Heart, Lung and Circulation最新文献

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Audit on the Use of Computed Tomography Coronary Angiography at Christchurch Hospital 对基督城医院计算机断层扫描冠状动脉造影术使用情况的审计

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.091

引用次数: 0

Assessment of Sub Clinical Left Ventricular Ischemia using Oxygen Sensitive Cardiovascular Magnetic Resonance Imaging in Patients with Systemic Sclerosis 利用氧敏感心血管磁共振成像评估系统性硬化症患者亚临床左心室缺血情况

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.088

引用次数: 0

Time to Support Cardiac Sonographer-Led Transthoracic Reporting—A Pilot Study 支持心脏超声技师经胸报告的时间--试点研究

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.070

引用次数: 0

Investigating the Role of Genes and the Environment in Heart Failure With Preserved Ejection Fraction 研究基因和环境在射血分数保留型心力衰竭中的作用

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.019

引用次数: 0

Cost-Effectiveness of Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation in the Australian Health Care System 心血管磁共振用于澳大利亚医疗系统心脏移植术后排斥反应监测的成本效益。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.03.004

Background

Heart transplantation is an effective treatment for end-stage congestive heart failure, however, achieving the right balance of immunosuppression to maintain graft function while minimising adverse effects is challenging. Serial endomyocardial biopsies (EMBs) are currently the standard for rejection surveillance, despite being invasive. Replacing EMB-based surveillance with cardiac magnetic resonance (CMR)-based surveillance for acute cardiac allograft rejection has shown feasibility. This study aimed to assess the cost-effectiveness of CMR-based surveillance in the first year after heart transplantation.

Method

A prospective clinical trial was conducted with 40 orthotopic heart transplant (OHT) recipients. Participants were randomly allocated into two surveillance groups: EMB-based, and CMR-based. The trial included economic evaluations, comparing the frequency and cost of surveillance modalities in relation to quality-adjusted life years (QALYs) within the first year post-transplantation. Sensitivity analysis encompassed modelled data from observed EMB and CMR arms, integrating two hypothetical models of expedited CMR-based surveillance.

Results

In the CMR cohort, 238 CMR scans and 15 EMBs were conducted, versus (vs) 235 EMBs in the EMB group. CMR surveillance yielded comparable rejection rates (CMR 74 vs EMB 94 events, p=0.10) and did not increase hospitalisation risk (CMR 32 vs EMB 46 events, p=0.031). It significantly reduced the necessity for invasive EMBs by 94%, lowered costs by an average of AUD$32,878.61, and enhanced cumulative QALY by 0.588 compared with EMB. Sensitivity analysis showed that increased surveillance with expedited CMR Models 1 and 2 were more cost-effective than EMB (all p<0.01), with CMR Model 1 achieving the greatest cost savings (AUD$34,091.12±AUD$23,271.86 less) and utility increase (+0.62±1.49 QALYs, p=0.011), signifying an optimal cost–utility ratio. Model 2 showed comparable utility to the base CMR model (p=0.900) while offering the benefit of heightened surveillance frequency during periods of elevated rejection risk.

Conclusions

CMR-based rejection surveillance in orthotopic heart transplant recipients provides a cost-effective alternative to EMB-based surveillance. Furthermore, it reduces the need for invasive procedures, without increased risk of rejection or hospitalisation for patients, and can be incorporated economically for expedited surveillance. These findings have important implications for improving patient care and optimising resource allocation in post-transplant management.

背景：心脏移植是治疗终末期充血性心力衰竭的有效方法，然而，如何在保持移植功能的同时最大限度地减少不良反应，实现免疫抑制的适当平衡是一项挑战。连续心内膜活检（EMB）是目前监测排斥反应的标准方法，尽管它具有创伤性。用基于心脏磁共振（CMR）的急性心脏同种异体移植排斥反应监测取代基于 EMB 的监测已显示出可行性。本研究旨在评估心脏移植术后第一年基于CMR监测的成本效益：方法：对 40 名正位心脏移植（OHT）受者进行了前瞻性临床试验。参与者被随机分配到两个监测组：以 EMB 为基础的监测组和以 CMR 为基础的监测组。试验包括经济评估，比较了移植后第一年内监测模式的频率和成本与质量调整生命年（QALYs）的关系。敏感性分析包括观察到的EMB和CMR臂的模型数据，整合了基于CMR的快速监测的两个假设模型：CMR组共进行了238次CMR扫描和15次EMB检查，而EMB组共进行了235次EMB检查。CMR监测的排异率相当（CMR 74 例 vs EMB 94 例，P=0.10），且不增加住院风险（CMR 32 例 vs EMB 46 例，P=0.031）。与 EMB 相比，CMR 将侵入性 EMB 的必要性大幅降低了 94%，平均成本降低了 32,878.61 澳元，累计 QALY 提高了 0.588。敏感性分析表明，与 EMB 相比，通过加快 CMR 模式 1 和 2 加强监控更具成本效益（所有 pConclusions）：对正位心脏移植受者进行基于 CMR 的排斥监测，是一种替代 EMB 监测的经济有效的方法。此外，它减少了对侵入性程序的需求，不会增加排斥反应或患者住院的风险，而且可以经济地纳入快速监测。这些发现对改善患者护理和优化移植后管理的资源分配具有重要意义。

