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A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 9699

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Special Issue Editor

Dr. Jae Hwan Choi

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Guest Editor

Department of Surgery, University of South Florida, Tampa, FL 33612, USA
Interests: cardiothoracic surgery; outcomes research; mechanical circulatory support; heart transplantation

Special Issue Information

Dear Colleagues,

The field of cardiac surgery has seen remarkable development in the recent years, owing to new technological advancements providing room for improvement in surgical outcomes, at the expense of growing procedural complexities. As such, the role of research in identifying procedural outcomes as well as their related risk factors is proving to be more important than ever. Through these academic endeavors, we as surgeons are able to draw evidence-based conclusions regarding surgical techniques, identify areas of improvement, as well as make apt clinical decisions to better serve our often feeble patient population. In this Special Issue of The Journal of Cardiovascular Development and Disease, we invite you to contribute your research on procedural outcomes and patient risk factors pertaining to cardiac surgery. We hope that this Special Issue will provide the reader with a comprehensive and up-to-date view of the currently available surgical modalities, as well as provide a forum for in-depth discussions regarding their clinical implications.

Dr. Jae Hwan Choi
Guest Editor

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Keywords

cardiac surgery
outcomes research
risk factor analysis
mechanical circulatory support
heart transplantation

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Published Papers (9 papers)

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Research

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14 pages, 4605 KiB

Open AccessArticle

Different Proteins as Biomarkers for Sac Shrinkage After Endovascular Aortic Repair of Abdominal Aortic Aneurysms

by Alexander Zimmermann, Daniela Reitnauer, Yankey Yundung, Anna-Leonie Menges, Lorenz Meuli, Jaroslav Pelisek and Benedikt Reutersberg

J. Cardiovasc. Dev. Dis. 2024, 11(11), 374; https://doi.org/10.3390/jcdd11110374 - 20 Nov 2024

Viewed by 280

Abstract

Background: This study aims to identify circulating biomarkers by using proteomic analysis associated with sac shrinkage or expansion in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). Methods: Plasma samples were analysed from 32 patients treated with EVAR between 10/2009 and 10/2020. Patients were divided into two groups based on postoperative sac behaviour: sac shrinkage (≥5 mm reduction) and no shrinkage (stabilisation or expansion). Proteomic analysis was performed using high-resolution liquid chromatography-tandem mass spectrometry (LC-MS/MS), with abundant protein depletion to enhance the detection of low-abundant proteins. Results: Of the 32 patients, 20 exhibited sac shrinkage, and 12 showed no shrinkage. Proteomic analysis identified 632 proteins, with significant differential abundance observed after adjusting for relevant clinical parameters. Notably, neurogranin (NRGN) levels were significantly associated with hypertension and smoking, while casein alpha S1 (CSN1S1) levels varied with statin use. Differentially abundant proteins related to aortic diameter included calpastatin, SCUBE3, and ubiquitin-conjugating enzyme E2, among others. Conclusions: Proteomic profiling revealed distinct biomarker patterns associated with sac behaviour in EVAR-treated AAA patients. These findings suggest potential therapeutic targets for enhancing EVAR outcomes and underscore the need for further investigation into the biological mechanisms underlying aneurysm sac shrinkage and stability. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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9 pages, 989 KiB

Open AccessArticle

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

by Fausto Biancari, Giorgio Mastroiacovo, Mauro Rinaldi, Luisa Ferrante, Timo Mäkikallio, Tatu Juvonen, Giovanni Mariscalco, Zein El-Dean, Matteo Pettinari, Javier Rodriguez Lega, Angel G. Pinto, Andrea Perrotti, Francesco Onorati, Konrad Wisniewski, Till Demal, Petr Kacer, Jan Rocek, Dario Di Perna, Igor Vendramin, Daniela Piani, Eduard Quintana, Robert Pruna-Guillen, Joscha Buech, Caroline Radner, Manoj Kuduvalli, Amer Harky, Antonio Fiore, Angelo M. Dell’Aquila, Giuseppe Gatti, Lenard Conradi, Mark Field, Arianna Galotta, Daniele Fileccia, Giuseppe Nanci and Sven Peterss Show full author list Hide full author list

