In September 2019, the preferred surgical approach shifted for patients undergoing mitral valve (MV) surgery at our institution. The aim of this study was to compare minimally invasive surgery (MIS) with prior conventional sternotomy (CS) approach, to assess quality and safety of MIS in a non-high volume center. . This single-center retrospective observational study comprised 254 patients, 102 CS patients and 152 MIS patients, who underwent MV surgery for mitral regurgitation with or without concomitant procedures (i.e. tricuspid valve surgery, atrial fibrillation ablation, closure of ASD) between January 2015 and October 2023. . CS patients were older with a higher preoperative risk profile. Mitral repair was the predominant procedure regardless of surgical approach. MIS had longer intraoperative times, yet were equal to CS in regard to myocardial injury, intensive care unit stay and postoperative complications. MIS had lower rates of permanent pacemaker insertions (4% vs. 13%;  < .014) and a shorter postoperative length of stay (5 vs. 7 days;  < .001). The 30-day mortality was low (1% vs 2%;  > .5). Proposed learning curve of MIS was demonstrated by a tendency of reduced intraoperative times with growing experience. . MIS is a feasible alternative to the CS approach for MV surgery even at non-high volume centers. MV surgery with MIS results in a shorter postoperative length of stay, with comparable outcomes in terms of low mortality as well as surgical and postoperative morbidity. We believe that the prolonged intraoperative times will shorten with increased experience of these procedures.

Due to aging population, nonagenarians are increasingly undergoing percutaneous coronary intervention (PCI). However, the safety and efficacy of PCI in this elderly population remains somewhat unknown.

. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. . To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. . Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included ( = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. . After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34-3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36-9.75]), DTNP-V1 > 0.1 mV (HR 3.78, [1.15-12.4]), LAVI >48 ml/m (HR 4.43, [2.02-9.70]), moderate mitral regurgitation (HR 4.40, [1.57-12.4]), and RV-FAC <35% (HR 2.30, [1.03-5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. . ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF.

The ESCAPER project explores cardiovascular resilience in individuals who, despite a high-risk factor burden-longstanding Type 1 Diabetes (T1D), obesity, or kidney failure-avoid or delay macrovascular complications. This suggests underlying protective mechanisms. Initiated in September 2022, this exploratory study aims to uncover and define these mechanisms, potentially leading to novel therapeutic targets in preventive medicine. Participants from the Skåne region, Southern Sweden, are divided into three subgroups: (1) T1D patients (>30 years duration) without macrovascular complications or macroalbuminuria, (2) obese individuals with normal cardiac function and no cardiovascular medications, and (3) kidney failure patients awaiting transplantation with no arterial calcification, alongside respective controls. Comprehensive phenotyping includes 24-h blood pressure, ECG monitoring, vascular ultrasound, cardiac MRI, and ergospirometry (in a subgroup), along with laboratory investigations, including biomarker and omics analyses. Arterial biopsies are collected from kidney failure patients. The study leverages Swedish national medical registries for detailed follow-up of healthcare utilization, diagnoses, and prescriptions, enabling longitudinal outcome assessments. Initial findings from 90 T1D patients and 31 obese individuals indicate well-managed cardiovascular risk factors. The T1D subgroup shows a mean BMI of 25.6 kg/m and HbA1c of 52 mmol/mol, while the obesity subgroup presents a BMI of 32.9 kg/m with normal glucose levels. ESCAPER has the potential to advance understanding of cardiovascular resilience and refine prevention strategies. Its comprehensive methodology and registry-based follow-up provide robust insights into protective mechanisms and long-term outcomes.

