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Chen W, Yu P, Chen C, Cai S, Chen J, Zheng C, Chen C, Zheng L, Guo C. Association Between the Red Blood Cell Distribution Width and 30-Day Mortality in Intensive Care Patients Undergoing Cardiac Surgery: A Retrospective Observational Study Based on the Medical Information Mart for Intensive Care-IV Database. Ann Lab Med 2024; 44:401-409. [PMID: 38469636 PMCID: PMC11169773 DOI: 10.3343/alm.2023.0345] [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: 09/03/2023] [Revised: 12/06/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Background Millions of patients undergo cardiac surgery each year. The red blood cell distribution width (RDW) could help predict the prognosis of patients who undergo percutaneous coronary intervention or coronary artery bypass surgery. We investigated whether the RDW has robust predictive value for the 30-day mortality among patients in an intensive care unit (ICU) after undergoing cardiac surgery. Methods Using the Medical Information Mart for Intensive Care-IV Database, we retrieved data for 11,634 patients who underwent cardiac surgery in an ICU. We performed multivariate Cox regression analysis to model the association between the RDW and 30-day mortality and plotted Kaplan-Meier curves. Subgroup analyses were stratified using relevant covariates. Receiver operating characteristic (ROC) curves were used to determine the predictive value of the RDWs. Results The total 30-day mortality rate was 4.2% (485/11,502). The elevated-RDW group had a higher 30-day mortality rate than the normal-RDW group (P&0.001). The robustness of our data analysis was confirmed by performing subgroup analyses. Each unit increase in the RDW was associated with a 17% increase in 30-day mortality when the RDW was used as a continuous variable (adjusted hazard ratio=1.17, 95% confidence interval, 1.10-1.25). Our ROC results showed the predictive value of the RDW. Conclusions An elevated RDW was associated with a higher 30-day mortality in patients after undergoing cardiac surgery in an ICU setting. The RDW can serve as an efficient and accessible method for predicting the mortality of patients in ICUs following cardiac surgery.
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Affiliation(s)
- Weiqiang Chen
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Peiling Yu
- Department of Anaesthesiology, Third People’s Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Chao Chen
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Shaoyan Cai
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Junheng Chen
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Chunqin Zheng
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Chaojin Chen
- Department of Anaesthesiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China
| | - Liangjie Zheng
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Chunming Guo
- Department of Anaesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
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Tadege M, Tegegne AS, Dessie ZG. Cardiac patients' surgery outcome and associated factors in Ethiopia: application of machine learning. BMC Pediatr 2024; 24:395. [PMID: 38886745 PMCID: PMC11184771 DOI: 10.1186/s12887-024-04870-4] [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: 05/22/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases are a class of heart and blood vessel-related illnesses. In Sub-Saharan Africa, including Ethiopia, preventable heart disease continues to be a significant factor, contrasting with its presence in developed nations. Therefore, the objective of the study was to assess the prevalence of death due to cardiac disease and its risk factors among heart patients in Ethiopia. METHODS The current investigation included all cardiac patients who had cardiac surgery in the country between 2012 and 2023. A total of 1520 individuals were participated in the study. Data collection took place between February 2022 and January 2023. The study design was a retrospective cohort since the study track back patients' chart since 2012. Machine learning algorithms were applied for data analysis. For machine learning algorithms comparison, lift and AUC was applied. RESULTS From all possible algorithms, logistic algorithm at 90%/10% was the best fit since it produces the maximum AUC value. In addition, based on the lift value of 3.33, it can be concluded that the logistic regression algorithm was performing well and providing substantial improvement over random selection. From the logistic regression machine learning algorithms, age, saturated oxygen, ejection fraction, duration of cardiac center stays after surgery, waiting time to surgery, hemoglobin, and creatinine were significant predictors of death. CONCLUSION Some of the predictors for the death of cardiac disease patients are identified as such special attention should be given to aged patients, for patients waiting for long periods of time to get surgery, lower saturated oxygen, higher creatinine value, lower ejection fraction and for patients with lower hemoglobin values.
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Affiliation(s)
- Melaku Tadege
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
- Regional Data Management Center for Health (RDMC), Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia.
| | | | - Zelalem G Dessie
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
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Najafi MS, Nematollahi S, Vakili-Basir A, Jalali A, Gholami A, Dashtkoohi M, Davoodi S, Pashang M, Movahedi N, Abbasi K, Mansourian S, Ashraf H, Ahmadi Tafti SH. Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft. IJC HEART & VASCULATURE 2024; 52:101412. [PMID: 38694271 PMCID: PMC11060952 DOI: 10.1016/j.ijcha.2024.101412] [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: 01/19/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
Introduction Reduced left ventricular ejection fraction (LVEF) is a well-known predictor of adverse events after cardiac surgery. We aimed to assess the outcomes in patients with low LVEF undergoing coronary artery bypass graft. Methods In this retrospective cohort, we included all patients with left ventricular ejection fraction ≤ 40 who underwent coronary artery bypass grafting between March 2007 and March 2016 (with a median follow-up of nine years) at Tehran Heart Center. Demographics and clinical characteristics were extracted from the data registry. Akaike information criterion (AIC) was used. The univariate Cox regression was performed. We investigated the predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) using Cox multivariable regression. Results In total, 5,532 cases (79 % male) with a mean age of 65.58 were included in the study. The nine-year overall survival was calculated at 68 %, and more than half of the patients had MACCE (55 %). In adjusted multivariable Cox regression analysis, moderate to severe mitral valve regurgitation, glomerular filtration rate ≤ 60, mild right ventricular dysfunction, and valvular heart disease independently predicted higher mortality. The abovementioned predictors and peripheral vascular disease significantly increased MACCE. Conclusion Our study indicates the clinical significance of mitral regurgitation, valvular heart disease, and renal function in patients with low ejection fraction treated by coronary artery bypass grafting surgery. Identifying predictors of adverse events can help with clinical decision-making and risk stratification, ultimately improving patient outcomes.
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Affiliation(s)
- Mohammad Sadeq Najafi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Nematollahi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Vakili-Basir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Gholami
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadese Dashtkoohi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Davoodi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Namvar Movahedi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kyomars Abbasi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Tadege M, Tegegne AS, Dessie ZG. Post-surgery survival and associated factors for cardiac patients in Ethiopia: applications of machine learning, semi-parametric and parametric modelling. BMC Med Inform Decis Mak 2024; 24:91. [PMID: 38553701 PMCID: PMC10979627 DOI: 10.1186/s12911-024-02480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Living in poverty, especially in low-income countries, are more affected by cardiovascular disease. Unlike the developed countries, it remains a significant cause of preventable heart disease in the Sub-Saharan region, including Ethiopia. According to the Ethiopian Ministry of Health statement, around 40,000 cardiac patients have been waiting for surgery in Ethiopia since September 2020. There is insufficient information about long-term cardiac patients' post-survival after cardiac surgery in Ethiopia. Therefore, the main objective of the current study was to determine the long-term post-cardiac surgery patients' survival status in Ethiopia. METHODS All patients attended from 2012 to 2023 throughout the country were included in the current study. The total number of participants was 1520 heart disease patients. The data collection procedure was conducted from February 2022- January 2023. Machine learning algorithms were applied. Gompertz regression was used also for the multivariable analysis report. RESULTS From possible machine learning models, random survival forest were preferred. It emphasizes, the most important variable for clinical prediction was SPO2, Age, time to surgery waiting time, and creatinine value and it accounts, 42.55%, 25.17%,11.82%, and 12.19% respectively. From the Gompertz regression, lower saturated oxygen, higher age, lower ejection fraction, short period of cardiac center stays after surgery, prolonged waiting time to surgery, and creating value were statistically significant predictors of death outcome for post-cardiac surgery patients' survival in Ethiopia. CONCLUSION Some of the risk factors for the death of post-cardiac surgery patients are identified in the current investigation. Particular attention should be given to patients with prolonged waiting times and aged patients. Since there were only two fully active cardiac centers in Ethiopia it is far from an adequate number of centers for more than 120 million population, therefore, the study highly recommended to increase the number of cardiac centers that serve as cardiac surgery in Ethiopia.
