Conventional Cardiac Surgery Research Articles

Effect of Fast-Track Postoperative Recovery on Patients Outcome in Conventional Adult Cardiac Surgery

Effect of Fast-Track Postoperative Recovery on Patients Outcome in Conventional Adult Cardiac Surgery

THE “BACK TO THE FUTURE” OF CARDIOTHORACIC SURGERY: HIGH–RISK INTERVENTIONAL PROCEDURE TURNED DOWN TO CONVENTIONAL CARDIAC SURGERY

Abstract Background Structural interventional cardiology has been introduced at the beginning of our century to address high–risk patient suffering from severe aortic stenosis. Since then several technique and technology have been proposed to address an increasing population of patients and mitral valve diseases have been also addressed. While several authors are pushing up the indications for structural interventional procedures, however, we are experiencing some situations were conventional surgery is considered an alternative to high risk interventional procedures. Here we present a peculiar case of “back to the future” in cardiothoracic surgery. Case Description A 76 yo female patient, was referred to our Division from a peripheral Hospital suffering from severe aortic stenosis and coronary artery diseases. Medical history of the patient included persistent AF, COPD, arterial peripheral vascular disease, moderate chronic renal insufficiency and moderate dilatation of ascending aorta. Patient was previously assessed by another Centre and a percutaneous treatment (PTCA+TAVI) was proposed. Due to further admission for cardiac failure–related symptoms, however, patient was urgently referred to our Division. Fig 1 and 2 summarized clinical findings. “Heart team” evaluation, based also on the product specialist evaluation, considered the patient not suitable for interventional procedure due to the high risk of sub–optimal medium–term prognosis. Due to further clinical deterioration an extremely high–risk surgical procedure was mandatory. Results Surgical procedure included a sutureless aortic valve replacement, a MV plasty, a double coronary graft + a cpmbined carotid endoarterectomy. Postoperative course was free from significant complications and the patient was discharged to rehabilitation clinic on 15th postoperative days. Conclusion Despite interventional procedure are continuing to increase either as number of procedure either as complexity of diseases treated, conventional cardiac surgery remains still the only option for treatment in many clinical scenario. As a sort of “back to the future” situation, patient originally referred for interventional procedures are turned down due to the high risk of sub–optimal results. In such condition conventional cardiac surgery, performed with high level of accuracy could represent the last and only treatment option for high risk patients.

Correlation between The Duration of Cardiopulmonary Bypass Time and The Occurrence of Morbidity and Mortality in Conventional Adult Cardiac Surgery

Correlation between The Duration of Cardiopulmonary Bypass Time and The Occurrence of Morbidity and Mortality in Conventional Adult Cardiac Surgery

Myocardial protection in cardiac surgery-hindsight from the 2020s.

Myocardial protection and specifically cardioplegia have been extensively investigated in the beginnings of cardiac surgery. After cardiopulmonary bypass had become routine, more and more cardiac operations were possible, requiring reliable and reproducible protection for times of blood flow interruptions to the most energy-demanding organ of the body. The concepts of hypothermia and cardioplegia evolved as tools to extend cardiac ischaemia tolerance to a degree considered safe for the required operation. A plethora of different solutions and delivery techniques were developed achieving remarkable outcomes with cross-clamp times of up to 120 min and more. With the beginning of the new millennium, interest in myocardial protection research declined and, as a consequence, conventional cardiac surgery is currently performed using myocardial protection strategies that have not changed in decades. However, the context, in which cardiac surgery is currently performed, has changed during this time. Patients are now older and suffer from more comorbidities and, thus, other organs move more and more into the centre of risk assessment. Yet, systemic effects of cardioplegic solutions have never been in the focus of attention. They say hindsight is always 20-20. We therefore review the biochemical principles of ischaemia, reperfusion and cardioplegic extension of ischaemia tolerance and address the concepts of myocardial protection with 'hindsight from the 2020s'. In light of rising patient risk profiles, minimizing surgical trauma and improving perioperative morbidity management becomes key today. For cardioplegia, this means accounting not only for cardiac, but also for systemic effects of cardioplegic solutions.

Impact of Previous Conventional Cardiac Surgery on the Clinical Outcomes After Heart Transplantation.

