Cardiothoracic Surgery Department Research Articles

Weight loss, glycolipid profile changes in type 2 diabetes patients after esophagectomy: a propensity score matching analysis.

Type 2 diabetes mellitus (T2DM) is a common co-morbidity in patients who receive esophagectomy and has unfavorable effects on glucose and lipid metabolism in patients. This study examines how weight and glycolipid metabolism change in patients with T2DM following esophagectomy. This retrospective, one-center, observational analysis with a propensity score matching analysis (PSM) included 114 patients who underwent esophageal surgery in the Department of Cardiothoracic Surgery, the 900th Hospital of Joint Logistic Support Force from 2017 to 2020, which were separated into T2DM group and Non-T2DM group. Weight, body mass index (BMI), fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured and analyzed before and after the operation. Two groups showed similar reductions in weight and BMI after surgery. In the T2DM group, weight decreased from 63.10(10.31) before surgery to 55.10(11.60) kg at 6months (P < 0.001) with BMI decreasing from 22.67 (2.90) to 19.77 (3.48); While in the Non-T2DM group, weight decreased from 61.42 (8.46) to 53.19 (9.26) kg at 6months after surgery with BMI decline from 22.49 (2.77) before operation to 19.45 (3.08) at 6months after surgery. Fasting plasma glucose levels showed a significant decrease (P = 0.035) in the T2DM group at a six-month point of 7.00 (2.21) mmol/L compared to preoperative levels of 7.67 (2.32) mmol/L. HDL levels increased significantly in the Non-T2DM group at six months postoperatively at 1.52 (0.05) with P < 0.001 compared to preoperative levels of 1.22(0.04) mmol/L. TG, LDL, and TC levels decreased significantly in both groups from the preoperative to the 6-month point. Esophagectomy induces weight loss in T2DM and Non-T2DM groups, improves long-term glucose metabolism in the T2DM group, and enhances lipid metabolism in both groups. Further research is needed to understand their mechanisms.

The correlation study between the length and angle of ascending aortic and the incidence risk of acute type A aortic dissection.

This study utilized computed tomography angiography (CTA) to assess the risk of acute type A aortic dissection (ATAAD) by analyzing the imaging morphology indicators of the ascending aorta, along with the relevant risk factors associated with aortic dissection. The study utilized a retrospective observational research design. The population consisted of 172 patients who received treatment in the Department of Cardiothoracic Surgery at Qilu Hospital, Shandong University, from January 2018 to December 2022. The patients were divided into two groups: the ATAAD group (n = 97) and the thoracic aortic aneurysm group (TAA, n = 75). Demographic data and ascending aorta CTA measurements were collected from all patients. Single factor and multivariate logistic regression were employed to analyze the statistical differences in clinical data and ascending aorta CTA imaging morphology indicators between the two groups. The variables were included in logistic multivariate analysis for further screening, indicating that the length of the ascending aorta (LAA) before ATAAD (OR = 3.365; 95% CI :1.742-6.500, P<0.001), ascending arch angle (asc-arch angle, OR = 0.902; 95% CI: 0.816-0.996, P = 0.042) and the maximum aortic diameter (MAD) before ATAAD, (OR = 0.614; 95% CI: 0.507-0.743, P<0.001) showed statistically significant differences. This study suggests that increased LAA and MAD, as well as a smaller asc-arch angle may be high-risk factors for the onset of ATAAD.

Comparative study of total thoracoscopic mitral valve surgery and traditional open mitral valve surgery :propensity score matching study

