INTRODUCTION:Median sternotomy is the gold standard for cardiac surgery but carries a significant risk of wound complications, including sternal dehiscence and wound infections. OBJECTIVE:This study aimed to compare the early efficacy and complication rates of three distinct steel-wire sternal closure techniques and identify potential risk factors of complications. METHODS:We conducted a randomized controlled study on patients undergoing cardiac surgery. Patients were randomly allocated into three groups of sternal closure techniques: simple interrupted (Group A), figure-of-eight (Group B), or a modified combined technique (Group C). Baseline characteristics, intraoperative parameters, postoperative recovery outcomes, and sternal wound complications including sternal dehiscence and superficial and deep wound infections were evaluated. Binomial logistic regression was performed to determine independent risk factors for complications. RESULTS:One hundred sixty-five adult cardiac patients were finally included in the study. All three intervention groups (n = 55) were well-matched regarding baseline characteristics and intraoperative parameters. The incidence of sternal dehiscence (6.1%) and superficial (7.9%) and deep wound infections (3.6%) did not differ significantly among the three wire closure techniques (P > 0.05). However, logistic regression identified numerous factors associated with superficial sternal wound infections including old age, obesity (body mass index > 30), comorbidities, elevated C-reactive protein and HbA1C, prolonged cardiopulmonary bypass time, extended operative time, and longer intensive care unit stay (P < 0.05 for all). CONCLUSION:The three steel-wire closure techniques demonstrated comparable early postoperative stability and similar rates of sternal wound complications. Technique choice may be based on surgeon preference.
OBJECTIVE:The aim of this study was to determine the effect of preoperative intravenous saline hydration on postoperative renal functions and the prevention of acute kidney injury subsequent to open-heart surgery. METHODS:Our investigation was designed as a prospective, randomized, and controlled single-center trial. We included 110 patients with basal renal functions that were not disrupted and who were undergoing cardiac surgery from October to December 2020. The first group (control) had fluid restriction for 12 hours prior to surgery (n = 55), and the second group (case) was hydrated with 0.9% normal saline for 12 hours before surgery (n = 55). RESULTS:In the hydration group, creatinine values dropped below the preoperative values (P = 0.008) and the glomerular filtration rate values rose above the preoperative levels (P = 0.003). The early-term mortality rates were 0% for the hydration group and 5.45% for the control group (n = 3). Besides, in the hydration group, the glomerular filtration rate values on the 30th day and 360th day after surgery increased to levels even higher than those recorded preoperatively. CONCLUSIONS:As a result of much effort, we showed that preoperative hydration can prevent severe cardiac surgery-associated acute kidney injury and related in-hospital mortality.
Introduction: David procedure has shown to be a low-risk perioperative procedure even in challenged scenarios cases, with favorable long-term outcomes and additional benefits linked to the avoidance of prosthetic valves, including freedom from anticoagulation and reintervention, reduced risk of thromboembolic complications and endocarditis. Furthermore, an aortic valve preservation program in Colombia confers probably specific advantages to our population, considering the sociodemographic factors of middle-income countries. Methods: A retrospective analysis was conducted on the clinical and perioperative results, as well as short-term follow-up data of patients who underwent David procedure at one clinical center from Colombia between November 2021 and June 2024. Results: One hundred and three patients were treated, with a mean age of 60 years, of whom 82.3% were male. In most cases, the preoperative diagnosis was aortic root dilation, with 80% presenting severe aortic insufficiency. Also 11.6% were initially diagnosed with type A acute dissection. The 30-day mortality was 0.9%. There were no cases of perioperative myocardial infarction nor dialysis requirement. Other complications were atrial fibrillation in 29.13% and acute renal failure in 9.7%. Follow-up was completed in 97.08% of cases, with survival rates at one year of 99%. Freedom from reintervention, endocarditis, and freedom from anticoagulation at one year were 100%, 100%, and 67%, respectively. Conclusion: In our study, David procedure emerged as an effective procedure, offering potential benefits that could be particularly relevant in middle-income countries. Perioperative and follow-up outcomes were comparable to those reported in large series from high-income countries.