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引用次数: 0

Successful Implementation of Enhanced Recovery After Surgery (ERAS) in Paediatric Cardiac Surgery in Australia 澳大利亚在小儿心脏手术中成功实施了术后强化恢复 (ERAS)。

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.01.029

Background & Aim

Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia.

Methods

All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions.

Results

Of 1,084 patients who underwent cardiac surgery during the study period (October 2019–July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8–8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28–53.5 minutes) and 24.5 min (IQR 13–34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1–5.6 hours) and 4 days (IQR 4–5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups.

Conclusions

ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources.

背景& 目的快速通道或术后强化恢复（ERAS）是一种基于多学科团队方法的手术患者护理路径，旨在通过基于科学证据的方案在不增加风险的情况下优化恢复，并对方案进行持续监测，以确保合规和改进。这些方案已被证明可以缩短儿科心脏手术后机械通气的时间和重症监护室（ICU）的住院时间（LOS）。我们介绍了澳大利亚首次在儿科心脏手术中有序实施 ERAS 的情况。方法确定了 2019 年 10 月至 2023 年 7 月期间所有加入 ERAS 途径的患者。从医院记录中回顾性收集了2021年6月前手术患者的人口统计学和围手术期数据，并从2021年6月起前瞻性收集了这些数据。通过倾向匹配，从接受类似手术且未加入 ERAS 途径（2019 年 10 月之前）的患者中确定了对照组（非 ERAS）。患者的年龄、体重和阿里斯托尔综合评分均匹配。研究结果在研究期间（2019年10月至2023年7月）接受心脏手术的1084名患者中，有121名患者（11.2%）遵循了ERAS路径。手术时的中位年龄为4.8岁（四分位距[IQR] 2.8-8.8岁）。最常见的手术是关闭房间隔缺损（58 人，占 47.9%）。心肺旁路和交叉钳夹的中位时间分别为 40 分钟（IQR 28-53.5 分钟）和 24.5 分钟（IQR 13-34 分钟）。大多数患者在手术室拔管（108人，占89.3%）。重症监护室和住院时间的中位数分别为4.5小时（IQR 4.1-5.6小时）和4天（IQR 4-5天）。没有一名患者需要在从重症监护室出院后 24 小时内再次入住重症监护室。三（3）名患者（2.5%）需要再次介入治疗。与非ERAS组相比，ERAS组的术后机械通气时间、重症监护室和住院时间均明显缩短。两组患者的 ICU 再入院率、再介入率、并发症发生率和 30 天再入院次数均无明显差异。这种方法缩短了术后机械通气时间、重症监护室和住院时间，同时不会增加风险，从而实现了资源优化。

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引用次数: 0

Atrial and Ventricular Arrhythmias in Young, Lifelong and Retired Elite Endurance Athletes 年轻、终身和退役耐力精英运动员的心房和室性心律失常

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.034

引用次数: 0

Cinefluoroscopy Projection Angles for Optimal Aortic Mechanical Heart Valve Assessment 用于主动脉机械心脏瓣膜最佳评估的 Cinefluoroscopy 投影角度

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.100

引用次数: 0

Survival after Surgery for Isolated Rheumatic Aortic Disease in Under 18s 18 岁以下孤立性风湿性主动脉疾病手术后的存活率

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.040

引用次数: 0

Total Arterial Revascularisation Improves Long-Term Survival in Diabetic and Non-Diabetic Patients 全动脉血管再通术可提高糖尿病和非糖尿病患者的长期生存率

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation

Pub Date : 2024-08-01 DOI: 10.1016/j.hlc.2024.06.048

引用次数: 0

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