Background: To compare the clinical outcomes of three surgical approaches for treating adult atrial septal defects (ASD): Thoracoscopic-assisted right vertical infra-axillary thoracotomy (TARVIAT) under central cardiopulmonary bypass (CPB), totally thoracoscopic (TT), and median sternotomy (MS) approaches, and to assess the feasibility and safety of the TARIAVT approach. Methods: This study reviewed 62 cases patients of repairing atrial septal defects via a TARVIAT and central extracorporeal circulation from 2019 to 2023. The patients included 22 males, aged between 18 and 59 years, with a mean age of 33.35 ± 10.97 years. The surgical indications were adult patients with moderate to severe tricuspid regurgitation and who were unsuitable for interventional closure of atrial septal defects. Exclusion criteria included patients diagnosed with severe pulmonary hypertension or Eisenmenger syndrome. Additionally, 67 patients who underwent TT approach repair of ASD and 72 patients who underwent MS approach repair of ASD were selected as the control groups. Operative time, CPB time, aortic clamping time, postoperative Intensive care unit (ICU) stay, postoperative mechanical ventilation time, 24-hour postoperative chest drainage, incision length, postoperative hospital stay, hospital costs, and postoperative complications were compared to assess statistical differences. Results: There were no deaths or major complications observed in any of the three groups. Statistically significant differences were found among the three groups in terms of extracorporeal circulation time, aortic clamping time, surgical time, 24-hour postoperative chest drainage, postoperative mechanical ventilation time, postoperative ICU stay, incision length, and postoperative hospital stay (p < 0.05). The TT group exhibited longer CPB and aortic clamping times compared to the TARVIAT and MS groups, while demonstrating lower 24-hour postoperative chest drainage volumes compared to the TARIAVT and MS groups. Both the TARVIAT and TT groups showed shorter surgical times, postoperative mechanical ventilation times, postoperative ICU stay, incision lengths, and postoperative hospital. However, there were no statistically significant differences among the three groups regarding hospital costs, postoperative left ventricular ejection fraction (LVEF) values, and the incidence of postoperative complications (p > 0.05). Conclusions: TARVIAT under central CPB is feasible and safe for adult patients. This approach presents lower invasiveness, shorter operative duration, and faster recovery compared to other methods. In conclusion, the TARVIAT approach for repairing adult ASD is both safe and effective, offering a viable surgical option for this condition.
{"title":"A Clinical Study on the Treatment of Adult Atrial Septal Defect Using Thoracoscopic-Assisted Right Vertical Infra-Axillary Thoracotomy, Total Thoracoscopic, and Median Sternotomy Approaches","authors":"Heqi Zhang, Haoju Dong, Shubo Song, Hua Cao, Chongyang Yan, Maozheng Xuan, Taibing Fan, Weijie Liang","doi":"10.59958/hsf.7823","DOIUrl":"https://doi.org/10.59958/hsf.7823","url":null,"abstract":"Background: To compare the clinical outcomes of three surgical approaches for treating adult atrial septal defects (ASD): Thoracoscopic-assisted right vertical infra-axillary thoracotomy (TARVIAT) under central cardiopulmonary bypass (CPB), totally thoracoscopic (TT), and median sternotomy (MS) approaches, and to assess the feasibility and safety of the TARIAVT approach. Methods: This study reviewed 62 cases patients of repairing atrial septal defects via a TARVIAT and central extracorporeal circulation from 2019 to 2023. The patients included 22 males, aged between 18 and 59 years, with a mean age of 33.35 ± 10.97 years. The surgical indications were adult patients with moderate to severe tricuspid regurgitation and who were unsuitable for interventional closure of atrial septal defects. Exclusion criteria included patients diagnosed with severe pulmonary