The Heart Surgery Forum[JOURNAL]
Sun
200 papers
Percutaneous versus Cutdown Access for Endovascular Aortic Repair.
Altoijry A, Alsheikh S, Alanezi T … +4 more , Aljabri B, Aldossary MY, Altuwaijri T, Iqbal K
Heart Surg Forum · 2023 Sep · PMID 37920077 · Publisher ↗
BACKGROUND: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair. METHODS: We retros...
BACKGROUND: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair. METHODS: We retrospectively reviewed the medical records of 59 patients who underwent a thoracic/abdominal endovascular aortic repair at a single tertiary care hospital between 2015 and 2022. Based on their femoral access type, the patients were categorized into the "percutaneous" or "cutdown" groups. Using a computerized sheet, relevant patient data (including demographic information and patient risk factors) were collected. The operative duration, complication rates, mortality rates, intensive care unit admission and stay durations, and total hospital stay were compared between the two groups. The primary outcomes were differences in the postoperative morbidity and mortality associated with the two approaches. RESULTS: The cutdown and percutaneous groups comprised 24 (41%) and 35 (59%) patients, respectively. The two groups displayed comparable demographic and clinical characteristics (p > 0.05). However, the vascular anatomy differed with the common femoral artery diameter being larger in the percutaneous group compared to the cutdown group (9.63 ± 1.81 mm vs. 8.49 ± 1.54 mm, p = 0.028). The ratio of the sheath diameter to the common femoral artery diameter was significantly lower in the percutaneous group than in the cutdown group (0.73 ± 0.16 vs. 0.85 ± 0.20, p = 0.027). A ratio of ≥0.74 was associated with a higher risk of complications (odds ratio, 12.0; 95% confidence interval, 1.4-102.2; p = 0.023) and mortality (odds ratio, 5.79; 95% confidence interval, 1.13-29.6; p = 0.035). Additionally, the operative duration was significantly shorter in the percutaneous group than in the cutdown group (141.43 ± 97.05 min vs. 218.46 ± 126.31 min, p = 0.001). Compared to the cutdown group, the percutaneous group experienced a shorter total hospital stay (21.54 ± 21.49 days vs. 11.60 ± 12.09 days, p = 0.022) and lower intensive care unit-admission rates (66.7% vs. 40%, p = 0.044). CONCLUSION: The percutaneous approach is a viable and more time-efficient alternative to the traditional cutdown method for delivering vascular endografts. It is associated with a significantly shorter operative duration and briefer hospital stays. Additionally, the ratio of the sheath diameter to the common femoral artery diameter can help surgeons preoperatively predict and anticipate the risks of complications and mortality. Future in-depth research is necessary to better understand the association between this ratio and postoperative outcomes and complications.
The Value of Soluble ST2 in Predicting Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients.
Hua Y, Zhang W, Li X
Heart Surg Forum · 2023 Oct · PMID 37920076 · Publisher ↗
OBJECTIVE: To investigate the predictive value of soluble growth stimulation expressed gene 2 (sST2) for the development of Cardiorenal syndrome type 1 (CRS1) in patients with acute myocardial infarction during hospitali...
OBJECTIVE: To investigate the predictive value of soluble growth stimulation expressed gene 2 (sST2) for the development of Cardiorenal syndrome type 1 (CRS1) in patients with acute myocardial infarction during hospitalization. METHODS: A retrospective study included 202 patients with acute myocardial infarction, divided into the CRS1 group (n = 61) and the Non-CRS1 group (n = 141) by the CRS1 occurrence. A logistic regression analysis was applied to find independent predictors of the CRS1 occurrence during hospitalization. Receiver operating characteristic (ROC) curves were applied to analyze the predictive values of sST2, N-terminal pro-B type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR). RESULT: The multivariate logistic regression analysis revealed that sST2, NT-proBNP, eGFR, Multivessel coronary artery disease, and diuretic use were independent predictors of the CRS1 occurrence during hospitalization. Application of ROC curve analysis displayed that sST2 had the largest area under the curve (AUC) value of 0.874, sensitivity of 0.770, and specificity of 0.894; sST2, eGFR, and NT-proBNP as combined predictors had an AUC value of 0.908, sensitivity of 0.820, and specificity of 0.908. The ROC curves of sST2 and the combined predictive indices were compared using MedCalc software (version 19.6.3), and no statistically significant difference was found between the two (p = 0.142). The cutoff values of the three indicators were determined by the maximum Youden index. When sST2 ≥61.8 ng/mL, eGFR ≤80.6 mL/min/1.73 m2 and NT-proBNP ≥1525 pg/mL were classified as abnormal range, it was found that more number of abnormal indicators may be more advantageous of risk stratification in CRS1. CONCLUSIONS: sST2 can be used as a novel predictor of the CRS1 occurrence in patients with acute myocardial infarction during hospitalization. sST2, eGFR, and NT-proBNP combined may have better predictive value.
