Cardiovascular Surgery Department Research Articles

Risk assessments of drug-related problems for cardiac surgery patients.

Patients undergoing cardiac surgery are considered at high risk for developing drug-related problems (DRPs) due to comorbidities and complexity of drug treatment. This study aimed to identify DRPs in patients undergoing cardiac surgery and to develop and implement a framework to reduce potential risks associated with drugtreatment. Prospectively designed quasi-experimental study. This study consisted of observational (risk assessment and framework development) and interventional (framework implementation) periods and was conducted at a department of cardiovascular surgery in a university hospital. An expert panel evaluated the causes of DRPs. Then a framework was developed in consensus to identify safeguards to be implemented during the interventionalperiod. A total of 200 patients (100 patients per study period) were included. During the observational period, a total of 275 DRPs and 487 causes were identified; 74.5% of DRPs were not solved. For the risk analysis, 487causes were evaluated and only 32.6% were considered acceptable risk. By implementing the framework in the interventional period, 215 DRPs and 304 causes were identified and 386interventions were recommended by a clinical pharmacist. Atotal of 342 (88.6%) interventions were accepted by a health care team, and 128 (59.5%) DRPs were completely solved. For the risk analysis, 304 causes were evaluated and 84.9% were considered acceptable risk ( P < .001 compared with the observational period). It is possible to reduce risk levels or prevent occurrence of DRPs by implementing a framework for risk management developed by a multidisciplinary care team in areas such as cardiac surgery where time is limited.

Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study

ObjectiveInadequate remodeling of residual aortic dissection (RAD) following repair of Stanford A or B aortic dissections has been identified as a significant predictor of patient mortality. This study evaluates the short- to mid-term outcomes of staged reinterventions for RAD at a single center with prospective follow-up.MethodsData were retrospectively collected from patients with RAD who underwent staged reinterventions or received none-surgery treatment in the Cardiovascular Surgery Department of our hospital between July 2019 and December 2021. The cohort included 54 patients with residual distal aortic dissection post-primary surgery, comprising 28 who underwent open surgery and 26 who received thoracic endovascular aortic repair (TEVAR). Patients were divided into two groups: those who underwent staged stent interventions for distal dissection [staged reintervention (SR) group] and those who did not undergo surgery (non-surgery group). For the SR group, second or third staged stent interventions were performed. The study assessed distal remodeling of aortic dissection between the groups, focusing on endpoints such as mortality (both general and aortic-specific), occurrences of visceral branch occlusion, necessity for further interventions, and significant adverse events. Morphological changes were analyzed to determine the therapeutic impact.ResultsThe study encompassed 54 participants, with 33 in the SR group and 21 in the non-surgical control group. Baseline demographics and clinical characteristics were statistically comparable across both groups. During an average follow-up of 31.5 ± 7.0 months, aortic-related mortality was 0% in both groups; all-cause mortality was 3% (one case) and 5% (one case) in the SR and control groups, respectively, with no statistically significant difference noted. In the SR group, a single patient experienced complications, including renal artery thrombosis, leading to diminished blood flow. An increased true lumen (TL) area and a decreased false lumen area at various aortic planes were observed in the SR group compared to the control group.ConclusionThe staged reintervention strategy for treating RAD is safe and provides promising early results.

Therapeutic strategy for totally thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation

Objective: To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass. Methods: This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People's Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period. Results: The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of (M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation (OR=11.424, 95%CI: 1.477 to 144.564, P=0.033) and excessive rewarming (OR=15.249, 95%CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions: The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency

