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Clinical Outcomes with High- versus Low-Dose Tranexamic Acid Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-22 DOI: 10.1055/s-0044-1791233
Hussain Sohail Rangwala, Burhanuddin Sohail Rangwala, Moath Alotaibi, Mohammad Arham Siddiq, Amna Qamber, Syeda Dua E Zehra Zaidi, Tooba Naveed, Hufsa Naveed, Syed Talal Azam, Ishaque Hameed

Objectives:  Antifibrinolytics, such as tranexamic acid (TXA), are widely used in cardiac surgery to reduce bleeding risks; however, the optimal dosage for TXA infusion remains a subject of debate. Hence, this study aims to evaluate the safety and efficacy of high-dose compared with low-dose TXA infusion in cardiac surgery patients.

Methods:  PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched until June 10, 2023, for studies assessing efficacy outcomes (e.g., blood loss, transfusions) and safety outcomes (e.g., mortality, complications).

Results:  Results were analyzed via random-effects model, using Mantel-Haenszel risk ratio (RR) and standard mean difference (SMD). P-value < 0.05 was considered significant. We analyzed 17 studies involving 93,206 participants (mean age 59.3 years, study duration 3 months to 10 years). Our analysis found significant reductions in total blood loss (SMD, -0.17 g; CI, -0.34 to -0.01; p = 0.04), 24-hour blood loss (SMD, -0.23 g; p = 0.005), and the need for fresh frozen plasma (FFP) transfusions (RR: 0.94; CI, 0.89 to 1.00; p = 0.05) with high-dose TXA. Chest tube output was also lower (SMD, -0.12 g; p = 0.0006), but postoperative seizures increased (RR: 2.23; CI, 1.70 to 2.93; p < 0.00001) with high-dose TXA. For other outcomes like blood transfusions, hospital/ICU stay, mortality, stroke, myocardial infarction, pulmonary embolism, renal dysfunction, and reoperation, no significant differences were found between high-dose and low-dose TXA regimens.

Conclusion:  Our study showed that high TXA dose effectively reduce postoperative bleeding, chest tube drainage, and the need for FFP transfusion, but it increases the risk of seizures. Increasing TXA dose did not affect thromboembolic events or mortality. This emphasizes the importance of weighing the benefits and risks when selecting the appropriate TXA regimen for each patient.

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引用次数: 0
Pathology-Independent Expansion of Indications for Rapid-Deployment Aortic Valve Replacement: Midterm Outcomes. 快速部署主动脉瓣置换术适应症的病理独立扩展:中期结果。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-21 DOI: 10.1055/s-0044-1790240
Seon Yong Bae, Kyung Hwan Kim, Suk Ho Sohn, Yoonjin Kang, Ji Seong Kim, Jae Woong Choi

Background:  This study evaluated the midterm outcomes of rapid deployment aortic valve replacement (RDAVR) performed regardless of pathology for various aortic valve diseases at a single center.

Methods:  Of the 344 patients who underwent RDAVR using Edwards INTUITY during the study period at our institution, 176 had bicuspid valve diseases (51.2%), 20 had pure aortic regurgitation (5.8%), and 4 had infective endocarditis (1.2%). Median follow-up duration was 28.6 months (maximum: 86.4 months). Midterm clinical outcomes were evaluated, and the changes of valve hemodynamics from early postoperative period to 5 years after surgery were also investigated.

Results:  Mean age was 68.9 ± 9.8 years, and 46.2% of the patients were female. Isolated RDAVR was performed in 90 patients (26.2%), and concomitant procedures, including aortic surgery (48.8%), mitral valve surgery (20.3%), arrhythmia surgery (9.0%), tricuspid valve surgery (7.0%), and coronary artery bypass grafting (5.5%), were performed in 254 patients (73.8%). Operative mortality occurred in 11 patients (3.2%), and permanent pacemaker implantation was required in 5 patients (1.5%) in early postoperative period. Overall survival rate was 86.9% at 5 years, and cumulative incidence of cardiac death was 6.3% at 5 years. No deterioration of valve hemodynamics was observed at midterm echocardiographic evaluation in either the overall population or for each size of valve.

Conclusion:  Isolated or concomitant aortic valve replacement using rapid-deployment valves was performed for various aortic valve diseases regardless of the underlying pathology at our institution, and the clinical and hemodynamic outcomes were excellent for up to 5 years.

