When I was a medical student rotating on the various clinical services and thinking about career decisions, a common refrain from those offering advice on these decisions was that an early 'branch in the career decision tree' was deciding whether you liked caring for patients or liked doing procedures. I sensed that this advice was creating, or at least suggesting, a false or inaccurate choice. In fact, I even remember hearing that surgeons should not get too close to their patients in order to retain a sense of detachment. Somehow I just didn't see it that way.
{"title":"Pull Up a Chair, Sit Down, and Listen.","authors":"C. Tribble","doi":"10.1532/hsf.4757","DOIUrl":"https://doi.org/10.1532/hsf.4757","url":null,"abstract":"When I was a medical student rotating on the various clinical services and thinking about career decisions, a common refrain from those offering advice on these decisions was that an early 'branch in the career decision tree' was deciding whether you liked caring for patients or liked doing procedures. I sensed that this advice was creating, or at least suggesting, a false or inaccurate choice. In fact, I even remember hearing that surgeons should not get too close to their patients in order to retain a sense of detachment. Somehow I just didn't see it that way.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122683518","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}
Raymond J. Strobel, M. Khaja, A. Peruri, M. Mullen, A. Kadl, Aditya M Sharma, N. Teman
Massive pulmonary embolism (PE) is associated with high mortality rates. Pulmonary Embolism Response Team (PERT) collaboration with prompt access to veno-arterial extracorporeal membrane oxygenation (VA ECMO) during mechanical or aspiration thrombectomy for massive PE can be life-saving; ECMO stand-by should be considered for high-risk cases. We describe a case of massive PE treated with intraprocedural VA ECMO during the catheter-directed intervention.
{"title":"Veno-Arterial Extracorporeal Membrane Oxygenation and Thrombectomy for Massive Pulmonary Embolism.","authors":"Raymond J. Strobel, M. Khaja, A. Peruri, M. Mullen, A. Kadl, Aditya M Sharma, N. Teman","doi":"10.1532/hsf.4435","DOIUrl":"https://doi.org/10.1532/hsf.4435","url":null,"abstract":"Massive pulmonary embolism (PE) is associated with high mortality rates. Pulmonary Embolism Response Team (PERT) collaboration with prompt access to veno-arterial extracorporeal membrane oxygenation (VA ECMO) during mechanical or aspiration thrombectomy for massive PE can be life-saving; ECMO stand-by should be considered for high-risk cases. We describe a case of massive PE treated with intraprocedural VA ECMO during the catheter-directed intervention.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124582467","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}
F. Kyhl, M. Smerup, A. D. Jensen, J. Butt, Lauge Østergaard, Hanna H Dagnegård, L. Køber, E. Fosbøl
BACKGROUND Infective endocarditis (IE) with involvement of the aortic root is associated with high short-term mortality and morbidity. Long-term data are sparse, and the existing studies with long-term data are restricted by a low number of patients and do not report mortality risks of different age groups. OBJECTIVE This study examined the all-cause mortality risk postoperatively of patients with first-time IE who underwent aortic root replacement (ARR), according to age at the time of surgery, with one and 10 years follow-up. METHODS Patients with first-time IE who underwent ARR surgery from 2000-2016 were identified in Danish nationwide administrative registries and divided into age groups: ≤60, 61-74, and ≥75 years. We compared one- and 10-year mortality risk using multivariable Cox regression across the three age groups. RESULTS We identified 258 patients who underwent ARR (26.0% female, 42.6% with prosthetic valves, median age 64 years (IQR 55-73), of whom 98, 112, and 48 patients were ≤60 years, 61-74 years, and >75 years, respectively. The corresponding in-hospital mortality risk was 10.2%, 22.3%, and 29.2% (P = .01), respectively. The one-year postoperative mortality risk was 17.3%, 28.6%, and 33.3% (P = 0.05), while at 10 years after surgery, it was 31.8%, 62.9%, and 77.1% (P < 0.01), respectively. The adjusted 10-year hazard ratio was higher in the 61-74 and >75-year age groups (HR 1.94 [1.18-3.16] and 2.46 [1.35-4.49]) compared with the ≤60. CONCLUSION Aortic root replacement in patients with first-time IE was associated with a high in-hospital and one- and 10-year mortality with worse outcomes with age.
