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Lai YJ, Chang SH, Tung YC, Chang GJ, Almeida CD, Chen WJ, Yeh YH, Tsai FC. Naringin activates semaphorin 3A to ameliorate TGF-β-induced endothelial-to-mesenchymal transition related to atrial fibrillation. J Cell Physiol 2024; 239:e31248. [PMID: 38501506 DOI: 10.1002/jcp.31248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The loss of semaphorin 3A (Sema3A), which is related to endothelial-to-mesenchymal transition (EndMT) in atrial fibrosis, is implicated in the pathogenesis of atrial fibrillation (AF). To explore the mechanisms by which EndMT affects atrial fibrosis and assess the potential of a Sema3A activator (naringin) to prevent atrial fibrosis by targeting transforming growth factor-beta (TGF-β)-induced EndMT, we used human atria, isolated human atrial endocardial endothelial cells (AEECs), and used transgenic mice expressing TGF-β specifically in cardiac tissues (TGF-β transgenic mice). We evaluated an EndMT marker (Twist), a proliferation marker (proliferating cell nuclear antigen; PCNA), and an endothelial cell (EC) marker (CD31) through triple immunohistochemistry and confirmed that both EndMT and EC proliferation contribute to atrial endocardial fibrosis during AF in TGF-β transgenic mice and AF patient tissue sections. Additionally, we investigated the impact of naringin on EndMT and EC proliferation in AEECs and atrial fibroblasts. Naringin exhibited an antiproliferative effect, to which AEECs were more responsive. Subsequently, we downregulated Sema3A in AEECs using small interfering RNA to clarify a correlation between the reduction in Sema3A and the elevation of EndMT markers. Naringin treatment induced the expression of Sema3A and a concurrent decrease in EndMT markers. Furthermore, naringin administration ameliorated AF and endocardial fibrosis in TGF-β transgenic mice by stimulating Sema3A expression, inhibiting EndMT markers, reducing atrial fibrosis, and lowering AF vulnerability. This suggests therapeutic potential for naringin in AF treatment.
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Affiliation(s)
- Ying-Ju Lai
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Respiratory Care, Chang-Gung University of Science and Technology, Chia-Yi, Puzi, Taiwan
| | - Shang-Hung Chang
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Ying-Chang Tung
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Gwo-Jyh Chang
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Celina De Almeida
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Wei-Jan Chen
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang-Gung Memorial Hospital, Tao-Yuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University Tao-Yuan, Tao-Yuan, Taiwan
| | - Feng-Chun Tsai
- Department of Surgery, Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Tsai PC, Ko AMS, Chen YL, Chiu CH, Yeh YH, Tsai FC. Exosomal miRNA Changes Associated with Restoration to Sinus Rhythm in Atrial Fibrillation Patients. Int J Mol Sci 2024; 25:3861. [PMID: 38612670 PMCID: PMC11011649 DOI: 10.3390/ijms25073861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
We aimed to identify serum exosomal microRNAs (miRNAs) associated with the transition from atrial fibrillation (AF) to sinus rhythm (SR) and investigate their potential as biomarkers for the early recurrence of AF within three months post-treatment. We collected blood samples from eight AF patients at Chang Gung Memorial Hospital in Taiwan both immediately before and within 14 days following rhythm control treatment. Exosomes were isolated from these samples, and small RNA sequencing was performed. Using DESeq2 analysis, we identified nine miRNAs (16-2-3p, 22-3p, 23a-3p, 23b-3p, 125a-5p, 328-3p, 423-5p, 504-5p, and 582-3p) associated with restoration to SR. Further analysis using the DIABLO model revealed a correlation between the decreased expression of miR-125a-5p and miR-328-3p and the early recurrence of AF. Furthermore, early recurrence is associated with a longer duration of AF, presumably indicating a more extensive state of underlying cardiac remodeling. In addition, the reads were mapped to mRNA sequences, leading to the identification of 14 mRNAs (AC005041.1, ARHGEF12, AMT, ANO8, BCL11A, DIO3OS, EIF4ENIF1, G2E3-AS1, HERC3, LARS, NT5E, PITX1, SLC16A12, and ZBTB21) associated with restoration to SR. Monitoring these serum exosomal miRNA and mRNA expression patterns may be beneficial for optimizing treatment outcomes in AF patients.
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Affiliation(s)
- Pei-Chien Tsai
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
- Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Albert Min-Shan Ko
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
- Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Yu-Lin Chen
- Department of Biomedical Sciences, Chang Gung University, Taoyuan City 33302, Taiwan; (P.-C.T.); (A.M.-S.K.); (Y.-L.C.)
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Feng-Chun Tsai
- Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung City 80708, Taiwan
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Li HY, Tsai FC, Lu CH, Chou AH, Huang HC, Gersak B. Sutureless Valve in Bicuspid Aortic Stenosis: Modified Technique and Midterm Outcome. Thorac Cardiovasc Surg 2023; 71:535-541. [PMID: 35144289 DOI: 10.1055/s-0042-1742684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The sutureless valve has gained popularity for degenerative aortic valve stenosis but not congenital bicuspid aortic valve (BAV) due to anatomical challenges. We reviewed our modified implant techniques for patients with BAV. METHODS From June 2015 to June 2019, 66 patients with aortic valve stenosis were treated with the Perceval sutureless valve, 20 of whom had BAV. The demographics, type of BAV (the Sievers classification), and associated pathologies, surgical outcomes, and midterm hemodynamics were recorded. RESULTS The median age was 64 (range: 49-81) years and the Society of Thoracic Surgeons score was 2.186 (range: 0.407-6.384). Annular plication was performed in 9 (75%) of 12 type 0 and 3 (37.5%) of 8 type I, with implanted valve sizes of M, L, and XL in 6, 10, 4 cases, respectively. Three patients, all type 0 in the initial learning periods, required intraoperative redeployment due to malposition of the valve. The final implant was successful in all without conversion to traditional prosthesis. The median extubation time was 4 hours and the durations of intensive care unit and hospital stay were 1 and 6 days. At a median follow-up of 46 (23-72) months, there was one late mortality due to hemorrhagic stroke sequel. The last echo revealed none had more than mild paravalvular leakage and the mean transvalvular pressure gradient remained stable at 9.70 (range: 6.94-15.0) mm Hg. CONCLUSION The sutureless valve can achieve satisfactory outcomes in BAV without paravalvular leakage and excellent hemodynamics. It may serve as the benchmark for transcatheter aortic valve implantation in this unique population.
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Affiliation(s)
- Han-Yan Li
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Cheng-Hui Lu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Huei-Chiun Huang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Borut Gersak
- University of Ljubljana School of Medicine, Chair of Surgery, Ljubljana, Slovenia Nisteri, Medicine and Research, Ljubljana, Slovenia
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Chan YH, Tsai FC, Chang GJ, Lai YJ, Chang SH, Chen WJ, Yeh YH. CD44 regulates Epac1-mediated β-adrenergic-receptor-induced Ca 2+-handling abnormalities: implication in cardiac arrhythmias. J Biomed Sci 2023; 30:55. [PMID: 37452346 PMCID: PMC10347873 DOI: 10.1186/s12929-023-00944-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Sustained, chronic activation of β-adrenergic receptor (β-AR) signaling leads to cardiac arrhythmias, with exchange proteins directly activated by cAMP (Epac1 and Epac2) as key mediators. This study aimed to evaluate whether CD44, a transmembrane receptor mediating various cellular responses, participates in Epac-dependent arrhythmias. METHODS The heart tissue from CD44 knockout (CD44-/-) mice, cultured HL-1 myocytes and the tissue of human ventricle were used for western blot, co-immunoprecipitaiton and confocal studies. Line-scanning confocal imaging was used for the study of cellular Ca2+ sparks on myocytes. Optical mapping and intra-cardiac pacing were applied for arrhythmia studies on mice's hearts. RESULTS In mice, isoproterenol, a β-AR agonist, upregulated CD44 and Epac1 and increased the association between CD44 and Epac1. Isoproterenol upregulated the expression of phospho-CaMKII (p-CaMKII), phospho-ryanodine receptor (p-RyR), and phospho-phospholamban (p-PLN) in mice and cultured myocytes; these effects were attenuated in CD44-/- mice compared with wild-type controls. In vitro, isoproterenol, 8-CPT-cAMP (an Epac agonist), and osteopontin (a ligand of CD44) significantly upregulated the expression of p-CaMKII, p-RyR, and p-PLN; this effect was attenuated by CD44 small interfering RNA (siRNA). In myocytes, resting Ca2+ sparks were induced by isoproterenol and overexpressed CD44, which were prevented by inhibiting CD44. Ex vivo optical mapping and in vivo intra-cardiac pacing studies showed isoproterenol-induced triggered events and arrhythmias in ventricles were prevented in CD44-/- mice. The inducibility of ventricular arrhythmias (VAs) was attenuated in CD44-/- HF mice compared with wild-type HF controls. In patients, CD44 were upregulated, and the association between CD44 and Epac1 were increased in ventricles with reduced contractility. CONCLUSION CD44 regulates β-AR- and Epac1-mediated Ca2+-handling abnormalities and VAs. Inhibition of CD44 is effective in reducing VAs in HF, which is potentially a novel therapeutic target for preventing the arrhythmias and sudden cardiac death in patients with diseased hearts.
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Affiliation(s)
- Yi-Hsin Chan
- Cardiovascular Division, Chang-Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Ying-Ju Lai
- Department of Respiratory Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Cardiovascular Division, Chang-Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Jan Chen
- Cardiovascular Division, Chang-Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Yung-Hsin Yeh
- Cardiovascular Division, Chang-Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan, Taoyuan, Taiwan.