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Affiliation(s)
- Melaku Tadege
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
- Regional Data Management Center for Health (RDMC), Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia.
| | | | - Zelalem G Dessie
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- School of Mathematics, Statistics and Computer Science, University of KwaZulu- Natal, Durban, South Africa
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Sanetra K, Gerber W, Domaradzki W, Mazur M, Synak M, Kubaszewska M, Kaźmierczak P, Buszman PP, Bochenek A. Use of del Nido cardioplegia in acute coronary syndrome cases with decreased ejection fraction. Perfusion 2024; 39:353-361. [PMID: 36472195 DOI: 10.1177/02676591221144166] [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: 12/22/2023]
Abstract
BACKGROUND There has been increasing interest in using del Nido cardioplegia in adult cardiac surgery. However, there is limited evidence for its efficacy in patients with acute coronary syndrome and reduced ejection fraction. METHODS This study examined patients with decreased ejection fraction (EF < 40%) who were hospitalized due to acute coronary syndrome and received either del Nido (DN) or cold blood cardioplegia (CB). The patients were matched based on age, gender, myocardial infarction at baseline, and number of conducted surgical procedures. An analysis was conducted on postoperative biomarker release (high-sensitivity troponin T and isoenzyme creatine kinase-MB (CK-MB)), changes in myocardial contractility and perioperative outcomes. RESULTS 62 pairs of patients with similar baseline characteristics were selected. 51.6% of pairs underwent isolated coronary artery bypass grafting, while 48.4% underwent a complex procedure. Postoperative troponin values did not differ significantly at 12 h (median (IQR): 606.7 (381.4-974.8) pg/mL vs. 552 (231.8-1579.5) pg/mL; p = 0.913), nor did CK-MB (median (IQR): 24.3 (12.6-45.5) ng/mL vs. 23.7 (12.3-49.8) ng/mL; p = 0.972). The postoperative EF was similar between groups (median (IQR): 30% (30-35%) vs. 34% (30-38%); p = 0.323). No difference in perioperative mortality, myocardial infarction, stroke, or composite endpoint was noted. In a multivariate analysis, the cardioplegia protocol did not affect biomarker release or changes in ejection fraction. The first stage of acute kidney injury was more frequent in the CB group (28.5% vs. 9.7%, p = 0.033). CONCLUSIONS Both del Nido and cold blood cardioplegia provide adequate cardioprotection in patients with acute coronary syndrome with decreased ejection fraction.
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Affiliation(s)
- Krzysztof Sanetra
- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
| | - Wojciech Domaradzki
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Marta Mazur
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Magdalena Synak
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Marta Kubaszewska
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | - Piotr P Buszman
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Department of Cardiac Surgery, Academy of Silesia, Katowice, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
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Zhu Y, Pei L, Li N, Zhu Y. Preoperative sST2 levels relate to myocardial remodeling and cardiac function improvement after cardiac valve surgery. ESC Heart Fail 2024; 11:91-98. [PMID: 37820741 PMCID: PMC10804203 DOI: 10.1002/ehf2.14541] [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: 03/28/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS We aim to investigate the correlation between preoperative soluble suppression of tumourigenicity 2 (sST2) and postoperative myocardial remodelling and cardiac function in patients with valvular heart disease. METHODS AND RESULTS This retrospective study included patients who underwent heart valve surgery at the General Hospital of Northern Theatre Command from July 2019 to June 2020. Preoperative, early postoperative, and 1-month postoperative cardiac ultrasound data were collected. Multivariable linear regression was used to analyse the factors associated with preoperative sST2 and postoperative cardiac function parameters. A receiver operator characteristic curve analysis was used to analyse the predictive value of sST2 for left ventricular ejection fraction (LVEF) reduction at 1 month after surgery. This study included 156 patients. Left ventricular end-systolic volume (b = 0.125, P = 0.004), atrial fibrillation (b = 7.933, P = 0.003), and coronary artery disease (b = 5.826, P = 0.043) were correlated with the preoperative sST2 levels. Preoperative sST2 was independently associated with early postoperative left ventricular end-systolic volume (b = -0.136, P = 0.035), left ventricular end-diastolic volume (b = -0.225, P = 0.036), and LVEF (b = 0.056, P = 0.008). At 1 month after surgery, LVEF (r = -0.234, P = 0.023) and reduction in LVEF (r = -0.316, P = 0.002) were negatively correlated with preoperative sST2. The area under the receiver operator characteristic curve of preoperative sST2 in predicting LVEF reduction at 1 month was 0.646, with a sensitivity of 0.357 and a specificity of 0.918. CONCLUSIONS Preoperative sST2 levels are related to early postoperative myocardial remodelling and have a predictive value for the improvement of cardiac function 1 month after surgery.
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Affiliation(s)
- Yan Zhu
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Lipeng Pei
- Department of Obstetrics and GynecologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Ning Li
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yan Zhu
- Department of Cardiovascular SurgeryGeneral Hospital of Northern Theater CommandShenyangChina
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Hong L, Feng T, Qiu R, Lin S, Xue Y, Huang K, Chen C, Wang J, Xie R, Song S, Zhang C, Zou J. A novel interpretative tool for early prediction of low cardiac output syndrome after valve surgery: online machine learning models. Ann Med 2023; 55:2293244. [PMID: 38128272 PMCID: PMC10763875 DOI: 10.1080/07853890.2023.2293244] [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: 06/06/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Low cardiac output syndrome (LCOS) is a severe complication after valve surgery, with no uniform standard for early identification. We developed interpretative machine learning (ML) models for predicting LCOS risk preoperatively and 0.5 h postoperatively for intervention in advance. METHODS A total of 2218 patients undergoing valve surgery from June 2019 to Dec 2021 were finally enrolled to construct preoperative and postoperative models. Logistic regression, support vector machine (SVM), random forest classifier, extreme gradient boosting, and deep neural network were executed for model construction, and the performance of models was evaluated by area under the curve (AUC) of the receiver operating characteristic and calibration curves. Our models were interpreted through SHapley Additive exPlanations, and presented as an online tool to improve clinical operability. RESULTS The SVM algorithm was chosen for modeling due to better AUC and calibration capability. The AUCs of the preoperative and postoperative models were 0.786 (95% CI 0.729-0.843) and 0.863 (95% CI 0.824-0.902), and the Brier scores were 0.123 and 0.107. Our models have higher timeliness and interpretability, and wider coverage than the vasoactive-inotropic score, and the AUC of the postoperative model was significantly higher. Our preoperative and postoperative models are available online at http://njfh-yxb.com.cn:2022/lcos. CONCLUSIONS The first interpretable ML tool with two prediction periods for online early prediction of LCOS risk after valve surgery was successfully built in this study, in which the SVM model has the best performance, reserving enough time for early precise intervention in critical care.
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Affiliation(s)
- Liang Hong
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianling Feng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Runze Qiu
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Shiteng Lin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yinying Xue
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kaizong Huang
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Jiawen Wang
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Rongrong Xie
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Sanbing Song
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cui Zhang
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
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Zhang Y, Zhang L, Zhao W, Li N, Chen G, Ge J, Su X, Ge S, Sun C. Cardiac structural and functional remodeling in the fetuses associated with maternal hypothyroidism during pregnancy. J Matern Fetal Neonatal Med 2023; 36:2203796. [PMID: 37121903 DOI: 10.1080/14767058.2023.2203796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES We sought to investigate the effect of maternal hypothyroidism during pregnancy on fetal cardiac structural and functional remodeling using fetal echocardiography. METHODS A total of 59 pregnant women with history of hypothyroidism were prospectively enrolled as the study group, and 74 normal fetuses as the control group. Fetal echocardiography was performed on each subject. Demographic, clinical, and fetal echocardiographic variables were measured, including left ventricular (LV) and right ventricular (RV) free wall and ventricular septal thickness, fractional shortening (FS), stroke volume (SV), cardiac output (CO), combined cardiac output (CCO), cardiac index (CI), combined cardiac index (CCI), aortic and pulmonary artery velocity, ductus venosus (DV) and pulmonary vein (PV) spectral Doppler, and Tei index. RESULTS The incidence of echogenic intracardiac foci (EIF) was higher in the study group than that in the control group (18.6% vs. 6.8%, p = .036). The thickness of LV free wall and interventricular septum was reduced, the pulmonary velocities and CCI, RV FS, CO, and CI were lower, the S, D, S/A, and pulsatility index (PI) of DV were higher, and LV Tei index was higher in the study group compared with the control group. There was no significant difference in other variables between the two groups. CONCLUSIONS There is cardiac remodeling, and systolic, diastolic functional alterations in fetuses with maternal hypothyroidism. Further investigation is warranted to develop strategies to optimize the outcome of these fetuses.
