The Heart Surgery Forum[JOURNAL]
Sun
200 papers
The Clinical Significance of Lncrna GAS5 And Mir-222-3p in Carotid Artery Stenosis.
Li S, Zhao F, He Y … +2 more , E Y, Wang C
Heart Surg Forum · 2022 Jul · PMID 36052916 · Publisher ↗
BACKGROUND: Carotid artery stenosis (CAS) is the major pathogen of cerebral infarction and brain death. Early detection and risk prediction could help the diagnosis and improve the outcome of patients. The clinical signi...
BACKGROUND: Carotid artery stenosis (CAS) is the major pathogen of cerebral infarction and brain death. Early detection and risk prediction could help the diagnosis and improve the outcome of patients. The clinical significance of lncRNA GAS5 (GAS5) and miR-222-3p in the diagnosis and prognosis of CAS was evaluated in this study to explore novel effective biomarkers of CAS. METHODS: A total of 72 CAS patients and 63 healthy individuals (control) were enrolled in this study. The expression levels of GAS5 and miR-222-3p in study subjects were detected using PCR. The ROC, Kaplan-Meier, and Cox regression analyses were carried out to estimate the diagnostic and prognostic value of GAS5 and miR-222-3p in CAS. The interaction between GAS5 and miR-222-3p was disclosed by the dual-luciferase reporter. RESULTS: The reduced expression of GAS5 and elevated expression of miR-222-3p were observed in CAS patients compared with the healthy controls, and a significant correlation between their expression levels in CAS was revealed. GAS5 and miR-222-3p could discriminate CAS patients from the healthy controls with high sensitivity and specificity. The GAS5 downregulation and miR-222-3p upregulation could predict the poor prognosis of CAS patients and may be associated with the severe development of patients. In human vascular smooth muscle cells, miR-222-3p could negatively regulate the luciferase activity of GAS5. CONCLUSION: Both GAS5 and miR-222-3p served as the diagnostic and prognostic biomarkers of CAS. The function of GAS5 might result from the regulation of miR-222-3p, which needs further validation.
Preoperative QRS Duration Predicts the Responsiveness of Chronic Heart Failure Patients with Pacemaker Indications to Left Bundle Branch Area Pacing Treatment.
Chen TP, Geng X, Fang YX … +2 more , Yin YC, Zhang NJ
Heart Surg Forum · 2022 Jul · PMID 36052915 · Publisher ↗
BACKGROUND: This study investigated the predictive value of preoperative QRS duration (QRSd) in responsiveness of chronic heart failure (CHF) patients with pacemaker indications to the left bundle branch area pacing (LBB...
BACKGROUND: This study investigated the predictive value of preoperative QRS duration (QRSd) in responsiveness of chronic heart failure (CHF) patients with pacemaker indications to the left bundle branch area pacing (LBBAP). METHODS: Thirty-one CHF patients with cardiac function categorized as NYHA class II or above and indications for pacemaker therapy who successfully underwent LBBAP treatment were enrolled in this study. Based on the 12-month postoperative responsiveness to treatment, patients were divided into a responsiveness group (N = 16) and a no-responsiveness group (N = 15). Data from all patients were collected for analysis. Multivariate binary logistic regression analysis was used to determine the independent factors associated with the responsiveness to LBBAP treatment. RESULTS: Among the 31 patients with LBBAP, 16 patients (51.6%) responded to the treatment, and 15 patients (48.4%) had no response. There were significant differences between the two groups with regard to complete left bundle branch block (CLBBB), preoperative QRSd, and preoperative left ventricular peak time (LVAT). Univariate logistic regression analysis showed that CLBBB, preoperative QRSd, and preoperative LVAT all were significantly correlated with responsiveness to LBBAP. Multivariate binary logistic regression analysis showed that QRSd was an independent predictor of responsiveness to LBBAP. The maximum area under the ROC curve for QRSd was 0.827 (95%C.I.:0.663-0.991), the maximum Youden index was 0.679, with the optimal cutoff point of QRSd ≥ 153 ms, a sensitivity of 81.3%, and a specificity of 86.7%. CONCLUSION: Preoperative QRSd predicts the responsiveness of CHF patients with pacemaker indications to LBBAP.
Primary Osteosarcoma of Left Atrial Appendage in a Patient with Rheumatic Heart Disease.