背景:本研究评估了快速部署主动脉瓣置换术(RDAVR)的中期结果,不考虑病理,在单一中心治疗各种主动脉瓣疾病。方法:在我院344例使用Edwards INTUITY进行RDAVR的患者中,176例有双尖瓣疾病(51.2%),20例有单纯主动脉反流(5.8%),4例有感染性心内膜炎(1.2%)。中位随访时间为28.6个月(最长86.4个月)。评估中期临床结果,并研究术后早期至术后5年瓣膜血流动力学的变化。结果:患者平均年龄68.9±9.8岁,女性占46.2%。90例(26.2%)患者接受了孤立性RDAVR手术,254例(73.8%)患者接受了伴随手术,包括主动脉手术(48.8%)、二尖瓣手术(20.3%)、心律失常手术(9.0%)、三尖瓣手术(7.0%)和冠状动脉旁路移植术(5.5%)。11例(3.2%)患者发生手术死亡,5例(1.5%)患者术后早期需要植入永久性起搏器。5年总生存率为86.9%,5年累积心源性死亡发生率为6.3%。在中期超声心动图评估中,无论是总体人群还是每种大小的瓣膜,都没有观察到瓣膜血流动力学的恶化。结论:我们的机构对各种主动脉瓣疾病进行了单独或合并的快速部署瓣膜置换术,无论其潜在病理如何,临床和血流动力学结果都很好,长达5年。
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引用次数: 0
Analysis of Factors Affecting Prolonged Air Leak and Expansion Failure in the Lung after Resection in Patients with Pulmonary Malignancy and Predictive Value of Preoperative Quantitative Chest Computed Tomography. 恶性肺肿瘤患者术后肺长时间漏气和肺扩张失败的影响因素分析及术前定量胸部ct预测价值。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-21 DOI: 10.1055/a-2508-6067
Gizem Kececi Ozgur, Hasan Yavuz, Alpaslan Cakan, Kevser Durgun, Ayse Gul Ergonul, Tevfik Ilker Akcam, Ali Özdil, Selen Bayraktaroglu, Kutsal Turhan, Ufuk Cagirici

Background:  The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation area (LAA%) measured on preoperative quantitative chest computed tomography (Q-: CT) in predicting the development of postoperative PAL and the expansion time of the remaining lung (ET) in patients undergoing resection for lung malignancy was investigated.

Methods:  The data of 202 cases who underwent lung resection between July 2020 and December 2022 were analyzed. The factors affecting the development of PAL and ET were investigated using univariate and multivariate analyses. The cut-off value for LAA% was determined and its relationship with postoperative results was examined.

Results:  In univariate analyses, for PAL, age (p = 0.022), presence of chronic obstructive pulmonary disease (COPD; p < 0.001), body mass index (BMI; p = 0.006), FEV1 (p = 0.020), FEV1/FVC (p < 0.001), LAA% (p = 0.008), diagnosis (p = 0.007), and surgical procedure (p < 0.001); for ET, diagnosis (p < 0.001) and surgical procedure (p = 0.001) were significant factors. A negative correlation between ET and BMI and FEV1/FVC (p < 0.01) and a positive correlation (p < 0.05) was detected with LAA%. The cut-off value for LAA% was calculated as 1.065. Multivariate analyses showed that the probability of developing PAL, increased 3.17-, 7.68-, and 3.08-fold in patients with COPD, lobectomy, and those above the cut-off value for LAA%, respectively (p = 0.045, p < 0.001, and p = 0.011). In addition, FEV1/FVC (p = 0.027), BMI (p = 0.016), and surgical procedure (p = 0.001) were shown to be independent factors affecting ET.

Conclusion:  Our study revealed the factors affecting PAL and expansion failure in the lung. Within this scope, it was concluded that preoperative Q-CT may have an important role in predicting the development of PAL and ET in the postoperative period and that LAA% measurement is an effective, objective, and practical method for taking precautions against possible complications.

背景:分析影响肺恶性肿瘤切除术患者肺长时间漏气(PAL)和肺扩张失败的因素。在此背景下,研究了术前定量胸部计算机断层扫描(Q-: CT)测量的低衰减面积百分比(LAA%)在预测肺恶性肿瘤切除术患者术后PAL发展和剩余肺扩张时间(ET)中的价值。方法:对2020年7月至2022年12月期间行肺切除术的202例患者的资料进行分析。采用单因素和多因素分析探讨影响PAL和ET发展的因素。确定LAA%的临界值,并检查其与术后结果的关系。结果:在单变量分析中,对于PAL,年龄(p = 0.022),存在慢性阻塞性肺疾病(COPD;p = 0.006)、FEV1 (p = 0.020)、FEV1/FVC (p = 0.008)、诊断(p = 0.007)和手术方式(p p = 0.001)是影响因素。ET与BMI、FEV1/FVC呈负相关(p = 0.045, p = 0.011)。此外,FEV1/FVC (p = 0.027)、BMI (p = 0.016)和手术方式(p = 0.001)是影响et的独立因素。结论:本研究揭示了影响PAL和肺扩张衰竭的因素。在此范围内,我们认为术前Q-CT对预测术后PAL和ET的发展可能有重要作用,LAA%测量是一种有效、客观、实用的预防可能并发症的方法。
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引用次数: 0
Early Surgical Outcomes in Infective Endocarditis Before and During COVID-19 Pandemic. COVID-19 大流行之前和期间感染性心内膜炎的早期手术效果。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1055/a-2489-6268
Jang-Sun Lee, Virna L Sales, Annette Moter, Walter Eichinger