Predictive Value of the Lipoprotein(a) to Prealbumin Ratio and of the NT-proBNP to LVEF Ratio for Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome.
Zhang Y, Shi F
Heart Surg Forum · 2023 Oct · PMID 37920075 · Publisher ↗
OBJECTIVE: To investigate the lipoprotein(a) [Lp(a)] to prealbumin (PA) ratio and the N-terminal pro-brain natriuretic peptide (NT-proBNP) to left ventricular ejection fraction (LVEF) ratio for the prediction of major ad...
OBJECTIVE: To investigate the lipoprotein(a) [Lp(a)] to prealbumin (PA) ratio and the N-terminal pro-brain natriuretic peptide (NT-proBNP) to left ventricular ejection fraction (LVEF) ratio for the prediction of major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). METHODS: A 1:1 matched case-control study was performed to retrospectively analyze ACS patients who underwent PCI from January 2022 to June 2022. Patients with MACE were selected as the case group (n = 55), and age- and gender-matched patients without MACE were selected as the control group (n = 55). Clinical data for the two groups was compared by univariate and multivariate logistic regression analysis. Risk factors and the odds ratio (OR) for MACE in ACS patients were evaluated, and receiver operating characteristic curve (ROC) were used to evaluate the Lp(a)/PA ratio, the NT-proBNP/LVEF ratio, and their combination for the prediction of MACE in ACS patients. RESULTS: The MACE and non-MACE groups showed statistically significant differences for time from onset to PCI, LVEF, NT-proBNP, white blood cell (WBC), Lp(a), PA, Lp(a)/PA, NT-proBNP/LVEF, number of catheterizations, number of implanted stents >2, and support diameter >3 (p < 0.05). Multivariate logistic regression analysis showed that LVEF, Lp(a)/PA and NT-proBNP/LVEF were independent risk factors for MACE. ROC curve analysis for Lp(a)/PA showed that the area under the curve (AUC) for the prediction of MACE was 0.779 (0.693-0.864), the cut-off point was 1.36, the sensitivity was 69.1%, and the specificity was 74.5%. The AUC for NT-proBNP/LVEF in predicting MACE was 0.827 (0.75-0.904), the cut-off point was 61.04, the sensitivity was 65.5%, and the specificity was 92.7%. For the combination of Lp(a)/PA and NT-proBNP/LVEF, the AUC for the prediction of MACE was 0.889 (0.830-0.947), the cut-off point was 0.37, the sensitivity was 81.8%, and the specificity was 81.8%. CONCLUSION: The combination of Lp(a)/PA and NT-proBNP/LVEF at admission showed good predictive value for the occurrence of MACE in ACS patients after PCI.
Expanding the Criteria for Heart Transplantation Donors: A Review of DCD, Increased Ischemic Times, HCV, HIV, and Extended Criteria Donors.
T Jenkins R, M Shah M, L Larson E … +3 more , L Zhou A, M Ruck J, Kilic A
Heart Surg Forum · 2023 Oct · PMID 37920074 · Publisher ↗
With the demand for heart transplantation continuing to outpace the available donor organs, previously underutilized donors are now being reconsidered. We sought to describe the emerging techniques and outcomes of expand...
With the demand for heart transplantation continuing to outpace the available donor organs, previously underutilized donors are now being reconsidered. We sought to describe the emerging techniques and outcomes of expanded criteria heart transplantation. A comprehensive review of the recent literature concerning expanded donor selection in heart transplantation was performed using the PubMed MEDLINE database. To characterize trends in transplant practice, the United Network for Organ Sharing (UNOS/OPTN) registry was queried for all adult isolated heart transplants since 2010, and data regarding transplant parameters was collected. Donation after cardiac death (DCD), DCD with normothermic regional perfusion, increased ischemic time, hepatitis C positive donor organs, HIV-positive donor organs, and extended criteria donors were identified as promising avenues currently being explored to expand the number of donor organs. The utilization of various expanded criteria for heart transplantation was summarized since 2010 and showed an increasing use of these donor organs, contributing to the overall increasing frequency of heart transplantation. Utilization of expanded criteria for donor selection in heart transplantation has the potential to increase the supply of donor organs with comparable outcomes in selected recipients.
