Hasil untuk "Diseases of the circulatory (Cardiovascular) system"

Aleksandr E. Vendrov, Jamille Silveira Fernandes Chamon, Julia Levin et al.

Background Aging and male sex are major risk factors for abdominal aortic aneurysm (AAA), a disease characterized by vascular cell phenotypic switching and aortic wall remodeling. Mitochondrial oxidative stress has been implicated in these changes. We previously demonstrated that NOX4 (NADPH oxidase 4) expression and activity increase with age in cardiovascular cells, promoting mitochondrial oxidative stress and vascular dysfunction. This study investigates whether NOX4‐driven mitochondrial oxidative stress and DNA damage promote AAA development through vascular cell reprogramming. Methods We used mitochondria‐targeted Nox4‐overexpressing (Nox4TG) mice with an Apoe−/− background to model angiotensin II (Ang II)‐induced AAA. AAA incidence, aortic morphology, reactive oxygen species levels, DNA damage markers, and wall remodeling parameters were assessed in Apoe−/−, Apoe−/−/Nox4TG, and Apoe−/−/Nox4−/− mice. Vascular cell populations were analyzed by spectral flow cytometry and gene expression profiling. In vitro, Ang II‐treated smooth muscle cells (SMCs) from wild‐type, Nox4TG, and Nox4−/− mice were evaluated for mitochondrial reactive oxygen species, DNA damage, and activation of inflammatory pathways. Results Apoe−/−/Nox4TG mice exhibited the highest AAA incidence, aortic dilation, reactive oxygen species levels, DNA damage, and inflammation, whereas Apoe−/−/Nox4−/− mice were most protected. Macrophage‐like SMCs increased, and contractile SMCs decreased in Nox4TG aortas. Ang II‐treated Nox4TG SMCs showed elevated mitochondrial reactive oxygen species, DNA damage, and cyclic GMP‐AMP synthase‐STING (stimulator of interferon genes) activation. Flow cytometry analysis confirmed the presence of aneurysmal SMC with reduced ACTA2 (actin alpha 2, smooth muscle), MYH11 (myosin heavy chain 11), TAGLN (transgelin), and increased CD68, CD11b, and LGALS3 expression. Conclusions NOX4‐dependent mitochondrial DNA damage and activation of DNA‐sensing pathways promote SMC phenotypic switching, inflammation, and aortic wall remodeling in AAA. Targeting NOX4 and enhancing mitochondrial function may offer therapeutic strategies for AAA prevention.

Karan Chawla, MD, MBA, MS, Jonathan H. Lin, MD, Lindsey Korepta, MD

Post-traumatic pseudoaneurysms are rare complications of lower extremity fractures, especially in children, and may arise after high-energy trauma. This case report details a 13-year-old boy who developed a delayed anterior tibial artery pseudoaneurysm after surgical fixation of a tibia and fibula fracture. Despite initial recovery, he presented with a recurrent pulsatile ankle mass. Imaging confirmed a pseudoaneurysm, and endovascular coil embolization was chosen to avoid disrupting surgical hardware. The procedure resolved symptoms and halted blood flow into the lesion. This case highlights the importance of considering vascular injuries in persistent symptoms and supports minimally invasive endovascular techniques in pediatric trauma care.

Daniel Schroth, Ria Garg, Xhoi Bocova et al.

