The left internal mammary artery (LIMA) remains the preferred conduit for coronary artery bypass grafting (CABG). However, diabetic patients face an increased risk of deep sternal wound infection (DSWI), particularly aft...The left internal mammary artery (LIMA) remains the preferred conduit for coronary artery bypass grafting (CABG). However, diabetic patients face an increased risk of deep sternal wound infection (DSWI), particularly after pedicled LIMA harvesting, which may impair sternal perfusion. Skeletonized harvesting preserves sternal vascularity and may reduce infection risk, but current evidence remains limited and inconsistent.Three different databases were assessed. The primary outcome was the occurrence of DSWI. Secondary outcomes were hospital length of stay (LOS), cardiopulmonary bypass (CPB) time, blood transfusion rates, and aortic cross-clamp time. A random effects model was performed.Three retrospective studies involving 400 diabetic patients were included, of whom 190 underwent skeletonized and 210 pedicled LIMA harvesting. Skeletonized harvesting was associated with significantly reduced risk of DSWI (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.07-0.88; = 0.031). CPB (mean difference [MD]: 3.03 minutes; 95% CI: 1.18-4.88; = 0.001) and aortic cross-clamp times (MD: 3.06 minutes; 95% CI: 2.03-4.10; < 0.001) were slightly longer in the skeletonized group. No significant differences were observed in hospital LOS ( = 0.159) or blood transfusion requirements ( = 0.959).Skeletonized LIMA harvesting is associated with lower odds of DSWI in diabetic patients undergoing CABG, despite modestly longer operative times.
Left atrial enlargement is a well-recognized marker of adverse cardiovascular outcomes, but its impact on early morbidity and mortality after valve replacement remains uncertain.We retrospectively reviewed 422 patients w...Left atrial enlargement is a well-recognized marker of adverse cardiovascular outcomes, but its impact on early morbidity and mortality after valve replacement remains uncertain.We retrospectively reviewed 422 patients who underwent aortic and/or mitral valve replacement (MVR) for rheumatic heart disease at X between 2004 and 2022. Preoperative left atrial diameter index (LADI) was measured, and patients were classified as normal (<2.3 cm/m) or abnormal (≥2.3 cm/m). Clinical, operative, and postoperative outcomes were compared. The primary endpoint was 30-day all-cause mortality; secondary endpoints included postoperative atrial fibrillation (POAF), neurological events, renal impairment, re-exploration for bleeding, and intraoperative pacing wire requirement.Nearly half of patients (48.8%) had abnormal LADI. Patients with enlarged atria were more often female, had smaller body size, and were significantly more likely to undergo MVR (42.7% versus 18.1%, < 0.001). Abnormal LADI was strongly associated with POAF (16.0% versus 7.4%, = 0.006) and intraoperative pacing wire insertion (38.3% versus 23.5%, = 0.001). Multivariate analysis confirmed severe LADI as an independent predictor of POAF (OR 3.91, = 0.001) and pacing requirements (OR 2.31, = 0.004). No significant differences were observed in 30-day mortality, stroke/transient ischemic attack, renal dysfunction, or bleeding complications.Preoperative LADI is an independent predictor of postoperative arrhythmic complications and pacing needs after valve replacement, but not early mortality. Incorporating LADI into preoperative risk assessment may improve rhythm surveillance and perioperative planning. Future prospective studies should evaluate its long-term prognostic value and role in reverse remodeling after surgery.
Aortic annular enlargement has become an essential component of contemporary aortic valve surgery, particularly in the context of patient-prosthesis mismatch. We describe several practical technical adaptations to a Y-in...Aortic annular enlargement has become an essential component of contemporary aortic valve surgery, particularly in the context of patient-prosthesis mismatch. We describe several practical technical adaptations to a Y-incision-based annular enlargement approach, derived from our institutional experience. These modifications focus on patch material selection, suturing strategy, and external reinforcement, with the aim of simplifying execution and enhancing hemostatic reliability while preserving the conceptual framework of the technique.
Endoscopic graft harvesting was first introduced clinically in the 1990s and is currently used in 80-90% of all CABG cases in the United States. Several studies have compared open and endoscopic harvesting techniques in...Endoscopic graft harvesting was first introduced clinically in the 1990s and is currently used in 80-90% of all CABG cases in the United States. Several studies have compared open and endoscopic harvesting techniques in terms of long-term clinical outcomes and major adverse events. In summary, endoscopic graft harvesting allows for reduced postoperative pain, minimization of wound infection risk and a better cosmetic result with higher patients' satisfaction. Harvester experience guarantees a graft quality that is comparable to open harvesting techniques. Thus, American as well as European guidelines recommend endoscopic harvesting - particularly in patients at high risk of wound healing disorders.