Association Analysis between Maternal Serum Biomarkers and Fetal Congenital Heart Disease.
Jiang H, Lin Y, He X
Heart Surg Forum · 2023 Oct · PMID 37920073 · Publisher ↗
OBJECTIVE: To investigate the association of maternal serum biomarkers alpha fetal protein (AFP), β-human chorionic gonadotropin (HCG) and unconjugated estriol 3 (uE3) in the second trimester with fetal congenital heart...
OBJECTIVE: To investigate the association of maternal serum biomarkers alpha fetal protein (AFP), β-human chorionic gonadotropin (HCG) and unconjugated estriol 3 (uE3) in the second trimester with fetal congenital heart disease (CHD) in low risk populations during the screening of Down's syndrome. METHODS: 109 cases diagnosed with fetal CHD in the second trimester by fetal echocardiography were enrolled as the CHD group. Pregnancy- and gestational-age matched 344 cases without fetal CHD were used as the control group. The values of maternal serum biomarkers HCG, AFP and uE3 were tested and the association with CHD was analyzed. RESULTS: The means of HCG multiple of median (MoM) and AFP MoM were higher, while the mean of uE3 MoM was lower in the CHD group than those of the control group (p < 0.05). The number of cases with HCG MoM ≥85% quantile, AFP MoM ≥85% quantile was more, while that with uE3 MoM ≤15% quantile was less in the CHD group than that of the control group (p < 0.05). The univariate logistic regression analysis showed that fetal CHD was associated with high values of HCG MoM and AFP MoM and low value of uE3 MoM as well as the HCG MoM ≥85% quantile, AFP MoM ≥85% quantile and the uE3 MoM ≤15% quantile. The multivariate logistic regression analysis showed that HCG MoM ≥85% quantile and AFP MoM ≥85% quantile or the uE3 ≤15% quantile were the independent factors of fetal CHD. In addition, the risk of fetal CHD was higher when one situation existed among the HCG MoM ≥85% quantile, AFP MoM ≥85% quantile and the uE3 MoM ≤15% quantile. The risk of fetal CHD was much higher when both the HCG MoM ≥85% quantile and AFP MoM ≥85% quantile existed or both the HCG MoM ≥85% quantile and the uE3 MoM existed ≤15% quantile. CONCLUSIONS: Second trimester maternal serum biomarkers may be useful indicators for fetal evaluation for CHD to screen positive pregnancies without identified chromosomal defects.
Assessment of Total Ropivacaine Concentration in Blood after Bilateral Pecto-Intercostal Fascial Block Combined with Rectus Sheath Block in Cardiac Surgery Patients.
Wang L, Jiang B, Shi Y … +3 more , Liu B, Jiang L, Feng Y
Heart Surg Forum · 2023 Oct · PMID 37920072 · Publisher ↗
OBJECTIVES: Pecto-intercostal fascial block (PIFB) and rectus sheath block (RSB) have been combined to offer better analgesia for cardiac surgery patients, but safety of the analgesic protocol with a large volume of ropi...
OBJECTIVES: Pecto-intercostal fascial block (PIFB) and rectus sheath block (RSB) have been combined to offer better analgesia for cardiac surgery patients, but safety of the analgesic protocol with a large volume of ropivacaine is uncertain. METHODS: This is a prospective observational study at Peking University People's Hospital to investigate the pharmacokinetic profile of ropivacaine after combined regional blocks. Patients undergoing elective cardiac surgery by a median sternotomy were enrolled to receive bilateral PIFB and RSB with 70 mL 0.3% ropivacaine (total dose 210 mg). Blood was sampled at 5, 10, 15, 30, 60, 90 and 120 mins after blocks. Total blood concentration of ropivacaine for patients were measured. RESULTS: Ten patients were enrolled and analyzed. The peak total ropivacaine concentration varied from 0.67 to 2.42 µg/mL. Time to reach the peak values mainly located between 10 and 30 mins after the performance. No patients had ropivacaine concentration values above toxic threshold (4.3 µg/mL), and there were no systemic toxicity symptoms during the perioperative period. CONCLUSIONS: PIFB combined with RSB in a general injection of 70 mL 0.3% ropivacaine does not give rise to toxic levels, and it is an effective and safe analgesic protocol for cardiac surgery patients.