Objective: To examine the early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency. Methods: This is a retrospective cohort study. The clinical data of 124 patients with BAV insufficiency who underwent aortic valve repair from January 2017 to June 2023 in the Department of Cardiovascular Surgery at Fuwai Hospital were analyzed retrospectively. There were 117 males and 7 females with an age of (38.1±12.7) years (range: 14 to 65 years). Depending on whether the aortic sinus was replaced or not, surgical approaches were divided into valve sparing root replacement (reimplantation, remodeling, modified remodeling) and isolated aortic valve repair (annuloplasty, isolated aortic valve leaflet repair). Perioperative and follow-up data were collected. Kaplan-Meier method was used to plot the curves of survival rate, free recurrence rate of massive aortic valve insufficiency and free re-operation rate, and Log-rank test was used for comparison between groups. Results: Among the surgeries, there were 47 cases of reimplantation, 8 cases of remodeling, 8 cases of modified remodeling, 48 cases of aortic annuloplasty (external annuloplasty in 22 cases, CV-0 annuloplasty in 26 cases), and 13 cases of isolated leaflet repair. Leaflet plication was the most used leaflet repair technique, used in 103 patients. The cardiopulmonary bypass time was (133.7±56.9) minutes (range: 48 to 461 minutes), and aortic cross-clamp time was (103.8±47.8) minutes (range: 25 to 306 minutes), with no surgical mortality. All patients underwent outpatient or telephone follow-up. The cumulative follow-up time was 340.3 person-years and the mean follow-up time was (M (IQR)) 34.0 (25.5) months (range: 3 to 76 months). The 5-year survival rate was 98.4%, the 5-year freedom from significant insufficiency rate was 93.4% and the 5-year freedom from aortic valve reoperation rate was 95.6%. The subgroup analysis revealed a significantly better freedom from the significant insufficiency rate in the aortic valve annular reduction group compared to the non-reduction group (P<0.01). Conclusions: Aortic valve repair in patients with bicuspid aortic insufficiency could obtain steady early to mid-term outcomes. Aortic annuloplasty can reduce the risk of recurrent aortic valve insufficiency in patients undergoing aortic repair.

Technical exploration and early results of two-port total thoracoscopic aortic-mitral double-valve replacement

Objective: To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement. Methods: This is a retrospective case series study. The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. There were 32 males and 18 females, with an age of (55.3±8.8) years (range: 21 to 62 years). Among them, 36 cases had rheumatic heart disease and 14 cases had infective endocarditis. The 3rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole, the total thoracoscopic double-valve replacement were successfully carried out. Baseline data, intraoperative information, surgical outcomes, and postoperative complications were collected for all patients. Results: The cardiopulmonary bypass time was (168.2±30.9) minutes (range: 125 to 187 minutes), the aortic cross-clamping time was (118.8±16.5) minutes (range: 96 to 147 minutes). Five patients received bioprosthetic valves, and 45 received mechanical prosthetic valves. Postoperative mechanical ventilation lasted (9.6±3.4) hours (range: 5.1 to 14.2 hours), the ICU stay was (24.8±7.3) hours (range: 16.3 to 30.1 hours), and the postoperative hospital stay was (6.5±1.2) days (range: 5.0 to 8.0 days). Four patients received red blood cell transfusions of (2.7±0.9) units (range: 2 to 4 units), and the postoperative chest drainage volume was (222.1±56.3) ml (range: 175 to 289 ml). No deaths occurred intraoperatively or in the early postoperative period. One patient required reoperation due to bleeding in the aortic incision. Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve, with no cases of third-degree atrioventricular block or conversions to median sternotomy. Conclusions: The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory, demonstrating safety and efficacy. This surgical approach expands the scope of total thoracoscopic cardiac surgery, which warrants further investigation and research.

Evaluation of Single/Multiple Joint Effects of Lipid Profiles on Hypertension, Diabetes Mellitus and Obesity Accompanying Coronary Artery Disease

