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Sueda K, Hiraoka E, Kitamura K, Norisue Y, Suzuki T, Takahashi O, Ito J, Tabata M. Validation study of EuroSCORE II for dialysis patients: A single-center study in Japan. J Cardiol 2024; 84:30-35. [PMID: 37802204 DOI: 10.1016/j.jjcc.2023.09.011] [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: 01/20/2023] [Revised: 08/17/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II is a predictive model for in-hospital mortality after cardiac surgery. Although it has good performance among the general population undergoing cardiac surgery, it has not been validated among dialysis patients, who have a higher rate of mortality after cardiac surgery. This study aimed to evaluate the performance of the model in predicting in-hospital mortality in maintenance dialysis patients undergoing cardiac surgery. METHODS This retrospective, single-center study included adult patients on maintenance dialysis who underwent open cardiac surgery at our institution. Calibration performance of EuroSCORE II for in-hospital death was determined based on the comparison between expected and observed mortalities for low- (EuroSCORE II <4 %), intermediate- (4-8 %), and high-risk (>8 %) groups. The area under receiver operating characteristic curve (AUROC) was investigated to determine the model's discrimination performance. RESULTS A total of 163 patients (male, 73.6 %; median age, 70 years; median dialysis vintage, 9 years; median EuroSCORE II, 3.3 %) were included. The mortality rate was 9.2 %. The observed mortality rates (vs. mean expected mortality) rates were 2.1 % (vs. 2.4 %), 7.5 % (vs. 5.5 %), and 34.5 % (vs. 21.1 %) in the low-, intermediate-, and high-risk groups, respectively. Its AUROC was 0.825 (95 % confidence interval, 0.711-0.940). CONCLUSIONS Although EuroSCORE II model adequately estimated in-hospital mortality in the low-and intermediate-risk groups (EuroSCORE II <8 %), it underestimated in-hospital mortality in the high-risk group (EuroSCORE II >8 %) among maintenance dialysis patients. The discrimination performance of the model for in-hospital death was good among maintenance dialysis patients.
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Affiliation(s)
- Keishiro Sueda
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Koichi Kitamura
- Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Yasuhiro Norisue
- Department of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Toshihiko Suzuki
- Department of Nephrology, Endocrinology, and Diabetes, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Osamu Takahashi
- Department of Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Joji Ito
- Department of Cardiothoracic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - Minoru Tabata
- Department of Cardiothoracic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan; Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Laimoud M, Alanazi MN, Maghirang MJ, Al-Mutlaq SM, Althibait S, Ghamry R, Qureshi R, Alanazi B, Alomran M, Bakheet Z, Al-Halees Z. Impact of Chronic Kidney Disease on Clinical Outcomes during Hospitalization and Five-Year Follow-Up after Coronary Artery Bypass Grafting. Crit Care Res Pract 2023; 2023:9364913. [PMID: 37795473 PMCID: PMC10547561 DOI: 10.1155/2023/9364913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023] Open
Abstract
Background Chronic kidney disease (CKD) is often associated with multiple comorbidities including diabetes mellitus, and each has its own complications and impact after cardiac surgery including coronary revascularization. The objective of this work was to study the impact of CKD on clinical outcomes after coronary artery bypass grafting (CABG) and to compare outcomes in patients with different grades of renal functions. We retrospectively reviewed all patients who underwent CABG from January 2016 to August 2020 at our tertiary care hospital using electronic medical records. Results The study included 410 patients with a median age of 60 years, and 28.6% of them had CKD and hospital mortality of 2.7%. About 71.4% of the patients had GFR > 60 mL/min per 1.73 m2, 18.1% had early CKD (GFR 30-60), 2.7% had late CKD (GFR < 30), and 7.8% of them had end-stage renal disease (ESRD) requiring dialysis. The CKD group had significantly more frequent hospital mortality (p = 0.04), acute cerebrovascular stroke (p = 0.03), acute kidney injury (AKI) (p < 0.001), longer ICU stay (p = 0.002), post-ICU stay (p = 0.001), and sternotomy wound debridement (p = 0.03) compared to the non-CKD group. The frequencies of new need for dialysis were 2.4% vs. 14.9% vs. 45.5% (p < 0.001) in the patients with GFR > 60 mL/min per 1.73 m2, early CKD, and late CKD, respectively. Acute cerebral stroke (OR: 10.29, 95% CI: 1.82-58.08, and p = 0.008), new need for dialysis (OR: 25.617, 95% CI: 13.78-85.47, and p < 0.001), and emergency surgery (OR: 3.1, 95% CI: 1.82-12.37, and p = 0.036) were the independent predictors of hospital mortality after CABG. The patients with CKD had an increased risk of strokes (HR: 2.14, 95% CI: 1.20-3.81, and p = 0.01) but insignificant mortality increase (HR: 1.44, 95% CI: 0.42-4.92, and p = 0.56) during follow-up. Conclusion The patients with CKD, especially the late grade, had worse postoperative early and late outcomes compared to non-CKD patients after CABG. Patients with dialysis-independent CKD had increased risks of needing dialysis, hospital mortality, and permanent dialysis after CABG.