J. Cardiovasc. Dev. Dis. 2024, 11(11), 370; https://doi.org/10.3390/jcdd11110370 - 19 Nov 2024

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Abstract

Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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8 pages, 1095 KiB

Open AccessArticle

Endo-Aortic Clamp for Minimally Invasive Redo Mitral Valve Surgery: Early Outcome

by Cristina Barbero, Marco Pocar, Andrea Costamagna, Cecilia Capozza, Valentina Aloi, Erik Cura Stura, Stefano Salizzoni and Mauro Rinaldi

J. Cardiovasc. Dev. Dis. 2024, 11(11), 358; https://doi.org/10.3390/jcdd11110358 - 6 Nov 2024

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Abstract

Objective: Redo mitral valve surgery still represents a challenging and high-risk procedure in cardiac surgery. The incidence of cardiac structural injuries during re-sternotomy remains consistent and is reported to be an independent risk factor for hospital mortality. Minimally invasive cardiac surgery with retrograde femoral arterial perfusion and endo-aortic clamping avoids re-entry injuries and reduces the requirement for dissection of adhesions and the risk of damage to cardiac structures. The aim of this study is to analyze redo patients undergoing mitral valve surgery with retrograde arterial perfusion and endo-aortic clamping setting. Methods: A retrospective analysis was performed on patients undergoing surgery from 2006 to 2022. Exclusion criteria were more than mild aortic regurgitation, moderate-to-severe peripheral vascular disease, dilated ascending aorta, and a lack of preoperative vascular screening. The primary outcome was perioperative mortality. Results: Two hundred eighty-five patients were analyzed. Mean age was 63.8 ± 13.3 years, mean EuroSCORE was 16.5 ± 14.5%, and one quarter of the patients had undergone two or more previous procedures via sternotomy. Perioperative mortality was 3.9% (11/285). Stroke was reported in six (2.1%) patients. Median intensive care unit and hospital length of stay were 1 and 8 days, respectively. Conclusions: Endo-aortic clamping setting in redo MV surgery avoids re-entry injuries and allows the surgeon to clamp the aorta and deliver the cardioplegia with minimal dissection of adhesions. In high-volume and experienced centers, this approach can be applied safely and effectively and may in the near future become the standard of care for redo mitral valve surgery. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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12 pages, 2580 KiB

Open AccessArticle

The Right Coronary Anatomy and Operative Topography of the Tricuspid Valve Annulus

by Michał Piotrowski, Marian Burysz, Jakub Batko, Radosław Litwinowicz, Mariusz Kowalewski, Krzysztof Bartuś, Krzysztof Wróbel, Łukasz Graczykowski and Artur Słomka

J. Cardiovasc. Dev. Dis. 2024, 11(6), 159; https://doi.org/10.3390/jcdd11060159 - 21 May 2024

Viewed by 1143

Abstract

Background: The region of the tricuspid valve is an important area for various cardiac interventions. In particular, the spatial relationships between the right coronary artery and the annulus of the tricuspid valve should be considered during surgical interventions. The aim of this study was to provide an accurate description of the clinical anatomy and topography of this region. Methods: We analyzed 107 computed tomography scans (44% female, age 62.1 ± 9.4 years) of the tricuspid valve region. The circumference of the free wall of the tricuspid valve annulus was divided into 13 annular points and measurements were taken at each point. The prevalence of danger zones (distance between artery and annulus less than 2 mm) was also investigated. Results: Danger zones were found in 20.56% of the cases studied. The highest prevalence of danger zones and the smallest distances were found at the annular points of the tricuspid valve located at the posterior insertion of the leaflets, without observed sex-specific differences. Conclusion: The highest risk of iatrogenic damage to the right coronary artery is in the posterior part of the tricuspid valve annulus. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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16 pages, 1870 KiB

Open AccessArticle

The Predictors and Outcomes of Functional Mitral Stenosis following Surgical Mitral Valve Repair: A Retrospective Analysis

by Yu-Ning Hu, Wen-Huang Lee, Meng-Ta Tsai, Yi-Chen Wang, Chao-Jung Shih, Yu-Ching Huang and Jun-Neng Roan

