Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

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David Rain
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Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Optimizing Outcomes in Adult Cardiac Surgery: Innovations, Challenges, and Future Directions

Manhal Rebhi Al Ramahi*, Nader Mahmoud Mohammad Bani Younis

Cardiac Surgery, Al Hussain AlSalt AlJadeed Hospital, Alsalt, Jordan

Abstract: Adult cardiac surgery remains one of the most complex and critical fields in modern medicine, with significant advancements over the past decades contributing to improved patient outcomes. However, despite these advancements, challenges persist in optimizing surgical results, reducing complications, and improving long-term survival and quality of life for patients. This research aims to provide a comprehensive analysis of current innovations in adult cardiac surgery, examining how these developments are addressing existing challenges and shaping the future of the field. The study begins with an overview of the most prevalent cardiac conditions necessitating surgical intervention, including coronary artery disease, valvular heart disease, and aortic aneurysms. We explore the latest surgical techniques, such as minimally invasive surgery, robotic-assisted procedures, and transcatheter interventions, assessing their impact on patient outcomes compared to traditional open-heart surgery. Additionally, we investigate the role of enhanced perioperative care, including the use of advanced imaging technologies, personalized anesthesia protocols, and improved post-operative rehabilitation strategies. A key focus of this research is the ongoing challenge of managing high-risk patients, including those with comorbidities, advanced age, or complex anatomical considerations. We analyze the effectiveness of preoperative risk stratification tools, the development of tailored surgical approaches, and the implementation of enhanced recovery protocols to improve outcomes in these patient populations. The study also delves into the economic and ethical considerations of adopting new technologies and procedures in cardiac surgery. We discuss the balance between innovation and accessibility, highlighting the need for evidence-based practices that ensure equitable care for all patients. Finally, the research outlines future directions in adult cardiac surgery, emphasizing the potential of emerging technologies such as artificial intelligence, 3D printing, and regenerative medicine to revolutionize the field. By examining these innovations in the context of current challenges, this research aims to provide valuable insights for clinicians, researchers, and policy makers dedicated to advancing the care of adult cardiac surgery patients.

Keywords: Adult Cardiac Surgery, Coronary Artery Disease, Valvular Heart Disease, Minimally Invasive Surgery, Robotic-Assisted Surgery, Transcatheter Interventions, High-Risk Patients, Preoperative Risk Assessment, Enhanced Recovery Protocols, Cardiovascular Innovations

Received March 26, 2025; Revised April 29, 2025; Accepted May 06, 2025

Citation: Manhal Rebhi Al Ramahi, Nader Mahmoud Mohammad Bani Younis, Optimizing Outcomes in Adult Cardiac Surgery: Innovations, Challenges, and Future Directions. Global Journal of Surgery, 13 (1). 1-11. January 2025. doi:10.12691/js-13-1-1

1. Introduction

Adult cardiac surgery represents a critical domain within cardiovascular medicine, essential for treating severe and often life-threatening heart conditions, including coronary artery disease, valvular heart disorders, and aortic aneurysms. As the incidence of cardiovascular disease continues to increase globally, the need for effective and safe surgical interventions has grown exponentially. Over the past several decades, significant advancements have been made in surgical techniques, perioperative care, and patient management, leading to substantial improvements in patient outcomes and survival rates. However, these advancements have also brought forth new challenges, particularly in managing complex cases and ensuring that cutting-edge innovations are accessible to all patients.

Historically, open-heart surgery has been the cornerstone of cardiac surgical practice. While this approach remains the gold standard for many procedures, the field is experiencing a paradigm shift towards less invasive techniques. Minimally invasive surgery, robotic-assisted procedures, and transcatheter interventions have begun to revolutionize the landscape of adult cardiac surgery. These innovations promise numerous benefits, including reduced postoperative pain, shorter hospital stays, and quicker recoveries. Nevertheless, their widespread adoption is hindered by factors such as the varying levels of surgeon expertise, the availability of resources, and the diverse clinical presentations of patients.

One of the foremost challenges in adult cardiac surgery is the management of high-risk patients, particularly those with multiple comorbidities, advanced age, or complex anatomical considerations. The development of advanced preoperative risk assessment tools, along with tailored surgical techniques and enhanced recovery protocols, has shown potential in improving outcomes for these patients. However, integrating these advancements into standard practice remains a significant hurdle that requires ongoing research and innovation.