Zhang D, Wei S, Liu D … +1 more , Guo Y
Heart Surg Forum · 2022 Jul · PMID 36052914 · Publisher ↗
Primary cardiac osteosarcoma is extremely rare, with all arising from the atrium, right ventricle, and cardiac valve, according to previous reports. We report a case of primary osteosarcoma of the left atrial appendage i...
Primary cardiac osteosarcoma is extremely rare, with all arising from the atrium, right ventricle, and cardiac valve, according to previous reports. We report a case of primary osteosarcoma of the left atrial appendage in a patient. We present a process of preoperative misdiagnosis, intraoperative confirmed diagnosis, and complete resection.
Reversible Myocardial Calcification Following Acute Heart Failure and Kidney Injury Caused by Valsalva Sinus Rupture.
Chen W, Liu J, Ma G … +3 more , Liu X, Miao Q, Zhang C
Heart Surg Forum · 2022 Jul · PMID 36052913 · Publisher ↗
A 47-year-old previously healthy man was referred to a local hospital with chest tightness, oliguria, and lower extremity edema for seven days. An initial investigation revealed acute heart failure and kidney injury. The...
A 47-year-old previously healthy man was referred to a local hospital with chest tightness, oliguria, and lower extremity edema for seven days. An initial investigation revealed acute heart failure and kidney injury. The patient was intensively treated with cardiac and renal replacement therapy, and cardiorenal function improved one week later. Two months later, echocardiography was performed because chest tightness and edema had not resolved. Echocardiography showed Valsalva sinus rupture, and the patient was transferred to our center. Myocardial calcification was observed in the left ventricular wall on computed tomography after admission. The patient underwent cardiac surgery and recovered smoothly. At the three-year follow up, the patient was asymptomatic with normal renal function and serum electrolytes. Imaging revealed a significant reduction in diffuse calcification of the left ventricular wall. This case indicates that this rare form of reversible myocardial calcification may be associated with acute heart and renal failure caused by Valsalva sinus rupture. The results of this case will guide clinicians about further management and timely referral of such patients to appropriate specialties.
A Model to Predict in-Hospital Death in Patients with Type B Acute Aortic Dissection: A Single-Center Retrospective Observational Study.
Li W, Zhou J, Cheng C
Heart Surg Forum · 2022 Jul · PMID 36052912 · Publisher ↗
BACKGROUND: Acute type B aortic dissection (BAAD), as a catastrophic disease, is linked to high morbidity and mortality. The current research is to create a simple risk model to predict in-hospital mortality in BAAD pati...
BACKGROUND: Acute type B aortic dissection (BAAD), as a catastrophic disease, is linked to high morbidity and mortality. The current research is to create a simple risk model to predict in-hospital mortality in BAAD patients based on laboratory results. METHODS: Patients with BAAD were included from April 1, 2017, to November 30, 2019, in the hospital. Clinical features and laboratory results were collected. Logistic regression analyses and ROC were applied to the evaluation. RESULTS: Hemoglobin (HB) (114.88 ± 28.42 (nonsurvivor) vs. 134.95 ± 17.88 (survivor), P < 0.001) and UREA (10.93 ± 7.02 (nonsurvivor) vs. 7.17 ± 3.77 (survivor), P = 0.001) were significantly different. In multivariate analysis, HB (hazard ratio (HR): 0.124; 95% confidence interval (CI) 0.025 - 0.627; P = 0.012) and UREA (HR: 8.765; 95% CI 2.022 - 37.993; P = 0.004) were independent predictors of in-hospital death. Then, a model with good performance (AUC 0.761 (0.677 - 0.832) was developed. CONCLUSION: A simple model with good prediction value was developed. With this model, physicians quickly can identify high-risk patients, determine the best treatment strategies, and improve prognosis.
Endoscopic Versus Conventional Vein Harvest Technique: Histological and Immunohistochemical Evaluation of Venous Wall Integrity.
Aboollo MF, Awadallah KM, Elsharkawy T … +2 more , Abd Elaziz ME, Hafez BA
Heart Surg Forum · 2022 Jul · PMID 36052911 · Publisher ↗
BACKGROUND: The introduction of endoscopic saphenous vein graft harvesting has been known for two decades. It offers benefits related to decreased rate of donner site complications. Debates related to its safety in terms...