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Affiliation(s)
- Mohamed Laimoud
- Cardiovascular Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Mosleh Nazzel Alanazi
- Cardiovascular Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mary Jane Maghirang
- Cardiovascular Nursing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shatha Mohamed Al-Mutlaq
- Cardiac Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Suha Althibait
- Cardiac Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rasha Ghamry
- Nephrology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rehan Qureshi
- Cardiovascular Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Boshra Alanazi
- College of Medicine, Almaarefa University, Riyadh, Saudi Arabia
| | - Munirah Alomran
- Cardiovascular Nursing Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeina Bakheet
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zohair Al-Halees
- Cardiac Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Tsukihara H, Motomura N, Takamoto S. Audit-Based Quality Validation of the Japan Cardiovascular Surgery Database. Circ J 2021; 85:2014-2018. [PMID: 34421106 DOI: 10.1253/circj.cj-21-0444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Japan Cardiovascular Surgery Database (JCVSD) is a nationwide registry of patients undergoing cardiovascular surgery in Japan. To investigate and improve data quality, we have been conducting on-site institutional audits since 2004. This study aimed to investigate the accuracy of the registered data by comparing it to site visit data.Methods and Results:The subjects of this study were the 95 facilities at which a site visit was conducted. The case registration accuracy was 98.74%. Furthermore, we confirmed high data input accuracy of >90% for almost all fields. Approximately 99% of cases had been correctly entered for diabetes, aortic stenosis, and mortality. We also discovered which fields were more likely to be incorrectly captured and the causes thereof, as well as problems regarding some definitions and the input system itself. CONCLUSIONS We were able to confirm high registration accuracy in the JCVSD. Appropriately resourced, focused site visits as part of a national audit are capable of accurate data collection on which continual nationwide quality control can be based. Continued work and development to further improve the quality of the database are mandatory to maintain a high standard of cardiovascular surgery in Japan.
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Affiliation(s)
- Hiroyuki Tsukihara
- Department of Cardiothoracic Surgery, The University of Tokyo.,Japan Cardiovascular Surgery Database
| | - Noboru Motomura
- Japan Cardiovascular Surgery Database.,Department of Cardiovascular Surgery, Toho University Sakura Medical Center
| | - Shinichi Takamoto
- Japan Cardiovascular Surgery Database.,Department of Health Policy and Management, School of Medicine, Keio University
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Lozada-Ramos H, Daza-Arana JE, Zárate González M, Medina Gallo LF, Lanas F. Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:78-84. [PMID: 34338494 DOI: 10.23736/s0021-9509.21.11829-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To determine the factors associated with in-hospital mortality after a coronary artery bypass (CABG) in a high-complexity clinic in the city of Santiago de Cali. METHODS A retrospective case-control analytical study was performed. Cases were defined as adult patients that had undergone CABG and died within 30 days of the surgery. Patients aged ≥18 years that had undergone isolated surgeries, i.e. procedures without other interventions combined, were included. This study excluded patients that had missing data in their medical records, had previously been in a state of coma, or had previously undergone cardiac surgery other than a bypass procedure. Exposure variables were measured at three stages: preoperative, intraoperative, and postoperative. RESULTS The study included 77 cases and 308 controls. The most common cause of death was cardiogenic shock (53.2%), followed by sepsis (27.3%). The multinomial logistic regression model revealed an association of in-hospital mortality with preoperative variables of age >75 years (odds ratio [OR] 2.5, 95% confidence interval [CI95%]: 1.1-5.8, p = 0.032), low socioeconomic status (OR 2.3, CI95%: 1.1-5.2, p = 0.034), heart failure (HF) (OR 3.2, CI95%: 1.5-7.0, p = 0.002), unstable angina (OR 4.2, CI95%: 1.9-9.0, p = 0.000), acute myocardial infarction (AMI) ≤7 days (OR 3.9, CI95%: 1.1-13.7, p = 0.037), chronic kidney insufficiency (CKI) (OR 2.9, CI95%: 1.2-7.0, p = 0.018), peripheral vascular disease (PVD) (OR 2.8, CI95%: 1.2-6.8, p = 0.019), and urgent/emergent surgery (OR 8.2, CI95%: 2.0-34.5, p = 0.004). Of the intraoperative variables, the model showed an association between the use of inotropic agents (OR 2.8, CI95%: 1.3-6.4, p = 0.011) and cardiogenic shock (OR 50.6, CI95%: 7.5-339, p = 0.000). CONCLUSIONS This study identifies the factors during preoperative and intraoperative periods that are associated with in-hospital mortality in patients that have undergone CABG.