hypertension or Eisenmenger syndrome. Additionally, 67 patients who underwent TT approach repair of ASD and 72 patients who underwent MS approach repair of ASD were selected as the control groups. Operative time, CPB time, aortic clamping time, postoperative Intensive care unit (ICU) stay, postoperative mechanical ventilation time, 24-hour postoperative chest drainage, incision length, postoperative hospital stay, hospital costs, and postoperative complications were compared to assess statistical differences. Results: There were no deaths or major complications observed in any of the three groups. Statistically significant differences were found among the three groups in terms of extracorporeal circulation time, aortic clamping time, surgical time, 24-hour postoperative chest drainage, postoperative mechanical ventilation time, postoperative ICU stay, incision length, and postoperative hospital stay (p < 0.05). The TT group exhibited longer CPB and aortic clamping times compared to the TARVIAT and MS groups, while demonstrating lower 24-hour postoperative chest drainage volumes compared to the TARIAVT and MS groups. Both the TARVIAT and TT groups showed shorter surgical times, postoperative mechanical ventilation times, postoperative ICU stay, incision lengths, and postoperative hospital. However, there were no statistically significant differences among the three groups regarding hospital costs, postoperative left ventricular ejection fraction (LVEF) values, and the incidence of postoperative complications (p > 0.05). Conclusions: TARVIAT under central CPB is feasible and safe for adult patients. This approach presents lower invasiveness, shorter operative duration, and faster recovery compared to other methods. In conclusion, the TARVIAT approach for repairing adult ASD is both safe and effective, offering a viable surgical option for this condition.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"47 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141927060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mediastinitis remains a potentially fatal complication of cardiac surgery. This study reviews the risk factors for mediastinitis after cardiac surgery, and discusses current treatment and prevention of this complication. This review explores three major independent risk factors for mediastinitis including individual patient factors, surgical procedures and microbiology. The perioperative period is influenced by the utilization of the internal mammary artery in conjunction with coronary artery bypass grafting, sternal fixation, vacuum-assisted closure, and negative pressure wound therapy. Staphylococcus aureus and Staphylococcus epidermidis are frequently encountered microorganisms. Additionally, aerobic gram-negative microorganisms and other infrequent microorganisms are also exhibiting a rising trend. Since sternal fixation devices effectively enhance sternal stability, alleviate wound pain, and decrease the occurrence of postoperative mediastinitis, they have been specifically incorporated into certain therapeutic and prophylactic approaches for addressing this complication. Despite the heightened awareness regarding mediastinitis, the large proportion of individuals at risk underscores the crucial need for rigorous monitoring of potential risk factors, posing a significant challenge to the implementation of effective therapeutic and preventative strategies.
