The heart surgery forum最新文献_第3页

A Single-Centre, Retrospective Research Evaluation of the Effect of Extended Intervention Model Based on Case Management of Treatment Compliance and Cardiac Function on Patients with Chronic Heart Failure 基于治疗依从性和心功能个案管理的扩展干预模式对慢性心力衰竭患者的影响的单中心回顾性研究评估

The heart surgery forum

Pub Date : 2023-12-13 DOI: 10.59958/hsf.6729

Songna Ren, Xuemian Yang, Yuan Niu, Xiaohui Hao, Suosuo Wang, Songjie Ren, Yiqing Liu

Objective: To explore the effect of case management-based extended intervention model on treatment compliance and cardiac function in patients with chronic heart failure. Methods: This study retrospectively analysed the clinical data of 203 patients with chronic heart failure at Xingtai Third Hospital from January 2019 to January 2022. In accordance with different intervention programs, the patients were divided into a study group (SG, n = 102) and a reference group (RG, n = 101). The SG received the extended intervention model based on case management, and the RG adopted the conventional intervention model. Comparison was conducted on the treatment compliance, cardiac function, activity of daily living scale (ADL) scores and readmission rates in both groups. Results: After intervention, the SG showed higher treatment compliance (p < 0.05), lower heart rate, higher left ventricular ejection fraction, ratio of transmitral peak rapid filling velocity to transmitral peak atrial filling velocity at mitral orifice and six-minute walk distance (p < 0.001) and significantly lower ADL score and readmission rates than the RG (p < 0.05). Conclusion: The extended intervention model based on case management positively influences the treatment compliance of patients with chronic heart failure and continuously improves patients' cardiac function, reduces the readmission rate, enhances daily living ability, comprehensively increases clinical efficacy and benefits patients for a long period.

目的探讨基于个案管理的扩展干预模式对慢性心力衰竭患者治疗依从性和心脏功能的影响。方法：回顾性分析邢台市第三医院 203 例慢性心力衰竭患者的临床资料：本研究回顾性分析了邢台市第三医院2019年1月至2022年1月203例慢性心力衰竭患者的临床资料。根据不同的干预方案，将患者分为研究组（SG，n = 102）和参照组（RG，n = 101）。研究组接受基于病例管理的扩展干预模式，参照组采用常规干预模式。对两组患者的治疗依从性、心脏功能、日常生活活动量表（ADL）评分和再入院率进行比较。结果显示干预后，SG 的治疗依从性更高（P < 0.05），心率更低，左室射血分数、二尖瓣口处二尖瓣快速充盈峰值速度与二尖瓣口处心房充盈峰值速度之比以及六分钟步行距离更高（P < 0.001），ADL 评分和再入院率明显低于 RG（P < 0.05）。结论基于病例管理的延伸干预模式对慢性心力衰竭患者的治疗依从性有积极影响，可持续改善患者心功能，降低再入院率，提高日常生活能力，全面提高临床疗效，使患者长期受益。

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引用次数: 0

Costs and Readmissions Associated with Type A Aortic Dissections at High- and Low-Volume Centers 高容量和低容量中心 A 型主动脉夹层的相关费用和再住院率

The heart surgery forum

Pub Date : 2023-12-13 DOI: 10.59958/hsf.6821

Alice L Zhou, L. Yesantharao, E. Etchill, I. Barbur, Benjamin L. Shou, Hamza Aziz, C. W. Choi, Jennifer S. Lawton, Ahmet Kilic

