The National Institute of Cardiovascular Diseases

Background Intestinal pneumatosis, the presence of gas and free air in the extraluminal space of the gastrointestinal tract can still be challenging for clinicians as the severity of underlying illness and adequate therapy might be difficult to assess, especially for complex patients following solid organ transplantations. Objective Purpose of this study was to analyse the occurrence of pneumatosis in patients following heart transplantation at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia . Methods We designed this study as a single centre retrospective observational study. Study population included 19 patients who underwent computed tomography scan on which the abdomen was captured from a total of 125 transplanted patients Results Out of 19 patients, intestinal pneumatosis was detected in four patients of which in one it was evaluated only as discrete. Pseudo-pneumatosis was detected in four patients. In the intestinal pneumatosis group, three patients had uneventful course requiring no specific therapy and one patient underwent emergent laparotomy for ileus. Sixteen of the 19 patients who underwent a computed tomography scan had no clinical signs of acute abdomen, although three of them (18.75%) had intestinal pneumatosis. There was no statistical difference between the groups of patients with and without intestinal pneumatosis in terms of preoperative, intraoperative and postoperative characteristics including the hospital course. Conclusion Pneumatosis intestinalis is a relatively common radiological finding in patients post heart transplantation. This radiological sign can accompany variety of clinical conditions from completely benign to life-threatening requiring emergency surgery

Introduction A new implantable cardioverter‐defibrillator (ICD) lead with a polyurethane cover added for improved long‐term reliance was investigated in a post‐market study. Methods The prospective BIO|MASTER Pamira study is designed to evaluate the new Pamira ICD lead in patients undergoing de‐novo ICD or cardiac resynchronization therapy (CRT‐D) implantation. We report first data from implantation and 6‐month follow‐up. Results Despite its slightly larger diameter, the lead demonstrated similar or improved handling during implantation compared to its predecessor without polyurethane cover. Conclusion All results from implantation and short‐term follow‐up aligned with expectations. To show an improved reliance, long‐term data will be required.

Background/Aim This study investigated the therapeutic potential of lipophosphonoxin (LPPO), an antibacterial agent, loaded into polycaprolactone nanofiber dressings (NANO-LPPO) for full-thickness wound healing. Using a porcine model, we aimed to assess the impact of areal weight of the dressing (10, 20 and 30 g/m²) on wound-healing outcomes and validate findings from previous murine studies. Materials and Methods Full-thickness wounds were created on porcine skin and treated with the NANO-LPPO dressings of differing thickness. Positive control (Aquacel Ag+) and standard control (Jelonet) groups were included for comparison. Wound-healing progression was evaluated macroscopically and on the histological level. Results Macroscopic observations indicated no signs of infection in any group, with wounds covered by scabs by day 14. Thicker dressings (areal weights of 30 and 20 g/m²) demonstrated superior performance in promoting the formation of granulation tissue and healing compared to the thinner version (areal weight of 10 g/m²). LPPO-loading enhanced scaffold wettability and biodegradability without impairing healing outcomes. Both control groups exhibited similar healing characteristics. Conclusion The findings underscore the importance of optimizing dressing thickness for effective wound healing. NANO-LPPO dressings exhibit translational potential as a therapeutic option for full-thickness wounds, warranting further preclinical and regulatory evaluation to support clinical application.

The aim of the open label extension (OLE) of CTREPH study was to characterize multimodal treatment in patients with severe inoperable CTEPH, to describe long‐term subcutaneous (SC) treprostinil safety and tolerability, and to evaluate change in functional class and exercise capacity over 24 months since completion of the blinded phase of CTREPH. The target population in the OLE consisted of patients who completed 24 weeks of blinded treatment with either high‐dose treprostinil of around 30 ng/kg/min (former high‐dose group), or low‐dose treprostinil of around 3 ng/kg/min (former low‐dose group) in the CTREPH study. From the start of OLE, treprostinil dose and any additional therapy were chosen according to the standard of care and physician's discretion. Out of 47 enrolled patients, 20 patients received other PH drugs during OLE and 17 patients underwent at least 1 BPA session. Number of treprostinil‐related AEs was substantially higher in the former low‐dose group in comparison to the former high‐dose group. Related AEs were also more frequent during the first 6 months of the preceding blinded trial than over 24 months of OLE, especially infusion site pain and all local infusion site reactions. No new safety signal was detected. Evaluated clinical outcomes show sustained benefit from long‐term treprostinil treatment. Long‐term SC treprostinil is a safe and effective component of multimodal treatment for patients with severe CTEPH. Patients who tolerate treprostinil after initiation are likely to continue tolerating it over time, with the clinical benefit maintained over 24 months.