Rahlfs SS, Sachweh JS, Kozlik-Feldmann RG
… +3 more, Biermann D, Hübler M, Carstens H
Thorac Cardiovasc Surg
· 2026 Jan · PMID 41760349
·
Full text
Right ventricular outflow tract (RVOT) obstruction is a hallmark of tetralogy of Fallot (ToF) and related anatomies. Surgical strategies include valve-sparing techniques or transannular patch (TAP) enlargements, optional...Right ventricular outflow tract (RVOT) obstruction is a hallmark of tetralogy of Fallot (ToF) and related anatomies. Surgical strategies include valve-sparing techniques or transannular patch (TAP) enlargements, optionally with monocusp patch plasty to restore valve competence. This study compares short- and medium-term outcomes of these strategies based on institutional data.A retrospective analysis was conducted on 83 ToF patients who underwent surgery between 2007 and 2021. Median age and weight at surgery were 164 days and 6.0 kg, respectively. Patients were grouped by surgical approach: valve-sparing (commissurotomy/delamination, = 27; primary infundibulotomy, = 7) and TAP (without monocusp, = 38; with monocusp, = 11). The primary endpoint was freedom from reintervention.Significant preoperative differences were found between groups, including valve morphology, pulmonary annulus z-values, oxygen saturation, and prior palliative interventions. Valve-sparing techniques were associated with less postoperative moderate/severe pulmonary regurgitation (17.6% versus 73.5%; < 0.001) and a trend toward shorter ICU stays. TAP with monocusp resulted in significantly less pulmonary regurgitation than TAP alone (36.4% versus 84.2%; = 0.002) and showed a trend toward fewer reinterventions after 5 years (0% versus 38.5%; = 0.073), with a significant difference at 10 years (14.3% versus 71.4%; = 0.024).Valve-sparing approaches yield better early outcomes and fewer long-term reinterventions when anatomically feasible. When TAP is necessary, adding a monocusp patch significantly reduces postoperative regurgitation and improves long-term durability.
Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy (ETS) for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully...Compensatory hyperhidrosis remains the most significant complication after endoscopic thoracic sympathectomy (ETS) for primary palmar hyperhidrosis. However, its temporal evolution and long-term predictors are not fully elucidated.This multicenter retrospective study included 226 patients who underwent bilateral clip-based ETS between 2009 and 2023. Patients were stratified by surgical level: R3 ( = 60), R4 ( = 72), R2-R4 ( = 81), and asymmetric interruption ( = 13). Compensatory hyperhidrosis severity was assessed at 6 and 12 months, and final follow-up (mean 98 months). Logistic regression identified independent predictors of compensatory hyperhidrosis, recurrence, and patient satisfaction.Complete palmar dryness was achieved in 84.5% of patients. Compensatory hyperhidrosis occurred in 48.7%, exclusively within the first 6 postoperative months, with no late-onset cases. During long-term follow-up, spontaneous regression of compensatory hyperhidrosis was observed in 28.2% of affected patients. Compensatory hyperhidrosis incidence differed significantly across surgical levels ( = 0.011): 38.3% (R3), 55.6% (R4), 63.0% (R2-R4), and 30.8% (asymmetric). Multivariate analysis confirmed multi-level R2-R4 sympathectomy as an independent predictor of compensatory hyperhidrosis (OR = 2.18, = 0.042), while single-level R4 interruption provided the lowest persistent compensatory hyperhidrosis burden. Overall satisfaction was 79.6%, and recurrence-not compensatory hyperhidrosis-was the main determinant of dissatisfaction (OR = 2.48, < 0.001). Smoking history independently predicted recurrence (OR = 2.09, = 0.042).Compensatory hyperhidrosis develops exclusively during the early postoperative period and shows partial spontaneous improvement over time. Multi-level interruption significantly increases compensatory hyperhidrosis risk without improving efficacy, supporting limited single-level approaches (preferably R4). These findings emphasize the importance of surgical level selection, smoking cessation, and realistic postoperative counseling.
