The Heart Surgery Forum[JOURNAL]
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200 papers
Can Inflammation Indices Preoperatively Predict Acute Kidney Injury after Cardiac Surgery?
Yildirim S
Heart Surg Forum · 2023 Dec · PMID 38178350 · Publisher ↗
BACKGROUND: Coronary artery disease is a condition characterized by atherosclerosis and inflammation in the vessel wall. In patient undergoing surgery, a systemic inflammatory-like condition occurs in the postoperative p...
BACKGROUND: Coronary artery disease is a condition characterized by atherosclerosis and inflammation in the vessel wall. In patient undergoing surgery, a systemic inflammatory-like condition occurs in the postoperative period through mediators that develop due to acute stress. METHODS: 581 patients enrolled from the hospital records from 2019 and 2022 retrospectively. Systemic immune inflammation index (SII), systemic inflammation response index (SIRI) and aggregated index of systemic inflammation (AISI) values were calculated from peripheral blood samples taken at hospital admission using the formula SII = platelet (P) × neutrophil (N) / lymphocyte (L), SIRI = N × monocyte (M) / L, AISI = (N × M × P) / L. RESULTS: The mean age of the 581 patients included in the study was 63.97 ± 8.77 years. 45% of the patients were women. Mean cardio-pulmonary bypass time (CPBT) was 100.31 ± 31.94 and mean cross-clamp time (CCT) was 59.79 ± 24.07. When the correlation of acute kidney injury (AKI) development was analyzed with the variables (P/L ratio, N/L ratio, SII, SIRI, AISI, CCT and CPBT), all variables we tested and age were found to be significantly correlated (p < 0.01). CONCLUSION: We think that the calculations we tested in our study, together with the understanding of the complexity of the inflammatory system, will constitute an important step in the detection of AKI.
Identification of Anesthetic-Induced Cardiovascular Biomarkers in Off-Pump Coronary Artery Bypass Grafting Surgery Using Weighted Gene Co-Expression Network Analysis and Machine Learning.
Hou J, Li J
Heart Surg Forum · 2023 Dec · PMID 38178349 · Publisher ↗
BACKGROUND: This study aimed to select anesthesia-induced zinc finger protein-related gene biomarkers that predict cardiovascular function during off-pump coronary artery bypass grafting (OPCABG). METHODS: Gene expressio...
BACKGROUND: This study aimed to select anesthesia-induced zinc finger protein-related gene biomarkers that predict cardiovascular function during off-pump coronary artery bypass grafting (OPCABG). METHODS: Gene expression data from GSE4386 included 20 post-anesthesia and 20 pre-anesthesia atrial tissue samples. Zinc finger protein-related genes (ZFPRGs) were searched in the UniProt database and anesthesia-induced differentially expressed genes (DEGs) were identified Weighted gene co-expression network analysis (WGCNA) was used to screen hub genes, and three machine learning algorithms were used to further screen for cardiovascular biomarkers. Diagnostic accuracy was evaluated using a nomogram model. Gene set enrichment analysis was used to analyze the pathways enriched by the biomarkers. A microRNA (miRNA)-mRNA-transcription factor (TF) regulatory network was established to explore the potential regulatory mechanisms of these biomarkers. Disease-related drugs were predicted using the Comparative Toxicogenomics Database (CTD). RESULTS: A total of 1102 cardioprotection-related DEGs were selected between the pre- and post-anesthesia groups. Additionally, 1095 hub genes were obtained based on WGCNA, and 2274 ZFPRGs were downloaded from the UniProt database. After Venn analysis and machine learning, ZNF420, RNF135, and BNC2 were selected as cardioprotection-related zinc finger biomarkers during OPCABG. Receiver operating characteristic (ROC) curves and nomogram models confirmed the diagnostic value and accuracy of the three cardioprotective biomarkers. Pathway enrichment analysis revealed that ZNF420 is involved in the cell cycle and the tricarboxylic acid cycle. RNF135 and BNC2 were enriched in the oxidative phosphorylation pathway. In the constructed miRNA-mRNA-TF network, miR-182-5p and miR-16-5p simultaneously regulated three cardioprotective biomarkers. CONCLUSION: Three cardioprotection-related zinc finger protein biomarkers (ZNF420, RNF135, and BNC2) were identified using OPCABG samples.
Costs and Readmissions Associated with Type A Aortic Dissections at High- and Low-Volume Centers.
Zhou AL, Yesantharao LV, Etchill EW … +6 more , Barbur I, Shou BL, Aziz H, Choi CW, Lawton JS, Kilic A
Heart Surg Forum · 2023 Dec · PMID 38178348 · Publisher ↗
BACKGROUND: Costs and readmissions associated with type A aortic dissection repairs are not well understood. We investigated statewide readmissions, costs, and outcomes associated with the surgical management of type A a...