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Affiliation(s)
- Heiler Lozada-Ramos
- Medicine Program, Universidad Santiago de Cali, Santiago de Cali, Colombia - .,Biomedical Research Institute Group, Universidad Santiago de Cali, Santiago de Cali, Colombia -
| | - Jorge E Daza-Arana
- Physiotherapy Program, Universidad Santiago de Cali, Santiago de Cali, Colombia.,Health and Movement Research Group, Universidad Santiago de Cali, Santiago de Cali, Colombia
| | - Mauricio Zárate González
- Cardiovascular Surgery Service, Clínica de Occidente, Santiago de Cali, Santiago de Cali, Colombia
| | - Luis F Medina Gallo
- Cardiovascular Surgery Service, Clínica de Occidente, Santiago de Cali, Santiago de Cali, Colombia
| | - Fernando Lanas
- Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
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Minatoya K. Impact of renal dysfunction on arch replacement in a database study. Eur J Cardiothorac Surg 2021; 61:170-171. [PMID: 34322710 DOI: 10.1093/ejcts/ezab329] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Palamuthusingam D, Nadarajah A, Johnson DW, Pascoe EM, Hawley CM, Fahim M. Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis. BMC Nephrol 2021; 22:97. [PMID: 33736605 PMCID: PMC7977605 DOI: 10.1186/s12882-021-02279-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. METHODS Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. RESULTS Forty-nine studies involving 10,513,934 patients with normal kidney function and 43,092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29-2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). CONCLUSION Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland, 4131, Australia.
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia.
- School of Medicine, Griffith University, 68 University Dr, Meadowbrook, QLD, 4131, Australia.
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Doherty St, Birtinya, Queensland, 4575, Australia
| | - David Wayne Johnson
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Translational Research Institute, Brisbane, Australia
| | - Elaine Marie Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Carmel Marie Hawley
- Faculty of Medicine, University of Queensland, Armstrong Road & Loganlea Road, St Lucia, Queensland, 4072, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Magid Fahim
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
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Balkan B, Magin H. What are the factors affecting the progression of kidney failure, mortality and morbidity after cardiac surgery in patients with chronic kidney disease? J Card Surg 2021; 36:2021-2028. [PMID: 33694184 DOI: 10.1111/jocs.15493] [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: 04/25/2020] [Revised: 01/11/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Acute kidney injury occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases and associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. We aimed to investigate the factors affecting the progression of kidney disease during cardiac surgery in preoperative chronic kidney disease patients (CKD). METHODS The demographic data of patients and preoperatively studied parameters are: American Society of Anesthesiologists Classification, diabetes mellitus, hypertension, left ventricular ejection fractions, estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. The pre and postoperative parameters recorded were glucose, blood urea nitrogen (BUN), creatinine, hemoglobin, and eGFR. In the intensive care follow-up, discharge status, revision status and 30-day mortality rates and complications were analyzed. RESULTS One hundred and thirty-eight patients (87 males, 51 females; mean age 61.7 years) were included, the mean preoperative Euro score II value was 8.72 ± 7.09 (7.3 ± 6.2 in the survival group and 13.1 ± 7.9. 83 in the deceased group). The number of patients who underwent revision surgery due to postoperative bleeding were 36 (26.09%) and the 30-day surgical mortality was 24.64% (n = 34). CONCLUSION Age, complication, euro score, cross-clamp time, pulmonary artery pressure, postoperative BUN, creatine, and CKD-EPI-GFR were found to be significantly effective in predicting 30-day mortality of the patients.
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Affiliation(s)
- Bedih Balkan
- Department of Anesthesiology and intensive care, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and research Hospital, Saglık Bilimleri University, Istanbul, Turkey
| | - Hasan Magin
- Department of Nephrology, Karolinska University Hospital, Huddinge, Sweden
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Pang PYK, Teow CKJ, Huang MJ, Naik MJ, Lim SL, Chao VTT, Tan TE, Chua YL, Sin YK. Long-term prognosis in patients with end-stage renal disease after coronary artery bypass grafting. J Thorac Dis 2020; 12:6722-6730. [PMID: 33282373 PMCID: PMC7711392 DOI: 10.21037/jtd-20-2046] [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] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG. Methods A retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015. Results Mean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06-1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89-0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00-11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03-1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15-2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19-0.92) as factors influencing long-term survival. Conclusions CABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.
