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Suffredini G, Le L, Lee S, Gao WD, Robich MP, Aziz H, Kilic A, Lawton JS, Voegtline K, Olson S, Brown CH, Lima JAC, Das S, Dodd-o JM. The Impact of Silent Liver Disease on Hospital Length of Stay Following Isolated Coronary Artery Bypass Grafting Surgery. J Clin Med 2024; 13:3397. [PMID: 38929926 PMCID: PMC11204604 DOI: 10.3390/jcm13123397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (< 9.5 kPa, ≥ 9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06-0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68-0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification.
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Affiliation(s)
- Giancarlo Suffredini
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (L.L.); (W.D.G.); (C.H.B.); (J.M.D.)
| | - Lan Le
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (L.L.); (W.D.G.); (C.H.B.); (J.M.D.)
| | - Seoho Lee
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.L.); (S.D.)
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (L.L.); (W.D.G.); (C.H.B.); (J.M.D.)
| | - Michael P. Robich
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (M.P.R.); (H.A.); (A.K.); (J.S.L.)
| | - Hamza Aziz
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (M.P.R.); (H.A.); (A.K.); (J.S.L.)
| | - Ahmet Kilic
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (M.P.R.); (H.A.); (A.K.); (J.S.L.)
| | - Jennifer S. Lawton
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (M.P.R.); (H.A.); (A.K.); (J.S.L.)
| | - Kristin Voegtline
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University, Baltimore, MD 21205, USA; (K.V.); (S.O.)
| | - Sarah Olson
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University, Baltimore, MD 21205, USA; (K.V.); (S.O.)
| | - Charles Hugh Brown
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (L.L.); (W.D.G.); (C.H.B.); (J.M.D.)
| | - Joao A. C. Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Samarjit Das
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.L.); (S.D.)
| | - Jeffrey M. Dodd-o
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesia, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (L.L.); (W.D.G.); (C.H.B.); (J.M.D.)
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2
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Ostojic A, Mahmud N, Reddy KR. Surgical risk stratification in patients with cirrhosis. Hepatol Int 2024; 18:876-891. [PMID: 38472607 DOI: 10.1007/s12072-024-10644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
Individuals with cirrhosis experience higher morbidity and mortality rates than the general population, irrespective of the type or scope of surgery. This increased risk is attributed to adverse effects of liver disease, encompassing coagulation dysfunction, altered metabolism of anesthesia and sedatives, immunologic dysfunction, hemorrhage related to varices, malnutrition and frailty, impaired wound healing, as well as diminished portal blood flow, overall hepatic circulation, and hepatic oxygen supply during surgical procedures. Therefore, a frequent clinical dilemma is whether surgical interventions should be pursued in patients with cirrhosis. Several risk scores are widely used to aid in the decision-making process, each with specific advantages and limitations. This review aims to discuss the preoperative risk factors in patients with cirrhosis, describe and compare surgical risk assessment models used in everyday practice, provide insights into the surgical risk according to the type of surgery and present recommendations for optimizing those with cirrhosis for surgical procedures. As the primary focus is on currently available risk models, the review describes the predictive value of each model, highlighting its specific advantages and limitations. Furthermore, for models that do not account for the type of surgical procedure to be performed, the review suggests incorporating both patient-related and surgery-related risks into the decision-making process. Finally, we provide an algorithm for the preoperative assessment of patients with cirrhosis before elective surgery as well as guidance perioperative management.
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Affiliation(s)
- Ana Ostojic
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA.