Background: Conventional median open mitral valve replacement surgery usually requires a 20-30cm size incision to ensure adequate visual exposure. So, while we complete the valve replacement, it also brings about a series of problems. The appearance of TV thoracoscope changes the exposure of the surgical field. Because the microscopic field is enlarged, it not only makes the surgical vision clearer, but also greatly shortens the incision, reduces bleeding, and conceals the incision, minimizing the trauma and shortening the postoperative recovery time, which is in line with the concept of modern health. Aim: All technological innovation is controversial in the early stage, and it is such debate that can promote the progress and development of technology.This study was conducted in the context of this debate to summarize the experience of Total thoracoscopic mitral valve surgery in our center.Total thoracoscopic mitral valve replacement surgery and traditional median incision mitral valve replacement surgery were compared by the propensity score matching method.Evaluate its safety and merits. Methods: From January 2018 to December 2020, a total of 139 patients in the thoracoscopic group were eligible in the cardiothoracic surgery department of our hospital, and 1066 cases of traditional median sternotomy mitral valve replacement. After propensity score matching, 125 patients were selected in the thoracoscopic group, among 1066 patients with median incision MVR, 1:1 matched to 125, as the control group in the thoracoscopic group. Results: The results showed that the mean operative time in the thoracoscopic MVR group was significantly longer than that in the control group (185.73 ± 43.04 vs. 164.58 ± 40.28, p=0.0016). Similarly, both the mean CPB time and aortic block time were significantly longer than those in the control group (108.37±30.57min vs. 79.18±17.65min, p &lt;0.0001; 66.59±29.63min vs. 45.09±19.68min, p &lt;0.0001. Moreover, the proportion of patients with CPB greater than 120min and aortic block greater than 90min was significantly higher than the control group (24.1% vs. 3.2%, p &lt;0.0001,14.4% vs. 2.4%, p=0.0237). In addition, there was no significant difference in the mean ICU observation time between the two groups (49.35±34.51h vs. 48.72±25.89h, p=0. 8792). Differently, the mean endotracheal intubation time was significantly lower in the thoracoscopic MVR group compared to the control group (18.52±6.07h vs. 25.45±14.18h, p=0.0032). Similarly, the length of stay in the thoracoscopic group was 9.13 ± 4.58 days, which was significantly lower than 11.12 ± 5.76 days in the control group (p=0.0004). There was no significant difference in the postoperative hemoglobin concentration or platelet count between the two groups of MVR patients. Mean intraoperative bleeding volume in the thoracoscopic MVR group was significantly less than that in the control group (158.37±100.91ml vs.250.74 ± 81.34, P &lt;0.0001). Similarly, the mean postoperative discharge in the thoracoscopic MVR group was significantly than in the control group (428.39±361.38ml vs. 514.07 ± 347.92ml, p=0.0383). For patients with postoperative blood products, there were 37 (29.6%) in the thoracoscopic group and 33 (26.4%) in the control group. There was no significant difference between the two groups. Similarly, there was no significant difference in the mean total hospital costs between the two groups. Conclusion: This study shows that it has feasibility and safety for total thoracoscopic mitral valve replacement for mitral valve lesions, which can reduce the time and stay of the hospital compared with conventional direct surgery, and obtain good minimally invasive and cosmetic effect, and lay a theoretical and clinical foundation for the application of thoracoscopic technology in cardiac surgery, which has important scientific significance.

[Correlation between prognostic nutritional index and pleural thickness with survival time of epithelial malignant pleural mesothelioma patients].

Objective: To explore the role of prognostic nutritional index (PNI) and pleural thickness in the prognostic evaluation of patients with epithelial malignant pleural mesothelioma (MPM) . Methods: In April 2022, a retrospective analysis was conducted on the data and laboratory data of 41 patients with epithelial MPM admitted to the cardiothoracic surgery department of Chuxiong Yi Autonomous Prefecture People's Hospital from January 2018 to May 2021. Univariate and multivariate analysis were used to evaluate the relationships between total survival time, clinical characteristics, PNI and pleural thickness in patients. Results: The 41 patients were mostly male (26 cases, 63.4%) , with a median age of 55 years old. The main clinical manifestations were chest pain (53.7%) , bloody pleural effusion (75.6%) , and chest pain combined with bloody pleural effusion (36.6%) . The median survival time of patients with different TNM stage, efficacy after 4 cycles of chemotherapy, PNI, maximum pleural thickness after chemotherapy (post max) , sum of post max in 3 zones after chemotherapy (post sum) were statistically different (χ(2)=3.89, 14.51, 15.33, 4.33, 12.05, P<0.05) . Compared with patients with high PNI and post sum<32.26 mm, MPM patients with low PNI and post sum≥32.26 mm have higher risk of death, and the differences were statistically significant (HR=1.52, 95%CI: 1.75-11.93, P=0.002; HR=1.70, 95%CI: 1.84-16.23, P=0.002) . Conclusion: PNI and post sum can be used to predict the prognosis of patients with epithelial MPM.

