Cross-clamping Research Articles

The Use of Arterial Blood Gases Analysis to Evaluate Lung Injury in Children with Congenital Heart Disease Disease who Undergo On-pump Cardiac Surgery

Abstract: congenital heart disease is a defect in the heart or great vessel discovered during infancy or later in life. Congenital heart disease is divided into acyanotic and cyanotic. Surgery is the main therapeutic option for any congenital heart disease. The cardiopulmonary bypass has advancements in open heart surgery. It provides circulatory and respiratory support. Aortic cross-clamp is necessary in most open heart surgeries to isolate the heart from circulation. Patients undergoing cardiac surgery on cardiopulmonary bypass often have disturbances in arterial blood gases, including partial pressure of oxygen, partial pressure of carbon dioxide, PH value, and bicarbonate. Aim of study: The study aimed to investigate the serial changes in arterial blood gases before, during, and after open heart surgery and to find the correlation between these changes and aortic cross-clamp time. Conclusion: This study finds the partial pressure of carbon dioxide is more predictive of lung injury after open heart surgery than the P/F ratio in cyanotic cases. While in acyanotic cases, the P/F ratio and partial pressure of carbon dioxide are important to determine lung injury. Also, this study finds that the prolonged cross-clamp time increases lung injury after open heart surgery.

Surgical treatment of retroperitoneal liposarcoma using the technology of endoprosthetic replacement of the abdominal aorta and left common iliac artery with an endoprosthesis

Soft tissue sarcomas are rare malignancies, accounting for approximately 1% of all malignancies in adults, with approximately 15–20% of all soft tissue sarcomas arising in the retroperitoneal space. Guidelines for the surgical treatment of retroperitoneal sarcomas are still lacking. Criteria for unresectability remain unclear, and indications and compliance with surgical treatment vary. A special focus is made on vascular resections in retroperitoneal sarcomas. Surgical intervention with resection of the main vessels in case of their involvement allows for a radical operation and naturally improves long-term results. However, only isolated cases of surgical interventions with resection of the main vessels for retroperitoneal sarcomas are described in the literature. The article describes a unique clinical case of a two-stage successful surgical treatment of a patient with retroperitoneal liposarcoma and invasion of the aorta and left common iliac artery. At the first stage, an intravascular graft stent was installed. The second stage was en bloc tumor removal, nephrectomy and left hemicolectomy, resection of the infrarenal segment of the abdominal aorta and left common iliac artery. The discussion provides an analysis of publications on the role of vascular resections in retroperitoneal sarcomas. The technique of two-stage surgical treatment using endoprosthetics of the main vessel at the first stage, compared to one-stage resection and prosthetics, used in our work has a number of advantages: no need for intraoperative prosthetics of the vessel; no clamping of the abdominal aorta and iliac arteries to form anastomoses; minimal blood loss and reduced surgery time; reduced risk of thrombosis and embolism. Taking into account the above advantages, this technique can be recommended for retroperitoneal sarcomas with invasion of the main vessels.

Implantation of a sutureless aortic valve into the ring of a mechanical valve: an extreme solution for extreme cases.

Reoperations due to dysfunction of artificial mechanical aortic valves represent a complex and high-risk surgical procedure, particularly for elderly patients. In this report, we present a case of an 81-year-old female patient where, due to structural degeneration of the mechanical valve, an emergency surgical procedure was indicated. After the removal of the valve leaflets, a sutureless aortic valve was implanted within the mechanical ring. In our case, we demonstrate that such an approach is a safe alternative for high-risk patients, who cannot undergo percutaneous procedures. By reducing the duration of cardiopulmonary bypass and aortic clamping, the surgical outcomes and complication rates can be significantly improved.

Growth Differentiation Factor 15 as a Biomarker for Risk Stratification in the Cardiothoracic Surgery Intensive Care Unit.

