A highly structured, technologically advanced educational paradigm has replaced the unstructured apprenticeship approach in the training of cardiothoracic surgeons. Early surgical education, which was historically based on the "see one, do one, teach one" principle, mostly depended on one-on-one mentoring and varying operative exposure, with the shortcomings of conventional training becoming more obvious as cardiothoracic surgery developed into a unique, high-stakes specialty requiring extraordinary technical accuracy and judgment. This evolution led to the implemention of standardized curricula, competency-based assessments, and simulation-based learning to ensure consistent skill acquisition and patient safety. In an increasingly digitized and globalized world, personalized learning pathways, objective skill evaluation, and remote training access are all made possible by recent developments in virtual reality (VR), artificial intelligence (AI), and real-time data analytics, further changing surgical education and thereby shaping the future of surgical proficiency.
Introduction:Sternal dehiscence remains a significant complication after coronary artery bypass grafting (CABG), particularly in high-risk patients. Evidence comparing rigid plate fixation with conventional wire cerclage is limited. Aim:To compare clinical outcomes and perioperative resource utilization between rigid plate fixation and wire cerclage for sternal closure after CABG. Material and methods:This retrospective single-center cohort study included 118 patients undergoing CABG (plate fixation n = 58; wire cerclage n = 60). The primary endpoint was sternal dehiscence. Secondary outcomes included wound infection, postoperative drainage, length of stay, and 30-day mortality. Results:Plate fixation was associated with significantly lower sternal dehiscence (3.4% vs. 11.6%; p = 0.04), shorter length of hospital stay (7.4 ±2.1 vs. 9.1 ±2.6 days; p = 0.02), and lower postoperative drainage volumes (p = 0.03). Among obese patients, complication rates were significantly lower with plate fixation (p < 0.05). Thirty-day mortality was similar between groups. Conclusions:Rigid plate fixation is associated with improved sternal stability and reduced morbidity, particularly among high-risk CABG patients.
Introduction:Surgical site infections (SSIs) are one of the most serious complications in surgery and are associated with significant mortality and morbidity. Prophylactic systemic antibiotics are not completely effective in SSI prevention. Aim:The purpose of this study was to assess outcomes of routine application of a gentamicin-impregnated sponge. Material and methods:The study involved 363 consecutive patients with a mean age of 62.7 ±12.1 years who underwent cardiac surgical operations from complete or partial midline sternotomy. In group S (n = 196) a gentamicin-impregnated sponge was placed retrosternally. whereas in group C (n = 167) no local antibiotics were used. The other aspects of the perioperative prophylactic protocol were not changed during the study. Postoperative adverse events were assessed with special attention to SSI rate. Results:Patients of both groups were comparable in terms of the majority of pre- and intraoperative variables. The only exception was lower BMI in group S (28.3 ±4.2 kg/m2) than in group C (29.5 ±4.8 kg/m2; p = 0.013); however, prevalence of obese subjects was comparable between groups (36.7% vs. 41.6%, in group S and group C, respectively; ns). Any adverse events in the early postoperative period were more frequent in group C (22.3%) than in group S (19.8%) (p = 0.040), mainly due to SSI rate (4.1% vs. 10.7%) (p = 0.017). Routine application of a gentamicin-impregnated sponge led to a marked reduction in deep SSI rates from 5.4% to 1.5% (p = 0.040) but not in superficial SSI rates (5.4% vs. 2.6%; p = 0.162). Conclusions:Our study suggested that routine application of a gentamicin-impregnated sponge may be efficacious in prevention of deep wound infection following cardiac surgical procedures irrespective of risk profile.
This narrative review examines when patients disqualified from transcatheter aortic valve implantation (TAVI) should be referred to palliative care, offering practical guidance for Heart Team decision-making. A targeted search of PubMed and Scopus (2010-2025) was conducted, integrating palliative care practice and brief clinical vignettes. Recurrent triggers for palliative referral include advanced frailty likely to limit recovery, multimorbidity with refractory symptoms, patient or family preference for comfort-focused treatment, and anatomical or physiological unsuitability for TAVI confirmed by a multidisciplinary Heart Team. Best-practice themes include early symptom-directed pharmacotherapy, comprehensive psychosocial and spiritual support, explicit documentation of care goals, and coordinated transitions to community or home-based services. Early, structured collaboration among cardiology, cardiac surgery, and palliative medicine can optimise quality of life, minimise futile interventions, and ensure continuity of care in patients with TAVI-ineligible severe aortic stenosis. Prospective studies should validate integration models and quality indicators to ensure their effectiveness.