Surgical left atrial appendage occlusion (S-LAAO) is increasingly performed during cardiac surgery, but perioperative outcomes remain uncertain. Using a nationwide Japanese inpatient database, we analyzed 25,059 adults undergoing valve or coronary bypass surgery (2020 - 2022). After propensity score matching (n = 2,543 each), addition of S-LAAO was not associated with differences in in-hospital mortality, transfusion, reoperation, or 30-day readmission compared to non-S-LAAO group. However, prolonged inotropic support (≥ 2 days) was more frequent with S-LAAO (40.8% vs. 34.7%; odds ratio 1.29, 95% confidence interval: 1.13 - 1.47). Addition of S-LAAO did not increase mortality but was linked to greater inotrope use, warranting further investigation.
INTRODUCTION:Women have historically been underrepresented in leadership positions and academia in cardiothoracic surgery, creating barriers to career advancement and limiting role models for trainees. While publications are used to measure success in academia, invited articles such as editorials often represent a formal recognition of expertise. The objective of this study was to identify trends in the gender of editorial authors published in cardiothoracic surgery journals. METHODS:Editorials published between 2018 and 2022 across 16 peer-reviewed cardiothoracic surgery journals were analyzed. Author gender was estimated using a validated tool (https://gender-api.com/) with additional verification using available institutional profiles. RESULTS:In total, 806 editorials were published with a total of 1,858 authors (293 women, 16%). Women authors were predominantly from the United States of America (45%) followed by India (9%) and Germany (8%). The percentage of women first authors increased between 2018 and 2022 (P < 0.001); 9% in 2018, 9% in 2019, 17% in 2020, 16% in 2021, and 23% in 2022. A similar trend was observed for women senior authorship (P < 0.0001) (6% in 2018, 9% in 2019, 14% in 2020, 15% in 2021, and 18% in 2022) as well as for editorials with all-women authorship (P < 0.0001), increasing steadily from 9% in 2018 to 20% in 2022. CONCLUSION:Women authorship in editorials published in cardiothoracic surgery journals has steadily increased in recent years. Despite progress, women still make up less than a quarter of first and senior authors, highlighting a critical gap in gender equity in academic leadership that must be urgently addressed.
INTRODUCTION:Cycle ergometer in the postoperative period of open-heart surgery is a safe and economical exercise option. However, its specific effects, whether or not associated with conventional physiotherapy, are not well established in current literature. The objective of this study was to evaluate the effects of cycle ergometer exercise associated or not with conventional physical therapy, compared with only conventional physical therapy, on functional capacity, hospitalization time, peripheral muscle strength, and pulmonary complications of patients after open-heart surgery. METHODS:MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Physiotherapy Evidence Database, and Cochrane Library were searched; manual searches were also conducted in the references of the included studies. Randomized controlled trials that analyzed the effects of cycle ergometer exercise associated or not with conventional physical therapy compared with only conventional physical therapy in adult patients after an open-heart surgery were included. Methodological quality was assessed by Cochrane risk-of-bias tool, and the meta-analysis was undertaken using RevMan 5.3. RESULTS:Mean difference in the six-minute walk test (31 meters, 95% confidence interval [CI]: 1.59 to 60.3 meters, P = 0.04) was higher and in intensive care unit stay was lower (-0.5 days, 95% CI: -0.86 to -0.14 days, P = 0.007) in the intervention group. The total hospitalization time (-0.18 days, 95% CI: -0.73 to 0.38 days, P = 0.53) didn't change between groups. CONCLUSION:Cycle ergometer exercises improved functional capacity but with no clinically relevant effects on hospitalization time after open-heart surgeries.
INTRODUCTION:Public awareness and interest significantly influence research priorities and healthcare advancements. This study investigates the relationship between public interest, represented by Google Trends Relative Search Volume (RSV), and cardiothoracic research outputs over 21 years (2004 - 2024). METHODS:A total of 26 conditions/surgeries representing eight topics of general cardiothoracic interest were identified from a review of various social media pages, society webpages, and hospital information bulletins. Data on the conditions were collected from Google Trends and PubMed®. RSV values were calculated annually, and publication counts were extracted for each condition. The study used R (v4.3.3) for all statistical analyses and predictive models. RESULTS:Trauma-related conditions and extracorporeal membrane oxygenation (ECMO) demonstrated increasing RSV and publication trends, with strong positive correlations (e.g., ECMO: r = 0.88, P < 0.0001). Conditions such as congenital cardiac anomalies (e.g., tetralogy of Fallot: r = -0.74, P < 0.0001) showed a negative correlation, with declining RSV despite ongoing research. Multiple regression revealed a significant positive relationship between RSV and publication counts when conditions were controlled (slope = 16.68, R2 = 0.8081, P < 0.0001). Feature importance analysis showed that "Condition" had a slightly greater influence than RSV on publication trends. CONCLUSION:The study demonstrates variability between public interest and research output across cardiothoracic conditions. While some conditions, such as trauma-related cases and ECMO, show alignment between public awareness and publication activity, others, including congenital anomalies, exhibit divergence.
