Cardiothoracic Surgery - Science topic

Background Pulmonary thromboendarterectomy (PTE) surgery, the gold standard for treatment of chronic thromboembolic pulmonary hypertension (CTEPH), is complicated by reperfusion lung injury (RPLI) in anywhere from 10-40% of cases. Postoperative pneumonia (PNA) following PTE is not well described, but its rates of 17-35% may be higher than expected...

Background Antibiotic prophylaxis in surgery is a standard measure to reduce the risk of microbial contamination following an incision. For most surgeries, a single dose of antibiotics is generally required. However, in patients undergoing coronary artery bypass graft (CABG) procedure, antibiotics have been administered for ≥ 24 hours as data on th...

Pneumothorax (PTX) is a known complication of invasive mechanical ventilation, however it is a rare occurrence in patients being treated with noninvasive positive pressure ventilation (NPPV) for obstructive sleep apnea (OSA). The best course of action in managing their OSA is not well documented. Previous case report published by Rajdev et al (2020...

Increasing numbers of cardiothoracic surgery residents are resigning, without completing their training. This study analyzes how their turnover intention is related to the training environment, and individual psychological factors. Responses by 57 Korean cardiothoracic surgery residents were analyzed. Their levels of depression, anxiety, grit, and...

Background and Objectives: To analyze the patient outcome and complication rate of axillary artery cannulation for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients who could not be weaned from cardiopulmonary bypass after cardiothoracic surgery. Materials and Methods: We analyzed the data of 179 patients who were supported wi...

Objective: To analyze the effect of psychological nursing combined with health education on the quality of life of patients with lung cancer. Methods: 80 patients with lung cancer admitted to our hospital’s Department of Cardiothoracic Surgery from January 2022 to December 2022 were selected as the research objects. Those who received basic nursing...

Embolism is a common complication in infective endocarditis which may lead to serious complications, such as stroke, intestinal ischemia, and peripheral embolization. A comprehensive literature search was performed and the registry at our centre, including 390 cases of infective endocarditis, diagnosed between 2010 and 2020, was investigated. Large...

Introduction Mild or moderate liver cirrhosis increases the risk of complications after cardiac surgery. Ascites is the most common complication associated with liver cirrhosis. However, the prognostic value of ascites on postoperative morbidity and mortality after cardiac surgery remains uninvestigated. Methods A retrospective study included 69 p...

Haemophilia B is a rare inherited bleeding disorder in which patients have impaired coagulation. This study describes a patient with Haemophilia B and paroxysmal supraventricular tachycardia (PSVT) who underwent radio frequency catheter ablation (RFCA). The perioperative replacement therapy with coagulation factor IX (FIX) was agreed upon after an...

Spontaneous pneumomediastinum (SPM) is a rare but potentially life-threatening clinical entity in which free air is introduced into the mediastinum. It most commonly presents in young males and has an incidence of approximately 0.002% of the general population. Symptoms include sudden onset chest pain, dyspnea, neck pain, vomiting, and odynophagia....

This literature review examines perfusion safety in cardiothoracic surgery, with a primary focus on cardiopulmonary bypass (CPB) and circulatory devices. PRISMA guidelines were followed and various databases, including PubMed, MEDLINE, and Google Scholar, were searched using relevant keywords to identify pertinent studies and literature on the subj...

The declining interest in pursuing MCh Cardiothoracic and Vascular Surgery (CTVS) programs presents a significant concern within the medical community. This letter addresses the multifaceted factors contributing to this decline and proposes strategies to rekindle interest in this prestigious and rewarding super specialty. The perceived demerits of...

Background Acute kidney injury (AKI) is a major burden among hospitalized and critical care patients. Among hospitalized patients that progress to severe AKI there is increased risk for morbidity, mortality, and the need for renal replacement therapy (RRT). As there are no specific treatments for AKI, the discovery of novel biomarkers that predict...

