Cardiopulmonary Bypass Time Research Articles

Predictive value of NT-pro BNP on outcomes of children with ventricular septal defect surgery

BackgroundLimited study has shown whether NT-proBNP is related to the prognosis of children wth ventricular septal defect (VSD) surgery. The study was conducted to determine the predictive value of NT-proBNP on outcomes of children with VSD surgery.MethodsA total of 798 children with VSD surgery were enrolled, with NT-proBNP measured at preoperatively and 24-h postoperatively. The short- and mid-term clinical outcomes were recorded. Propensity scores (PS) was performed to acquire pre-op and post NT-proBNP 24-h PS-matched cohorts for comparisons between groups.ResultsIn the pre NT-proBNP PS-matched cohort, the higher NT pro-BNP group had longer hospitalization time and lower post-op 1-month EF value compared with low NT pro-BNP group (all P < 0.05), and there wasn't significant difference of mechanical ventilation time, cardiopulmonary bypass (CPB) time, intensive care unit (CCU) stay, and ejection fraction (EF) values of 3 month to 12 months after surgery (all P > 0.05). In the post NT-proBNP PS-matched cohort, there wasn't significant difference of mechanical ventilation time, CPB time, CCU stay, hospitalization time, and EF values of 1 month to 12 months after surgery between two groups (all P > 0.05).ConclusionsVSD children with higher pre NT-proBNP level had longer hospital stays after surgery than those with lower level. Pre NT-proBNP level had no effect on mechanical ventilation time, CPB time, ACC time and CCU stay and cardiac function after 3 months postoperatively. Post-op 24-h NT pro-BNP level wasn't associated with clinical outcomes.

Unsupervised machine learning model for phenogroup-based stratification in acute type A aortic dissection to identify postoperative acute gastrointestinal injury

ObjectiveWe aimed to explore the application value of unsupervised machine learning in identifying acute gastrointestinal injury (AGI) after extracorporeal circulation for acute type A aortic dissection (ATAAD).MethodsPatients who underwent extracorporeal circulation for ATAAD at the First Hospital of Lanzhou University from January 2016 to January 2021 were included. Unsupervised machine learning algorithm was used to stratify patients into different phenogroups according to the similarity of their clinical features and laboratory test results. The differences in the incidence of perioperative AGI and other adverse events among different phenogroups were compared. Logistic regression was used to analyze the high-risk factors for AGI in each phenogroups and random forest (RF) algorithms were used to construct diagnostic models for AGI in different phenogroups.ResultsA total of 188 patients were included, with 166 males and 22 females. Unsupervised Machine Learning stratified patients into three phenogroups (phenogroup A, B, and C). Compared with other phenogroups, phenogroup B patients were older (P < 0.01), had higher preoperative lactate and D-dimer levels, and had the highest incidence of AGI (52.5%, P < 0.001) and in-hospital mortality (18.6%, P = 0.002). The random forest model showed that the top four risk factors for AGI in phenogroup B were cardiopulmonary bypass time, operation time, aortic clamping time, and ventilator time, which were significantly different from other phenogroups. The areas under the curve (AUCs) for diagnosing postoperative AGI of phenogroup A, B, and C were 0.943 (0.854–0.992), 0.990 (0.966–1.000), and 0.964 (0.899–0.997) using the RF model, respectively.ConclusionPhenogroup stratification based on unsupervised learning can accurately identify high-risk populations for postoperative AGI in ATAAD, providing a new approach for implementing individualized preventive and therapeutic measures in clinical practice.