Growth Differentiation Factor 15 (GDF15) is an emerging biomarker that significantly increases during acute stress responses, such as infections, and is moderately elevated in chronic and inflammation-driven conditions. While evidence suggests that high levels of GDF15 in cardiac surgery are associated with worse outcomes, its utility as an evaluator of early postoperative complications remains unclear. This study aims to characterize the postoperative profile of GDF15 in patients undergoing isolated surgical aortic valve replacement, evaluating its association with short-term outcomes. Serum samples from patients undergoing cardiac surgery were collected preoperatively and at defined postoperative time points (1 h, 6 h, 12 h, 24 h, and 48 h) to measure GDF15 levels. GDF15 levels significantly increased after surgery, peaking at 6 h. A positive correlation was observed between GDF15 levels and both cardiopulmonary bypass and aortic cross-clamp times. Notably, patients who developed postoperative acute kidney injury (AKI) or required prolonged hemodynamic support had significantly higher GDF15 levels, with increased mechanical ventilation time and extended intensive care unit length of stay. Furthermore, GDF15 levels correlated with postoperative SOFA scores at 24 h after surgery. GDF15 may be a valuable biomarker for risk stratification and guiding therapeutic decisions in cardiac surgery patients. Higher GDF15 levels were significantly associated with prolonged hemodynamic support, postoperative AKI, and measures of illness severity.

Effect of lactate levels on extubation time in coronary artery bypass grafting surgery.

In current practice, fast-track protocols are gaining importance in patients undergoing cardiac surgery. For this purpose, besides different application techniques, biomarkers are frequently examined in the peri-operative period. We aimed to examine whether serum lactate levels at different peri-operative intervals had an effect on the extubation time. The patients were analysed in two groups according to the extubation time (early < 6 hours, and late extubation > 6 hours). Individual characteristics, co-existing diseases, blood transfusion, inotropic support, intra-aortic balloon pump, cardiopulmonary bypass time, aortic cross-clamp time, and the serial measurements of serum lactate levels were recorded. Correlations of serial measurements of lactate levels and the peri-operative variables with extubation times were analysed. No significant differences were observed between the groups in terms of co-existing diseases and individual characteristics. However, cardiopulmonary bypass, aortic cross-clamp times and all lactate levels after aortic cross-clamping were found to be significantly different (p = 0.001). A statistically significant correlation was found between the cut-off value of 1.7 for serum lactate levels after aortic-cross clamping (L2); 1.9 for levels after aortic cross-clamp removal (L3); 2.2 for levels after cardiopumonary bypass (L4); 2.1 for levels after intensive care admission (L5); 1.7 for levels after first postoperative hour in the intensive care unit (L6), and 1.8 for the difference between pre-operative levels (L0) and the peak level of lactate in the peri-operative period (ΔL) in predicting extubation time (p < 0.01). We concluded that cardiopulmonary bypass and aortic cross-clamp times, and intra-operative serum lactate levels were important in predicting early extubation after isolated coronary artery bypass graft surgery.

Role of del Nido Cardioplegia Solution in Prolonged Aortic Cross-clamp Cardiac Surgery: A Prospective Study.

The myocardial-protective effect of del Nido cardioplegia solution was evaluated in adult patients undergoing prolonged aortic cross-clamping during cardiac surgery. Prospective cohort. Single-center tertiary academic medical center. A total of 462 patients scheduled for cardiac surgery under cardiopulmonary bypass with an expected aortic cross-clamp time >120 minutes between January 2020 and January 2024 were enrolled. Patients with an expected aortic cross-clamp time >120 minutes were randomly assigned to low- and high-risk del Nido and Buckberg groups, with 112 patients in each group. Serum levels of cardiac troponin T and creatine kinase-MB were measured at 1, 24, and 48 hours after operation. The occurrence of atrial fibrillation within 48 hours postoperatively and other intraoperative and postoperative parameters were recorded. No significant differences were observed in preoperative parameters between the groups. The level of cardiac troponin T was significantly higher in the low-risk del Nido group than in the Buckberg group at 24 hours postoperatively (p < 0.05). However, no significant differences were observed in cardiac troponin T or creatine kinase-MB levels at the other time points. The incidence of postoperative atrial fibrillation in the Buckberg group at 48 hours was significantly higher than the del Nido group in both the low- and high-risk groups (p < 0.05). The incidence of postoperative atrial fibrillation at 48 hours was significantly lower in the del Nido group than in the Buckberg group. del Nido cardioplegia solution can be safely used for high-risk patients undergoing prolonged aortic cross-clamping.