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
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Lin CY, Wu MY, Tseng CN, Lee HF, Tsai FC. Delayed sternal closure for intractable bleeding after acute type A aortic dissection repair: outcomes and risk factors analyses. J Cardiothorac Surg 2022; 17:184. [PMID: 35982501 PMCID: PMC9389841 DOI: 10.1186/s13019-022-01946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperative coagulopathy and intractable bleeding are severe complications in acute type A aortic dissection (ATAAD) repair surgery. Mediastinal packing with delayed sternal closure (DSC) is a commonly adapted technique to stabilize the hemorrhagic tendency. This retrospective study aims to investigate the early and late outcomes and risk factors in patients who underwent DSC procedure during ATAAD repair surgery. METHODS This study investigated 704 consecutive patients who underwent ATAAD repair at this institution between January 2007 and September 2020. These patients were dichotomized into the DSC (n = 109; 15.5%) and primary sternal closure (PSC) groups (n = 595; 84.5%). The clinical features, surgical information, postoperative complications, 5-years cumulative survival, and freedom from reoperation rates were compared. A multivariate logistic regression analysis was used to identify the independent risk factors for patients who underwent DSC. RESULTS The DSC group showed a higher rate of hemopericardium and preoperative malperfusion, and was associated with longer cardiopulmonary bypass and aortic clamping times and a higher rate of intraoperative extracorporeal membrane oxygenation (ECMO) support. The DSC group showed higher blood transfusion volumes and rate of reexploration for bleeding after surgery. However, the in-hospital mortality rates (17.4% vs. 13.3%; P = 0.249), 5-year survival rates (66.9% vs. 68.2%; P = 0.635), and freedom from reoperation rates (89.1% vs. 82.5%; P = 0.344) were comparable between the DSC and PSC groups. Multivariate analysis revealed that hemopericardium, preoperative malperfusion, and intraoperative ECMO support were risk factors for implementing DSC. CONCLUSIONS DSC is an efficient life-saving technique to stabilize patients with intractable bleeding after undergoing ATAAD repair surgery, which leads to acceptable short- and long-term outcomes. Patients who were at risk for intractable bleeding should have early decision-making for implementing DSC.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. .,Department of Cardiothoracic and Vascular Surgery, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, JinCheng Rd, TuCheng, New Taipei City, 236, Taiwan.
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Feng-Chun Tsai
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Lai YJ, Tsai FC, Chang GJ, Chang SH, Huang CC, Chen WJ, Yeh YH. miR-181b targets semaphorin 3A to mediate TGF-β-induced endothelial-mesenchymal transition related to atrial fibrillation. J Clin Invest 2022; 132:142548. [PMID: 35775491 PMCID: PMC9246393 DOI: 10.1172/jci142548] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrosis is an essential contributor to atrial fibrillation (AF). It remains unclear whether atrial endocardial endothelial cells (AEECs) that undergo endothelial-mesenchymal transition (EndMT) are among the sources of atrial fibroblasts. We studied human atria, TGF-β-treated human AEECs, cardiac-specific TGF-β-transgenic mice, and heart failure rabbits to identify the underlying mechanism of EndMT in atrial fibrosis. Using isolated AEECs, we found that miR-181b was induced in TGF-β-treated AEECs, which decreased semaphorin 3A (Sema3A) and increased EndMT markers, and these effects could be reversed by a miR-181b antagomir. Experiments in which Sema3A was increased by a peptide or decreased by a siRNA in AEECs revealed a mechanistic link between Sema3A and LIM-kinase 1/phosphorylated cofilin (LIMK/p-cofilin) signaling and suggested that Sema3A is upstream of LIMK in regulating actin remodeling through p-cofilin. Administration of the miR-181b antagomir or recombinant Sema3A to TGF-β-transgenic mice evoked increased Sema3A, reduced EndMT markers, and significantly decreased atrial fibrosis and AF vulnerability. Our study provides a mechanistic link between the induction of EndMT by TGF-β via miR-181b/Sema3A/LIMK/p-cofilin signaling to atrial fibrosis. Blocking miR-181b and increasing Sema3A are potential strategies for AF therapeutic intervention.
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Affiliation(s)
- Ying-Ju Lai
- Cardiovascular Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Department of Respiratory Therapy, Chang Gung University College of Medicine, Tao Yuan, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chia Yi, Taiwan
| | - Feng-Chun Tsai
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Department of Medicine and
| | - Gwo-Jyh Chang
- Cardiovascular Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Tao Yuan, Taiwan
| | - Shang-Hung Chang
- Cardiovascular Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Department of Medicine and
| | - Chung-Chi Huang
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Tao Yuan, Taiwan.,Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Tao Yuan, Taiwan
| | - Wei-Jan Chen
- Cardiovascular Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Department of Medicine and
| | - Yung-Hsin Yeh
- Cardiovascular Department, Chang Gung Memorial Hospital, Tao Yuan, Taiwan.,Department of Medicine and
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Lin WJ, Chang YL, Weng LC, Tsai FC, Huang HC, Yeh SL, Chen KH. Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO. Int J Environ Res Public Health 2022; 19:ijerph19063333. [PMID: 35329031 PMCID: PMC8954682 DOI: 10.3390/ijerph19063333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/16/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study’s aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015–October 2016 (n = 52) and September 2019–August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale–Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.
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Affiliation(s)
- Wan-Jung Lin
- Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Huei-Chiun Huang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Correspondence: ; Tel.: +886-3-211-8800 (ext. 5211)
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Chen KH, Lee PS, Tsai FC, Weng LC, Yeh SL, Huang HC, Lin SS. Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study. Heart Lung 2021; 52:76-85. [PMID: 34911020 DOI: 10.1016/j.hrtlng.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.
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Affiliation(s)
- Kang-Hua Chen
- Associate Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Associate Research Fellow, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan.
| | - Pei-Shan Lee
- Surgical Intensive Care Unit, Fu Jen Catholic University Hospital, Taipei, Taiwan
| | - Feng-Chun Tsai
- Associate Professor, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou Branch, Taiwan
| | - Li-Chueh Weng
- Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Research Fellow, Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Ling Yeh
- Director, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan; Adjunct Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Huei-Chiun Huang
- Case Manager, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Siang Lin
- Clinical Nursing Teacher, Department of Nursing, Chang Gung University of Science and Technology Taiwan
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Chiu LC, Chuang LP, Lin SW, Li HH, Leu SW, Chang KW, Huang CH, Chiu TH, Wu HP, Tsai FC, Huang CC, Hu HC, Kao KC. Comparisons of Outcomes between Patients with Direct and Indirect Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation. Membranes (Basel) 2021; 11:membranes11080644. [PMID: 34436407 PMCID: PMC8397979 DOI: 10.3390/membranes11080644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/20/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome caused by direct (local damage to lung parenchyma) or indirect lung injury (insults from extrapulmonary sites with acute systemic inflammatory response), the clinical and biological complexity can have a profound effect on clinical outcomes. We performed a retrospective analysis of 152 severe ARDS patients receiving extracorporeal membrane oxygenation (ECMO). Our objective was to assess the differences in clinical characteristics and outcomes of direct and indirect ARDS patients receiving ECMO. Overall hospital mortality was 53.3%. A total of 118 patients were assigned to the direct ARDS group, and 34 patients were assigned to the indirect ARDS group. The 28-, 60-, and 90-day hospital mortality rates were significantly higher among indirect ARDS patients (all p < 0.05). Cox regression models demonstrated that among direct ARDS patients, diabetes mellitus, immunocompromised status, ARDS duration before ECMO, and SOFA score during the first 3 days of ECMO were independently associated with mortality. In indirect ARDS patients, SOFA score and dynamic compliance during the first 3 days of ECMO were independently associated with mortality. Our findings revealed that among patients receiving ECMO, direct and indirect subphenotypes of ARDS have distinct clinical outcomes and different predictors for mortality.
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Affiliation(s)
- Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan 33302, Taiwan
| | - Li-Pang Chuang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Hsin-Hsien Li
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
| | - Shaw-Woei Leu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Chi-Hsien Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Tzu-Hsuan Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
| | - Huang-Pin Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Chung-Chi Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8467)
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (S.-W.L.); (K.-W.C.); (C.-H.H.); (T.-H.C.); (C.-C.H.); (K.-C.K.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
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10
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Lin CY, Tung TH, Wu MY, Tseng CN, Tsai FC. Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients. J Cardiothorac Surg 2021; 16:208. [PMID: 34330304 PMCID: PMC8324439 DOI: 10.1186/s13019-021-01594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan. .,Department of Cardiothoracic and Vascular Surgery, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, JinCheng Rd, TuCheng, New Taipei City, 236, Taiwan.
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hoispital of Zhejiang Province Affiliated To Wenzhou Medical University, Linhai, Zhejiang, China
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Feng-Chun Tsai
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
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11
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Lee TH, Lee CC, Chen JJ, Fan PC, Tu YR, Yen CL, Kuo G, Chen SW, Tsai FC, Chang CH. Assessment of Cardiopulmonary Bypass Duration Improves Novel Biomarker Detection for Predicting Postoperative Acute Kidney Injury after Cardiovascular Surgery. J Clin Med 2021; 10:jcm10132741. [PMID: 34206256 PMCID: PMC8268369 DOI: 10.3390/jcm10132741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Urinary liver-type fatty acid binding protein (L-FABP) is a novel biomarker with promising performance in detecting kidney injury. Previous studies reported that L-FABP showed moderate discrimination in patients that underwent cardiac surgery, and other studies revealed that longer duration of cardiopulmonary bypass (CPB) was associated with a higher risk of postoperative acute kidney injury (AKI). This study aims to examine assessing CPB duration first, then examining L-FABP can improve the discriminatory ability of L-FABP in postoperative AKI. A total of 144 patients who received cardiovascular surgery were enrolled. Urinary L-FABP levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the whole study population, the AUROC of urinary L-FABP in predicting postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively. By assessing patients according to CPB duration, the urinary L-FABP at 16 to 18 h showed more favorable discriminating ability with AUROC of 0.742. Urinary L-FABP exhibited good performance in discriminating the onset of AKI within 7 days after cardiovascular surgery. Assessing postoperative risk of AKI through CPB duration first and then using urinary L-FABP examination can provide more accurate and satisfactory performance in predicting postoperative AKI.
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Affiliation(s)
- Tao Han Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Ran Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
| | - Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (S.-W.C.); (F.-C.T.)
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (S.-W.C.); (F.-C.T.)
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (T.H.L.); (C.-C.L.); (J.-J.C.); (P.-C.F.); (Y.-R.T.); (C.-L.Y.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200
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12
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Chiu LC, Chuang LP, Leu SW, Lin YJ, Chang CJ, Li HH, Tsai FC, Chang CH, Hung CY, Lin SW, Hu HC, Huang CC, Wu HP, Kao KC. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching. Membranes (Basel) 2021; 11:membranes11060393. [PMID: 34073487 PMCID: PMC8227965 DOI: 10.3390/membranes11060393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.
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Affiliation(s)
- Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung University, Taoyuan 33302, Taiwan
| | - Li-Pang Chuang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
| | - Shaw-Woei Leu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.L.); (C.-J.C.)
| | - Chee-Jen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-J.L.); (C.-J.C.)
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chen-Yiu Hung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chung-Chi Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Huang-Pin Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan; (L.-C.C.); (L.-P.C.); (S.-W.L.); (C.-H.C.); (C.-Y.H.); (S.-W.L.); (H.-C.H.); (C.-C.H.)
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8467)
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Tsai FC. Not every aortic stenosis should go for transcatheter aortic valve implant (TAVI) first after low risk trials. Ann Thorac Surg 2021; 113:697-698. [PMID: 33744220 DOI: 10.1016/j.athoracsur.2021.03.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Feng-Chun Tsai
- Division of Cardiothoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu Shin St, Kwei-Shan, Taoyuan 33373, Taiwan.