Objective: Although cardiovascular diseases are among the most prominent causes of mortality/morbidity in the world, they are even more important together with comorbidities. This study aims to reveal the single/multiple effects of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride (TG) on hypertension (HT), type 2 diabetes mellitus (T2DM) and obesity accompanying coronary artery disease (CAD). Method: The data were retrospectively achieved from the records of CAD patients undergoing coronary bypass surgery at the Department of Cardiovascular Surgery, Medical Center, University. The medical knowledge discovery process (MKDP) was applied to the data concerning HT, DM, obesity, TC, HDL-C, LDL-C, and TG variables. Different methods were used to determine the optimal cut-off points of lipid profiles. Logistic regression analysis (LRA) was examined the single/multiple effects of lipid profiles on HT, T2DM, and obesity. Results: TC, LDL-C, TG, and HDL-C lipid profiles categorized according to the cut-off points determined in the current study were analyzed with LRA models. LDL-C (&gt;117 mg/dL)*TC (&gt;191 mg/dL)*HDL-C (&gt;37.2 mg/dL) in HT and TC (&gt;190 mg/dL)*TG (&gt;197) mg/dL)*HDL-C (&gt;36.3 mg/dL) in T2DM interaction terms had a moderate effect size. LDL-C (&gt;115 mg/dL)*TG (&gt;197 mg/dL)*HDL-C (&gt;36.3 mg/dL) interaction terms in T2DM and TC (&gt;192 mg/dL)*LDL-C (&gt;117 mg/dL)*HDL-C (&gt;36.8 mg/dL), TK (&gt;192 mg/dL)*TG (&gt;193 mg/dL)*HDL-C (&gt;36.8 mg/dL) and LDL-C (&gt;117 mg/dL)*TG (&gt;193 mg/dL)*HDL-C (&gt;36.8 mg/dL) interaction terms in obesity were reported as having a high effect size. Conclusion: In conclusion, it is recommended to use the approach that analyzes the cut-off points proposed in this study for lipid profiles in predicting HT, T2DM, and obesity.

Candida auris Outbreak in a Multidisciplinary Hospital in Romania during the Post-Pandemic Era: Potential Solutions and Challenges in Surveillance and Epidemiological Control.

Candida auris is a newly emerging yeast, which is raising public health concerns due to its outbreak potential, lack of protocols for decontamination and isolation of patients or contacts, increased resistance to common antifungals, and associated high mortality. This research aimed to describe the challenges related to identifying the outbreak, limiting further contamination, and treating affected individuals. We retrospectively analyzed all cases of C. auris detected between October 2022 and August 2023, but our investigation focused on a three-month-long outbreak in the department of cardio-vascular surgery and the related intensive care unit. Along with isolated cases in different wards, we identified 13 patients who became infected or colonized in the same area and time, even though the epidemiological link could only be traced in 10 patients, according to the epidemiologic investigation. In conclusion, our study emphasizes the substantial challenge encountered in clinical practice when attempting to diagnose and limit the spread of an outbreak. Therefore, it is crucial to promptly apply contact precaution measures and appropriate environmental cleaning, from the first positive case detected.

Epidemiology of Fontan-associated liver disease in Japan: Results from a nationwide survey in 2021.

Although the Fontan procedure has improved the survival of patients with single-ventricle heart disease, the long-term consequences of the procedure have been a concern. This study aimed to explore the patients' postoperative clinical characteristics, including a diagnosis of Fontan-associated liver disease (FALD). A nationwide Japanese epidemiological survey of post-Fontan patients was undertaken in 2021. The survey targets were selected from all departments of pediatrics, pediatric surgery, cardiology, cardiovascular surgery, and gastroenterology using stratified random sampling by the number of beds. Each department was asked to complete a mail-back questionnaire on the numbers of patients and their clinical characteristics. The diagnosis of FALD was made by each attending physician. The estimated number of post-Fontan patients was 7810 (95% confidence interval, 5430-10200) in 2020, with a period prevalence of 61.9 per million. During the follow-up of 13.8years after the Fontan procedure, 40% of patients were diagnosed with FALD. An elevated γ-glutamyl transpeptidase level was the most common finding leading to the FALD diagnosis (41%), and 45% of the patients also showed liver fibrosis. Compared with non-FALD patients, FALD patients were older, had longer duration since the Fontan procedure, and had more severe cardiac or liver conditions. However, more than half of the non-FALD patients had elevated liver enzyme levels, suggesting underestimation of the number of FALD patients. In 2020, approximately 40% of post-Fontan patients underwent follow-up with a diagnosis of FALD, although the lack of established diagnostic criteria for FALD could affect the reported prevalence of FALD.

Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection

ObjectiveTo investigate the independent risk factors for postoperative prolonged ICU stay in patients with Stanford type A aortic dissection (TAAD) and assess the clinical outcomes of prolonged ICU stay.MethodThe clinical data of 100 patients with TAAD admitted to the Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were retrospectively collected and analyzed. Patients were divided into two groups, based on the postoperative ICU stay (7 days as the threshold), regular ICU stay group (< 7 days) and prolonged ICU stay group (≥ 7 days). First, preoperative and intraoperative materials were collected for univariate analysis. Then, the significant variables after univariate analysis were analyzed using logistic regression, and the final independent risk factors for prolonged ICU stay were determined. Meanwhile, the postoperative clinical outcomes were analyzed with the aim of assessing the clinical outcomes due to prolonged ICU stay.ResultsThere were 65 and 35 patients in the regular ICU stay group and the prolonged ICU stay group, respectively. In accordance with the result of univariate analysis in the two groups, emergency surgery (χ2 = 13.598; P < 0.001), preoperative urea nitrogen (t = 3.006; P = 0.004), cardiopulmonary bypass (CPB) time (t = 2.671; P = 0.001) and surgery time (t = 2.630; P = 0.010) were significant. All significant variates were analyzed through logistic regression, and it was found that emergency surgery (OR = 0.192; 95% CI: 0.065–0.561), preoperative urea nitrogen (OR = 0.775; 95% CI: 0.634–0.947) and cardiopulmonary time (OR = 0.988; 95% CI: 0.979–0.998) were independent risk factors for prolonged postoperative ICU stay. The Receiver Operating Characteristic (ROC) curves of these three factors were also effective in predicting postoperative prolonged ICU stay (Emergency surgery, AUC = 0.308, 95% CI: 0.201–0.415; Preoperative urea nitrogen, AUC = 0.288, 95% CI: 0.185–0.392; cardiopulmonary time, AUC = 0.340, 95% CI: 0.223–0.457). Moreover, compared with a single factor, the predictive value of combined factors was more significant (AUC = 0.810, 95% CI: 0.722–0.897). For the comparison of postoperative data in the two groups,, compared with the regular ICU stay group, the incidence of adverse events in the prolonged ICU stay group increased significantly, including limb disability of limbs (χ2 = 22.182; P < 0.001), severe organ injury (χ2 = 23.077; P < 0.001), tracheotomy (χ2 = 17.582; P < 0.001), reintubation (χ2 = 28.020; P < 0.001), 72 h tracheal extubation after surgery (χ2 = 29.335; P < 0.001), 12 h consciousness recovery after surgery (χ2 = 18.445; P < 0.001), ICU re-entering (χ2 = 9.496; P = 0.002) and irregular discharging (χ2 = 24.969; P < 0.001).ConclusionEmergency surgery, preoperative urea nitrogen, and CPB time are risk factors for postoperative prolonged ICU stay after TAAD surgery. Furthermore, prolonged ICU stay is associated with worse clinical outcomes. Hence, a reasonable strategy should be adopted proactively focusing on the risk factors to shorten ICU stays and improve clinical outcomes.

Effects of percutaneous closure of atrial septal defects via the right internal jugular vein.