J. Cardiovasc. Dev. Dis. 2023, 10(11), 470; https://doi.org/10.3390/jcdd10110470 - 19 Nov 2023

Cited by 1 | Viewed by 1939

Abstract

To optimize mitral valve repair outcomes, it is crucial to comprehend the predictors of functional mitral valve stenosis (FMS), to enhance preoperative assessments, and to adapt intraoperative treatment strategies. This study aimed to identify FMS risk factors, contributing valuable insights for refining surgical techniques. Among 228 selected patients, 215 underwent postoperative echocardiography follow-ups, and 36 met the FMS criteria based on a mean trans-mitral pressure gradient of >5 mmHg. Patients with FMS exhibited higher pulmonary systolic arterial pressure and increased late mortality during the follow-up. Univariable logistic regression analysis identified several risk factors for FMS, including end-stage renal disease, anterior leaflet lesion, concomitant aortic valve replacement, smaller ring size, ring type, and neochordae implantation. Conversely, resection alone and resection combined with neochordae implantation had protective effects against FMS. Multivariable logistic regression analysis revealed that smaller ring sizes and patch repair independently predicted FMS. When focusing on degenerative mitral regurgitation, the neochordae implantation without resection in leaflet repair, emerged as an independent predictor of FMS. Surgeons should weigh the substantial impact of surgical procedures on postoperative trans-mitral pressure gradients, emphasizing preoperative evaluation and techniques such as precise ring size assessment and effective leaflet management. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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Review

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17 pages, 1531 KiB

Open AccessReview

Sternal Wound Reconstruction Following Deep Sternal Wound Infection: Past, Present and Future: A Literature Review

by Arwa Khashkhusha, Sundas Butt, Mariam Abdelghaffar, William Wang, Asveny Rajananthanan, Sakshi Roy, Bakht Noor Khurshid, Mohamed Zeinah and Amer Harky

J. Cardiovasc. Dev. Dis. 2024, 11(11), 361; https://doi.org/10.3390/jcdd11110361 - 7 Nov 2024

Viewed by 466

Abstract

This literature review critically examines the historical, current, and prospective dimensions of sternal wound reconstruction in the specific context of deep sternal wound infection (DSWI), aiming to enhance patient outcomes and optimise surgical techniques. Preventive measures, including prophylactic antibiotic administration and surgical site preparation, are crucial in reducing the incidence of DSWI. Effective management necessitates a multidisciplinary approach encompassing surgical debridement, drainage, and sternum repair utilising diverse procedures in conjunction with antibiotic therapy. Traditional approaches to managing DSWI involved closed irrigation and drainage techniques. While these methods exhibited certain advantages, they also exhibited limitations and varying degrees of success. The current care paradigms emphasise prophylactic antibiotic administration and surgical interventions like closed suction and irrigation, vacuum-assisted closure, and flap reconstruction. Future advancements in surgical techniques and technology hold promise for further enhancing sternal wound reconstruction. This review separates and emphasises the distinct roles of prophylaxis, antibiotic treatment, and reconstructive techniques, each relevant specifically to DSWI management. Collaborative efforts between cardiac and plastic surgeons, supported by ongoing research and innovation, are indispensable to advance sternal wound restoration and achieve superior outcomes in terms of patient welfare, morbidity and mortality reduction, and surgical efficacy. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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13 pages, 2308 KiB

Open AccessReview

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

by Mariagrazia Piscione, Valeria Cammalleri, Giorgio Antonelli, Valeria Maria De Luca, Myriam Carpenito, Dario Gaudio, Nino Cocco, Antonio Nenna, Carmelo Dominici, Antonio Bianchi, Francesco Grigioni and Gian Paolo Ussia

