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.
{"title":"Clinical Outcomes with High- versus Low-Dose Tranexamic Acid Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.","authors":"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","doi":"10.1055/s-0044-1791233","DOIUrl":"https://doi.org/10.1055/s-0044-1791233","url":null,"abstract":"<p><strong>Objectives: </strong> 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.</p><p><strong>Methods: </strong> 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).</p><p><strong>Results: </strong> Results were analyzed via random-effects model, using Mantel-Haenszel risk ratio (RR) and standard mean difference (SMD). <i>P</i>-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; <i>p</i> = 0.04), 24-hour blood loss (SMD, -0.23 g; <i>p</i> = 0.005), and the need for fresh frozen plasma (FFP) transfusions (RR: 0.94; CI, 0.89 to 1.00; <i>p</i> = 0.05) with high-dose TXA. Chest tube output was also lower (SMD, -0.12 g; <i>p</i> = 0.0006), but postoperative seizures increased (RR: 2.23; CI, 1.70 to 2.93; <i>p</i> < 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.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024670","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}
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.
{"title":"Pathology-Independent Expansion of Indications for Rapid-Deployment Aortic Valve Replacement: Midterm Outcomes.","authors":"Seon Yong Bae, Kyung Hwan Kim, Suk Ho Sohn, Yoonjin Kang, Ji Seong Kim, Jae Woong Choi","doi":"10.1055/s-0044-1790240","DOIUrl":"https://doi.org/10.1055/s-0044-1790240","url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Methods: </strong> 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.</p><p><strong>Results: </strong> 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.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012049","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}
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.
{"title":"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.","authors":"Gizem Kececi Ozgur, Hasan Yavuz, Alpaslan Cakan, Kevser Durgun, Ayse Gul Ergonul, Tevfik Ilker Akcam, Ali Özdil, Selen Bayraktaroglu, Kutsal Turhan, Ufuk Cagirici","doi":"10.1055/a-2508-6067","DOIUrl":"https://doi.org/10.1055/a-2508-6067","url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Methods: </strong> 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.</p><p><strong>Results: </strong> In univariate analyses, for PAL, age (<i>p</i> = 0.022), presence of chronic obstructive pulmonary disease (COPD; <i>p</i> < 0.001), body mass index (BMI; <i>p</i> = 0.006), FEV<sub>1</sub> (<i>p</i> = 0.020), FEV<sub>1</sub>/FVC (<i>p</i> < 0.001), LAA% (<i>p</i> = 0.008), diagnosis (<i>p</i> = 0.007), and surgical procedure (<i>p</i> < 0.001); for ET, diagnosis (<i>p</i> < 0.001) and surgical procedure (<i>p</i> = 0.001) were significant factors. A negative correlation between ET and BMI and FEV<sub>1</sub>/FVC (<i>p</i> < 0.01) and a positive correlation (<i>p</i> < 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 (<i>p</i> = 0.045, <i>p</i> < 0.001, and <i>p</i> = 0.011). In addition, FEV<sub>1</sub>/FVC (<i>p</i> = 0.027), BMI (<i>p</i> = 0.016), and surgical procedure (<i>p</i> = 0.001) were shown to be independent factors affecting ET.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012083","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}
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.
{"title":"Early Surgical Outcomes in Infective Endocarditis Before and During COVID-19 Pandemic.","authors":"Jang-Sun Lee, Virna L Sales, Annette Moter, Walter Eichinger","doi":"10.1055/a-2489-6268","DOIUrl":"10.1055/a-2489-6268","url":null,"abstract":"<p><strong>Background: </strong> 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.</p><p><strong>Methods: </strong> This observational, community-based study compared two cohorts of surgical candidates: a pandemic cohort from March 2020 to November 2021 (<i>n</i> = 84) and a pre-pandemic cohort from August 2018 to March 2020 (before the lockdown, <i>n</i> = 94). Preoperative status and postoperative in-hospital complications were analyzed and compared between the groups.</p><p><strong>Results: </strong> The pandemic cohort experienced longer symptom onset to diagnosis intervals (14.5 versus 8 days, <i>p</i> = 0.529). A higher incidence of definite IE was observed after the lockdown according to the modified Duke criteria (82.1% versus 68.1%, <i>p</i> = 0.035). Patients presented with more severe symptoms post-lockdown (NYHA Class III: 50% versus 33%; Class IV: 22.6% versus 11.7%, <i>p</i> = 0.001). Postoperative complications, such as re-thoracotomy due to bleeding and hemofiltration for acute renal failure, were significantly more frequent after the lockdown (<i>p</i> < 0.05). However, in-hospital survival rates did not differ significantly between the groups.</p><p><strong>Conclusion: </strong> 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.</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":"142740627","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}
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.
{"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}
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}
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.
{"title":"Conduction Disorders after Rapid Deployment Aortic Valve Replacement Compared to Conventional Aortic Valve Replacement.","authors":"Markus Schlömicher, Katrin Prümmer, Peter Haldenwang, Vadim Moustafine, Dinah Berres, Matthias Bechtel, Justus T Strauch","doi":"10.1055/a-2464-2727","DOIUrl":"10.1055/a-2464-2727","url":null,"abstract":"<p><strong>Objectives: </strong> 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).</p><p><strong>Materials and methods: </strong> 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.</p><p><strong>Results: </strong> Patients in both groups had comparable Society of Thoracic surgeons risc (STS) scores (2.9 ± 1.6 vs. 3.1 ± 2.2, <i>p</i> = 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 (<i>p</i> = 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 (<i>p</i> < 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 (<i>p</i> = 0.193). The left bundle branch block (LBBB) was increased in the RDAVR group after 12 months (19.3% vs. 5.1%, <i>p</i> < 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, <i>p</i> < 0.001). Mortality did not differ between both groups after 12 months (HR: 1.09; 95% CI: 0.46-1.83, <i>p</i> = 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628595","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}
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.
{"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}
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.
{"title":"Correlation between Left Ventricular Mass and Cardiac Troponin T in Cardiac Surgery.","authors":"Dror B Leviner, Ayelet R Touitou, Salim Adawi, Erez Sharoni","doi":"10.1055/a-2489-6222","DOIUrl":"https://doi.org/10.1055/a-2489-6222","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955368","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}
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。
{"title":"Renal Function After Combined Treatment for Coronary Disease and Aortic Valve Replacement.","authors":"Zulfugar T Taghiyev, Katharina E Jäger, Martin V Fuchs, Peter Roth, Oliver Dörr, Andreas Böning","doi":"10.1055/a-2493-1495","DOIUrl":"10.1055/a-2493-1495","url":null,"abstract":"<p><strong>Objectives: </strong> 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).</p><p><strong>Methods: </strong> 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.</p><p><strong>Results: </strong> 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), <i>p</i> = 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.</p><p><strong>Conclusion: </strong> 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.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755527","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}