Journal of Cardiac Surgery最新文献

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.

Background: Congenital aortic valve (AV) disease is viewed in 2% of the population and in 20 out of 1000 neonates are presented with bicuspid configuration. Treatment of the congenital AV diseases requires multiple interventions. The ultimate goal is to provide adequate close to physiological left ventricle outflow and minimization of regurgitation. The optimal operative management of AV disease in children and young adults remains controversial. AV neocuspidization with glutaraldehyde-treated autologous pericardium may be a satisfactory alternative in pediatric cardiac surgery.

Objectives: The data of the AVNeo procedure results enable a comparative analysis of various AV reconstructive approaches in the pediatric cohort. In this article, we present the comparative study of various techniques in pediatric AV surgery, including the immediate and midterm outcomes of AVNeo, commissurotomy with aortic leaflet augmentation using pericardial patch (“free style” technique), and Ross procedure.

Study Design: We conducted a retrospective analysis of the early and midterm results of surgical AV disease treatment of 44 children in 5 cardiac surgery centers from 2014 to 2022. The patients were divided into 3 groups: group I: glutaraldehyde-treated autologous pericardium AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). We described the immediate and midterm outcomes. The study design was approved by the ethics committees of the participating centers.

Results: A total of 44 children after surgical treatment of the AV disease in 5 cardiac surgery centers were included in the study and were grouped as group I: AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). The median follow-up period was 57 ± 23.8 months. In-hospital mortality was 4.5% (n = 2). In the midterm follow-up, the peak pressure gradient was 18.45 ± 4.63 mmHg for group I and 8.9 ± 1.6 mmHg for group III (p = 0.00001), respectively. The cumulative freedom from reoperations was 100%, 30%, and 95.2% for 40 months of follow-up and 100%, 30%, and 83.4% for 70 months of follow-up in I, II, and III groups, respectively. No cases of midterm mortality were detected in all groups.

Conclusion: The AV neocuspidization with glutaraldehyde-treated autologous pericardium has an enormous advantage in pediatric AV surgery, significantly surpassing the freedom from resurgery of repair procedures and having comparable results with the Ross procedure in the midterm follow-up.

Background: Postinfarct ventricular septal defect (PIVSD) is a serious complication of acute myocardial infarction (AMI). Transcatheter closure is a potential alternative to surgical closure for PIVSD patients.

Objective: This meta-analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.

Methods: A systemic search of PubMed and Embase until January 2023 identified studies comparing transcatheter versus surgical PIVSD closure. Primary outcomes included short-term mortality. Short-term mortality referred to the number of in-hospital or 30-day deaths. Secondary outcomes comprised residual shunt/reintervention incidence, difference in time from AMI or PIVSD diagnosis to intervention, the presence of cardiogenic shock, incidence of perioperative mechanical support, PIVSD size difference, and overall mortality at follow-up.

Results: Seven studies comprising 603 patients were included. Short-term mortality (OR, 1.30; 95% CI [0.90, 1.89]; p = 0.17; I²  = 3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; p = 0.01; I²  = 63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; p = 0.09; I²  = 83.0%) were significantly different; however, the other secondary outcomes were not significantly different.

Conclusion: Transcatheter and surgical closure demonstrate similar short-term mortality. Despite a higher incidence of residual shunt or reintervention in transcatheter closure, it may be a viable option in patients with small size of PIVSD.

Background: Hypertrophic cardiomyopathy (HCM) is commonly associated with mitral valve pathology. A large majority of patients with HCM have elongated anterior and posterior mitral leaflets. There remains debate regarding the necessity and role of concomitant mitral valve surgery at the time of septal myectomy. We aimed to describe the characteristics and share our surgical experiences with this specific group of patients.

Methods: This retrospective single-center study investigates adult patients with HCM, with or without elongated mitral valve leaflets (MVLs), who underwent elective septal myectomy with or without concomitant mitral valve intervention, between January 1, 2016, and June 30, 2020. Clinical data were obtained from institutional medical records as well as the Society of Thoracic Surgeons data registry. The clinical characteristics and in-hospital surgical outcomes were compared between patients with an elongated MVL and those without.