Objectives Medication errors are a leading source of preventable harm in healthcare, affecting approximately 1 in 30 patients, with a substantial proportion resulting in severe outcomes. In response, the European Association of Hospital Pharmacists convened a Special Interest Group (SIG) to propose comprehensive and sustainable strategies for reducing these errors across Europe, employing a systems approach. Methods 89 anonymised medication error reports, and empirical data from the SIG members’ daily practice, were analysed to identify root causes, classified into system-level and individual errors. Expert subgroups then linked root causes to targeted preventive measures. A literature review was conducted, searching PubMed and Embase databases, to assess existing standards and identify gaps in medication safety practices, which informed the analysis. Results Analysis revealed that governance deficiencies and inconsistent implementation of existing legal standards contribute significantly to medication errors. System-level issues, including inadequate oversight, understaffing and insufficient technical infrastructures, along with individual errors from cognitive lapses, were prevalent. The literature review supported these findings and highlighted the variability in medication safety practices across systems, underscoring the importance of strategic improvements in healthcare policies. Conclusions Findings highlight the critical need for robust governance, comprehensive policy frameworks and enhanced safety cultures to prevent medication errors. Automation and improved human–machine interfaces are recommended to mitigate active failures and enhance system reliability. This systems-thinking approach, supported by strengthening legislation and better resource allocation, is essential for reducing medication errors and improving patient safety.

Aims Adults with congenital heart disease (ACHD) knowledge regarding their heart condition is crucial for optimal long-term outcome. Previous studies from Northwestern Europe showed that important gaps in ACHD knowledge still exist. This study evaluates ACHD patients’ knowledge in Central and Southeastern Europe (CESEE) and aims to identify opportunities for improving lifelong ACHD care and outcomes in this region. Methods and results A structured survey regarding the baseline heart condition knowledge was prospectively distributed to stable ACHD patients over a 1-year period (2021–22). Patients’ responses were verified by their ACHD physicians to ensure accurate background information. Amongst 1650 patients (age 34.5 ± 14) across 14 CESEE countries, the majority (1023, 62.0%) had simple congenital heart disease with at least one previous heart procedure performed (1201, 72.8%); 1060 (64.2%) were asymptomatic, and 875 (53.8%) had secondary school education. Overall, 576 (34.9%) did not have basic knowledge regarding their congenital heart disease, and 146 (12.2%) did not have basic understanding regarding their previous heart procedure/s. Patients considered their life expectancy similar to the general population (P = 0.039). Encouragingly, 962 (59.5%) expressed a desire to learn more, and 929 (58.1%) favoured technological integration in their care. Conclusion Significant knowledge gaps exist amongst CESEE ACHD patients regarding their heart condition. Better ACHD patient education on current health and prospects is urgently needed. The results of this study should serve for developing congenital heart disease structured transitional and educational programmes in CESEE incorporating technology for their ACHD care and education to enhance patients’ health knowledge and healthy life behaviours to positively influence their lifelong prospects.

Vascular access-induced limb ischaemia is a potentially severe complication. A classification system for clinical assessment and treatment would be a useful clinical tool for standardising management. There are several classifications described in the current literature using inconsistent terminology. The aim of this review is to identify all the reported classification systems of vascular access-induced limb ischaemia and to present a comprehensive summary. PubMed, Scopus, Web of Science, Google Scholar and the ClinicalTrials.gov registry were searched from inception to the 17th of October 2024. All articles containing newly proposed classifications regarding haemodialysis vascular access were eligible. There were no restrictions to the full text’s language or the type of study. The classifications were evaluated using a modified Buchbinder’s classification critical appraisal tool. From 4694 screened papers, 59 full-text papers were retrieved, and eight articles contained classifications based only on the severity of vascular access-induced limb ischaemia. According to the modified Buchbinder critical appraisal, the classifications identified were overall good quality. The systems are all based on clinical symptoms but use inconsistent terminology and do not consider various aetiologies. We present a summary and propose a unified classification based on the anatomical location of the pathology, which leads to high- or low-flow ischaemia, along with a suitable therapeutic approach for each type.