Analysis of the risk factors of delayed extubation after surgery for Ebstein’s anomaly

ObjectiveIn this study, we aimed to screen the risk factors for delayed extubation after surgery for Ebstein’s anomaly (EA), determine the diagnostic cut-off values, and develop a prediction equation to accurately encourage rapid recovery after surgery.MethodsThe perioperative data of 76 pediatric patients undergoing EA surgery in the Surgical Department of the Pediatric Heart Center of Anzhen Hospital from September 2013 to September 2021 were retrospectively analyzed.ResultsAmong these cases, 37 (48.6%) were male, with an average age of 4.67 (2, 11.19) years and an average weight of 18 (12.4, 37) kg. The median postoperative duration of mechanical ventilation was 18 (10, 24) h, and the duration of mechanical ventilation ≥ 24 h (75th percentile) was defined as delayed extubation. Body weight (11.25 kg) and preoperative oxygen saturation (SpO2) (95.5%) were protective factors, while the simplified Great Ormond Street Echocardiogram (GOSE) value (0.995) and the intraoperative cardiopulmonary bypass (CPB) time (135 min) were the risk factors. The prediction model was developed based on these indexes: logit (P) = 8.9 + (0.02 × CPB time) + (2.2 × simplified GOSE) – (0.14 × preoperative SpO2) − (0.06 × body weight), and the area under the receiver operator characteristic (ROC) curve was 83.4% (P < 0.01). Patients with delayed extubation had a longer intensive care unit stay and a higher incidence of adverse events (P < 0.01).ConclusionLow body weight, low preoperative SpO2, high GOSE value, and long intraoperative CPB time for pediatric patients with EA are likely to lead to prolonged postoperative duration of mechanical ventilation. For low-risk children, early extubation after surgery can be more actively encouraged; however, more care should be taken to avoid the risk of re-intubation.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR. All consecutive VSRR at two centers from 2005-2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and Fine-Gray sub-distribution hazard model were used to identify factors associated with 10-year survival and aortic valve (AV) reintervention, respectively. Of 778 VSRR, 69 (8.9%) were reoperative sternotomies. Compared to primary, reoperative VSRR patients were younger (43 [34-54] vs 51 [39-61] years, p<0.001) and had less aortic insufficiency (33.3% vs 48.5%, p=0.02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%, p=0.01) and prolonged ventilation (24.6% vs 9.9%, p<0.001); operative mortality was higher in reoperative VSRR (2.9% (2/69) vs 1.4% (10/709)) although not significantly (p=0.66). Ten-year survival was 82.0% [70.0-96.0] and AV reintervention rate was 11.8% [2.3-19.4] after reoperative VSRR. After IPTW adjustment, survival and AV reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (p=0.13) or AV reintervention (p=0.77) on multivariable analysis. Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and AV reintervention rates were acceptable and comparable to primary VSRR.

Protein alterations in patients with delirium after cardiac surgery: An exploratory case-control sub-study of the VISION Cardiac Surgery Biobank.

Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways. To agnostically discover novel biomarkers of delirium, we conducted a case-control sub-study using the VISION-Cardiac Surgery biobank. Our objective was to identify candidate biomarkers to investigate in future studies. We obtained a convenience sample of 30 patients with delirium on postoperative day 1 matched to 30 matched controls by age, sex, ethnicity, center and cardiopulmonary bypass time. The Olink Explore 3K platform was used to identify blood protein alterations on postoperative day 3. Protein concentrations were expressed as normalized protein expression (NPx) units (log2 fold scale). We compared protein expression between cases and controls using a paired t-test and reported significantly different biomarkers based on a False Discovery Rate (FDR)-adjusted p-value<0.05. Of 2,865 unique serum proteins, 26 (0.9%) were significantly associated with delirium status; all were elevated in cases versus controls at an FDR<0.05. Pathway analysis identified "calcium-release channel activity" (Padj=0.02) and "Guanosine 5' triphosphate (GTP)-binding" (Padj=0.005) functions as characteristic of proteins associated with delirium. The top three differentially expressed biomarkers were FKBP1B (Padj=0.003), C2CD2L (Padj=0.004), and RAB6B (Padj=0.004). The inflammatory biomarker IL-8 (CXCL8) (mean difference = 2.36; P=3.6x10-4) was also associated with delirium. We identified 26 biomarkers significantly associated with delirium; all are novel except for IL-8. We did not identify an association between delirium and recognized neuro-inflammatory proteins and markers of brain injury, which supports using biomarkers to differentiate between delirium and other neurological conditions. While exploratory, our findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.