Introduction:The esophagus is a complex anatomical structure extending through the neck, thorax, and abdomen, and injuries can occur at any of these levels. Although rare, esophageal injuries constitute clinical emergencies that may lead to high morbidity and mortality, especially when diagnosis and treatment are delayed. Aim:This study aims to evaluate the demographic, clinical, and prognostic features of esophageal injuries managed with surgical intervention. Material and methods:This retrospective study includes 75 patients who underwent surgical treatment for esophageal injury between 2003 and 2023. Demographic data, injury etiology, anatomical localization, treatment methods, complication rates, mortality, and length of hospital stay were analyzed. Results:The mean age of the patients was 35.24 ±22.06 years, with 64% being male. Of the injuries, 78.7% were traumatic, and 21.3% were iatrogenic in origin. Cervical esophageal injuries accounted for 53.3%, while thoracic injuries represented 46.7%. Primary surgical repair was performed in 66.7% of patients, whereas 33.3% were managed conservatively based on clinical indications. Delayed diagnosis emerged as the most significant factor contributing to increased complication and mortality rates. Higher mortality was particularly observed in cervical esophageal injuries, where non-surgical management was more commonly preferred. The most frequent complication was mediastinitis, and the overall mortality rate was determined to be 12%. The mean length of hospital stay was 25.69 ±25.508 days, influenced by the timing of diagnosis, etiology, and accompanying pathologies. Conclusions:Surgical repair remains an effective and preferable treatment option for selected cases of esophageal injury. Early diagnosis and appropriate management play a crucial role in reducing morbidity and mortality. Clinical decision-making should consider anatomical location, etiology, and the patient's general condition.
Introduction:Intra-aortic balloon pump (IABP) therapy is a widely used mechanical circulatory support method for patients with advanced heart failure, including those awaiting orthotopic heart transplantation (OHT). Traditional femoral access limits patient mobility and may not be suitable in cases of peripheral artery disease. Aim:This study evaluates the feasibility and safety of a fully percutaneous, sheathless IABP implantation via the left subclavian artery as a bridge to transplantation. Material and methods:Between June and December 2024, 10 patients in critical condition (1 F, 9 M, mean age: 58 years) underwent IABP implantation using ultrasound-guided puncture of the left subclavian artery without surgical exposure. The balloon was inserted sheathless and secured to the chest wall. Device removal was also performed percutaneously with a 6F AngioSeal closure device. Results:Definitive therapy (OHT or LVAD) was achieved in 60% of patients. The mean IABP support duration was 21.6 days (up to 69 days). There were no local access site complications. Two device-related mechanical issues were managed without sequelae. One fatal outcome was potentially related to embolic complications; others were due to progressive multiorgan failure. The subclavian approach preserved femoral access and enabled early mobilization. Conclusions:Sheathless percutaneous subclavian IABP implantation appears to be a feasible and safe strategy for bridging critically ill patients to definitive therapy. It reduces vascular trauma, facilitates patient mobilization, and allows surgical access to be avoided. Further studies in larger cohorts are warranted to confirm these promising results.
Introduction:Lung cancer is the leading cause of cancer-related mortality worldwide. Surgical resection remains the standard treatment for early stage non-small cell lung cancer (NSCLC). Postoperative complications significantly affect patient outcomes, and nutritional status has emerged as an important factor influencing surgical morbidity. Body mass index (BMI) is a practical and widely used indicator of nutritional status; however, its impact on postoperative outcomes after lung resection remains controversial. Aim:BMI is a practical and widely used indicator of nutritional status; however, its impact on postoperative outcomes after lung resection remains controversial. Material and methods:This retrospective study included patients who underwent anatomical lung resection with systematic lymph node dissection for NSCLC between 2018 and 2021. Patients were categorized according to BMI as having moderate nutritional status (BMI 18-25 kg/m2) or good nutritional status (BMI > 25 kg/m2). Statistical comparisons between groups were performed using appropriate parametric and non-parametric tests, with a p-value < 0.05 considered statistically significant. Results:A total of 172 patients were included in the analysis. Serum albumin levels were significantly higher in patients with good nutritional status (p = 0.027). Postoperative length of hospital stay was significantly longer in the moderate nutritional status group (p < 0.001). Additionally, postoperative complications and prolonged air leakage were significantly more frequent in patients with moderate nutritional status (p = 0.002, p = 0.009, respectively). Conclusions:Patients with a good nutritional status demonstrated more favorable postoperative outcomes, including fewer complications, reduced incidence of prolonged air leakage, and shorter hospital stays. Higher serum albumin levels in this group suggest a protective effect of better nutritional reserves. These findings support the concept that nutritional status plays a critical role in postoperative recovery following lung cancer surgery. Although BMI is a simple and accessible tool, future studies incorporating detailed body composition analysis and standardized perioperative care protocols may further refine risk stratification and optimize outcomes in NSCLC patients.
