Cardiac Surgery Intervention Research Articles

Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies

Cardiac Surgery and Transcatheter Intervention for Valvular Heart Disease in Carcinoid Syndrome: Risk Factors, Outcomes, and Evolving Therapeutic Strategies

Low initial cerebral regional cerebral saturation (rSO2) unresponsive to intervention in cardiac surgery: When can we consider a false positive low rSO2 value?

Low initial cerebral regional cerebral saturation (rSO2) unresponsive to intervention in cardiac surgery: When can we consider a false positive low rSO2 value?

Short-term mechanical circulatory support in adults with congenital heart disease: indications and outcomes

Abstract Background An increasing number of adults with congenital heart disease (ACHD) present with heart failure (HF), which may require short- or long-term mechanical circulatory support (MCS), often around cardiac surgery or other interventions. Even though MCS has entered ACHD practice over the last few years, little is known on its indications and outcomes in this population. Purpose To assess the use and outcomes of short-term MCS in ACHD patients in a specialist centre, and assess the predictive power of the Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score in this population. Methods Data on all ACHD patients who received MCS since 2008 in a single tertiary centre were collected. Immediate, short and longer-term outcomes were also collected, including death, complications, and weaning success. Logistic regression and ROC analysis were performed to identify predictors of in-hospital mortality. Result There were 65 episodes of MCS in 63 patients during the study period: age 36.9+-13.6 years, 61.5% male. Most patients had CHD of moderate or severe complexity (49.2% moderate and 10.8% severe according to ESC guidelines). The most common anatomical diagnoses were left outflow tract obstruction in 35.4%, Marfan syndrome in 20.0% and tetralogy of Fallot or pulmonary atresia in 10.8%. The most common indications for ECMO were perioperative support (not endocarditis) in 55.6%, HF in 14.3%, pneumonia in 12.7% and endocarditis-related surgery in 7.9%. A critical preoperative status was present in 26.8%; median PEACH score (a validated ACHD peri-operative risk score) was 1.0[1.0-3.0] and ACHS score was 0.6[0.6-1.0]. Median SAVE score was -4.0[-9.0–2.0], with 21(43.8%) in SAVE class 4 or 5. VA-ECMO was used in 69.2%, VV-ECMO in 21.5%, BiVAD-ECMO in 4.6% and RVAD support in 4.6% of patients. The median duration of ECMO support was 198.6[133.0-354.2] hours. Complications included ischemic stroke (15.4%), intracerebral bleeding (9.2%), and other thromboembolism (23.8%). Successful weaning was achieved in 56.2%, whereas 4.6% were switched to more definitive MCS. In-hospital mortality was 47.7%, and this was higher in patients receiving VA support (OR 4.92, 95%CI:1.32-23.93, p=0.03). For patients on VA-ECMO or BiVAD support, the presence of Marfan syndrome (OR 4.92, 95%CI:1.32-23.93, p=0.03) and a lower (worse) SAVE score (OR 1.3 per point reduction, 95%CI:1.11-1.59, p=0.004) were associated with in-hospital mortality. An adjusted SAVE score that accounted for the presence of heritable thoracic aortic diseases (HTAD, -3 points) performed well at predicting in-hospital mortality (AUC increasing from 0.73 to 0.8, Figure). Conclusions Short-term MCS is a useful temporary rescue intervention in patients with ACHD, as a bridge to recovery or durable support, with 1 in 2 patients surviving to hospital discharge. The SAVE score adjusted for HTAD can reliably predict outcomes in patients with VA-ECMO and requires external validation.Figure

Clinical implications of hepatorenal function in patients undergoing percutaneous coronary intervention: insights from the SAKURA PCI2 registry