Results: In total, 379 patients underwent septal myectomy, and 22 patients with intrinsic mitral valve disease were excluded. In addition, 23 patients were excluded due to missing data. Of the remaining 334 patients, 131 (39.2%) had elongated MVL and concomitant MVL plication. Patients with elongated MVL had higher rates of preoperative mitral valve systolic anterior motion (SAM) (94.7% vs. 86.7%, p = 0.019) and higher preoperative provoked left ventricular outflow tract gradient (LVOTG) (134.5 mmHg versus 125.3 mmHg, p = 0.046). Post septal myectomy and mitral valve plication, they had lower rates of postoperative residual mitral regurgitation (3.8% vs. 12.8%, p = 0.006), comparable rates of residual SAM (28.2% vs. 31.5%, p = 0.524), postoperative provoked LVOTG (15.4 mmHg vs. 14.0 mmHg, p = 0.317), 30-day major adverse cardiopulmonary events (2.3% vs. 3.9%, p = 0.409), and mortality (0% vs. 1.0%, p = 0.255).

Conclusions: Elongated MVLs contribute more significantly to dynamic LVOT obstruction, as evidenced during provocative testing. Concomitant mitral valve intervention during septal myectomy can be performed safely and may provide an effective strategy to resolve SAM and stress-induced LVOTG.

Objective: The lung is a target organ of diabetes mellitus (DM) via glycation of pulmonary elastin and collagen. In addition, hyperglycemia facilitates hypercapnic respiratory failure, which is instead mitigated by low-carbohydrate high-lipid (LC-HL) nutrition. We sought to determine the association between diabetes and severe respiratory failure (SRF, i.e., need of reintubationtracheostomy) after open aortic arch replacement (AAR).

Methods: Machine learning algorithms were evaluated for precision and recall (F2 score) and for clinical applicability to predict SRF. Conditional regression evaluated independent predictors of SRF after 1:2 propensity-score matching.

Results: Information on diabetic status was available in 1275 patients undergoing AAR (1997–2023). Although support vector machine presented the highest F2 score (F2 = 0.337), conditional inference trees provided the most clinically applicable algorithm: diabetes was the best predictor of SRF, which occurred in 20/150 diabetics (13.3%) vs. 40/1125 nondiabetics (3.6%) (p < 0.01). In diabetics, left ventricular ejection fraction (LVEF) was the next best predictor of SRF, which occurred in 8/20 diabetics with LVEF ≤ 30% (40%) vs. 12/130 diabetics with LVEF >30% (9.2%) (p = 0.02). In nondiabetics, chronic obstructive pulmonary disease (COPD) was the next best predictor of respiratory failure, which occurred in 14/177 nondiabetics with COPD (7.9%) vs. 26/948 nondiabetics without COPD (2.7%) (p = 0.01). In the matched sample, diabetes was independently able to predict SRF (OR 2.20, 95% CI 1.10 | 4.42).

Conclusions: DM was the best predictor of SRF after AAR. Strict glycemic control and LC-HL nutrition should be evaluated as measures to reduce postoperative SRF in diabetic patients.

Objective: Calafiore and modified del Nido cardioplegic solutions are currently being used during coronary artery bypass surgery. This study aims to compare myocardial ischemic stress associated with both solutions by studying the changes in cardiac metabolites during cardioplegic ischemic arrest and early reperfusion.

Methods: Biopsy specimens were taken from the left ventricles of 20 patients undergoing routine coronary artery bypass grafting using Calafiore or modified del Nido cardioplegic solutions. Biopsies were taken immediately after the beginning of extracorporeal circulation (basal biopsy), 30 min after application of the aortic cross-clamp (ischemic biopsy), and 20 min following the removal of aortic cross-clamp (reperfusion biopsy) and were analyzed for their amino acid and lactic acid contents using amino acid analyzer and appropriate kits. Peripheral blood samples were also collected for the determination of blood concentrations of cardiac proteins (CK-MB and troponin I) using an immunofluorescence scanner.

Results: Both CK-MB and troponin I increased significantly 12 h postoperatively and were associated with an increase in myocardial lactic acid, but there were no significant differences in markers of myocardial injury between the two groups. Comparison of amino acid concentrations between the two groups according to sampling time showed that glutamic acid concentrations were significantly lower in the Calafiore cardioplegia group compared to the del Nido cardioplegia group, but there were no other significant differences in markers of metabolic stress (taurine and alanine/glutamate ratio) between the two groups. Moreover, there were no significant differences in changes in amino acid concentrations regardless of the type of cardioplegic solution used.

Conclusions: Cardioplegic ischemic arrest and early reperfusion are associated with a rise in myocardial metabolic stress. Both Calafiore and modified del Nido cardioplegic solutions are effective in attenuating myocardial substrate derangements and confer equal myocardial protection during routine coronary artery bypass surgery.

Trial Registration: ClinicalTrials.gov identifier: NCT06287372