In addition to clinical challenges, the economic and ethical implications of adopting new surgical technologies must be carefully considered. The balance between fostering innovation and maintaining cost-effective, equitable care is crucial to ensuring that advancements in cardiac surgery benefit all patient populations. The disparities in access to these cutting-edge treatments highlight the need for policies and practices that promote fairness and inclusivity in healthcare.

This research aims to provide a comprehensive overview of the current state of adult cardiac surgery, focusing on recent innovations, the challenges associated with high-risk patient management, and the future directions of the field. By analyzing the latest developments and identifying areas for improvement, this study seeks to contribute valuable insights that will aid clinicians, researchers, and policymakers in enhancing the outcomes of adult cardiac surgery.

Cardiac surgery in the adult population is a complex and critical medical intervention that is often necessary to treat various cardiac conditions. Literature on adult cardiac surgery encompasses a wide range of topics including surgical techniques, patient outcomes, complications, and advancements in the field. Several studies have highlighted the importance of preoperative evaluation, perioperative management, and postoperative care in improving patient outcomes following cardiac surgery. One key aspect of adult cardiac surgery literature is the evaluation of different surgical techniques such as coronary artery bypass grafting (CABG), valve replacement, and heart transplantation. Studies have compared the efficacy and safety of these procedures, highlighting the importance of individualized treatment plans based on patient characteristics and underlying cardiac pathology. [1]

Adult cardiac surgery presents significant economic concerns due to its high costs and impact on healthcare systems. A literature review on this topic reveals several key factors influencing the economic aspects of adult cardiac surgery. Studies by Zywot et al. (2018) have highlighted the rising costs associated with advanced surgical techniques and technology in cardiac procedures. [2] Additionally, research by Smith and Jones (2019) emphasizes the economic burden of post-operative complications and readmissions following cardiac surgery. [3]

2. Methods

Study Design

This research aimed at evaluating the impact of recent innovations in adult cardiac surgery on patient outcomes. The study also explores the challenges associated with managing high-risk patients and examines the economic and ethical implications of these innovations.

Study Population

The study includes adult patients aged 18 and older who underwent cardiac surgery at AlHussain AlSalt Aljadeed Hospital in AlSalt - Jordan between December 1, 2022 and September 30, 2024. Patients were eligible for inclusion with a diagnosis of Coronary Artery Disease, 3 Vessel Disease with total occlusion of the Left Main Artery, Valvular Heart Disease, Aortic Aneurysm, Congenital Heart Defects,Heart Failure, Arrhythmia and underwent surgical intervention, including Coronary Artery Bypass Graft (CABG),Valve Replacement, Transcatheter Procedure, Implantation of VAD(Ventricular Assist Device), Implantation of Pacemaker or ICD,Pericardial Effusion and Draining. Exclusion criteria included patients who had previous cardiac surgeries within the last 6 months and those with terminal illnesses.

Research on patient outcomes following adult cardiac surgery has shown a significant improvement in survival rates and quality of life postoperatively. Factors such as age, comorbidities, and surgical complications have been identified as predictors of surgical outcomes requiring comprehensive risk assessment and management strategies. [4]

Data Collection

Data was gathered from the electronic medical records (EMR) of 212 patients in the hospital setting, with a keen focus on various parameters encompassing the preoperative, intraoperative, and postoperative phases.The following variables were extracted:

Demographic Information

Figure 1. Demographic Distribution of Age Groups in Cardiac Surgery Patients:

The age distribution of patients undergoing cardiac surgery highlights significant insights into the population most affected by cardiac conditions requiring surgical intervention. The data reveals that:

• 18-30 years old (4.2%): This group represents a small proportion of patients, likely due to the relatively lower prevalence of advanced cardiac diseases in younger individuals. This suggests that cardiac surgeries in this range group are primarily due to congenital heart conditions, early onset of cardiovascular diseases, or rare complications.

• 31-50 years old (20.3%): A larger portion of patients falls within this range, potentially reflecting the early onset of lifestyle- related cardiac conditions such as coronary artery disease or valvular disorders. These patients may have potential benefit from advancements in early diagnostic techniques and interventions aimed at delaying disease progression.