Introduction Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 – 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes o...

This case report investigates the management of a clot in transit (CIT), a rare but possibly life-threatening condition discovered in a small percentage of pulmonary embolism (PE) cases. CITs are thrombi lodged within the right-side heart chambers or the major veins, and there are currently no universal guidelines for their management though the li...

The prevalence of moderate to severe postoperative pain in the pediatric population was high. The presence of pain adversely affected long-term health-related quality of life after pediatric cardiac surgery. Massage therapy has been tested in various populations and found to be remarkably effective in relieving pain. This treatment includes noninva...

Background Candida pericardial infection is a rare clinical entity usually related to recent cardiothoracic surgery and chronic debilitating conditions. During the COVID‐19 pandemic, invasive fungal infections have been on the rise, likely due to a combination of factors such as immunosuppression, underlying conditions like diabetes, and surgical p...

Background and objectives Postoperative delirium (POD) is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in POD-development. This study aimed to investigate the relevance of BChE activity as a biomarker for POD after cardiac surgery or p...

Disclosure: A. Abu Limon: None. S.A. Aldasouqi: Consulting Fee; Self; Abbott Laboratories. P. Kachhadia: None. S. Khan: None. Introduction: Ectopic thyroid tissue is a rare but known developmental abnormality during the descent of the thyroid tissue from the floor of the foregut to its final location Infront of the trachea. The most frequent ectopi...

Disclosure: M. Ahmad: None. B. Arshad: None. U. Tarabichi: None. A.P. Calimag: None. Introduction: Hypothyroidism if left untreated can have devastating consequences both short and long term. We present you a case in which patient developed large pericardial effusion within a few months of stopping levothyroxine. Pericardial effusion is a relativel...

oronary artery stent infections are infrequent, but associated with a high mortality rate. Coronary stents were inaugurated in 1987 but, only 16 cases of infection have been reported so far.We report a new case in a 53-year-old man presented to our hospital with complaints of fatigue and weight loss for one month. He presented with chest pain one...

The purpose of this retrospective study was to identify the most common causative organisms responsible for surgical site infections (SSIs) in Cardiothoracic surgery using a sample of patients from the South Tees NHSFT (JCUH) in England. It includes the frequency of infections, as well as whether they were superficial/deep, and leg/sternal wound in...

Background: LivaNova 3T heating and cooling devices (HCDs) have been associated with Mycobacterium chimaera , a Mycobacterium avium -intracellulare (MAIC) species, infections after cardiothoracic surgery. We describe our outbreak, which persisted despite escalating infection control measures. Methods: We identified patients with a positive MAIC cul...

Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung...

Introduction : Chylothorax is an uncommon medical condition caused by the accumulation of chylous fluid in the pleural space. Chylothorax has no predilection for sex or age. The prevalence after various cardiothoracic surgeries is 0.2% to 1%. Mortality and morbidity rates are around 10%. Respiratory distress may occur due to compression of the lung...

Foreword by Eric Topol; Artificial Intelligence in Clinical Practice: How AI Technologies Impact Medical Research and Clinics compiles the current research on Artificial Intelligence (AI) within each medical subspecialty for use as a reference to assist with diagnosis, clinical decision-making, disease prediction and prevention, and the facilitati...

Key Clinical Message Despite emphasis for emergent surgical treatment of Stanford type A aortic dissections, pregnant patients that are clinically stable may safely receive a staged approach instead, with delivery followed by delayed dissection repair.

We describe a rare case of classical Hodgkin lymphoma (HL) in a 20-year-old female patient. She presented to our hospital with chest wall swelling after months of post-chest trauma management. The swelling was initially treated as an infected hematoma, and the patient was referred for surgical evacuation. During the surgery, the swelling was found...

Background and Purpose To explore the feasibility of the modified blood collection method in pre-deposit autotransfusion in patients undergoing thoracotomy surgery. Methods This double-blinded randomised controlled trial enrolled 92 patients from the cardiothoracic surgery department from February 2019 to October 2020. Results Compared with the c...