Background:  Infective endocarditis (IE) is associated with extremely high surgical mortality. During the SARS-CoV-2 pandemic, hospitals restructured their intensive care units and outpatient services to prioritize COVID-19 care, which may have affected the outcomes of patients requiring urgent procedures. This study aimed to evaluate the impact of the pandemic on surgical outcomes of IE patients in Southern Germany.

Methods:  This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 (n = 84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, n = 94). Preoperative status and postoperative in-hospital complications were analyzed and compared between the groups.

Results:  The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 versus 8 days, p = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% versus 68.1%, p = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% versus 33%; Class IV: 22.6% versus 11.7%, p = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown (p < 0.05). However, in-hospital survival rates did not differ significantly between the groups.

Conclusion:  The COVID-19 pandemic and related lockdown measures were associated with delayed diagnoses and worse perioperative outcomes for surgical IE patients, highlighting the need for improved management strategies during public health crises.

背景:感染性心内膜炎(IE感染性心内膜炎(IE)与极高的手术死亡率有关。在 SARS-CoV-2 大流行期间,医院重组了重症监护室和门诊服务,优先考虑 COVID-19 治疗,这可能会影响需要紧急手术的患者的治疗效果。本研究旨在评估疫情对德国南部 IE 患者手术效果的影响:这项基于社区的观察性研究比较了两组手术候选者:2020 年 3 月至 2021 年 11 月的大流行候选者(人数=84)和 2018 年 8 月至 2020 年 3 月的大流行前候选者(封锁前,人数=94)。对两组患者的术前状况和术后院内并发症进行了分析和比较:结果:大流行组从症状出现到确诊的时间间隔更长(14.5 天 vs. 8 天,p = 0.529)。根据修改后的杜克标准(82.1% vs. 68.1%,p = 0.035),锁定后确诊 IE 的发生率更高。锁定后患者的症状更严重(NYHA III 级:50% 对 33%;IV 级:22.6% 对 11.7%,p = 0.001)。术后并发症,如因出血而再次进行胸廓切开术和因急性肾功能衰竭而进行血液滤过,在封锁后发生的频率明显更高(P < 0.05)。然而,两组患者的院内存活率并无明显差异:结论:COVID-19 大流行和相关封锁措施与外科 IE 患者的诊断延迟和围手术期预后恶化有关,凸显了在公共卫生危机期间改进管理策略的必要性。
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引用次数: 0
Impact of Body Mass Index on the Initial Phase of a Minimally Invasive Aortic Valve Program. 身体质量指数对初始微创主动脉瓣程序的影响。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1055/a-2498-2031
Elias Ewais, Nadja Bauer, Markus Schlömicher, Matthias Bechtel, Vadim Moustafine, Nazha Hamdani, Justus T Strauch, Peter Lukas Haldenwang

Background:  In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the impact of body mass index (BMI) on the outcome of an initial MIS-AVR program.

Material and methods:  A total of 307 patients underwent MIS-AVR between January 2013 and December 2015, the initial phase of our MIS-AVR program. They were divided into normal/overweight (BMI <30 kg/m2) versus obese patients (BMI ≥30 kg/m2). Primary endpoints included 30-day and 2-year mortality and stroke. Secondary endpoints comprised type 3 bleeding, PPM, paravalvular leakage, wound healing disorders (WHDs), and pacemaker rates.

