The latest medical research on Cardiothoracic Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cardiothoracic surgery gathered by our medical AI research bot.

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Robotics vs Laparoscopy in Foregut Surgery: Systematic Review and Meta-Analysis Analyzing Hiatal Hernia Repair and Heller Myotomy.

Journal of the

Laparoscopic surgery remains the mainstay of treating foregut pathologies. Several studies have shown improved outcomes with the robotic approach. A systematic review and meta-analysis comparing outcomes of robotic and laparoscopic hiatal hernia repairs (HHR) and Heller myotomy (HM) repairs is needed.

PubMed, Embase and Scopus databases were searched for studies published between January 2010 and November 2022. The risk of bias was assessed using the Cochrane ROBINS-I tool. Assessed outcomes included intra- and post-operative outcomes. We pooled the dichotomous data using the Mantel-Haenszel random effects model to report odds ratio (OR) and 95% confidence intervals (95% CIs) and continuous data to report mean difference (MD) and 95% CIs.

Twenty-two comparative studies enrolling 196,339 patients were included. Thirteen (13,426 robotic, 168,335 laparoscopic patients) studies assessed HHR outcomes, while nine (2,384 robotic, 12,225 laparoscopic patients) assessed HM outcomes. Robotic HHR had a non-significantly shorter length of hospital stay (LOS) [MD -0.41 (95% CI -0.87, -0.05)], fewer conversions to open [OR 0.22 (95% CI 0.03, 1.49)], and lower morbidity rates [OR 0.76 (95% CI 0.47, 1.23)]. Robotic HM led to significantly fewer esophageal perforations [OR 0.36 (95% CI 0.15, 0.83)], reinterventions [OR 0.18 (95% CI 0.07, 0.47)] a non-significantly shorter LOS [MD -0.31 (95% CI -0.62, 0.00)]. Both robotic HM and HHR had significantly longer operative times.

Laparoscopic and robotic HHR and HM repairs have similar safety profiles and perioperative outcomes. Randomized controlled trials are warranted to compare the two methods, given the low to moderate quality of included studies.

Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive esophagectomy.

Cardiothoracic Surgery

Severe pulmonary complications such as postoperative respiratory failure can occur after minimally invasive oesophagectomy. However, the risk factors have not been well identified. This study aimed to develop a predictive model for the occurrence of postoperative respiratory failure with a large sample.

We collected data from patients with oesophageal cancer who received minimally invasive oesophagectomy at Shanghai Chest Hospital from 2019 to 2022. Univariable and backward stepwise logistic regression analysis of 19 pre- and intraoperative factors were used before model fitting, and its performance was evaluated with the receiver operating characteristic curve. Internal validation was assessed with calibration plot, decision curve analysis, and area under curve with its 95% confidence intervals, obtained from 1000 resamples set by Bootstrap method.

This study enrolled 2,386 patients, of which 57 (2.4%) patients developed postoperative respiratory failure. Backward stepwise logistic regression analysis revealed that age, BMI, cardiovascular disease, diabetes, diffusion capacity of the lungs for carbon monoxide, tumour location, and duration of chest surgery ≥101.5mins were predictive factors. A predictive model was constructed and showed acceptable performance (Area Under Curve: 0.755). The internal validation with the Bootstrap method proves the good agreement for prediction and reality.

Obesity, severe diffusion dysfunction and upper segment oesophageal cancer were strong predictive factors. The established predictive model has acceptable predictive validity for postoperative respiratory failure after minimally invasive oesophagectomy, which may improve the identification of high-risk patients and enable healthcare professionals to preform risk assessment for postoperative respiratory failure at the initial consultation.

Sex differences in Long-Term survival after total arterial coronary artery bypass grafting.

Cardiothoracic Surgery

It is uncertain if the evidence on improved long-term survival of total arterial coronary artery bypass grafting applies to in female patients. This study aims to compare the long-term survival outcomes of using total arterial revascularisation versus at least one saphenous vein graft separately for men and women.

This retrospective analysis of the Australian and New Zealand Society of Cardiac-Thoracic Surgical Database had administrative linkage to the National Death Index. We identified all patients undergoing primary isolated coronary bypass from June 2001 to January 2020 inclusive. Following sex stratification, propensity score matching with 36 variables and Cox proportional hazard regression were used to facilitate adjusted comparisons. A Cox interaction-term analysis was performed to investigate the impact of sex on TAR survival benefit. The primary outcome was all-cause mortality.

