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Purpose Patients undergoing open‐heart surgery often face significant challenges in postoperative cognitive dysfunction (POCD). There has been growing interest in understanding how anesthesia medications, such as dexmedetomidine (DEX) and midazolam, impact cognitive function in these patients. Method This comprehensive review aims to detail the effect of DEX and midazolam on cognitive outcomes following open‐heart surgery. Findings Midazolam, a highly selective and commonly used benzodiazepine for preoperative anxiolytics and sedation has been associated with POCD. However, evidence regarding its impact on cognitive function is vague; some studies suggest a potential link between midazolam administration and cognitive impairment, while others report no effect or even an improvement in cognitive abilities. DEX is a potential neuroprotective agent in cardiac surgery. The effects of DEX on cognitive function, including a reduction in POCD incidence and severity, have been reported in several studies. It modulates the inflammatory responses, attenuates oxidative stress, and preserves cerebral perfusion. Although DEX and midazolam show promising results, their effects on cognitive function following open‐heart surgery are yet to be elucidated. Conclusion Various factors, including patient characteristics, perioperative management, and surgical procedures, may influence these outcomes, highlighting the need for further research to better understand the roles of these agents in cognitive function following open‐heart surgery.

Low vitamin D (serum or plasma 25‐hydroxyvitamin D (25(OH)D)) is a global pandemic and associates with a greater prevalence in all‐cause and cardiovascular mortality and morbidity. Open‐heart surgery is a form of acute stress that decreases circulating 25(OH)D concentrations and exacerbates the preponderance of low vitamin D in a patient population already characterized by low levels. Although supplemental vitamin D increases 25(OH)D, it is unknown if supplemental vitamin D can overcome the decreases in circulating 25(OH)D induced by open‐heart surgery. We sought to identify if supplemental vitamin D protects against the acute decrease in plasma 25(OH)D propagated by open‐heart surgery during perioperative care. Participants undergoing open‐heart surgery were randomly assigned (double‐blind) to one of two groups: (a) vitamin D (n = 75; cholecalciferol, 50,000 IU/dose) or (b) placebo (n = 75). Participants received supplements on three separate occasions: orally the evening before surgery and either orally or per nasogastric tube on postoperative days 1 and 2. Plasma 25(OH)D concentrations were measured at baseline (the day before surgery and before the first supplement bolus), after surgery on postoperative days 1, 2, 3, and 4, at hospital discharge (5–8 days after surgery), and at an elective outpatient follow‐up visit at 6 months. Supplemental vitamin D abolished the acute decrease in 25(OH)D induced by open‐heart surgery during postoperative care. Moreover, plasma 25(OH)D gradually increased from baseline to day 3 and remained significantly increased thereafter but plateaued to discharge with supplemental vitamin D. We conclude that perioperative vitamin D supplementation protects against the immediate decrease in plasma 25(OH)D induced by open‐heart surgery. ClinicalTrials.gov Identifier: NCT02460211. Open‐heart surgery induces acute stress and acute stress is detrimental to circulating 25‐hydroxyvitamin D (25(OH)D) concentration. We found that perioperative vitamin D supplementation abolished the decrease in circulating 25(OH)D following open‐heart surgery. Thus, supplemental vitamin D protects against the deleterious impact of acute stress on circulating 25(OH)D concentrations.

