Journal of Cardiac Surgery最新文献

{"title":"Effect of Modified Remote Ischemic Preconditioning on Perioperative Outcomes of CABG Patients With CPB","authors":"Qi Sun,&nbsp;Xiaotong Wang,&nbsp;Guodong Wang,&nbsp;Chunyan Huan,&nbsp;Minjia Guo,&nbsp;Jie Liu,&nbsp;Wanling Wu,&nbsp;Yuanyuan Luo,&nbsp;Hong Zhu,&nbsp;Yongbo Hou,&nbsp;Guoxiang Wang,&nbsp;Defeng Pan","doi":"10.1155/jocs/8854092","DOIUrl":"https://doi.org/10.1155/jocs/8854092","url":null,"abstract":"<div>\u0000 <p><b>Objective:</b> To investigate the effect of modified remote ischemic preconditioning (MRIC) on perioperative outcomes in patients undergoing coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB).</p>\u0000 <p><b>Methods:</b> This study included 118 patients who planned to undergo CABG surgery at the Affiliated Hospital of Xuzhou Medical University. These patients were randomly divided into the MRIC group (<i>n</i> = 40), remote ischemic preconditioning (RIPC) group (<i>n</i> = 39), or control group (<i>n</i> = 39). The MRIC group received 3 cycles of 5 min ischemia/5 min reperfusion on the left upper limb at 2 days, 1 day, and 2 h preoperatively. The RIPC group received RIPC 2 h preoperatively, while the control group did not receive ischemic preconditioning. The STS score of patients was calculated according to the coronary angiography results and clinical data for risk stratification. The serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP), creatine kinase MB (CK-MB), high-sensitivity cardiac troponin-T (hs-cTnT), and creatinine (Cr) of patients were recorded at postoperative 0, 12th, 24th, 48th, 72th h , and seventh days for each patient. Major adverse cardiac events (MACEs) in the hospital were recorded.</p>\u0000 <p><b>Results:</b> A total of 118 participants were included. The overall MACE incidence was 83.4%. A total of 36 MACE cases (92.3%) occurred in the control group, 28 cases (70.0%) in the MRIC group (RR: 0.75; 95% CI: 0.61–0.95), and 35 cases (89.7%) in the RIPC group (RR: 0.97; 95% CI: 0.84–1.12). Compared to the control group, MRIC and RIPC groups had lower concentrations of CK-MB at postoperative 0 and 12th h (<i>p</i> &lt; 0.05); MRIC group had lower concentrations of hs-cTnT at postoperative 12th h (<i>p</i> &lt; 0.05). The MRIC group had a higher concentration of NT-proBNP at postoperative 24th, 48th, and 72th h (<i>p</i> &lt; 0.05). The differences in the concentration of Cr among the three groups were not statistically significant (<i>p</i> &gt; 0.05); There was no statistically significant difference in the effects of MRIC on the indexes of the low-risk patients and the medium-high-risk patients (<i>p</i> &gt; 0.05).</p>\u0000 <p><b>Conclusion:</b> (1) MRIC has cardioprotective effects and reduces the occurrence of postoperative MACE. (2) MRIC could not reduce the concentrations of NT-proBNP and Cr postoperatively. (3) MRIC showed no significant difference in myocardial protection in patients with different STS score risk stratifications.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/8854092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144292742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin II Use in Postcardiac Surgery Vasoplegic Syndrome Patients: A Single-Center Descriptive Experience","authors":"Jonathan S. Auerbach,&nbsp;Hayley B. Gershengorn,&nbsp;Jorge L. Cabrera,&nbsp;Joseph Lamelas,&nbsp;Samira S. Patel,&nbsp;Tanira D. Ferreira,&nbsp;Daitiara Perez,&nbsp;Pankaj Jain","doi":"10.1155/jocs/8801912","DOIUrl":"https://doi.org/10.1155/jocs/8801912","url":null,"abstract":"<div>\u0000 <p><b>Objectives:</b> We evaluated real world use of angiotensin II (AT II) in patients with vasoplegic syndrome (VS) following cardiac surgery.