The Heart Surgery Forum[JOURNAL]
Sun
200 papers
Effects of Remote Ischemic Preconditioning on Delirium and Neurological Function in Patients Undergoing Cardiac Surgery: A Multicenter Randomized Controlled Trial.
Liu T, Liu X, Wan R
Heart Surg Forum · 2023 Aug · PMID 37679084 · Publisher ↗
BACKGROUND: Postoperative delirium (POD) and neurological dysfunction are very common following cardiac surgery and deteriorate the patient's prognosis and the outcome of surgical procedures. A clinically effective manag...
BACKGROUND: Postoperative delirium (POD) and neurological dysfunction are very common following cardiac surgery and deteriorate the patient's prognosis and the outcome of surgical procedures. A clinically effective management strategy or drug is not yet available for POD. Additionally, it is unknown whether remote ischemic preconditioning (RIPC) has neuroprotective and anti-delirium benefits in patients who undergo cardiac surgery. METHODS: This study examined whether RIPC can improve POD and neurological function in cardiac surgery patients. We screened 510 consecutive adult patients aged 18 and older who underwent cardiac surgery between January 2018 and December 2022. Then, 448 of these patients were recruited in the trial as the intention to treat (ITT) group, who were then randomly assigned to receive either a control (n = 223) or RIPC treatment (n = 225). The primary outcome measures were hospitalization postoperative delirium, six-month modified Rankins scale (mRS), hospital cerebral infarction, 30-day overall mortality, neuron-specific enolase (NSE) and S-100b levels, related adverse effects, hospital costs, and hospital stay. RESULTS: A statistically significant variation was not observed between the two groups in terms of the baseline clinical data. In contrast to the control group, the POD in the RIPC group was considerably alleviated. RIPC treatment also decreased the levels of NSE and S-100b, which alleviated nerve injury. The adverse impacts of RIPC-induced objective indicators of tissue or neurovascular damage were similar in both groups, showing no significant variations between the two. The hospital stays and hospitalization costs also decreased significantly in the RIPC-treated patients. CONCLUSION: The study findings suggested that RIPC may benefit cardiac surgery patients by reducing POD, alleviating injury, and lowering hospital expenditures and length of stay. Cardiac surgery patients can be treated with RIPC, which is an effective and safe technique.
3D Printing-Assisted versus Conventional Extracorporeal Fenestration Tevar for Stanford Type B Arteries Dissection with Undesirable Proximal Anchoring Zone: Efficacy Analysis.
Zheng R, Zhu F, Cheng C … +7 more , Huang W, Zhang H, He X, Lu Q, Xi H, Shen K, Yu H
Heart Surg Forum · 2023 Aug · PMID 37679083 · Publisher ↗
BACKGROUND: To compare the outcomes of two Thoracic Endovascular Aortic Repair (TEVAR) techniques of Left Subclavian Artery (LSA) reconstruction for Stanford Type B Aortic Dissection (TBAD) patients with undesirable prox...
BACKGROUND: To compare the outcomes of two Thoracic Endovascular Aortic Repair (TEVAR) techniques of Left Subclavian Artery (LSA) reconstruction for Stanford Type B Aortic Dissection (TBAD) patients with undesirable proximal anchoring zone. METHODS: We retrospectively reviewed 57 patients with TBAD who underwent either three dimensional (3D)-printing-assisted extracorporeal fenestration (n = 32) or conventional extracorporeal fenestration (n = 25) from December 2021 to January 2023. We compared their demographic characteristics, operative time, technical success rate, complication rate, secondary intervention rate, mortality rate, and aortic remodeling. RESULTS: Compared with the conventional group, the 3D-printing-assisted group had a significantly shorter operative time (147.84 ± 33.94 min vs. 223.40 ± 65.93 min, p < 0.001), a significantly lower rate of immediate endoleak (3.1% vs. 24%, p = 0.048) and a significantly higher rate of true lumen diameter expansion in the stent-graft segment (all p < 0.05), but a significantly longer stent graft modification time (37.63 ± 2.99 min vs. 28.4 ± 2.12 min, p < 0.001). There were no significant differences in other outcomes between the two groups (p > 0.05). The degree of false lumen thrombosis was higher in the stent-graft segment than in the non-stent-graft segment in both groups and the difference was statistically significant (X2 = 5.390, 4.878; p = 0.02, 0.027). CONCLUSIONS: Both techniques are safe and effective for TBAD with an undesirable proximal landing zone. The 3D-printing-assisted extracorporeal fenestration TEVAR technique has advantages in operative time, endoleak risk, and aortic remodeling, while the traditional extracorporeal fenestration TEVAR technique has advantages in stent modification.