The impact of the type, purpose, and timing of prior surgery on heart transplantation (HT) remains unclear. This study investigated the influence of conventional cardiac surgery (PCCS) on HT outcomes. This study analyzed HTs performed between 1999 and 2019 at a single institution. Patients were categorized into two groups: those with and without PCCS. Short-term outcomes, including post-transplant complications and mortality rates, were evaluated. Cox proportional and Kaplan-Meier survival analyses were used to identify risk factors for mortality and assess long-term survival, respectively. Of 368 patients, 29% had PCCS. Patients with PCCS had a higher incidence of post-transplant complications. The in-hospital and 1year mortality rates were higher in the PCCS group. PCCS and cardiopulmonary bypass time were significant risk factors for 1year mortality (hazard ratios = 2.485 and 1.005, respectively). The long-term survival rates were lower in the PCCS group, particularly in the first year. In sub-analysis, patients with ischemic cardiomyopathy and PCCS had the poorest outcomes. The era of surgery and timing of PCCS in relation to HT did not significantly impact outcomes. In conclusion, PCCS worsen the HT outcomes, especially in patients with ischemic etiology. However, the timing of PCCS and era of HT did not significantly affect this concern.

The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers.

Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.

Evaluation of (Wet) and (Dry) Mediastinal Chest Drainage in Minimally Invasive and Conventional Cardiac Surgery.

Drainage of fluid and evacuation of air from the pericardial and pleural spaces after cardiothoracic surgery is necessary to prevent effusion, tamponade, and pneumothorax, and also to detect hemorrhage. For this purpose, negative-pressure drains are placed in the mediastinum and pleural cavities. We compared the efficacy and safety of two systems wet and dry drainage for the management and monitoring of negative pressure and anti-reflux valve safety systems, to promote healing of the pleural and pericardial cavities. Two devices for mediastinal chest drainage [Venice PAS (Wet) and Rome PAS (Dry); both Eurosets SRL, Medolla, Italy] were evaluated in terms of safety, efficacy and clinical outcomes in a cohort of 60 patients who underwent elective cardiac surgery procedures. The patients were divided into a minimally invasive cardiac surgery (MICS) group [n=30; mitral valve surgery (MVS) by right anterolateral mini-thoracotomy] and a conventional cardiac surgery (CCS) group [n=30; coronary arterial bypass grafting (CABG) in full sternotomy] at a single institution (Anthea Hospital GVM Care & Research, Bari, Italy). Negative pressure was managed with a target value of -20 cmH2O measured in the chest tube and was related to the device: deviation of ± 1 cmH2O for the Venice PAS (Wet) and 0 cmH2O for the Rome PAS (Dry) in the MICS group; deviation of 1 ± 0.8 cmH2O for the Venice PAS (Wet) and 0.8±0.2 cmH2O for the Rome PAS (Dry) in the CCS group. A constant volumetric air leak meter (VALM) value and the absence of air-leak bubbling were correlated with the absence of air in the pleural cavity and complete pulmonary re-expansion to restore normal respiratory dynamics in the MICS group for both models of chest drainage. The maximum total pericardial blood drained was 1104 ± 302 ml with Venice PAS (Wet) and 1530 ± 230 with Rome PAS (Dry) in the CCS group. There were no reports of cardiac tamponade in either group. The two mediastinal chest drainage devices [Venice PAS (Wet) and Rome PAS (Dry)] in this study were effective, accurate for measuring the applied negative pressure, and safe in their application after cardiac surgery procedures via minimally invasive and conventional approaches for blood and liquid drainage, prevention of cardiac tamponade, and restoration of normal respiratory dynamics after surgical pneumothorax. Both systems are equipped with anti-reflux valves to prevent air and blood from entering the drainage, and no adverse events were reported.

