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Takahashi T, Watanabe H, Mochizuki M, Kikuchi Y, Kitahara E, Yokoyama-Nishitani M, Morisawa T, Saitoh M, Iwatsu K, Minamino T, Tabata M, Fujiwara T, Daida H. Relationship between prehabilitation responsiveness and postoperative physical functional recovery in cardiovascular surgery. J Cardiol 2024:S0914-5087(24)00097-2. [PMID: 38839042 DOI: 10.1016/j.jjcc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The purpose of this study was to examine the relationship between responsiveness to prehabilitation and postoperative recovery of physical function in cardiac surgery patients. METHODS Ninety-three cardiac surgery patients (mean age: 76.4 years) were included in this retrospective cohort study. Preoperative physical function was measured using the Short Physical Performance Battery (SPPB), and a prehabilitation exercise program was implemented for the SPPB domains with low scores. Among the patients, those whose SPPB score was over 11 from the start of prehabilitation and remained over 11 on the day before surgery were defined as the high-functioning group, and those whose SPPB score improved by 2 points or more from the start of prehabilitation and exceeded 11 points were defined as the responder group. Those whose SPPB score did not exceed 11 immediately before surgery were classified as non-responders. The characteristics of each group and postoperative recovery of physical function were investigated. RESULTS There were no serious adverse events during prehabilitation. Mean days of prehabilitation was 5.4 days. The responder group showed faster improvement in postoperative physical function and shorter time to ambulatory independence than the non-responder group. The non-responder group had lower preoperative skeletal muscle index, more severe preoperative New York Heart Association classification, and a history of musculoskeletal disease or stroke. CONCLUSION There were responders and non-responders to prehabilitation among cardiac surgery patients. Cardiac surgery patients who respond to prehabilitation had faster recovery of physical function. Further research is needed to determine what type of prehabilitation is more effective in postoperative recovery of physical function in cardiac surgery patients.
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Affiliation(s)
- Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan.
| | - Hidetaka Watanabe
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | | | - Yuta Kikuchi
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Eriko Kitahara
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Miho Yokoyama-Nishitani
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Kotaro Iwatsu
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Juntendo University Graduate School of Health Science, Tokyo, Japan
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Benck KN, Alnajar A, Lamelas J. Impact of Bariatric Surgery on Mortality of Mitral Valve Surgery: A National Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:540-546. [PMID: 37990444 DOI: 10.1177/15569845231207394] [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] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Obesity is a common comorbidity of cardiac surgery patients. The goal of this study is to determine if a lower weight achieved through bariatric surgery has any association with mitral valve (MV) replacement or repair surgery mortality. METHODS This study used a retrospective analysis of the National Inpatient Sample dataset from 2012 to 2020. Adult patients who underwent MV surgery with normal weight following bariatric surgery (n = 1,125) and patients with obesity (n = 48,555) were compared. The primary outcome was in-hospital mortality. RESULTS This study included 49,680 patients. The median age was 64 (55 to 71) years, and the majority were female (55%). Bariatric surgery was found to significantly decrease the odds of mortality, even after adjusting for important covariates, indicating a reduction of mortality risk by 54% (adjusted odds ratio = 0.46, p = 0.024). Other significant protective factors include isolated and elective surgery. Significant risk factors were older age, female sex, and diabetes mellitus. Patients who were obese demonstrated longer lengths of stay (LOS), greater transfers to other facilities, and higher hospital costs. CONCLUSIONS In patients receiving MV surgery, bariatric surgery demonstrated significant survival benefits during hospitalization, in addition to reducing LOS and cost. Our data support prior evidence of bariatric surgery improving cardiovascular outcomes. Therefore, bariatric surgery may be a meaningful method of weight loss to improve surgical patient outcomes in patients with obesity. However, longer-term data are needed.
