Volume 41 - Issue 3

INTRODUCTION: The CHA₂DS₂-VA score, which is used to determine the risk of thromboembolism in patients with atrial fibrillation, has been shown to be a predictor of mortality in many cardiovascular diseases. However, there is no data in the literature on the effect of CHA₂DS₂-VA score on in-hospital mortality in patients with acute aortic dissection (AAD). We aimed to determine the effect of CHA₂DS₂-VA score on in-hospital mortality in patients with AAD.
METHODS: This retrospective cohort study included 113 patients (89 males, 24 females, age 58.7±10.5 years) who underwent surgical treatment for AAD. CHA₂DS₂-VA scores were calculated. All cases of in-hospital mortality during the follow-up period were identified and recorded. Patients were grouped as with and without mortality.
RESULTS: Among patients with AAD, in-hospital mortality was observed in 30 cases (27.5%). Mortality rates in patients with CHA₂DS₂-VA 1, 2, 3 and ≥ 4 were 7%, 13%, 27%, and 53%, respectively. Age, CHA₂DS₂-VA score, and high-sensitivity C-reactive protein serum level independently determined the patients with mortality, and each one unit increase in these parameters predicted 11.3%, 2.19-fold, and 3.2% mortality increase, respectively. In receiver operating characteristic analysis, when the cutoff value of CHA₂DS₂-VA score was taken as 3, it was found to determine the development of mortality due to AAD with 80.5% sensitivity and 78.6% specificity.
CONCLUSION: CHA₂DS₂-VA score is independently associated with the development of in-hospital mortality in patients with AAD. According to the findings of our study, the CHA₂DS₂-VA score may serve as a prognostic marker in patients with AAD.

INTRODUCTION: Public awareness and interest significantly influence research priorities and healthcare advancements. This study investigates the relationship between public interest, represented by Google Trends Relative Search Volume (RSV), and cardiothoracic research outputs over 21 years (2004 – 2024).
METHODS: A total of 26 conditions/surgeries representing eight topics of general cardiothoracic interest were identified from a review of various social media pages, society webpages, and hospital information bulletins. Data on the conditions were collected from Google Trends and PubMed^®. RSV values were calculated annually, and publication counts were extracted for each condition. The study used R (v4.3.3) for all statistical analyses and predictive models.
RESULTS: Trauma-related conditions and extracorporeal membrane oxygenation (ECMO) demonstrated increasing RSV and publication trends, with strong positive correlations (e.g., ECMO: r = 0.88, P < 0.0001). Conditions such as congenital cardiac anomalies (e.g., tetralogy of Fallot: r = -0.74, P < 0.0001) showed a negative correlation, with declining RSV despite ongoing research. Multiple regression revealed a significant positive relationship between RSV and publication counts when conditions were controlled (slope = 16.68, R² = 0.8081, P < 0.0001). Feature importance analysis showed that "Condition" had a slightly greater influence than RSV on publication trends.
CONCLUSION: The study demonstrates variability between public interest and research output across cardiothoracic conditions. While some conditions, such as trauma-related cases and ECMO, show alignment between public awareness and publication activity, others, including congenital anomalies, exhibit divergence.

INTRODUCTION: Women have historically been underrepresented in leadership positions and academia in cardiothoracic surgery, creating barriers to career advancement and limiting role models for trainees. While publications are used to measure success in academia, invited articles such as editorials often represent a formal recognition of expertise. The objective of this study was to identify trends in the gender of editorial authors published in cardiothoracic surgery journals.
METHODS: Editorials published between 2018 and 2022 across 16 peer-reviewed cardiothoracic surgery journals were analyzed. Author gender was estimated using a validated tool (https://gender-api.com/) with additional verification using available institutional profiles.
RESULTS: In total, 806 editorials were published with a total of 1,858 authors (293 women, 16%). Women authors were predominantly from the United States of America (45%) followed by India (9%) and Germany (8%). The percentage of women first authors increased between 2018 and 2022 (P < 0.001); 9% in 2018, 9% in 2019, 17% in 2020, 16% in 2021, and 23% in 2022. A similar trend was observed for women senior authorship (P < 0.0001) (6% in 2018, 9% in 2019, 14% in 2020, 15% in 2021, and 18% in 2022) as well as for editorials with all-women authorship (P < 0.0001), increasing steadily from 9% in 2018 to 20% in 2022.
CONCLUSION: Women authorship in editorials published in cardiothoracic surgery journals has steadily increased in recent years. Despite progress, women still make up less than a quarter of first and senior authors, highlighting a critical gap in gender equity in academic leadership that must be urgently addressed.

