Journal of Cardiac Surgery最新文献

{"title":"Effect of Topically Applied Milrinone or Nitroglycerin on Internal Mammary Artery Free Flow","authors":"Ahmad Walid Izzat,&nbsp;Salman Aissami,&nbsp;Rakan Saadoun,&nbsp;Mohammad Bashar Izzat","doi":"10.1155/2024/1679793","DOIUrl":"10.1155/2024/1679793","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Surgical mobilization of the internal mammary artery (IMA) can induce graft vasospasm, which is commonly managed by wrapping the IMA in a vasodilator-soaked swab before grafting. However, the choice of the most effective topical vasodilator remains the subject of continued investigation. We carried out a prospective randomized controlled trial to compare the effect of topically applied milrinone, nitroglycerin, and normal saline on IMA free flow. <i>Methods</i>. Forty-six consecutive patients undergoing elective primary coronary artery bypass grafting were enrolled. After the left IMA was harvested, free flow was measured under controlled hemodynamic conditions before any intervention (flow 1) and at a mean of 12.5 minutes after the topical application of one of three agents (milrinone, nitroglycerin, or normal saline) on the IMA (flow 2). <i>Results</i>. All agents induced a significant increase in IMA flow, and flow 2 was significantly higher in the nitroglycerin and milrinone groups compared to the normal saline group, even while controlling for flow 1 as a centered continuous variable. Nevertheless, there was no statistically significant difference in flow 2 between the nitroglycerin and milrinone groups. <i>Conclusions</i>. Topically applied milrinone and nitroglycerin can increase blood flow of the IMA significantly in the early period after surgical mobilization. IMA blood flow was greater after the topical application of milrinone compared to nitroglycerin, but this has failed to reach statistical significance in the present study setting. This trial is registered with NCT06301880.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1679793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140681497","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":"Factors Influencing Pain Scores and Opioid Demand after Robotically Assisted Cardiac Surgery","authors":"Irsa Hasan,&nbsp;Laura Seese,&nbsp;Rachel Deitz,&nbsp;Faaz Ashraf,&nbsp;Takuya Ogami,&nbsp;Kathirvel Subramaniam,&nbsp;Michael Boisen,&nbsp;Pyongsoo Yoon,&nbsp;David West,&nbsp;David Kaczorowski,&nbsp;Ibrahim Sultan,&nbsp;Johannes Bonatti","doi":"10.1155/2024/3325296","DOIUrl":"10.1155/2024/3325296","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. Introduction of minimally invasive cardiac surgery anticipated the reduction in postoperative pain but little quantitative data are available on this effect. This study investigated factors influencing pain scores and opioid demand after robotically assisted cardiac procedures. <i>Methods</i>. Using data derived from prospective robotic cardiac surgery and anesthesia databases, we analyzed 75 patients undergoing robotic cardiac surgery between July 2021 and December 2022. Study endpoints were mean cumulative pain scores measured on a 0–10 scale and opioid use on postoperative days (PODs) 1 to 4. Pain scores and oral morphine equivalent (OME) were correlated with perioperative variables. <i>Results</i>. Postoperatively, 39/75 (52%) of patients were extubated in the operating room (OR) and 34/75 (45.3%) were extubated within 24 hours of surgery. Mean pain scores declined from 5.8 (SD 1.5) on POD 1 to 3.8 (SD 1.6) on POD 4 and OME fell from 34.9 (SD 29) mg to 8.2 (SD 11.8) mg. OME use correlated significantly with pain scores (<i>p</i> &lt; 0.01). Higher pain scores on postoperative day (POD) 1 were associated with diabetes (<i>p</i> = 0.006), tobacco use (<i>p</i> = 0.006), and extubation in the OR (<i>p</i> = 0.017). Opioid utilization was higher in younger patients (<i>p</i> &lt; 0.001), heavier patients (<i>p</i> = 0.033), active tobacco users (<i>p</i> = 0.01), longer procedure times (<i>p</i> = 0.002), and those extubated in the OR (<i>p</i> &lt; 0.001). <i>Conclusion</i>. Pain and opioid consumption after robotically assisted cardiac surgery are moderate but decline steadily within the first four postoperative days. Tobacco use and extubation in the OR were associated with increased pain and opioid consumption.