Results:  In all 191 patients exhibited a BMI <30 kg/m2, while 116 patients had a BMI ≥30 kg/m2. The BMI groups did not differ in baseline characteristics, excepting a higher peripheral arterial disease incidence among obese patients (15.7% vs. 26.7%; p = 0.01). Aortic clamp time (75 ± 29 min vs. 87 ± 37 min; p = 0.001), cardiopulmonary bypass (104 ± 36 min vs. 124 ± 56 min; p = 0.0002), and ventilation times (26 ± 6 h vs. 44 ± 8 h; p = 0.03) were longer in obese patients. They demonstrated a higher risk for bleeding (2.6% vs. 9.5%; p = 0.008) but lower pacemaker rates (9% vs. 3%; p = 0.02). PPM, paravalvular leakage, and WHD exhibited no group differences. No BMI-related differences revealed in 30-day mortality (4.7% vs. 3.4%) and stroke rates (2% vs. 2.6%), as well as 2-year mortality (12.6% vs. 11.2%) and stroke rates (2.1% vs. 2.6%).

Conclusion:  In the initial phase of an MIS-AVR program, the 30-day mortality may be elevated. Despite longer operative times and an increased risk for bleeding in obese patients, no influence of BMI on postoperative morbidity, mortality, or stroke rates was observed.

背景:在肥胖患者中,微创主动脉瓣置换术(MIS-AVR)面临挑战,患者-假体不匹配(PPM)的风险升高。本回顾性单中心研究评估了体重指数(BMI)对初始MIS-AVR方案结果的影响。材料和方法:2013年1月至2015年12月期间,307例患者接受了MIS-AVR,这是我们MIS-AVR项目的初始阶段。结果:191例患者表现出bmi异常。结论:在MIS-AVR计划的初始阶段,30天死亡率可能升高。尽管肥胖患者的手术时间更长,出血风险增加,但未观察到BMI对术后发病率、死亡率或卒中发生率的影响。
{"title":"Impact of Body Mass Index on the Initial Phase of a Minimally Invasive Aortic Valve Program.","authors":"Elias Ewais, Nadja Bauer, Markus Schlömicher, Matthias Bechtel, Vadim Moustafine, Nazha Hamdani, Justus T Strauch, Peter Lukas Haldenwang","doi":"10.1055/a-2498-2031","DOIUrl":"10.1055/a-2498-2031","url":null,"abstract":"<p><strong>Background: </strong> In obese patients, minimally invasive surgical aortic valve replacement (MIS-AVR) presents challenges, and the risk of patient-prosthesis mismatch (PPM) is elevated. This retrospective single-center study evaluates the impact of body mass index (BMI) on the outcome of an initial MIS-AVR program.</p><p><strong>Material and methods: </strong> A total of 307 patients underwent MIS-AVR between January 2013 and December 2015, the initial phase of our MIS-AVR program. They were divided into normal/overweight (BMI <30 kg/m<sup>2</sup>) versus obese patients (BMI ≥30 kg/m<sup>2</sup>). Primary endpoints included 30-day and 2-year mortality and stroke. Secondary endpoints comprised type 3 bleeding, PPM, paravalvular leakage, wound healing disorders (WHDs), and pacemaker rates.</p><p><strong>Results: </strong> In all 191 patients exhibited a BMI <30 kg/m<sup>2</sup>, while 116 patients had a BMI ≥30 kg/m<sup>2</sup>. The BMI groups did not differ in baseline characteristics, excepting a higher peripheral arterial disease incidence among obese patients (15.7% vs. 26.7%; <i>p</i> = 0.01). Aortic clamp time (75 ± 29 min vs. 87 ± 37 min; <i>p</i> = 0.001), cardiopulmonary bypass (104 ± 36 min vs. 124 ± 56 min; <i>p</i> = 0.0002), and ventilation times (26 ± 6 h vs. 44 ± 8 h; <i>p</i> = 0.03) were longer in obese patients. They demonstrated a higher risk for bleeding (2.6% vs. 9.5%; <i>p</i> = 0.008) but lower pacemaker rates (9% vs. 3%; <i>p</i> = 0.02). PPM, paravalvular leakage, and WHD exhibited no group differences. No BMI-related differences revealed in 30-day mortality (4.7% vs. 3.4%) and stroke rates (2% vs. 2.6%), as well as 2-year mortality (12.6% vs. 11.2%) and stroke rates (2.1% vs. 2.6%).</p><p><strong>Conclusion: </strong> In the initial phase of an MIS-AVR program, the 30-day mortality may be elevated. Despite longer operative times and an increased risk for bleeding in obese patients, no influence of BMI on postoperative morbidity, mortality, or stroke rates was observed.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prone Positioning for Acute Respiratory Failure after PEA: An Initial Experience. 俯卧位治疗PEA后急性呼吸衰竭的初步经验。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-20 DOI: 10.1055/a-2508-0644
Koray Ak, Majd Tarazi, Fatih Öztürk, Şehnaz Olgun Yıldızeli, Alper Kararmaz, Bulent Mutlu, Bedrettin Yildizeli

Background:  We retrospectively analyzed patients who underwent prone positioning (PP) for acute respiratory failure after pulmonary endarterectomy (PEA).

