Search

OBJECTIVES To estimate gender disparities among first and last authorships in cardiothoracic randomized controlled trials (RCTs) and association of gender with publications in high-impact journals. METHODS PubMed/MEDLINE database was searched from 1 January 2014 to 31 December 2020 using R statistical software via the 'easyPubMed' package to retrieve pertinent data. The 'gender' package was utilized to determine gender using the United States Social Security Administration Baby Name Data. The percentage of female first and last authors were computed along with determining the uniqueness of the names. The association of gender and publication in high-impact peer-reviewed journals was delineated. Jonckheere's trend was computed. RESULTS The database search retrieved a total of 4820 RCTs, of which gender was encoded for the first author in 3247 (67%) RCTs, among which 911 (28%) studies had women as first authors, with a similar trend across 7 years (P   =  0.23). Gender was encoded for the last author of 3204 (66%) RCTs, of which 622 (19%) studies had women as last authors, with a similar trend across 7 years (P   =  0.45). A total of 627 studies were published in high-impact-factor journals, among which 79 (16%) studies had female first authors and 67 (13%) studies had female last authors. CONCLUSIONS There is an obvious gender disparity of first and last authors in cardiothoracic surgery-related RCTs, with a similar trend across 7 years. However, the post-hoc analysis did demonstrate a positive trend with an increase in the number of female first authors, demonstrating progress. [ABSTRACT FROM AUTHOR]

Introduction: The 'gap' continues to exist between the Indigenous and non‐Indigenous populations within Australia, with Indigenous Australians continuing to experience poorer health outcomes, and a reduced life expectancy of 10.6 years for males and 9.5 for females. Indigenous Australians are far more likely to suffer from ischaemic heart disease. We sought to investigate the outcomes of Indigenous Australians undergoing isolated coronary artery bypass graft surgery (CABG) at a single institution. Methods: A retrospective cohort study comparing Indigenous with non‐Indigenous Australians from prospectively collected data were performed for all patients who underwent isolated CABG at a single centre between 2015 and 2018. The primary endpoint was 30‐day mortality with secondary endpoints including deep sternal wound infection, new renal failure, length of stay, stroke and rate of readmission. Results: A total of 905 patients were included in the study. The Indigenous cohort had 130 patients and the non‐Indigenous cohort contained 775 patients. The baseline preoperative characteristics were significantly different between the two cohorts, with Indigenous patients younger (55.7 vs. 64.6 years), more likely to be female (33.1% vs. 16.4%) and to be dialysis‐dependent (10% vs. 1.2%). The primary outcome was more likely in Indigenous Australians, with a 30‐day mortality rate of 3.1% compared with 0.8%. There was a higher incidence of new renal failure (12.3% vs. 5.9%), red blood cell transfusion (30% vs. 20.8%). Conclusion: Indigenous patients undergoing CABG at our institution have significantly more co‐morbidities as well as worse post‐operative outcomes and strategies to address this are urgently required. [ABSTRACT FROM AUTHOR]

Background Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. Methods This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA). Results The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51–0.93) in the training cohort and 0.82 (95% CI, 0.68–0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%. Conclusion In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population. [ABSTRACT FROM AUTHOR]

Background: The Cardio-Thoracic (CT) professional group experienced a significant increase in stress and workload during and after the COVID-19 pandemic. The Society for Cardiothoracic Surgery (SCTS) in Great Britain and Ireland with the aim of endorsing positive change. Aim of this project was to understand the Mental Health (MH) and wellbeing status of the CT professionals and to explore Virtual Reality Mindfulness as an intervention to improve MH and wellbeing. Methods: In February 2022, the SCTS created a Mental Health and Wellbeing Working Group to identify the problem and find solutions. This exploratory project was carried out in two stages. Stage one was an online survey conducted in March 2022 and stage two was a Virtual Reality (VR) mindfulness workshop in March 2023, using the Rescape™ VR mindfulness tool. Results: Stage one: An online QR code survey was sent out to 150 members with 129 (86%) completed responses. 92% expressed that SCTS should create awareness about mental health and wellbeing. 99% said that they should be allowed to speak up and create interventions for members to access, support and relax. Three main themes identified about why CT staff do not discuss their Mental Health problems were fear of lack of awareness (72%), lack of confidentiality (60%) and impact on career (60%). Stage two: 88 members attended the VR session of which 76 (86%) completed the anonymous questionnaire. 97% reported usage was a pleasurable experience, 91% felt more relaxed, 82% felt less stressed, 90% felt calmer and 89% had their mood enhanced. Conclusion: Our study findings indicate that CT staff experience considerable effects on their mental health and wellbeing. However, there is a hesitancy to recognise and seek assistance due to concerns about confidentiality and career repercussions. The virtual reality mindfulness session served as a beneficial supplement, with a positive impact in this pilot cohort. [ABSTRACT FROM AUTHOR]

Treatment for infective endocarditis (IE) is usually medical, with surgery reserved for those failing medical management or developing complications. Currently, 25%–50% of patients undergo surgery for IE with a 70%–80% immediate survival rate. However, there is controversy over the timing of surgery following cerebrovascular events, which occur in 15%–30% of IE patients. This study aimed to investigate whether surgical management is superior to medical management in patients with IE and to determine the optimal timing for surgery following the development of neurological symptoms. Data were collected retrospectively between 2012 and 2018 from 436 patients diagnosed with IE and treated at our tertiary teaching hospital. The authors analysed the type of treatment, the timing of surgery, and the outcomes of these including mortality, IE recurrence, and length of hospital stay. A total of 421 patients were included in the analysis. More than two-thirds (69.1%) of patients underwent surgical intervention. The survival rate of patients having surgery for IE was 77.2%, compared to 50.7% in patients who did not undergo surgical intervention. 6.8% of patients presented with neurological symptoms; 73.3% of these patients had surgery within 14 days with a 90.9% survival. This study finds surgery to be safe with a seemingly higher survival rate compared to medical management alone, although this may be confounded by patients in the medical group being less likely to have surgery. Surgery in patients presenting with neurological symptoms is safe within 2 weeks from presentation with excellent outcomes. [ABSTRACT FROM AUTHOR]