BACKGROUND: The introduction of endoscopic saphenous vein graft harvesting has been known for two decades. It offers benefits related to decreased rate of donner site complications. Debates related to its safety in terms of trauma to the wall of the venous graft and long-term graft patency have been raised, but few studies had investigated this point. Our aim is to compare the endoscopic saphenous vein harvest and conventional harvest techniques, in terms of the integrity of the wall of the vein graft. METHODS: A prospective study in which we examined 80 samples of saphenous vein from 80 patients to whom coronary artery bypass grafting was done. Patients randomly were assigned to either technique. Vein samples were taken from patients having the conventional technique (group 1, 40 patients) and from patients having endoscopic vein harvest (group 2, 40 patients). Vein samples were stained with Hematoxylin & Eosin, Masson's trichrome, and immunohistochemical stain for CD 31 and then examined by light microscopy. The degree of intimal staining was graded from 0% to 100%, which is directly related to the degree of intimal preservation (the least injury, the more the staining score) and vein media changes were reported. RESULTS: Patient characteristics were comparable in the groups. Group 1 (conventional group) was better than group 2 (endoscopic group), regarding endothelial integrity and medial changes although it was statistically not significant. CONCLUSION: Both the conventional and endoscopic techniques are comparable, regarding the intimal preservation of the venous graft.
Coronary Angiography Within 48 Hours Before Cardiac Surgery Increases the Risk of Postoperative Acute Kidney Injury.
Zhou H, Xiong H, Zheng X … +2 more , Yang H, Xu S
Heart Surg Forum · 2022 Jul · PMID 36052910 · Publisher ↗
BACKGROUND: Cardiac surgery and coronary examination, such as invasive coronary angiography (CAG), are both possibly associated with acute kidney injury (AKI). Preoperative CAG examination and cardiac surgery within a sh...
BACKGROUND: Cardiac surgery and coronary examination, such as invasive coronary angiography (CAG), are both possibly associated with acute kidney injury (AKI). Preoperative CAG examination and cardiac surgery within a short interval may increase the incidence of AKI. METHODS: We retrospectively reviewed 1112 patients who underwent CAG examination within 30 days prior to the cardiac operation in this study. Postoperative AKI was defined, according to Kidney Disease Improving Global Outcomes Definition and Staging (KDIGO) criteria. RESULTS: The total incidence of AKI was 40.8% and cystatin C level was 1.260 (1.028, 1.672) mg/L. For patients who received CAG, age, body mass index, cardiopulmonary time, and the time interval between preoperative CAG examination and cardiac operation within 48h was shown to be independent predictors of postoperative AKI. The incidence of AKI in patients undergoing preoperative CAG within 48h was 11.2% higher than in those more than 48h (P < 0.001). Patients undergoing valve surgery with or without coronary artery bypass grafting (CABG) exhibited a higher AKI risk than those only accepting CABG. The in-hospital stay of patients who developed AKI was 2 days longer than those without AKI. However, undergoing CAG within 48h prior to cardiac operation did not prolong ICU length of stay or hospital length of stay, nor did it increase the risk of death or renal failure after an operation. CONCLUSION: Undergoing CAG within 48 hours before cardiac surgery increases the risk of postoperative AKI.
Negative Pressure Wound Therapy Becomes the Treatment of Choice of Deep Sternal Wound Infection.
Gegouskov V, Manchev G, Goranovska V … +1 more , Stoykov D
Heart Surg Forum · 2022 Aug · PMID 36052909 · Publisher ↗
BACKGROUND: Sternal wound infection, especially deep sternal wound infection, is a serious complication after open heart surgery. It leads to a marked increase in hospital stay, financial expenses, and mortality. Treatme...
