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Two of the Current Hot Challenges in Cardiac Surgery: Rising...
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Two of the Current Hot Challenges in Cardiac Surgery: Rising Endocarditis Cases and Extensive Use of Antithrombotics

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 3904

Special Issue Editors

Prof. Dr. Daniel Wendt

E-Mail Website
Guest Editor
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, 45147 Essen, Germany
Interests: adult cardiac surgery; interventional cardiac surgery/cardiology; minimal-invasive cardiac surgery; minimal-invasive mitral valve operations; transcatheter aortic valve implantation; experimental cardiac surgery; heart failure
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jurij M. Kalisnik

E-Mail Website
Guest Editor
1. Department of Cardiac Surgery, Paracelsus Medical University, 40791 Nuremberg, Germany
2. Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
Interests: cardiac surgery; heart rate variability; atrial fibrillation; cardiovascular surgery; coronary artery bypass surgery; apllied science in cardiovascular domain; new biosensors and biomarkers; artificial intelligence

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Cardiovascular Development and Disease focuses on the current rise in infective endocarditis and the extensive use of antithrombotic agents in cardiac surgery.

It is a real pleasure to serve as a guest editor of this Special Issue of the Journal of Cardiovascular Development and Disease together with my Co-Editor Professor Jurij M. Kalisnik.

In recent days, modern cardiac surgery has changed, confronting cardiac surgeons with new and different problems. The latter dwells on the fact that patients presenting with increasingly more complex indications, with a higher incidence of comorbidities, are older and frailer than years ago. Further, in all well-developed countries, we are witnessing a growing number of valve substitute implantations (either transcatheter or surgical valve prostheses implantations), with the subsequent rise of infective endocarditis. Despite emerging promising new concepts, including anti-infective drugs, surgical techniques and advanced perioperative care, the treatment of infective endocarditis still poses a major challenge, especially in the light of worldwide growing incidence. Not surprisingly, this devastating disease is causing severe morbidity and despite best practices and innovative concepts, mortality rates are still unacceptably high.

Another problem in modern cardiac surgery lies in the current increase of antithrombotic drugs, such as the incorporation of new P2Y12 inhibitors in the contemporary treatment of coronary artery disease. Moreover, direct-acting oral anticoagulants (DOACs) are now the preferred agents for long-term anticoagulation because due to their more predictable clinical and better benefit:risk profile than warfarin. With the current increase of, e.g., non-valvular atrial fibrillation in elderly patients, a parallel increase of prescription of these medicaments is anticipated. In cases where surgery can be postponed, a preoperative discontinuation period (“washout”) is recommended. However, especially in cardiac surgery, many patients have to be operated on an urgent or even emergent basis. For these surgeries, taking place before the recommended washout period has expired, severe bleeding complications might ensue culminating in potentially life-threatening complications. Therefore, new reversal drugs as well as novel removal concepts are intensively being evaluated, gaining increasing attention.

Prof. Dr. Daniel Wendt
Prof. Dr. Jurij M. Kalisnik
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 Cardiovascular Development and Disease is an international peer-reviewed open access monthly 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 2700 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

  • new treatment options/concepts in infective endocarditis
  • surgical techniques
  • extracorporeal techniques
  • new scoring algorithms
  • new anti-infective drugs
  • sepsis
  • drug removal (antithrombotics)
  • bleeding complications in cardiac surgery
  • economical aspects

Published Papers (3 papers)

