Open Cardiac Surgery Research Articles

Reconstruction of Infected Mediastinal Wound with an Omental Flap Harvested Laparoscopically After Cardiac Surgery: Report of Two Cases and Literature Review

Background: Deep sternal wound infection and dehiscence are two serious complications after open cardiac surgery. Omental flap harvesting is recognized as one of the management options, with traditionally non-favorable outcomes due to laparotomy stress on patients. Objective: Herein, however, we report our experience with two patients who have developed a mediastinal wound infection following coronary artery bypass grafting and were reconstructed with omental flaps harvested laparoscopically. Case Presentation: Two 74-year-old females, who were known to have multiple comorbidities, developed a sternal wound infection after coronary artery bypass graft. Several operative trials and non-operative measures have been attempted to manage the infections and/or reconstruct the wound but failed. Both patients then underwent laparoscopic omental flap harvesting for reconstruction and exhibited significant clinical improvement postoperatively. Discussion: Omental flap is considered a feasible option for reconstruction of sternal wound dehiscence developing after open cardiac surgery because it is usually well-vascularized, contains a large number of immunologically active cells and has the ability to absorb wound secretions. The traditional method of harvesting is conventional laparotomy, but it carries high rates of morbidity. Therefore, laparoscopic harvesting can be utilized as an alternative with better outcomes. Conclusion: Laparoscopic omental flap harvesting is considered a feasible and safe procedure to manage sternal wound dehiscence after open cardiac surgery, with satisfactory surgical outcomes.

Treatment algorithm for post sternotomy wound infection - our experience.

Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are aknown phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop atreatment algorithm for superficial and deep sternotomy wound infections. Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Slučajni nalaz retke anomalije aurikule leve pretkomore - prikaz slučaja

Introduction. Congenital hypoplasia of the left atrial appendage (LAA) with stenotic ostium in an abnormal position is an extremely rare entity. We report an exceptional case of hypoplastic LAA with ostial stenosis in an abnormal location in the patient with mitral valve stenosis that was mistaken in the transesophageal echocardiography (TEE) for an intraluminal thrombus. Case report. A 43-year-old woman was admitted to our center with dyspnea on exertion. TEE revealed the presence of severe mitral stenosis and clot in the LAA. The patient underwent open cardiac surgery by cardiopulmonary bypass. Intraoperative inspection of the left atrium revealed hypoplasia of the LAA with stenotic and slit-like ostium. There was also a malposition of the LAA that was placed in a paravalvular location. The ostium of the LAA was not round and wide but narrowed and slit-like. Conclusion. The authors believe that this anomaly may have some physiologic consequences in patients with mild structural failure. Indeed, this anomaly may aggravate the severity of structural failure by pressure burden on the atrial wall and valve.

Preoperative serum potassium levels as a risk factor in postoperative atrial fibrillation in open cardiac surgery patient: A retrospective, observational study

Preoperative serum potassium levels as a risk factor in postoperative atrial fibrillation in open cardiac surgery patient: A retrospective, observational study

Development of a prognostic nomogram for patients underwent extracorporeal circulation auxiliary to open cardiac surgery on hospital mortality: a retrospective cohort study.

Extracorporeal circulation auxiliary to open cardiac surgery (ECAOCS) is one of the most complex surgical procedures and carries a very high risk of death. We developed a nomogram from a retrospective study to predict the risk of death during patient hospitalization. All clinical data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We extracted clinical variables for the first 24 hours after admission to the intensive care unit (ICU) in a total of 880 patients who underwent ECAOCS. All patients were randomly divided into training and validation cohort in a ratio of 7:3. All variables included in the study were subjected to univariate logistic regression analysis. In order to prevent overfitting and to address the problem of severe covariance, all factors with P<0.05 in the univariate logistic regression analysis were analyzed using the least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was developed based on the factors output from the LASSO regression and a nomogram was plotted. The receiver operating characteristic (ROC) curve was constructed and the area under the curve (AUC) was calculated in training and validation cohort. Finally, the evaluation of the model was performed by calibration curves and Hosmer-Lemeshow goodness-of-fit test (HL test) and decision curve analysis (DCA) was performed. Indicators included in the nomogram were anion gap (AG), central venous pressure (CVP), glucose, creatinine (Cr), prothrombin time (PT), activated partial thromboplastin time (APTT), bicarbonate ion (HCO3 -), cerebrovascular disease (CVD), peripheral vascular disease (PVD), and acute myocardial infarction (AMI). Our study developed a model for predicting postoperative hospital mortality in patients underwent ECAOCS by incorporating AG, CVP, glucose, Cr, APTT, HCO3 -, CVD, AMI, and PVD from the first 24 hours after admission to the ICU. Extracorporeal circulation; cardiac surgery; intensive care; nomogram; prediction model.