Background and Objectives: Most patients with cardiovascular disease have limited health literacy and knowledge. The promotion of knowledge among patients with coronary artery disease is an integral part of health maintenance and the minimisation of secondary cardiac events. The aim of this study was to map the percent proportion of answers and scores obtained from them in the studied domains. Materials and Methods: In this cross-sectional study, a Coronary Artery Disease Education Questionnaire (CADE-Q II) was used to verify knowledge gaps in the five studied domains. In total, 253 patients with coronary artery disease completed the CADE-Q II, which targeted five domains: health status, risk factors, exercise, nutrition and psychosocial risk. Data were collected between June 2021 and November 2024. Results: An analysis of the data found a total mean CADE-Q II score of 61.05 ± 11.42 SD out of 93 points. Our research showed that the total mean score of a group of patients corresponded to an acceptable level of knowledge. Patients in the cohort provided a total of 7843 responses for the five study domains. In total, 46.8% of patients scored all answers correctly in terms of risk factors, 49.0% in terms of nutrition, 53.1% in terms of health status, 64.4% in terms of psychosocial risk, and 65.0% in terms of exercise. Conclusions: The use of the CADE-Q II questionnaire, with its focus on the studied domains, verifies patient knowledge and provides a foundation for education, the provision of effective information and the promotion of secondary prevention knowledge.

The Berlin Heart EXCOR has been utilized as a bridge to transplant (BTT) in adult patients with end-stage heart failure. The aim of this short communication is to present our experience with post-transplant complications and outcomes in patients supported by the Berlin Heart EXCOR system. From January 2022 to December 2024, six patients with end-stage biventricular heart failure underwent implantation of the Berlin Heart EXCOR as a BTT. Three patients died while on support, and three patients successfully underwent transplantation. The median time to heart transplantation was 210 days (range: 74–600 days). One patient is alive and doing well 54 months after heart transplantation. However, the other two patients died on postoperative days 16 and 133 due to intestinal ischemia and infection ( Pseudomonas aeruginosa pneumonia and sepsis), respectively. In conclusion, although the results of our study are not very encouraging, they reflect outcomes in a critically ill group of patients with limited treatment options.

Objectives Aortic valve repair by tricuspidization with leaflet extensions is utilized in the management of aortic valve disease in children and adolescents. The aim of this study is to evaluate the long-term outcomes following aortic valve tricuspidization using polytetrafluoroethylene (PTFE) leaflet extensions at a single center. Methods We conducted a retrospective single-center analysis of 50 patients who underwent aortic valvuloplasty by tricuspidization with PTFE leaflet extensions between 2008 and 2024. Results Fifty patients (37/50, 74% female) underwent aortic valvuloplasty using PTFE. The median age was 13 (interquartile range [IQR]: 1.8-25) years. During the median follow-up duration of 8.5 years (IQR: 8 months-15.8 years), 18 patients required reoperation at a mean of 7.3 ± 4 years. The 15-year survival rate was 95.6% (95% confidence interval [CI], 88%-98.8%), and 2 late deaths occurred. The freedom from reoperation at 1, 5, and 12 years was 100% (95% CI, 100%-100%), 82.8% (95% CI, 66.6%-91.4%), and 44.2% (95% CI, 26.2%-61%), respectively. At discharge, the mean peak systolic aortic valve gradients (15 ± 10 mm Hg) were significantly lower than preoperative (72 ± 35 mm Hg) values ( P < .001). Mean of left ventricular end-diastolic diameter/body surface area index decreased from 38 ± 13 mm preoperatively to 34.4 ± 10.5 mm postoperatively, then reduced to 32 ± 7 mm at the latest follow-up ( P = .003). Aortic regurgitation improved in all patients, and none had more than mild aortic regurgitation at hospital discharge. Conclusions Aortic leaflet extension valvuloplasty using PTFE is effective, safe, with excellent survival and favorable long-term outcomes. It provides reliable palliation in patients with congenital aortic valve diseases until a more permanent replacement alternative is available.

The new guidelines for the management of peripheral arterial and aortic diseases (PAAD) from the European Society of Cardiology and endorsed by the European Society of Vascular Medicine (ESVM), emphasize on a comprehensive and multidisciplinary approach focusing on prevention, diagnosis, treatment, and follow-up of patients with a wide range of PAAD, including lower extremity peripheral arterial disease (PAD). The aim of this summary, focusing on PAD and coordinated by the Young Academy of ESVM, is to provide young angiologists with the fundamental principles of these guidelines and to assist them in navigating their everyday clinical practice. PAD diagnosis relies on objective evaluation of flow/oxygen reduction at rest, with arterial ultrasound as the first imaging modality to confirm the presence of arterial lesions. The main goals of PAD management are not only to improve functioning and prevent the occurrence of adverse events at the lower limb level, but also to reduce the overall atherosclerotic burden and achieve the general well-being of patients. To this end, traditional and nontraditional cardiovascular risk factors need to be properly addressed through lifestyle changes and tailored drug therapies. For patients with exertional limb symptoms, supervised exercise training is recommended. Interventional treatment is indicated for limb salvage in patients with chronic limb threatening ischemia and may also be discussed in a multidisciplinary setting in less severe patients with persisting symptoms and reduced quality of life after a minimum period of optimal medical treatment including exercise therapy. For trainees or young specialists in Angiology/Vascular Medicine, these guidelines provide essential elements to improve patient management, encourage interdisciplinary collaboration, and ensure an integrated approach to vascular diseases.