BACKGROUND: Costs and readmissions associated with type A aortic dissection repairs are not well understood. We investigated statewide readmissions, costs, and outcomes associated with the surgical management of type A aortic dissection repairs at low- and high-volume centers. METHODS: We identified all adult type A aortic dissection patients who underwent operative repair in the Maryland Health Services Cost Review Commission's database (2012-2020). Hospitals were stratified into high- (top quartile of total repairs) or low-volume centers. RESULTS: Of the 249 patients included, 193 (77.5%) were treated at a high-volume center. Patients treated at high- and low-volume centers had no differences in age, sex, race, primary payer, or severity (all p > 0.5). High- compared to low-volume centers had a greater proportion of patients transferred in (71.5% vs. 17.9%, p < 0.001). High-volume centers also had longer lengths of stay (12 vs. 8 days, p < 0.001), similar inpatient mortality (13.0% vs. 16.1%, p = 0.6), and similar proportion of patients readmitted (54.9% vs. 51.8%, p = 0.7). High-volume centers had greater index admission costs ($114,859 vs. $72,090, p < 0.001) and similar readmission costs ($48,367 vs. $42,204, p = 0.5). At high-volume centers, transferred patients compared to direct admissions had greater severity of illness (p = 0.05), similar mortality (p = 0.53), and greater lengths of stay (p = 0.05). CONCLUSIONS: High-volume centers had a greater number of patients transferred from other institutions compared to low-volume centers. High-volume centers were associated with increased index admission resource utilization, with transfer patients having higher illness severity and greater resource utilization, yet similar mortality, compared to direct admission patients.
Effects of Home-based Remote Cardiac Rehabilitation on Left Ventricular Function and Fear of Exercise in Patients after Percutaneous Coronary Intervention (PCI): A Retrospective Cohort Study.
Xizhen Gao, Lan Zhang, Chen Z
Heart Surg Forum · 2023 Dec · PMID 38178347 · Publisher ↗
AIM: This study aims to explore the effects of home-based remote cardiac rehabilitation on left ventricular function and exercise fear in patients after percutaneous coronary intervention (PCI). METHODS: A total of 232 p...
AIM: This study aims to explore the effects of home-based remote cardiac rehabilitation on left ventricular function and exercise fear in patients after percutaneous coronary intervention (PCI). METHODS: A total of 232 patients with coronary heart disease after PCI treated in Tianshan Traditional Chinese Medicine Hospital from January 2020 to December 2022 were retrospectively analyzed. The patients were divided into the remote rehabilitation group (169 cases) and the routine group (63 cases) according to the exposure factor (home-based remote cardiac rehabilitation). Changes in left ventricular function and sports phobia Tampa Scale in patients with coronary heart disease after PCI were compared using propensity score matching to reduce selection bias and confounding factors. RESULTS: After the intervention, the scores of patients in the tele-rehabilitation group were significantly higher than those in the conventional group in terms of fear of movement, perception of danger, fear of movement, avoidance of movement, and dysfunction (p-value < 0.05). Left heart function was compared between the tele-rehabilitation group and the conventional group. Patients in the tele-rehabilitation group had significantly higher peak mitral valve blood flow in the early diastolic period (E), peak mitral valve blood flow in the late diastolic period (A), six-minute walk test (6MWT), and ratio of the peak mitral valve blood flow in the early diastolic period to the peak mitral valve blood flow in the late diastolic period (E/A) than those in the conventional group (p-value < 0.05). However, the peak deceleration time and isovolumic diastolic time in the early mitral valve diastolic period were significantly higher in the tele-rehabilitation group than in the conventional group (p-value < 0.05). CONCLUSIONS: Home-based remote cardiac rehabilitation instruction can improve the heart function and exercise fear state of patients after PCI.
A Novel Risk Score to Predict Thirty-Day Readmissions after Acute Type A Aortic Dissections.
Ahmad D, Aranda-Michel E, Serna-Gallegos D … +7 more , Arnaoutakis GJ, A Brown J, Yousef S, Rao R, Wang Y, Phillippi J, Sultan I
Heart Surg Forum · 2023 Dec · PMID 38178346 · Full text
BACKGROUND: Readmissions following acute type A aortic dissections (ATAAD) are associated with potentially worse clinical outcomes and increased hospital costs. Predicting which patients are at risk for readmission may g...
