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OBJECTIVES: To compare the designed treatment protocols for the Quantra QPlus and rotational thromboelastometry (ROTEM) with regard to transfusion advice. DESIGN: Prospective observational study. SETTING: Maastricht University Medical Center, The Netherlands. PARTICIPANTS: Adults with elective cardiopulmonary bypass surgery with a ROTEM test. INTERVENTIONS: ROTEM tests were performed postoperatively for standard monitoring of coagulation status and clinical decision making. Simultaneously, a concurrent sample was analyzed for the Quantra QPlus. MEASUREMENTS AND MAIN RESULTS: A total of 100 samples were analyzed using both the ROTEM and Quantra QPlus. Agreement between the transfusion advice for the ROTEM and Quantra QPlus protocols were compared using Cohen κ values for i.a. fibrinogen, platelet concentrates, and fresh frozen plasma (FFP). The agreement between ROTEM and Quantra QPlus was poor for overall transfusion (0.174) and fibrinogen transfusion (0.300). The agreement of cutoff values for fibrinogen clot stiffness for the Quantra QPlus and EXTEM A10 for the ROTEM was poor (0.160). The fibrinogen clot stiffness and FIBTEM A10 had a moderate agreement (0.731). A Cohen κ could not be calculated for the agreement of protamine, thrombocytes, FFP or cutoff values for these transfusions since frequencies included zero in these cases. The Quantra QPlus transfusion protocol advises transfusion in many non-bleeders, adjustments appear to be necessary. In a small group of cases in which clinically relevant blood loss was observed, the Quantra QPlus advised administration of transfusion products, whereas the ROTEM tests did not. CONCLUSION: ROTEM-guided and Quantra-guided transfusion did not correspond in this patient group, and agreement was moderate at best. Specificity and sensitivity for transfusion within protocols were heterogeneous between the methods. More clinical research in high-bleeding risk populations is needed to determine the clinical impact of the different protocols.

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Haemangioma of the ribs is considered an extremely rare benign tumour. Here, we present a case of a young male with left tenth rib haemangioma vascularised by a costal artery giving the artery of Adamkiewicz presented as chronic cough. This was successfully treated through preoperative embolisation and surgical resection. A preoperative angiogram was performed to identify the origin of the artery of Adamkiewicz. The final diagnosis was confirmed histopathologically. There were no complications in the postoperative course and no recurrence during 12 months of follow-up.

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This was the case of a male patient in his 60s, who suddenly collapsed. When the ambulance team arrived, the initial waveform was pulseless electrical activity; accordingly, a supraglottic airway device was inserted, and the patient was immediately transported to a referring hospital. On arrival, the patient resumed spontaneous circulation, the patient was diagnosed with Stanford type B acute aortic dissection and was referred to the author's hospital, where diffuse swelling of the anterior cervical region was revealed. CT performed by the previous hospital revealed compression of the trachea. The cause of cardiac arrest was considered to be severe airway stenosis secondary to a retropharyngeal haematoma associated with Stanford type B acute aortic dissection. Stanford type B acute aortic dissection can be complicated by retropharyngeal haematomas, which can lead to airway obstruction and even cardiac arrest. This condition also requires careful airway examination.

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Although rare in the general population, pulmonary fungal infections usually occur in immunocompromised patients. The mainstay of pulmonary fungal infection treatment is prolonged intravenous antifungal therapy. However, surgical management may be required in cases of complex disease, resistance to medical therapy or percutaneous procedures, or associated complications such as fungal empyema and massive hemoptysis. In this series, we present three patients with complicated thoracic fungal infections who underwent individualized surgical management over a 3-month period in 2022 at our institution. Complicated pulmonary fungal infections require surgical intervention to ensure complete resolution. The choice of operation is dependent on several factors, and surgeons operating on these patients must be privy to the various surgical modalities that may be required to successfully treat these patients.