Abstract Background Hepatorenal function is a prognostic predictor for heart failure, cardiac surgery, and transcatheter intervention for structural heart disease. However, the clinical implications of hepatorenal function assessed by the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score is still unclear in patients undergoing percutaneous coronary intervention (PCI). Purpose This study aimed to clarify the association between clinical prognosis and the MELD-XI score. Methods We analyzed 993 patients who underwent PCI from June 2020 to July 2022 in the SAKURA PCI2 registry, a prospective multicenter registry. Patients were stratified into high (>10) or low (≤10) MELD-XI scores. Primary outcome was defined as 2-year major adverse cardio or cerebrovascular event (MACCE), including all-cause death, ischemic stroke, and non-fatal myocardial infarction. Secondary outcome was defined as major bleeding according to the Bleeding Academic Research Consortium 3 or 5. Results Of study participating patients, 253 patients (25.5%) were stratified into a high MELD-XI score group and had a higher prevalence of the high bleeding risk than patients with a low MELD-XI score (92.5% vs. 53.7%, p<0.01). Patients with a high MELD-XI score were associated with MACCE (13.1% vs. 2.7%, p<0.01; adjusted HR 3.78, 95%CI 1.78-8.03, p<0.01) and major bleeding (4.0% vs. 1.3%, p<0.01: unadjusted HR 3.32, 95%CI 1.35-8.18, p=0.01). Moreover, these associations remained consistent in patients with chronic and acute coronary syndrome (MACCE, p for interaction=0.89; major bleeding; p for interaction=0.64). Conclusion A high MELD-XI score was associated with an increased risk of MACCE and major bleeding within two years. Therefore, the MELD-XI score could provide information for risk stratification in patients undergoing PCI.Outcomes

Outcomes With the WATCHMAN FLX in Everyday Clinical Practice From the NCDR Left Atrial Appendage Occlusion Registry.

PINNACLE FLX (Protection Against Embolism for Nonvalvular AF Patients: Investigational Device Evaluation of the WATCHMAN FLX LAA Closure Technology) demonstrated improved outcomes and low incidence of adverse events with the WATCHMAN FLX device in a controlled setting. The National Cardiovascular Disease Registry's Left Atrial Appendage Occlusion Registry was utilized to assess the safety and effectiveness of WATCHMAN FLX in contemporary clinical practice in the United States. The WATCHMAN FLX Device Surveillance Post Approval Analysis Plan used data from the Left Atrial Appendage Occlusion registry to identify patients undergoing WATCHMAN FLX implantation between August 2020 and September 2022. The key safety end point was defined as all-cause death, ischemic stroke, systemic embolism, or device or procedure-related events requiring open cardiac surgery or major endovascular intervention between device implantation and hospital discharge. Major adverse events were reported at hospital discharge, 45 days, and 1 year. Among 97 185 patients in the Left Atrial Appendage Occlusion registry undergoing WATCHMAN FLX, successful implantation occurred in 97.5% (n=94 784) of patients. The key safety end point occurred in 0.45% of patients. At 45 days post-procedure, all-cause death occurred in 0.81% patients, ischemic stroke in 0.23%, major bleeding in 3.1%, pericardial effusion requiring intervention in 0.50%, device-related thrombus in 0.44%, and device embolism in 0.04% patients. No peri-device leak was observed in 83.1% of patients at 45 days. At 1 year, the rate of all-cause death was 8.2%, the rate of any stroke was 1.5% (ischemic stroke, 1.2%), and major bleeding occurred in 6.4% of patients. In a large contemporary cohort of patients with the WATCHMAN FLX device, the rates of implant success and clinical outcomes through 1 year were comparable with the PINNACLE FLX study, demonstrating that favorable outcomes achieved in the pivotal approval study can be replicated in routine clinical practice.

The Other Side of the Coin: Transesophageal Echocardiography Complications following Cardiac Surgery and Transcatheter Structural Heart Interventions.

Transesophageal echocardiography (TEE) is widely used in cardiac surgery and interventional cardiology and is often an indispensable tool, giving supportive anatomical understanding and smooth guidance in both settings. Despite it being considered safe, fatal complications can commonly occur after a TEE examination in cardiac surgery operating rooms and catheterization laboratories. Currently, there is a lack of awareness of the scale of the problem, as there are only small amounts of data available, mainly derived from the surgical literature. This review summarizes the main predisposing factors for TEE-associated complications (classified as patient and procedure-related) and the main preventive strategies. We aim to apply preventive strategies more broadly, especially to patients at high risk of developing TEE-related serious adverse events.