Everything You Need to Know about Venting during Cardiac Surgery (And It's More than You Thought!).
Tribble C
Heart Surg Forum · 2023 Oct · PMID 37920071 · Publisher ↗
Abstract loading — click title to view on PubMed.
Sex-Based Differences in Early Outcomes Following Mitral Valve Surgery for Degenerative Disease.
Al-Zubaidi FI, Pufulete M, Salmasi MY … +2 more , Angelini GD, Vohra HA
Heart Surg Forum · 2023 Oct · PMID 37920070 · Publisher ↗
OBJECTIVES: To determine whether sex-based differences exist following surgery for degenerative mitral valve disease. METHODS: Using a national database, we analysed data on mitral valve surgery for degenerative disease...
OBJECTIVES: To determine whether sex-based differences exist following surgery for degenerative mitral valve disease. METHODS: Using a national database, we analysed data on mitral valve surgery for degenerative disease (n = 22,658) between January 2000 and March 2019 in the UK. We split the cohort into men (n = 14,681) and women (n = 7977) and compared background characteristics, intraoperative variables and early postoperative outcomes. Our primary outcome was hospital mortality; secondary outcomes included re-exploration for bleeding, prolonged admission (>10 days) and mitral replacement. We used binary logistic regression models for all outcomes, with multiplicative interaction terms to determine the nature of any differences. RESULTS: Women presented older (70 ± 11 years vs. 67 ± 11 years, p < 0.001) with worse symptom profiles (New York Heart Association Class III-IV 57% vs. 44%, p < 0.001). They had higher rates of preoperative atrial fibrillation (39% vs. 35%, p < 0.001) and tricuspid disease requiring surgery (21% vs. 15%, p < 0.001). They had lower repair rates (66% vs. 76%, p < 0.001), higher mortality (3% vs. 2%, p < 0.001) and were more likely to have a prolonged admission (48% vs. 40%, p < 0.001). Female sex was an independent predictor of mortality (odds ratio (OR): 1.52, 95% CI: 1.21-1.90, p < 0.001). Age and Canadian Cardiovascular Society (CCS) score showed significant interactions with sex. The relationship between advancing age and mortality was found to be more pronounced in women. CONCLUSIONS: (1) Female sex is an independent predictor of hospital mortality, prolonged hospital admission and mitral valve replacement. (2) The relationship between female sex and mortality is exacerbated by worsening CCS score and advancing age. (3) Women have significantly lower repair rates.
Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery.
Yasar E, Duman ZM, Bayram M … +3 more , Gürsoy M, Kadiroğulları E, Aydın Ü
Heart Surg Forum · 2023 Oct · PMID 37920069 · Publisher ↗
BACKGROUND: Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduc...
BACKGROUND: Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduced complications. This study aimed to investigate the outcomes of robotic-assisted coronary surgery, focusing particularly on the impact of obesity. METHODS: A total of 210 consecutive patients underwent robotic-assisted coronary surgery over an eight-year period at a single institution. Patients were categorized based on body mass index (BMI), distinguishing between obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. The analysis encompassed preoperative characteristics, operative factors, and postoperative outcomes. RESULTS: Comparisons between obese and non-obese patients revealed similar preoperative comorbidities. However, the operation time was prolonged in the obese group (p = 0.03). Major cardiac and cerebrovascular events, along with overall complications, displayed no significant disparities between the groups. Notably, superficial wound infections were more prevalent among obese patients (p = 0.03). Importantly, intensive care unit and hospital stay times were comparable between the two groups. CONCLUSION: Robotic-assisted coronary surgery demonstrates its potential as a viable alternative to conventional open-heart procedures, offering benefits such as reduced mortality rates, shorter hospital stays, and minimized perioperative complications. This study's findings underscore the feasibility and safety of this approach, with outcomes comparable between obese and non-obese patients.
I Need You to be Me: Talking with Our Patients, Their Families, and Their Doctors.