Unveiling immune-metabolic interaction in Atherosclerosis via Comprehensive Landscape of Hub Genes and Immune Microenvironment.
Liu F, Li T, Liu X … +1 more , Qin D
Heart Surg Forum · 2023 Aug · PMID 37679082 · Publisher ↗
OBJECTIVE: Atherosclerosis (AS) as a major cause of cardiovascular diseases, is considered a chronic inflammatory disease and accelerates by inflammation, lipid metabolism disorder and other mechanisms. AS pathogenesis a...
OBJECTIVE: Atherosclerosis (AS) as a major cause of cardiovascular diseases, is considered a chronic inflammatory disease and accelerates by inflammation, lipid metabolism disorder and other mechanisms. AS pathogenesis and its relationship with immune regulation and metabolic interactions is still not fully elucidated. The purpose of this study is to delve into the correlation between mitochondrial metabolism and immunity in AS, and identify potential therapeutic targets for clinical treatment. METHODS: Hub genes associated with mitochondrial metabolism and the pathogenesis of AS were identified by performing differentially expressed genes (DEGs) analysis and Weighted Gene Co-expression Network Analysis (WGCNA) based on two gene expression datasets (GSE100927 and GSE43292). And the biological processes and pathways of DEGs were determined through gene ontology (GO) and Gene Set Enrichment Analysis (GSEA) analysis. Then stepwise regression, random forest, and Lasso regression machine learning were used to evaluate the diagnostic value of hub genes. After that, the immune infiltration and single cell sequencing dataset GSE184073 were analyzed, and the immune cell composition in peripheral blood from AS patients using Mass Cytometry were detected to further consider the influence of immunoregulation. RESULTS: Ten hub genes associated with mitochondrial metabolism and AS pathogenesis were identified, including NDUFS4, AIFM3, IDUA, TNF, CHKA, SLC11A1, SLC35C1, SLC37A2, ARSB, SLC16A5. GO and GSEA analysis showed their correlation with immunity and inflammation. Lasso regression revealed that TNF and ARSB had relatively good diagnostic performance. Further exploration was conducted on the expression of these hub genes in the immune microenvironment and their correlation with different immune factors. Mass cytometry demonstrated the influence of the vascular immune microenvironment on the pathogenesis of AS. CONCLUSIONS: Our study provides a more comprehensive understanding of the complex relationships between immune and metabolic factors and their impact on the microenvironment of AS. The identification of hub genes in AS may provide new targets for therapeutic intervention.
Systemic Immune-Inflammation Index Predicts Restenosis after Interventions for Lower Extremity Arteriosclerosis Obliterans.
Tian SY
Heart Surg Forum · 2023 May · PMID 37401437 · Publisher ↗
BACKGROUND: To investigate the association between the pretreatment systemic immune-inflammation index (SII) and restenosis after interventions for lower extremity arteriosclerosis obliterans (ASO). METHODS: We retrospec...
BACKGROUND: To investigate the association between the pretreatment systemic immune-inflammation index (SII) and restenosis after interventions for lower extremity arteriosclerosis obliterans (ASO). METHODS: We retrospectively evaluated 309 patients with ASO who underwent endovascular interventions between January 2018 and December 2021. Pretreatment inflammatory markers, including the SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and C-reactive protein (CRP) were collected. The logistic regression model was used to determine the associations between these inflammatory markers and restenosis. Clinical manifestations, ankle-brachial index (ABI), and quality of life after intervention also were compared. RESULTS: The pretreatment SII (p < 0.001), NLR (p < 0.001), PLR (p < 0.001), SIRI (p = 0.002), AISI (p < 0.001), and CRP (p = 0.036) were significantly higher in patients with restenosis than in those without restenosis. Among the four markers, SII had the highest area under the curve (AUC) in predicting restenosis (SII vs. NLR vs. PLR vs. SIRI vs. AISI vs. CRP: 0.715 vs. 0.689 vs. 0.695 vs. 0.643 vs. 0.691 vs. 0.596). Multivariate analysis revealed that the pretreatment SII was the only independent factor for restenosis (hazard ratio [HR]: 4.102; 95% confidence interval [CI]: 1.155-14.567; p = 0.029). Moreover, a lower SII was associated with significantly better improvements in clinical manifestations (Rutherford classification 1-2: 67.5% vs. 52.9%, p = 0.038) and ABI (median: 0.29 vs. 0.22; p = 0.029), together with better quality of life (p < 0.05 for physical functioning, social functioning, pain, and mental health). CONCLUSIONS: The pretreatment SII is an independent predictor of restenosis after interventions in patients with lower extremity ASO, providing more accurate prognosis prediction than other inflammatory markers.
