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Bucciarelli V, Bianco F, Biasi A, Primavera M, Baldinelli A, Colaneri M, Gallina S, Pozzi M. The predictive role of neutrophil-to-lymphocyte ratio in post-operative arrhythmias in pediatric patients after cardiopulmonary bypass surgery. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery.
Purpose
To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB.
Methods
We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27±10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 hours from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed.
Results
Diagnoses of 146 patients included atrial septal defect (n=36), ventricular septal defect (n=20), pulmonary atresia/stenosis (n=10), tetralogy of Fallot (n=20), endocardial cushion defect (n=8), left ventricular outflow tract obstruction (n=14), anomalous origin of coronary artery (n=6), complex CHD (n=13), interrupted/hypoplastic aortic arch (n=12), anomalous pulmonary artery venous return (n=3). The mean CPB time was 121.6±84.6 minutes. The median ICU hospitalization was 48 hours [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P=0.034 and P=0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (Log-rank, P=0.029), especially when associated with POA (Log-rank, P=0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P=0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P=0.012, respectively], but not with JET.
Conclusions
24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Bucciarelli
- University Hospital Riuniti of Ancona, Paediatric and Congenital Cardiac Surgery and Cardiology, Ancona, Italy
| | - F Bianco
- University Hospital Riuniti of Ancona, Paediatric and Congenital Cardiac Surgery and Cardiology, Ancona, Italy
| | - A Biasi
- University of Chieti-Pescara, Cardiology Unit, Chieti, Italy
| | - M Primavera
- University of Chieti-Pescara, Cardiology Unit, Chieti, Italy
| | - A Baldinelli
- University Hospital Riuniti of Ancona, Paediatric and Congenital Cardiac Surgery and Cardiology, Ancona, Italy
| | - M Colaneri
- University Hospital Riuniti of Ancona, Paediatric and Congenital Cardiac Surgery and Cardiology, Ancona, Italy
| | - S Gallina
- G. d'Annunzio University, Department of Neurosciences, Imaging and Clinical Sciences, Chieti, Italy
| | - M Pozzi
- University Hospital Riuniti of Ancona, Paediatric and Congenital Cardiac Surgery and Cardiology, Ancona, Italy
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Bianco F, Colaneri M, Bucciarelli V, Surace FC, Iezzi FC, Primavera M, Biasi AC, Berton E, Baldoni M, Baldinelli A, Pozzi M, Gallina S. Ross procedure and aortic valve repair: long-term echocardiographic outcomes, quality of life and physical activity of different aortic valve surgery procedures. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
To compare long-term outcomes of aortic valve repair (AVr) and pulmonary autograft replacement (Ross procedure) in terms of echocardiographic parameters, quality of life (QoL), physical activity (PA).
Methods
In 2005-19, 129 patients (median age 22 [13, 33 IQR], 75% males) underwent aortic surgery in our Department: 40 were Ross (22 years [19, 51 IQR]), 67 AVr (17 years [1, 50 IQR]) and 22 aortic valve replacements (52 years [30, 80 IQR]). We focused on Ross and AVr. Retrospectively, relevant data were collected from medical records and phone re-calls. Physical activity (spontaneous and active) and QoL were assessed utilizing the IPAQ and SF-36 questionnaires. All patients underwent echocardiography pre/post-surgery and the follow-up lasted 12 ± 4 years.
Results
At the baseline, Ross patients had more aortic stenosis than insufficiency (P = 0.045). At the follow-up, Ross procedures presented more right-ventricle and aortic annulus dilatation (P = 0.002 and P = 0.030, respectively), but higher left-ventricular global longitudinal strain (LV GLS: 18 ± 3.2 % vs. 16 ± 3.3, P = 0.0027). Conversely, AVr experienced more re-do operations (Log-rank P = 0.005). Ross reported better QoL (SF-36: 0.8 ± 0.07 vs. 19 ± 0.4, P-0.045) and were also more active in daily PA (IPAQ ≥ 2500 Mets: 63.8% vs. 6%; P = 0.006). Ross patients practiced more sports activities than AVr (P = 0.011).