: A newly discovered renal syndrome, shrunken pore syndrome (SPS), has been shown to increase mortality regardless of renal function. SPS is defined as an estimated glomerular filtration rate (eGFR) of cystatin C ≤ 60% than eGFR. We set out to study SPS in relation to the survival of heart transplantation patients with a follow-up of up to 12 years. This was a single-center cohort study including 253 consecutive patients undergoing heart transplantation. The prevalence of SPS at different time points post-transplantation and its effect on survival was evaluated using Kaplan-Meier's analysis and multivariable Cox proportional hazards regression. The prevalence of SPS was 7.5% the day after transplantation (D1), which rose to 71% week 4 after surgery. There was no difference in survival for patients with SPS D1 compared to patients without SPS D1. Patients with SPS 4 weeks compared to patients without SPS 4 weeks after transplantation showed a 5- and 10-year survival of 73% vs. 93% ( = .02) and 63% vs. 90% ( = .005), respectively. SPS developed during the postoperative period was also found to be an independent predictor of mortality (HR 4.65; 95% CI 1.36-15.8). SPS that developed in the postoperative course after heart transplantation was found to be an independent predictor of mortality with a severe negative impact on 5- and 10-year survival.

. To investigate rates of alcohol screening and brief interventions (SBI) in cardiology, and to examine associations between patient characteristics and the implementation of screening and brief interventions (BIs). . Cross-sectional survey of cardiology patients (aged ≥18 years) in three towns/cities in Sweden (Falun, Gävle, Stockholm). Self-reported study outcomes included: (a) being screened for alcohol use and (b) receiving a BI. Covariates included sociodemographic characteristics and clinical factors. We examined associations between covariates and study outcomes using logistic regression models. . From a total of 1051 participants (median age = 73 years, 66% men), 54% were screened for alcohol use, mostly by doctors (48%) and nurses (40%). Odds ratios (ORs) for being screened were lower among participants aged ≥80 years (OR = 0.57, 95% confidence intervals (CI) = 0.41-0.79), relative to those aged 65-79 years, and higher among participants with overweight (OR = 1.84, 95%CI = 1.38-2.44). Of those screened, 12% received BIs. Odds ratios for receiving BIs were higher among: men (OR = 3.04, 95%CI = 1.41-6.56), current smokers (OR = 10.88, 95%CI = 3.86-30.69), and participants with hazardous drinking (OR = 5.66, 95%CI = 2.59-12.36). . Just over half cardiology patients were screened for alcohol use. Almost two-thirds of those identified with hazardous drinking did not receive BIs. Screening and BI practices varied according to individual participant characteristics, and there was a shortfall in screening among the elderly. Findings indicate inconsistent implementation of European cardiology guidelines, which recommend universal screening, and highlight a need for improved implementation strategies.

. Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with longer life expectancies. The need for permanent pacemaker implantation (PPI) following TAVI has been associated with increased all-cause mortality and morbidity. This study aimed to identify ECG, CT, and procedural predictors of PPI following TAVI. We conducted a retrospective observational study at the University Hospital of North Norway. Patients who underwent TAVI with SAPIEN 3 or SAPIEN 3 Ultra valves were included, while those with prior pacemakers, self-expanding valves, or valve-in-valve procedures were excluded. Data were collected from medical records, pre-operative CT scans, and procedural angiography. A total of 416 low- to intermediate-risk patients with a median age of 82 years were included. Of these, 64 patients (15.4%) required PPI within ≤30 days following the index procedure. Multivariable regression analysis identified the following predictors for PPI: pre-existing right bundle branch block (odds ratio (OR), 10.7; 95% CI, 4.74-24.3), first-degree atrioventricular block (OR, 2.62; 95% CI, 1.08-6.32), membranous septum length (OR, 0.77; 95% CI, 0.65-0.90), left ventricular outflow tract calcification (OR, 2.18; 95% CI, 1.12-4.27), and the use of 29 mm valves (OR, 2.33; 95% CI, 1.09-4.97). Our study found the following predictors of PPI following TAVI: pre-existing right bundle branch block, first-degree atrioventricular block, the use of 29 mm valves and the presence of left ventricular outflow tract calcification. Additionally, a short MS was found to increase the chance of PPI; therefore, MS measurements should be included in pre-operative assessments to identify at-risk patients.