Background and Objectives: Adequate nutritional supplementation in infants with cardiac malformations after surgical repair is a challenge. Critically ill infants in the early postoperative period are in a catabolic stress. The mismatch between estimated energy requirement (EER) and the intake in the postoperative period is multifactorial, predisposing them to complications such as immune deficiency, more infection, and growth failure. This study aimed to assess the feasibility and efficacy of enriched breast milk feed on postoperative recovery and growth of infants after open heart surgery. Methodology: Fifty infants <6 months of age were prospectively randomized in the trial for enteral nutrition (EN) postoperatively from day 1 to 10, after obtaining the Institute Ethics Committee's approval. They were equally divided into two groups on the basis of the feed they received: Control group was fed with expressed breast milk (EBM; 0.65 kcal/ml) and intervention group was fed with EBM + energy supplementation/fortification with human milk fortifier (7.5 kcal/2 g)/Simyl medium-chain triglyceride oil (7.8 kcal/ml). Energy need for each infant was calculated as per EER at 90 kcal/kg/day, as the target requirement. The intra- and post-operative variables such as cardiopulmonary bypass and aortic cross-clamp times, ventilation duration, Intensive Care Unit (ICU), and hospital length of stay and mortality were recorded. Anthropometric and hematological parameters and infection control data were recorded in a predesigned pro forma. Data were analyzed using Stata 14.1 software. Results: The duration of mechanical ventilation, length of ICU stay (LOIS), length of hospital stay (LOHS), infection rate, and mortality rate were lower in the intervention group compared to the control group although none of the differences were statistically significant. Infants in control group needed mechanical ventilation for about a day more (i.e., 153.6 ± 149.0 h vs. 123.2 ± 107.0 h; P = 0.20) than those in the intervention group. Similarly, infants in control group stayed for longer duration in the ICU (13.2 ± 8.9 days) and hospital (16.5 ± 9.8 days) as compared to the intervention group (11.0 ± 6.1 days; 14.1 ± 7.0 days) (P = 0.14 and 0.17, respectively). The LOIS and LOHS were decreased by 2.2 and 2.4 days, respectively, in the intervention group compared to control group. The infection rate (3/25; 5/25) and mortality rate (1/25; 2/25) were lower in the intervention group than those in the control group. The energy intake in the intervention group was 40 kcal more (i.e., 127.2 ± 56.1 kcal vs. 87.1 ± 38.3 kcal) than the control group on the 10th postoperative day. Conclusions: Early enteral/oral feeding after cardiac surgery is feasible and recommended. In addition, enriching the EBM is helpful in achieving the maximum possible calorie intake in the postoperative period. EN therapy might help in providing adequate nutrition, and it decreases ventilation duration, infection rate, LOIS, LOHS, and mortality.

Background Percutaneous vertebroplasty (PVP) is a minimally invasive surgical technique in which polymethyl methacrylate (PMMA) is injected into the weakened vertebral body to strengthen it. However, this procedure is associated with various complications, the most common being cement leakage. Cardiac perforation caused by cement escape into the venous system is another complication, which is rare but potentially life‐threatening even if not treated promptly. Case Presentation Here, we report two elderly patients who developed cardiac perforation caused by cement escape into veins following PVP. Both patients had a history of severe osteoporosis. On admission, they presented with lower back pain and limited movement. MRI revealed vertebral bodies compression fracture in both patients. Considering the advanced age of the patients, PVP was performed to avoid the risk of potential complications associated with nonoperative therapy. Unfortunately, the rare and fatal postoperative complication, cardiac perforation caused by cement escape into veins, occurred in both patients. Emergency open‐heart surgery was performed to remove cement material and repair the heart, both patients recovered well and were discharged. Conclusions Although PVP is a safe and minimally invasive surgical technique, it is associated with various serious complications as seen in the present cases. We therefore recommend that surgeons should be aware of such complications. Appropriate timing of surgical operation, meticulous surgical procedures, early intraoperative and postoperative monitoring of cement leakage may improve outcomes of patients with such complications. Percutaneous vertebroplasty (PVP) is a minimally invasive surgical technique for treating various vertebral disorders via transpedicular injection of polymethyl methacrylate into affected vertebrae. Here, we report two rare cases of cardiac perforation caused by cement escape into the venous system after PVP. The complications were corrected via open‐heart surgery and patients were discharged after good recovery.