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Affiliation(s)
- Yanhong Zhang
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Lisi Zhang
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Wei Zhao
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Na Li
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Guihong Chen
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jun Ge
- Department of Nutrition, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xingna Su
- Department of Ultrasound, The Maternal and Child Health Hospital of Ningjin County, Xingtai, China
| | - Shuping Ge
- Department of Pediatric and Adult Congenital Cardiology, Geisinger Heart and Vascular Institute, Geisinger Clinic, Danville, PA, USA
| | - Congxin Sun
- Department of Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
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Brown S, Nassar K, Razzouk J, Kashyap AK, Won M, Shehadeh T, Salabat R, Rabkin DG, Chung JS. Outcomes of coronary artery bypass surgery using modified del Nido cardioplegia in patients with poor ventricular function. J Cardiothorac Surg 2023; 18:346. [PMID: 38031138 PMCID: PMC10685478 DOI: 10.1186/s13019-023-02466-0] [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: 05/08/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND del Nido cardioplegia (DN) has been shown to be safe in adult patients undergoing isolated coronary artery bypass grafting with normal left ventricular ejection fraction. We sought to determine whether it was also safe in adult patients with diminished left ventricular function. METHODS All patients with preoperative left ventricular ejection fraction ≤ 40% undergoing isolated coronary artery bypass grafting between 1/1/2019 and 7/10/2022 were retrospectively analyzed. Off-pump and beating heart cases were excluded. Patients were divided by surgeon preference between conventional cardioplegia (CCP) and DN. Baseline and intraoperative characteristics and short-term postoperative outcomes were compared. RESULTS Six surgeons performed 829 isolated coronary artery bypass operations during the study. Two-hundred seventy-two met study criteria. Three surgeons used exclusively CCP for the duration of the study, two used exclusively DN and one switched from CCP to DN mid-way through. Group totals were: CCP n = 181 and DN n = 91. There were no significant differences in baseline characteristics including mean left ventricular ejection fraction (CCP 32.5 ± 7.4% vs. DN 33.4 ± 7.29%, p = 0.939). Other than a significant decrease in bypass time for DN (113.20 ± 37.2 vs. 122.43 ± 34.3 min, p = 0.043) there were no intergroup differences in urgency, number of grafts, ischemic time or incidence of blood transfusion. Postoperative outcomes between CCP and DN were similar including incidence of atrial fibrillation (12.2% vs. 8.8%, p = 0.403), intensive care length of stay (3.7 ± 2.3 vs. 4.3 ± 3.7 days, p = 0.886), total length of stay (5.7 ± 3.7 vs. 6.3 ± 4.4 days, p = 0.922) and 30-day mortality (3.85% vs. 1.10%, p = 0.205). CONCLUSION Compared to conventional cardioplegia, del Nido cardioplegia provides equivalent short-term outcomes in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting.
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Affiliation(s)
- Samuel Brown
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Kholoud Nassar
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Jacob Razzouk
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Abishek K Kashyap
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Mitchell Won
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Thaer Shehadeh
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - Reza Salabat
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
| | - David G Rabkin
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA.
| | - Joshua S Chung
- Department of Cardiothoracic Surgery, Loma Linda University Medical Center, Coleman Pavilion, Suite 21121, 11175 Campus Street, Loma Linda, CA, 92354, USA
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10
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Pieri M, Bonizzoni MA, Belletti A, Calabrò MG, Fominskiy E, Nardelli P, Ortalda A, Scandroglio AM. Extracorporeal Blood Purification with CytoSorb in 359 Critically Ill Patients. Blood Purif 2023; 52:759-767. [PMID: 37669640 DOI: 10.1159/000530872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Critically ill patients with inflammatory dysregulation and organ disfunction may benefit from blood purification, although the use of this technique has not been described in large case series. We evaluated clinical outcomes and survival in high-risk intensive care unit (ICU) patients who underwent extracorporeal blood purification. METHODS 359 consecutive ICU patients treated with CytoSorb were included. RESULTS Main admission diagnoses were 120 (34%) refractory cardiac arrest under mechanical chest compression; 101 (28%) profound cardiogenic shock; 81 (23%) post-cardiotomy cardiogenic shock; and 37 (10%) respiratory failure. Fifteen patients (4%) were positive for SARS-CoV-2 infection. We observed 49% 30-day mortality, 57% ICU mortality, and 62% hospital mortality, all lower than the 71% mortality predicted by SAPS II and 68% predicted by SOFA score. Parameters of shock and organ failure, above all vasoactive inotropic score, reduced during CytoSorb treatment. Multivariable analysis identified SAPS II, lactate dehydrogenase, ICU stay duration, vasoactive inotropic score, lactates, intra-aortic counterpulsation on top of VA-ECMO, and total bilirubin as predictors of mortality. No CytoSorb-related complications occurred. CONCLUSION CytoSorb treatment was effective in reducing laboratory parameters of shock and vasoactive inotropic score with possible survival implications in a large population of critically ill patients.
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Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo A Bonizzoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria G Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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11
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Welker CC, Mielke JAR, Ramakrishna H. Levosimendan and Low Cardiac Output After Cardiac Surgery: Analysis of Trial Data. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00182-9. [PMID: 37028989 DOI: 10.1053/j.jvca.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Carson C Welker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jr Arthur R Mielke
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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12
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Jiang Y, Yang Z, Shao L, Shen H, Teng X, Chen Y, Ding Y, Fan J, Yu Y, Shen Z. Clinical Outcomes by Consolidation of Bone Marrow Stem Cell Therapy and Coronary Artery Bypass Graft in Patients With Heart Failure With Reduced Ejection Fraction: A Meta-analysis. Cell Transplant 2023; 32:9636897231152381. [PMID: 36786355 PMCID: PMC9932762 DOI: 10.1177/09636897231152381] [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] [Indexed: 02/15/2023] Open
Abstract
Bone marrow stem cell (BMSC) transplantation during coronary artery bypass graft (CABG) is an innovative treatment for ischemic heart disease (IHD). We conduct a meta-analysis to examine whether patients with IHD presenting heart failure with reduced ejection fraction (HFrEF) can be beneficent from CABG with additional BMSC transplantation. Electronic searches were performed on PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov from their inception to July 2021. The efficacy was based on left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and 6-min walk test (6MWT) change after treatment. Eight randomized-controlled trials (RCTs) were included in this meta-analysis, with a total of 350 patients. Results showed BMSC transplantation significantly improved the LVEF [mean difference (MD) = 6.23%, 95% confidence interval (CI): 3.22%-9.24%, P < 0.0001], LVEDVi (MD = -20.15 ml/m2, 95% CI: -30.49 to -9.82 ml/m2, P < 0.00001), and LVESVi (MD = -17.69 ml/m2, 95% CI: -25.24 to -10.14 ml/m2, P < 0.00001). There was no statistically significant difference in the improvement of LVEDD, LVEDV, and 6MWT between the cell transplantation group and control groups. Subgroup analysis revealed that the intervention for control group could affect the efficacy of BMSC transplantation. Sensitivity analysis found the conclusion of LVEDD, LVEDV, and 6MWT changes was not stable. Therefore, among patients with IHD presenting HFrEF, BMSC transplantation during CABG is promising to be beneficial for postoperative left ventricular (LV) function improvement. However, according to the unstable results of the sensitivity analysis, it cannot be concluded whether the extra step has a positive effect on left ventricular remodeling and exercise capacity. RCTs with larger cohorts and more strict protocols are needed to validate these conclusions.
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Affiliation(s)
- Yinhao Jiang
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Ziying Yang
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Lianbo Shao
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Han Shen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Xiaomei Teng
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Yihuan Chen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Yinglong Ding
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Jiaming Fan
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - You Yu
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China
| | - Zhenya Shen
- Department of Cardiovascular Surgery of
the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow
University, Suzhou, People’s Republic of China,Zhenya Shen, Department of Cardiovascular
Surgery of the First Affiliated Hospital & Institute for Cardiovascular
Science, Soochow University, No. 899, Pinghai Road, Suzhou 215006, Jiangsu,
People’s Republic of China.
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13
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Xiaoyu X, Jie R, Chengjun L, Feng X, Jing L. Early-Stage Vasoactive-Inotropic Score and Left Ventricular Ejection Fraction Following Cardiac Surgery: A Comparison of Two Non-invasive Heart Function Monitoring Technologies in the Prognosis of Infants. IRANIAN JOURNAL OF PEDIATRICS 2023; 33. [DOI: 10.5812/ijp-131666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Objectives: This study aimed to compare the efficiencies of the vasoactive-inotropic score (VIS) and left ventricular ejection fraction (LVEF) in predicting the condition and prognosis of children with congenital heart disease (CHD). Methods: We retrospectively reviewed the medical charts of 104 infants aged < 1 year who underwent cardiac surgery with cardiopulmonary bypass. The maximum and mean postoperative VIS in the first and second 24 hours [VIS (24MAX), VIS (24MEA), VIS (48MAX), and VIS (48MEA)] were recorded. Similarly, LVEF within 24 hours following surgery was monitored. Receiver operator curve (ROC), regression analysis, chi-square test, and t-test were used to analyze both heart function monitoring technologies Results: Receiver operating characteristic analysis revealed that VIS was strongly associated with adverse events and death [area under ROC (AUROC) > 0.90, P = 0.00], with the two most representative scores being VIS (24MEA) and VIS (48MAX), with cut-off points of 19.42 (sensitivity = 100%; specificity = 93.90%) and 22 (sensitivity = 100%; specificity = 93.90%), respectively for death, and 18.02 (sensitivity = 91.70%; specificity = 89.10%) and 17.75 (sensitivity = 91.70%; specificity = 90.20%), respectively for adverse events. Infants with higher VIS had significantly higher mortality, higher incidence of clinical adverse events, higher lactic acid value, and longer mechanical ventilation and ICU stay (P < 0.05). However, LVEF within 24 hours following surgery was not associated with death (AUROC = 0.65, P = 0.33) or adverse events (AUROC = 0.53, P = 0.81). Moreover, there was no significant change in the length of ICU stay, duration of mechanical ventilation, and lactate value (P > 0.05). Conclusions: Vasoactive-inotropic score at an early stage following surgery was significantly associated with the condition and prognosis of infants with congenital heart disease; however, the predictive value of LVEF within 24 hours following surgery was lower.