FREQUENCY OF ACUTE KIDNEY INJURY IN PATIENTS POST-CORONARY ARTERY BYPASS GRAFTING AT TERTIARY CARE HOSPITAL, KARACHI

A descriptive study was conducted at the Department of Medicine and Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from May 27, 2019, to November 27, 2019, to determine the frequency of acute kidney injury in patients after coronary artery bypass grafting. A total of 174 patients who underwent coronary artery bypass graft surgery were enrolled in the study. Postoperatively, all patients were closely observed for acute kidney injury up to 48 hours post-surgery. The demographic characteristics of the participants revealed a mean age of 54.14±9.49 years, with 108 (62.1%) being males and 66 (37.9%) females. Out of the total participants, 25 (14.4%) experienced acute kidney injuries, while 149 (85.6%) did not show any signs of acute kidney injuries. The findings suggest that acute kidney injury is a common complication following isolated coronary artery bypass graft (CABG) surgery. This observation holds significant clinical importance, as it is associated with unfavourable postoperative outcomes, prolonged stays in the intensive care unit (ICU), and elevated fatality rates. These insights underscore the need for careful monitoring and management of renal function in patients undergoing CABG surgery to mitigate the impact of acute kidney injury on overall postoperative well-being.

Outcomes of Clampless Real Chimney Technique with Dacron Graft and Sleeve Banding of the Ascending Aorta for Total Debranching Endovascular Arch Repair

Background: Hybrid aortic arch repair with debranching of the supra-aortic vessels carries a high risk of cerebral infarction and fatal complications associated with side clamping of the ascending aorta. A previous study had reported the “real chimney” technique, a novel method for clamp-free total debranching thoracic endovascular aortic repair with the ascending aortic sleeve banding with dacron. In this study, we aim to build upon this foundation by presenting our experience with the early and midterm outcomes of this technique. Methods: We retrospectively reviewed the medical records of 61 consecutive older adult patients with aortic arch pathologies and a high risk of open repair who underwent total debranching thoracic endovascular aortic repair using the real chimney technique at our institution between January 2014 and June 2022. This technique was used to anastomose the ascending aorta with the main trunk of the triple-branched prosthetic graft. Results: The mean patient age was 75.1 years, and 54% of patients were transferred from medical facilities with cardiothoracic surgery departments. The comorbidities included chronic obstructive pulmonary disease (49.2%), chronic kidney disease (63.9%), coronary artery disease (27.9%), and history of stroke (31.1%). No 30-day mortality was observed. Complications included postoperative renal failure requiring permanent hemodialysis (4; 6.6%), stroke (modified Rankin scale score: ≥2 in 5; 8.2%), permanent paraplegia (1; 1.6%), and permanent paraparesis (4; 6.6%). The median follow-up period was 40.5±28.5 months. The postoperative survival rates at 5 years were 66.8%. No patients experienced complications associated with the aorta or anastomosis site; only 1 patient required an additional procedure for stenosis of the anastomosis site (midterm). An aneurysmal diameter reduction of ≥3 mm was observed in 37 cases (60.7%), and the mean aneurysmal diameter reduction was 5.3 mm. Conclusions: The postoperative outcome of total debranching thoracic endovascular aortic arch repair is not only acceptable but also promising, particularly in patients at high risk of open repair. Clinical Impact Our novel real chimney technique for total debranching thoracic endovascular aortic repair of aortic arch pathologies in patients who were at a high-risk for open repair resulted in no 30-day mortality and no complications related to the aorta or the real chimney anastomosis site. The real chimney technique is effective for managing aortic arch pathologies and enables less invasive total debranching thoracic endovascular aortic arch repair without the need for extracorporeal circulation and clamping of the ascending aorta

Predicting post-discharge complications in cardiothoracic surgery: A clinical decision support system to optimize remote patient monitoring resources