INTRODUCTION:he CHA2DS2-VA score, which is used to determine the risk of thromboembolism in patients with atrial fibrillation, has been shown to be a predictor of mortality in many cardiovascular diseases. However, there is no data in the literature on the effect of CHA2DS2-VA score on in-hospital mortality in patients with acute aortic dissection (AAD). We aimed to determine the effect of CHA2DS2-VA score on in-hospital mortality in patients with AAD. METHODS:This retrospective cohort study included 113 patients (89 males, 24 females, age 58.7±10.5 years) who underwent surgical treatment for AAD. CHA2DS2-VA scores were calculated. All cases of in-hospital mortality during the follow-up period were identified and recorded. Patients were grouped as with and without mortality. RESULTS:Among patients with AAD, in-hospital mortality was observed in 30 cases (27.5%). Mortality rates in patients with CHA2DS2-VA 1, 2, 3 and ≥ 4 were 7%, 13%, 27%, and 53%, respectively. Age, CHA2DS2-VA score, and high-sensitivity C-reactive protein serum level independently determined the patients with mortality, and each one unit increase in these parameters predicted 11.3%, 2.19-fold, and 3.2% mortality increase, respectively. In receiver operating characteristic analysis, when the cutoff value of CHA2DS2-VA score was taken as 3, it was found to determine the development of mortality due to AAD with 80.5% sensitivity and 78.6% specificity. CONCLUSION:CHA2DS2-VA score is independently associated with the development of in-hospital mortality in patients with AAD. According to the findings of our study, the CHA2DS2-VA score may serve as a prognostic marker in patients with AAD.
INTRODUCTION:The aim of our study is to investigate the relationship and predictive significance of routinely measured serum lactate values with postoperative atrial fibrillation (POAF) in patients following isolated coronary artery bypass grafting (CABG). METHOD:Between 2022 and 2023, 250 patients who underwent isolated CABG were prospectively examined. Patients were divided into two groups, those with POAF (Group 1) and those without POAF (Group 2). Preoperative and postoperative 0th, 2nd, 4th, 8th, and 24th-hour lactate values were measured. RESULT:POAF was observed in 58 (23.2%) patients. There was no statistical difference between the groups in terms of ejection fraction, number of bypass grafts, cross-clamping time, cardiopulmonary bypass time, drainage, and beating operation rates. No statistically significant difference was found between the preoperative values and postoperative lactate values at zero, two, four, eight, and 24 hours between the groups. No statistically significant difference was found between the groups in terms of the difference between postoperative 0th, 4th, 8th, and 24th-hour and preoperative serum lactate levels. No statistically significant difference was found between postoperative 4th, 8th, and 24th-hour and postoperative 0th-hour serum lactate levels. Mortality, cerebrovascular accident, length of intensive care unit stay, and hospital stay were higher in Group 1. CONCLUSION:We found that early postoperative lactate values were higher in patients with POAF than in those without POAF, although this difference did not reach statistical significance. Lactate values alone are insufficient to predict POAF following CABG.
INTRODUCTION:Functionally univentricular hearts represent nearly 10% of all congenital heart defects, and the Fontan procedure is used in the heterogeneous group of patients who have them. Although early mortality after the Fontan procedure has declined internationally, data from middle-income countries remain scarce. METHODS:This is a single-center retrospective observational study made through a review of the medical records of all pediatric patients who underwent the Fontan procedure from 2007 to 2020 in a public cardiac surgery referral center in Brazil. RESULTS:Fontan procedure with an extracardiac conduit was performed in 78 children (52.6% female), predominantly for tricuspid atresia (55.1%), at a mean age of 12.1 ± 3.2 years. Preoperative oxygen saturation averaged 78.6 (± 7.4)%. Thirty-day mortality was 13.0%. Mortality decreased from 22.9% before 2015 to 4.8% after 2015 (P = 0.037), concurrent with yearly increase in surgical volume and a rise in operating-room extubation rates (from 2.9% to 47.6%, P = 0.001). One in five patients presented with malnutrition or low body weight. In the multivariate analysis, we found a hazard ratio of 65.05 (95% confidence interval: 7.923 - 534.1; P = 0.0001) for in-hospital mortality associated with postoperative acute kidney injury. CONCLUSIONS:Patients underwent the Fontan procedure at a relatively late age. Mortality decreased over time alongside increased surgical volume and operating-room extubation rates. Nutritional status emerged as a potentially modifiable risk factor, whereas postoperative acute kidney injury was a strong independent predictor of in-hospital mortality, underscoring the critical impact of perioperative care.
