Journal of Cardiac Surgery最新文献

Background: Surgical dogma advocates for the use of homograft in invasive aortic valve endocarditis due to a perceived advantage in the prevention of recurrent infection. However, conclusive data to support this strategy are lacking. This study evaluated outcomes of root replacement in invasive aortic valve endocarditis using homografts or prosthetic-valved conduits.

Methods: A retrospective review of a single U.S. academic center’s aortic database identified 150 patients who underwent aortic root replacement for invasive aortic valve endocarditis from 2002 to 2022. Patients undergoing the Ross procedure or aortic valve replacement without root replacement were excluded from the study. Patients were divided into two groups based upon the type of valved conduit implanted. Preoperative characteristics, postoperative morbidity, reintervention for recurrence of infection, and short- and long-term survival were compared between the two groups.

Results: There were 70 patients who underwent a homograft root replacement (homograft), and 80 patients who received either a bioprosthetic or mechanical-valved conduit (prosthetic). The mean age of patients was 53.3 ± 15.6 and 21.3% were female. The overall incidence of preoperative stroke and aortic root abscess was 42% and 71%, respectively. There was no difference between the two groups in age, gender, end-stage renal disease, cardiogenic shock, and aortic root abscess. The prosthetic group had a higher incidence of preoperative stroke (prosthetic 52% vs. homograft 25%, p = 0.02). The incidence of preoperative prosthetic valve endocarditis was 30% for the cohort and significantly higher in the homograft group (p = 0.02). Reoperative sternotomy was 78.7% among the groups with a higher likelihood among the homograft group. Cardiopulmonary bypass and cross clamp times were shorter in the prosthetic group (p < 0.05). There was no difference in postoperative stroke or renal failure between the two groups. The 30-day mortality for the entire cohort was 20.1% and was increased in the homograft group (homograft 25.7% vs. prosthetic 16.3%, p = 0.15). At 7 years follow-up, survival was 62% in the prosthetic group and 53% in the homograft group. The need for reintervention due to recurrence of infection was 3.2% for the entire series and equivalent (homograft 3.5%, vs. prosthetic 4.2%, p = 0.82) between the groups.

Conclusions: The use of homograft for root replacement does not provide significant improved short- or long-term outcomes compared with prosthetic-valved conduits in invasive endocarditis. In this patient population, these data refute the necessity for a more complex procedure using homograft in these high-risk patients and conduit selection should be tailored to individual anatomy and surgeon-specific experience.

Background: With the increasing adoption of robotic technology in adult cardiac surgery patients, improved surgeon experience and wider utilization have been reported. However, interpreting trends in robotic congenital surgery is more challenging. By performing a systematic review, the authors aim to evaluate the current literature on robotic congenital operations.

Methods: The protocol was registered with PROSPERO. The inclusion and exclusion criteria were established based on the population, intervention, comparison, and outcome (PICO) framework. A comprehensive literature search was conducted from January 1998 to December 2021. Studies involving patients undergoing congenital cardiac surgery operations performed with robotic assistance were included. Two independent reviewers screened titles/abstracts and then full text of eligible studies. A third reviewer resolved any discrepancies. The Newcastle–Ottawa Scale was applied to quantify quality assessment for nonrandomized observational studies.

Results: A total of one-hundred twenty-eight publications underwent full-text review, and 66 studies were included. Overwhelmingly, the majority are from single institutions and observational and retrospective studies. The population was mostly adults with only 10.6% (7/66) studies solely reporting pediatric patients. About 50% of the studies were case reports (28/66). Selective reporting of outcomes varied widely across studies. Cumulative mortality rates were 0.3%. The highest incidence of morbidities included pleural effusion (12.3%), reoperation for bleeding (10.7%), atrial fibrillation (10.7%), heart block (9.5%), and peripheral cannulation–related complications (8.6%). The overall quality of the studies was unsatisfactory, with the majority of studies receiving a score of 3 out of 9.

Conclusions: Most publications were case reports or small case series performed in adults and restricted to a few international institutions. To address these clinical challenges, technological improvements and advanced training will be mandatory before wider application to children and complex congenital diagnoses. Unfortunately, the overall quality of studies is poor, with inconsistent outcomes reporting. Improved and standardized reporting will be necessary before an appropriate evaluation of robotics in the treatment of congenital heart disease is feasible.

Background: Mitral valve repair with the edge-to-edge technique (Alfieri stitch) has been described for over 20 years, yet little is published on late durability and potential risk of mitral stenosis remains controversial. The primary objective of this study is to describe characteristics and late durability of Alfieri stitch in mitral valve repair.

Methods: From 2004 to 2019, we reviewed data from our prospectively maintained institutional database on 1175 consecutive patients with degenerative mitral regurgitation (MR) who underwent repair. Patients undergoing concomitant operations were included. Propensity score matching was performed on patients with and without Alfieri stitch to compare clinical (survival and reoperation) and echocardiographic (moderate or severe MR [“moderate or more MR”], severe MR, and mitral stenosis) outcomes up to 10 years.

