The Heart Surgery Forum[JOURNAL]
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200 papers
AKAP1 in Renal Patients with AHF to Reduce Ferroptosis of Cardiomyocyte.
Fang Y, Xu J, Huang R
Heart Surg Forum · 2024 Jan · PMID 38286648 · Publisher ↗
BACKGROUND: This study mainly investigated the mechanism and effects of AKAP1 in renal patients with acute heart failure (AHF). METHODS: Patients with renal patients with AHF and normal volunteers were collected. The lef...
BACKGROUND: This study mainly investigated the mechanism and effects of AKAP1 in renal patients with acute heart failure (AHF). METHODS: Patients with renal patients with AHF and normal volunteers were collected. The left anterior descending arteries (LAD) of mice were ligated to induce myocardial infarction. RESULTS: AKAP1 messenger RNA (mRNA) expression was found to be down-regulated in renal patients with AHF. The serum levels of AKAP1 mRNA expression were negatively correlated with collagen I/III in patients. AKAP1 mRNA and protein expression in the heart tissue of mice with AHF were also found to be down-regulated in a time-dependent manner. Short hairpin (Sh)-AKAP1 promotes AHF in a mouse model. AKAP1 up-regulation reduces reactive oxygen species (ROS)-induced oxidative stress in an In Vitro model. AKAP1 up-regulation also reduces ROS-induced lipid peroxidation ferroptosis in an In Vitro model. AKAP1 induces NDUFS1 expression to increase GPX4 activity levels. AKAP1 protein interlinked with the NDUFS1 protein. Up-regulation of the AKAP1 gene reduced NDUFS1 ubiquitination, while down-regulation of the AKAP1 gene increased NDUFS1 ubiquitination in a model. In vivo imaging showed that the sh-AKAP1 virus reduced NDUFS1 expression in the heart of a mouse model. CONCLUSIONS: AKAP1 reduced ROS-induced lipid peroxidation ferroptosis through the inhibition of ubiquitination of NDUFS by mitochondrial damage in model of renal patients with AHF, suggest a novel target for AHF treatment.
Cerebral Embolism and MINOCA Secondary to Left Atrial Myxoma after Occlusion of Atrial Septal Defect by Amplatzer Occluder: A Case Report.
Hao Y, Fan C, Gao Y … +4 more , Liu Y, Cao H, Lu L, Shen Y
Heart Surg Forum · 2024 Jan · PMID 38286647 · Publisher ↗
Primary heart tumors are rare, with atrial myxomas being the most common type. Atrial myxomas can lead to embolisms, heart obstruction, and systemic symptoms. Herein, we report a case of 72-year-old woman who presented w...
Primary heart tumors are rare, with atrial myxomas being the most common type. Atrial myxomas can lead to embolisms, heart obstruction, and systemic symptoms. Herein, we report a case of 72-year-old woman who presented with a left atrial myxoma at the atrial septal defect occluder, a new acute cerebral infarction, and MINOCA (myocardial infarction with no obstructive coronary atherosclerosis). Left atrial myxoma is a common primary cardiac tumor; however, left atrial myxomas arising after percutaneous atrial septal defect occlusion are rare. Additionally, the patient presented with a new case of multiple systemic emboli. The patient underwent surgical resection of a left atrial myxoma, occluder, and left atrium, and atrial septal repair, and was discharged with good recovery for outpatient follow-up. The possibility of a cardiac tumor, especially an atrial myxoma, which can lead to a series of complications, should be considered at the closure site after percutaneous atrial septal closure. Therefore, active surgical treatment and long-term follow-up are warranted in such cases.
Working Around: The Use of AngioVac and Micra Transcatheter Leadless Pacemaker Implantation in a Critically Ill Patient Receiving Extracorporeal Membrane Oxygenation.
Morse R, Joseph M
Heart Surg Forum · 2024 Jan · PMID 38286646 · Publisher ↗
The use of extracorporeal membrane oxygenation (ECMO) in critically ill patients has been on the rise in recent years. While ECMO has provided substantial benefit to patients who need cardiopulmonary support, its require...
The use of extracorporeal membrane oxygenation (ECMO) in critically ill patients has been on the rise in recent years. While ECMO has provided substantial benefit to patients who need cardiopulmonary support, its required use of large-bore catheters in major blood vessels often precludes the use of other transcatheter therapies. In this article, we demonstrate that two transcatheter procedures, AngioVac right-sided cardiac thrombus removal and Micra leadless pacemaker placement, both requiring large bore access, can both be safely and effectively implemented in patients who are dependent on ECMO to maintain cardiopulmonary function.
Effects of Concomitant CABG on Outcomes in Veterans Who Require Surgery for Endocarditis.