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Tsai FC, Li HY, Chou AH, Huang HC, Gersak B. Modified Implant Technique of Perceval Sutureless Valve in Congenital Type 0 Bicuspid Valve Stenosis. Ann Thorac Surg 2021; 111:e369-e371. [PMID: 33524356 DOI: 10.1016/j.athoracsur.2020.10.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 02/06/2020] [Revised: 08/31/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
The Perceval sutureless valve has gained in popularity for treating degenerative aortic valve stenosis but not for congenital type 0 bicuspid aortic valve owing to anatomic challenges. We modified implant techniques following the four principles of ECHO-an acronym for elasticity, circularity, height, and orientation-to prevent paravalvular leakage and malposition.
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Affiliation(s)
- Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Yan Li
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huei-Chiun Huang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Borut Gersak
- Department of Surgery, University of Ljubljana School of Medicine, Ljubljana, Slovenia; Nisteri, Medicine and Research, Ljubljana, Slovenia.
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15
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Chiu LC, Lin SW, Chuang LP, Li HH, Liu PH, Tsai FC, Chang CH, Hung CY, Lee CS, Leu SW, Hu HC, Huang CC, Wu HP, Kao KC. Mechanical power during extracorporeal membrane oxygenation and hospital mortality in patients with acute respiratory distress syndrome. Crit Care 2021; 25:13. [PMID: 33407733 PMCID: PMC7787230 DOI: 10.1186/s13054-020-03428-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
Background Mechanical power (MP) refers to the energy delivered by a ventilator to the respiratory system per unit of time. MP referenced to predicted body weight (PBW) or respiratory system compliance have better predictive value for mortality than MP alone in acute respiratory distress syndrome (ARDS). Our objective was to assess the potential impact of consecutive changes of MP on hospital mortality among ARDS patients receiving extracorporeal membrane oxygenation (ECMO).
Methods We performed a retrospective analysis of patients with severe ARDS receiving ECMO in a tertiary care referral center in Taiwan between May 2006 and October 2015. Serial changes of MP during ECMO were recorded. Results A total of 152 patients with severe ARDS rescued with ECMO were analyzed. Overall hospital mortality was 53.3%. There were no significant differences between survivors and nonsurvivors in terms of baseline values of MP or other ventilator settings. Cox regression models demonstrated that mean MP alone, MP referenced to PBW, and MP referenced to compliance during the first 3 days of ECMO were all independently associated with hospital mortality. Higher MP referenced to compliance (HR 2.289 [95% CI 1.214–4.314], p = 0.010) was associated with a higher risk of death than MP itself (HR 1.060 [95% CI 1.018–1.104], p = 0.005) or MP referenced to PBW (HR 1.004 [95% CI 1.002–1.007], p < 0.001). The 90-day hospital mortality of patients with high MP (> 14.4 J/min) during the first 3 days of ECMO was significantly higher than that of patients with low MP (≦ 14.4 J/min) (70.7% vs. 46.8%, p = 0.004), and the 90-day hospital mortality of patients with high MP referenced to compliance (> 0.53 J/min/ml/cm H2O) during the first 3 days of ECMO was significantly higher than that of patients with low MP referenced to compliance (≦ 0.53 J/min/ml/cm H2O) (63.6% vs. 29.7%, p < 0.001). Conclusions MP during the first 3 days of ECMO was the only ventilatory variable independently associated with 90-day hospital mortality, and MP referenced to compliance during ECMO was more predictive for mortality than was MP alone.
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Affiliation(s)
- Li-Chung Chiu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pi-Hua Liu
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.,Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chen-Yiu Hung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.,Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
| | - Shaw-Woei Leu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Chi Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huang-Pin Wu
- Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, No. 5, Fu-Shing St., GuiShan, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Department of Intensive Care, Xiamen Chang Gung Hospital, Xiamen, China.
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16
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Lin CY, See LC, Tseng CN, Wu MY, Han Y, Lu CH, Tsai FC. Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience. Sci Rep 2020; 10:14883. [PMID: 32913262 PMCID: PMC7484816 DOI: 10.1038/s41598-020-71961-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan. .,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Centre, 5 Fu-Shing Street, Kwei-Shan, Taoyuan, 333, Taiwan. .,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Tucheng Branch, New Taipei, Taiwan.
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang-Gung University, Taoyuan, Taiwan.,Division of Rheumatology, Allergy and Immunology, Linkou Medical Centre, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Centre, 5 Fu-Shing Street, Kwei-Shan, Taoyuan, 333, Taiwan
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Centre, 5 Fu-Shing Street, Kwei-Shan, Taoyuan, 333, Taiwan
| | - Yi Han
- Department of Public Health, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Cheng-Hui Lu
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Department of Cardiology, Chang-Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Centre, 5 Fu-Shing Street, Kwei-Shan, Taoyuan, 333, Taiwan
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17
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Tseng YC, Tsai FC, Chou ST, Hsu CY, Cheng JH, Chen CM. Evaluation of pharyngeal airway volume for different dentofacial skeletal patterns using cone-beam computed tomography. J Dent Sci 2020; 16:51-57. [PMID: 33384778 PMCID: PMC7770282 DOI: 10.1016/j.jds.2020.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/16/2020] [Indexed: 11/21/2022] Open
Abstract
Background/purpose Understanding of the three-dimensional airway space in three skeletal patterns is important in orthodontic treatment. This study investigated differences between the volume of pharyngeal airway sections and the smallest cross-sectional area in three skeletal patterns by using cone-beam computed tomography (CBCT). Materials and methods The 90 patients were collected to measure total pharyngeal airway volume (TP), velopharyngeal airway volume (VP), glossopharyngeal airway volume (GP), oropharyngeal airway volume (OP), hypopharyngeal airway volume (HP), and the smallest cross-sectional areas (SCA) of the upper respiratory tract as well as other relevant anatomical structures. The mean values differences between classes were analyzed using ANOVA. Pearson's test was used to compare classes in terms of the correlations between different factors. Results Patients in skeletal classes I and III exhibited significantly higher SCA values (322.6 mm2and 344.5 mm2 respectively) than those in skeletal class II (240.8 mm2). Subjects from skeletal classes I and III exhibited significantly higher values of VP, HP, and OP than those in skeletal class II. Skeletal classes I and III exhibited significantly higher TP values (31190.1 mm3 and 30696.2 mm3, respectively) than those in skeletal class II (22386.0 mm3). Non-significant relationships were discovered between pharyngeal airway and skeletal pattern. Conversely, significant relationships were found between TP and gender, ANB, SNB, hyoid and pogonion positions. Conclusion The skeletal class II has smaller airway volume than those in skeletal class I and III. The pharyngeal airway volumes could serve as a guide in differentiating the different skeletal classes in clinical settings.
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Affiliation(s)
- Yu-Chuan Tseng
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Feng-Chun Tsai
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Szu-Ting Chou
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jung-Hsuan Cheng
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chun-Ming Chen
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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18
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Tsai FC, Chang GJ, Lai YJ, Chang SH, Chen WJ, Yeh YH. Ubiquitin Pathway Is Associated with Worsening Left Ventricle Function after Mitral Valve Repair: A Global Gene Expression Study. Int J Mol Sci 2020; 21:ijms21145073. [PMID: 32708358 PMCID: PMC7404186 DOI: 10.3390/ijms21145073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
The molecular mechanism for worsening left ventricular (LV) function after mitral valve (MV) repair for chronic mitral regurgitation remains unknown. We wished to assess the LV transcriptome and identify determinants associated with worsening LV function post-MV repair. A total of 13 patients who underwent MV repair for chronic primary mitral regurgitation were divided into two groups, preserved LV function (N = 8) and worsening LV function (N = 5), for the study. Specimens of LV from the patients taken during surgery were used for the gene microarray study. Cardiomyocyte cell line HL-1 cells were transfected with gene-containing plasmids and further evaluated for mRNA and protein expression, apoptosis, and contractile protein degradation. Of 67,258 expressed sequence tags, microarrays identified 718 genes to be differentially expressed between preserved-LVF and worsening-LVF, including genes related to the protein ubiquitination pathway, bone morphogenetic protein (BMP) receptors, and regulation of eIF4 and p70S6K signaling. In addition, worsening-LVF was associated with altered expressions of genes pathologically relevant to heart failure, such asdownregulated apelin receptors and upregulated peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1A). HL-1 cardiomyocyte cells transfected with ubiquitination-related genes demonstrated activation of the protein ubiquitination pathwaywith an increase in the ubiquitin activating enzyme E1 (UAE-E1). It also led to increased apoptosis, downregulated and ubiquitinated X-linked inhibitor of apoptosis protein (XIAP), and reduced cell viability. Overexpression of ubiquitination-related genes also resulted in degradation and increased ubiquitination of α-smooth muscle actin (SMA). In conclusion, worsening-LVF presented differential gene expression profiles from preserved-LVF after MV repair. Upregulation of protein ubiquitination-related genes associated with worsening-LVF after MV repair may exert adverse effects on LV through increased apoptosis and contractile protein degradation.
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Affiliation(s)
- Feng-Chun Tsai
- Division of Cardiovascular and Thoracic Surgery, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan;
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Taoyuan 333, Taiwan;
| | - Ying-Ju Lai
- Department of Respiratory Therapy, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan;
| | - Shang-Hung Chang
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wei-Jan Chen
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yung-Hsin Yeh
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: ; Tel./Fax: +886-3-3271192
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19
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Lee HA, Su IL, Chen SW, Wu VCC, Chen DY, Chu PH, Chou AH, Cheng YT, Lin PJ, Tsai FC. Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis. PeerJ 2020; 8:e9102. [PMID: 32435538 PMCID: PMC7227658 DOI: 10.7717/peerj.9102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
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Affiliation(s)
- Hsiu-An Lee
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - I-Li Su
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ting Cheng
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
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20
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Wong WK, Chen SW, Chou AH, Lee HA, Cheng YT, Tsai FC, Lee KT, Wu VCC, Wang CL, Chang SH, Chu PH. Late Outcomes of Valve Repair Versus Replacement in Isolated and Concomitant Tricuspid Valve Surgery: A Nationwide Cohort Study. J Am Heart Assoc 2020; 9:e015637. [PMID: 32301369 PMCID: PMC7428522 DOI: 10.1161/jaha.119.015637] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Surgery for tricuspid valve (TV) diseases is associated with poor prognosis, but few studies have described the long‐term outcomes by comparing TV repair and replacement in isolated and concomitant TV surgeries separately. Methods and Results Between 2000 and 2013, adult patients who underwent TV repair or replacement surgeries were identified from the Taiwan National Health Insurance Research Database. Outcomes of interest included all‐cause mortality, composite outcome, and readmission attributable to any cause. Inverse probability of treatment weighting was used to reduce confounding effects. A total of 2644 patients with a mean follow‐up of 4.9 years were included. Of them, 12.6% and 87.4% underwent isolated and concomitant TV surgery, respectively. The in‐hospital mortality rates for isolated and concomitant TV surgery were 8.7% and 8.6%, respectively, whereas all‐cause mortality rates were 41.7% and 36.8%, respectively. Compared with TV replacement, TV repair demonstrated significantly lower risks of all‐cause mortality (concomitant: hazard ratio [HR], 0.76; 95% CI, 0.59–0.99), composite outcome (isolated: subdistribution HR, 0.55; 95% CI, 0.35–0.89; concomitant: subdistribution HR, 0.63; 95% CI, 0.46–0.86), and readmission (isolated: subdistribution HR, 0.64; 95% CI, 0.46–0.91; concomitant: subdistribution HR, 0.72; 95% CI, 0.60–0.86), except insignificant difference in all‐cause mortality in isolated surgery. Conclusions Compared with replacement, TV repair is associated with better short‐ and long‐term outcomes in both isolated and concomitant TV surgery. However, further prospective clinical trials are warranted.