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14
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Yeşiler Fİ, Akmatov N, Nurumbetova O, Beyazpınar DS, Şahintürk H, Gedik E, Zeyneloğlu P. Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients. Cureus 2022; 14:e31602. [DOI: 10.7759/cureus.31602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
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15
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Ganizada B, Heuts S, Willems C, Cortenraad I, Tunnissen W, Maessen JG, Bidar E, Natour E. Aortic root replacement in severe left ventricular dysfunction: The added value of beating-heart surgery. J Card Surg 2022; 37:3984-3987. [PMID: 36047388 PMCID: PMC9826073 DOI: 10.1111/jocs.16879] [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: 07/19/2022] [Accepted: 08/13/2022] [Indexed: 01/11/2023]
Abstract
There are limits to the use of cardioplegic arrest during complex cardiac surgical procedures, especially in patients with severe left ventricular dysfunction. In the current report, we graphically present the detailed surgical strategy and technique for beating-heart aortic root replacement with concomitant coronary bypass grafting, for patients otherwise deemed inoperable. With support of cardiopulmonary bypass (CPB), beating-heart bypass surgery is realized, after which the bypass grafts can selectively be connected to the CPB, preserving coronary flow. Then, on the beating and perfused heart, a complex procedure such as aortic root replacement can be performed, without jeopardizing postoperative cardiac function. However, several important caveats and remarks regarding the use of beating-heart surgery should be considered, including: coronary perfusion verification and maintenance, temperature management, and prevention of air embolisms. By use of this strategy, risks associated with cardioplegic arrest are minimized, while it circumvents the potential need for long-term postoperative extracorporeal membrane oxygenation.
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Affiliation(s)
- Berta Ganizada
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Colin Willems
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Inez Cortenraad
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Willemijn Tunnissen
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Jos G. Maessen
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Elham Bidar
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Ehsan Natour
- Department of Cardiothoracic SurgeryMaastricht University Medical Center+MaastrichtThe Netherlands,Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
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16
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Arafat AA, Alawami MH, Hassan E, Alshammari A, AlFayez LA, Albabtain MA, Ismail HH, Adam AI, Pragliola C, Algarni KD. Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction. Angiology 2022:33197221121012. [DOI: 10.1177/00033197221121012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, there is no preference for surgical (SAVR) vs transcatheter (TAVR) aortic valve replacement in patients with low ejection fraction (EF). The present study retrospectively compared the outcomes of SAVR vs TAVR in patients with EF ≤40% (70 SAVR and 117 TAVR patients). Study outcomes were survival and the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission. The patients who had TAVR were older (median: 75 (25-75th percentiles: 69-81) vs 51 (39-66) years old; P < .001) with higher EuroSCORE II (4.95 (2.99-9.85) vs 2 (1.5-3.25); P < .001). Postoperative renal impairment was more common with SAVR (8 (12.5%) vs 4 (3.42%); P = .03), and they had longer hospital stay [9 (7-15) vs 4 (2-8) days; P < .001). There was no difference between groups in stroke, reintervention, and readmission (Sub-distributional Hazard ratio: .95 (.37-2.45); P = .92). Survival at 1 and 5 years was 95% and 91% with SAVR and 89% and 63% with TAVR. Adjusted survival was comparable between groups. EF improved significantly (β: .28 (.23-.33); P < 0.001) with no difference between groups ( P = .85). In conclusion, TAVR could be as safe as SAVR in patients with low EF.
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Affiliation(s)
- Amr A. Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Murtadha H. Alawami
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Essam Hassan
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ahmad Alshammari
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Latifa A. AlFayez
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah A. Albabtain
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Huda H. Ismail
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Adam I. Adam
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled D. Algarni
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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17
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Akhtar Z, Sohal M, Kontogiannis C, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in Coronary Venous Drainage: Challenges and Solutions in Delivering Cardiac Resynchronisation Therapy. J Cardiovasc Electrophysiol 2022; 33:1262-1271. [PMID: 35524414 DOI: 10.1111/jce.15524] [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: 02/21/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties. METHODS From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted 'normal' anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected. RESULTS From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an 'unroofed' coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant. CONCLUSION CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, London, UK
| | | | - Idris Harding
- Department of Cardiology, St George's University Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Royal Surrey County Hospital, Guildford, UK
| | - Abhay Bajpai
- Department of Cardiology, St George's University Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Frimley Park Hospital, Surrey, UK
| | - Simon Pearse
- Department of Cardiology, St George's University Hospital, London, UK
| | - Ian Beeton
- Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
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18
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Zand M, Sattarzadeh R, Larti F, Mansouri P, Tavoosi A. Right ventricular diastolic function predicts clinical atrial fibrillation after coronary artery bypass graft. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:35. [PMID: 35968213 PMCID: PMC9374141 DOI: 10.4103/jrms.jrms_816_19] [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: 12/11/2019] [Revised: 06/07/2020] [Accepted: 11/25/2021] [Indexed: 11/04/2022]
Abstract
Background Patients with moderate-severe left ventricular systolic dysfunction undergoing coronary artery bypass graft (CABG) surgery are at high risk of mortality and morbidity. Our aim is to evaluate the right ventricular (RV) diastolic function in these patients, and monitor its effects on postoperation outcomes. Materials and Methods In a cohort study, patients with moderate-severe left ventricular systolic dysfunction (ejection fraction ≤35%) who were candidate for CABG were included. Baseline transthoracic echocardiography (TTE) was performed, and RV diastolic function measures were obtained. After CABG, the length of intubation, inotrope dependency, hospital stay in intensive care unit and ward, in-hospital and after discharge mortality, postoperative atrial fibrillation (POAF) were evaluated in all patients. Results Sixty-seven patients were prospectively included in the study. The mean ± standard deviation age of our patients was 61.4 ± 9.3. There was no difference between grades of RV diastolic function and postoperative outcomes. However, we found significant difference between grades of RV diastolic function and onset of in hospital, and total POAF (P-value = 0.017). Multivariate analysis demonstrated that preoperative tricuspidEt/E't (ratio of peak early-diastolic flow rate across the tricuspid valve orifice to peak early-diastolic velocity at the lateral tricuspid annulus), left atrial volume and "high risk" Euroscore II were independent predictors for POAF during hospitalization and total POAF in patients with moderate to severely impaired left ventricular systolic function (P-values were 0.04, 0.003 and 0.001, respectively). Conclusion We believe that patients with increased tricuspid Et/E't are high risk for POAF; therefore, any risk score for POAF should include a comprehensive TTE including evaluation of RV diastolic function before surgery.
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Affiliation(s)
- Mehdi Zand
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Mansouri
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavoosi
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
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19
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Kurniawaty J, Setianto BY, Supomo, Widyastuti Y, Boom CE. The Effect of Low Preoperative Ejection Fraction on Mortality After Cardiac Surgery in Indonesia. Vasc Health Risk Manag 2022; 18:131-137. [PMID: 35356550 PMCID: PMC8959716 DOI: 10.2147/vhrm.s350671] [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: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Among cardiac surgery patients, low preoperative left ventricular ejection fraction (LVEF) is common and has been associated with poor outcomes. The objective of this study was to assess the association between LVEF and postoperative mortality in patients undergoing open-heart surgery in several hospitals in Indonesia. Methods We conducted a multicenter study with the retrospective design using data from patients undergoing open-heart surgery in 4 institutions in Indonesia. Data regarding LVEF and other potential risk factors were extracted from medical records and compiled in one datasheet. Statistical analyses were performed to assess if low LVEF was associated with postoperative mortality and identify other potential risk factors. Results A total of 4789 patients underwent cardiac surgery in participating centers during the study period. Of these, 189 subjects (3.9%) had poor preoperative LVEF. Poor LVEF was associated with postoperative mortality (adjusted OR 2.761, 95% CI 1.763–4.323, p < 0.001). Based on types of surgery, LVEF had a significant association with mortality only in CABG patients, while there was no such association in valve surgery and inconclusive in congenital surgery patients. Other significant independent predictors of in-hospital mortality included age more than 65 years old, non-elective surgery, the complexity of procedures, history of cardiac surgery, organ failure, CARE score ≥ 3, NYHA class ≥ III, and poor right ventricular function. Conclusion Patients with low preoperative LVEF undergoing open-heart surgery had a higher risk of postoperative mortality. Cardiac surgery can be performed with acceptable mortality rates. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcomes.