Pregnancy Outcomes in Women with Arrhythmias following Surgical Repair of Cardiac Defects.

The goal of this study was to investigate whether preexisting cardiac arrhythmias are associated with adverse obstetrical outcomes in women with a history of open cardiac surgery. This was a retrospective cohort study of women with a history of open cardiac surgery who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2007 through December 2018. Women with the isolated percutaneous cardiac surgical repair were excluded. Maternal and neonatal outcomes were compared between patients with preexisting cardiac arrhythmias and patients without preexisting cardiac arrhythmias. Maternal outcomes studied were intensive care unit admission, postpartum blood loss greater than 1,000 mL, congestive heart failure development, preeclampsia with severe features, postpartum readmission, postpartum cardiac events, and postpartum length of stay >5 days. Neonatal outcomes investigated were low birth weight <2,500 g, Apgar's scores <7 at 5 minutes, and neonatal intensive care unit admission. Multivariate logistic regression model was used to calculate the adjusted odds ratio (aOR) and 95% confidence intervals. The outcomes for 69 deliveries from 56 women with a history of open cardiac surgery were examined. Thirty-three women (48%) had arrhythmias after cardiac surgery with fourteen (20%) requiring implantable cardioverted defibrillators. Two women (6%) with preexisting arrhythmias after cardiac surgery developed postpartum volume overload requiring readmission (p = 0.06). After controlling for age, gestational age at delivery, and BMI, preeclampsia with severe features (p = 0.02) and low birth weight neonates (p = 0.02, aOR = 2.26 [0.56-9.03]) remained statistically more like to occur in patients with preexisting cardiac arrhythmias than in patients without preexisting arrhythmias. Women with a history of open cardiac surgery and preexisting cardiac arrhythmias prior to pregnancy are more likely to develop preeclampsia with severe features and have low birth weight neonates compared with women with a history of open cardiac surgery without preexisting cardiac arrhythmias. · Preexisting arrhythmias after cardiac surgery was associated with a risk of preeclampsia.. · Neonates of women with preexisting cardiac arrhythmias are more likely to be low birth weight.. · Forty-seven percent of women with open cardiac surgery developed subsequent arrhythmias..

Con: General Anesthesia Should No Longer Routinely Be Used for Transfemoral Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) procedures were introduced in the early 2000s as an alternative to surgical aortic valve replacement (SAVR) in high-risk patients who were not surgical candidates. 1 Bourantas CV Serruys PW. Evolution of transcatheter aortic valve replacement. Circ Res. 2014; 114: 1037-1051 Crossref PubMed Scopus (54) Google Scholar The safety of the procedure improved over time as the procedure became more widespread and new deployment devices, valves, and percutaneous access were refined. 1 Bourantas CV Serruys PW. Evolution of transcatheter aortic valve replacement. Circ Res. 2014; 114: 1037-1051 Crossref PubMed Scopus (54) Google Scholar Encouraging outcomes, such as a decreased hospital length of stay and improved morbidity, have expanded access to TAVRs to populations deemed intermediate and low-risk for SAVR. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar According to the Society of Thoracic Surgery-American College of Cardiology Transcatheter Valve Therapy Registry, >70,000 TAVRs were performed in the United States in 2019, surpassing the number of SAVRs that year. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar The most common access site is increasingly transfemoral (95% in 2019), and the need for conversion to open cardiac surgery with the use of cardiopulmonary bypass has significantly decreased from 4% to 0.4% since the introduction of TAVRs. 2 Carroll JD Mack MJ Vemulapalli S et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020; 76: 2492-2516 Crossref PubMed Scopus (294) Google Scholar The focus of care surrounding TAVRs is now shifting to a minimally invasive approach with shorter procedure time, shorter hospital length of stay, and reduced costs. 3 Sawan MA Calhoun AE Grubb KJ et al. Update on minimalist TAVR care pathways: Approaches to care in 2022. Curr Cardiol Rep. 2022; 24: 1179-1187 Crossref PubMed Scopus (2) Google Scholar Although both conscious sedation and general anesthesia techniques can be used for TAVR procedures, the authors assert that conscious sedation is superior as it helps achieve these goals with potentially less risk.