Methods:  A total of 125 patients underwent PEA and the outcome related to patients who underwent PP for acute respiratory failure after surgery was analyzed.

Results:  In all 13 patients (10%) underwent PP at the mean duration of 28.2 ± 10.6 hours after surgery and the mean prone time was 29.4 ± 9.8 hours. Compared with the pre-prone values, there was a significant improvement in the mean arterial oxygen to fraction of inspired oxygen ratio at the end of PP (119.4 ± 12.4 versus 202 ± 58.3) (p = 0.0002). Eight patients (61%) revealed a significant improvement in oxygenation with PP. Five patients who remained unresponsive underwent extracorporeal membrane oxygenation and four of them were weaned off successfully. In multivariate logistic stepwise analysis, the need for a moderate inotropy (odds ratio [OR]: 3.1) and low preoperative cardiac index (OR: 0.2) were independent predictors of PP. Under PP, the most common complication was ventilator-associated pneumonia (n = 9, 70%) and PP was found to be an independent predictor of ventilator-associated pneumonia (OR: 10.3). Early mortality was seen in three patients (23%, sepsis in two and adult respiratory distress syndrome in one).

Conclusion:  In the early care of acute respiratory failure following PTE, PP may be a feasible option, despite an increased risk of ventilator-associated pneumonia. More research involving a larger sample size is necessary.

背景:我们回顾性分析了肺动脉内膜切除术(PEA)后急性呼吸衰竭患者采用俯卧位(PP)。方法:分析125例急性呼吸衰竭患者行PEA及术后行PP的相关结果。结果:13例(10%)患者术后平均持续时间28.2±10.6小时,平均俯卧时间29.4±9.8小时。与倾向前值相比,PP结束时平均动脉氧与吸入氧比显著改善(119.4±12.4 vs 202±58.3)(p=0.0002)。8例患者(61%)显示PP对氧合有显著改善。5例仍无反应的患者接受了体外膜氧合,其中4例成功脱机。在多因素logistic逐步分析中,需要适度的心肌收缩(比值比(OR): 3.1)和术前心脏指数低(OR:0.2)是PP的独立预测因子。在PP下,最常见的并发症是呼吸机相关肺炎(n= 9,70 %),而PP是呼吸机相关肺炎的独立预测因子(OR:10.3)。早期死亡3例(23%,败血症2例,成人呼吸窘迫综合征1例)。结论:在PTE后急性呼吸衰竭的早期护理中,PP可能是一个可行的选择,尽管它增加了呼吸机相关性肺炎的风险。更多的研究涉及更大的样本量是必要的。
{"title":"Prone Positioning for Acute Respiratory Failure after PEA: An Initial Experience.","authors":"Koray Ak, Majd Tarazi, Fatih Öztürk, Şehnaz Olgun Yıldızeli, Alper Kararmaz, Bulent Mutlu, Bedrettin Yildizeli","doi":"10.1055/a-2508-0644","DOIUrl":"10.1055/a-2508-0644","url":null,"abstract":"<p><strong>Background: </strong> We retrospectively analyzed patients who underwent prone positioning (PP) for acute respiratory failure after pulmonary endarterectomy (PEA).</p><p><strong>Methods: </strong> A total of 125 patients underwent PEA and the outcome related to patients who underwent PP for acute respiratory failure after surgery was analyzed.</p><p><strong>Results: </strong> In all 13 patients (10%) underwent PP at the mean duration of 28.2 ± 10.6 hours after surgery and the mean prone time was 29.4 ± 9.8 hours. Compared with the pre-prone values, there was a significant improvement in the mean arterial oxygen to fraction of inspired oxygen ratio at the end of PP (119.4 ± 12.4 versus 202 ± 58.3) (<i>p</i> = 0.0002). Eight patients (61%) revealed a significant improvement in oxygenation with PP. Five patients who remained unresponsive underwent extracorporeal membrane oxygenation and four of them were weaned off successfully. In multivariate logistic stepwise analysis, the need for a moderate inotropy (odds ratio [OR]: 3.1) and low preoperative cardiac index (OR: 0.2) were independent predictors of PP. Under PP, the most common complication was ventilator-associated pneumonia (<i>n</i> = 9, 70%) and PP was found to be an independent predictor of ventilator-associated pneumonia (OR: 10.3). Early mortality was seen in three patients (23%, sepsis in two and adult respiratory distress syndrome in one).</p><p><strong>Conclusion: </strong> In the early care of acute respiratory failure following PTE, PP may be a feasible option, despite an increased risk of ventilator-associated pneumonia. More research involving a larger sample size is necessary.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Conduction Disorders after Rapid Deployment Aortic Valve Replacement Compared to Conventional Aortic Valve Replacement. 与传统 AVR 相比,快速部署 AVR 后会出现传导障碍。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-16 DOI: 10.1055/a-2464-2727
Markus Schlömicher, Katrin Prümmer, Peter Haldenwang, Vadim Moustafine, Dinah Berres, Matthias Bechtel, Justus T Strauch

