Cardiac Surgery Patients Research Articles

Clinical risk factors for postoperative infection in adult cardiac surgery with cardiopulmonary bypass: a retrospective study.

Clinical risk factors for postoperative infection in adult cardiac surgery with cardiopulmonary bypass: a retrospective study.

Targeting the CD39/CD73 pathway: New insights into cardiac fibrosis and inflammation in female cardiac surgery patients.

Targeting the CD39/CD73 pathway: New insights into cardiac fibrosis and inflammation in female cardiac surgery patients.

Preoperative ECG-assisted feature engineering enhances prediction of new-onset atrial fibrillation after cardiac surgery.

Preoperative ECG-assisted feature engineering enhances prediction of new-onset atrial fibrillation after cardiac surgery.

ICU nurses' perceptions on family involvement in delirium care for postoperative cardiac surgery patients: A qualitative study.

ICU nurses' perceptions on family involvement in delirium care for postoperative cardiac surgery patients: A qualitative study.

Prospective Observational Study of the Optinal Timing of Extubation in Cardiac Surgery Patients

Prospective Observational Study of the Optinal Timing of Extubation in Cardiac Surgery Patients

Combined pathogenic characteristics to analyze susceptibility factors of postoperative pneumonia in patients undergoing cardiac surgery

Postoperative infection prevention is crucial for cardiac surgery patients. This study enrolled 579 cardiac surgery patients from November 2021 to July 2022, reporting a 12.3% incidence of postoperative pneumonia. Blood sugar, Montreal Cognitive Assessment (MoCA) scores, respiratory failure, and complications were linked to respiratory infections. Significant differences in biomarkers, including creatine kinase, urine volume, alanine transaminase (ALT), hemoglobin, and PaO2/FiO2, were observed between pneumonia types. Bacterial pneumonia cases showed positive correlations between ALT, urine volume, and infection, while hemoglobin and PaO2/FiO2 correlated negatively. The most common pathogens were Klebsiella pneumoniae (20.3%), Acinetobacter baumannii (11.6%), and Pseudomonas aeruginosa (10.9%). Identifying susceptibility factors and pathogenic characteristics can guide effective prevention strategies. Monitoring and oxygen therapy remain essential for reducing postoperative pneumonia risk in cardiac surgery patients.

Assessment of arterial whole blood redox potential during cardiopulmonary bypass.

Imbalance in the redox equilibrium is common in any type of aggression. Cardiopulmonary bypass (CPB) initiation induces metabolic perturbations, and reliable biological monitoring tools for this condition are currently limited (e.g., lactate/pyruvate ratio). The measurement of arterial whole blood redox potential (Eredox) provides a systemic assessment of the redox state and may serve as a valuable marker for detecting metabolic perturbations during CPB. In this prospective exploratory study involving patients undergoing cardiac surgery, we investigated variations in Eredox and lactate/pyruvate ratio during CPB initiation. Using a prospective exploratory study design, we assessed the changes in Eredox and relevant variables during the initiation of CPB in 16 cardiac surgery patients. Upon initiation of CPB we observed a significant decrease in arterial whole blood redox potential (101.90 mV + /- 11.52 vs. 41.80 mV + /- 10,26; p < 0.0001). Concomitantly, the lactate/pyruvate ratio significantly increased (12.81 + /- 0.90 vs 67.1 + /- 7.94; p < 0.0001) while the acetoacetate/β-hydroxybutyrate ratio significantly decreased (1.11 + /- 0.19 vs. 0.54 + /- 0.05 at 0 min; p = 0.0055). The circulatory failure indicated by changes in the lactate/pyruvate ratio and ketone bodies at the initiation of CPB correlated with a significant reduction in Eredox. Arterial Eredox is a novel variable that holds promise in the detection and monitoring of metabolic aggression during CPB. Its assessment during CPB initiation could provide valuable insights into the patient's circulatory status, as the Eredox appears to be more sensitive than lactate for monitoring circulatory insufficiency.