Tribble C
Heart Surg Forum · 2023 Aug · PMID 37691277 · Publisher ↗
Abstract loading — click title to view on PubMed.
Roles of Immune and Oxidative Stress-Related Factors in the Diagnosis of Coronary Artery Disease: A Retrospective Study.
Shu Y, Zheng Y, Guo Y … +2 more , Zhu D, Huang S
Heart Surg Forum · 2023 Aug · PMID 37691276 · Publisher ↗
BACKGROUND: Coronary artery disease (CAD) is one of the main causes of sudden death, but its exact pathogenesis requires further study. Thus, this study aimed to explore the immune and oxidative stress-related factors in...
BACKGROUND: Coronary artery disease (CAD) is one of the main causes of sudden death, but its exact pathogenesis requires further study. Thus, this study aimed to explore the immune and oxidative stress-related factors in CAD progression and their roles in CAD diagnosis. METHODS: Bioinformatics analysis was used in this study, and the GSE23561 dataset (training set) we used contained the transcriptome sequencing results of six CAD peripheral blood samples and nine control samples. The data were obtained and analysed by querying the Gene Expression Omnibus database. First, the differentially expressed immune and oxidative stress-related genes (DEIOGs) between the groups were identified. DEIOGs were then analysed based on Gene Ontology annotation and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. A protein-protein interaction (PPI) network for DEIOGs was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database, and hub genes were identified through the PPI network. Moreover, transcription factors and microRNAs (miRNAs) targeting hub genes were identified to explore the potential regulatory mechanisms of hub genes. The receiver operating characteristic (ROC) curve analysis was constructed to examine the role of hub genes in CAD diagnosis. Finally, the data of GSE23561 (validated set) were used to validate the diagnostic potential of these hub genes. RESULTS: Primarily, 66 DEIOGs were identified, which are involved in many important pathways related to CAD, such as the "mitogen-activated protein kinase (MAPK) signalling pathway" and "lipid and atherosclerosis". A PPI network of DEIOGs was then constructed, and 10 hub genes were identified sequentially. A total of 37 transcription factors and 481 miRNAs that played important roles in hub genes regulation were identified. The ROC curves indicated that five special hub genes (Fos, Il6, Jun, Mapk3, and Mmp9) could serve as potential diagnostic biomarkers for CAD. CONCLUSIONS: Bioinformatics analysis technology was used to identify 10 hub DEIOGs that might play a crucial role in CAD progression, and five special hub genes (Fos, Il6, Jun, Mapk3, and Mmp9) could be regarded as potential biomarkers for CAD diagnosis. However, further studies are required to verify the functions of these hub genes.
Prognosis Analysis of Children with Interrupted Aortic Arch Complicated with Ventricular Septal Defect and Other Associated Intracardiac Defects after One-Stage Radical Surgery.
Song H, Cao L, Zhang H
Heart Surg Forum · 2023 Aug · PMID 37691275 · Publisher ↗
BACKGROUND: High rates of mortality and aortic arch stenosis have been reported for one-stage radical surgery of interruption of aortic arch (IAA) with ventricular septal defect (VSD) and other associated intracardiac de...
BACKGROUND: High rates of mortality and aortic arch stenosis have been reported for one-stage radical surgery of interruption of aortic arch (IAA) with ventricular septal defect (VSD) and other associated intracardiac defects, but the sample size of the study is relatively small, and the credibility of the study is not high. The risk factors of death and aortic arch stenosis will be analyzed in a large sample size of infants with IAA, VSD and other associated intracardiac defects after one-stage radical resection. METHODS: A retrospective analysis was performed on 152 children with IAA, VSD and other associated intracardiac defects from January 2006 to January 2017 who had undergone one-stage radical resection, including 95 cases of type A and 57 cases of type B. January 2006-December 2011 as the early period, and January 2012-January 2017 as the late period. Cox proportional hazards regression model was used to analyze the risk factors for mortality and aortic arch stenosis after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software. RESULTS: 22 cases (14.47%) died, 27 cases (17.76%) developed aortic arch stenosis. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year survival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (Hazard Ratio (HR) = 0.551, 95% Confidence Interval (CI): 0.320-0.984, p = 0.004), low body weight (HR = 0.632, 95% CI: 0.313-0.966, p = 0.003), large ratio of VSD diameter/aortic diameter (VSD/AO) (HR = 2.547, 95% CI: 1.095-7.517, p = 0.044), long duration of cardiopulmonary bypass (HR = 1.374, 95% CI: 1.000-3.227, p = 0.038), and left ventricular outflow tract obstruction (LVOTO) (HR = 3.959, 95% CI: 1.123-9.268, p = 0.015) were independent risk factors for postoperative death. The surgical period (January 2006-December 2011) (HR = 0.439, 95% CI: 0.109-0.964, p = 0.046) and the addition of pericardial anastomosis to the anterior aortic wall (HR = 0.398, 95% CI: 0.182-0.870, p = 0.021) were independent risk factors for postoperative aortic arch stenosis. CONCLUSIONS: Children with low age, low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOTO, the surgical period (January 2006-December 2011) and pericardial anastomosis with anterior aortic wall have poor prognosis.
