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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Aortic valve repair versus mechanical valve replacement for root aneurysm: The CAVIAAR Multicentric Study.

European Journal of Heart Failure

Despite growing evidence that aortic valve repair improves long-term patient outcomes and quality of life, aortic valves are mostly replaced. We evaluate the effect of aortic valve repair versus replacement in patients with dystrophic aortic root aneurysm up to 4 years.

The multicentric CAVIAAR prospective cohort study enrolled 261 patients: 130 underwent standardized aortic valve repair (REPAIR) consisting of remodelling root repair with expansible aortic ring annuloplasty, and 131 received mechanical composite valve and graft replacement (REPLACE). Primary outcome was a composite criterion of mortality, reoperation, thromboembolic or major bleeding events, endocarditis or operating site infections, pacemaker implantation and heart failure, analyzed with propensity score-weighted Cox model analysis. Secondary outcomes included Major Adverse Valve Related Events (MAVRE) and components of primary outcome.

Mean age was 56.1 years, valve was bicuspid in 115 patients (44.7%). Up to 4 years, REPAIR did not significantly differ from REPLACE in terms of primary outcome (HR 0.66 [0.39; 1.12]), but showed significantly less valve-related deaths (HR 0.09 [0.02; 0.34]) and major bleeding events (HR 0.37 [0.16; 0.85]) without an increased risk of valve-related reoperation (HR 2.10 [0.64; 6.96]). When accounting for occurrence of multiple events in a single patient, REPAIR group had half the occurrence of MAVRE (RR 0.51 [0.31; 0.86]).

Although primary outcome did not significantly differ between REPAIR and REPLACE group, the trend is in favour of REPAIR by a significant reduction of valve-related deaths and major bleeding events. Long-term follow-up beyond 4 years is needed to confirm these findings.

Custodiol-N versus Custodiol: a prospective randomized double-blind multicenter phase III trial in patients undergoing elective coronary bypass surgery.

European Journal of Heart Failure

HTK-Solution (Custodiol) is a well-established cardioplegic and organ preservation solution. We currently developed a novel HTK-based solution, Custodiol-N, which includes iron chelators to reduce oxidative injury, as well as L-arginine, to improve endothelial function. In this first in-human study, Custodiol-N compared to Custodiol in patients undergoing elective coronary artery bypass surgery. The aim of this comparison was to evaluate the safety and ability of Custodiol-N to protect cardiac tissue.

The study was designed as a prospective randomized double-blind non-inferiority trial. Primary end-point was area under the curve (AUC) of creatine kinase MB (CK-MB) within the first 24 h after surgery. Secondary end-points included peak CK-MB and troponin-T and AUC of troponin-T release, cardiac index, cumulative catecholamine dose, ICU-stay and mortality. All values in the abstract are given as mean ± SD, p < 0.05 was considered statistically significant.

Early termination of the trial was performed per protocol as the primary non-inferiority end-point was reached after inclusion of 101 patients. CK-MB AUC (878 ± 549 vs 779 ± 439 h* U/l, non-inferiority p < 0.001, Custodiol vs Custodiol-N) and troponin-T AUC (12990 ± 8347 vs 13498 ± 6513 h*pg/ml, noninferiority p < 0.001, Custodiol vs Custodiol-N) were similar in both groups. Although the trial was designed for non-inferiority, peak CK-MB (52 ± 40 vs. 42 ± 28 U/l, superiority p < 0.03, Custodiol vs Custodiol-N) was significantly lower in the Custodiol-N group.

This study shows that Custodiol-N is safe and provides similar cardiac protection as the established HTK-Custodiol solution. Significantly reduced peak CK-MB levels in the Custodiol-N group in the full analysis set may implicate a beneficial effect on ischaemia/reperfusion injury in the setting of coronary bypass surgery.

Parsimonious risk model for predicting mortality after surgical lung biopsy for interstitial lung disease.

European Journal of Heart Failure

To develop a risk model for predicting postoperative mortality and morbidity in patients with interstitial lung disease undergoing surgical lung biopsy.

From 2004 to 2019, patients who underwent surgical lung biopsy for interstitial lung disease were included in this study. Based on the findings of the multivariable analysis using preoperative clinical variables, a risk model for predicting postoperative mortality and morbidity was developed.

During the study period, 1177 patients were enrolled. Among them, morbidity and mortality occurred in 45 (3.8%) and 29 (2.5%) patients, respectively, which gradually declined over time from 8.9% in 2004-2005 to 0% in 2018-2019. In the final multivariable analysis, the dyspnoea grade, a forced vital capacity of ≤ 60%, preoperative oxygen therapy, and preoperative intensive care unit stay were found to be the independent factors associated with both morbidity and mortality; smoking> 40 pack-years was additionally identified as a factor related to mortality. Diffusing capacity of carbon monoxide ≤ 50%, which was a significant factor in the univariable analysis, became insignificant after adjustment for the forced vital capacity in the multivariable analysis. The risk scoring system based on this model showed a good discriminant ability for both morbidity (area under the receiver operating characteristic curve [95% confidence interval]: 0.830 [0.726-0.932]) and mortality (0.887 [0.804-0.975]).