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3325296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693318","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":"Postoperative Serum Procalcitonin Level Can Be a Useful Marker of Bacterial Infection after Cardiac Surgery Utilizing Cardiopulmonary Bypass","authors":"Niramol Tongboon,&nbsp;Khunthorn Kadeetham,&nbsp;Piya Samankatiwat","doi":"10.1155/2024/7518552","DOIUrl":"10.1155/2024/7518552","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. Procalcitonin level is generally undetectable from blood sample under normal physiological condition. However, its production can be greatly stimulated by the presence of various inflammatory responses, especially those caused by bacterial infection. We aimed to determine if postoperative procalcitonin level could be used to predict bacterial infection more promptly than bacterial culture results. <i>Materials and Methods</i>. We performed a retrospective case-control study by collecting postoperative procalcitonin as well as white blood cell level of patients undergoing cardiac surgery using cardiopulmonary bypass from electronic medical records of Ramathibodi Hospital between 1st January 2019 and 30th June 2023. Patients with pre-existing inflammatory syndromes or proven bacterial infection, who had been receiving preoperative treatment-dose antibiotics or steroids, who underwent non-elective surgery, and whose medical record data were lost or insufficiently recorded were excluded. Demographic data and operative details were also collected and reviewed. <i>Results</i>. From a total of 146 patients in our study, 42 patients developed proven postoperative bacterial infection. The level of procalcitonin with greatest association to postoperative bacterial infection from our study was 4.13 ng/dl on postoperative day 7. White blood cell level, however, was less predictive of bacterial infection. <i>Conclusions</i>. Procalcitonin level, when utilized alongside clinical presentation, proved to be useful as a predictor of bacterial infection during postoperative day 7. A larger, prospective trial of our continuing series would further strengthen our results.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/7518552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140707427","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":"Utilization of Vein Grafts in Coronary Artery Bypass Grafting: Reasons and Outcomes in a Bilateral Mammary Artery First Center","authors":"Andreas Schaefer,&nbsp;Tim Knochenhauer,&nbsp;Jens Brickwedel,&nbsp;Beate Reiter,&nbsp;Svante Zipfel,&nbsp;Yvonne Schneeberger,&nbsp;Hermann Reichenspurner,&nbsp;Bjoern Sill","doi":"10.1155/2024/3443680","DOIUrl":"10.1155/2024/3443680","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. Despite guideline recommendations for use of bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG), a large proportion of patients still receive saphenous vein grafts (SVG). We herein aimed to identify reasons for SVG use at a center with a BIMA utilization rate between 60 and 70% and compare outcomes of patients undergoing CABG with either BIMA or left internal mammary artery (LIMA) plus SVG. <i>Methods</i>. Between 2013 and 2022, 4145 consecutive patients underwent isolated CABG at our center. Of those, 2067 patients received BIMA (group 1) and 1206 patients received LIMA/SVG (group 2). A propensity score-matched analysis was performed to adjust for baseline differences. <i>Results</i>. Group 2 presented with higher age, more female patients, and more patients with acute coronary syndrome including NSTEMI/STEMI with more urgent/emergency CABG. In unadjusted analysis group 2 presented adverse 30-day outcomes compared to group 1 with a higher mortality (18/2067, 0.9% vs. 34/1206, 2.8%; <i>p</i> &lt; 0.001), higher rate of re-revascularization (52/2067, 2.5% vs. 50/1206, 4.1%; <i>p</i> &lt; 0.001), more stroke (20/2067; 1.0% vs. 33/1206, 2.7%; <i>p</i> &lt; 0.001), and more postoperative renal failure (17/2067, 0.8% vs. 27/1206, 2.2%; <i>p</i> = 0.001). After adjustment for baseline characteristics, 30-day outcomes were comparable. <i>Conclusions</i>. After adjustment for baseline characteristics no differences in outcomes were found between groups suggesting a safe applicability of BIMA even in patients with acute coronary syndrome undergoing urgent/emergency CABG. Reasons for SVG use were higher age, female gender, and acute coronary syndrome with urgent/emergency CABG. Outcomes of both groups were excellent with low rates of primary endpoints.