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Preoperative Optimization in Cardiac Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 April 2026 | Viewed by 3974

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Special Issue Editor

Dr. Jason M. Ali

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Guest Editor

Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
Interests: minimal-access cardiac surgery; risk scoring; EuroSCORE; postoperative outcomes; heart and lung transplantation
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Dear Colleagues,

Preoperative optimization in cardiac surgery plays a crucial role in enhancing patient outcomes and reducing postoperative complications. This comprehensive approach involves the systematic evaluation and management of patients before undergoing cardiac surgical procedures. Key components of preoperative optimization include risk assessment, cardiovascular evaluation, optimization of comorbid conditions, and patient education. By addressing modifiable risk factors such as hypertension, diabetes, and smoking, preoperative optimization aims to improve overall cardiovascular health and reduce perioperative risks. Strategies may include medication adjustments, lifestyle modifications, and targeted interventions to optimize cardiac function and minimize surgical complications. Multidisciplinary collaboration among cardiologists, cardiac surgeons, anesthesiologists, and other healthcare professionals is essential in developing individualized preoperative plans tailored to each patient's specific needs. Through effective preoperative optimization, the goal is to enhance surgical outcomes, shorten hospital stays, and promote long-term cardiovascular health.

Dr. Jason M. Ali
Guest Editor

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Keywords

preoperative optimization
cardiac surgery
risk assessment
comorbid conditions
multidisciplinary collaboration
perioperative risks
cardiovascular evaluation

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Published Papers (3 papers)

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Research

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9 pages, 647 KB

Open AccessArticle

Rethinking Preoperative Risk Evaluation: How Well Does EuroSCORE II Predict Long-Term Mortality After Cardiac Surgery?—A Single-Centre Retrospective Analysis

by Andreas Koköfer, Lukas Simon Fischer, Bernhard Wernly, Daniel Dankl, Crispiana Cozowicz, Elke Boxhammer, Richard Rezar, Christian Dinges, Jan Waskowski and Niklas Rodemund

J. Clin. Med. 2026, 15(2), 837; https://doi.org/10.3390/jcm15020837 - 20 Jan 2026

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Abstract

Objectives: EuroSCORE II is widely used to predict perioperative and 30-day mortality in cardiac surgery, yet data on its ability to predict long-term outcomes remain limited. This study investigates whether EuroSCORE II is associated with one-year and long-term mortality in a heterogeneous population undergoing major cardiac surgery with cardiopulmonary bypass. Methods: A retrospective cohort study was conducted including 2179 patients who underwent elective or urgent cardiac surgery with cardiopulmonary bypass between 2017 and 2021 at the University Hospital Salzburg. Data were extracted from the Salzburg Intensive Care database (SICdb) and supplemented with mortality information from Statistik Austria. EuroSCORE II values were compared between survivors and non-survivors. Kaplan–Meier analyses, Cox regression and logistic regression with ROC analysis were performed to evaluate the predictive association of EuroSCORE II with mortality. Results: EuroSCORE II was significantly higher in patients who died within one year and in those who died during a mean follow-up period of 1152.67 ± 521.39 days. Patients who survived at least one year had a median EuroSCORE II of 2.2, whereas those who died within one year had a median of 7.0. Cox regression demonstrated a hazard ratio of 1.062 for one-year mortality and 1.058 for long-term mortality. Kaplan–Meier curves showed significantly reduced survival with increasing EuroSCORE II quartiles. Logistic regression for one-year mortality yielded an AUC of 0.773, indicating good discriminative ability. Conclusions: EuroSCORE II is significantly associated with long-term mortality after major cardiac surgery, demonstrating good discriminatory performance. These findings support its potential utility not only as a short-term but also as a long-term prognostic indicator in cardiac surgery populations. Full article

(This article belongs to the Special Issue Preoperative Optimization in Cardiac Surgery)