The Relationship between Aortic Clamping Time and Platelet-lymphocyte Ratio in Isolated Coronary Artery Bypass Surgery

Objectives: This study aims to evaluate the relationship between aortic clamp duration acute coronary syndrome (ACS) and platelet-to-lymphocyte ratio (PLR) in patients undergoing isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: This retrospective study included 96 patients who underwent elective isolated CABG at a single center between June 2021 and September 2023. Patients were divided into two groups according to median ACS: Group I (ACS &lt;66.2 min, n=54) and Group II (ACS &gt;66.2 min, n=42). Demographic data, pre-operative and 24-h post-operative platelet and lymphocyte counts, and operative details were recorded. PLR was calculated using the platelet/ lymphocyte formula. Statistical analyses were performed using IBM Statistical Packages for the Social Sciences 25.0. Results: The mean ages of Group I and Group II were 63.6±8.8 and 66±8.9 years, respectively (p&gt;0.05). There was no significant difference in pre- and post-operative PLR values between the groups (p&gt;0.05). There was no correlation between post-operative PLR and the duration of CPB and ACS (p&gt;0.05). However, there was a strong positive correlation between CPB and ACS durations (p&lt;0.001). Conclusion: The study revealed that there was no significant correlation between post-operative PLR and perioperative ACS and CPB durations. While post-operative PLR increased significantly in both groups, this increase was not associated with the duration of ACS or CPB. PLR may be a useful biomarker in determining inflammation and adverse outcomes in CABG, but larger-scale, randomized, prospective studies are needed to confirm these findings.

Near-infrared spectroscopy during organ donation in brain-dead patients

Near-infrared spectroscopy (NIRS) is essential for monitoring cerebral oxygenation in anaesthesia and critical care, offering non-invasive insights into regional cerebral oxygen saturation (rSO2). However, extracerebral contamination can compromise NIRS accuracy. The O3™ regional oximetry system, with its advanced multi-wavelength technology, may contribute by providing more accurate measurements. In a study involving brain-dead organ donors, near-normal rSO2 values were initially observed despite cerebral anoxia, suggesting extracerebral signal interference. Following aortic clamping and cessation of circulation, rSO2 levels dropped but remained above zero, indicating potential limitations in accurately detecting severe hypoxia. This case study demonstrated the effectiveness of the O3™ system in monitoring rSO2 in such critical situations, uniquely supported by the cerebral haemoglobin index, oxygenated haemoglobin index, and deoxygenated haemoglobin index. The findings emphasise the importance of understanding oxygen transport mechanisms and haemoglobin affinity to accurately interpret NIRS data, especially in brain-dead patients and organ donation procedures.

Impact of Enhanced Recovery After Surgery protocol with multimodal anesthesia on perioperative outcomes after open abdominal aortic aneurysm repair.

Enhanced Recovery After Surgery (ERAS) clinical pathways have demonstrated improved perioperative outcomes after major surgery. However, its adoption within vascular surgery has been limited. In this study, we examined the impact of an ERAS protocol with multimodal anesthesia on open abdominal aortic aneurysm (AAA) repair by comparing early outcomes before and after its implementation. This retrospective study analyzed early outcomes after elective open repairs of intact AAA performed from 2013 to 2023 at a single institution. Eighty consecutive patients treated after implementation of an ERAS protocol with multimodal anesthesia were compared with 161 patients treated before its implementation. Propensity score matching based on age, gender, body mass index, Vascular Quality Initiative AAA Mortality Risk Score, Rockwood Frailty Scale, aortic cross clamp location, aneurysm size, and type of exposure was performed to achieve one:one matching using the nearest neighbor technique. Quantile and logistic regression assessed the impact of the ERAS protocol on length of stay, 30-day mortality, opioid consumption (morphine milligram equivalents), hospital cost, complications, and readmissions. Both groups (ERAS vs pre-ERAS, respectively) were predominantly male (80% vs 73%; P= .27), with a median age of 74years. Similar mean Vascular Quality Initiative predicted mortality (2.9% vs 4.0%; P= .13), clinical frailty score (3.1 vs 3.3; P= .17), aneurysm size (60 mm vs 62mm; P= .06), rates of suprarenal cross-clamp (76% vs 88%; P= .07), chronic obstructive pulmonary disease (29% vs 31%; P= .73), chronic kidney disease (14% vs 16%; P= .66), myocardial disease (16% vs 20%; P= .54), and cerebrovascular disease (15% vs 19%; P= .53) were observed in the matched groups. ERAS was associated with a reduction in length of stay by 3days (P< .001), a decrease in opioid consumption by 37 morphine milligram equivalents (P< .001), and a reduction in hospital costs by US$4704 (P< .001). There was a trend toward a lower risk of major complications (odds ratio, 0.44; 95% confidence interval, 0.2-1.1; P= .06). Thirty-day mortality (5% vs 6.3%; P=.73) and readmission (7.9% vs 13.2%; P= .29) rates were similar in both groups. An ERAS protocol using a multimodal anesthesia was associated with improved early outcomes compared with patients treated before ERAS implementation. These results mirror similar benefits seen in nonvascular ERAS programs, and broader application should be considered in institutions that perform a high volume of open aortic repairs.