BACKGROUND: Readmissions following acute type A aortic dissections (ATAAD) are associated with potentially worse clinical outcomes and increased hospital costs. Predicting which patients are at risk for readmission may guide patient management prior to discharge. METHODS: The National Readmissions Database was utilized to identify patients treated for ATAAD between 2010 and 2018. Univariate mixed effects logistic regression was used to assess each variable. Variables were assigned risk points based off the bootstrapped (bias-corrected) odds ratio of the final variable model according to the Johnson's scoring system. A mixed effect logistic regression was run on the risk score (sum of risk points) and 30-day readmission. Calibration plots and predicted readmission curves were generated for model assessment. RESULTS: A total of 30,727 type A aortic dissections were identified. The majority of ATAAD (66%) were in men with a median age of 61 years and 30-day readmission rate of 19.4%. The risk scores ranging from -1 to 14 mapped to readmission probabilities between 3.5% and 29% for ATAAD. The predictive model showed good calibration and receiver operator characteristics with an area under the curve (AUC) of 0.81. Being a resident of the hospital state (OR: 2.01 [1.64, 2.47], p < 0.001) was the highest contributor to readmissions followed by chronic kidney disease (1.35 [1.16, 1.56], p = 0), discharge to a short-term facility (1.31 [1.09, 1.57], p = 0.003), and developing a myocardial infarction (1.20 [1.00, 1.45], p = 0.048). CONCLUSIONS: The readmission model had good predictive capability given by the large AUC. Being a resident in the State of the index admission was the most significant contributor to readmission.
Hospital Care for Adult Patients with Congenital Heart Diseases.
Johnson AJ, McGrath LB, Khan AM … +5 more , Broberg CS, Otaki Y, Shen I, Muralidaran A, Bhamidipati CM
Heart Surg Forum · 2023 Dec · PMID 38178345 · Publisher ↗
OBJECTIVE: The ideal type of hospital to care for adult congenital heart disease (ACHD) patients is not well known. Hospital competitiveness, clinical volume and market structure can influence clinical outcomes. We sough...
OBJECTIVE: The ideal type of hospital to care for adult congenital heart disease (ACHD) patients is not well known. Hospital competitiveness, clinical volume and market structure can influence clinical outcomes. We sought to understand how hospital competitiveness affects clinical outcomes in ACHD patients in the era prior to the Adult Congenital Heart Association accreditation program. METHODS: Patient discharges with ACHD diagnosis codes were filtered between 2006-2011 from an all-payer inpatient healthcare database. Hospital-level data was linked to market structure patient flow. A common measure of market concentration used to determine market competitiveness-the Herfindahl-Hirschman Index (HHI)-was stratified into: more competitive (HHI ≤25th percentile), moderately competitive (HHI 25th to <75th percentile), and less competitive (HHI ≥75th percentile) hospital. Any complication, home discharge and mortality were analyzed with clustered mixed effects logistic regression. The combined impact of HHI and any complication on mortality by interaction was assessed. RESULTS: A total of 67,434 patient discharges were isolated. More competitive hospitals discharged the least number of patients (N = 15,270, 22.6%) versus moderately competitive (N = 36,244, 53.7%) and less competitive (N = 15,920, 23.6%) hospitals. The adjusted odds of any complication or home discharge were not associated with hospital competitiveness strata. Compared to more competitive hospitals, mortality at moderately competitive hospitals (Adjusted Odds Ratio (AOR) 0.79, 95% CI: 0.66-0.94) and less competitive hospitals (AOR 0.79, 95% CI: 0.63-0.98) were lower (p = 0.025). Age, race, elective admission, transfer status, and payer mix were all significantly associated with adjusted odds of any complication, home discharge and mortality (p ≤ 0.05). Having any complication independently increased the adjusted odds of mortality more than 6-fold (p < 0.001), and this trend was independent of HHI strata. Failure to rescue an ACHD patient from mortality after having any complication is highest at less competitive hospitals. Sensitivity analysis which excluded the transfer status variable, showed that any complication (p = 0.047) and mortality (p = 0.01) were independently associated with HHI strata. CONCLUSIONS: Whether lower competition allow hospitals to focus more on quality of care is unknown. Hospital competitiveness and outcome seem to have an inverse trend relationship among ACHD patients. Since medical care is frequently provided away from the home area, hospital selection is an important issue for ACHD patients. Further research is needed to determine why competitiveness is linked to surgical outcomes in this population.
Clinical Efficacy of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Coronary Heart Disease Patients with SYNTAX Score ≥33 and Euro Score ≥6: A Single-Center Retrospective Analysis.
Wu Z, Chen X, Zhou Y … +2 more , Gong N, Chang Z
Heart Surg Forum · 2023 Dec · PMID 38178344 · Publisher ↗
OBJECTIVE: To observe clinical efficacy of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary heart disease patients with SYNTAX scores (SS) ≥33 and Euro Scores (ES) ≥6 who are unsu...
