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.

Cardiac hemangiomas are benign neoplasms of extremely rare occurrence and, in most cases, asymptomatic, commonly detected incidentally during examinations performed for other clinical indications. To confirm the diagnosis and prevent potential complications, surgical excision followed by histopathological analysis is recommended. In this case report, we describe a left ventricular hemangioma incidentally identified during an echocardiographic examination.

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: Sudden cardiac death remains a significant risk for patients with heart failure (HF). Current guidelines recommend implantable cardioverter defibrillator (ICD) for patients with low left ventricular ejection fraction (LVEF). However, the effectiveness and necessity of ICDs in patients with normal LVEF raise questions, especially given associated complications and costs.
OBJECTIVE: This study aims to evaluate the electrocardiographic predictors of appropriate ICD therapy (antiTachycardia pacing [ATP]/shocks) in patients with HF.
METHODS: We conducted an analysis of 160 consecutive HF patients (New York Heart Association class I-III, LVEF ≤ 35%) undergoing ICD controls from January 2023 to December 2024. Patients were classified into two groups based on the occurrence of appropriate ATP or ICD shocks. Electrocardiographic parameters including QRS duration, QTc interval, intrinsicoid deflection (ID), and fragmented QRS (fQRS) were assessed. Statistical analyses, including receiver operating characteristic curves and logistic regression, were performed to identify independent predictors of appropriate ICD therapy.
RESULTS: The ATP/shock group exhibited significantly prolonged QRS and QTc intervals, increased ID, and higher Selvester scores compared to the non-shock group. Notably, an ID > 50 ms emerged as a strong predictor of ICD therapy (sensitivity 96.3%, specificity 95.3%). Univariate and multivariate analyses identified ID, fQRS, and Selvester score as independent predictors of appropriate ICD therapy.
CONCLUSION: Elevated ID, alongside other electrocardiographic parameters, serves as a valuable predictor for appropriate ICD therapy in HF patients. These findings support the potential for refining ICD implantation criteria, emphasizing the importance of detailed electrocardiographic evaluation in predicting arrhythmic events.