Research

11 pages, 1506 KiB

Open AccessArticle

Validation of Perioperative Troponin Levels for Predicting Postoperative Mortality and Long-Term Survival in Patients Undergoing Surgery for Hepatobiliary and Pancreatic Cancer

by Dimitrios E. Magouliotis, Evangelos Tatsios, Grigorios Giamouzis, Athina A. Samara, Andrew Xanthopoulos, Alexandros Briasoulis, John Skoularigis, Thanos Athanasiou, Metaxia Bareka, Christos Kourek and Dimitris Zacharoulis

J. Cardiovasc. Dev. Dis. 2024, 11(4), 130; https://doi.org/10.3390/jcdd11040130 - 22 Apr 2024

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Abstract

Background: Hepatopancreato and biliary (HPB) tumors represent some of the leading cancer-related causes of death worldwide, with the majority of patients undergoing surgery in the context of a multimodal treatment strategy. Consequently, the implementation of an accurate risk stratification tool is crucial to [...] Read more.

Background: Hepatopancreato and biliary (HPB) tumors represent some of the leading cancer-related causes of death worldwide, with the majority of patients undergoing surgery in the context of a multimodal treatment strategy. Consequently, the implementation of an accurate risk stratification tool is crucial to facilitate informed consent, along with clinical decision making, and to compare surgical outcomes among different healthcare providers for either service evaluation or clinical audit. Perioperative troponin levels have been proposed as a feasible and easy-to-use tool in order to evaluate the risk of postoperative myocardial injury and 30-day mortality. The purpose of the present study is to validate the perioperative troponin levels as a prognostic factor regarding postoperative myocardial injury and 30-day mortality in Greek adult patients undergoing HPB surgery. Method: In total, 195 patients undergoing surgery performed by a single surgical team in a single tertiary hospital (2020–2022) were included. Perioperative levels of troponin before surgery and at 24 and 48 h postoperatively were assessed. Model accuracy was assessed by observed-to-expected (O:E) ratios, and area under the receiver operating characteristic curve (AUC). Survival at one year postoperatively was compared between patients with high and normal TnT levels at 24 h postoperatively. Results: Thirteen patients (6.6%) died within 30 days of surgery. TnT levels at 24 h postoperatively were associated with excellent discrimination and provided the best-performing calibration. Patients with normal TnT levels at 24 h postoperatively were associated with higher long-term survival compared to those with high TnT levels. Conclusions: TnT at 24 h postoperatively is an efficient risk assessment tool that should be implemented in the perioperative pathway of patients undergoing surgery for HPB cancer. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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11 pages, 1069 KiB

Open AccessArticle

Mitral Valve Surgery for Mitral Regurgitation Results in Reduced Left Ventricular Ejection Fraction in Barlow’s Disease as Compared with Fibro-Elastic Deficiency

by Lobke L. Pype, Philippe B. Bertrand, Philippe Debonnaire, Sebastiaan Dhont, Boukje Hoekman, Bernard P. Paelinck, Dina De Bock, Hein Heidbuchel, Emeline M. Van Craenenbroeck and Caroline M. Van De Heyning

J. Cardiovasc. Dev. Dis. 2024, 11(3), 71; https://doi.org/10.3390/jcdd11030071 - 21 Feb 2024

Viewed by 987

Abstract

Surgical correction of severe mitral regurgitation (MR) can reverse left ventricular (LV) remodeling in patients with mitral valve prolapse (MVP). However, whether this process is similar to the case in Barlow’s Disease (BD) and Fibro-elastic Deficiency (FED) is currently unknown. The aim of [...] Read more.