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Review

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18 pages, 974 KB

Open AccessReview

Anemia and Iron Deficiency in Cardiac Surgery Patients: Prevalence, Implications, and Therapeutic Considerations

by Isabelle Frei, Annika Léonie Gogniat, Andreas Buser and Daniel Bolliger

J. Clin. Med. 2025, 14(22), 8261; https://doi.org/10.3390/jcm14228261 - 20 Nov 2025

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Abstract

Preoperative anemia and non-anemic iron deficiency are common in cardiac surgery patients. Both are frequently caused by absolute iron deficiency or are associated with chronic diseases and inflammation. Multiple studies have shown an association between preoperative anemia and increased RBC transfusion, prolonged intensive care unit and hospital length of stay, and higher postoperative morbidity and mortality. The impact of preoperative non-anemic iron deficiency on postoperative adverse outcome is less clear, but worsened postoperative outcomes have been suggested. Accordingly, treatment for anemia and iron deficiency is a primary goal in preoperative optimization in cardiac surgery patients. Several guidelines recommend timely supplementation with modern oral iron formulation as first-line intervention, followed by intravenous iron administration in case of patient intolerance or time restriction. In patients with non-pure iron deficiency or in ultra-short treatment strategies, the combined therapy of intravenous iron and erythropoiesis-stimulating agents seems safe and most efficacious to increase red blood mass before surgery. However, the positive effects of preoperative interventions in anemic or iron-deficient patients were mostly limited to reduced transfusion of red blood cells, whereas lower morbidity and mortality were shown in limited studies only. It is also important to note that allogeneic blood products are a limited resource, and preoperative oral iron supplementation showed the best cost-effectiveness. Full article

(This article belongs to the Special Issue Preoperative Optimization in Cardiac Surgery)

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19 pages, 738 KB

Open AccessReview

The Use of Advanced Glycation End-Product Measurements to Predict Post-Operative Complications After Cardiac Surgery

by Divya S. Agrawal, Jose C. Motta and Jason M. Ali

J. Clin. Med. 2025, 14(17), 6176; https://doi.org/10.3390/jcm14176176 - 1 Sep 2025

Viewed by 1020

Abstract

Background/Objectives: Frailty is increasingly recognised as an important contributor to outcomes following cardiac surgery. There are various measures of frailty described, but many include subjective assessments impacting reliability and reproducibility of measurement. A potential biomarker: advanced glycation end products (AGEs) have been suggested to closely correlate with frailty. This may offer the opportunity to objectively measure frailty and have potential use in preoperative risk assessment. The objective and aim of this narrative review is to assess the association between AGEs and outcomes following surgery, in order to evaluate the use of AGEs for preoperative risk assessment. Methods: This review involved searching five databases including the following: MEDLINE (through Ovid), Embase, Cochrane, ClinicalTrials.gov, and a specified Google Scholar search for studies published between database inception and 20 February 2025. The 1142 identified articles were then subjected to various inclusion and exclusion criteria. This exclusion criteria included all articles that were not in the English language, studies involving patients under 18 years of age, and studies that were incomplete or for whom the data was not yet available. This left 11 articles for which a ‘related articles’ search was performed on Google Scholar on 6 March 2025, as per the PRISMA-S extension guidelines, to obtain all relevant articles available. In the end, data analysis was conducted on 13 articles with a total of 2402 participants. These were categorised by type of surgery before analysis was performed for each surgical category. The quality of evidence was assessed using ROBINS-I tool and a risk of bias table has been provided. This study was provided no external sources of funding. Results: Four out of the five studies in cardiac surgery showed a statistically significant association between AGE levels and post-operative complications and outcomes. This association was also seen across thoracic and general surgery. Association was demonstrated with various post-operative complications as well as mortality. These relationships are supported by various pathophysiological mechanisms, including the ability of AGEs to induce oxidative stress, activate inflammatory mediators, and cause endothelial dysfunction. Conclusions: There is a body of evidence supporting the association between AGEs level and cardiac surgical outcomes. This objective measure of frailty could have significant utility in preoperative risk assessment and offer the opportunity to identify patients who will benefit from undergoing prehabilitation. Full article

(This article belongs to the Special Issue Preoperative Optimization in Cardiac Surgery)

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