</p>\u0000 <p><b>Design:</b> A retrospective chart review was performed to describe and evaluate VS following cardiac surgery under cardiopulmonary bypass (CPB) for AT II use and associated outcomes. Among these outcomes examined were death, stroke, myocardial infarction, acute kidney injury (AKI), tracheostomy need, ventilator hours, and hospital and cardiovascular intensive care unit (CVICU) lengths of stay (LOS). These outcomes were compared across patients with VS who received AT II vs. patients who did not receive AT II using Wilcoxon rank sum and Chi-square testing, as appropriate.</p>\u0000 <p><b>Setting:</b> Academic medical center.</p>\u0000 <p><b>Participants:</b> Adult postcardiac surgery VS patients.</p>\u0000 <p><b>Interventions:</b> AT II vs. non-AT II receiving VS patients.</p>\u0000 <p><b>Measurements and Main Results:</b> Of 2013 included patients undergoing cardiac surgery under CPB during the study period, 52 met criteria for VS, 11 (21.2%) received AT II, and 41 (71.8%) did not. The incidence of AKI, tracheostomy, CVICU LOS, and hospital LOS was higher in the AT II group (Tables 1 and 2). The median maximum postoperative NEE dose within 24 h following surgery was higher in the AT II group: 0.44 mcg/kg/min (IQR 0.39, 0.57) versus 0.23 mcg/kg/min (IQR 0.21, 0.26, <i>p</i> &lt; 0.001).</p>\u0000 <p><b>Conclusions:</b> AT II use was rare among cardiac surgical patients. AT II use was associated with increased resource use. AT II patients were on higher pressure dosing and may have had worse outcomes without AT II. Larger, prospective studies are needed to understand the impact of AT II on outcomes in this population.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/8801912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Venous Thromboembolism Following Coronary Bypass Surgery","authors":"Alex M. Wisniewski,&nbsp;Raymond J. Strobel,&nbsp;Andrew Young,&nbsp;Anthony V. Norman,&nbsp;Evan P. Rotar,&nbsp;Bakhtiar Chaudry,&nbsp;Mira Sridharan,&nbsp;Aditya Sharma,&nbsp;J. Hunter Mehaffey,&nbsp;Vinay Badhwar,&nbsp;Gorav Ailawadi,&nbsp;Irving L. Kron,&nbsp;Mohammed Quader,&nbsp;Nicholas R. Teman","doi":"10.1155/jocs/2717349","DOIUrl":"https://doi.org/10.1155/jocs/2717349","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Venous thromboembolism (VTE) is a rare complication after coronary artery bypass surgery (CABG), leading to increased morbidity and mortality. There are no current societal guidelines directing prophylaxis. Utilizing a regional database, we sought to determine the prevalence of VTE and characterize regional center practices.</p>\u0000 <p><b>Methods:</b> We identified all patients undergoing on-pump, isolated CABG (2010–2020). Patients on oral therapeutic anticoagulation or requiring mechanical circulatory support were excluded. Participating centers were surveyed to determine center level practices. Multivariable regression and hierarchical logistic regression were utilized for risk-adjusted outcomes and influence of center practices on VTE rates, respectively.</p>\u0000 <p><b>Results:</b> Of 20,719 CABG patients, the overall prevalence of postoperative VTE was 1.3% (266/20,719). Patients developing VTE were more often female (30.1% vs. 23.4%, <i>p</i> = 0.01), had higher STS predicted risk of mortality (1.2% [0.7%, 2.2%] vs. 0.9% [0.5%, 1.7%], <i>p</i> &lt; 0.001) and higher unadjusted operative mortality (4.1% vs. 1.0%, <i>p</i> &lt; 0.001). Risk-adjusted analysis demonstrated pulmonary embolism as an independent predictor of mortality (OR = 3.4 [1.06, 11.0], <i>p</i> = 0.04). Increasing time from admission to surgery (OR = 1.05 [1.01, 1.09], <i>p</i> = 0.001), preoperative heparin use (OR = 1.47 [1.13, 1.90], <i>p</i> = 0.004), and intraoperative prothrombin complex concentrate (PCC) (OR = 4.85 [1.47, 15.96], <i>p</i> = 0.009) were predictors of VTE. Regional practices were mainly homogenous with no specific center-level protocol associated with decreases in VTE.