OBJECTIVE: To observe clinical efficacy of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary heart disease patients with SYNTAX scores (SS) ≥33 and Euro Scores (ES) ≥6 who are unsuitable for or have declined coronary artery bypass graft (CABG). METHODS: A total of 117 patients with SS ≥33 and Euro Score (ES) ≥6 who were unsuitable for and/or who had declined CABG between Jan 2021 and June 2022 were enrolled in this retrospective analysis. All patients accepted optimal medical therapy and some accepted an FFR-guided PCI procedure. Patients who only underwent optimal medical therapy were divided into the optimal medical therapy group (OMT group) and patients who simultaneously underwent FFR-guided PCI procedure were divided into the PCI group in this retrospective analysis. All patients accepted follow-up for at least 12 months after discharge. RESULTS: SS and ES in the two groups were not statistically different (p > 0.05). Patients with chronic total occlusion accounted for a greater proportion in the PCI subgroup (31.3%, 5/16) than in other subgroups. Eighteen (18.6%, 18/97) cases in the PCI group developed major adverse cardiac and cerebrovascular events (MACCEs). There were 12 (60%, 12/20) cases of MACCEs in the OMT group, which was statistically different from the PCI group (p < 0.05). CONCLUSIONS: Based on optimal medical therapy, FFR-guided PCI can still have clinical benefit to coronary artery disease patients with SS ≥33 who were not suitable for CABG.
Factors Influencing the Incidence of Pneumonia after Coronary Artery Bypass Grafting.
Zhang Y, Zhang P, Li H … +4 more , Chi H, Zheng N, Pan X, Tang C
Heart Surg Forum · 2023 Dec · PMID 38178343 · Publisher ↗
OBJECTIVE: This study aimed to explore and analyze the factors affecting the incidence of pneumonia after coronary artery bypass grafting (CABG) to provide reference for the prevention of such situation. METHODS: A total...
OBJECTIVE: This study aimed to explore and analyze the factors affecting the incidence of pneumonia after coronary artery bypass grafting (CABG) to provide reference for the prevention of such situation. METHODS: A total of 500 patients who underwent CABG in a hospital were selected. From March 2019 to March 2022, 410 patients without pneumonia and 90 patients with pneumonia were divided into groups A and B. The influencing factors and pathogen composition of postoperative pneumonia were discussed and analyzed. RESULTS: Univariable analysis results showed that age, cardiac function grade, occurrence of smoking, operation time, tracheal intubation time, suspended red-blood-cell transfusion and hospital stay in group B were higher than those in group A. Multivariable logistic analysis results showed that operation time, smoking history, and tracheal intubation time were risk factors for pneumonia after CABG. Among the 90 patients with postoperative pneumonia, 90 had pathogens, 81 had Gram-negative bacteria, 4 had Gram-positive bacteria, and 5 had fungi. CONCLUSIONS: Patients after CABG were more likely to develop pneumonia. Operation time, smoking history, and tracheal intubation time were the risk factors of pneumonia after CABG. Most of these patients had Gram-negative bacteria. Patient intervention based on the influencing factors can effectively prevent the occurrence of postoperative pneumonia.
Cardiac Manifestation of Rosai-Dorfman Disease: A Case Report and a Systematic Review.
Samadzadeh Tabrizi N, Dogar MH, Wilkinson D … +3 more , Stout P, Neragi-Miandoab S, Samy S
Heart Surg Forum · 2023 Dec · PMID 38178342 · Publisher ↗
BACKGROUND: Rosai-Dorfman disease is a rare condition that typically presents as a nodal disease. Cardiac involvement is extremely uncommon, occurring in 0.1-0.2% of cases, which has hindered our understanding. We report...
BACKGROUND: Rosai-Dorfman disease is a rare condition that typically presents as a nodal disease. Cardiac involvement is extremely uncommon, occurring in 0.1-0.2% of cases, which has hindered our understanding. We report a case of Rosai-Dorfman disease (RDD) related cardiac manifestation in a patient without nodal involvement. Further, we conduct a comprehensive review of the literature to consolidate data on how patients with cardiac manifestations of RDD are typically managed and treated. METHODS: A systematic review of PubMed, Web of Science, and Embase was conducted to identify cases of RDD with cardiac involvement. Out of 464 studies identified, 42 publications encompassing 43 patients met the criteria and were incorporated in this review. We gathered data on patient demographics, as well as their management and treatment approaches. Additionally, we share our own experience with a patient who presented with a cardiac mass related to RDD. RESULTS: Out of the 43 patients, only 20.9% (n = 9) had a documented history of RDD prior to cardiac manifestations. Nodal involvement was reported in 32.6% (n = 14), while extranodal extracardiac involvement was reported in 46.5% (n = 20). Upon presentation, the most prevalent symptoms were dyspnea (48.8%, n = 21), chest discomfort (41.9%, n = 18), and lower extremity edema (16.3%, n = 7). Cardiac manifestations were most frequently found in the right atrium (41.9%, n = 18) and pericardium (18.6%, n = 8). Treatment encompassed systemic medical therapy (34.9%, n = 15) and cardiac surgery (39.5%, n = 17). The median follow-up period was 12 months (with a range of 1 to 36), and 8 patients (18.6%) experienced mortality. Our patient, who had a cardiac mass in the left atrium, underwent resection and has remained symptom-free without any recurrence for the past 5 years. CONCLUSION: The frequency of cardiac related-RDD manifestations may be greater than initially perceived. These results underscore the significance of identifying RDD and its cardiac-related presentations, facilitating timely diagnosis and treatment for affected individuals.
