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Clinical Outcomes of Cardiac Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 7530

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Prof. Dr. Ugolino Livi

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Guest Editor

Department of Cardiothoracic Science, Department of Medical Area (DAME), University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy
Interests: heart transplantation; mechanical circulatory support; mitral valve disease; prosthetic cardiac valves; aortic disease
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Prof. Dr. Igor Vendramin

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Guest Editor

Division of Cardiac Surgery, University of Udine Medical School, Udine, Italy
Interests: aortic surgery; mitral valve disease; aortic valve disease; heart transplantation; mechanical circulatory support

Prof. Dr. Uberto Bortolotti

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Guest Editor

Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
Interests: mitral valve disease; aortic valve disease; prosthetic cardiac valves; aorta and great vessels

Special Issue Information

Dear Colleagues,

Cardiac surgery has undergone incredible developments over the last decades, achieving results, particularly in terms of patient outcomes, unexpected many years ago. Improvements in patient care and technological advancements have allowed for providing more favorable outlooks in the majority of patients with various cardiovascular diseases. We believe that there is a need to periodically assess the status of established, as well as new surgical procedures. Therefore, we felt that this should be the right time to verify up-to-date achievements and where we plan, expect or hope to arrive in the next future. The aim of this publication is to gather data, opinions and results on the most important topics of cardiovascular surgery, providing an update on many aspects of both congenital and acquired heart diseases. The Special Issue is open to those willing to participate and share experiences and results by submitting pertinent contributions which will undergo a peer review process.

We really hope that many of you will join us in what we expect to be an exciting journey at the end of which knowledge in various fields of cardiovascular diseases will be enhanced.

Prof. Dr. Ugolino Livi
Prof. Dr. Igor Vendramin
Prof. Dr. Uberto Bortolotti
Guest Editors

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Keywords

acquired heart disease
congenital heart disease
early and long-term results
minimally invasive techniques
trans-catheter techniques

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Published Papers (6 papers)

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Research

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13 pages, 3208 KiB

Open AccessArticle

Donor Heart Preservation for Heart Transplantation: Single-Center Experience with Three Different Techniques

by Andrea Lechiancole, Gregorio Gliozzi, Sandro Sponga, Pierluigi Visentin, Antonio Beltrami, Daniela Piani, Giovanni Benedetti, Cristian Daffarra, Andriy Dralov, Matteo Meneguzzi, Giorgio Guzzi, Alessandro Di Lorenzo, Laura Stella, Uberto Bortolotti, Ugolino Livi and Igor Vendramin

J. Clin. Med. 2025, 14(4), 1108; https://doi.org/10.3390/jcm14041108 - 9 Feb 2025

Cited by 1 | Viewed by 665

Abstract

Objectives: In addition to traditional ice-cold storage (ICS), other techniques are emerging in the field of donor heart preservation for heart transplantation (HTx). However, in many centers, it could be difficult to justify their use, due to the higher costs and the greater technical complexity compared to ICS. This study aims to analyze the results obtained for HTx at our center employing ICS, controlled hypothermia with Paragonix SherpaPak (PSP), and ex vivo normothermic perfusion with Organ Care System (OCS) as donor graft preservation strategies. Methods: All HTx performed at the University Hospital of Udine, between January 2020 and August 2024, was analyzed and patient outcomes and complications after HTx were assessed. Endomyocardial biopsies were performed in donor hearts immediately after retrieval (T₀), before implantation (T₁), and at reperfusion (T₂) to evaluate signs of myocardial damage. Results: Overall, 100 patients were transplanted with a donor heart preserved with ICS (n = 30), PSP (n = 36), or OCS (n = 34). Compared to ICS, PSP and OCS recipients showed a higher median IMPACT score (5 vs. 8 vs. 7, respectively, p = 0.05) and tended to have a higher rate of bridging to HTx with a long-term ventricular assist device (7% vs. 17% vs. 29%, p = 0.06). OCS was more commonly used in cases of expected ischemic time >4 h compared to ICS and PSP (p < 0.01). Histologically, severe degrees of cellular damage were higher in those hearts preserved with ICS. The 30-day mortality was 3% vs. 6% vs. 9% in ICS, PSP, and OCS groups, respectively (p = 0.65). Moderate-to-severe primary graft dysfunction was 37% vs. 11% vs. 17% (p = 0.03) in the three groups. Conclusions: PSP and OCS seem to be valid alternatives to traditional ICS, and their use could be strongly considered, particularly in the most complex and critical settings, until further data are available on more patient experiences. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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12 pages, 428 KiB

