Journal of Cardiac Surgery最新文献

Objective

To determine whether the use of everting, pledgeted mattress suture (EPMS) technique for aortic valve replacement is advantageous compared to other commonly used techniques.

Methods

From January 2002 to January 2022, 709 isolated aortic valve replacements were performed using the EPMS technique, and 3749 replacements were completed using other techniques. After propensity-matching for aortic valve size and prosthesis type, demographics, patient profile, valve pathophysiologic disorders, and echocardiographic measurements, 641 well-matched pairs were identified. Primary endpoints were the prevalence of stroke, paravalvular leak, and postoperative valve gradient. Secondary endpoints were in-hospital clinical outcomes, left ventricular (LV) remodeling, reoperations, and survival.

Results

There was no significant difference in stroke (5 [0.78%] vs. 10 [1.6%], p = 0.19) or paravalvular leak (3 [0.47%] vs. 3 [0.47%], p > 0.9) between EPMS and non-EPMS groups, respectively. The EPMS group had shorter clamp times (median: 39 vs. 54 min, p < 0.0001), similar length of hospital stay, and operative mortality (1.0% vs. 0.69%, p = 0.52). Postoperative gradients were higher in the EPMS group (16 vs. 15 mmHg at 1 year, and 21 vs. 17 mmHg at 10 years, p = 0.01). There was no difference in temporal trends of postoperative LV mass index, freedom from reoperation, or survival. In patients with prior cardiac surgery, the EPMS group had shorter clamp times (median: 41 vs. 55 min, p < 0.0001), a lower prevalence of postoperative atrial fibrillation (27 [19%] vs. 47 [35%], p = 0.005), and less renal failure (0 [0%] vs. 5 [2.6%], p = 0.03). Other outcomes did not differ significantly between groups.

Conclusion

EPMS for aortic valve replacement did not show benefit over other techniques. Although there is a small but statistically significant difference in postoperative valve gradients, it is not clinically significant. Shorter operating times along with better clinical outcomes are likely more reflective of specific surgeon expertise than the type of suture technique.

Objectives

To describe the clinical outcomes of patients with severe aortic valve stenosis (AS) and concomitant mitral regurgitation (MR) undergoing transcatheter aortic valve replacement (TAVR)

Methods

A propensity-score matched analysis including 267 patients who underwent TAVR between 2009 and 2023. Information on pre-, intra-, and postoperative variables was collected. The main outcomes were survival and freedom from readmission for heart failure on long term follow-up comparing the group with significant MR (sMR) (moderate–severe) vs. the control group.

Results

The prevalence of sMR was 22%. TAVR improved the severity of MR in 65% of the patients. There were no significant differences on the main early postoperative outcomes. sMR was not associated with a lower survival on long-term follow-up but readmission for heart failure was higher in this group.

Conclusions

MR is highly prevalent in patients undergoing TAVR. The procedure has a beneficial effect on the severity of concomitant MR. sMR was not associated with a higher mortality in long-term follow-up, patients with sMR experience a significant improvement in symptoms after TAVR although sMR was associated with higher heart failure readmissions.

Introduction

Coronary artery disease (CAD) is a major cause of death worldwide, and coronary artery bypass grafting (CABG) is the standard treatment for severe cases. However, the influence of age on the risk of cardiac events and the recovery of quality of life after surgery remains unclear, particularly when patients before and after a key age threshold are compared.

Methods

We conducted a prospective cohort study of 231 patients who underwent isolated CABG at an academic center in Tehran, Iran. Of these, 203 survivors (61 aged ≤ 55 years and 142 aged > 55 years) completed a 1-year follow-up. We assessed major adverse cardiac events (MACEs), all-cause mortality, myocardial infarction, stroke, hospitalization for heart failure, and repeat revascularization and evaluated health-related quality of life via the 36-item Short Form Health Survey (SF-36).

Results

At 1 year, the overall mortality rate was approximately 7% (n = 16), with younger patients having a lower rate (1.59%) than older adults did (8.93%). No significant differences were found in other MACEs (p values: cardiac-related readmission = 0.428, myocardial infarction = 0.555, heart failure hospitalization = 1), and the stroke incidence was 0% in both groups. Younger patients had significantly higher physical component scores (p value = 0.012). After adjustment, older age was associated with lower odds of being in a higher mental component summary quartile (odds ratio = 0.53, p value = 0.048).

Conclusion

Older age was associated with slower recovery after CABG, both physically and mentally. Personalized rehabilitation and close follow-up may improve outcomes. Age-specific care strategies are essential for improving recovery and long-term health.

Objectives

Approximately two-thirds of patients undergoing cardiac surgery experience postoperative complications, which may lead to significant clinical consequences. RBT-1, an investigational drug with anti-inflammatory and antioxidant properties, elicits a preconditioning response and was shown to improve clinical outcomes when administered within 24–48 hours prior to surgery (modified intention-to-treat population). The current post hoc analysis evaluated the efficacy of RBT-1 in reducing postoperative complications in the entire study population without excluding patients based on when surgery occurred relative to study drug administration.