{"title":"Long-Term Mortality in Different Age Groups of Patients with Infective Endocarditis Who Undergo Aortic Root Replacement: A Nationwide Study.","authors":"F. Kyhl, M. Smerup, A. D. Jensen, J. Butt, Lauge Østergaard, Hanna H Dagnegård, L. Køber, E. Fosbøl","doi":"10.1532/hsf.4555","DOIUrl":"https://doi.org/10.1532/hsf.4555","url":null,"abstract":"BACKGROUND\u0000Infective endocarditis (IE) with involvement of the aortic root is associated with high short-term mortality and morbidity. Long-term data are sparse, and the existing studies with long-term data are restricted by a low number of patients and do not report mortality risks of different age groups.\u0000\u0000\u0000OBJECTIVE\u0000This study examined the all-cause mortality risk postoperatively of patients with first-time IE who underwent aortic root replacement (ARR), according to age at the time of surgery, with one and 10 years follow-up.\u0000\u0000\u0000METHODS\u0000Patients with first-time IE who underwent ARR surgery from 2000-2016 were identified in Danish nationwide administrative registries and divided into age groups: ≤60, 61-74, and ≥75 years. We compared one- and 10-year mortality risk using multivariable Cox regression across the three age groups.\u0000\u0000\u0000RESULTS\u0000We identified 258 patients who underwent ARR (26.0% female, 42.6% with prosthetic valves, median age 64 years (IQR 55-73), of whom 98, 112, and 48 patients were ≤60 years, 61-74 years, and >75 years, respectively. The corresponding in-hospital mortality risk was 10.2%, 22.3%, and 29.2% (P = .01), respectively. The one-year postoperative mortality risk was 17.3%, 28.6%, and 33.3% (P = 0.05), while at 10 years after surgery, it was 31.8%, 62.9%, and 77.1% (P < 0.01), respectively. The adjusted 10-year hazard ratio was higher in the 61-74 and >75-year age groups (HR 1.94 [1.18-3.16] and 2.46 [1.35-4.49]) compared with the ≤60.\u0000\u0000\u0000CONCLUSION\u0000Aortic root replacement in patients with first-time IE was associated with a high in-hospital and one- and 10-year mortality with worse outcomes with age.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125616549","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}
R. Sandoval, C. Faust, Tobias Kruger, M. Mustafi, H. Magunia, F. Neunhoeffer, M. Hofbeck, C. Schlensak
INTRODUCTION The aim of this study was to determine whether whole-body perfusion (WBP) consisting of a combined antegrade cerebral perfusion (ACP) and lower body perfusion (LBP) improves the outcome after aortic arch reconstruction surgery in neonates compared with ACP. METHODS Sixty-five consecutive patients under one year of age who underwent aortic arch reconstruction as the main procedure or as part of a more complex surgery from 2014-2020 in our center were included. The patients were separated into two groups, according to the perfusion strategy, either ACP (34 patients) as the control group or WBP (31 patients) as the intervention group. LBP was achieved through an arterial sheath in the femoral artery. Outcome parameters were postoperative renal, gastrointestinal, and neurological complications and 30-day mortality. RESULTS The patients in the WBP group showed lower intraoperative lactate levels and close to normal early postoperative renal and hepatic enzymes and LDH at PICU admission compared with the patients in the ACP group. The number of patients suffering from postoperative neurological complications and multiorgan failure was lower in the WBP group. CONCLUSION In our experience, the combined use of ACP and LBP through the femoral artery showed an improvement, regarding postoperative neurologic complications in neonates and infants undergoing aortic arch surgery.