Cardiac surgery patients are highly prone to severe complications post-discharge. Close follow-up through remote patient monitoring can help detect adverse outcomes earlier or prevent them, closing the gap between hospital and home care. However, equipment is limited due to economic and human resource constraints. This issue raises the need for efficient risk estimation to provide clinicians with insights into the potential benefit of remote monitoring for each patient. Standard models, such as the EuroSCORE, predict the mortality risk before the surgery. While these are used and validated in real settings, the models lack information collected during or following the surgery, determinant to predict adverse outcomes occurring further in the future. This paper proposes a Clinical Decision Support System based on Machine Learning to estimate the risk of severe complications within 90 days following cardiothoracic surgery discharge, an innovative objective underexplored in the literature. Health records from a cardiothoracic surgery department regarding 5 045 patients (60.8% male) collected throughout ten years were used to train predictive models. Clinicians' insights contributed to improving data preparation and extending traditional pipeline optimization techniques, addressing medical Artificial Intelligence requirements. Two separate test sets were used to evaluate the generalizability, one derived from a patient-grouped 70/30 split and another including all surgeries from the last available year. The achieved Area Under the Receiver Operating Characteristic curve on these test sets was 69.5% and 65.3%, respectively. Also, additional testing was implemented to simulate a real-world use case considering the weekly distribution of remote patient monitoring resources post-discharge. Compared to the random resource allocation, the selection of patients with respect to the outputs of the proposed model was proven beneficial, as it led to a higher number of high-risk patients receiving remote monitoring equipment.

Early improvement of ejection fraction in patients with reduced ejection fraction after coronary artery bypass grafting

BackgroundDespite advancements in surgical technique, myocardial shield, and postoperative care, Coronary artery bypass grafting (CABG) among patients with reduced ejection fraction (EF) remains a surgical challenge due to their greater postoperative morbidity and mortality. This study aims to determine the early outcome of patients with reduced LVEF undergoing CABG and the improvement in the ejection fraction after revascularization. MethodsA total of 62 patients with impaired Left Ventricular (LV) systolic function (LVEF = 35–40 %) who underwent isolated On-pump CABG at the Department of Cardiothoracic Surgery in Assiut University Hospitals and who had met the listed inclusion and exclusion criteria were eligible for the study. Different variables (preoperative, intraoperative, and postoperative) were collected, studied, and compared. ResultsThe mean age of the patients was 57.81 ± 7.57 years, 66.1 % were male and 33.9 % were female. 44 (71.0%) patients were administered antegrade cardioplegia, whereas 18 (29.0%) patients were administered antegrade plus retrograde cardioplegia. Mean LVEF increased significantly from 37.97 ± 1.38% before surgery to 51.87 ± 3.54% after surgery (P ˂ 0.05). Post-operative low cardiac output syndrome occurred in 37 (59.7 %) of patients, pulmonary complications in 15 (24.2%), neurological complications in 10 (16.1%), sternal wound infection in 9 (14.5%), atrial fibrillation in 5 (8.1%) and acute kidney injury in 5 (8.1 %) of patients. In-hospital mortality was 16.1% (10 patients). ConclusionBased on the findings, CABG in patients with reduced preoperative LVEF improves the postoperative LVEF and NYHA functional class.

Effect of Psychological Nursing Combined with Health Education on the Quality of Life of Patients with Lung Cancer

Objective: To analyze the effect of psychological nursing combined with health education on the quality of life of patients with lung cancer. Methods: 80 patients with lung cancer admitted to our hospital’s Department of Cardiothoracic Surgery from January 2022 to December 2022 were selected as the research objects. Those who received basic nursing care from January to June were classified as the reference group, and those who received psychological nursing and health education from July to December were classified as the combination group, with 40 cases in each group. The combination group was given psychological nursing and health education; the reference group was given primary nursing care. The negative emotions experienced, the nursing satisfaction, the pain levels 1–7 days after operation, and the quality of life of both groups were compared. Results: Before the intervention, there was no statistically significant difference in the negative emotions between the two groups of patients (P &gt; 0.05); after the intervention, the combination group experienced significantly less negative emotions compared to the control group (P &lt; 0.05). Besides, the nursing satisfaction evaluation indicators such as targeted measures, nursing effects, individualized treatment, and level of professionalism of the combination group were significantly better than those in the reference group (P &lt; 0.05). There was no significant difference in the pain level of both groups of patients 1 day after surgery (P &gt; 0.05); however, in 3d and 7d after the surgery, the combination group experienced significantly less pain than the reference group (P &lt; 0.05). The social skills, physical pain, health status, physiological function, and other quality of life scores in the combined group were significantly higher than those in the reference group (P &lt; 0.05). Conclusion: Psychological nursing and health education can improve the quality of life of patients with lung cancer.

Unveiling the nexus of postoperative fever and delirium in cardiac surgery: identifying predictors for enhanced patient care.

Postoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions. In a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation. The overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763-0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively. This study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.