Thoracic Endovascular Aortic Repair Versus Open Surgery for Stanford Type B Aortic Dissection: A Meta-Analysis and Systematic Review.
Yu Y, Wang J, Duan B … +1 more , Wang P
Heart Surg Forum · 2023 Jun · PMID 37401436 · Publisher ↗
BACKGROUND: Thoracic endovascular aortic repair is a relatively new technique relative to open surgery, and our aim was to assess whether there is a difference in the risk of common postoperative complications between th...
BACKGROUND: Thoracic endovascular aortic repair is a relatively new technique relative to open surgery, and our aim was to assess whether there is a difference in the risk of common postoperative complications between thoracic endovascular aortic repair and open surgery. METHODS: The PubMed, Web of Science, and Cochrane library were systematically searched for trials comparing thoracic endovascular aortic repair and open surgical repair from January 2000 to September 2022. Primary outcome was death, other outcomes included common associated complications. Data were combined using risk ratio or standardized mean difference with 95% confidence interval. Funnel plot and egger's test were used for assessing publication bias. The study protocol was registered prospectively with PROSPERO (CRD42022372324). RESULTS: This trial included 11 controlled clinical studies with 3667 patients. Thoracic endovascular aortic repair had lower risk of death (risk ratio [RR], 0.59; 95% CI, 0.49 to 0.73; p < 0.00001; I2 = 0), dialysis (RR, 0.55; 95% CI, 0.47 to 0.65; p < 0.00001; I2 = 37%), stroke (RR, 0.71; 95% CI, 0.51 to 0.98; p = 0.03; I2 = 40%), bleeding (RR, 0.44; 95% CI, 0.23 to 0.83; p = 0.01; I2 = 56%), and respiratory complications (RR, 0.67; 95% CI, 0.60 to 0.76; p < 0.00001; I2 = 37%) compared with open surgical repair. In addition, the length of hospital stay was shorter in the thoracic endovascular aortic repair group (SMD, -0.84; 95% CI, -1.30 to -0.38; p = 0.0003; I2 = 80%). CONCLUSIONS: Thoracic endovascular aortic repair has significant advantages over open surgical repair, in terms of postoperative complications and survival in Stanford type B aortic dissection patients.
Application of Machine Learning Algorithms to Predict New-Onset Postoperative Atrial Fibrillation and Identify Risk Factors Following Isolated Valve Surgery.
Zhu S, Che H, Fan Y … +1 more , Jiang S
Heart Surg Forum · 2023 Jun · PMID 37401435 · Publisher ↗
BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common complication after valvular surgery, but its etiology and risk factors are incompletely understood. This study investigates the benefits o...
BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common complication after valvular surgery, but its etiology and risk factors are incompletely understood. This study investigates the benefits of machine learning methods in risk prediction and in identifying relative perioperative variables for POAF after valve surgery. METHODS: This retrospective study involved 847 patients, who underwent isolated valve surgery from January 2018 to September 2021 in our institution. We used machine learning algorithms to predict new-onset postoperative atrial fibrillation and to select relatively important variables from a set of 123 preoperative characteristics and intraoperative information. RESULTS: The support vector machine (SVM) model demonstrated the best area under the receiver operating characteristic (AUC) value of 0.786, followed by logistic regression (AUC = 0.745) and the Complement Naive Bayes (CNB) model (AUC = 0.672). Left atrium diameter, age, estimated glomerular filtration rate (eGFR), duration of cardiopulmonary bypass, New York Heart Association (NYHA) class III-IV, and preoperative hemoglobin were high-ranked variables. CONCLUSIONS: Risk models based on machine learning algorithms may be superior to traditional models, which were primarily based on logistic algorithms to predict the occurrence of POAF after valve surgery. Further prospective multicenter studies are needed to confirm the performance of SVM in predicting POAF.
