Journal of Cardiac Surgery最新文献

{"title":"Donation after Circulatory Death Does Not Worsen Survival after Heart Transplant for Patients with a Durable Left Ventricular Assist Device","authors":"Erin M. Schumer,&nbsp;Kukbin Choi,&nbsp;Doug A. Gouchoe,&nbsp;Divyaam Satija,&nbsp;Andrew N. Rosenbaum,&nbsp;Sudhir Kushwaha,&nbsp;Atta Behfar,&nbsp;Mauricio A. Villavicencio,&nbsp;Philip J. Spencer","doi":"10.1155/2024/5578819","DOIUrl":"https://doi.org/10.1155/2024/5578819","url":null,"abstract":"<div>\u0000 <p>Heart transplantation from donors after circulatory death (DCD) has demonstrated increased primary graft dysfunction. Durable mechanical circulatory (MCS) recipients have slightly higher perioperative risk but excellent long-term survival. We sought to determine if the use of DCD donors impacted outcomes for patients with MCS. The United Network for Organ Sharing database was queried from 2019 to 2023 for all adult recipients who underwent heart transplant with a durable left ventricular assist device (LVAD). Outcomes were compared for recipients of DBD and DCD donors. Kaplan–Meier analysis was used to compare survival. A total of 3449 recipients underwent heart transplant who met the study criteria. The number of DCD and DBD donors was 288 (8.4%) and 3161 (92.6%). There was no difference in the length of stay, postoperative dialysis, pacemaker, stroke rate, or in-hospital mortality. Recipients with durable LVADs of DCD donors had a higher rate of treatment for rejection within the first year. Overall survival was not different between DBD and DCD donors (<i>p</i> = 0.153). Postoperative and survival outcomes for DCD donation remain similar between patients with and without MCS. These findings may help decrease waitlist time for patients with durable MCS.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5578819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536555","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":"Training in Advanced Coronary Artery Bypass Surgery in the United Kingdom","authors":"Jeremy Chan,&nbsp;Shubhra Sinha,&nbsp;Daniel P. Fudulu,&nbsp;Tim Dong,&nbsp;Pradeep Narayan,&nbsp;Gianni D. Angelini","doi":"10.1155/2024/2140060","DOIUrl":"https://doi.org/10.1155/2024/2140060","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off-pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. <i>Methods</i>. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. <i>Results</i>. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (<i>n</i> = 79759/327025). Trainees performed 27.10% (63934/235920) on-pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, <i>p</i> &lt; 0.001) and aortic cross-clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, <i>p</i> &lt; 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, <i>p</i> &lt; 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, <i>p</i> &lt; 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in-hospital mortality (1.0% vs 0.9%, <i>p</i> = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), <i>p</i> = 0.33), return to theatre (4.2% vs 4.47%, <i>p</i> = 0.089), postoperative renal dialysis (1.4% vs 1.1%, <i>p</i> = 0.076), and deep sternal wound infection (0.6% vs 0.6%, <i>p</i> = 0.87). Trainees performed 17.17% (8661/41778) off-pump cases. Consultants had a higher in-hospital mortality (1.2% vs 0.9%, <i>p</i> = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), <i>p</i> = 0.27), return to theatre (3.8% vs 3.9%, <i>p</i> = 0.69), postoperative renal dialysis (2.0% vs 1.6%, <i>p</i> = 0.059), and deep sternal wound infection (1.0% vs 0.8%, <i>p</i> = 0.66). <i>Conclusion</i>. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients’ safety.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2140060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141430313","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":"Longer-Term Outcomes of the Yacoub versus Bentall Procedure in a Nationwide Propensity-Matched Comparison","authors":"Jan Gofus,&nbsp;Jiri Jarkovsky,&nbsp;Anna Klechova,&nbsp;Jaroslav Hlubocky,&nbsp;Stepan Cerny,&nbsp;Martin Urban,&nbsp;Pavel Zacek,&nbsp;Jan Vojacek","doi":"10.1155/2024/7595067","DOIUrl":"https://doi.org/10.1155/2024/7595067","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Aortic root replacement with a composite mechanical valve graft (Bentall procedure) has been a recommended strategy in patients with aortic root aneurysm with or without aortic regurgitation. Aortic root remodeling (Yacoub procedure) has emerged as a valve-sparing alternative although there is only scarce multicenter evidence. The aim of our study was to provide nationwide comparison of these two strategies. <i>Methods</i>. This was a retrospective study of data from national registry of cardiac surgery. Using propensity-score matching, we compared all the patients undergoing the Bentall procedure in the Czech Republic between 2010 and 2021 with patients after the Yacoub procedure from four experienced centers. <i>Results</i>. During the study period, 199 patients underwent Yacoub and 526 had Bentall procedure. Of those, 166 pairs were selected and compared. There was no significant difference in perioperative outcomes and in mortality (<i>p</i> = 0.96) over the follow-up of 5.7 vs. 6.4 years. The Bentall procedure was associated with a higher risk of major bleeding or thromboembolism (<i>p</i> &lt; 0.001), and the Yacoub procedure led to a higher risk of rehospitalizations for valve failure (<i>p</i> = 0.01). <i>Conclusions</i>. In a nationwide propensity-matched study, Bentall and Yacoub procedures yield similar longer-term survival. Yacoub offers better freedom from thromboembolism or bleeding at the cost of higher risk of valve failure.