AimsEpidemiological surveillance has raised safety concerns for mRNA SARS-CoV-2-vaccination-related myocarditis. We aimed to analyze epidemiological, clinical and imaging findings associated with clinical outcomes in these patients in an international multi-center registry (NCT05268458).Methods and resultsPatients with clinical and CMR diagnosis of acute myocarditis within 30 days after mRNA SARS-CoV-2—vaccination were included from five centers in Canada and Germany between 05/21 and 01/22. Clinical follow-up on persistent symptoms was collected. We enrolled 59 patients (80% males, mean age 29 years) with CMR-derived mild myocarditis (hs-Troponin-T 552 [249–1,193] ng/L, CRP 28 [13–51] mg/L; LVEF 57 ± 7%, LGE 3 [2–5] segments). Most common symptoms at baseline were chest pain (92%) and dyspnea (37%). Follow-up data from 50 patients showed overall symptomatic burden improvement. However, 12/50 patients (24%, 75% females, mean age 37 years) reported persisting symptoms (median interval 228 days) of chest pain (n = 8/12, 67%), dyspnea (n = 7/12, 58%), with increasing occurrence of fatigue (n = 5/12, 42%) and palpitations (n = 2/12, 17%). These patients had initial lower CRP, lower cardiac involvement in CMR, and fewer ECG changes. Significant predictors of persisting symptoms were female sex and dyspnea at initial presentation. Initial severity of myocarditis was not associated with persisting complaints.ConclusionA relevant proportion of patients with mRNA SARS-CoV-2-vaccination-related myocarditis report persisting complaints. While young males are usually affected, patients with persisting symptoms were predominantly females and older. The severity of the initial cardiac involvement not predicting these symptoms may suggest an extracardiac origin.

Karol Kaziród-Wolski, Aleksandra Piotrowska, Janusz Sielski et al.

Introduction: Many factors related to the switch to summer/winter time interfere with biological rhythms. Objectives: This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). Patients and methods: Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. Results: We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. Conclusions: The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.

Parveen A, Devika R

Cardiovascular diseases, like coronary heart disease or artery disorders (arteriosclerosis, including artery solidification), heart failure (myocardial infarction), arrhythmias, congestive heart condition, stroke, elevated vital signs (hypertension), rheumatic heart disorder, and other circulatory system dysfunctions are the most common causes of death worldwide. Cardiovascular disorders are treated with stenting, coronary bypass surgery grafting, anticoagulants, antiplatelet agents, and other pharmacological and surgical procedures; however, these have limitations due to their adverse effects. Fibrinolytic agents degrade fibrin through enzymatic and biochemical processes. There are various enzymes that are currently used as a treatment for CVDs, like Streptokinase, Nattokinase, Staphylokinase, Urokinase, etc. These enzymes are derived from various sources like bacteria, fungi, algae, marine organisms, plants, snakes, and other organisms. This review deals with the fibrinolytic enzymes, their mechanisms, sources, and their therapeutic potential.

Lin Liu, Qinghua Zhang, Juan Gui et al.

Anthropogenic magnetite nanoparticles have been identified to present in human brain and circulatory system, which are potentially linked with the incidence of neurodegenerative and cardiovascular diseases. Specifically, magnetite nanoparticles originated...