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Affiliation(s)
- Juni Kurniawaty
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Budi Yuli Setianto
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Supomo
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cindy E Boom
- Harapan Kita National Heart Center, Jakarta, Indonesia
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20
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Association between left ventricular ejection fraction and mortality after Bentall procedure. Heart Vessels 2022; 37:1462-1469. [DOI: 10.1007/s00380-022-02028-9] [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: 10/05/2021] [Accepted: 01/14/2022] [Indexed: 11/04/2022]
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21
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Brovman EY, Tolis G, Hirji S, Axtell A, Fields K, Muehlschlegel JD, Urman RD, Deseda GAC, Kaneko T, Karamnov S. Association Between Early Extubation and Postoperative Reintubation After Elective Cardiac Surgery: A Bi-institutional Study. J Cardiothorac Vasc Anesth 2022; 36:1258-1264. [PMID: 34980525 DOI: 10.1053/j.jvca.2021.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is unknown if remaining intubated after cardiac surgery is associated with a decreased risk of postoperative reintubation. The primary objective of this study was to investigate whether there was an association between the timing of extubation and the risk of reintubation after cardiac surgery. DESIGN A retrospective, observational study. SETTING Two university-affiliated tertiary care centers. PARTICIPANTS A total of 9,517 patients undergoing either isolated coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 6,609 isolated CABGs and 2,908 isolated AVRs were performed during the study period. Reintubation occurred in 112 patients (1.64%) after CABG and 44 patients (1.5%) after AVR. After multivariate logistic regression analysis, early extubation (within the first 6 postoperative hours) was not associated with a risk of reintubation after CABG (odds ratio [OR] 0.53, 95% CI 0.26-1.06) and AVR (OR 0.52, 95% CI 0.22-1.22). Risk factors for reintubation included increased age in both the CABG (OR per 10-year increase, 1.63; 95% CI 1.28-2.08) and AVR (OR per 10-year increase, 1.50; 95% CI 1.12-2.01) cohorts. Total bypass time, race, and New York Heart Association (NYHA) functional class were not associated with reintubation risk. CONCLUSION Reintubation after CABGs and AVRs is a rare event, and advanced age is an independent risk factor. Risk is not increased with early extubation. This temporal association and low overall rate of reintubation suggest the strategies for extubation should be modified in this patient population.
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Affiliation(s)
- Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - George Tolis
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
| | - Sameer Hirji
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Andrea Axtell
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
| | - Kara Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - J Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gaston A Cudemis Deseda
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Sergey Karamnov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
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22
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6594528. [DOI: 10.1093/ejcts/ezac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
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23
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Duan L, Hu GH, Wang E, Zhang CL, Huang LJ, Duan YY. Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study. BMC Cardiovasc Disord 2021; 21:604. [PMID: 34922443 PMCID: PMC8683821 DOI: 10.1186/s12872-021-02411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. METHODS The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. RESULTS Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. CONCLUSIONS DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.
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Affiliation(s)
- Lian Duan
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Guo-Huang Hu
- Department of Surgery, Affiliated Changsha Hospital of Hunan Normal University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
| | - Cheng-Liang Zhang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Jin Huang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Ying Duan
- Department of Occupational and Environmental Health, Public Health School, Central South University, Changsha, China
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24
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Transcatheter pulmonary balloon valvuloplasty of severe valvar pulmonary stenosis and atrial septal defect in patient with severe cyanosis and very low ventricle ejection fractions: a bailout procedure. Cardiol Young 2021; 31:2028-2030. [PMID: 34016212 DOI: 10.1017/s1047951121001967] [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] [Indexed: 11/07/2022]
Abstract
Most cases of severe or critical pulmonary stenosis are detected early and interventional management is routine within the first days of life. We present a case of a thirteen-year-old boy diagnosed with pulmonary stenosis and atrial septal defect with low ventricle ejection fraction. The patient underwent staged pulmonary balloon valvuloplasty and interventional atrial septal defect closure with good results.
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25
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Bianco V, Kilic A, Aranda-Michel E, Serna-Gallegos D, Dunn-Lewis C, Chen S, Thoma F, Navid F, Sultan I. Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes. JTCVS OPEN 2021; 7:157-164. [PMID: 36003744 PMCID: PMC9390660 DOI: 10.1016/j.xjon.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Courtenay Dunn-Lewis
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Shangzhen Chen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
- Address for reprints: Ibrahim Sultan, MD, Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Center for Thoracic Aortic Disease, University of Pittsburgh, Heart and Vascular Institute, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite 715, Pittsburgh, PA 15232.
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26
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Zeng X, Hu Y, Shu L, Li J, Duan H, Shu Q, Li H. Explainable machine-learning predictions for complications after pediatric congenital heart surgery. Sci Rep 2021; 11:17244. [PMID: 34446783 PMCID: PMC8390484 DOI: 10.1038/s41598-021-96721-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022] Open
Abstract
The quality of treatment and prognosis after pediatric congenital heart surgery remains unsatisfactory. A reliable prediction model for postoperative complications of congenital heart surgery patients is essential to enable prompt initiation of therapy and improve the quality of prognosis. Here, we develop an interpretable machine-learning-based model that integrates patient demographics, surgery-specific features and intraoperative blood pressure data for accurately predicting complications after pediatric congenital heart surgery. We used blood pressure variability and the k-means algorithm combined with a smoothed formulation of dynamic time wrapping to extract features from time-series data. In addition, SHAP framework was used to provide explanations of the prediction. Our model achieved the best performance both in binary and multi-label classification compared with other consensus-based risk models. In addition, this explainable model explains why a prediction was made to help improve the clinical understanding of complication risk and generate actionable knowledge in practice. The combination of model performance and interpretability is easy for clinicians to trust and provide insight into how they should respond before the condition worsens after pediatric congenital heart surgery.
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Affiliation(s)
- Xian Zeng
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yaoqin Hu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Liqi Shu
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, USA
| | - Jianhua Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
| | - Haomin Li
- The Children's Hospital of Zhejiang University School of Medicine and National Clinical Research Center for Child Health, Hangzhou, China.
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27
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Hsiung MC, Yin WH, Lee YT, Tsao TP, Lee KC, Huang KC, Chen PE, Chiang WH, Tung TH, Wei J. Effects of Transapical Transcatheter Mitral Valve Implantation. Front Cardiovasc Med 2021; 8:633369. [PMID: 34179124 PMCID: PMC8225931 DOI: 10.3389/fcvm.2021.633369] [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: 11/25/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes. Methods: We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results. Results: We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction (n = 58) and failed annuloplasty rings (n = 14) who underwent redo SRMVR (n = 36) or TAMVI (n = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (p-value = 0.02). TAMVI patients were more severe in New York Heart Association (p-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (p-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months (p < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3–24 months. Conclusions: In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.
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Affiliation(s)
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,School of Medicine, Institute of Microbiology and Immunology, National Yang Ming University, Taipei, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.,Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | | | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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28
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Lee S, Jang EJ, Jo J, Park D, Ryu HG. Institutional case-volume-incorporated mortality risk prediction model after cardiac surgery. Asian J Surg 2021; 45:189-196. [PMID: 34049789 DOI: 10.1016/j.asjsur.2021.04.047] [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: 12/04/2020] [Revised: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Most risk prediction models predicting short-term mortality after cardiac surgery incorporate patient characteristics, laboratory data, and type of surgery, but do not account for surgical experience. Considering the impact of case volume on patient outcome after high-risk procedures, we attempted to develop a risk prediction model for mortality after cardiac surgery that incorporates institutional case volume. METHODS Adult patients who underwent cardiac surgery from 2009 to 2016 were identified. Patients who underwent cardiac surgery (n = 57,804) were randomly divided into the derivation cohort (n = 28,902) or the validation cohorts (n = 28,902). A risk prediction model for in-hospital mortality and 1-year mortality was developed from the derivation cohort and the performance of the model was evaluated in the validation cohort. RESULTS The model demonstrated fair discrimination (c-statistics, 0.76 for in-hospital mortality in both cohorts; 0.74 for 1-year mortality in both cohorts) and acceptable calibration. Hospitals were classified based on case volume into 50 or less, 50-100, 100-200, or more than 200 average cardiac surgery cases per year and case volume was a significant variable in the prediction model. CONCLUSIONS A new risk prediction model that incorporates institutional case volume and accurately predicts in-hospital and 1-year mortality after cardiac surgery was developed and validated.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, South Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, 1375 Gyeongdong-Ro Andong, Gyeongsangbuk-do, 36729, South Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, South Korea
| | - Dongnyeok Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, South Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, South Korea.
