European Journal of Cardio-Thoracic Surgery最新文献

{"title":"Associations of sarcopenia and malnutrition with 30-day in-hospital morbidity and mortality after cardiac surgery.","authors":"Takahiro Abe, Tasuku Inao, Yasushige Shingu, Akira Yamada, Shingo Takada, Arata Fukushima, Noriko Oyama-Manabe, Isao Yokota, Satoru Wakasa, Shintaro Kinugawa, Takashi Yokota","doi":"10.1093/ejcts/ezae456","DOIUrl":"10.1093/ejcts/ezae456","url":null,"abstract":"<p><strong>Objectives: </strong>Sarcopenia and malnutrition often occur simultaneously in adults with cardiovascular diseases. Our objective was to determine the associations of preoperative sarcopenia and malnutrition with major adverse cardiac and cerebral events (MACCE) after cardiac surgery.</p><p><strong>Methods: </strong>We retrospectively analysed 154 consecutive patients who underwent elective cardiac surgery between January 2015 and June 2018 at two institutions in Japan. Sarcopenia and nutritional status were preoperatively assessed by bilateral psoas muscle volume index (PMVI) using CT scans and the prognostic nutritional index (PNI), respectively.</p><p><strong>Results: </strong>The median age in the total cohort was 69 years, and 43% were women. Within 30 days after surgery, 20 patients developed in-hospital MACCE and seven patients died of any cause. Low PMVI (<72.25 cm3/m2) and low PNI (<48.15) were each independent predictors of postoperative MACCE occurrence with odds ratios (95% confidence interval) of 3.58 (1.22-10.53) and 3.73 (1.25-11.09) when adjusted for age and sex, and 3.25 (1.07-9.87) and 3.27 (1.08-9.89) when adjusted for preoperative left ventricular ejection fraction, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, and anticoagulant. In addition, the combination of low PMVI and low PNI conferred the highest risk of in-hospital MACCE among the four groups (i.e. the low PMVI, low PNI, low PMVI + low PNI and neither low PMVI nor low PNI groups).</p><p><strong>Conclusions: </strong>Preoperative low PMVI and low PNI were respectively associated with 30-day in-hospital MACCE occurrence after cardiac surgery. Notably, coexistence of these reductions further enhanced the risk of postoperative MACCE.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women in cardiac surgery: a global workforce analysis.","authors":"Aliya Izumi, Grace Lee, Zoya Gomes, Maral Ouzounian, Penelope Adinku, Lorena Montes, Dominique Vervoort","doi":"10.1093/ejcts/ezae463","DOIUrl":"10.1093/ejcts/ezae463","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac surgery remains one of the most gender-imbalanced surgical specialties. Women constitute 6-11% of the North American workforce, while other regional data are scarce. Despite the acknowledged under-representation of women in cardiac surgery globally and evidence that surgeon-patient gender concordance enhances postoperative outcomes, precise figures remain poorly defined. Herein, we provide the 1st global quantification of women cardiac surgeons (WCS) and explore correlates of workforce diversity.</p><p><strong>Methods: </strong>The Cardiothoracic Surgery Network database was queried for cardiac surgeons within each country and cross-validated with external sources. Profile pronouns and the genderize.io application determined surgeon sex. Data were stratified by country, geographical region and national income group, and correlation analyses with socioeconomic and gender parity metrics were performed.</p><p><strong>Results: </strong>Women constitute 8.0% (1178/14 651) of the international cardiac surgical workforce, with a median of 0.00 WCS per million women (interquartile range: 0.00-0.09). North America (11.4%) and Europe (10.3%) lead regional representation, while East Asia (2.9%) and the Middle East (1.7%) rank lowest. High-income countries (9.9%) have double the proportion of WCS as low- and middle-income countries (4.8%), with a notable absence among low-income countries. Female representation correlates with Gross National Income per capita (τ = 0.39), the Global Gender Gap Index (τ = 0.26) and health expenditure (τ = 0.26).</p><p><strong>Conclusions: </strong>Improving female representation in cardiac surgery is essential to advancing social justice and overall patient care. Yet, WCS remain a minority worldwide, with the most pronounced disparities in low- and middle-income countries and regions with low Gross National Income, Global Gender Gap Index and health expenditure. Confronting these inequities will require targeted mentorship efforts and addressing country-specific entry barriers, necessitating further research into the unique factors influencing women in low- and middle-income countries.