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Special Issue "Challenges and Opportunities in Cardiac Surgery"

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

Deadline for manuscript submissions: 22 October 2023 | Viewed by 2861

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Special Issue Editor

Dr. Federica Jiritano

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Guest Editor

Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
Interests: mechanical circulatory support; extracorporeal membrane oxygenator; aortic valve replacement; valve surgery; coronary artery bypass grafting; thrombocytopenia; inflammatory biomarkers; minimally invasive surgery

Special Issue Information

Dear Colleagues,

Cardiac surgeons have always been quick problem-solvers and efficient decision-makers. The scientific and technological advancements that have taken place in our field over the past few years highlight these qualities. However, there are significant challenges that we need to overcome. We are dealing with cases far more complicated than in the past.

In this Special Issue, entitled “Challenges and Opportunities in Cardiac Surgery”, I call for papers regarding all types of clinical research to address unmet clinical needs in cardiac surgery. Its aim is to present an overview of the current knowledge, latest evidence, and unresolved issues in this field.

Original research articles, meta-analyses, and reviews are welcome for this Special Issue. Research areas may include (but are not limited to) the following:

Redo cardiac surgery;
Cardiac surgery after endovascular or percutaneous procedures for cardiac valves or aortic diseases;
Management of prosthetic endocarditis;
Degeneration of bioprosthetic heart valves and management strategies;
Complex aortic surgery and cerebral protection;
Advances in mechanical circulatory support;
Innovative strategies in cardiopulmonary bypass management and myocardial protection;
Challenges in the perioperative management of cardiac surgery patients;
Minimally invasive cardiac surgery;
Education and training in cardiothoracic surgery.

Dr. Federica Jiritano
Guest Editor

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
redo cardiac surgery
prosthetic heart valve degeneration
mechanical circulatory support
myocardial protection, aortic surgery
heart valve surgery
prosthetic endocarditis

Published Papers (4 papers)

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Research

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Open AccessArticle

Combining Machine Learning and Urine Oximetry: Towards an Intraoperative AKI Risk Prediction Algorithm

Lars Lofgren

Natalie Silverton

and

Kai Kuck

J. Clin. Med. 2023, 12(17), 5567; https://doi.org/10.3390/jcm12175567 - 26 Aug 2023

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Abstract

Acute kidney injury (AKI) affects up to 50% of cardiac surgery patients. The definition of AKI is based on changes in serum creatinine relative to a baseline measurement or a decrease in urine output. These monitoring methods lead to a delayed diagnosis. Monitoring the partial pressure of oxygen in urine (PuO₂) may provide a method to assess the patient’s AKI risk status dynamically. This study aimed to assess the predictive capability of two machine learning algorithms for AKI in cardiac surgery patients. One algorithm incorporated a feature derived from PuO₂ monitoring, while the other algorithm solely relied on preoperative risk factors. The hypothesis was that the model incorporating PuO₂ information would exhibit a higher area under the receiver operator characteristic curve (AUROC). An automated forward variable selection method was used to identify the best preoperative features. The AUROC for individual features derived from the PuO₂ monitor was used to pick the single best PuO₂-based feature. The AUROC for the preoperative plus PuO₂ model vs. the preoperative-only model was 0.78 vs. 0.66 (p-value < 0.01). In summary, a model that includes an intraoperative PuO₂ feature better predicts AKI than one that only includes preoperative patient data. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Cardiac Surgery)