Red Blood Cell Transfusion Strategies in Cardiovascular Interventions.

Acute coronary syndrome, cardiac surgery, and cardiac structural interventions are among the most common situations leading to allogeneic red blood cell consumption due to the prevalence of bleeding and anemia. The wide variability in the use of transfusions derives from the current lack of data, and the absence of strong evidence and clear guideline recommendations. The current approach is to avoid unnecessary blood transfusions and limit their use to life-saving conditions; this conservative strategy derives from often controversial and inconclusive results of observational and randomized studies where liberal and restricted red blood transfusion strategies seemed to have similar outcomes. The pivotal question for future research lies in elucidating whether blood transfusions function as an active participant or merely a catalyst in amplifying adverse events. The present review aims to summarize the current literature data and critically analyze the available evidence for red blood transfusions in cardiac interventions.

MISDIAGNOSED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN AS A CAUSE OF RIGHT VENTRICULAR DILATION IN TRICUSPID VALVE DYSPLASIA

Abstract A 38–year–old woman comes to our attention for regular follow–up of a known tricuspid valve dysplasia, diagnosed since she was 19 years old. The patient has been persistently asymptomatic and hemodynamically compensated. In previous cardiac assessments, there was moderate and stable tricuspid regurgitation (TR) that never reached the diagnostic criteria for Ebstein‘s anomaly (7 mm). The right atrium was dilated, and the right ventricle was at the upper limits of normal dimensions. However, our evaluation revealed a worsening of TR to a severe degree, associated with valvular annulus dilation and severe dilation of the right ventricle, which remained normokinetic, and evident diastolic overload of the interventricular septum. Therefore, a cardiac surgery intervention was indicated to correct the valvulopathy. During hospitalization, a transthoracic echocardiogram was repeated to investigate a possible cause of right ventricular overload, not fully explained by the relatively short duration of severe TR. During the exam, suspecting Partial Anomalous Pulmonary Venous Return (PAPVR) as one of the possible determinants, a vessel compatible with left superior pulmonary venous return was visualized, which converged into the anonymous vein and then into the right superior vena cava. Further diagnostic investigation with magnetic resonance angiography and computed tomography angiography confirmed the severe dilation of the right cardiac chambers and the presence of left upper pulmonary venous return and part of the left lower lobe into the left anonymous vein, with a Qp/Qs of 1.7 in relation to the pre–tricuspidal shunt. Therefore, a cardiac surgery intervention was indicated for PAPVR correction. However, previously unnoticed thrombocytosis was revealed in the hematological exams, leading to the initiation of a pertinent hematological workup and the cardiac surgery intervention was postponed to reduce the risk of perioperative complications. In conclusion, PAPVR is a rare congenital condition that can remain asymptomatic until adulthood due to a chronic adaptation of the right heart to volume overload and should, therefore, be considered in the differential diagnosis of right cardiac chambers dilation, especially when other causes do not justify its pathophysiology.

Efficacy of electroacupuncture on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass: a systematic review and Meta-analysis.