</p>\u0000 <p><b>Conclusion:</b> VTE following CABG is an infrequent postoperative complication with pulmonary embolism as an independent predictor of mortality. Increasing time from admission to surgery and intraoperative PCC may increase the risk of VTE.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/2717349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Diagnostic and Postoperative Outcome Predictions Through Machine Learning: A Focused Analysis on Noncardiac and Cardiac Surgeries","authors":"Alexander Lombardo,&nbsp;Christopher Hannemann,&nbsp;Syme Aftab,&nbsp;Yashika Paul,&nbsp;Brandon Stretton,&nbsp;Ammar Zaka,&nbsp;Joshua Kovoor,&nbsp;Aashray Gupta,&nbsp;Stephen Bacchi","doi":"10.1155/jocs/5521566","DOIUrl":"https://doi.org/10.1155/jocs/5521566","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Traditional risk scoring tools have assisted to guide surgical practice for decades. Machine learning algorithms build upon this concept to allow dynamic and tailored patient information. These algorithms have been employed across most surgical specialties with multiple aims, including cost of care assessment, risk stratification, and prediction of procedural survival.</p>\u0000 <p><b>Methods:</b> Paper selection was based on three main criteria: relevance, recency, and novelty. Relevant studies were identified through a comprehensive search of major databases, including PubMed and Scopus.</p>\u0000 <p><b>Results:</b> Machine learning algorithms pose significant advantages compared to traditional risk scoring tools. Across cardiac and noncardiac specialties, multiple studies have identified machine learning algorithms as superior to control or traditional scoring tools at diagnosis.</p>\u0000 <p><b>Conclusion:</b> In this focused analysis, we have identified the potential of machine learning to aid in diagnosis, management, and prediction of postoperative outcomes. Surgeons must continue to integrate machine learning into their practice with the aim of improving both patient and surgeon-based outcomes.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5521566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No-Touch Harvesting Technique of the Great Saphenous Vein Graft Affects Graft Flow Velocity During Coronary Artery Bypass Grafting","authors":"Hiroshi Kurazumi,&nbsp;Ryo Suzuki,&nbsp;Ryosuke Nawata,&nbsp;Toshiki Yokoyama,&nbsp;Kazumasa Matsunaga,&nbsp;Sarii Tsubone,&nbsp;Yutaro Matsuno,&nbsp;Bungo Shirasawa,&nbsp;Akihito Mikamo,&nbsp;Kimikazu Hamano","doi":"10.1155/jocs/9517612","DOIUrl":"https://doi.org/10.1155/jocs/9517612","url":null,"abstract":"<div>\u0000 <p><b>Objectives:</b> We aimed to investigate whether the no-touch (NT) harvesting technique for the great saphenous vein graft (SVG) affects graft flow velocity during coronary artery bypass grafting.</p>\u0000 <p><b>Methods:</b> The study included 132 and 138 conduits that underwent NT and conventional (CV) harvesting techniques, respectively (NT and CV groups, respectively). Transit-time flow measurements and contrast-enhanced computed tomography (CT) were performed to assess graft flow velocity and patency.</p>\u0000 <p><b>Results:</b> Intraoperative graft flows, assessed using a transit-time flowmeter, were 40 ± 19 and 48 ± 27 mL/min/anastomosis in the NT and CV groups, respectively. Preoperative SVG diameters, assessed via vascular ultrasound, were 2.8 ± 0.7 and 2.8 ± 0.8 mm in the NT and CV groups, respectively. However, postoperative SVG diameters, measured using contrast-enhanced CT, were 2.7 ± 0.5 and 3.5 ± 0.6 mm in the NT and CV groups, respectively, indicating a significant reduction in the NT group (<i>p</i> &lt; 0.01). Graft flow velocities, calculated from graft flow and vascular diameter, were 7.3 ± 4.2 and 5.4 ± 3.2 cm/s/anastomosis in the NT and CV groups, respectively, being significantly higher in the NT group (<i>p</i> &lt; 0.01). The incidence of postoperative occlusion was significantly lower in the NT group (two conduits, 1.5%) than in the CV group (10 conduits, 7.3%) (<i>p</i> = 0.02). Significant differences were found in the 5-year patency rates between the two groups (NT group, 98.4%; CV group, 92.9%; <i>p</i> = 0.04).