Percutaneous atrial septal defect (ASD) closure is the preferred treatment for patients with suitable ASD anatomy. The safety and effectiveness of transcatheter closure have been established. However, reports on transesophageal echocardiography (TEE)-guided percutaneous closure of ASD via the right internal jugular vein (RIJV) are limited. The study aims to discuss the safety and effectiveness of percutaneous trans-jugular vein closure of ASD. We conducted a retrospective analysis of patients (n=103) with secondary ASD who underwent surgical treatment in the Department of Cardiovascular Surgery, the Second Hospital of Jilin University between July 2015 to July 2022. The article is a cross-sectional study. Clinical data, including age, gender, weight, defect diameter, tricuspid regurgitation, left atrial (LA) size, and the operation results, were collected and evaluated. Nonparametric rank sum tests were used to assess tricuspid regurgitation before and after surgery, while paired sample t-tests were used to compare LA size before and after surgery. TEE-guided percutaneous closure of ASD via the RIJV was successfully performed in 97 out of 103 (94.2%) cases. The average procedure time was 34.48±13.06 min, and the mean age at the time of the procedure and ASD size were 36±18 years and 15.45±5.82 mm, respectively. On analyzing medical records and echocardiographic images, postoperative complications were found to occur in four (3.9%) patients. Among these, three patients had residual shunt as indicated by echocardiography during the operation, which subsequently disappeared at the three-month follow-up. One patient developed atrial fibrillation after surgery but returned to normal sinus rhythm with medication. Percutaneous closure of ASD via the RIJV was unsuccessful in 6 patients (5.8%), with 5 of them undergoing transthoracic ASD closure and achieving satisfactory results. One patient refused further surgical treatment. No pericardial effusion, thrombosis, atrioventricular block, or other complications were observed during the 3-month to 1-year follow-up period. ASD closure via the RIJV is a safe and effective therapeutic approach. The initial results are satisfactory, but further studies with large sample sizes and long-term follow-up are warranted to assess the long-term outcomes.

Evaluation of surgical outcomes in mechanical aortic valve replacement at Hue Central Hospital

Background: Mechanical aortic valve replacement (AVR) is the preferred treatment for young patients with severe aortic valve disease. Objective: To assess the outcomes of mechanical AVR. Methods: This study included 41 patients who underwent mechanical AVR at the Department of Cardiovascular and Thoracic Surgery, Hue Central Hospital, from January 2021 to January 2023. Results: The average age was 49.17 ± 10.78 years, with a male-to-female ratio of 4:3. Pre-surgery, 51.23% were in NYHA class I-II, and 48.77% in NYHA III-IV. Key measurements included a left ventricular ejection fraction (LVEF) of 56.17 ± 9.23%, a left ventricular end-diastolic diameter (LVEDD) of 52.66 ± 8.35 mm, and a left ventricular end-systolic diameter (LVESD) of 36.88 ± 8.02 mm. At 6 months, 87.81% were in NYHA I-II, and 12.19% in NYHA III-IV; LVEF was 61.68 ± 2.55%, LVEDD was 44.15 ± 4.08 mm, and LVESD was 29.0 ± 3.77 mm. Complications of acute kidney failure 7.31%, cardiac arrhythmia 4.88%. There were no deaths after surgery. Conclusion: Mechanical AVR surgery is a safe and effective treatment option. Key words: mechanical aortic valve replacement, aortic valve replacement, aortic valve.

A wearable six-minute walk-based system to predict postoperative pulmonary complications after cardiac valve surgery: an exploratory study

In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

Multivariate analysis of the factors affecting medical students' decision to join the cardiovascular surgery department.

The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey.

Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February11, 2019 and July24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.

Determination of Stenosis and Arrhythmia After Surgical Operation of Partial Anomalous Pulmonary Venous Drainage in Mid &amp; Longterm (Comparison of Double/Single Patch and Warden Operation in Partial Anomalous Pulmonary Venous Drainage): A Comparative Study of Two Different Time Intervals