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Affiliation(s)
- Wang-Kin Wong
- School of Medicine Chang Gung University Taoyuan City Taiwan.,Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Shao-Wei Chen
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.,Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology Chang Gung Memorial Hospital Linkou Medical Center Chang Gung University Taoyuan City Taiwan
| | - Hsiu-An Lee
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Yu-Ting Cheng
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Feng-Chun Tsai
- Division of Cardiac Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Kuang-Tso Lee
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Chun-Li Wang
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Shang-Hung Chang
- Center for Big Data Analytics and Statistics Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.,Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan
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21
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Lin CY, Lu CH, Lee HA, See LC, Wu MY, Han Y, Tseng CN, Su IL, Li HY, Tsai FC. Elderly versus non-elderly patients undergoing surgery for left-sided native valve infective endocarditis: A 10-year institutional experience. Sci Rep 2020; 10:2690. [PMID: 32060394 PMCID: PMC7021775 DOI: 10.1038/s41598-020-59657-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/03/2020] [Indexed: 12/16/2022] Open
Abstract
This retrospective study aimed to clarify the short- and mid-term outcomes of elderly patients who underwent surgery to treat left-sided native valve infective endocarditis (LSNIE). Between July 2005 and September 2015, 179 patients underwent surgical treatment for active LSNIE at a single institution. Patients were classified into two groups: ≥65 years (elderly group) and <65 years (non-elderly group). Clinical features, surgical information, postoperative complications, and three-year survival rates were compared. The average ages were 74.2 ± 6.4 and 45.2 ± 12.6 years in the elderly and non-elderly groups, respectively. The elderly group had a higher predicted mortality rate and a lower incidence of preoperative septic emboli-related complications. Echocardiographic assessments of infected valves were generally homogenous between the groups. The elderly patients had a higher in-hospital mortality rate than the non-elderly patients (26.3% vs. 5.7%, P = 0.001). For patients who survived to discharge, the three-year cumulative survival rates were 75.0% ± 8.2% and 81.2% ± 3.4% in the elderly and non-elderly groups, respectively (P = 0.484). In conclusion, elderly patients are at a higher risk of in-hospital mortality after surgery for LSNIE. However, once elderly patients are stabilized by surgical treatment and survive to discharge, the mid-term outcomes are promising.
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Affiliation(s)
- Chun-Yu Lin
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC. .,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC.
| | - Cheng-Hui Lu
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Department of Cardiology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Hsiu-An Lee
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang-Gung University, Taoyuan, Taiwan, ROC.,Division of Rheumatology, Allergy and Immunology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Meng-Yu Wu
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Yi Han
- Department of Public Health, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Nan Tseng
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - I-Li Su
- Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Han-Yan Li
- Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
| | - Feng-Chun Tsai
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC.,Department of Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, ROC
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Kuo G, Chen SW, Fan PC, Wu VCC, Chou AH, Lee CC, Chu PH, Tsai FC, Tian YC, Chang CH. Analysis of survival after initiation of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation. BMC Nephrol 2019; 20:318. [PMID: 31412791 PMCID: PMC6694695 DOI: 10.1186/s12882-019-1516-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/08/2019] [Indexed: 01/29/2023] Open
Abstract
Background No study has specifically investigated the duration of continuous renal replacement therapy (CRRT) in patients who experienced acute kidney injury during extracorporeal membrane oxygenation (ECMO) support. However, there are concerns that prolonged CRRT may be futile. Methods We conducted a retrospective population-based cohort study using Taiwan National Health Insurance Research Database data collected between January 1, 2007 and December 31, 2013. Patients who received ECMO and CRRT during the study period were included. We divided patients into three groups based on the duration of CRRT received: ≤ 3 days, 4–6 days, and ≥ 7 days. The outcomes were all-cause mortality, end-stage renal disease, ventilator dependency, and readmission rate. Results There were 247, 134 and 187 patients who survived the hospitalization in the CRRT for ≤3 days, 4–6 days and > 7 days respectively. Survival after discharge did not differ significantly between CRRT for 4–6 days vs. ≤ 3 days (adjusted hazard ratio [aHR] 1.16, 95% confidence interval [CI] 0.85–1.57), between CRRT for > 7 days vs. ≤ 3 days (aHR 1.001, 95% CI 0.73–1.38) and between CRRT for > 7 days vs. 4–6 days (aHR 0.87, 95% CI 0.62–1.22). The patients who received CRRT for ≥7 days had a higher risk of ESRD than did those who received CRRT for ≤3 days (adjusted hazard ratio [aHR] 3.46, 95% confidence interval [CI] 1.47–8.14) and for 4–6 days (aHR 3.10, 95% CI 1.03–9.29). The incidence of ventilator dependence was higher in the patients with CRRT ≥7 days than in those with ≤3 days (aHR 2.45, 95% CI 1.32–4.54). The CRRT ≥7 days group also exhibited a higher readmission rate than did the 4–6 days and ≤ 3 days groups (aHR 1.43, 95% CI 1.04–1.96 and aHR 1.67, 95% CI 1.13–2.47, respectively). Conclusions Our study found similar long-term survival but increased ESRD and ventilator dependency among ECMO patients who underwent CRRT for ≥7 days. These results offer reason to be concerned that this aggressive life support may maintain patient survival but do so at the cost of long-term disabilities and a lower quality of life. Electronic supplementary material The online version of this article (10.1186/s12882-019-1516-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- George Kuo
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, No.5, Fuxing Street, Guishan District, Taoyuan City, Taiwan, 33305
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, No.5, Fuxing Street, Guishan District, Taoyuan City, Taiwan, 33305
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, No.5, Fuxing Street, Guishan District, Taoyuan City, Taiwan, 33305
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, No.5, Fuxing Street, Guishan District, Taoyuan City, Taiwan, 33305
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, No.5, Fuxing Street, Guishan District, Taoyuan City, Taiwan, 33305.
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Lin CH, Lin CH, Tsai FC, Lin PJ. Unilateral Pedicled Pectoralis Major Harvested by Endoscopic-Assisted Method Achieves Adequate Management of Sternal Infection and Mediastinitis. J Reconstr Microsurg 2019; 35:705-712. [PMID: 31362322 DOI: 10.1055/s-0039-1695089] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bilateral PM muscles or combination with rectus abdominis or omentum are commonly used for upper and lower sternal wound infections. Unilateral PM harvesting using endoscopic-assisted method may have a simple, safe, and reliable entire muscle harvesting with comparable result of less donor-site violation. METHODS A retrospective review was performed from 2003 till 2015 on 38 patients referred to a single plastic surgeon for treatment of sternal wound infection following median sternotomy for cardiovascular surgery. After the humerus insertion of PM was cut with the assistance of endoscope visualization, all the other PM insertions on the sternum, rib, and clavicle were divided, the unilateral pedicled PM can be advanced approximately 10 cm to cover the cephalad and caudal sternum, and fill the retrosternal mediastinum. RESULTS Four re-explorations in three patients for postoperative hematoma occurred. No early recurrent infection for wound dehiscence experienced. Three patients died of multiple organs failures as 30-day mortality. Two patients underwent late recurrent infections; one patient had twice wire infection removals at 4 and 6 months after transfer, and the other had another PM for rib osteomyelitis in 3 years. CONCLUSION Unilateral PM transfer is justified to provide a simple, reliable, straightforward procedure for sternal infection management and mediastinal obliteration without violation of second flap in compromised patients.
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Affiliation(s)
- Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Chiayi, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital in Linko, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital in Linko, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital in Linko, Chang Gung University, Taoyuan, Taiwan
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Chen SW, Chu Y, Wu VCC, Tsai FC, Nan YY, Lee HF, Chang CH, Chu PH, Wu S, Lin PJ. Microenvironment of saphenous vein graft preservation prior to coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2019; 28:71-78. [PMID: 29986023 DOI: 10.1093/icvts/ivy201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/18/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The best preservation solution for a free vascular graft prior to coronary artery bypass grafting (CABG) remains controversial. The aim of this investigation was to evaluate the microenvironment of the human saphenous vein graft when preserved in normal saline (NS) solution or autologous heparinized whole blood (AWB). METHODS Between January 2014 and December 2014, 21 patients who underwent CABG were enrolled and a total of 162 saphenous vein graft rings were collected. NS and AWB were used to investigate the influence of the microenvironment. The hypoxia, oxidative stress and vascular apoptosis were assayed by western blot, and endothelial integrity was assessed by immunohistochemical analysis. RESULTS The level of PaO2 in AWB was lower than that in NS (median: 100.5 mmHg vs 185.8 mmHg, P = 0.004). This hypoxic condition led to the production of more hypoxia-inducible factor-1 (median: 60.1% vs 15.1%, P = 0.008) and endothelial nitric oxide synthase (median: 52.6% vs 25%, P = 0.046) within 30 min of preservation time. The fact that higher levels of glutathione peroxidase resulted in the preservation of AWB suggests that it is beneficial to boost the vascular antioxidant defense with lower levels of NOX2. AWB led to increased Bcl-2, reduced cytochrome c and cleaved 85 kDa poly ADP-ribose polymerase apoptotic fragments. CONCLUSIONS We concluded that AWB possesses a microenvironment that is superior to that of NS for saphenous vein graft preservation prior to CABG.
