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New Perspectives in Cardiothoracic Surgery
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New Perspectives in Cardiothoracic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 17140

Special Issue Editors

Dr. Konstantinos S. Mylonas

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Guest Editor
Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
Interests: congenital heart disease; heart failure; cardiac transplantation; cardiovascular stem cell genetics; proatherogenic inflammation
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Dimitrios C. Angouras

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Guest Editor
Department of Cardiac Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: multiarterial grafting; valve repair techniques; thoracic aortic aneurysms and dissection; aortic biomechanics; pericardial decompression syndrome; frailty assessment; risk stratification models

Special Issue Information

Dear Colleagues,

The field of cardiothoracic surgery has seen tremendous growth in recent years. Staggering technological advancements have enabled the integration of off-pump CABG, miniaturized CPB circuits, and hybrid revascularization approaches in the armamentarium of practicing cardiac surgeons. Compelling evidence demonstrates the reproducibility, safety, and efficacy of minimally invasive cardiac surgery, including thoracoscopically-assisted and totally endoscopic approaches. Once thought to be unamenable to reparative surgery, aortic valve disease has promoted revolutionized forms of treatment, with a broad application and standardization of valve-sparing aortic root replacement procedures, the Ozaki technique, and more. Percutaneous approaches, including but not limited to TAVI and MitraClip, have also found application in the care of high-risk patients with structural heart disease. Similarly, endovascular techniques have a fast-expanding role in patients with aortic aneurysms and dissections, nearly eliminating major surgery in selected cases. Breakthroughs in mechanical circulatory support have also been instrumental in managing patients with end-stage cardiopulmonary failure. Thoracic surgical oncology has also experienced a major change with the advent of VATS and robotic technology. In this ever-changing landscape, residency and fellowship programs must strive to equip the next generation of cardiothoracic surgeons with a versatile skill set that includes open, minimally invasive, and transcatheter expertise.

Original research articles, meta-analyses, and reviews are welcome in this Special Issue. Research areas may include (but are not limited to) the following:

  • CABG surgery—conduit dilemmas and off-pump CABG;
  • New-generation prosthetic valves and emerging lifetime valve management strategies;
  • Novel repair techniques for diseased native valves;
  • Transcatheter approaches;
  • Complex aortic surgery and thoracic endovascular techniques;
  • Mechanical circulatory support (LVAD, BiVAD, TAH, ECMO, percutaneous devices);
  • Advances in cardiopulmonary bypass circuits and myocardial/organ protection strategies;
  • Heart/lung transplantation and novel immunosuppression regimens;
  • Advances in the surgical management of pediatric and adult congenital heart disease;
  • Challenges in the perioperative, anesthetic, and ICU management of cardiothoracic patients;
  • Minimally invasive cardiac surgery;
  • VATS and robotic thoracic surgical oncology;
  • Education and training in cardiothoracic surgery.

Dr. Konstantinos S. Mylonas
Prof. Dr. Dimitrios C. Angouras
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary artery bypass graft surgery
  • aortic surgery
  • valve surgery
  • pediatric cardiac surgery
  • cardiothoracic transplantation
  • lung cancer
  • pneumonectomy
  • lobectomy
  • segmentectomy
  • esophagectomy

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Published Papers (6 papers)

