The prognosis and risk factors of hepatic dysfunction (HD) after open ascending aortic surgery are not well defined. This study aims to analyze the prognosis and identify the major risk factors for patients with HD after open ascending aortic surgery.
A retrospective analysis was conducted on patients who underwent open ascending aortic surgery at Shandong First Medical University Affiliated Shandong Provincial Hospital from June 2019 to June 2021. Perioperative clinical data were analyzed, and postoperative HD was defined based on the peak MELD-XI value recorded at any time during the first 7 postoperative days. Univariate and multivariate binary logistic regression was used to identify risk factors and develop a predictive model, which was then evaluated with the Receiver Operating Characteristic (ROC) curve and plotted with nomogram.
Of the 335 patients, 223 (66.6%) were diagnosed with postoperative HD. HD patients had prolonged ICU and hospital stays and a higher risk of hyperbilirubinemia, liver failure, kidney injury, and other complications. However, HD did not affect in-hospital mortality. Independent risk factors for postoperative HD included gender (p = 0.014), BMI (p = 0.022), aortic cross-clamp time (p = 0.007), preoperative HD (p < 0.001), and intraoperative red blood cell transfusion volume (p < 0.001). The area under the curve (AUC) was 0.803 (p < 0.001, 95% CI: 0.754–0.851), with a sensitivity of 74.4% and a specificity of 75.9%.
The MELD-XI score is a reliable tool for diagnosing HD after open ascending aortic surgery, particularly for patients on warfarin postoperatively. Postoperative HD following open ascending aortic surgery is common and associated with worse outcomes, although it does not affect in-hospital mortality. The identified risk factors and predictive model provide a valuable tool for prevention and management of postoperative HD. Larger studies are needed for further validation in the future.
The Bentall–De Bono procedure stands as the primary treatment method for ascending aortic aneurysms together with their associated valve disorders. The procedure requires a complete sternotomy for execution, but this method causes multiple complications which decrease patient comfort. This exploratory study aimed to evaluate the feasibility and early-to-midterm outcomes of the Bentall procedure performed via a right infra-axillary mini-thoracotomy.
The researchers studied data from patients who received this surgical procedure during the period from January 2020 through December 2024. Preoperative data, surgical details, postoperative complications, and follow-up outcomes were recorded. Changes in left ventricular dimensions were evaluated using a paired t-test; the learning curve was assessed by comparing the first and last twelve cases.
A total of 24 patients were included. The mean age was 54.3 years, and 75% were male. The mean operation time was 248 min, cardiopulmonary bypass time was 142 min, and cross-clamp time was 108 min. No sternotomy conversion was required. Thirty-day mortality was zero, with a major complication rate of 4.2% and a minor complication rate of 33.3%. At a mean follow-up of 26.5 months, 1- and 2-year survival rates were 100%. Left ventricular end-diastolic diameter decreased from 58.4 mm to 52.1 mm (p < 0.001). At the final follow-up, 83% of patients were in NYHA Class I.
Bentall–De Bono surgery via a right infra-axillary mini-thoracotomy appears to be feasible in selected patients. These preliminary findings suggest potentially low major complication rates and encouraging functional outcomes; however, given the retrospective design and limited sample size, results should be considered hypothesis-generating. Comparative studies are needed to establish safety and efficacy relative to conventional sternotomy.
Postpump chorea is a rare but potentially disabling movement disorder that arises days to weeks after cardiopulmonary bypass, most often following deep hypothermic circulatory arrest in pediatric patients undergoing repair of complex congenital heart defects. Clinically, postpump chorea presents as involuntary, nonrhythmic, choreiform, and athetotic movements after an initial asymptomatic period.
We present a detailed case of a two-year-old male with an interrupted aortic arch and a large ventricular septal defect who developed persistent chorea four days after deep hypothermic circulatory arrest repair at 18°C for 145 min. A focused literature review was conducted in May 2025 via PubMed, MEDLINE, Scopus, and Google Scholar.
Our patient’s structural neuroimaging and metabolic/autoimmune workups were unremarkable. Initial treatment with clonazepam yielded partial improvement; addition of haloperidol provided further relief but did not fully resolve chorea, which persisted intermittently at the last follow-up. Antegrade cerebral perfusion through the innominate artery was not used due to anatomic constraints and the need for complete arch reconstruction. Literature review confirms postpump chorea onset typically 3–14 days postcardiopulmonary bypass, frequent normal findings on CT/MRI, and variable responses to benzodiazepines, dopamine antagonists, and VMAT-2 inhibitors. Identified risk factors include prolonged deep hypothermic circulatory arrest time, lower target temperatures, pH-stat management, and cyanotic shunts.
Postpump chorea demands high clinical vigilance despite normal imaging. Prevention through optimized cardiopulmonary bypass techniques, including moderate hypothermia, controlled rewarming, pH-stat blood gas management, emboli filtration, and real-time cerebral monitoring, is paramount. First-line medical therapy (clonazepam and haloperidol) should be initiated promptly, with VMAT-2 inhibitors or corticosteroids reserved for refractory cases. Future multicenter studies are needed to refine neuroprotective strategies and define long-term neurodevelopmental outcomes.
Percutaneous coronary intervention (PCI) is an effective option for myocardial revascularization, even for high-risk patients. As a result, more patients who undergo coronary artery bypass grafting (CABG) have previously had PCI. This study aims to assess the impact of prior PCI on the occurrence of major adverse cardiac events (MACEs) within 1 year of CABG.
We performed a propensity-matched analysis of adult patients who underwent isolated CABG at our institution from January 2018 to December 2023. We evaluated patient demographics, medication, laboratory results, previous PCI, and clinical data. Our main goal was to compare and predict any differences in MACE between patients with a history of PCI and those without. An optimal propensity score (OPS) matching technique was used to create matched groups based on patients’ preoperative characteristics and risk factors, thereby controlling for selection bias associated with prior PCI.
Over 5 years, 375 patients received isolated CABG. Using 2:1 OPS, 219 patients were matched and included in the final analysis (58.4% of the original cohort). The average age was 62 years, and 82% were male. Of the studied group, 185 patients (84.5%) had diabetes; 59 patients (26.9%) experienced MACE; and 73 patients (33%) had previous PCI, with 53% of those undergoing PCI within 12 months of surgery. Factors such as age under 61 years, prior PCI, low hemoglobin levels (less than 12 g/dL), BMI below 30 kg/m2, ejection fraction less than 40%, and nonelective surgery were strongly associated with 1-year MACE, as identified by stepwise multivariate logistic regression analyses.
In the current era, using propensity-matched groups, a history of PCI before CABG has no direct impact on the risk of MACE within 1 year of CABG surgery. Lower LVEF and hemoglobin levels before CABG were significantly predictive of MACE within 1 year after the procedure. To maximize benefit and minimize harm, it is recommended to focus on optimizing patient status before surgery to achieve the best outcomes.
To determine whether the use of everting, pledgeted mattress suture (EPMS) technique for aortic valve replacement is advantageous compared to other commonly used techniques.
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.
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.
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.
To describe the clinical outcomes of patients with severe aortic valve stenosis (AS) and concomitant mitral regurgitation (MR) undergoing transcatheter aortic valve replacement (TAVR)
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.
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.
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.
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.
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).
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).
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.
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.
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.
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.
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
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).
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.
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]).
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.
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