Duggan J, Peters A, Halbert SA … +4 more , Arnott S, LaPiano J, Antevil J, Trachiotis GD
Heart Surg Forum · 2024 Jan · PMID 38286645 · Publisher ↗
BACKGROUND: Infective Endocarditis (IE) is a complicated disease frequently accompanied by coronary artery disease (CAD) though no clear guidelines exist for when concomitant revascularization should be undertaken once v...
BACKGROUND: Infective Endocarditis (IE) is a complicated disease frequently accompanied by coronary artery disease (CAD) though no clear guidelines exist for when concomitant revascularization should be undertaken once valve surgery is indicated. Data on this topic within the United States (US) Veteran population, who have unique healthcare needs when compared to the civilian population, is sparse. We investigated the impact of concomitant coronary artery bypass grafting (CABG) on morbidity and mortality in US Veterans requiring surgical management of IE. METHODS: We identified 489 patients who underwent surgical management of IE between January 1 2010 and December 31 2020 at any of 43 Veterans Affairs (VA) cardiac surgery centers in the US. Patients were stratified based on who underwent concomitant CABG at the time of operation. Primary outcomes included the occurrence of postoperative myocardial infarction (MI), stroke, or mortality. Continuous variables were compared using independent t-tests or Mann Whitney U tests, and categorical variables were compared using the Chi square test. Cox proportional-hazard models were used to calculate risk for primary outcomes based on group. RESULTS: 61 patients (12.5%) underwent concomitant CABG for CAD. After adjusting for significant covariates, patients who underwent CABG had a higher long-term risk of MI (adjusted hazard ratios (aHR) 2.37, 95% CI: 1.29-4.35, p = 0.005) and higher risk of MI at 30-days (aHR 2.34, 95% CI: 1.06-5.19, p = 0.035). Concomitant CABG was not associated with long-term stroke or death, 30-day stroke or death, or perioperative complications. On sub-analysis of patients with moderate to severe CAD, rates of MI were higher in the CABG group at 30 days (25.9 vs. 3.4%, p = 0.016) and 1 year (33.3 vs. 3.4%, p = 0.004), though not long-term. The mean number of grafts was 1.51 ± 0.76, with only one graft performed in 65.6% (40/61) of patients. CONCLUSIONS: Concomitant CABG at the time of operation for IE was associated with increased risk of MI at 30-day and long-term, though most CABGs involved a low number of grafts. It was not associated with 30-day stroke or death, long term stroke or death, or perioperative complications. The optimal treatment of CAD noted during preoperative evaluation for veterans undergoing surgery for IE remains unclear.
Effects of Short-Term Episodes of Atrial Fibrillation after Coronary Artery Bypass Grafting on the Long-term Incidence of Atrial Fibrillation and Ischemic Stroke.
Chen L, Dai W
Heart Surg Forum · 2024 Jan · PMID 38286644 · Publisher ↗
BACKGROUND: To explore whether postoperative atrial fibrillation (POAF) has an impact on the incidence of late atrial fibrillation (AF) and late ischemic stroke after isolated coronary artery bypass grafting (CABG) compa...
BACKGROUND: To explore whether postoperative atrial fibrillation (POAF) has an impact on the incidence of late atrial fibrillation (AF) and late ischemic stroke after isolated coronary artery bypass grafting (CABG) compared to non-POAF patients. METHODS: A total of 243 eligible patients were followed for five years, and divided into a POAF group (n = 69) and a non-POAF group (n = 174). The primary end point was the incidence of late AF, and late ischemic stroke. Kaplan-Meier analyses and Cox proportional hazards models were used to examine whether POAF is an independent risk factor for the occurrence of late AF and late ischemic stroke. RESULTS: POAF patients were older than non-POAF patients. During the 5-year follow-up, the late occurrence of AF was significantly higher in POAF patients than in non-POAF (15.9% vs. 7.9% p = 0.006). There was no significant difference in the incidence of late ischemic stroke between POAF and non-POAF groups (p = 0.406). COX proportional regression analysis showed that POAF was independently associated with the late occurrence of AF (hazard ratio (HR) 3.27; 95% confidence interval (CI): 1.33-8.03, p = 0.01). CONCLUSION: POAF is an independent risk factor for the occurrence of late AF but not stroke after isolated CABG.
A Meta-Analysis for Postoperative Alternations of Aortic Coarctation.
Bao Y, Wang Z, Shan S … +2 more , Wang X, Gong Y
Heart Surg Forum · 2024 Jan · PMID 38286643 · Publisher ↗
OBJECTIVE: To investigate postoperative vascular changes of patients with coarctation of the aorta (CoA). METHODS: Literature review of updated articles was performed in June 2023 through the following databases: PubMed,...
