Journal of Cardiothoracic Surgery最新文献

Objective: This study sought to evaluate the value of a CO₂ field-flooding device in cardiopulmonary bypass (CPB) surgical procedures for congenital heart disease (CHD) performed via a right-side small incision approach.

Methods: Between April 2022 and December 2023, 234 children with simple CHD who underwent CPB via a right-side small incision approach were separated into a control group (n = 93) without the use of a CO₂ field-flooding device and a treatment group (n = 141) in which this device was added to the traditional surgical manual exhaust. Demographic, perioperative, arterial blood gas (ABG), and laboratory test data were then compared between these groups of patients.

Results: There was a significant difference in abnormal electrocardiogram (ECG) after aorta de-clamping during CPB, and interventions for abnormal ECG after aorta de-clamping during CPB between the control and treatment groups (17(18.3%) vs.14(9.9%), P = 0.048;12(85.7%) vs.7(50%),P = 0.013). The treatment group exhibited a lower pH (7.34 ± 0.07 vs. 7.36 ± 0.06, P = 0.039) and a higher PaCO₂ (43.08 ± 7.36 vs. 38.86 ± 5.65 mmHg, P = 0.042) at the time of 30 min after initiation of CPB. A significant reduction in postoperative CK-MB was observed in treatment group (41.20 ± 17.88 vs. 56.57 ± 22.99 U/L, P = 0.002). Lower 3-day postoperative CRP levels were also observed in the treatment group relative to control (5.77 ± 0.48 vs. 9.45 ± 0.98 mg/L, P < 0.001). The S100ß concentration in the relevant patient cohort increased significantly from the time just after induction, intubation, and installation of the right central venous line to the time of admission to CCU (71.61 ± 11.83 vs. 124.04 ± 38.80, P = 0.01) and at the time of 24 h after operation (71.61 ± 11.83 vs. 101.97 ± 30.31, P = 0.01). No differences on S100β serum concentration level were found at the time of installation of the right central venous line between two groups. But there were statistically significant differences in S100β serum concentration level at the time of admission to CCU between control group and treatment group. (161.19 ± 6.62 vs. 86.89 ± 9.69 pg/ml, P = 0.01). Similar results were observed at the time of 24 h after operation. (127.62 ± 19.44 vs. 76.33 ± 10.40, P = 0.01).

Conclusion: These data suggest that the CO₂ field-flooding device can safely be used when performing CPB surgical procedures via a right-side small incision approach to treat CHD without hypercapnia. The use of such a CO2 field-flooding device at a flow rate of 5 L/min may help protect against cardiac and nervous system damage in children undergoing CHD surgery.

Mitral and aortic annular calcification is an age-related degenerative process that can result in severe mitral and/or aortic stenosis and/or regurgitation. Annular calcification not only increases the surgical complexity but also increases the risk of complications. In this case report, we present the innovative use of the Sonopet ultrasonic surgical aspirator for aortic and mitral annular decalcification in a patient with hypertrophic obstructive cardiomyopathy, mild aortic stenosis and moderate mitral regurgitation in the presence of mitral annular calcification (MAC) and aorto-mitral curtain calcification.

Objective: To observe how cognitive behavioral intervention affects physical symptoms, B-type Natriuretic Peptide (BNP), Red Cell Distribution Width (RDW), and C-reactive Protein (CRP) in elderly patients with heart failure.

Methods: Convenient sampling method was used to select 98 elderly heart failure patients who visited our hospital from January 2022 to December 2020. Patients were divided into a control group and an observation group using the red and blue ball method, with 49 cases in each group. Control group received routine intervention, while observation group received cognitive behavioral intervention on the basis of control group. The changes in the somatosensory scale scores of patients with heart failure before and after routine treatment were recorded. The changes in blood BNP, RDW, and CRP levels were measured before and within 4 weeks, 8 weeks after intervention.

Results: After intervention, the dimensions and total scores of DHFq scale in observation group were lower than control group's during the same period (P < 0.05). The total DHFq scale score in observation group improved faster (P < 0.05). Both groups of patients showed a decrease in BNP after intervention compared to before (P < 0.05). The levels of DNP, RDW, and CRP in observation group after intervention were lower than control group's (P < 0.05).

Conclusion: Cognitive behavioral intervention for elderly patients with heart failure can alleviate their physical symptoms, promote the improvement of vascular function indicators BNP and RDW, and reduce inflammatory factor CRP in the body, reducing the burden on the healthcare system.

Objective: the study aimed to analyze the therapeutic effects of neuromuscular electrical stimulation (NMES) combined with respiratory muscle training (RMT) on patients with moderate-to-severe chronic obstructive pulmonary disease (COPD).