{"title":"Impact of Whole-Body Perfusion in Postoperative Outcomes After Aortic Arch Reconstruction Surgery in Neonates and Infants.","authors":"R. Sandoval, C. Faust, Tobias Kruger, M. Mustafi, H. Magunia, F. Neunhoeffer, M. Hofbeck, C. Schlensak","doi":"10.1532/hsf.4501","DOIUrl":"https://doi.org/10.1532/hsf.4501","url":null,"abstract":"INTRODUCTION\u0000The aim of this study was to determine whether whole-body perfusion (WBP) consisting of a combined antegrade cerebral perfusion (ACP) and lower body perfusion (LBP) improves the outcome after aortic arch reconstruction surgery in neonates compared with ACP.\u0000\u0000\u0000METHODS\u0000Sixty-five consecutive patients under one year of age who underwent aortic arch reconstruction as the main procedure or as part of a more complex surgery from 2014-2020 in our center were included. The patients were separated into two groups, according to the perfusion strategy, either ACP (34 patients) as the control group or WBP (31 patients) as the intervention group. LBP was achieved through an arterial sheath in the femoral artery. Outcome parameters were postoperative renal, gastrointestinal, and neurological complications and 30-day mortality.\u0000\u0000\u0000RESULTS\u0000The patients in the WBP group showed lower intraoperative lactate levels and close to normal early postoperative renal and hepatic enzymes and LDH at PICU admission compared with the patients in the ACP group. The number of patients suffering from postoperative neurological complications and multiorgan failure was lower in the WBP group.\u0000\u0000\u0000CONCLUSION\u0000In our experience, the combined use of ACP and LBP through the femoral artery showed an improvement, regarding postoperative neurologic complications in neonates and infants undergoing aortic arch surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121983501","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}
Huai-Dong Chen, Shiqiang Wang, Dingwen Zheng, F. He
We report a case of a tracheal foreign body caused by a sewing needle. After about four months, the patient showed delayed dry cough and hemoptysis. The sewing needle that pierced the tracheal wall damaged the aorta, and we performed endovascular stenting to prevent arterial bleeding and removed it under a bronchoscope. The patient smoothly recovered after the operation. This case proves that treatment strategies for patients with foreign bodies in the trachea can be individualized.
{"title":"Delayed Presentation Injury of Descending Aorta and Bronchus Due to Sewing Needle Penetration: A Case Report.","authors":"Huai-Dong Chen, Shiqiang Wang, Dingwen Zheng, F. He","doi":"10.1532/hsf.4461","DOIUrl":"https://doi.org/10.1532/hsf.4461","url":null,"abstract":"We report a case of a tracheal foreign body caused by a sewing needle. After about four months, the patient showed delayed dry cough and hemoptysis. The sewing needle that pierced the tracheal wall damaged the aorta, and we performed endovascular stenting to prevent arterial bleeding and removed it under a bronchoscope. The patient smoothly recovered after the operation. This case proves that treatment strategies for patients with foreign bodies in the trachea can be individualized.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123957269","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}
Cardiopulmonary bypass (CPB), though indispensable in many cardiac surgery procedures, has several undesirable consequences. The aim of this study was to identify potential genes that may reduce the inflammatory response and complications after CPB. The GSE132176 dataset was selected from the Gene Expression Omnibus (GEO) database and included 10 patients with tetralogy of Fallot and 10 patients with an atrial septal defect who underwent CPB surgery. TSV files were downloaded after GEO2R processing. Protein-protein interaction analysis of common differentially expressed genes (DEGs) was performed using the Search Tool for the Retrieval of Interacting Genes. Gene modules and hub genes were visualized in the protein-protein interaction network using Cytoscape. Enrichment analysis was performed for all important DEGs, modular genes, and hub genes. A total of 72 DEGs were screened, including two functional and one hub gene module. FOS modular genes were primarily enriched in NGF-stimulated transcription, spinal cord injury, and PID AP1 pathway. The ATF3 modular gene was mainly enriched in cytomegalovirus infection and transcriptional misregulation in cancer. Hub gene modules were primarily enriched in the PID AP1 pathway, positive regulation of pri-miRNA transcription by RNA polymerase II, and the PID ATF2 pathway. FOS, JUN, ATF3, and EGR1 were the four most important hub genes; the top three hub genes were involved in the formation of AP-1 and enriched in the AP-1 pathway. Finally, we measured the expression levels of these four genes in patients undergoing CPB via qRT-PCR, and the results were consistent with those obtained in bioinformatic analysis. FOS, JUN, ATF3, and EGR1 and the AP-1 pathway may play key roles in inflammation and complications caused by CPB.
