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Cardiovascular Medicine and Cardiac Surgery
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Cardiovascular Medicine and Cardiac Surgery

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

Deadline for manuscript submissions: 31 May 2024 | Viewed by 7467

Special Issue Editors

Dr. Paolo Nardi

E-Mail Website
Guest Editor
Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University of Rome, 00133 Rome, Italy
Interests: regenerative therapy for myocardial infarction; coronary artery bypass grafting; myocardial protection, ascending aortic aneurysms: genetic role and aortic wall stress; ascending aorta surgery; adult cardiac surgery
Dr. Calogera Pisano

E-Mail Website
Guest Editor
Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University of Rome, 00133 Rome, Italy
Interests: tricuspid valve surgery; aortic valve surgery; ascending aorta aneurysm and aortopathy; bicuspid aortic valve pathophysiology; mitral valve surgery; coronary artery bypass grafting surgery
Dr. Marco Alfonso Perrone

E-Mail Website
Guest Editor
Department of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy
Interests: cardiovascular disease; cardiac biomarkers; heart failure; cardiac imaging; congenital heart disease; sports cardiology; exercise training; pediatric cardiology; atherosclerosis; cardiovascular prevention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is a great honor for me and the associate co-guest editors to participate in this Special Issue of the Journal of Clinical Medicine, entitled “Cardiovascular Medicine and Cardiac Surgery”, which will focus on modern medical and surgical treatments of cardiovascular diseases. The scope of the Special Issue is focused on the modern advancements in cardiovascular medicine and surgery, including surgical innovations and techniques currently used in cardiac centers, as well as modern treatments of various cardiac pathologies of medical and surgical interest. The different typologies of the manuscripts proposed by authors could be centered both on prospective data and on retrospective observational studies, with both intraoperative and long-term results. The long-term results will be useful for evaluating the real importance of medical and surgical treatment of the various pathologies examined, such as valvulopathies, aortopathies, and ischemic heart disease.

Dr. Paolo Nardi
Dr. Calogera Pisano
Dr. Marco Alfonso Perrone
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

  • coronary artery disease
  • coronary artery bypass grafting surgery
  • long-term results
  • heart valves diseases
  • aortic aneurysm surgery
  • heart valve surgery

Published Papers (5 papers)