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Affiliation(s)
- Kelley N Benck
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
| | - Ahmed Alnajar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
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Oezpeker UC, Hoefer D, Barbieri F, Gollmann-Tepekoeylue C, Johannes H, Clemens E, Suat E, Adel S, Sasa R, Mueller L, Grimm M, Bonaros N. Isolated annuloplasty in elderly patients with secondary mitral valve regurgitation: short- and long-term outcomes with a less invasive approach. Front Cardiovasc Med 2023; 10:1193156. [PMID: 37915742 PMCID: PMC10617676 DOI: 10.3389/fcvm.2023.1193156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Background Long-term outcomes of elderly and frail patients with secondary mitral valve regurgitation (MR) are inconclusive. Especially in patients with co-morbidities such as atherosclerosis who are suffering from heart failure, optimal medical therapy (OMT) is the preferred therapy relative to surgical or percutaneous interventions. It remains challenging to identify the most successful therapy to improve symptoms and increase life expectancy. To reduce surgical trauma for these patients, minimally invasive mitral valve surgery (MIMVS) was developed; this has shown promising medium-term results, but there is still a lack of evidence regarding long-term results. The aim of this investigation was to describe the long-term outcomes of less invasive mitral valve surgery (MVS) in elderly patients. Methods In this longitudinal retrospective analysis, 67 patients (aged ≥70 years) with secondary MR who underwent MV repair ± tricuspid valve repair (TVR) were identified. MVS was performed via minithoracotomy (MT) in most cases (n = 54); in patients with contraindications for MIMVS, partial upper sternotomy (PS) was the preferred route for surgical access (n = 13). The appropriate access route was chosen according to the patient's clinical condition and comorbidities. We analyzed reoperation-free long-term survival, combined operative success (lack of residual MR, conversion to MV replacement, or larger thoracic incisions), and perioperative safety (at 30 days: mortality, re-thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation, stroke, myocardial infarction). In a subgroup analysis, we compared long-term survival in MVS patients with and without TVR. Results The median age of patients (62.7% female) was 74 years (interquartile range: 72-76 years), with a median EuroSCORE2 of 2.8% (1.5%-4.6%) and N-terminal pro-brain natriuretic peptide plasma levels of 1,434 ng/L (1035-2149 ng/L). The median follow-up period was 5.6 years (2.7-8.5 years). The reoperation-free long-term survival rate up to 10 years was 66.2%. Combined operative success and perioperative safety were achieved in 94% and 76% of patients, respectively. Additional TVR was performed in 56.7% of patients, without any significant difference in survival rates compared to the group without TVR (p = 0.417; HR 1.473, 95% CI 0.578-3.757). Conclusion Less invasive MV repair for secondary MR shows excellent operative success and safety in selected patients. Freedom from significant MR and from the need for reoperation indicates long-lasting efficacy. These results should be considered in heart team discussions regarding allocation of patients to surgical mitral procedures.
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Affiliation(s)
- Ulvi Cenk Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Hoefer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Fabian Barbieri
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | - Holfeld Johannes
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Engler Clemens
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ersahin Suat
- Department of Cardiovascular Surgery, Sakarya University, Adapazari, Türkiye
| | - Sakic Adel
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rajsic Sasa
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ludwig Mueller
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Alnajar A, Benck KN, Dar T, Hirji SA, Ibrahim W, Detweiler B, Vuddanda V, Balise R, Rao JS, Lu M, Lamelas J. Predictors of outcomes in patients with obesity following mitral valve surgery. JTCVS OPEN 2023; 15:127-150. [PMID: 37808032 PMCID: PMC10556846 DOI: 10.1016/j.xjon.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 10/10/2023]
Abstract
Objective Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care. Methods A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable. Results Of the 48,775 patients with obesity, 34% had morbid obesity (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Kelley N. Benck
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Tawseef Dar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Sameer A. Hirji
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Walid Ibrahim
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Brian Detweiler
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Venkat Vuddanda
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Raymond Balise
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - J. Sunil Rao
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Min Lu