Open AccessArticle

Assessing the Predictive Impact of Preoperative Lactate Dehydrogenase to Albumin Ratio on Outcomes Following Coronary Artery Bypass Graft Surgery

by Ozgur Baris, Canbolat Mert Holat, Mustafa Eren Tosun, Ulviye Serenay Yaman, Aysegul Durmaz, Mustafa Canikoglu, Oguz Omay and Sadan Yavuz

J. Clin. Med. 2025, 14(2), 554; https://doi.org/10.3390/jcm14020554 - 16 Jan 2025

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Abstract

Background: The lactate dehydrogenase to albumin ratio (LAR) is a novel inflammatory marker and a potential predictor of mortality in various conditions. No research has yet examined LAR’s impact on mortality in cardiac surgery patients. This study evaluated LAR’s role in predicting mortality and complications in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis of 377 CABG patients (93 women, 24.7%; 284 men, 75.3%; mean age 65.9 years) from 2020 to 2024 was conducted. Data included demographics, preoperative characteristics, surgical details, and postoperative outcomes, along with ICU and hospital length of stay (LOS). Results: In-hospital mortality was 6.1% (n = 23). Independent predictors were low preoperative ejection fraction (EF) (OR: 0.96, p = 0.024), baseline LAR (OR: 1.08, p = 0.000), LOS-ICU (OR: 1.1, p = 0.000), postoperative ventricular tachycardia (OR: 37.9, p = 0.006), and acute renal failure (OR: 12.1, p = 0.000). Mortality cases had a higher median LAR than survivors (8.6 vs. 5.2, p = 0.000). Elevated LAR correlated with lower preoperative EF (r = −0.227, p = 0.000), longer LOS-ICU (r = 0.17, p = 0.001), and longer LOS-hospital (r = 0.208, p = 0.000). A LAR cut-off of 7.097 predicted mortality (AUC: 0.823, sensitivity 78.3%, specificity 77.1%). Elevated LAR values were observed in all groups with postoperative complications (p < 0.05), indicating its consistent association with negative outcomes. Conclusions: LAR is a valuable predictor of in-hospital mortality and postoperative complications in CABG patients. Elevated LAR is associated with longer ICU/hospital stays and poorer outcomes. Preoperative LAR assessment can guide risk stratification, forecast mortality, and inform surgical planning and treatment strategies. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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16 pages, 13004 KiB

Open AccessArticle

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature—Description of Different Approaches and Tools

by Andrzej Kutarski, Wojciech Jacheć, Radosław Pietura, Marek Czajkowski, Paweł Stefańczyk, Jarosław Kosior, Sebastian Sawonik and Dorota Nowosielecka

J. Clin. Med. 2025, 14(1), 282; https://doi.org/10.3390/jcm14010282 - 6 Jan 2025

Viewed by 645

Abstract

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Methods: Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Results: Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter (“spaghetti twisting technique”). Conclusions: (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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8 pages, 1028 KiB

Open AccessArticle

A Historical Perspective and Update on Robotic Mitral Valve Surgery

by Amy Chartrain, Alfredo Trento, George Gill, Dominic Emerson, Wen Cheng, Danny Ramzy and Joanna Chikwe

J. Clin. Med. 2024, 13(21), 6375; https://doi.org/10.3390/jcm13216375 - 24 Oct 2024

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Abstract

Background/Objectives: Minimally invasive techniques for mitral valve repair have evolved over the past thirty years and include mini-thoracotomies and the robotic platform. This study provides a historical perspective on minimally invasive mitral valve approaches and evaluates long-term outcomes of a large series of robotic mitral valve repairs. Methods: A single-institution, prospectively maintained registry was used to evaluate robotic mitral valve repairs performed by four surgeons from 2005 to 2023. There were 1412 robotic mitral valve repairs performed during this time and stratified by the first 120 and subsequent patients. We evaluated operative outcomes and freedom from more than 2+ mitral regurgitation at five years as well as ten-year survival. Results: Of the 1412 robotic mitral valve repairs performed, 93.6% (n = 1322) were for degenerative disease. Compared to the first 120 patients, the subsequent patients had a significant reduction in cross-clamp time (112 (IQR = 103–130) versus 75 (IQR = 65–88) min) and cardiopulmonary bypass time (153.5 (IQR = 134.5–177.5) versus 116 (IQR = 103–136) min), and all with p < 0.01. The majority of patients had posterior leaflet prolapse (65.6%, n = 926). The repair rate was 98.1%, n = 1385. Survival at ten-year follow-up for the patients included in the first 120 procedures was 91.5% (95% confidence interval (CI) = 86.4–96.6%) versus 92.8% (95% CI = 91.7–93.9%) for the patients who were in the latter group, p = 0.58. Freedom from >2+ mitral regurgitation at 5 years was 97.0% (95% CI = 95.3–98.7%) for the patients in the first 120 procedures and 92.7% (95% CI = 91.5–93.9%), p = 0.22, for those in the latter group. Conclusions: The robotic platform offers an excellent durable repair for mitral regurgitation in our experience of over 1400 patients. The robotic platform for mitral valve repair offers a teachable and safe approach to mitral valve disease for patients. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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12 pages, 2562 KiB