• Patients in the cardiac intensive care unit have become increasingly complex and require multidisciplinary care. • There are limited and heterogeneous data on the role of multidisciplinary teams in acute cardiovascular care. • Further data on optimal leadership structure, training paradigms, staffing ratios, system-based logistics, and outcomes are needed. As cardiovascular care continues to advance and with an aging population with higher comorbidities, the epidemiology of the cardiac intensive care unit has undergone a paradigm shift. There has been increasing emphasis on the development of multidisciplinary teams (MDTs) for providing holistic care to complex critically ill patients, analogous to heart teams for chronic cardiovascular care. Outside of cardiovascular medicine, MDTs in critical care medicine focus on implementation of guideline-directed care, prevention of iatrogenic harm, communication with patients and families, point-of-care decision-making, and the development of care plans. MDTs in acute cardiovascular care include physicians from cardiovascular medicine, critical care medicine, interventional cardiology, cardiac surgery, and advanced heart failure, in addition to nonphysician team members. In this document, we seek to describe the changes in patients in the cardiac intensive care unit, health care delivery, composition, logistics, outcomes, training, and future directions for MDTs involved in acute cardiovascular care. As a part of the comprehensive review, we performed a scoping of concepts of MDTs, acute hospital care, and cardiovascular conditions and procedures. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compile data on the effectiveness of music therapy for patients undergoing cardiothoracic surgery. Background: After cardiac and thoracic surgery, patients often experience physiological and psychological complications, such as anxiety, pain, stress, depression and changes in vital signs, which have a great impact on prognosis. Methods: A systematic search of six databases was performed to identify randomized controlled trials investigating music therapy and cardiothoracic surgery. The data were extracted from the qualified research, the data without heterogeneity were analysed by random-effects model (REM) meta-analysis, and the data with heterogeneity were analysed by fixed-effects model (FEM) meta-analysis. We evaluated anxiety, pain, duration of mechanical ventilation, hospital length of stay, stress hormones, opioid consumption, and vital signs, including heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), diastolic blood pressure (DBP), and systolic blood pressure (SBP) after cardiothoracic surgery. The meta-analysis and sensitivity analysis were performed with RevMan 5.4 and Stata 14 software, and trial sequential analysis was conducted using TSA 0.9.5.10 Beta software. This study was conducted in accordance with the PRISMA guidelines and was registered with PROSPERO. Results: The study included 24 randomized controlled trials with a total of 1576 patients. Our analysis showed that music therapy can significantly reduce the anxiety scores (SMD= -0.74, 95% CI [-0.96, -0.53], p < 0.01) and pain scores (SMD= -1.21, 95% CI [-1.78, -0.65], p < 0.01) of patients after cardiothoracic surgery. Compared with the control group, music therapy dramatically raised postoperative SpO2 (SMD = 0.75, 95% CI [0.11, 1.39], p = 0.02). In addition, the experimental group had significant statistical significance in reducing HR, SBP and opioid consumption. However, there was no significant difference in respiratory rate, stress hormones, diastolic blood pressure, length of hospital stay, or the duration of mechanical ventilation between the two groups. Conclusions: Music therapy can significantly reduce anxiety, pain, HR, SBP, and postoperative opioid use and even improve SpO2 in patients who undergo cardiothoracic surgery. Music therapy has a positive effect on patients after cardiothoracic surgery with few side effects, so it is promising for use in clinics. Trial registration: RROSPERO (registration number: CRD42023424602). [ABSTRACT FROM AUTHOR]

Background: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. Case presentation: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. Conclusions: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible. [ABSTRACT FROM AUTHOR]

Background: The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. Methods: A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. Results: Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High‐Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. Conclusion: Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training. [ABSTRACT FROM AUTHOR]

Background: Pleural empyema is significant cause of morbidity and mortality. Debate in the literature exists regarding the best initial and definitive therapy, with recent research demonstrating superior short‐term outcomes with initial surgical intervention. Despite this, the impact of surgical intervention on long‐term outcomes has been incompletely described. A systematic review was undertaken to assess the current evidence evaluating the long‐term impact of surgical intervention. Methods: A systematic review was undertaken according to PRISMA guidelines utilizing three databases. Articles included all papers where patients received surgical intervention for empyema with outcomes evaluated beyond 90 days. Two reviewers extracted and reviewed the articles. Grey literature was included. Results: Eleven studies and two abstracts were extracted. One study and two abstracts evaluated the quality of life outcomes, two studies evaluated dyspnoea outcomes, seven studies evaluated long‐term lung function and two studies evaluated mortality and re‐admissions. 60–65% of patients had no dyspnoea between 2 and 7 years follow‐up. In six of seven studies, normal lung function was achieved in patients with chronic fibrothorax with FEV1% and FVC% improvements between 14–30% and 13–50%, respectively. The results from such biased cohorts could not be extrapolated to conclude that surgical intervention results in better outcomes than ICC drainage. Risk of bias was severe for all 11 studies. Conclusion: Surgical intervention potentially improves post‐operative lung function, long‐term dyspnoea, and mortality. The impact this has on quality of life remains unknown. Future prospective trials with homogenous comparative groups are required to better define the role of surgery and its impact on long‐term outcomes. [ABSTRACT FROM AUTHOR]