Background: Costs and readmissions associated with type A aortic dissection repairs are not well understood. We investigated statewide readmissions, costs, and outcomes associated with the surgical management of type A aortic dissection repairs at low- and high-volume centers. Methods: We identified all adult type A aortic dissection patients who underwent operative repair in the Maryland Health Services Cost Review Commission's database (2012–2020). Hospitals were stratified into high- (top quartile of total repairs) or low-volume centers. Results: Of the 249 patients included, 193 (77.5%) were treated at a high-volume center. Patients treated at high- and low-volume centers had no differences in age, sex, race, primary payer, or severity (all p > 0.5). High- compared to low-volume centers had a greater proportion of patients transferred in (71.5% vs. 17.9%, p < 0.001). High-volume centers also had longer lengths of stay (12 vs. 8 days, p < 0.001), similar inpatient mortality (13.0% vs. 16.1%, p = 0.6), and similar proportion of patients readmitted (54.9% vs. 51.8%, p = 0.7). High-volume centers had greater index admission costs ($114,859 vs. $72,090, p < 0.001) and similar readmission costs ($48,367 vs. $42,204, p = 0.5). At high-volume centers, transferred patients compared to direct admissions had greater severity of illness (p = 0.05), similar mortality (p = 0.53), and greater lengths of stay (p = 0.05). Conclusions: High-volume centers had a greater number of patients transferred from other institutions compared to low-volume centers. High-volume centers were associated with increased index admission resource utilization, with transfer patients having higher illness severity and greater resource utilization, yet similar mortality, compared to direct admission patients.

背景：与 A 型主动脉夹层修补术相关的成本和再入院率还不是很清楚。我们在全州范围内调查了低流量和高流量中心与 A 型主动脉夹层修复手术管理相关的再入院率、成本和结果。方法：我们在马里兰州卫生服务成本审查委员会的数据库（2012-2020 年）中确定了所有接受手术修复的成人 A 型主动脉夹层患者。将医院分为高量（总修复量的前四分之一）或低量中心。结果：在纳入的 249 名患者中，193 人（77.5%）在高容量中心接受治疗。在高流量中心和低流量中心接受治疗的患者在年龄、性别、种族、主要付款人或严重程度方面没有差异（所有 p > 0.5）。与低流量中心相比，高流量中心的转入患者比例更高（71.5% 对 17.9%，P < 0.001）。高流量中心的住院时间也更长（12 天 vs. 8 天，p < 0.001），住院患者死亡率相似（13.0% vs. 16.1%，p = 0.6），再入院患者比例相似（54.9% vs. 51.8%，p = 0.7）。高流量中心的指标入院费用更高（114,859 美元对 72,090 美元，p < 0.001），再入院费用相似（48,367 美元对 42,204 美元，p = 0.5）。在高流量中心，与直接入院患者相比，转院患者的病情严重程度更高（p = 0.05），死亡率相似（p = 0.53），住院时间更长（p = 0.05）。结论：与低流量中心相比，高流量中心从其他机构转来的病人数量更多。与直接入院的患者相比，转院患者的病情严重程度更高，资源利用率更高，但死亡率相似。

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引用次数: 0

A Novel Risk Score to Predict Thirty-Day Readmissions after Acute Type A Aortic Dissections 预测急性 A 型主动脉夹层术后三十天再入院的新型风险评分法

The heart surgery forum

Pub Date : 2023-12-13 DOI: 10.59958/hsf.6819

Danial Ahmad, E. Aranda-Michel, Derek Serna-Gallegos, G. Arnaoutakis, James A. Brown, Sarah Yousef, Rashmi Rao, Yisi Wang, Julie Phillippi, Ibrahim Sultan

Background: Readmissions following acute type A aortic dissections (ATAAD) are associated with potentially worse clinical outcomes and increased hospital costs. Predicting which patients are at risk for readmission may guide patient management prior to discharge. Methods: The National Readmissions Database was utilized to identify patients treated for ATAAD between 2010 and 2018. Univariate mixed effects logistic regression was used to assess each variable. Variables were assigned risk points based off the bootstrapped (bias-corrected) odds ratio of the final variable model according to the Johnson's scoring system. A mixed effect logistic regression was run on the risk score (sum of risk points) and 30-day readmission. Calibration plots and predicted readmission curves were generated for model assessment. Results: A total of 30,727 type A aortic dissections were identified. The majority of ATAAD (66%) were in men with a median age of 61 years and 30-day readmission rate of 19.4%. The risk scores ranging from –1 to 14 mapped to readmission probabilities between 3.5% and 29% for ATAAD. The predictive model showed good calibration and receiver operator characteristics with an area under the curve (AUC) of 0.81. Being a resident of the hospital state (OR: 2.01 [1.64, 2.47], p < 0.001) was the highest contributor to readmissions followed by chronic kidney disease (1.35 [1.16, 1.56], p = 0), discharge to a short-term facility (1.31 [1.09, 1.57], p = 0.003), and developing a myocardial infarction (1.20 [1.00, 1.45], p = 0.048). Conclusions: The readmission model had good predictive capability given by the large AUC. Being a resident in the State of the index admission was the most significant contributor to readmission.