体外循环(CPB)虽然在许多心脏外科手术中不可或缺，但也有一些不良后果。本研究的目的是确定可能减少CPB后炎症反应和并发症的潜在基因。GSE132176数据集从基因表达综合数据库(GEO)中选择，包括10例法洛四联症患者和10例房间隔缺损患者，他们接受了CPB手术。GEO2R处理后下载TSV文件。利用互作基因检索工具(Search Tool for Retrieval of interintergenes)对共同差异表达基因(DEGs)进行蛋白-蛋白互作分析。利用Cytoscape可视化了蛋白-蛋白相互作用网络中的基因模块和枢纽基因。对所有重要的deg、模块化基因和枢纽基因进行富集分析。共筛选到72个deg，包括2个功能基因模块和1个枢纽基因模块。FOS模块基因主要富集于ngf刺激的转录、脊髓损伤和PID AP1通路。ATF3模块基因主要富集于巨细胞病毒感染和肿瘤中转录失调。Hub基因模块主要富集于PID AP1通路、RNA聚合酶II对pri-miRNA转录的正向调控以及PID ATF2通路。FOS、JUN、ATF3和EGR1是四个最重要的枢纽基因;前3个枢纽基因参与AP-1的形成，并富集于AP-1通路。最后，我们通过qRT-PCR检测了这四个基因在CPB患者中的表达水平，结果与生物信息学分析结果一致。FOS、JUN、ATF3、EGR1和AP-1通路可能在CPB引起的炎症和并发症中发挥关键作用。
{"title":"Bioinformatics Analysis Reveals Hub Genes That May Reduce Inflammation and Complications After Cardiopulmonary Bypass.","authors":"Quan Qi, Yibo Yan, Cheng Luo, Chen Fang, Yugui Li, Xiongwei Cai, Guoxing Ling, Haitao Song, Baoshi Zheng","doi":"10.1532/hsf.4487","DOIUrl":"https://doi.org/10.1532/hsf.4487","url":null,"abstract":"Cardiopulmonary bypass (CPB), though indispensable in many cardiac surgery procedures, has several undesirable consequences. The aim of this study was to identify potential genes that may reduce the inflammatory response and complications after CPB. The GSE132176 dataset was selected from the Gene Expression Omnibus (GEO) database and included 10 patients with tetralogy of Fallot and 10 patients with an atrial septal defect who underwent CPB surgery. TSV files were downloaded after GEO2R processing. Protein-protein interaction analysis of common differentially expressed genes (DEGs) was performed using the Search Tool for the Retrieval of Interacting Genes. Gene modules and hub genes were visualized in the protein-protein interaction network using Cytoscape. Enrichment analysis was performed for all important DEGs, modular genes, and hub genes. A total of 72 DEGs were screened, including two functional and one hub gene module. FOS modular genes were primarily enriched in NGF-stimulated transcription, spinal cord injury, and PID AP1 pathway. The ATF3 modular gene was mainly enriched in cytomegalovirus infection and transcriptional misregulation in cancer. Hub gene modules were primarily enriched in the PID AP1 pathway, positive regulation of pri-miRNA transcription by RNA polymerase II, and the PID ATF2 pathway. FOS, JUN, ATF3, and EGR1 were the four most important hub genes; the top three hub genes were involved in the formation of AP-1 and enriched in the AP-1 pathway. Finally, we measured the expression levels of these four genes in patients undergoing CPB via qRT-PCR, and the results were consistent with those obtained in bioinformatic analysis. FOS, JUN, ATF3, and EGR1 and the AP-1 pathway may play key roles in inflammation and complications caused by CPB.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123851850","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 A one-month-old neonate presented to the hospital with dyspnea and bloody stool, which happened suddenly and progressed over two days. CASE PRESENTATION Computed tomography and three-dimensional reconstruction of the trachea and heart was done, demonstrating significant trachea stenosis, aberrant right subclavian artery arising from Kommerell's diverticulum, and patent ductus arteriosus. Reconstruction of the aberrant subclavian artery, resection of the diverticulum, and ligation of ductus arteriosus was performed. CONCLUSION The case reported a rare combination of congenital anomalies and rare clinical manifestations at the same time. We thought the anatomical anomalies caused necrotizing enterocolitis (NEC), which lead to bloody stool.