Background and Importance Peripheral artery disease is a common condition, particularly in geriatric populations with comorbidities such as hypertension, dyslipidaemia, or diabetes. These patients are at an elevated risk of cardiovascular morbidity and mortality, and frequently experience polypharmacy, which increases the likelihood of drug related problems (DRPs) and treatment failure. Aim and Objectives This study, a subanalysis of a previous investigation, aimed to evaluate the impact of pharmacist-led interventions on the prevalence of DRPs in geriatric patients undergoing vascular surgery. Material and Methods This study, a subanalysis of a previous study conducted on adult patients, focused specifically on geriatric patients (≥ 65 years old) diagnosed with carotid artery disease or lower extremity artery disease, all of whom were prescribed at least three medications. Comprehensive medication reconciliation and medication reviews were conducted by hospital pharmacists at both admission and discharge. Pharmacist-recommended interventions were documented and communicated to the attending physicians. Patients were provided with individualised pharmacotherapy education upon discharge to enhance medication adherence and understanding. Results The study cohort included 80 geriatric patients, with a significant decrease in the mean number of DRPs per patient, from 2.26 ± 2.12 at admission to 1.51 ± 1.87 at discharge (p < 0.001). The most common DRPs involved untreated symptoms or indications. Naftidrofuryl, considered a potentially inappropriate medication for older adults per the EU (7)-PIM list, was used by 50% of patients at both admission and discharge. Cardiovascular drugs contributed to 26.91% of DRPs, with atorvastatin (for untreated indications) most implicated at admission, and pantoprazole (unnecessary treatment) at discharge. Physicians accepted 57.9% of pharmacist-recommended interventions. A standardised DRP severity scale was not used due to the novelty of pharmacist-led DRP identification in our setting, limited physician familiarity with such recommendations, and their high workload, all of which impacted acceptance rates. Nearly half of the patients showed a good understanding of their pharmacotherapy at admission. Conclusion and Relevance Pharmacist-led interventions were associated with a significant reduction in DRPs among vascular surgery patients. This underscores the critical role of pharmacists in optimising medication management, improving therapeutic outcomes, and reducing the risk of medication related complications in this high-risk population. References and/or Acknowledgements • https://pubmed.ncbi.nlm.nih.gov/36862371/ • https://pubmed.ncbi.nlm.nih.gov/31157072/ • https://pubmed.ncbi.nlm.nih.gov/24796911/ • https://pubmed.ncbi.nlm.nih.gov/31156996/ • https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf Conflict of Interest No conflict of interest

Background and Importance Intravenous administration is the most common method of drug delivery in intensive care units.¹ Critically ill patients often have limited vascular access, necessitating the administration of multiple medications into the same lumen of the vascular catheter, which increases the risk of incompatibilities. The administration of incompatible medications can have serious consequences for the patient (treatment failure, microembolism, increased toxicity of the drug). For Y-site infusion, the drugs must be both physically and chemically compatible. There is often insufficient information on drug compatibility and where it exists, it is difficult to interpret.² Aim and Objectives The aim of the work was to create a table of compatibilities for Y-site administration of intravenous drugs used in our hospital. Materials and Methods In collaboration with nurses, we identified the most used medications administered by continuous infusion. The evaluation of compatibility was based on an extensive literature review, included SmPC, ASHP Injectable Drug Information, the Stabilis database and published articles. Due to limited published data, experimental in vitro compatibility testing was performed for several medications. The physical compatibility was assessed by mixing two drugs in 1:1 ratio at the concentrations used in clinical practice in our hospital in duplicates. Mixture was visually compared to the diluent solution using black and white backgrounds (Ph.Eur.2.9.20), immediately after mixing and 10 minutes later. Incompatibility was determined if any of the following occurred: precipitate formation, colour change, cloudiness of the solution. Results A total of 30 drugs in 435 combinations were evaluated. Based on the literature review, we were able to identify 108 compatible, three incompatible mixtures of two drugs administered via a Y-site and 21 compatible mixtures only under certain conditions. Experimental in vitro testing was performed for 14 drugs in 67 combinations. We confirmed 59 compatible and eight incompatible mixtures, most often in combination with amiodarone and hydrocortisone. Conclusion and Relevance As a result of this project an institutional guideline titled ‘Compatibility of intravenously administered drugs via Y-site’ was implemented in our institution. The purpose is to standardise practices across various departments of the hospital and ensure correct and safe Y-site administration. References and/or Acknowledgements • Ayari G, et al. Y-site compatibility of IV medications commonly used in ICU: laboratory tests on 75 mixtures involving nine main drugs. Pharmaceutical Technology in Hospital Pharmacy 2022; 7 (1):80–87. ISSN 2365-2411. • Castells Lao G, et al. Compatibility of drugs administered as Y-site infusion in ICU: a systematic review. Medicina Intensiva. 2020; 44 (2):80–87. ISSN 21735727.