背景：急性 A 型主动脉夹层（ATAAD）术后再入院可能会导致更差的临床预后和更高的住院费用。预测哪些患者有再次入院的风险可以指导出院前的患者管理。方法：利用美国国家再入院数据库（National Readmissions Database）来识别2010年至2018年间接受ATAAD治疗的患者。采用单变量混合效应逻辑回归评估每个变量。根据约翰逊评分系统，基于最终变量模型的自引导（偏差校正）几率，为变量分配风险点。对风险评分（风险点总和）和 30 天再入院情况进行混合效应逻辑回归。生成校准图和预测再入院曲线，以便对模型进行评估。结果：共发现 30,727 例 A 型主动脉夹层。大部分（66%）ATAAD 患者为男性，中位年龄为 61 岁，30 天再入院率为 19.4%。风险评分从-1到14，与ATAAD再入院概率的对应关系为3.5%到29%。预测模型显示出良好的校准和接收器运算特性，曲线下面积（AUC）为 0.81。住院州居民（OR：2.01 [1.64, 2.47]，p < 0.001）是导致再入院的最大因素，其次是慢性肾病（1.35 [1.16, 1.56]，p = 0）、出院到短期机构（1.31 [1.09, 1.57]，p = 0.003）和心肌梗死（1.20 [1.00, 1.45]，p = 0.048）。结论从较大的 AUC 值来看，再入院模型具有良好的预测能力。作为指数入院时所在州的居民是导致再入院的最重要因素。

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引用次数: 0

A Comparative Study of 64-Slice Coronary CT Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the Identification of Coronary Artery Stenosis 64 片冠状动脉 CT 血管造影 (CCTA) 与心肌灌注成像 (MPI) 在识别冠状动脉狭窄方面的比较研究

The heart surgery forum

Pub Date : 2023-12-13 DOI: 10.59958/hsf.6685

Bin Li, Dandan Wu

Objective: The aim of this study was to compare the diagnostic accuracy of 64-Slice Coronary Computer Tomography Angiography (CCTA) and Myocardial Perfusion Imaging (MPI) in the identification of significant coronary artery stenosis (>50% luminal narrowing). Methods: A total of 120 patients suspected of having coronary artery disease were divided into two groups, with 60 patients in each group. Group 1 underwent CCTA and group 2 underwent MPI. Diagnostic accuracy parameters, image quality, radiation exposure, and procedure time were compared. Results: CCTA demonstrated higher sensitivity (90% vs. 80%, p = 0.049) and similar specificity (75% vs. 70%, p = 0.453) compared to MPI. Image quality was slightly superior in the CCTA group. Radiation exposure was significantly lower in the CCTA group compared to the MPI group (3.5 ± 1.2 mSv vs. 9.4 ± 1.7 mSv, p < 0.001). The procedure time for CCTA was also significantly less than that for MPI (10.3 ± 2.1 minutes vs. 45.2 ± 5.3 minutes, p < 0.001). Conclusion: CCTA showed superior sensitivity, image quality, and efficiency compared to MPI while exposing patients to a lower radiation dose. Further multicenter studies with larger patient populations are needed to validate these findings.

