Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights

Acute type A aortic dissection in patients with non-prior cardiac surgery vs. prior cardiac surgery: a systematic review and meta-analysis

Background

Patients with prior cardiac surgery undergoing acute type A aortic dissection (ATAAD) are thought to have worse clinical outcomes as compared to the patients without prior cardiac surgery.

Aim

To compare the safety and efficacy of ATAAD in patients with prior cardiac surgery.

Methods

We systematically searched PubMed, Cochrane Library and Google Scholar from database inception until April 2024. We included nine studies which consisted of a population of 524 in the prior surgery group and 5,249 in the non-prior surgery group. Our primary outcome was mortality. Secondary outcomes included reoperation for bleeding, myocardial infarction, stroke, renal failure, sternal wound infection, cardiopulmonary bypass (CPB) time, cross-clamp time, hospital stay, and ICU stay.

Results

Our pooled estimate shows a significantly lower rate of mortality in the non-prior cardiac surgery group compared to the prior cardiac surgery group (RR = 0.60, 95% CI = 0.48-0.74). Among the secondary outcomes, the rate of reoperation for bleeding was significantly lower in the non-prior cardiac surgery group (RR = 0.66, 95% CI = 0.50-0.88). Additionally, the non-prior cardiac surgery group had significantly shorter CPB time (MD = -31.06, 95% CI = -52.20 to -9.93) and cross-clamp time (MD = -21.95, 95% CI = -42.65 to -1.24). All other secondary outcomes were statistically insignificant.

Conclusion

Patients with prior cardiac surgery have a higher mortality rate as compared to patients who have not undergone cardiac surgery previously. Patients with prior cardiac surgery have higher mortality and longer CPB and cross-clamp times. Tailored strategies are needed to improve outcomes in this high-risk group.

Predictors of length of hospital stay after pediatric Ebstein anomaly corrective surgery: a retrospective cohort study

BACKGROUND

The remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient's hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA).

METHODS

We conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.

RESULTS

A total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.

CONCLUSION

We identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.

Postoperative C-reactive protein levels correlate with reduced spinal column mobility after median sternotomy: a prospective cohort study

Background

The sternum is connected to the spinal column via the ribs, forming the thorax. Therefore, it is necessary to consider the effect of a midline sternotomy on the spinal column, but no in vivo studies have been conducted to date. We investigated the changes in the range of motion of the spinal column before and after midline sternotomy and the perioperative factors that have the greatest influence.

Methods

The participants were patients who had undergone cardiac surgery through a standby midline sternotomy. Spinal range of motion in forward flexion was measured before and after surgery. The following perioperative factors were investigated: operating time, days to postoperative measurement, C-reactive protein (CRP) measurement on the third postoperative day, the day of the start of bed release, and the stage of bed release progression on the second postoperative day. Statistics were compared between the two groups before and after surgery for each factor. Multiple regression analysis (forced entry method) was then performed with the change in spinal range of motion, which showed statistical differences between the preoperative and postoperative groups, as the dependent variable and each perioperative factor as the independent variable.

Results

The study included 93 patients. Postoperatively, there was a significant decrease in thoracic spine range of motion. Multiple regression analysis showed that an increase in CRP on the third postoperative day was responsible for the decrease in thoracic range of motion (β=-0.30, P<0.01).

Conclusions

After median sternotomy, thoracic spine range of motion was decreased and correlated with postoperative inflammation.