Determinants of Acute Kidney Injury in Children Undergoing Cardiopulmonary Bypass: Single-Center Experience in Saudi Arabia.

Introduction Cardiopulmonary bypass (CPB) is a machine used in open cardiac surgeries and has been linked to many complications, one of which is acute kidney injury (AKI). Also, the Kidney Disease Improving Global Outcomes (KDIGO) criteria are used to diagnose AKI in the pediatric population. The study aimed to investigatethe association between cardiopulmonary bypass duration and renal function impairment in pediatric patients who had cardiac surgery. Methods Thiswas an observational, cross-sectional study conducted at the King Abdulaziz Medical City, King Faisal Cardiac Center, the section of the Pediatric Cardiac Intensive Care Unit (PICU), Ministry of National Guard Health Affairs, from January 2016 to December 2019. Patients younger than 14 years old, those having a cardiac surgery where CPB was implemented, normal pre-operative kidney functions, and having a cardiac surgery longer than 60 minutes (min) were included. The exclusion criteria were patients known to have pre-operative renal impairment and patients with pre-operative hemodynamic instability or cardiac arrest. Demographics ofpre-operative, intra-operative, andpost-operativedatawere extracted, and Statistical Package for the Social Sciences (SPSS) version 25 (Armonk, NY: IBM Corp.) was used for analysis. For descriptive statistics, frequencies and percentages for qualitative data were examined, while mean and standard deviation (SD) or median and interquartile range (IQR) quantitativedata were used accordingly. Student's t-test,Mann-Whitney(median test), chi-square, or Fisher's exact tests were used for univariate analysis accordingly. Logistic regression analysis was used to determine significant predictors for developing AKI. A p-value of <0.05 would be considered significant. Results Of the 111 patients,87 patients were included in the analysis. The median age was six months, IQR two to 13 months, body mass index (BMI) mean of 13.8, and SD 3.6. There was similar sex distribution, male 47.1% vs. female 52.9%. There were no patients in Risk Adjustment for Congenital Heart Surgery (RACHS) who scored 5 or 6. The AKI prevalence was 31% (27/87) within three days after surgery. One patient had stage 2 AKI; the rest were mild. One patient (3.7%) died. The CPB time was significantly longer in patients who developed AKI 150 (104-202), vs. non-AKI 104(82-142) min, p=0.004. In the AKI group, the mean baseline (pre-operative) serum creatinine (sCr) was significantly lower, whereas, it was significantly higher at 24 hours (h), and 48 hpost-operation (p=0.001, 0.001, and 0.036, respectively). Additionally, the estimated Glomerular Filtration Rate (eGFR) was significantly higher in the AKI group at 24 h(p=0.007). In logistical regression analysis, CPB time (per minunit time) was a significant predictor for developing AKI, OR 1.015, p=0.011 as a measured outcome. However, only CPB time >180 minwas highly significant with OR 16.2, p=00.6 compared to CPB time 121-180 minOR 2.3, p=0.29 and CPB time 91-120 minOR 1.2, p=0.84. Conclusion Acute kidney injury is an expected complication of pediatric congenital heart surgery receiving CPB. Although in our single-center experience, CPB duration was a significant predictor for AKI; however, it is considered a mild complication that does not contribute significantly to short-term morbidity or mortality. A larger multicenter, national prospective data registryis recommended to explore long-term effects.