研究目的本研究旨在比较 64 片冠状动脉计算机断层扫描（CCTA）和心肌灌注成像（MPI）在识别冠状动脉明显狭窄（管腔狭窄>50%）方面的诊断准确性。研究方法将 120 名疑似冠状动脉疾病患者分为两组，每组 60 人。第一组接受 CCTA 检查，第二组接受 MPI 检查。比较诊断准确性参数、图像质量、辐射暴露和手术时间。结果显示与 MPI 相比，CCTA 的灵敏度更高（90% 对 80%，p = 0.049），特异性相似（75% 对 70%，p = 0.453）。CCTA 组的图像质量略胜一筹。CCTA 组的辐射量明显低于 MPI 组（3.5 ± 1.2 mSv 对 9.4 ± 1.7 mSv，p < 0.001）。CCTA 的手术时间也明显少于 MPI（10.3 ± 2.1 分钟 vs 45.2 ± 5.3 分钟，p < 0.001）。结论与 MPI 相比，CCTA 在灵敏度、图像质量和效率方面都更胜一筹，同时患者受到的辐射剂量也更低。要验证这些发现，还需要对更多患者进行进一步的多中心研究。

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引用次数: 0

Female Gender in Cardiac Surgery: Is it Still a Significant Risk? A Retrospective Study in Saudi Arabia 心脏手术中的女性性别：是否仍有重大风险？沙特阿拉伯的一项回顾性研究

The heart surgery forum

Pub Date : 2023-12-13 DOI: 10.59958/hsf.6929

Khaled Ebrahim Al-Ebrahim, Abdullah Hisham Baghaffar, M. Fatani, Lamis Award Alassiri, S. A. Albishri, Atheer Mohammed Althaqafi, Reem Abdulkhaliq Alghamdi, Nura Fikri Alshoaibi, S. S. Algarni, Marah Meshal Alsulami, Saud Abdulaziz Albukhari, A. K. Alassiri, A. Elassal

Background: Female sex is considered an independent predictor for mortality and morbidity following cardiac surgery. This study is to review the outcomes of adult cardiac surgery between males and females in a Saudi tertiary referral hospital. Method: This was a retrospective study for 925 adult patients operated on for ischemic coronary artery disease and acquired aortic and mitral valvular heart disease from 2015 to August 2023. We analyzed patient characteristics, intraoperative data, and postoperative results to compare outcomes between males and females. Results: Preoperative risk factors were not significantly different in both groups. Postoperative outcomes showed gender-based differences. In univariable analysis, females, compared to males, had significantly greater odds of prolonged postoperative ventilation (>24 hours), 32.8% of females compared to 20.7% of males (p < 0.001). Also, sternal wound infection was notably higher among females (13.3%) (p < 0.001). Mortality also exhibited a significant association, with 14.2% of females experiencing mortality compared to 9.4% of males (p = 0.049). In the multivariable analysis for elevated postoperative troponin, the use of pre-operative intra-aortic balloon pump, urgent/emergent surgery, elevated pre-operative troponin and combined bypass grafting with valve surgery, were also predictive of higher post-operative troponin concentrations (beta = 0.43, 95% CI: 0.25 to 0.62, p < 0.001). Conclusion: Females in Saudi Arabia have an increased risk of short-term morbidity and mortality after cardiac surgery compared to males. Vague and delayed presentation and then the late diagnosis and referral are likely the main contributing factors. This highlights the need to implement preoperative measures to improve early diagnosis and referral to eliminate gender bias.

背景：女性性别被认为是心脏手术后死亡率和发病率的独立预测因素。本研究旨在回顾沙特一家三级转诊医院中男女成人心脏手术的结果。方法：这是一项回顾性研究，研究对象是 2015 年至 2023 年 8 月期间因缺血性冠状动脉疾病以及获得性主动脉瓣和二尖瓣心脏病而接受手术的 925 名成人患者。我们分析了患者特征、术中数据和术后结果，比较了男性和女性的结果。结果：两组患者的术前风险因素无明显差异。术后结果显示出性别差异。在单变量分析中，女性术后通气时间延长（>24 小时）的几率明显高于男性，女性为 32.8%，男性为 20.7%（P < 0.001）。此外，女性胸骨伤口感染率明显更高（13.3%）（P < 0.001）。死亡率也有显著关联，女性死亡率为 14.2%，而男性为 9.4%（p = 0.049）。在术后肌钙蛋白升高的多变量分析中，术前使用主动脉内球囊反搏泵、紧急/急诊手术、术前肌钙蛋白升高以及合并瓣膜手术的旁路移植术也可预测较高的术后肌钙蛋白浓度（β = 0.43，95% CI：0.25 至 0.62，p < 0.001）。结论与男性相比，沙特阿拉伯女性在心脏手术后短期内发病和死亡的风险更高。症状模糊和延迟出现以及诊断和转诊过晚可能是主要原因。这凸显了实施术前措施以改善早期诊断和转诊以消除性别偏见的必要性。