• 51-70 years old (67.5%): This group constitutes the majority of patients, emphasizing that middle-aged to older adults are the primary recipients of cardiac surgeries. This could be attributed to the cumulative effect of aging, lifestyle factors, and the progression of chronic cardiovascular conditions. This demographic highlights the need for precision in surgical approaches, preoperative optimization, and postoperative rehabilitation tailored to the physiological changes associated with aging.

• 71-90 years old (8%): the representation of this older age group is notable, as it reflects the growing trend of extending cardiac interventions to patients in advanced age brackets. This can be attributed to advancements in surgical techniques, anesthesia , and perioperative care, enabling older adults to undergo these complex procedures with better outcomes. However, it also underscores the importance of comprehensive risk assessment and multidisciplinary care to address age-related comorbidities.

Figure 2. Gender Distribution among Adult Cardiac Surgery Patients

The data reveals a significant gender disparity among patients undergoing adult cardiac surgery:

• Males (77.4%): The overwhelming majority of patients are male, reflecting the higher prevalence of cardiovascular diseases in men. Studies have shown that men are more prone to conditions such as coronary artery disease and myocardial infarction at younger ages compared to women, likely due to differences in hormonal protection, lifestyle factors, and genetic predispositions. This highlights the importance of targeted preventive strategies and early interventions tailored to men.

• Females (22.6%): Women represent a smaller proportion of the patient population, which may be attributed to several factors. Women generally develop cardiovascular diseases later in life, often post -menopause, when the protective effects of estrogen decline. Additionally, underdiagnosis and delayed recognition of heart disease in women could contribute to the lower representation. This underscores the need for improved awareness in gender specific tools and management strategies to address these disparities.

Figure 3. Lifestyle Factors in Cardiac Surgery Patients

The lifestyle data gathered provides important insights into habits that may contribute to the prevalence of cardiac conditions and influence surgical outcomes.

• Cigarette Smoker (66.4%): A significant majority of patients report cigarette smoking as a lifestyle habit. Smoking is a well - established risk factor for cardiovascular disease, contributing to conditions such as coronary artery disease, atherosclerosis, an impaired vascular function. The higher percentage of smokers highlights the critical need for targeted smoking cessation programs, particularly for preoperative optimization and postoperative recovery.

Implications: Smoking increases perioperative risks, including poor wound healing, respiratory complications, and higher likelihood of adverse cardiovascular events. Addressing this risk through pre- surgical counselling and smoking cessation support can significantly improve surgical outcomes.

• Vape Users (2.5%): A relatively small proportion of patients report vaping. While Vaping is often marketed as a safer alternative to smoking, emerging research indicates that it may still pose cardiovascular risks, including increased blood pressure and endothelial dysfunction.

Implications: The presence of vape users among patients signals the need for further investigation into its long -term effects on cardiac health, as well as preoperative guidelines addressing vaping cessation.

• Alcohol Intake (1.4%): Only a small percentage of patients report alcohol consumption. While moderate alcohol intake has been debated for potential cardiovascular benefits, excessive use is associated with hypertension, arrhythmias and other cardiac complications. The low prevalence may indicate either underreporting or a less significant role of alcohol as a risk factor in this patient population.

Implications: Education on the potential risks of alcohol abuse, as well as its impact on surgical and recovery outcomes, remains important, even for a small subset of patients.

• No Vices (29.7%): Nearly one-third of patients report no smoking, vaping or alcohol use, suggesting healthier lifestyle choices in this group. This demographic represents a lower risk population for certain cardiovascular conditions directly linked to these vices.

Implications: While this group may face fewer lifestyle- related risks, other factors such as diet, physical activity, and genetic predispositions should be explored to understand their cardiac health needs comprehensively.

Preoperative Assessments

Interpreting the Body Mass Index (BMI) data for adult cardiac surgery is crucial in understanding the relationship between patients' BMI distribution and potential outcomes, challenges, and opportunities for innovation within the field. The BMI data gathered from patients who underwent cardiac surgery provides valuable insights that can inform decision-making and improve patient care.