J. Cardiovasc. Dev. Dis. 2024, 11(11), 359; https://doi.org/10.3390/jcdd11110359 - 7 Nov 2024

Viewed by 468

Abstract

Carcinoid heart disease (CHD) affects right-sided valves and causes significant mortality and morbidity. Even though the pathophysiology of the disease is not entirely understood, it is known that chronic exposure to high levels of circulating serotonin is the main factor responsible for developing valvular heart disease. Cardiac imaging plays a critical role in the management of CHD, so the final diagnosis can be performed through multimodal imaging techniques and the measurement of biomarkers. Moreover, in observational studies, surgical treatment of carcinoid-induced valve disease has been found to improve outcomes. Despite advancements in pre-operative preparation in recent years, mortality rates remain high in elderly patients and those with multiple comorbidities due to the risk of intra-operative carcinoid crisis and high post-operative bleeding. In this comprehensive review, we will analyze the causes of carcinoid syndrome and how it can result in severe right heart failure. The role of different imaging modalities in detecting heart valve disease will be discussed together with the therapeutic options at our disposal, such as medical treatment, surgery, and the novel role of transcatheter intervention. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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18 pages, 336 KiB

Open AccessReview

Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation

by Armaan F. Akbar, Alice L. Zhou, Annie Wang, Amy S. N. Feng, Alexandra A. Rizaldi, Jessica M. Ruck and Ahmet Kilic

J. Cardiovasc. Dev. Dis. 2024, 11(4), 119; https://doi.org/10.3390/jcdd11040119 - 15 Apr 2024

Viewed by 1535

Abstract

Heart transplantation and durable left ventricular assist devices (LVADs) represent two definitive therapies for end-stage heart failure in the modern era. Despite technological advances, both treatment modalities continue to experience unique risks that impact surgical and perioperative decision-making. Here, we review special populations and factors that impact risk in LVAD and heart transplant surgery and examine critical decisions in the management of these patients. As both heart transplantation and the use of durable LVADs as destination therapy continue to increase, these considerations will be of increasing relevance in managing advanced heart failure and improving outcomes. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

Other

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8 pages, 693 KiB

Open AccessBrief Report

Outcomes after Perioperative Transient Ischemic Attack Following Cardiac Surgery

by Urvish Jain, Bhav Jain, James Brown, Ibrahim B. Sultan, Floyd Thoma, Katherine M. Anetakis, Jeffrey R. Balzer, Kathirvel Subramaniam, Sarah Yousef, Yisi Wang, Raul Nogueira and Parthasarathy D. Thirumala

J. Cardiovasc. Dev. Dis. 2024, 11(1), 27; https://doi.org/10.3390/jcdd11010027 - 17 Jan 2024

Cited by 1 | Viewed by 2212

Abstract

Perioperative transient ischemic attacks (PTIAs) are associated with significantly increased rates of postoperative complications such as low cardiac output, atrial fibrillation, and significantly higher mortality in cardiac procedures. The current literature on PTIAs is sparse and understudied. Therefore, we aim to understand the effects of PTIA on hospital utilization, readmission, and morbidity. Using data on all the cardiac procedures at the University of Pittsburgh Medical Center from 2011 to 2019, fine and gray analysis was performed to identify whether PTIAs and covariables correlate with increased hospital utilization, stroke, all-cause readmission, Major Adverse Cardiac and Cerebrovascular Events (MACCE), MI, and all-cause mortality. Logistic regression for longer hospitalization showed that PTIA (HR: 2.199 [95% CI: 1.416–3.416] increased utilization rates. Fine and gray modeling indicated that PTIA (HR: 1.444 [95% CI: 1.096–1.902], p < 0.01) increased the rates of follow-up all-cause readmission. However, PTIA (HR: 1.643 [95% CI: 0.913–2.956] was not statistically significant for stroke readmission modeling. Multivariate modeling for MACCE events within 30 days of surgery (HR: 0.524 [95% CI: 0.171–1.605], p > 0.25) and anytime during the follow-up period (HR: 1.116 [95% CI: 0.825–1.509], p > 0.45) showed no significant correlation with PTIA. As a result of PTIA’s significant burden on the healthcare system due to increased utilization, it is critical to better define and recognize PTIA for timely management to improve perioperative outcomes. Full article

(This article belongs to the Special Issue Risk Factors and Outcomes in Cardiac Surgery)

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