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引用次数: 0

Peak Blood Lactate at 24 h after ECMO Can Predict 30-day Mortality in Infants after Complex Cardiac Surgery ECMO 术后 24 小时的血乳酸峰值可预测复杂心脏手术后婴儿的 30 天死亡率

The heart surgery forum

Pub Date : 2023-12-07 DOI: 10.59958/hsf.5639

Fanwei Meng, Jianchao Li, Weijie Liang, Haoju Dong, Bing Li, Xiaoliang Qian, Leiyi Yang, Zhaoyun Cheng

Objective: Peak blood lactate at 24 h after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants after complex cardiac surgery. Methods: Twenty-eight infants with ECMO after complex congenital heart disease surgery were selected from March 2019 to March 2022 in our hospital. The infants were divided into survival group (n = 11) and non-survival group (n = 17) according to 30-day survival after discharge from hospital. The risk factors at 30-day mortality after discharge were analyzed by Cox regression analysis. Results: When compared to the non-survival group, there were significant differences in peak blood lactate at 24 h after ECMO, liver dysfunction and multiple organ dysfunction syndrome (MODS) in the survival group (p < 0.05). Cox regression analysis showed that peak blood lactate at 24 h after ECMO (HR = 1.074, 95% CI: 1.005–1.149, p = 0.036) and MODS (HR = 4.120, 95% CI: 1.373–12.362, p = 0.012) were related risk factors affecting the prognosis of infants. The best cutoff value for the peak blood lactate at 24 h after ECMO was 10.2 mmol/L. The area under the curve (AUC) for predicting the 30-day survival rate of the ECMO assisted infants after discharge from hospital was 0.770 (95% CI: 0.592–0.948, p = 0.018), with a sensitivity of 94.1% and specificity of 54.5%. Conclusion: The peak blood lactate at 24 h after ECMO can predict the 30-day mortality after discharge of infants treated with ECMO after complex cardiac surgery. The best cut-off value for peak blood lactate at 24 h after ECMO was 10.2 mmol/L.

目的:体外膜氧合(ECMO)后24 h血乳酸峰值可预测复杂心脏手术后婴儿30天死亡率。方法:选取2019年3月至2022年3月在我院进行复杂先天性心脏病手术后行ECMO的患儿28例。根据患儿出院后30天生存率分为生存组(n = 11)和非生存组(n = 17)。采用Cox回归分析出院后30天死亡率的危险因素。结果:与非生存组比较，生存组患者ECMO后24 h血乳酸峰值、肝功能障碍、多器官功能障碍综合征(MODS)等指标差异均有统计学意义(p < 0.05)。Cox回归分析显示，ECMO后24 h血乳酸峰值(HR = 1.074, 95% CI: 1.005 ~ 1.149, p = 0.036)和MODS (HR = 4.120, 95% CI: 1.373 ~ 12.362, p = 0.012)是影响患儿预后的相关危险因素。ECMO后24 h血乳酸峰值的最佳临界值为10.2 mmol/L。预测ECMO辅助婴儿出院后30天生存率的曲线下面积(AUC)为0.770 (95% CI: 0.592-0.948, p = 0.018)，敏感性为94.1%，特异性为54.5%。结论:ECMO后24 h血乳酸峰值可预测复杂心脏手术后ECMO患儿出院后30天死亡率。ECMO后24 h血乳酸峰值的最佳临界值为10.2 mmol/L。