Methods: 135 patients with moderate/severe chronic obstructive pulmonary disease were selected as the research object and randomly selected. 72 cases were divided into rehabilitation group and 63 cases in control group. 63 healthy individuals who underwent physical examination in the same period were also included in the internal control group (blank group). Data on pulmonary function parameters (FEV₁, FEV₁%pred, FEV₁/FVC ratio), blood gas analysis parameters (arterial oxygen partial pressure (PaO₂), carbon dioxide partial pressure (PaCO₂), and arterial oxygen saturation (SaO₂)), and anxiety and depression scores were collected before and after the intervention for the RG, CG, and BG. Additionally, the COPD assessment test (CAT) scores were recorded for both the RG and CG.

Results: following intervention, PaO₂ was clearly reduced, and PaCO₂ and SaO₂ were visibly higher in subjects; PaO₂ was clearly reduced, and PaCO₂ and SaO₂ were visibly higher in the RG as against the CG; Forced expiratory volume in one second (FEV₁), percentage of predicted FEV₁ (FEV₁%pred), and FEV₁/forced vital capacity (FVC) in subjects were visibly higher, and FEV₁%pred and FEV₁/FVC were visibly higher in the RG as against the CG; The CAT scores and anxiety and depression scores in subjects were clearly reduced, and those were clearly reduced in the RG as against the CG (P < 0.05).

Conclusion: NMES and pulmonary rehabilitation (PR) exercise training can visibly improve the lung function, oxygenation capacity, carbon dioxide exhalation, and quality of life (QoL) in COPD patients, effectively alleviating anxiety and depression.

Background: There are still gaps in the study of the miRNA and its SNPs in some diseases such as non-small cell lung cancer (NSCLC). The study aimed to provide useful information on the treatment of NSCLC by investigating the association between miR-21 and its SNPs and NSCLC susceptibility.

Methods: The serum of NSCLC patients (n = 205) and cancer-free controls (n = 217) were collected in this study for RNA extraction. The qRT-PCR was used to evaluate the expression of miR-21 and Taqman qPCR was used for genotyping and quantifying miR-21 SNPs (rs1292037, rs6504593). The association of the expression of miR-21, the miR-21 SNPs and their interactions with the susceptibility of NSCLC patients were analysed using logistic regression analysis in this study.

Results: This study showed that the overexpression of miR-21 was related to NSCLC. The C allele and CC genotypes of rs1292037 and rs6504593 were associated with the increased risk of NSCLC susceptibility. Moreover, the interactions of rs1292037 and rs6504593 were also a risk factor for NSCLC. The CC genotypes of rs1292037 and rs6504593 were associated with the increase of miR-21 expression.

Conclusion: The overexpression of miR-21, the miR-21 SNPs rs1292037 and rs6504593 and their interactions were associated with NSCLC susceptibility. MiR-21 and its SNPs have potential for being targets in the therapy of NSCLC. This study provided important information for the treatment of NSCLC.

Background: Hyperglycemia is an independent risk factor for perioperative complications and mortality after cardiac surgery. Freestyle Libre Continuous glucose monitor (CGM) is an interstitial glucose monitoring system, which has been proven to be stable and accurate in various disease.

Materials and methods: 86 patients with hyperglycemia after cardiac surgery between October 2021 and October 2022 in the cardiovascular ICU, were enrolled in this study. We evaluated systematic errors and numerical accuracy in blood glucose (BG) between two groups using Bland-Altman analysis and mean absolute relative difference (MARD). The clinical accuracy was assessed by consensus and Clarke error grid.

Results: 435 paired sensor-reference values were enrolled between the Freestyle and venous BG. The MARD was 18.2% with the Bland-Altman standard bias of 31.87 mg/dL. 1851 paired values were enrolled between the Freestyle and arterial BG. The MARD was 21.5%, and the Bland-Altman standard bias was 41.45 mg/dL. 432 paired values were enrolled between the arterial and venous BG. The MARD was 8.4%, and the Bland-Altman standard bias was - 9.95 mg/dL.

Conclusions: Our study demonstrated the relatively low accuracy of Freestyle Libre CGM for critical patients after cardiac surgery. The arterial blood gas glucose analysis acts as an effective tool to improve BG management.

Objective: Patients on direct-acting oral anticoagulants (DOACs) are at high risk of perioperative bleeding complications. Intraoperative hemoadsorption is a novel strategy to reduce perioperative bleeding in patients on DOACs undergoing non-deferable cardiac surgery. The international STAR-registry reports real-world clinical outcomes associated with this application.

Methods: The hemoadsorption device was incorporated into the cardiopulmonary bypass (CPB) circuit and active for the duration of the pump run. Patients on DOACs undergoing CABG and/or single valve surgery before completing the recommended washout were included. Outcome measurements included bleeding events according to standardized definitions and 24-hour chest-tube-drainage (CTD).

