Objective To investigate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and outcomes following cardiovascular surgery with deep hypothermic circulatory arrest (DHCA). Methods This was a retrospective analysis. All procedures with DHCA from July 1997 to January 2025 were included. Maximally selected rank statistics identified the optimal NLR cutoff. This NLR cutoff was used for comparisons between high- and low-NLR cohorts. Multivariable regression (MVA) assessed independent association with outcomes. NLR was evaluated as a continuous variable in MVA to assess association irrespective of derived cutoff. The primary outcome was the composite of in-hospital major adverse events (MAEs), consisting of: operative mortality (OM), myocardial infarction, cerebrovascular accident, re-exploration for bleeding, tracheostomy and new postoperative dialysis. The secondary outcome was all-cause mortality. Results Analysis included 1335 patients, with 16.7%(223/1335) in the high-NLR cohort (≥6.22). The high-NLR cohort had increased incidence of smoking (62.8%[140/223] vs. 52.1%[579/1112], p=0.004), chronic obstructive pulmonary disease (26.9%[60/223] vs. 14.1%[157/1112], p<0.001), peripheral vascular disease (11.7%[26/223] vs. 7.3%[81/1112], p=0.04) and renal disease (37.2%[83/223] vs. 12.3%[137/1112], p<0.001). The incidence of MAE was higher in the high-NLR cohort (11.7%[26/223] vs. 5.8%[64/1112], p=0.002). Median follow-up was 10.6 years (95% Confidence Interval [CI]:9.9-11.6). Ten-year survival was lower in high-NLR cohort (52.7%[95%CI:46-60.5] vs.71.3%[95%CI:68.2-74.5]). On MVA, NLR was associated with increased risk of MAE (Odds Ratio 1.04 [95%CI:1.00-1.07], p=0.02) and all-cause mortality (Hazard Ratio 1.03 [95%CI:1.02-1.05], p<0.001). Conclusion Preoperative NLR was associated with increased risk of morbidity and all-cause mortality, independent of comorbidities, following cardiovascular surgery with DHCA.

Objective: To investigate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and outcomes following cardiovascular surgery with deep hypothermic circulatory arrest (DHCA). Methods: This was a retrospective analysis. All cardiovascular surgical procedures with DHCA between July 1997 and January 2025 were included. Maximally selected rank statistics identified the optimal NLR cutoff. This NLR cutoff was used for comparisons between high-NLR and low-NLR cohorts. Multivariable regression analysis assessed independent associations with outcomes. NLR was evaluated as a continuous variable to assess associations irrespective of derived cutoff. The primary outcome was the composite of in-hospital major adverse events (MAE), consisting of operative mortality, myocardial infarction, cerebrovascular accident, reexploration for bleeding, tracheostomy, and new postoperative dialysis. The secondary outcome was all-cause mortality. Results: Our analysis included 1335 patients, with 16.7% (223/1335) in the high-NLR cohort (≥6.22). The high-NLR cohort had increased incidence of smoking (62.8% [140/223] vs 52.1% [579/1112]; P = .004), chronic obstructive pulmonary disease (26.9% [60/223] vs 14.1% [157/1112]; P < .001), peripheral vascular disease (11.7% [26/223] vs 7.3% [81/1112]; P = .04), and renal disease (37.2% [83/223] vs 12.3% [137/1112]; P < .001). The incidence of MAE was higher in the high-NLR cohort (11.7% [26/223] vs 5.8% [64/1112]; P = .002). Median follow-up was 10.6 years (95% confidence interval [CI], 9.9-11.6 years). Ten-year survival was lower in high-NLR cohort (52.7% [95% CI, 46%-60.5%] vs 71.3% [95% CI, 68.2%-74.5%]). On multivariate analysis, NLR was associated with increased risk of MAE (odds ratio, 1.04; 95% CI, 1.00-1.07; P = .02) and all-cause mortality (hazrd ratio, 1.03; 95% CI, 1.02-1.05; P < .001). Conclusions: Preoperative NLR was associated with increased risk of morbidity and all-cause mortality independent of comorbidities following cardiovascular surgery with DHCA.