{"title":"Peak Blood Lactate at 24 h after ECMO Can Predict 30-day Mortality in Infants after Complex Cardiac Surgery","authors":"Fanwei Meng, Jianchao Li, Weijie Liang, Haoju Dong, Bing Li, Xiaoliang Qian, Leiyi Yang, Zhaoyun Cheng","doi":"10.59958/hsf.5639","DOIUrl":"https://doi.org/10.59958/hsf.5639","url":null,"abstract":"Objective: Peak blood lactate at 24 h after extracorporeal membrane oxygenation (ECMO) can predict 30-day mortality in infants after complex cardiac surgery. Methods: Twenty-eight infants with ECMO after complex congenital heart disease surgery were selected from March 2019 to March 2022 in our hospital. The infants were divided into survival group (n = 11) and non-survival group (n = 17) according to 30-day survival after discharge from hospital. The risk factors at 30-day mortality after discharge were analyzed by Cox regression analysis. Results: When compared to the non-survival group, there were significant differences in peak blood lactate at 24 h after ECMO, liver dysfunction and multiple organ dysfunction syndrome (MODS) in the survival group (p < 0.05). Cox regression analysis showed that peak blood lactate at 24 h after ECMO (HR = 1.074, 95% CI: 1.005–1.149, p = 0.036) and MODS (HR = 4.120, 95% CI: 1.373–12.362, p = 0.012) were related risk factors affecting the prognosis of infants. The best cutoff value for the peak blood lactate at 24 h after ECMO was 10.2 mmol/L. The area under the curve (AUC) for predicting the 30-day survival rate of the ECMO assisted infants after discharge from hospital was 0.770 (95% CI: 0.592–0.948, p = 0.018), with a sensitivity of 94.1% and specificity of 54.5%. Conclusion: The peak blood lactate at 24 h after ECMO can predict the 30-day mortality after discharge of infants treated with ECMO after complex cardiac surgery. The best cut-off value for peak blood lactate at 24 h after ECMO was 10.2 mmol/L.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"8 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138591609","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}

引用次数: 0

Correlation between Mean Platelet Volume and Gensini Score in Patients with Coronary Heart Disease in Different Diabetic States 不同糖尿病状态下冠心病患者的平均血小板体积与 Gensini 评分之间的相关性

The heart surgery forum

Pub Date : 2023-12-07 DOI: 10.59958/hsf.6937

Qining Qiu, Guohong Zhu, Gang Peng, Lumin Wang, Hao Lu, Ye Xu, Wenjun Zhang, Yun Shen, Yanrong Ye, QianZhou Lv, Qingle Wang

Subject: To investigate the correlation between mean platelet volume (MPV) levels and Gensini scores in stable coronary heart disease (CHD) patients with or without diabetes. Methods: A retrospective analysis was conducted on 2525 patients with stable CHD in Zhongshan Hospital, Fudan University. There were 1274 in the low MPV group and 1251 in the high MPV group, divided by a median MPV level of 10.9 fL. In the total population, 1605 patients were non-diabetic and 920 were diabetic. The severity of coronary artery disease was quantified using the Gensini score. Results: The Gensini score was significantly higher in the high MPV group than in the low MPV group (p < 0.001). MPV levels increased significantly with the number of stenotic (>50%) coronary vessels (p < 0.001). The Spearman analysis showed a positive correlation between MPV and Gensini score (r = 0.189, p < 0.001), which was more significant in the diabetic subgroup (r = 0.232, p < 0.001). Receiver operating characteristic (ROC) curves were employed to assess the predictive value of MPV for high Gensini scores, using the median value of 32 points as the cutoff. MPV levels in the diabetes cohort exhibited a higher predictive value for high Gensini scores (area under the curve: 0.635 [0.614–0.657], p < 0.001). Multivariate linear regression analysis showed that diabetes and MPV were independently associated with Gensini scores. Conclusion: MPV levels in stable CHD patients can predict the severity of coronary artery stenosis. This correlation is more significant in the presence of diabetes.