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29
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Lind AY, Totzeck M, Rassaf T, Jánosi RA. [Aortic stenosis - Selection of the appropriate TAVR patient]. MMW Fortschr Med 2021; 163:46-53. [PMID: 33844225 DOI: 10.1007/s15006-021-9714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alexander Y Lind
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum,, UniversitätDuisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - Matthias Totzeck
- - Klinik f. Kardiologie u. Angilogie -, Westdt.Herz- u. Gefäßzentrum\/Univ.-Klinikum Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Tienush Rassaf
- - Universitätsklinikum Essen -, Westdt. Herz- u. Gefäßzentrum\/Klinik f. Kardiologie, Hufelandstr. 55, 45122, Essen, Germany
| | - R Alexander Jánosi
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum, Universität Duisburg-Essen, Hufelandstraße 55, D-45147, Essen, Germany
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30
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Bianco V, Kilic A, Mulukutla S, Gleason TG, Kliner D, Allen CC, Habertheuer A, Aranda-Michel E, Humar R, Navid F, Wang Y, Sultan I. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction. J Thorac Cardiovasc Surg 2021; 161:1022-1031.e5. [DOI: 10.1016/j.jtcvs.2020.06.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
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31
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Lee S, Jang EJ, Jo J, Jang D, Kim BR, Ryu HG. Effect of institutional case volume on mid-term mortality after coronary artery bypass grafting surgery. Gen Thorac Cardiovasc Surg 2021; 69:1275-1282. [PMID: 33428084 DOI: 10.1007/s11748-020-01578-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The impact of center case volume on mid-term postoperative outcome after coronary artery bypass grafting surgery (CABG) is still controversial and requires investigation. The aim of this study was to compare mid-term survival after CABG according to the institutional annual CABG case volume. METHODS Adult patients (≥ 18 years) who underwent CABG from 2009 to 2016 were identified by searching National Health Insurance database of Korea for CABG procedure codes. Hospitals were classified into three groups based on annual case volume; low-volume centers (< 20 cases/year), medium-volume centers (20-50 cases/year), and high-volume centers (> 50 cases/year). RESULTS A total of 22,575 CABG were performed in 95 centers during the study period, and 14,697 (65.1%) cases performed at 15 high-volume centers, 5,262 (23.3%) cases at 26 medium-volume centers, and 2,616 (11.6%) cases at 54 low-volume centers. The overall 1-year mortality rate was the lowest in high-volume centers (6.5%), followed by medium-volume centers (10.6%) and low-volume centers (15.2%). Logistic regression identified medium-volume centers (adjusted OR 1.30 [95% CI 1.15-1.49], P < 0.01) and low-volume centers (adjusted OR 1.75 [95% CI 1.51-2.03], P < 0.01) as risk factors for 1-year mortality after CABG compared to high-volume centers. In the Cox proportional hazard model, low- and medium-volume centers were significantly risk factors for poor survival (adjusted HR 1.41 [95% CI 1.31-1.54], P < 0.01 and HR 1.26 [95% CI 1.17-1.35], P < 0.01 for low- and medium-volume centers, respectively). CONCLUSIONS Higher institutional case volume of CABG was associated with lower mid-term mortality.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, 1375 Gyeongdong-Ro, Andong, 36729, Republic of Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, Republic of Korea
| | - Dongyeon Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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32
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Adil A, Setiawan P, Sembiring Y, Arif S, Amin H. Acute kidney injury incidence following cardiac surgery: A risk factor analysis. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_202_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Farkash A, Pevni D, Mohr R, Kramer A, Ziv-Baran T, Paz Y, Nesher N, Ben-Gal Y. Single versus bilateral internal thoracic artery grafting in patients with low ejection fraction. Medicine (Baltimore) 2020; 99:e22842. [PMID: 33126324 PMCID: PMC7598827 DOI: 10.1097/md.0000000000022842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronary artery bypass grafting (CABG) is the standard of care for the treatment of complex coronary artery disease. However, the optimal surgical treatment for patients with reduced left ventricular function with low ejection fraction (EF) is inconclusive. In our center, left-sided coronary grafting with bilateral internal thoracic artery (BITA) is generally the preferred method for surgical revascularization, also for patients with low EF. We compared early and long-term outcomes between BITA grafting and single internal thoracic artery (SITA) grafting in patients with low EF.We evaluated short- and long-term outcomes of all patients who underwent surgical revascularization in our center during 1996 to 2011, according to EF ≥30% and <30%. Univariate and multivariate analyses were performed. In addition, patients who underwent BITA and SITA grafting were matched using propensity score matching.In total, 5337 patients with multivessel disease underwent surgical revascularization during the study period. Of them, 394 had low EF. Among these, 188 underwent SITA revascularization and 206 BITA grafting. Those who underwent SITA were more likely to have comorbidities such as chronic obstructive pulmonary disease, diabetes, congestive heart failure, chronic renal failure, and a critical preoperative condition including preoperative intra-aortic balloon pump insertion.Statistically significant differences were not observed between the SITA and BITA groups in 30-day mortality (8.5% vs 6.8%, P = .55), sternal wound infection (2.7% vs 1.0%, P = .27), stroke (3.7% vs 6.3%, P = .24), and perioperative myocardial infarction (5.9% vs 2.9%, P = .15). Long-term survival (median follow up of 14 years, interquartile range, 11.2-18.9) was also similar between the groups. Propensity score matching (129 matched pairs) yielded similar early and long-term outcomes for the groups.This study did not demonstrate any clinical benefit for BITA compared with SITA revascularization in individuals with low EF.
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Affiliation(s)
- Ariel Farkash
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Dmitri Pevni
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Rephael Mohr
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Amir Kramer
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yosef Paz
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Nahum Nesher
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
| | - Yanai Ben-Gal
- Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine
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Fan FD, Zhang HT, Pan T, Tang XL, Wang DJ. Evaluation of β-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery. BMC Cardiovasc Disord 2020; 20:379. [PMID: 32819270 PMCID: PMC7439680 DOI: 10.1186/s12872-020-01651-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures. Methods We performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n = 386) and non-survival group (n = 124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, β-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of β-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles. Results Patients were followed for a median period of 24 months (interquartile range: 11–44 months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used β-blocker (HR: 2.056, 95%CI:1.236–3.420, P = 0.005) compared with survival group. After propensity matching, the group which always used β-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P = 0.030). Conclusions The risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used β-blockers in patients with LVEF≤35%. The discharge prescription of β-blocker should be cautiously administrated in those patients.
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Affiliation(s)
- Fu-Dong Fan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hai-Tao Zhang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Beijing, 100010, China
| | - Tuo Pan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Xin-Long Tang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Number 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. .,Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Beijing, 100010, China.
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35
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Spencer C, Khatri N, Smeltz AM. Determinants of Discrepancy in the Left Ventricular Systolic Function Evaluation Between Preoperative and Intraoperative Evaluations. Semin Cardiothorac Vasc Anesth 2020; 24:321-327. [PMID: 32605429 DOI: 10.1177/1089253220936784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unexpectedly decreased left ventricular global systolic function can be difficult to manage, even for patients undergoing elective cardiac surgery, and should prompt a multidisciplinary discussion. Therefore, in this review, we discuss the evidence describing key perioperative variables expected to influence left ventricular systolic function to facilitate this discussion.