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Research

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11 pages, 1110 KiB  
Article
A Comprehensive Clinical Outcome Analysis of Endoscopic Vessel Harvesting for Coronary Artery Bypass Surgery
by Hari Kumar Sampath, Terence Ji Hui Lee, Chua E. Cher, Shen Liang, Ooi Oon Cheong, Theo Kofidis, Sorokin Vitaly and Faizus Sazzad
J. Clin. Med. 2024, 13(12), 3405; https://doi.org/10.3390/jcm13123405 - 11 Jun 2024
Viewed by 1100
Abstract
Background: The long saphenous vein is routinely used for coronary bypass graft (CABG) surgery, and two primary techniques are commonly utilized: endoscopic vessel harvesting (EVH) and open vessel harvesting (OVH). The aim of this study was to compare the clinical outcomes of the [...] Read more.
Background: The long saphenous vein is routinely used for coronary bypass graft (CABG) surgery, and two primary techniques are commonly utilized: endoscopic vessel harvesting (EVH) and open vessel harvesting (OVH). The aim of this study was to compare the clinical outcomes of the EVH and OVH techniques used for CABG within the confines of a tertiary hospital. Methods: The clinical data of all patients subjected to either EVH or OVH for CABG surgery between 2014 and 2018 were retrospectively analyzed. Statistical analysis was performed to discern variations in the rates of postoperative complications between EVH and OVH. Results: A cohort of 1884 individuals were included in this study, 75.3% of whom underwent EVH. Notably, the incidence of postoperative leg wound complications was significantly different between the patients who underwent OVH and the patients who underwent EVH, with incidence rates of 18.6% and 32%, respectively (p < 0.001). Leg wound complications (p < 0.001; OR 1.946; 95% CI 1.528–2.477) and leg wound infections (p = 0.050, OR 1.517, 95% CI 0.999–2.303) were significantly associated with OVH. Moreover, leg wound hematoma (p = 0.039, OR = 0.402, 95% CI = 0.169–0.957) and EVH were strongly associated. Conclusions: The large sample of patients and the inclusion of a range of Asian ethnic groups provided notable insights into postoperative complications related to different modalities. EVH was associated with a lower incidence of postoperative leg wound complications, which suggests that EVH is a better modality for those undergoing CABG surgery. Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)
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7 pages, 1450 KiB  
Communication
External Stenting for Saphenous Vein Grafts in Coronary Surgery: A Systematic Review and Meta-Analysis
by Giovanni Jr Soletti, Arnaldo Dimagli, Lamia Harik, Gianmarco Cancelli, Roberto Perezgrovas-Olaria, Talal Alzghari, Michele Dell’Aquila, Jordan Leith, Sabrina Castagnini, Christopher Lau, Leonard N. Girardi and Mario Gaudino
J. Clin. Med. 2023, 12(23), 7395; https://doi.org/10.3390/jcm12237395 - 29 Nov 2023
Cited by 2 | Viewed by 1087
Abstract
The external stenting of saphenous vein grafts (SVGs) during coronary artery bypass grafting (CABG) has been proven to reduce intimal hyperplasia (IH) in animal models, paving the way for human randomized controlled trials (RCTs) to be conducted. Herein, we performed a study-level meta-analysis [...] Read more.
The external stenting of saphenous vein grafts (SVGs) during coronary artery bypass grafting (CABG) has been proven to reduce intimal hyperplasia (IH) in animal models, paving the way for human randomized controlled trials (RCTs) to be conducted. Herein, we performed a study-level meta-analysis to assess the impact of the Venous External SupporT (VEST) device, an external stent, on the outcomes of SVGs. A systematic search was conducted to identify all RCTs comparing VEST-stented to non-stented SVGs in patients undergoing CABG. The primary outcome was graft occlusion. The main secondary outcomes were repeat revascularization, SVG IH area, and intimal-medial thickness. Two RCTs totaling 407 patients were included. At a mean follow-up of 1.5 years, there was no difference in graft occlusion between groups (incidence rate ratio: 1.11; 95% confidence interval (CI): 0.80–1.53). The rate of repeat revascularization was also similar (odds ratio: 0.66; 95% CI: 0.27–1.64). The IH area (standardized mean difference (SMD): −0.45; 95% CI: −0.79 to −0.10) and intimal-medial thickness (SMD: −0.50; 95% CI: −0.90 to −0.10) were significantly reduced in the VEST group. Our findings show that significant reductions in the IH area and the intimal-medial thickness in VEST-stented SVGs do not currently translate into a lesser need for repeat revascularization or less graft occlusion events compared to non-stented SVGs at 1.5 years after CABG. Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)
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7 pages, 420 KiB  
Article
The Role of the N-Terminal of the Prohormone Brain Natriuretic Peptide in Predicting Postoperative Multiple Organ Dysfunction Syndrome
by Piotr Duchnowski
J. Clin. Med. 2022, 11(23), 7217; https://doi.org/10.3390/jcm11237217 - 5 Dec 2022
Cited by 6 | Viewed by 1542
Abstract
Background: Multiple organ dysfunction syndrome (MODS) is the progressive and potentially reversible dysfunction of at least two organ systems in the course of an acute and life-threatening disorder of systemic homeostasis. MODS is a serious post-cardiac-surgery complication in valvular heart disease that is [...] Read more.
Background: Multiple organ dysfunction syndrome (MODS) is the progressive and potentially reversible dysfunction of at least two organ systems in the course of an acute and life-threatening disorder of systemic homeostasis. MODS is a serious post-cardiac-surgery complication in valvular heart disease that is associated with a high risk of death. This study assessed the predictive ability of selected preoperative and perioperative parameters for the occurrence of MODS in the early postoperative period in a group of patients with severe valvular heart disease. Methods: Subsequent patients with significant symptomatic valvular heart disease who underwent cardiac surgery were recruited in the study. The main end-point was postoperative MODS, defined as a dysfunction of at least two organs—perioperative stroke, heart failure requiring mechanical circulatory support, respiratory failure requiring mechanical ventilation, and postoperative acute kidney injury requiring renal replacement therapy. A logistic regression was used to assess relationships between variables. Results: There were 602 patients recruited for this study. The main end-point occurred in 40 patients. Preoperative NT-proBNP (OR 1.026; 95% CI 1.012–1.041; p = 0.001) and hemoglobin (OR 0.653; 95% CI 0.503–0.847; p = 0.003) are independent predictors of the primary end-point in a multivariate regression analysis. The cut-off point for the NT-proBNP value for postoperative MODS was calculated at 1300 pg/mL. Conclusions: A high preoperative level of NTpro-BNP may be associated with the onset of MODS in the early postoperative period. The results of the study may also suggest that earlier cardiac surgery for significant valvular heart disease may be associated with an improved prognosis in this group of patients. Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)
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Review