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A male patient in his 50s presented to the emergency department with a three-day history of shortness of breath, New York Heart Association class IV, and oxygen desaturation. His physical examination revealed a large volume radial pulse with bibasal crepitation in the lungs and a soft diastolic murmur in the aortic area on auscultation of his heart. He was managed on the line of decompensated heart failure. Transthoracic echocardiography showed a dissection flap in the ascending aorta with acute severe aortic regurgitation. A subsequent urgent CT angiography of the whole aorta confirmed a complex type A aortic dissection with an aneurysmal ascending aorta. An emergency type A aortic dissection repair (modified Bentall's procedure) was done. The patient made a good recovery, was discharged successfully 2 weeks after the procedure and was doing well on postoperative follow-up.

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Interprofessional education, an approach where healthcare professionals from various disciplines learn with, from, and about each other, is widely recognized as an important strategy for improving collaborative practice and patient outcomes. This narrative review explores the current state and future directions of interprofessional education in cardiothoracic surgery. We conducted a literature search using the PubMed, Scopus, and Web of Science databases, focusing on English-language articles published after 2000. Our qualitative synthesis identified key themes related to interprofessional education interventions, outcomes, and challenges. The integration of interprofessional education in cardiothoracic surgery training programs varies across regions, with a common focus on teamwork and interpersonal communication. Simulation-based training has emerged as a leading modality for cultivating these skills in multidisciplinary settings, with studies showing improvements in team performance, crisis management, and patient safety. However, significant hurdles remain, including professional socialization, hierarchies, stereotypes, resistance to role expansion, and logistical constraints. Future efforts in this field should prioritize deeper curricular integration, continuous faculty development, strong leadership support, robust outcome evaluation, and sustained political and financial commitment. The integration of interprofessional education in cardiothoracic surgery offers considerable potential for enhancing patient care quality, but realizing this vision requires a multifaceted approach. This approach must address individual, organizational, and systemic factors to build an evidence-based framework for implementation.

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BACKGROUND: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. CASE PRESENTATION: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. CONCLUSIONS: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.

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Simulation experiences are valuable to the training of future successful surgeons. These experiences introduce trainees to operational concepts through hands-on engagement within a low-stress environment to promote skill, information retention, and increased competency for future success in real-life scenarios. The study aimed to develop a low-cost, reproducible surgical simulation for teaching aortic valve replacement using porcine models. This study employed a single-center educational workshop design to provide trainees with a comprehensive wet laboratory experience in surgical aortic valve replacement using a porcine model. The simulation involved step-by-step procedures using porcine hearts in a wet lab environment, emphasizing specific surgical techniques such as suturing, knot tying, and valve replacement. Simulated valves were created using insulation foaming and aluminum wiring. The study was conducted at a southeastern medical school's wet lab. Thirty-eight preclinical medical students participated. The simulation was designed to provide a comprehensive overview of the steps involved in aortic valve replacement using porcine models. It emphasized the importance of teamwork, fundamental surgical skills, and effective communication within a surgical setting. The low-cost surgical simulation allowed trainees to learn technical skills that could be tailored to their proficiency level. Simulation for cardiothoracic procedures is limited by monetary spending and the availability of adequate materials to create a beneficial learning experience. This low-cost simulation allows resource-limited institutions to provide their students an additional opportunity to practice fundamental surgical principles such as suturing.

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Pulmonary mucormycosis is a rare, life-threatening fungal infection usually seen in immunocompromised patients. Mortality in such patients is high due to underlying immunosuppression and poor general condition of the patients. Invasion of the adjacent structures is known but, to the best of our knowledge, pulmonary mucormycosis presenting with a full thickness chest wall erosion has not been reported. We report such a case with chest wall destruction with superadded bacterial infection. The use of prosthetic materials for chest wall reconstruction was not possible due to the presence of infection. In addition, there were other intra-operative and post-operative challenges which we managed using a multidisciplinary approach. This report highlights the successful outcome of this complex situation using pre-operative optimisation, adequate surgical debridement and effective management of post-operative complications with patience and perseverance.

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Pulmonary sclerosing pneumocytoma (PSP) is a rare benign pulmonary tumour, most reported cases of PSP are from Eastern Asia, with a female to male ratio of 5:1, and average age at diagnosis in the 5th decade. We present the case of a 63-year-old Caucasian woman diagnosed with PSP who underwent a left lower lobe basal segmentectomy with systematic nodal dissection, performed via video assisted thoracic surgery (VATS).