Effects of Thoracic Paravertebral Block on Postoperative Analgesia in Infants and Small Children undergoing Ultra-Fast Track Cardiac Anesthesia: A Randomized Controlled Trial

To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would improve postoperative analgesia in infants and small children undergoing open cardiac surgery in the protocol of an ultra-fast track cardiac anesthesia (UFTCA). A single-center, prospective, randomized, controlled study. At a tertiary children's medical center. A total of 180 children undergoing cardiac surgery, aged 1 month to 3 years. Patients are allocated randomly to TPVB and parent- and/or nurse-controlled intravenous analgesia (PNCA) group (Group T) or PNCA group (Group P). The primary outcome is the postoperative pain scores. The secondary outcome are intraoperative consumption of sufentanil, time to extubation, using of neostigmine, cumulative total and invalid PCA attempts in 24 and 48 hours after surgery, hospitalization characteristics, perioperative blood glucose, postoperative arterial oxygen partial pressure, arterial carbon dioxide partial pressure (PaCO2) and brain natriuretic peptide (BNP). The postoperative pain scores within 24 hours, intraoperative consumption of sufentanil, total, and invalid PCA attempts in 24 and 48 hours, perioperative blood glucose and BNP on the seventh day in Group T were all significantly lower than those in Group P (p < 0.001). The time to extubation, the use of neostigmine, and PaCO2 on the sixth hour, postoperatively, were significantly smaller in Group T than those in Group P (p < 0.05). There were no significant differences in the hospitalizations between the 2 groups. A combination of bilateral single dose TPVB and PNCA pain management is superior to a PNCA pain management alone in infants and small children undergoing open cardiac surgery and contributes to a rapid recovery with preferable perioperative outcomes in the protocol of UFTCA.

The Analgesic Effects of the Addition of Intravenous Ibuprofen to a Multimodal Analgesia Regimen for Pain Management After Pediatric Cardiac Surgery: A Randomized Controlled Study

Intravenous ibuprofen is used to control fever and pain. This study aimed to assess the analgesic effects of the addition of intravenous ibuprofen to a multimodal analgesia regimen for pain management after pediatric cardiac surgery. A randomized, controlled, double-blinded, superiority study. University hospital. Seventy-eight pediatric patients who underwent open cardiac surgery using midline sternotomy incision were screened for eligibility; 10 patients were excluded, leaving 68 patients (34 patients in the ibuprofen group and 34 patients in the control group) for final data analysis. Patients were randomly allocated to either the ibuprofen group, in which the patient received intravenous ibuprofen infusion of 10 mg/kg/6 hours for 24 hours, or the control group, in which the patient received a placebo 0.9% saline. The primary endpoint was the 24-hour postoperative fentanyl consumption, and the secondary endpoints were postoperative modified objective pain score and the incidence of ibuprofen-related side effects (eg, vomiting, epigastric pain, bleeding, and renal dysfunction). The mean total fentanyl consumption (μg/kg) during the first postoperative 24 hours after extubation was significantly lower (p<0.001) in the ibuprofen group (3.5 ± 1.3) than the control group (5.1 ± 1.4). The median postoperative modified objective pain score was significantly lower (p < 0.05) in the ibuprofen group than the control group at 0 hours, 2 hours, 12 hours, 16 hours, 20 hours, and 24 hours postoperatively. Ibuprofen did not cause significant increases in the incidences of bleeding, epigastric pain, and vomiting. Postoperative renal dysfunction was not reported in any patient. The addition of intravenous ibuprofen to a multimodal analgesia regimen for pain management after pediatric cardiac surgery improved postoperative analgesia in terms of reduction of opioid consumption and pain scores.

Subsequent cardiac surgery after transcatheter aortic valve implantation: Indications and outcomes.

Aim of this study was to report on indications and clinical outcomes of patients who underwent subsequent open-cardiac surgery after transcatheter aortic valve implantation TAVI. Between 01/2011 and 12/2020 our centre performed 4043 TAVI procedures. Twenty-seven patients (including patients in whom TAVI was performed in other centres) underwent subsequent open-heart surgery via cardiopulmonary bypass. Demographic, intraprocedural data, indications for, and outcomes after surgery were evaluated. Indications for cardiac surgery (aged 79 [IQR 76-84]; 59.3% male) were endocarditis (n = 11; 40.7%), annular rupture, severe paravalvular leak and severe stenosis in three (11.1%) patients, respectively as well as in one patient each (3.7%) severe tricuspid valve regurgitation, valve thrombosis, valve malposition, valve migration, ostial right coronary artery obstruction, left ventricular rupture and type A aortic dissection. The interval between the index TAVI procedure to open surgery was 3 months (IQR 0-26 months). Eight patients underwent emergent surgical conversions. Immediate procedural and procedural mortality was 25.9% and 40.7%, respectively and all-cause mortality was 51.9% (11/12 died for cardiovascular reasons). No disabling stroke was observed postoperatively. New permanent pacemaker implantation was required in threepatients (11.1%). Subsequent open-cardiac surgery after TAVI is rare, but may urgently become necessary due to TAVI related complications or progressing other cardiac pathologies. Despite a substantial early attrition rate clinical outcome is acceptable and a relevant number of these high-risk patients can be discharged even after emergency conversions. The option of subsequent surgical conversion remains.