OBJECTIVE: To investigate postoperative vascular changes of patients with coarctation of the aorta (CoA). METHODS: Literature review of updated articles was performed in June 2023 through the following databases: PubMed, Web of Science, EMBASE, Crohrane Library, CNKI and Wanfang database. All the case-control studies regarding the postoperative changes of vascular structure and function in patients with CoA were analyzed. RESULTS: A total of 596 articles from the above databases were initially identified, with 10 articles being selected for meta-analysis. The analysis showed that weighted mean difference (WMD) of carotid intima-media thickness (cIMT) was 0.07 (95% CI = 0.01~0.13, p < 0.01) and WMD of flow mediated dilation (FMD) was -4.36 (95% CI = -7.49~-1.24, p < 0.01), respectively. The postoperative cIMT of CoA patients was higher than that of the control group, but the postoperative FMD was lower than that of the control group. CONCLUSIONS: The operation on CoA patients ameliorates anatomical deformity in the vascular structures. However, intima-media thickening and endothelial malfunction remain as the key postoperative issues.
Analysis of the Influencing Factors of Postoperative Constipation in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional and Prospective Study.
Zhang P, Liu C, Qi W … +2 more , Xie X, Su Y
Heart Surg Forum · 2024 Jan · PMID 38286642 · Publisher ↗
BACKGROUND: The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery. METHODS: This study included a cohort of 379 patients who u...
BACKGROUND: The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery. METHODS: This study included a cohort of 379 patients who underwent cardiovascular surgery at Nanjing Drum Tower Hospital. The patient cohort was stratified into two groups based on the presence or absence of postoperative constipation. Utilizing logistic regression analysis, both univariate and multivariate analyses were conducted to elucidate the factors influencing defecation problems. The predictive accuracy of the findings was subsequently evaluated through the receiver operating characteristic (ROC) curve. RESULTS: Among the cohort of 379 patients subjected to cardiovascular surgery, a noteworthy 20.8% (n = 79) reported incidences of postoperative defecation issues. A multivariate logistic regression analysis showed that age (odds ratio (OR) = 1.063, 95% confidence interval (CI) 1.034-1.097, p < 0.001), operation time (OR = 1.004, 95% CI: 1.000-1.008, p = 0.028), ventilator usage time (OR = 1.032, 95% CI: 1.010-1.055, p = 0.004), polypharmacy (OR = 2.134, 95% CI: 1.069-4.321, p = 0.032), use of cough medicine (OR = 2.981, 95% CI: 1.271-6.942, p = 0.011) and psychological or behavioral barriers to defecation in the hospital environment (OR = 31.039, 95% CI: 14.313-73.179, p < 0.001) were independent risk factors for postoperative constipation in patients undergoing cardiovascular surgery. The area under the curve (AUC) for predicting postoperative constipation was 0.885. CONCLUSION: In the pursuit of optimizing postoperative recovery and mitigating postoperative constipation incidence, a targeted approach is imperative. Specifically, a focused intervention directed towards elderly patients, extended operation and prolonged ventilator durations, polypharmacy regimens, use of cough medicine, and those with psychological or behavioral barriers to defecation within the hospital milieu emerges as pivotal.
Left Atrial Low Voltage Areas Predicts Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis.
Zhang W, Wang Y, Wang H … +4 more , Shao Y, Dong Q, Li S, Gu Y
Heart Surg Forum · 2024 Jan · PMID 38286641 · Publisher ↗
BACKGROUND: Low voltage areas (LVAs) on left atrial (LA) voltage mapping correlate with atrial fibrosis. However, there is no uniform standard for the definition of LVAs, or mapping techniques and mapping rhythms, so tha...
