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New Updates on Cardiovascular and Thoracic Surgery
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New Updates on Cardiovascular and Thoracic Surgery

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 March 2022) | Viewed by 14285

Special Issue Editors

Dr. Kristofer Charlton-Ouw

E-Mail Website
Guest Editor
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
Interests: aortic dissection and aneurysm; thoracic outlet syndrome; peripheral arterial disease; traumatic arterial injury; hemodialysis access; cerebrovascular diseases
Prof. Dr. Keshava Rajagopal

E-Mail Website
Co-Guest Editor
Heart, HCA Houston Healthcare, Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX, USA
Interests: surgical treatments for end-stage heart and lung disease; general adult cardiac surgery; molecular cardiovascular physiology; cardiovascular bioengineering

Special Issue Information

Dear Colleagues,

There are several topics in cardiac, thoracic, and vascular surgery that receive less attention due to rarity of the disease process and/or the location of concentrations of expertise in only a few centers.  This Special Issue will address some of these uncommon content areas since we are all bound to see unusual or interesting cases in the clinics or emergency rooms of our practices.  One such example is thoracic outlet syndrome.  This entity is treated by a minority of surgeons in their respective specialties, yet can have acute presentations requiring emergent intervention.  Similarly, only a few specialists have broad experience exposing the anterolateral thoracic and lumbosacral spine.  Although most thoracic surgeons treat lung and esophageal cancers, experience with inferior vena cava tumors, such as renal cell and leiomyosarcomas, tend to be concentrated in a few centers.  This issue will address some common themes but also knowledge deficiencies in the diagnosis, evaluation, and surgical treatment of these uncommon disorders.

Extracorporeal circulation is necessary to accomplish most of both adult and pediatric cardiac and thoracic aortic surgical procedures. However, several types of non-cardio-aortic disorders may benefit from or require extracorporeal circulatory strategies in order to undertake operative treatment. These include airway and vena caval masses. We review these less common uses of extracorporeal circulation.  In addition, pericardial diseases have a relatively poorly understood pathophysiology in comparison to cardiac diseases. Consequently, the indications for treatment, as well as optimal operative techniques, are not well-defined. We review pericardial diseases from a surgical perspective.

Dr. Kristofer Charlton-Ouw
Prof. Dr. Keshava Rajagopal
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic dissection and aneurysm
  • thoracic outlet syndrome
  • general adult cardiac surgery
  • thoracic Surgery

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Published Papers (4 papers)