Surgical correction of severe mitral regurgitation (MR) can reverse left ventricular (LV) remodeling in patients with mitral valve prolapse (MVP). However, whether this process is similar to the case in Barlow’s Disease (BD) and Fibro-elastic Deficiency (FED) is currently unknown. The aim of this study is to evaluate post-operative LV reverse remodeling and function in patients with BD versus FED. In this study, 100 MVP patients (BD = 37 and FED = 63) with severe MR who underwent mitral valve surgery at three Belgian centers were retrospectively included. Transthoracic echocardiography was used to assess MR severity, LV volumes and function before surgery and 6 months thereafter. Baseline MR severity, LV ejection fraction (LVEF), indexed LV end-diastolic (LVEDVi) and end-systolic volumes (LVESVi) were not different between the groups. After a median follow-up of 278 days, there was a similar decrease in LVEDVi, but a trend towards a smaller decrease in LVESVi in BD compared to FED (−3.0 ± 11.2 mL/m² vs. −5.3 ± 9.0 mL/m²; p = 0.154). This resulted in a significantly larger decrease in LVEF in BD (−8.3 ± 9.6%) versus FED (−3.9 ± 6.9%) after adjusting for baseline LVEF (p < 0.001) and type of surgical intervention (p = 0.01). These findings suggest that LV (reverse) remodeling in BD could be affected by other mechanisms beyond volume overload, potentially involving concomitant cardiomyopathy. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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11 pages, 572 KiB

Open AccessArticle

The Impact of Frailty on Outcomes of Proximal Aortic Aneurysm Surgery: A Nationwide Analysis

by Edward D. Percy, Thais Faggion Vinholo, Paige Newell, Supreet Singh, Sameer Hirji, Jake Awtry, Robert Semco, Muntasir Chowdhury, Alexander K. Reed, Sainath Asokan, Alexandra Malarczyk, Alexis Okoh, Morgan Harloff, Farhang Yazdchi, Tsuyoshi Kaneko and Ashraf A. Sabe

J. Cardiovasc. Dev. Dis. 2024, 11(1), 32; https://doi.org/10.3390/jcdd11010032 - 20 Jan 2024

Cited by 1 | Viewed by 1378

Abstract

(1) Background: This study examines frailty’s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016–2017 National Inpatient Sample were included. Frailty was defined by the [...] Read more.

(1) Background: This study examines frailty’s impact on proximal aortic surgery outcomes. (2) Methods: All patients with a thoracic aortic aneurysm who underwent aortic root, ascending aorta, or arch surgery from the 2016–2017 National Inpatient Sample were included. Frailty was defined by the Adjusted Clinical Groups Frailty Indicator. Outcomes of interest included in-hospital mortality and a composite of death, stroke, acute kidney injury (AKI), and major bleeding (MACE). (3) Results: Among 5745 patients, 405 (7.0%) met frailty criteria. Frail patients were older, with higher rates of chronic pulmonary disease, diabetes, and chronic kidney disease. There was no difference in in-hospital death (4.9% vs. 2.4%, p = 0.169); however, the frail group exhibited higher rates of stroke and AKI. Frail patients had a longer length of stay (17 vs. 8 days), and higher rates of non-home discharge (74.1% vs. 54.3%) than non-frail patients (both p < 0.001). Sensitivity analysis confirmed increased morbidity and mortality in frail individuals. After adjusting for patient comorbidities and hospital characteristics, frailty independently predicted MACE (OR 4.29 [1.88–9.78], p = 0.001), while age alone did not (OR 1.00 [0.99–1.02], p = 0.568). Urban teaching center status predicted a lower risk of MACE (OR 0.27 [0.08–0.94], p = 0.039). (4) Conclusions: Frailty is associated with increased morbidity in proximal aortic surgery and is a more significant predictor of mortality than age. Coordinated treatment in urban institutions may enhance outcomes for this high-risk group. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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10 pages, 4899 KiB

Open AccessArticle

Surgical Strategy for Sternal Closure in Patients with Surgical Myocardial Revascularization Using Mammary Arteries

by Mircea Robu, Bogdan Rădulescu, Irina Margarint, Ovidiu Știru, Iulian Antoniac, Daniela Gheorghiță, Cristian Voica, Claudia Nica, Mihai Cacoveanu, Luminița Iliuță, Vlad Anton Iliescu and Horațiu Moldovan

J. Cardiovasc. Dev. Dis. 2023, 10(11), 457; https://doi.org/10.3390/jcdd10110457 - 11 Nov 2023

Viewed by 1486

Abstract

Background: Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher [...] Read more.