Methods

A total of 135 patients were randomized to receive a single infusion of RBT-1 (n = 91) or placebo (n = 44) at least 1 day before undergoing nonemergent coronary artery bypass graft (CABG) and/or heart valve surgery on cardiopulmonary bypass (CPB) and were followed for 90 days postsurgery. Clinical outcomes assessed included ventilator time, intensive care unit (ICU) and hospital length of stay (LOS), cardiopulmonary readmission, and other clinical events of interest.

Results

In this analysis, RBT-1 reduced ventilator time, ICU, and hospital LOS by 0.98 days (NS), 2.59 days (p = 0.026), and 1.35 days (NS), respectively, compared with placebo. The incidence of 30-day cardiopulmonary readmission was significantly reduced by RBT-1 (4.6% vs. 17.5%, placebo; p = 0.035). Additionally, RBT-1 showed a trend in reductions in several clinical events of interest, including anemia, atrial fibrillation, and fluid overload.

Conclusions

Trends in improved clinical outcomes were seen with RBT-1 treatment in this post hoc analysis that included all patients enrolled in a Phase 2 clinical study regardless of surgery delay beyond 2 days posttreatment. A Phase 3 study is underway to confirm these improved clinical outcomes in a larger study population.

Trial Registration: ClinicalTrials.gov identifier: NCT06021457

Background

Acute type A aortic dissection (ATAD) is life-threatening and requires emergency surgical repair. Patients face increased risk of postoperative coagulopathy and hemodynamic instability, prompting some surgeons to leave the chest open and return 48–72 h later for delayed sternal closure (DSC). Whether DSC increases postoperative complications remains understudied. This study aims to evaluate outcomes after ATAD repair in patients undergoing DSC versus primary sternal closure (PSC).

Methods

This single-center retrospective study included 130 ATAD patients who underwent surgery between 2016 and 2024. Patients left the OR with either a closed chest (PSC) or an open chest for DSC. The primary outcome was all-cause mortality at 90 days postoperatively. Secondary outcomes included length of stay, a composite of postoperative infection (superficial and deep sternal wound, graft infection, bacteremia, and pneumonia), and 5-year mortality.

Results

Of 130 patients, 23% (n = 30) left the OR with an open chest with a median time to DSC of 2 [2; 3] days. Cardiopulmonary bypass time was higher in open versus closed chest patients (open chest: 237.9 ± 76.4; closed chest: 194.0 ± 51.8 min; p = 0.006). The 90-day mortality rate was 20.0% (n = 26), with no significant difference between open versus closed chest patients (open chest: 23.3%, n = 7; closed chest: 19.0%, n = 19; p = 0.60, RR 1.2 [0.6; 2.6]). There was no significant difference in ICU length of stay (open chest: 9.8 ± 11.0; closed chest: 9.0 ± 12.3 days; p = 0.18) or hospital (open chest: 22.2 ± 18.4; closed chest: 20.2 ± 22.8 days; p = 0.21) length of stay. There was no significant difference in postoperative infection (open chest: 26.7%, n = 8; closed chest: 20.0%, n = 20; p = 0.44, RR 1.3 [0.7; 2.7]) or 5-year mortality (open chest: 26.7%, n = 8; closed chest: 25.0%, n = 25; p = 0.86, RR 1.1[0.5; 2.1]).

Conclusions

In patients presenting with ATAD, postoperative outcomes are similar regardless of whether patients left the OR with a closed chest or with an open chest for DSC. Our findings indicate that leaving the chest open after ATAD repair is an appropriate strategy to mitigate perioperative coagulopathy and/or hemodynamic instability.

Background

There is an increasing trend to offer mitral valve surgery to patients ≥ 75 years of age for severe mitral regurgitation or stenosis. These patients have multiple comorbid conditions which may affect clinical outcomes. We present long-term outcomes following mitral valve surgery in patients ≥ 75 years.

Methods

A prospective institutional study was performed. We analyzed data on patients ≥ 75 years who underwent mitral valve surgery from January 2013 to July 2023.

Results

168 patients were included in the study with a mean age of 79 ± 1.2 years and a median EuroSCORE II of 4.7 and a median Logistic EuroSCORE of 11.02. The timing of surgery was urgent in 43.5% and elective in 56.5% of patients. There was no difference in preoperative variables between the urgent and elective groups. Infective endocarditis was present in 8% of urgent cases and 1% in elective patients. Mitral valve repair was performed in 46% of both groups, respectively, that is, urgent and elective groups. Tricuspid valve surgery was performed in 8.2% and 14.7% of patients, surgical ablation for atrial fibrillation in 4.1% and 10.5% of patients, and closure of left atrial appendage in 17.8% and 6.3% of patients, CABG in 38.4% and 32.6% of patients, and aortic valve replacement in 17.8% and 12.6% of patients. In-hospital mortality was 6.9% in the urgent group and 1.1% in the elective group. Postoperative neurological changes were seen in 4% of elective patients and 1% in the urgent group, and there was no difference in the requirement of CVVH between the two groups. One- and five-year survival rates are 92% and 84%, respectively, in the elective group and 88% and 77%, respectively, in the urgent group. Cumulative survival for both groups is 77% at 10 years.