{"title":"Causes of Mediastinitis and Its Surgical Treatment","authors":"Yalu Yu, Jiaqi Xia, Qin Jiang","doi":"10.59958/hsf.7617","DOIUrl":"https://doi.org/10.59958/hsf.7617","url":null,"abstract":"Mediastinitis remains a potentially fatal complication of cardiac surgery. This study reviews the risk factors for mediastinitis after cardiac surgery, and discusses current treatment and prevention of this complication. This review explores three major independent risk factors for mediastinitis including individual patient factors, surgical procedures and microbiology. The perioperative period is influenced by the utilization of the internal mammary artery in conjunction with coronary artery bypass grafting, sternal fixation, vacuum-assisted closure, and negative pressure wound therapy. Staphylococcus aureus and Staphylococcus epidermidis are frequently encountered microorganisms. Additionally, aerobic gram-negative microorganisms and other infrequent microorganisms are also exhibiting a rising trend. Since sternal fixation devices effectively enhance sternal stability, alleviate wound pain, and decrease the occurrence of postoperative mediastinitis, they have been specifically incorporated into certain therapeutic and prophylactic approaches for addressing this complication. Despite the heightened awareness regarding mediastinitis, the large proportion of individuals at risk underscores the crucial need for rigorous monitoring of potential risk factors, posing a significant challenge to the implementation of effective therapeutic and preventative strategies.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"96 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aims to systematically analyze the impact of exercise-based cardiac rehabilitation on patients undergoing percutaneous coronary intervention (PCI). Methods: We searched for original studies on the effect of exercise-based cardiac rehabilitation on patients undergoing PCI published in domestic and foreign databases such as PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Network (CNKI), and VIP until December 2023. Studies retrieved were screened, and meta-analysis was extracted. The quality of the literature was evaluated; meta-analysis was carried out by RevMan5.4 software (Cochrane Collaboration, Oxford, UK). Results: A total of 1073 sufferers undergoing PCI were included in 11 literatures. Meta-analysis displayed that cardiogenic mortality [risk ratio (RR) = 0.23, 95% confidence interval (CI) (0.08, 0.64)], coronary restenosis rate [RR = 0.59, 95% CI (0.41, 0.87)], revascularization rate [RR = 0.58, 95% CI (0.43, 0.79)], incidence of recurrent angina pectoris [RR = 0.41, 95% CI (0.27, 0.62)], and late lumen loss [RR = –0.60, 95% CI (–0.98, –0.23)] in the trial group, were lower than those in the control group (p < 0.05). No significant difference was found in the recurrence rate of myocardial infarction between the test group and the control group [RR = 0.52, 95% CI (0.22, 1.25)]. Conclusion: Exercise-based cardiac rehabilitation therapy can effectively reduce the risk of major adverse cardio-cerebrovascular events, such as cardiogenic death and coronary restenosis after PCI; it reduces the late lumen loss of the stent coronary segment and has no obvious effect on the recurrence of myocardial infarction. However, this therapy tends to reduce the recurrence rate of myocardial infarction.
研究目的本研究旨在系统分析以运动为基础的心脏康复对经皮冠状动脉介入治疗（PCI）患者的影响。研究方法检索截至 2023 年 12 月在 PubMed、Web of Science、Embase、Cochrane Library、中国知网（CNKI）、VIP 等国内外数据库中发表的关于运动性心脏康复对 PCI 患者影响的原创性研究。对检索到的研究进行筛选，并提取荟萃分析。对文献质量进行评估；采用RevMan5.4软件（Cochrane Collaboration，英国牛津）进行荟萃分析。结果：11篇文献共纳入了1073名接受PCI治疗的患者。Meta 分析显示，心源性死亡率[风险比 (RR) = 0.23，95% 置信区间 (CI) (0.08, 0.64)]、冠状动脉再狭窄率[RR = 0.59，95% CI (0.41, 0.87)]、血运重建率[RR = 0.58，95% CI (0.43, 0.79）]、复发性心绞痛发生率[RR = 0.41, 95% CI (0.27, 0.62)]和晚期管腔缺损率[RR = -0.60, 95% CI (-0.98, -0.23)]均低于对照组（P < 0.05）。试验组与对照组的心肌梗死复发率无明显差异[RR = 0.52，95% CI (0.22，1.25)]。结论以运动为基础的心脏康复治疗能有效降低 PCI 术后心源性死亡和冠脉再狭窄等主要心脑血管不良事件的风险；能减少支架冠脉段的晚期管腔损失，对心肌梗死的复发无明显影响。不过，这种疗法往往会降低心肌梗死的复发率。