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Affiliation(s)
- Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen Chu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yun Nan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Semon Wu
- Department of Life Science, Chinese Culture University, Taipei, Taiwan
| | - Pyng-Jing Lin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
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Huang HC, Wang CH, Tsai FC. [Driveline Wound Care: Key to the Long-Term Use of Implantable Ventricular Assist Devices]. Hu Li Za Zhi 2019; 66:87-94. [PMID: 31342505 DOI: 10.6224/jn.201908_66(4).11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Heart failure is a complicated chronic disease. Although numerous new medications are used to treat and improve the quality of life of patients with heart failure, the final treatment for terminal heart failure still relies heavily on heart transplants. However, as the number of heart donations is limited, many health institutions implant mechanical assist devices to perform heart functions temporarily. These implanted ventricular assist devices help reduce heart failure symptoms and enhance quality of life. However, driveline infection is one of the more severe complications associated with these devices. If this infection is not controlled, another heart surgery will be necessary to replace the device. Severe driveline infection may even lead to patient death. An approach to care that includes driveline wound care standardization and immobilization of the driveline has been shown to effectively decrease the incidence of driveline infections and to increase the survival rate. As Taiwan still lacks the relevant clinical care standards for implantable ventricular assist device support and driveline wound care, this study introduces the relevant Western literature and the author's clinical experience related to driveline wound management. We hope that this article serves as a useful reference for related nursing care.
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Affiliation(s)
- Huei-Chiun Huang
- MSN, RN, Case Manager of Cardiovascular Surgery, Department of Nursing, Linkou Chang Gung Memorial Hospital, Taiwan, ROC
| | - Chao-Hui Wang
- MSN, RN, Supervisor, Department of Nursing, Linkou Chang Gung Memorial Hospital, and Adjunct Lecturer, School of Nursing, Chang Gung University, Taiwan, ROC
| | - Feng-Chun Tsai
- MD, Attending Physician, Department of Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC.
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Su IL, Wu VCC, Chou AH, Yang CH, Chu PH, Liu KS, Tsai FC, Lin PJ, Chang CH, Chen SW. Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery. Medicine (Baltimore) 2019; 98:e16303. [PMID: 31335676 PMCID: PMC6708865 DOI: 10.1097/md.0000000000016303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection.This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS.A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups (P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62-0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03-1.12) were associated with ARDS risk.Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.
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Affiliation(s)
- I-Li Su
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | | | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | | | | | - Kuo-Sheng Liu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | - Pyng-Jing Lin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery
| | | | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
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Tsai TY, Tu KH, Tsai FC, Nan YY, Fan PC, Chang CH, Tian YC, Fang JT, Yang CW, Chen YC. Prognostic value of endothelial biomarkers in refractory cardiogenic shock with ECLS: a prospective monocentric study. BMC Anesthesiol 2019; 19:73. [PMID: 31092199 PMCID: PMC6521489 DOI: 10.1186/s12871-019-0747-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, the mortality rate of patients on ECMO is often high. Recent studies have suggested that endothelial activation with subsequent vascular barrier breakdown is a critical pathogenic mechanism of organ damage and is related to the outcome of critical illness. This study aimed to determine whether endothelial biomarkers can be served as prognostic factors for the outcome of patients on ECMO. METHODS This prospective study enrolled 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. RESULTS The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had the ability to discriminate mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). CONCLUSIONS In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.
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Affiliation(s)
- Tsung-Yu Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kun-Hua Tu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Yun Nan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Chun Fan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Chung Tian
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ji-Tseng Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Wei Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Chang Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.222, Maijin Road, Anle District, Keelung, Taiwan.
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Chen SW, Lu YA, Lee CC, Chou AH, Wu VCC, Chang SW, Fan PC, Tian YC, Tsai FC, Chang CH. Long-term outcomes after extracorporeal membrane oxygenation in patients with dialysis-requiring acute kidney injury: A cohort study. PLoS One 2019; 14:e0212352. [PMID: 30865662 PMCID: PMC6415889 DOI: 10.1371/journal.pone.0212352] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/31/2019] [Indexed: 12/28/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication of extracorporeal membrane oxygenation (ECMO) treatment. The aim of this study was to elucidate the long-term outcomes of adult patients with AKI who receive ECMO. Materials and methods The study analyzed encrypted datasets from Taiwan’s National Health Insurance Research Database. The data of 3251 patients who received first-time ECMO treatment between January 1, 2003, and December 31, 2013, were analyzed. Characteristics and outcomes were compared between patients who required dialysis for AKI (D-AKI) and those who did not in order to evaluate the impact of D-AKI on long-term mortality and major adverse kidney events. Results Of the 3251 patients, 54.1% had D-AKI. Compared with the patients without D-AKI, those with D-AKI had higher rates of all-cause mortality (52.3% vs. 33.3%; adjusted hazard ratio [aHR] 1.82, 95% confidence interval [CI] 1.53–2.17), chronic kidney disease (13.7% vs. 8.1%; adjusted subdistribution HR [aSHR] 1.66, 95% CI 1.16–2.38), and end-stage renal disease (5.2% vs. 0.5%; aSHR 14.28, 95% CI 4.67–43.62). The long-term mortality of patients who survived more than 90 days after discharge was 22.0% (153/695), 32.3% (91/282), and 50.0% (10/20) in the patients without D-AKI, with recovery D-AKI, and with nonrecovery D-AKI who required long-term dialysis, respectively, demonstrating a significant trend (Pfor trend <0.001). Conclusion AKI is associated with an increased risk of long-term mortality and major adverse kidney events in adult patients who receive ECMO.
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Affiliation(s)
- Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-An Lu
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch and Linkou Medical Center, Taoyuan City, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- * E-mail: ,
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Chen YJ, Ho CT, Tsai FC, Lin CP, Hsu LA, Wang CL, Lee KT, Ho WJ. Outcomes of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension at a Single Center in Taiwan. Acta Cardiol Sin 2019; 35:153-164. [PMID: 30930563 PMCID: PMC6434418 DOI: 10.6515/acs.201903_35(2).20180904a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group IV pulmonary hypertension. This study aimed to report our institutional experience in managing CTEPH. METHODS We prospectively collected the data of 23 patients diagnosed with CTEPH between August 2001 and August 2017 in Linkou Chang Gung Memorial Hospital. Baseline characteristics including functional class (FC), 6-minute walk distance (6MWD), comorbidities, hematological and biochemical data, echocardiography, cardiac catheterization, and selective pulmonary angiography were recorded at diagnosis. All patients were referred to a cardiac surgeon for pulmonary endarterectomy (PEA) assessment. RESULTS The mean age at diagnosis was 48.4 ± 16.1 years. Nineteen patients (83%) underwent PEA with mean postoperative follow-up of 37.7 ± 42.8 months. The in-hospital mortality rate of PEA was 11%. The 1-, 2-, 3- and 5-year overall survival rates were 89%, 89%, 81%, and 50%, respectively. After 3 months of PEA, all patients had improvements in FC, 6MWD (from 326 ± 62 to 420 ± 63 m), B-type natriuretic peptide level (from 602 ± 599 to 268 ± 565 pg/mL), and systolic pulmonary artery pressure (from 79 ± 19 to 48 ± 19 mmHg). The patients with proximal disease (Jamieson type 1 or 2) had better survival than those with distal disease (Jamieson type 3 or 4), but there was no significant difference in mortality between FC III and IV. All of the four patients who did not undergo PEA survived for more than 3 years. CONCLUSIONS Significant improvements in symptoms, functional capacity, and hemodynamics were achieved in the CTEPH patients after PEA. However, the overall survival was still unsatisfactory.
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Affiliation(s)
- Yu-Jhou Chen
- College of Medicine, Chang Gung University, Chang Gung Memorial Hospital
| | | | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Ting PC, Wu VCC, Liao CC, Chou AH, Tsai FC, Lin PJ, Chen CY, Chen SW. Preoperative Right Ventricular Dysfunction Indicates High Vasoactive Support Needed After Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:686-693. [DOI: 10.1053/j.jvca.2018.07.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 01/13/2023]
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Lin CY, Tseng CN, Lee HA, Ho HT, Tsai FC. Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience. PLoS One 2019; 14:e0211900. [PMID: 30726302 PMCID: PMC6364944 DOI: 10.1371/journal.pone.0211900] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/22/2019] [Indexed: 02/05/2023] Open
Abstract
Background Repair of acute type A aortic dissection (ATAAD) is a complex and emergent cardiovascular surgery that is associated with high perioperative morbidity and mortality. Each cannulation strategy has different benefits and drawbacks during cardiopulmonary bypass. Using a retrospective study design, we aimed to clarify the safety and efficacy of right axillary artery cannulation in combination with femoral artery cannulation compared to single arterial cannulation for ATAAD repair. Methods From January 2007 to July 2017, 476 adult patients underwent ATAAD repair at a single institution. Patients were classified into groups according to their cannulation strategy: the double arterial cannulation (DAC) group (n = 377; 79.2%) or single arterial cannulation (SAC) group (n = 99; 20.8%). Preoperative demographics, surgical information, and postoperative recovery were compared between both groups. Survival and freedom from reoperation rates were analyzed using the Kaplan-Meier actuarial method. Results Demographics, comorbidities, and surgical procedures were generally homogenous between the two groups, except for sex, age, and rate of extensive aortic repair. Patients who underwent DAC had lower in-hospital mortality (13.5% vs. 25.3%; P = 0.005) and lower incidence of malperfusion-related complications (18.8% vs. 30.3%; P = 0.011) than those who underwent SAC. During multivariate analysis, SAC was identified as an in-hospital mortality predictor (odds ratio, 2.81; 95% confidence interval, 1.52–5.17; P = 0.001), as were preoperative ventilator support, intraoperative extracorporeal membrane oxygenation installation, and postoperative malperfusion-related complications. Three-year cumulative survival and freedom from reoperation rates were 74.8% and 85.3% for the DAC group and 62.6% and 81.1% for the SAC group, respectively (P = 0.010 and 0.430, respectively). Conclusions With acceptable short- and mid-term outcomes, DAC is effective and safe for establishing cardiopulmonary bypass during ATAAD repair.
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Affiliation(s)
- Chun-Yu Lin
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail:
| | - Chi-Nan Tseng
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsiu-An Lee
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Heng-Tsan Ho
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Feng-Chun Tsai
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Abstract
BACKGROUND Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians' abilities to support symptom recovery. AIMS To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. METHODS A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. RESULTS Data were obtained from patients ( N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. CONCLUSIONS Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting.
