Volume 41 - Issue 3

INTRODUCTION: The CHA₂DS₂-VA score, which is used to determine the risk of thromboembolism in patients with atrial fibrillation, has been shown to be a predictor of mortality in many cardiovascular diseases. However, there is no data in the literature on the effect of CHA₂DS₂-VA score on in-hospital mortality in patients with acute aortic dissection (AAD). We aimed to determine the effect of CHA₂DS₂-VA score on in-hospital mortality in patients with AAD.
METHODS: This retrospective cohort study included 113 patients (89 males, 24 females, age 58.7±10.5 years) who underwent surgical treatment for AAD. CHA₂DS₂-VA scores were calculated. All cases of in-hospital mortality during the follow-up period were identified and recorded. Patients were grouped as with and without mortality.
RESULTS: Among patients with AAD, in-hospital mortality was observed in 30 cases (27.5%). Mortality rates in patients with CHA₂DS₂-VA 1, 2, 3 and ≥ 4 were 7%, 13%, 27%, and 53%, respectively. Age, CHA₂DS₂-VA score, and high-sensitivity C-reactive protein serum level independently determined the patients with mortality, and each one unit increase in these parameters predicted 11.3%, 2.19-fold, and 3.2% mortality increase, respectively. In receiver operating characteristic analysis, when the cutoff value of CHA₂DS₂-VA score was taken as 3, it was found to determine the development of mortality due to AAD with 80.5% sensitivity and 78.6% specificity.
CONCLUSION: CHA₂DS₂-VA score is independently associated with the development of in-hospital mortality in patients with AAD. According to the findings of our study, the CHA₂DS₂-VA score may serve as a prognostic marker in patients with AAD.

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.