BACKGROUND: Sternal wound infection, especially deep sternal wound infection, is a serious complication after open heart surgery. It leads to a marked increase in hospital stay, financial expenses, and mortality. Treatment is primarily surgical and may be divided into conventional treatment methods and negative pressure wound therapy. MATERIALS AND METHODS: Between 2010 and 2021, 77 patients presenting back after cardiac surgery with deep sternal wound infection were treated surgically. Conventional treatment methods were utilized in 45 patients and included wound revision with primary closure, continuous wound irrigation, and open treatment with secondary closure. Negative-pressure wound therapy (NPWT) was applied in 32 patients. The two treatment arms were compared by two primary outcomes - rate of recurrent infection and hospital mortality. Predictors of mortality and infectious recurrence were identified using multivariate logistic regression. RESULTS: Recurrent infection occurred in 18.2% of cases and mortality was 13% in the whole group. NPWT was more successful in preventing recurrent infection OR: 5.4 (95% CI: 1.1-27.5; P = 0.044) than conventional treatment and more than moderate left ventricular systolic dysfunction (EF<40%) predisposed to infectious recurrence - OR: 4.7 (95% CI: 1.05-22.1; P = 0.049). Recurrent infection itself was the strongest predictor of mortality in the multivariate model OR: 0.14 (95% CI: 0.03 - 0.58; P = 0.007). CONCLUSION: NPWT as an initial method of wound preconditioning followed by definitive wound closure effectively reduces the rate of infectious recurrence and patient mortality. It may become the modality of first choice when dealing with complicated incisional infections following heart surgery.
Moderate Hypothermic Circulatory Arrest Model in Rats: A New Model with Hyperkalemia-Induced Cardioplegia.
Gao Y, Tang Z, Liu Y … +3 more , Fan J, Liu Y, Wang H
Heart Surg Forum · 2022 Jul · PMID 36052908 · Publisher ↗
BACKGROUND: Moderate hypothermic circulatory arrest (MHCA) is a safe and effective method of cardiopulmonary bypass (CPB). However, most present rat models involve a deep hypothermic circulatory arrest, which cannot exac...
BACKGROUND: Moderate hypothermic circulatory arrest (MHCA) is a safe and effective method of cardiopulmonary bypass (CPB). However, most present rat models involve a deep hypothermic circulatory arrest, which cannot exactly reflect the clinical situation. The aim of this study was to establish a novel and safe rat model of MHCA with hyperkalemia-induced cardioplegia to study the pathophysiology of potential complications. METHODS: Ten adult male Sprague-Dawley rats (age, 16-18 weeks; weight, 450-550 g) were used. The entire CPB circuit consisted of a reservoir, peristaltic pump, membrane oxygenator, heat exchanger, and hemoconcentrator, all of which were connected via silicon tubing. The prime solution was approximately 19 mL. The right jugular vein, right femoral artery, and left femoral artery were cannulated. Blood was drained from the right atrium through the right jugular vein and perfused to the rats via the left femoral artery. CPB was commenced at a full flow rate. The rats were cooled to a rectal temperature of 25°C, and cardioplegia was induced by systemic hyperkalemia. After that, MHCA was carried out for 30 min. At the same time, system self-ultrafiltration was carried out to decrease the concentration of potassium by a hemoconcentrator. The circulatory arrest was followed by reperfusion and over 30 min of rewarming. CPB carefully was terminated. Blood in the circuit slowly was centrifuged for autotransfusion. Blood gas and hemodynamic parameters were recorded at each time point before CPB, before MHCA, at 10 min after the initiation of rewarming, and after CPB. RESULTS: All CPB and MHCA procedures successfully were achieved. One rat died of respiratory failure. Cardioplegia with systemic hyperkalemia was induced by 1 mL of 10% potassium chloride injected into the reservoir, and the concentration of potassium was maintained at 17 ± 3 mmol/L. Cardiac function and blood pressure were stable after the operation. CONCLUSIONS: A novel and safe rat model of MHCA with hyperkalemia-induced cardioplegia successfully was established.
Rapidly Progressive Right Atrial Angiosarcoma with Atrial Perforation.
Zheng D, Tang H, Yang BF … +1 more , Wu J
Heart Surg Forum · 2022 Jul · PMID 36052907 · Publisher ↗
Cardiac angiosarcomas are highly aggressive, extremely rare malignancies with a poor prognosis. We report the case of a 39-year-old woman presenting with a right atrial angiosarcoma with perforation of the right atrium....
Cardiac angiosarcomas are highly aggressive, extremely rare malignancies with a poor prognosis. We report the case of a 39-year-old woman presenting with a right atrial angiosarcoma with perforation of the right atrium. There is almost always a diagnostic lag for cardiac angiosarcoma, leading to a poor prognosis. Cardiovascular sarcoma is one of the most invasive malignant tumors. Radical resection surgery as the core of comprehensive treatment presently is the best treatment plan.