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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Hassanabad AF, Deniset JF, Fedak PWM. Pericardial Inflammatory Mediators That Can Drive Postoperative Atrial Fibrillation in Cardiac Surgery Patients. Can J Cardiol 2023; 39:1090-1102. [PMID: 37301368 DOI: 10.1016/j.cjca.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
Postoperative atrial fibrillation (POAF) is a common dysrhythmia that affects a significant number of patients undergoing cardiac surgery. Many studies aim to better understand this complex postsurgical complication by analysing circulating biomarkers in patients who develop POAF. More recently, the pericardial space was shown to contain inflammatory mediators that could trigger POAF. In this review we summarise recent studies that examine the immune mediators present in the pericardial space and their potential implications for the pathophysiology of POAF in cardiac surgery patients. Ongoing research in this area should better delineate the multifactorial etiology of POAF, where specific markers may be targeted to reduce the incidence of POAF and improve outcomes for this patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Justin F Deniset
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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6
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An Individualized, Less-Invasive Surgical Approach Algorithm Improves Outcome in Elderly Patients Undergoing Mitral Valve Surgery. J Cardiovasc Dev Dis 2023; 10:jcdd10010028. [PMID: 36661923 PMCID: PMC9862192 DOI: 10.3390/jcdd10010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND For mitral valve surgery (MVS) in elderly, frail patients with increasing life expectancy, finding the least harmful means of access is a challenge. In the complexity of MVS approach evolution, using three different approaches (mini-thoracotomy (MT), partial upper-sternotomy (PS), full-sternotomy (FS), we developed a personalized, minimized-invasiveness algorithm for MVS. METHODS In this retrospective analysis, 517 elderly patients (≥70 years) were identified who had undergone MVS ± TV repair. MVS was performed via MT (n = 274), FS (n = 128) and PS (n = 115). The appropriate access type was defined according to several clinical patient conditions. Using uni- and multivariate regression models, we analyzed combined operative success (residual MV regurgitation, conversion to MV replacement or larger thoracic incisions); perioperative success (30-days mortality, thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation); and reoperation-free long-term survival. An additional EuroSCORE2 adjustment was performed to reduce the bias of clinical conditions between all access types. RESULTS The EuroSCORE2-adjusted Cox regression analysis showed significantly increased reoperation-free survival in the MT cohort compared to FS (HR 0.640; 95% CI 0.442-0.926; p = 0.018). Mortality was additionally reduced after the implementation of PS (p = 0.023). Combined operative success was comparable between the three access types. The perioperative success was higher in the MT cohort compared to FS (OR 2.19, 95% CI 1.32-3.63; p = 0.002). CONCLUSION Less-invasive approaches in elderly patients improve perioperative success and reoperation-free survival in those undergoing MVS procedures.
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7
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Watkins AR, Fialka N, El-Andari R, Kang JJH, Bozso SJ, Moon MC, Nagendran J, Nagendran J. Mortality and morbidity of surgical and transcatheter mitral valve repair in octogenarians: A systematic review. J Card Surg 2022; 37:2752-2760. [PMID: 35652892 DOI: 10.1111/jocs.16653] [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: 12/03/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Valvular heart disease (VHD) is a prominent problem in healthcare today with mitral regurgitation (MR) being the leading cause of VHD in the elderly population. While mitral valve repair (MVr) surgery is one of the only options for the end-stage disease, octogenarians are often denied MVr due to concerns with operative mortality and postoperative morbidity. To provide information on this underrepresented group of surgical patients, a systematic approach was taken to review the mortality and morbidity rates of octogenarians who received MVr. METHODS Pubmed and Medline were searched for articles containing outcomes of octogenarians receiving surgical mitral valve repair (SMVr) or transcatheter mitral valve repair (TMVr) published after 2000. Ten articles met the inclusion criteria for a total of 7968 patients included in the analysis using Microsoft Excel, Version 2105. RESULTS Short-term mortality rates for SMVr and TMVr were 2.6% and 1.4% for in-hospital, and 7.8% and 3.3% for 30 days, respectively. The average incidence of stroke, acute kidney injury, infection, and major bleeding for SMVr were 3.2%, 11.2%, 7.7%, and 24%, respectively, and 0.3%, 6.7%, 2.7%, and 7.9% for TMVr, respectively. CONCLUSION Octogenarians receiving SMVr or TMVr experienced similar rates of short-term mortality and morbidity as younger populations, and when considering life expectancy, midterm mortality was also similar. With these results, denying octogenarians MVr operations based on age alone should be reconsidered. Depending on risk factors and comorbidities, either SMVr or TMVr is a viable and relatively safe option for octogenarians with severe MR.