Prognostic value of ascites in patients with liver cirrhosis undergoing cardiac surgery

IntroductionMild or moderate liver cirrhosis increases the risk of complications after cardiac surgery. Ascites is the most common complication associated with liver cirrhosis. However, the prognostic value of ascites on postoperative morbidity and mortality after cardiac surgery remains uninvestigated.MethodsA retrospective study included 69 patients with preoperatively diagnosed liver cirrhosis who underwent cardiac surgery between January 2009 and January 2018 at the Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany. The patients were divided into ascites and non-ascites groups based on preoperatively diagnosed ascites. Thirty-day mortality, postoperative complications, length of stay, and blood transfusions were analyzed postoperatively.ResultsOut of the total of 69 patients, 14 (21%) had preoperatively diagnosed ascites. Ascites group had more postoperative complications such as blood transfusions (packed red blood cells: 78.6% vs. 40.0%, p = 0.010; fresh frozen plasma: 57.1% vs. 29.1%, p = 0.049), acute kidney injury (78.6% vs. 45.5%, p = 0.027), longer ICU stay (8 vs. 3 days, p = 0.044) with prolonged mechanical ventilation (57.1% vs. 23.6%, p = 0.015) and tracheotomy (28.6% vs. 3.6%, p = 0.003). The 30-day mortality rate was significantly higher in the ascites group than in the non-ascites group (35.7% vs. 5.5%, p = 0.002).ConclusionAscites should be implemented in preoperative risk score assessments in cirrhotic patients undergoing cardiac surgery. Preoperative treatment of ascites could reduce the negative impact of ascites on postoperative complications after cardiac surgery. However, this needs to be thoroughly investigated in prospective randomized clinical trials.Graphical abstract

Supracardiac Total Anomalous Pulmonary Venous Connection in Adolescence.

Background Supracardiac total anomalous pulmonary communication (TAPVC) constitutes a rare congenital cardiac anomaly. Most babies with supracardiac TAPVC are diagnosed in infancy and undergo complete surgical repair during infancy. Delayed presentation of supracardiac TAPVC is rare, and the surgical outcomes are not well known. This retrospective study was conducted to determine the presentation and surgical outcome of supracardiac TAPVC among adolescents, which constitutes an extremely rare subgroup of TAPVC. Methodology This retrospective analysis was conducted among 15 adolescent patients with supracardiac TAPVC who underwent surgical repair in the cardiothoracic surgery department of a tertiary care center in India. This study aimed to assess the intraoperative, postoperative, immediate, early, and late outcomes of adolescent patients with supracardiac TAPVC who had undergone surgical repair between 2010 and 2014 in a tertiary care center in India. Results The study included 15 patients with a diagnosis of isolated supracardiac TAPVC. A mild degree of cyanosis was present in eight patients, recurrent episodes of lower respiratory tract infections were present in five patients, and dyspnea (New York Heart Association I/II) was noted in 12 patients. Mean oxygen saturation was 92% (range = 85-93%), and mean pulmonary artery pressure was 24 mmHg (range = 15-50 mmHg). After median stenotomy, a wide anastomosis was made between the common pulmonary venous chamber and the posterior wall of the left atrium. A fenestration was made in the Dacron patch in three patients who had raised pulmonary vascular resistance (PVR) preoperatively. Twelve patients were weaned off cardiopulmonary bypass (CPB) with minimal inotropic support. Three patients who had high preoperative PVR had difficulty in weaning from CPB. The mean CPB and cross-clamp time was 75 ± 12 minutes and 58 ± 9 minutes, respectively. Atrial fibrillation was noted in five (33.3%) patients in the early postoperative period, and three (20%) patients had pulmonary artery hypertensive crises postoperatively. There was no superficial or deep sternal wound infection in the postoperative period. Mild and moderate right ventricular dysfunction was present in four (26.67%) and two (13.3%) patients, respectively, in the postoperative period. On two-dimensional echocardiography during follow-up at the end of one year, there was no gradient across the anastomosis, and pulmonary artery pressure was normal in all patients. Conclusions Surgical repair of supracardiac TAPVC in adolescence has an excellent outcome. Survival of patients with supracardiac TAPVC until adolescence depends on the presence of a dilated vertical vein and a large atrial septal defect facilitating unobstructed pulmonary venous flow. The aim of the surgical repair should be to create a wide anastomosis between the left atrium and the pulmonary venous chamber which should be bigger than the size of the mitral valve orifice indexed to the body surface area as it would amount to no or negligible anastomotic gradient postoperatively.