Long-Term Survival Benefits of Porcine versus Pericardial Bioprostheses in Elderly Patients Undergoing Isolated Aortic Valve Replacement: A 32-Year Study.
Ebra G, Traad EA, Kurlansky PA
Heart Surg Forum · 2023 Dec · PMID 38178341 · Publisher ↗
BACKGROUND: The elderly population is growing at an unprecedented rate. Aortic valve disease increases with age. Bioprostheses are the valves of choice for older patients; however, the optimal tissue valve remains undete...
BACKGROUND: The elderly population is growing at an unprecedented rate. Aortic valve disease increases with age. Bioprostheses are the valves of choice for older patients; however, the optimal tissue valve remains undetermined. The purpose of this investigation was to perform a life-of-patient survival comparison of the prototypical porcine and pericardial prostheses in elderly patients. METHODS: The study population (N = 1480) consisted of patients 65 years of age and older who underwent isolated aortic valve replacement from 1990 through 2005 with a Carpentier-Edwards Porcine (n = 650) or Pericardial (n = 830) bioprosthesis. Propensity score-matched groups were created. RESULTS: Valve selection was not associated with operative mortality. Survival estimates at 10 years were better for Pericardial (41.8%; 95% CI: 37.9 to 45.7) than Porcine (32.6%; 95% CI: 28.8 to 36.3); and 5.2% (95% CI: 3.2 to 7.1) versus 2.0%; (95% CI: 0.8 to 3.2) at 20 years (p < 0.001). E-value analysis found minimal influence of unknown study confounders. Factors associated with long-term mortality were porcine valve (p < 0.001), age (p < 0.001), diabetes mellitus (p < 0.001), preop renal insufficiency (p < 0.001), peripheral artery disease (p = 0.011), congestive heart failure (p = 0.003), New York Heart Association Class III or IV (p = 0.004), surgical history-reoperation (p = 0.012), transient ischemic attack (p = 0.009), prolonged ventilation (p = 0.010), postop renal insufficiency (p < 0.001), and atrial fibrillation (p = 0.009). The indexed Effective Orifice Area (EOAi) was assessed and did not influence observed long-term survival differences. CONCLUSIONS: This unusual lifetime study provided substantial evidence for the superiority of the pericardial over the porcine bioprosthesis in the aortic position in elderly patients. It demonstrated enhanced long-term survival benefits for elderly patients without any increase in perioperative mortality. It is intended to inform future investigation into aortic valve design.
On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization.
Kilic Y, Jalalzai I, Sonmez E … +1 more , Erkut B
Heart Surg Forum · 2023 Dec · PMID 38178340 · Publisher ↗
BACKGROUND: When acute coronary syndrome patients necessitate immediate revascularization, heart-on-pump coronary artery bypass grafting may be regarded as a viable substitute for conventional on-pump surgery. Our clinic...
BACKGROUND: When acute coronary syndrome patients necessitate immediate revascularization, heart-on-pump coronary artery bypass grafting may be regarded as a viable substitute for conventional on-pump surgery. Our clinical experience and initial outcomes of heart-on-pump coronary surgery in patients with acute coronary syndrome are detailed in this article. METHOD: This research endeavor was a retrospective analysis that spanned the years March 2011 to August 2023. The sample size comprised 2816 patients who had undergone coronary artery surgery. During this period, the same surgical team performed coronary artery bypass surgery on 411 of these patients, who underwent beating heart surgery while on cardiopulmonary bypass support and without cardioplegic arrest; this was done under emergency conditions. RESULT: 9.3 ± 2.2 hours elapsed between the initiation of acute myocardial infarction and the commencement of coronary artery bypass grafting (CABG). A mean of 4.0 grafts was applied (2.2 ± 1.1). Mortality in hospitals was calculated for sixteen patients. Following surgery, twenty-six patients developed an inadequate cardiac output syndrome. Despite having renal dysfunction, none of the eight individuals needed hemodialysis. The mean duration of stay in intensive care was 3.2 (2.2 ± 1.1) days, while the mean length of hospitalization was 9.2 (4.3 ± 2.4) days. CONCLUSION: We believe that for high-risk patients with multivascular coronary artery disease who require an emergency coronary artery bypass graft, on-pump beating heart revascularization could be a viable option.