L. Shpagina, O. Gerasimenko, I. Novikova et al.

Introduction. The negative dynamics of the increase in the prevalence of cardiovascular pathology among industrial workers observed in recent decades within the framework of the tasks of the scientific specialty "occupational health" determines the importance of studying not only professional, but also comorbid pathology in workers, diseases accompanying the professional route, assessing the role of production factors in the development of somatic diseases, including diseases of the circulatory system, in in particular, arterial hypertension. The study aims to research the possibilities of early diagnosis of vascular disorders in vibration disease in combination with arterial hypertension based on the assessment of endothelial and hemostasiological parameters. Materials and methods. The study involved 253 patients of the Center for Occupational Pathology of the Novosibirsk State Medical Institution "City Clinical Hospital No. 2", including 144 people working in contact with local vibration for more than 15 years, among them 75 people with vibration disease, 69 people with a combination of vibration disease and hypertension; 72 people with hypertension those who work outside the influence of local vibration and 37 people who work outside of contact with local vibration and have no history of hypertension. The researchers conducted a comparative assessment of the indicators of systemic, vascular-platelet, plasma-coagulation hemostasis, the state of markers of endothelial-cellular hemostasis. Authors determined the aggregation activity of platelets, also studied adhesion molecules, the functional state of the endothelium. We considered the differences statistically significant at p≤0.05. Results. During the study the researchers found that endothelial dysfunction in vibration disease in combination with arterial hypertension is closely related to the expression of signaling molecules, an increase in endothelin-1 levels in combination with increased production of vascular endothelial growth factor and transforming growth factor. Endothelial markers can be associated with the frequency of unfavorable polymorphic gene variants. In systemic hemostasis, there are: an increase in the level of thrombospondin and thrombomodulin, platelet growth factor in conditions of decreased plasminogen activity, an increase in the concentration of α2-macroglobulin and fibrin breakdown products. We also identified earlier endothelial-hemostasiological markers of vascular disorders. Limitations. The study was conducted on the basis of Novosibirsk State Medical University and on the basis of the City Clinical Hospital No. 2. The limitations of the study may be the unidirectionality of the study performed and the small sample of patients participating in the research. Conclusion. As a result of studying the clinical, functional and molecular characteristics of vibration disease occurring in combination with arterial hypertension, scientists have obtained new knowledge. It is possible to use such knowledge to improve the diagnosis and treatment of patients, scientific justification of health risks, development of prevention and rehabilitation programs. Ethics. All patients have previously signed an informed consent form to participate in the study. The Ethics Committee of the Novosibirsk State Medical University and the State Medical Institution of the City Clinical Hospital No. 2 has approved the research program, the content of the informed consent, materials of the article.

Khawla A. Kasar, Maha H. Al-Bahrani, Ahmed A. Mohsin

The rates of morbidity and mortality for acute myocardial infarction (AMI) have been rising quickly in the last few years. In the systemic circulatory loop, the heart normally pumps blood to the body's extremities. Cardiovascular disease, however, results from any heart function problem. The most fatal diseases in the world are known to be those involving the cardiovascular system. Over the past decade, biochemical marker testing are an important step in the diagnosis, and management of heart failure and in lowering one's risk of developing cardiovascular disease. Early diagnosis is paramount to choosing a clear and effective treatment strategy. Cardiac biomarkers are another effective method for classifying myocardial injury. The myocardial enzymatic biomarkers, also known as myocardial necrosis biomarkers, were among the various biomarkers that were initially studied. This review aims to allow for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

Qun Zhang, Yu Han, Shukun Sun et al.

Abstract Objective Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages. Methods A systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment. Results We included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency. Conclusions IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS.

Georges Jourdi, Georges Jourdi, Anne Godier et al.

Antiplatelet agents, with aspirin and P2Y12 receptor antagonists as major key molecules, are currently the cornerstone of pharmacological treatment of atherothrombotic events including a variety of cardio- and cerebro-vascular as well as peripheral artery diseases. Over the last decades, significant changes have been made to antiplatelet therapeutic and prophylactic strategies. The shift from a population-based approach to patient-centered precision medicine requires greater awareness of individual risks and benefits associated with the different antiplatelet strategies, so that the right patient gets the right therapy at the right time. In this review, we present the currently available antiplatelet agents, outline different management strategies, particularly in case of bleeding or in perioperative setting, and develop the concept of high on-treatment platelet reactivity and the steps toward person-centered precision medicine aiming to optimize patient care.

Arnaud D. Kaze, Sebhat Erqou, Prasanna Santhanam et al.