Incidence Rate of Post Coronary Artery Shunt Complications; Age Dependent!

Numerous complications, such as postoperative arrhythmia and stroke, have been observed following coronary artery bypass graft (CABG) surgery. This study sought to examine the impact of aging on the incidence of post-coronary artery shunt complications. Aging is a physiological process experienced by every living cell, beginning early in development. Age plays a crucial role in determining postoperative complications, including those related to CABG. A retrospective analysis was conducted on 290 patients who underwent CABG at the Mordovian Republic Hospital between 2017 and 2021. The sample was divided into two age-based groups: the first group comprised 126 patients (mean age range: 55.21-60.00), and the second group included 163 patients (mean age range: 66.11-80.00). Statistical analyses employed in this study encompassed descriptive statistics, Chi-square test, T-test, one-way ANOVA test, ROC analysis, and Pearson correlation using Statistica 12 software. Elderly patients in the second group demonstrated a higher incidence of post-CABG arrhythmia (p < 0.012528). Moreover, the second group experienced markedly longer ICU and total hospitalization days following CABG, with p-values of less than 0.000000 and 0.000072, respectively. Notably, elderly individuals in the second group faced an increased risk of developing psychosis after CABG surgery (p < 0.007379). Furthermore, psychosis was found to be significantly associated with longer ICU hospitalization (p < 0.000140). Postoperative stroke occurred more frequently among the elderly (second group) with a p-value of less than 0.037736. Consequently, postoperative stroke was associated with extended ICU hospitalization (p < 0.000747). The usage of internal thoracic arteries (ITAs) was lower among the elderly (second group), with a p-value of less than 0.016145. Regarding correlations, a direct association was observed between age and ICU days, total hospitalization days, and the number of complications, with correlation coefficients (r) of 0.189046, 0.141415, and 0.138565, respectively. Elderly individuals in the second group who undergo CABG face a greater risk of developing psychosis, arrhythmia, prolonged total and ICU hospitalization, and stroke. The presence of arrhythmia, which is commonly observed in patients aged 63 years and older, significantly affects total hospitalization days. The number of complications is influenced by age, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, ICU hospitalization, and total hospitalization duration.

Early Patient Outcome and Left Ventricular Function After Mitral Valve Replacement Using a Tilting Disc Mechanical Valve With Total Preservation of Mitral Valvular Apparatus.

Introduction The study aimed to retrospectively evaluate the early patient outcome and left ventricular function after mitral valve replacement with a tilting disc valve and total preservation. Patients and methods This retrospective observational study includes patients who underwent mitral valve replacement using a tilting disc valve with total preservation of mitral valvular and subvalvular apparatus from July 2021 to August 2022 at a single center. Results The data were reviewed retrospectively for age, sex, comorbidities, operating time, aortic cross-clamp time, cardiopulmonary bypass time, preoperative and postoperative left ventricular ejection fraction, mean gradient across the mitral valve, left ventricular diameter, left atrial size, atrial fibrillation, complications, mortality, and early patient outcome. Echocardiographic and clinical data were compared for the preoperative and postoperative periods. A significant difference in the preoperative and postoperative left atrial size, pulmonary arterial pressure, New York Heart Association class, and mean gradient across the mitral valve was found. However, the difference between the preoperative and postoperative ejection fraction and left ventricular diameter in systole and diastole was not significant. Conclusion Early patient outcome after mitral valve replacement with a tilting disc valve and total preservation of mitral valvular apparatus gives good results with minimal morbidity and mortality. Favorable patient outcomes in this study lay to rest any skepticism regarding total preservation while using a tilting disc valve. The technique of total preservation is safe while using a tilting disc valve, and it helps in the preservation of the left ventricular ejection fraction and gives a low gradient across the valve.