To evaluate the efficacy of electroacupuncture (EA) intervention on myocardial protection and postoperative rehabilitation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Eight databases, including PubMed, Embase, the Cochrane Library, Web of Science, Chinese BioMedical Literature Database, China National Knowledge Infrastructure Database, Wanfang Data, China Science and Technology Journal Database, and two clinical trial registries, were searched. All randomized controlled trials (RCTs) related to EA intervention in cardiac surgery with CPB were collected. Based on the inclusion and exclusion criteria, two researchers independently screened articles and extracted data. After the quality evaluation, RevMan 5.3 software was used for analysis. Fourteen RCTs involving 836 patients were included. Compared with the control treatment, EA significantly increased the incidence of cardiac automatic rebeat after aortic unclamping [relative risk (RR) = 1.15, 95% confidence interval (CI) (1.01, 1.31), P < 0.05; moderate]. Twenty-four hours after aortic unclamping, EA significantly increased the superoxide dismutase [standardized mean difference (SMD) = 0.96, 95% CI(0.32, 1.61), P < 0.05; low], and interleukin (IL)-2 [SMD = 1.33, 95% CI(0.19, 2.47), P < 0.05; very low] expression levels and decreased the malondialdehyde [SMD =－1.62, 95% CI(－2.15, －1.09), P < 0.05; moderate], tumour necrosis factor-α [SMD = －1.28, 95% CI(－2.37, －0.19), P < 0.05; moderate], and cardiac troponin I [SMD = －1.09, 95% CI(－1.85, －0.32), P < 0.05; low] expression levels as well as the inotrope scores [SMD = －0.77, 95% CI(－1.22, －0.31), P < 0.05; high]. There was no difference in IL-6 and IL-10 expression levels. The amount of intraoperative sedative [SMD = -0.31, 95% CI(－0.54, －0.09), P < 0.05; moderate] and opioid analgesic [SMD = -0.96, 95% CI(－1.53, －0.38), P < 0.05; low] medication was significantly lower in the EA group than in the control group. Moreover, the postoperative tracheal intubation time [SMD = －0.92, 95% CI(－1.40, －0.45), P < 0.05; low] and intensive care unit stay [SMD = －1.71, 95% CI(－3.06, －0.36), P < 0.05; low] were significantly shorter in the EA group than in the control group. There were no differences in the time to get out of bed for the first time, total days of antibiotic use after surgery, or postoperative hospital stay. No adverse reactions related to EA were reported in any of the included studies. In cardiac surgery with CPB, EA may be a safe and effective strategy to reduce myocardial ischaemia-reperfusion injury and speed up the recovery of patients after surgery. These findings must be interpreted with caution, as most of the evidence was of low or moderate quality. More RCTs with larger sample sizes and higher quality are needed to provide more convincing evidence.

First Experience With Amulet in the United States: Early Insights From EMERGE LAA Postapproval Study.

The Food and Drug Administration approved the Amulet occluder (Abbott) after demonstrating safety and effectiveness in the Amulet IDE (AMPLATZER Amulet LAA Occluder) trial. The aim of the EMERGE Left Atrial Appendage study is to evaluate early postapproval outcomes of the Amulet occluder in the United States using data from the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry. Patients with a commercial Amulet occluder implant attempt between Food and Drug Administration approval (August 14, 2021) and December 31, 2022, were included. The safety composite endpoint included all-cause death, ischemic stroke, systemic embolism, or device/procedure-related events requiring open cardiac surgery or endovascular intervention between device implantation and 7days or hospital discharge (whichever is later). Major adverse events through 45days were also reported and stratified by operator experience (early [<10 cases], moderate [10-29 cases], and high [30+ cases]). A total of 5,499 patients underwent attempted Amulet occluder implantation. Implant success was 95.8%, and complete closure was 97.2% post-left atrial appendage occlusion and 87.1% at 45days. A safety composite endpoint event occurred in 0.76% patients. Any major adverse event occurred in 2.9% and 5.7% of patients in-hospital and through 45days, respectively, driven by major bleeding and pericardial effusion (PE) requiring intervention. PE requiring surgery or percutaneous intervention decreased significantly with increasing experience both in-hospital (early vs high operator experience 1.8% vs 1.1%; P = 0.006) and at 45days (2.3% vs 1.5%; P = 0.012). The EMERGE Left Atrial Appendage study demonstrates favorable safety and effectiveness of theAmulet occluder in the real-world setting. More experienced operators had improved implant success and fewerPEs,suggesting a learning curve effect implanting this dual occlusive mechanism device.

A formalized shared decision-making process with individualized decision aids for older patients referred for cardiac surgery.