We retrospectively investigated 20 patients who underwent partial anomalous pulmonary venous drainage (PAPVD) surgery with single-double patch, and Warden operation after surgical treatment in Hacettepe Medical School, department of cardiovascular surgery (group A) and 62 patients who underwent surgery with double patch in Eskişehir Osmangazi Medical School and 10 patients in Muğla Sıtkı Koçman Medical School (group B including 72 patients) at different time intervals. We compared postoperative v. cava superior stenosis, pulmonary vein stenosis and arrhythmia in regards of different techniques. We constituted 2 groups: 20 patients of Hacettepe Medical School between 2005-2011 (group A) and 72 patients of Muğla Sıtkı Koçman and Eskişehir Osmangazi Medical School between 2015-2022 (group B). Group A included 12 females, 8 males, the mean age was 5.7±3 years, ranging between 0.42 and 11 years, the mean weight was 18.67±9.01 kg, ranging between 5.50 and 41 kg. Group B included 39 females, 33 males, the mean age was 6.68±3.70 years, ranging between 1 and 17 years, mean weight was 23.58±14.75 kg, ranging between 8 and 80 kg. Clinical findings, electrocardiographic, echocardiographic evaluations were obtained. We found neither early nor late mortality in both groups. The mean follow-up duration were 39.73 months and 49.82 months respectively. No pulmonary venous or v. cava superior stenosis occurred in both groups. Reoperation for residual atrial septal defects required in 1 patient who underwent Warden procedure,1 patient who underwent double patch technique in group A. It didn’t require reoperation in group B. In group A, 6 patients presented rhythm disturbance in early postoperative period, as well as 4 patients in group B. In follow-up all patient recovered to sinus rhythm in both groups. Pacemaker wasn’t required. PAPVD can be safely operated using different procedures. Meticulous dissection nearby sinus node (SN) should be emphasized to avoid injury of SN for all techniques.

Outcomes after surgical repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries: a series of 104 cases

Objective: To examine the early and midterm surgical outcome of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCA) using revised surgical strategies. Methods: A retrospective analysis of clinical data, surgical methods, and follow-up results was performed of 104 cases of PA/VSD/MAPCA in Department of Cardiovascular Surgery, Guangzhou Women and Children's Medical Center from January 2017 to September 2022. There were 55 males and 49 females, aged (M(IQR)) 33.9(84.0) months (range: 0.5 to 209.6 months) at the first surgical procedures. The anatomical classification included 89 cases of type B and 15 cases of type C. The number of major aortopulmonary collateral arteries was 4.2 (3.0) (range: 1 to 8). The Kaplan-Meier method was used for survival estimation. Results: In the first stage of surgery, 50 patients underwent a complete primary repair, 12 patients underwent partial repair, 32 patients underwent palliative right ventricular-pulmonary artery connection, and only 10 patients chose the Blalock-Taussig shunt. There were 10 cases of early death. In the second stage, 14 patients underwent complete repair and 4 patients underwent partial repair with no early death. The interval between the two surgeries was 19 (10) months (range: 9 to 48 months). Finally, during the 40 (34) months follow-up period, a total of 64 patients were complete repair and the right/left ventricular pressure ratio after complete repair was 0.63±0.16 (range: 0.36 to 1.00). Survival analysis showed that survival rates at 1 and 5 years after first-stage surgery were both 89.4% (95%CI: 83.5% to 95.3%). At 28 (34) months (range: 1 to 67 months) of follow-up after complete repair, the survival analysis showed that the survival rates at 1 and 5 years were both 95.2% (95%CI: 89.9% to 100%). Conclusions: Using combined approaches tailored to individual patients and optimized unifocalization strategy, the complete repair rate at one stage and the cumulative complete repair rate at 5 years improved significantly with a lower right/left ventricular pressure ratio and satisfactory early and intermediate survival.

Laubry-PEZZI Syndrome Surgical Repair in Adult: A Case Report

The presence of aortic regurgitation (AR) in the setting of the ventricular septal defect (VSD) has always been a management challenge. A 21-year-old male patient presented to the Cardiovascular surgery department with a restrictive perimembranous VSD with severe aortic regurgitation (AR). VSD was first diagnosed at 3 years of age. The surgical correction was decided when he was symptomatic of severe aortic regurgitation. Trans-aortic approach was performed to close the ventricular septal defect and correct the aortic regurgitation simultaneously. Surgical management was followed by a complete heart block.