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of direct mesenteric perfusion on malperfusion in acute type A aortic dissection repair.","authors":"Ryota Yamamoto, Wataru Kato, Yoshiyuki Tokuda, Koshi Yamaki, Koji Morita, Tomonari Uemura, Toshikuni Yamamoto, Hideki Ito, Tomo Yoshizumi, Sachie Terazawa, Yuji Narita, Masato Mutsuga","doi":"10.1093/ejcts/ezae452","DOIUrl":"10.1093/ejcts/ezae452","url":null,"abstract":"<p><strong>Objectives: </strong>Mesenteric malperfusion in acute aortic dissection remains a life-threatening complication with no standardized treatment strategy. This study aimed to describe and evaluate the outcomes of our integrated approach combining exploratory laparotomy, immediate mesenteric reperfusion, and central aortic repair.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with acute aortic dissection with a preoperative diagnosis of mesenteric malperfusion who were treated between August 2011 and November 2022. Our surgical approach was to establish cardiopulmonary bypass, followed by exploratory laparotomy with mesenteric artery flow assessment using Doppler ultrasound and direct perfusion if needed, central aortic repair, and subsequent mesenteric artery reconstruction. The primary end-point was the 30-day operative mortality.</p><p><strong>Results: </strong>Among 217 patients with acute aortic dissection, 12 (5.5%) had mesenteric malperfusion on preoperative computed tomography. Ten patients underwent exploratory laparotomy, where Doppler ultrasonography revealed reduced mesenteric blood flow in five patients (2.3% of the total 217 patients). These patients underwent direct perfusion of the mesenteric artery via a side branch of the cardiopulmonary bypass circuit. Doppler ultrasound confirmed the restoration of mesenteric blood flow in all perfused patients. No bowel resections were required. The operative mortality in patients with mesenteric malperfusion was 20%. The causes of death were stroke (n = 1) and acute myocardial infarction (n = 1).</p><p><strong>Conclusions: </strong>Our integrated surgical strategy combining central aortic repair with concurrent exploratory laparotomy and immediate mesenteric perfusion demonstrated technical feasibility in managing mesenteric malperfusion during aortic repair. Further prospective studies with larger cohorts are warranted to validate these findings.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisociety endorsement of the 2024 European guideline recommendations on coronary revascularization.","authors":"Victor Dayan, Joseph F Sabik, Minoru Ono, Marc Ruel, Song Wan, Lars G Svensson, Leonard N Girardi, Y Joseph Woo, Vinay Badhwar, Marc R Moon, Wilson Y Szeto, Vinod H Thourani, Rui M S Almeida, Zhe Zheng, Walter J Gomes, Dawn S Hui, Rosemary F Kelly, Miguel Sousa Uva, Joanna Chikwe, Faisal G Bakaeen","doi":"10.1093/ejcts/ezae417","DOIUrl":"https://doi.org/10.1093/ejcts/ezae417","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":"67 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valve expansion: the next frontier for lifetime management in transcatheter aortic valve implantation.","authors":"Arif Khokhar, Ole De Backer","doi":"10.1093/ejcts/ezaf003","DOIUrl":"10.1093/ejcts/ezaf003","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 EACTS Guidelines on perioperative medication in adult cardiac surgery.","authors":"Anders Jeppsson, Bianca Rocca, Emma C Hansson, Tomas Gudbjartsson, Stefan James, Juan Carlos Kaski, Ulf Landmesser, Giovanni Landoni, Pedro Magro, Emily Pan, Hanne Berg Ravn, Sigrid Sandner, Elena Sandoval, Miguel Sousa Uva, Milan Milojevic","doi":"10.1093/ejcts/ezae355","DOIUrl":"10.1093/ejcts/ezae355","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Rajakumar.","authors":"Tim Dong, Shubhra Sinha, Gianni D Angelini","doi":"10.1093/ejcts/ezaf002","DOIUrl":"10.1093/ejcts/ezaf002","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for blood culture-negative infective endocarditis: outcomes and the role of molecular biological imaging as diagnostic approach†.","authors":"Herko Grubitzsch, Johannes Erik Puritz, Dustin Greve, Hector Rodriguez Cetina Biefer, Dinah von Schöning, Judith Kikhney, Annette Moter, Stefanie-Teodora Sima, Matthias Schneider-Reigbert, Miriam Songa Stegemann, Frieder Pfäfflin, Volkmar Falk","doi":"10.1093/ejcts/ezae453","DOIUrl":"10.1093/ejcts/ezae453","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to analyse outcomes of surgery for blood culture-negative infective endocarditis (BCNIE) and to evaluate the role of molecular biological imaging.