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/7595067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424823","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":"Microaxial Flow Pumps for Cardiogenic Shock: Effects on Hemodynamics, Hemolysis, and End-Organ Recovery","authors":"Lauren E. Parker,&nbsp;Lillian Kang,&nbsp;Carmelo A. Milano,&nbsp;Alejandro A. Lobo,&nbsp;Julie W. Doberne,&nbsp;Muath Bishawi,&nbsp;Christopher. W. Jensen,&nbsp;Chetan B. Patel,&nbsp;Adam D. DeVore,&nbsp;Stuart D. Russell,&nbsp;Jason N. Katz,&nbsp;Jacob N. Schroder","doi":"10.1155/2024/3584383","DOIUrl":"https://doi.org/10.1155/2024/3584383","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The Impella 5.5 offers a less invasive transvalvular approach to left ventricular mechanical support. End-organ recovery and hemolysis have been well-studied with durable left ventricular assist devices but effects of Impella 5.5 on these parameters are less well described. <i>Methods</i>. All Impella 5.5 recipients between August 2020 and June 2023 were reviewed from a single institution. Hemodynamics and laboratory values were compared between preimplant and prior to device removal. Hemolysis was defined as postoperative lactate dehydrogenase &gt;1000 IU/L with concurrent plasma-free hemoglobin &gt;50 mg/dL. Paired Wilcoxon tests compared the median of differences between preimplant and pre-explant values. <i>Results</i>. We studied 127 consecutive implants of the Impella 5.5. Thirty-one patients had concomitant VA-ECMO, and one received Impella 5.5 after durable LVAD explant; these cases were excluded. Our final cohort included 95 patients, with an average age of 55.29 ± 14.5 years. Median implant duration was 11 days (IQR:6–16 days). To avoid confounding hemodynamic factors, we restricted hemodynamic analysis to the 37 patients who received isolated Impella 5.5, excluding those with prior IABP, Impella CP, acute MI, or prior cardiac surgery. These patients experienced improvements from baseline in pulmonary vascular resistance (−77.03 dynes/sec/cm⁻⁵, <i>p</i> &lt; 0.01) and wedge pressure (−6.5 mmHg, <i>p</i> &lt; 0.01). Furthermore, cardiac index improved from baseline (+1.3, <i>p</i> &lt; 0.01). In the total cohort (<i>n</i> = 95), pre-explant creatinine (−0.2 mg/dL, <i>p</i> &lt; 0.01) and ALT (−9.0 mg/dL, <i>p</i> &lt; 0.01) decreased relative to values before the implant. Twenty-three (24%) met criteria for hemolysis; however, none underwent device removal for clinically significant hemolysis. Takeback was required in 25 patients, 22 of which were for axillary hematoma. <i>Conclusions</i>. Impella 5.5 support acutely improved markers of end-organ function and hemodynamics, including PVR.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3584383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141264579","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 Effects of Propafenone on Postoperative Atrial Fibrillation in Adult Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials","authors":"Jin-He Deng,&nbsp;Jing Li,&nbsp;Fan-Rong He,&nbsp;Yun-Tai Yao,&nbsp; The Evidence in Cardiovascular Anesthesia (EICA) Group","doi":"10.1155/2024/5579727","DOIUrl":"10.1155/2024/5579727","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Previous research has only conducted a restricted amount of investigations on the effectiveness of propafenone in preventing and treating of atrial fibrillation (AF) after cardiac surgery. Hence, a comprehensive evaluation and meta-analysis were performed to evaluate the effectiveness and safety of propafenone in individuals undergoing cardiac surgery for postoperative atrial fibrillation (POAF). <i>Methods</i>. A meta-analysis of randomized controlled trials was conducted. Until September 15th, 2023, various databases were searched. The main focal points consisted of the presence of POAF, transition from AF to sinus rhythm, and reappearance of AF. The odds ratios (ORs) for treatment effects on dichotomous variables were calculated. <i>Results</i>. The analysis of data included 9 controlled trials that were randomized and had 1014 patients. The findings indicated that propafenone has a significant impact on reducing the occurrence of POAF in adult patients who undergo cardiac surgery (OR, 0.52; 95% CI: 0.30, 0.89; <i>P</i> = 0.02). In addition, it was observed that propafenone significantly increase the rate of conversion to sinus rhythm from AF within 20 min (OR, 5.39; 95% CI: 2.25, 12.91; <i>P</i> = 0.0002) and 1 hour (OR, 2.89; 95% CI: 1.50, 5.57; <i>P</i> = 0.002) after administration. Surprisingly, the administration of propafenone treatment did not have a significant impact on the rate of conversion to sinus rhythm from AF within 24 hours (OR, 0.63; 95% CI: 0.38, 1.04; <i>P</i> = 0.07) after administration. <i>Conclusions</i>. The present study suggests that the postoperative administration of propafenone to adult cardiac surgery patients is both safe and effective for preventing and treating POAF.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2024 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5579727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141021694","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":"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":"2024 1","pages":""},"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":"2024 1","pages":""},"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":"2024 1","pages":""},"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":"2024 1","pages":""},"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":"2024 1","pages":""},"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}