Mid-term outcome and quality of life after Bentall procedure: single-center experience

The aim – to evaluate the mid-term results and quality of life of patients who underwent Bentall procedure.Materials and methods. The research included 55 patients who underwent planned surgical treatment at the Heart Institute of Ministry of Health of Ukraine from 2015 to 2023. The mean age of the 55 patients (53 (96.36 %) males), who underwent the Bentall procedure (composite graft replacement of the aortic root), was 52.36 ± 1.56 years. We analyzed basic characteristics of the patients, intraoperative and postoperative data. The quality of life was assessed before and in the mid-term period after operations by the Medical Outcomes Study Short Form 36 (MOS SF-36) questionnaire.Results. An average duration of the follow-up period was (3.61 ± 0.28) (СІ 3.05–4.16) years ranging from 1.0 to 9.0 years. Overall, in-hospital mortality and 30-day mortality was 1.89 % (n = 1). The only case of death was caused by the acute respiratory distress syndrome. The 5-year survival rate was 94.61 ± 3.10 % for all patients. It is reasonable to say that all 3 cases of death were due to a non-cardiac cause, i.e. stroke, malignancy and acute abdomen. The average duration of the operations was 244.48 ± 7.67 minutes, the total duration of artificial blood circulation was 138.73 ± 6.47 minutes, aorta clamping time – 95.82 ± 4.79 minutes. The mean duration of hospital staying was 16.98 ± 0.91 days, intensive care unit – 4.84 ± 0.33 days. The number of patients extubated up to 8 hours after surgery was 41 (74.55 %) patients. The operation significantly improved parameters of the quality of life. Conclusions. Patients after Bentall procedure have low overall in-hospital mortality and 30-day mortality (1 (1.89 %)). The 5-year survival rate was 94.61 ± 3.10 %. All three case of death during follow-up period were due to non-cardiac causes. Excellent mid-term results prove that Bentall procedure must be a routine surgery for patients with aortic root aneurysm, mixed aortic valve pathology and anatomically altered aortic valve leaflets. The operation significantly improved quality of life of patients in all domains.

Emergency thoracotomy of chest trauma: A cohort of 30 case series

Background: Chest trauma is one of the leading causes of death in all age groups and accounts for 25–50% of all traumatic injuries. A small but significant proportion of individuals with thoracic injuries need an emergency thoracotomy (ET) during their primary resuscitation, although the majority can be managed conservatively. Surgical intervention has been recommended for the withdrawal of pericardial tamponade, control of large air leaks, open cardiac massage, direct management of pulmonary hemorrhage, and cross-clamping of the thoracic aorta. Thoracotomy can be used to define emergency thoracotomies. The aim of the study was to evaluate the demographic characteristics and outcomes of ET for chest trauma. The study also examined the indications for ET and the outcomes of mortality and prognosis in chest trauma patients who underwent ET in the operating room. Methodology: A cross-sectional study was conducted on 30 patients who were randomly chosen and admitted to Al-Imamain Al-Kadhymain Teaching Hospital between March 2022 and March 2023. Results: The mean age of the sample population was 31.1 years. Males made up 21 (70%) of the sample, while females made up 9 (30%). There were 22 penetrating chest injuries (73.3%), compared with 8 blunt chest injuries (26.7%): 26 (86.7%) were alive, while 4 (13.3%) were dead. Conclusion: The need for an ET to save the life of a trauma patient must be made better known. Patient delays in transport to the hospital play a crucial role in saving the lives of trauma victims. We must provide the emergency department with all the necessary equipment to perform an urgent thoracotomy.

Comparison of Immediate Outcomes of Pulmonary Valve-Sparing and Transannular Patch Techniques for Correction of Tetralogy of Fallot.

