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New Progress and Challenges in Clinical Cardiac Surgery
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New Progress and Challenges in Clinical Cardiac Surgery

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

Deadline for manuscript submissions: 20 February 2025 | Viewed by 3964

Special Issue Editor

Prof. Dr. Giuseppe Nasso

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy
Interests: coronary artery bypass surgery; coronary artery disease; interventional cardiology; cardiac surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to serve as a platform for exploring the latest advancements and persistent challenges in clinical cardiac surgery. It seeks to reflect the current research status in the field, shed light on core problems, and foster innovation that can drive significant improvements in clinical medicine. Our primary objectives include showcasing breakthroughs in cardiac surgical techniques, addressing complex issues encountered in clinical practice, and promoting collaborative efforts to enhance patient care and surgical outcomes.

The scope of this Special Issue encompasses a wide array of topics within clinical cardiac surgery. We invite research articles, case studies, and reviews that delve into various aspects, including novel surgical approaches, postoperative complications, patient outcomes, advancements in surgical technology, and the integration of emerging technologies such as robotics and telemedicine. The focus is on practical, real-world applications, with an emphasis on how these developments impact the field of clinical medicine.

We extend an invitation to leading cardiac surgeons, researchers, and clinical experts to contribute their insights and findings to this Special Issue. By collating their experiences, innovations, and research outcomes, we aim to create a collaborative environment that can shape the future of clinical cardiac surgery. The mobilization of knowledge within this Special Issue will have a direct and positive impact on clinical medicine by addressing the current challenges and driving innovation, thereby improving the quality of care and outcomes for patients undergoing cardiac surgical procedures.

Prof. Dr. Giuseppe Nasso
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary artery bypass grafting (CABG)
  • mitral valve repair
  • aortic valve replacement
  • percutaneous coronary intervention (PCI)
  • heart transplantation
  • atrial fibrillation ablation
  • ventricular assist devices (vad)
  • minimally invasive cardiac surgery

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Published Papers (3 papers)

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Research

12 pages, 1075 KiB  
Article
The Impact of Silent Liver Disease on Hospital Length of Stay Following Isolated Coronary Artery Bypass Grafting Surgery
by Giancarlo Suffredini, Lan Le, Seoho Lee, Wei Dong Gao, Michael P. Robich, Hamza Aziz, Ahmet Kilic, Jennifer S. Lawton, Kristin Voegtline, Sarah Olson, Charles Hugh Brown, Joao A. C. Lima, Samarjit Das and Jeffrey M. Dodd-o
J. Clin. Med. 2024, 13(12), 3397; https://doi.org/10.3390/jcm13123397 - 10 Jun 2024
Viewed by 797
Abstract
Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ [...] Read more.
Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (< 9.5 kPa, ≥ 9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06–0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68–0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification. Full article
(This article belongs to the Special Issue New Progress and Challenges in Clinical Cardiac Surgery)
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12 pages, 1059 KiB  
Article
Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results
by Giuseppe Nasso, Walter Vignaroli, Vincenzo Amodeo, Francesco Bartolomucci, Claudio Larosa, Gaetano Contegiacomo, Maria Antonietta Demola, Cataldo Girasoli, Antongiulio Valenzano, Flavio Fiore, Raffaele Bonifazi, Vera Triggiani, Vincenza Vitobello, Giacomo Errico, Angela Lamanna, Dritan Hila, Tommaso Loizzo, Rosalba Franchino, Stefano Sechi, Giovanni Valenti, Giuseppe Diaferia, Mario Siro Brigiani, Serena Arima, Mario Angelelli, Antonio Curcio, Francesco Greco, Ernesto Greco, Giuseppe Speziale and Giuseppe Santarpinoadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(10), 2987; https://doi.org/10.3390/jcm13102987 - 19 May 2024
Viewed by 1193
Abstract
Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent [...] Read more.
Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16–5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events. Full article
(This article belongs to the Special Issue New Progress and Challenges in Clinical Cardiac Surgery)
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15 pages, 36503 KiB  
Article
Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience
by Alfonso Agnino, Laura Giroletti, Ascanio Graniero, Piersilvio Gerometta, Matteo Parrinello, Giovanni Albano, Eduardo Celentano, Ernesto Cristiano, Giuseppe Nasso and Natasja M. S. de Groot
J. Clin. Med. 2024, 13(6), 1563; https://doi.org/10.3390/jcm13061563 - 8 Mar 2024
Viewed by 1575
Abstract
Background: Pulmonary vein isolation is currently considered to be the gold standard for ablating paroxysmal atrial fibrillation. However, its efficacy is limited in patients with persistent atrial fibrillation. The convergent procedure has emerged as a hybrid ablation. This study aims, for the first [...] Read more.
Background: Pulmonary vein isolation is currently considered to be the gold standard for ablating paroxysmal atrial fibrillation. However, its efficacy is limited in patients with persistent atrial fibrillation. The convergent procedure has emerged as a hybrid ablation. This study aims, for the first time in the literature, to introduce a hybrid approach that includes epicardial ablation with cutting-edge robotic technology and subsequent electrophysiological study to verify and an endocardial ablation to complete the ablation lines. Methods: We present 18 cases of robotic-assisted epicardial hybrid ablation performed between April and December 2023 on patients with long-standing persistent atrial fibrillation (mean age: 64 ± 5 years; mean duration: 4 ± 2 years). All of the procedures were performed at “Humanitas Gavazzeni Hospital”, Bergamo, Italy. Robot-assisted epicardial ablation performed using the “Epi-Sense AtriCure” device was guided by monitoring electrogram morphology and point-by-point impedance drop. This approach also included left atrial appendage occlusion and the disconnection of the ligament of Marshall. An electrophysiological study and endocardial ablation were planned three months after the procedure. Results: The procedure was successfully executed in all patients with no major complications and a mean operative time of 142 ± 22 min. None of the cases required conversion to full sternotomy or minithoracotomy. The procedure was performed in all cases without extracorporeal circulation and on a beating heart. Fifteen patients (83%) were extubated in the operating room. The length of stay in the intensive care unit was less than 24 h. Acute restoration of sinus rhythm was achieved in 12 out of the 18 patients (67%); the median duration of their hospital stay was two days. In the electrophysiological study, seven pts had sinus rhythm, two had atrial fibrillation, and one patient developed atrial flutter at 3-month follow-up. Patients underwent transcatheter ablation to complete the lesion set and, at the time of discharge, were all in sinus rhythm. Conclusions: In our initial experience, surgical atrial fibrillation ablation consisting of a unilateral thoracoscopic technique facilitated by a robotic platform and continuous EGM monitoring has proven to be safe and feasible. For the electrophysiological study at 3 months, completing the gaps in the surgical ablation lines could improve the clinical results of the technique in terms of sinus rhythm stability. However, mid- and long-term follow-up is required to demonstrate this. Full article
(This article belongs to the Special Issue New Progress and Challenges in Clinical Cardiac Surgery)
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