Female Gender in Cardiac Surgery: Is it Still a Significant Risk? A Retrospective Study in Saudi Arabia.
Al-Ebrahim KE, Baghaffar AH, Fatani MA … +10 more , Alassiri LA, Albishri SA, Althaqafi AM, Alghamdi RA, Alshoaibi NF, Algarni SS, Alsulami MM, Albukhari SA, Alassiri AK, Elassal AA
Heart Surg Forum · 2023 Dec · PMID 38178339 · Publisher ↗
BACKGROUND: Female sex is considered an independent predictor for mortality and morbidity following cardiac surgery. This study is to review the outcomes of adult cardiac surgery between males and females in a Saudi tert...
BACKGROUND: Female sex is considered an independent predictor for mortality and morbidity following cardiac surgery. This study is to review the outcomes of adult cardiac surgery between males and females in a Saudi tertiary referral hospital. METHOD: This was a retrospective study for 925 adult patients operated on for ischemic coronary artery disease and acquired aortic and mitral valvular heart disease from 2015 to August 2023. We analyzed patient characteristics, intraoperative data, and postoperative results to compare outcomes between males and females. RESULTS: Preoperative risk factors were not significantly different in both groups. Postoperative outcomes showed gender-based differences. In univariable analysis, females, compared to males, had significantly greater odds of prolonged postoperative ventilation (>24 hours), 32.8% of females compared to 20.7% of males (p < 0.001). Also, sternal wound infection was notably higher among females (13.3%) (p < 0.001). Mortality also exhibited a significant association, with 14.2% of females experiencing mortality compared to 9.4% of males (p = 0.049). In the multivariable analysis for elevated postoperative troponin, the use of pre-operative intra-aortic balloon pump, urgent/emergent surgery, elevated pre-operative troponin and combined bypass grafting with valve surgery, were also predictive of higher post-operative troponin concentrations (beta = 0.43, 95% CI: 0.25 to 0.62, p < 0.001). CONCLUSION: Females in Saudi Arabia have an increased risk of short-term morbidity and mortality after cardiac surgery compared to males. Vague and delayed presentation and then the late diagnosis and referral are likely the main contributing factors. This highlights the need to implement preoperative measures to improve early diagnosis and referral to eliminate gender bias.
You Will Be Held For Questioning: The Secrets of Multiple-Choice Test Makers & Test Takers.
Wisniewski A, Tribble C
Heart Surg Forum · 2023 Dec · PMID 38178338 · Publisher ↗
Abstract loading — click title to view on PubMed.
Preoperative Sarcopenia Assessment Using Pectoralis Muscle Mass Indicated Poor Mid-term Cardiac Surgery Prognosis.
Machii Y, Kitashima F, Hayashi Y … +4 more , Harada A, Kamata K, Eguchi N, Tanaka M
Heart Surg Forum · 2023 Dec · PMID 38178337 · Publisher ↗
BACKGROUND: Many studies have defined sarcopenia based on psoas muscle mass using abdominal computed tomography (CT). We hypothesized that sarcopenia can be assessed by measuring pectoralis muscle mass on chest CT and ai...
BACKGROUND: Many studies have defined sarcopenia based on psoas muscle mass using abdominal computed tomography (CT). We hypothesized that sarcopenia can be assessed by measuring pectoralis muscle mass on chest CT and aimed to examine its relationship with the postoperative prognosis of cardiac surgery. METHODS: This retrospective study included 189 patients who underwent cardiac surgery via median sternotomy between July 2020 and June 2022. We excluded patients <70 years old, urgent/emergent cases, no chest CT within 90 days before surgery, and cases in which evaluation of the pectoralis muscle was impossible with CT. The pectoralis muscle area (PMA) was measured using a preoperative chest CT. The sarcopenia cut-off value was defined as the lowest sex-specific tertile in PMA at the level of the 4th thoracic vertebrae. RESULTS: Eighty patients were included. The lower tertile were classified as the sarcopenia group (SG) (n = 26) and the rest as the non-sarcopenia group (NSG) (n = 54). In the SG, 1-year survival was significantly worse than that in NSG (NSG: 92.7% vs. SG: 54.9%, p < 0.0001). In the multivariate model, sarcopenia was an independent risk factor for mid-term all-cause death (hazard ratio, 4.89; 95% confidence interval: 1.14-21.0, p = 0.033). CONCLUSION: Preoperative sarcopenia defined using PMA was associated with poor mid-term survival after elective cardiac surgery via median sternotomy. The pectoralis muscle mass observed through a chest CT could be used for preoperative risk scoring in older patients undergoing cardiac surgery.
Elevated AST/ALT (De Ritis) Ratio is a Risk Factor of Drainage Volume after Aortic Arch Surgery.