Real World Testing of a Clinical Strategy to Start Early Peritoneal Dialysis for High-Risk Newborns Following Cardiac Surgery.

The beneficial impact of peritoneal dialysis (PD) catheter placement following cardiopulmonary bypass in young infants has been demonstrated. But the indications to start early peritoneal dialysis are not agreed upon. This retrospective single center study was conducted to evaluate the performance of a clinical strategy for early PD start. PD catheters were placed in the operating room (OR) following cardiopulmonary bypass (CPB). Those with prolonged CPB times (>180 minutes), post-operative (post-op) oligo-anuria and/or inability to achieve negative fluid balance in post-op 24 hours were evaluated as high-risk and selected for early PD start (PD +). All PD + were started within the first post-op 24 hours. Primary outcomes were 5% fluid accumulation at post-op 48 hours and severe acute kidney injury (AKI) at post-op day 5. There were forty-nine newborns. Twenty-nine subjects were early PD (PD +) starts and twenty used the PD catheter as an abdominal drain (PD -). Baseline demographic data were similar. Both groups were oliguric during post-op first 8 hours (p= 0.906). The Early PD (+) group produced significantly less urine output during post-op day 1 (0.98 vs 3.02 ml/kg/hour; p= 0.001). At post-op 48 hours, early PD (+) group had similar prevalence of 5% fluid accumulation as early PD (-), 5 (16.7%) vs. 2 (7.41%), respectively (p= 0.427). Severe AKI incidence at post-op day 5 was similar between the groups (17.3% vs 5.0%; p=0.204). Time to extubation was longer for early PD (+) group compared to PD (-) group, 10.0 days [7.0;16.0] vs. 4.0 days [4.0;10.0] (p=0.017). Persistent oliguria and inability to achieve negative fluid balance during initial post-op 24 hours may identify those newborns who will benefit from early PD. The first post-operative 8 hours was indiscriminative for this strategy. PD start may ameliorate the disadvantage for the designated group.

Myocardial Protection Using Antegrade Cardioplegia Alone Compared to Antegrade Combined with Vein Cardioplegia in On-Pump Coronary Artery Bypass Graft Surgery

Cardioplegia is an integral component of myocardial protection. Standard delivery of cardioplegia includes antegrade and retrograde method. Retrograde technique may cause injury to the coronary sinus and inadequate right ventricular protection while antegrade alone may be inadequate especially delivery of cardioplegia through very stenotic vessels. Therefore, in this study we compare myocardial protection using antegrade cardioplegia alone compared to combination of antegrade and vein cardioplegia in on pump coronary artery bypass graft surgery. This is a cross sectional retrospective study. Two groups of patients (antegrade combined with vein cardioplegia-study group and antegrade cardioplegia alone- control group) were studied. The study group consists of 42 patients while the control group consists of 39 patients. Study population are patients aged between 30-80 years old between 1 January 2019 and 30 April 2023. Intraoperative characteristics such as cardiopulmonary bypass time, aortic cross clamp time, cardioplegia volume, number of post-operative inotropes, ventricular tachycardia and fibrillation after aortic unclamping and postoperative characteristics such as hospital stay, ICU stay, mortality, intra-aortic balloon pump insertion, chest reopen for bleeding and postoperative atrial fibrillation were compared. The results of this study showed that cardiopulmonary bypass time, hospital stay, mortality, postoperative IABP insertion and postoperative arrhythmia rate for both groups were similar, however not statistically significant. The study group required less inotropes before transfer to ICU. (2.83 VS 3.10, P=0.04). The primary finding of this study shows that there is no difference in terms of myocardial protection with antegrade combined with vein cardioplegia as compared antegrade cardioplegia alone.

Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment

BackgroundPatients with comorbid coronary artery disease and valvular heart disease usually undergo coronary artery bypass grafting alongside valve replacement or ring repair surgeries. Following these procedures, they typically receive a combination of anticoagulation and antiplatelet therapy, which notably heightens their bleeding risk. However, Current scoring systems provide limited predictive capability.MethodsA total of 500 adult patients treated with anticoagulation plus antiplatelet therapy after cardiac surgery were randomly divided into the training set and the validation set at a ratio of 7:3. Predictive factors were identified using univariate logistic regression, LASSO regression and multivariable analysis. Various models were developed, validated and evaluated by using methods including ROC curves, calibration curves, the Hosmer-Lemeshow test, net reclassification improvement (NRI), integrated discrimination improvement (IDI) index, decision curve analysis (DCA) and clinical impact curves (CIC).ResultsMod2 showed the best performance (AUC of validation set = 0.863) which consists of 8 independent predictive factors (gender, age &amp;gt; 65 years, diabetes, anemia, atrial fibrillation, cardiopulmonary bypass time, intraoperative bleeding and postoperative drainage), with a significantly higher AUC compared to Mod1 (only preoperative factors) and Mod3 (the HAS-BLED scoring model). NRI and IDI analyses further confirmed the superior predictive ability of Mod2 (NRI &amp;lt; 0.05, IDI &amp;lt; 0.05). Both DCA and CIC indicated that Mod2 exhibited good clinical applicability.ConclusionThis research established and validated a nomogram model incorporating eight predictive factors to evaluate the bleeding risk in patients who receive anticoagulation combined with antiplatelet therapy following cardiac surgery. The model holds significant potential for clinical applications in bleeding risk assessment, decision-making and personalized treatment strategies.

The cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with atrial fibrillation undergoing valvular replacement and Cox maze III procedure.

The study was to assess the myocardial protection effects of the histidine-tryptophan-ketoglutarate (HTK) solution and the 4:1 blood cardioplegia (BC) in patients with atrial fibrillation (AF) who were subjected to valvular replacement concomitant with the Cox maze III surgery. A cohort of 148 individuals afflicted with AF, who received valve replacement surgery in conjunction with the Cox maze III procedure at our clinic within the period extending from 2015 to 2023, were enrolled. Subsequent to adjustment by propensity score matching (PSM), the patients were categorized into two distinct groups: the HTK group and the BC group. The primary end points assessed inotropic support requirements, complications, troponin trend, mechanical ventilation time and the intensive care unit stay. Arrhythmias, aortic cross-clamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points. No substantive disparities were observed concerning mortality rates, arrhythmias, neurological events, or renal complications. The duration of cardiopulmonary bypass and the aortic cross-clamp time did not demonstrate any marked variations between both groups, with p-values of 0.71 and 0.05, respectively. The time required for weaning from mechanical ventilation and the length of postoperative hospitalization were notably less in the group receiving HTK solution (p < 0.001 and p = 0.03, respectively). While inotropic support need was higher in the BC group (p = 0.02). Conversely, the dosage and frequency of perfusions were considerably increased in the BC group (p < 0.001 for each parameter). Within subgroups stratified by longer than 150min of aortic cross-clamping duration, those in the BC cohort had significantly elevated peaks of cardiac troponin I (cTnI) (p = 0.01), whereas individuals in the HTK group experienced less mechanical ventilation time (p = 0.002) and shorter durations of intensive care unit admission (p < 0.001). The LVEF value in the HTK group was higher compared to that in the BC group in the 3-month follow-up data (p = 0.02). Both the HTK and 4:1 blood cardioplegia could be used safely in patients with AF who were subject to valvular replacement and Cox maze III procedure. However, the utilization of HTK conferred a greater advantage in diminishing the duration of mechanical ventilation weaning and the duration of postoperative hospitalization. HTK may be a better myocardial protection in patients with long cross-clamp time. The follow-up data indicated that HTK might be superior to 4:1 blood cardioplegia in the short-medium term cardiac function.