{"title":"Effects of Exercise-Based Cardiac Rehabilitation on Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis","authors":"Xuedan Bao, Weiwei Hong, Liyao Feng","doi":"10.59958/hsf.7287","DOIUrl":"https://doi.org/10.59958/hsf.7287","url":null,"abstract":"Objective: This study aims to systematically analyze the impact of exercise-based cardiac rehabilitation on patients undergoing percutaneous coronary intervention (PCI). Methods: We searched for original studies on the effect of exercise-based cardiac rehabilitation on patients undergoing PCI published in domestic and foreign databases such as PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Network (CNKI), and VIP until December 2023. Studies retrieved were screened, and meta-analysis was extracted. The quality of the literature was evaluated; meta-analysis was carried out by RevMan5.4 software (Cochrane Collaboration, Oxford, UK). Results: A total of 1073 sufferers undergoing PCI were included in 11 literatures. Meta-analysis displayed that cardiogenic mortality [risk ratio (RR) = 0.23, 95% confidence interval (CI) (0.08, 0.64)], coronary restenosis rate [RR = 0.59, 95% CI (0.41, 0.87)], revascularization rate [RR = 0.58, 95% CI (0.43, 0.79)], incidence of recurrent angina pectoris [RR = 0.41, 95% CI (0.27, 0.62)], and late lumen loss [RR = –0.60, 95% CI (–0.98, –0.23)] in the trial group, were lower than those in the control group (p < 0.05). No significant difference was found in the recurrence rate of myocardial infarction between the test group and the control group [RR = 0.52, 95% CI (0.22, 1.25)]. Conclusion: Exercise-based cardiac rehabilitation therapy can effectively reduce the risk of major adverse cardio-cerebrovascular events, such as cardiogenic death and coronary restenosis after PCI; it reduces the late lumen loss of the stent coronary segment and has no obvious effect on the recurrence of myocardial infarction. However, this therapy tends to reduce the recurrence rate of myocardial infarction.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tingting Ye, Yuncao Fan, Jianzhi Shao, Qizeng Wang, Taotao Wang
Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 > 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.
{"title":"A Meta-Analysis Comparing General Anesthesia, Deep Sedation, and Conscious Sedation for Catheter Ablation of Atrial Fibrillation","authors":"Tingting Ye, Yuncao Fan, Jianzhi Shao, Qizeng Wang, Taotao Wang","doi":"10.59958/hsf.7153","DOIUrl":"https://doi.org/10.59958/hsf.7153","url":null,"abstract":"Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 > 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaobing Ni, Long Tang, Chongbing Huang, Quanchao Song, Libo Wang, Sihong Wang
Objective: To explore the effect of sodium–glucose cotransporter (SGLT-2) inhibitors on cardiac function, blood glucose level, and prognosis in patients with type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI). Methods: A retrospective analysis was conducted on the clinical data of 195 patients with T2DM who underwent PCI in our hospital between September 2019 and August 2023. The patients were divided into control and observation groups on the basis of medical records. The general demographic information of all participants was collected. Propensity score matching (PSM) was employed to balance baseline data, allowing for the comparison of good cardiac function rates, cardiac function index levels, blood glucose levels, and adverse reactions after matching. Results: PSM matching was performed in a 1:1 ratio on the 84 patients enrolled in the two groups. The baseline data of the two groups were not statistically significantly different. Compared with those in the control group, the level of left ventricular ejection fraction had significantly increased and levels of left ventricular end-systolic diameter, glycosylated hemoglobin, fasting blood glucose, and 2 h postprandial blood glucose had significantly decreased in the observation group after treatment (p < 0.05). Left ventricular end-diastolic diameter and left ventricular posterior wall thickness (p > 0.05) showed no significant changes. The observation group had a higher rate of good cardiac function (95.24% vs. 80.95%) and lower total incidence of adverse reactions (11.90% vs. 30.95%) than the control group (p < 0.05). Conclusions: SGLT-2 inhibitors can significantly improve cardiac function and blood glucose levels in patients with T2DM after PCI with few adverse reactions and remarkable prognosis recovery effect. Therefore, they can be used in clinical practice.