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Research

12 pages, 1196 KiB  
Article
Perioperative Individualized Goal Directed Therapy for Cardiac Surgery: A Historical-Prospective, Comparative Effectiveness Study
by Davinder Ramsingh, Huayong Hu, Manshu Yan, Ryan Lauer, David Rabkin, Jason Gatling, Rosario Floridia, Mckinzey Martinez, Ihab Dorotta and Anees Razzouk
J. Clin. Med. 2021, 10(3), 400; https://doi.org/10.3390/jcm10030400 - 21 Jan 2021
Cited by 8 | Viewed by 4034
Abstract
Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing [...] Read more.
Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing on the implementation of a GDT protocol, which was applied from the immediate post-bypass period into the intensive care unit (ICU). Our hypothesis was that this novel GDT protocol would decrease ICU length of stay and possibly improve postoperative outcomes. Methods: This was a historical prospective, QI study for patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Integral to the QI project was education towards all associated providers on the concepts related to GDT. The protocol involved identifying patient specific targets for cardiac index and mean arterial pressure. These targets were maintained from the post-CPB period to the first 12 h in the ICU. Statistical comparisons were performed between the year after GDT therapy was launched to the last two years prior to protocol implementation. The primary outcome was ICU length of stay. Results: There was a significant decrease in ICU length of stay when comparing the year after the protocol initiation to years prior, from a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes demonstrated a significant reduction in total administered volumes of inotropic medication(milrinone). All other vasopressors demonstrated no differences across years. Hospital length of stay comparisons did not demonstrate a significant reduction. Conclusion: These results suggest that an individualized goal directed therapy for cardiac surgery patients can reduce ICU length of stay and decrease amount of inotropic therapy. Full article
(This article belongs to the Special Issue New Updates on Cardiovascular and Thoracic Surgery)
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9 pages, 226 KiB  
Article
Cardiac Complications Following Cardiac Surgery Procedures
by Jakub Udzik, Sandra Sienkiewicz, Andrzej Biskupski, Aleksandra Szylińska, Zuzanna Kowalska and Patrick Biskupski
J. Clin. Med. 2020, 9(10), 3347; https://doi.org/10.3390/jcm9103347 - 18 Oct 2020
Cited by 14 | Viewed by 4273
Abstract
Background: Elderly patients and those with multiple concomitant disorders are nowadays qualified for cardiac surgery procedures, which is related to higher incidence of the postoperative complications. Aim: The aim of this study was a retrospective analysis of the perioperative factors potentially contributing to [...] Read more.
Background: Elderly patients and those with multiple concomitant disorders are nowadays qualified for cardiac surgery procedures, which is related to higher incidence of the postoperative complications. Aim: The aim of this study was a retrospective analysis of the perioperative factors potentially contributing to occurrence of cardiac incidents after cardiac surgery procedures. Methods: Data of 552 patients of the cardiac surgery clinic were collected and analyzed. Data concerning medical history, previous treatment, laboratory results, additional tests results, operation and hospitalization period were examined. Results: In the study population of 552 patients, cardiac complications were observed in 49.5% of them. Among cardiac complications, the most frequent were supraventricular tachycardia (30.1%) and atrial fibrillation (27.4%). Postoperative bradycardia occurred in 5.25% patients, half of whom required temporary cardiac pacing. Conclusions: The risk of incidence of cardiac complications after cardiac surgery procedures depends mostly on patient’s age, EuroSCORE Logistic (ESL) score, left ventricular ejection fraction, myocardial hypertrophy, presence of paroxysmal AF and coincidence of nephrological complications. The necessity of performing more than one heart defibrillation after removing aortic cross-clamp favors early postoperative bradycardia. Considering the outcomes of this study, continuing reperfusion at least until 1/3 of the aortic cross-clamp time brings no additional benefits to the patients. Full article
(This article belongs to the Special Issue New Updates on Cardiovascular and Thoracic Surgery)
9 pages, 404 KiB  
Article
Characteristics of Trauma Mortality in Patients with Aortic Injury in Harris County, Texas
by Ronald Chang, Stacy A. Drake, John B. Holcomb, Garrett Phillips, Charles E. Wade and Kristofer M. Charlton-Ouw
J. Clin. Med. 2020, 9(9), 2965; https://doi.org/10.3390/jcm9092965 - 14 Sep 2020
Cited by 8 | Viewed by 2465
Abstract
Background: The National Academies of Science have issued a call for zero preventable trauma deaths. The mortality characteristics in all patients with aortic injury are not well described. Methods: All prehospital and hospital medical examiner records for deaths occurring in Harris County, Texas [...] Read more.
Background: The National Academies of Science have issued a call for zero preventable trauma deaths. The mortality characteristics in all patients with aortic injury are not well described. Methods: All prehospital and hospital medical examiner records for deaths occurring in Harris County, Texas in 2014 were retrospectively reviewed, and patients with traumatic aortic injury were selected. The level of aortic injury was categorized by zone (0 through 9) and further grouped by aortic region (arch, zones 0 to 2; descending thoracic, zones 3 to 5; visceral abdominal, zones 6 to 8; infrarenal, zone 9). Multiple investigators used standardized criteria to categorize deaths as preventable, potentially preventable, or non-preventable. Results: Of 1848 trauma deaths, 192 (10%) had aortic injury. There were 59 (31%) aortic arch, 144 (75%) descending thoracic, 19 (10%) visceral abdominal, and 20 (10%) infrarenal aortic injuries. There were 178 (93%) non-preventable deaths and 14 (7%) potentially preventable deaths, and none were preventable. Non-preventable deaths were associated with blunt trauma (69%) and the arch or thoracic aorta (93%), whereas potentially preventable deaths were associated with penetrating trauma (93%) and the visceral abdominal or infrarenal aorta (79%) (all p < 0.05). Half of potentially preventable deaths (n = 7) occurred at the scene, and half occurred at a trauma center. Conclusion: Potentially preventable deaths after aortic injury were associated with penetrating mechanism and injury to the visceral abdominal and/or infrarenal aorta. Optimal prehospital and ED treatment include temporizing hemorrhage control, hemostatic resuscitation, and faster transport to definitive treatment. Full article
(This article belongs to the Special Issue New Updates on Cardiovascular and Thoracic Surgery)
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11 pages, 360 KiB  
Article
Late Outcome after Surgery for Type-A Aortic Dissection
by Mikko Jormalainen, Peter Raivio, Fausto Biancari, Caius Mustonen, Hannu-Pekka Honkanen, Maarit Venermo, Antti Vento and Tatu Juvonen
J. Clin. Med. 2020, 9(9), 2731; https://doi.org/10.3390/jcm9092731 - 24 Aug 2020
Cited by 4 | Viewed by 2565
Abstract
The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the [...] Read more.
The aim of this study was to evaluate all-cause mortality and aortic reoperations after surgery for Stanford type A aortic dissection (TAAD). We evaluated the late outcome of patients who underwent surgery for acute TAAD from January 2005 to December 2017 at the Helsinki University Hospital, Finland. We studied 309 patients (DeBakey type I TAAD: 89.3%) who underwent repair of TAAD. Aortic root repair was performed in 94 patients (30.4%), hemiarch repair in 264 patients (85.4%) and partial/total aortic arch repair in 32 patients (10.4%). Hospital mortality was 13.6%. At 10 years, all-cause mortality was 34.9%, and the cumulative incidence of aortic reoperation or late aortic-related death was 15.6%, of any aortic reoperation 14.6%, reoperation on the aortic root 6.6%, on the aortic arch, descending thoracic and/or abdominal aorta 8.7%, on the descending thoracic and/or abdominal aorta 6.4%, and on the abdominal aorta 3.8%. At 10 years, cumulative incidence of reoperation on the distal aorta was higher in patients with a diameter of the descending thoracic aorta ≥35 mm at primary surgery (cumulative incidence in the overall series: 13.2% vs. 4.0%, SHR 3.993, 95%CI 1.316–12.120; DeBakey type I aortic dissection: 13.6% vs. 4.5%, SHR 3.610, 95%CI 1.193–10.913; patients with dissected descending thoracic aorta: 15.8% vs. 5.9%, SHR 3.211, 95%CI 1.067–9.664). In conclusion, surgical repair of TAAD limited to the aortic segments involved by the intimal tear was associated with favorable survival and a low rate of aortic reoperations. However, patients with enlarged descending thoracic aorta at primary surgery had higher risk of late reoperation. Half of the distal aortic reinterventions were performed on the abdominal aorta. Full article
(This article belongs to the Special Issue New Updates on Cardiovascular and Thoracic Surgery)
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