We aimed to assess the prospective associations of sleep duration and quality with the risk of cardiometabolic multimorbidity (CMM) and the interplay with physical activity. Sleep duration and quality and physical activity were self-reported using standardized questionnaires. Cardiometabolic multimorbidity was defined as the presence of at least two multiple long-term conditions (hypertension, diabetes, coronary heart disease, stroke, and other cardiovascular diseases) at follow-up. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression models adjusted for cardiometabolic risk factors including physical activity. We included 3,428 participants [mean (SD) age 63 (9) years, 44.8% male] free of hypertension, coronary heart disease, diabetes, and stroke at baseline. At 15 years follow-up, 206 participants developed CMM. There was an approximate U-shaped trend between sleep duration and CMM risk. Compared to sleep duration of 7-8 hrs/day, the multivariable OR (95% CI) for CMM was 1.39 (1.03-1.90) for sleep duration ≤6 hrs/day and 1.05 (0.55-2.00) for sleep duration ≥9 hrs/day. The odds of CMM appeared to decrease with each additional hour of sleep among participants with short sleep duration (≤6 hrs/day), although this association did not reach statistical significance (OR, 0.78, 95% CI: 0.59-1.02). Sleep quality or physical activity was not associated with CMM. Short sleep duration is associated with an increased CMM risk independent of physical activity. The observed trend suggests that increasing sleep duration among short sleepers may help mitigate CMM risk.

Invasive coronary angiography (ICA) is the gold standard in evaluating stent patency after percutaneous coronary intervention (PCI), but it carries a risk of potentially life-threatening complications. Third-generation coronary computed tomography angiography (CCTA) offers a non-invasive, safer follow-up method, but real-world data are lacking. This study evaluated the ability of CCTA to rule out in-stent restenosis (ISR) in long stents at long-term follow-up. This prospective, single-centre study (NCT06543641) included consecutive patients treated with PCI for coronary chronic total occlusion with long stents (left anterior descending coronary artery and right coronary artery ≥38 mm, left circumflex coronary artery ≥30 mm) in 2014-2019. All patients underwent third-generation dual-source CCTA. Patients with CCTA showing significant ISR, inconclusive results, or symptomatic native artery lesions underwent ICA. The study included 45 patients (median age 67 (IQR 62-73) years, 87% males) with 47 stents (median length 51 mm, range 36-132 mm). CCTA ruled out significant ISR in 87% ( = 39) of the patients. CCTA indicated five ISRs and one inconclusive result in six (13%) patients, all of whom underwent ICA. Additionally, ICA was conducted for five patients due to a native artery lesion(s) on CCTA and angina. ICA showed significant stenosis in all six patients (100%) with ISR or inconclusive CCTA finding in the long stent. Third-generation CCTA could rule out significant ISR in a vast majority of cases (87%,  = 39) and without a risk of complications associated with ICA. CCTA provides a non-invasive, lower risk method for long-term revascularization follow-up.

Interventional left atrial appendage occlusion (LAAO) was developed as a treatment option for patients who cannot receive traditional anticoagulation therapies. To date, randomized study data on this treatment are still limited, so registries and other non-randomized studies may help define the role of LAAO in clinical practice.

Patients with acute type A aortic dissection (ATAAD) presenting with cerebral malperfusion have significantly poorer postoperative outcomes, making the decision whether to perform acute surgery difficult. The aim of this study was to investigate types of neurological symptoms and radiological findings and their association with permanent neurological injury and mortality following ATAAD repair.

This study aimed to estimate the prevalence of atrial fibrillation (AF) and identify its associated comorbidities in adults aged 45 years and older, using data from the Swedish general population study EpiHealth. In a cross-sectional design, data of health history, lifestyle factors, anthropometric measurement, and 1-lead ECG recordings from participants in the EpiHealth study were linked to data from the Swedish Patient Registry. Among the 22,616 participants (56.2% women), the overall prevalence of AF was 3.9%, of which 0.3% were newly diagnosed cases identified by single 1-lead ECG at cohort examination. AF prevalence was higher in men than in women across all age groups and increased with age, reaching 17.2% among men aged 75 years and older. Participants with AF had a higher prevalence of cardiovascular comorbidities compared to those without AF. The findings highlight the increasing prevalence of AF with advancing age and its higher occurrence in men compared to women. The screening-detected prevalence of AF of 0.3% among participants in this general population study suggests that simple 1-lead ECG could be a manageable approach to screen for AF. The strong association between AF and cardiovascular comorbidities emphasizes the need for management strategies to address this condition, particularly in older adults.