Preoperative Levosimendan Administration in Heart Transplant Patients with Severe Hepatic and Renal Impairment: A Retrospective Study.
Zheng Q, Lan H, Guo Q … +6 more , Li C, Xiong T, Zhang J, Wang G, Dong N, Shi J
Heart Surg Forum · 2023 Aug · PMID 37679092 · Publisher ↗
BACKGROUND: The cardio-renal syndrome and hepatic impairment play a critical role in end-stage heart failure (HF). Levosimendan is an effective inotropic agent used to maintain cardiac output similar to classic cardioton...
BACKGROUND: The cardio-renal syndrome and hepatic impairment play a critical role in end-stage heart failure (HF). Levosimendan is an effective inotropic agent used to maintain cardiac output similar to classic cardiotonic like dobutamine/dopamine. This current research aims to investigate the clinical outcomes of levosimendan and dobutamine/dopamine in Chinese heart transplant awaiting patients with severe hepatic or renal impairment. METHODS: We performed a retrospective analysis of 568 heart transplant awaiting individuals with severe hepatic or renal impairment who treated with levosimendan or dobutamine/dopamine in our institution between January 2015 and December 2020. Univariate Cox proportional hazard models and Kaplan-Meier survival curves were applied. The primary endpoint was defined as death included inhospital mortality and the mortality at 30 days, 90 days, 180 days and 1 year after heart transplantation. RESULTS: There were no significant differences in mortality rate at 30, 90, 180 days and 1 years after heart transplantation between the levosimendan and non-levosimendan groups, or between subgroups of patients with severe hepatic impairment or renal impairment. The results were consistent before and after propensity score matching. CONCLUSIONS: In the population with advanced heart failure awaiting heart transplantation, levosimendan did not increase short- or long-term mortality rates after surgery compared to dobutamine/dopamine, regardless of their hepatic or renal function. Severe hepatic or renal impairment were not necessarily considered a contraindication for levosimendan in these patients.
Giant Solitary Fibrous Tumor of the Ascending Aortic Wall Causing Reversible Heart Failure: A Case Report and Review of the Literature.
Guo P, Liu S, Abuheit EMI … +3 more , Jia X, Jian L, Wang Y
Heart Surg Forum · 2023 Aug · PMID 37679091 · Publisher ↗
A 56-year-old woman was admitted to our hospital with a 2-week history of chest tightness and fatigue, and an echocardiogram revealed a massive polyserous cavity effusion. A massive (13.5 cm maximum diameter) intraperica...
A 56-year-old woman was admitted to our hospital with a 2-week history of chest tightness and fatigue, and an echocardiogram revealed a massive polyserous cavity effusion. A massive (13.5 cm maximum diameter) intrapericardial mass was discovered using computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI) in the ascending aortic wall. A pericardial biopsy was performed and diagnosed as a solitary fibrous tumor (SFT). After successful mass resection, an immunohistochemical test was positive for CD34, STAT-6, CD34, and Bcl2, which indicates a giant benign solitary fibrous tumor of the ascending aortic wall. After three years of follow-up, the patient is symptom-free, and histological indications of malignancy were absent. A giant benign solitary fibrous tumor is extremely rare in the heart, especially from the ascending aorta wall, and experience with this tumor location is limited, so close follow-up at regular intervals is considered necessary. We present this case, followed by a literature review on SFTs involving the heart and management approaches.
Impella Implantation as a Bridge to Surgery for Repair of Aorto-Right Ventricular Fistula Following Prosthetic Valve Endocarditis: A Case Report.