Dizziness Result From Anomalous Origin of Left Common Carotid Artery.
Liu DX, Cao YR, Guo K … +3 more , Liao YF, Cao P, Zhang D
Heart Surg Forum · 2022 Jul · PMID 36052906 · Publisher ↗
BACKGROUND: The anomalous origin of the left common carotid artery from the pulmonary artery is extremely scarce. At present, there are few relevant research and medical treatment data. This case is intended to provide r...
BACKGROUND: The anomalous origin of the left common carotid artery from the pulmonary artery is extremely scarce. At present, there are few relevant research and medical treatment data. This case is intended to provide relevant information and share treatment experiences. Case information: A 6-year-old child was diagnosed with patent ductus arteriosus and underwent surgery five years ago with occasional dizziness. After examination, it was found that the abnormality of her left common carotid artery originated from the pulmonary artery, and the patient underwent arterial ligation with the monitoring of cerebral oxygen consumption by near-infrared spectroscopy after careful preoperative evaluation. At present, it has been two years after the operation, and the patient is in good condition and has received regular follow-up. CONCLUSION: For patients with an abnormal left common carotid artery from the pulmonary artery, after careful preoperative evaluation such as cerebral angiography, under the monitoring of cerebral oxygen consumption by near-infrared spectroscopy, ligation of the proximal end of the artery of abnormal origin is safe and feasible.
A Diuretic Response is Associated with the Early Prognosis of Patients Undergoing Repeat Tricuspid Valve Surgery Due to Severe Tricuspid Regurgitation After Left-Sided Valvular Surgery.
Liu R, Xu J, Li Y … +4 more , Li B, Liu S, Pan G, Tong M
Heart Surg Forum · 2022 Jul · PMID 36052905 · Publisher ↗
OBJECTIVE: To analyze the factors affecting the early prognosis of patients undergoing repeat tricuspid valve surgery due to severe tricuspid regurgitation after left-sided valvular surgery. METHOD: We retrospectively an...
OBJECTIVE: To analyze the factors affecting the early prognosis of patients undergoing repeat tricuspid valve surgery due to severe tricuspid regurgitation after left-sided valvular surgery. METHOD: We retrospectively analyzed 76 patients undergoing repeat tricuspid valve surgery due to severe tricuspid regurgitation after left-sided valvular surgery at Peking University International Hospital between October 2017 and February 2021. Patients were divided into two groups, according to preoperative weight control and whether the adjusted diuretic dose exceeded 40 mg of furosemide (or the equivalent dose). The factors affecting the early prognosis were analyzed through postoperative follow up. RESULTS: Thirty-five male patients (46.1%), aged 57±13 years, were enrolled in the study. For the patients who received a preoperative same dose of furosemide ≥40 mg/day and a same dose of furosemide <40 mg/day, the baseline data basically were the same. There were 76 patients (100%) who were followed up. Endpoint events during the follow up were as follows: Six patients (7.9%) died, two patients (2.6%) were admitted to the hospital or transferred to the intensive care unit due to cardiac insufficiency, and other conditions such as severe tricuspid regurgitation on repeat ultrasound, bilateral lower extremity edema, and inability to reduce or stop diuretics were found in five cases (6.6%). Compared with the group with the same dose of furosemide <40 mg/day group, the ≥40 mg/day group had a higher incidence of endpoints (12, 27.3% vs. 1, 3.1%, P = 0.006). CONCLUSION: In patients undergoing repeat tricuspid valve surgery due to severe tricuspid regurgitation after left-sided valvular surgery, a diuretic response was associated with surgical prognosis. Compared with the low-dose furosemide group, the high-dose group (≥40 mg/) had a significantly increased incidence of early events.
Comparison of Sternal Fixation Strategies After Open-Heart Surgery Via a Median Sternal Incision.
Liu J, Chen X, Ma G … +4 more , Liu X, Li X, Miao Q, Zhang C
Heart Surg Forum · 2022 Jul · PMID 36052904 · Publisher ↗
OBJECTIVES: To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery. METHODS: A total of 293 patients who underwent open-heart surgery with a medi...
