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State of the Art of the Management of Cardiac Surgical...
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State of the Art of the Management of Cardiac Surgical Intensive Care Patients

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

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 5792

Special Issue Editors

Dr. Andrea Montisci

E-Mail Website
Guest Editor
Division of Cardiothoracic Intensive Care, Cardiothoracic Department, ASST Spedali Civili, Brescia, Italy
Interests: cardiogenic shock; mechanical circulatory support; ventricular assist devices; right ventricular dysfunction; veno-arterial ecmo; veno-venous ecmo; cardiac anesthesia; ARDS; cardiovascular physiology
Dr. Lorenzo Di Bacco

E-Mail Website
Guest Editor
Cardiac Surgery Unit, Cardiothoracic Department, ASST Spedali Civili, Brescia, Italy
Interests: cardiac surgery; sutureless and rapid deployment valves; minimally invasive cardiac surgery; mechanical circulatory support; mitral valve repair; arrhythmia surgery
Prof. Dr. Federico Pappalardo

E-Mail
Guest Editor
Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
Interests: cardiogenic shock; advanced heart failure; mechanical circulatory support; ventricular assist devices; biocompatibility; right ventricular dysfunction; veno-arterial ecmo; veno-venous ecmo; ARDS
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the last two decades, the landscape of cardiac surgery has deeply changed, due to the combined effect of an increased risk profile of patients and a significant advancement of surgical techniques.

The role of minimally invasive cardiac surgery has been strengthened and the extraordinary expansion of transcatheter procedures pushed towards the development of hybrid strategies, encompassing both valvular and coronary artery disease, representing a true revolution of the clinical field, especially for those patients who where previously considered inoperable.

The aging of the population and the increased burden of comorbidities dictated profound changes of the perioperative management, calling cardiac surgical intensive care medicine on to act on multiple fronts: a better evaluation of the preoperative risk, the implementation of perioperative optimization strategies in heart failure patients and the expansion of the  application of mechanical circulatory support therapies in the perioperative period.

Moreover, the pandemic of COVID-19, with its supposed long-lasting effects, could force a global rethinking of healthcare systems and should prompt further studies, aimed to clarify the possible interplay between SARS-CoV-2 and cardiovascular diseases.

For this Special Issue, we aimed to encourage submissions that focus on the most controversial and cutting-edge topics in the field.

Dr. Andrea Montisci
Dr. Lorenzo Di Bacco
Prof. Dr. Federico Pappalardo
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

  • cardiac surgery
  • COVID-19
  • perioperative medicine
  • cardiothoracic intensive care

Published Papers (3 papers)