Figure 4. BMI Distribution Among Patients Undergoing Cardiac Surgery

1. Distribution Analysis

• The BMI values range from 19 to 47, with the majority of patients in the overweight (25-29.9) and obesity (≥30) categories.

• The most frequent BMI categories are 29 (32 patients), followed by 30 (20 patients), and 32 (19 patients).

2. Clinical Relevance

• Impact on Surgical Outcomes:

• Overweight and Obese Categories: These patients typically face higher risks of perioperative complications, such as infections, delayed wound healing, and respiratory challenges. They also tend to have longer recovery times.

• Underweight Patients (BMI < 19): Although few in this dataset, they may have reduced physiological reserves, making them more vulnerable to surgical stress and poor healing.

• Innovations to Address BMI-Associated Risks:

• Prehabilitation Programs: Customized programs to optimize weight and cardiovascular fitness pre-surgery could improve outcomes.

• Tailored Anesthetic and Surgical Approaches: Minimally invasive techniques may reduce the risks associated with higher BMI.

• Postoperative Care Enhancements: Obesity-related complications could be mitigated through advanced wound care protocols and enhanced monitoring.

3. Challenges

• Managing patients with BMI > 35 (categorized as Class II and III Obesity) presents challenges in:

• Surgical Accessibility: Difficulties due to body habitus.

• Equipment Limitations: Standard surgical tools may not accommodate extreme BMIs.

• Anesthetic Challenges: Increased risk of airway and ventilatory complications.

• Long-Term Cardiac Rehabilitation: Obesity limits physical activity post-surgery, reducing rehabilitation effectiveness.

4. Future Directions

• Customized Surgical Planning:

• Utilizing predictive modeling to tailor interventions based on BMI.

• Innovative Technologies:

• Robotics and advanced imaging to overcome physical and technical challenges posed by higher BMIs.

• Focus on Weight Management Programs:

• Multidisciplinary pre- and post-surgical interventions combining dietary, pharmacological, and behavioral strategies to optimize BMI.

• Long-Term Data Collection and Analysis:

• Establishing BMI-outcome correlations specific to cardiac surgeries to inform practice guidelines.

• Addressing BMI-specific Needs: The concentration of patients in the higher BMI ranges underscores the need for targeted strategies.

• Multidisciplinary Collaboration: Integrating nutritionists, physiotherapists, and bariatric specialists into the cardiac surgery team can improve outcomes.

Figure 5. The following data represent the distribution of patients based on their EuroSCORE (European System for Cardiac Operative Risk Evaluation), which is a risk stratification tool used in cardiac surgery

Risk Categories:

• Low-Risk (Score ≤ 3):

• Patients: 40

• Percentage: 18.87%

Moderate-Risk (Score 4–9):

• Patients: 162

• Percentage: 76.42%

High-Risk (Score ≥ 10):

• Patients: 10

• Percentage: 4.72%

1. Dominance of Moderate-Risk Group:

• A significant majority of patients (76.42%) fall into the moderate-risk category, suggesting this group should be the focus of most interventions and innovations.

2. Low and High-Risk Representation:

• Low-risk patients account for 18.87% of the total, showing a need for continued preventive measures.

• High-risk patients are a small subset (4.72%), but they might require highly specialized care and innovations to optimize outcomes.

3. Central Tendency:

• The mean score (5.35) and median score (5) align closely with the moderate-risk category, reinforcing its prominence.

Figure 6. STS Score

1. Overall Distribution:

• The total number of patients analyzed is 212, distributed across a wide range of STS scores from 1 to 111.

• A significant majority of patients have scores between 11 and 20, representing a critical range where intervention outcomes could vary substantially.

2. Most Common Scores:

• The most frequently occurring score is 11, accounting for 38 patients (17.9%).

• Other notable peaks include:

• 17 with 21 patients (9.9%).

• 19 with 17 patients (8.0%).

• 16 with 14 patients (6.6%).

These scores suggest a clustering in the moderate-to-high-risk category, reflecting the need for focused perioperative strategies.

3. Rare Scores:

• Low-frequency scores like 1, 2, 3, and the exceptionally high scores 50 and 111 represent extremes.

• Low scores (e.g., 1, 2, 3): Likely indicate patients with minimal risk, suggesting excellent pre-surgical conditions.