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3443680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140748011","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":"The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis","authors":"Mohammed Al-Tawil,&nbsp;Christine Friedrich,&nbsp;Kira Mandler,&nbsp;Julia Brandl,&nbsp;Mohamed Salem,&nbsp;Jan Schoettler,&nbsp;Nora de Silva,&nbsp;Thomas Puehler,&nbsp;Jochen Cremer,&nbsp;Assad Haneya","doi":"10.1155/2024/9575684","DOIUrl":"10.1155/2024/9575684","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Infective endocarditis (IE) is considered a life-threatening cardiac infection with a predilection to involve heart valves. One of the most feared complications of IE is the development of new-onset neurological complications (NCs). The aim of this study is to compare the short- and long-term outcomes of surgery in patients with IE presenting with vs. without NCs. <i>Methods</i>. We retrospectively reviewed patient records which were regularly collected in our institutional database. Between January 2002 and August 2020, 438 consecutive patients who underwent open cardiac surgery in our university hospital due to IE were included in the retrospective study. <i>Results</i>. Of the total cohort, 89 patients (20.3%) had preoperative NCs. Patients in the NC group were more likely to be female (33.7% vs. 23.5%; <i>P</i> = 0.049), had more acute kindly injury at presentation (22.5% vs. 10.0%; <i>P</i> = 0.002), were more likely to be admitted to ICU (36.0% vs. 18.3%; <i>P</i> &lt; 0.001), and had significantly more vegetations (84.3% vs. 69.8%; <i>P</i> = 0.006) and overall higher preoperative embolization (92.1% vs. 11.7%; <i>P</i> &lt; 0.001). <i>Staphylococcus aureus</i> as causative organism of IE was significantly higher in the NC group (35.2% vs. 16.1%; <i>P</i> &lt; 0.001). Patients in the NC group had significantly higher affection of the mitral valve. There was no difference in postoperative outcomes between the two groups. The long-term survival was also similar in both groups. Preoperative atrial fibrillation (adjusted odds ratio (aOR): 2.03; 95% CI [1.04–3.93]; <i>P</i> = 0.037) and <i>Staphylococcus aureus</i> IE (aOR: 2.60; 95% CI [1.4–4.8]; <i>P</i> = 0.002) were independent risk factors of developing NCs, while previous endocarditis was a protective factor (aOR: 0.33; 95% CI [0.11–0.99]; <i>P</i> = 0.048). <i>Conclusion</i>. Our study emphasizes the shared risk factors between mortality and developing NCs. NCs are critical in IE’s clinical presentation, but they do not independently predict short- or long-term survival following surgery for IE.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/9575684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140261416","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":"Pulmonary Venous Index as Additional Diagnostic Criteria for Fontan Palliation","authors":"D. V. Kovalev,&nbsp;S. A. Alexandrova,&nbsp;I. A. Yurlov,&nbsp;M. M. Zelenikin,&nbsp;I. P. Aslanidis,&nbsp;V. P. Podzolkov","doi":"10.1155/2024/5599994","DOIUrl":"10.1155/2024/5599994","url":null,"abstract":"<div>\u0000 <p><i>Backgroud</i>. The results of the Fontan operation, depending on the anatomy of the pulmonary arteries, have been studied quite well. Various indices have been proposed to assess the degree of hypoplasia of the pulmonary arterial bed (Nakata, Reddy, and McGoon indexes). At the same time, an obstruction of pulmonary venous blood return may be considered as a contraindication to Fontan operation. <i>Aim of the Study</i>. To present an optimal method for pulmonary venous index (PVI) calculation based on computed tomography angiography (CTA) enhancement of the heart data in patients with a functional single ventricle. <i>Materials and Methods</i>. 63 patients with a functional single ventricle (SV) underwent CTА (Philips, Brilliance iCT) before the Fontan operation. Axial sections were reconstructed to a thickness of 0.75–3 mm using soft tissue and lung filters, followed by postprocessing of the data (Horos and OsiriX software) and construction of multiplanar and 3D images. The diagnoses were presented by various types of SV of the heart. The age of the patients ranged from 3 to 30 years (median 7 years). Comparison of PVI was carried out in patients of two groups: those who survived the intervention (<i>n</i> = 55 patients) and those who died (<i>n</i> = 8). The evaluation of the pulmonary veins (PV) and the calculation of the pulmonary venous index (PVI) were carried out based on the measurement of each pulmonary vein at 2 levels (at the level of the orifices and bifurcation). The calculation of the PVI was carried out according to the formula: the sum of the cross-sectional area of the main pulmonary veins, related to the body surface area. 3 variants of PVI calculation were compared: taking into account the values of the PV areas at the level of the orifices, the bifurcation, and the sum of the minimum areas of each of the PVs. <i>Results</i>. In the group of survived patients, the median PVI at the level of the PV orifices was 292 mm/m², and in the group of deceased, it was 242 mm/m²(<i>p</i> = 0.0326); at the level of PV bifurcation in the group of survivors, it was 299 mm/m², and in the group of dead patients, it was 281 mm/m²(<i>p</i> = 0.0776); the minimum PVI was 257 mm/m² in the survivor group and 218 mm/m² in the deceased group (<i>p</i> = 0.006). An ROC analysis performed to determine the critical value of the minimum PVI affecting survival after Fontan operation revealed that PVI measured taking into account the minimum dimensions of the areas of the PV is a significant risk factor for death after Fontan operation (<i>p</i> = 0.00015), with its value (cutoff) &lt;233.5 mm²/m². <i>Conclusion</i>. The value of the minimum PVI can be an important morphological indicator of the state of PV blood return and serve as an additional criterion in determining indications for the Fontan operation.