{"title":"Aberrant Right Subclavian Artery with Kommerell's Diverticulum and Patent Ductus Arteriosus: Unusual Combination of Congenital Heart Anomalies and Clinical Manifestations in A Neonate.","authors":"Zhuoma Xiongqiu, Tiange Li, Q. An","doi":"10.1532/hsf.4455","DOIUrl":"https://doi.org/10.1532/hsf.4455","url":null,"abstract":"BACKGROUND\u0000A one-month-old neonate presented to the hospital with dyspnea and bloody stool, which happened suddenly and progressed over two days.\u0000\u0000\u0000CASE PRESENTATION\u0000Computed tomography and three-dimensional reconstruction of the trachea and heart was done, demonstrating significant trachea stenosis, aberrant right subclavian artery arising from Kommerell's diverticulum, and patent ductus arteriosus. Reconstruction of the aberrant subclavian artery, resection of the diverticulum, and ligation of ductus arteriosus was performed.\u0000\u0000\u0000CONCLUSION\u0000The case reported a rare combination of congenital anomalies and rare clinical manifestations at the same time. We thought the anatomical anomalies caused necrotizing enterocolitis (NEC), which lead to bloody stool.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131257045","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}
S. Ponnuru, Bineesh K Radhakrishnan, R. Sudevan, J. Karunakaran
BACKGROUND Surgical revascularization by coronary artery bypass grafting (CABG) is the gold standard treatment for coronary artery disease. But, in patients with severe left ventricular dysfunction (ischemic cardiomyopathy), the result of CABG is different from those with normal left ventricular function. The coronary artery disease pattern in the Indian subconti-nent is different from the western world, due to the diffuse nature of coronary involvement, the smaller size of native vessels, increased prevalence of diabetes mellitus and other risk factors, and more prevalence of severe left ventricular dysfunction. Most of the studies regarding the surgical outcomes in ischemic cardiomyopathy come from western countries. This study attempts to assess the outcomes of surgical management of ischemic cardiomyopathy in the Indian subcontinent. METHODS A single-center retrospective cohort study was conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. The data of CAD pa-tients, who underwent surgical coronary revascularization for severe LV dysfunction from January 2010 to December 2014, were collected from the hospital records and through tele-phonic interviews in a structured study proforma. A total of 146 patients satisfied the criteria and were followed up for a period of 5 years. RESULTS The mean age of the study population was 55.6 (8.8) years. Male preponderance was observed (94.52%; N = 138). CABG alone was done in 62.3% (N = 91) of the study partici-pants. CABG with linear plication was done in 23.3% (N = 34), CABG with MV repair in 7.5% (N = 11), and CABG with DORS in 6.8% (N = 10). The majority of patients (N = 54, 37%) received 4 grafts. Thirty-day mortality observed in the study population was 11 (7.5%). The causes documented were cardiac causes in 9 (82%), cerebrovascular events in one (9%), and septicemia in one (9%). The mean of 5-year survival of the study population was 94.2 (3.5) months with 95% CI 87.32, 101.13. There was a substantial improvement in the degree of mitral regurgitation. Ejection fraction (EF) also showed improvement. The mean preoperative EF was 29.51 (4.84%) and that of post-op was 39.92 (9.0%). CONCLUSION Despite the challenges of diffusely diseased coronary arteries, severe LV dysfunction, addressing associated significant MR and ventricular aneurysms, the outcome of surgical management of CAD with severe LV dysfunction, in the Indian population can be done with acceptable results. Randomized control studies in this subset can provide more solid evidence in this regard.