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Affiliation(s)
- Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Christopher K J Teow
- Ministry of Health Holdings, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Jie Huang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Madhava J Naik
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - See Lim Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Teing Ee Tan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Yamauchi T, Yamamoto H, Miyata H, Kobayashi J, Masai T, Motomura N. Surgical Aortic Valve Replacement for Aortic Stenosis in Dialysis Patients ― Analysis of Japan Cardiovascular Surgery Database ―. Circ J 2020; 84:1271-1276. [DOI: 10.1253/circj.cj-20-0042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takafumi Masai
- Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center
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Kumada Y, Ishii H, Oshima S, Ito R, Umemoto N, Takahashi H, Murohara T. Association of protein-energy wasting and inflammation status with mortality after coronary revascularisation in patients on haemodialysis. Open Heart 2020; 7:e001276. [PMID: 32709700 PMCID: PMC7380732 DOI: 10.1136/openhrt-2020-001276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Protein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients. METHODS We enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):<91.5, T2: 91.5-98.1 and T3:>98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5-7.0 mg/L and T3:≥7.1 mg/L). RESULTS Kaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). Declined GNRI (HR 2.40, 95% CI 1.58 to 3.74, p<0.0001 for T1 vs T3) and elevated CRP (HR 2.31, 95% CI 1.58 to 3.43, p<0.0001 for T3 vs T1) were identified as independent predictors of mortality. In combined setting of both variables, risk of mortality was 5.55 times higher (95% CI 2.64 to 13.6, p<0.0001) in T1 of GNRI with T3 of CRP than in T3 of GNRI with T1 of CRP. Addition of GNRI and CRP in a model with established risk factors improved C-statistics (0.648 to 0.724, p<0.0001) greater than that of each alone. CONCLUSION Preprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.
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Affiliation(s)
- Yoshitaka Kumada
- Cardiovascular Surgery, Matsunami General Hospital, Hashima-gun, Gifu, Japan
| | - Hideki Ishii
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Satoru Oshima
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Ryuta Ito
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Norio Umemoto
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | | | - Toyoaki Murohara
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Palamuthusingam D, Nadarajah A, Pascoe EM, Craig J, Johnson DW, Hawley CM, Fahim M. Postoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0234402. [PMID: 32589638 PMCID: PMC7319352 DOI: 10.1371/journal.pone.0234402] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 01/11/2023] Open
Abstract
RATIONALE & OBJECTIVE The prognostic significance of dialysis-dependent end-stage kidney disease on postoperative mortality is unclear. This study aims to estimate the odds of postoperative mortality in patients receiving chronic dialysis undergoing elective surgery compared to patients with normal kidney function, and to examine the influence of comorbidities on the excess mortality risk. METHODS A systematic search of studies published up to January 2020 was conducted using MEDLINE, EMBASE and CENTRAL databases. Eligible studies reported postoperative 30-day or in-hospital mortality in chronic dialysis patients compared to patients with normal kidney function undergoing elective surgery. Two investigators independently reviewed all abstracts and performed risk of bias assessments using the Newcastle-Ottawa Scale. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Relative mortality risk estimates were obtained using random effects meta-analysis. Heterogeneity was explored using meta-regression. (PROSPERO CRD42017076565). RESULTS Forty-nine studies involving 41, 822 chronic dialysis and 10, 476, 321 non-dialysis patients undergoing elective surgery were included. Patients on chronic dialysis had a greatly increased postoperative mortality odds compared to patients with normal kidney function. The excess risk ranged from OR 10.8 (95%CI 7.3-15.9) following orthopaedic surgery to OR 4.0 (95%CI 3.2-4.9) after vascular surgery. Adjustment for age and comorbidity attenuated the excess odds but remained higher for patients on chronic dialysis, irrespective of surgical discipline. Meta-regression analysis demonstrated an inverse linear relationship between excess mortality risk and study-level mean age (slope -0.06; P = 0.001) and diabetes prevalence (slope -0.02; p = 0.001). CONCLUSIONS Patients on chronic dialysis have an increased odds for postoperative mortality following elective surgery across all surgical disciplines. This relationship is consistent among all studies, with the excess postoperative mortality attributable to end-stage kidney disease and chronic dialysis treatment may be lower among older patients with diabetes.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South and Integrated Nephrology and Transplant Services, Logan Hospital, Meadowbrook, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- School of Medicine, Griffith University, Mount Gravatt, Queensland, Australia
| | - Arun Nadarajah
- Department of Surgery, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David W. Johnson
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Carmel M. Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
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12
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Bahrainwala JZ, Gelfand SL, Shah A, Abramovitz B, Hoffman B, Leonberg-Yoo AK. Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD. Am J Kidney Dis 2020; 75:245-255. [DOI: 10.1053/j.ajkd.2019.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/01/2019] [Indexed: 11/11/2022]
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13
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Yamauchi T, Takano H, Miyata H, Motomura N, Takamoto S. Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis - Risk Model From a Japan Cardiovascular Surgery Database. Circ Rep 2020; 1:131-136. [PMID: 33693127 PMCID: PMC7890290 DOI: 10.1253/circrep.cr-19-0010] [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] [Indexed: 11/13/2022] Open
Abstract
Background:
The aim of this study was to determine adequate indication for transcatheter aortic valve replacement (TAVR). We analyzed risk factors of surgical aortic valve replacement (SAVR) not only for mortality, but also for morbidity, including long hospital stay (≥90 days) and patient activity at discharge, in patients who underwent SAVR for aortic stenosis (AS). Methods and Results:
Using the Japan Adult Cardiovascular Surgery Database (JCVSD), 13,961 patients with or without coronary artery bypass grafting who underwent elective SAVR for AS were identified from January 2008 to December 2012. The hospital mortality rate was 3.1%. The percentage of patients who had long hospital stay (≥90 days) and who had moderately or severely decompressed activity at discharge (modified Rankin scale ≥4) was 2.9% and 6.5%, respectively. Eleven and 20 preoperative predictors of hospital mortality and morbidity, respectively, including long hospital stay and compromised status at discharge, were identified. Based on these risk factors, the risk model predicted hospital mortality (area under the curve [AUC], 0.732) and morbidity (AUC, 0.694). Conclusions:
Using JCVSD, a risk model of SAVR was developed for AS. This model can identify patients at high risk not only for mortality, but also for mortality and morbidity, including long hospital stay and status at discharge.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, The University of Tokyo Tokyo Japan
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center Sakura Japan
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Bianco V, Kilic A, Gleason TG, Aranda-Michel E, Harinstein ME, Thoma F, Navid F, Sultan I. Outcomes in patients with solid organ transplants undergoing cardiac surgery. J Thorac Cardiovasc Surg 2019; 160:701-707. [PMID: 31564544 DOI: 10.1016/j.jtcvs.2019.07.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Long-term outcomes after cardiac surgery in solid organ transplant recipients are limited in the contemporary literature. The objective of this study is to evaluate postoperative outcomes in these patients, including variables associated with mortality and readmissions. METHODS All adults undergoing isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve cardiac surgical procedures from 2011 to 2018 were included in this study. Patients with solid organ transplants undergoing cardiac surgery were studied. Primary outcomes included operative (30-day) and 5-year mortality. RESULTS A total of 11,190 patients underwent isolated coronary artery bypass grafting, isolated valve, or coronary artery bypass grafting + valve operations at our institution from 2011 to 2018. Of these, 129 patients (1%) had solid organ transplants and underwent isolated coronary artery bypass grafting (n = 84), isolated valve (n = 30), or coronary artery bypass grafting + valve (n = 15). Type of organ transplant included 84 patients (65%) with kidney, 27 patients (21%) with liver, 9 patients (7%) with heart, and 9 patients (7%) with lung transplants. The median Society of Thoracic Surgeons Predicted Risk Of Mortality for the cohort was 2.73 (Q1-Q3: 1.67-6.33). Three patients (2%) had an operative (30-day) mortality. Significant variables associated with 5-year mortality on multivariable Cox regression analysis included chronic obstructive pulmonary disease (hazard ratio, 2.44; 1.01-5.90; P = .048) and congestive heart failure (hazard ratio, 4.45; 1.81-10.9; P = .001). Significant variables associated with 5-year readmissions included chronic obstructive pulmonary disease, dialysis dependence, and concomittant valve surgery with coronary artery bypass grafting. Five-year readmission rate was 88%, and patients with valve operations (± coronary artery bypass grafting) had significantly lower (P = .009) freedom from readmission (6%). CONCLUSIONS Cardiac surgery can be performed with low operative mortality and good long-term survival in patients with solid organ transplants. Five-year hospital readmissions are common, with significantly more readmissions in patients who had valve procedures.
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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
| | - Thomas G Gleason
- 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
| | - Matthew E Harinstein
- 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.
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15
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Bianco V, Kilic A, Gleason TG, Aranda‐Michel E, Navid F, Sultan I. Longitudinal outcomes of dialysis‐dependent patients undergoing isolated coronary artery bypass grafting. J Card Surg 2019; 34:110-117. [DOI: 10.1111/jocs.13991] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Valentino Bianco
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Thomas G. Gleason
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Forozan Navid
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburgh Pennsylvania
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16
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Surgical outcomes of acute type A aortic dissection in dialysis patients. Gen Thorac Cardiovasc Surg 2018; 67:501-509. [PMID: 30552649 DOI: 10.1007/s11748-018-1051-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute type A aortic dissection (ATAAD) is relatively uncommon in dialysis patients, and characteristics and repair outcomes are not fully understood. PATIENTS AND METHODS Patients with ATAAD (n = 960) were divided into a dialysis group (n = 19) and non-dialysis group (n = 941), depending on whether they required dialysis for preoperative end-stage renal disease (ESRD). Hospital charts and imaging data were reviewed, and characteristics and outcomes were compared between the groups. Segmental aortic wall or intima/media flap calcification in the thoracic and abdominal aorta was assessed in the dialysis patients. RESULTS The leading primary causes of ESRD were polycystic kidney disease (n = 5) and chronic glomerulonephritis (n = 5). There were no significant differences (dialysis group vs. non-dialysis group) in age (60.5 vs. 64.5 years), preoperative hemodynamics, or organ ischemia. Dialysis patients were more likely to have an entry tear in the aortic arch (42% vs. 15%, p = 0.003). These patients showed moderate-to-severe calcification (multiple focal or single focal calcification > 10 mm) in the ascending aorta (17%), aortic arch (61%), descending aorta (67%), and abdominal aorta (83%). Arch replacement was common in this group (37% vs. 18%, p = 0.030). Although in-hospital mortality was increased in this group (21% vs. 7%, p = 0.059), morbidities did not differ significantly. Six-year survival was 60.3 ± 13.4% and 78.8 ± 1.6%, respectively (p = 0.01). CONCLUSIONS Dialysis patients tend to have aortic calcification and a primary tear in the aortic arch. Outcomes are acceptable.