{"title":"Effects of SGLT-2 Inhibitors on Cardiac Function, Blood Glucose Levels, and Prognosis in Patients with Type 2 Diabetes Mellitus after Percutaneous Coronary Intervention: A Propensity Score Matching Study","authors":"Xiaobing Ni, Long Tang, Chongbing Huang, Quanchao Song, Libo Wang, Sihong Wang","doi":"10.59958/hsf.7519","DOIUrl":"https://doi.org/10.59958/hsf.7519","url":null,"abstract":"Objective: To explore the effect of sodium–glucose cotransporter (SGLT-2) inhibitors on cardiac function, blood glucose level, and prognosis in patients with type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI). Methods: A retrospective analysis was conducted on the clinical data of 195 patients with T2DM who underwent PCI in our hospital between September 2019 and August 2023. The patients were divided into control and observation groups on the basis of medical records. The general demographic information of all participants was collected. Propensity score matching (PSM) was employed to balance baseline data, allowing for the comparison of good cardiac function rates, cardiac function index levels, blood glucose levels, and adverse reactions after matching. Results: PSM matching was performed in a 1:1 ratio on the 84 patients enrolled in the two groups. The baseline data of the two groups were not statistically significantly different. Compared with those in the control group, the level of left ventricular ejection fraction had significantly increased and levels of left ventricular end-systolic diameter, glycosylated hemoglobin, fasting blood glucose, and 2 h postprandial blood glucose had significantly decreased in the observation group after treatment (p < 0.05). Left ventricular end-diastolic diameter and left ventricular posterior wall thickness (p > 0.05) showed no significant changes. The observation group had a higher rate of good cardiac function (95.24% vs. 80.95%) and lower total incidence of adverse reactions (11.90% vs. 30.95%) than the control group (p < 0.05). Conclusions: SGLT-2 inhibitors can significantly improve cardiac function and blood glucose levels in patients with T2DM after PCI with few adverse reactions and remarkable prognosis recovery effect. Therefore, they can be used in clinical practice.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"35 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141649174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased adverse outcomes. However, the relationship of fluid balance and POAF is not clear yet. Accordingly, this study aims to study the relationship of fluid balance and POAF, and to evaluate the other risk factors of POAF in patients undergoing elective on-pump CABG with or without valve surgery in our center. Methods: A retrospective study between October 2018 and December 2022 including 261 patients who underwent CABG undergoing cardiopulmonary bypass was performed. The fluid balance on the first 4 days in the intensive care unit (ICU) and other potential perioperative risk factors for POAF were collected and analyzed using univariate and multivariate analyses to identify risk factors following CABG. The in-hospital adverse outcomes of POAF were also evaluated. Results: 261 adult CABG patients were evaluated, of whom 22 were excluded due to a history of atrial fibrillation or other causes. Among them, 72 patients developed POAF (30.1%). The mean fluid balance was negative on the first 3 days. Negative fluid balance was less on postoperative day 0 (POD 0) in those developing POAF than in those not developing POAF (–12.88 ± 12.47 vs. –17.48 ± 10.03 mL/kg, p = 0.003). No differences were noted for POD 1 and POD 2. Multiple logistic regression analysis showed age >60 years (adjusted odds ratio (OR), 3.86 [95% confidence interval (CI): 1.99 to 7.48]), left atrial antero-posterior (AP) dimension >42 mm (adjusted OR, 2.68 [95% CI: 1.45 to 4.93]), total blood transfusions >400 mL (adjusted OR, 1.96 [95% CI: 1.05 to 3.63]), and positive fluid balance on POD 0 (adjusted OR, 2.93 [95% CI: 1.01 to 8.51]) were independent perioperative risk factors for POAF. Conclusions: The incidence of POAF is not significantly reduced even with a fluid restriction strategy after CABG, and positive fluid balance on the day of surgery is a risk factor for POAF, rather than on POD 1 and POD 2. In addition, advanced age, left atrial enlargement, and increased perioperative blood transfusion are all risk factors for POAF.