Comprehension of risks, benefits and alternative treatment options is poor among patients referred for cardiac surgery interventions. We sought to explore the impact of a formalized shared decision-making (SDM) process on patient comprehension and decisional quality among older patients referred for cardiac surgery. We developed and evaluated a paper-based decision aid for cardiac surgery within the context of a prospective SDM design. Surgeons were trained in SDM through a Web-based program. We acted as decisional coaches, going through the decision aids with the patients and their families, and remaining available for consultation. Patients (aged ≥ 65 yr) undergoing isolated valve, coronary artery bypass graft (CABG) or CABG and valve surgery were eligible. Participants in the non-SDM phase followed standard care. Participants in the SDM group received a decision aid following cardiac catheterization, populated with individualized risk assessment, personal profile and comorbidity status. Both groups were assessed before surgery on comprehension, decisional conflict, decisional quality, anxiety and depression. We included 98 patients in the SDM group and 97 in the non-SDM group. Patients who received decision aids through a formalized SDM approach scored higher in comprehension (median 15.0, interquartile range [IQR] 12.0-18.0) than those who did not (median 9.0, IQR 7.0-12.0, p < 0.001). Decisional quality was greater in the SDM group (median 82.0, IQR 73.0-91.0) than in the non-SDM group (median 76.0, IQR 62.0-82.0, p < 0.05). Decisional conflict scores were lower in the SDM group (mean 1.76, standard deviation [SD] 1.14) than in the non-SDM group (mean 5.26, SD 1.02, p < 0.05). Anxiety and depression scores showed no significant difference between groups. Institution of a formalized SDM process including individualized decision aids improved comprehension of risks, benefits and alternatives to cardiac surgery, as well as decisional quality, and did not result in increased levels of anxiety.

Application progress of nursing intervention in cardiac surgery

As a stressor, cardiac surgery affects the physiology and psychology of patients, as well as their postoperative recovery. Patients tend to worry about cognitive deficiency, pain, discomfort, the risk of death, sleep, complications, and other factors, resulting in stress and anxiety. Moreover, serious adverse events, such as circulatory and respiratory dysfunction and infection, tend to occur after cardiac surgery and increase the economic burden on patients. Therefore, appropriate nursing interventions should be selected to strengthen patients’ cognitive levels, compliance, and postoperative practices to accelerate their recovery, reduce complications, and shorten hospital stays so as to contribute to patients’ lives and health.

Predictive value of lung ultrasound combined with ACEF score in patients with acute myocardial infarction

Abstract Objectives Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) determines the severity of pulmonary edema by measuring the number of B-lines and has been proved to be of great significance in predicting the poor prognosis of AMI. ACEF (Age, Creatinine, and Ejection Fraction) score has been validated as effective predictor for prognosis in patients undergoing elective cardiac surgery or percutaneous coronary intervention (PCI). However, whether lung ultrasound combined with ACEF score has incremental value in predicting the prognosis of patients with AMI is still unclear. This study aimed to investigate their predictive value in patients with AMI. Methods We performed preoperative echocardiography and LUS in patients with AMI who underwent emergency PCI in our hospital from February 2021 to June 2022，collected clinical data from all patients and conducted ACEF score [ACEF score formula: age/ejection fraction + 1 (if creatinine&amp;gt;176 μmol/L)]. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers &amp;lt;5), mild (B-line numbers ≥5 and &amp;lt;15), moderate (B-line numbers ≥15 and &amp;lt;30), and severe (B-line numbers ≥30). The adverse events were defined as all-cause death, recurrent myocardial infarction, Myocardial ischemia induced revascularization, and heart failure. Results 224 patients were enrolled, and the average length of hospital stay was 9.71±8.99 days. The ACEF score was positively correlated with the number of B lines (r = 0.43, P&amp;lt;0.01) and NT-proBNP (r =0.66, P&amp;lt;0.01) during hospitalization，The number of B-lines was positively correlated with NT-proBNP (r =0.38, P&amp;lt;0.01). In multivariate Logistic regression analysis, the number of B-lines during hospitalization (OR 1.093 [95%CI: 1.048-1.140], P&amp;lt;0.01) and ACEF score (OR 3.974 [95%CI: 1.680-9.400], P&amp;lt;0.01) were independent predictors of adverse events in AMI patients during hospitalization. For in-hospital results, the area under the receiver operating characteristic curves (AUCs) of ACEF score, LUS and their combination were 0.825 (P&amp;lt;0.01), 0.821(P&amp;lt; 0.01) and 0.880(P&amp;lt;0.01), respectively. 169 patients were followed up for an average of 11.00±6.52 months. In multivariate Cox analysis, the number of B-lines (HR 1.045 [95%CI: 1.023-1.069], P&amp;lt;0.01) and ACEF score (HR 1.649, 95%CI 1.103-2.463, P&amp;lt;0.05) were related with increasing risks of adverse events during follow-up. The area under the AUCs of ACEF score, LUS and their combination were 0.712 (P&amp;lt;0.01), 0.730(P&amp;lt; 0.01) and 0.755(P&amp;lt;0.01), respectively. Conclusions The number of B-lines combined with ACEF score provides incremental value for the risk of adverse events in patients, which is of great significance for risk stratification of patients with AMI.ROC curve during hospitalizationROC curve during follow-up

