European Society of Anaesthesiology.

Although the likelihood of PRD in patients without pre-existing renal dysfunction is relatively low, it dramatically increases mortality, morbidity and length of stay after CABG. Mildly elevated (>1.2 mg/dl) preoperative serum creatinine level significantly increases the perioperative mortality and morbidity.

We developed a set of risk-prediction models that can be used as an instrument to provide information to clinicians and patients about the risk of postoperative major morbidity in our patient population undergoing isolated CABG.

The technique of repair of postinfarction dyskinetic LV aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. Both techniques achieved good results with respect to perioperative mortality, late functional status and survival.

Rationale: Efficient communication between heart cells is vital to ensure the anisotropic propagation of electrical impulses, a function mainly accomplished by gap junctions (GJ) composed of Cx43 (connexin 43). Although the molecular mechanisms remain unclear, altered distribution and function of gap junctions have been associated with acute myocardial infarction and heart failure. Objective: A recent proteomic study from our laboratory identified EHD1 (Eps15 [endocytic adaptor epidermal growth factor receptor substrate 15] homology domain-containing protein 1) as a novel interactor of Cx43 in the heart. Methods and Results: In the present work, we demonstrate that knockdown of EHD1 impaired the internalization of Cx43, preserving gap junction-intercellular coupling in cardiomyocytes. Interaction of Cx43 with EHD1 was mediated by Eps15 and promoted by phosphorylation and ubiquitination of Cx43. Overexpression of wild-type EHD1 accelerated internalization of Cx43 and exacerbated ischemia-induced lateralization of Cx43 in isolated adult cardiomyocytes. In addition, we show that EHDs associate with Cx43 in human and murine failing hearts. Conclusions: Overall, we identified EHDs as novel regulators of endocytic trafficking of Cx43, participating in the pathological remodeling of gap junctions, paving the way to innovative therapeutic strategies aiming at preserving intercellular communication in the heart.

Staging of carotid and coronary operations resulted in low global perioperative mortality and morbidity rates in these high-risk patients and is a good alternative therapeutic option.

Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG.

C ardiac transplantation has become a relatively common procedure, but its major limiting factor is still the shortage of donor hearts. The donor pool can potentially be increased by relaxing selection criteria or by performing innovative procedures on the donor heart, such as valve repair. We present a recent case of successful transplantation after mitral valve repair in a heart with moderate rheumatic valve disease. Clinical SummaryA 52-year-old man with end-stage congestive heart failure caused by idiopathic dilated cardiomyopathy was evaluated and listed for cardiac transplantation. On January 18, 2004, a 35-year-old woman without a history of cardiac disease experienced brain death from a hemorrhagic cerebral accident and was selected as a multiorgan donor. The transthoracic echocardiogram showed evidence of mildly to moderately sclerotic leaflets with otherwise good motion and no evidence of stenosis (mitral valve area, 3.0 cm 2 ) and mild mitral regurgitation. Regional and global myocardial contractility was unimpaired, and the ejection fraction was normal. Because there were no other contraindications to heart donation, we decided to proceed with the transplantation.The heart was transported to our center, and the mitral valve was carefully inspected through the open left atrium. The free edges of the leaflets were mildly fibrosed and retracted, and the posteromedial commissure was moderately fused, as were the corresponding chordae tendineae. The valve was tested with injection of cold saline into the left ventricle after the aorta was clamped. There was a central jet of regurgitation caused by incomplete coaptation of the leaflets as a result of some retraction of the free edges. Because the valve disease was thought to be more significant than anticipated before the heart procurement, it was decided to proceed to bench repair of the mitral valve. A commissurotomy of the posteromedial commissure, followed by division of fused chordae tendineae, was performed. Additionally, although there was only mild annular enlargement, an annuloplasty was performed to increase the area of leaflet coaptation and to prevent future annular enlargement. The posterior annulus was plicated with a double continuous 3-0 polyester suture placed from trigone to trigone ( Figure 1). The valve was again tested, and good coaptation of the leaflets was observed. This was a straightforward procedure with understandably excellent exposure, and it required less than 10 minutes of additional ischemic time.The heart was them implanted by a bicaval anastomotic technique. The crossclamp time was 35 minutes. The ischemic time of the donor heart was 84 minutes. Intraoperative transesophageal echocardiography revealed minimal mitral regurgitation. Donor heart function was excellent. There was no transvalvular gradient, as determined by direct measurement of simultaneous left ventricular and left atrial pressures. DiscussionCardiac transplantation has become a relatively common procedure, with the major limiting factor being the shortage ...