Results: Overall, 1175 patients underwent mitral valve repair; 55.1% (n = 648) received the Alfieri stitch. The median follow-up was 4.7 (2.0, 8.2) years. Matched patients with and without Alfieri stitch had similar cumulative incidence (CI) of moderate or more MR (24% ± 5% vs. 17% ± 4%, p = 0.2, respectively), severe MR (5% ± 2% vs. 4% ± 2%, p = 0.3), and mitral reoperation (9% ± 3% vs. 2% ± 1%, p = 0.06) with no difference in survival (84% ± 3% vs. 81% ± 3%, p = 0.2). The Alfieri stitch resulted in a slightly higher mean mitral valve gradient (3.9% ± 1.5 mmHg vs. 3.6% ± 1.6 mmHg, p = 0.0003). The CI of mitral stenosis at 10 years was negligible (one patient with Alfieri stitch and two patients without Alfieri stitch).

Conclusions: In selected patients with degenerative mitral regurgitation, mitral valve repair with Alfieri stitch is durable with late outcomes comparable with other repair techniques. The Alfieri stitch may be a useful tool in selecting complex mitral pathology with minimal increased incidence of mitral stenosis. Further investigation is needed to delineate best indications for the use of Alfieri stitch.

Purpose: The safety and long-term durability of minimally invasive mitral valvuloplasty (MIMVP) remain controversial. This study aimed to compare the perioperative and long-term outcomes of minimally invasive mitral valve surgery (MIMVS) and conventional sternotomy.

Methods: This study included 476 patients who underwent mitral valve surgeries at our institution between January 2011 and December 2023. Patients were classified according to whether they underwent sternotomy: the nonsternotomy (NS: 271 cases) and sternotomy (S: 205 cases) groups. Perioperative and long-term outcomes were compared between the two groups.

Results: The NS group had a lower preoperative age and EuroScore II. In the S group, the left ventricular ejection fraction was lower, while the left ventricular end-systolic diameter and left atrial diameter were larger. Operative time, cardiopulmonary bypass time, and aortic cross-clamp time were longer in the NS group. Postoperative atrial fibrillation, more transfusion, and increased length of hospital stay were more frequent in the S group. The 10-year freedom from reoperation and 10-year survival rates in the NS and S groups were 98.1% vs. 93.6% (p = 0.07) and 94.8% vs. 86.9%, respectively (p = 0.08), with no significant differences.

Conclusion: MIMVP demonstrates noninferior perioperative and long-term outcomes compared with conventional sternotomy.

Introduction: Ruptured abdominal aortic aneurysm (RAAA) is a very severe condition with 17.4%–45.1% 30-day mortality rates. The 30-day death prediction model for patients with RAAA is one of the most significant models developed by Harborview Medical Center (HMC). The Harborview Risk Score (HRS) was calculated using the following four preoperative factors: minimum systolic blood pressure, age, Pondus Hydrogenii (pH), and creatinine (Cr). The objective was to evaluate the validity and dependability of the HMC model for predicting 30-day mortality with a large data sample.

Methods: The medical subject heading (MeSH) was used to search the electronic database. Four key indicators, the 30-day mortality rate, and the HRS score were among the data that were retrieved. The inclusion criteria include RAAA patients, applying the HMC prediction model and with baseline data, and the exclusion criteria include other prediction models and studies with incomplete baseline data from patients.

Results: There were 2931 participants in total throughout 7 trials; 1536 of these patients came from the National Surgical Quality Improvement Program (NSQIP) database, and the other patients came from single center in each project. Thirty-day mortality was 34.9% (95% CI: 0.27–0.33) on average. The majority of the patients (n = 2616, 89.25%) had an HRS score of 0–2. All patients who had a score of 4 died, no matter which single center they were in. Furthermore, with every extra point that a patient with a score of 0–3 received, their death rate rose by around 15%–20%.

Conclusion: The HMC prediction model is a trustworthy prediction model that can more simply and accurately predict 30-day postoperative mortality through the use of age, pH, Cr, and minimum systolic blood pressure. It also provides more preoperative counsel and assessment to the patient, family, and physician.

Background: There is currently little data in the literature evaluating the long-term outcomes of reoperative aortic root replacement after previous aortic root replacement, and there are no studies comparing how these outcomes differ based on the approach of the initial aortic root replacement. Our objective was to determine the outcomes of reoperative aortic root replacement following prior aortic root replacement with either the total root or inclusion root techniques.

Methods: This study was a retrospective cohort analysis of 260 patients who underwent redo aortic root replacement from September 1994 to July 2024. Previous root replacements were done with the total root technique in 90 patients and inclusion root technique in 170 patients. The primary outcomes of the study were perioperative complications, operative mortality, and late survival.