OBJECTIVE:To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis. METHODS:We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared. RESULTS:Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; P = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; P = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; P < .001), renal dysfunction (8.3% vs 22.7% vs 45%; P < .001), shock (0.1% vs 10.7% vs 15%; P < .001), and ruptures (0.4% vs 10.7% vs 10%; P < .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; P < .001) and operative mortality (0.4% vs 1.3% vs 7.5%; P = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; P = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; P = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; P < .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; P < .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; P < .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; P < .001) were associated with late mortality but primary diagnosis was not. CONCLUSIONS:The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.

OBJECTIVE:To assess long-term survival and operative outcomes of open descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair at a high-volume center. METHODS:We identified all consecutive patients undergoing DTA/TAAA repair between 1997 and 2023 and stratified based on aneurysm extent. Operative outcomes were assessed by univariable and multivariable analysis. Long-term survival was estimated by Kaplan-Meier method. RESULTS:Of 1020 patients, 273 had DTA and 747 had TAAA (53.1% extent I, 18.5% extent II, 20.2% extent III, 7.6% extent IV, and 5% extent V). Operative mortality (OM) was 4.6% overall, 5.1% in the DTA group, and 4.4% in the TAAA group. The incidence of myocardial infarction was 0.5%; stroke, 1.8%; tracheostomy, 6.9%; dialysis, 4.8%; and paraplegia, 1.3%. On multivariable analysis, diabetes (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.20-5.13; P = .014) and renal insufficiency (OR, 3.17; 95% CI, 1.63-6.13; P < .001) were associated with OM. In the TAAA group, extent II aneurysm (OR, 3.56; 95% CI, 1.59-7.96; P = .002) was associated with OM. The median follow-up was 6.72 (95% CI, 5.73-7.81) years. Five- and 10-year survival were 67.2% and 48.2% for the DTA group and 69.9% and 47.5% for the TAAA group. In the TAAA group, 5- and 10-year survival were 76.4% and 49.4% for extent I, 62.5% and 43.3% for extent II, 60.1% and 45.6% for extent III, and 72.6% and 47.4% for extent IV. Age (hazard ratio [HR], 1.04; 95% CI, 1.02-1.05; P < .001), chronic obstructive pulmonary disease (HR, 1.55; 95% CI, 1.25-1.92; P < .001), diabetes (HR, 1.5; 95% CI, 1.09-2.07; P = .013), renal insufficiency (HR, 1.47; 95% CI, 1.18-1.85; P < .001), shock (HR, 1.83; 95% CI, 1.19-2.81; P = .006), and urgent/emergent surgery (HR, 1.27; 95% CI, 1.03-1.58; P = .027) were associated with long-term mortality. CONCLUSIONS:At experienced centers, operative outcomes and long-term survival after open DTA/TAAA repair are encouraging. Short-term outcomes are dependent on preoperative risk factors and aneurysm extent, while long-term survival is dependent on age and chronic comorbidities.

Improved laparoscopic techniques have engendered many new gastrointestinal and other intracavity abdominal procedures. Groin hernias have also been repaired with the assistance of the laparoscope via both transperitoneal and properitoneal approaches, but less emphasis has been placed upon repair of hernias of the anterior abdominal wall. A technique for the transperitoneal, laparoscopic repair of anterior abdominal wall hernias using a composite mesh prosthesis is presented. The technique is applicable to hernias in many locations.

A planned elective repair, via the laparoscope, of a spigelian hernia is described. The repair was performed using a composite mesh prosthesis consisting of a sandwich of polyester fiber mesh and polyglactin 910 mesh, sutured together with polyglactin 910 suture at the operating table before introduction. The technique is applicable to other hernias of the anterior abdominal wall.