Conclusions
In a relatively small cohort of young and adults post aortic surgery patients, Ross procedures had better prognosis in terms of re-do operations; presented better ventricular function, as assessed by LV GLS. Ross patients had better long-term QoL and showed more spontaneous PA and involvement in sports activity.
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Affiliation(s)
- F Bianco
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - M Colaneri
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - V Bucciarelli
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - FC Surace
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - FC Iezzi
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - M Primavera
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - AC Biasi
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - E Berton
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - M Baldoni
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - A Baldinelli
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - M Pozzi
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - S Gallina
- G. d"Annunzio University, Cardiology, Chieti, Italy
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Bianco F, Colaneri M, Bucciarelli V, Surace FC, Iezzi FV, Giusti G, Primavera M, Biasi A, Gallina S, Pozzi M. 1163 Diagnostic performance of a new echocardiographic method for coronary arteries abnormalities assessment. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The echocardiographic assessment of coronary arteries abnormalities (CCA) has always been challenging. In this view, we aimed to assess the performance of a new echocardiographic-based diagnostic method for CAA in pediatric and young adults’ population.
Methods
over 5 years, we examined all the outpatients undergoing routine echocardiography in our department. Our method consisted of 4-focused specific view scan: parasternal short-axis, parasternal long-axis, both left and right outflow tract, and apical 5-chamber view. Coronary-CT confirmed the CAA diagnosis. Two independent physicians retrospective reviewed the echocardiographic images, in a double-blinded fashion (coronary-CT and diagnosis), for performance analysis.
Results
in 2014-18, 5,998 outpatients underwent echocardiography (median age 14 years [6, 21 - IQR]). A total of 27 CAA were diagnosed: overall prevalence 0.0045%, 0.022% of incidence. N = 17/27 were anomalous aortic origin of coronary arteries (AAOCA), N = 3/27 anomalous coronary arteries from the pulmonary artery (ACAPA), and 7/27 fistulas. After the implementation, we found a progressive increment of CAA diagnosis (P for Trend = 0.038), in particular of AAOCA: both left and right coronaries (P-trend = 0.021 and P = trend 0.010, respectively). Our method showed better sensitivity than traditional CAA echocardiographic evaluation: 85% vs 55%, P = 0.032 [AUC 0.77, 95% CI (0.68, 0.87) and AUC 0.92, 95% CI (0.85, 0.99), respectively], with a good interobserver agreement for the adjudicated double-blinded retrospective diagnosis (99.75%, K = 0.73, P < 0.001).
Conclusions
the application of a new echocardiographic-based method for CAA-detection led to a significantly increased rate of identified anomalies. This approach demonstrated better sensitivity than traditional echocardiographic assessment. Implementing this protocol in clinical practice may improve the CAA diagnosis, and probably reduce the occurrence of CAA-related sudden cardiac death.
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Affiliation(s)
- F Bianco
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - M Colaneri
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - V Bucciarelli
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - F C Surace
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - F V Iezzi
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - G Giusti
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
| | - M Primavera
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - A Biasi
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - S Gallina
- G. d"Annunzio University, Cardiology, Chieti, Italy
| | - M Pozzi
- University Hospital Riuniti of Ancona, Pediatric and Congenital Cardiology and Cardiac Surgery, Ancona, Italy
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Primignani P, Travi M, Biasi A, Sbrocca F, Piga A, Scagni P, Cantù Rajnoldi A. Identification of the new polymorphism IVS1-91 C-->T in the beta globin gene. Hum Mutat 1999; 14:272. [PMID: 10477492 DOI: 10.1002/(sici)1098-1004(1999)14:3<272::aid-humu19>3.0.co;2-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- P Primignani
- Laboratorio di Genetica Molecolare, I.C.P. Clinica Mangiagalli, Milano, Italia
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