bleeding (ORS).
METHODS: Two hundred ninety-seven diabetic patients who underwent isolated coronary artery bypass operation between 2017 and 2019 were reviewed. The patients were grouped according to amount of drainage (> 850 mL/day) and the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding severity grade. Previously identified risk factors and scoring systems (Papworth, WILL-BLEED, Association of Cardiothoracic Anesthetists perioperative risk of blood transfusion [ACTA-PORT], Transfusion Risk and Clinical Knowledge [TRACK], and Transfusion Risk Understanding Scoring Tool [TRUST]) were analyzed.
RESULTS: Papworth was better predictive for E-CABG bleeding grades 2 - 3. WILL-BLEED, ACTA-PORT, TRACK, and TRUST had no discriminatory value in terms of E-CABG bleeding grades 2 - 3. Among the parameters in the scoring systems, gender, preoperative hemoglobin (or hematocrit) value, preoperative platelet count, use of antiplatelets until less than five days prior to the operation, and preoperative creatinine (or estimated glomerular filtration rate) values should be included in the scoring system we aim to establish in the future, the ORS.
CONCLUSION: The current scoring systems do not provide satisfactory results in predicting postoperative bleeding. Female gender, lower body mass index, and preoperative platelet count were associated with increased postoperative bleeding. There is a need for an ORS which gives more precise results in predicting postoperative bleeding.