Thorac Cardiovasc Surg
· 2026 Jan · PMID 41698647
·
Full text
Mitral regurgitation (MR) associated with atrial septal defect (ASD) has been observed to improve following ASD closure; however, aggravation of preexisting MR can occur postprocedure, with the underlying mechanisms of t...Mitral regurgitation (MR) associated with atrial septal defect (ASD) has been observed to improve following ASD closure; however, aggravation of preexisting MR can occur postprocedure, with the underlying mechanisms of these adverse outcomes remaining poorly understood.This retrospective study evaluated 95 patients who underwent surgical secundum ASD closure, all of whom received preoperative and postoperative transthoracic echocardiography (TTE). Patient characteristics from preoperative TTE, as well as sex and age, were analyzed to identify predictors of MR. Follow-up TTE was conducted at 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure, with all patients successfully completing the 2-year follow-up.The univariate logistic regression analysis indicated that age, gender, LA, RA-VD, RA-HD, RV, ASD diameter, AS diameter, PAP, and peak tricuspid regurgitation velocity may serve as predictors of MR worsening. Subsequent multiple logistic regression analysis revealed that LA size was an independent predictor of MR worsening and acted as a protective factor. Our research indicates a marked reduction in the right cardiac system after ASD closure, with significant remodeling of the LA within the first 6 months. The relative size of the LV increased notably within 2 years. The postoperative changes in LA differed between the worsening MR group and the nonworsening MR group.In conclusion, "prophylactic" mitral annuloplasty during ASD surgery may prove advantageous for patients with an enlarged LA, and the presence of additional risk factors associated with mitral annuloplasty heightens the recommendation for concurrent intervention.
Despite developments in the past 20 years in the treatment of native valve (NVE) endocarditis, including the multidisciplinary endocarditis team approach and advances in perioperative care, outcome improvements are lacki...Despite developments in the past 20 years in the treatment of native valve (NVE) endocarditis, including the multidisciplinary endocarditis team approach and advances in perioperative care, outcome improvements are lacking. This study compares a contemporary with a historic cohort of NVE patients.All patients undergoing first-time cardiac surgery for NVE in two periods were evaluated in a retrospective observational single-center trial. The historic period included patients from 1998 to 2003 and the contemporary cohort 2021 to 2024.Of the 359 patients who were included, 155 were in the historic cohort (years 1998-2003) and 204 in the contemporary (years 2021-2024). The annual caseload increased significantly from 25.8 to 51.0 annual cases ( < 0.01). Patient baselines changed, being nowadays older (62.6 vs. 55.5 years, < 0.001), having higher BMI (26.9 kg/m vs. 25.3 kg/m, < 0.01) and higher EuroSCORE II (8.7% vs. 5.0%, < 0.001). Accordingly, the preoperative clinical presentation also worsened with an increase in septic embolizations (33.8% vs. 22.6%, = 0.04) and acute kidney injury (15.2% vs. 1.9%, < 0.001). Minimally invasive procedures were newly established (41.2% vs. 0%). The contemporary group faced a higher rate of postoperative dialysis, longer intensive care unit stay, and higher perioperative mortality (14.2% vs. 6.5%, = 0.03). Nonetheless, survival at 1 year was comparable (78.4% vs. 79.9, = 0.52).Contemporary patients have higher risk profiles and annual caseloads. This translates into increased postoperative morbidity and mortality; however long-term outcomes have remained constant.
Physiologic healing processes and foreign body reactions can mimic infective conditions in F-FDG-PET/CT for the detection of deep sternal wound infections. To date, nothing is known about the metabolic presentation of su...Physiologic healing processes and foreign body reactions can mimic infective conditions in F-FDG-PET/CT for the detection of deep sternal wound infections. To date, nothing is known about the metabolic presentation of surgically applied bone wax to the sternum for hemostasis during sternotomy in F-FDG-PET/CT imaging. Therefore, this study aims to assess the sternal FDG uptake after the application of bone wax during sternotomy.A total of 25 patients with a history of cardiac surgery (1.3-5.5 years ago) were examined by F-FDG-PET/CT with dual time point imaging. The sternal FDG uptake was assessed visually (as positive or negative) and metrically using the maximum standardized uptake values (SUV) calculated automatically. The SUV was compared between the patients with and without the use of bone wax and among patients with and without positive sternal findings in the visual analysis. A correlation analysis was performed between the time since surgery and the sternal SUV.In all eight patients (32%) had received bone wax. In those patients, the mean sternal SUV was higher compared to the group without bone wax, both in the early (4.74 ± 1.28 vs. 3.70 ± 1.44; = 0.0969) and in the late images (6.62 ± 2.67 vs. 4.36 ± 1.44; = 0.0289). Moreover, the use of bone wax was strongly associated with positive sternal findings in the visual analysis (OR = 10; 95%CI = 0.995-100.462; = 0.0421). The correlation analysis revealed a slightly decreasing trend without significance (Spearman's ρ = -0.139; = 0.505).The use of bone wax during sternotomy could be associated with increased sternal uptake of FDG on F-FDG-PET/CT, even several years after surgery. This finding should be considered in the evaluation of potential deep sternal wound infections.