Cardiac surgeries are classified as "clean procedures" as they do not involve access to any space populated by the patient's microbiota. Nevertheless, the development of sternal wound infection (SWI) can sometimes occur. The aim of the study was to analyze risk factors of SWI, efficacy of antiseptics procedures, skin microbiota colonization/recolonization, and their impact on infection development in patients undergoing cardiac surgery. Of 500 patients who had undergone cardiac surgery through a median sternotomy, perioperative swabs of standardized surgical cut area were taken at three-time points: '1'-after admission to treatment rooms, '2'-before incision; '3'-before chest reconstruction. Material was cultured and grown bacterial colonies were counted. Out of the total population, 23 patients developed SWI and 11 had suspicion of SWI while 466 were without SWI. Risk factors which had statistically significant impact of infection development were high body mass index (BMI) and use of cardiopulmonary bypass (CPB) during operation. The most common SWI-pathogens were coagulase-negative staphylococci (CoNS) and Gram-negative bacilli. From the perioperative period, CoNS and Staphylococcus aureus were isolated. When simultaneous positive cultures in 'swab-1 and -3' were observed (respectively, ≥87 and ≥17 bacterial colonies), the risk of complications was higher (patients with SWI – 69.57%; without SWI – 6.71%). Regarding point '3', significant differences were noted in the general level of grown colonies. About 3 times more bacterial colonies were grown in the group with healing problems and SWI. SWI development is multifactorial. The rate of skin microbiota recolonization during surgery may suggests that being more colonized in the surgical incision area was more susceptible to local complications. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the prevalence of gender bias in the field of cardiothoracic vascular surgery in India and compared women surgeons and trainees in India and abroad. Methods: This was a comparative, cross-sectional analytical study using an online questionnaire. The survey included questions about demographics, career choice, training, academic and leadership opportunities, and the impact of choosing cardiothoracic-vascular surgery as a career on personal life. Results: A total of 203 practicing surgeons and trainees participated in the study and included 121 (59.6%) men and 82 (40.3%) women. Out of the 82 women, 48 (58.5%) were from India, and 34 (41.5%) were from other countries. Satisfaction with the specialty was similar among men and women (105 (86.7%) vs. 68 (82.9%), p = 0.44 respectively). Majority (n = 30, 62.5%) of the female surgeons in India reported being discriminated against, as well as receiving favored treatment 11 (22.9%). Compared to men, women surgeons in India were more frequently advised against pursuing a career in cardiothoracic and vascular surgery (p < 0.001) and were more frequently subjected to gender-related references (p < 0.001). In addition, they had fewer presentation opportunities (p = 0.016) at national or regional meetings during their training compared to men. Additionally, 50% (24) of the women in India reported being single, in contrast to 7% (6) of men, and only 15 (31.3%) women reported having a child, compared to 57 (66.3%) of the men. Conclusion: The study revealed significant gender disparities within the field of cardiothoracic vascular surgery in India and highlights the urgent need to address gender disparities and bias in cardiothoracic vascular surgery. [ABSTRACT FROM AUTHOR]

Unprofessional behaviour in the workplace, such as bullying, harassment, and discrimination, remains common in the cardiothoracic surgery unit. Despite its prevalence, there is little consensus on what constitutes unprofessional behaviour in the workplace of a cardiothoracic surgeon. In this review, we aim to narrow down the definition of unprofessional behaviour among cardiothoracic surgeons, identify its prevalence and the factors contributing to it, as well as explore potential preventive and support measures. We searched the MEDLINE and Web of Science databases (2000-2022), focusing on publications within psychology, medicine, general surgery, and cardiothoracic surgery for inclusion in a focused review. The current review identified 89 papers that highlight the complexity of defining unprofessional behaviour and its prevalence in cardiothoracic surgery units. Psychosocial professional challenges, hierarchical relationships within the medical team, and a high-stress environment may prompt unprofessional behaviour, which can manifest in both overt and covert actions. Such behaviour negatively mpacts medical services for patients, the psycho-emotional state of employees, and the overall functioning of the medical institution. The most effective support measures are characterized by being proactive, anticipating potential problems before they occur. Unprofessional behaviour should be considered an organizational concern, not merely an issue between individual team members. This perspective is essential for fostering a healthy work environment. The leaders of cardiothoracic surgery, given their high status and authority, play a pivotal role in this regard; their focus on inclusiveness of employees with lower status or responsibility is crucial for promoting a culture of psychosocial safety. This culture should be characterized by trust, honesty, and mutual respect, ensuring that every team member feels valued and respected. By prioritizing these values, leaders can minimize the risk of unprofessional behaviour, ultimately leading to an improvement in the quality of medical services for patients, an improvement in the psycho-emotional state of employees and the functioning of the organization as a whole.

Abstract Background The Cardio-Thoracic (CT) professional group experienced a significant increase in stress and workload during and after the COVID-19 pandemic. The Society for Cardiothoracic Surgery (SCTS) in Great Britain and Ireland with the aim of endorsing positive change. Aim of this project was to understand the Mental Health (MH) and wellbeing status of the CT professionals and to explore Virtual Reality Mindfulness as an intervention to improve MH and wellbeing. Methods In February 2022, the SCTS created a Mental Health and Wellbeing Working Group to identify the problem and find solutions. This exploratory project was carried out in two stages. Stage one was an online survey conducted in March 2022 and stage two was a Virtual Reality (VR) mindfulness workshop in March 2023, using the Rescape™ VR mindfulness tool. Results Stage one: An online QR code survey was sent out to 150 members with 129 (86%) completed responses. 92% expressed that SCTS should create awareness about mental health and wellbeing. 99% said that they should be allowed to speak up and create interventions for members to access, support and relax. Three main themes identified about why CT staff do not discuss their Mental Health problems were fear of lack of awareness (72%), lack of confidentiality (60%) and impact on career (60%). Stage two: 88 members attended the VR session of which 76 (86%) completed the anonymous questionnaire. 97% reported usage was a pleasurable experience, 91% felt more relaxed, 82% felt less stressed, 90% felt calmer and 89% had their mood enhanced. Conclusion Our study findings indicate that CT staff experience considerable effects on their mental health and wellbeing. However, there is a hesitancy to recognise and seek assistance due to concerns about confidentiality and career repercussions. The virtual reality mindfulness session served as a beneficial supplement, with a positive impact in this pilot cohort.