目的:探讨伴有或不伴有糖尿病的稳定型冠心病(CHD)患者平均血小板体积(MPV)水平与Gensini评分的相关性。方法:对复旦大学附属中山医院2525例稳定期冠心病患者进行回顾性分析。低MPV组1274例，高MPV组1251例，除以中位MPV水平10.9 fL。在总人口中，1605例为非糖尿病患者，920例为糖尿病患者。冠状动脉疾病的严重程度用Gensini评分进行量化。结果:高MPV组Gensini评分明显高于低MPV组(p < 0.001)。MPV水平随着狭窄冠脉数量(>50%)的增加而显著升高(p < 0.001)。Spearman分析显示MPV与Gensini评分呈正相关(r = 0.189, p < 0.001)，且在糖尿病亚组中更为显著(r = 0.232, p < 0.001)。采用受试者工作特征(Receiver operating characteristic, ROC)曲线评估MPV对Gensini评分较高的预测价值，以32分的中位数作为截止值。糖尿病队列中MPV水平对Gensini评分较高具有较高的预测价值(曲线下面积:0.635 [0.614-0.657]，p < 0.001)。多元线性回归分析显示糖尿病和MPV与Gensini评分独立相关。结论:稳定期冠心病患者MPV水平可预测冠状动脉狭窄的严重程度。这种相关性在糖尿病患者中更为显著。

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引用次数: 0

A Case Report of Arteriovenous Fistula Penetrating into the Ascending Aorta Due to Right Internal Jugular Vein Placement. 右颈内静脉置管致动静脉瘘穿透升主动脉1例。

IF 0.6

The heart surgery forum

Pub Date : 2022-10-31 DOI: 10.1532/hsf.4937

Fanwei Meng, Zhi-Ping Liu, Jian Wang

Internal jugular vein placement is frequently utilized in clinical practice for rapid infusion, intraoperative monitoring, peritoneal dialysis, and access for interventions. Additionally, the process may lead to complications like hematoma, infection, misdirection of the artery, pneumothorax, and arteriovenous fistula. In the case described in this report, all vascular ruptures effectively were repaired because when internal jugular vein placement was adopted, a dialysis catheter would go through the right internal jugular vein into the subclavian artery, then the ascending aorta via the cephalic trunk, and finally the ectopic catheter would be surgically removed. The patient was released from the hospital on the seventh postoperative day after maintaining stable vital signs throughout the procedure.

颈内静脉放置在临床实践中经常用于快速输液，术中监测，腹膜透析和干预措施的获取。此外，该过程可能导致血肿、感染、动脉误导、气胸和动静脉瘘等并发症。本病例采用颈内静脉置管时，透析导管经右颈内静脉进入锁骨下动脉，再经头干进入升主动脉，最后手术取出异位导管，所有血管破裂均得到有效修复。患者在手术过程中生命体征稳定，于术后第7天出院。

引用次数: 0

Mesenteric Ischemia After Cardiac Surgery in Dialysis Patients: An Overlooked Risk Factor. 透析患者心脏手术后肠系膜缺血:一个被忽视的危险因素。

IF 0.6

The heart surgery forum

Pub Date : 2022-10-31 DOI: 10.1532/hsf.4859

Daisuke Takeyoshi, Tomonori Shirasaka, Keisuke Shibagaki, Ryo Okubo, Shingo Kunioka, Yuta Kikuchi, Hiroyuki Kamiya

Background: No study has examined the association of the calcification of abdominal artery orifices with nonocclusive mesenteric ischemia (NOMI) in dialysis patients undergoing cardiac surgery. Thus, this study aimed to determine whether calcification of abdominal blood vessel orifices in hemodialysis patients may be a risk factor for NOMI and examine the long-term survival of dialysis patients after undergoing cardiac surgery.

Methods: From April 2014 to September 2020, 100 dialysis patients underwent cardiac surgery at our hospital. The calcification of the celiac artery (CA) and superior mesenteric artery (SMA) was evaluated by computed tomography, and the degree of orifice stenosis was graded as follows: patent, 0; partial occlusion, 1; and complete occlusion, 2.