Recent guidelines advocate postoperative aortic surveillance without clear distinction between aortic valve phenotypes. We sought to determine the long-term occurrence and location of distal aortic complications and aortic growth rates postoperatively in patients with bicuspid and tricuspid aortic valves, respectively.

. In this study, we investigated the different effects of roller and centrifugal pumps on blood and myocardial tissue structure in a normothermic machine-perfused porcine heart model. . We selected 16 healthy Guangxi Bama miniature pigs weighing 25-30 kg and randomly divided them into two groups, one perfused by a roller pump and the other perfused by a centrifugal pump. We recorded hemodynamic parameters, measured blood gases to test for erythrocyte destruction, coagulation, myocardial injury markers, and inflammatory factors, and observed pathological and ultrastructural changes in the left ventricular wall myocardial tissue. There were no differences in perfusion, heart rate, blood gases, hemolysis, or cardiac enzyme levels between the two groups ( > .05). The centrifugal pump group had a higher platelet count, fibrinogen level, and prothrombin time and lower levels of D-dimer ( < .05). In the centrifugal pump group, compared to the roller pump group, the pro-inflammatory factor levels were significantly higher and interleukin-10 levels were significantly lower ( < .05). Hematoxylin-eosin staining and transmission electron microscopy results showed no difference in the degree of myocardial tissue damage between the two groups. The results of this study suggested that the centrifugal pump model reduced platelet destruction, prolonged prothrombin time, avoided excessive fibrinogen activation, and attenuated elevated D-dimer levels. However, the centrifugal pump induced a greater inflammatory response compared to roller pump.

. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to provide cardiorespiratory support in cardiogenic shock (CS), but selection of patients and timing of ECMO-start remain a challenge. This study aims to describe the 1 year outcome of VA-ECMO for CS with focus on etiology and severity of shock. VA-ECMO was used on 371 occasions between 2004 and 2019 at our center. Of these, 177 patients received VA-ECMO for CS and were included in this retrospective single-center study. Univariable and multivariable logistic regression models were used to determine predictors of all-cause mortality at 1 year. Patients were grouped according to underlying etiology: non-ischemic heart failure (NIHF,  = 49), ischemic heart disease (IHD,  = 83) and miscellaneous diagnoses (Misc,  = 45). Markers of disease severity were lower for patients with NIHF. One year survival was 40% for all patients, 57%, 36% and 27% for the NIHF-, IHD and Misc-groups, respectively ( < .01). Univariable logistic regression analysis identified several variables associated with 1-year mortality, such as underlying etiology, pH and lactate, while biventricular failure was associated with a better prognosis. However, in the multivariable analysis, only ECPR remained significantly associated with increased mortality (OR 3.67, (CI 1.66-8.31),  < .01) In this retrospective study of VA-ECMO for CS, we found an acceptable one-year survival rate of 40%, with a more favorable outcome for NIHF-patients. The negative association of ECPR with a higher 1 year mortality suggests the importance of patient selection as well as timing of the VA-ECMO before deterioration to cardiac arrest.

The aim was to resuscitate and evaluate hearts after 22 min of cardiac arrest with the goal of increasing the number of usable hearts from controlled donation after circulatory death (cDCD).

Sudden cardiac death (SCD) is a leading cause of mortality among individuals with congenital heart disease (CHD), and risk stratification remains challenging. This study aimed to describe the underlying structural cardiac abnormalities in a national cohort of SCD victims with CHD, their socioeconomic status, and interactions with the healthcare system before death.