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Affiliation(s)
- Ming-Fen Tsai
- 1 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | | | - Debra Moser
- 3 University of Kentucky, College of Nursing, USA
| | - Tsuey-Yuan Huang
- 4 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | - Feng-Chun Tsai
- 5 Chang Gung Memorial Hospital, Division of Cardiovascular Surgery, Taiwan
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Lee CC, Chang CH, Chen SW, Fan PC, Chang SW, Chen YT, Nan YY, Lin PJ, Tsai FC. Preoperative risk assessment improves biomarker detection for predicting acute kidney injury after cardiac surgery. PLoS One 2018; 13:e0203447. [PMID: 30180211 PMCID: PMC6122821 DOI: 10.1371/journal.pone.0203447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/21/2018] [Indexed: 01/22/2023] Open
Abstract
Background Although urinary neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising biomarker for the early detection of kidney injury, previous studies of adult patients who underwent cardiac surgery have reported only moderate discrimination. The age, creatinine, and ejection fraction (ACEF) score is a preoperative validated risk model with satisfactory accuracy for predicting AKI following cardiac surgery. It remains unknown whether combining preoperative risk assessment through ACEF scores followed by urinary NGAL test in a population of high-risk individuals is an optimal approach with improved predictive performance. Material and methods A total of 177 consecutive patients who underwent cardiac surgery were enrolled. Clinical characteristics, prognostic model scores, and outcomes were assessed. Urinary NGAL were examined within 6 hours after cardiac surgery. Patients were stratified according to preoperative ACEF scores, and comparisons were made using the area under the receiver operator characteristic curve (AUROC) for the prediction of AKI. Results A total of 45.8% (81/177) of the patients had AKI. As expected, patients with ACEF scores ≥ 1.1 were older and more likely to have class III or IV heart failure. They were also more likely to have diabetes mellitus, myocardial infarction, and peripheral arterial disease. Urinary NGAL alone moderately predicted AKI, with an AUROC of 0.732. Risk stratification by ACEF scores ≥ 1.1 substantially improved the AUROC of urinary NGAL to 0.873 (95% confidence interval, 0.784–0.961; P < .001). Conclusions Risk stratification by preoperative ACEF scores ≥ 1.1, followed by postoperative urinary NGAL, provides more satisfactory risk discrimination than does urinary NGAL alone for the early detection of AKI after cardiac surgery. Future studies should investigate whether this strategy could improve the outcomes and cost-effectiveness of care in patients undergoing cardiac surgery.
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Affiliation(s)
- Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ting Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yun Nan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lin CY, Lee HA, Lin PJ, Wang CL, Hung KC, Tsai FC. Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution. Biomed J 2018; 41:265-272. [PMID: 30348270 PMCID: PMC6198014 DOI: 10.1016/j.bj.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 03/22/2018] [Accepted: 04/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Sutureless aortic valve replacement (SU-AVR) has emerged as a promising alternative for the treatment of patients with aortic valve stenosis. This study aims to assess the safety and efficacy of SU-AVR in an elderly Asian population. METHODS From June 2015 to May 2016, 15 adults with severe aortic stenosis (9 females) with a median age of 79 years underwent Perceval sutureless bioprosthesis (LivaNova, UK) implantation in a single Taiwanese institution; peri-operative recovery, clinical improvement, and valve performance were analyzed. RESULTS Three (20%) patients underwent concomitant procedures (coronary artery bypass grafting, 1 patient; maze, 2 patients) and 6/12 (50%) patients underwent J-ministernotomy for isolated SU-AVR. Median cardiopulmonary bypass and cross-clamp time were 105 min and 69 min, respectively. All sutureless bioprosthesis were implanted successfully without conversion to a traditional valve, but 2 patients (13.3%) need intraoperative valve repositioning because of paravalvular leakage. Median extubation time and intensive care unit stay were 5 h and 2 days, respectively. One patient experienced in-hospital mortality due to sudden collapse thought secondary to high degree atrioventricular block. Serial echocardiographic evaluations were performed preoperatively and at 1, 3, and 6 months postoperatively. The final echocardiographic exams showed nothing greater than mild aortic insufficiency and the median mean trans-valvular gradient was 13.2 (range, 6.0-26.3) mmHg. CONCLUSIONS By simplified procedure and improved hemodynamics, SU-AVR can be implanted safely in elderly Asian population with excellent valvular performance.
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Affiliation(s)
- Chun-Yu Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-An Lee
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Li Wang
- Department of Cardiovascular Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chun Hung
- Department of Cardiovascular Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chen KH, Chen YT, Yeh SL, Weng LC, Tsai FC. Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study. PLoS One 2018; 13:e0196778. [PMID: 29746522 PMCID: PMC5945013 DOI: 10.1371/journal.pone.0196778] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 04/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients’ survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study’s aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period. Study design A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants’ QOL at 12 months after discharge was compared with the general population. Results A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores. Conclusions This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.
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Affiliation(s)
- Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Yu-Ting Chen
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital and Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- * E-mail:
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Chen YJ, Wang JS, Hsu CC, Lin PJ, Tsai FC, Wen MS, Kuo CT, Huang SC. Cerebral desaturation in heart failure: Potential prognostic value and physiologic basis. PLoS One 2018; 13:e0196299. [PMID: 29689105 PMCID: PMC5916527 DOI: 10.1371/journal.pone.0196299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/10/2018] [Indexed: 01/01/2023] Open
Abstract
Cerebral tissue oxygen saturation (SctO2) reflects cerebral perfusion and tissue oxygen consumption, which decline in some patients with heart failure with reduced ejection fraction (HFrEF) or stroke, especially during exercise. Its physiologic basis and clinical significance remain unclear. We aimed to investigate the association of SctO2 with oxygen transport physiology and known prognostic factors during both rest and exercise in patients with HFrEF or stroke. Thirty-four HFrEF patients, 26 stroke patients, and 17 healthy controls performed an incremental cardiopulmonary exercise test using a bicycle ergometer. Integrated near-infrared spectroscopy and automatic gas analysis were used to measure cerebral tissue oxygenation and cardiac and ventilatory parameters. We found that SctO2 (rest; peak) were significantly lower in the HFrEF (66.3±13.3%; 63.4±13.8%,) than in the stroke (72.1±4.2%; 72.7±4.5%) and control (73.1±2.8%; 72±3.2%) groups. In the HFrEF group, SctO2 at rest (SctO2rest) and peak SctO2 (SctO2peak) were linearly correlated with brain natriuretic peptide (BNP), peak oxygen consumption ( V˙O2peak), and oxygen uptake efficiency slope (r between -0.561 and 0.677, p < 0.001). Stepwise linear regression showed that SctO2rest was determined by partial pressure of end-tidal carbon dioxide at rest (PETCO2rest), hemoglobin, and mean arterial pressure at rest (MAPrest) (adjusted R = 0.681, p < 0.05), while SctO2peak was mainly affected by peak carbon dioxide production ( V˙CO2peak) (adjusted R = 0.653, p < 0.05) in patients with HFrEF. In conclusion, the study delineates the relationship of cerebral saturation and parameters associated with oxygen delivery. Moreover, SctO2peak and SctO2rest are correlated with some well-recognized prognostic factors in HFrEF, suggesting its potential prognostic value.
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Affiliation(s)
- Yu-Jen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jong-Shyan Wang
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Pyng-Jing Lin
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Shien Wen
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Tai Kuo
- Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shu-Chun Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail:
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Lee HA, Cheng YT, Wu VCC, Chou AH, Chu PH, Tsai FC, Chen SW. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg 2018; 156:1473-1483.e2. [PMID: 29843917 DOI: 10.1016/j.jtcvs.2018.04.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The feasibility and long-term outcomes of mitral valve (MV) repair in patients with infective endocarditis (IE) remain unclear. METHODS Using Taiwan's National Health Insurance Research Database, we identified 1999 patients who underwent MV surgery for IE during 2000 to 2013. The patients were more likely to have undergone valve replacement (1575 patients; 78.8%) than valve repair (424 patients; 21.2%). After 1:1 propensity score matching, 352 patients in each group were included for analysis. Perioperative outcomes and late composite end points, comprising all-cause mortality, MV reoperation, any stroke, major bleeding, and readmission for heart failure, were compared. RESULTS Patients who received MV repair had fewer perioperative complications, lower in-hospital mortality rates (6.3% vs 10.8%; P = .031), and lower risks of late mortality (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.44-0.80), and composite end point (HR, 0.67; 95% CI, 0.52-0.87) during a mean follow-up of 4.8 years. Subgroup analysis revealed a trend in which the beneficial effect of MV repair was not apparent when surgeries were performed in hospitals within the lowest volume quartile (P for interaction = .091). In patients who underwent surgery during active IE, MV repair was also related to a lower rate of late mortality (HR, 0.64; 95% CI, 0.48-0.85). CONCLUSIONS Mitral repair for IE has better perioperative and late outcomes than mitral replacement. Mitral repair performed by an experienced team is recommended for IE patients instead of MV replacement whenever possible, even with an active infection status.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Feng-Chun Tsai
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Jenq CC, Tsai FC, Tsai TY, Hsieh SY, Lai YW, Tian YC, Chang MY, Lin CY, Fang JT, Yang CW, Chen YC. Effect of Anemia on Prognosis in Patients on Extracorporeal Membrane Oxygenation. Artif Organs 2018; 42:705-713. [PMID: 29602175 DOI: 10.1111/aor.13123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/02/2017] [Accepted: 01/02/2018] [Indexed: 12/23/2022]
Abstract
Anemia is a component of the pathological triangle in cardiorenal anemia syndrome and is a risk factor for mortality in acute respiratory distress syndrome. This study assessed the predictive value of anemia for outcomes in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) support. This retrospective study analyzed patients who received ECMO support at the cardiovascular surgery intensive care unit in the study institute between July 2003 and March 2012. Patient data, such as demographic information, etiologies of ECMO implementation, clinical parameters, and in-hospital and 6-month mortality rates, were statistically analyzed. The overall in-hospital mortality rate among the enrolled 295 patients was 55.6%. Multivariate logistical regression analysis indicated that age, albumin levels, sequential organ failure assessment (SOFA) score, and hemoglobin (Hb) level on ECMO day 1 exhibited independent prognostic significance for predicting in-hospital mortality rate. The SOFA score exhibited the highest areas under the receiver operating characteristic curve value (0.812 ± 0.025). The Hb level on ECMO day 1 exhibited satisfactory calibration and discriminatory power. The cumulative 6-month survival rates differed significantly between patients with Hb levels less than and more than 8.85 g/dL (30.6 vs. 54.0%, respectively, P < 0.001). This study indicated that old age, low albumin levels, low Hb levels, and higher SOFA scores on ECMO day 1 increased the risk of mortality. The Hb level is a readily measurable parameter and with good predictive power for critical patients on ECMO.