Abstract Aim This study aimed to compile data on the effectiveness of music therapy for patients undergoing cardiothoracic surgery. Background After cardiac and thoracic surgery, patients often experience physiological and psychological complications, such as anxiety, pain, stress, depression and changes in vital signs, which have a great impact on prognosis. Methods A systematic search of six databases was performed to identify randomized controlled trials investigating music therapy and cardiothoracic surgery. The data were extracted from the qualified research, the data without heterogeneity were analysed by random-effects model (REM) meta-analysis, and the data with heterogeneity were analysed by fixed-effects model (FEM) meta-analysis. We evaluated anxiety, pain, duration of mechanical ventilation, hospital length of stay, stress hormones, opioid consumption, and vital signs, including heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), diastolic blood pressure (DBP), and systolic blood pressure (SBP) after cardiothoracic surgery. The meta-analysis and sensitivity analysis were performed with RevMan 5.4 and Stata 14 software, and trial sequential analysis was conducted using TSA 0.9.5.10 Beta software. This study was conducted in accordance with the PRISMA guidelines and was registered with PROSPERO. Results The study included 24 randomized controlled trials with a total of 1576 patients. Our analysis showed that music therapy can significantly reduce the anxiety scores (SMD= -0.74, 95% CI [-0.96, -0.53], p

Abstract Background Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. Case presentation A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. Conclusions Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.

Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p

Objective: Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. Method: Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. Results: African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. Conclusions: Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

Abstract Background Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. Objective We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. Methods This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. Results Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. Conclusions The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation.

Here, we report a rare case of a 22-year-old female presenting with recurrent chest pain mimicking inferior ST-elevation myocardial infarction (STEMI) but ultimately attributed to an aortic aneurysm. Despite facing initial challenges in diagnosis, such as normal troponin levels and temporary electrocardiogram (ECG) changes, advanced imaging showed a large mass in the chest pressing on the right coronary artery. Prompt multidisciplinary intervention, including surgical resection of the aneurysm, led to successful management and improved outcomes. This case highlights the importance of considering unusual etiologies in atypical presentations of myocardial infarction, necessitating comprehensive evaluation and collaboration among various specialties for optimal patient care. [ABSTRACT FROM AUTHOR]

Unprofessional behaviour in the workplace, such as bullying, harassment, and discrimination, remains common in the cardiothoracic surgery unit. Despite its prevalence, there is little consensus on what constitutes unprofessional behaviour in the workplace of a cardiothoracic surgeon. In this review, we aim to narrow down the definition of unprofessional behaviour among cardiothoracic surgeons, identify its prevalence and the factors contributing to it, as well as explore potential preventive and support measures. We searched the MEDLINE and Web of Science databases (2000-2022), focusing on publications within psychology, medicine, general surgery, and cardiothoracic surgery for inclusion in a focused review. The current review identified 89 papers that highlight the complexity of defining unprofessional behaviour and its prevalence in cardiothoracic surgery units. Psychosocial professional challenges, hierarchical relationships within the medical team, and a high-stress environment may prompt unprofessional behaviour, which can manifest in both overt and covert actions. Such behaviour negatively impacts medical services for patients, the psycho-emotional state of employees, and the overall functioning of the medical institution. The most effective support measures are characterized by being proactive, anticipating potential problems before they occur. Unprofessional behaviour should be considered an organizational concern, not merely an issue between individual team members. This perspective is essential for fostering a healthy work environment. The leaders of cardiothoracic surgery, given their high status and authority, play a pivotal role in this regard; their focus on inclusiveness of employees with lower status or responsibility is crucial for promoting a culture of psychosocial safety. This culture should be characterized by trust, honesty, and mutual respect, ensuring that every team member feels valued and respected. By prioritizing these values, leaders can minimize the risk of unprofessional behaviour, ultimately leading to an improvement in the quality of medical services for patients, an improvement in the psycho-emotional state of employees and the functioning of the organization as a whole. [ABSTRACT FROM AUTHOR]

Background: Due to the distinctive nature of cardiac surgery, patients suffering from hereditary spherocytosis (HS) are potentially at a high risk of perioperative complications resulting from hemolysis. Despite being the most prevalent cause of hereditary chronic hemolysis, the standards of surgical management are based solely on expert opinion. Objective: We analyze the risk of hemolysis in HS patients after cardiac surgery based on a systematic review of the literature. We also describe a case of a patient with hereditary spherocytosis who underwent aortic valve repair. Methods: This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42023417666) and included records from Embase, MEDLINE, Web of Science, and Google Scholar databases. The case study investigates a 38-year-old patient who underwent surgery for an aortic valve defect in mid-2022. Results: Of the 787 search results, 21 studies describing 23 cases of HS undergoing cardiac surgery were included in the final analysis. Hemolysis was diagnosed in five patients (one coronary artery bypass graft surgery, two aortic valve bioprosthesis, one ventricular septal defect closure, and one mitral valve plasty). None of the patients died in the perioperative period. Also, no significant clinical hemolysis was observed in our patient during the perioperative period. Conclusions: The literature data show that hemolysis is not common in patients with HS undergoing various cardiac surgery techniques. The typical management of a patient with mild/moderate HS does not appear to increase the risk of significant clinical hemolysis. Commonly accepted beliefs about factors inducing hemolysis during cardiac surgery may not be fully justified and require further investigation. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to describe early and mid‐term morbidity and mortality in octogenarian patients undergoing CABG, to determine if outcomes are comparable to younger patients undergoing the same procedure. Methods: We conducted a retrospective analysis of the first 901 patients who underwent cardiac surgery at a large newly established tertiary hospital in Western Australia from February 2015 to September 2019. Inclusion criteria involved all patients undergoing coronary artery bypass grafting. Exclusion criteria included patients who underwent concomitant valve or aortic procedure. Results: From a cohort of 901 patients, 37 octogenarian patients underwent CABG. Octogenarian patients had a higher rate of post‐operative transfusion 35.1% versus 21.4% (P = 0.048), a higher rate of post‐op acute kidney injury 40.5% versus 17.2% (P < 0.0001), a higher rate of post‐operative atrial arrythmia requiring treatment 40.5% versus 22.5% (P = 0.011) and higher rate of return to theatre (13.5% versus 4.7%, P = 0.018), with bleeding/tamponade being the most likely reason (10.8% versus 2.7%). Octogenarian patients had a longer post‐operative length of stay (LOS) with a median LOS of 10 versus 7 days (P < 0.0001). There was no increase in hospital readmission rate, in‐hospital mortality or 1 year mortality in octogenarian patients. 24‐month and 36‐month survivals were 95.2% and 89.6% in octogenarians and 95.3% and 91.5% in the younger group. Conclusions: Despite an increase in post‐operative morbidity and LOS, there was no difference in hospital readmission, in‐hospital mortality or 1 year mortality in octogenarian patients who underwent CABG. CABG is safe and remains an important management option for these patients. [ABSTRACT FROM AUTHOR]