{"title":"Outcomes of Coronary Artery Disease Patients with Severe Left Ventricular Dysfunction Undergoing Surgical Management.","authors":"S. Ponnuru, Bineesh K Radhakrishnan, R. Sudevan, J. Karunakaran","doi":"10.1532/hsf.4353","DOIUrl":"https://doi.org/10.1532/hsf.4353","url":null,"abstract":"BACKGROUND\u0000Surgical revascularization by coronary artery bypass grafting (CABG) is the gold standard treatment for coronary artery disease. But, in patients with severe left ventricular dysfunction (ischemic cardiomyopathy), the result of CABG is different from those with normal left ventricular function. The coronary artery disease pattern in the Indian subconti-nent is different from the western world, due to the diffuse nature of coronary involvement, the smaller size of native vessels, increased prevalence of diabetes mellitus and other risk factors, and more prevalence of severe left ventricular dysfunction. Most of the studies regarding the surgical outcomes in ischemic cardiomyopathy come from western countries. This study attempts to assess the outcomes of surgical management of ischemic cardiomyopathy in the Indian subcontinent.\u0000\u0000\u0000METHODS\u0000A single-center retrospective cohort study was conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. The data of CAD pa-tients, who underwent surgical coronary revascularization for severe LV dysfunction from January 2010 to December 2014, were collected from the hospital records and through tele-phonic interviews in a structured study proforma. A total of 146 patients satisfied the criteria and were followed up for a period of 5 years.\u0000\u0000\u0000RESULTS\u0000The mean age of the study population was 55.6 (8.8) years. Male preponderance was observed (94.52%; N = 138). CABG alone was done in 62.3% (N = 91) of the study partici-pants. CABG with linear plication was done in 23.3% (N = 34), CABG with MV repair in 7.5% (N = 11), and CABG with DORS in 6.8% (N = 10). The majority of patients (N = 54, 37%) received 4 grafts. Thirty-day mortality observed in the study population was 11 (7.5%). The causes documented were cardiac causes in 9 (82%), cerebrovascular events in one (9%), and septicemia in one (9%). The mean of 5-year survival of the study population was 94.2 (3.5) months with 95% CI 87.32, 101.13. There was a substantial improvement in the degree of mitral regurgitation. Ejection fraction (EF) also showed improvement. The mean preoperative EF was 29.51 (4.84%) and that of post-op was 39.92 (9.0%).\u0000\u0000\u0000CONCLUSION\u0000Despite the challenges of diffusely diseased coronary arteries, severe LV dysfunction, addressing associated significant MR and ventricular aneurysms, the outcome of surgical management of CAD with severe LV dysfunction, in the Indian population can be done with acceptable results. Randomized control studies in this subset can provide more solid evidence in this regard.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121186871","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}
L. Rankovic-Nicic, D. Unić-Stojanović, Maja Milosevic, S. Mićović, Tjasa Ivosevic, Milica Stojicic, P. Otasevic
BACKGROUND Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open-heart surgery, with an incidence between 8.9% and 39%. Studies have shown that even a slight increase in serum creatinine levels after cardiac surgery significantly affects the mortality and morbidity of these patients. AIM This study sought to determine the predictors and incidence of acute kidney injury (AKI) in patients older than 70 years undergoing elective valvular surgery. METHODS Prospective study included 156 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) at Dedinje Cardiovascular Institute between January and September 2019. Isolated valvular surgery was performed in 87 patients, while the remaining 69 patients underwent combined coronary and valvular surgery. The development and stage of CSA-AKI were diagnosed, according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Predictors and incidence of CSA-AKI development were assessed using univariate binary logistic regression analysis. RESULTS The incidence of CSA-AKI was 17.3%. CSA-AKI stage 1 was diagnosed in 25 patients (16.02%). CSA-AKI stage 2 was noted in one patient (0.64%), as well as stage 3 (0.64%). In six patients (3.85%), renal replacement therapy (RRT) was required. Using univariate binary logistic analysis, the following parameters were identified as predictors for CSA-AKI development: duration of cardiopulmonary bypass (OR 1.01; CI 95% (1.01-1.02); P = .002), duration of aortic clamping (OR 1.02; CI 95% (1.01-1.03); P = .002), lactate levels during the intensive care unit (ICU) stay (OR 1.33; CI 95% (1.04-1.70); P = .026), duration of mechanical ventilation (MV) (OR 1.03; CI 95% (1.1-1.07); P = .014), the use of inotropic drugs (adrenaline, dobutamine) (OR 0.38: CI 95% (0.16-0.9); P = .026; and OR 0.23; CI 95% (0.1-0.56); P = .0019, respectively), and the use of diuretics (OR 0.24; CI95% (0.06-095); P = .041). Using Mann-Whitney U test for independent samples show that the group of patients who developed CSA-AKI had significantly longer duration of hospitalization (Z = -2.751); P = .006), prolonged ICU stay (Z = -4.160; P < .001), and need for prolonged mechanical ventilation (Z = -4.411; P < .001). CONCLUSION Independent predictors for AKI development after valvular surgery in patients older than 70 years are prolonged mechanical ventilation and increased lactate values, while the use of diuretics after surgery reduces the incidence of AKI. Also, the development of CSA-AKI is associated with prolonged ICU stay and a longer duration of hospitalization.