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Li S, Liu S, Chen Q, Ge P, Jiang J, Sheng X, Chen S. Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis. Int J Surg 2018; 53:1-4. [PMID: 29548699 DOI: 10.1016/j.ijsu.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/25/2018] [Accepted: 03/08/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hyperkalaemia is one of the most common reasons for patients requiring emergency treatment. This study is to investigate the risk factors of postoperative hyperkalemia in renal failure patients undergoing parathyroidectomy with autotransplantation (PTXa). METHODS One hundred and eight patients [ 54 men and 54 women; age, 45.1 ± 11.1 years (mean ± SD)] with secondary hyperparathyroidism undergoing parathyroidectomy with autotransplantation were involved in this study. Laboratory chemistries (hemoglobin, fasting blood glucose, serum calcium level, alkaline phosphatase, phosphorus, parathyroid hormone) were measured before surgery. Serum potassium level was obtained before surgery and at 0 h after surgery. RESULTS Serum potassium level increased in 108 patients after surgery (P < 0.05). Sixteen patients (14.8%) potassium levels rose more than 6.0 mmol/L after parathyroidectomy with autotransplantation. Age and preoperative serum potassium level were significantly negative correlated with postoperative serum potassium level. Correlation analysis and receiver operating characteristic curve method confirmed that use of the preoperative serum potassium level was the primary predictor of postoperative hyperkalemia. The cutoff point for preoperative serum potassium level was 4.40 mmol/L, according to the Youden index of the receiver operating characteristic curve. CONCLUSIONS Preoperative serum potassium increased after parathyroidectomy with autotransplantation in patients with secondary hyperparathyroidism. The preoperative serum potassium level could help the surgeon to predict postoperative hyperkalemia in case of emergency dialysis following surgery.
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Affiliation(s)
- Sijia Li
- Department of Nephrology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China
| | - Qiuhuan Chen
- Department of Otolaryngology, Zhaoqing Gaoyao People's Hospital, Zhaoqing City, PR China
| | - Pingjiang Ge
- Department of Otolaryngology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China.
| | - Jie Jiang
- Department of Otolaryngology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China
| | - Xiaoli Sheng
- Department of Otolaryngology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China
| | - Shaohua Chen
- Department of Otolaryngology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou City, PR China
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18
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Nakahara Y, Yoshida S, Kanemura T, Yamagishi S, Tochigi S, Osaka S. Bilateral Internal Thoracic Artery Grafts in Hemodialysis: A Single-Center Propensity Score Analysis. Ann Thorac Surg 2018; 105:153-159. [DOI: 10.1016/j.athoracsur.2017.05.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 12/19/2022]
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19
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Hori D, Yamaguchi A, Adachi H. Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients. Ann Vasc Dis 2017; 10:79-87. [PMID: 29034031 PMCID: PMC5579782 DOI: 10.3400/avd.ra.17-00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022] Open
Abstract
The number of patients requiring hemodialysis is continuously increasing around the world. Hemodialysis affects patient quality of life and it is also associated with a higher risk for cardiovascular events. In addition to traditional risk factors for cardiovascular events such as hypertension, hyperlipidemia, and diabetes, hemodialysis is associated with hyperphosphatemia, chronic inflammation, vascular calcification, and anemia which accelerate atherosclerosis, vascular stiffness, and cardiac ischemia. Treatment strategy for coronary revascularization in this progressive disease remains controversial. However, a systematic treatment including medical therapy and complete revascularization through a less invasive strategy should be considered in addressing this problem. This review discusses the epidemiology, vascular pathology and current treatment options in patients with end-stage renal disease requiring coronary revascularization.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
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Zhang B, Zheng Y, Fang L, Dai H, Zhu D, Kong Y. Mitral valve repair with the "respect" approach in dialysis-dependent patients: a single-center experience. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:302. [PMID: 27668222 DOI: 10.21037/atm.2016.08.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Morbidity and mortality risks in patients with end-stage renal disease (ESRD) undergoing mitral valve surgery are high; however, little is known regarding the risks and results of mitral valve repair in these patients. METHODS We retrospectively reviewed the clinical data of dialysis-dependent patients who underwent mitral valve repair with the "respect" approach between April 2012 and April 2015 in our institution. RESULTS All five identified patients survived and their data were included in the analysis. Follow-up ranged from 3 to 48 months with a median of 24±8.9 months. Patients' cardiac function improved postoperatively with two patients in New York Heart Association class I and three patients in class II. Three patients had no or trivial mitral valve regurgitation, two patients had mild regurgitation, and none had moderate or higher regurgitation. Left ventricular end diastolic volume decreased significantly: from 166.2±32.7 mL preoperatively to 123.1±24.5 mL postoperatively (P<0.001). CONCLUSIONS With the "respect" approach, mitral valve repair in dialysis-dependent patients with prolapse of the posterior leaflet provided good and stable results; however, appropriate perioperative management was critical in these patients.