Debranching Thoracic Endovascular Aortic Repair Combined with Ascending Aortic Banding: Analysis of a New Surgical Procedure.
Gao HQ, Xu SD, Zheng J
Heart Surg Forum · 2023 Jun · PMID 37401434 · Publisher ↗
BACKGROUND: To analyze the clinical effect of debranching thoracic endovascular aortic repair combined with ascending aortic banding. METHODS: The clinical data of patients who underwent a debranching thoracic endovascul...
BACKGROUND: To analyze the clinical effect of debranching thoracic endovascular aortic repair combined with ascending aortic banding. METHODS: The clinical data of patients who underwent a debranching thoracic endovascular aortic repair combined with ascending aortic banding at Anzhen Hospital (Beijing, China) between January 2019 and December 2021 were reviewed to evaluate the occurrence and outcomes of postoperative complications. RESULTS: A total of 30 patients underwent a debranching thoracic endovascular aortic repair combined with ascending aortic banding. There were 28 male patients (93.3%) with an average age of 59.9 ± 11.8 years. Twenty-five patients underwent simultaneous surgery and five patients had staged surgery. Postoperatively, two patients developed complete paraplegia (6.7%), three patients developed incomplete paraplegia (10%), two patients developed cerebral infarction (6.7%), and one patient developed femoral artery thromboembolism (3.3%). No patient died during the perioperative period, and one patient (3.3%) died during the follow-up period. None of the patients underwent retrograde type A aortic dissection during the perioperative and postoperative follow-up periods. CONCLUSIONS: Banding the ascending aorta with a vascular graft to restrict its movement and to serve as the proximal anchoring area of the stent graft can reduce the risk of retrograde type A aortic dissection.
A Study for QOL and Surgical Incision Pain in Patients Undergoing Totally Thoracoscopic Combined Aortic and Mitral Valve Replacement Surgery.
Xu Z, Wang H, Wang W … +1 more , Dai X
Heart Surg Forum · 2023 May · PMID 37401433 · Publisher ↗
BACKGROUND: In recent years, based on traditional median sternotomy surgery, totally thoracoscopic for aortic and mitral valve replacement surgery is increasingly being performed despite little published evidence. This s...
BACKGROUND: In recent years, based on traditional median sternotomy surgery, totally thoracoscopic for aortic and mitral valve replacement surgery is increasingly being performed despite little published evidence. This study investigated postoperative pain and short-term quality of life (QOL) of patients undergoing double valve replacement surgery. METHODS: From November 2021 to December 2022, 141 patients with double valvular heart disease who underwent thoracoscopic group (N = 62) and median sternotomy group (N = 79) were included. Clinical data were recorded, and a visual analog scale (VAS) was used to measure postoperative pain intensity. The medical outcomes study (MOS) 36-item Short-Form Health Survey assessed short-term QOL after surgery. RESULTS: Sixty-two patients underwent total thoracic double valve replacement, and 79 patients underwent median sternotomy double valve replacement. Both groups were similar in terms of demographics and general clinical data, as well as the incidence of postoperative adverse events. The VAS scores of the thoracoscopic group were lower than those in the median sternotomy group. The hospital stay time was significantly shorter in the thoracoscopic group than in the median sternotomy group (30.2 ± 12 days vs. 36 ± 19 days, p = 0.03). The scores of bodily pains and some of the subscales in SF-36 were significantly different between the two groups (p < 0.05). CONCLUSIONS: Thoracoscopic combined aortic and mitral valve replacement surgery can reduce postoperative pain and improve short-term postoperative QOL, which has specific clinical application value.
Cost-Effectiveness and Clinical Outcome of Transcatheter Versus Sutureless Aortic Valve Replacement.
Indelen C, Bas T, Kar A … +4 more , Ergenç E, Karademir BC, Sismanoglu M, Kirali K
Heart Surg Forum · 2023 Jun · PMID 37401432 · Publisher ↗
BACKGROUND: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are becoming increasingly common. The aim of this study is to compare the clinical outcome and cost-effectivenes...