Narita M, Tsutsui M, Ushioda R … +3 more , Kikuchi Y, Shirasaka T, Kamiya H
Heart Surg Forum · 2023 Jul · PMID 37679090 · Publisher ↗
For patients with cardiogenic shock, delaying surgery with mechanical circulatory support is reported to yield better outcomes than emergency surgery. We report on an 82-year-old man diagnosed with vertebral osteomyeliti...
For patients with cardiogenic shock, delaying surgery with mechanical circulatory support is reported to yield better outcomes than emergency surgery. We report on an 82-year-old man diagnosed with vertebral osteomyelitis with concomitant infective endocarditis. Chest radiographs revealed a growing abscess, which resulted in an aorto-right ventricular fistula. Providing Impella support allowed for hemodynamic stabilization prior to surgery. The patient had an uneventful postoperative course and reported to be well in a follow-up 1 year later. Impella support can be used as a bridge to surgery for repairing fistulous tract formation in patients in cardiogenic shock.
A Retrospective Study of the No-Contact Technique to Obtain Radial Arteries for Coronary Artery Bypass Grafting.
Zhao Y, Zhang X, Song Y … +5 more , Xia Y, Huang D, Zhang J, Liu D, Zhang D
Heart Surg Forum · 2023 Aug · PMID 37679089 · Publisher ↗
BACKGROUND: To retrospectively study the experience with application of no-touch technique in radial artery (RA)-based coronary artery bypass grafting (CABG). METHODS: Clinical data of patients who underwent RA-based mul...
BACKGROUND: To retrospectively study the experience with application of no-touch technique in radial artery (RA)-based coronary artery bypass grafting (CABG). METHODS: Clinical data of patients who underwent RA-based multi- (n = 45) or full-arterial CABG (n = 27) between January 2019 and June 2022 in the Affiliated Hospital of ZunYi Medical University were collected. The incidence of main cardiovascular events at 30-day follow-up, the antebrachial union condition and the vessel patency rate were analyzed. RESULTS: A total of 66 RAs were harvested and 70 RAs used as grafts. The number of RA used per patient was 1.46. Delayed antebrachial union occurred in 1 patient (1.45%). There was no death, cerebral infarction, myocardial infarction or revascularization at follow-up. Early coronary computed tomography (CT) after surgery revealed occlusion in 1 RA, with the patency rate being 98.57%. CONCLUSIONS: The No-touch RA harvesting technique, preservation and postoperative management applied in this study are effective and rational, and the application of RA as the graft in CABG is safe.
Starting Pediatric VAD Program: Transforming Challenges into Opportunities; A Case Series of a Single Center.
Bakoš M, Novak M, Šarić D … +11 more , Bartoniček D, Belina D, Đurić Ž, Anić D, Čolak Ž, Konosić S, Mihalec M, Rubić F, Matić T, Međimurec G, Planinc M
Heart Surg Forum · 2023 Aug · PMID 37679088 · Publisher ↗
BACKGROUND: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options includ...
BACKGROUND: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach. METHODS: We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy. RESULTS: The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients. CONCLUSIONS: To establish a VAD program, numerous specialties must be included with adequate training and learning for all team members.
The Effect of Onset Time on In-Hospital Mortality in Patients with Acute Type A Aortic Dissection of Different Gender: A Retrospective Cohort Study.
Peng Y, Ni H, Pan Q … +4 more , Lin L, Li S, Chen L, Lin Y
Heart Surg Forum · 2023 Aug · PMID 37679087 · Publisher ↗
BACKGROUND: Although the research on gender in acute type A aortic dissection (AAAD) patients has increased in recent years, the results are still controversial. The effect of time of onset on in-hospital mortality in pa...