The effect of platelet-rich plasma on sternal healing postmedian sternotomy in patients undergoing open heart surgery

Background Plasma is the fluid portion of blood which contains clotting factors, other proteins, and ions. Platelet-rich plasma (PRP) is defined as a volume of the plasma fraction of autologous blood with many more platelets than what is typically found in blood. The concentration of platelets and thereby the concentration of growth factors (GFs) can be 5 to 10 times greater (or richer) than usual. The aim of this study is to evaluate the effect of PRP on sternal healing post median sternotomy in patients undergoing cardiac surgery. Patients and methods A single-center, prospective, comparative study. We recruited 100 patients who were referred for open heart surgery, through median sternotomy, to our Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt between March 2020 and January 2022. Patients were divided into two equal groups; the study group where we applied topical autologous PRP to the sternal edges before sternal closure, and the control group who did not receive PRP. Results The two groups were similar in their demographics. We found no significant benefit in terms of sternal healing between the two groups assessed by measuring bone density. Superficial and deep wound infections were similar in both groups; however, we found a marked reduction in blood loss in patients who received PRP (group 1) compared with control group (group 2). Conclusion Applying PRP topically to the sternal edges following median sternotomy did not improve sternal healing of the incidence of superficial or deep sternal wound infection. It may be beneficial in reducing blood loss from the sternal edges and hence blood transfusion requirement following surgery.

A commentary on "burnout in surgeons: a qualitative investigation into contributors and potential solutions" (Int J Surg101 (2022) 106613).

aCentral Laboratory, Chongqing University FuLing Hospital bDepartment of Ophtalmology, Chongqing University FuLing Hospital cDepartment of Otorhinolaryngology，Chongqing University FuLing Hospital dDepartment of Cardiothoracic Surgery,Chongqing University FuLing Hospital Published online ■ ■ *Corresponding author. Address: Department of Cardiothoracic Surgery,Chongqing University FuLing Hospital, Chongqing, 408000, P.R.China and Luo Xiaohua, Department of Otorhinolaryngology,Chongqing University FuLing Hospital, Chongqing, 408000, P.R.China. E-mail address: [email protected] (F. Luo). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0/

Optimisation and Effect Analysis of the Blood Collection Method in Pre-Deposit Autotransfusion Patients Undergoing Thoracotomy Surgery.

To explore the feasibility of the modified blood collection method in pre-deposit autotransfusion in patients undergoing thoracotomy surgery. This double-blinded randomised controlled trial enrolled 92 patients from the cardiothoracic surgery department from February 2019 to October 2020. Compared with the conventional blood collection method, the modified blood collection method avoided blood overflow from the oblique plane of the needle (χ2 = 61.986, P < 0.01) and reduced the diameter of the bruising area after 24 hours (χ2 = 24.611, P < 0.01). Furthermore, due to optimising the blood collection method, diastolic blood pressure reduced slightly before and after blood collection (t = 2.036, P < 0.05), and patients in the test group had less pain (based on the numerical rating score) (t = 5.556, P < 0.01). Meanwhile, the time required to collect 400 mL of blood was shortened (t = 17.744, p < 0.01). An improved blood collection method can enhance the blood donation experience, avoid blood spillage, lessen pain and reduce adverse reactions. This may be of great significance in ensuring blood quality and the safety of subsequent transfusions. ClinicalTrials.gov Identifier: NCT05539846.

1016 A Quality Improvement Project Addressing the Healthcare Dimension of Effectiveness in a Large Cardiothoracic Surgery Department by Ensuring the Contents of the Current Emergency Surgical Chest Drain Boxes Are Correctly Stocked Through Additional Rigorous Checks by June 2022, by Using the Model for Improvement Approach