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BACKGROUND: As more integrated cardiothoracic (CT) surgical residency programs are developed, there is increased interest in factors influencing specialty selection during undergraduate medical education. This study aimed to nationally assess interests and perceptions of CT surgery from medical students pursuing surgery and factors influencing such interests. METHODS: Active members of the American College of Osteopathic Surgeons - Medical Student Section were invited to complete an original survey. Means and 95% confidence intervals were calculated and graphed for questions using Likert scale responses. The comparison of mean responses for students in preclinical versus clinical years was assessed by a Kruskal-Wallis non-parametric ANOVA. Differences between response proportions were assessed via Bonferroni Comparison of Column Proportions. RESULTS: There were 306 surveys completed. Interest in CT surgery was indicated by 10.24% of respondents with preclinical students comprising 84.3% of those responses. Most students interested in CT surgery experienced certain factors including clinical exposure (78.4%), shadowing (81.8%), volunteering (57.1%), and significant personal/life events (86.2%) before medical school. Preclinical students noted exposure to CT surgery during preclinical years would further increase their interest when compared to clinical students (µ=4.12 versus µ=3.51, P<0.000). Importantly, clinical students feel significantly less supported by their school to pursue CT surgery compared to preclinical students (µ=2.45 versus µ=3.40, P<0.000). CONCLUSIONS: All factors establishing interest in CT surgery occurred before students entered medical school and during preclinical years. While there are negative perceptions associated with CT surgery, these may be ameliorated with increased support and resources for CT surgery during the preclinical years.

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Background: This study aimed to examine the prevalence of gender bias in the field of cardiothoracic vascular surgery in India and compared women surgeons and trainees in India and abroad. Methods: This was a comparative, cross-sectional analytical study using an online questionnaire. The survey included questions about demographics, career choice, training, academic and leadership opportunities, and the impact of choosing cardiothoracic-vascular surgery as a career on personal life. Results: A total of 203 practicing surgeons and trainees participated in the study and included 121 (59.6%) men and 82 (40.3%) women. Out of the 82 women, 48 (58.5%) were from India, and 34 (41.5%) were from other countries. Satisfaction with the specialty was similar among men and women (105 (86.7%) vs. 68 (82.9%), p = 0.44 respectively). Majority (n = 30, 62.5%) of the female surgeons in India reported being discriminated against, as well as receiving favored treatment 11 (22.9%). Compared to men, women surgeons in India were more frequently advised against pursuing a career in cardiothoracic and vascular surgery (p < 0.001) and were more frequently subjected to gender-related references (p < 0.001). In addition, they had fewer presentation opportunities (p = 0.016) at national or regional meetings during their training compared to men. Additionally, 50% (24) of the women in India reported being single, in contrast to 7% (6) of men, and only 15 (31.3%) women reported having a child, compared to 57 (66.3%) of the men. Conclusion: The study revealed significant gender disparities within the field of cardiothoracic vascular surgery in India and highlights the urgent need to address gender disparities and bias in cardiothoracic vascular surgery.

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Changes in cardiothoracic surgery (CTS) workforce trends have affected training paradigms to include the establishment of integrated six-year CTS residency (I6) programs. This study aimed to determine commitment of selected I6 program applicants to the specialty. Internal archives at a single institution were accessed to identify applicants interviewed for an I6 position from 2014 to 2016. A systematic internet search of publicly available information was performed to identify the trainee's current specialty. Descriptive analysis was performed. Forty-seven applicants were identified. Successful search results were achieved for 97.9 % of the applicants. One applicant was excluded, resulting in a cohort of 45. 48.9 % of the applicants successfully matched into I6 programs. Of the 23 who did not match into an I6 program, 91.3 % began a General Surgery (GS) residency. When looking solely at the GS trainees, 71.4 % sought and matched into a traditional or 4/3 CTS residency. In total, 77.8 % of the cohort are currently pursuing careers in cardiothoracic surgery. The study identified a strong continued interest in the field of CT Surgery among those interviewed for integrated residency. The methodology used in this study provided an effective way to follow career choice of applicants interviewed and could be applied by additional programs to further elucidate career choice and levels of commitment.