BACKGROUND: Low voltage areas (LVAs) on left atrial (LA) voltage mapping correlate with atrial fibrosis. However, there is no uniform standard for the definition of LVAs, or mapping techniques and mapping rhythms, so that the predictive value of left atrial LVAs for recurrence of atrial fibrillation (AF) is uncertain. This study aimed to explore the relationship between the presence of pre-ablation left atrial LVAs and the risk of recurrent AF after catheter ablation. METHODS: The databases of PubMed, Embase, Web of science, Cochrane library, Scopus, Wanfang Datebase, China National Knowledge Infrastructure, China Biology Medicine and China Scientific Journal Datebase were searched from inception to 31 July 2023. Relevant studies regarding left atrial LVAs prior to ablation to predict postoperative recurrence of AF were identified and analyzed. The efficacy endpoints were defined as the recurrence of atrial arrhythmia lasting over 30 s. RESULTS: A total of 12 studies with 1070 patients were included. We found the presence of pre-ablation left atrial LVAs correlated with the risk of recurrent AF after ablation (hazard ratio (HR) = 2.87, 95% confidence interval (CI): 2.33-3.52). The presence of pre-ablation left atrial LVAs can predict the risk of recurrent AF after ablation both in the follow-up duration ≤12 months group and follow-up duration >12 months group (follow-up duration ≤12 months: HR = 2.93, 95% CI: 2.20-3.90; follow-up duration >12 months: HR = 2.80, 95% CI: 2.09-3.77). The presence of pre-ablation left atrial LVAs correlated with the risk of recurrent AF after ablation in paroxysmal AF (HR = 2.89, 95% CI: 1.97-4.24). CONCLUSIONS: The presence of pre-ablation left atrial LVAs correlate with the risk of recurrent AF after catheter ablation.
Effects of Phase Ⅰ Cardiac Rehabilitation Combined with Cognitive Behavioural Therapy on Cardiac Function, Exercise Capacity and Mental Health in Patients after Aortic Valve Replacement: A Retrospective Study.
Bai Z, Jiang Y, Wang M
Heart Surg Forum · 2024 Jan · PMID 38286640 · Publisher ↗
OBJECTIVE: To explore the application effect of phase Ⅰ cardiac rehabilitation (CR-Ⅰ) combined with cognitive behavioural therapy (CBT) on patients after aortic valve replacement (AVR). METHODS: This study retrospectivel...
OBJECTIVE: To explore the application effect of phase Ⅰ cardiac rehabilitation (CR-Ⅰ) combined with cognitive behavioural therapy (CBT) on patients after aortic valve replacement (AVR). METHODS: This study retrospectively analysed the data of 441 patients after AVR in our hospital from January 2020 to May 2023. A total of 38 patients who did not meet the inclusion criteria were excluded. A total of 403 patients were included. In accordance with different postoperative management schemes, the included patients were divided into the reference group (n = 202, received CR-Ⅰ) and the observation group (n = 201, received CR-Ⅰ+CBT). The cardiac function, exercise capacity and mental health of the two groups were compared. RESULTS: Before management, both groups had no significant differences in left ventricular end diastolic diameter (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF) and six-minute walking test (6MWT) scores (p > 0.05). At discharge and 3 months after discharge, the observation group had significantly lower LVEDD and LVESD and remarkably higher LVEF and 6MWT scores than the reference group (p < 0.001). The proportions of autonomous activity in bed within 3-4 days after surgery, autonomous out-of-bed activity within 8-10 days after surgery and autonomous walking 200 m within 12-15 days after surgery were distinctly higher (p < 0.001) and the incidence of adverse reactions was overtly lower (p < 0.001) in the observation group than in the reference group. Before management, both groups had no significant difference in their scores on the State-Trait Anxiety Inventory (STAI) (p > 0.05). At discharge and 3 months after discharge, the observation group had lower STAI scores than the reference group (p < 0.001). CONCLUSION: CR-Ⅰ combined with CBT effectively improves the cardiac function, independent exercise capacity and mental health level of patients after AVR and provides a new direction for the formulation and selection of follow-up clinical management.
You Either Pull Freight or You are Freight-Admonition #1 for Third Year Medical Students on a Surgery Service.
Tribble C
Heart Surg Forum · 2024 Jan · PMID 38286639 · Publisher ↗
Abstract loading — click title to view on PubMed.
Peak Blood Lactate at 24 h after ECMO Can Predict 30-day Mortality in Infants after Complex Cardiac Surgery.
Meng F, Li J, Liang W … +5 more , Dong H, Li B, Qian X, Yang L, Cheng Z
Heart Surg Forum · 2023 Dec · PMID 38178360 · Publisher ↗
OBJECTIVE: Peak blood lactate at 24 h after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants after complex cardiac surgery. METHODS: Twenty-eight infants with ECMO after complex congenit...