Abstract Background Emergency chest drain insertion on cardiothoracic wards is frequent occurrence due to complications such as pneumothorax. The emergency insertion requires the immediate availability of a significant amount of sterile equipment. A box containing all the equipment on the ward was checked and restocked by the ward nursing staff, however, data suggested missing equipment was prevalent. This has implications for clinical effectiveness, timely intervention, and ultimately patient safety. Aim This project establishes the frequency of missing items and aims to reduce this frequency through more rigorous checks of the emergency chest drain box contents. Method Retrospective analysis of the box contents was performed over 3 months to establish baseline data. Thoracic surgery doctors completed a questionnaire, before and after the changes, about their experiences with the emergency chest drain boxes and missing items. A revised stock checklist was produced in collaboration with the project champion, the audit lead for thoracic surgery, and the procedural document team. The checklist introduction used transformational leadership. Subsequent completeness data was collected, in addition to a follow-up questionnaire. Results There was an 81% reduction in the 3-month average number of reported missing items following implementation; and a 92% increase in perceived confidence that the box will be correctly stocked. Conclusions An 81% reduction using two Plan Do Study Act (PDSA) cycles represents an improvement in effectiveness. There are plans to implement a single-use, pre-packed emergency chest drains insertion pack. The ongoing third PDSA cycle introduces the single-use pack, ongoing improvement will be demonstrated with repeat audits.

Comparison between Myocardial Glycogen Storage in CABG after Using Blood Cardioplegia versus HTK Solution

Abstract Background Inadequate myocardial protection in long ischaemic periods followed by reperfusion is an issue of concern in cardiac surgery. Cardioplegic solutions improve the tolerance to ischaemia and reperfusion by preserving myocardial energy reserves, preventing osmotic and electrolyte imbalances and buffering acidosis. Objective This somewhat surprising given the high number of procedures performed worldwide with this cardioplegic solution. As such, the purpose of this study was to assess the safety of the HTK solution when compared with our standard blood cardioplegia in coronary artery bypass graft operations via assessment of myocardial glycogen storage. Patients and Methods This was a retrospective, convenient, non- randomized study conducted on 40 consecutive patients who underwent isolated elective CABG at department of cardiothoracic surgery at Ain Shams University Hospitals. The aim of the study was to compare early outcomes of Custodiol versus blood cardioplegia in coronary artery bypass graft surgery via assessment of glycogen storage in myocarduim via assessment of myocardial glycogen storage. at Ain Shams University Hospitals. Results There was no statistically significant difference between the two groups of myocardial glycogen storage post-operative. Conclusion There was statistically significant difference between the pre and post-operative in both custodial and blood cardioplegia. There was no statistically significant difference between the two groups of myocardial protection in mortality and morbidity. Custodiol cardioplegia is an easy technique and simple without need of preparation or repeated administration.

A simple transseptal approach versus the conventional left atrial approach for mitral valve procedures: a retrospective study.

Having good exposure to the mitral apparatus during mitral valve replacement is a vital decision every cardiac surgeon must take. This study was conducted to compare the simple transseptal approach and the conventional left atrial approach for mitral valve procedures, to evaluate the safety and efficacy of the simple transseptal approach during open heart mitral valve procedures, as the conventional left atrial approach may not provide optimal exposure, especially in unfavorable anatomical and operative situations. This is a retrospective study. It has been conducted on 140 patients who were diagnosed with heart diseases that required mitral valve replacement. Surgeries were performed in the Cardiothoracic Surgery Department. Mitral procedure was done through median sternotomy incision under general anesthesia on a cardiopulmonary bypass machine with cold antegrade cardioplegia. Demographic data, preoperative diagnosis, intraoperative findings, hospital stay, complications, and mortality were documented and revised. One hundred and forty patients were enrolled in this study with a median age of 39years, and no significant differences as regards the baseline demographic data as age, sex, and body mass index (BMI). A total of 68 patients underwent mitral valve replacement through the simple transseptal approach and 72 patients through the conventional left atrial approach. Both studied groups had insignificant differences as regards bypass time, re-operation rate, postoperative complications, hospital stay, and mortality. The simple transseptal approach through the midpoint of the fossa ovalis could be a safe and even favorable alternative to the traditional left atriotomy approach in certain difficult operative situations during mitral valve replacement surgery.

Incidence and trends of nosocomial infection in a tertiary general hospital in China from 2018 to 2021: a retrospective observational study.