Introduction: Intraoperative assessment of graft patency and cardioplegia distribution during coronary artery bypass grafting (CABG) is essential for surgical success but remains challenging in resource-limited settings. Conventional tools such as flow measurement or intraoperative angiography are often unavailable in public hospitals, where evaluation relies mainly on clinical judgment. Methods: We conducted a prospective observational case series of 10 CABG patients operated between February and July 2025 at a public university hospital. Myocardial temperature distribution during cardioplegia infusion and after grafting was monitored with a portable smartphone-based thermal camera (FLIR One Pro). Results: Thermal imaging documented cardioplegia distribution and graft patency in all cases. In one patient, heterogeneous distribution in the lateral wall was identified, leading to a change in surgical sequence and improved myocardial protection. All patients were weaned from bypass with stable rhythm, showed expected postoperative troponin kinetics, and had no new wall motion abnormalities on echocardiography. Conclusion: Portable thermal imaging is a feasible, safe, and inexpensive method for real-time intraoperative evaluation of cardioplegia distribution and graft patency in CABG. It may represent a valuable adjunct in resource-limited environments. Larger studies are needed to confirm these findings.
Introduction:This study investigated the relationship between the serum aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, the presence and progression of abdominal aortic aneurysms (AAA), assessing its potential as an accessible biochemical marker for patients at risk of rapid aneurysmal growth. Methods: A total of 180 patients were retrospectively analyzed: 90 with AAA and 90 age-and risk factor-matched controls. Demographic characteristics, risk factors, laboratory parameters, and imaging data were reviewed. The AAA group was divided into rapid and slow enlargement subgroups based on six-month computed tomography measurements. Logistic regression, receiver operating characteristic (ROC) analyses were used to evaluate predictive and discriminative performance, and quartile analysis explored potential threshold effects. Results: AST/ALT ratio, triglycerides, low-density lipoprotein (LDL) cholesterol, and white blood cell (WBC) count were significantly higher in patients with AAA. Rapid AAA enlargement group had higher AST/ALT ratios, triglycerides, LDL cholesterol, and WBC counts. The AST/ALT ratio was independently associated with AAA presence (odds ratio 2.63; 95% confidence interval [CI] 1.44-5.09; P = 0.002) but not with rapid progression (P = 0.10). ROC analysis showed good discrimination for AAA presence (area under the curve [AUC] = 0.72; 95% CI 0.65-0.79) and moderate ability for rapid enlargement (AUC= 0.65; 95% CI 0.54-0.76). Quartile-based analysis revealed a stepwise increase in AAA prevalence with higher AST/ALT categories. Conclusion: An elevated AST/ALT ratio is associated with AAA presence but does not independently predict progression, suggesting it reflects hepatic-vascular inflammatory interaction rather than serving as a prognostic marker.
Professor Enio Buffolo, born on Dezember 9th, 1941, was a pioneer in thoracic and cardiovascular surgery in Brazil. His career spanned over six decades, during which he made groundbreaking contributions to world cardiac surgery, including the development of off-pump coronary artery bypass, endovascular treatment of aortic aneurysms, and the introduction of transcatheter aortic valve implantation in Brazil. He held numerous leadership roles, mentored generations of surgeons, and published extensively. His legacy is defined by visionary leadership, academic excellence, and deep humanistic values that continue to shape cardiovascular medicine in Brazil and beyond. If unanimous opinions are rare, just as rare are those that serve as examples, in their most diverse conducts, for family, friends, and coworkers. Dr. Enio Buffolo has a special place among this category of citizenship and humanism.