Balloon expandable vs. self-expandable transcatheter aortic valve prosthesis short-term results of retrospective study

Transcutaneous aortic valve implantation has been established as an effective method for the treatment of highgrade aortic stenosis in non-operative, high-risk for conventional surgery patients. According to the developed implantation technologies, the prostheses are divided into balloon-expandable valve prostheses (balloon-expandable valves, BEV) and self-expanding valve prostheses (self-expanding prostheses SEV). The two types of devices have different models for implantation, stratum architecture, cusps characteristics, leading to different hemodynamics, frequency of use and performance of normal prosthesis function. The research aims to monitor the short-term results, up to 1 month after discharge, in terms of mortality, the manifestation of heart failure, (para) prosthetic regurgitation, implantation of a pacemaker, and vascular complications. Materials and methods: the article presents a retrospective follow-up of a total of 230 high-risk for conventional cardiac surgery patients with high-grade aortic stenosis treated in a cardiology clinic at UMHAT St. Ekaterina Sofia until 2020, divided into two groups depending on the implanted type of prosthesis. Conclusions: The results obtained based on our experience prove the safety of new prostheses. When choosing between BEV and SEV, the best clinical outcome requires a good knowledge of the strengths and weaknesses of using medical devices with a personalized approach consistent with the clinical and anatomical characteristics of the patient.

Can Minimally Invasive Multivessel Coronary Revascularization Be a Routine Approach?

Advancement in the field of cardiovascular surgery has emerged with various minimally invasive approaches for the treatment of multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. This study describes our routine technical approach and clinical experience of minimally invasive coronary artery bypass via left anterior minithoracotomy for the treatment of patients with multivessel coronary lesions. Our experience includes 100 consecutive patients who were operated between July 2020 and April 2021. The left internal thoracic artery was harvested in all patients. Radial arterial grafts and saphenous vein grafts were harvested endoscopically. Patients were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy. We had single mortality (1%), no early postoperative myocardial infarction was observed. None of our patients was converted to sternotomy (0%). The mean number of bypass was 3.1 ± 0.8, the mean cross-clamping time was 78.1 ± 20.6 minutes, the mean CPB time was 153.2 ± 37.5 minutes, the average intubation time was 6.33 ± 11.29 hours, the mean intensive care unit stay was 1.62 ± 1.78 days, the mean hospital stay was 4.98 ± 3.01 days, the average total operation time was 4.20 ± 0.92 hours, and the average pleural drain was 393.8 ± 169.7 mL. Minimally invasive coronary artery bypass grafting via left anterior minithoracotomy can be routinely performed with safety and it is feasible, reproducible with a short learning curve. Further multicenter studies are needed for the standardization of our technique.

Impact of minimally invasive mitral valve surgery on sexual dysfunction in male patients

BackgroundSexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations.MethodsPatients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire.ResultsThere were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health.ConclusionsIn our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.

Conventional cardiac surgery in patients with end-stage coronary artery disease: yesterday and today.

Surgical therapy of combined coronary artery disease (CAD) and heart failure, also referred to as end-stage CAD, has evolved throughout the years and patients are currently being offered traditional coronary artery bypass grafting (CABG), with or without surgical ventricle restoration (SVR), interventions for ischemic mitral valve regurgitation, heart transplantation or implantation of mechanical cardiovascular support systems. Among surgical methods, operative myocardial revascularization (with or without ventricle restoration) is still playing an important role, aiming at restoration of proper myocardial perfusion, especially if heart muscle viability is present. Facing the donor shortage, CABG may constitute a valuable alternative to transplantation in selected patients. In individuals considered not suitable for surgical revascularization, implantation of mechanical circulatory support (MCS) not only appears as a salvage procedure, but also allows for reevaluation of future therapy directions. This article aims at providing an overview of evolving and current surgical practices in patients with end-stage CAD.