Abstract 14609: Exposure to Any Hospitalization and Specific Invasive Procedures Post Open Heart Valve Surgery Increases the Risk of Endocarditis

Introduction: Infective endocarditis (IE) after cardiac valve surgery is associated with high morbidity and mortality. Nosocomial exposure is a growing cause of IE in general. We investigated the risk of post valve surgery endocarditis (PVE) in patient who had any hospitalization and specific nosocomial exposures after open heart valve surgery. Methods: We identified all ≥18yo patients who had their first open heart cardiac valve surgery between 2001-2017 in New South Wales, Australia from the Admitted Patient Data Collection (APDC) registry. Patients with prior/current IE diagnosis at time of index valve surgery were excluded. Follow up was until 31 Dec 2018 with mortality and morbidity tracked from the respective death and APDC registries. Analyses based on Cox regression modelling included age, sex, background diagnoses and features of index valve surgery as time independent covariates, with any hospitalization (separately for specific invasive procedures) post index valve surgery as time dependent exposure covariates for risk of PVE within 6 months of exposure. Results: In total 23747 patients (median age [IQR] 73yo [65-79yo, 63% male) had cardiac valve surgery: 60% isolated aortic valve (n=15065), 28% isolated mitral valve (n=6702), 10% multiple valves (n=2385) and 1.5% right sided valves (n=357). 5.4% (n=1293) of patients experienced PVE at a median 2.9 years (IQR 0.7-6.2) after index valve surgery, with 65% (n=838) occurring within 6 months of any hospitalization. Any hospitalization exposure was associated with an adjusted hazard ratio of 4.0 for developing PVE (95% confidence interval 3.5-4.5). In addition, specific invasive procedures including repeat valve surgery were associated with an elevated risk for PVE (Figure). Conclusions: PVE is significantly more common after any hospitalization with specific invasive procedures carrying differential risk. Care should be taken to avoid unnecessary hospitalizations and procedures in these patients.

John H. Gibbon and the development of the heart-lung machine: The beginnings of open cardiac surgery.

The authors declare no conflict of interest.

Evaluating the Safety and Efficacy of a Novel Polysaccharide Hemostatic System for Multidisciplinary Application: A Multicenter Prospective Randomized Controlled Trial

Introduction: Operative blood loss is associated with postoperative morbidity and mortality. Hemostatic agents are used as adjunctive methods for hemostasis during surgery and to prevent postoperative bleeding. We evaluated safety and efficacy of an investigational polysaccharide hemostatic (PH) device, compared with an FDA-approved control in clinical use comprising microporous polysaccharide hemospheres (MPH), to achieve hemostasis of bleeding surfaces during surgery. Methods: This prospective multicenter trial enrolled patients undergoing open elective cardiac, general, or urological operation. Patients were stratified by bleeding severity and therapeutic area, then randomized 1:1 to receive PH or MPH. Bleeding assessments occurred intraoperatively using a novel bleeding assessment methodology. Primary endpoint was non-inferiority as compared with control via effective hemostasis at 7 minutes. Patients were followed postoperatively, discharge, and 6-weeks. Survival was assessed in oncology patients at 24-months. Safety of PH vs MPH was determined by comparing relative incidence of adverse events. Results: Across 19 centers, 324 (161 PH, 163 MPH) patients were randomized; approximately half underwent general surgery, while 25% each underwent cardiac and urologic surgery. PH met the primary endpoint of hemostatic success at 7-minutes demonstrating efficacy of PH was non-inferior to MPH. No significant differences were found in adverse event rates or supplementary safety measures. Six deaths were reported through 6-week follow-up. There was no difference in survival at 2 years (76% (PH) vs 74% (MPH), p = 0.66) for patients undergoing cancer operation. Conclusion: Across 3 therapeutic areas, PH was noninferior to MPH at all hemostasis assessment time points. No safety concerns were identified.