This study primarily aimed to compare the mechanical ventilation durations between pulmonary valve-sparing and transannular patch repair techniques in the surgical correction of Tetralogy of Fallot. Secondary objectives included comparison of demographic characteristics, cardiopulmonary bypass parameters, postoperative vasoactive inotrope requirements, incidence of cardiac conduction abnormalities, echocardiographic findings, intensive care unit and hospitalisation durations, reoperations rates, morbidity and mortality between the 2 approaches. This retrospective cohort study was conducted at the Royal Hospital, Muscat, Oman, between January 2016 and December 2019. This study included 102 paediatric patients who underwent complete surgical correction of Tetralogy of Fallot over 3 years, either by a pulmonary valve-sparing technique (Group 1, n = 43) or by transannular patch repair (Group 2, n = 59). Data for both primary and secondary outcomes were extracted from hospital records. Mechanical ventilation duration was significantly shorter in Group 1 (P = 0.039). Patients in Group 1 were generally older, with shorter cardiopulmonary bypass and aortic clamp times, lower inotrope scores, and shorter chest tube retention, intensive care unit and hospitalisation periods. Junctional ectopic tachycardia and severe pulmonary regurgitation were significantly more common in Group 2, while right ventricular outflow tract peak pressure gradients were higher in Group 1. Multivariate analysis identified patient weight as the only independent predictor of mechanical ventilation duration. Pulmonary valve preservation was associated with better early outcomes, including reduced mechanical ventilation duration, lower vasoactive inotrope scores, decreased postoperative arrhythmias and shorter hospital stay.

Prevalence and risk factors for hospital-acquired pneumonia after on-pump cardiac surgery

Aim. To study the prevalence and risk factors (RF) for hospital-acquired pneumonia (HAP) after on-pump cardiac surgery in a modern cohort of patients.Material and methods. This retrospective analysis of the medical records of cardiovascular surgery patients, operated on in the period from January 1, 2022 to December 31, 2022. The study consistently included 417 patients who underwent on-pump cardiac surgery. The incidence and timing of HAP development were assessed. The influence of the main demographic, clinical, and perioperative factors on HAP risk was studied.Results. The pneumonia prevalence per year was 27,6%, including after the Frozen Elephant Trunk (FET) procedure — 32%, after coronary artery bypass grafting (CABG) — 29,5%, after combined CABG and heart valve surgery — 26,2%, after isolated valve surgery — 25,9%, after thoracic aortic hemiarch replacement — 19,5%. Pneumonia developed on the 4,6±2,9 day after surgery. The risk of pneumonia increased with atrial fibrillation (AF) before surgery (odds ratio (OR) 3,17; 95% confidence interval (CI): 1,67; 6,02, p=0,0002), on-pump duration (OR 1,01; 95% CI: 1,00; 1,01; p=0,0006), aortic cross-clamping (OR 1,01; 95% CI: 1,00; 1,01; p=0,0002) and mechanical ventilation (OR 1,03; 95% CI: 1,01; 1,05; p=0,005). Pneumonia predictors were on-pump duration ≥96 min (sensitivity 67,7%, specificity 64,6%, AUC=0,681, p=0,0006) and mechanical ventilation ≥14 h (sensitivity 63,1%, specificity 69,3%, AUC=0,641, p=0,005), as well as preoperative AF (sensitivity 61%, specificity 75%, p=0,0002).Conclusion. Preoperative AF, on-pump duration ≥96 min and mechanical ventilation ≥14 h serve as categorical and quantitative predictors of postoperative HAP in a modern cohort of patients.

Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia.

Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas' (STH) solutions in MICS. Methods: Medical electronic databases were thoroughly searched without time restrictions, including all types of studies except for study protocols and animal research. The final search was completed in June 2024. Subsequently, a network meta-regression was performed on both primary and secondary endpoints, utilizing R (The R Foundation for Statistical Computing, version 3.6.2) for the analysis. Meta-analyses were carried out using Review Manager software. Results: A total of 15 studies, enrolling 2282 patients, were included in the analysis. None of the comparisons showed statistically significant differences in in-hospital mortality between the four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13-80.84; DN vs. HTK, OR: 1.42, 95% CI: 0.28-7.23; STH vs. HTK, OR: 1.25, 95% CI: 0.19-8.20). Conclusions: In this network meta-analysis of cardioplegia solutions in MICS, no significant differences were observed in major clinical outcomes across the solutions. Cardioplegia solutions that provide long-lasting myocardial protection with a single dose, such as DN and HTK, were found to be safely applied in MICS. DN was associated with shorter CPB times and HTK was associated with shorter hospital stays, though these differences may not have clinical implications.