Ce qu'un réanimateur doit savoir des TAVI

Le rétrécissement aortique est la valvulopathie acquise la plus fréquente. Quand il devient serré et symptomatique, la mortalité à 2 ans est proche de 80% en l’absence de prise en charge. Le traitement repose sur le remplacement valvulaire, historiquement réalisé par voie chirurgicale. L’avènement des procédures percutanées par cathétérisme cardiaque TAVI (Trans-catheter Aortic Valve Implantation) a tout d’abord permis de traiterdes patients jugés inopérables, puis avec l’avancée des connaissances cette procédure s’est étendue aux populations à risque chirurgicale élevépuis intermédiaire, et a même été validée chez les patients à bas risque aux Etats-Unis suite à de grandes études multicentriques. Le principe consiste à implanter une bioprothèse aortique suturée sur un stent directement au sein de la valve native calcifiée, soit par un procédé de dilatation au ballonnet, soit par un procédé auto-expansé. Le TAVI présente l’avantage d’une procédure peu invasive, le plus souvent réalisée sous anesthésie locale et sédation, et une durée de séjour courte. La récupération fonctionnelle est plus rapide qu’après chirurgie cardiaque conventionnelle.Un autre avantage par rapport à la chirurgie cardiaque conventionnelle est un moindre taux de complications graves (choc cardiogénique, saignement majeure, accident vasculaire cérébrale, insuffisance rénale, décès toute cause). En revanche certaines complications sont plus spécifiques du TAVI comme l’apparition d’un trouble conduction de haut degré nécessitant la pose d’un pacemaker, et l’existence de complications vasculaires. La surveillance en soins intensifs en découlant est donc plus courte qu’après chirurgie et doit probablement être personnalisée selon le risque du patient.&#x0D; L’utilisation du TAVI chez les sujets à risque et/ou âgés semble parfaitement implanté en France. L’extension des indications à des sujets à bas risque et plus jeunes n’est pas encore autorisée en France et en Europe. L’étude de la durabilité des bioprothèses implantées par voie percutanée à long terme nécessite des investigations supplémentaires.

Percutaneous Transapical Access for Performing Interventional Procedures in Patients with Structural Heart Pathologies: a Single Center Experience

The paper describes the experience of percutaneous transapical access (PTA) usage for performing transcatheter structural interventions in 7 patients. Four patients had paravalvular insufficiency of the prosthetic mitral valve, one patient had a reshunt of ventricular septal defect and a pseudoaneurysm in the area of fibrous mitral-aortic continuity. Two patients underwent PTA for diagnostic examination. The visualization methods, planning algorithm, and technique of the procedure have been described. The overall efficiency was 100%, the degree of paravalvular leak was reduced in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction.&#x0D; The aim. This study was designed to evaluate modern outlooks about the use of PTA during interventions, enhance the available data and extrapolate the authors’ own experience with the development of their own conclusions and recommendations.&#x0D; Materials and methods. To differentiate structural pathology, the initial selection of patients was performed according to the findings of transthoracic and transesophageal ultrasound. The next step in planning of PTA is analysis of computed tomography (CT) data with 3D reconstruction.&#x0D; PTA and subsequent interventions were performed in the hybrid catheterization laboratory after evaluation of CT data, guided by transesophageal echocardiography (TEE), and with the establishment of optimal angles of the angiograph arc for the best fluoroscopic imaging. Besides, in order to avoid trauma of left anterior descending coronary artery, selective angiography was performed. Surgical team support was essential in all cases.&#x0D; Results. The overall efficiency was 100%, reduction of the degree of paravalvular leak was achieved in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction.&#x0D; Discussion. The subject of our research was PTA for structural interventions. Available data of the world literature shows that this technology has been developed since the end of the last century.&#x0D; The main complications that can be encountered during the intervention by PTA were: hemothorax; hemopericardium/tamponade; rupture of the coronary artery; pneumothorax; arrhythmia; death.&#x0D; In four out of five cases, we used a Lifetech HeartR PDA occluder to close the puncture site of the left ventricular apex. In the fifth case, LifeTech mVSD occluder was used.&#x0D; Conclusions. Correction of structural pathology by routine use of PTA requires a comprehensive approach to the diagnosis of this pathology using transthoracic and transesophageal echocardiography, contrast-enhanced CT and 3D reconstruction. Support of a multidisciplinary team to provide transition to conventional cardiac surgery access in case of periprocedural complications is mandatory. Due to the emergence of specialized implants, as well as the development of imaging techniques, PTA requires attention and further study.

Valve Thrombosis Or Hypo-attenuating Leaflet Thickening After Tavr And Savr: Is There A Need For Different Therapeutic Strategies?

Introduction: Transcatheter aortic valve repair (TAVR) and conventional cardiac surgery with valve replacement using sutureless bioprostheses are possible options to treat severe symptomatic aortic valve stenosis. No definite guidelines exist regarding the postinterventional anticoagulation therapy especially in patients with atrial fibrillation.

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks.