Abstract Background It remains unclear how the variability of adiposity indices relates to incident HF. This study evaluated the associations of the variability in several adiposity indices with incident heart failure (HF) in individuals with type 2 diabetes (T2DM). Methods We included 4073 participants from the Look AHEAD (Action for Health in Diabetes) study. We assessed variability of body mass index (BMI), waist circumference (WC), and body weight across four annual visits using three variability metrics, the variability independent of the mean (VIM), coefficient of variation (CV), and intraindividual standard deviation (SD). Multivariable Cox regression models were used to generate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for incident HF. Results Over a median of 6.7 years, 120 participants developed incident HF. After adjusting for relevant confounders including baseline adiposity levels, the aHR for the highest (Q4) versus lowest quartile (Q1) of VIM of BMI was 3.61 (95% CI 1.91–6.80). The corresponding aHRs for CV and SD of BMI were 2.48 (95% CI 1.36–4.53) and 2.88 (1.52–5.46), respectively. Regarding WC variability, the equivalent aHRs were 1.90 (95% CI 1.11–3.26), 1.79 (95% CI 1.07–3.01), and 1.73 (1.01–2.95) for Q4 versus Q1 of VIM, CV and SD of WC, respectively. Conclusions In a large sample of adults with T2DM, a greater variability of adiposity indices was associated with higher risks of incident HF, independently of traditional risk factors and baseline adiposity levels. Registration-URL: https://clinicaltrials.gov/ct2/show/NCT00000620 .

X. Sainsily, D. Coquerel, Hugo Giguère et al.

Objectives: Arterial hypertension, when exacerbated by excessive dietary salt intake, worsens the morbidity and mortality rates associated with cardiovascular and renal diseases. Stimulation of the apelinergic system appears to protect against several circulatory system diseases, but it remains unknown if such beneficial effects are conserved in severe hypertension. Therefore, we aimed at determining whether continuous infusion of apelinergic ligands (i.e., Apelin-13 and Elabela) exerted cardiorenal protective effects in spontaneously hypertensive (SHR) rats receiving high-salt diet. Methods: A combination of echocardiography, binding assay, histology, and biochemical approaches were used to investigate the cardiovascular and renal effects of Apelin-13 or Elabela infusion over 6 weeks in SHR fed with normal-salt or high-salt chow. Results: High-salt intake upregulated the cardiac and renal expression of APJ receptor in SHR. Importantly, Elabela was more effective than Apelin-13 in reducing high blood pressure, cardiovascular and renal dysfunctions, fibrosis and hypertrophy in high-salt fed SHR. Unlike Apelin-13, the beneficial effects of Elabela were associated with a counter-regulatory role of the ACE/ACE2/neprilysin axis of the renin-angiotensin-aldosterone system (RAAS) in heart and kidneys of salt-loaded SHR. Interestingly, Elabela also displayed higher affinity for APJ in the presence of high salt concentration and better resistance to RAAS enzymes known to cleave Apelin-13. Conclusion: These findings highlight the protective action of the apelinergic system against salt-induced severe hypertension and cardiorenal failure. As compared with Apelin-13, Elabela displays superior pharmacodynamic and pharmacokinetic properties that warrant further investigation of its therapeutic use in cardiovascular and kidney diseases.