Background: Coronary artery bypass grafting has evolved from all venous grafts to bilateral mammary artery (BIMA) grafting. This was possible due to the long-term patency of the left and right internal mammary demonstrated in angiography studies compared to venous grafts. However, despite higher survival rates when using bilateral mammary arteries, multiple studies report a higher rate of surgical site infections, most notably deep sternal wound infections, a so-called “never event”. Methods: We designed a prospective study between 1 January 2022 and 31 December 2022 and included all patients proposed for total arterial myocardial revascularization in order to investigate the rate of surgical site infections (SSI). Chest closure in all patients was performed using a three-step protocol. The first step refers to sternal closure. If the patient’s BMI is below 35 kg/m², sternal closure is achieved using the “butterfly” technique with standard steel wires. If the patient’s BMI exceeds 35 kg/m², we use nitinol clips or hybrid wire cable ties according to the surgeon’s preference for sternal closure. The main advantages of these systems are a larger implant-to-bone contact with a reduced risk of bone fracture. The second step refers to presternal fat closure with two resorbable monofilament sutures in a way that the edges of the skin perfectly align at the end. The third step is skin closure combined with negative pressure wound therapy. Results: This system was applied to 217 patients. A total of 197 patients had bilateral mammary artery grafts. We report only 13 (5.9%) superficial SSI and only one (0.46%) deep SSI. The preoperative risk of major wound infection was 3.9 +/− 2.7. Bilateral mammary artery grafting was not associated with surgical site infection in a univariate analysis. Conclusions: We believe this strategy of sternal wound closure can reduce the incidence of deep surgical site infection when two mammary arteries are used in coronary artery bypass surgery. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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9 pages, 5105 KiB

Open AccessCommunication

Ex-Vivo Preservation of Heart Allografts—An Overview of the Current State

by Perin Kothari

J. Cardiovasc. Dev. Dis. 2023, 10(3), 105; https://doi.org/10.3390/jcdd10030105 - 02 Mar 2023

Cited by 5 | Viewed by 2633

Abstract

As heart transplantation continues to be the gold-standard therapy for end-stage heart failure, the supply-demand imbalance of available organs worsens. Until recently, there have been no advances in increasing the donor pool, as prolonged cold ischemic time excludes the use of certain donors. [...] Read more.

As heart transplantation continues to be the gold-standard therapy for end-stage heart failure, the supply-demand imbalance of available organs worsens. Until recently, there have been no advances in increasing the donor pool, as prolonged cold ischemic time excludes the use of certain donors. The TransMedics Organ Care System (OCS) allows for ex-vivo normothermic perfusion, which allows for a reduction of cold ischemic time and allows for long-distance procurements. Furthermore, the OCS allows for real-time monitoring and assessment of allograft quality, which can be crucial for extended-criteria donors or donation after cardiac death (DCD) donors. Conversely, the XVIVO device allows for hypothermic perfusion to preserve allografts. Despite their limitations, these devices have the potential to alleviate the supply-demand imbalance in donor availability. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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12 pages, 1265 KiB

Open AccessArticle

Does Gender Influence the Indication of Treatment and Long-Term Prognosis in Severe Aortic Stenosis?

by Celia Gil Llopis, Amparo Valls Serral, Ildefonso Roldán Torres, Maria Belén Contreras Tornero, Ana Cuevas Vilaplana, Adrian Sorribes Alonso, Pablo Escribano Escribano, Pau Gimeno Tio, Esther Galiana Talavera, Juan Geraldo Martínez, Paula Gramage Sanchis, Alberto Hidalgo Mateos and Vicente Mora Llabata

J. Cardiovasc. Dev. Dis. 2023, 10(2), 38; https://doi.org/10.3390/jcdd10020038 - 22 Jan 2023

Cited by 1 | Viewed by 1459

Abstract

Introduction: It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender. Methods: Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient ≥ 40 mmHg and/or aortic valvular area < 1 cm² [...] Read more.