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Open AccessArticle

The Association of Infection with Delirium in the Post-Operative Period after Elective CABG Surgery

and

J. Clin. Med. 2023, 12(14), 4736; https://doi.org/10.3390/jcm12144736 - 17 Jul 2023

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Abstract

Delirium is one of the most common complications of coronary artery by-pass graft (CABG) surgery. The identification of patients at increased risk of delirium and the implementation of preventive measures to reduce the risk of postoperative delirium is necessary to improve treatment outcomes after CABG. The aim of this study was to assess the association between postoperative delirium and postoperative infection and 10-year mortality in patients undergoing CABG surgery. This is a retrospective, observational cohort study of patients undergoing planned on-pump CABG between April 2010 and December 2012. We analysed a group of 3098 patients operated on in our cardiac surgery centre, from whom we selected a cohort of patients undergoing planned CABG surgery. All patients were assessed for postoperative infection, such as pneumonia, bloodstream infections (BSIs) and surgical site infections (SSIs). Patients who experienced postoperative delirium were significantly more likely to have infection (7.4% vs. 22%; p = 0.0037). As regards particular types of infection, significant differences were only found for pneumonia and sternal SSIs. Patients who experienced postoperative delirium had significantly lower 5-year (p = 0.0136) and 10-year (p = 0.0134) survival. Postoperative delirium significantly increases long-term mortality in patients undergoing CABG surgery. Pneumonia and sternal SSIs significantly increase the risk of postoperative delirium in cardiac surgery patients. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Cardiac Surgery)

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Open AccessArticle

Impact of Post-Operative Infection after CABG on Long-Term Survival

and

J. Clin. Med. 2023, 12(9), 3125; https://doi.org/10.3390/jcm12093125 - 25 Apr 2023

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Abstract

Coronary artery bypass grafting (CABG) is one of the most common cardiac surgical procedures. It is commonly known that post-operative infection has a negative impact on the patient’s short-term treatment outcomes and long-term prognosis. The aim of the present study was to assess the impact of perioperative infection on 5-year and 10-year survival in patients undergoing elective on-pump CABG surgery. The present prospective observational study was carried out between 1 July 2010 and 31 August 2012 among patients undergoing cardiac surgery at our centre. Infections were identified according to the ECDC definitions. We initially assessed the incidence of infection and its relationship with the parameters analysed. We then analysed the effect of particular parameters, including infection, on 5-year and 10-year survival after surgery. We also analysed the impact of particular types of infection on the risk of death within the period analysed. The significant risk factors for reduced survival were age (HR 1.05, CI 1.02–1.07), peripheral artery disease (HR 1.99, CI 1.28–3.10), reduced LVEF after surgery (HR 0.96, CI 0.94–0.99), post-operative myocardial infarction (HR 1.45, CI 1.05–2.02) and infection (HR 3.10, CI 2.20–4.28). We found a strong relationship between post-operative infections and 5-year and 10-year mortality in patients undergoing CABG. Pneumonia and BSI were the only types of infection that were found to have a significant impact on increased long-term mortality after CABG surgery. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Cardiac Surgery)

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Review

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Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection

and

J. Clin. Med. 2023, 12(6), 2271; https://doi.org/10.3390/jcm12062271 - 15 Mar 2023

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Abstract

Background: Perioperative stroke remains a devastating complication in the operative treatment of acute type A aortic dissection. To reduce the risk of perioperative stroke, different perfusion techniques can be applied. A consensus on the preferred cerebral protection strategy does not exist. Methods: To provide an overview about the different cerebral protection strategies, literature research on Medline/PubMed was performed. All available original articles reporting on cerebral protection in surgery for acute type A aortic dissection and neurologic outcomes since 2010 were included. Results: Antegrade and retrograde cerebral perfusion may provide similar neurological outcomes while outperforming deep hypothermic circulatory arrest. The choice of arterial cannulation site and chosen level of hypothermia are influencing factors for perioperative stroke. Conclusions: Deep hypothermic circulatory arrest is not recommended as the sole cerebral protection technique. Antegrade and retrograde cerebral perfusion are today’s standard to provide cerebral protection during aortic surgery. Bilateral antegrade cerebral perfusion potentially leads to superior outcomes during prolonged circulatory arrest times between 30 and 50 min. Arterial cannulation sites with antegrade perfusion (axillary, central or carotid artery) in combination with moderate hypothermia seem to be advantageous. Every concept should be complemented by adequate intraoperative neuromonitoring. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Cardiac Surgery)

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Special Issue "Challenges and Opportunities in Cardiac Surgery"

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