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16 pages, 324 KiB  
Review
Bioprosthetic Valves for Lifetime Management of Aortic Stenosis: Pearls and Pitfalls
by Konstantinos S. Mylonas and Dimitrios C. Angouras
J. Clin. Med. 2023, 12(22), 7063; https://doi.org/10.3390/jcm12227063 - 13 Nov 2023
Cited by 3 | Viewed by 2475
Abstract
This review explores the use of bioprosthetic valves for the lifetime management of patients with aortic stenosis, considering recent advancements in surgical (SAV) and transcatheter bioprostheses (TAV). We examine the strengths and challenges of each approach and their long-term implications. We highlight differences [...] Read more.
This review explores the use of bioprosthetic valves for the lifetime management of patients with aortic stenosis, considering recent advancements in surgical (SAV) and transcatheter bioprostheses (TAV). We examine the strengths and challenges of each approach and their long-term implications. We highlight differences among surgical bioprostheses regarding durability and consider novel surgical valves such as the Inspiris Resilia, Intuity rapid deployment, and Perceval sutureless bioprostheses. The impact of hemodynamics on the performance and durability of these prostheses is discussed, as well as the benefits and considerations of aortic root enlargement during Surgical Aortic Valve Replacement (SAVR). Alternative surgical methods like the Ross procedure and the Ozaki technique are also considered. Addressing bioprosthesis failure, we compare TAV-in-SAV with redo SAVR. Challenges with TAVR, such as TAV explantation and considerations for coronary circulation, are outlined. Finally, we explore the potential challenges and limitations of several clinical strategies, including the TAVR-first approach, in the context of aortic stenosis lifetime management. This concise review provides a snapshot of the current landscape in aortic bioprostheses for physicians and surgeons. Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)
20 pages, 388 KiB  
Review
Surgical Site Infection in Cardiac Surgery
by Agnieszka Zukowska and Maciej Zukowski
J. Clin. Med. 2022, 11(23), 6991; https://doi.org/10.3390/jcm11236991 - 26 Nov 2022
Cited by 25 | Viewed by 7755
Abstract
Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from [...] Read more.
Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)

Other

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15 pages, 1958 KiB  
Systematic Review
Sarcopenia Adversely Affects Outcomes following Cardiac Surgery: A Systematic Review and Meta-Analysis
by Ali Ansaripour, Arian Arjomandi Rad, Marinos Koulouroudias, Dimitrios Angouras, Thanos Athanasiou and Antonios Kourliouros
J. Clin. Med. 2023, 12(17), 5573; https://doi.org/10.3390/jcm12175573 - 26 Aug 2023
Cited by 6 | Viewed by 1751
Abstract
Background: Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia [...] Read more.
Background: Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia on cardiac surgery outcomes. Methods: A systematic review and meta-analysis followed PRISMA guidelines from inception to April 2023 in EMBASE, MEDLINE, Cochrane database, and Google Scholar. Twelve studies involving 2717 patients undergoing cardiac surgery were included. Primary outcomes were early and late mortality; secondary outcomes included surgical time, infection rates, and functional outcomes. Statistical analyses were performed using appropriate methods. Results: Sarcopenic patients (906 patients) had a significantly higher risk of early mortality (OR: 2.40, 95% CI: 1.44 to 3.99, p = 0.0007) and late mortality (OR: 2.65, 95% CI: 1.57 to 4.48, p = 0.0003) compared to non-sarcopenic patients (1811 patients). There were no significant differences in overall surgical time or infection rates. However, sarcopenic patients had longer ICU stays, higher rates of renal dialysis, care home discharge, and longer intubation times. Conclusion: Sarcopenia significantly increases the risk of early and late mortality following cardiac surgery, and sarcopenic patients also experience poorer functional outcomes. Full article
(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)
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