Fibroblasts, the most abundant cell type in the human body, play crucial roles in biological processes such as inflammation and cancer progression. They originate from the mesoderm or neural-crest-derived ectomesenchyme. Ectomesenchyme-derived fibroblasts contribute to facial formation and do not express HOX genes during development. The expression and role of the HOX genes in adult fibroblasts is not known. We investigated whether the developmental pattern persists into adulthood and under pathological conditions, such as cancer. We collected adult fibroblasts of ectomesenchymal and mesodermal origins from distinct body parts. The isolated fibroblasts were characterised by immunocytochemistry, and their transcriptome was analysed by whole genome profiling. Significant differences were observed between normal fibroblasts from the face (ectomesenchyme) and upper limb (mesoderm), particularly in genes associated with limb development, including HOX genes, e.g., HOXA9 and HOXD9. Notably, the pattern of HOX gene expression remained consistent postnatally, even in fibroblasts from pathological tissues, including inflammatory states and cancer-associated fibroblasts from primary and metastatic tumours. Therefore, the distinctive HOX gene expression pattern can serve as an indicator of the topological origin of fibroblasts. The influence of cell position and HOX gene expression in fibroblasts on disease progression warrants further investigation.

Vitamin E, known for its antioxidant properties, has been studied extensively for its potential health benefits, particularly in mitigating skin and overall health complications. The skin serves as a crucial barrier against environmental stressors and oxidative damage. Vitamin E, comprising tocopherols and tocotrienols, acts as a potent antioxidant, scavenging free radicals that contribute to skin aging, inflammation, and diseases. Studies have demonstrated that Vitamin E supplementation can enhance skin health by protecting against UV-induced damage, improving moisture retention, and promoting wound healing. These effects are attributed to its ability to stabilize cell membranes and modulate inflammatory responses, thereby supporting skin integrity and function. Beyond dermatological benefits, Vitamin E supplementation shows promise in improving overall health outcomes. Research suggests that Vitamin E may reduce cardiovascular risk by inhibiting oxidative modification of lipoproteins and enhancing endothelial function. Moreover, it has been associated with potential benefits in neuroprotection, immune modulation, and management of chronic diseases such as diabetes and arthritis. These systemic effects are mediated through its antioxidant and anti-inflammatory properties, which contribute to cellular health and function. However, the effectiveness of Vitamin E supplementation can vary based on several factors, including dosage, formulation, and individual health status. High doses of Vitamin E, in particular, have raised concerns regarding adverse effects and interactions with medications. Therefore, careful consideration of dosage and monitoring of health outcomes are essential in clinical settings. In conclusion, Vitamin E supplementation holds promise in ameliorating skin and health complications through its antioxidant and anti-inflammatory actions. While evidence supports its beneficial effects on skin integrity, wound healing, and systemic health markers, further research is warranted to elucidate optimal dosage regimens and long-term safety profiles. Clinicians and researchers alike should continue to explore Vitamin E’s potential in personalized medicine approaches, aiming to optimize health outcomes while minimizing risks associated with supplementation. This paper will elucidate the multifaceted role of Vitamin E in promoting skin health and overall well-being, highlighting its potential as a therapeutic adjunct in dermatology, cancer, infertility, heart diseases and preventive medicine. Future research endeavors should focus on refining supplementation protocols and expanding our understanding of Vitamin E’s mechanisms of action across various health conditions.