Long‐Term Results of Minimally Invasive Mitral Valvuloplasty: Insights From a 12‐Year Single‐Center Experience

Purpose: The safety and long‐term durability of minimally invasive mitral valvuloplasty (MIMVP) remain controversial. This study aimed to compare the perioperative and long‐term outcomes of minimally invasive mitral valve surgery (MIMVS) and conventional sternotomy.Methods: This study included 476 patients who underwent mitral valve surgeries at our institution between January 2011 and December 2023. Patients were classified according to whether they underwent sternotomy: the nonsternotomy (NS: 271 cases) and sternotomy (S: 205 cases) groups. Perioperative and long‐term outcomes were compared between the two groups.Results: The NS group had a lower preoperative age and EuroScore II. In the S group, the left ventricular ejection fraction was lower, while the left ventricular end‐systolic diameter and left atrial diameter were larger. Operative time, cardiopulmonary bypass time, and aortic cross‐clamp time were longer in the NS group. Postoperative atrial fibrillation, more transfusion, and increased length of hospital stay were more frequent in the S group. The 10‐year freedom from reoperation and 10‐year survival rates in the NS and S groups were 98.1% vs. 93.6% (p = 0.07) and 94.8% vs. 86.9%, respectively (p = 0.08), with no significant differences.Conclusion: MIMVP demonstrates noninferior perioperative and long‐term outcomes compared with conventional sternotomy.

Prolonged Cardiopulmonary Bypass Time-Induced Endothelial Dysfunction via Glypican-1 Shedding, Inflammation, and Matrix Metalloproteinase 9 in Patients Undergoing Cardiac Surgery

Objectives: A prolonged cardiopulmonary bypass (CPB) time of over 180 min is linked to poorer outcomes and higher mortality in cardiac surgery. This study examines how glypican-1 shedding, matrix metallopeptidase 9 (MMP9), and the pro-inflammatory cytokine IL-1β may contribute to endothelial dysfunction in patients undergoing on-pump surgery with an extended CPB. Methods: Fifty-one patients undergoing cardiac surgical procedures were divided into two groups based on the intraoperative CPB duration: (i) normal CPB (&lt;180 min, n = 23) and (ii) prolonged CPB (&gt;180 min, n = 28). The preoperative, intraoperative, and postoperative plasma levels of glypican-1, MMP9, and IL-1β were measured. Results: Before surgery, the plasma levels of glypican-1, MMP9, and IL-1β were comparable between the normal CPB and the prolonged CPB groups. However, after the end of the CPB, all three markers showed significant elevation in the prolonged CPB group compared to the normal CPB group. Significant correlations were observed between the intraoperative and postoperative levels of MMP9, IL-1β, and glypican-1. A strong positive correlation was also observed between the intraoperative and postoperative levels of glypican-1 and the duration of the CPB. Conclusions: A prolonged CPB triggers a systemic inflammatory response and activates MMP9, leading to glypican-1 shedding and endothelial dysfunction.

Safety of prolonged bilateral antegrade cerebral perfusion in aortic arch surgery with moderate hypothermia.