Following the COVID-19 infection, the sternum dislocation and wound dehiscence resulted in an infection complicating the recovery of an immunosuppressed patient after bilateral lung transplantation. Anaerobic culture (96 h) of milky cloudy wound secretion resulted in the growth of pinpoint haemolytic colonies identified as Metamycoplasma hominis (formerly Mycoplasma hominis). The search for the endogenous source of the infection found the bacterium exclusively in the patient's sputum, making a possible link to donor lung M. hominis colonization. Unfortunately, the donor samples were no longer available. The wound infection was successfully treated with 17 days of clindamycin despite the continuous PCR detection of M. hominis in the sputum after the end of the treatment. [ABSTRACT FROM AUTHOR]

Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumour, most reported cases of PSP are from Eastern Asia, with a female to male ratio of 5:1, and average age at diagnosis in the 5th decade. We present the case of a 63-year-old Caucasian woman diagnosed with PSP who underwent a left lower lobe basal segmentectomy with systematic nodal dissection, performed via video assisted thoracic surgery (VATS). [ABSTRACT FROM AUTHOR]

Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.

Background: Oscillation and pulmonary expansion (OPE) therapy can decrease postoperative pulmonary complications in a general surgical population, but its effect after cardiac surgery has not been reported, to our knowledge. We hypothesized that using an OPE device after cardiac surgery before extubation would decrease pulmonary complications. Methods: This retrospective cohort study included adults undergoing elective open cardiac surgery at our institution from January 2018 through January 2019, who had an American Society of Anesthesiologists score of 3 or greater. For mechanically ventilated patients after cardiac surgery, a new OPE protocol was adopted, comprising an initial 10-min OPE treatment administered in-line with the ventilator circuit, then continued treatments for 48 h after extubation. The primary outcome measure was the occurrence of severe postoperative respiratory complications, including the need for antibiotics, increased use of supplemental oxygen, and prolonged hospital length of stay (LOS). Demographic, clinical, and outcome data were compared between patients receiving usual care (involving post-extubation hyperinflation) and those treated under the new OPE protocol. The primary outcome measure was the occurrence of severe postoperative respiratory complications, including the need for antibiotics, increased use of supplemental oxygen, and prolonged hospital length of stay (LOS). Demographic, clinical, and outcome data were compared between patients receiving usual care (involving post-extubation hyperinflation) and those treated under the new OPE protocol. Results: Of 104 patients, 54 patients received usual care, and 50 received OPE. Usual-care recipients had more men (74% vs. 62%; p = 0.19) and were older (median, 70 vs. 67 years; p = 0.009) than OPE recipients. The OPE group had a significantly shorter hospital LOS than the usual-care group (mean, 6.2 vs. 7.4 days; p = 0.04). Other measures improved with OPE but did not reach significance: shorter ventilator duration (mean, 0.6 vs. 1.1 days with usual care; p = 0.06) and shorter LOS in the intensive care unit (mean, 2.7 vs. 3.4 days; p = 0.06). On multivariate analysis, intensive care unit LOS was significantly shorter for the OPE group (mean difference, −0.85 days; 95% CI, −1.65 to −0.06; p = 0.04). The OPE group had a lower percentage of postoperative complications (10% vs. 20%). Conclusions: OPE therapy after cardiac surgery is associated with decreased intensive care unit (ICU) and hospital LOS.

Background and Aims: Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use. Materials and Methods: One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient’s hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically. Results: Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety. Conclusions: This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment.

Abstract Background conventional coronary artery bypass grafting (CCABG) tends to cause severe complications in patients with comorbid Coronary Artery Diseases (CAD) and diabetes. On the other hand, the Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting (MICS CABG) via transthoracic incision is associated with rapid recovery and reduced complications. Adding to the limited literature, this study compares CCABG and MICS CABG in terms of efficacy and safety. Methods Herein, 104 CCABG and MICS CABG cases (52 cases each) were included. The patients were recruited from the Minimally Invasive Cardiac Surgery Center, Anzhen Hospital, between January 2017 and December 2021 and were selected based on the Propensity Score Matching (PSM) model. The key outcomes included All-cause Death, Myocardial Infarction (MI), Cerebrovascular Events, revascularization, Adverse Wound Healing Events and one-year patency of the graft by coronary CTA. Results Compared to CCABG, MICS CABG had longer surgical durations [4.25 (1.50) h vs.4.00 (1.13) h, P = 0.028], but showed a reduced intraoperative blood loss [600.00 (400.00) mL vs.700.00 (300.00) mL, P = 0.032] and a lower secondary incision debridement and suturing rate (5.8% vs.19.2%, P = 0.038). In follow up, no statistically significant differences were found between the two groups in the cumulative Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) incidence (7.7% vs. 5.9%), all-cause mortality (0 vs. 0), MI incidence (1.9% vs. 2.0%), cerebral apoplexy incidence (5.8% vs. 3.9%), and repeated revascularization incidence (0 vs. 0) (P > 0.05). Additionally, coronary CTA results revealed that the two groups’ one-year graft patency (94.2% vs. 90.2%, P = 0.761) showed no statistically significant difference. Conclusion In patients with comorbid CAD and diabetes, MICS CABG and CCABG had comparable revascularization performances. Moreover, MICS CABG can effectively reduce, if not prevent, poor clinical outcomes/complications, including incision healing, sternal infection and prolonged length of stay in diabetes patients.