</p>\u0000 <p><b>Conclusions:</b> The NT SVG harvesting technique prevents postoperative graft diameter expansion and significantly increases graft flow velocity and patency. Further randomized studies are needed to determine whether differences in blood flow velocity are essential for graft patency over an extended observation period.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9517612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Isosurface Geometric Measurement on Volume-Rendered Images for Quantitative Measurements of Complex Cardiac Anatomical Features","authors":"Kenichi Kamiya,&nbsp;Yukihiro Nagatani,&nbsp;Jun Matsubayashi,&nbsp;Ryo Uemura,&nbsp;Tatsuya Oki,&nbsp;Yuji Matsubayashi,&nbsp;Shinya Terada,&nbsp;Piers Vigers,&nbsp;Susumu Nakata,&nbsp;Yoshiyuki Watanabe,&nbsp;Tomoaki Suzuki","doi":"10.1155/jocs/5193639","DOIUrl":"https://doi.org/10.1155/jocs/5193639","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Measuring living heart anatomy using three-dimensional (3D) images remains challenging. To address this, a method called isosurface measurement on volume-rendered images (IMVR) has been developed. This study aims to validate IMVR in quantitative measurement by comparing it with curved planar reformation (CPR).</p>\u0000 <p><b>Methods:</b> Five 3D-printed human cardiac models created from computed tomography (CT) images were optically scanned, and selected features were measured for reference. The models were CT-scanned, and the datasets were processed for IMVR and CPR measurements. Overall, 157 anatomical features (105 in the aortic root, 52 in the coronary artery) were measured three times by two observers for each method, and the agreement with the reference values was assessed using the Bland–Altman analysis.</p>\u0000 <p><b>Results:</b> In the aortic root measurement, the lower and upper 95% limits of agreement (LOAs, mm) for IMVR were (−3.1, 2.4) and (−1.3, 0.9), whereas those for CPR were (−5.9, 5.2) and (−5.9, 6.3). In the coronary artery measurement, the LOAs for IMVR were (−2.6, 2.2) and (−1.2, 0.8), while those for CPR were (−9.2, 8.6) and (−9.5, 8.5). For both methods, the intraclass coefficient indicated high intra- and interobserver reliability.</p>\u0000 <p><b>Conclusion:</b> IMVR demonstrated greater precision than CPR and facilitated 3D measurements of complex cardiovascular features.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5193639","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-Analysis on Coronary Artery Bypass Grafting With Single Versus Bilateral Internal Mammary Artery Grafts in Patients With End-Stage Renal Disease","authors":"Giorgio Mastroiacovo,&nbsp;Aliya Izumi,&nbsp;Daniele Fileccia,&nbsp;Yasuhiko Kawaguchi,&nbsp;Bobby Yanagawa,&nbsp;Fausto Biancari,&nbsp;Sergio Pirola,&nbsp;Nicolò Capra,&nbsp;Bonomi Alice,&nbsp;Gianluca Polvani","doi":"10.1155/jocs/2709364","DOIUrl":"https://doi.org/10.1155/jocs/2709364","url":null,"abstract":"<div>\u0000 <p>Patients with end-stage renal disease (ESRD) and concomitant coronary artery disease (CAD) present unique challenges for coronary revascularization. While coronary artery bypass grafting (CABG) is recommended over percutaneous coronary intervention in this population, the optimal surgical strategy remains controversial. This meta-analysis provides an updated comparison of outcomes for ESRD patients undergoing CABG with either bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafting. A total of nine studies involving 911 patients were included. Our findings revealed no significant differences in perioperative mortality (<i>p</i> = 0.57), deep sternal wound infection (<i>p</i> = 0.41), or major adverse cardiac and cerebrovascular events (<i>p</i> = 0.54) between groups. Long-term survival rates were also comparable at one, three, five, and seven years postoperatively. The pooled hazard ratio for all-cause mortality was 0.82 (95% CI: 0.61–1.12; <i>p</i> = 0.21), indicating no explicit survival advantage for either grafting strategy. These results are consistent with existing literature and suggest that both BITA and SITA grafting are safe and effective in this high-risk group. As medical advances continue to extend the life expectancy of patients with ESRD, additional research focused on optimizing the management of ESRD-related CAD will be essential to improving perioperative and long-term outcomes for these high-risk patients.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/2709364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Left-Sided Infective Endocarditis: 15 Years of Experience","authors":"Lourdes Montero Cruces,&nbsp;Manuel Carnero Alcázar,&nbsp;Daniel Pérez Camargo,&nbsp;Paula Campelos Fernández,&nbsp;Javier Cobiella Carnicer,&nbsp;Fernando José Reguillo Lacruz,&nbsp;Carmen Olmos Blanco,&nbsp;Isidre Vilacosta,&nbsp;Maria Alejandra Giraldo Molano,&nbsp;Juan Miguel Miranda Torrón,&nbsp;María Belén Solís Chavez,&nbsp;Pablo Zulet Fraile,&nbsp;Fernando González Romo,&nbsp;Paloma Merino Amador,&nbsp;Luis Carlos Maroto Castellanos","doi":"10.1155/jocs/6686030","DOIUrl":"https://doi.org/10.1155/jocs/6686030","url":null,"abstract":"<div>\u0000 <p><b>Introduction and Objectives:</b> Infective endocarditis (IE) presents a high mortality rate despite medical and surgical advances. The objective of this study is to describe our experience in the surgical treatment of left-sided valvular IE.</p>\u0000 <p><b>Methods:</b> A retrospective analysis was performed on patients operated for left-sided valvular IE from March 2006 to August 2023. Fine-gray competitive risk regression model was used to analyze recurrence, while logistic regression and Cox regression models were assessed to identify independent variables associated with hospital mortality and long-term mortality.</p>\u0000 <p><b>Results:</b> Out of 566 patients diagnosed with IE, 352 (62.2%) underwent surgery for left-sided valvular involvement. Of these patients, 65.9% were male with a median age of 67.8 years. The causative microorganism was isolated in 84.4% of cases. Hospital mortality was 19.0% (<i>n</i> = 67). Age over 69 years and preoperative cardiogenic shock were independent risk factors for hospital mortality. A recurrence of endocarditis was observed in 11.7% (<i>n</i> = 41) of patients (26 relapses and 15 reinfections), with prosthetic endocarditis being an independent risk predictor (HR 2.03 (CI 1.09–3.79); <i>p</i> = 0.004). Survival rates at 1, 5, and 10 years were 75.2%, 66.2%, and 47.1%, respectively. Age over 60 years, preoperative cardiogenic shock, preoperative moderate left ventricular dysfunction, mitral surgery, postoperative low cardiac output, postoperative acute kidney injury AKIN III, and postoperative stroke were independent variables associated with long-term mortality.</p>\u0000 <p><b>Conclusions:</b> Surgery is indicated in more than 60% of patients with IE. Despite this, IE remains a complex disease associated with high in-hospital morbidity and mortality and a decrease in long-term survival.