INTRODUCTION: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker for heart stress and heart failure, with its production triggered by the stretching of cardiac fibers. This study investigates if elevated NT-proBNP levels can independently predict poor outcomes for patients undergoing heart surgery.
METHODS: A systematic review was performed in the PubMed^®, Latin American and Caribbean Health Sciences Literature (or LILACS), Physiotherapy Evidence Database (PEDro), Web of Science, and Embase databases, with the following descriptors: "NT-proBNP" OR "NTproBNP" OR "N- terminal pro-B-type natriuretic peptide" OR "N- terminal pro brain natriuretic peptide" OR "amino terminal pro brain natriuretic peptide" AND "Cardiovascular Surgical Procedures" NOT "Pediatric" OR "children" NOT "cancer" OR "oncology" NOT "animal*". Articles that evaluated NT-proBNP and adverse outcomes in cardiac surgical patients were chosen. The levels of evidence and the strength of recommendation were assessed considering the Grading of Recommendations, Assessment, Development and Evaluation (or GRADE) system and validity by the PEDro scale. For systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) criteria and the Population, Intervention, Comparison, Outcome (or PICO) strategy were followed.
RESULTS: Forty-seven articles were included, of which 17 were related to serious complications, including mortality.
CONCLUSION: Preoperative NT-proBNP is a prognostic marker for mortality, length of stay in the postoperative intensive care unit, postoperative acute kidney injury, postoperative atrial fibrillation, postoperative low cardiac output, postoperative prolonged mechanical ventilation time, prolonged hospitalization time, unscheduled hospital readmission related to heart problems, and postoperative heart failure.

The rising cardiovascular disease burden in Africa necessitates a strengthened healthcare system including enhanced access to cardiac surgery, the definitive treatment for several surgical cardiovascular diseases. Though open-heart surgery, the most invasive type of cardiac surgery, was already possible in Africa over five decades ago, with pioneering surgeons performing atrial septal defect repairs via surface cooling in Ghana as early as 1964, its development across the continent has been hindered by significant challenges. This study highlights the challenges faced by both established and nascent open-heart surgery programs across Africa. We further identify key areas for sustaining and expanding open-heart surgery programs, including robust training for surgeons and support staff, resource allocation, and enhanced capacity building. By systematically analyzing the landscape of open-heart surgery in Africa, this paper proposes a multifactorial approach to overcome these limitations and ensure equitable access to this life-saving intervention for a vastly underserved population.

INTRODUCTION: Several clinical trials have demonstrated the non-inferiority of transcatheter aortic valve replacement compared with surgical aortic valve replacement in patients with severe aortic stenosis and low to intermediate surgical risk. However, mid-term results are still contentious. We performed this meta-analysis to compare the safety and efficacy of transcatheter vs. surgical aortic valve replacement in the mid-term in patients with aortic stenosis at low to moderate surgical risk.
METHODS: We searched Embase, PubMed^®, and Cochrane databases for randomized clinical trials that compared transcatheter with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis with a follow-up of at least four years. Outcomes of interest were all-cause mortality and disabling stroke.
RESULTS: We included six randomized clinical trials encompassing 6,444 patients with severe aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic valve replacement. There was no difference in all-cause mortality (risk ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25; P = 0.30) and disabling stroke (RR 0.95; 95% CI 0.75 - 1.21; P = 0.67) between groups. In the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10 - 1.49) was higher in the transcatheter group. The new pacemaker implantation (RR 2.22; 95% CI 1.42 - 3.45) rate was higher in the transcatheter group. However, the new atrial fibrillation (RR 0.40; 95% CI 0.31 - 0.52) rate was higher in the surgical group.
CONCLUSION: Mid-term mortality and disabling stroke rates in patients with severe aortic stenosis treated with either transcatheter or surgical aortic valve replacement were similar.