Outcomes of leadless pacemaker implantation after cardiac surgery and transcatheter structural valve interventions.

Permanent pacing indications are common after cardiac surgery and transcatheter structural valve interventions. Leadless pacemakers (LPs) have emerged as a useful alternative to transvenous pacemakers. However, current commercially available LPs are unable to provide atrial pacing or cardiac resynchronization and relatively little is known about LP outcomes after cardiac surgery and transcatheter valve interventions. This retrospective study included patients who received a Micra VR (MicraTM MC1VR01) or Micra AV (MicraTM MC1AVR1) (Medtronic) leadless pacemaker following cardiac surgery or transcatheter structural valve intervention between September 2014 and September 2022. Device performance and clinical outcomes, including ventricular pacing burden, ejection fraction, and need for conversion to transvenous pacing systems, were evaluated during follow-up. A total of 78 patients were included, of whom 40 received a Micra VR LP implant, and 38 received a Micra AV LP implant. The mean age of the cohort was 65.9 ± 17.9 years, and 48.1% were females. The follow-up duration for the entire cohort was 1.3 ± 1.1 years: 1.6 ± 1.3 years for the Micra VR group and 0.8 ± 0.5 years for the Micra AV group. Among the cohort, 50 patients had undergone cardiac surgery and 28 underwent transcatheter structural valve interventions. Device electrical performance was excellent during follow-up, with a small but clinically insignificant increase in ventricular pacing threshold and a slight decrease in pacing impedance. The mean right ventricle pacing (RVP) burden significantly decreased over time in the entire cohort (74.3% ± 37.2% postprocedure vs. 47.7% ± 40.6% at last follow-up, p < .001), and left ventricle ejection fraction (LVEF) showed a modest but significant downward trend during follow-up (55.0% ± 10.6% vs. 51.5% ± 11.2% p < .001). Patients with Micra VR implants had significantly reduced LVEF during follow-up (54.1% ± 11.9% vs. 48.8% ± 11.9%, p = .003), whereas LVEF appeared stable in the Micra AV group during follow-up (56.1% ± 9.0% vs. 54.6% ± 9.7%, p = .06). Six patients (7.7%) required conversion to transvenous pacing systems, four who required cardiac resynchronization for drop in LVEF with high RVP burden and two who required dual-chamber pacemakers for symptomatic sinus node dysfunction. Leadless pacemakers provide a useful alternative to transvenous pacemakers in appropriately selected patients after cardiac surgery and transcatheter structural valve interventions. Device performance is excellent over medium-term follow-up. However, a significant minority of patients require conversion to transvenous pacing systems for cardiac resynchronization or atrial pacing support, demonstrating the need for close electrophysiologic follow-up in this cohort.