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Research

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12 pages, 950 KiB  
Article
Practice Patterns of Antithrombotic Therapy during the Early Postoperative Course of Cardiac Surgery
by Thomas Klein, Hugo Bignolas, Nicolas Mongardon, Osama Abou-Arab, Pierre Grégoire Guinot, Adrien Bouglé and Philippe Guerci
J. Clin. Med. 2023, 12(5), 2029; https://doi.org/10.3390/jcm12052029 - 3 Mar 2023
Viewed by 1350
Abstract
Background: The current practices regarding the management of antithrombotic therapy during the early postoperative course of cardiac surgery are not well described. Methods: An online survey with multiple-choice questions was sent to cardiac anesthesiologists and intensivists from France. Results: The response rate was [...] Read more.
Background: The current practices regarding the management of antithrombotic therapy during the early postoperative course of cardiac surgery are not well described. Methods: An online survey with multiple-choice questions was sent to cardiac anesthesiologists and intensivists from France. Results: The response rate was 27% (n = 149), with 2/3 of the respondents having less than 10 years of experience. A total of 83% of the respondents reported using an institutional protocol for antithrombotic management. A total of 85% (n = 123) of the respondents regularly used low-molecular-weight heparin (LMWH) during the immediate postoperative course. For 23%, 38%, 9%, and 22% of the physicians, LMWH administration was initiated between the 4th and 6th hour, between the 6th and 12th hour, between the 12th and 24th hour, and on postoperative day 1, respectively. The main reasons for not using LMWH (n = 23) were a perceived increased risk of perioperative bleeding (22%), poor reversal compared with unfractionated heparin (74%), local habits and the refusal of surgeons (57%), and its overly complex management (35%). The modalities of LMWH use were widely varied among the physicians. Chest drains were mostly removed within 3 days of surgery with an unchanged dose of antithrombotic therapy. Regarding temporary epicardial pacing wire removal anticoagulation, 54%, 30%, and 17% of the respondents left the dose unchanged, suspended the anticoagulation, or lowered the anticoagulation dose, respectively. Conclusion: LMWH was inconsistently used after cardiac surgery. Further research is warranted to provide high-quality evidence regarding the benefits and safety of LMWH use early after cardiac surgery. Full article
(This article belongs to the Special Issue State of the Art of the Management of Cardiac Surgical Intensive Care Patients)
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11 pages, 1381 KiB  
Article
Benchmark of Intraoperative Activity in Cardiac Surgery: A Comparison between Pre- and Post-Operative Prognostic Models
by Anna Zamperoni, Greta Carrara, Massimiliano Greco, Carlotta Rossi, Elena Garbero, Giovanni Nattino, Giuseppe Minniti, Paolo Del Sarto, Guido Bertolini, Stefano Finazzi and Cardiac Surgical Intensive Care Writing Committee (GiViTI)
J. Clin. Med. 2022, 11(11), 3231; https://doi.org/10.3390/jcm11113231 - 6 Jun 2022
Cited by 1 | Viewed by 1682
Abstract
Objectives: Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including [...] Read more.
Objectives: Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including data collected before surgery and data collected at the end of surgery, to evaluate patient risk evolution over time and assess the direct contribution of surgery. Methods: A total of 15,882 cardiac surgery patients from a Margherita-Prosafe cohort study were included in the analysis. Probability of death was estimated using two logistic regression models (preoperative data only vs. post-operative data, also including information at discharge from the operatory theatre), testing calibration and discrimination of each model. Results: Pre-operative and post-operative models were built and demonstrate good discrimination and calibration with AUC = 0.81 and 0.87, respectively. Relative difference in pre- and post-operative mortality in separate centers ranged from −0.36 (95% CI: −0.44–−0.28) to 0.58 (95% CI: 0.46–0.71). The usefulness of this two-fold preoperative model to benchmark medical care in single hospital is exemplified in four cases. Conclusions: Predicted post-operative mortality differs from predicted pre-operative mortality, and the distance between the two models represent the impact of surgery on patient outcomes. A double-fold model can assess the impact of the intra-operative team and the evolution of patient risk over time, and benchmark different hospitals on patients subgroups to promote an improvement in medical care in each center. Full article
(This article belongs to the Special Issue State of the Art of the Management of Cardiac Surgical Intensive Care Patients)
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Review

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18 pages, 5199 KiB  
Review
Cerebral Perfusion and Neuromonitoring during Complex Aortic Arch Surgery: A Narrative Review
by Andrea Montisci, Giulia Maj, Corrado Cavozza, Andrea Audo, Stefano Benussi, Fabrizio Rosati, Sergio Cattaneo, Lorenzo Di Bacco and Federico Pappalardo
J. Clin. Med. 2023, 12(10), 3470; https://doi.org/10.3390/jcm12103470 - 15 May 2023
Cited by 2 | Viewed by 2152
Abstract
Complex ascending and aortic arch surgery requires the implementation of different cerebral protection strategies to avoid or limit the probability of intraoperative brain damage during circulatory arrest. The etiology of the damage is multifactorial, involving cerebral embolism, hypoperfusion, hypoxia and inflammatory response. These [...] Read more.
Complex ascending and aortic arch surgery requires the implementation of different cerebral protection strategies to avoid or limit the probability of intraoperative brain damage during circulatory arrest. The etiology of the damage is multifactorial, involving cerebral embolism, hypoperfusion, hypoxia and inflammatory response. These protective strategies include the use of deep or moderate hypothermia to reduce the cerebral oxygen consumption, allowing the toleration of a variable period of absence of cerebral blood flow, and the use of different cerebral perfusion techniques, both anterograde and retrograde, on top of hypothermia, to avoid any period of intraoperative brain ischemia. In this narrative review, the pathophysiology of cerebral damage during aortic surgery is described. The different options for brain protection, including hypothermia, anterograde or retrograde cerebral perfusion, are also analyzed, with a critical review of the advantages and limitations under a technical point of view. Finally, the current systems of intraoperative brain monitoring are also discussed. Full article
(This article belongs to the Special Issue State of the Art of the Management of Cardiac Surgical Intensive Care Patients)
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