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6686030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Intensive Care Unit Length of Stay and One-Year Mortality Following Cardiac Surgery","authors":"Gregory A. Panza,&nbsp;Raymond G. McKay,&nbsp;Susan Collazo,&nbsp;Deborah Loya,&nbsp;Carolyn Burke-Martindale,&nbsp;Jeffrey F. Mather,&nbsp;Sabet W. Hashim","doi":"10.1155/jocs/6654088","DOIUrl":"https://doi.org/10.1155/jocs/6654088","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Prolonged intensive care unit (ICU) length of stay (LOS) following cardiac surgery has been associated with higher resource utilization and increased in-hospital mortality. Few reports have investigated the association between prolonged ICU LOS and subsequent mortality following hospital discharge.</p>\u0000 <p><b>Methods:</b> The relationship between ICU LOS and 1-year all-cause mortality was assessed in 2799 patients treated with coronary artery bypass grafting with and without concomitant valve surgery at a large tertiary center between January 1, 2017, and December 31, 2021. Multivariable logistic regression and Cox proportional hazards regression examined ICU LOS as a predictor of 1-year mortality and to define the risk of mortality for ICU stays ranging from &lt; 4 to &gt; 14 days.</p>\u0000 <p><b>Results:</b> Patients (<i>N</i> = 2799) included 76.1% males and 23.9% females aged 67.9 ± 9.9 years. Surgeries included isolated CABG (76.9%) and CABG with valve surgery (23.1%). Patients had a median ICU LOS of 1.93 days (IQR = 2.71), and 92 patients (3.3%) expired within 1 year of hospital discharge. ICU LOS was a significant predictor of 1-year mortality (OR = 1.09, 95% CI = 1.06, 1.12, <i>p</i> &lt; 0.001), while controlling for significant covariates. The prevalence of 1-year all-cause mortality progressively increased by ICU LOS cutoffs: &lt; 4 days (1.9%), ≥ 4 days (7.2%), &gt; 7 days (17.5%), and &gt; 14 days (31.9%). Survival analysis further indicated that 1-year mortality risk increased by ICU LOS cutoffs: ≥ 4 days (HR = 1.88, 95% CI = 1.19, 2.98, <i>p</i> = 0.007), &gt; 7 days (HR = 3.80, 95% CI = 2.31, 6.25, <i>p</i> &lt; 0.001), and &gt; 14 days (HR = 10.15, 95% CI = 5.64, 18.25, <i>p</i> &lt; 0.001).</p>\u0000 <p><b>Conclusions:</b> For each additional ICU day following CABG with and without valve surgery, the odds of 1-year mortality increased by 9.0% when controlling for significant covariates. The risk of 1-year all-cause mortality increased by 88%, 280%, and 915% for ICU LOS ≥ 4 days, &gt; 7 days, and &gt; 14 days, respectively. These data indicate the need for more frequent postdischarge medical surveillance in patients with prolonged ICU stay.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6654088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homograft Root Replacement Does Not Provide Superior Outcomes in Invasive Aortic Valve Endocarditis Compared With Prosthetic Valve Conduits","authors":"Woodrow J. Farrington,&nbsp;Xiaoying Lou,&nbsp;Jonathan R. Zurcher,&nbsp;Edward P. Chen,&nbsp;William Brent Keeling,&nbsp;Bradley G. Leshnower","doi":"10.1155/jocs/3790458","DOIUrl":"https://doi.org/10.1155/jocs/3790458","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> 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.</p>\u0000 <p><b>Methods:</b> 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.</p>\u0000 <p><b>Results:</b> 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%, <i>p</i> = 0.02). The incidence of preoperative prosthetic valve endocarditis was 30% for the cohort and significantly higher in the homograft group (<i>p</i> = 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 (<i>p</i> &lt; 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%, <i>p</i> = 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%, <i>p</i> = 0.82) between the groups.</p>\u0000 <p><b>Conclusions:</b> 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.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3790458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}