• High scores (e.g., 50 and 111): Represent very high-risk patients requiring advanced monitoring and tailored surgical interventions.

4. Implications for Outcomes:

• Scores between 11 and 20 dominate the dataset and likely represent patients with manageable but significant risks.

• Identifying patterns in this range (e.g., outcomes based on surgical techniques or comorbidities) could help optimize resource allocation.

5. Actionable Insights:

• Targeted Interventions: For scores 11 to 20, specific protocols can be developed to improve outcomes, as these patients form a significant portion of the population.

• High-Risk Patients: Patients with scores 50 and above need specialized, multi-disciplinary care pathways due to their critical conditions.

3. Comorbidities

Comorbidities play a crucial role in the outcomes of adult cardiac surgery, influencing both perioperative risks and long -term recovery . Patients undergoing cardiac procedures often present with multiple pre- existing conditions that can complicate surgical management and post - operative recovery.

In this study, Hypertension(84.9%) emerged as the most prevalent comorbidity, underscoring its strong association with cardiovascular disease and the increased risk of complications such as arrhythmias and heart failure. Diabetes (56.1%) and Dyslipidemia (51.9 %) were also highly prevalent, reflecting the metabolic and vascular challenges these conditions pose in surgical patients.Chronic Kidney Disease (11.8%) - though less common- adds significant perioperative risks, particularly regarding fluid balance and medication metabolism. Lastly, Obesity (6.6 %), though the least frequent, remains a notable impact on wound healing, infection risk and respiratory function.

Understanding these comorbidities is essential for optimizing surgical outcomes through tailored perioperative strategies, risk stratification and post-operative plans.

Figure 7. Comorbidities

Figure 8. Pre Operative Assessment (Diagnosis)

Pre Operative Assessment (Diagnosis)

Perioperative assessment in adult cardiac surgery plays a crucial role in optimizing outcomes by ensuring comprehensive evaluation and management of patients before, during, and after surgery. This assessment involves a multidisciplinary approach that includes thorough preoperative evaluation, risk assessment, and optimization of comorbidities to minimize complications and improve postoperative recovery. [5]

Key components of perioperative assessment in adult cardiac surgery include assessing cardiac function, evaluating pulmonary function, identifying and optimizing comorbidities such as diabetes and hypertension, and addressing psychological factors that may impact surgical outcomes. Additionally, assessing nutritional status, identifying potential drug interactions, and ensuring adequate patient education are essential aspects of perioperative assessment.[6]

Perioperative assessment in adult cardiac surgery is a critical step in ensuring the best possible outcomes for patients undergoing cardiac procedures. By following evidence-based guidelines and incorporating a comprehensive approach to assessment, healthcare providers can effectively optimize outcomes and improve patient care.

In this study, Coronary Artery Disease (CAD) is the most common diagnosis, making it the dominant condition among patients. Valvular Heart Disease (VHD) follows, suggesting a significant but smaller proportion of patients require valve-related interventions. 3 Vessel Disease with total occlusion of the Left Main Artery indicating a subset of severe coronary disease.

4. Comorbid Conditions

• 3 cases involved both Coronary Artery Disease and Valvular Heart Disease, highlighting the complexity of managing dual pathology.

• 1 case involved CAD, Valvular Heart Disease, Heart Failure, and Arrhythmia, representing a highly critical condition.

• 1 case involved CAD and Heart Failure, showing the overlap between coronary disease and cardiac dysfunction.

• 1 case involved Valvular Heart Disease and Heart Failure, which may indicate advanced-stage valvular dysfunction.

Implications for Surgery and Patient Management:

• High prevalence of CAD suggests a strong need for coronary interventions, including bypass surgery and percutaneous coronary intervention (PCI).

• Valvular cases require careful pre-operative assessment for valve replacement or repair strategies.

• Severe multi-vessel disease cases and those with additional complications (heart failure, arrhythmia) will need multidisciplinary planning for surgical and post-operative care.

Cardiac Surgery encompasses a range of interventions tailored to address various cardiovascular pathologies, from ischemic heart disease to structural and congenital abnormalities. The choice of procedure is influenced by patient- specific factors, disease severity and advancements in surgical techniques.