Relative Factor Analysis of Postoperative Complications in Infants Below 1 Year Undergoing Repair of Ventricular Septal Defect Combined with Other Procedures through a Right Axillary Incision

Background: Compared to the traditional surgical repair of isolated ventricular septal defects, the proportion of complex congenital heart diseases has been increasing due to advancements in diagnostic capabilities and surgical techniques. Concomitant surgeries to correct multiple congenital heart diseases have become the preferred choice. Therefore, the evaluation of the safety of the combined correction of ventricular septal defects with other cardiac anomalies in young children through a right axillary incision and the analysis of related factors of perioperative complications needs to be investigated. Methods: A retrospective study was conducted on a single-center patient sample from January 2018 to December 2022 to compare outcomes between infants undergoing isolated ventricular septal defect (VSD) repair via a right axillary thoracotomy (control group) and those undergoing VSD repair combined with other cardiac procedures (experimental group). Results: A total of 397 eligible infants were included. After baseline data were matched using propensity score matching, the experimental group (n = 181) and the control group (n = 107) showed no significant differences in intraoperative blood loss, postoperative total drainage, length of hospital stay, duration of ICU monitoring, Vasoactive-Inotropic Score (VIS), pre-discharge left ventricular ejection fraction, fractional shortening (FS), postoperative severe pulmonary infection, reoperation, mortality, postoperative atrioventricular block, chylothorax, cardiac arrest, pericardial effusion, pneumothorax, pulmonary atelectasis, tricuspid regurgitation, myocardial injury, abdominal effusion, and metabolic acidosis. However, the control group had shorter surgical time [28.00 (90.00, 196.00) vs. 140.00 (95.00, 658.00) min, p &lt; 0.05], shorter cardiopulmonary bypass time [58.00 (24.00, 114.00) vs. 66.00 (33.00, 422.00) min, p &lt; 0.05], shorter aortic cross-clamp time [32.00 (17.00, 62.00) vs. 37.00 (15.00, 142.00) min, p &lt; 0.05], and shorter postoperative mechanical ventilation time [22.00 (0, 99.00) vs. 23.00 (3.00, 193.00) h, p &lt; 0.05]. The rate of abdominal effusion was lower in the experimental group than in the control group (p = 0.044). In the analysis of postoperative complication-related factors, the preoperative grade of tricuspid regurgitation, postoperative mechanical ventilation time, and VIS were positively correlated with abdominal effusion and satisfied the variable (p &lt; 0.05) in each of three established models. In the single-factor analysis, both VIS and preoperative lymphocyte count were (p &lt; 0.1) related to pericardial effusion; however, in the multi-factor analysis, only VIS met the threshold (p &lt; 0.05). Gender, height, and VIS were each associated with pleural effusion (p &lt; 0.05). Conclusion: The combination of ventricular septal defect repair with other cardiac procedures via a right axillary thoracotomy did not significantly differ from isolated VSD repair in terms of postoperative complications, monitoring, and length of hospital stay. However, increased surgical complexity was associated with longer surgical and mechanical ventilation times. Factors such as tricuspid regurgitation severity, duration of postoperative mechanical ventilation, and VIS were identified as relative factors for postoperative effusion. Additionally, the risk of postoperative pericardial effusion increased with higher VIS, while gender, height, and VIS were identified as relative factors for postoperative chylothorax.

Hyperlactataemia Following Crystalloid Cardiopulmonary Bypass Priming in Paediatric Cardiac Surgery-Benign or Malignant? A Retrospective Study.