Introduction: Patients recovering from cardiothoracic surgery in acute care experience physical and psychosocial challenges impacting participation in activities of daily living. Occupational therapists are well positioned to address these needs; however, there is little evidence exploring occupational therapy's role in this area. Method: This retrospective study of electronic medical records examined changes in activities of daily living participation for adult patients (n = 37) who received occupational therapy in acute care while recovering from cardiothoracic surgery via median sternotomy. Wilcoxon signed-rank tests and paired t -tests compared patients' scores on the Functional Independence Measure (FIM) and Activity Measure for Post-Acute Care "6-Clicks" Daily Activity Inpatient Short Form at occupational therapy evaluation and discharge from their inpatient stay. Results: Patients showed statistically significant improvements on both assessments in activities of daily living participation while receiving occupational therapy services following cardiothoracic surgery. Lower body dressing, toileting, and bed mobility showed the greatest increases in the FIM categories. Conclusion: Occupational therapists are valuable in addressing the complex needs of patients recovering from cardiothoracic surgery in acute care. Continued research is needed to provide further evidence supporting occupational therapy's unique role in this setting. [ABSTRACT FROM AUTHOR]

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 registries show that 20–40% of patients with infective endocarditis (IE) are affected by embolism. In many instances, embolism is present already at the time of diagnosis. The rate of embolism during the hospital stay in our data was 11%. However, only 2% developed clinical embolism during or following surgery. According to recent guidelines, previous embolism, and the presence of vegetations > 10 mm present an indication for surgical treatment. Routine imaging revealed non-symptomatic cerebral embolism in 8.5% of surgical patients. However, it is not clear whether detection of non-symptomatic embolism and consecutive surgical treatment improves the prognosis of infective endocarditis. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to synthesize and examine the literature on the use of neuraxial anesthesia and analgesia during cardiothoracic surgery. As cardiothoracic procedures often require systemic anticoagulation, neuraxial techniques are quite often underutilized due to the theoretical risk of epidural hematoma. In this review, we seek to examine the literature to review the indications and contraindications and to explore if neuraxial anesthesia and analgesia has a role in cardiothoracic surgery. Recent Findings: Neuraxial techniques have multiple advantages during cardiothoracic surgery including coronary vasodilation, decreased sympathetic surge, and a decreased cortisol level leading to overall reduction in stress response. Multiple studies have shown an improvement in pain scores, reduction in pulmonary complications, faster extubation times, with minimal complications when neuraxial techniques are utilized in cardiothoracic surgeries. Summary: Given the numerous advantages and minimal complications of neuraxial techniques in cardiothoracic surgeries, we hope its utilization continues to increase. Moving forward, we hope additional studies continue to reaffirm the benefits of neuraxial anesthesia and analgesia for cardiothoracic surgeries to improve its utilization. [ABSTRACT FROM AUTHOR]

Background: conventional coronary artery bypass grafting (CCABG) tends to cause severe complications in patients with comorbid Coronary Artery Diseases (CAD) and diabetes. On the other hand, the Minimally Invasive Cardiac Surgery Coronary Artery Bypass Grafting (MICS CABG) via transthoracic incision is associated with rapid recovery and reduced complications. Adding to the limited literature, this study compares CCABG and MICS CABG in terms of efficacy and safety. Methods: Herein, 104 CCABG and MICS CABG cases (52 cases each) were included. The patients were recruited from the Minimally Invasive Cardiac Surgery Center, Anzhen Hospital, between January 2017 and December 2021 and were selected based on the Propensity Score Matching (PSM) model. The key outcomes included All-cause Death, Myocardial Infarction (MI), Cerebrovascular Events, revascularization, Adverse Wound Healing Events and one-year patency of the graft by coronary CTA. Results: Compared to CCABG, MICS CABG had longer surgical durations [4.25 (1.50) h vs.4.00 (1.13) h, P = 0.028], but showed a reduced intraoperative blood loss [600.00 (400.00) mL vs.700.00 (300.00) mL, P = 0.032] and a lower secondary incision debridement and suturing rate (5.8% vs.19.2%, P = 0.038). In follow up, no statistically significant differences were found between the two groups in the cumulative Major Adverse Cardiovascular and Cerebrovascular Events (MACCEs) incidence (7.7% vs. 5.9%), all-cause mortality (0 vs. 0), MI incidence (1.9% vs. 2.0%), cerebral apoplexy incidence (5.8% vs. 3.9%), and repeated revascularization incidence (0 vs. 0) (P > 0.05). Additionally, coronary CTA results revealed that the two groups' one-year graft patency (94.2% vs. 90.2%, P = 0.761) showed no statistically significant difference. Conclusion: In patients with comorbid CAD and diabetes, MICS CABG and CCABG had comparable revascularization performances. Moreover, MICS CABG can effectively reduce, if not prevent, poor clinical outcomes/complications, including incision healing, sternal infection and prolonged length of stay in diabetes patients. [ABSTRACT FROM AUTHOR]