Perioperative selenium administration in cardiac surgery patients, a way out to reduce post surgical adversities? A meta analysis.

The oxidative damage suffered in cardiac surgery is associated with declining trace elements which lead to the development of multi organ dysfunction (MOD), acute kidney injury (AKI), or increased length of hospital stay (LOS). Recent evidence shows the cardioprotective role of the trace element selenium as it mitigates worsening outcomes post cardiac surgery. Hence, this meta analysis aims to investigate the role of selenium in lowering cardiac surgery related adverse outcomes. Literature search of five electronic databases was performed from the inception of the paper till 29th July, 2023. Eligibility criteria included; (a) randomized clinical trials with Adult patients (≥18 years) undergoing cardiac surgery (b) intervention with selenium pre or/and postoperatively; (c) a control group of a placebo, normal saline, or no selenium. Outcomes of interest include postoperative mortality, LOS in the hospital and Intensive Care Unit (ICU), AKI, troponin I, and Creatinine Kinase-MB (CK-MB). The Cochrane bias assessment tool was used to evaluate the risk of bias. Outcomes were pooled with the Mantel-Haenszel Random-effects model using Review Manager. Seven RCTs with 2,521 patients and 65% of males were included in this paper. No noticable differences were observed between selenium and control groups in terms of postoperative AKI, mortality, LOS in hospital and ICU, troponin I, and CK-MB levels. All studies had a low risk of bias on quality assessment. Our meta analysis demonstrated no discernible effects of selenium infusion on post operative complications among patients undergoing cardiac surgery. Further large scale multi centered studies comparing the protective role of selenium with combined therapy of other bioactive agents are needed to provide convincing explanations. PROSPERO Identifier: 424920.

Digital Health for Patients Undergoing Cardiac Surgery: A Systematic Review.

Digital health interventions have shown promise in improving patient outcomes and experiences in various healthcare settings. However, their effectiveness in the context of cardiac surgery remains uncertain. This systematic review aims to evaluate the existing evidence on the use of digital health interventions for patients undergoing cardiac surgery. A comprehensive search of PubMed MEDLINE, Elsevier EMBASE, Elsevier Scopus databases, and ClinicalTrials.gov was conducted to identify relevant studies published up to the present. Studies that examined the effects of digital health interventions, including mobile applications and web-based interventions, on perioperative care and patient outcomes in cardiac surgery were included. The data were extracted and synthesized to provide a comprehensive overview of the findings. The search yielded 15 studies composed of 4041 patients, analyzing the feasibility and implementation of mobile or internet applications for patients undergoing cardiac surgery. The studies included the use of mobile applications (ManageMySurgery, SeamlessMD, mHeart, Telediaglog, ExSed, Soulage Tavie, Heart Health application, and Mayo Clinic Health Connection) and web-based interventions (Heartnet and Active Heart). The findings indicated that these digital health interventions were associated with improved patient engagement, satisfaction, and reduced healthcare utilization. Patients reported finding the interventions helpful in their recovery process, and there was evidence of enhanced symptom monitoring and timely intervention. The completion rates of modules varied depending on the phase of care, with higher engagement observed during the acute phase. Interest in using digital health applications was expressed by patients, regardless of age, gender, or complexity of the cardiac defect. The results demonstrated that web-based interventions resulted in improvements in mental health, quality of life, and eHealth literacy. This systematic review highlights the potential benefits of digital health interventions in the context of cardiac surgery. Further research, including randomized controlled trials, is needed to establish the effectiveness, feasibility, and generalizability of digital health interventions in cardiac surgery.