J. Yfantopoulos, Marianna Protopapa, A. Chantzaras et al.

Non-communicable diseases (NCDs) are the leading causes of death across the world [1, 2], these including cardiovascular disease, cancer, chronic respiratory diseases, and diabetes. This fact represents a great threat to socioeconomic development given that more than 70% of all deaths globally and 80% of deaths in lowand middle-income countries are attributed to NCDs [2]. In 2013, the World Health Organization (WHO) adopted a target of 25% reduction in mortality from NCDs by 2025 [2]. In the European Union, approximately 550,000 people die prematurely each year from NCDs [3], while in Greece, 38% of deaths are attributed to diseases of the circulatory system, 25% to cancer, 20% to respiratory diseases, and 1.85% to diabetes [4]. Morbidity and mortality from these diseases can be avoided by a healthier lifestyle, disease prevention, and medication adherence. The 2018 OECD report [5] states that the health system’s resilience, more efficient spending policies, and long-term sustainability can be supported by adopting better strategies aiming at improvements in medication adherence. Cardiovascular diseases (CVDs) are the main type of NCDs, including heart disease, stroke, hypertension, congestive heart failure, and arteriosclerosis, most of them being associated with metabolic syndrome [6]. Despite the existence/implementation of effective therapies, cardiovascular outcomes still remain suboptimal [7–9]. Previous studies [10–17] have documented the relationship between insulin resistance and CVDs, taking into consideration other confounding factors such as body mass index [18–20], smoking, hypertension, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol. The 10-year financial crisis and the current COVID-19 pandemic have had a significant impact on the functioning of the health systems, highlighting the need for more effective and efficient management, at the same time ensuring equity and access to new therapies [21]. Adherence is an important factor in the effectiveness of long-term therapy and is defined by the WHO as “the extent to which a person’s behavior-taking medication, following a diet, and/or executing lifestyle changes corresponds with agreed recommendations from a health care provider” [22, 23]. According to Kravitz et al. [24], non-adherence to medication for cardiovascular diseases has been estimated to be higher than 60%. Self-assessed adherence in patients with coronary heart disease is less than 40% for the combination of aspirin, β-inhibitor, and a lipid-lowering agent in both short-term and cohort studies [25]. According to the Ascertaining Barriers for Compliance (ABC) Project, nonadherence in Greece is as high as 50% [26]. The period that follows immediately after discharge from the hospital is one linked to a high risk of medication non-adherence. Nearly one out of four patients is partially or completely non-adherent to treatment received after discharge from the hospital [27]. Concerning hypertensive patients who take just one medication as prescribed, 50% will stop taking antihypertensive medications within 6–12 months and only about 40% will continue statin treatment for 2 years for acute coronary heart disease [25, 28]. Medication adherence obviously greatly affects the effectiveness of treatment and, consequently, health outcomes, and patients’ quality of life [29]. Early non-adherence to treatment leads to a significant reduction in life expectancy by 1 year after hospitalization in myocardial infarction [27]. Secondary non-adherence (non-adherence to instructions or non-adherence to the prescription) has been shown to lead to increased mortality and hospitalization rates, plus additional costs [30–33]. * John Yfantopoulos yfantopoulos@gmail.com

L. Łykowska-Szuber, Karolina Wołodźko, A. Rychter et al.

While respiratory symptoms are prevalent in SARS-CoV-2 infected patients, growing evidence indicates that COVID-19 affects a wide variety of organs. Coronaviruses affect not only the respiratory system, but also the circulatory, nervous and digestive systems. The most common comorbidities in COVID-19 patients are hypertension, followed by diabetes, cardiovascular, and respiratory disease. Most conditions predisposing to SARS-CoV-2 infection are closely related to the metabolic syndrome. Obesity and chronic diseases, including liver disease, are associated with the induction of pro-inflammatory conditions and a reduction in immune response disorders, leading to the suspicion that these conditions may increase the susceptibility to SARS-CoV2 infection and the risk of complications. The definition of liver damage caused by COVID-19 has not yet been established. COVID-19 may contribute to both primary and secondary liver injury in people with pre-existing chronic disease and impaired liver reserves, leading to exacerbation of underlying disease, liver decompensation, or acute chronic liver failure. Therefore, many researchers have interpreted it as clinical or laboratory abnormalities in the course of the disease and treatment in patients with or without pre-existing liver disease. The research results available so far indicate that patients with liver disease require special attention in the event of COVID-19 infection.