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Affiliation(s)
- Chang-Chyi Jenq
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Yu Tsai
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sue-Yun Hsieh
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yi-Wen Lai
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ya-Chung Tian
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Yang Chang
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chan-Yu Lin
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ji-Tseng Fang
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Wei Yang
- Kidney Institute, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yung-Chang Chen
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
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Lee HA, Lin CY, Chen YC, Chen SW, Nan YY, Liu KS, Wu MY, Chang YS, Chu JJ, Lin PJ, Tsai FC. Surgical interventions of isolated active mitral valve endocarditis: Predisposing factors and impact of neurological insults on final outcome. Medicine (Baltimore) 2018. [PMID: 29538196 PMCID: PMC5882381 DOI: 10.1097/md.0000000000010054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The feasibility and durability of mitral valve (MV) repair in active infective endocarditis (IE) has been reported, but proper management of perioperative neurological complications and surgical timing remains uncertain and may crucially affect the outcome.In this single-center retrospective observational study, patients who underwent isolated MV surgery for active native IE in our institution between August 2005 and August 2015 were reviewed and analyzed. Patients who were operated on for healed IE or who required combined procedures were excluded from this study.A total of 71 patients were enrolled in the study with a repair rate of 53.5% (n = 38). Isolated posterior leaflet lesion was found in 15 patients (21%) and was related to higher reparability (86.7%, P = .004). The overall in-hospital mortality was 10 (14.1%): 3 (7.9%) in the repair group and 7 (21.2%) in replacement group (P = .17). Prognosis was not related to age, preoperative renal function, cerebral emboli, or duration of antibiotics. The only significant predictor was postoperative intracranial hemorrhage (ICH) [odds ratio 14.628 (1.649-129.78), P = .04]. At a mean follow-up period of 43.1 months, neither recurrent endocarditis nor late cardiac death was observed in both groups.Surgical timing and procedural options of MV surgery in active native IE did not make any difference, but occurrence of ICH after surgery jeopardized the final outcome. Routine preoperative brain imaging to detect silent ICH or mycotic aneurysm and aggressive treatment of these lesions may prevent catastrophe and optimize the results.
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Affiliation(s)
- Hsiu-An Lee
- Department of Thoracic and Cardiovascular Surgery
| | - Chun-Yu Lin
- Department of Thoracic and Cardiovascular Surgery
| | - Yung-Chang Chen
- Department of Nephrology, Chang-Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | | | - Yu-Yun Nan
- Department of Thoracic and Cardiovascular Surgery
| | | | - Meng-Yu Wu
- Department of Thoracic and Cardiovascular Surgery
| | | | - Jaw-Ji Chu
- Department of Thoracic and Cardiovascular Surgery
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Ting PC, Chou AH, Liao CC, Wu VCC, Tsai FC, Chu JJ, Yang MW, Chang SC. Comparison of right ventricular measurements by perioperative transesophageal echocardiography as a predictor of hemodynamic instability following cardiac surgery. J Chin Med Assoc 2017; 80:774-781. [PMID: 29030027 DOI: 10.1016/j.jcma.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/23/2017] [Accepted: 08/07/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery. METHODS This study enrolled consecutive patients referred for cardiac surgeries. Exclusion criteria were non-sinus rhythm or contraindications to transesophageal echocardiography (TEE). TEE exam and simultaneous pulmonary hemodynamics were recorded in two stages: after induction of anesthesia and before sternotomy (stage 1), and after sternal closure (stage 2). RV measurements performed offline included fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), peak systolic tricuspid annular velocity (RVS'), myocardial performance index (RVMPI), and global longitudinal strain (RVGLS). The end point was defined as prolonged use (>24 h) of postoperative inotropic agent in the intensive care unit (ICU). RESULTS The study population included 68 patients (mean age 61 ± 11 y; 49 men). Twenty-two of these patients (32%) were administered inotropic agents for a prolonged period with a mean duration of 63.9 ± 5.3 h, accompanied with significantly longer ventilator use (p = 0.006) and longer ICU stay (p = 0.001) than patients without a prolonged inotropic agent use. Multivariable analysis demonstrated that only RVGLS in either stage 1 (odds ratio [OR] 1.11, p = 0.048) or stage 2 (OR 1.15, p = 0.018) was significantly associated with the outcome, especially a RVGLS > -13.5% in stage 2 demonstrating high risk of prolonged inotropic agent use after cardiac surgery (OR 7.37, p = 0.016). CONCLUSION RVGLSs performed using perioperative TEE are reliably associated with hemodynamic instability following cardiac surgery. This finding adds substantial information to postoperative critical care.
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Affiliation(s)
- Pei-Chi Ting
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Chia-Chih Liao
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | | | - Feng-Chun Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Jaw-Ji Chu
- Division of Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Min-Wen Yang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan, ROC
| | - Shi-Chuan Chang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Chan MJ, Lee CC, Chen SW, Tsai FC, Lin PJ, Fan PC, Hsu HH, Chang MY, Chen YC, Chang CH. Effect of different surgical type of coronary artery bypass grafting on kidney injury: A propensity score analysis. Medicine (Baltimore) 2017; 96:e8395. [PMID: 29137024 PMCID: PMC5690717 DOI: 10.1097/md.0000000000008395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. Off-pump surgery results in lower kidney dysfunction than conventional on-pump arrest surgery. On-pump arrest surgery results in a lower revascularization rate compared with off-pump surgery. On-pump beating heart (OPBH) CABG combines the advantages of beating heart surgery and cardiopulmonary bypass. This study compared the renal outcomes of 3 cardiac surgical methods. From January 2010 to December 2012, 373 patients who underwent on-pump CABG were enrolled. Propensity analysis was performed to compare the postoperative outcomes of postoperative AKI, renal replacement therapy (RRT), intensive care unit (ICU) stay, mortality, and extubating time. In total, 98 patients received conventional on-pump surgery, 160 received OPBH surgery, and 115 received off-pump surgery. The Society of Thoracic Surgeons scores of these 3 groups were 6.1 ± 13.6, 7.4 ± 13.6, and 5.6 ± 10.9, respectively. Propensity analysis revealed lower AKI incidence in the off-pump group than in the on-pump surgery group. No substantial differences were observed in mortality, RRT, and the ICU stay between the off-pump and OPBH surgery groups. Among the 3 surgical methods, off-pump surgery results in lower AKI incidence. The short-term outcome, including kidney function, of OPBH surgery is similar to that of the off-pump group. Therefore, OPBH surgery is a considerable choice for patients with a high surgical risk.
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Affiliation(s)
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
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Tsai FC, Ghorbani S, Greenwald BD, Jang S, Dumot JA, McKinley MJ, Shaheen NJ, Habr F, Wolfsen HC, Abrams JA, Lightdale CJ, Nishioka NS, Johnston MH, Zfass A, Coyle WJ. Safety and efficacy of endoscopic spray cryotherapy for esophageal cancer. Dis Esophagus 2017; 30:1-7. [PMID: 28881903 DOI: 10.1093/dote/dox087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 06/03/2017] [Indexed: 12/11/2022]
Abstract
Although surgery is traditionally the standard of care for esophageal cancer, esophagectomy carries significant morbidity. Alternative endoscopic therapies are needed for patients who are not candidates for conventional treatment. The objective of this study is to assess the safety, efficacy, and tolerability of spray cryotherapy of esophageal adenocarcinoma. This study includes patients with esophageal adenocarcinoma who had failed or were not candidates for conventional therapy enrolled retrospectively and prospectively in an open-label registry and patients in a retrospective cohort from 11 academic and community practices. Endoscopic spray cryotherapy was performed until biopsy proven local tumor eradication or until treatment was halted due to progression of disease, patient withdrawal or comorbidities. Eighty-eight patients with esophageal adenocarcinoma (median age 76, 80.7% male, mean length 5.1 cm) underwent 359 treatments (mean 4.4 per patient). Tumor stages included 39 with T1a, 25 with T1b, 9 with unspecified T1, and 15 with T2. Eighty-six patients completed treatment with complete response of intraluminal disease in 55.8%, including complete response in 76.3% for T1a, 45.8% for T1b, 66.2% for all T1, and 6.7% for T2. Mean follow-up was 18.4 months. There were no deaths or perforations related to spray cryotherapy. Strictures developed in 12 of 88 patients (13.6%) but were present before spray cryotherapy in 3 of 12. This study suggests that endoscopic spray cryotherapy is a safe, well-tolerated, and effective treatment option for early esophageal adenocarcinoma.
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Affiliation(s)
- F C Tsai
- Scripps Clinic, La Jolla, California
| | | | - B D Greenwald
- University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Maryland
| | - S Jang
- Cleveland Clinic, Cleveland, Ohio
| | | | - M J McKinley
- North Shore LIJ Health System and ProHEALTHcare Associates, Syosset & Lake Success, New York
| | - N J Shaheen
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - F Habr
- Alpert School of Medicine of Brown University, Providence, Rhode Island
| | - H C Wolfsen
- Mayo Clinic Jacksonville, Jacksonville, Florida
| | - J A Abrams
- Columbia University Medical Center, New York, New York
| | - C J Lightdale
- Columbia University Medical Center, New York, New York
| | - N S Nishioka
- Massachusetts General Hospital, Boston, Massachusetts
| | - M H Johnston
- Lancaster Gastroenterology, Inc., Lancaster, Pennsylvania
| | - A Zfass
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - W J Coyle
- Scripps Clinic, La Jolla, California
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Liu KS, Lee CH, Lee D, Liu M, Tsai FC, Tseng YY. Sustained local delivery of high-concentration vancomycin from a hybrid biodegradable, antibiotic-eluting, nanofiber-loaded endovascular prosthesis for treatment of mycotic aortic aneurysms. J Vasc Surg 2017; 68:597-606. [PMID: 29066243 DOI: 10.1016/j.jvs.2017.07.142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovascular repair for mycotic aortic aneurysm (MAA) is a less invasive alternative to open surgery, although the placement of a stent graft in an infected environment remains controversial. In this study, we developed hybrid biodegradable, vancomycin-eluting, nanofiber-loaded endovascular prostheses and evaluated antibiotic release from the endovascular prostheses both in vitro and in vivo. METHODS Poly(D,L)-lactide-co-glycolide and vancomycin were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into nanofibrous tubes, which were mounted onto commercial vascular stents and endovascular aortic stent grafts. In vitro antibiotic release from the nanofibers was characterized using an elution method and high-performance liquid chromatography. Antibiotic release from the hybrid stent graft was analyzed in a three-dimensional-printed model of a circulating MAA. The in vivo drug release characteristics were examined by implanting the antibiotic-eluting stents in the abdominal aorta of New Zealand white rabbits (n = 15). RESULTS The in vitro study demonstrated that the biodegradable nanofibers and the nanofiber-loaded stent graft provided sustained release of high concentrations of vancomycin for up to 30 days. The in vivo study showed that the nanofiber-loaded stent exhibited excellent biocompatibility and released high concentrations of vancomycin into the local aortic wall for 8 weeks. CONCLUSIONS The proposed biodegradable vancomycin-eluting nanofibers significantly contribute to the achievement of local and sustainable delivery of antibiotics to the aneurysm sac and the aortic wall, and these nanofibers may have therapeutic applications for MAAs.