{"title":"Fluid Balance and Risk of Postoperative Atrial Fibrillation after On-pump Coronary Artery Bypass Grafting Surgery","authors":"Yaqiong Xiao, Can Zhao, Jianping Xu, Guangyu Pan","doi":"10.59958/hsf.7661","DOIUrl":"https://doi.org/10.59958/hsf.7661","url":null,"abstract":"Background: Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased adverse outcomes. However, the relationship of fluid balance and POAF is not clear yet. Accordingly, this study aims to study the relationship of fluid balance and POAF, and to evaluate the other risk factors of POAF in patients undergoing elective on-pump CABG with or without valve surgery in our center. Methods: A retrospective study between October 2018 and December 2022 including 261 patients who underwent CABG undergoing cardiopulmonary bypass was performed. The fluid balance on the first 4 days in the intensive care unit (ICU) and other potential perioperative risk factors for POAF were collected and analyzed using univariate and multivariate analyses to identify risk factors following CABG. The in-hospital adverse outcomes of POAF were also evaluated. Results: 261 adult CABG patients were evaluated, of whom 22 were excluded due to a history of atrial fibrillation or other causes. Among them, 72 patients developed POAF (30.1%). The mean fluid balance was negative on the first 3 days. Negative fluid balance was less on postoperative day 0 (POD 0) in those developing POAF than in those not developing POAF (–12.88 ± 12.47 vs. –17.48 ± 10.03 mL/kg, p = 0.003). No differences were noted for POD 1 and POD 2. Multiple logistic regression analysis showed age >60 years (adjusted odds ratio (OR), 3.86 [95% confidence interval (CI): 1.99 to 7.48]), left atrial antero-posterior (AP) dimension >42 mm (adjusted OR, 2.68 [95% CI: 1.45 to 4.93]), total blood transfusions >400 mL (adjusted OR, 1.96 [95% CI: 1.05 to 3.63]), and positive fluid balance on POD 0 (adjusted OR, 2.93 [95% CI: 1.01 to 8.51]) were independent perioperative risk factors for POAF. Conclusions: The incidence of POAF is not significantly reduced even with a fluid restriction strategy after CABG, and positive fluid balance on the day of surgery is a risk factor for POAF, rather than on POD 1 and POD 2. In addition, advanced age, left atrial enlargement, and increased perioperative blood transfusion are all risk factors for POAF.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"74 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To explore the risk factors of postoperative arrhythmia in patients with coronary heart disease (CHD) and to establish a Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients. Methods: Retrospectively, the medical data of CHD patients (from January 2021 to January 2024, n = 390) were collected. According to whether arrhythmia occurred after percutaneous coronary intervention surgery, patients were divided into the arrhythmia group (n = 130) and non-arrhythmia group (n = 260). The risk factors of postoperative arrhythmia were obtained by multi-factor logistic regression analysis. A Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients was established using R language and underwent verification. Results: The results of multi-factor logistic regression analysis showed that diastolic pressure, heart function grade at III–IV, creatinine, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) peak value, total bilirubin (TBIL) and red cell distribution width (RDW) were the risk factors inducing postoperative arrhythmia in CHD patients. Based on these risk factors, a Nomogram model was successfully established. The verification results revealed that the predicted values were basically consistent with the actual values, indicating that the Nomogram model had good prediction ability. The area under the curve (AUC) value was 0.974, suggesting the high prediction efficiency of Nomogram model. Conclusion: Diastolic pressure, heart function grade at III–IV, creatinine, CRP, NT-ProBNP peak value, TBIL and RDW are the risk factors of postoperative arrhythmia in CHD patients. Nomogram model based on these risk factors has good prediction efficiency and underlying clinical value.