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Affiliation(s)
- Abeline R Watkins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jimmy J H Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Rate and rhythm control are still considered equivalent strategies for symptom control using the Atrial Fibrillation Better Care algorithm recommended by the recent atrial fibrillation guideline. In acute situations or critically ill patients, a personalized approach should be used for rapid rhythm or rate control. Even though electrical cardioversion is generally indicated in haemodynamically unstable patients or for rapid effective rhythm control in critically ill patients, this is not always possible due to the high percentage of failure or relapses in such patients. Rate control remains the background therapy for all these patients, and often rapid rate control is mandatory. Short and rapid-onset-acting beta-blockers are the most suitable drugs for acute rate control. Esmolol was the classical example; however, landiolol a newer very selective beta-blocker, recently included in the European atrial fibrillation guideline, has a more favourable pharmacokinetic and pharmacodynamic profile with less haemodynamic interference and is better appropriate for critically ill patients.
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9
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McHugh JW, Talha KM, Baddour LM, Fischer KM, Crestanello J, Arghami A, DeSimone DC. Bloodstream Infection Following Cardiac Valve Repair: A Population-Based Study. Open Forum Infect Dis 2021; 8:ofab493. [PMID: 34938821 PMCID: PMC8687125 DOI: 10.1093/ofid/ofab493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to determine the incidence, epidemiology, and
associated risk factors of bloodstream infection (BSI) in patients who had
previously undergone cardiac valve repair. Methods A population-based study that included 7 counties in southeastern Minnesota
using the expanded Rochester Epidemiology Project (e-REP) for adults
(≥18 years) who underwent valve repair between 1 January 2010 and 31
December 2018 was conducted. Electronic health records were screened for
development of BSI and infective endocarditis (IE) from the date of valve
repair through 30 July 2020. A 1:4 nested case-control analysis was
performed to determine an association, if any, of male sex, Charlson
comorbidity index (CCI), and county of residence with BSI. Results A total of 335 patients underwent valve repair, of whom 28 (8.3%) developed
an index case of BSI, with 14 episodes occurring within 1 year of surgery.
The median age of patients with BSI was 70 years, and 79% were male. The
crude incidence of BSI was 1671 cases per 100000 person-years and
Escherichia coli was the most common pathogen.
Case-control analysis demonstrated a significant correlation between CCI and
incidence of BSI (P < .001). Only 4 (14.3%)
patients developed IE concurrent with the onset of BSI, and no patients
developed IE subsequent to BSI. Conclusions The crude incidence of BSI following valve repair was higher in our e-REP
cohort than previous population-based studies, and half of the BSI cases
occurred within 1 year of surgery. Patients with a higher CCI at baseline
were at increased risk of subsequent BSI.
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Affiliation(s)
- Jack W McHugh
- Department of Internal Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Karen M Fischer
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Juan Crestanello
- Division of Cardiovascular Surgery, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Arman Arghami
- Division of Cardiovascular Surgery, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA
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10
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Minhas AS, Rahman F, Gavin N, Cedars A, Vaught AJ, Zakaria S, Resar J, Schena S, Schulman S, Zhao D, Hays AG, Michos ED. Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease. Am J Cardiol 2021; 158:90-97. [PMID: 34452683 PMCID: PMC8765669 DOI: 10.1016/j.amjcard.2021.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare demographics, comorbidities, and obstetric and cardiovascular complications during delivery hospitalizations. After adjusting for clinical and socioeconomic factors, logistic regression was performed to investigate associations between valvular disease and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease. Women with valvular disease were older, had longer length of stays, and higher costs associated with delivery. They had higher prevalence of underlying cardiovascular comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%; pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2]) and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13 to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22 [19 to 27]). There were valve lesion-specific differences in the magnitude of risk but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular complications. In conclusion, pregnant women with stenotic and regurgitant valvular disease have a greater burden of cardiovascular comorbidities and increased odds of obstetric and cardiovascular events at delivery. These women may benefit from specialized care from a Cardio-Obstetrics team.