Optimizing Preoperative Iron Deficiency Anemia in Patients Undergoing Cardiac Surgery

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidney injury, increased length of stay, and increased mortality. At the University of Virginia (UVA) Medical Center, there was no institutional process in place to identify and treat iron deficiency anemia in patients planned to undergo cardiac surgery. Objective: The UVA Perioperative Blood Management Committee is a newly-formed multidisciplinary group consisting of members from the departments of Hematology, Anesthesiology, Thoracic and Cardiovascular Surgery, Perfusion, and Blood Bank who work together to improve perioperative patient outcomes and blood product utilization. We set out to implement a testing algorithm with the purpose of improving the proportion of anemic patients undergoing cardiac surgery who have iron studies performed in the outpatient setting, thereby improving the percentage of patients receiving intravenous (IV) iron preoperatively. Methods: We adapted two published perioperative treatment algorithms (Lin, Hematology Am Soc Hematol Educ Program 2019; Munting and Klein, Anaesthesia 2019) which recommend iron therapy in patients with hemoglobin &amp;lt; 13 g/dL, ferritin &amp;lt; 100 µg/L, and/or transferrin saturation &amp;lt; 20% for our cardiac surgery preoperative clinic. In November 2022, we implemented a reflex test within Epic electronic medical record that automatically sent ferritin, iron, and transferrin for patients with hemoglobin &amp;lt; 13 g/dL to evaluate for iron deficiency. Patients meeting parameters for iron deficiency (ferritin &amp;lt; 30 ng/mL and/or transferrin saturation &amp;lt; 20%) were then scheduled for iron infusions. We compared the percentage of patients undergoing testing for iron deficiency, as well as the percentage of anemic patients receiving iron infusion preoperatively, to those from a six month period prior to our start date. Results: Between May 31, 2022 and October 31, 2022, 19% of cardiac surgery patients at UVA with hemoglobin values &amp;lt; 13 g/dL had iron studies drawn in the three months prior to surgery. After implementing outpatient reflex iron testing, that number increased to 42% between November 2022 and May 2023 (p &amp;lt; 0.001). In the six months prior to implementation, four iron deficient cardiac surgery patients received preoperative IV iron an average of one day prior to surgery. Between November 1, 2022 and May 29, 2023, fifteen patients received IV iron an average of 5.7 days prior to surgery. The patients who received IV iron had lower rates of blood transfusions than anemic patients who did not receive IV iron (53% vs. 65%) and fewer units of blood transfused per patient who received blood (3.1 vs. 5.7). Conclusions: Results from the first seven months of this project suggest that using a standardized testing methodology in the outpatient setting can increase the uptake of iron testing and thereby treatment of iron deficiency anemia in the preoperative setting. Patients who received IV iron had lower rates of blood transfusions and received fewer units of blood on average than anemic patients who did not receive IV iron. We next plan to implement an iron testing strategy in cardiac surgery inpatients to further improve rates of iron testing and iron infusions in this population. We have created an IRB-approved database to study more patient-centered outcomes such as acute kidney injury, stroke, length of stay, readmissions, and mortality to determine if we can detect a measurable impact from IV iron administration in our patient population.

What Happens to Mild-to-Moderate Chronic Ischemic Mitral Regurgitation Following Isolated Coronary Artery Bypass Surgery?

Introduction: The aim of this study was to assess the efficacy of isolated coronary artery bypass grafting (CABG) on preoperatively existing mild-to-moderate chronic ischemic mitral regurgitation. Patients and Methods: A retrospective analysis was conducted on 30 patients who had coronary artery disease and chronic ischemic mitral regurgitation, and underwent isolated CABG at the Department of Cardiovascular Surgery, Kocaeli University, between January 2012 and February 2014. Preoperative demographic and clinical characteristics, as well as postoperative outcomes, were evaluated. The degree of IMR, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), and left atrial dimension (LAD) were assessed preoperatively, and at the postoperative 12th month. Results: There was no mortality during the early postoperative period. There were statistically similar measurements for LVEF, LVESD, LVEDD, and LAD between preoperative and postoperative periods (p&gt; 0.05). However, a decrease in the degree of IMR was detected during the specified periods (p&lt; 0.05). Conclusion: Isolated CABG can be safely performed in patients with mild/moderate chronic ischemic mitral regurgitation. The efficacy of isolated CABG was demonstrated to improve the degree of mitral regurgitation in selected patients based on echocardiographic measurements.