</p><p><strong>Methods: </strong>Patients undergoing surgery for native or prosthetic valve endocarditis from 2013 to 2022 were analysed regarding blood culture-positive infective endocarditis (BCPIE) and BCNIE. For laboratory diagnostics in BCNIE, excised valves or prostheses underwent conventional microbiological culture and fluorescence in situ hybridization combined with 16S rRNA-gene polymerase chain reaction and sequencing (FISHseq).</p><p><strong>Results: </strong>Of 521 patients overall, we identified 473 patients (342 males, mean age 63 ± 14.4 years) with preoperative blood cultures: 396 with BCPIE (83.7%) and 77 with BCNIE (16.3%). Preoperative characteristics and operative procedures were comparable between groups and the calculated perioperative risk (EuroSCORE II) was identical (BCNIE: 12.2 ± 8.8%, BCPIE: 12.9 ± 11.9%, P = 0.788). At surgery, signs of infective endocarditis were present in 71%, missing in 18% and inconclusive in 10% of patients with BCNIE. While valve cultures alone identified pathogens in 32% of BCNIE patients, the combination with FISHseq confirmed the infective aetiology in 98% and identified causative pathogens in 52%. Overall, early mortality was similar in BCNIE (16.9%) and BCPIE (18.2%, P = 0.620), but increased in 37 BCNIE patients without pathogen identification compared to 40 patients with pathogen identification (27.0% vs 7.5%, P = 0.032).</p><p><strong>Conclusions: </strong>Integrating FISHseq as molecular biological imaging technique into valve analysis algorithms in patients undergoing surgery for BCNIE increases diagnostic gain and potentially improves outcome.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven-year outcomes after surgical aortic valve replacement with a stented bovine pericardial bioprosthesis in over 1100 patients: a prospective multicentre analysis.","authors":"Joseph F Sabik, Vivek Rao, Francois Dagenais, Michael G Moront, Michael J Reardon, Himanshu J Patel, Jae K Oh, Shinichi Fukuhara, Louis Labrousse, Ralf Günzinger, Kamran Baig, Saki Ito, Tianhua Wu, Robert J M Klautz","doi":"10.1093/ejcts/ezae414","DOIUrl":"10.1093/ejcts/ezae414","url":null,"abstract":"<p><strong>Objectives: </strong>Safety, efficacy and durability are important considerations when selecting a bioprosthesis for aortic valve replacement (AVR). This study assessed 7-year clinical outcomes and haemodynamic performance of the Avalus bioprosthesis.</p><p><strong>Methods: </strong>Patients indicated for surgical AVR were enrolled in this prospective, nonrandomized trial, conducted across 39 sites globally. The primary end-point of this analysis was freedom from surgical explant or percutaneous valve-in-valve reintervention due to structural valve deterioration (SVD) at 7 years of follow-up, determined using Kaplan-Meier (KM) analysis. We also evaluated a composite end-point of SVD and/or severe haemodynamic dysfunction requiring reintervention. Survival, valve-related safety events and haemodynamic performance were assessed. Deaths and safety events were adjudicated by an independent clinical events committee.</p><p><strong>Results: </strong>A total of 1132 patients underwent surgical AVR. Mean age was 70 years; 854 patients (75%) were men. The mean STS risk of mortality was 2.0 ± 1.4%, and 659 patients (58%) had a New York Heart Association classification of I/II. One or more concomitant procedures were performed in 577 patients (51%). At 7 years, the Kaplan-Meier rate of freedom from SVD/severe haemodynamic dysfunction requiring reintervention was 1.2% (0.5-2.5%) with no cases adjudicated as SVD. The survival rate was 82.6% (79.5-85.0%). The KM event rate was 5.7% (4.3-7.7%) for reintervention, 6.3% (4.9-8.3%) for endocarditis and 0.4% (0.1-1.1%) for valve thrombosis. Mean aortic gradient, dimensionless velocity index and effective orifice area were 13.8 ± 5.9 mmHg, 0.42 ± 0.09 and 1.99 ± 0.53 cm2, respectively.</p><p><strong>Conclusions: </strong>This analysis demonstrated excellent durability of the Avalus valve with good clinical outcomes and stable haemodynamic performance through 7 years of follow-up.</p>","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing machine learning based mortality predictions in cardiac surgery: unlocking the full potential of ML-based risk scores.","authors":"Hamrish Kumar Rajakumar","doi":"10.1093/ejcts/ezaf001","DOIUrl":"10.1093/ejcts/ezaf001","url":null,"abstract":"","PeriodicalId":11938,"journal":{"name":"European Journal of Cardio-Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}