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Chen P, Chen M, Zhao D, Chen L, Wei J, Ding R, Pu J, Liu Q, Chen Z, Wang L. Risk factors and early outcomes of prolonged mechanical ventilation following redo aortic arch surgery: A retrospective study. Heart Lung 2024; 64:55-61. [PMID: 38042097 DOI: 10.1016/j.hrtlng.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Redo aortic arch surgery is complex and associated with higher risks and mortality. Prolonged mechanical ventilation (PMV) after cardiac surgery is linked to early adverse outcomes and increased costs. OBJECTIVES Identify specific risk factors and early complications associated with PMV following redo aortic arch surgery. METHODS Retrospective study at Fuwai Hospital involving 203 patients. Data on patient characteristics, intraoperative factors, and outcomes were analyzed. RESULTS A total of 203 patients were included, with 42.4 % requiring PMV. PMV patients had longer ICU stays (P < 0.001), lower discharge ADL scores (P < 0.001), and higher hospitalization costs (P < 0.001). While there was no significant difference in-hospital mortality between the two groups, the long-term survival rate in the PMV group was lower than that in the non-PMV group (P = 0.029). Multivariate analysis identified longer cardiopulmonary bypass time (OR 1.008, 95% CI, 1.002 - 1.014, P = 0.006), elevated intraoperative red blood cell transfusion(OR 1.214, 95% CI, 1.057 - 1.393, P = 0.006), higher PEEP (OR 1.296, 95% CI 1.089 - 1.542, P = 0.003), and total arch replacement (OR 3.241, 95% CI 1.392 - 7.543, P = 0.006) as independent risk factors for PMV. CONCLUSION PMV following redo aortic arch surgery is linked to early adverse outcomes, increased healthcare costs, and reduced long-term survival, with longer cardiopulmonary bypass times, elevated intraoperative red blood cell transfusion, higher PEEP, and total arch replacement as independent risk factors.
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Affiliation(s)
- Pengfei Chen
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingjian Chen
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Diming Zhao
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Chen
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinhua Wei
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runyu Ding
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jundong Pu
- Intensive Care Unit, Dali Bai Autonomous Prefecture People's Hospital, Dali, Yunnan, China
| | - Quan Liu
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zujun Chen
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Liqing Wang
- Cardiovascular Surgery Department, Fuwai Hospital, National Center for Cardiovescular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Liu F, Li ZW, Liu XR, Liu XY, Yang J. The Effect of Liver Cirrhosis on Patients Undergoing Cardiac Surgery. Glob Heart 2023; 18:54. [PMID: 37811135 PMCID: PMC10558028 DOI: 10.5334/gh.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
The aim of this study was to investigate the impact of liver cirrhosis (LC) on postoperative complications and long-term outcomes in patients who underwent cardiac surgery. Three databases, including PubMed, Embase, and the Cochrane Library, were searched on July 24, 2022. A total of 1,535,129 patients were enrolled in the seven included studies for analysis. According to our analysis, LC was a risk factor for postoperative overall complications (OR = 1.48, 95% CI = 1.21 to 1.81, I2 = 90.35%, P = 0.00 < 0.1). For various complications, more patients developed pulmonary (OR = 1.86, 95% CI = 1.21 to 2.87, I2 = 90.79%, P = 0.00 < 0.1), gastrointestinal (OR = 2.03, 95% CI = 1.32 to 3.11, I2 = 0.00%, P = 0.00 < 0.05), renal (OR = 2.20, 95% CI = 1.41 to 3.45, I2 = 91.60%, P = 0.00 < 0.1), neurological (OR = 1.14, 95% CI = 1.03 to 1.26, I2 = 7.35%, P = 0.01 < 0.05), and infectious (OR = 2.02, 95% CI = 1.17 to 3.50, I2 = 92.37%, P = 0.01 < 0.1) complications after surgery in the LC group. As for cardiovascular (OR = 1.07, 95% CI = 0.85 to 1.35, I2 = 75.23%, P = 0.58 > 0.1) complications, there was no statistical significance between the 2 groups. As for long-term outcomes, we found that in-hospital death (OR = 2.53, 95% CI = 1.86 to 3.20, I2 = 44.58%, P = 0.00 < 0.05) and death (OR = 3.31, 95% CI = 1.54 to 5.07, I2 = 93.81%, P = 0.00 < 0.1) in the LC group were higher than the non-LC group. LC was a risk factor for cardiac surgery. Patients with LC who would undergo cardiac surgery should be fully assessed for the risks of cardiac surgery. Similarly, the surgeon should assess the patient's liver function before surgery.
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Affiliation(s)
- Fei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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5
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Gerlach RM. Cirrhosis: Getting to the Heart of the Matter. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00797-8. [PMID: 37880040 DOI: 10.1053/j.jvca.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Rebecca M Gerlach
- Pre-anesthesia Clinic, Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM.