This single-center, retrospective analysis presents data from 611 patients with a secundum type atrial septal defect (ASD II) closure. Included were patients >2 years of age. Patients presented at a median (range) age of...This single-center, retrospective analysis presents data from 611 patients with a secundum type atrial septal defect (ASD II) closure. Included were patients >2 years of age. Patients presented at a median (range) age of 6.95 (2-86) years for interventional closure of ASD II. Out of 611 patients, 215 underwent intracardiac repair based on transthoracic echocardiography (ECHO) findings. Transcatheter device closure was attempted and successfully performed in 300 out of 396 patients (Amplatzer™ Septal Occluder [ASO], = 290 patients). Follow-up was 3.3 years (1 day-21.8 years) in patients with interventional closure of ASD II and 0.7 years (3 days-14.7 years; < 0.001; Mann-Whitney) in patients after surgical closure. There was no in-hospital mortality in both groups. One patient, after Amplatzer device closure with an absent aortic rim, developed erosion, which was treated by cardiac surgery and patch closure of ASD II. Two patients showed dislocation of the device. In 231 out of 396 patients, right ventricular dimension normalized completely as determined on the last follow-up visit. Six patients at a median age of 60 (49.4-68.7) years presented with atrial fibrillation, which persisted after ASD II closure. About 26 patients (6.6%) showed pulmonary hypertension (PH), with 1 presenting with coincidental ASD II and severe PH. Closure of ASD II can be accomplished safely by interventional catheterization and intracardiac repair. In most cases, perioperative transthoracic and transesophageal ECHO is sufficient to decide whether a surgical approach or interventional closure is the best option to close the defect.
This study investigated the effect of preoperative fat mass index (FMI), fat-free mass index (FFMI), fat mass ratio (FMR), and fat-free mass ratio (FFMR) on postoperative morbidity and mortality in coronary artery bypass...This study investigated the effect of preoperative fat mass index (FMI), fat-free mass index (FFMI), fat mass ratio (FMR), and fat-free mass ratio (FFMR) on postoperative morbidity and mortality in coronary artery bypass grafting (CABG) patients.About 120 patients were included in this prospective study. The patients' FMI, FFMI, FMR, and FFMR were evaluated preoperatively along with other clinically significant data. The postoperative morbidities were recorded. Receiver operating characteristic (ROC) curve analyses were made to determine threshold values of FMR, FFMR, and FMI for wound dehiscence. The multivariate logistic regression analysis was made to assess the independent risk factors for infection site leakage.ROC analysis yielded threshold values of FMR 0.26, FFMR 0.73, and FMI 7.46. FMI, FMR, and FFMR were associated with parameters including body mass index (BMI), diabetes, and wound dehiscence (80.7% sensitivity and 87.3% specificity [area under the curve = 0.600, 95% CI: 0.789-0.919, < 0.001]). FMR >0.26 and FFMR <0.73 were associated with high pulmonary embolism risk. Patients with FFMI (men: 18.7-21 kg/m, women: 14.9-17.2 kg/m) had significantly less postoperative atrial fibrillation and wound dehiscence. Patients with FMR >0.26 and FMI >7.46 are at a 3- to 38-fold increased risk of wound dehiscence, irrespective of their BMI. Fat mass measurements were not associated with mortality.Our study demonstrates that preoperative fat mass measurements can effectively predict postoperative morbidity in CABG patients. Fat mass measurements are valuable for risk prediction, especially in non-obese patients.
The objective of this study was to compare clinical outcomes of total arch replacement (TAR) combined with stented elephant trunk (SET) implantation and hybrid aortic arch repair (HAAR) for type A acute aortic dissection...The objective of this study was to compare clinical outcomes of total arch replacement (TAR) combined with stented elephant trunk (SET) implantation and hybrid aortic arch repair (HAAR) for type A acute aortic dissection (TA-AAD) in patients older than 60 years.We studied records of patients with TA-AAD older than 60 years in our hospital between January 2016 and December 2018. About 68 patients underwent TAR combined with SET implantation (SET group), and 56 patients underwent HAAR (hybrid group). Outcomes included operative data, postoperative data, and 2 years of follow-up data.Comparing with the SET group, the hybrid group experienced shorter time on surgery duration ( < 0.001), cardiopulmonary bypass ( < 0.001), aortic cross-clamp ( < 0.001), mechanical ventilation ( < 0.001), ICU stay ( < 0.001), and hospital length of stay ( < 0.001). The hybrid group showed a lower rate of pulmonary infection and renal failure ( = 0.023; = 0.022, respectively). Blood product use was less in the hybrid group ( 0.001). The hybrid group had a trend toward reducing the 30-day mortality rate, stroke, and transient mental dysfunction. The hybrid group had a trend toward improving the 2-year survival rate and reintervention-free rate, but the results did not reach a significant level.Hybrid procedure could be safely performed in patients older than 60 years with TA-AAD. This procedure may be associated with encouraging surgical results and promising outcomes in the early and mid-term.