BACKGROUND: Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are becoming increasingly common. The aim of this study is to compare the clinical outcome and cost-effectiveness of the two methods. METHODS: In this study, cross-sectional retrospective data were collected on 327 patients who underwent SU-AVR (n = 168) and TAVI (n = 159). Homogeneous groups were provided by the "propensity score matching" method, and 61 patients from the SU-AVR group and 53 patients from the TAVI group were included in the study sample. RESULTS: The two groups did not have statistically different death rates, complications after surgery, lengths of hospital stays, or visits to the intensive care unit. It is stated that the SU-AVR method provides an additional 1.14 Quality-Adjusted Life Year (QALY) compared to the TAVI method. The TAVI was more expensive than the SU-AVR in our study, but the difference was not statistically significant ($40,520.62 vs. $38,405.62, p > 0.05). For SU-AVR, the most expensive factor was the length of stay in the intensive care unit; for TAVI, it was arrhythmia, bleeding, and renal failure. CONCLUSIONS: These bioprostheses are safe and effective treatments for valve stenosis. Clinical outcomes were similar between the two groups. Therefore, clinicians may find it difficult to determine an effective treatment strategy. According to the evaluation made in terms of cost-effectiveness, it was found that the SU-AVR method gave a higher QALY at a lower cost compared to the TAVI method. However, this result is not statistically significant.
Early and Mid-Term Outcomes of Delayed Sternum Closure Strategy in Adult Cardiac Surgery: A Single-Center Experience.
Alagha S, Çiçekçioğlu F, Ekim H … +1 more , Miniksar ÖH
Heart Surg Forum · 2023 May · PMID 37401431 · Publisher ↗
BACKGROUND: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of...
BACKGROUND: Delayed sternum closure is a crucial strategy in the management of hemodynamic instability after weaning from cardiopulmonary bypass. This study aimed to evaluate our outcomes with this technique in light of the literature. METHODS: We retrospectively reviewed the data of all the patients who developed postcardiotomy hemodynamic compromise and intraaotic balloon pump was inserted between November 2014 to January 2022. Patients were divided into two groups: primary sternal closure group, and delayed sternum closure group. Patients' demographic data, hemodynamic parameters, and postoperative morbidities were recorded. RESULTS: Delayed sternum closure was performed in 16 patients with an incidence of 3.6%. The most common indication was hemodynamic instability in 14 patients (82%), followed by arrhythmia in 2 patients (12%) and diffuse bleeding in 1 patient (6%). The mean time to sternum closure was 21 (±7) hours. Three patients died (19%), p > 0.999. The median follow-up period was 25 months. Survival analysis revealed that the survival rate was 92%, p = 0.921. Deep sternal infection was observed in one patient with (6%), p > 0.999. multivariate logistic regression analysis revealed that end-diastolic diameter [odds ratio (OR) 4.5, 95% CI (1.19-17), p = 0.027], right ventricle diameter [OR 3.9, 95% CI (1.3-10.7), p = 0.012] and aortic clamp time [OR 1.16, 95% CI (1.02-1.12), p = 0.008] were independent risk factors for delayed sternum closure. CONCLUSIONS: Elective delayed sternal closure is a safe and effective method for treating postcardiotomy hemodynamic instability. It can be performed with a low incidence of mortality and sternal infections.
Comparison of Carotid Blood Flow Measured by Ultrasound and Cardiac Output in Patients Undergoing Cardiac Surgery.
Bu XY, Wang JK, Zhang Y … +5 more , Chen LH, Liu JC, Zhao YM, Shi HW, Ge YL
Heart Surg Forum · 2023 May · PMID 37401430 · Publisher ↗
BACKGROUND: In general, cerebral blood flow accounts for 10-15% of cardiac output (CO), of which about 75% is delivered through the carotid arteries. Hence, if carotid blood flow (CBF) is constantly proportional to CO wi...
BACKGROUND: In general, cerebral blood flow accounts for 10-15% of cardiac output (CO), of which about 75% is delivered through the carotid arteries. Hence, if carotid blood flow (CBF) is constantly proportional to CO with high reproducibility and reliability, it would be of great value to measure CBF as an alternative to CO. The aim of this study was to investigate the direct correlation between CBF and CO. We hypothesized that measurement of CBF could be a good substitute for CO, even under more extreme hemodynamic conditions, for a wider range of critically ill patients. METHODS: Patients aged 65-80 years, undergoing elective cardiac surgery were included in this study. CBF in different cardiac cycles were measured by ultrasound: systolic carotid blood flow (SCF), diastolic carotid blood flow (DCF), and total (systolic and diastolic) carotid blood flow (TCF). CO simultaneously was measured by transesophageal echocardiography. RESULTS: For all patients, the correlation coefficients between SCF and CO, TCF and CO were 0.45 and 0.30, respectively, which were statistically significant, but not between DCF and CO. There was no significant correlation between either SCF, TCF or DCF and CO, when CO was <3.5 L/min. CONCLUSIONS: Systolic carotid blood flow may be used as a better index to replace CO. However, the method of direct measurement of CO is essential when the patient's heart function is poor.