Local problem: Sternal wound infections (SWIs), whether superficial or deep, are associated with increased morbidity, mortality, and costs. From 2016 to 2017, our facility saw a 50% decrease in SWIs among patients undergoing cardiothoracic surgery with sternotomy. From 2017 to 2018, however, we identified a 33% increase in SWIs, prompting us to address our cardiac nurses' sternal wound care education and practice. Purpose: The purpose of our quality improvement (QI) project was to identify opportunities for improvement in postoperative sternal incision care and to implement evidence-based processes to reduce the incidence of SWIs among cardiothoracic surgery patients. Methods: A literature review was performed to identify interventions focused on evidence-based SWI reduction. During the first quarter of 2019, our postoperative incision care guidelines were revised and released to staff, a new surgical wound cleansing product was supplied, and RN education was provided. Cardiac nurses were surveyed in April 2019 to identify any remaining knowledge and practice deficits and to assess their adherence to the new guidelines. The survey responses helped us to further improve our nurse education. We also provided periodic nurse reeducation and enhanced patient and family education. All such interventions were implemented by the end of June 2019. Results: Between January and June 2019, we had one SWI. From July 2019 through December 2020, an 18-month period, we experienced zero SWIs. Although beginning in 2021, we saw an increase in SWIs—four in 2021 and five in 2022—our incidence rates remain below 0.5% and we continue to work toward an SWI goal of zero. Conclusion: This QI project identified opportunities for improvement, implemented evidence-based strategies for wound care and education, and successfully achieved a zero SWI rate for a period of 18 months. This quality improvement project aimed to identify opportunities for improvement in postoperative sternal incision care and to implement evidence-based methods to reduce the incidence of sternal wound infections among cardiothoracic surgery patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use. Materials and Methods: One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient's hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically. Results: Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety. Conclusions: This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing cardiothoracic surgery frequently encounter perioperative neurocognitive disorders (PND), which can include postoperative delirium (POD) and postoperative cognitive decline (POCD). Currently, there is not enough evidence to support the use of electroencephalograms (EEGs) in preventing POD and POCD among cardiothoracic surgery patients. This meta-analysis examined the importance of EEG monitoring in POD and POCD. Methods: Cochrane Library, PubMed, and EMBASE databases were searched to obtain the relevant literature. This analysis identified trials based on the inclusion and exclusion criteria. The Cochrane tool was used to evaluate the methodological quality of the included studies. Review Manager software (version 5.3) was applied to analyze the data. Results: Four randomized controlled trials (RCTs) were included in this meta-analysis, with 1096 participants. Our results found no correlation between EEG monitoring and lower POD risk (relative risk (RR): 0.81; 95% CI: 0.55-1.18; p = 0.270). There was also no statistically significant difference between the EEG group and the control group in the red cell transfusions (RR: 0.86; 95% CI: 0.51-1.46; p = 0.590), intensive care unit (ICU) stay (mean deviation (MD): -0.46; 95% CI: -1.53-0.62; p = 0.410), hospital stay (MD: -0.27; 95% CI: -2.00-1.47; p = 0.760), and mortality (RR: 0.33; 95% CI: 0.03-3.59; p = 0.360). Only one trial reported an incidence of POCD, meaning we did not conduct data analysis on POCD risk. Conclusions: This meta-analysis did not find evidence supporting EEG monitoring as a potential method to reduce POD incidence in cardiothoracic surgery patients. In the future, more high-quality RCTs with larger sample sizes are needed to validate the relationship between EEG monitoring and POD/POCD further. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) following cardiothoracic surgery can pose significant challenges to patient recovery and outcome. This systematic review and meta‐analysis aim to identify and quantify the risk factors associated with SSIs in patients undergoing cardiothoracic surgery. A comprehensive literature search adhering to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and based on the PICO paradigm was conducted across four databases: PubMed, Embase, Web of Science and the Cochrane Library, without any temporal restrictions. The meta‐analysis incorporated studies detailing the risk factors for post‐operative sternal infections, especially those reporting odds ratios (OR) or relative risks with 95% confidence intervals (CI). Quality assessment of the studies was done using the Newcastle‐Ottawa Scale. Statistical analysis was executed using the chi‐square tests for inter‐study heterogeneity, with further analyses depending on I2 values. Sensitivity analyses were performed, and potential publication bias was also assessed. An initial dataset of 2442 articles was refined to 21 articles after thorough evaluations based on inclusion and exclusion criteria. Patients with diabetes mellitus have an OR of 1.80 (95% CI: 1.40–2.20) for the incidence of SSIs, while obese patients demonstrate an OR of 1.63 (95% CI: 1.40–1.87). Individuals who undergo intraoperative blood transfusion present an OR of 1.13 (95% CI: 1.07–1.18), and smokers manifest an OR of 1.32 (95% CI: 1.03–1.60). These findings unequivocally indicate a pronounced association between these factors and an elevated risk of SSIs post‐operatively. This meta‐analysis confirms that diabetes, obesity, intraoperative transfusion and smoking heighten the risk of SSIs post‐cardiac surgery. Clinicians should be alert to these factors to optimise patient outcomes. [ABSTRACT FROM AUTHOR]

Local problem: In 2019 and the first half of 2020, our facility experienced an increase in the number and severity of hospital-acquired pressure injuries (HAPIs) among our cardiothoracic surgery population. Fifty percent of these HAPIs occurred within 72 hours of surgery. A review of the literature revealed that alternating pressure overlays (APOs) have been successfully used to prevent HAPIs in surgical patients. Purpose: The primary purpose of our quality improvement (QI) project was to measure perioperative HAPI rates in cardiothoracic surgery patients after the addition of APOs to our HAPI prevention protocol. Our secondary purpose was to identify common factors among those patients who developed HAPIs. Methods: This QI project collected both pre- and postintervention data and compared the findings. A nurse-led team was responsible for measuring HAPI rates during the intervention--from July through October 2020--which involved placing an APO under cardiothoracic surgery patients during the 72-hour perioperative period. APOs were placed on all operating room (OR) tables and remained with the patients following surgery. Bed linens and skin care products were standardized for consistency. Lifts were used to reduce friction during repositioning. Results: During preintervention data collection, we identified 10 patients who developed HAPIs (seven out of 1,174 cardiothoracic surgery patients in 2019, for a HAPI rate of 0.6%, and three out of 333 patients in the first half of 2020, for a HAPI rate of 0.9%). During the four-month intervention period, in which APOs were used in 331 patients undergoing cardiothoracic surgery, no HAPIs developed. Conclusion: Use of an APO in cardiothoracic ORs and critical care units may help reduce HAPI rates. [ABSTRACT FROM AUTHOR]