OBJECTIVES: To explore the personalized treatment strategy of sternal fixation and closure of sternal median incision in open cardiac surgery. METHODS: A total of 293 patients who underwent open-heart surgery with a median sternal incision at Peking Union Medical College Hospital from January 2019 to March 2021 were divided into two groups, according to the timing and type of treatment. The first 169 patients received single-wire fixation and closure (control group), while the subsequent 124 patients received double-wire fixation and closure (study group). The patients were followed up for three months to observe the duration of pain, sternal instability, and occurrence of chest wound infection. RESULTS: The average age was 53±30 years in the control group and 55±34 years in the study group (P = 0.594). There were no significant differences in baseline data between the two groups (P > 0.05). Compared with the control group, the study group had a shorter duration of pain (P < 0.05), smaller drainage volume within three days postoperatively (650 ml vs. 770 ml, P < 0.05), lower incidence of superficial sternal wound infection (2.4% vs. 8.9%, P = 0.042), and lower incidence of sternal instability (1.6% vs. 8.3%, P = 0.026). Deep sternal wound infection occurred in two patients in the control group and none in the study group; however, this difference was not significant. No surgery-related deaths occurred. CONCLUSIONS: Selecting the appropriate sternal fixation and closure method, according to the characteristics of patients, can reduce the incidence of sternal incision complications. We proposed a personalized selection strategy for sternal fixation and closure, which requires verification in clinical studies.
Efficacy and Safety Results of Different Ablation Technologies for Persistent Atrial Fibrillation Treatment.
Baimbetov A, Bizhanov K, Yakupova I … +4 more , Jukenova A, Ualiyeva A, Tursunkhanov Z, Bigeldiyev N
Heart Surg Forum · 2022 Aug · PMID 36052903 · Publisher ↗
INTRODUCTION: Pulmonary vein isolation is the primary goal in treating patients with paroxysmal atrial fibrillation using catheter ablation. This study's purpose is a comparative assessment of the efficacy and safety of...
INTRODUCTION: Pulmonary vein isolation is the primary goal in treating patients with paroxysmal atrial fibrillation using catheter ablation. This study's purpose is a comparative assessment of the efficacy and safety of two strategies for catheter treatment in patients with persistent atrial fibrillation. PATIENTS AND METHODS: The study included 127 patients with persistent atrial fibrillation during the last six months before inclusion in the study. The average follow-up period was 24 months. RESULTS: The primary efficacy endpoint (death, cerebrovascular event, or serious complications associated with treatment) occurred in 15 patients in the cryoballoon ablation group and 14 patients in the radiofrequency ablation group. The Kaplan-Meier survival estimates were 30% and 28%, and the risk ratio 0.96 and 95% of the confidence interval. CONCLUSIONS: The treatment in patients with persistent atria fibrillation, using catheter ablation with contact force control catheter treatment with the pulmonary vein isolation, was more efficient.
Off-Pump Coronary Artery Bypass Grafting with Malignant Tumor Resection Involving Different Organs: The Comparison of Long-Term Prognosis and Risk Factor Analysis Related to Survival.
Zhang Y, Li F, Yang Y … +2 more , Xiao F, Wang J
Heart Surg Forum · 2022 Aug · PMID 36052902 · Publisher ↗
BACKGROUND: This study aimed to analyze the influence of the primary site of tumor location on off-pump coronary artery bypass grafting (OPCABG) surgery combined with concurrent tumor resection and to identify factors af...
BACKGROUND: This study aimed to analyze the influence of the primary site of tumor location on off-pump coronary artery bypass grafting (OPCABG) surgery combined with concurrent tumor resection and to identify factors affecting long-term survival. METHODS: Fifty-seven patients with coronary artery disease (CAD) and malignancy who underwent simultaneous surgery retrospectively were enrolled. The primary site of tumor locations and cancer stage were used as a basis for grouping. The long-term survival among the subgroups was compared, and the risk factors related to survival were analyzed. RESULTS: The median follow-up period was 40 months. The 5-year cumulative survival rate of patients undergoing OPCABG and tumor resection was 74%. There was no significant difference in long-term survival among the four oncological location subgroups (P = 0.8), while significant difference was found among the two cancer stage subgroups (P = 0.0076). On univariable and multivariable Cox regression analysis, only cancer stage was an independent predictor of the long-term mortality rate (hazard ratio 5.42, P = 0.007). CONCLUSION: For patients with potentially curable cancer and surgically correctable CAD, the safety of simultaneous surgery is confident. The primary site of tumor location does not significantly affect the long-term survival of these patients. The long-term survival rate strongly correlates with tumor stage.