INTRODUCTION:Surgical site infection (SSI) following coronary artery bypass grafting (CABG) is a significant challenge that impacts quality of life and healthcare costs. Despite advances in surgical techniques and infection control measures, wound complications remain a major cause of morbidity and mortality. This study aimed to determine the incidence and factors associated with an increased risk of developing postoperative SSI in patients undergoing CABG. METHODS:Retrospective cohort study with patients undergoing isolated CABG in a Brazilian hospital organization. Clinical data were collected through the hospital's information system. Univariate and multivariate analyses were used to determine risk factors associated with SSI. The analyses were performed using Jamovi® software, with a significance set at P < 0.05. RESULTS:A total of 412 patients were enrolled in the study, comprising 292 (70.8%) men, with a mean age of 62.7 ± 8.6 years. A total of 54 (13.1%) patients developed SSI. After multivariate regression analysis, the odds ratios (OR) (95% confidence interval [CI]) of independent predictors of SSI were female sex (OR: 2.067; 95% CI: 1.030 - 4.148), higher preoperative body mass index (OR: 1.113; 95% CI: 1.038 - 1.194), nutritional risk (Nutritional Risk Screening 2002 score ≥ 3) (OR: 2.468; 95% CI: 1.034 - 5.886), and hospitalization time (OR: 1.057; 95% CI: 1.031 - 1.082). CONCLUSION:There are patient-related factors that increase the likelihood of developing an SSI after CABG. These findings suggest that addressing modifiable perioperative SSI risk factors may be beneficial in reducing SSI rates and enhancing postoperative recovery.
INTRODUCTION:Postoperative complications such as pericardial and pleural effusions, cardiac tamponade, and atrial fibrillation (AF) are common after coronary artery bypass grafting (CABG). While standard chest tubes are routinely used for drainage, Jackson-Pratt drains (JP-D) may offer advantages due to their flexible design and ability to maintain negative pressure. METHODS:This retrospective study compared outcomes between patients who received conventional chest tubes drains (CT-D group) (n = 672; 2016 - 2020) and those who received JP-D in addition to standard drains (JP-D group, n = 706; 2020 - 2023) after CABG. Demographic, operative, and postoperative data were collected and analyzed. RESULTS:Both groups were similar in baseline characteristics (P > 0.05 for all). The JP-D group had significantly lower rates of cardiac tamponade (0.28% vs. 1.78%, P = 0.008), reoperation (1.55% vs. 4.61%, P = 0.001), wound infections (2.1% vs. 4.1%, P = 0.024), 30-day mortality (1.1% vs. 2.0%, P = 0.035), and postoperative AF (9.2% vs. 16.8%, P = 0.039). Despite a higher first-day drainage volume (480 ± 150 mL vs. 360 ± 120 mL, P = 0.030), total drainage volume was similar. Pulmonary complications, including atelectasis and pneumonia, were also significantly reduced in the JP-D group. CONCLUSIONS:The use of JP-D in conjunction with standard thoracic drainage after CABG was associated with improved postoperative outcomes, including reduced effusion-related complications and AF. These findings suggest potential benefits of JP-D in cardiac surgery, though prospective studies are warranted to confirm these results.
INTRODUCTION:Postoperative atrial fibrillation (POAF) is associated with an increased risk of morbidity and mortality. This study aims to investigate the predictive value of uric acid/albumin ratio (UAR) for POAF following isolated coronary artery bypass grafting (CABG). METHODS:This retrospective study screened patients who underwent isolated CABG between June 2017 and January 2024. POAF was diagnosed using standard clinical criteria. UAR was calculated by dividing the uric acid level by the albumin value. RESULTS:This study included a total of 396 patients, who were categorized into two groups: POAF- and POAF+. Among them, 321 patients (mean age: 61.7 ± 10.8 years; 74.7% male) belonged to the POAF- group, while 75 patients (mean age: 71.3 ± 10.04 years; 68.1% male) were in the POAF+ group. While there were no significant differences observed between the groups in terms of sex, those in the POAF+ group were statistically older. The univariate and multivariate regression analyses revealed that age, C-reactive protein, hypertension, serum uric acid level, and UAR are independent risk factors for POAF. In the receiver operating characteristics analysis, the UAR (area under the curve [AUC]: 0.775) was found to be a better indicator compared to uric acid (AUC: 0.649) and serum albumin (AUC: 0.606), with a sensitivity of 70.5% and a specificity of 69.2%. CONCLUSION:UAR was shown to be an independent risk factor for POAF following isolated CABG.