Conclusion

Mitral valve surgery in association with concomitant valve or CABG operations can be safely performed in elderly patients with good early and late outcomes. Excellent 10-year survival outcomes are seen with minimal attrition in those patients who have survived to 5 years.

Background

Infective endocarditis (IE) is an increasingly more common disease with poor prognosis. Recently, a few single-center studies about IE patient characteristics and surgical outcomes have been published from the capital area in Southern Finland. Our aim was to provide the first descriptive analysis of surgically treated IE patients in the northernmost university hospital in Finland.

Methods

All IE patients who had their first operation due to IE between 1998 and 2018 were retrospectively collected from the hospital discharge register, and their electronic patient records were analyzed. Follow-up for survival lasted to the end of 2021. The primary endpoint in survival analyses was all-cause mortality.

Results

A total of 128 novel IE cases were operated between 1998–2018. Twenty (15.6%) of the patients had a history of intravenous drug use. The median (1st–3rd quartile) follow-up after surgery was 76 (26–139) months. A total of 49 (45.5%) of the nonusers and 11 (55.0%) of the drug users died during the follow-up period. The 90-day mortality was significantly higher among nonusers compared with patients using intravenous drugs (18.5% vs. 0.0%, p = 0.036). Staphylococcus aureus was the most common underlying pathogen (42% of all cases) and posed nearly a 2-fold risk for overall mortality even after adjusting for confounding: hazard ratio: 1.781 (95% confidence interval: 1.054–3.008, p = 0.031).

Conclusions

IE is a rare disease with poor outcomes. S. aureus is the most common underlying pathogen and a major risk factor for mortality in patients not using intravenous drugs.

Objectives

This study aims to assess the effectiveness of a new adhesive composite barrier for preventing scars between the sternum and the intracardiac structures.

Methods

A pilot, prospective, single-center, randomized controlled study encompassing neonates with ventricular septal defect who received staged correction between January and September 2024. Patients (n = 20) were divided into two groups. After pulmonary artery banding, the study group (n = 10) had the new adhesive composite barrier implanted in the pericardium before the sternum was closed (n = 10). The control group (n = 10) had no barrier. After 3–6 months, all patients had complete correction of the ventricular septal defect, and the barrier was explanted in the study group. We recorded palliative procedure duration and continuously monitored clinical data and resternotomy duration. The histological severity of fibrosis and inflammatory reaction was assessed in the study group.

Results

No patients died during the study. The palliative procedure duration, length of stay in the ICU, and length of hospitalization did not differ between the groups. During complete correction, the severity of the adhesion process was estimated in both groups and made up 1.6 ± 0.6 points in the study group and 2.3 ± 0.6 points (p < 0.04) in the control group. The length of hospital stay after VSD repair was the same (p = 0.84). The overall degree of fibrotic changes was lower in the study group: 1.9 ± 0.3 points as compared to 2.3 ± 0.4 (p = 0.049) in the control group.

Conclusions

The new adhesive composite Reperen-based barriers were easily separated from the surrounding tissues without adhering to the sternum or intracardiac structures and demonstrate high potential when used as adhesion barriers in cardiac surgery.

Introduction

The amount of very old patients requiring cardiac surgery increases. Commonly, most cardiac surgery procedures are performed on the cardioplegically arrested heart. However, myocardial protection in old patients currently has very limited evidence. Thus, we investigated the impact of old age on myocardial protection using the three commonly applied cardioplegic solutions Calafiore, Buckberg, and histidine–tryptophane–ketoglutarate (HTK) in valve surgery.

Material and Methods

In our department, we retrospectively included all adult (≥ 18 years) patients who received elective or urgent valve surgery for single or multiple heart valve disease. We compared the peak value and area under the curve (AuC) of the high-sensitive troponin t (TnT) and creatine kinase muscle brain-type (CK-MB) concentrations during the first, second, and third 24-h periods after removal of the aortic cross-clamp of patients ≥ 75 and < 75 years of age.

Results

In the Calafiore population, the peak CK-MB (p = 0.047) release and AuC (p = 0.038) were significantly higher in patients ≥ 75 years. In the Buckberg population, the peak TnT (p < 0.001) and CK-MB (p = 0.001) release and the TnT (p = 0.001) and CK-MB (p = 0.002) AuC were significantly higher in older patients. Neither the peak TnT (p = 0.929) or CK-MB (p = 0.279) release nor the TnT (p = 0.851) or CK-MB (p = 0.486) AuC was significantly different between patients < 75 years, as compared to those ≥ 75 years of age in the HTK population.

Conclusion

Myocardial protection is not independent of age, at least not in valve surgery. Patients ≥ 75 years develop a more pronounced myocardial injury when Calafiore or Buckberg cardioplegia is used. However, when HTK is used, myocardial protection is equally achieved in adult patients < and ≥ 75 years.