INTRODUCTION: David procedure has shown to be a low-risk perioperative procedure even in challenged scenarios cases, with favorable long-term outcomes and additional benefits linked to the avoidance of prosthetic valves, including freedom from anticoagulation and reintervention, reduced risk of thromboembolic complications and endocarditis. Furthermore, an aortic valve preservation program in Colombia confers probably specific advantages to our population, considering the sociodemographic factors of middle-income countries.
METHODS: A retrospective analysis was conducted on the clinical and perioperative results, as well as short-term follow-up data of patients who underwent David procedure at one clinical center from Colombia between November 2021 and June 2024.
RESULTS: One hundred and three patients were treated, with a mean age of 60 years, of whom 82.3% were male. In most cases, the preoperative diagnosis was aortic root dilation, with 80% presenting severe aortic insufficiency. Also 11.6% were initially diagnosed with type A acute dissection. The 30-day mortality was 0.9%. There were no cases of perioperative myocardial infarction nor dialysis requirement. Other complications were atrial fibrillation in 29.13% and acute renal failure in 9.7%. Follow-up was completed in 97.08% of cases, with survival rates at one year of 99%. Freedom from reintervention, endocarditis, and freedom from anticoagulation at one year were 100%, 100%, and 67%, respectively.
CONCLUSION: In our study, David procedure emerged as an effective procedure, offering potential benefits that could be particularly relevant in middle-income countries. Perioperative and follow-up outcomes were comparable to those reported in large series from high-income countries.

OBJECTIVE: To compare the clinical efficacy and safety of intra-aortic balloon pump (IABP) and levosimendan in coronary artery bypass grafting (CABG).
METHODS: A systematic search of PubMed^®, Embase, Cochrane Library, and Google Scholar was conducted through July 2024. Outcomes analyzed included atrial fibrillation, postoperative mediastinitis, the requirement for inotropic support, in-hospital mortality, postoperative intensive care unit (ICU) stay, postoperative length of stay, ventilation time, and mean arterial pressure (MAP) levels.
RESULTS: The analysis included nine studies with 681 patients. Levosimendan presented advantage over IABP in CABG patients in terms of postoperative ICU stay, postoperative length of stay, and reduction in MAP levels, with effect sizes: mean difference (MD) = -0.83, 95% confidence interval (CI) -0.97 to -0.68, P < 0.00001 = -1.14, 95% CI: -1.33 to -0.95, P < 0.00001, and MD = -4.55, 95% CI: -6.14 to -2.96, P < 0.00001, respectively. Levosimendan had an advantage on subgroup analyses in terms of postoperative ICU stay and postoperative length of stay, with effect sizes: MD = -0.83, 95% CI: -0.93 to -0.72, P < 0.00001 and MD = -1.14, 95% CI: -1.28 to -1.01, P < 0.00001, respectively. However, the incidence of postoperative mediastinitis was higher in the levosimendan group (relative risk = 1.45, 95% CI: 0.88 to 2.38), though not statistically significant.
CONCLUSION: Levosimendan may improve recovery and hemodynamic outcomes in high-risk CABG patients compared to IABP but may be associated with a higher, though non-significant, risk of mediastinitis. Further high-quality studies are warranted.

INTRODUCTION: Cycle ergometer in the postoperative period of open-heart surgery is a safe and economical exercise option. However, its specific effects, whether or not associated with conventional physiotherapy, are not well established in current literature. The objective of this study was to evaluate the effects of cycle ergometer exercise associated or not with conventional physical therapy, compared with only conventional physical therapy, on functional capacity, hospitalization time, peripheral muscle strength, and pulmonary complications of patients after open-heart surgery.
METHODS: MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, Embase, Physiotherapy Evidence Database, and Cochrane Library were searched; manual searches were also conducted in the references of the included studies. Randomized controlled trials that analyzed the effects of cycle ergometer exercise associated or not with conventional physical therapy compared with only conventional physical therapy in adult patients after an open-heart surgery were included. Methodological quality was assessed by Cochrane risk-of-bias tool, and the meta-analysis was undertaken using RevMan 5.3.
RESULTS: Mean difference in the six-minute walk test (31 meters, 95% confidence interval [CI]: 1.59 to 60.3 meters, P = 0.04) was higher and in intensive care unit stay was lower (-0.5 days, 95% CI: -0.86 to -0.14 days, P = 0.007) in the intervention group. The total hospitalization time (-0.18 days, 95% CI: -0.73 to 0.38 days, P = 0.53) didn't change between groups.
CONCLUSION: Cycle ergometer exercises improved functional capacity but with no clinically relevant effects on hospitalization time after open-heart surgeries.

Surgical left atrial appendage occlusion (S-LAAO) is increasingly performed during cardiac surgery, but perioperative outcomes remain uncertain. Using a nationwide Japanese inpatient database, we analyzed 25,059 adults undergoing valve or coronary bypass surgery (2020 – 2022). After propensity score matching (n = 2,543 each), addition of S-LAAO was not associated with differences in in-hospital mortality, transfusion, reoperation, or 30-day readmission compared to non-S-LAAO group. However, prolonged inotropic support (≥ 2 days) was more frequent with S-LAAO (40.8% vs. 34.7%; odds ratio 1.29, 95% confidence interval: 1.13 – 1.47). Addition of S-LAAO did not increase mortality but was linked to greater inotrope use, warranting further investigation.

We present a clinical case of mitral insufficiency in a 59-year-old patient with dextrocardia and complete transposition of the viscera. The patient underwent mitral valve posterior leaflet repair and annuloplasty. During the operation, a "mirror inversion” of the equipment and surgery team position was carried out. The special feature of the operation was due to the fact that the aorta and great vessels in the wound were mirror-image. The postoperative period proceeded without complications. Being aware of the patient's dextrocardia and hence organizing the surgical procedure appropriately, we could achieve good results in radical surgery for valvular heart disease.