OBJECTIVE: Peak blood lactate at 24 h after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants after complex cardiac surgery. METHODS: Twenty-eight infants with ECMO after complex congenital heart disease surgery were selected from March 2019 to March 2022 in our hospital. The infants were divided into survival group (n = 11) and non-survival group (n = 17) according to 30-day survival after discharge from hospital. The risk factors at 30-day mortality after discharge were analyzed by Cox regression analysis. RESULTS: When compared to the non-survival group, there were significant differences in peak blood lactate at 24 h after ECMO, liver dysfunction and multiple organ dysfunction syndrome (MODS) in the survival group (p < 0.05). Cox regression analysis showed that peak blood lactate at 24 h after ECMO (HR = 1.074, 95% CI: 1.005-1.149, p = 0.036) and MODS (HR = 4.120, 95% CI: 1.373-12.362, p = 0.012) were related risk factors affecting the prognosis of infants. The best cutoff value for the peak blood lactate at 24 h after ECMO was 10.2 mmol/L. The area under the curve (AUC) for predicting the 30-day survival rate of the ECMO assisted infants after discharge from hospital was 0.770 (95% CI: 0.592-0.948, p = 0.018), with a sensitivity of 94.1% and specificity of 54.5%. CONCLUSION: The peak blood lactate at 24 h after ECMO can predict the 30-day mortality after discharge of infants treated with ECMO after complex cardiac surgery. The best cut-off value for peak blood lactate at 24 h after ECMO was 10.2 mmol/L.
Central Catheter-Induced Cardiac Tamponade in Neonates: Two Case Reports.
Kim H, Choi KH
Heart Surg Forum · 2023 Nov · PMID 38178359 · Publisher ↗
Intraoperative central venous catheter (CVC) insertion has become a routine procedure for pediatric cardiac surgery patients at our center. The case in which large amounts of pericardial effusion resulting in cardiac tam...
Intraoperative central venous catheter (CVC) insertion has become a routine procedure for pediatric cardiac surgery patients at our center. The case in which large amounts of pericardial effusion resulting in cardiac tamponade other than direct puncture of the catheter is a rare, but often causes fatal complications. Two of our patients suffered cardiac collapse after surgery owing to cardiac tamponade. Both the patients were successfully treated with pericardiocentesis, and the pericardial fluid had a high glucose level. Subsequently, the patients were discharged without any sequelae. During a serial radiographic follow-up, we found a pre-event alteration in the CVC angulation. These two cases highlight the fact that clinicians should pay attention to serial follow-up of chest radiography for monitoring any changes in the catheter status, such as its position or angulation, to prevent unexpected complications. The only way to prevent fatal complications due to CVC is timely recognition of any alteration in CVC based on radiological examinations. In instances of CVC changes, the issues should be addressed as quickly as possible.
Risk Factors of Postoperative Infection in Newborns with Congenital Heart Disease.
Zhang L, Guleng W
Heart Surg Forum · 2023 Dec · PMID 38178358 · Publisher ↗
AIMS: This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease. METHODS: From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagn...
AIMS: This study aims to explore the risk factors of postoperative infection in newborns with congenital heart disease. METHODS: From January 2019 to January 2023, 78 neonates with congenital heart disease who were diagnosed and treated in our hospital with postoperative infection as well as an age- and sex-matched non-infected group (n = 78) were enrolled. After collecting the data and clinical information of 156 children, we compared the differences in the days of catheter indwelling, days of mechanical ventilation, times of blood transfusion, days of intensive care unit (ICU) stay, and survival status between postoperative infection and non-infection groups. Multivariate logistic regression was used to analyze the risk factors of postoperative infection in newborns with congenital heart disease. RESULTS: Age (11 ± 4 vs. 10 ± 5 days) and sex (56.4% vs. 52.6%) were comparable between the infection and non-infection groups. Children in the infection group had lower birth weight, higher proportion of cesarean section, lower oxygen saturation levels, and higher risk adjustment in congenital heart surgery (RACHS-1) scores than those in the non-infection group. In terms of postoperative indicators, neonates in the infection group had longer catheter indwelling time, mechanical ventilation time, ICU hospitalization days, and more blood transfusion times than those in the non-infection group. Multivariate logistic regression analysis showed that oxygen saturation <85% (OR: 6.5; 95% CI: 3.7-15.4), catheter indwelling days >14 days (OR: 3.2; 95% CI: 2.1-10.7), and ICU stay >10 days (OR: 7.1; 95% CI: 3.6-18.5) were independent risk factors for postoperative infection in newborns with congenital heart disease. CONCLUSION: Low oxygen saturation, prolonged catheterization days, and prolonged ICU stay were independent risk factors for postoperative infection in neonates with congenital heart disease undergoing cardiac surgery.
Association between Left Ventricular Longitudinal Strain (GLS) and Prognosis of the Patients Undergoing Heart Valve Surgery with Preserved Left Ventricular Ejection Fraction.
Xue YY, Chen SY, Xiao JL … +5 more , Shen X, Xu H, Hong L, Song XC, Zhang C
Heart Surg Forum · 2023 Dec · PMID 38178357 · Publisher ↗
PURPOSE: Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction. This study aimed to determine the association between GLS and postoperative intensity of inotropic support in the...