Results: Eight patients experienced NOMI, and all of them died. SMA calcification scores were not significantly different between the NOMI and non-NOMI groups (1.38±0.52 vs. 1.13±0.69; P = 0.247). However, the average CA orifice calcification score was significantly greater in the NOMI group than in the non-NOMI group (1.63±0.52 vs. 1.15±0.65; P = 0.039), and the SMA+CA orifice calcification scores were significantly different between the groups (3.00±0.76 vs. [non-NOMI] 2.25±1.18; P = 0.028). In all patients, the 30-day and in-hospital mortality rates were 13% and 18%, respectively. All patients were completely followed up with a mean follow-up period of 604±585 days. Kaplan-Meier survival curves showed that patients with SMA and CA calcification tended to have a shorter overall survival than patients without calcification; however, no significant difference was noted.

Conclusions: The calcification of CA and/or SMA orifices was associated with postoperative NOMI and poor long-term survival among dialysis patients undergoing cardiac surgery.

背景:没有研究调查心脏手术透析患者腹动脉口钙化与非闭塞性肠系膜缺血(NOMI)的关系。因此，本研究旨在确定血液透析患者腹部血管口钙化是否可能是发生NOMI的危险因素，并研究透析患者心脏手术后的长期生存。方法:2014年4月至2020年9月在我院行心脏手术透析患者100例。ct检查乳糜动脉(CA)和肠系膜上动脉(SMA)的钙化情况，并对裂口狭窄程度进行分级:通畅，0;局部闭塞，1;完全闭塞，2。结果:8例患者发生NOMI，全部死亡。NOMI组和非NOMI组的SMA钙化评分差异无统计学意义(1.38±0.52∶1.13±0.69;P = 0.247)。然而，NOMI组的CA孔钙化平均评分明显高于非NOMI组(1.63±0.52∶1.15±0.65;P = 0.039)， SMA+CA孔钙化评分组间差异有统计学意义(3.00±0.76 vs.[非nomi] 2.25±1.18;P = 0.028)。所有患者的30天死亡率和住院死亡率分别为13%和18%。所有患者均得到完全随访，平均随访时间604±585天。Kaplan-Meier生存曲线显示，SMA和CA钙化患者的总生存期往往比没有钙化的患者短;然而，没有发现显著差异。结论:在接受心脏手术的透析患者中，CA和/或SMA孔的钙化与术后NOMI和较差的长期生存有关。

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引用次数: 1

Short-Term Nutritional Support Improves The Preoperative Nutritional Status of Infants With Non-Restrictive Ventricular Septal Defect: A Prospective Controlled Study. 短期营养支持改善非限制性室间隔缺损婴儿术前营养状况:一项前瞻性对照研究。

IF 0.6

The heart surgery forum

Pub Date : 2022-10-31 DOI: 10.1532/hsf.5009

Li-Ping Xu, Shi-Hao Lin, Qi-Liang Zhang, Yirong Zheng, Guangming Lin

Objective: To investigate the effect of short-term nutritional support on improving preoperative nutritional status of infants with non-restrictive ventricular septal defect.

Methods: A prospective randomized controlled study was conducted from June 2021 to December 2021 at a provincial children's hospital in China. The difference of nutritional status between the intervention group and the control group after short-term nutritional support was compared.

Results: After one month of nutritional support, the weight, STRONGkids score, albumin, prealbumin, and hemoglobin in the intervention group significantly were higher than those in the control group (P < 0.05). The postoperative intensive care time and discharge time of the two groups significantly were lower in the intervention group than those in the control group (P < 0.05).

Conclusion: The preoperative nutritional support of 1 month for infants with non-restrictive ventricular septal defect can effectively improve their preoperative nutritional status and promote postoperative recovery.

目的:探讨短期营养支持对改善非限制性室间隔缺损婴儿术前营养状况的影响。方法:于2021年6月至2021年12月在中国某省级儿童医院进行前瞻性随机对照研究。比较干预组与对照组短期营养支持后的营养状况差异。结果:营养支持1个月后，干预组患儿体重、STRONGkids评分、白蛋白、前白蛋白、血红蛋白均显著高于对照组(P < 0.05)。干预组两组患者术后重症监护时间、出院时间均显著低于对照组(P < 0.05)。结论:非限制性室间隔缺损患儿术前1个月营养支持可有效改善患儿术前营养状况，促进患儿术后恢复。

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