Background. Pulmonary endarterectomy (PEA) is the only definitive and potentially curative therapy for chronic thromboembolic pulmonary hypertension (CTEPH), associated with impressive improvements in symptoms and haemodynamics. However, it is only offered at a few centres in South Africa. The characteristics and outcomes of patients undergoing PEA...

A lung abscess is characterized as a clinical ailment arising from the localized suppurative necrosis of lung parenchyma. This condition primarily results from the complications of aspiration pneumonia due to anaerobic microorganisms originating from the oral cavity. Clinically, patients typically manifest symptoms such as fever, malaise, and a pro...

Recent studies have suggested worse outcomes in patients exposed to hyperoxia while supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, there are no data regarding the effect of reducing hyperoxia exposure in this population by adjusting the fraction of inspired oxygen (FiO2) of the sweep gas of the ECMO circuit. A re...

Background: Human albumin, a vital plasma protein with diverse molecular properties, has garnered interest for its therapeutic potential in various diseases, including critical illnesses. However, the efficacy of albumin infusion in critical care and its associated complications remains controversial. To address this, a review of recent meta-analy...

Aortic and visceral aneurysms affect large arterial vessels, including the thoracic and abdominal aorta, as well as visceral arterial branches, such as the splenic, hepatic, and mesenteric arteries, respectively. Although these clinical entities have not been equally researched, it seems that they might share certain common pathophysiological chang...

This letter highlights the need for a structured pathway for Perfusionists to work across borders in order to address workforce shortages and provide comparable opportunities to other medical professions. Perfusionists play a critical role in cardiothoracic surgery but face significant barriers when seeking international employment. The limited pat...

Objectives: To investigate the performance of the EuroSCORE II over time and dynamics in values of predictors included in the model. Methods: A cohort study was performed using data from the Netherlands Heart Registration (NHR). All cardiothoracic surgical procedures performed between January 1, 2013 and December 31, 2019 were included for analy...

Medical students in the Netherlands have a relatively low exposure to cardiothoracic surgery and cardiology. This results in discrepancies between starting levels of medical residents and expected standards in clinical practice. Another side effect is the international decline in interest in a career in these cardiovascular fields. To compensate fo...

Background: The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for better systemic perfusion. To date, serum la...

Background Mediastinal Liposarcoma (ML) is an exceedingly rare neoplasm, accounting for less than 1% of all liposarcomas. Surgical resection is the most effective therapeutic modality, while adjuvant radiation therapy may be recommended for unresectable tumors. Case presentation This case report presents a rare case of a 52-year-old Syrian male pa...

Background Intrathoracic migration of breast prostheses has been described after both open and minimally-invasive cardiothoracic and breast surgery, with several proposed mechanisms of migration. Case presentation In this report, we describe an unusual presentation of intrathoracic prosthetic migration following remote minimally-invasive cardiac su...

Key Clinical Message Sternal fractures are commonly due to blunt force trauma and reduction is an invasive surgical procedure typically indicated for refractory pain sternal instability. There were various modalities used for treatment and fixation of the sternal fractures. Sternal displacement fractures are traumatic injuries that may require surg...

Objectives We aimed to clarify the long-term outcomes and prognosis of vocal cord paralysis (VCP) after cardiothoracic surgery in infants as well as the usefulness of laryngeal ultrasound (LUS) as screening for VCP. Methods Overall, 967 infants aged 1-year-old or younger who underwent cardiothoracic surgery between 2008 and 2022 were included in t...

Background: Transcatheter repair emerges as a treatment option in patients with tricuspid regurgitation (TR) and high surgical risk. Aims: This study aimed to compare leaflet-based and annuloplasty-based transcatheter repair in patients with TR. Methods: In a retrospective analysis consecutive patients undergoing either transcatheter edge-to-e...

