The Journal of cardiovascular surgery最新文献

{"title":"Primary delayed sternal closure in adult cardiac surgery: a systematic review of protocols.","authors":"Hannah L McMullen, David Blitzer, Hannah Copeland","doi":"10.23736/S0021-9509.24.13024-8","DOIUrl":"10.23736/S0021-9509.24.13024-8","url":null,"abstract":"<p><strong>Introduction: </strong>Primary delayed sternal closure (DSC) is a useful tool in the management of certain critically unstable patients after cardiac surgery, but there is a paucity of consensus management guidelines. This review aimed to identify critical key areas in DSC management.</p><p><strong>Evidence acquisition: </strong>Systematic literature search was conducted in January 2023 and performed using Embase and PubMed. For original research articles were included that described outcomes and/or protocols for primary adult DSC patients, excluding articles on pediatric patients and secondary DSC.</p><p><strong>Evidence synthesis: </strong>Eleven retrospective review original articles examined protocols for adult patients undergoing DSC. Hemodynamic instability and uncontrolled bleeding/coagulopathy were the two most common indications. Time to chest closure ranged 22 hours - 8.7 days. A range of dressings were employed, including Esmark and VAC dressings, with about half of authors not disclosing details. VAC was endorsed by several authors specifically for management of uncontrolled hemorrhage/coagulopathy. There was no consensus regarding irrigation solution for mediastinal prepping, with or without antibiotic solution. There was a lack of consensus on antibiotic selection and duration, varying from 2 and 3 multidrug regimens of broad-spectrum antibiotics, with/without antifungals. Mediastinal re-exploration varied from undefined intervals to regimented 24-48-hour interval re-explorations, with final closures in the OR or ICU.</p><p><strong>Conclusions: </strong>The optimum care for the patient with an open chest is evolving, and although there is a lack of a consensus DSC protocol, this review identifies mediastinal management, antimicrobial prophylaxis, and mediastinal re-exploration schedules/protocols as key areas for study to determine optimal care for DSC patients.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"533-538"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passing the torch, a fond farewell.","authors":"Fabio Verzini","doi":"10.23736/S0021-9509.24.13261-2","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13261-2","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 6","pages":"507-508"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Sternum Guard vs. bone wax in post-cardiac surgery patients: a randomized controlled trial.","authors":"Dudy A Hanafy, Konda K Muroso, Sugisman Sugisman, Tri W Soetisna, Amin Tjubandi, Dicky A Wartono, Bagus Herlambang, Pribadi W Busro","doi":"10.23736/S0021-9509.24.13042-X","DOIUrl":"10.23736/S0021-9509.24.13042-X","url":null,"abstract":"<p><strong>Background: </strong>Median sternotomy offers the main access during cardiac surgery. However, a surgical site infection (SSI) of the sternum is a distressing complication following this procedure. The incidence of postoperative superficial and deep SSI in cardiac surgery varies from 1.3% to 12.8%. Bone wax, a nonabsorbable substance applied as a mechanical barrier following a median sternotomy, can increase the risk of postoperative sternal dehiscence. Sternum Guard (Vygon, Ecouen, France), a sternal protection device used to cover the sternum after a median sternotomy, offers mechanical protection to prevent lesions on the sternum. The aim of this study was to compare the effectiveness of Sternum Guard (Vygon) and bone wax in reducing SSI and facilitating hemostasis in post-cardiac surgery patients.</p><p><strong>Methods: </strong>This single-blinded, single center randomized controlled trial comprised 414 adult patients who underwent cardiac surgery. The postoperative outcomes assessed were SSI and the quantity of blood lost from the sternal edges in the Sternum Guard (Vygon; treatment) and bone wax (control) groups.</p><p><strong>Results: </strong>The superficial SSI prevalence in the Sternum Guard group was lower than that in the bone wax group (2.9% vs. 8.2%, respectively; P=0.018). The incidence of deep SSI was also lower in the Sternum Guard group (1%) compared to the control group (2.9%) although this was not statistically significant (P=0.284). In terms of intraoperative sternal bleeding, Sternum Guard (Vygon) absorbed more than the sterile drapes used in the control group (84.97±115.99 vs. 81.18±14.62, respectively; P=0.012).</p><p><strong>Conclusions: </strong>Sternum Guard (Vygon) had a significantly lower incidence of postoperative infection and bleeding from the sternum compared to bone wax.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"539-545"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of the automated suture system in valvular heart surgery: a multicenter, prospective registry.","authors":"Marie-Catherine Morgant, Chloé Bernard, Sebastien Gerelli, Nicolas Chavanis, Ilir Hysi, Olivier Fabre, Fabien Doguet, Elodie Berg, Olivier Bouchot","doi":"10.23736/S0021-9509.24.13039-X","DOIUrl":"10.23736/S0021-9509.24.13039-X","url":null,"abstract":"<p><strong>Background: </strong>In the last years, the Cor-Knot^® device has been increasingly used in heart valve surgery. Our aim was to investigate the incidence of valvular complications in patients who underwent valvular surgery using the Cor-Knot^® device in multicentric cohorts at one-year follow-up.