Aim To identify the factors associated with postoperative complications within the first 24 h among individuals who have undergone open‐heart surgery. Design A cross‐sectional study. Methods The participants were 192 elective open‐heart surgery patients admitted to a university hospital in Bangkok, Thailand. Data were collected through data recording forms and questionnaires between August 2023 and February 2024, including the clinical frailty scale health questionnaire, serum creatinine assessment form, systemic immune‐inflammation index, vasoactive‐inotropic score, Society of Thoracic Surgeons risk score and the comprehensive complication index. Multiple regression was used to analyse the data. Results Most of the participants (64.06%) were male with an average age of 63.14 (13.22) years. Almost a half of them (45.31%) were diagnosed with coronary artery disease. Frailty, kidney function, inflammation, the amount of packed red cells transfused, vasopressors and inotropes and operative risk were statistically significantly the factors affecting the severity of complications in patients after open‐heart surgery during the first 24 h. Conclusion The factors associated with postoperative complications specifically within 24 h after open‐heart surgery should be closely monitored, including frailty, kidney function, inflammation, the amount of packed red cells transfused, vasopressors and inotropes and operative risk in order to prevent the postoperative complications. Patient or Public Contribution All participants contributed to the conducting of this study by participating in a one‐day pre‐operation and post‐operation within 24 h.

Background: Because of recent advances in cardiopulmonary bypass (CPB) surgery, there are broadened indications to approach patients with a high operative risk. Meanwhile, there is an increasing number of patients with severe liver dysfunction subjected to open-heart surgery. This retrospective study was designed to evaluate the operative indications and clinical outcomes in patients with liver cirrhosis (LC) undergoing open-heart surgery. In addition, determinants influencing their prognosis were assessed. Patients and Methods: Between May 1996 and June 2005, 24 patients with LC underwent CPB open-heart surgery in our institution. The preoperative severity of the LC was determined according to the Child-Pugh classification. Their perioperative data were analyzed. Several perioperative factors were compared by multivariate logistic regression analysis between survivors and nonsurvivors to determine possible risk factors contributing to mortality. Results:There were 14 females and 10 males. Their age ranged from 36 to 72 (mean 53 ± 13) years. Seventeen cases were classified as having Child-Pugh class A LC, 6 as having Child-Pugh class B, and 1 as having Child-Pugh class C LC. All patients underwent CPB surgery. The mean operation time and the cross-clamp time were 160 ± 53 and 90 ± 42 min, respectively. During the first 24 h after the operation, the mean chest tube output was 1,080 ± 320 ml. The mean duration of mechanical ventilation was 32 ± 22 h, and the mean intensive care unit stay was 11 ± 8 days. Sixty-six percent of the patients experienced significant morbidity. Fifty-three percent of the patients with Child-Pugh class A LC and 100% of those with Child-Pugh class B and C LC suffered postoperative complications. The overall mortality rate was 25%. The postoperative mortality rates of the patients with Child-Pugh class A, B, and C LC were 6, 67, and 100%, respectively. Preoperative serum total bilirubin and cholinesterase levels and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values along with CPB time were identified as the important predictors to differentiate between survivors and nonsurvivors by multivariate logistic regression analysis. Conclusions: The Child-Pugh class is associated with hepatic decompensation and mortality after open-heart CPB surgery in patients with LC. Such surgery can be performed safely in patients with a Child-Pugh class A LC. But cardiac interventions using CPB in patients with more advanced LC are associated with high mortality and morbidity rates. The preoperative total plasma bilirubin and cholinesterase concentrations as well as the EuroSCORE along with the CPB time are identified as statistically significant predictors of mortality after open-heart surgery in patients with LC. Our findings indicate that patients with chronic liver disease scheduled for open-heart surgery should be carefully evaluated before the operation and that the CPB duration should be as short as possible.