A 49-year-old male with untreated type 2 diabetes and a family history of coronary artery disease (CAD) presented with right flank pain and profound progressive dyspnea on exertion to the emergency department of Ben Taub Hospital, a tertiary county hospital. Workup revealed right renal cell carcinoma with metastatic extension into the inferior vena...

A 53-year-old male presented with worsening fever, chest pain, and dyspnea during the past 2 weeks. He was hypoxic, tachycardic, and hypotensive on admission. Labs were notable for high-sensitivity troponin of 657 pg/mL and B-type natriuretic peptide of 1,648 pg/mL. Chest imaging was consistent with acute respiratory distress syndrome. Transthoraci...

Background Chylothorax is a very rare form of pleural effusion in children, especially after the neonatal period, and predominantly occurs secondary to cardiothoracic surgery. It can lead to significant respiratory distress, immunodeficiency, and malnutrition. Effective treatment strategies are therefore required to reduce morbidity. Case presenta...

Many patients suffer from postoperative pain after surgery, which causes discomfort and influences recovery after the operation. During surgery, the anesthetists usually rely on their own experience when anesthetizing, which is not stable for avoiding postoperative pain. Hence, it is essential to predict postoperative pain and give proper doses acc...

Cardiopulmonary bypass (CPB) is often used in cardiothoracic surgery because its nonphysiological state causes pathophysiological changes in the body, causing multiorgan and multitissue damage to varying degrees. Postoperative cognitive dysfunction (POCD) is a common central nervous system complication after cardiac surgery. The etiology and mechan...

BACKGROUNDː The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for a better systemic perfusion. To date, serum l...

The sinus of Valsalva presents the initial segment of the aorta from where the coronary vessels arise. Sinus of Valsalva aneurysms (SOVAs) present as progressive dilatation of the aortic sinus. SOVA arises both from the congenital and acquired weakness of the elastic lamina of the aortic media. Though most of the SOVAs are asymptomatic and diagnose...

Management of malignant hemispheric stroke (MHS) after cardiothoracic surgery (CTS) remains difficult as decision-making needs to consider severe cardiovascular comorbidities and complex coagulation management. The results of previous randomized controlled trials on decompressive surgery for MHS cannot be generally translated to this patient popula...

Objectives: Reconstruction of cardiovascular anatomy with patch material is integral to the repair of congenital heart disease. We present validation of a laser projection platform for the preparation of surgical patches as proof-of-concept for intraoperative use in patient-specific planning of paediatric cardiac surgery reconstructions. Methods:...

Background: Lung volume reduction (LVR) is an effective treatment option offered to patients with emphysema. There is no formalised LVR referral network in Ireland. A rigorous approach to agreeing and implementing a LVR referral framework in an Irish context is required. A Delphi process was used to provide a basis for a framework of multi-discipl...

Endocarditis is defined as an infection of the cardiac endothelium. The incidence occurs from 2 to 10 cases per 100,000 people/year. Cardiovascular complications, including cardiac arrest, cardiogenic shock, myocardial infarction, acute heart failure, and heart block. The case of a 51-year-old male patient with fever, asthenia, adynamia, and chills...

Background The presence of Nucleated Red Blood Cells (NRBCs) in critically ill patients is associated with higher mortality and poor prognosis. Although patients on extracorporeal support such as veno-venous or veno-arterial extracorporeal membrane oxygenation (VV/VA-ECMO) are severely ill, NRBCs have rarely been investigated regarding their predic...

Key Clinical Message Use of pacemakers has increased in recent years, and they have become the premier treatment option for several arrhythmias. However, they are not without risk; this case report aims to show the importance of follow‐up and adherence to guidelines, and methods to diagnose a life‐threatening complication.