Of the 69,624 eligible patients receiving at least two grafts, 13,019 (18.7%) were female patients. Matching generated 14,951 male and 3,530 female pairs. Compared to vein-dependent procedures, total arterial revascularization was associated with significantly reduced incidence of long-term all-cause mortality for both male (HR, 0.86; 95% CI, 0.81-0.91; P < 0.001) and female (HR, 0.82; 95% CI, 0.73-0.91; P < 0.001) cohorts. Interaction term analysis indicated no significant subgroup effect from sex (P = 0.573) on the survival advantage of total arterial revascularization. The treatment effect provided by total arterial revascularisation remained significant across most sex-stratified disease subgroups.

Total arterial revascularization, when compared to the use of at least one saphenous vein graft, provides comparable superior long-term survival outcomes in both females and males.

Configuration of the neo-aortic root after chimney reconstruction in the norwood procedure.

Cardiothoracic Surgery

After staged reconstruction for hypoplastic left heart syndrome (HLHS), the neoaortic root tends to dilate, and the incidence of significant neoaortic valve insufficiency increases with time. This study aimed to evaluate the mid-term outcomes of the neoaortic root geometries and valve function after chimney reconstruction in the Norwood procedure.

Between 2013 and 2021, 20 consecutive patients who underwent chimney reconstruction during the Norwood procedure for HLHS and its variants in our institution were enrolled. The actual diameters of the following points were measured, and Z-scores were calculated based on the normal aortic root geometries using the long axis view of echocardiography at the pre-Norwood stage and the lateral view of angiography at pre-Glenn, pre-Fontan, post-Fontan, and follow-up (age 5-6 years) stages: neoaortic valve annulus; sinus of Valsalva; sinotubular junction; and ascending aorta just proximal to the anastomosis to the aortic arch. The degree of neoaortic valve regurgitation was evaluated by echocardiography at each stage.

The median follow-up period was 3.9 years. Neo-aortic roots after chimney reconstruction were spared from progressive dilation over time. With growth, the conical configuration of the neoaortic roots was preserved without geometrical distortion. The Z-scores of the annulus, sinus of Valsalva, sinotubular junction, and ascending aorta ranged roughly from 4 to 6, 4 to 6, 2 to 4, and 0 to 2, respectively. All neoaortic valves at each stage had mild or no regurgitation.

Chimney reconstruction prevented neoaortic root dilation and avoided significant neoaortic valve regurgitation in the mid-term. These neoaortic dimensions with smooth flow profiles in the neo-aorta after chimney reconstruction may have contributed to the current results. Further studies are needed to clarify the long-term outcomes.

Population-based study on surgical care for primary spontaneous pneumothorax.

Cardiothoracic Surgery

The optimal surgical strategy for primary spontaneous pneumothorax remains a matter of debate and variation in surgical practice is expected. This variation may influence clinical outcomes, such as postoperative complications and length of stay. This national population-based registry study provides an overview and extent of variability of current surgical practice and outcomes in the Netherlands.

To identify national patterns of care and between-hospital variability in the treatment of primary spontaneous pneumothorax, patients who underwent surgical pleurodesis and/or bullectomy between 2014- 2021, were identified from the Dutch Lung Cancer Audit-Surgery database. The type of surgical intervention, postoperative complications, length of stay and ipsilateral recurrences were recorded.

Out of 4,338 patients, 1,851 patients were identified to have primary spontaneous pneumothorax. The median age was 25 years (interquartile range 20-31) and 82% was male. The most performed surgical procedure was bullectomy with pleurodesis (83%). The overall complication rate was 12% (Clavien Dindo grade ≥III 6%), with the highest recorded incidence for persistent air leak >5 days (5%). Median postoperative length of stay was 4 days (interquartile range 3-6) and 0.7% underwent a repeat pleurodesis for ipsilateral recurrence. Complication rate and length of stay differed considerably between hospitals. There were no differences between the surgical procedures. In the Netherlands, surgical patients with primary spontaneous pneumothorax are preferably treated with bullectomy plus pleurodesis. Postoperative complications and length of stay vary widely and are considerable in this young patient group. This may be reduced by optimization of surgical care.

Acute cement dust poisoning: Rigid bronchoscopy and mechanical insufflation-exufflation as an effective and novel treatment for its management.

Cardiothoracic Surgery

This clinical case shows the repercussions of acute exposure to cement dust in the respiratory tract and other mucous membranes. Following a cement...

Examining online international health professions education: a mixed methods review of barriers, facilitators, and early outcomes★.

Journal of Extra-Corporeal Technology

Access to quality healthcare education across the world is disproportionate. This study explores the potential for Cardiovascular Perfusion education to be delivered online to reach international students.

Exploratory mixed methods were used to identify the barriers, facilitators, and early outcomes of online international health professions education.