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BACKGROUND: Treatment for infective endocarditis (IE) is usually medical, with surgery reserved for those failing medical management or developing complications. Currently, 25%-50% of patients undergo surgery for IE with a 70%-80% immediate survival rate. However, there is controversy over the timing of surgery following cerebrovascular events, which occur in 15%-30% of IE patients. This study aimed to investigate whether surgical management is superior to medical management in patients with IE and to determine the optimal timing for surgery following the development of neurological symptoms. METHODS: Data were collected retrospectively between 2012 and 2018 from 436 patients diagnosed with IE and treated at our tertiary teaching hospital. The authors analysed the type of treatment, the timing of surgery, and the outcomes of these including mortality, IE recurrence, and length of hospital stay. RESULTS: A total of 421 patients were included in the analysis. More than two-thirds (69.1%) of patients underwent surgical intervention. The survival rate of patients having surgery for IE was 77.2%, compared to 50.7% in patients who did not undergo surgical intervention. 6.8% of patients presented with neurological symptoms; 73.3% of these patients had surgery within 14 days with a 90.9% survival. CONCLUSION: This study finds surgery to be safe with a seemingly higher survival rate compared to medical management alone, although this may be confounded by patients in the medical group being less likely to have surgery. Surgery in patients presenting with neurological symptoms is safe within 2 weeks from presentation with excellent outcomes.

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INTRODUCTION: Surgical repair is the standard of care for most infants and children with congenital heart disease. Cardiopulmonary bypass (CPB) is required to facilitate these operations but elicits a systemic inflammatory response, leading to postoperative organ dysfunction, morbidity and prolonged recovery after the surgery. Subzero-balance ultrafiltration (SBUF) has been shown to extract proinflammatory cytokines continuously throughout the CPB exposure. We hypothesize that a high-exchange SBUF (H-SBUF) will have a clinically relevant anti-inflammatory effect compared with a low-exchange SBUF (L-SBUF). METHODS AND ANALYSIS: The ULTrafiltration to enhance Recovery After paediatric cardiac surgery (ULTRA) trial is a randomised, double-blind, parallel-group randomised trial conducted in a single paediatric cardiac surgery centre. Ninety-six patients less than 15 kg undergoing cardiac surgery with CPB will be randomly assigned to H-SBUF during CPB or L-SBUF during CPB in a 1:1 ratio with stratification by The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) score 1 and STAT score 2-5. The primary outcome is peak postoperative vasoactive-ventilation-renal score. Time series and peak values of vasoactive-ventilation renal score, vasoactive-inotrope score, ventilation index and oxygenation index will be collected. Secondary clinical outcomes include acute kidney injury, ventilator-free days, inotrope-free days, low cardiac output syndrome, mechanical circulatory support, intensive care unit length of stay and operative mortality. Secondary biomarker data include cytokine, chemokine and complement factor concentrations at baseline before CPB, at the end of CPB exposure and 24 hours following CPB. Analyses will be conducted on an intention-to-treat principle. ETHICS AND DISSEMINATION: The study has ethics approval (#1024932 dated August 31, 2021) and enrolment commenced in September 2021. The primary manuscript and any subsequent analyses will be submitted for peer-reviewed publication. TRIAL REGISTRATION NUMBER: NCT04920643.

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BACKGROUND: The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. METHODS: A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. RESULTS: Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. CONCLUSION: Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

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Objective: Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. Method: Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. Results: African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. Conclusions: Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

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Cardiopulmonary bypass and extracorporeal membrane oxygenation have many similarities, but there are significant differences in managing hemostasis. Cardiopulmonary bypass includes shorter mechanical circulatory support times, blood stasis, higher flows, and an increased blood-air interface. These factors cause differences in the risk of coagulopathy, management of anticoagulation, monitoring of the hemostatic system, and management of coagulopathy. This article aims to identify these key differences in the hemostatic system between patients on cardiopulmonary bypass and those on extracorporeal membrane oxygenation.