Figure 9, Coronary Artery Bypass Graft (CABG) surgery was the most frequently performed procedure (81.6%), reinforcing its role as the standard treatment for severe coronary artery disease . Valve replacement (13.7%) was also a significant intervention, reflecting the burden of valvular heart disease requiring surgical correction. less commonly, transcatheter procedures (0.5%) were utilized, suggesting a preference for open surgery in most cases.

Although ventricular assist devices (VAD) and pacemaker implantations were not recorded, the presence of pericardial effusion drainage cases (2.8%) and congenital heart surgeries (4.7%) highlight the diversity of cardiac pathologies requiring surgical intervention . These findings emphasize the importance of a multidisciplinary approach in optimizing surgical outcomes and improving patient prognosis.

Figure 9. Intraoperative Data (Type of Surgery Performed/ Intervention)

Figure 10. Post Operative Outcome

Figure 11. Complications following Cardiac Surgery

Intraoperative Data: Type of surgery

Post-Operative Outcomes in Adult Cardiac Surgery

Post-operative outcomes in adult cardiac surgery are key indicators of patient recovery and healthcare efficiency. These outcomes are often assessed using metrics such as the length of hospital stay (LOS) and ICU admission rates, which provide insights into surgical success, complications, and resource utilization. Furthermore, studies by Brown et al. (2020) have explored the cost-effectiveness of different surgical approaches in adult cardiac procedures, shedding light on the importance of optimizing resource allocation. Moreover, the research by Johnson and Lee (2017) underscores the financial implications of prolonged hospital stays and intensive care unit utilization in adult cardiac surgery patients. [7]

From the available data:

• The majority of patients had a hospital stay of 4-7 days, suggesting a typical recovery period following cardiac surgery.

• A smaller proportion required extended hospitalization (10-15 days or more than 15 days), which may indicate complications, comorbidities, or delayed recovery.

• ICU admissions were most common within the 2-3 day category, likely reflecting standard post-operative monitoring before transitioning to a general ward.

• A decreasing trend in ICU stays beyond this period suggests that prolonged intensive care is relatively uncommon but could be associated with severe cases or post-surgical complications.

Understanding these trends helps optimize patient management strategies, enhance recovery protocols, and minimize prolonged hospital stays, ultimately improving overall patient outcomes.

Post-Operative Complications in Adult Cardiac Surgery

Post-operative complications significantly impact recovery, length of hospital stay, and overall patient outcomes following adult cardiac surgery. Identifying and addressing these complications is crucial for optimizing post-surgical care.

Interpretation:

• Infection (2.8%) and bleeding (2.4%) were relatively uncommon but remain critical concerns that can prolong recovery and increase morbidity.

• A significant majority (94.8%) of reported complications fell under "Others," including:

ο Cardiac-related issues: Arrhythmias, heart failure, rapid atrial fibrillation, and low ejection fraction (EF) were prevalent concerns. These complications may require prolonged monitoring, medication adjustments, or additional interventions.

ο Respiratory complications: Pulmonary edema, chest infections, and chronic obstructive pulmonary disease (COPD) highlight the importance of postoperative respiratory management, especially in high-risk patients.

ο Neurological complications: Stroke and cerebrovascular accidents (CVA) were reported, emphasizing the need for perioperative neuroprotection strategies.

ο Other metabolic and surgical concerns: Issues like uncontrolled diabetes mellitus (DM), uncontrolled INR, pleural effusion, and the need for redo surgeries further illustrate the multifactorial nature of post-operative challenges.

Understanding the distribution and nature of these complications helps refine surgical techniques, enhance post-operative monitoring, and develop targeted interventions to improve patient outcomes.

Figure 12. Readmission

Hospital readmission following cardiac surgery is a critical metric for evaluating post-operative outcomes and patient recovery. Research has shown that readmissions can often be attributed to various factors such as post-operative complications, inadequate discharge planning, and underlying comorbidities (Bagai et al., 2018). These factors can significantly impact the overall success of the surgical procedure and the patient's long-term health.[8]

Several studies have highlighted the importance of addressing these issues to reduce the rate of hospital readmissions following cardiac surgery. For example, a study by Vemulapalli et al. (2019) emphasized the need for comprehensive discharge planning to prevent readmissions related to medication errors and post-operative complications. [9] Similarly, Khera et al. (2020) underscored the role of effective communication between healthcare providers and patients in ensuring a smooth transition from hospital to home, thereby reducing the risk of readmission. [10]

Moreover, the presence of underlying comorbidities has been identified as a significant risk factor for readmission following cardiac surgery (Stahel et al., 2017). [11]

Managing these comorbidities effectively during the perioperative period can help improve patient outcomes and reduce the likelihood of readmission.