Acute post-operative pain following sternotomy in cardiac surgery should be adequately managed so as to avoid adverse hemodynamic consequences and pulmonary complications. In the era of fast tracking, adequate and efficient technique of post-operative analgesia enables early extubation, mobilization and discharge from intensive care unit. Due to increasing expertise in ultrasound guided blocks there is a recent surge in trial of bilateral nerve blocks for pain relief following sternotomy. The aim of this article was to review non-neuraxial regional blocks for analgesia following sternotomy in cardiac surgery. Due to the paucity of similar studies and heterogeneity, the assessment of bias, systematic review or pooled analysis/meta-analysis was not feasible. A total of 17 articles were found to be directly related to the performance of non-neuraxial regional nerve blocks across all study designs. Due to scarcity of literature, comments cannot be made on the superiority of these blocks over each other. However, most of the reviewed techniques were found to be equally efficacious or better than conventional and established techniques.

Assessment of Nursing Care on Patient’s Outcomes after Minimally Invasive and Conventional Cardiac Surgery

In Minimally invasive heart surgery the patient experiences less pain and quicker recovery Aim: the study aimed to assess nursing care on patient’s outcomes after minimally invasive and conventional cardiac surgery Patient and method. Design: descriptive research design was utilized in the study. Setting: this study was conducted in the postoperative ICU, Heart Assuit University Hospital. Sample: a convenience sample of 60 patients 30 minimally and 30 conventional. Four tools have been to utilized to gather the data, ToolI: patient's assessment sheet, Tool II: Intraoperative assessment sheet, Tool III: postoperative assessment sheet and Tool IV: patient outcome assessment sheet. Results: A number of clinical outcomes were significantly improved with minimally than conventional including pain assessment30.8%, quality of life91.27±3.03,blood transfusion35.1% and length of stay in intensive care unit.was3.04±0.74.Conclusions:assessment of nursing care founded that patients with minimally invasive associated with decreased bleeding, blood product transfusion, ventilation time, intensive care unit stay and less pain than conventional group. Recommendation: Establishing a standardized protocol for nursing care after cardiac surgery. Repeat this research on a large probability sample acquired from different geographical areas in Egypt.

Outcomes of Conventional Cardiac Surgery in Patients With Severely Reduced Ejection Fraction in the Modern Era

This study evaluates the outcomes of conventional cardiac surgery in patients with a left ventricular ejection fraction (LVEF) of 25% or less. Patients with preoperative low LVEF (25% or less) undergoing The Society of Thoracic Surgeons (STS) indexed cardiac operations from 2010 to 2018 were included. The primary outcome was survival. Secondary outcomes included major postoperative complications and readmission rates. Multivariable Cox regression was utilized for risk adjustment. Subanalyses evaluated the effect of preoperative inotropes as well as the impact of low LVEF on survival and readmission compared with propensity matched patients with LVEF greater than 25%. In all, 9467 patients underwent STS-indexed cardiac operations during the study period, including 588 with LVEF of 25% or less. The low LVEF group included 397 (67.5%) isolated coronary artery bypass graft, 51 (8.67%) isolated valve, and 140 (23.8%) concomitant coronary artery bypass graft and valve operations. Survival of low LVEF patients was not affected by operative procedure but instead by traditional risk factors such as advanced age and medical comorbidities. Freedom from hospital readmission for heart failure was 57.2% at 5-year follow-up. Patients receiving preoperative inotropes had reduced survival, although the majority were still alive at 5 years (53.1% vs 64.9%, P= .002). In addition, propensity matched patients with LVEF 25% or less and LVEF greater than 25% had similar survival and hazards for mortality at 30-day, 1-year, and 5-year follow-up. Despite a high-risk profile, patients with reduced preoperative LVEF can undergo conventional cardiac surgery with acceptable outcomes. The majority of patients, including those receiving preoperative inotropes, were alive and free from heart failure readmissions at 5 years.

Improving the prognostic value of ∆PCO2 following cardiac surgery: a prospective pilot study.