Aim: We aimed to investigate the changes in respiratory mechanics in adult patients undergoing open heart surgery (OHS) while using volume-controlled auto-flow (VCAF) ventilation mode. Materials and Methods: After obtaining ethics committee's approval and informed consent, 30 patients (17 males and 13 females; mean age: 57.3 ± 17.0 years; mean weight; 74.9 ± 13.6 kg) scheduled for OHS were enrolled. Mechanical ventilation was carried out using VCAF mode (VT: 5-8 mL/kg, I/E: 1/2, 10 ± 2 fr/min). Values of dynamic compliance (Cdyn) and resistance (R) were obtained at six time points (TPs). Normally distributed variables were analyzed with repeated measure of analysis of variance and Bonferroni tests. For abnormally distributed variables, Friedman variance analysis and Wilcoxon signed-rank tests were used. Values were expressed as mean ± standard deviation. P value <0.05 was considered significant. Results: Cdyn (mL/mbar) and R (mbar/L/s) values were as follows - (1) before sternotomy (S): 49.9 ± 17.1 and 7.8 ± 3.6; (2) after S: 56.7 ± 18.3 and 7.1 ± 3.7; (3) after S and after sternal retractor placement: 48.7 ± 16.1 and 8.3 ± 4.4; (4) after weaning from cardiopulmonary bypass and following decannulation while retractor was in place: 49.6 ± 16.5 and 8.1 ± 4.0; (5) after retractor removal: 56.5 ± 19.6 and 7.4 ± 3.7; and (6) after sternal closure: 43.1 ± 14.2 and 9.6 ± 9.1, respectively. Significant differences were observed in Cdyn and R between; first and second TPs, second and third TPs, fourth and fifth TPs, and fifth and sixth TPs. Also, significant difference in Cdyn was found between first and sixth TPs, but it was not found in R. Conclusion: Cdyn decreases, but R remains the same in cardiac surgical patients when mechanical ventilation is performed with VCAF ventilation mode. Additionally, Cdyn is negatively affected by the presence of sternal retractor and the sternal closure in OHS.

CT angiography may be useful for early diagnosis of ischemic stroke after cardiac surgery. When patients diagnosed with large‐vessel occlusion, endovascular thrombectomy may be a therapeutic option and may improve their neurological complications. CT angiography may be useful for early diagnosis of ischemic stroke after cardiac surgery. When patients diagnosed with large‐vessel occlusion, endovascular thrombectomy may be a therapeutic option and may improve their neurological complications.

Epicardial left ventricular leads can be implanted at open‐heart surgery for cardiac resynchronization therapy. We report a 2‐year‐old fractured epicardial left ventricular lead detected at generator implant. It highlights the importance of good surgical implant technique and of rigorous lead evaluation for signs of impending failure at generator implant. Epicardial left ventricular leads can be implanted at open‐heart surgery for cardiac resynchronization therapy. We report a 2‐year‐old fractured epicardial left ventricular lead detected at generator implant. It highlights the importance of good surgical implant technique and of rigorous lead evaluation for signs of impending failure at generator implant.

Transcatheter aortic valve implantation (TAVI) is an established treatment for patients >75 years old with severe aortic stenosis. From the technique's beginnings in the early 2000s, over 20 years of experience in the TAVI procedure have allowed its wide diffusion with optimal procedural results. Intraprocedural complications during TAVI are yet a fearful scenario, sometimes requiring emergent open-heart surgery (EOHS) that is burdened by high intraoperative mortality (50% at 30 days). Furthermore, also when a surgical treatment is not needed, intraprocedural complications have a challenging management and a critical impact on patients’ prognosis. The volume of procedures in the last 10 years has been observed to increase substantially, with an incidence of major intraprocedural complications of around 1%. However, the features and specific incidence for each complication have not been revised recently. This work aims to update the knowledge about major intraprocedural complications during TAVI, considering the increased operators' experience and recent device developments. An updated point of view on major intraprocedural complications could suggest a need for change in the TAVI paradigm, promoting TAVI programs even in centers without on-site cardiac surgery.