Qualitative analysis yielded four primary and nine subthemes. Multiple interventions were implemented in the planning of a novel online international Extracorporeal Science (ECS) program based on these themes. Quantitative data from the first semester of the new ECS program was collected along with data from the traditional entry-level program and historic data from previous entry-level cohorts. No significant correlations or differences were found between students. Student satisfaction surveys were determined to be equivalent for each group. Mixed data analysis revealed exceptional student satisfaction in areas where qualitative feedback was incorporated into the program design.

Online international education may be a viable option in the health professions. Barriers and facilitators to this mode of education were identified and utilized in designing one such program. Early outcomes from the novel ECS program reveal that student performance and satisfaction are equivalent to those of a traditional in-person training program.

Preliminary report of extracorporeal blood purification therapy in patients receiving LVAD: Cytosorb or Jafron HA330.

Journal of Extra-Corporeal Technology

Left ventricular assist device (LVAD) candidates are at increased risk of immune dysregulation and infectious complications. To attenuate the elevated proinflammatory cytokine levels and associated adverse clinical outcomes, it has been postulated that extracorporeal blood purification could improve the overall survival rate and morbidity of patients undergoing LVAD implantation.

We retrospectively reviewed prospectively collected data of 15 patients who underwent LVAD implantation at our center between January 2021 and March 2022. Of these, 15 (100%) who received HeartMate 3™ (St. Jude Medical, Abbott, MN, USA) device were eligible. Intraoperatively, patients were single randomized 1:1:1 to three groups: group 1, patients who received Cytosorb therapy (n = 5; installed in the CPB circuit); group 2, patients who received Jafron HA330 (n = 5; installed in the CPB circuit); and control group 3, patients who did not receive filter (n = 5; usual care, neither Cytosorb nor Jafron during CPB). Baseline patient characteristics and intraoperative data were compared between the groups. Blood sample analyses were performed to assess the levels of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) in both preoperative and postoperative data.

Baseline patient characteristics were similar in all three groups. We found that IL1α; IL 6; IL8; Lactatedehydrogenase, PCT, pro-BNP, CRP; Leukocyte, and TNFα levels significantly increased with LVAD implantation and that neither Cytosorb nor Jafron influenced this response. In-hospital mortality and overall survival during follow-up were similar among the groups.

Our preliminary results showed that hemoadsorption therapy using Cytosorb or Jafron hemoadsorption (HA) 330 may not be clinically beneficial for patients with advanced heart failure undergoing LVAD implantation. Large prospective studies are needed to evaluate the potential role of HA therapy in improving outcomes in patients undergoing LVAD implantation.

Perfusion techniques for an 800 g premature neonate undergoing Arterial Switch Procedure for Transposition of the Great Arteries★.

Journal of Extra-Corporeal Technology

Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth cent...

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout.

Journal of Extra-Corporeal Technology

The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy.

A thorough search of relevant studies on ECMO circuits and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria.

In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve the safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.

Advocating for an open communication culture in perfusion and cardiothoracic community: a call to action.

Journal of Extra-Corporeal Technology

This article advocates for an open communication culture in the perfusion and cardiothoracic community to enhance patient safety during surgery. Al...

Self-reported preoperative depressive symptoms and survival after cardiac surgery.

Cardiothoracic Surgery

Depression has been associated with increased cardiovascular morbidity and mortality. This study aimed to determine whether self-reported preoperative depressive symptoms were associated with worse long-term survival in patients undergoing cardiac surgery.

This population-based, observational cohort study included patients who had undergone cardiac surgery at Karolinska University Hospital between 2013 and 2016. Self-reported data about depressive symptoms were collected using the Patient Health Questionnaire (PHQ-9) and other patient data were collected from the institutional surgical database and medical charts. Depression was defined as a PHQ-9 score ≥10. Weighted flexible parametric survival models were used to estimate the association between self-reported preoperative depressive symptoms and all-cause mortality and to quantify absolute survival differences.

Of the 1120 study patients, 162 (14.5%) had depressive symptoms before cardiac surgery. During a mean follow-up of 7.2 years (maximum, 9.2 years), there were 36 deaths in 1129 person-years (PYs) in the depressed group, compared to 160 deaths in 6889 PYs in the non-depressed group. In the adjusted analysis, self-reported depressive symptoms were associated with worse long-term survival (HR = 1.66; 95% CI, 1.09-2.54) compared with no reported depressive symptoms. The absolute survival differences (% and 95% CI) between the non-depressed and the depressed patients were -1.9 (-3.9-0.19), -5.7 (-11- -0.01), and -9.7 (-19- -0.4) after 1, 5, and 8 years, respectively.

Self-reported preoperative depressive symptoms were associated with worse long-term survival following cardiac surgery and should be regarded as important as other classical risk factors.