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Affiliation(s)
- Busheng Zhang
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yue Zheng
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Liang Fang
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Huangdong Dai
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Dan Zhu
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ye Kong
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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21
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Çevirme D, Adademir T, Aksüt M, Örki T, Çakalağaoğlu KC, Alp M, Kirali K. Factors associated with early mortality in haemodialysis patients undergoing coronary artery bypass surgery. Cardiovasc J Afr 2016; 28:108-111. [PMID: 27701480 PMCID: PMC5488051 DOI: 10.5830/cvja-2016-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/29/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction: Coronary artery bypass grafting (CABG) results in higher morbidity and mortality rates in end-stage renal disease (ESRD) patient populations than in patients with normal renal function. This study aimed to identify the early results of CABG performed on ESRD patients, and the factors that affected the mortality rates of those patients. Methods: A retrospective evaluation of our hospital database revealed 84 haemodialysis-receiving patients who underwent CABG during the years 2006 to 2012. Mortality was observed in 21 patients (group 1), and this group was compared with the remaining patients (group 2) for peri-operative parameters such as age, EuroSCORE, functional capacity, myocardial infarction, use of inotropes and completeness of revascularisation. Results: The study included 60 male (71.4%) and 24 female patients (28.6%); the participants’ mean age was 59.50 ± 9.93 years. The pre-operative additive EuroSCORE was 7.96 ± 2.88 (range: 2–18). Pre-operative functional capacity was impaired in 35.7% of the patients [New York Heart Association (NYHA) classes III–IV]. Mean age and preoperative EuroSCORE values of group 1 were significantly higher than those of group 2. Impaired functional capacity (NHYA classes III–IV) was also associated with mortality (OR: 3.333; 95% CI: 1.199–9.268). Fifty-four patients (64.3%) underwent on-pump CABG procedures, and 30 (35.7%) underwent off-pump CABG procedures. The study found no statistically significant difference in mortality rates between these two techniques. Mortality occurred in 12 patients (22.2%) in the on-pump group and in nine (30%) in the off-pump group. Complete revascularisation was performed on 46 patients (85.2%) in the on-pump group and seven (23.3%) in the off-pump group (p < 0.001). Conclusion Advanced age, impaired NYHA functional capacity and pre-operative hypertension were determinative for early-term surgical mortality. An on-pump surgical technique is recommended to ensure completeness of revascularisation.
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Affiliation(s)
- Deniz Çevirme
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Taylan Adademir
- Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
| | - Mehmet Aksüt
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Tülay Örki
- Department of Anesthesiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | | | - Mete Alp
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Kaan Kirali
- Department of Cardiovascular Surgery, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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22
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Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome. J Artif Organs 2016; 19:134-40. [DOI: 10.1007/s10047-015-0883-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
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Feyko J, Hazard H, Cardinal J, Thomay A, Cho S. Pancreatectomy in Patients with Impaired Renal Function: How Risky is It? Am Surg 2016. [DOI: 10.1177/000313481608200110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic renal impairment causes profound physiologic and metabolic changes. Its impact on surgical outcome after pancreatectomy is not well established. We sought to quantify complication rates of pancreatectomy in patients with chronic renal impairment. Database from the American College of Surgeons National Surgical Quality Improvement Project (2005–2011) was queried to identify patients with chronic renal impairment who underwent pancreatectomy. The study population consisted of 16,708 patients of whom 16,649 patients were not on dialysis and 59 patients were on dialysis. Overall mortality for those on dialysis was 5.1 per cent, whereas it was 2.3 per cent for those not on dialysis ( P = 0.114). Patients on dialysis were more likely to have failure to wean ventilation ( P < 0.001), reintubation ( P = 0.004), myocardial infarction ( P = 0.007), and sepsis ( P = 0.046). Patients not on dialysis were then divided into three groups: serum creatinine levels <1.2 mg/dL, between 1.2 mg/dL and 2.0 mg/dL, and >2.0 mg/dL. We found the mortality rates for these three groups were 2.0 per cent, 4.6 per cent, and 7.5 per cent, respectively ( P < 0.001). In conclusion, need for dialysis is associated with increased postoperative complications. Increased serum creatinine levels were associated with increased mortality rates. These findings should facilitate informative risk/benefit calculation for patients with renal impairment who are considering pancreatectomy.
