ABSTRACT
BACKGROUND: A pulmonary artery catheter is often used in cardiac surgery despite its uncertain effectiveness. The aim of this pilot study was to investigate the associations between the use of a pulmonary artery catheter and clinical outcomes in off-pump coronary artery bypass grafting. METHODS: Patients over 20 years of age who had undergone off-pump coronary artery bypass grafting between December 2018 and November 2021 were enrolled in this single-center retrospective pilot study. The propensity score of pulmonary artery catheterization was calculated. Multivariate analysis including the propensity score as a covariate was performed to assess clinical outcomes. The primary outcome was the composite outcome of in-hospital death, unplanned intraoperative conversion to cardiopulmonary bypass, resuscitated cardiac arrest, mechanical circulatory support, myocardial infarction, stroke, new initiation of renal replacement therapy, inhaled nitric oxide, re-intubation and tracheostomy. RESULTS: Among the 315 patients who were enrolled, 298 were included in the final analysis. A pulmonary artery catheter was inserted in 131 patients. There were 50 patients with the composite outcome including two in-hospital deaths. Multivariate logistic regression analysis showed that pulmonary artery catheterization was not significantly related to the composite outcome. Clinical outcomes worsened significantly as the number of anastomoses increased (odds ratio: 1.450, 95% confidence interval: 1.040-2.040, P=0.029). CONCLUSIONS: Pulmonary artery catheterization did not improve the clinical outcomes in off-pump coronary artery bypass grafting in this pilot study.
ABSTRACT
The aim of this study was to investigate the association of postoperative acute kidney injury and unplanned re-admission rate due to heart failure at 2 years follow-up in patients who had extra-cardiac Fontan conversion. This was a retrospective single-center study of patients who underwent conversion from classic Fontan to extra-cardiac Fontan between January 2014 and December 2021. Acute kidney injury was defined using the Kidney Disease Improving Global Outcomes criteria. A total of 47 patients underwent Fontan conversion. Acute kidney injury occurred in 22 patients (46.8%) and 5 patients with acute kidney injury needed renal replacement therapy. Unplanned re-admission rate at 2-year follow-up was significantly higher in patients with acute kidney injury even when renal function returned to baseline (8 [36.4%] vs. 3 [12.0%], p = 0.026 by the log-rank test). In conclusion, postoperative acute kidney injury after extra-cardiac Fontan conversion was associated with unplanned re-admission due to heart failure at 2-year follow-up even though renal function was recovered.
ABSTRACT
BACKGROUND: Neonate patients have a reduced thoracic cavity, making thoracoscopic procedures even more challenging than their adult counterparts. METHODS: We evaluated five control strategies for robot-assisted thoracoscopic surgical looping in simulations and experiments with a physical robotic system in a neonate surgical phantom. The strategies are composed of state-of-the-art constrained optimization and a novel looping force feedback term. RESULTS: All control strategies allowed users to successfully perform looping. A user study in simulation showed that the proposed strategy was superior in terms of Physical demand p < 0.05 $\left(p< 0.05\right)$ and task duration p < 0.05 $\left(p< 0.05\right)$ . The cumulative sum analysis of inexperienced users shows that the proposed looping force feedback can speed up the learning. Results with surgeons did not show a significant difference among control strategies. CONCLUSIONS: Assistive strategies in looping show promise and further work is needed to extend these benefits to other subtasks in robot-aided surgical suturing.