Contemporary Management of Acute Pulmonary Embolism: Evolution of Catheter-based Therapy.

Acute pulmonary embolism (PE) affects more than 100 000 people in the United States annually and is the third leading cardiovascular cause of death. The standard management for PE is systemic anticoagulation therapy. However, a subset of patients experience hemodynamic decompensation, despite conservative measures. Traditionally, these patients have been treated with systemic administration of thrombolytic agents or open cardiac surgery, although attempts at endovascular treatment have a long history that dates back to the 1960s. The technology for catheter-based therapy for acute PE is rapidly evolving, with multiple devices approved over the past decade. Currently available devices fall into two broad categories of treatment methods: catheter-directed thrombolysis and percutaneous suction thrombectomy. Catheter-directed thrombolysis is the infusion of thrombolytic agents directly into the occluded pulmonary arteries to increase local delivery and decrease the total dose. Suction thrombectomy involves the use of small- or large-bore catheters to mechanically aspirate a clot from the pulmonary arteries without the need for a thrombolytic agent. A thorough understanding of the various risk stratification schemes and the available evidence for each device is critical for optimal treatment of this complex entity. Multiple ongoing studies will improve our understanding of the role of catheter-based therapy for acute PE in the next 5-10 years. A multidisciplinary approach through PE response teams has become the management standard at most institutions. An invited commentary by Bulman and Weinstein is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Real-time 3D scans of cardiac surgery using a single optical-see-through head-mounted display in a mobile setup

Microsoft HoloLens 2 (HL2) is often found in research and products as a cutting-edge device in Mixed Reality medical applications. One application is surgical telementoring, that allows a remote expert to support surgeries in real-time from afar. However, in this field of research two problems are encountered: First, many systems rely on additional sensors to record the surgery in 3D which makes the deployment cumbersome. Second, clinical testing under real-world surgery conditions is only performed in a small number of research works. In this article, we present a standalone system that allows the capturing of 3D recordings of open cardiac surgeries under clinical conditions using only the existing sensors of HL2. We show difficulties that arose during development, especially related to the optical system of the HL2, and present how they can be solved. The system has successfully been used to record surgeries from the surgeons point of view and the obtained material can be used to reconstruct a 3D view for evaluation by an expert. In a preliminary study, we present a recording of a captured surgery under real-world clinical conditions to expert surgeons which estimate the quality of the recordings and their overall applicability for diagnosis and support. The study shows benefits from a 3D reconstruction compared to video-only transmission regarding perceived quality and feeling of immersion.

The Impact of Nonconvulsive Status Epilepticus after Cardiac Surgery on Outcome.

Neurological complications after heart surgery are associated with tremendous morbidity and mortality. Nonconvulsive status epilepticus (NCSE), which can only be verified by EEG, may cause secondary brain damage. Its frequency and its impact on outcomes after cardiac surgery is still unclear. We collected the neurological files and clinical data of all our patients after heart surgery who, in the course of their ICU stay, had been seen by a neurologist who ordered an EEG. Within 18 months, 1457 patients had cardiac surgery on cardiopulmonary bypass. EEG was requested for 89 patients. Seizures were detected in 39 patients and NCSE was detected in 11 patients. Open heart surgery was performed in all 11 NSCE patients, of whom eight showed concomitant brain insults. None had a history of epilepsy. Despite the inhibition of seizure activity with antiseizure medication, clinical improvement was only noted in seven NCSE patients, three of whom were in cerebral performance category 2 and four in category 3 at hospital discharge. The four patients without neurological benefit subsequently died in the ICU. The occurrence of NCSE after open cardiac surgery is significant and frequently associated with brain injury. It seems prudent to perform EEG studies early to interrupt seizure activity and mitigate secondary cerebral injury.