A Rare Cause of Right Heart Failure in An Adult: Congenital Gerbode Defect.
Al-Sarraf N, Hasan M, Ahmad NB … +1 more , Alhumaidan A
Heart Surg Forum · 2022 Jul · PMID 36052901 · Publisher ↗
Gerbode defect is a rare defect describing a left ventricle to right atrium shunt with symptoms dependent on the size and degree of the shunt. It is either a congenital defect detected in infancy, or an acquired case rep...
Gerbode defect is a rare defect describing a left ventricle to right atrium shunt with symptoms dependent on the size and degree of the shunt. It is either a congenital defect detected in infancy, or an acquired case reported in older age. Diagnosis by means of echocardiography and cardiac magnetic resonance imaging is of paramount importance before surgical correction is contemplated to achieve a good prognosis.
Frequency and Risk Factors of Unplanned 30-Day Readmission After Open Heart Surgeries: A Retrospective Study in a Tertiary Care Center.
Almramhi K, Aljehani M, Bamuflih M … +5 more , Alghamdi S, Banser S, Almousa A, Alabdulwahab S, Al-Ebrahim K
Heart Surg Forum · 2022 Aug · PMID 36052900 · Publisher ↗
BACKGROUND: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned r...
BACKGROUND: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned readmission rate, determinants, and most common events within 30 days post-cardiac surgery. Recommendations to prevent or minimize these complications are included. METHODS: Setting and design - a retrospective record review was conducted among all adult patients, who underwent open heart surgery between 2010 and 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Using Google Forms, we manually collected data from hospital records. STATISTICAL ANALYSIS USED: binomial logistic regression model (using the backward stepwise method). Regression outcomes were expressed as odds ratios (ORs) and 95% CIs. A P-value of < 0.05 indicated statistical significance. RESULTS: Among 400 patients who underwent cardiac surgery, 343 patients were included in the study, including 53 unplanned readmissions, which was a rate of 16.3% (95% CI, 12.8 to 20.6%). The most frequently reported reasons for readmission were sternal wound infections (7.3%), pleural effusion (2.0%), and heart failure (1.7%). Female gender, high postoperative LDH and urea were the most important risk factors. CONCLUSION: Discharge planning, patient education, and cardiac surgery nurse home visit constitute the most important factors to minimize 30 days of unplanned readmission.
Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Adults and Pediatrics; Prevention is the Optimal Management.
Alghamdi AA, Aqeeli MO, Alshammari FK … +3 more , Altalhi SM, Bajebair AM, Al-Ebrahim Frcsc KE
Heart Surg Forum · 2022 Jul · PMID 36052899 · Publisher ↗
BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant and severe complication that affects morbidity and mortality. We studied both pediatric and adult patients using the Acute Kidney Inju...
BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant and severe complication that affects morbidity and mortality. We studied both pediatric and adult patients using the Acute Kidney Injury Network (AKIN) definition. METHODS: This was an observational retrospective cohort study done at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, and approved by the ethical committee. The exclusion criteria were baseline serum creatinine (SCr) ≥ 4 mg/dL or preexisting renal failure requiring dialysis, reoperation, death within 24 hours postoperatively, and operative mortality or missing data. We included 941 patients in the analysis using statistical software SPSS, version 15.0. RESULTS: Of the total number of patients, 28.68% in the adult group and 20.07% in the pediatric group developed CSA-AKI. Adult risk factors included the age group 60-69 years, cardiopulmonary bypass (CPB), number of grafts, and hypertension. In the pediatric group, CPB, aortic cross-clamping (ACX), and the lower preoperative SCr were the main risk factors Conclusion: Conventional conservative management and preoperative identification of predictor risk factors are essential for preventing CSA-AKI, constituting the primary strategy for optimal management.
Intraoperative Fenestration of Frozen Elephant Trunk (FET) and Total Arch Replacement for Aortic Dissection in Aberrant Subclavian Artery.