We developed a scoring system for predicting the risk of morbidity and mortality, which could help determine surgical candidates for lung biopsy among patients with interstitial lung disease.

How can the rate of nontherapeutic thymectomy be reduced?

Interactive Cardiovascular and Thoracic Surgery

To determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it.

From 2016 to 2020, consecutive patients who underwent thymectomy were retrospective reviewed. Univariable and multivariable analyses were used to identify the correlation factors of nontherapeutic thymectomy. A receiver operating characteristic (ROC) curve was analyzed to assess the cutoff threshold of factors correlated with nontherapeutic thymectomy.

A total of 1,039 patients were included in this study. Overall, 78.4% (n = 814) of thymectomies were therapeutic and 21.6% (n = 225) were nontherapeutic. Thymoma (57.9%, n = 602) was the most common diagnoses in therapeutic thymectomy. Among those of nontherapeutic thymectomy, thymic cysts (11.9%, n = 124) were the most common lesion. Compared with therapeutic thymectomy, patients with nontherapeutic thymectomy were more likely to be younger (median age 50.1 vs 55.6 years, P < 0.001) with a smaller precontrast and postcontrast CT value (p < 0.001, p < 0.001), as well as ΔCT value [10.7 vs 23.5 Hounsfield units (HU), p < 0.001]. Multivariable analysis indicated that only age and ΔCT value were significantly different between therapeutic and nontherapeutic thymectomy groups. ROC curve analysis showed that cutoff values of age and ΔCT value were 44 years and 6 HU, respectively. Patients with age ≤ 44 years and a ΔCT value ≤ 6 HU had a 95% probability of nontherapeutic thymectomy.

Surgeons should be cautious to perform thymectomy for patients with age ≤ 44 years and ΔCT value ≤6 HU. This simple clinical standard is helpful to reduce the rate of nontherapeutic thymectomy.

Early post-operative pain after subxiphoid uniportal thoracoscopic major lung resection: a prospective, single blinded, randomized controlled trial.

Interactive Cardiovascular and Thoracic Surgery

There has been inability to generalize the proposed benefit of subxiphoid uniportal thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal thoracoscopic surgery (UVATS) due to some sort of preoperative selection bias. So, we conducted this prospective, single blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who would undergo major lung resection for early-stage lung cancer.

262 patients were randomly allocated between 2 groups (each has 131 patients) according to the approach; the 1st UVATS group and the 2nd SVATS group. Numerical rating scale (NRS) of pain was collected at 24 hours and 48 hours during rest and cough. In addition, different perioperative variables were analyzed and compared between both groups.

Multiple linear regression analysis showed that type of the surgical approach was a significant predictor for postoperative NRS. NRS was significantly lower in SVATS group after 24 hours during rest and cough and after 48 hours during cough. Postoperatively, patients in SVATS groups moved out of bed significantly earlier (16.37(2.54) vs 18.05(3.29) hours, p < 0.001). SVATS group showed significant higher rate of intraoperative arrhythmia (20(15.3%) vs 3(2.3%) patients, p = 0.03).

SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than UVATS approach. Operating upon patients with cardiac problems through SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia.

The trial was registered under clinical Identifier: NCT03331588.

Giant Subaortic Left Ventricular Diverticulum with Aortic Regurgitation and Stenosis.

Interactive Cardiovascular and Thoracic Surgery

Subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly, it could be asymptomatic but sometimes develop fata...

Associated Factors And Short-Term Mortality Of Early versus Late Acute Kidney Injury Following on-pump Cardiac Surgery.

Interactive Cardiovascular and Thoracic Surgery

Acute kidney injury (AKI) is common following cardiac surgery. The aimed was to investigate characteristics of AKI occurred within 48 hours and during 48 hours to 7 days after cardiac surgery.

Patient data was extracted from Medical Information Mart for Intensive Care III (MIMIC III) database. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guideline, and divided into early (within 48 hours) and late (during 48 hours to 7 days) AKI. Multivariable logistic regression models were established to investigate risk factors for AKI. Cox proportional hazards model was used to analyze 90-day survival.

AKI occurred in 51.2% (2741/5356) patients within the first 7 days following cardiac surgery, with the peak occurrence at 36-48 hours. Incidence of early and late AKI were 41.9% and 9.2%, respectively. Patients with late AKI were older and had more comorbidities compared to early AKI patients. Risk factors associated with early AKI included age, body mass index (BMI), congestive heart failure, diabetes. While late AKI was related to atrial fibrillation, estimated glomerular filtration rate (eGFR), sepsis, norepinephrine, mechanical ventilation, packed red blood cell transfusion. In Cox proportional model, both late and early AKI were independently associated with 90-day mortality, and patients with early AKI had better survival than those with late AKI.

AKI occurred earlier was distinguishable from AKI occurred later after cardiac surgery. Time frame should be taken into consideration.

Surgical Reconstruction of a Giant Left Ventricular Aneurysm with Prior Unloading using a Microaxial-Pump.