The neocuspidization technique using autologous pericardium (AVNeo^®) is a recent alternative for aortic valve replacement in selected patients. Between 2019 and 2023, we applied it in 56 patients, evaluating surgical outcomes, survival, reintervention rates, and clinical and echocardiographic results. We analyzed its advantages, patient selection criteria, limitations, and management of bicuspid valves. We also assessed whether it is suitable for all patients and discussed the midterm outcomes observed. AVNeo^® may offer a promising option, especially for younger patients, by preserving native anatomy and avoiding prosthetic materials, though long-term data and further research are still needed.

INTRODUCTION: Frailty syndrome is a significant risk factor for elderly patients undergoing cardiovascular surgery. However, there is no consensus on which criteria are most effective for assessing frailty in this context.
OBJECTIVE: This study aimed to evaluate the relationship between different widely cited frailty syndrome criteria and postoperative morbidity and mortality.
METHODS: Patients aged ≥ 60 years scheduled for coronary artery bypass graft, valve, and/or ascending aortic surgery were assessed for frailty preoperatively. Frailty was defined by Clinical Frailty Scale (CFS) ≥ 4, Katz Index ≥ 1, Short Physical Performance Battery (SPPB) ≤ 6, Fried Frailty Phenotype (FFP) ≥ 3 or abnormal values in 15-feet gait speed (GS) test, or hand grip strength. Clinical outcomes, including mortality and major adverse cardiovascular and cerebral events (MACCE), were assessed 30 days post-surgery.
RESULTS: Among 137 patients (70.1% male, mean age 69.43 ± 5.98 years), frailty prevalence ranged from 13.1% to 43.1%, depending on criterion, with no significant differences by age strata or surgery type. At 30-day follow-up, mortality was 5.1% (n = 7), and a total of 29 MACCE (21.1%) were recorded. Patients identified as frail by the FFP, CFS, SPPB, and GS criteria showed a significant association with mortality and MACCE. Multivariate analysis indicated FFP and CFS as independent risk factors for MACCE with equivalent prognostic prediction.
CONCLUSION: Frailty is a prevalent condition among elderly patients undergoing cardiovascular surgery and is associated with mortality and morbidity. Frailty defined by FFP and CFS criteria was independently associated with higher MACCE rates.

INTRODUCTION: Reoperative cardiac surgery is associated with a higher risk of complications due to technical difficulties compared to the first-time surgery. This study aims to compare the early outcomes of median sternotomy (MS) and lateral thoracotomy (LT) procedures in patients with a history of previous open-heart surgery who underwent left ventricular assist device (LVAD) implantation with cardiopulmonary bypass (CPB).
METHODS: A retrospective analysis was conducted on 36 patients who received LVAD implants for end-stage heart failure between November 2012 and June 2015. The patients were divided into Group 1 (MS, n = 18) and Group 2 (LT, n = 18).
RESULTS: The mean age of the patients was 57.2 ± 9.4 years (range: 24 – 70 years), and only 8.3% were female. Demographic data, preoperative characteristics, use of blood products, anesthetic drugs, and complications were similar in both groups (P > 0.05). The MS group had significantly longer operation duration (101 ± 46 minutes vs. 70 ± 20 minutes, P = 0.038) and CPB time (328 ± 79 minutes vs. 265 ± 47 minutes, P = 0.048) compared to the LT group. Postoperative analgesic consumption and pain scores were similar between the two groups (P > 0.05).
CONCLUSION: In patients with a history of previous cardiac surgery, LVAD implantation with LT through CPB demonstrated favorable outcomes regarding reduced operation duration and CPB time. However, it did not positively impact the duration of stay in the intensive care unit, hospital stay, use of blood products, and complications.