Zhang J, Kang Z, Fei Z … +3 more , Fan Y, Guo Y, Shi J
Heart Surg Forum · 2022 Jul · PMID 36052898 · Publisher ↗
BACKGROUND: Total arch replacement (TAR) and the frozen elephant trunk (FET) routinely are performed to treat aortic dissection. When aortic dissection combines with the aberrant right subclavian artery (aRSA), routine T...
BACKGROUND: Total arch replacement (TAR) and the frozen elephant trunk (FET) routinely are performed to treat aortic dissection. When aortic dissection combines with the aberrant right subclavian artery (aRSA), routine TAR+FET will occlude the ostium of aRSA. But there is no consensus regarding the optimal surgical strategy to revascularize the aRSA. We seek an uncomplicated and less time-intensive way to reconstruct the aRSA. METHODS: From July 2020 to April 2022, six patients with aortic dissection and aRSA underwent TAR+FET and intraoperative fenestration on the descending trunk. The mean age of the patients was 51.7 (SD 16.2; range 30.0-72.0). TAR+FET was performed via a median sternotomy and under cardiopulmonary bypass (CPB) and moderate hypothermic circulatory arrest (HCA). A fenestra of descending trunk was made intraoperative. RESULTS: There was no operative death in hospital and follow up. The average aortic cross-clamp time, SACP time, and lower body circulatory arrest time was 138.8 (SD 22.5; range 103.0-156.0) min and 28.3 (SD 3.9; range 25.0-35.0) min. Bleeding, neurological deficit, visceral ischemia, injury to the spinal cord, or organ dysfunction was not observed. Follow-up CTA showed the blood flow of aRSA was patent in all patients. CONCLUSION: TAR+FET and intraoperative fenestration on the descending trunk is an efficacious approach. It also reduces the difficulty of reconstruction the aRSA in aortic dissection patients.
Efficacy of Intraoperative Low Dose Intravenous Amiodarone in Pharmacologic Cardioversion in Patients with Preoperative Atrial Fibrillation Presenting for Mitral Valve Replacement Surgery Randomized Control Trial.
Kamal F, Abd Al Jawad MN, Gamal M
Heart Surg Forum · 2022 Jul · PMID 36052897 · Publisher ↗
BACKGROUND: Atrial fibrillation (AF) is the most common form of dysrhythmia observed in the clinical field, causing multiple morbidities, such as thromboembolic complications. Hence, the maintenance of sinus rhythm is su...
BACKGROUND: Atrial fibrillation (AF) is the most common form of dysrhythmia observed in the clinical field, causing multiple morbidities, such as thromboembolic complications. Hence, the maintenance of sinus rhythm is superior to rate control. This study tests the efficacy of single- and low-dose amiodarone on the persistence of AF after surgery before transfer to the intensive care unit. METHODS: A double-blinded, randomized controlled trial assessed 113 patients who underwent mitral valve surgery with preoperative chronic AF. Patients were divided into two groups: the control group (N = 55) who received 50 mL of 5% dextrose over 10 min after general anesthesia induction, and the amiodarone group (N = 58) who received 1 mg/kg of amiodarone diluted in 50 mL of 5% dextrose over 10 min shortly after anesthesia induction. RESULTS: The amiodarone group had a statistically significant successful conversion of preoperative AF to normal sinus rhythm in 40 patients (72.73%). The control group demonstrated spontaneous conversion from AF to a normal sinus rhythm in seven patients (12.73%). The sinus rhythm was maintained in 60% of patients (36), as four patients reverted to AF during the hospital stay despite the initial normal sinus rhythm after the operation. In contrast, 53 (96.36%) patients in the control group were discharged from the hospital with a controlled rate of AF. In addition, low-dose amiodarone caused a statistically significant reduction in heart rates at 10, 30, and 60 min after declamping, extended throughout the first 24 h with mean heart rates of 97.233±7.311, 99.509±8.482, and 97.940±7.715 bpm, respectively. In comparison, the control group had heart rates of 115.382±7.547, 115.055±13.919, and 113.618±8.765 bpm at these times. The mean postoperative heart rate at the end of the first 24 h was 97.793±7.189 bpm in the amiodarone group and 113.036±9.737 bpm in the control group. No mortality or need for mechanical support was recorded in either group. CONCLUSIONS: Single and low-dose intraoperative intravenous amiodarone during mitral valve surgery may be practical to aid in pharmacological cardioversion of patients with preoperative chronic AF presenting for mitral valve surgery.
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