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6
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Shingina A, Chadha R, Lim N, Pillai A, Vodkin I, Montenovo M, Heller T, Yardeni D, Ganger D. Combined heart-liver transplantation practices survey in North America: Evaluation and organ listing practices. Liver Transpl 2023; 29:591-597. [PMID: 36745932 PMCID: PMC10191975 DOI: 10.1097/lvt.0000000000000079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/04/2023] [Indexed: 02/07/2023]
Abstract
We conducted a web-based survey to characterize liver transplant (LT) evaluation and listing practices for patients being evaluated for combined heart-liver transplantation (CHLT), with a specific emphasis on patients with congenital heart disease (CHD), around transplant centers in North America. Very few protocols for liver evaluation and listing in patients undergoing combined heart-liver transplantation are published, and no guidelines currently exist on this topic. A subject of intense debate in the transplant community is the decision of which patients with CHD and liver disease benefit from CHLT compared with heart transplantation. A focus group from the American Society of Transplantation Liver-Intestine Community of Practice Education Subcommittee developed a web-based survey that included questions (1) respondee demographic information; (2) LT evaluation practices in CHLT; (3) liver organ listing practices in CHLT, and (4) 4 clinical vignettes with case-based scenarios in CHLT liver listings among CHD patients who underwent Fontan palliation. The survey was distributed to medical and surgical LT program directors of 47 centers that had completed at least 1 CHLT up to July 2021 in the US and the University of Toronto, Canada. The survey had an excellent 83% response rate (87% for centers that completed at least 1 CHLT in the past 5 y). Total 66.7% used transjugular liver biopsy with HVPG measurements, 30% used percutaneous liver biopsy with no consensus on the use of a fibrosis staging system, 95% mandated contrasted cross-sectional imaging, and 65% upper endoscopy. The following isolated findings evaluation mandated CHLT listing: isolated elevated HVPG (61.5%); the presence of portosystemic collaterals on imaging (67.5%); the endoscopic presence of esophageal or gastric varices (75%), and the presence of HCC (80%), whereas the majority of centers did not feel that the presence of isolated splenomegaly (100%), thrombocytopenia (81.6%), endoscopic findings of portal hypertensive gastropathy (66.7%), or highly sensitized patients (84.6%) justified CHLT. In our survey of North American centers that had performed at least 1 CHLT in the past 5 years, we observed heterogeneity in practices for both evaluation and listing protocols in these patients.
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Affiliation(s)
- Alexandra Shingina
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan Chadha
- Department of Anesthesiology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Nicholas Lim
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, University of Chicago, Chicago, Illinois, USA
| | - Irene Vodkin
- Division of Gastroenterology and Hepatology, University of California, San Diego, San Diego, California
| | - Martin Montenovo
- Division of Liver Transplant and Hepatobiliary Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - David Yardeni
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel Ganger
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
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7
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Kirov H, Doenst T. Metabolomische Charakterisierung von herzchirurgischen Patienten mit Leberdysfunktion – COINTREAU-Trial. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-023-00561-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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8
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Gill J, Zahra F, Retzer E. In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement. Am J Cardiol 2022; 176:89-95. [PMID: 35644696 DOI: 10.1016/j.amjcard.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/01/2022]
Abstract
Durability is a major limitation with bioprosthetic heart valves. For mitral valve prosthesis dysfunction, redo surgical mitral valve replacement (rSMVR) has been the mainstay of treatment; however, transcatheter mitral valve-in-valve replacement (mViV) has emerged as a viable alternative. Data comparing these procedures remains limited; therefore, we sought to compare the real-world in-hospital mortality, likelihood of adverse peri-operative outcomes, and predictors of mortality between rSMVR versus mViV using the National Inpatient Sample. During the study period, a weighted total of 1,890 patients (78%) underwent rSMVR, and 520 (22%) underwent mViV. After propensity matching, there were 310 patients in each cohort. There was no statistically significant difference in mortality with these procedures (odds ratio 1.53; 95% confidence interval 0.67 to 3.45; p = 0.31). rSMVR was associated with increased length of hospitalization (13 vs 7.5 days; p <0.001), increased medical costs ($324,124 vs $241,147; p <0.001), and increased peri-operative complications compared with mViV. Predictors of mortality unique to rSMVR were age >75 years, cirrhosis, sleep apnea, malnourishment/low body mass index, and obesity, signalizing greater suitability for mViV in these populations.