This study investigates the impact of bilateral antegrade cerebral perfusion time on outcomes in aortic arch surgery. In total, 961 patients underwent either hemi arch (n = 385) or total arch replacement (n = 576) with bilateral antegrade cerebral perfusion and moderate hypothermia management between 2006 and 2020 across 2 aortic centers. Antegrade cerebral perfusion time was categorized into 4 groups (≤30 min: n = 169, 30-60min: n = 298, 60-90min: n = 261, >90min: n = 233). Inverse probability treatment weighting yielded a well-balanced cohort among the 4 groups except for the cannulation site. Adjusted cubic spline and multivariable logistic analysis were performed, controlling for surgical procedure, cannulation site and cardiopulmonary bypass time, to identify the relationship between antegrade cerebral perfusion time and major in-hospital complications including mortality, stroke, acute renal failure, and prolonged ventilation. There remained a significant difference in surgical procedures and cardiopulmonary bypass time in the matched cohort. The incidences of mortality and stroke did not show significant trend (P = 0.052 and P = 0.717 respectively). Cubic spline curves showed that odds ratios did not increase linearly for any complications with increasing antegrade cerebral perfusion time. Furthermore, antegrade cerebral perfusion time, even exceeding 90 min, was not associated with complication rates (mortality: odds ratio = 1.459 [0.368-6.049], p = 0.595; stroke: 0.310 [0.058-1.635], p = 0.166; renal failure: 1.744 [0.521-6.094], p = 0.374; prolonged ventilation: 1.502 [0.535-4.286], p = 0.442), whereas cardiopulmonary bypass time was associated with mortality and prolonged ventilation. Even when antegrade cerebral perfusion time exceeded 90 min, it was not associated with major in-hospital complications, questioning its validity as a marker for surgical insult.

The multi-center mid-term clinical outcomes of combined complete preservation of chordal structure mitral valve replacement with total anatomic complete arterial myocardial revascularization for coronary patients with moderate-to-severe or severe ischemic mitral regurgitation

Objective: To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR). Methods: This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results: In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ²=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ²=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts (χ²=5.24, P=0.155). Conclusion: The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

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.

Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy-Application of 3D Printing and Virtual Reality.

Major aortopulmonary collateral arteries (MAPCAs) are rare remnants of pulmonary circulation embryological development usually associated with complex congenital anomalies of the right ventricular outflow tract and pulmonary arteries. Effective management requires surgical unifocalization of MAPCAs and native pulmonary arteries (NPAs). Traditional imaging may lack the spatial clarity needed for precise surgical planning. This study evaluated the feasibility of integrating three-dimensional (3D) printing and virtual reality (VR) into preoperative planning to improve surgical precision, team communication, and parental understanding. In a prospective cohort study, nine infants undergoing MAPCA unifocalization were included. Four patients underwent conventional imaging-based planning (control), while five were additionally assessed using VR and 3D-printed models (intervention). The outcomes measured included operative times, team confidence, collaboration, and parental satisfaction. Statistical analysis was performed using standard tests. The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group. Intraoperative complications were absent in the VR/3D group but occurred in the control group. Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05). Parents also expressed higher satisfaction, with better comprehension of their child's anatomy and surgical plan. VR and 3D printing enhanced preoperative planning, surgical precision, and communication, proving valuable for complex congenital heart surgery. These technologies offer promising potential to improve clinical outcomes and patient-family experiences, meriting further investigation in larger studies.

Comparison of Sutureless and Sutured Aortic Valve Replacements in Patients with Redo Infective Endocarditis.

Background and Objectives: This study aims to assess the postoperative outcomes and complications of sutureless and sutured aortic valve replacement in patients with infective endocarditis. Materials and Methods: A total of 58 patients who underwent redo aortic valve replacement for bacterial or non-bacterial endocarditis between January 2018 and March 2023 were included in our study. Surgical procedures were performed through a full median sternotomy due to redo cases and to provide optimal access. Demographic characteristics, operative times, postoperative complications and some echocardiographic data were compared. All cases were meticulously evaluated preoperatively by a cardiac team to select the best treatment option. Results: The mean ICU length of stay was significantly shorter in the sutureless valve group at 5.4 ± 3.9 days compared to 7.9 ± 4.1 days in the sutured valve group (p = 0.029). However, the sutureless group had a mean operation time of 164.7 ± 37.3 min, while the sutured group had a mean operation time of 197.7 ± 45.6 min (p = 0.044). Again, the difference in cardiopulmonary bypass times between the two groups was statistically significant (p = 0.039). And again, four (14.2%) patients in the sutureless group underwent reoperation due to bleeding, while eight (26.6%) patients in the sutured group underwent postoperative bleeding control (p = 0.048). Conclusions: Our study suggests that sutureless aortic valve replacement may offer advantages in terms of operative efficiency and postoperative recovery compared to conventional sutured valves, with some significant differences in terms of some complications.

Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic dissection.

To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET). Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR+ FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on antegrade cerebral perfusion: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analyzed, and baseline characteristics between the two groups were assessed. The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (p = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, p = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (p = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs 93.67%, p = 0.133). Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing total arch replacement. The use of b-ACP significantly reduces the incidence of TND.

Evaluation of early extubation in the operating room for paediatric patients after congenital open-heart surgery.

Advances in surgical and perioperative care have reduced the need for prolonged mechanical ventilation in children following cardiac surgery. To evaluate the feasibility and assess the clinical outcomes of an early extubation strategy in the operating room for children undergoing congenital heart surgery, including neonates (age < 28 days). This is a retrospective analysis including congenital open-heart surgery cases. We excluded patients who remained open chest postoperatively or patients with severe hemodynamic instability and high inotropic support from the study. Study variables include age, gender, weight, preoperative cardiac diagnosis, preoperative diagnosis of genetic or chromosomal abnormalities, prematurity, preoperative mechanical ventilation (invasive or non-invasive), cardiopulmonary bypass time, circulatory arrest time, postoperative use of inotropes, duration of mechanical ventilation, postoperative respiratory complication, sepsis, bleeding or other complications, paediatric cardiac ICU stay, total hospital stay, incidence of failed extubation, and operative or postoperative mortality. This study included 163 patients who underwent congenital open cardiac surgery, out of these studied patients, 118 (72.4%) were extubated in the operating room. In total, 19.6% of studied patients had Down syndrome. Other genetic or chromosomal disorders were present among 8.6% of studied patients. There was a statistically significant difference between operating room extubation group and non-operating room extubation group regarding Risk Adjustment for Congenital Heart Surgery Score classification, postoperative paediatric ICU duration, postoperative hospital length of stay, vasoactive-inotrope score, duration of inotrope, open chest, and mortality. Extubation in the operating room after congenital open-heart surgery was successful in most of our patients, even following complex procedures.

A model for predicting AKI after cardiopulmonary bypass surgery in Chinese patients with normal preoperative renal function

ObjectiveTo develop and validate a predictive model for acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery in Chinese patients with normal preoperative renal function.MethodFrom January 1, 2015, to September 1, 2022, a total of 1003 patients were included in the analysis as a development cohort. We used the ratio of 7:3 to divide the patients into a training group (n = 703) and a testing group (n = 300). In addition, a total of 178 patients were collected as an external validation cohort from January 1, 2023, to May 1, 2023. In the training group, independent risk factors for postoperative AKI were identified through the least absolute shrinkage and selection operator (LASSO) regression and multifactor logistic regression analysis. A nomogram predictive model was then established. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, as well as calibration curve and decision curve, were used for validation of the model.ResultsAge, body mass index (BMI), emergent surgery, CPB time, intraoperative use of adrenaline, and postoperative procalcitonin (PCT) were identified as important risk factors for AKI after CPB surgery (P < 0.05). The nomogram predictive model demonstrated good discrimination (AUC: 0.772 (95%CI: 0.735 − 0.809), 0.780 (95% CI: 0.724 − 0.835), and 0.798 (95% CI: 0.731 − 0.865)), calibration (Hosmer and Lemeshow goodness of fit test: P-value 0.6941, 0.9539, and 0.2358), and clinical utility (the threshold probability values in the decision curves are respectively > 12%, > 10%, and 16% ~ 75%) in the training, testing, and external validation groups.ConclusionThe predictive model, which was established in Chinese patients with normal preoperative renal function, has high accuracy, calibration, and clinical utility. Clinicians can utilize this model to predict and potentially reduce the incidence of AKI after CPB surgery in the Chinese population.

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.