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Affiliation(s)
- Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Faisal Rahman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicole Gavin
- Department of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ari Cedars
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arthur Jason Vaught
- Department of Maternal Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jon Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefano Schena
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Schulman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Barker CM, Reynolds MR, Reardon MJ, Van Houten JL, Murphy SM, Mollenkopf SA, Feldman TE. Relation of Institutional Mitral Valve Surgical Volume to Surgical and Transcatheter Outcomes in Medicare Patients. Am J Cardiol 2021; 147:94-100. [PMID: 33662328 DOI: 10.1016/j.amjcard.2021.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
There are limited data to support proposed increases to the minimum institutional mitral valve (MV) surgery volume required to begin a transcatheter mitral valve repair (TMVr) program. The current study examined the association between institutional MV procedure volumes and outcomes. All 2017 Medicare fee-for-service patients who received a TMVr or MV surgery procedure were included and analyzed separately. The exposure was institutional MV surgery volume: low (1 to 24), medium (25 to 39) or high (40+). Outcomes were in-hospital mortality and 1-year postdischarge mortality and cardiovascular rehospitalization. For MV surgery patients, in-hospital mortality rates were 6.4% at low-volume, 8.7% at medium-volume and 9.8% at high-volume facilities. Rates were significantly higher for low-volume [OR = 1.50, 95% CI (1.23 to 1.84)] and medium-volume [OR = 1.33, 95% CI (1.06 to 1.67)] compared with high-volume facilities. There was no statistically significant relationship between institutional MV surgery volume and in-hospital mortality for TMVr patients, either at low-volume [OR = 1.52, 95% CI (0.56, 4.13)] or medium-volume [OR = 1.58, 95% CI (0.82, 3.02)] facilities, compared with high-volume facilities. Across all volume categories, in-hospital mortality rates for TMVr patients were relatively low (2.3% on average). For both cohorts, the rates of 1-year mortality and cardiovascular rehospitalizations were not significantly higher at low- or medium-volume MV surgery facilities, as compared with high-volume. In conclusion, among Medicare patients, there was a relation between institutional MV surgery volume and in-hospital mortality for MV surgery patients, but not for TMVr patients.
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Rasmussen SR, Nielsen RV, Eriksson F, Dons M, Vedel AG, Buggeskov KB, Møgelvang R, Ostrowski SR, Ravn HB. Prognostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor and High-Sensitivity C-Reactive Protein on Postoperative Mortality in Patients Undergoing Elective On-Pump Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:2415-2423. [PMID: 33243671 DOI: 10.1053/j.jvca.2020.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Elevated soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-reactive protein (hsCRP) have been associated with increased mortality in patients with cardiovascular disease. The aim of the present study was to explore the relationship between suPAR and hsCRP values and associated mortality after elective cardiac surgery. A secondary aim was to assess whether a combined risk model of European System for Cardiac Operative Risk Evaluation (EuroSCORE II), suPAR, and/or hsCRP would improve the prognostic accuracy compared with EuroSCORE II alone. DESIGN Retrospective observational study. SETTING Single-center, university hospital. PARTICIPANTS Adult patients admitted for elective on-pump cardiac surgery were included. Biobank blood samples were obtained from previous research projects at a tertiary heart center from 2012 to 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 931 patients were included. Kaplan-Meier and Cox proportional hazard analyses were used to explore a potential association between preoperative suPAR and hsCRP values and all-cause mortality up to one year after surgery. Thirty-day mortality was predicted from suPAR, hsCRP, and EuroSCORE II by logistic regression and compared using area under the receiver operating characteristics curve and Brier scores. After adjustment for known confounders, a doubling of suPAR and hsCRP corresponded to a hazard ratio for all-cause mortality of 2.27 (95% confidence interval 1.65-3.11; p < 0.001) and 1.26 (95% confidence interval 1.07-1.49; p = 0.005), respectively. However, adding the biomarkers to EuroSCORE II did not improve prediction/discrimination with respect to 30-day mortality. CONCLUSIONS Elevated preoperative levels of suPAR and hsCRP were associated with all-cause mortality in elective cardiac surgery patients. However, inclusion of biomarkers did not improve the prognostic accuracy of EuroSCORE II.
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Affiliation(s)
- Sebastian Roed Rasmussen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Rikke Vibeke Nielsen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frank Eriksson
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maria Dons
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Grønborg Vedel
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katrine Bredahl Buggeskov
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Clinical Cardiovascular Research Unit, Svendborg, University of Southern Denmark, Svendborg, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Oliveros Rodríguez H, Buitrago G, Castellanos Saavedra P. Use of matching methods in observational studies with critical patients and renal outcomes. Scoping review. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The use of matching techniques in observational studies has been increasing and is not always used appropriately. Clinical experiments are not always feasible in critical patients with renal outcomes, and observational studies are an important alternative.
Objective: Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and assessing renal outcomes.
Methods: Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and 2020 up to week 10, which studied different exposures in the critically ill patient with renal outcomes and used propensity matching methods.