Results: The median age of the entire cohort was 57 years, and 79% were males. The prior total root group was younger, had more Marfan syndrome, and more concomitant ascending/arch replacement. Perioperatively, the groups had similar recovery times and complication rates, though there was more postoperative sepsis in the prior total root group (5.6% vs. 0.6%), Operative mortality was 4.2% in the whole cohort; 5.6% in the total root group versus 3.5% in the inclusion root group, p = 0.44. Survival at 5 and 10 years was 84% and 70% in the whole cohort, respectively. The 5-year survival was similar between the groups at 81% in the total root group and 85% in the inclusion root group, p = 0.82. Cox proportional hazards regression showed infection as a primary indication and was a significant risk factor for late mortality (hazard ratio 2.55 [95% CI: 1.45, 4.50], p = 0.001), as was diabetes (HR: 2.00 [95% CI: 1.04, 3.82], p = 0.037), but previous total root versus inclusion root procedure was not (hazard ratio 1.10 [95% CI: 0.58, 2.09], p = 0.77).

Conclusions: Reoperative aortic root replacement following prior root replacement can be performed with good short- and long-term outcomes after either total root or inclusion root replacement.

Hemolymphangiomas of the heart are one of the rarest types of cardiac tumors. We describe the case of a 63-year-old woman with a large hemolymphangioma arising from the left atrial appendage. Complete resection of this rare tumor was performed successfully, with no tumor recurrence during the 8-year follow-up.

Standard chest tubes (CTs) used to drain retained blood can become occluded from blood clots, leading to ineffective drainage and postoperative complications such as cardiac tamponade. Chest tube clearance strategies (CTCSs) were developed to improve CT patency. Our meta-analysis compared the safety and efficacy of CTCS versus CT following cardiac surgery. The PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were searched from 1946 to 2023 for studies that compared CTCS to CT. Two investigators independently reviewed, screened, extracted, and assessed the data prior to performing a random effects meta-analysis using R. The primary outcome was re-exploration and the secondary outcomes were retained blood syndrome, mortality, blood products, stroke, cardiac arrest, atrial fibrillation, ventilation time, intensive care unit (ICU) time, hospital length of stay, and chest drainage. Five studies (2288 patients) were included. There were two clinical trials (n = 620) and three observational studies (1668 patients). Compared to CT, CTCS had a significant reduction of postoperative atrial fibrillation (risk ratio (RR) 0.80, 95% CI 0.70 to 0.92, I² = 17%, p < 0.01). There was no significant difference in re-exploration, retained blood syndrome, hospital length of stay, and ICU length of stay. However, with the addition of four unmatched studies (n = 2583), CTCS was associated with a significant reduction in re-exploration (RR 0.52, 95% CI 0.37 to 0.73, I² = 34%, p < 0.01), retained blood syndrome (RR 0.71, 95% CI 0.53 to 0.95, I² = 72%, p = 0.02), hospital length of stay (mean difference (MD) −0.40, 95% CI −0.78 to −0.01, I² = 49%, p = 0.04), and chest drainage (MD 0.80, 95% CI 0.70 to 0.92, I² = 17%, p < 0.01). Drawing from results including the unmatched studies, CTCSs are associated with fewer postoperative complications compared to CT. This was achieved without major differences in chest drainage, supporting the important role of preventing even small accumulations of blood in the pericardial space.

Objectives: The American College of Cardiology (ACC) guidelines recommend the same imaging frequency for all bioprosthetic valves, but some have demonstrated poor durability. We aimed to assess mortality differences between small (19–21 mm) and large (23–29 mm) in Mitroflow and Carpentier-Edwards Perimount aortic valves.

Methods: A retrospective observational study was conducted by all patients undergoing isolated surgical aortic valve replacement with Mitroflow or Perimount in Western Denmark between 1999 and 2014 and followed until January 2024. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular mortality and sudden cardiac death. A propensity score-matched analysis was performed.

Results: A total of 1150 patients were analyzed, with 496 (43%) receiving Mitroflow valves and 654 (57%) receiving Perimount valves. In the Mitroflow group, 108 (22%) had a valve size of 19–21 mm, and 388 (78%) in the size range of 23–29 mm. In the Perimount group, the distribution was 99 (15%) and 555 (85%), respectively. The compromised survival of Mitroflow valves was attributed to the valve type, regardless of the valve sizes. Larger Mitroflow valves exhibited the same compromised late mortality as smaller valves, 66.7% vs 61.5%, respectively (p = 0.95). The same pattern of mortality was observed in the matched population, with Perimount demonstrating significant lower risk of mortality.

Conclusion: Mitroflow valves were associated with a poorer prognosis compared to Perimount valves. Additionally, larger Mitroflow valves were not associated with an improved prognosis compared to smaller valve sizes. EuroSCORE2 had a significant impact on patient survival.