Conflicting results have been published on prognostic significance of central venous to arterial PCO2 difference (∆PCO2) after cardiac surgery. We compared the prognostic value of ∆PCO2 on intensive care unit (ICU) admission to an original algorithm combining ∆PCO2, ERO2 and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO2 and its correlations with ERO2 and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases were collected on ICU admission and at 6, 12 and 24 h postoperatively. High ∆PCO2 (≥ 6 mmHg) on ICU admission was found to be very frequent (64% of patients). Correlations between ∆PCO2 and ERO2 or lactate for POD1 values and variations were weak or non-existent. On ICU admission, a high ∆PCO2 did not predict a prolonged ICU length of stay (LOS). Conversely, a significant increase in both ICU and hospital LOS was observed in high-risk patients identified by the algorithm: 3.5 (3.0–6.3) days versus 7.0 (6.0–8.0) days (p = 0.01) and 12.0 (8.0–15.0) versus 8.0 (8.0–9.0) days (p < 0.01), respectively. An algorithm incorporating ICU admission values of ∆PCO2, ERO2 and lactate defined a high-risk profile that predicted prolonged ICU and hospital stays better than ∆PCO2 alone.

Cardiac surgery 2018 reviewed.

For the year 2018, more than 22,000 published references can be found in PubMed when entering the search term "cardiac surgery". As in the last 4years, this review focusses on conventional cardiac surgery publications which provide important and interesting information especially relevant for non-surgical colleagues. Interventional techniques have been considered if they were published in the context of classic surgical techniques. We have again reviewed the fields of coronary revascularization and valve surgery and briefly touched on aortic surgery and surgery for terminal heart failure. For revascularization of complex coronary artery disease, bypass grafting was reconfirmed as gold standard and computer-tomographic angiography established equipoise for decision-making with classic angiography. For aortic valve treatment, some new longer-term outcomes from TAVI vs. SAVR trials confirmed equipoise of both treatments for high and medium risk. New information was provided for INR-management of mechanical aortic valves as well as long-term experiences for alternatives to mechanical valves (i.e., Ross and the relatively new Ozaki procedure). In the mitral and tricuspid field, prevalence data illustrate a significant amount of under-treatment for mitral and tricuspid valve regurgitation and evidence for life prolonging-effects of surgery. Finally, elongation of the ascending aorta was identified as new risk factor for aortic dissection and 2years outcome of the newest generation of left ventricular assist devices demonstrate impressive improvements in outcome. While this article attempts to summarize the most pertinent publications, it does not expect to be complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery and a stimulus for in-depth reading.

Impact of preoperative extracorporeal life support on left ventricular assist device outcomes: A comparative study.

To investigate whether preoperative short-term extracorporeal life support therapy in patients undergoing continuous-flow left ventricular assist device implantation has an impact on the outcome regarding survival and adverse events. Between January 2011 and May 2018, 100 consecutive patients received HeartMate II, HeartWare, or HeartMate III for end-stage heart failure. Mean age was 64.2 ± 10.3 years. Three patient groups were identified: without preoperative extracorporeal life support (non-extracorporeal life support group, n = 80), with preoperative extracorporeal life support due to postcardiotomy shock after conventional cardiac surgery (postcardiotomy shock group, n = 9), and with preoperative extracorporeal life support without previous surgery (non-postcardiotomy shock group, n = 11). The primary endpoint was overall survival after device implantation. Secondary endpoints were adverse events during the follow-up period. Survival was significantly different between the groups (p < 0.05): 30-day, 6-month, and 1-year survival rates were 85%, 68%, and 61% for non-extracorporeal life support group; 44%, 22%, and 22% for postcardiotomy shock group; and 45%, 27%, and 24% for non-postcardiotomy shock group, respectively. Furthermore, in both extracorporeal life support groups (postcardiotomy shock and non-postcardiotomy shock), there were a higher incidence (p < 0.05) of postoperative right heart failure (30% vs 66.7% vs 54.5%), acute renal failure requiring dialysis (20% vs 77.8% vs 54.5%), and respiratory failure (31.3% vs 88.9% vs 81.8%). Continuous-flow left ventricular assist device implantation with prior extracorporeal life support appears to have a worse outcome regarding survival, right heart failure, renal and respiratory dysfunction (p < 0.05). Future studies have to be done to evaluate the outcome after extracorporeal life support bridge pre-left ventricular assist device, especially as ultima ratio in postcardiotomy shock patients.