Risk Factors for Acute Postoperative Delirium in Cardiac Surgery Patients >65 Years Old

Background: Acute postoperative delirium is the most common neuropsychiatric disorder in cardiac surgery patients in the intensive care unit (ICU). The purpose of this study was to evaluate the possible risk factors of postoperative delirium (POD) for cardiac surgery patients in the ICU. Materials and Methods: The study population was composed of 86 cardiac surgery patients managed postoperatively in the cardiac surgery ICU. Presence of POD in patients was evaluated by the CAM-ICU scale. Results: According to the CAM-ICU scale, 22 (25.6%) patients presented POD; history of smoking, alcohol use, COPD, and preoperative permanent atrial fibrillation were associated with POD (for all, p < 0.05). The type of cardiac surgery operations, type of analgesia, and red blood cell transfusion in the ICU were not associated with POD (p > 0.05), while cardiac arrhythmia in the ICU, hypoxemia in the ICU after extubation (pO2 < 60 mmHg), and heart rate after extubation were predisposing factors for POD (for all, p < 0.05). Multivariable logistic regression analysis (adjusted to risk factors) showed that hypoxemia after extubation (OR = 20.6; 95%CI: 2.82–150), heart rate after extubation (OR = 0.95; 95% CI: 0.92–0.98), and alcohol use (OR = 74.3; 95%CI: 6.41–861) were predictive factors for acute postoperative delirium (for all, p < 0.05). Conclusion: Alcohol use and respiratory dysfunction before and after heart operation were associated with acute postoperative delirium in cardiac surgery ICU patients.

Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study

BackgroundWe aimed to compare the effectiveness of bilateral erector spinae plane (ESP) block and superficial parasternal intercostal plane (S-PIP) + ESP block in acute post-sternotomy pain following cardiac surgery.MethodsForty-seven patients aged between 18 and 80 years of age with American Society of Anesthesiologists class II–III due to undergo median sternotomy for cardiac surgery were included in this prospective, randomized, double-blinded study. Following randomization into two groups, one group received bilateral ultrasound-guided ESP and the other S-PIP plus ESP block. Morphine consumption within the first 24 h after surgery was the primary outcome of the study while NRS scores at rest, NRS scores when coughing, time taken until extubation, use of rescue analgesic, presence of nausea/vomiting, length of hospital and intensive care unit (ICU) stay, and patient satisfaction were secondary outcome measures.ResultsMorphine use up to 24 h following surgery was statistically significantly different between the ESP block and ESP + S-PIP block groups (18.63 ± 6.60 [15.84–21.41] mg/24 h vs 14.41 ± 5.38 [12.08–16.74] mg/24 h, p = 0.021). The ESP + S-PIP block group had considerably reduced pain scores compared to the ESP block group across all time points. Rescue analgesics were required in 21 (87.5%) patients in the ESP block group and seven (30.4%) in the ESP + S-PIP group (p < 0.001). PONV, length of stay in the ICU and hospital, and time to extubation were similar between groups.ConclusionsIn open cardiac surgery, the combination of ESP and S-PIP blocks lowers pain scores and postoperative morphine requirement of patients.Trial registrationClinicaltrials Registration No: NCT05191953, Registration Date: 14/01/2022.

The Fried Frailty Phenotype in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

Frailty is an increasingly recognized marker of poor surgical outcomes in cardiac surgery. Frailty first was described in the seminal "Fried" paper, which constitutes the longest-standing and most well-recognized definition. This study aimed to assess the impact of the Fried and modified Fried frailty classifications on patient outcomes following cardiac surgery. The PUBMED, MEDLINE, and EMBASE databases were searched from January 2000 until August 2021 for studies evaluating postoperative outcomes using the Fried or modified Fried frailty indexes in open cardiac surgical procedures. Primary outcomes were one-year survival and postoperative quality of life. Secondary outcomes included postoperative complications, intensive care unit (ICU) length of stay (LOS), total hospital LOS, and institutional discharge. Eight eligible studies were identified. Meta-analysis identified that frailty was associated with an increased risk of one-year mortality (Risk Ratio [RR]:2.23;95% confidence interval [CI]1.17 -4.23), postoperative complications (RR 1.78;95% CI 1.27 - 2.50), ICU LOS (Mean difference [MD] 21.2 hours;95% CI 8.42 - 33.94), hospital LOS (MD 3.29 days; 95% CI 2.19 - 4.94), and institutional discharge (RR 3.29;95% CI 2.19 - 4.94). A narrative review of quality of life suggested an improvement following surgery, with frail patients demonstrating a greater improvement from baseline over non-frail patients. Frailty is associated with a higher degree of surgical morbidity, and frail patients are twice as likely to experience mortality within one-year post-operatively. Despite this, quality of life also improves dramatically in frail patients. Frailty, in itself, does not constitute a contraindication to cardiac surgery.