Yan W, Zhang Q, Wang T … +3 more , Sun J, Qian X, Ji B
Heart Surg Forum · 2023 Dec · PMID 38178336 · Publisher ↗
BACKGROUND: To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery. METHODS...
BACKGROUND: To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery. METHODS: This retrospective cohort study was conducted from January 2017 to December 2018. The exposure factor was the preoperative AST/ALT ratio and the primary outcome was the total amount of the drainage volume. The optimal AST/ALT ratio cutoff value was determined by the maximum Youden index. Accordingly, we defined the ratio ≥0.92 as a high AST/ALT ratio and <0.92 as a low AST/ALT ratio. Based on the median drainage volume of all participants, we dichotomized the study population: patients with a total drainage volume of 1670 mL or more were classified into high-output group (HOPG) and the remaining patients were classified into the low-output group (LOPG). Univariable and multivariable logistic regression analyses were conducted to investigate the correlation between the elevated AST/ALT ratio and drainage volume. RESULTS: 425 participants were enrolled. 213 participants were divided into the LOPG and the others were in the HOPG. 244 participants were divided into the low AST/ALT ratio group. In the univariable logistic regression analysis, the odds ratio (OR) and 95% condifence interval (CI) for the large drainage volume in participants with elevated AST/ALT ratio were 1.810 and 1.226-2.670 (p = 0.003). After adjustments with the confounders, multivariable logistic regression analysis showed an elevated AST/ALT ratio was significantly associated with the total amount of drainage volume (OR = 1.725, 95% CI 1.115-2.669, p = 0.014). CONCLUSIONS: Preoperative elevated AST/ALT ratio is an independent risk factor for the pericardial and mediastinal drainage volume in patients undergoing aortic arch surgery. It might represent a novel marker for individual risk assessment for cardiac surgery.
The Postoperative Platelet to Creatinine Ratio as A Prognostic Index of In-Hospital Mortality in Patients with Acute Type A Aortic Dissection.
Wang Y, Qiu S, Chen Y … +2 more , Cheng X, Zhou J
Heart Surg Forum · 2023 Dec · PMID 38178335 · Publisher ↗
BACKGROUND: The purpose of the investigation was to assess the value of post-operation platelet to creatinine ratio (PCR) in predicting in-hospital mortality among patients with acute type A aortic dissection (TAAAD). ME...
BACKGROUND: The purpose of the investigation was to assess the value of post-operation platelet to creatinine ratio (PCR) in predicting in-hospital mortality among patients with acute type A aortic dissection (TAAAD). METHODS: A retrospective study was carried out from January 2017 to December 2019. The best cutoff value of post-operation PCR was assessed by receiver operating characteristic (ROC) curve. Patients were divided into survivors and nonsurvivors. Univariate and multivariate logistic analyses were carried out to identify independent risk factors influencing in-hospital mortality. RESULTS: A total of 171 patients were included in this investigation, with an in-hospital mortality rate of 18.1%. The optimal cut-off value of post-operation PCR was 0.7242 (area under the ROC curve (AUC): 0.798, 95% confidence interval (CI) 0.730-0.856, p < 0.001), and the sensitivity and specificity were 74.2% and 74.3%. The levels of post-operation PCR were lower in nonsurvivors than in survivors (0.56 ± 0.33 vs. 1.50 ± 1.36, p < 0.001). Multivariate logistic regression analysis displayed that post-operation PCR was positively related to in-hospital survivors when confounding factors were adjusted (HR = 8.850, 95% CI = 2.611-30.303, p < 0.001). CONCLUSIONS: Post-operative PCR is a readily accessible and cost-effective biomarker that is independently associated with in-hospital mortality in TAAAD patients. Furthermore, it exhibits superior performance in predicting patient outcomes following surgery.
Correlation between Mean Platelet Volume and Gensini Score in Patients with Coronary Heart Disease in Different Diabetic States.
Qiu Q, Zhu G, Peng G … +8 more , Wang L, Lu H, Xu Y, Zhang W, Shen Y, Ye Y, Lv Q, Wang Q
Heart Surg Forum · 2023 Dec · PMID 38178334 · Publisher ↗
SUBJECT: To investigate the correlation between mean platelet volume (MPV) levels and Gensini scores in stable coronary heart disease (CHD) patients with or without diabetes. METHODS: A retrospective analysis was conduct...