Perioperative Levels of Troponin and BNP and the Outcome after Coronary Artery Bypass Grafting.
Abdelrehim AR, Alnasser FA, Alnozaha FA … +8 more , Uddin MSH, Sandogji HI, Aynusah HR, Alluhaybi ASS, Alahmadi RA, Alahmadi HM, Alharbi WM, Shabaan AM
Heart Surg Forum · 2023 May · PMID 37401429 · Publisher ↗
BACKGROUND: The independent predictive values of troponin I (cTnI) and B-type natriuretic peptide (BNP) after coronary artery bypass grafting (CABG) have been reported in several studies. However, adjustment only has bee...
BACKGROUND: The independent predictive values of troponin I (cTnI) and B-type natriuretic peptide (BNP) after coronary artery bypass grafting (CABG) have been reported in several studies. However, adjustment only has been limited to preoperative risk factors. AIM: This study was conducted to assess the independent values of postoperative cTnI and BNP to predict the outcome after CABG with adjustment for preoperative risk estimates and postoperative complications and to report risk stratification gains, when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE) combined with postoperative biomarkers. METHODS: This retrospective cohort study included 282 consecutive patients undergoing CABG between January 2018 and December 2021. We evaluated the preoperative and postoperative cTnI and BNP, EuroSCORE, and postoperative complications. The composite endpoint was death or cardiac-related adverse events. RESULTS: The AUROC for postoperative cTnI was significantly higher than that of BNP (0.777 vs. 0.625, p = 0.041). The optimal cut-off values to predict the composite outcome were >4830 (pg/mL) and >6.95 (ng/mL) for BNP and cTnI, respectively. Adjustment for relevant and significant perioperative factors showed that postoperative BNP and cTnI had a high discriminatory power (C-index = 0.773 and 0.895, respectively) for predicting major adverse events. CONCLUSIONS: Postoperative BNP and cTnI are independent predictors of death or major adverse events, following CABG, and can add to the predictive power of EuroSCORE II.
Aortic Root Dilatation Measured by Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot.
Chungsomprasong P, Kraikriangsri C, Vijarnsorn C … +6 more , Chanthong P, Durongpisitkul K, Pacharapakornpong T, Kanjanauthai S, Nakyen S, Soongswang J
Heart Surg Forum · 2023 Jun · PMID 37401428 · Publisher ↗
BACKGROUND: Aortic root dilatation (AoD) frequently occurs following repaired tetralogy of Fallot (rTOF). The objective of this study was to assess aortic dimensions, investigate the prevalence of AoD, and identify predi...
BACKGROUND: Aortic root dilatation (AoD) frequently occurs following repaired tetralogy of Fallot (rTOF). The objective of this study was to assess aortic dimensions, investigate the prevalence of AoD, and identify predictors of AoD in rTOF patients. METHODS: A cross-sectional retrospective study was conducted in repaired TOF patients from 2009 to 2020. Aortic root diameters were measured by cardiac magnetic resonance (CMR). Severe AoD of the aortic sinus (AoS) was defined as a Z-score (z) of >4, reflecting a mean percentile ≥99.99%. RESULTS: Two hundred forty-eight patients, with a median age of 28.2 years (10.2-65.3 years), were included in the study. The median age at the time of repair was 6.6 years (0.8-40.5 years) and the median interval between the repair and CMR study was 18.9 years (2.0-54.8 years). The prevalence of severe AoD was found to be 35.2% when defined by an AoS z greater than 4 and 27.6% when defined by a AoS diameter ≥40 mm, respectively. A total of 101 patients (40.7%) had aortic regurgitation (AR), with 7 patients (2.8%) having moderate AR. Multivariate analysis revealed that severe AoD was only associated with the left ventricular end diastolic volume index (LVEDVi) and a longer duration after repair. The age at the time of repair for TOF was found not to be correlated with the development of AoD. CONCLUSIONS: After repair of TOF, severe AoD was found to be prevalent, but no fatal complications were observed in our study. Mild AR was also commonly observed. Larger LVEDVi and a longer duration after repair were identified as factors associated with the development of severe AoD. Therefore, routine monitoring of AoD is recommended.