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9
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Ostovar R, Schroeter F, Albes JM. Reply to Nezic. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6619562. [PMID: 35766821 DOI: 10.1093/ejcts/ezac372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Roya Ostovar
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Filip Schroeter
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
| | - Johannes Maximilian Albes
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau, Germany
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10
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Nezic D. Early outcome of patients with liver cirrhosis undergoing cardiac surgery. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6619556. [PMID: 35766816 DOI: 10.1093/ejcts/ezac356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/21/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Dusko Nezic
- Department of Cardiac Surgery, 'Dedinje' Cardiovascular Institute, Belgrade, Serbia
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11
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Helpfulness of the liver disease scores in cardiac surgery for cirrhotic patients. Gen Thorac Cardiovasc Surg 2022; 70:770-778. [DOI: 10.1007/s11748-022-01797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
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12
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6575310. [DOI: 10.1093/ejcts/ezac128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/31/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
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13
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Shang L, Ao Y, Lv L, Lv L, Zhang Y, Hou J, Yao J, Wu Z. Preoperative Liver Function Test Abnormalities Were Associated With Short-Term and Long-Term Prognosis in Cardiac Surgery Patients Without Liver Disease. Front Cardiovasc Med 2021; 8:772430. [PMID: 34790710 PMCID: PMC8591306 DOI: 10.3389/fcvm.2021.772430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: To explore the value of preoperative liver function tests (LFTs) for the prognosis of cardiac surgery patients without liver disease. Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to extract the clinical data. Adult cardiac patients (≥18 years) without liver disease in the database were enrolled. The association of LFTs with the time of hospital stay and ICU stay was analyzed with the Spearman correlation. Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariable logistic regression was used to identify LFTs that were independent prognostic factors of mortality. Results: A total of 2,565 patients were enrolled in this study. Albumin (ALB) was negatively associated with the time of hospital stay and ICU stay, while alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin were positively associated with the time of hospital stay and ICU stay (all p < 0.001). Abnormal ALB, ALT, AST, and total bilirubin were associated with lower 90-day and 4-year survival (all p < 0.001) and could be used as independent risk factors for hospital mortality and 90-day mortality. However, only ALB and total bilirubin were independent risk factors for 4-year mortality. Conclusion: Preoperative LFT abnormalities were associated with short-term and long-term prognosis of cardiac surgery patients without liver disease.
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Affiliation(s)
- Liqun Shang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuanhan Ao
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Linhua Lv
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Lihua Lv
- Department of Pharmacy, Shaoyang University, Shaoyang, China
| | - Yubi Zhang
- Department of Hematology Oncology, Shaoyang Central Hospital, Shaoyang, China
| | - Jian Hou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jianping Yao
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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14
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Garatti A. Cardiac surgery in patients with liver cirrhosis: can we paint all patients with the same brush? Ann Thorac Surg 2021; 114:605-606. [PMID: 34389307 DOI: 10.1016/j.athoracsur.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Garatti
- Cardiac Surgery Department "E. Malan", IRCCS Policlinico S. Donato, Via Morandi 30, 20097 S. Donato Milanese, Milan, Italy.
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- Cardiac Surgery Department "E. Malan", IRCCS Policlinico S. Donato, Via Morandi 30, 20097 S. Donato Milanese, Milan, Italy
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15
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Lou W. The use of β-blockers in patients with liver cirrhosis who undergo cardiac surgery. Ann Thorac Surg 2021; 114:605. [PMID: 34302804 DOI: 10.1016/j.athoracsur.2021.06.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Weihua Lou
- Department of Cardiothoracic Surgery, YiWu Central Hospital, Jiangdong Rd, No. 699, Yiwu 322000, Zhejiang, China.
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