Objectives:  We evaluated and compared early postprocedural and midterm incidence and evolution of atrioventricular and intraventricular conduction disorders following rapid deployment aortic valve replacement (RDAVR) and conventional aortic valve replacement (AVR).

Materials and methods:  One hundred and forty-seven patients who underwent isolated rapid deployment AVR between 2017 and 2021 as well as 128 patients after conventional biological AVR in the same period were included in this study. ECGs recorded at baseline, discharge, and 12 months were retrospectively analyzed. Intrinsic rhythm, PQ interval, QRS duration, and atrioventricular and intraventricular conduction were evaluated and compared between both groups.

Results:  Patients in both groups had comparable Society of Thoracic surgeons risc (STS) scores (2.9 ± 1.6 vs. 3.1 ± 2.2, p = 0.32) and comparable baseline characteristics. The mean age was 73.4 ± 5.7 years in the RDAVR group and 74.2 ± 5.9 years in the AVR group, respectively. At baseline, the mean QRS width was 95.7 ± 25.5 ms in the RDAVR group, and 97.3 ± 23.5 ms in the AVR group, respectively (p = 0.590). At discharge, the mean QRS width in the RDAVR group was significantly increased with 117.4 ± 28.6 ms and a mean ΔQRS width of 21.7 ± 26.3 ms (p < 0.001) compared with baseline. No significant changes in QRS width were found in the AVR group with a mean value of 101.2 ± 24.1 ms and a mean ΔQRS width of 3.9 ± 23.9 ms at discharge (p = 0.193). The left bundle branch block (LBBB) was increased in the RDAVR group after 12 months (19.3% vs. 5.1%, p < 0.001). Permanent pacemaker implantation (PPI) rates were significantly higher in the RDAVR group after 12 months (hazard ratio (HR): 4.68; 95% CI: 2.23-7.43, p < 0.001). Mortality did not differ between both groups after 12 months (HR: 1.09; 95% CI: 0.46-1.83, p = 0.835) CONCLUSION:  Patients after RDAVR showed significantly higher rates of LBBB and PPI after 12 months. However, higher mortality was not observed in the RDAVR group.

目的 我们评估并比较了快速部署 AVR 和传统 AVR 后房室和室内传导障碍的发生率和演变情况。方法 本研究纳入了 2017 年至 2021 年期间接受孤立快速部署房室重建术的 147 例患者,以及同期接受传统生物房室重建术的 128 例患者。对基线、出院和 12 个月时记录的心电图进行回顾性分析。结果 两组患者的 STS 评分相当(2.9 ± 1.6 vs 3.1 ± 2.2 p=0.32),基线特征相当。出院时,RDAVR 组的平均 QRS 宽度显著增加,为 117.4  28.6 ms,而  组的平均 QRS 宽度为 21.7  26.3 ms(p
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引用次数: 0
Radiation exposure during cardiac interventions in CHD: German Registry 2012-2020. CHD心脏干预期间的辐射暴露:德国登记处2012-2020。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-13 DOI: 10.1055/a-2514-7436
Anja Tengler, Jörg Michel, Claudia Arenz, UIrike Bauer, Jens Beudt, Alexander Horke, Gunter Kerst, Andreas Beckmann, Michael Hofbeck

Background: Since patients with congenital heart defects (CHD) frequently require life-long medical care and repeat invasive treatment, radiation exposure during interventional procedures is a relevant issue concerning potential radiation related risks. Therefore, an analysis on radiation data from the German Registry for Cardiac Operations and Interventions in patients with CHD was performed.

Methods: From January 2012 until December 2020 a total of 28,374 cardiac catheter interventions were recorded. 8 specified interventions were selected for evaluation: ASD/PFO, PDA and VSD occlusion, CoA balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty and transcatheter pulmonary valve implantation. Radiation exposure data included total fluoroscopy time (TFT), dose area product (DAP) and DAP per body weight (DAP/BW).