Results: Most publications are cohort studies 94 (94. 9 %), five studies (5. 1 %) were cross-sectional. The main pharmacological intervention was the use of antibiotics in seven studies (7. 1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10. 1%). The balance between the baseline characteristics assessed by standardized means, in only 28 studies (28. 2%). Most studies 95 (96 %) used logistic regression to calculate the propensity index.
Conclusion: Major inconsistencies were observed in the use of methods and in the reporting of findings. A summary is made of the aspects to be considered in the use of the methods and reporting of the findings with the matching by propensity index.
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McCann M, Stamp N, Ngui A, Litton E. Cardiac Prehabilitation. J Cardiothorac Vasc Anesth 2019; 33:2255-2265. [DOI: 10.1053/j.jvca.2019.01.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 02/06/2023]
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Fellahi JL, Heringlake M, Knotzer J, Fornier W, Cazenave L, Guarracino F. Landiolol for managing atrial fibrillation in post-cardiac surgery. Eur Heart J Suppl 2018; 20:A4-A9. [PMID: 30188961 PMCID: PMC5909770 DOI: 10.1093/eurheartj/sux038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 01/26/2023]
Abstract
Landiolol is an intravenous ultra-short acting beta-blocker which has been used in Japan for many years to prevent and/or to treat post-operative atrial fibrillation following cardiac surgery. The drug is now available in Europe. This article is a systematic review of literature regarding the use of landiolol in that specific surgical setting.
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Affiliation(s)
- Jean-Luc Fellahi
- Service d’Anesthésie-Réanimation, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, Lyon Cedex 03, France
| | - Matthias Heringlake
- Department of Anesthesiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Johann Knotzer
- Institut für Anästhesiologie und Intensivmedizin II, Klinikum Wels-Grieskirchen, Grieskirchner Str. 42, Wels, Austria
| | - William Fornier
- Service d’Anesthésie-Réanimation, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, Lyon Cedex 03, France
| | - Laure Cazenave
- Service d’Anesthésie-Réanimation, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, Lyon Cedex 03, France
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Cardiothoracic and Vascular Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Via Roma n. 67, Pisa, Italy
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Mkalaluh S, Szczechowicz M, Dib B, Szabo G, Karck M, Weymann A. Outcomes and Predictors of Mortality After Mitral Valve Surgery in High-Risk Elderly Patients: The Heidelberg Experience. Med Sci Monit 2017; 23:6193-6200. [PMID: 29289956 PMCID: PMC5757865 DOI: 10.12659/msm.906003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Overall, life expectancy at the age of 80 has significantly increased in the industrialized world and the proportion of this age class undergoing cardiac surgery has also grown. In this context, we have analyzed a contemporary series of octogenarians undergoing mitral valve surgery at our institution. Material/Methods We performed a retrospective analysis of 138 consecutive octogenarians receiving mitral valve surgery between January 2006 and April 2017. Preoperative comorbidities, early mortality, postoperative clinical course, and predictors of mortality were examined. Results The mean age was 82.4±2.0 years and 50% (n=69) were male. Preoperative comorbidities included history of heart infarction (24.6%, n=34), chronic renal failure (37.7%, n=52), and COPD (27.5%, n=38). A total of 52.9% (n=73) had a history of previous cardiac decompensation, while 20 (14.5%) presented with cardiogenic shock or cardiac arrest. In all, 33 patients (23.9%) underwent emergency surgery. There were only 39 isolated mitral valve procedures, while 99 patients (71.7%) underwent various concomitant procedures. The intensive care unit average length of stay was 5.3±7.5 days. Respiratory complications and sepsis were the most frequent postoperative complications. Emergency surgery and concomitant coronary artery bypass grafting were the most important predictors of early mortality. The overall 30-day mortality was 18.1% (n=25). The mean follow-up time was 1.7±2.3 years. Conclusions Octogenarians are increasingly represented in cardiac surgery and combined procedures. Prudent patient selection is necessary for optimizing postoperative outcomes among the elderly. In our seriously ill octogenarian cohort, mitral valve surgery was associated with moderate but acceptable mid-term survival.
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Affiliation(s)
- Sabreen Mkalaluh
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Marcin Szczechowicz
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Bashar Dib
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Gabor Szabo
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany.,Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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