Extended Reality Applications in Cardiac Surgery and Interventional Cardiology

Extended reality combines the real and digital worlds. This technology has found applications in all fields of medicine, including cardiac surgery and interventional cardiology. The paper describes the application of three types of extended reality, namely virtual, augmented and mixed realities.&#x0D; The aim. To explain the principles of operation of various types of extended reality using non-medical and medical applications as examples; to analyze the data from specialized publications in the field of cardiac interventions.&#x0D; Materials. Articles from the Pubmed database.&#x0D; Results. The article highlights important details of the heart and blood vessels image creation technique with which users operate. Primary data is obtained from imaging modalities like tomography or ultrasound, then it is segmented and processed for the virtual viewing. In virtual reality, three-dimensional (3D) images of the heart defects are analyzed in depth, and virtual manipulations can be performed that simulate the course of the operation. Virtual reality includes printing the heart on a 3D printer with subsequent executions on physical models, both diagnostic dissections and therapeutic surgical or endovascular simulations. In augmented reality, the created image of the internal anatomy of the defect is present near the surgeon, without interfering medical manipulations. In mixed reality, a virtual image is superimposed on the patient’s body, creating a detailed navigation map.&#x0D; Conclusions. Extended reality application deepens the understanding of anatomy due to stereoscopic visualization of the structure of the heart and blood vessels. Creating a model of a patient’s heart defect and simulating an operation on it shortens the “learning curve”, improves the professional skills of surgeons and cardiologists, and also allows for surgical and endovascular interventions individualization. Planning interventions in cardiac surgery and interventional cardiology with extended reality technologies influences decision-making and reduces the duration of operations.

Acute pericarditis complicating transcatheter mitral valve repair: A case report

Post-cardiac injury syndrome may occur after acute myocardial infarction, cardiac surgery or percutaneous cardiac interventions, such as percutaneous coronary angioplasty, pacemaker lead insertion and post-ablation procedures. In this case report, we describe the case of an 80-year-old female patient

Identifying Patients With Secondary Mitral Regurgitation and Heart Failure who may Benefit From Transcatheter Edge-to-Edge Repair in the Wellington Region

As the New Zealand population ages, the incidence of heart failure and valvular disease increases. The Cardiovascular Outcomes Assessment of MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial showed decreased rates of hospitalisation for heart failure and all-cause mortality with transcatheter edge-to-edge repair (TEER) for clinically significant secondary mitral regurgitation (MR) within 24 months of follow-up compared with medical therapy. This retrospective observational study aimed to identify patients who may benefit from TEER in Wellington. This study retrospectively reviewed the electronic records of 337 consecutive patients aged ≥18 years who presented to Wellington Hospital from April to September 2022 with heart failure and identified those who met modified COAPT criteria: at least moderate secondary mitral regurgitation, left ventricular ejection fraction (LVEF) 20%–50% on echocardiography, and who did not meet criteria for cardiac surgery or other valve intervention. Forty patients met the modified COAPT criteria: 27 (68%) were male and 13 (33%) were female. The mean age was 71.7 years. Of them, 55% were New Zealand European, 23% were Pasifika, and 13% were New Zealand Māori. A total of 58% had moderate MR, 33% had moderate–severe MR, and 10% had severe MR; the median LVEF was 30%. The median survival was 309 days in those who met the modified COAPT criteria compared with 365 days in those who did not (non-statistically significant). Among patients who presented to Wellington Hospital with heart failure, a significant proportion (11.9%) had clinically significant secondary MR, who trend towards shorter survival times compared with those who present with heart failure in general. According to international guidelines and trial data such as COAPT, these patients would have potentially benefitted from TEER.

A case report of chylous ascites after cardiac surgery

Abstract Background Chylous ascites (CA), an emulsion rich in triglycerides, is a rare type of ascites, especially after cardiac surgery. Also, there are few reports of the occurrence of CA after mitral valve replacement, aortic valve replacement, tricuspid valvuloplasty, and coronary artery bypass grafting. Case presentation We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence, aortic incompetence, tricuspid incompetence, and coronary atherosclerotic heart disease. Fifteen days after surgery, 3000 mL of milky-yellow ascites appeared in the abdominal cavity, diagnosed as CA by laboratory examination. The ascites gradually disappeared after being drained, and the patients improved. The curative was objective, but the exact cause is not clear. Conclusion Although CA is rare, it may occur during the surgical intervention in cardiac surgery.