SUBJECT: To investigate the correlation between mean platelet volume (MPV) levels and Gensini scores in stable coronary heart disease (CHD) patients with or without diabetes. METHODS: A retrospective analysis was conducted on 2525 patients with stable CHD in Zhongshan Hospital, Fudan University. There were 1274 in the low MPV group and 1251 in the high MPV group, divided by a median MPV level of 10.9 fL. In the total population, 1605 patients were non-diabetic and 920 were diabetic. The severity of coronary artery disease was quantified using the Gensini score. RESULTS: The Gensini score was significantly higher in the high MPV group than in the low MPV group (p < 0.001). MPV levels increased significantly with the number of stenotic (>50%) coronary vessels (p < 0.001). The Spearman analysis showed a positive correlation between MPV and Gensini score (r = 0.189, p < 0.001), which was more significant in the diabetic subgroup (r = 0.232, p < 0.001). Receiver operating characteristic (ROC) curves were employed to assess the predictive value of MPV for high Gensini scores, using the median value of 32 points as the cutoff. MPV levels in the diabetes cohort exhibited a higher predictive value for high Gensini scores (area under the curve: 0.635 [0.614-0.657], p < 0.001). Multivariate linear regression analysis showed that diabetes and MPV were independently associated with Gensini scores. CONCLUSION: MPV levels in stable CHD patients can predict the severity of coronary artery stenosis. This correlation is more significant in the presence of diabetes.
Development and Validation of a Novel Nomogram for Predicting Perioperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting Surgery.
Shoulei Chen, Cheng Luo, Chen Fang … +8 more , Yugui Li, Xiongwei Cai, Guoxing Ling, Haitao Song, Sida Fan, Linsheng Mi, Sai Zheng, Baoshi Zheng
Heart Surg Forum · 2023 Dec · PMID 38178333 · Publisher ↗
BACKGROUND: The aim of this work was to create a novel model for predicting acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCABG). METHODS: The individuals who underwent OPCABG were randomly sepa...
BACKGROUND: The aim of this work was to create a novel model for predicting acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCABG). METHODS: The individuals who underwent OPCABG were randomly separated into a derivation group and a validation group, at a 7:3 ratio. The primary outcome was AKI under the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. To optimize feature selection and construct a nomogram, both least absolute shrinkage and selection operator regression (LASSO) and logistic regression analysis were utilized. The nomogram was assessed in various ways: with the C-index, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA). RESULTS: The use of an intra-aortic balloon pump (IABP), systolic blood pressure, smoking and baseline serum creatinine were identified as independent impact factors. The C-index of the nomogram was 0.733 (95% confidence interval (CI) = 0.669-0.791) and 0.786 (95% CI = 0.693-0.878) in the training and validation groups, respectively. The area under the curve (AUC) of the internal validation was 0.715 using bootstrapping with 1000 replicates. The calibration plot revealed that the predicted outcomes aligned well with the observations. DCA and CICA suggested that the model had clinical benefit. CONCLUSION: The nomogram that relied on clinical characteristics proved to be a dependable instrument to predict AKI after OPCABG. This model is conveniently applicable in clinical settings and will be a valuable resource for assessing timely medical measures to mitigate risk.
Effects of Anesthetics on Cardiac Repolarization in Adults: A Network Meta-Analysis of Randomized Clinical Trials.
Cai Y, Yi Z, Ou H … +3 more , Dou Y, Huang H, Chen B
Heart Surg Forum · 2023 Dec · PMID 38178332 · Publisher ↗
OBJECTIVES: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest ris...
OBJECTIVES: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome. METHODS: Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970). RESULTS: Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI): 16.10, 33.54) and desflurane (95% CI: 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI: 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI: 17.78, 29.63), halothane (95% CI: 11.29, 41.24), desflurane (95% CI: 23.79, 39.88), and isoflurane (95% CI: 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI: 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%), halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct meta-analysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI: 23.12, 57.86). Other secondary outcomes showed no conclusive findings. CONCLUSIONS: This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence.
Converting the Fontan Circulation: Challenges and Evolution.
Kanakis M, Chatziantoniou A, Rorris FP … +3 more , Chamogeorgakis T, Kostolny M, Bobos D
Heart Surg Forum · 2023 Dec · PMID 38178331 · Publisher ↗
The Fontan operation, the final palliative step after a series of complex operations in patients with univentricular hearts, has undergone multiple modifications throughout the last decades, with the goal of finding the...
The Fontan operation, the final palliative step after a series of complex operations in patients with univentricular hearts, has undergone multiple modifications throughout the last decades, with the goal of finding the method which combines the optimal hemodynamic effects of the Fontan circulation with minimal long term side effects. An understanding of the operative evolution and subsequent side effects, as well as the management thereof seems imperative. Since its inception by Francis Fontan the, now obsolete, initial atriopulmonary connection has passed through several milestones into having now reached the era of total cavopulmonary connection. However, recently published results bring to light the new option of biventricular conversion which comes to challenge the management of Fontan patients as we know it. Currently, there is no consensus as to whether to continue with palliation in this challenging group of patients or proceed with heart transplantation. In this collective review, we provide a historic overview of the Fontan evolution as well as future insights, discussing the perspectives of options for patients with failing Fontan, including the latest addition of biventricular correction.
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