Interactive Cardiovascular and Thoracic Surgery

A 46-year-old male patient presented with cardiac decompensation due to a giant left ventricular aneurysm combined with a severely reduced left ven...

An ACTH-secreting tumor hidden in a congenitally hypoplastic left lung.

Interactive Cardiovascular and Thoracic Surgery

Ectopic ACTH syndrome(EAS) has historically been a therapeutic challenge because of difficulty localizing occult ACTH-secreting tumors. Here we rep...

Effect of preservation solution and distension pressure on saphenous vein's endothelium.

Interactive Cardiovascular and Thoracic Surgery

Approaches to improve saphenous vein (SV) patency in coronary artery bypass graft (CABG) surgery remain relevant. This study aimed to evaluate the effects of different preservation solutions, and different pressures of intraluminal distention on the endothelium of SV segments in CABG.

42 SV segments obtained from twelve patients undergoing CABG were divided into seven groups. Group 1 (control) was prepared without preservation or intraluminal distension, while the other six groups were preserved in autologous heparinized autologous arterial blood (AAB), or normal saline (NS), with distention pressures of 30 mmHg, 100 mmHg and 300 mmHg. To assess the effects of using these solutions and pressures on the endothelium, the grafts were analyzed by scanning electron microscopy (SEM), with measurement of endothelial damage degree.

Segments in group 1 showed minimal endothelial damage. SV grafts preserved with NS had significantly greater endothelial damage both compared to the control group and compared to groups preserved with AAB (p < 0.001). Segments distended with pressures up to 100 mmHg showed less damage when compared to those distended at 300 mmHg, with the ones subjected to higher pressures presenting a maximum degree of damage, with considerable loss and separation of endothelial cells, extensive foci of exposure of the basement membrane, and numerous fractures of the intimate layer, without differences regarding the solution used.

Preparation of SV using NS and with intraluminal distension pressures above 100 mmHg are factors related to increased damage to the venous endothelium.

Surgical aortic valve replacement in patients aged 50-69 years-insights from the German Aortic Valve Registry (GARY).

European Journal of Heart Failure

The aim of this study was to analyze the outcome of patients between 50 and 69 years of age undergoing biological or mechanical aortic valve replacement.

Data was collected from the German Aortic Valve Registry (GARY). Data was analyzed regarding baseline characteristics and outcome parameters such as 5-year survival, stroke and reintervention.

3046 patients undergoing isolated SAVR between 2011 and 2012 were investigated and a propensity score matching was performed. Within this period 2239 patients received a biological prostheses, while 807 patients received a mechanical prosthesis. Mean age in the biological group was 63.07 (±5.11) and 57.34 (±4.67) in the mechanical group (SMD 1.172). In the overall cohort, there were more female patients in the biological group (32.7% vs 28.4%) and log EuroSCORE I was higher (5.41% vs 4.26). After propensity matching (610 pairs) there was no difference in the mortality at 5-year follow-up (FU) (12.1% biological vs 9.2% mechanical p = 0.05) nor for reoperation/reintervention (2.5% biological vs 2.0% mechanical, p = 0.546). Patients undergoing mechanical aortic valve replacement suffered from a higher stroke rate 3.3 vs 1.5% (p = 0.04) at 5-year-FU.

Aortic valve replacement with biological or mechanical prostheses showed similar five-year-outcomes for survival and reoperation in a propensity matched cohort, but significant increased stroke rate after mechanical aortic valve replacement. This could influence the choice of a mechanical valve in younger patients.

False lumen/true lumen wall pressure ratio is increased in acute non-A non-B aortic dissection.

Interactive Cardiovascular and Thoracic Surgery

We aimed to determine whether non-A non-B aortic dissection differs in morphologic and haemodynamic properties from type B aortic dissection.

We simulated and compared haemodynamics of patients with acute type B or acute non-A non-B aortic dissection by means of computational fluid dynamics. Wall pressure and wall shear stress in both the true lumen and false lumen at early, mid-, and late systole were evaluated. Morphology, wall shear stress, and the false lumen/true lumen wall pressure ratio were compared between groups.

Nineteen patients (type B, n = 7; non-A non-B, n = 12) were included. Median age (51 [46, 67] vs 53 [50, 63] years; P = 0.71) and a complicated course (14% vs 33%; P = 0.6) did not differ between the type B group and non-A non-B group. However, median entry tear width was increased in the non-A non-B group (9.7 [7.3, 12.7] vs 16.3 [11.9, 24.9] mm; P = 0.010). Streamlines showed, in patients with non-A non-B aortic dissection, blood from the true lumen flowed into the false lumen via the entry tear. Prevalence of a false lumen/true lumen wall pressure ratio >1.0 (type B vs non-A non-B) at early, mid-, and late systole was 57% vs 83% (P = 0.31), 43% vs 83% (P = 0.13), and 57% vs 75% (P = 0.62), respectively. Wall shear stress did not differ between the groups.

The increased false lumen/true lumen wall pressure ratio observed during systole in non-A non-B aortic dissection may beget a complicated presentation.