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Research

10 pages, 1995 KiB  
Article
Hemoadsorption Using CytoSorb® in Patients with Infective Endocarditis: A German-Based Budget Impact Analysis
by Cristina Rao, Franziska Preissing, Matthias Thielmann, Daniel Wendt, Zaki Haidari, Jurij Matija Kalisnik, Lothar Daake and Karl Traeger
J. Cardiovasc. Dev. Dis. 2023, 10(9), 366; https://doi.org/10.3390/jcdd10090366 - 26 Aug 2023
Cited by 2 | Viewed by 1324
Abstract
A considerable number of infective endocarditis (IE) patients require cardiac surgery with an increased risk for postoperative sepsis. Intraoperative hemoadsorption may diminish the risk of postoperative hyperinflammation with potential economic implications for intensive care unit (ICU) occupation. The present study aimed to theoretically [...] Read more.
A considerable number of infective endocarditis (IE) patients require cardiac surgery with an increased risk for postoperative sepsis. Intraoperative hemoadsorption may diminish the risk of postoperative hyperinflammation with potential economic implications for intensive care unit (ICU) occupation. The present study aimed to theoretically investigate the budget impact of a reduced length of ICU stay in IE patients treated with intraoperative hemoadsorption in the German healthcare system. Data on ICU occupation were extrapolated from a retrospective study on IE patients treated with hemoadsorption. An Excel-based budget impact model was developed to simulate the patient course over the ICU stay. A base-case scenario without therapy reimbursement and a scenario with full therapy reimbursement were explored. The annual eligible German IE patient population was derived from official German Diagnostic-Related Group (DRG) volume data. One-way deterministic sensitivity analysis and multivariate analysis were performed to evaluate the uncertainty over the model results. The use of intraoperative hemoadsorption resulted in EUR 2298 being saved per patient in the base-case scenario without therapy reimbursement. The savings increased to EUR 3804 per patient in the case of full device-specific reimbursement. Deterministic and probabilistic sensitivity analyses confirmed the robustness of savings, with a probability of savings of 87% and 99% in the base-case and full reimbursement scenario, respectively. Intraoperative hemoadsorption in IE patients might have relevant economic benefits related to reduced ICU stays, resulting in improved resource use. Further evaluations in larger prospective cohorts are warranted. Full article
(This article belongs to the Special Issue Two of the Current Hot Challenges in Cardiac Surgery: Rising Endocarditis Cases and Extensive Use of Antithrombotics)
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12 pages, 1393 KiB  
Article
Three Decades of Experience with Aortic Prosthetic Valve Endocarditis
by Antonella Galeone, Jacopo Gardellini, Diletta Trojan, Venanzio Di Nicola, Renato Di Gaetano, Giuseppe Faggian and Giovanni Battista Luciani
J. Cardiovasc. Dev. Dis. 2023, 10(8), 338; https://doi.org/10.3390/jcdd10080338 - 6 Aug 2023
Cited by 2 | Viewed by 1150
Abstract
The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male [...] Read more.
The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male and 29 female, aged 67 ± 12 years, underwent surgery for a-PVE at our institution between 1994 and 2021. Median time from the original cardiac surgery was 1.9 [0.6–5.6] years, and 47 (33%) patients developed an early a-PVE. Of these patients, 73 (51%) underwent aortic valve replacement (AVR) with a biological or mechanical PAV, 12 (8%) underwent aortic root replacement (ARR) with a biological or mechanical PVC, and 59 (42%) underwent AVR or ARR with a CAH. Patients treated with a CAH had significantly more circumferential annular abscess multiple valve involvement, longer CPB and aortic cross-clamping times, and needed more postoperative pacemaker implantation than patients treated with a PAV. No difference was observed in survival, reoperation rates, or recurrence of IE between patients treated with a PAV, a PVC, or a CAH. CAHs are technically more demanding and more often used in patients who have extensive annular abscess and multiple valve involvement. However, the use of CAH is safe in patients with complex a-PVE, and it shows excellent early and long-term outcomes. Full article
(This article belongs to the Special Issue Two of the Current Hot Challenges in Cardiac Surgery: Rising Endocarditis Cases and Extensive Use of Antithrombotics)
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10 pages, 911 KiB  
Article
Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery
by Zaki Haidari, Daniel Wendt, Matthias Thielmann, Heinz Jakob, Arjang Ruhparwar and Mohamed El-Gabry
J. Cardiovasc. Dev. Dis. 2023, 10(4), 146; https://doi.org/10.3390/jcdd10040146 - 30 Mar 2023
Cited by 2 | Viewed by 1098
Abstract
Background: Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and [...] Read more.
Background: Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. Methods: Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. Results: After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, p < 0.001. The 30-day and 2-year mortality were 20% versus 13% (p = 0.396) and 33% versus 27% (p = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, p = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (p = 0.242). Conclusions: Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy. Full article
(This article belongs to the Special Issue Two of the Current Hot Challenges in Cardiac Surgery: Rising Endocarditis Cases and Extensive Use of Antithrombotics)
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