Pulmonary Complications in Children After Cardiac Surgery and Its Relationship to Neutrophil-Lymphocyte Ratio: A Retrospective Study

Background: This study aimed to investigate the incidence and predisposing factors of pulmonary complications in pediatric patients undergoing cardiac surgery and its relationship with the neutrophil-to-lymphocyte ratio (NLR) in the open-heart surgery intensive care unit (ICU-OH) of the Children’s Medical Center Hospital (CMC) in Tehran, Iran. Methods: In this retrospective cohort study, 457 children who underwent open-heart surgery and were transferred to ICU-OH postoperatively were included. Data on age, gender, weight, hospital stay, and risk adjustment for congenital heart surgery (RACHS-1) scores were collected. The incidence of pulmonary complications and its association with NLR were analyzed. Results: The RACHS-1 risk category distribution: Category 1 (15%, n = 65), category 2 (54%, n = 232), category 3 (23%, n = 99), and category 4 (8%, n = 34). Pulmonary complications occurred in 68 children (15.8%), with the highest incidence in infants under one month (34%, n = 18; P &lt; 0.001). Postoperative NLR levels were significantly higher than preoperative levels and were elevated in patients without pulmonary complications, suggesting NLR as a potential predictive factor. Conclusions: The NLR may serve as a useful biomarker for predicting pulmonary complications in pediatric cardiac surgery patients. Further studies are needed to validate these findings and explore underlying mechanisms.

Cardiac surgery rehabilitation pathways and patient experiences: exploring gaps, challenges, and opportunities

Abstract Background In Denmark, cardiac rehabilitation (CR) is publicly funded and supported by an automatic referral system. However, participation rates, indicate underutilization. A comprehensive understanding of patient pathways and the reasons for low engagement in rehabilitation programs after cardiac surgery is lacking, necessitating further investigation. Purpose This study aims to map and analyse existing CR pathways after cardiac surgery, and to explore recovery experiences of patients and their relatives. The objective is to identify their challenges, unmet needs, and reasons for non-participation in CR. Methods A qualitative, multi-method research design was used, combining metro mapping. Metro mapping of rehabilitation pathways involved document analysis, stakeholder consultations, practice observations, and go-along interviews with clinicians and semi-structured interviews with a purposive sample of patients (n=18) who had not engaged in CR within 9-13 weeks after discharge, and their relatives (n=10) in different national settings. Results The analysis highlighted significant variability in the processes of referral, enrolment, and follow-up, along with disparities in the content and delivery of CR programs. A persistent gap in care was identified, marked by a prolonged transitional phase in which patients and their families experienced significant uncertainty, diminished well-being, and a lack of person-centred care. There was a clear demand for more individualized rehabilitation plans to better align with patient needs and preferences. Conclusion This study provides a holistic overview of CR pathways by integrating perspectives from healthcare professionals, patients, and their relatives. It identifies critical gaps in the current system that potentially impede patient recovery and participation in CR. The findings emphasize the necessity for a restructured CR pathway, co-designed with contributions from clinicians, patients, and their families, to enhance service delivery and optimize patient outcomes.

Clinical Features of Postoperative Delirium in Patients Who Underwent Cardiac Surgery

Background: the increasing number of cardiac surgeries in older patients with serious cardiovascular diseases, the frequent development of postoperative delirium, its unfavorable prognosis, and underdiagnosis of certain types of delirium determined the relevance of this study. The aim was to identify clinical types of postoperative delirium in patients who underwent cardiac surgery. Patients and Methods: a total of 157 patients participated in prospective observational study of clinical types of postoperative delirium in patients undergoing cardiac surgery. The study was conducted at the cardiac surgery and cardiology intensive care departments of the Sverdlovsk Regional Clinical Hospital No.1. Clinical, psychopathological, psychometric, and statistical methods were used. Results: 31 patients (19.7% of the total number of operated patients who participated in this study) with delirium were identified in the early postoperative period. Based on the psychometric (total scores of the Confusion Assessment Method Intensive Care Unit and Richmond Agitation-Sedation Scale) and clinical and psychopathological assessment of the patients’ condition, clinical heterogeneity of postoperative delirium was revealed. Different types of delirium were determined including hypoactive type in 87.1% f, mixed in 9.7% and hyperactive delirium in 3.2% of cases. The syndromic structure of hyperactive and hypoactive postoperative delirium is different. Discussion: different syndromic structure of hyperactive and hypoactive types of delirium allow us to assume the different pathogenetic mechanisms. This may partially explain the insufficient sensitivity of the diagnostic tools used. Conclusion: improvement of the typology of delirium in cardiac surgery patients is necessary to predict the development of postoperative delirium and develop methods for its prevention.

The Effects of Dexamethasone in Cardiac Surgery: A Registry-Based, Real-World Data Analysis of Clinical Outcomes From the Netherlands Heart Registration.