Results: A total of 62 patients were included from 7 institutions in Austria, Germany, Sweden, and the UK (mean age 69.9 ± 7.5years, 71% male). Approximately half were on apixaban and the other half was split between rivaroxaban and edoxaban with 21% of patients also on aspirin. Surgery occurred at a median time of 28.9 h since the last DOAC dose with single valve surgery accounting for 2/3 of cases. Mean CPB duration was 118.6 ± 46.4 min. Severe bleeding (UDPB ≥ 3) occurred in 4.8%, and BARC-4 bleeding occurred in 3.2% of the patients. Only one patient (1.6%) required reoperation for bleeding control. The mean 24-hour CTD was 771.3 ± 482.79mL. No device-related adverse events were reported.

Conclusions: This interim report of the ongoing STAR-registry shows that, in patients on DOAC undergoing non-deferable CABG and/or single valve surgery, the use of intraoperative hemoadsorption is associated with low rates of severe perioperative bleeding complications. Further prospective studies in larger cohorts are needed to validate the efficacy of this method.

Clinical registration number: ClinicalTrials.gov identifier: NCT05077124.

Objective: To assess the effectiveness and safety profiles of rivaroxaban compared to low molecular weight heparin (LMWH) in managing lower extremity deep vein thrombosis (DVT) subsequent to thoracoscopic lung cancer surgery.

Methods: Sixty patients diagnosed with lower extremity deep vein thrombosis (DVT) following thoracoscopic lung cancer surgery were randomly assigned to two groups: the experimental group comprising 30 patients treated with rivaroxaban, and the control group consisting of 30 patients treated with low molecular weight heparin (LMWH). The fundamental clinical characteristics of patients in both groups were documented, encompassing parameters, along with pre- and post-surgical lower limb vascular ultrasound findings. Additionally, variations in drainage volume over the initial three days following the procedure were also noted. Patients were subjected to a three-month follow-up period, during which data from one-month and three-month postoperative examinations were collected.

Results: Patients from both groups exhibited satisfactory wound healing postoperatively. D-dimer levels remained stable, and lower extremity vascular ultrasound evaluations showed no signs of additional thrombus formation. Moreover, there were no reported cases of distant postoperative complications such as pleural effusion, gingival bleeding, or gastrointestinal bleeding. Nonetheless, subcutaneous bruising was observed in six patients from the control group, all localized at the sites of LMWH injections.

Conclusion: Rivaroxaban demonstrates efficacy comparable to LMWH in patients with lower extremity deep vein thrombosis following thoracoscopic lung cancer surgery, while exhibiting a superior safety profile compared to LMWH.

Background: Hybrid coronary revascularisation benefits patients with multivessel disease, as it amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI). We present a 63-year-old female with triple-vessel coronary artery disease including marked ostial stenosis of the left main coronary artery, as well as moderate stenosis of the right coronary artery. The risk of death following heart surgery (EuroSCORE II) is 4.27%. The patient exhibited multiple morbidities including chronic obstructive pulmonary disease, renal impairment, extracardiac arteriopathy, and multiple prior gastrointestinal surgeries, as well as a recent episode of paroxysmal atrial fibrillation. A MIDCAB procedure without electrocoagulation was stipulated by the ENT specialist due to the patient's cochlear implant.

Conclusion: A successful MIDCAB procedure omitting electrocoagulation was performed for the first time for multivessel coronary disease in a multimorbid patient as part of a hybrid approach.

In many hospitals, patients undergoing cardiac surgery receive a higher amount of blood products transfusions compared to other disciplines. Blood transfusion comes with risks and drawbacks, such as increased morbidity and mortality across different patient groups, and specifically patients undergoing cardiac surgery, and high costs. Patient Blood Management (PBM) practices focus on the application of evidence based medical and surgical concepts in order to preserve the patient's own blood. Unfortunately, studies suggest that only a small fraction of published guidelines are implemented and followed into daily clinical practicedue to clear guidance, concerns about risks, and lack of knowledge, interdisciplinary commitment or resources. The widespread adoption of electronic health record (EHR) offers the opportunity to improve clinical outcomes through use of decision support system to guide the healthcare providers through best practices and guidelines. Decision support systems can be active, data-based, patient-specific and act timely, and can be more useful that adding new clinical practice guidelines. This case study quantifies the quality of the data registration and provides the results for adherence to perioperative PBM guidelines for coronary artery bypass grafting (CABG) procedures during a three-year period (2018 to 2020), in the St. Antonius hospital, a single heart center that performs over 10% of the total number of heart operations in the Netherlands. With this case study we identify some of the possible improvement factors for PBM in our center. We also quantify the impact of the quality of the registration in the EHR on the analysis results and on possible implementation of decision support systems.