Various mechanisms leading to early hyperlactataemia post-cardiac surgery have been postulated. Specifically, in the paediatric population, benign early hyperlactataemia may be associated with crystalloid priming in the cardiopulmonary bypass circuit. The aim of this study was to review paediatric patients who had crystalloid prime and assess their outcomes. A retrospective review of paediatric patients who underwent cardiac surgery with crystalloid prime at our institution between November 2014 and May 2018 was performed. Data were collected from medical and laboratory records. Among 569 patients, 237 (42%) received a crystalloid prime; 51 (22%) were excluded due to intraoperative hyperlactataemia. Of the remaining 186 patients, 98 (53%) developed hyperlactataemia postoperatively. Patients with hyperlactataemia had longer cardiopulmonary bypass and aortic cross-clamp times but similar Aristotle complexity scores. Patients with postoperative hyperlactataemia had higher peak VIS [median 8 (IQR 0-8) vs. 5 (IQR 0-8)] within the first 24 h (p = 0.002). However, there was no difference in the duration of ventilation between the two groups (p = 0.14). Yet only 58% of patients with hyperlactataemia were discharged from the ICU within 24 h, compared to 78% without hyperlactataemia. In this study population, transient postoperative hyperlactataemia in paediatric patients with crystalloid prime may not necessarily indicate tissue hypoxaemia. Despite a similar duration of ventilation in patients with and without hyperlactataemia, patients with hyperlactataemia had a longer duration of inotropes and ICU stay. Consideration should be given to discontinuing inotropes in patients with crystalloid prime and postoperative early hyperlactataemia once they are extubated.

Introducing sequential partial aortic clamp technique for proximal anastomoses and its advantages in myocardial protection in coronary artery bypass grafting

Ischemic heart disease (IHD) is a common and potentially lethal cardiovascular disorder. Coronary artery bypass grafting (CABG) is a standard procedure for treating IHD. This study aims to introduce a novel technique for proximal anastomoses in CABG. This clinical trial studied 29 cases and 29 matched controls. Data were gathered from June 2014 to June 2023. Regarding proximal anastomoses, the sequential partial aortic clamp was performed in cases, and the partial aortic clamp was done for controls. In the sequential partial aortic clamp technique, a relatively small or medium vascular clamp was used instead of one clamp for all proximal anastomoses, which closed a small amount of the aortic wall at each stage. At each stage, only one hole in the aortic wall and only one anastomosis between the conduit and the aorta was performed. After the end of each anastomosis, the clamp was opened and placed on another part of the aorta, and the next anastomosis was performed. CK-MB (p < 0.001, Eta Squared = 0.255) level was significantly lower in cases that underwent sequential partial ascending aorta clamping. However, cTnI level was not statistically different among cases and controls(p = 0.05). Of all patients, 3 (10.3%) cases and 12 (41.4%) controls developed with postoperative atrial fibrillation (p = 0.007). The sequential partial aortic clamp technique leads to less myocardial injury than the partial aortic clamp technique. Also, patients undergoing sequential partial aortic clamp technique are less likely to develop postoperative atrial fibrillation.

Right mini-thoracotomy for concomitant aortic valve replacement and right coronary artery bypass graft

Background Full sternotomy is the standard approach for combined surgery. Evidence of the minimally invasive approach’s advantages for aortic and mitral valve surgery has been reported. Our aim was to report our experience with minithoracotomy for elective patients presenting with aortic valve stenosis associated with right coronary artery disease. Material and methods Between January 2016 and August 2021, 17 patients underwent concomitant aortic valve replacement and right coronary artery bypass grafting by right anterior thoracotomy. Results The mean age was 73.3 years and the mean EuroSCORE 2 was 2.07 ± 1.24. Mean cardiopulmonary bypass and aortic cross-clamp times were 148 ± 29 min and 111 ± 20 min. Thirteen patients (76.0%) had femoral cannulation. Nine saphenous veins (53%), seven right internal thoracic arteries (41%), and one radial artery (6%) were used as a graft. Twelve patients benefited from ultrasonic flow measurements to control the graft. The mean flow rate was 47 ± 39 ml/min, and the mean pulsatility index was 2.4 ± 1.2. The mean postoperative transvalvular gradient was 10.9 ± 4 mmHg. Two patients presented with Grade 1 aortic insufficiency (12%). There was no 30-day mortality. Conclusions Combined aortic valve replacement and right coronary artery bypass grafting through right anterior thoracotomy is reliable and reproducible in selected patients.