In cardiac surgery, modulating the inflammatory response with prophylactic steroids may reduce morbidity and mortality. We aimed to evaluate the association of dexamethasone use with clinical outcomes and its variation in clinical practice in a real-world setting. This retrospective, population-based study evaluated data of elective and urgent to on-pump cardiac surgery patients from the Netherlands Heart Registration between 2013 and 2021. Patients who received perioperative dexamethasone were compared to those who did not. The primary outcomes were 30-day mortality and a composite of 30-day mortality, in-hospital stroke, and 30-day renal or respiratory failure. Secondary outcomes included the individual components of the composite outcome, a composite of infection-related outcomes, arrhythmias, and length of hospital stay. Propensity score matching was applied to adjust for confounders. Clinical practice variation was assessed through a national survey of Dutch cardiac anesthesiologists. In the study, 54,694 patients were included, with 40,891 patients (74.8%) receiving dexamethasone. After propensity score matching, dexamethasone use was associated with a lower risk of the composite clinical outcome (odds ratio [OR] 0.82, 95% confidence interval [CI], 0.72-0.92, P < .001), with a significant reduction in renal failure (OR 0.57, 95% CI, 0.47-0.70, P < .001). The length of hospital stay was significantly shorter (B -0.17, 95% CI, -0.32 to -0.02, P = .025). Other individual components of the composite outcome and secondary outcomes did not show a significant association with dexamethasone use. However, in patients >80 years, dexamethasone use was associated with increased 30-day mortality (OR 1.52, 95% CI, 1.01-2.28, P = .044). The observed benefits were consistent across other demographic and clinical subgroups. The survey indicated substantial variability in dexamethasone use across centers and anesthesiologists. Prophylactic dexamethasone during adult cardiac surgery was associated with reduced composite clinical outcomes, renal failure, and shorter hospital stays, and seemed associated with 30-day mortality in patients >80 years old.

PREVALENCE AND RISK FACTORS OF POSTOPERATIVE INFECTIONS IN CARDIAC SURGERY PATIENTS USING AI ASSESSMENT

Background: Surgical site infections (SSIs) are among the most common and costly complications following cardiac surgery, significantly affecting morbidity and mortality rates. Traditional risk assessment models often fail to capture complex interactions among variables, limiting predictive precision. Recent advances in artificial intelligence (AI) offer opportunities to enhance infection prediction and prevention. Objective: To assess the prevalence of surgical site infections in cardiac surgery patients and identify associated risk factors using AI-driven analysis tools. Methods: This cross-sectional study was conducted over eight months (June 2024–February 2025) at two tertiary care cardiac centers. A total of 600 adult patients undergoing cardiac surgery were enrolled based on defined inclusion and exclusion criteria. Data were collected from electronic health records and included demographic, preoperative, intraoperative, and postoperative variables. Surgical site infections were diagnosed using CDC criteria and validated through independent clinical review. Statistical analysis included univariate and multivariate logistic regression, while machine learning models—Random Forest and Gradient Boosting—were developed to assess predictive accuracy. Results: SSIs occurred in 14% of patients (n=84), with superficial incisional infections being most common. Diabetes (OR 2.5), obesity (OR 2.1), surgery duration &gt;5 hours (OR 3.2), re-exploration (OR 4.0), and prolonged ventilation (OR 3.5) were significant independent predictors. Gradient Boosting demonstrated superior predictive performance with an AUC-ROC of 0.91 compared to 0.89 for Random Forest. Conclusion: The integration of AI models enhances the predictive accuracy of SSI risk stratification in cardiac surgery. Early identification of high-risk patients through AI tools can support targeted prevention strategies and improve surgical outcomes.

Improving urinary oxygen monitoring with a transit time algorithm: enhancing AKI detection in cardiac surgery.

Acute kidney injury (AKI) affects 40-50% of cardiac surgery patients and is closely linked to renal medullary hypoxia. Although urinary oxygen partial pressure (PuO2) offers real-time insight into renal oxygenation, variable urine transit times through the urinary catheter can impair measurement accuracy. This study aimed to develop an algorithm that calculates transit time by modeling urine flow as discrete particles and to assess whether it improves PuO2 estimation. The proposed algorithm models urine flow as discrete particles, tracking transit time through the urinary catheter. The transit time allows correcting oxygen measurements at the catheter exit, mitigating distortions from variable flow rates. Validation used a bench-top system with a flow sensor, a 30-cm glass tube simulating a catheter, and optode-based oxygen sensors positioned inside a flask and at the catheter entry and exit. Flow rates spanned 20-450 mL/h, and flask oxygen 15-120 mmHg, with exit compared to entrance values. Without adjustment, the root mean square error (RMSE) between entrance and exit oxygen measurements was 15.71 mmHg. Incorporating the transit time correction reduced the RMSE to 5.82 mmHg. This marked improvement indicates that the corrected measurements more accurately reflect the true oxygen levels entering the catheter across various flow conditions. By accounting for dynamic urine transit times, the proposed algorithm substantially enhances the accuracy of urinary oxygen monitoring. This improvement in estimating renal oxygenation may facilitate noninvasive detection of renal hypoxia and allow for timely interventions to reduce the incidence and severity of AKI in cardiac surgery patients.