PURPOSE: Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction. This study aimed to determine the association between GLS and postoperative intensity of inotropic support in the patients undergoing heart valve surgery with preserved left ventricular ejection fraction. METHODS: 74 patients with preserved left ventricular ejection fraction who underwent valve surgery during the period between March 2021 and June 2022 were included in this prospective observational study. Transthoracic echocardiography including strain analysis with speckle tracking was performed before surgery. Patients were stratified according to the left ventricle (LV) GLS: LV-GLS ≥-16% (Impaired GLS group) and LV-GLS <-16% (Normal GLS group). The primary endpoint was postoperative vasoactive inotropic score. A high vasoactive inotropic score (VIS) was defined as a maximum VIS of ≥15 within 24 hours postoperatively. Postoperative adverse events, baseline clinical and echocardiographic data were also recorded. We invested the ability of preoperative GLS in predicting adverse postoperative outcomes, such as prolonged mechanical ventilation and the need for pharmacologic hemodynamic support after cardiac surgery. RESULTS: Seventy-four patients were included and analyzed in this study, including thirty-three in impaired GLS group and forty-one in normal GLS group. In-hospital mortality was 1.27% (1/74). Patients in impaired GLS group were more likely to have prolonged mechanical ventilation (p = 0.041). Multivariable logistic regression analysis revealed that the apical four-chamber view of the left ventricle (A4C)-GLS was significantly associated with high VIS (OR 1.373, p = 0.007). A4C-GLS had a sensitivity of 62.5% and a specificity of 89.66% for predicting high VIS (area under the curve, 0.78). The relationships between GLS and other secondary outcome measures were not statistically significant. The optimal cutoff of A4C-GLS for postoperative high vasoactive inotropic score was -10.85%. CONCLUSION: Preoperative LV dysfunction is an independent risk factor for postoperative high VIS. A4C-GLS may be a reliable tool in predicting high VIS after cardiac surgery. Those patients with impaired contractility were at high risk for elevated inotropic support and prolonged mechanical ventilation after cardiac surgery. These findings suggest an important role for echocardiographic GLS in perioperative assessment of cardiac function in the patients undergoing cardiac surgery.
Interventional Bridging Therapy for Radical Cardiac Surgery in a Patient Seemed to be Inoperable Due to Very Poor Left Ventricular Function: A Case Report.
Lee J, Tsutsui M, Mochizuki N … +9 more , Setogawa Y, Suzuki F, Narita M, Hirofuji A, Kunioka S, Shirasaka T, Ishikawa N, Yuzawa S, Kamiya H
Heart Surg Forum · 2023 Nov · PMID 38178356 · Publisher ↗
Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a pati...
Cases that are inoperable owing to poor preoperative conditions are sometimes encountered. However, there are some cases that are led to radical treatment by performing bridge therapy. Here, we presented a case of a patient with complex cardiac disease in an inoperable state who underwent bridging therapy that led to successful surgical treatment. A 73-year-old male who received hemodialysis treatment and had severe aortic valve stenosis and coronary artery disease planned surgical treatment. However, he was deemed inoperable owing to his low cardiac function and hemodynamic instability. Therefore, to escape from a fatal condition, we first performed balloon aortic valvuloplasty and percutaneous coronary intervention as palliative procedures. Subsequently, his cardiac function and hemodynamic stability remarkably improved; therefore, after 1 month, we performed a successful radical surgical treatment. Even in inoperable patients, bridging therapy leading to radical treatment is possible.
Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement.
Hafız E, Altınbaş Ö, Kutlu IB … +2 more , Moda M, Celkan MA
Heart Surg Forum · 2023 Dec · PMID 38178355 · Publisher ↗
BACKGROUND: Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this st...
BACKGROUND: Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this study, we aimed to compare the effects of del Nido cardioplegia and microplegia, which were mostly used in our clinic for intraoperative and postoperative processes among patients who underwent elective mitral valve replacement. As a result, the comparison could be performed in a specific patient group without additional valvular or coronary disease, and cardioplegia distribution could be achieved more efficiently. METHODS: Between 2018 and 2023, a total of 120 patients who underwent elective mitral valve replacement via sternotomy with del Nido cardioplegia or microplegia were included in the study. Patients were divided into two groups; group 1 (del Nido, n = 64) and group 2 (microplegia, n = 56). Preoperative characteristics, intraoperative and postoperative early clinical data as primary outcomes, and postoperative mortality rates and intensive care costs as secondary outcomes were compared statistically. RESULTS: There were no statistically significant differences in terms of preoperative characteristics between the two groups. Duration of cross clamp differences between group 1 versus group 2 (45 ± 16 vs. 57 ± 19 min), cardiopulmonary bypass (56 ± 17 vs. 65 ± 21 min), intensive care length of stay (18.04 ± 7.41 vs. 22.37 ± 6.86 h), requirement of intraoperative defibrillation (n = 5 vs. n = 13), and intensive care costs were found to be statistically significantly lower in del Nido group. CONCLUSION: Either del Nido or microplegia solutions can be used safely in mitral valve replacement operations, however, del Nido cardioplegia has some advantages over intraoperative processes, such as lowering the cross clamp and cardiopulmonary bypass time. Furthermore, patients who received del Nido cardioplegia had shorter intensive care stay and required less intraoperative defibrillation compared with the microplegia group. Therefore, less exposure to anesthesia, the prevention of infection due to shortened operation duration, and greater cost-effectiveness can be achieved by using del Nido cardioplegia instead of microplegia.