INTRODUCTION: Choosing a surgical technique in patients with acute type A aortic dissection is still a debatable issue. In patients with massive aortic root destruction, the Bentall procedure is a gold standard. Aortic valve reimplantation is a reliable alternative, especially in patients with the preserved anatomy of aortic valve leaflets.
OBJECTIVE: To compare the results of modified valve sparing procedure and composite root replacement in patients with acute type A aortic dissection.
METHODS: In total, 62 patients were included in this study. Of those, 27 patients underwent aortic valve reimplantation, and 35 had the Bentall procedure with the Kouchoukos modification.
RESULTS: Preoperative demographics and clinical characteristics were analyzed in both groups. Similar indicators of preoperative malperfusion were observed in both. Cardiopulmonary bypass time (P = 0.125) and aortic clamping time (P = 0.001) were longer (≈ 30 minutes) in the reimplantation group while the time of circulatory arrest was longer in the Bentall group (P = 0.290). Hospital mortality rates were 8.3% in the reimplantation group and 22.9% in the Bentall group. During the long-term follow-up period, there were six (25%) deaths in the reimplantation group and 10 (28.6%) deaths in the Bentall group. The aortic regurgitation degree was stable in all cases up to the moment of last contact with the patients.
CONCLUSION: Modified aortic valve reimplantation shows good immediate and long-term outcomes in patients with acute type A aortic dissection.

OBJECTIVE: This study aimed to investigate the frequency of persistent left superior vena cava (PLSVC) and its impact on outcomes in children undergoing congenital heart surgery.
METHODS: The study was conducted retrospectively in cases diagnosed with congenital heart disease who were operated on under the age of 16 years between October 1st, 2021, and October 1st, 2024, at two major tertiary centers. The frequency of PLSVC and its possible impact on surgical outcomes were evaluated in these cases. The results were analyzed statistically.
RESULTS: There were 4,000 cases during the study period, with 52% being male. The median weight was 5.2 kg (interquartile range 4.5 - 6 kg). PLSVC was detected in a total of 260 cases (6.5%). Of these cases, 92.3% (240/260) drained into the coronary sinus, while 7.7% (20/260) drained directly into the left atrium. In 251 (96.5%) of the patients with PLSVC, there was a right SVC, while nine (3.5%) did not have a right SVC. Of the 251 patients with double SVC, 105 (42%) had a normal innominate vein. PLSVC was primarily associated with heterotaxy syndrome, atrioventricular septal defect, and vascular ring defects.
CONCLUSION: There is an increased frequency of PLSVC among certain congenital heart disease groups, and raising awareness during echocardiographic examination can facilitate the diagnosis of PLSVC. Preoperative diagnosis of PLSVC can help in managing complications more effectively

INTRODUCTION: The aims of this study are to compare sternal closure techniques (single, figure-of-8, and combined use) in patients undergoing cardiac surgery and to investigate their relationship with postoperative sternal complications.
METHOD: Between 2023 and 2024, 645 patients (470 males; mean age 58.5 ± 11.1 years) who underwent cardiac surgery were evaluated. The patients were divided into three groups: Group 1, simple wire (n = 141); Group 2, figure-of-8 (n = 224); and Group 3, combination of these two techniques (n = 280). Preoperative and perioperative data, postoperative complications, and sternal complications were compared between these groups.
RESULT: The distribution ratio of the groups is 141 (22%), 224 (35%), and 280 (43%) in Groups 1, 2, and 3, respectively. There was no significant difference between the groups regarding basic demographic characteristics, comorbidities, and operative data. There was no difference between the groups in terms of postoperative exploration, delayed chest closure, subxiphoid decompression, superficial sternal wound infection (SSWI), deep sternal wound infection (DSWI), vacuum-assisted closure usage, intubation time, intensive care unit stay, and mortality. The hospital stay was found to be shorter in Group 3 compared to the other groups (median 8 days - 7 days, P = 0.02).
CONCLUSION: In patients undergoing cardiac surgery, we found no difference in sternal complications (DSWI, SSWI) between the three most commonly used closure techniques (simple wire, figure-of-8, and their combination). We found that the length of hospital stay was shorter in patients with the combined technique than in the other two techniques.