Joaquim de Souza Cavalcanti was a pioneer among us - the Brazilian State of Pernambuco and North-Northeast region - in cardiac surgery in its initial phase (Blalock-Taussig surgery and mitral valvulotomy), in thoracic surgery (pneumectomy, lung lobectomy and segmentectomy, lung decortication, and mediastinal tumor resection), and in numerous techni...

Background and objectives: Currently, no evidence-based criteria exist for decision making in the post anesthesia care unit (PACU). This could be valuable for the allocation of postoperative patients to the appropriate level of care and beneficial for patient outcomes such as unanticipated intensive care unit (ICU) admissions. The aim is to assess...

We herein report a case of bilateral pneumothorax after a unilateral transbronchial lung cryobiopsy (TBLC). A 73-year-old man with no history of cardiothoracic surgery underwent a TBLC for the reevaluation of interstitial lung disease. Five hours later, he developed bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema. He underwent...

Objective: Cardiothoracic (CT) surgery is a surgical subspecialty that attracts few medical students. As integrated surgical residency programs continue to grow in number, there is increased interest in what factors influence specialty selection during undergraduate medical education. Previous institutional studies have studied allopathic medical s...

Objectives: It is unknown which confounding adjustment methods are currently used in the field of cardiothoracic surgery and whether these are appropriately applied. The aim of this study was to systematically evaluate the quality of conduct and reporting of confounding adjustment methods in observational studies on cardiothoracic interventions....

Solitary fibrous tumors (SFTs) are rare neoplasms arising from submesothelial connective tissue. Typically affecting elderly individuals, SFTs can exhibit malignant characteristics despite most cases being benign. Diagnosis often occurs incidentally on routine chest radiographs, and patients are usually asymptomatic unless the tumor causes compress...

Objective The COVID-19 pandemic has led to increased waiting times for elective treatments in many countries. This study seeks to address a deficit in the literature concerning the effect of long waits on the wider consumption of healthcare resources. Methods We carried out a retrospective treatment-control study in a healthcare system in South Wes...

Background Caring for critically ill patients with chest drain is an essential part of nursing practice, especially for those nurses who care for patients with complicated respiratory problems or undergo cardiothoracic surgery. Aim This study aims to assess the effect of an educational guideline on nurses' performance caring for critically ill pati...

Objectives: Prehabilitation through a digital platform could preoperatively improve the physical and mental fitness of patients undergoing cardiothoracic surgery, thereby improving treatment outcomes. This study aimed to describe the reasons and predictors of non-participation in a personalized digital prehabilitation care trial (Digital Cardiac C...

Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS...

A fifty-year-old woman with no past medical history presented with typical angina and dyspnea. Chest radiography was suggestive of Scimitar syndrome, a diagnosis that was confirmed with coronary CT angiography. The patient was managed surgically and has been symptom-free since surgical repair.

Introduction Continually rising life expectancy and a shift towards an ageing population are resulting in an increasing population of nonagenarians. By 2030, the global population of nonagenarians is expected to exceed 30 million. The incidence of symptomatic cardiac disease is reported to occur in 25% of those aged over 75 years. Therefore, the nu...

Neuroendocrine tumours (NETs) are rare but once metastasised, can lead to the release of vasoactive substances into the systemic circulation, and the classical features of carcinoid syndrome (CS) such as flushing and diarrhoea. A consequence of CS is carcinoid heart disease (CHD) which primarily affects the right-sided heart valves and can eventual...

BACKGROUND Although new-onset arrhythmia are a common problem in cardiothoracic surgery, their incidence in major non- cardiac surgery has not been studied properly. The aim of the study is to assess the incidence of arrhythmia after non cardiac surgery. While we have some data on postop arrhythmia after general surgery, we don’t have much data on...

Entrustable Professional Activities (EPA) are specialty specific tasks or responsibilities, combining the clinical workplace and the long-demanded competency-based medical education. The first step to transform time-based into EPA-based training is to reach consensus on core EPAs that describe sufficiently the workplace. We aimed to present a natio...