A Comparative Study of 64-Slice Coronary CT Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the Identification of Coronary Artery Stenosis.
Li B, Dandan Wu
Heart Surg Forum · 2023 Dec · PMID 38178354 · Publisher ↗
OBJECTIVE: The aim of this study was to compare the diagnostic accuracy of 64-Slice Coronary Computer Tomography Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the identification of significant coronary art...
OBJECTIVE: The aim of this study was to compare the diagnostic accuracy of 64-Slice Coronary Computer Tomography Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the identification of significant coronary artery stenosis (>50% luminal narrowing). METHODS: A total of 120 patients suspected of having coronary artery disease were divided into two groups, with 60 patients in each group. Group 1 underwent CCTA and group 2 underwent MPI. Diagnostic accuracy parameters, image quality, radiation exposure, and procedure time were compared. RESULTS: CCTA demonstrated higher sensitivity (90% vs. 80%, p = 0.049) and similar specificity (75% vs. 70%, p = 0.453) compared to MPI. Image quality was slightly superior in the CCTA group. Radiation exposure was significantly lower in the CCTA group compared to the MPI group (3.5 ± 1.2 mSv vs. 9.4 ± 1.7 mSv, p < 0.001). The procedure time for CCTA was also significantly less than that for MPI (10.3 ± 2.1 minutes vs. 45.2 ± 5.3 minutes, p < 0.001). CONCLUSION: CCTA showed superior sensitivity, image quality, and efficiency compared to MPI while exposing patients to a lower radiation dose. Further multicenter studies with larger patient populations are needed to validate these findings.
Microbiology of Infective Endocarditis in United States Veterans - Association Between Causative Organism and Short- and Long-Term Outcomes.
Duggan J, Peters A, Halbert S … +2 more , Antevil J, Trachiotis GD
Heart Surg Forum · 2023 Dec · PMID 38178353 · Publisher ↗
BACKGROUND: Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this m...
BACKGROUND: Previous studies have elucidated the relationship between causative organism and outcomes in infective endocarditis, however this relationship has not been studies in United States Veterans. The aim of this manuscript is to evaluate the association between causative organism and short-term and long-term outcomes in United States (US) Veterans with infective endocarditis (IE) requiring surgical management between 2010-2020. METHODS: We analyzed 489 patients with surgically treated IE from the Veterans Affairs (VA) Surgical Quality Improvement Program and the VA Informatics and Computing Infrastructure databases. Patients were divided into groups using causative organism identified from blood or intraoperative cultures - Staphylococcus, Streptococcus, Gram-negative rods, Enterococcus, Polymicrobial, and Unknown/Culture Negative. Other identified organisms were excluded from analysis. Cox proportional hazard models were used to calculate risk for stroke/transient ischemic attack (TIA), myocardial infarction (MI), and death based on group. The models were adjusted for covariates using backward elimination. Continuous variables were compared using ANOVA or Kruskal-Wallis H tests, and categorical variables were compared using Chi square tests. RESULTS: Mean follow-up was 4.0 ± 6.3 years. Gram negative rods (GNRs) were associated with greater risk of long-term mortality (adjusted hazard ratios (aHR) 2.15, 95% CI: 1.20-3.86, p = 0.01). Enterococcus was associated with long-term risk of MI (aHR 2.05, 95% CI: 1.07-3.94, p = 0.03). Resistant organisms, such as methicillin-resistant staphylococcus aureus, were associated with long-term risk of MI (aHR 2.51, 95% CI: 1.14-5.45, p = 0.02). Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation (48 hrs) (aHR 1.76, 95% CI: 1.05-2.97, p = 0.034), tracheostomy (aHR 5.64, 95% CI: 2.35-13.55, p < 0.001), and prolonged ICU stay (5 days) (aHR 1.39, 95% CI: 1.01-1.91, p = 0.043). CONCLUSIONS: In US Veterans, polymicrobial infections had notably worse perioperative outcomes but similar long-term outcomes in comparison to monomicrobial infections. GNR infections were associated with increased long-term mortality. Enterococcus and resistant organisms were associated with increased long-term risk of MI. Polymicrobial infections were associated with greater risk of perioperative complications, including prolonged mechanical ventilation, tracheostomy, and prolonged ICU stay.