Interpretation:

• 7.2% of patients required readmission, indicating that while the majority of patients had successful recoveries, a small percentage experienced post-discharge complications that necessitated hospital care.

• 92.8% of patients were not readmitted, suggesting that most post-operative care plans, rehabilitation strategies, and follow-ups were effective in preventing complications severe enough to require hospitalization.

Causes of Readmission

Given the previously analyzed complications (e.g., arrhythmias, infections, pulmonary edema, stroke, and uncontrolled diabetes), some potential reasons for readmission could include:

• Post-operative infections or wound complications

• Cardiac-related issues such as arrhythmias or heart failure

• Respiratory complications like pulmonary edema or pleural effusion

• Metabolic imbalances, such as uncontrolled diabetes or INR fluctuations

Implications for Patient Care

• Strengthening discharge planning and outpatient follow-up could help reduce readmission rates.

• Early identification and management of high-risk patients (e.g., those with comorbidities like COPD or diabetes) may prevent avoidable readmissions.

• Post-operative education on self-care, medication adherence, and warning signs of complications could further enhance outcomes.

Overall, the low readmission rate is a positive indicator of effective surgical and post-operative care, but further analysis of the readmitted cases could help refine future interventions.

The economic concerns surrounding adult cardiac surgery are multifaceted and require careful consideration to ensure optimal resource utilization and cost-effectiveness. By examining the factors influencing costs, such as advanced technologies, post-operative complications, and length of hospital stay, healthcare providers can implement strategies to mitigate economic burdens while maintaining high-quality care for patients undergoing cardiac surgery. [12]

Figure 13. Long-term Follow-up

Long-term follow-up after adult cardiac surgery is essential for ensuring optimal patient recovery and identifying any potential complications that may arise post-operation. However, in this study, only 12.9% of patients received long-term follow-up, while 87.1% did not. Understanding the reasons for follow-up can help improve post-surgical care and patient outcomes.

Among the patients who required long-term follow-up, the key reasons included:

• Cardiac complications: Heart failure, low ejection fraction (EF), ischemic heart disease (IHD), and arrhythmias.

• Surgical site infections: Wound infections, including leg and chest wounds.

• Anticoagulation management: Uncontrolled INR for mechanical valves and warfarin dose adjustments.

• Neurological events: Stroke and transient ischemic attack (TIA).

• Respiratory complications: Pulmonary congestion and heart-lung failure.

The predominance of heart failure and low EF among follow-up patients suggests the need for enhanced post-operative management strategies. Additionally, surgical site infections and anticoagulation issues highlight areas for quality improvement in perioperative care.

5. Discharge Criteria

Discharge disposition is a crucial indicator of post-operative recovery and overall surgical outcomes in adult cardiac surgery. This study, which included 112 patients, analyzed discharge destinations, revealing that the majority were discharged home (85.8%), while a smaller percentage required transfer to a long-term facility (6.1%). Unfortunately, 8% of patients did not survive post-surgery. Understanding these outcomes helps evaluate post-operative care quality and areas for improvement.

Figure 14. Discharge Criteria

Innovations, Challenges and Future Directions

In this study, it has become evident that the utilization of advanced technologies is imperative for enhancing the efficacy of adult cardiac surgery and improving patient outcomes. Among the innovative techniques that have shown promising results is minimal invasive cardiac surgery, a procedure that our center has successfully implemented with a remarkable 100% survival rate from operations, devoid of complications. Embracing such cutting-edge approaches not only signifies a commitment to excellence in healthcare but also underscores a dedication to prioritizing patient well-being.

The landscape of cardiac surgery is continuously evolving, presenting a myriad of advanced technologies that hold great potential in revolutionizing surgical practices. With a strategic focus on integrating these modern advancements into our clinical protocols, we anticipate a paradigm shift towards more efficient, cost-effective, and successful surgical interventions. By harnessing the power of these technologies, we aim to further elevate the standard of care we provide to our patients, ensuring optimal surgical outcomes and improved quality of life post-surgery.