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5599994","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140425171","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":"Impact of the Tricuspid Valve Detachment Technique on Hard-to-Expose Ventricular Septal Defect Closure","authors":"Shiho Yamazaki,&nbsp;Junichi Koizumi,&nbsp;Daiki Saito,&nbsp;Azuma Tabayashi,&nbsp;Takuya Goto,&nbsp;Norihiro Kondo,&nbsp;Akio Ikai,&nbsp;Hajime Kin","doi":"10.1155/2024/5280537","DOIUrl":"10.1155/2024/5280537","url":null,"abstract":"<div>\u0000 <p>Ventricular septal defect (VSD) closure is a common procedure in congenital heart surgery. The exposure of VSDs can be challenging, especially in cases involving the tricuspid septal or anterior leaflets, chordae, or subvalvular apparatus. Although tricuspid valve detachment has been suggested to improve surgical visibility, its long-term effects remain unclear. Herein, we investigated the outcomes of VSD closure with or without tricuspid valve detachment and assessed the impact of this technique on postoperative tricuspid valve function and atrioventricular conduction. In total, 175 patients who underwent isolated VSD closure through the right atrium were retrospectively enrolled and divided into 2 groups: the tricuspid valve detachment group (<i>n</i> = 17, 9.7%) and the nontricuspid valve detachment group (<i>n</i> = 158, 90.3%). Patient characteristics were comparable between the two groups, and medical records and echocardiography reports were reviewed for each patient. The primary outcomes were mortality and reoperation, whereas the secondary outcomes included residual VSD, tricuspid valve regurgitation, advanced atrioventricular block, and aortic valve regurgitation. Clinical variables were compared between the two groups. Overall, tricuspid valve detachment did not increase perioperative complications or affect long-term tricuspid valve function. There were no cases of mortality or reoperation in either group. Although the tricuspid valve detachment group had longer bypass and cross-clamp times, this did not significantly affect ventilation or intensive care unit stay duration. Follow-up echocardiography revealed no significant intergroup differences in tricuspid regurgitation, residual shunt, or aortic valve regurgitation. In conclusion, tricuspid valve detachment is a safe and reliable technique for the complete closure of hard-to-expose VSDs without compromising tricuspid valve function. Moreover, it does not increase the risk of adverse events, and its outcomes remain favorable during short- and long-term follow-ups.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5280537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139959833","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":"Benefits of On-X Mitral Valve Replacement in Cases of Infective Endocarditis","authors":"Manabu Shiraishi,&nbsp;Hiroki Arai,&nbsp;Shigeto Tokunaga,&nbsp;Kengo Teshima,&nbsp;Naoyuki Kimura,&nbsp;Atsushi Yamaguchi","doi":"10.1155/2024/3482523","DOIUrl":"10.1155/2024/3482523","url":null,"abstract":"<div>\u0000 <p><i>Purpose</i>. Mitral valve replacement (MVR) is necessary in cases of severe infective endocarditis (IE). Because the On-X valve is expected to be effective in reducing prosthesis-associated turbulent blood flow, we investigated the hemodynamic efficacy of the On-X valve when used for MVR in cases of mitral valve IE. <i>Methods</i>. We compared postoperative outcomes between two groups of patients who underwent MVR for IE: 13 given an On-X valve and 27 given an SJM valve. <i>Results</i>. There were no in-hospital deaths. Late death occurred in 6 cases, all in the SJM group (<i>P</i> = 0.1520). The incidence of late postoperative atrial fibrillation was relatively low in the On-X group (1 case vs. 10 cases, <i>P</i> = 0.068). Univariate analysis showed an association between the effective orifice area and postoperative atrial fibrillation. The effective orifice area and indexed effective orifice area were significantly larger in the On-X group at 2.8 ± 0.7 cm² vs. 2.2 ± 0.5 cm² (<i>P</i> = 0.007) and 1.8 ± 0.5 cm²/m² vs. 1.4 ± 0.4 cm² (<i>P</i> = 0.003), respectively. <i>Conclusions</i>. The suggested reduction in left atrial load attributed to the use of the On-X valve in MVR for IE may reduce the incidence of postoperative atrial fibrillation.