This study aimed to investigate the current status and changing trend of nosocomial infection in a tertiary general hospital in China, to provide a reference for the prevention and control of healthcare-associated/acquired infection (HAI). A retrospective investigation of the clinical data of HAI patients in Dongying People's Hospital in China from January 1, 2018, to December 31, 2021, was carried out. The incidence of HAI in different units and sites, distribution of pathogenic microorganisms, and antimicrobial use were investigated. The incidence of HAI was 0.93%. It was on the rise from 2018 to 2020 but declined in 2021. The departments with the highest rate of HAI were the Intensive Care Unit (ICU), neurosurgery department, cardiothoracic surgery department, and hematology department. HAI often occurs in the lower respiratory tract, urinary tract, and in blood. The most common pathogenic microorganisms in cases of HAI were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus. The rate of bacterial culture delivery for therapeutic drugs has increased from year to year. This study shows that the incidence of HAI in the hospital is generally low. Gram-negative bacteria are still the main source of HAI. The rate of bacterial culture delivery for therapeutic use improved over the years and has gradually been standardized. It is necessary to focus on the management of HAI in the ICU, neurosurgery, cardiothoracic surgery, and hematology departments.

#3169 EXPERIENCE IN INTRAOPERATIVE AUTOLOGOUS BLOOD SALVAGE IN PEDIATRIC CARDIAC SURGERY

Abstract Background and Aims Due to the drastic reduction in the number of voluntary blood donors has led to the need for the development of alternative strategies for allogeneic blood transfusion, which include the use of different strategies for autologous transfusion. Display: a) the use of "Cell-Saver" pediatric cardiac surgery at the Department of Cardiothoracic Surgery, Institute for Health Protection of Mother and Child of Serbia" Dr Vukan Cupic"; b) to analyze the reduced use of allogeneic blood and /or chemo products using "Cell-Saver" pediatric cardiac surgery; c) to evaluate the "cost benefit" of this strategy (e.g. the ratio of prices "set", "Cell-Saver") and pretransfusion rates processing one unit of allogeneic blood; d) to identify increased intraoperative security in complex. reconstructive and redocardiac surgery using the "Cell-Saver" combined with ultrafiltration (conventional or modified), particularly in cyanogenic congenital heart defects, and e) to establish and improve the hemodynamic status of hemoreologic operated child. Method A retrospective study was conducted. Experimental group included 63 patients (aged 12 days - 16 years and 4 months, body weight of patients that ranged between 2.9 kg and 80 kg - the mean body weight was 28.3 kg). In the experimental group patients were performed following cardiac surgery: 46 patients underwent reconstructive surgery (most often reoperations for cyanogenic congenital heart defects); 3 patients who underwent cardiovascular belief, and 3 patients who underwent cardio-surgical procedures had hematological disorders. The control group included 60 patients of similar age and body mass who underwent the cardio-surgical procedure without the use of "Cell-Saver" with application of allogeneic blood and/or chemo products during transfusion care. The following laboratory parameters were accompanied: hematocrit, platelet count, fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT), after 3, 6, and 12 hours postoperatively compared to the control group. We compared the volume of postoperative bleeding by patients of the experimental group with the control group (1h, 4h, 7h, 11h, 15h, 21h and 24h) and analyzed the amount of used allogeneic and autologous blood and/or hemoglobin products used in the transfusion care during hospitalization the experimental group compared with the control group. Results Postoperative administration of allogeneic blood and/or hemoproducts was statistically significantly lower in the experimental group using "CellSaver" than in the control group. The amount of salvaged blood after surgery ranged from 210 ml - 620 ml. Intraoperative hematocrit "rescued" autologous blood ranged between 0.32 l / l and 0.38 l / l. e range of values preoperative and postoperative hematocrit were lower in the experimental group than in the control group that used "Cell-Saver". The total volume of postoperative drainage content was significantly lower in the experimental group, which used "Cell-Saver" compared to the control group. The postoperative hematocrit was higher in the experimental group patients who used "Cell-Saver", compared with the same operating using allogeneic blood and/or hemoproducts patients in the control group. The mean platelet count, fibrinogen, PT and aPTT results showed no statistically significant difference between the experimental group of patients in whom we used "Cell-Saver" in comparison to the control group. Conclusion The results obtained by the retrospective analysis of above mentioned data indicate a positive therapeutic effect of the application of the "Cell Saver" that is most common in reoperations. With the introduction of the "bell" of small volume, the use of the Cell Saver has become an integral part of the pediatric cardiac surgery - perfusion, regardless of body weight, age and body surface area of the child. The performance of intraoperative "rescue" of autologous blood using the "Cell Saver", while the follow-up of pediatric patients in the perioperative and postoperative period has immeasurable significance of teamwork perfuser, expert specialist nursing, pediatrician, cardiac surgeon and transfusion.