Clinical Characteristics of Acute Lower Extremity Ischemia Due to Left Atrial Myxoma: A Rare Case Report with Review of Literature.
Zhou H, Yin Y, Sun Z
Heart Surg Forum · 2023 Jun · PMID 37401427 · Publisher ↗
Emboli caused by cardiac myxomas mostly occur in the cardiovascular or cerebrovascular systems and rarely in the lower extremity vasculature. We introduce the rare case of a patient with left atrial myxoma (LAM) whose ri...
Emboli caused by cardiac myxomas mostly occur in the cardiovascular or cerebrovascular systems and rarely in the lower extremity vasculature. We introduce the rare case of a patient with left atrial myxoma (LAM) whose right lower extremity (RLE) suffered from acute ischemia due to tumor fragments, along with a review of the relevant literature, and highlight the clinical characteristics of LAM. An 81-year-old female presented with acute ischemia of RLE. Color Doppler ultrasound showed no blood flow signal far from the RLE femoral artery. Computed tomography angiography showed an occlusion of the right common femoral artery. A transthoracic echocardiogram revealed a left atrial mass. Femoral artery embolectomy was performed under local anesthesia, followed by thoracotomy with tumor resection under general anesthesia on postoperative day seven. The tumor was pathologically confirmed as an atrial myxoma. A literature search of the PubMed database returned 58 cases of limb ischemia due to LAM, and the conclusions drawn from the statistical analysis were that emboli from LAM occurred most commonly in the aortoiliac and bilateral lower limb vasculature and were rarely associated with upper extremity and atrial fibrillation. Multisystem embolism is characteristic of cardiac myxoma. The removed embolus should be examined pathologically for signs of a cardiac myxoma. Lower-limb embolisms should be promptly diagnosed and treated to avoid osteofascial compartment syndrome.
Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement.
Gursoy M, Yaşar E, Guler S … +5 more , Yalcin L, Muradli T, Kadirogullari E, Kutluk E, Aydin U
Heart Surg Forum · 2023 Jun · PMID 37401426 · Publisher ↗
BACKGROUND: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with p...
BACKGROUND: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. METHODS: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. RESULTS: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). CONCLUSIONS: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.
A Potential Marker for Prognosis in Giant Left Ventricular Patients Undergoing Valve Surgery.
Fan L, Wu Y, Liu F … +1 more , Wu X
Heart Surg Forum · 2023 Jun · PMID 37401425 · Publisher ↗
BACKGROUND: Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoi...
BACKGROUND: Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoing valve surgery are still unknown. The purpose of this study was to explore the possible impact factors for giant left ventricle prognosis. METHODS: From September 2019 to September 2022, 75 patients with preoperative valvular disease with a giant left ventricle (left ventricular end diastolic diameter (LVEDD) >65 mm) underwent cardiac valve surgery. The changes in cardiac function one year after surgery were used to describe prognosis and analyze the potential independent factors affecting surgical prognosis. The left ventricular ejection fraction (LVEF) was considered to be recovered if it was ≥50% on follow-up echocardiography at least 6 months after the diagnosis. RESULTS: The cardiac function of patients with a giant left ventricular and valve disease improved. Compared with preoperation, the left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP), NT-proBNP, and cardio thoracic ratio (CTR) were significantly decreased (p < 0.05), and the ratio of severe heart failure was decreased from 60% to 37.33%. In the univariate analyses, the preoperative NT-proBNP levels and PASP were significantly associated with the cardiac function recovery (odds ratio [OR] = 1.001, 95% CI 1.000-1.002, p = 0.027; OR = 1.092, 95% CI 1.015-1.175, p = 0.018). However, during the diagnostic test, PASP did not account for cardiac function recovery (AUROC = 0.505, 95% CI = 0.387-0.713, p = 0.531). Based on the cutoff value in the experiment, we found that a NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757-0.946, p < 0.0001) was a potential prognostic marker for patients with a giant left ventricular valve disease. CONCLUSIONS: We have demonstrated that an elevated preoperative NT-proBNP level is an independent predictor of cardiac function recovery in a cohort of giant left ventricular patients undergoing valve surgery, and this is the first study about this specific cohort of patients.
Evaluating Short-Term Postoperative Outcomes in Minimally Invasive Mitral Valve Surgery for Patients with Rheumatic Disease.
