Examining the effects of coronary artery disease- and mitochondrial biogenesis-related genes' and microRNAs' expression levels on metabolic disorders in epicardial adipose tissue.

BACKGROUND AND AIMS: Epicardial adipose tissue (EAT) surrounds the heart and coronary arteries and is important for comprehending the pathogenesis of coronary artery disease (CAD). We aimed to evaluate the expressions of mitochondrial biogenesis- and CAD-related genes and miRNAs in EAT by comparing them to visceral adipose tissue (VAT) in CAD, diabetes, and obesity subgroups. METHODS: In this study, a total of 93 individuals were recruited, and EAT samples (63 CAD; 30 non-CAD) and VAT samples from 65 individuals (46 CAD; 19 non-CAD) were collected. For further analysis, the study population was divided according to obesity and diabetes status. PRKAA1, PPARGC1A, SIRT1, RELA, TNFA, and miR-155-5p, let-7g-5p, miR-1247-5p, miR-326 expression levels were examined. RESULTS: PRKAA1 and let-7g-5p were differentially expressed in EAT compared to VAT. TNFA expression was upregulated significantly in both tissues of CAD patients. In EAT, PRKAA1, PPARGC1A, and SIRT1 were downregulated with diabetes. Moreover, PPARGC1A expression is decreased under the condition of obesity in both tissues. EAT expressions of miR-1247-5p and miR-326 were downregulated with obesity, while miR-155-5p is decreased only in the VAT of obese. Also, miRNAs and genes were correlated with biochemical parameters and each other in EAT and VAT (p < 0.050). CONCLUSIONS: The findings demonstrating distinct let-7g-5p and AMPKα1 mRNA expression between EAT and VAT underscores the importance of tissue-specific regulation in different clinical outcomes. In addition, the differential expressions of investigated genes and miRNAs highlight their responsiveness to obesity, DM, and CAD in adipose tissues.

High-risk left main coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device: an alternative insertion technique.

Patients with high-risk coronary lesions such as left main stenosis and a severely depressed left ventricular ejection fraction are at risk of death and morbidity-related complications during coronary artery bypass surgery. Several alternative methods have been developed for managing this problem, but it is still challenging, even for highly experienced and well-equipped cardiac surgery centers. We report the case of a successful coronary artery bypass surgery supported by the Impella Recover LP 2.5 assist device and using an alternative insertion technique for the ascending aorta in a patient with high-risk coronary lesions, such as left main disease.

Revascularization in patients with severe left ventricular impairment who have ischemic heart disease.

OBJECTIVE: To assess the effect of coronary bypass grafting on left ventricular (LV) function, exercise capacity and symptom profile in patients with LV impairment and retrospectively evaluate the role of the different factors affecting LV. METHODS: A total of 45 patients (33 men, 12 women, mean age 63.49 +/- 7.38 years) with LV ejection fraction of less than 0.32 were admitted to the Istanbul University, Cardiology Institute, Istanbul, Turkey between January 2001 to June 2003 for coronary bypass operation. Preoperative and postoperative wall motion, functional class (New York Heart Association) and risk factors were analyzed. RESULTS: We had one perioperative mortality (2.2%) and 2 early postoperative mortality (4.4%) due to poor cardiac function. There was a significant increase in the mean LV ejection fraction from 26.64 +/- 5.17 to 32.98 +/- 6.38 (p<0.001) postoperatively. In this group the mean New York Heart Association grade improved from 2.07 +/- 0.76 to 1.5 +/- 0.79 (p<0.001). Preoperative functional class, congestive heart failure, arrhythmia, age, pre/postoperative complications were the main predictors of poor outcome following surgical revascularization for ischemic cardiomyopathy. CONCLUSION: In patients with severe LV impairment with myocardial hibernation, coronary artery bypass grafting improves both global and regional LV function and symptom profile. We therefore, recommend a coronary artery bypass grafting as an alternative to orthotopic heart transplantation whenever myocardial viability are documented.

Postoperative mechanical circulatory support with Biomedicus centrifugal pump.

Despite advances in surgical techniques, myocardial protection, and management protocols, approximately 1% of patients undergoing open heart operations still need mechanical circulatory support for severe cardiac dysfunction. The Biomedicus centrifugal pump, available in most cardiovascular centers, is a highly effective and relatively inexpensive system compared to other more sophisticated devices for the same purpose. Of 10 patients aged 5 to 61 years who were supported for 22 to 168 hours with a Biomedicus centrifugal pump, 7 (70%) were weaned from support, there was one hospital death, and 6 patients were discharged from hospital. Two sudden deaths occurred in the first 8 months after discharge. Four patients (40%) were still alive after follow-up of 11-55 months, with no restriction in their daily activities. The centrifugal pump is a very cost-effective support system with survival rates comparable to those of more sophisticated devices in short-term ventricular assistance.