In summary, it should be noted that the National Cardiac Surgery Registry (KROK) is a unique medical registry on an international scale. KROK contains complete nationwide data on over 500,000 cardiac surgeries performed in all adult and paediatric cardiac surgery centres, both public and private, between 2006 and 2025. Data on survival rates associated with cardiac surgery are verified annually with the National Death Registry. This allows for the assessment of 30-day and long-term hospital mortality over the 20 years of the registry's operation. Internationally recognized risk scales are included in the registry to assess outcomes, for both adult and paediatric cardiac surgery. The registry is "open," allowing for the combination of data from other registries based on the patient's PESEL number. The primary purpose of the registry is to evaluate the outcomes and course of surgical treatment in Polish cardiac surgery, with a comparative analysis of the quality of treatment across individual centres. This allows for monitoring surgical outcomes and treatment progress and for responding to outliers exceeding statistical norms. It also enables comparisons of results achieved in Poland with European and global results. The KROK registry is primarily a surgical registry, and the inclusion criterion is the performance of a cardiac surgery procedure. It does not contain epidemiological or cost data; however, its interoperability allows for combining registry data with, for example, cost data and obtaining cost-effectiveness analyses of cardiac surgery in Poland. Work on updating the registry software, including patient data entry forms, has now been completed. This includes updates to diagnoses and procedures, as well as the introduction of coding according to ICD-9, ICD-10, and ICD-11. Numerous changes concern the registry's functionality and user experience. The new version of the software should be released to users in early 2026, which will allow for the entry of data for 2026. The first report, "Polish Cardiac Surgery 2026", in the new version should be published in May 2027.
Bicuspid aortic valve (BAV)-related aortic regurgitation presents heterogeneous anatomic phenotypes that complicate durable valve repair. To ensure repair reproducibility, current guidelines recommend specialised aortic centres with transparent, published outcomes. This report summarizes the two-decade experience of a single Polish aortic centre integrating clinical, imaging, and surgical data to develop a standardized, phenotype-driven repair strategy. Across these institutional studies, commissural symmetry and circumferential annuloplasty consistently emerged as key determinants of durable repair, while advanced imaging demonstrated the superiority of complete annular stabilization over subcommissural techniques. Additional experience with valve-sparing root procedures and geometric ring annuloplasty in highly asymmetric BAVs further contributed to a unified treatment approach. Synthesizing these findings, the review presents a phenotype-driven decision-making algorithm developed at the centre to guide the selection of repair techniques and root interventions, with the aim of standardizing and optimizing long-term outcomes.
Mechanical circulatory support devices have become essential in the management of acute hemodynamic compromise, providing rapid, minimally invasive augmentation of cardiac output in heart failure, cardiogenic shock, high-risk percutaneous coronary intervention, post-cardiotomy ventricular dysfunction, and refractory cardiac arrest. Unlike conventional ventricular assist systems, percutaneous mechanical circulatory support devices are designed for swift deployment through peripheral vascular access and are intended for short-term support. Advancements over recent decades have substantially broadened the range of these devices. They vary widely in mechanism of action, flow capability, insertion technique, and hemodynamic targets, allowing tailored support for left-, right-, or biventricular failure. Parallel to technological innovation, evidence from major trials and international registries has refined contemporary practice by characterizing hemodynamic benefits, procedural outcomes, and device-specific limitations. This review synthesizes contemporary knowledge on pMCS systems, their designs, physiological effects, clinical indications, and limitations.