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Affiliation(s)
- Kuo-Sheng Liu
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Demei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Michelle Liu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yuan-Yun Tseng
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
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Ting PC, Chou AH, Chien-Chia Wu V, Tsai FC, Chu JJ, Chen CY, Lan TY, Chen SW. Relationship Between Right Ventricular Function and Atrial Fibrillation After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:1663-1671. [DOI: 10.1053/j.jvca.2017.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 11/11/2022]
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Chen SW, Chang CH, Chu Y, Chien-Chia Wu V, Lee CC, Chen DY, Lin PJ, Tsai FC. Postoperative Renal Outcomes of On-Pump Beating-Heart versus Cardioplegic Arrest Coronary Artery Bypass Grafting. Acta Cardiol Sin 2017; 33:542-550. [PMID: 28959109 DOI: 10.6515/acs20170603b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this investigation is to compare the postoperative renal outcomes after on-pump beating- heart versus conventional cardioplegic arrest coronary artery bypass grafting (CABG). METHODS Between January 2010 and December 2012, 254 patients who underwent isolated CABG were enrolled. The primary outcome was postoperative acute kidney injury (AKI) within 7 days [defined by the Kidney Disease Improving Global Outcome (KDIGO) Clinical Practice Guideline] and loss of kidney function at 1 year (defined as > 20% loss in estimated glomerular filtration rate from baseline preoperative creatinine level). RESULTS There was less AKI found for the on-pump beating-heart CABG (30.2% versus 46.3%; p = 0.010) group; with significant less stage I AKI (17.6% versus 29.5%; p = 0.035); a trend of less stage II AKI (4.4% versus 10.5%; p = 0.088) and no significant difference in stage III AKI (8.2% versus 6.3%; p = 0.587). The on-pump beating-heart group also had less patients who have lost their kidney function at 1 year (24.8% versus 41.2%; p = 0.021). Furthermore, multivariate analysis identified conventional arrest CABG is an independent risk factor for postoperative AKI and loss of kidney function at 1 year. CONCLUSIONS On-pump beating-heart CABG has superior short-term and mid-term renal outcomes than conventional cardioplegic arrest CABG.
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Affiliation(s)
- Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University.,Chang Gung Cardio-Renal Study Group, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University.,Kidney Research Center, Department of Nephrology.,Chang Gung Cardio-Renal Study Group, Taoyuan, Taiwan
| | - Yen Chu
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | | | - Cheng-Chia Lee
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University.,Kidney Research Center, Department of Nephrology.,Chang Gung Cardio-Renal Study Group, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
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Tsai TY, Chien H, Tsai FC, Pan HC, Yang HY, Lee SY, Hsu HH, Fang JT, Yang CW, Chen YC. Comparison of RIFLE, AKIN, and KDIGO classifications for assessing prognosis of patients on extracorporeal membrane oxygenation. J Formos Med Assoc 2017; 116:844-851. [PMID: 28874330 DOI: 10.1016/j.jfma.2017.08.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/PURPOSE Acute kidney injury (AKI) developing during extracorporeal membrane oxygenation (ECMO) is associated with very poor outcome. The Kidney Disease: Improving Global Outcomes (KDIGO) group published a new AKI definition in 2012. This study analyzed the outcomes of patients treated with ECMO and identified the relationship between the prognosis and the KDIGO classification. METHODS This study examined total 312 patients initially, and finally reviewed the medical records of 167 patients on ECMO support at a tertiary care university hospital between March 2002 and November 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predicators. RESULTS The overall mortality rate was 55.7%. In the analysis of the areas under the receiver operating characteristic curves, the KDIGO classification showed relatively higher discriminatory power (0.840 ± 0.032) than the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal failure (RIFLE) (0.826 ± 0.033) and Acute Kidney Injury Network (AKIN) (0.836 ± 0.032) criteria in predicting in-hospital mortality. Furthermore, multiple logistic regression analysis showed that KDIGO, hemoglobin, and Glasgow Coma Scale score on the first day of patients on ECMO were independent predictors for in-hospital mortality. Finally, cumulative survival rates at 6-month follow-up after hospital discharge differed significantly for KDIGO stage 3 versus KDIGO stage 0, 1, and 2 (p < 0.001); and KDIGO stage 2 versus KDIGO stage 0 (p < 0.05). CONCLUSION For those patients with ECMO support, the KDIGO classification proved to be a more reproducible evaluation tool with excellent prognostic abilities than RIFLE or AKIN classification.
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Affiliation(s)
- Tsung-Yu Tsai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Hao Chien
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taiwan
| | - Heng-Chih Pan
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Huang-Yu Yang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Shen-Yang Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Hsiang-Hao Hsu
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Ji-Tseng Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Chih-Wei Yang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taiwan.
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Li HY, Chang CH, Lee CC, Wu VCC, Chen DY, Chu PH, Liu KS, Tsai FC, Lin PJ, Chen SW. Risk analysis of dialysis-dependent patients who underwent coronary artery bypass grafting: Effects of dialysis modes on outcomes. Medicine (Baltimore) 2017; 96:e8146. [PMID: 28953653 PMCID: PMC5626296 DOI: 10.1097/md.0000000000008146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease is the major morbidity and leading cause of mortality for dialysis-dependent patients. This study aimed to stratify the risk factors and effects of dialysis modes in relation to coronary artery bypass grafting (CABG) surgery among dialysis-dependent patients.This retrospective study enrolled dialysis-dependent patients who underwent CABG from October 2005 to January 2015. All data of demographics, medical history, surgical details, postoperative complications, and in-hospital mortality were analyzed, and patients were categorized as those with or without in-hospital mortality and those with preoperative hemodialysis (HD) or peritoneal dialysis (PD).Of 134 enrolled patients, 25 (18.7%) had in-hospital mortality. Multivariate analyses identified that older age [odds ratio (OR): 1.110, 95% confidence interval (CI): 1.030-1.197, P = .006], previous stroke history (OR: 5.772, 95% CI: 1.643-20.275, P = .006), PD (OR: 19.607, 95% CI: 3.676-104.589, P < .001), and emergent operation (OR: 8.788, 95% CI: 2.697-28.636, P < .001) were statistically significant risk factors for in-hospital mortality among dialysis-dependent patients with CABG surgery. Patients with PD had a higher in-hospital mortality rate (58.3% vs 14.8%, P < .001) and lower 1-year overall survival (33.3% vs 56.6%, P = .031) than did HD patients. The major in-hospital mortality cause was cardiac events among HD patients and septic shock among PD patients.Among dialysis patients who received CABG, those with older age, previous stroke history, PD, and emergent operation had higher risks. Those with PD were prone to poorer in-hospital outcomes after CABG surgery.
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Affiliation(s)
- Han-Yan Li
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University
- Kidney Research Center, Department of Nephrology
| | - Cheng-Chia Lee
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University
- Kidney Research Center, Department of Nephrology
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan, ROC
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan, ROC
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan, ROC
| | - Kuo-Sheng Liu
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University
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Huang SC, Wong MK, Lin PJ, Tsai FC, Chu JJ, Wu MY, Fu TC, Wang JS. Short-term intensive training attenuates the exercise-induced interaction of mono-1/2 cells and platelets after coronary bypass in cardiac patients. Thromb Haemost 2017; 117:1761-1771. [PMID: 28492701 DOI: 10.1160/th17-03-0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/14/2017] [Indexed: 12/12/2022]
Abstract
The interaction between platelets and monocytes plays a critical role in the pathogenesis and progression of cardiovascular diseases. This study investigated how short-term intensive training (SIT) influences monocyte subset characteristics and exercise-induced monocyte and platelet aggregates (MPAs) following elective coronary bypass (CABG) in cardiac patients. Forty-nine patients hospitalised for CABG were randomised into SIT (N=26) and conventional training (CT, N=23) groups. The SIT subjects underwent supervised aerobic training at 80~120 % of the ventilatory anaerobic threshold based on sub-maximal exercise tests performed 7 days post-CABG for 20 sessions with two sessions/day and 30 min/session, which were completed within four weeks after surgery. The CT subjects performed light-intensity conditioning exercise for ≤4 sessions. Resting and maximal exercise-mediated monocyte characteristics and MPA were determined before and following intervention. The SIT group had a larger improvement in ventilation efficiency and anaerobic threshold than the CT group; the SIT group exhibited larger reductions in blood monocyte subtypes 1 and 2 (Mono1 and 2) counts at rest than the CT group; the SIT group but not the CT group exhibited attenuated formation of Mono1/platelet hetero-aggregation (MPA1) and CD42b expression on Mono1/2 caused by strenuous exercise; and plasma levels of macrophage inflammatory protein-1β and soluble P-selectin showed similar trends as Mono1/2 and MPA1, respectively. In conclusion, SIT modestly improved aerobic capacity in patients following CABG. Moreover, SIT simultaneously ameliorated the CD42b expression of Mono1/2 cells and maximal exercise-induced MPA1, which may reduce the risk of inflammatory thrombosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Jong-Shyan Wang
- Prof. Jong-Shyan Wang, Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan, Tel.: +886 3 2118800, ext 5748, E-mail:
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Cheng YT, Chen SW, Chang CH, Chu PH, Chen DY, Wu VCC, Liu KS, Nan YY, Tsai FC, Lin PJ. Impact of prior coronary stenting on the outcome of subsequent coronary artery bypass grafting. Biomed J 2017; 40:178-184. [PMID: 28651740 PMCID: PMC6136282 DOI: 10.1016/j.bj.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The percentage of patients referred for coronary artery bypass grafting (CABG) who have previously undergone percutaneous coronary interventions (PCIs) is increasing. The purpose of this study was to review the outcomes of patients who had received coronary stenting before CABG, and to examine the validity of a mortality risk stratification system in this patient group. METHODS From 2010 to 2012, 439 patients who underwent isolated CABG at our medical center were reviewed. The patients were divided into two study groups: those who had previously received coronary artery stenting (97 patients, 24.7%), and those who had not (342 patients, 75.3%). The patients who received balloon angioplasty were excluded. RESULTS There were no significant differences in baseline characteristics. The prior stenting group had a lower risk of mortality, although the difference was not significant. The prior stenting group had fewer graft anastomoses (p = 0.005), and hence a significantly shorter cardiopulmonary bypass time (p = 0.045) and shorter aortic cross-clamping time. Surgical mortality was similar between the two groups. The durations of intensive care unit stay and hospitalization were also similar. The discriminatory power of the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was lower in both group. CONCLUSIONS Prior coronary stenting does not affect short-term mortality in patients subsequently undergoing CABG surgery. The EuroSCORE does not predict perioperative mortality well for the patients who undergo coronary stenting before CABG.
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Affiliation(s)
- Yu-Ting Cheng
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Sheng Liu
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yun Nan
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pyng-Jing Lin
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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