Results: The cohort accounted for 9,350 procedures including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations resp. 496 stent implantations for CoA, 168 VSD occlusions and 703 TPVI. 610 ASD/PFO procedures (17.8%) were performed without radiation. Median annual TFT, DAP and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty and balloon dilatation of CoA median DAP/BW was <20.0 µGy*m²/kg, while median values of 26.3 µGy*m²/kg and 31.6 µGy*m²/kg were noted for stenting of CoA and VSD closure. Radiation burden was highest in TPVI with a median DAP/BW of 79.4 µGy*m²/kg.

Conclusion: A decrease of radiation exposure was found in 8 cardiac interventions from 1/2012 - 12/2020. Comparison with international registries revealed a good quality of radiation protection.

背景:由于先天性心脏缺陷(CHD)患者经常需要终身医疗护理和重复侵入性治疗,介入手术期间的辐射暴露是一个涉及潜在辐射相关风险的相关问题。因此,我们对德国冠心病患者心脏手术和干预登记中心的辐射数据进行了分析。方法:2012年1月至2020年12月,共记录28374例心导管介入。选择8种特定的干预措施进行评估:ASD/PFO, PDA和VSD闭塞,CoA球囊扩张和支架植入,主动脉瓣成形术,肺动脉瓣成形术和经导管肺动脉瓣植入术。辐射暴露数据包括总透视时间(TFT)、剂量面积积(DAP)和每体重DAP (DAP/BW)。结果:该队列共有9350例手术,包括3426例ASD/PFO闭塞,2039例PDA闭塞,599例主动脉瓣成形术和1536例肺动脉瓣成形术,383例球囊扩张术。CoA支架植入496例,VSD闭塞168例,TPVI 703例。610例ASD/PFO手术(17.8%)无放疗。年TFT、DAP和DAP/BW中位数持续下降,而辐射负担与干预复杂性相关:对于ASD/PFO和PDA闭塞,主动脉瓣和肺动脉瓣成形术和CoA球囊扩张,中位数DAP/BW为。结论:2012年1月- 2020年12月8例心脏干预均发现辐射暴露降低。与国际注册表的比较表明,辐射防护质量良好。
{"title":"Radiation exposure during cardiac interventions in CHD: German Registry 2012-2020.","authors":"Anja Tengler, Jörg Michel, Claudia Arenz, UIrike Bauer, Jens Beudt, Alexander Horke, Gunter Kerst, Andreas Beckmann, Michael Hofbeck","doi":"10.1055/a-2514-7436","DOIUrl":"https://doi.org/10.1055/a-2514-7436","url":null,"abstract":"<p><strong>Background: </strong>Since patients with congenital heart defects (CHD) frequently require life-long medical care and repeat invasive treatment, radiation exposure during interventional procedures is a relevant issue concerning potential radiation related risks. Therefore, an analysis on radiation data from the German Registry for Cardiac Operations and Interventions in patients with CHD was performed.</p><p><strong>Methods: </strong>From January 2012 until December 2020 a total of 28,374 cardiac catheter interventions were recorded. 8 specified interventions were selected for evaluation: ASD/PFO, PDA and VSD occlusion, CoA balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty and transcatheter pulmonary valve implantation. Radiation exposure data included total fluoroscopy time (TFT), dose area product (DAP) and DAP per body weight (DAP/BW).</p><p><strong>Results: </strong>The cohort accounted for 9,350 procedures including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations resp. 496 stent implantations for CoA, 168 VSD occlusions and 703 TPVI. 610 ASD/PFO procedures (17.8%) were performed without radiation. Median annual TFT, DAP and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty and balloon dilatation of CoA median DAP/BW was <20.0 µGy*m²/kg, while median values of 26.3 µGy*m²/kg and 31.6 µGy*m²/kg were noted for stenting of CoA and VSD closure. Radiation burden was highest in TPVI with a median DAP/BW of 79.4 µGy*m²/kg.</p><p><strong>Conclusion: </strong>A decrease of radiation exposure was found in 8 cardiac interventions from 1/2012 - 12/2020. Comparison with international registries revealed a good quality of radiation protection.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correlation between Left Ventricular Mass and Cardiac Troponin T in Cardiac Surgery. 心脏手术中左心室质量与心肌肌钙蛋白T的相关性研究。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-09 DOI: 10.1055/a-2489-6222
Dror B Leviner, Ayelet R Touitou, Salim Adawi, Erez Sharoni

Cardiac troponin levels might rise significantly after cardiac surgeries as a surgical outcome rather than ischemic myocardial damage alone, making the diagnosis of postoperative (type 5) myocardial infarction challenging. Previous studies have demonstrated that cardiac troponin is related to left ventricular mass, but this correlation was not investigated after cardiac surgery. We aimed to study a possible correlation between postoperative cardiac troponin levels and left ventricular mass index in patients who underwent cardiac surgery to refine the diagnosis of type 5 myocardial infarction, but observed no such correlation regardless of preoperative troponin levels or surgery type.