As we navigate the complexities of modern healthcare, it is imperative to remain at the forefront of technological advancements in cardiac surgery. By exploring and adopting innovative solutions tailored to meet the evolving needs of our patients, we pave the way for a future where excellence in cardiac care is not only achievable but sustainable. Through a proactive embrace of advanced technologies, we are poised to redefine the landscape of adult cardiac surgery, setting a new standard of excellence in patient care and surgical outcomes.

Several advancements in adult cardiac surgery, including minimally invasive techniques, robotic-assisted surgery, and transcatheter interventions, have revolutionized the field and provided new treatment options for patients with complex cardiac conditions.[13]

Artificial intelligence (AI) is being increasingly utilized in adult cardiac surgery for image analysis, preoperative planning, and predictive modeling. AI algorithms can analyze vast amounts of patient data to help surgeons make more informed decisions, leading to better treatment strategies and personalized care options. Additionally, AI-powered robotic systems have the potential to assist surgeons during complex procedures, reducing human error and improving surgical accuracy. [14]

3D printing technology has enabled the creation of patient-specific cardiac models, which can be used for preoperative planning, simulation, and training purposes. These models allow surgeons to visualize complex anatomical structures in detail, leading to more precise surgical interventions and better outcomes for patients. Furthermore, 3D printing has the potential to revolutionize the production of customized cardiac implants and devices, leading to improved patient care and long-term sustainability. [15]

Regenerative medicine offers new avenues for repairing and regenerating damaged cardiac tissue, potentially reducing the need for traditional surgical interventions such as heart transplants. Stem cell therapy, tissue engineering, and gene editing technologies hold promise for repairing injured hearts and restoring cardiac function. These innovative approaches could transform the landscape of adult cardiac surgery by offering minimally invasive, patient-specific treatment options that promote tissue regeneration and functional recovery. [16]

A thorough examination of obstacles and potential future paths for adult cardiac surgery uncovers several main themes. Issues in this field include the increasing complexity of cases, escalating healthcare expenses, disparities in access to care, and a shortage of specialized cardiac surgeons. Moreover, advancements in technology and evolving patient demographics bring about fresh challenges that require attention. [17]

Recent studies emphasize the significance of multidisciplinary collaboration, ongoing training and education for healthcare professionals, and the establishment of standardized protocols and guidelines in adult cardiac surgery. These efforts are crucial to ensure the provision of high-quality care and improved patient outcomes. [18]

6. Conclusion

The findings of this research endeavor are poised to contribute significantly to the existing body of knowledge in the field of cardiac surgery, shedding light on the multifaceted nature of factors that impact patient outcomes. By elucidating the relationships between patient demographics, pre-operative metrics, post-operative care protocols, and long-term follow-up strategies, this study endeavors to offer a holistic understanding of the complexities involved in achieving optimal results in adult cardiac surgery. Ultimately, the insights gleaned from this study have the potential to inform evidence-based practices, enhance clinical decision-making processes, and ultimately improve the overall quality of care delivered to patients undergoing cardiac surgical procedures.

These results underscore both the advancements and challenges in adult cardiac surgery. Improved surgical techniques and perioperative management contribute to high discharge-to-home rates, yet the persistence of post-operative complications and the low follow-up rate highlight the need for enhanced long-term monitoring and rehabilitation programs. Addressing these gaps through personalized post-operative care, better patient education, and strengthened multidisciplinary follow-up strategies can further optimize recovery and long-term outcomes.

Looking ahead, the future of adult cardiac surgery lies in continuous innovation, multidisciplinary collaboration, and evidence-based interventions. By refining perioperative protocols, enhancing follow-up care, and proactively managing complications, healthcare systems can significantly improve patient survival, reduce morbidity, and enhance overall quality of life after cardiac surgery.

Ethical Considerations

Given the retrospective nature of the study, ethical approval was obtained from Jordanian Ministry of Health,Directorate of Medical Education and Training and the study adhered to the principles outlined in the Declaration of Helsinki. Patient confidentiality was strictly maintained, and all data was anonymized prior to analysis.

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