How Would We Prevent Our Own Acute Kidney Injury After Cardiac Surgery?

How Would We Prevent Our Own Acute Kidney Injury After Cardiac Surgery?

Comparison of Perioperative Outcomes for Transfusion of Hemoconcentrated Bypass Versus Cell Saver Blood in Cardiac Surgical Patients.

Comparison of Perioperative Outcomes for Transfusion of Hemoconcentrated Bypass Versus Cell Saver Blood in Cardiac Surgical Patients.

Outcomes of Cardiac Surgery in Patients With Liver Cirrhosis: A Systematic Review and Meta-Analysis.

Cirrhosis is a progressive form of liver disease associated with significant patient morbidity and mortality. Model for End-Stage Liver Disease (MELD) and Child-Pugh scores are disease severity classification systems that carry predictive value for patients undergoing various procedures. Missing is a granular analysis exploring the association between liver disease severity and clinical outcomes among patients who require cardiac surgery. Our study extracted demographic, periprocedural, and postoperative clinical data for patients with liver cirrhosis undergoing cardiac surgery between 2000 and 2023. Continuous variables were pooled by meta-analysis utilizing a random effects model, and categorical variables were studied using meta-analysis of proportions with logit transformations. The most frequently observed Child-Pugh classification was class A in 60% of patients (95% confidence interval [CI]: 53-67), followed by class B in 33% (95% CI: 27-39) and class C in 4% (95% CI: 2-6). Notably, 30% of patients developed renal failure in the postoperative period (95% CI: 21-39), and overall in-patient mortality occurred in 11% of patients (95% CI: 9-14). There was a significant association between Child-Pugh classification and overall patient survival for 3 years in the postoperative period. No significant relationship was observed between preoperative MELD score and postoperative clinical outcomes. Preoperative Child-Pugh classification is associated with postoperative clinical outcomes among patients undergoing cardiac surgery. More granular data are required to understand the association between MELD scores and postoperative outcomes within the cardiac surgery population.

Effects of sarcopenia on postoperative recovery in elderly patients after cardiac surgery with cardiopulmonary bypass

BackgroundFew studies have assessed sarcopenia identified by erector spinae muscle (ESM) using thoracic computed tomography (CT) before cardiac surgery. We aimed to explore the relationship between sarcopenia evaluated via ESM and poor outcomes following cardiac surgery with cardiopulmonary bypass (CPB) in elderly patients.Methods268 patients older than 65 years who underwent cardiac surgery with CPB at our institution in 2020 were included in the retrospective, single center, cohort study. Preoperative chest CT scans were used to measure the cross-sectional areas of the ESM (ESMCSA), which were then adjusted for body surface area (BSA) to determine the muscle mass index. Patients were categorized into sarcopenia and non-sarcopenia groups based on ESMCSA/BSA scores, and their short- and long-term clinical outcomes were compared.ResultsThe ESMCSA/BSA detected sarcopenia in 51.1% of patients. Patients with sarcopenia had significantly extended durations of stay in both the intensive care unit and the hospital compared to those without sarcopenia. Furthermore, the incidence of major adverse events was significantly higher in the sarcopenia group compared to the non-sarcopenia group (15.3% vs. 32.1%, P < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that sarcopenia (OR 2.457, 95% CI 1.178–5.126, P = 0.017) independently predicted the risk of postoperative complications after adjusting for gender, preoperative nutritional status, serum albumin, estimated glomerular filtration rate, creatinine, white blood cell count, lymphocytes, type of surgery, surgical time, and aortic cross-clamp time. Kaplan–Meier survival analysis revealed a statistically significant difference in overall mortality between groups (log-rank P = 0.011). The Cox proportional hazards model identified preoperative sarcopenia as an independent risk factor for long-term mortality (HR, 2.132; 95% CI 1.144–3.972, P = 0.017).ConclusionOur study identified preoperative sarcopenia, assessed via ESM muscle mass on chest CT, as an independent predictor of postoperative complications and long-term overall mortality in elderly cardiac surgery patients with CPB.