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Affiliation(s)
- Jared Feyko
- From the Department of Surgical Oncology, West Virginia University Hospitals, Morgantown, West Virginia
| | - Hannah Hazard
- From the Department of Surgical Oncology, West Virginia University Hospitals, Morgantown, West Virginia
| | - Jon Cardinal
- From the Department of Surgical Oncology, West Virginia University Hospitals, Morgantown, West Virginia
| | - Alan Thomay
- From the Department of Surgical Oncology, West Virginia University Hospitals, Morgantown, West Virginia
| | - Sung Cho
- From the Department of Surgical Oncology, West Virginia University Hospitals, Morgantown, West Virginia
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Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kajimoto K, Kasai T, Tamura H, Okazaki S, Isoda K, Yamamoto T, Amano A, Daida H. Comparing mortality between coronary artery bypass grafting and percutaneous coronary intervention with drug-eluting stents in elderly with diabetes and multivessel coronary disease. Heart Vessels 2015; 31:1424-9. [PMID: 26412228 PMCID: PMC5010596 DOI: 10.1007/s00380-015-0746-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/09/2015] [Indexed: 12/01/2022]
Abstract
Coronary artery disease is a critical issue that requires physicians to consider appropriate treatment strategies, especially for elderly people who tend to have several comorbidities, including diabetes mellitus (DM) and multivessel disease (MVD). Several studies have been conducted comparing clinical outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in patients with DM and MVD. However, elderly people were excluded in those clinical studies. Therefore, there are no comparisons of clinical outcomes between CABG and PCI in elderly patients with DM and MVD. We compared all-cause mortality between PCI with drug-eluting stents (DES) and CABG in elderly patients with DM and MVD. A total of 483 (PCI; n = 256, CABG; n = 227) patients were analyzed. The median follow-up period was 1356 days (interquartile range of 810–1884). The all-cause mortality rate was not significantly different between CABG and PCI with DES groups. The CABG group had more patients with complex coronary lesions such as three-vessel disease or a left main trunk lesion. Older age, hemodialysis, and reduced LVEF were associated with increased long-term all-cause mortality in a multivariable Cox regression analysis. The rate of all-cause mortality was not significantly different between the PCI and CABG groups in elderly patients with DM and MVD in a single-center study.
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Affiliation(s)
- Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Hirokazu Konishi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kan Kajimoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Tamura
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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25
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Kumada Y, Ishii H, Aoyama T, Kamoi D, Kawamura Y, Sakakibara T, Nogaki H, Takahashi H, Murohara T. Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients. Circ J 2014; 78:986-92. [DOI: 10.1253/circj.cj-13-1357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshitaka Kumada
- Department of Cardiovascular Surgery, Matsunami General Hospital
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Aoyama
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | | | | | | | - Haruhiko Nogaki
- Department of Cardiovascular Surgery, Matsunami General Hospital
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Matsuda T, Miyagawa S, Fukushima S, Kitagawa-Sakakida S, Akimaru H, Horii-Komatsu M, Kawamoto A, Saito A, Asahara T, Sawa Y. Human cardiac stem cells with reduced notch signaling show enhanced therapeutic potential in a rat acute infarction model. Circ J 2013; 78:222-31. [PMID: 24107361 DOI: 10.1253/circj.cj-13-0534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Because human cardiac stem cells (CSC) have regeneration potential in damaged cardiac tissue, there is increasing interest in using them in cell-based therapies for cardiac failure. However, culture conditions, by which CSCs are expanded while maintaining their therapeutic potential, have not been optimized. We hypothesized that the plating cell-density would affect proliferation activity, differentiation and therapeutic potential of CSCs through the Notch signaling pathway. METHODS AND RESULTS Human CSCs were plated at 4 different densities. The population doubling time, C-KIT positivity, and dexamethasone-induced multidifferentiation potential were examined in vitro. The therapeutic potential of CSCs was assessed by transplanting them into a rat acute myocardial infarction (AMI) model. The low plating density (340cells/cm(2)) maintained the multidifferentiation potential with greater proliferation activity and C-KIT positivity in vitro. On the other hand, the high plating density (5,500cells/cm(2)) induced autonomous differentiation into endothelial cells by activating Notch signaling in vitro. CSCs cultured at low or high density with Notch signal inhibitor showed significantly greater therapeutic potential in vivo compared with those cultured at high density. CONCLUSIONS CSCs cultured with reduced Notch signaling showed better cardiomyogenic differentiation and therapeutic potentials in a rat AMI model. Thus, reducing Notch signaling is important when culturing CSCs for clinical applications.
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Affiliation(s)
- Takenori Matsuda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Naoto Miyagi
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
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