A Retrospective Clinical Study on Cardiovascular Complications from Colorectal Cancer.
Yin T, Yang J, Liu X … +2 more , Huang J, Dai E
Heart Surg Forum · 2023 Dec · PMID 38178352 · Publisher ↗
OBJECTIVE: To investigate the incidence and risk factors of cardiovascular complications amongst patients with colorectal cancer (CRC). METHODS: A retrospective cohort study was conducted on 2085 patients diagnosed with...
OBJECTIVE: To investigate the incidence and risk factors of cardiovascular complications amongst patients with colorectal cancer (CRC). METHODS: A retrospective cohort study was conducted on 2085 patients diagnosed with CRC in two tertiary hospitals in China between 2015 and 2020. The patients' medical records were reviewed to identify cardiovascular complications, including myocardial infarction, heart failure, stroke, hypertension, coronary heart disease, heart failure, and arrhythmia. The incidence rate of cardiovascular complications was calculated, and Cox proportional hazards regression analysis was used to identify risk factors. RESULTS: Of the 2085 CRC patients, 329 (15.8%) experienced cardiovascular complications during the follow-up period, with an incidence rate of 17.4 cases per 1000 person-years. The risk was significantly higher in patients who were older than 60 years (adjusted hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.22-3.41), had a higher level of low-density lipoprotein cholesterol (LDL-C) (adjusted HR 2.32, 95% CI 1.31-4.10), had higher levels of serum C-reactive protein (CRP) (adjusted HR 1.57, 95% CI 1.21-2.04), or who underwent chemotherapy or radiotherapy. CRC patients with cardiovascular complications had significantly higher levels of oxidative stress markers, including malondialdehyde (MDA) (5.8 ± 1.2 μmol/L vs. 3.4 ± 0.9 μmol/L, p < 0.001), lower levels of superoxide dismutase (SOD) (85.2 ± 15.6 U/mg protein vs. 112.5 ± 21.3 U/mg protein, p < 0.001), and lower levels of glutathione peroxidase (GPx) (15.6 ± 3.2 U/mg protein vs. 20.4 ± 4.1 U/mg protein, p < 0.001) compared to those without complications. A progressive increase was observed in the proportion of CRC patients with cardiovascular complications over time, rising from 10% in the first year to 38% by the tenth year of follow-up. CONCLUSION: Cardiovascular complications pose a high risk in CRC patients, particularly amongst older patients and those with higher levels of LDL-C or CRP. Regular monitoring of cardiovascular function should be considered in the management of patients with CRC.
A Single-Centre, Retrospective Research Evaluation of the Effect of Extended Intervention Model Based on Case Management of Treatment Compliance and Cardiac Function on Patients with Chronic Heart Failure.
Ren S, Yang X, Niu Y … +4 more , Hao X, Wang S, Ren S, Liu Y
Heart Surg Forum · 2023 Dec · PMID 38178351 · Publisher ↗
OBJECTIVE: To explore the effect of case management-based extended intervention model on treatment compliance and cardiac function in patients with chronic heart failure. METHODS: This study retrospectively analysed the...
OBJECTIVE: To explore the effect of case management-based extended intervention model on treatment compliance and cardiac function in patients with chronic heart failure. METHODS: This study retrospectively analysed the clinical data of 203 patients with chronic heart failure at Xingtai Third Hospital from January 2019 to January 2022. In accordance with different intervention programs, the patients were divided into a study group (SG, n = 102) and a reference group (RG, n = 101). The SG received the extended intervention model based on case management, and the RG adopted the conventional intervention model. Comparison was conducted on the treatment compliance, cardiac function, activity of daily living scale (ADL) scores and readmission rates in both groups. RESULTS: After intervention, the SG showed higher treatment compliance (p < 0.05), lower heart rate, higher left ventricular ejection fraction, ratio of transmitral peak rapid filling velocity to transmitral peak atrial filling velocity at mitral orifice and six-minute walk distance (p < 0.001) and significantly lower ADL score and readmission rates than the RG (p < 0.05). CONCLUSION: The extended intervention model based on case management positively influences the treatment compliance of patients with chronic heart failure and continuously improves patients' cardiac function, reduces the readmission rate, enhances daily living ability, comprehensively increases clinical efficacy and benefits patients for a long period.
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