Introduction: It is a matter of controversy whether the therapeutic strategy for severe aortic stenosis (AS) differs according to gender. Methods: Retrospective study of patients diagnosed with severe AS (transvalvular mean gradient ≥ 40 mmHg and/or aortic valvular area < 1 cm²) between 2009 and 2019. Our aim was to assess the association of sex on AVR or medical management and outcomes in patients with severe AS. Results: 452 patients were included. Women (51.1%) were older than men (80 ± 8.4 vs. 75.8 ± 9.9 years; p < 0.001). Aortic valve replacement (AVR) was performed less frequently in women (43.4% vs. 53.2%; p = 0.03), but multivariate analyses showed that sex was not an independent predictor factor for AVR. Age, Charlson index and symptoms were predictive factors (OR 0.81 [0.82–0.89], OR 0.81 [0.71–0.93], OR 22.02 [6.77–71.64]). Survival analysis revealed no significant association of sex within all-cause and cardiovascular mortalities (log-rank p = 0.63 and p = 0.07). Cox proportional hazards analyses showed AVR (HR: 0.1 [0.06–0.15]), Charlson index (HR: 1.13 [1.06–1.21]) and reduced LVEF (HR: 1.9 [1.32–2.73]) to be independent cardiovascular mortality predictors. Conclusions: Gender is not associated with AVR or long-term prognosis. Cardiovascular mortality was associated with older age, more comorbidity and worse LVEF. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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Review

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9 pages, 916 KiB

Open AccessReview

Epidemiology and Long-Term Outcomes in Thoracic Transplantation

by Abey S. Abraham, Manila Singh, Matthew S. Abraham and Sanchit Ahuja

J. Cardiovasc. Dev. Dis. 2023, 10(9), 397; https://doi.org/10.3390/jcdd10090397 - 18 Sep 2023

Cited by 2 | Viewed by 1361 | Correction

Abstract

Over the past five decades, outcomes for lung transplantation have significantly improved in the early post-operative period, such that lung transplant is now the gold standard treatment for end-stage respiratory disease. The major limitation that impacts lung transplant survival rates is the development [...] Read more.

Over the past five decades, outcomes for lung transplantation have significantly improved in the early post-operative period, such that lung transplant is now the gold standard treatment for end-stage respiratory disease. The major limitation that impacts lung transplant survival rates is the development of chronic lung allograft dysfunction (CLAD). CLAD affects around 50% of lung transplant recipients within five years of transplantation. We must also consider other factors impacting the survival rate such as the surgical technique (single versus double lung transplant), along with donor and recipient characteristics. The future is promising, with more research looking into ex vivo lung perfusion (EVLP) and bioengineered lungs, with the hope of increasing the donor pool and decreasing the risk of graft rejection. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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10 pages, 266 KiB

Open AccessReview

Longitudinal Outcomes Following Surgical Repair of Primary Mitral Regurgitation

by Yuan Qiu, Hiroki Takaya, Kay Maeda, David Messika-Zeitoun, Marc Ruel, Thierry Mesana and Vincent Chan

J. Cardiovasc. Dev. Dis. 2023, 10(3), 95; https://doi.org/10.3390/jcdd10030095 - 23 Feb 2023

Viewed by 1211

Abstract

Degenerative mitral valve (MV) disease is the most common cause of organic mitral regurgitation (MR) in developed countries. Surgical mitral valve repair is the gold standard treatment for primary MR. Surgical mitral valve repair is associated with excellent outcomes in terms of survival [...] Read more.

Degenerative mitral valve (MV) disease is the most common cause of organic mitral regurgitation (MR) in developed countries. Surgical mitral valve repair is the gold standard treatment for primary MR. Surgical mitral valve repair is associated with excellent outcomes in terms of survival and freedom from recurrent MR. As well, innovations in surgical repair techniques, including thoracoscopically and robotically assisted approaches, further reduce morbidity. Emerging catheter-based therapies may also provide advantages in select patient groups. Although the outcomes following surgical mitral valve repair are well described in the literature, longitudinal follow-up is heterogenous. Indeed, longitudinal follow-up and long-term data are vital to better advise treatment and counsel patients. Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

Other

Jump to: Research, Review

1 pages, 168 KiB

Open AccessCorrection

Correction: Abraham et al. Epidemiology and Long-Term Outcomes in Thoracic Transplantation. J. Cardiovasc. Dev. Dis. 2023, 10, 397

by Abey S. Abraham, Manila Singh, Matthew S. Abraham and Sanchit Ahuja

J. Cardiovasc. Dev. Dis. 2023, 10(12), 493; https://doi.org/10.3390/jcdd10120493 - 12 Dec 2023

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Abstract

In the published work [...] Full article

(This article belongs to the Special Issue Epidemiology and Long-Term Outcomes in Cardiac Surgery, Thoracic Transplantation, and Interventional Cardiology)

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