BACKGROUND: Although the research on gender in acute type A aortic dissection (AAAD) patients has increased in recent years, the results are still controversial. The effect of time of onset on in-hospital mortality in patients with AAAD of different gender is unclear. The purpose of this study was to investigate the effect of onset time on in-hospital mortality of patients with AAAD of different gender. METHODS: In this retrospective observational study, patients with AAAD were selected from June 2013 to March 2020. Patients' information was extracted from electronic medical records. Based on the onset time, the patients were categorized into four groups: group one (00:00-05:59), group two (6:00-11:59), group three (12:00-17:59), and group four (18:00-23:59). RESULTS: A total of 760 subjects were included in our study. There were 591 (77.8%) males and 169 (22.2%) females. In male patients, 79 cases died, in female patients, 19 cases died (p < 0.05). We conducted subgroup analysis according to gender, univariate Cox regression analysis of male patients showed that compared with the patients at onset time of 0:00-5:59, patients at onset time of 12:00-17:59 and 18:00-23:59 were associated with an increased risk of in-hospital mortality. Multivariate Cox regression analysis of male patients showed that the onset time of 18:00-23:59 remained as the significant risk factor of in-hospital mortality of male patients hazard ratio (HR) = 4.396 (p < 0.05). CONCLUSIONS: This analysis demonstrated that in-hospital mortality of AAAD patients was similar in different genders. In male patients, the onset time of 18:00-23:59 was significantly associated with an increased risk of in-hospital mortality.
The Outcome of Congenital Cardiac Surgery in Patients with Down Syndrome: Single-Center Experience.
Alnajjar AA, Salem SS, Baangood LS … +10 more , Al-Mutairi MB, Morsy MF, Al-Muhaya M, Alkodami AA, Sabtirul ML, Hussein MS, Altommeihi EW, Shaban AM, Alashwal M, Abdelrehim AR
Heart Surg Forum · 2023 Aug · PMID 37679086 · Publisher ↗
OBJECTIVES: This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospit...
OBJECTIVES: This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospital admission, and the need for catheter intervention among a cohort of patients. METHODS: This single-centre retrospective cohort study included consecutive Down syndrome patients who underwent cardiac surgery for congenital heart defects between January 2018 and December 2021. We reviewed the electronic medical records. Two hundred patients fulfilled the eligibility criteria with complete data reporting. The patients' perioperative data and outcomes were recorded. RESULTS: Females constituted 56.5%. Most (78.5%) patients showed accepted recovery. The incidence of all-cause in-hospital mortality was 3.0%. The rates of the need for a second operation, heart failure management, and permanent pacemaker insertion were 3.0%, 2.0%, and 2.5%, respectively. Only 8 (4.0%) patients stayed in the hospital for a long duration after chylothorax or tracheostomy (if intubated more than 2 weeks). The model had an accuracy of 99% and included the intraoperative transesophageal echocardiography (TEE) abnormalities (residual heart lesions) (adjusted odds ratio [AOR]: 26.541, p = 0.033), the duration of mechanical ventilation following the operation (AOR: 1.152, p = 0.009), and the occurrence of postoperative heart block (AOR: 76.447, p = 0.005). CONCLUSION: Surgical treatment of congenital heart defects in Down syndrome patients had good outcomes with accepted recovery (without intra-hospital or during follow-up mortality or morbidity) of 78.5% and a 3% incidence of in-hospital mortality. Though, the occurrence of chylothorax was considerably high, and resulted in a long hospital stay (more than 10 days). Repair of tetralogy of Fallot and coarctation of the aorta were associated with an increased likelihood of catheter intervention following the operation.
Successful Surgical Treatment of Mitral Valve Endocarditis Caused by Brucella: A Case Report.
Hong J, Xu B, Qian X … +1 more , He F
Heart Surg Forum · 2023 Aug · PMID 37679085 · Publisher ↗
Brucellosis endocarditis is a rare but life-threatening complication of brucellosis, involving congenital, prosthetic and even native valves. Its diagnosis and treatment is a great challenge for doctors. The patient's pr...
Brucellosis endocarditis is a rare but life-threatening complication of brucellosis, involving congenital, prosthetic and even native valves. Its diagnosis and treatment is a great challenge for doctors. The patient's prognosis requires prompt diagnosis and continuous evaluation of treatment plans to assess the need for either surgical intervention of the infected valves or continuation of antibiotic therapy alone. We present a patient with brucellosis endocarditis, predominantly involving the mitral valve, presenting with vegetations and prolapse of the anterior leaflet of the mitral valve with moderate to severe regurgitation. The patient was treated with triple antibiotic therapy before surgery. After the patient's blood culture results were negative, we removed the infected mitral valve vegetations and performed a mitral valve replacement. The patient was successfully extubated 4 hours after surgery and discharged 11 days after surgery. After discharge, the patient continued to receive triple antibiotic therapy for 2 months and was followed up at the cardiac surgery and infectious disease outpatient clinics.
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