Ushioda R, Shirasaka T, Sakboon B … +5 more , Cheewinmethasiri J, Yoongtong D, Hirofuji A, Kamiya H, Arayawudhikul N
Heart Surg Forum · 2023 Apr · PMID 37271578 · Publisher ↗
Minimally invasive mitral valve surgery (MIMVS) is widespread and has become a standard procedure in cardiac surgery [Chitwood 1997; Carpentier 1996]. Therefore, MIMVS is a common procedure for patients with degenerative...
Minimally invasive mitral valve surgery (MIMVS) is widespread and has become a standard procedure in cardiac surgery [Chitwood 1997; Carpentier 1996]. Therefore, MIMVS is a common procedure for patients with degenerative disease [Raanani 2010; Iribarne 2010] as well. However, the safety of MIMVS in patients with rheumatic heart disease (RHD) has not thoroughly been investigated, due to the low prevalence of RHD in developed countries, where MIMVS is standardized [Miceli 2015]. Here, we investigated the safety of MIMVS for patients with RHD at Lampang Hospital in Thailand.
Yoga Can Help You Practice and Teach Cardiothoracic Surgery.
Pastrana C, Tribble C
Heart Surg Forum · 2023 Apr · PMID 37216336 · Publisher ↗
Those who practice, and teach, thoracic and cardiovascular surgery and those who are training in this realm, as well as in many other disciplines, often endure debilitating physical stress and strain as a result of their...
Those who practice, and teach, thoracic and cardiovascular surgery and those who are training in this realm, as well as in many other disciplines, often endure debilitating physical stress and strain as a result of their practices. [Bishop, 2023] Despite the attention paid to issues such as proper adjustments for loupe magnification, optimal footwear, attention to 'micro-breaks', and paying attention to the ergonomics of performing long and intense operations, many surgeons still suffer discomfort and debility, and, even, disability. [Dalagher, 2019, Epstein, 2018, Alleblas, 2017, Giagio, 2019, Norasi, 2021] Dealing with those challenges should include what those practitioners can do outside of the operating room to increase their comfort and resilience, as well as what can be done in the operating room. One approach to dealing with these issues is to utilize the lessons and benefits of yoga. [Tribble, 2016].
Zen and the Art of Thriving in the Clerkship Year of Medical School.
Tribble C, Teman N
Heart Surg Forum · 2023 Apr · PMID 37216323 · Publisher ↗
You, as third year medical students, are all among the best learners on the planet. You had to be to get into this, or any other, medical school. Your academic prowess has been put to good use both prior to and in the fi...
You, as third year medical students, are all among the best learners on the planet. You had to be to get into this, or any other, medical school. Your academic prowess has been put to good use both prior to and in the first couple of years of med school. However, you are getting ready to start into the rest of your careers, when many, if not most, of those finely tuned academic and personal skills will not be as applicable to learning and working as clinical trainees nor, eventually, medical practitioners, as those skills have been in most of your prior educational experiences. Candidly, when I was making this same transition myself, over four decades ago, it took me a while, probably quite a while, to really come to grips with this transition. Between those days and now, I have spent quite a lot of time immersed in medical education, at every level from younger medical students to chief residents training in thoracic and cardiovascular surgery. At each level of your education and training, you will have to sort out the best educational strategies for yourself.
Implantation of a Sutureless Valve Into a Stented Prosthesis: An Open Salvage Procedure.
Alizzi A, Edwards J, Markou M … +3 more , Sanderson A, Ottens J, Polok D
Heart Surg Forum · 2023 Apr · PMID 37115005 · Publisher ↗
BACKGROUND: A 78-year-old male was admitted to our institute with increasing shortness of breath and decreased exercise tolerance. His increasing symptoms were not relieved with medical management. He had a complex medic...
BACKGROUND: A 78-year-old male was admitted to our institute with increasing shortness of breath and decreased exercise tolerance. His increasing symptoms were not relieved with medical management. He had a complex medical history that included aortic valve replacement (AVR). Echocardiography showed a deteriorating aortic bioprosthesis with severe aortic regurgitation. METHOD: Intraoperative extraction of this prosthesis proved technically challenging and a valve in valve successfully was implanted as a salvage procedure. RESULTS: The procedure was successful, and the patient made a full recovery. CONCLUSION: Open valve in valve implantation, despite technical difficulties, may be utilized as a salvage procedure.
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