Failure to provide one-lung ventilation can prohibit minimally invasive thoracic surgeries. Strategies for one-lung ventilation include double-lumen endotracheal tubes or endobronchial blockers, but rarely both. Inability to provide lung isolation after double-lumen endotracheal tube placement requires troubleshooting and sometimes the use of extra equipment. This case describes using a unique Y-shaped endobronchial blocker placed through a left-sided double-lumen endotracheal tube after failure to achieve lung isolation with a double-lumen endotracheal tube alone. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) post‐cardiothoracic surgery represent a significant challenge in patient care. Understanding the risk factors contributing to SSIs is essential for improving surgical outcomes and patient safety. A comprehensive retrospective analysis was conducted at our institution from January 2021 to December 2022. This study included 30 patients with SSIs and 60 without, following cardiothoracic open surgery. Data were collected on various variables, including hypertension, anaemia, operation time, hospital stay, alcohol consumption, smoking habits, Body Mass Index, age, and drainage tube placement. Univariate and multivariate logistic regression analyses were employed using SPSS software to identify significant predictors of SSIs. Univariate analysis indicated a strong correlation between SSIs and factors like smoking, diabetes mellitus, drainage tube placement, anaemia, and significant intraoperative blood loss (≥800 mL). These factors were statistically significant with p‐values < 0.05. Multivariate logistic regression further confirmed the impact of these factors, with high odds ratios indicating a substantial increase in SSI risk associated with these conditions. This study highlights intraoperative blood loss, anaemia, drainage tube placement, smoking, and diabetes mellitus as key risk factors for SSIs post‐cardiothoracic surgery. Recognising and addressing these factors through targeted preventive measures is crucial in clinical practice to reduce the incidence of SSIs and improve postoperative care in cardiothoracic surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Children undergoing cardiac surgery are at risk for acute kidney injury (AKI) and cardiac dysfunction. Opportunity exists in protecting end organ function with remote ischemic preconditioning. We hypothesize this intervention lessens kidney and myocardial injury. Methods We conducted a randomized, double blind, placebo controlled trial of remote ischemic preconditioning in children undergoing cardiac surgery. Pre-specified end points are change in creatinine, estimated glomerular filtration rate, development of AKI, B-type natriuretic peptide and troponin I at 6, 12, 24, 48, 72 h post separation from bypass. Results There were 45 in the treatment and 39 patients in the control group, median age of 3.5 and 3.8 years, respectively. There were no differences between groups in creatinine, cystatin C, eGFR at each time point. There was a trend for a larger rate of decrease, especially for cystatin C (p = 0.042) in the treatment group but the magnitude was small. AKI was observed in 21 (54%) of control and 16 (36%) of treatment group (p = 0.094). Adjusting for baseline creatinine, the odds ratio for AKI in treatment versus control was 0.31 (p = 0.037); adjusting for clinical characteristics, the odds ratio was 0.34 (p = 0.056). There were no differences in natriuretic peptide or troponin levels between groups. All secondary end points of clinical outcomes were not different. Conclusions There is suggestion of RIPC delivering some kidney protection in an at-risk pediatric population. Larger, higher risk population studies will be required to determine its efficacy. Trial registration and date: Clinicaltrials.gov NCT01260259; 2021.

Anomalous aortic origin of the right coronary artery (RCA) is a rare anatomic anomaly that is present in ~1% of the general population, and is often discovered incidentally through imaging performed for another purpose. Despite being an uncommon phenomenon, aberrant right coronary arterial origins can have devastating manifestations in half of affected patients. These include myocardial infarction, arrhythmias, heart failure, syncope, and sudden cardiac death secondary to ischemia of the cardiac tissue. This report describes a case of a 48-year-old female patient that was initially found to have ST-elevation myocardial infarction. During cardiac catheterization, the patient was discovered to have a type A aortic dissection. Cardiothoracic surgery was consulted, and she was immediately transferred to the operating room for repair. During the procedure, an anomalous RCA was discovered with its origin in the dissected tissue, which was initially ligated and then bypassed using greater saphenous vein graft. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 73-year-old man who underwent a transcatheter aortic valve replacement (TAVR) procedure for severe aortic stenosis. The procedure involved the use of transesophageal echocardiography (TEE) due to the patient's obesity and inadequate transthoracic echocardiography (TTE) window. During the procedure, the initially deployed valve became dislodged and a valve-in-valve approach was used to replace it. TEE played a crucial role in identifying the dislodgment and subsequent aortic tear, allowing for timely intervention. The article also compares the benefits of TEE and TTE in intraoperative imaging for TAVR procedures. [Extracted from the article]

Background: More than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees’ interest in global surgery to address barriers and promote cardiac healthcare worldwide. Methods: An online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata. Results: Seventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement. Conclusions: There is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.

One of the currently most asked questions in the field of medicine is how any specialty in the future will evolve to ensure better health for the patients by using current, unparalleled developments in all areas of science. This article will give an overview of new and evolving strategies for cardiothoracic (CT) surgery that are available today and will become available in the future in order to achieve this goal. In the founding era of CT surgery in the 1950s and 1960s, there was tremendous excitement about innovation and disruptive science, which eventually resulted in a completely new medical specialty, i.e. CT surgery. Entirely new treatment strategies were introduced for many cardiovascular diseases that had been considered incurable until then. As expected, alternative techniques have evolved in all fields of science during the last few decades, allowing great improvements in diagnostics and treatment in all medical specialties. The future of CT surgery will be determined by an unrestricted and unconditional investment in innovation, disruptive science and our own transformation using current achievements from many other fields. From the multitude of current and future possibilities, I will highlight 4 in this review: improvements in our current techniques, bringing CT surgery to low- and middle-income countries, revolutionizing the perioperative period and treating as yet untreatable diseases. These developments will allow us a continuation of the previously unheard-of treatment possibilities provided by ingenious innovations based on the fundamentals of CT surgery. [ABSTRACT FROM AUTHOR]