A Machine Learning Approach to Adaptive EWMA Control Charts: Insights From Cardiac Surgery Data

ABSTRACTThis study explores using a structured quality framework to enhance patient care quality and safety in healthcare environments. Assessing the performance of healthcare services is a complex task due to the wide range of health conditions among patients, making it difficult to establish consistent evaluation metrics. The study employs a support vector machine (SVM) regression model to address this issue, which helps analyze and manage patient risk factors effectively. To enhance the monitoring of healthcare service quality, this study introduces a new SVM‐based adaptive risk‐adjusted exponentially weighted moving average (SVM‐ARAEWMA) control chart. This chart is designed using the residuals generated by the SVM regression model, allowing for a more accurate assessment of variations in patient outcomes. This study demonstrates how SVM effectively assesses patient conditions by applying this methodology to real‐world data from cardiac surgery patients. Compared to traditional risk‐adjusted exponentially weighted moving average (RAEWMA) and adaptive RAEWMA (ARAEWMA) control methods, the SVM‐ARAEWMA chart is more effective in identifying critical changes in healthcare quality and patient outcomes.

Impact of the Enhanced Recovery After Surgery Program on Outcomes After Cardiac Surgery: One-Year Results.

To evaluate the clinical impact of enhanced recovery after surgery (ERAS) protocols implementation in the cardiac surgery department at Lausanne University Hospital (CHUV) comparing outcomes between a prospective ERAS cohort and a retrospective cohort from 2019. A prospective cohort of 228 patients undergoing elective cardiac surgery with ERAS protocols between May 2023 and August 2024 was compared to a retrospective cohort of 162 patients from 2019. Inclusion criteria included on-pump adult elective cardiac surgery patients via median sternotomy. Propensity score matching was applied based on six variables: age, sex, EuroSCORE II, type of surgery, previous cardiac surgery, and cardiopulmonary by-pass duration, resulting in two matched groups of 125 patients each. After matching, the ERAS group showed a significant reduction in median hospital length of stay from 11.0 to 9.0days (p=0.002). The proportion of patients free from any of the defined complications increased in the ERAS group from 43.2% to 61.7% (p=0.006), indicating an overall reduction in postoperative morbidity. ERAS implementation independently increased odds of being complication-free (OR 2.88 and p<0.001). Opioid use on postoperative day 2 decreased from 9.90 to 3.30 morphine milligram equivalents (MME) (p<0.001) and mobilization rates on postoperative day 1 improved from 65.3% to 81.4% (p=0.048). ERAS protocols implementation in cardiac surgery at CHUV resulted in reduced hospital length of stay, decreased opioid use, improved early mobilization, and a lower overall complication rate. These findings demonstrate the effectiveness of adapting international ERAS guidelines to local practices in cardiac surgery.

Impact of Preoperative STEMI on Postoperative Recovery and Complications Following Cardiac Surgery

Background: Comprehensive perioperative management strategies are advised for patients undergoing cardiac surgery who have a history of preoperative ST-segment elevation myocardial infarction (STEMI) because these patients have a higher risk for adverse postoperative outcomes. This systematic review explored the influence of preoperative STEMI on postoperative recovery and complications in cardiac surgery patients. Methods: A systematic search of PubMed, MEDLINE, EMBASE, and Cochrane Library databases was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies published between 1990 and 2024 were screened for inclusion based on predefined criteria. A total of 420 studies were initially identified, and eight studies, encompassing 1741 patients undergoing coronary artery bypass grafting (CABG), were included in the review. Two independent reviewers performed data extraction, and the quality of studies was assessed using the Newcastle–Ottawa scale. Key findings from each study were narratively synthesized to explore common themes and outcomes related to postoperative mortality, major adverse cardiac events (MACEs), and complications. Results: Of the 420 initially identified studies, eight met the inclusion criteria. Across these included studies, STEMI patients demonstrated higher postoperative mortality rates and increased incidence of MACEs compared to other cardiac surgery patients. Complications such as renal failure were particularly prevalent in patients with preoperative cardiogenic shock, with up to 50% of these patients requiring intra-aortic balloon pump (IABP) support. Recovery of left ventricular ejection fraction (LVEF) varied, ranging from 0.36 to 0.50, depending on the extent of preoperative myocardial dysfunction and the revascularization strategy employed. Variability in patient demographics, surgical techniques, and clinical settings contributed to differences in reported outcomes across studies. Conclusion: These findings underscore the importance of tailored perioperative strategies and specialized care protocols for STEMI patients undergoing cardiac surgery. By addressing the unique challenges posed by this high-risk group, healthcare providers can improve patient outcomes and reduce the incidence of postoperative complications.