心肌肌钙蛋白水平可能在心脏手术后显著升高,而不仅仅是缺血性心肌损伤,这使得术后(5型)心肌梗死的诊断具有挑战性。先前的研究表明,心肌肌钙蛋白与左心室质量有关,但在心脏手术后没有研究这种相关性。我们旨在研究心脏手术患者术后心肌肌钙蛋白水平与左心室质量指数之间可能的相关性,以完善5型心肌梗死的诊断,但无论术前肌钙蛋白水平或手术类型,均未观察到这种相关性。
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引用次数: 0
Renal Function After Combined Treatment for Coronary Disease and Aortic Valve Replacement. 冠心病与主动脉瓣置换术联合治疗后的肾功能。
IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-01-09 DOI: 10.1055/a-2493-1495
Zulfugar T Taghiyev, Katharina E Jäger, Martin V Fuchs, Peter Roth, Oliver Dörr, Andreas Böning

Objectives:  A single-center retrospective study was initialized to investigate the occurrence of acute kidney injury (AKI) and its impact on short- and long-term outcomes after aortic valve replacement in patients with aortic stenosis (AS) and complex coronary artery disease (CAD).

Methods:  Between January 2010 and December 2020, 1,232 patients with severe AS and CAD were treated. Propensity score matching generated 40 patient pairs with intermediate Society of Thoracic Surgeons (STS) risk scores (3.2 ± 0.3) and EuroSCORE II (4.1 ± 0.3) undergoing percutaneous (transcatheter aortic valve replacement [TAVR] + percutaneous coronary intervention [PCI]) or surgical (surgical aortic valve replacement [SAVR] + coronary artery bypass grafting [CABG]) combined procedures. The renal function-corrected ratio of contrast medium to body weight was calculated to determine the risk of postprocedural contrast medium-associated AKI. Renal retention values were recorded daily until the 7th day after the procedure.

Results:  The overall incidence of postprocedural AKI was similar between the groups. There was no correlation between the contrast medium volume to serum creatinine to body weight ratio and AKI occurrence. During the first 7 postprocedural days, creatinine clearance values were comparable: 68.97 ± 4.92 mL/min (SAVR + CABG) vs. 64.95 ± 9.78 mL/min (TAVR + PCI), mean difference 4.02, 95% CI (-24.5 to 16.4), p = 0.691. On the 7th day after the procedure, 35% (8/23) of patients with renal impairment had improved renal function. No correlation between impaired renal function and short- or long-term mortality was found in multivariable models.

Conclusion:  Contrast agents may temporarily impair renal function during a minimally invasive percutaneous approach; however, occurrence of AKI was not related to the amount of contrast medium, and AKI was not associated with short- and long-term mortality.

目的:开展一项单中心回顾性研究,探讨主动脉瓣狭窄(AS)合并复杂冠状动脉疾病(CAD)患者主动脉瓣置换术后急性肾损伤(AKI)的发生及其对短期和长期预后的影响。方法:2010年1月至2020年12月,对1232例重度主动脉瓣狭窄(AS)合并冠状动脉疾病(CAD)患者进行治疗。倾向评分匹配产生40对患者,STS风险评分为中等(3.2±0.3),EUROScore II为4.1±0.3),接受经皮(TAVR+PCI)或手术(SAVR+CABG)联合手术。计算造影剂与体重的肾功能校正比率,以确定术后造影剂相关AKI的风险。每天记录肾脏保留值,直到手术后第7天。结果:两组术后AKI总体发生率相近。造影剂体积与血清肌酐与体重之比与AKI的发生无相关性。术后前7天,肌酐清除率具有可比性:SAVR+CABG组68.97±4.92 ml/min vs. TAVR+PCI组64.95±9.78 ml/min,平均差4.02,95% CI [-24.5 ~ 16.4], p=0.691。35%(8/23)肾功能损害患者术后第7天肾功能改善。在多变量模型中没有发现肾功能受损与短期或长期死亡率之间的相关性。结论:造影剂在微创经皮入路中可能暂时损害肾功能;然而,AKI的发生与造影剂的用量无关,AKI与短期和长期死亡率无关。
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引用次数: 0
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Thoracic and Cardiovascular Surgeon
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