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Affiliation(s)
- Chad Spencer
- University of North Carolina at Chapel Hill, NC, USA
| | - Nasir Khatri
- University of North Carolina at Chapel Hill, NC, USA
| | - Alan M Smeltz
- University of North Carolina at Chapel Hill, NC, USA
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Zarrizi M, Paryad E, Ghanbari Khanghah A, Kazemnezhad Leili E, Faghani H. Endotracheal Tube Duration in Elderly Patients after the Coronary Artery Bypass Grafting Surgery. TANAFFOS 2020; 19:235-242. [PMID: 33815544 PMCID: PMC8008409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND In elderly patients, the management of the endotracheal tube after coronary artery bypass graft (CABG) can be challenging because they often have complex comorbidities. This study was done to determine endotracheal tube duration in elderly patients after CABG. MATERIALS AND METHODS This retrospective study was conducted on 397 patients aged over 65 years under mechanical ventilation after CABG. Patients in two groups of endotracheal tube duration of less than 8 h and more than 8 h were compared. Medical records were used for data gathering. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis test, and logistic regression model were used for data analysis. RESULTS Endotracheal tube duration was 9.9± 5.89 h in elderly patients. According to the results of the Mann-Whitney U test, there was a significant difference between the two groups in terms of the history of smoking (p = 0.023), history of diabetes (p= 0.062), left ventricular ejection fraction (p= 0.028), and type of operation in terms of emergency and non-emergency (p= 0.069). The logistic regression model showed predictive variables of the endotracheal tube duration after CABG in elderly patients over 65 years, including the history of smoking (1.179- 4.543, CI: 95%, β=0.839, and, p=0.015), history of myocardial infarction (0.188- 1.019, CI: 95%, p= 0.055, β= -0.827), and the left ventricular ejection fraction less than 50% (0.202-0752, CI: 95%, p= 0.005, β= -0.943). CONCLUSION Considering the predictive factors, the duration of the postoperative endotracheal tube can play an important role in the careful care of elderly patients after CABG.
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Affiliation(s)
- Maryam Zarrizi
- Critical Care Nursing, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ezzat Paryad
- GI Cancer Screening and Prevention Research Center (GCSPRC), Department of Nursing (Medical-Surgical), Instructor, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Atefeh Ghanbari Khanghah
- Social Determinants of Health Research Center (SCHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leili
- Guilan Road Trauma Research Center, Department of Biostatistics Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamed Faghani
- Critical Care Nursing, Dr. Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Smeltz AM, Kumar PA. Con: Qualitative Left Ventricular Ejection Fraction Is Not Sufficient for Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 35:335-338. [PMID: 32620495 DOI: 10.1053/j.jvca.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Priya A Kumar
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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Muthulakshmi M, Kavitha G. Cardiovascular Disorder Severity Detection Using Myocardial Anatomic Features Based Optimized Extreme Learning Machine Approach. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiménez-Rivera JJ, Álvarez-Castillo A, Ferrer-Rodríguez J, Iribarren-Sarrías JL, García-González MJ, Jorge-Pérez P, Lacalzada-Almeida J, Pérez-Hernández R, Montoto-López J, Martínez-Sanz R. Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy. J Cardiothorac Surg 2020; 15:108. [PMID: 32448319 PMCID: PMC7245898 DOI: 10.1186/s13019-020-01140-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary. Methods In a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed. Results Preconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1–4) vs 4(3–6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective. Conclusions Preconditioning with levosimendan, is a cost-effective strategy preventing postoperative low cardiac output in patients with moderate-severe left ventricular systolic dysfunction undergoing elective coronary artery bypass graft surgery.
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Affiliation(s)
- Juan José Jiménez-Rivera
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain.
| | - Andrea Álvarez-Castillo
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Jorge Ferrer-Rodríguez
- Health Economist, University of La Laguna, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - José Luis Iribarren-Sarrías
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Martín Jesús García-González
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Juan Lacalzada-Almeida
- Department of Cardiology, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Rosalía Pérez-Hernández
- Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Javier Montoto-López
- Department of Cardiovascular Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
| | - Rafael Martínez-Sanz
- Department of Cardiovascular Surgery, Hospital Universitario de Canarias, La Laguna, Tenerife, S.C.Tenerife, Canary Islands, Spain
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Pisano A, Torella M, Yavorovskiy A, Landoni G. The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:711-729. [PMID: 32434720 DOI: 10.1053/j.jvca.2020.03.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 11/11/2022]
Abstract
Despite improvements in surgical techniques and perioperative care, cardiac surgery still is burdened by relatively high mortality and frequent major postoperative complications, including myocardial dysfunction, pulmonary complications, neurologic injury, and acute kidney injury. Although the surgeon's skills and volume and patient- and procedure-related risk factors play a major role in the success of cardiac surgery, there is growing evidence that also optimizing perioperative care may improve outcomes significantly. The present review focuses on the aspects of perioperative care that are strictly related to the anesthesia regimen, with special reference to volatile anesthetics and neuraxial anesthesia, whose effect on outcome in adult cardiac surgery has been investigated extensively.
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Affiliation(s)
- Antonio Pisano
- Department of Critical Care, Cardiac Anesthesia and Intensive Care Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Andrey Yavorovskiy
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Gambardella I, Gaudino MFL, Rahouma M, Farrington WJ, Khan FM, Hameed I, Lau C, Iannacone E, Girardi LN. Impact of left ventricular ejection fraction on the outcomes of open repair of descending thoracic and thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 2019; 161:534-541.e5. [PMID: 31924362 DOI: 10.1016/j.jtcvs.2019.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To discern the impact of depressed left ventricular ejection fraction (LVEF) on the outcomes of open descending thoracic aneurysm (DTA) and thoracoabdominal aneurysms (TAAA) repair. METHODS Restricted cubic spline analysis was used to identify a threshold of LVEF, which corresponded to an increase in operative mortality and major adverse events (MAE: operative death, myocardial infarction, stroke, spinal cord injury, need for tracheostomy or dialysis). Logistic and Cox regression were performed to identify independent predictors of MAE, operative mortality, and survival. RESULTS DTA/TAAA repair was performed in 833 patients between 1997 and 2018. Restricted cubic spline analysis showed that patients with LVEF <40% (n = 66) had an increased risk of MAE (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.22-3.87; P < .01) and operative mortality (OR, 2.72; 95% CI, 1.21-6.12; P = .02) compared with the group with LVEF ≥40% (n = 767). The group with LVEF <40% had a worse preoperative profile (eg, coronary revascularization, 48.5% vs 17.3% [P < .01]; valvular disease, 82.8% vs 49.39% [P < .01]; renal insufficiency, 45.5% vs 26.1% [P < .01]; respiratory insufficiency, 36.4% vs 21.2% [P = .01]) and worse long-term survival (35.5% vs 44.7% at 10 years; P = .01). Nonetheless, on multivariate regression, depressed LVEF was not an independent predictor of operative mortality, MAE, or survival. CONCLUSIONS LVEF is not an independent predictor of adverse events in surgery for DTA.
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Affiliation(s)
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mohamad Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | | | - Faiza M Khan
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Erin Iannacone
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Pilarczyk K, Carstens H, Papathanasiou M, Luedike P, Koch A, Jakob H, Kamler M, Pizanis N. Prediction of acute kidney injury after left ventricular assist device implantation: Evaluation of clinical risk scores. Artif Organs 2019; 44:162-173. [PMID: 31361341 DOI: 10.1111/aor.13548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 01/19/2023]
Abstract
Acute kidney injury (AKI) is frequent in patients scheduled for implantation of a left ventricular assist device (LVAD) and associated with increased mortality. Although several risk models for the prediction of postoperative renal replacement therapy (RRT) have been developed for cardiothoracic patients, none of these scoring systems have been validated in LVAD patients. A retrospective, single center analysis of all patients undergoing LVAD implantation between September 2013 and July 2016 was performed. Primary outcome was AKI requiring RRT within 14 days after surgery. The predictive capacity of the Cleveland Clinic Score (CCS), the Society of Thoracic Surgeons Score (STS), and the Simplified Renal Index Score (SRI) were evaluated. 76 patients underwent LVAD implantation, 19 patients were excluded due to preoperative RRT. RRT was associated with a prolonged ventilation time, length of stay on the ICU and 180 day mortality (14(60.9%) vs 6(17.6%), P < .01). Whereas the Thakar Score (7.43 ± 1.75 vs 6.44 ± 1.44, P = .02) and the Mehta Score (28.12 ± 15.08 vs 21.53 ± 5.43, P = .02) were significantly higher in patients with RRT than in those without RRT, the SRI did not differ between these groups (3.96 ± 1.15 vs 3.44 ± 1.05, P = .08). Using ROC analyses, CCS, STS, and SRI showed moderate predictive capacity for RRT with an AUC of 0.661 ± 0.073 (P = .040), 0.637 ± 0.079 (P = .792), and 0.618 ± 0.075 (P = .764), respectively, with comparable accuracy in the Delong test. Using univariate logistic regression analysis, only the De Ritis Ratio (OR 2.67, P = .034) and MELD (OR 1.11, P = .028) were identified as predictors of postoperative RRT. Risk scores which are predictive in general cardiac surgery cannot predict RRT in patients after LVAD implantation. Therefore, it seems to be necessary to develop a specific risk score for this patient population.