</p><p><strong>Methods: </strong>Three hundred and sixty-eight patient underwent heart valve repair or replacement surgery using automated titanium suture fasteners in four cardiothoracic surgery departments between September 2018 and January 2020.</p><p><strong>Results: </strong>The mean age was 66.3±10.2 years. The mean Euroscore II was 3.14±5.65. Procedures were performed by right anterior mini-thoracotomy for 264 patients (71.7%) and by conventional sternotomy for 76 (20.7%). Isolated single valve surgery was most common (285 patients, 77.4%), 31 patients (8.4%) underwent isolated double valve surgery and 6 patients isolated triple valve surgery (1.6%). An associated procedure was performed in 46 patients (12.5%). Sixteen patients (4.3%) required permanent pacemaker implantation in the postoperative period. Eighteen patients died postoperatively (4.9%). Two patients had paravalvular leak ≥2 (0.5%). Mean follow-up was 14.7±7.1 months. Eight patients died during the follow-up (2.2%). Four patients had infectious endocarditis. The rate of valvular leak ≥2 was 1.5% and four patients underwent valve-related reoperation (1.2%), no reoperation was related to a valve lesion due to Cor-Knot^®. There were three pacemaker implantation (0.9%) and 12 patients had NYHA>2 (3.7%). No case of metallic embolization, prosthesis thrombosis or leaflet perforation was reported during follow-up.</p><p><strong>Conclusions: </strong>The use of the Cor-Knot^® automated knotting system in valve surgery is not associated with an increase in the rate of paravalvular leakage, permanent pacemaker implantation or mortality postoperatively or during follow-up.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 6","pages":"546-552"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does performing cardiac surgery after hours impact postoperative outcomes? A systematic review and meta-analysis.","authors":"Andrew O'Connell, Ryaan El-Andari, Nicholas M Fialka, Jeevan Nagendran, Steven R Meyer","doi":"10.23736/S0021-9509.24.13154-0","DOIUrl":"10.23736/S0021-9509.24.13154-0","url":null,"abstract":"<p><strong>Introduction: </strong>There has been concern regarding the safety of cardiac surgical intervention during off-hours. Sleep deprivation, resource limitations, and an increased case urgency have been postulated to increase off-hours surgical risk, although outcomes are inconsistent in the existing literature. In this systematic review and meta-analysis, we review the literature comparing patients undergoing cardiac surgery during on and off-hours.</p><p><strong>Evidence acquisition: </strong>PubMed and Embase were systematically searched for literature published from January 2000-September 2023, comparing outcomes of patients undergoing cardiac surgery during on and off-hours. Overall, 3540 manuscript titles and abstracts were screened and 11 articles were included.</p><p><strong>Evidence synthesis: </strong>Overall aggregate analysis indicated no significant differences in rates of in-hospital mortality(OR 1.04; 95% CI, 0.41-2.63; P=0.93) and perioperative morbidity, including stroke (P=0.52), reoperation (P=0.92), major bleeding (P=0.10), and renal complications (P=0.55). Composite rates of sternal wound infection favored on-hours surgery (P=0.01).</p><p><strong>Conclusions: </strong>Although inferior outcomes in patients undergoing cardiac surgery during off-hours have been noted, aggregate analysis largely revealed equivalent perioperative morbidity and mortality during on and off-hours surgery, although with the exclusion of one outlier study in-hospital mortality and reoperation favored on-hours surgery. Heterogeneity in outcomes is likely multifactorial, with surgical staff fatigue, patient preoperative risk, clinical setting, and resource limitations all contributing. Further investigation is required directly comparing emergent cardiac surgical intervention during on-hours and off-hours controlling for baseline surgical risk to elucidate the true impact of timing of surgery on postoperative outcomes.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"523-532"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of frailty on outcomes of patients undergoing elective endovascular thoraco-abdominal aortic aneurysm repair.","authors":"Simone Cuozzo, Enrico Sbarigia, Jihad Jabbour, Antonio Marzano, Carola D'Amico, Vincenzo Brizzi, Ombretta Martinelli","doi":"10.23736/S0021-9509.24.13052-2","DOIUrl":"10.23736/S0021-9509.24.13052-2","url":null,"abstract":"<p><strong>Background: </strong>Frailty and it score assessment by the Clinical Frailty Scale (CFS) have been recently proposed in surgery to overcome chronological age and major comorbidities as predictor tools of the surgical risks. We aim to evaluate the impact of frailty on outcomes of patients undergoing TAAA endovascular repair and whether CFS may be used as screening tool in the preoperative work-up and peri-operative risk stratification.</p><p><strong>Methods: </strong>REtrospective analysis of 76 patients (61 male, 74.9±6.9 years) undergoing elective branched-EVAR. Patients were divided in Group A (CFS<5) and Group B (CFS≥5). Post-operative morbidity, access-site related-complications, ICU- and in-hospital length-of-stay, reintervention rate, surgery- and all-causes related mortality were evaluated.</p><p><strong>Results: </strong>Fifty-four patients (71.1%) were classified as CFS<5, whereas twenty-two as CFS≥5. Demographics and comorbidities were homogeneous regardless of CFS class. No differences in term of MAE and of access-site related-complication but a greater perioperative and early mortality rate in the group of frail patients was noted (P=0.009, OR 11.8, 95% CI 1.35-3.58; P=0.019, respectively), as a longer hospitalization (P=0.007) and more frequent non-home discharge. Mid-term aneurysm- and all-causes related mortality was similar in both groups.