Giovanna Sannino, I. D. Falco, G. Pietro

One of the most important physiological parameters of the cardiovascular circulatory system is Blood Pressure. Several diseases are related to long-term abnormal blood pressure, i.e., hypertension; therefore, the early detection and assessment of this condition are crucial. The identification of hypertension, and, even more the evaluation of its risk stratification, by using wearable monitoring devices are now more realistic thanks to the advancements in Internet of Things, the improvements of digital sensors that are becoming more and more miniaturized, and the development of new signal processing and machine learning algorithms. In this scenario, a suitable biomedical signal is represented by the PhotoPlethysmoGraphy (PPG) signal. It can be acquired by using a simple, cheap, and wearable device, and can be used to evaluate several aspects of the cardiovascular system, e.g., the detection of abnormal heart rate, respiration rate, blood pressure, oxygen saturation, and so on. In this paper, we take into account the Cuff-Less Blood Pressure Estimation Data Set that contains, among others, PPG signals coming from a set of subjects, as well as the Blood Pressure values of the latter that is the hypertension level. Our aim is to investigate whether or not machine learning methods applied to these PPG signals can provide better results for the non-invasive classification and evaluation of subjects’ hypertension levels. To this aim, we have availed ourselves of a wide set of machine learning algorithms, based on different learning mechanisms, and have compared their results in terms of the effectiveness of the classification obtained.

Manuela Stoicescu

Julián M. Aristizábal

Resumen: Nuevas investigaciones han planteado un vínculo previamente no valorado lo suficiente, radiación ionizante y enfermedad cardiovascular, puesto que el interés se ha centrado en la radiación y el cáncer. El desarrollo en terapias oncológicas ha favorecido un aumento en la supervivencia de muchos pacientes, pero, por otro lado, ha influenciado el perfil de riesgo cardiovascular de los mismos: la exposición a la radioterapia torácica está asociada con enfermedad coronaria e incremento del riesgo de eventos cardiovasculares. Así mismo, existe evidencia incipiente que demuestra la relación entre exposición crónica a dosis moderadas o bajas de radiación y enfermedad cardiovascular. Abstract: Recent studies have established a link between ionising radiation and cardiovascular disease. This has not been sufficiently assessed before, as interest has focused on radiation and cancer. The development of cancer treatments has led to an increase in survival of many patients, but on the other hand, they have had an influence on the cardiovascular risk profile of many of them. The exposure to chest radiotherapy is associated with coronary disease and an increase in the risk of cardiovascular events. Furthermore, there is growing evidence that demonstrates the association between long-term exposure to moderate or low doses of radiations and cardiovascular disease. Palabras clave: Efectos de la radiación, Enfermedades cardiovasculares, Protección a radiación, Exposición ocupacional, Keywords: Effects of radiation, Cardiovascular diseases, Radiation protection, Occupational exposure

Gladdy George, A V Varsha, Madhu Andrew Philip et al.

Objectives: del Nido cardioplegia which was traditionally used for myocardial protection in pediatric congenital heart surgery is now being extensively utilized in adult cardiac surgery. The aim of this study was to compare the safety and efficacy of del Nido cardioplegia (DNC) with blood cardioplegia (BC). Materials and Methods: This is a historical cohort study using secondary data. Two hundred and eighty six patients who underwent coronary artery bypass graft (CABG) or valve surgery were included. They were divided into 2 matched cohorts of which 143 patients received BC and 143 patients received DNC. Results: There was no difference in cardiopulmonary bypass time (P = 0.516) and clamp time (P = 0.650) between the groups. The redosing of cardioplegia was significantly less for DNC (1.13 vs. 2.35, P = <0.001). The post bypass hemoglobin was higher for DNC (9.1 vs. 8.7, P = 0.011). The intraoperative and postoperative blood transfusion was comparable (P = 0.344) (P = 0.40). The incidence of clamp release ventricular fibrillation (P = 0.207) was similar. The creatine kinase-MB isotype levels for the CABG patients were comparable on all 3 days (P = 0.104), (P = 0.106), and (P = 0.158). The postoperative left ventricle ejection fraction was lesser but within normal range in the DNC group (53.4 vs. 56.0, P = <0.001). The duration of ventilation (P = 0.186), ICU days (P = 0.931), and postoperative complications (P = 0.354) were comparable. There was no 30-day mortality or postoperative myocardial infarction in both the groups. Conclusion: DNC provides equivalent myocardial protection, efficacy, and surgical workflow and had comparable clinical outcomes to that of BC. This study shows that DNC is a safe alternate to BC in CABG and valve surgeries.