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3482523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836277","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":"A Single-Center Experience in Low Ejection Fraction Coronary Artery Bypass Surgery","authors":"Amber Malhotra,&nbsp;Md Anamul Islam,&nbsp;Giuseppe Tavilla,&nbsp;Ramachandra Reddy,&nbsp;Thomas d’Amato,&nbsp;Sameer Gupta,&nbsp;Mustafa Baldawi","doi":"10.1155/2024/8827313","DOIUrl":"10.1155/2024/8827313","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Coronary artery bypass graft (CABG) in patients with an ejection fraction (EF) ≤ 35% predisposes them to higher complications and mortality risks. Given the usually compromised status of other end organs in low EF patients, ONCAB, involving cardiopulmonary bypass (CPB) and aortic cross-clamping, might intuitively pose more complications than OPCAB. <i>Objective</i>. To explore short- and long-term outcomes between ONCAB and OPCAB procedures in patients with EF ≤ 35%. <i>Methods</i>. A retrospective and observational analysis was conducted in 196 patients with EF ≤ 35% who underwent ONCAB (<i>n</i> = 58) or OPCAB (<i>n</i> = 138) procedures at a single center between January 2015 and May 2023. Baseline characteristics were well matched using the stabilized inverse probability treatment weighted matching technique. <i>Results</i>. After matching, ONCAB and OPCAB had comparable 30-day mortality and 30-day cardiac mortality. OPCAB exhibited significantly shorter length of hospital and ICU stays, with a trend towards more discharges to home. Rates of composite complication and its individual components such as acute kidney injury, reoperation bleeding, stroke, pneumonia, GI disease, and atrial fibrillation were similar between the two groups. Rates of sepsis, liver dysfunction, and blood transfusion were significantly lower in the OPCAB group. As assessed by EF and LVDD, neither procedure showed superiority in improving cardiac function. Median follow-up time was 4.9 (interquartile range: 2.1–7.2) years. After matching, long-term overall survival (1, 3, 7 years) and cardiac mortality rates were comparable between OPCAB and ONCAB. Cumulative rates of cardiac arrest, heart failure, myocardial infarction (MI), atrial fibrillation (Afib), renal disease, and readmission (overall and cardiac) at 7 years were similar. <i>Conclusion</i>. This study demonstrates comparable short-term and long-term outcomes between ONCAB and OPCAB in patients with reduced EF, with OPCAB favoring faster recovery. OPCAB appears as a safer and equally effective option for low EF CABG patients. Larger samples and longer follow-ups are needed for conclusive clinical evidence.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/8827313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139776590","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":"Impact of COVID-19 in the Age of Computer-Assisted Surgery: Cost and Effectiveness Comparison between Robotic and Minimally Invasive Mitral Valve Surgery in a Single-Center Experience","authors":"Laura Giroletti,&nbsp;Daniele Salvi,&nbsp;Lorenzo Peluso,&nbsp;Giovanni Albano,&nbsp;Ascanio Graniero,&nbsp;Valentina Grazioli,&nbsp;Nicola Villari,&nbsp;Claudio Roscitano,&nbsp;Matteo Parrinello,&nbsp;Ettore Lanzarone,&nbsp;Alfonso Agnino","doi":"10.1155/2024/2453937","DOIUrl":"10.1155/2024/2453937","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. We conducted a cost and effectiveness analysis comparing robotic vs minimally invasive mitral valve surgery (RMVS vs MIMVS). The aim was to assess whether the higher cost of the robotic technique could be mitigated by the clinical advantages. <i>Methods</i>. We included 118 patients undergoing RMVS and 233 patients undergoing MIMVS. Initially, RMVS experience was developed during the COVID-19 pandemic. A propensity score matching analysis was performed. Postoperative outcomes and cost of care were compared. <i>Results</i>. RMVS patients had significantly shorter ICU and hospital lengths of stay. They also had a significantly earlier return to home. The cost of the total hospitalization and healthcare services were also significantly lower. <i>Conclusion</i>. Shorter hospitalization and lower cost of postoperative healthcare services may mitigate the initial investment cost to purchase and maintain the robot. These benefits are all the more relevant considering that several RMVS treatments were carried out during the COVID-19 pandemic.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2453937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139838283","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}