</p><p><strong>Conclusions: </strong>Frailty seems to be associated with worse perioperative outcomes. CFS is a reliable tool to quantify the degree of disability due to frailty and to better assess the risks and benefits of endovascular TAAA repair. Frailty is not equated with inoperability but indicate the need for a tailored approach for the more vulnerable patients. Larger studies and a widespread use of frailty screening methods are needed to confirm its efficacy in the prediction of outcomes after endovascular interventions.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"515-522"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tabular review of contemporary open surgical repair experiences for treatment of thoracoabdominal aortic aneurysms.","authors":"Martina Cambiaghi, Lucas Ruiter Kanamori, Fernanda Jobim, Thomas Mesnard, Titia A Sulzer, Dora Babocs, Steven Maximus, Ying Huang, Fabio Verzini, Gustavo S Oderich","doi":"10.23736/S0021-9509.24.13167-9","DOIUrl":"10.23736/S0021-9509.24.13167-9","url":null,"abstract":"<p><p>Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is one of the most challenging operations due to extensive surgical dissection and exposure, risk of complications and need for reconstruction of the aorta and its branches. In the last two decades, endovascular techniques have evolved and now are considered a viable alternative to open surgical repair in patients with suitable anatomy. Regardless of which technique is selected, open or endovascular, reduction of postoperative morbidity and mortality requires large clinical volume, optimal patient selection and a multidisciplinary team that can take care of the surgical, anesthetic, critical care and postoperative issues that occur after these operations. The aim of this article is to summarize the clinical data on open surgical repair of thoracoabdominal aortic aneurysms in a schematic tabular format.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"490-498"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular lithotripsy: modifying calcification to improve outcomes.","authors":"Angela S Giese, Trissa A Babrowski, Ross Milner","doi":"10.23736/S0021-9509.24.13219-3","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13219-3","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"419"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring clinical results of innovative procedures.","authors":"Fabio Verzini","doi":"10.23736/S0021-9509.24.13221-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.13221-1","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 5","pages":"417-418"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142718148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of a new generation balloon expandable stent-graft (Gore VBX) as bridging stent for B-EVAR.","authors":"Ciro Ferrer, Ottavia Borghese, Bernardo Orellana, Carlotta Mancusi, Federico F Pennetta, Carlo Coscarella, Marco Giudice, Rocco Giudice","doi":"10.23736/S0021-9509.24.13071-6","DOIUrl":"10.23736/S0021-9509.24.13071-6","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report the results of a single-centre experience with a new generation balloon expandable stent-graft (Viabahn VBX; W. L. Gore & Associates, Flagstaff, AZ, USA) as bridging stent in branched endovascular aortic repair (B-EVAR).</p><p><strong>Methods: </strong>This is a retrospective single institution analysis of a prospectively maintained database. All patients undergone implantation of at least one VBX as bridging stent in B-EVAR over the last 5 years (from July 1, 2018, to November 31, 2023) were included. Primary outcomes were technical success, primary and secondary stent patency rate, branch-related reinterventions, and branch instability. Secondary outcomes were clinical success, mortality, and rate of aortic-related reinterventions.</p><p><strong>Results: </strong>This study involved 40 patients for a total of 147 VBX stent-grafts implanted in 141 target vessels as bridging stents in B-EVAR (62.5% off-the-shelf and 37.5% custom made devices; 65% with outer branches and 35% with inner branches) for the treatment of 38 (95%) degenerative and 2 (5%) postdissection aneurysms. In 28 cases (70%) a total transfemoral approach was used to deliver the bridging stents. Technical success was 100%. No target vessel was lost intraoperatively. Over a median follow-up of 26.5 months (range 0-74), primary and secondary patency, branch-related reintervention, and branch instability were 98.5% (139/141), 99.3% (140/141), 15% (6/40), and 4.9% (7/141), respectively. Four of the 7 cases of branch instability, all requiring an endovascular correction, were secondary to type Ic endoleak. Clinical success was 97.5% as effect of 1 perioperative death. During the follow-up other 6 patients died, contributing to an overall survival rate of 82.5%. The overall rate of aortic-related reinterventions was 20%.</p><p><strong>Conclusions: </strong>Despite further evaluation is mandatory to determine durability of the VBX in the long-term after B-EVAR, in our experience VBX demonstrated a high flexibility and trackability, excellent stent retention, and outstanding patency over time. A generous distal landing of the bridging stent into the target vessel should be always achieved, whereas possible, to reduce the risk of type Ic endoleak, which seems to be the main cause of branch instability.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"482-489"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}