{"title":"Analysis of Risk Factors of Postoperative Arrhythmia in Patients with Coronary Heart Disease and Establishment of Nomogram Risk Model","authors":"Jie Gao, Zhiying He, Xiaoqing Luo","doi":"10.59958/hsf.7521","DOIUrl":"https://doi.org/10.59958/hsf.7521","url":null,"abstract":"Background: To explore the risk factors of postoperative arrhythmia in patients with coronary heart disease (CHD) and to establish a Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients. Methods: Retrospectively, the medical data of CHD patients (from January 2021 to January 2024, n = 390) were collected. According to whether arrhythmia occurred after percutaneous coronary intervention surgery, patients were divided into the arrhythmia group (n = 130) and non-arrhythmia group (n = 260). The risk factors of postoperative arrhythmia were obtained by multi-factor logistic regression analysis. A Nomogram model for predicting the risk of postoperative arrhythmia in CHD patients was established using R language and underwent verification. Results: The results of multi-factor logistic regression analysis showed that diastolic pressure, heart function grade at III–IV, creatinine, C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) peak value, total bilirubin (TBIL) and red cell distribution width (RDW) were the risk factors inducing postoperative arrhythmia in CHD patients. Based on these risk factors, a Nomogram model was successfully established. The verification results revealed that the predicted values were basically consistent with the actual values, indicating that the Nomogram model had good prediction ability. The area under the curve (AUC) value was 0.974, suggesting the high prediction efficiency of Nomogram model. Conclusion: Diastolic pressure, heart function grade at III–IV, creatinine, CRP, NT-ProBNP peak value, TBIL and RDW are the risk factors of postoperative arrhythmia in CHD patients. Nomogram model based on these risk factors has good prediction efficiency and underlying clinical value.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"120 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141656907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There are still no accepted classification and recommendations for isolated tricuspid valve replacement (ITVR) surgery. So we aim to evaluate the applicability of the tricuspid valve regurgitation classification proposed by Latib in 2018 for ITVR surgery. Methods: We enrolled all patients who underwent ITVR from 2000 to 2021 in our center. Based on a novel classification, the patients were divided into five stages, and in-hospital mortality was used as the primary endpoint to analyze whether this classification scheme was a good way to evaluate the prognosis of patients at different stages and with different surgical options. Results: A total of 254 patients who underwent ITVR were divided into five stages. None of the patients was classified into stage 1, and stages 4/5 accounted for 159 (62.6%). There was no difference in age, gender, or body mass index (BMI). 178 (70.1%) patients underwent traditional open surgery and 76 (29.9%) opted for the transcatheter option. The main etiology was functional tricuspid regurgitation (FTR), with 64.9% of these patients in stage 4 or above. The overall in-hospital mortality rate was 14.2%, with 14.0% in stage 4 vs. 37.8% in stage 5 (p < 0.001). The patients in the intervention group were generally older, and coronary heart disease and atrial fibrillation were also more common (p < 0.05). Interventional mortality for stages 4 and 5 was 35.8% vs. 13.2% in the open group, but there was no significant difference between them after propensity score matching. Conclusions: The tricuspid regurgitation's (TR's) five-stage classifications can predict prognosis for different patients. After this classification, no difference was found between the two procedures, and open surgery is recommended for patients with acceptable general conditions.
{"title":"Evaluation Results and Recommendations of a Novel Tricuspid Regurgitation Classification for Isolated Tricuspid Valve Replacement Surgery","authors":"Jie Yu, Rui Ma, Lei Dong, Lu Liu, He Wang","doi":"10.59958/hsf.7423","DOIUrl":"https://doi.org/10.59958/hsf.7423","url":null,"abstract":"Background: There are still no accepted classification and recommendations for isolated tricuspid valve replacement (ITVR) surgery. So we aim to evaluate the applicability of the tricuspid valve regurgitation classification proposed by Latib in 2018 for ITVR surgery. Methods: We enrolled all patients who underwent ITVR from 2000 to 2021 in our center. Based on a novel classification, the patients were divided into five stages, and in-hospital mortality was used as the primary endpoint to analyze whether this classification scheme was a good way to evaluate the prognosis of patients at different stages and with different surgical options. Results: A total of 254 patients who underwent ITVR were divided into five stages. None of the patients was classified into stage 1, and stages 4/5 accounted for 159 (62.6%). There was no difference in age, gender, or body mass index (BMI). 