Open AccessArticle

Gender Differences in Survival after Coronary Artery Bypass Grafting—13-Year Results from KROK Registry

by Grzegorz Hirnle, Adrian Stankiewicz, Maciej Mitrosz, Sleiman Sebastian Aboul-Hassan, Marek Deja, Jan Rogowski, Romuald Cichoń, Lech Anisimowicz, Paweł Bugajski, Zdzisław Tobota, Bohdan Maruszewski and Tomasz Hrapkowicz

J. Clin. Med. 2024, 13(14), 4080; https://doi.org/10.3390/jcm13144080 - 12 Jul 2024

Cited by 2 | Viewed by 1277

Abstract

The influence of gender on both early and long-term outcomes of coronary artery bypass grafting (CABG) is not clearly defined. Objectives: This study aimed to assess the impact of gender on early and long-term mortality after CABG using data from the KROK Registry. Methods: All 133,973 adult patients who underwent CABG in Poland between 1 January 2009 and 31 December 2019 were included in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry). The study enrolled 90,541 patients: 68,401 men (75.55%) and 22,140 women (24.45%) who met the inclusion criteria. Then, 30-day mortality, 1-year mortality, and long-term mortality rates were compared. Results: Advanced age, higher Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) grade, diabetes, hypercholesterolemia, arterial hypertension, body mass index BMI > 35 kg/m², and renal failure, before the propensity matching, were more frequently observed in women. Women more frequently underwent urgent surgery, including single and double graft surgery, and off-pump CABG (OPCAB) (p < 0.001). In propensity-matched groups, early mortality (30 days) was significantly higher in women (3.4% versus 2.8%, p < 0.001). The annual mortality remained higher in this group (6.6% versus 6.0%, p = 0.025). However, long-term mortality differed significantly between the groups and was higher in the male group (33.0% men versus 28.8% women, p < 0.001). Conclusions: There are no apparent differences in long-term mortality between the two sexes in the entire population. In propensity-matched patients, early mortality was lower for men, but the long-term survival was found to be better in women. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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Review

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24 pages, 1404 KiB

Open AccessReview

Pushing the Survival Bar Higher: Two Decades of Innovation in Lung Transplantation

by Khalil Aburahma, Nunzio Davide de Manna, Christian Kuehn, Jawad Salman, Mark Greer and Fabio Ius

J. Clin. Med. 2024, 13(18), 5516; https://doi.org/10.3390/jcm13185516 - 18 Sep 2024

Cited by 3 | Viewed by 2592

Abstract

Survival after lung transplantation has significantly improved during the last two decades. The refinement of the already existing extracorporeal life support (ECLS) systems, such as extracorporeal membrane oxygenation (ECMO), and the introduction of new techniques for donor lung optimization, such as ex vivo lung perfusion (EVLP), have allowed the extension of transplant indication to patients with end-stage lung failure after acute respiratory distress syndrome (ARDS) and the expansion of the donor organ pool, due to the better evaluation and optimization of extended-criteria donor (ECD) lungs and of donors after circulatory death (DCD). The close monitoring of anti-HLA donor-specific antibodies (DSAs) has allowed the early recognition of pulmonary antibody-mediated rejection (AMR), which requires a completely different treatment and has a worse prognosis than acute cellular rejection (ACR). As such, the standardization of patient selection and post-transplant management has significantly contributed to this positive trend, especially at high-volume centers. This review focuses on lung transplantation after ARDS, on the role of EVLP in lung donor expansion, on ECMO as a principal cardiopulmonary support system in lung transplantation, and on the diagnosis and therapy of pulmonary AMR. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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