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Research

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12 pages, 409 KiB  
Article
Perioperative Transfusion and Mortality for Cardiovascular Surgery: A Cohort Study Based on Population in Republic of Korea
by Tak-Kyu Oh and In-Ae Song
J. Clin. Med. 2024, 13(8), 2328; https://doi.org/10.3390/jcm13082328 - 17 Apr 2024
Viewed by 329
Abstract
Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic [...] Read more.
Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic of Korea. This study includes adult patients who underwent cardiovascular surgery between 1 January 2010 and 31 December 2019. The endpoints were in-hospital mortality and the 1-year all-cause mortality. Results: The analysis included 62,794 cases, with transfusions used in 88.8% of cases. Multivariable logistic regression revealed that older age, comorbidities, hospital admission through the emergency room, aortic procedures (versus coronary artery bypass grafting), cardiopulmonary bypass, repeat procedures, and supportive therapies during the intensive care (extracorporeal membrane oxygenation and mechanical ventilation) were risk factors for blood transfusion. Female sex was associated with a lower risk of transfusion. Perioperative blood transfusion was associated with a 6.87-fold increased risk of in-hospital mortality (odds ratio [OR]: 6.87, 95% confidence interval [CI]: 3.95, 11.93; p < 0.001) and a 3.20-fold increased risk of 1-year all-cause mortality (OR: 3.35, 95% CI: 2.75, 3.93; p < 0.001). Conclusions: Blood transfusion is used at a high rate in cardiovascular surgeries, and it was associated with increases in the risk of in-hospital and 1-year all-cause mortality. However, these correlations should be viewed with caution as emergent phenomena rather than causative. Understanding factors associated with the need for blood transfusion can assist surgeons in predicting the outcomes of cardiovascular surgery and in tailoring procedures as needed to optimize outcomes. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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11 pages, 626 KiB  
Article
Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation
by Steven Deitelzweig, Amiee Kang, Jenny Jiang, Chuan Gao, Xuemei Luo, Nipun Atreja, Stella Han, Dong Cheng, Saarusri R Loganathan and Gregory Y. H. Lip
J. Clin. Med. 2024, 13(4), 1073; https://doi.org/10.3390/jcm13041073 - 14 Feb 2024
Viewed by 3009
Abstract
Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® [...] Read more.
Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, we identified NVAF patients initiating apixaban or rivaroxaban between 1 January 2013 and 31 December 2021. Patients switching therapies within 30 days before or 90 days after discontinuing their initial DOAC and those who continued initial therapy were included. The index date was the switch date for switchers, while continuers were assigned a hypothetic index date. Switchers and continuers were propensity score matched based on pre-index characteristics. Results: Among 167,868 apixaban and 65,888 rivaroxaban initiators, 2900 apixaban-to-rivaroxaban switchers were matched with 14,500 apixaban continuers, and 2873 rivaroxaban-to-apixaban switchers were matched with 14,365 rivaroxaban continuers. Apixaban-to-rivaroxaban switching was associated with higher stroke/SE risk (HR: 1.99, 95% CI: 1.38–2.88) and MB risk (HR:1.80, 95% CI: 1.46–2.23) than continuing apixaban. Rivaroxaban-to-apixaban switching had similar stroke/SE risk (HR: 0.74, 95% CI: 0.45–1.22) but lower MB risk (HR: 0.49, 95% CI: 0.38–0.65) than continuing rivaroxaban. Conclusions: These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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11 pages, 845 KiB  
Article
Assessment of Individualized Mean Perfusion Pressure Targets for the Prevention of Cardiac Surgery-Associated Acute Kidney Injury—The PrevHemAKI Randomized Controlled Trial
by Alicia Molina-Andujar, José Rios, Gaston J. Piñeiro, Elena Sandoval, Cristina Ibañez, Eduard Quintana, Purificación Matute, Rut Andrea, Teresa Lopez-Sobrino, Jordi Mercadal, Enric Reverter, Irene Rovira, Ana Maria Villar, Sara Fernandez, Manel Castellà and Esteban Poch
J. Clin. Med. 2023, 12(24), 7746; https://doi.org/10.3390/jcm12247746 - 18 Dec 2023
Viewed by 1303
Abstract
Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to [...] Read more.
Background: Retrospective studies support that mean perfusion pressure (MPP) deficit in cardiac surgery patients is associated with a higher incidence of acute kidney injury (CS-AKI). The aim of our study was to apply an algorithm based on MPP in the postoperative period to determine whether management with an individualized target reduces the incidence of CS-AKI. Methods: Randomized controlled trial of patients undergoing cardiac surgery with extracorporeal circulation. Adult patients submitted to valve replacement and/or bypass surgery with a high risk of CS-AKI evaluated by a Leicester score >30 were randomized to follow a target MPP of >75% of the calculated baseline or a standard hemodynamic management during the first postoperative 24 h. Results: Ninety-eight patients with an eGFR of 54 mL/min were included. There were no differences in MAP and MPP in the first 24 h between the randomized groups, although a higher use of noradrenaline was found in the intervention arm (38.78 vs. 63.27, p = 0.026). The percentage of time with MPP < 75% of measured baseline was similar in both groups (10 vs. 12.7%, p = 0.811). MAP during surgery was higher in the intervention group (73 vs. 77 mmHg, p = 0.008). The global incidence of CS-AKI was 36.7%, being 38.6% in the intervention group and 34.6% in the control group (p = 0.40). There were no differences in extrarenal complications between groups as well. Conclusion: An individualized hemodynamic management based on MPP compared to standard treatment in cardiac surgery patients was safe but did not reduce the incidence of CS-AKI in our study. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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11 pages, 2924 KiB  
Article
How Refined Surgical Technical Solutions Can Make Bentall Operation a Low-Risk Procedure: 20-Year Personal Experience at the “Root” of the Aortic Diseases—It Is Time to Change Surgical Guidelines
by Giovanni Ruvolo, Claudia Altieri, Carlo Bassano, Dario Buioni, Paolo Nardi and Calogera Pisano
J. Clin. Med. 2023, 12(23), 7330; https://doi.org/10.3390/jcm12237330 - 26 Nov 2023
Viewed by 744
Abstract
(1) Objective: Twenty years’ experience of Bentall–De Bono operations by one surgeon. (2) Methods: From January 2003 to September 2023, four-hundred-and-two patients aged 65.9 ± 15 years underwent a Bentall operation. The EuroScore-2 was 5.0% ± 3.8%. Associated procedures were performed on 113 [...] Read more.
(1) Objective: Twenty years’ experience of Bentall–De Bono operations by one surgeon. (2) Methods: From January 2003 to September 2023, four-hundred-and-two patients aged 65.9 ± 15 years underwent a Bentall operation. The EuroScore-2 was 5.0% ± 3.8%. Associated procedures were performed on 113 patients (28.1%). Results: Operative mortality was 1.2% (n = 5), in particular 0.69% (n = 2/289) for isolated Bentall operation, 2.65% (n = 3/113) for combined procedures (p < 0.05). Postoperative acute heart failure occurred in 38 patients (9.45%). Preoperative pulmonary hypertension (44 ± 14 vs. 33 ± 7 mmHg), cardiopulmonary bypass time (169 ± 61 min. vs. 124 ± 42 min.) and aortic cross-clamp time (133 ± 45 min. vs. 107 ± 34 min.) have been recognized as independent predictors of mortality and cardiac complications (p < 0.05). Conclusions: In our experience, the Bentall operation was associated with low operative mortality and low rate of complications. For this reason, in agreement with the patients, we have modified surgical indication for ascending aortic aneurysms and now we think that it is time to change surgical guidelines. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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Review

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25 pages, 1106 KiB  
Review
Inflammation in Heart Failure—Future Perspectives
by Alexandru Mircea Arvunescu, Ruxandra Florentina Ionescu, Sanda Maria Cretoiu, Silviu Ionel Dumitrescu, Ondin Zaharia and Ioan Tiberiu Nanea
J. Clin. Med. 2023, 12(24), 7738; https://doi.org/10.3390/jcm12247738 - 17 Dec 2023
Cited by 1 | Viewed by 1603
Abstract
Chronic heart failure is a terminal point of a vast majority of cardiac or extracardiac causes affecting around 1–2% of the global population and more than 10% of the people above the age of 65. Inflammation is persistently associated with chronic diseases, contributing [...] Read more.
Chronic heart failure is a terminal point of a vast majority of cardiac or extracardiac causes affecting around 1–2% of the global population and more than 10% of the people above the age of 65. Inflammation is persistently associated with chronic diseases, contributing in many cases to the progression of disease. Even in a low inflammatory state, past studies raised the question of whether inflammation is a constant condition, or if it is, rather, triggered in different amounts, according to the phenotype of heart failure. By evaluating the results of clinical studies which focused on proinflammatory cytokines, this review aims to identify the ones that are independent risk factors for heart failure decompensation or cardiovascular death. This review assessed the current evidence concerning the inflammatory activation cascade, but also future possible targets for inflammatory response modulation, which can further impact the course of heart failure. Full article
(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)
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