178 (70.1%) patients underwent traditional open surgery and 76 (29.9%) opted for the transcatheter option. The main etiology was functional tricuspid regurgitation (FTR), with 64.9% of these patients in stage 4 or above. The overall in-hospital mortality rate was 14.2%, with 14.0% in stage 4 vs. 37.8% in stage 5 (p < 0.001). The patients in the intervention group were generally older, and coronary heart disease and atrial fibrillation were also more common (p < 0.05). Interventional mortality for stages 4 and 5 was 35.8% vs. 13.2% in the open group, but there was no significant difference between them after propensity score matching. Conclusions: The tricuspid regurgitation's (TR's) five-stage classifications can predict prognosis for different patients. After this classification, no difference was found between the two procedures, and open surgery is recommended for patients with acceptable general conditions.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"17 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postoperative pulmonary complications (PPC) are the most frequently observed complications following cardiac surgery, leading to extended hospital stays and significant medical and economic burdens. Although surgical interventions for tricuspid valve disease are increasingly common, few risk factors for PPC in the context of tricuspid valve surgery have been identified. Uncovering these factors would have valuable clinical implications in terms of prognosis. Methods: We conducted a single-center retrospective study to evaluate preoperative factors associated with susceptibility to PPC in patients undergoing tricuspid valve surgery between 2018 to 2023. Independent predictors of PPC were identified using regression analysis. Results: Of the 147 patients included in the study, 29.9% (44 cases) experienced PPC. No statistically significant differences were observed in surgical procedures between the groups. Regression analysis identified smoking status (odds ratio [OR]: 7.69, p = 0.01), severity grade of tricuspid regurgitation (TR) (OR: 26.56, p < 0.01), recent respiratory infection (OR: 78.52, p < 0.01), and pulmonary hypertension (OR: 13.60, p < 0.01) as independent risk factors for PPC following tricuspid valve surgery. Conversely, the 6-minute walk distance (6MWD) (OR: 0.99, p = 0.01) and tricuspid annular plane systolic excursion (TAPSE) (OR: 0.61, p < 0.01) were identified as independent protective factors. Conclusion: The incidence of PPC following tricuspid valve surgery was determined to be 29.9%. The identified predictors—smoking status, severity of tricuspid regurgitation, recent respiratory infections, pulmonary hypertension, as well as protective factors like 6MWD and TAPSE—can offer valuable insights for optimizing the preoperative physiological conditions in patients undergoing tricuspid valve surgery.
{"title":"Preoperative Predictors of Postoperative Pulmonary Complication Following Isolated Tricuspid Valve Surgery","authors":"Jie Wu, Na He, Yuqiang Wang, Hong Li","doi":"10.59958/hsf.7635","DOIUrl":"https://doi.org/10.59958/hsf.7635","url":null,"abstract":"Background: Postoperative pulmonary complications (PPC) are the most frequently observed complications following cardiac surgery, leading to extended hospital stays and significant medical and economic burdens. Although surgical interventions for tricuspid valve disease are increasingly common, few risk factors for PPC in the context of tricuspid valve surgery have been identified. Uncovering these factors would have valuable clinical implications in terms of prognosis. Methods: We conducted a single-center retrospective study to evaluate preoperative factors associated with susceptibility to PPC in patients undergoing tricuspid valve surgery between 2018 to 2023. Independent predictors of PPC were identified using regression analysis. Results: Of the 147 patients included in the study, 29.9% (44 cases) experienced PPC. No statistically significant differences were observed in surgical procedures between the groups. Regression analysis identified smoking status (odds ratio [OR]: 7.69, p = 0.01), severity grade of tricuspid regurgitation (TR) (OR: 26.56, p < 0.01), recent respiratory infection (OR: 78.52, p < 0.01), and pulmonary hypertension (OR: 13.60, p < 0.01) as independent risk factors for PPC following tricuspid valve surgery. Conversely, the 6-minute walk distance (6MWD) (OR: 0.99, p = 0.01) and tricuspid annular plane systolic excursion (TAPSE) (OR: 0.61, p < 0.01) were identified as independent protective factors. Conclusion: The incidence of PPC following tricuspid valve surgery was determined to be 29.9%. The identified predictors—smoking status, severity of tricuspid regurgitation, recent respiratory infections, pulmonary hypertension, as well as protective factors like 6MWD and TAPSE—can offer valuable insights for optimizing the preoperative physiological conditions in patients undergoing tricuspid valve surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"70 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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