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Affiliation(s)
- Kevin Pilarczyk
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.,Department of Critical Care Medicine, imland Klinik Rendsburg, Rendsburg, Germany
| | - Henning Carstens
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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Influence of left ventricular ejection fraction on morbidity and mortality after aortic root replacement. J Thorac Cardiovasc Surg 2019; 158:984-991.e1. [DOI: 10.1016/j.jtcvs.2018.10.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/07/2018] [Accepted: 10/26/2018] [Indexed: 01/10/2023]
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Abuelkasem E, Wang DW, Omer MA, Abdelmoneim SS, Howard-Quijano K, Rakesh H, Subramaniam K. Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 2019; 123:408-420. [DOI: 10.1016/j.bja.2019.04.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023] Open
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Levosimendan use in patients with preoperative low ejection fraction undergoing cardiac surgery: A systematic review with meta-analysis and trial sequential analysis. J Clin Anesth 2019; 52:37-47. [DOI: 10.1016/j.jclinane.2018.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
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Duchnowski P, Hryniewiecki T, Koźma M, Mariusz K, Piotr S. High-sensitivity troponin T is a prognostic marker of hemodynamic instability in patients undergoing valve surgery. Biomark Med 2018; 12:1303-1309. [DOI: 10.2217/bmm-2018-0186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of perioperative hemodynamic instability is currently unknown. Methods: A prospective study was conducted on a group of 708 consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary end point was postoperative hemodynamic instability. The secondary end point was death from all causes in patients with perioperative hemodynamic instability. Results: The postoperative hemodynamic instability occurred in 131 patients. At multivariate analysis hs-TnT measured immediately after surgery and New York Heart Association classes remained independent predictors of the primary end point. Age and hs-TnT measured immediately after surgery were associated with an increased risk of death. Conclusion: Elevated postoperative hs-TnT was associated with a higher risk of postoperative hemodynamic instability and death.
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Affiliation(s)
- Piotr Duchnowski
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Małgorzata Koźma
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
| | - Kuśmierczyk Mariusz
- Department of Cardiosurgery & Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Szymański Piotr
- Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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Pieri M, De Luca M, Gerli C, Crivellari M, Buzzatti N, Denti P, Stamelos M, Zangrillo A, Landoni G, Monaco F. Anesthesiologic Management of Patients Undergoing Cardiac Transapical Procedures: Which Challenges in the Modern Era? J Cardiothorac Vasc Anesth 2018; 33:1883-1889. [PMID: 30581110 DOI: 10.1053/j.jvca.2018.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Patients undergoing transapical cardiac procedure are a minority of cardiac surgery patients but represent a challenge for cardiac anesthesiologists because they generally are older and have more comorbidities than do open heart cardiac surgery patients. The aims of this study were to describe the anesthetic experience with transapical procedures in a single high-volume center and to analyze the most critical aspects for anesthetic management. DESIGN Retrospective study. SETTING IRCCS San Raffaele Scientific Institute, Milan, Italy. PARTICIPANTS All patients undergoing a cardiac transapical procedure from January 2009 to April 2018 were included in this case series. INTERVENTIONS Patients were managed by a multidisciplinary heart team. The perioperative anesthetic approach and hemodynamic management were consistent and performed by a group of trained cardiac anesthesiologists. MEASUREMENTS AND MAIN RESULTS The study population comprised 143 patients: 81 (57%) underwent an aortic valve procedure, 60 (42%) a mitral valve intervention, 1 patient underwent a procedure involving both the aortic and mitral valves, and 1 patient underwent correction of a congenital heart defect. A major intraoperative complication occurred in 5 (3.5%) patients, the procedure was not technically feasible because of unsuitable anatomy in 3 patients, and conversion to open heart surgery was needed in 2 patients. All patients were admitted to the intensive care unit. Intensive care unit stay was 1 (1-3) days, and hospital stay was 6 (5-8) days. Hospital survival was 94%. CONCLUSIONS Patients undergoing transapical cardiac procedures are a minority of cardiac surgery patients, but represent a high-risk population. A patient-tailored anesthetic approach, in the context of the therapeutic strategy shared by the heart team, is crucial to improve outcomes.
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Affiliation(s)
- Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica De Luca
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Gerli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Crivellari
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matthaios Stamelos
- Department of Anaesthesiology, Henry Dunant Hospital Center, Athens, Greece
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Montone RA, Niccoli G. Percutaneous coronary intervention in patients refused from surgery: a different entity? Minerva Cardioangiol 2018. [DOI: 10.23736/s0026-4725.18.04656-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krichevskiy LA, Kozlov IA. Natriuretic Peptides in Cardiac Anesthesia and Intensive Care. J Cardiothorac Vasc Anesth 2018; 33:1407-1419. [PMID: 30228053 DOI: 10.1053/j.jvca.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Indexed: 01/16/2023]
Abstract
Natriuretic peptides, predominantly B-type, are widely used in cardiology as prognostic and diagnostic biomarkers or, much less often, as a substantive treatment tool. They are hormones that are produced mainly in the myocardium in response to overload and ischemia, and their level quite accurately reflects the degree of myocardial dysfunction. Although their use in cardiac anesthesia and intensive care setting seems to be very beneficial for assessing the risk of acute disturbance of myocardial function or its laboratory monitoring, the actual significance of natriuretic peptides in this area is not yet recognized. This is due to the lack of clear diagnostic and prognostic values for these biomarkers supported by high-quality researches. On the basis of the available data, main advantages, existing difficulties, and most effective ways of using natriuretic peptides for determining the risk of heart surgery and assessing the severity of sepsis, pneumonia, and other critical conditions have been discussed in this review. In addition, the expediency of using natriuretic peptides as target parameters for goal-oriented therapy and as a substantive tool for treatment is considered.
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Affiliation(s)
- Lev A Krichevskiy
- Department of Anesthesiology and Intensive Care, City Clinical Hospital n.a. S.S.Yudin, Department of Health of Moscow, Moscow, Russia.
| | - Igor A Kozlov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute n.a. M.F. Vladimirskiy, Moscow, Russia
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Lin CY, Lee KT, Ni MY, Tseng CN, Lee HA, Su IL, Ho HP, Tsai FC. Impact of reduced left ventricular function on repairing acute type A aortic dissection: Outcome and risk factors analysis from a single institutional experience. Medicine (Baltimore) 2018; 97:e12165. [PMID: 30170461 PMCID: PMC6392594 DOI: 10.1097/md.0000000000012165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Preoperative left ventricular dysfunction is a risk factor for postoperative mortality and morbidity in cardiovascular surgeries with cardiopulmonary bypass, including thoracic aortic surgery. Using a retrospective study design, this study aimed to clarify the short- and mid-term outcomes of patients who underwent acute type A aortic dissection (ATAAD) repair with reduced left ventricular function.Between July 2007 and February 2018, a total of 510 adult patients underwent surgical repair of ATAAD in a single institution. The patients were classified as having left ventricular ejection fraction (LVEF) <50% (low EF group, n = 86, 16.9%) and LVEF ≥50% (normal group, n = 424, 83.1%) according to transesophageal echocardiographic assessment at the operating room. Preoperative demographics, surgical information, and postoperative complication were compared between the two groups. Three-year survival was analyzed using the Kaplan-Meier actuarial method. Serial echocardiographic evaluations were performed at 1, 2, and 3 years postoperation.Demographics, comorbidities, and surgical procedures were generally homogenous between the 2 groups, except for a lower rate of aortic arch replacement in the low EF group. The averaged LVEFs were 44.3 ± 2.5% and 65.8 ± 6.6% among the low EF and normal groups, respectively. The patients with low EF had higher in-hospital mortality (23.3% versus 13.9%, P = .025) compared with the normal group. Multivariate analysis revealed that intraoperative myocardial failure requiring extracorporeal membrane oxygenation support was an in-hospital mortality predictor (odds ratio, 16.99; 95% confidence interval, 1.23-234.32; P = .034), as was preoperative serum creatinine >1.5 mg/dL. For patients who survived to discharge, the 3-year cumulative survival rates were 77.8% and 82.1% in the low EF and normal groups, respectively (P = .522). The serial echocardiograms revealed no postoperative deterioration of LVEF during the 3-year follow-up.Even with a more conservative aortic repair procedure, the patients with preoperative left ventricular dysfunction are at higher surgical risk for in-hospital mortality. However, once such patients are able to survive to discharge, the midterm outcome can still be promising.
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Affiliation(s)
- Chun-Yu Lin
- Department of Cardiothoracic and Vascular Surgery
| | | | - Ming-Yang Ni
- Department of Anesthesiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Hsiu-An Lee
- Department of Cardiothoracic and Vascular Surgery
| | - I-Li Su
- Department of Cardiothoracic and Vascular Surgery
| | - Heng-Psan Ho
- Department of Cardiothoracic and Vascular Surgery
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