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Cardiac Surgery: State of the Art and Future Perspectives

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 October 2024) | Viewed by 1741

Special Issue Editors


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Guest Editor
Cardiac Surgery Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
Interests: cardiac transplantation; DCD’s; MCS; LVAD; TAH; HOCM; PTE

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Guest Editor
Cardiac Surgery Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
Interests: TAVI; MICS; Robotics; mitral valve; AI

Special Issue Information

Dear Colleagues,

Cardiac surgery is a relatively young surgical specialty, with the first “modern” operations performed less than 70 years ago. Our mentors were pioneers in the field, and as knowledge and technology rapidly evolved, so too have the challenges facing current and future cardiac surgeons.

Today’s patients demand less invasive procedures, even for once-complex surgeries. At the same time, we must address the growing heart failure pandemic and the increasing prominence of transcatheter approaches.

Technology continues to be a driving force: minimally invasive techniques are becoming more accessible thanks to advanced training platforms and cutting-edge instrumentation, including ultra-high-definition 3D cameras and robotic surgery systems.

We have also seen significant progress in the durability of biological prostheses, extending their suitability for a broader patient population. Furthermore, percutaneous valves are evolving for mitral interventions, emphasizing the critical role of the “Interventional Cardiac Surgeon”.

Tailored endovascular approaches are expanding throughout the aorta, even addressing the once-formidable ascending tract. The field of transplantation is also reaching new frontiers with the introduction of DCDs and the timid attempts of xenotransplants in humans.

Long- and medium-term circulatory support options continue to improve. We are witnessing the development of miniaturized and fully implantable LVADs, artificial hearts, and versatile percutaneous pumps, offering a tangible vision of the future.

Finally, the integration of AI will revolutionize diagnosis, outcome monitoring, and the personalization of surgical risk calculations.

My co-guest editor, Dr. Folesani, and I aim to create a comprehensive and impactful scientific Special Issue that addresses these multifaceted aspects of cardiac surgery. We are honored to invite you to submit invaluable contributions, along with those of other esteemed experts in the field.

Dr. Sofìa Martìn-Suàrez
Dr. Gianluca Folesani
Guest Editors

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Keywords

  • minimal invasive
  • robotics in cardiac surgery
  • miniaturization
  • DCDs
  • FIVAD
  • tissue valves

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Published Papers (1 paper)

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17 pages, 6657 KiB  
Systematic Review
Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia
by Sadeq Al-Hasan-Al-Saegh, Sho Takemoto, Stefano Benenati, Saeed Shafiei, Senol Yavuz, Mattia Galli, Florian Helms, Lukman Amanov, Nunzio Davide De Manna, Saeed Torabi, Jan Karsten, Jan Dieter Schmitto, Fabio Ius, Tim Kaufeld, Jawad Salman, Aron-Frederik Popov, Bastian Schmack, Arjang Ruhparwar, Alina Zubarevich and Alexander Weymann
J. Clin. Med. 2024, 13(22), 6977; https://doi.org/10.3390/jcm13226977 - 19 Nov 2024
Viewed by 1402
Abstract
Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained [...] Read more.
Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas’ (STH) solutions in MICS. Methods: Medical electronic databases were thoroughly searched without time restrictions, including all types of studies except for study protocols and animal research. The final search was completed in June 2024. Subsequently, a network meta-regression was performed on both primary and secondary endpoints, utilizing R (The R Foundation for Statistical Computing, version 3.6.2) for the analysis. Meta-analyses were carried out using Review Manager software. Results: A total of 15 studies, enrolling 2282 patients, were included in the analysis. None of the comparisons showed statistically significant differences in in-hospital mortality between the four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13–80.84; DN vs. HTK, OR: 1.42, 95% CI: 0.28–7.23; STH vs. HTK, OR: 1.25, 95% CI: 0.19–8.20). Conclusions: In this network meta-analysis of cardioplegia solutions in MICS, no significant differences were observed in major clinical outcomes across the solutions. Cardioplegia solutions that provide long-lasting myocardial protection with a single dose, such as DN and HTK, were found to be safely applied in MICS. DN was associated with shorter CPB times and HTK was associated with shorter hospital stays, though these differences may not have clinical implications. Full article
(This article belongs to the Special Issue Cardiac Surgery: State of the Art and Future Perspectives)
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