{"title":"Predictors of Early Deterioration of Renal Function in Patients Older Than 70 Years Undergoing Valvular Surgery.","authors":"L. Rankovic-Nicic, D. Unić-Stojanović, Maja Milosevic, S. Mićović, Tjasa Ivosevic, Milica Stojicic, P. Otasevic","doi":"10.1532/hsf.4387","DOIUrl":"https://doi.org/10.1532/hsf.4387","url":null,"abstract":"BACKGROUND\u0000Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open-heart surgery, with an incidence between 8.9% and 39%. Studies have shown that even a slight increase in serum creatinine levels after cardiac surgery significantly affects the mortality and morbidity of these patients.\u0000\u0000\u0000AIM\u0000This study sought to determine the predictors and incidence of acute kidney injury (AKI) in patients older than 70 years undergoing elective valvular surgery.\u0000\u0000\u0000METHODS\u0000Prospective study included 156 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) at Dedinje Cardiovascular Institute between January and September 2019. Isolated valvular surgery was performed in 87 patients, while the remaining 69 patients underwent combined coronary and valvular surgery. The development and stage of CSA-AKI were diagnosed, according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Predictors and incidence of CSA-AKI development were assessed using univariate binary logistic regression analysis.\u0000\u0000\u0000RESULTS\u0000The incidence of CSA-AKI was 17.3%. CSA-AKI stage 1 was diagnosed in 25 patients (16.02%). CSA-AKI stage 2 was noted in one patient (0.64%), as well as stage 3 (0.64%). In six patients (3.85%), renal replacement therapy (RRT) was required. Using univariate binary logistic analysis, the following parameters were identified as predictors for CSA-AKI development: duration of cardiopulmonary bypass (OR 1.01; CI 95% (1.01-1.02); P = .002), duration of aortic clamping (OR 1.02; CI 95% (1.01-1.03); P = .002), lactate levels during the intensive care unit (ICU) stay (OR 1.33; CI 95% (1.04-1.70); P = .026), duration of mechanical ventilation (MV) (OR 1.03; CI 95% (1.1-1.07); P = .014), the use of inotropic drugs (adrenaline, dobutamine) (OR 0.38: CI 95% (0.16-0.9); P = .026; and OR 0.23; CI 95% (0.1-0.56); P = .0019, respectively), and the use of diuretics (OR 0.24; CI95% (0.06-095); P = .041). Using Mann-Whitney U test for independent samples show that the group of patients who developed CSA-AKI had significantly longer duration of hospitalization (Z = -2.751); P = .006), prolonged ICU stay (Z = -4.160; P < .001), and need for prolonged mechanical ventilation (Z = -4.411; P < .001).\u0000\u0000\u0000CONCLUSION\u0000Independent predictors for AKI development after valvular surgery in patients older than 70 years are prolonged mechanical ventilation and increased lactate values, while the use of diuretics after surgery reduces the incidence of AKI. Also, the development of CSA-AKI is associated with prolonged ICU stay and a longer duration of hospitalization.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127822539","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 To investigate the occurrence of acute pulmonary embolism in the intensive care unit (ICU) and analyze the related risk factors for predicting its severity. METHODS From January 2016 to December 2020, 83 patients with acute pulmonary embolism in the intensive care unit of Peking University People's Hospital were selected as the research subjects, including 34 males (40.96%) and 49 females (59.04%), with an average age of 62.06±16.83 years. The patients were divided into a high-risk group (N = 31), medium-risk group (N = 32), and low-risk group (N = 20), according to the guidelines for diagnosis and treatment of acute pulmonary embolism issued by ASH in 2020. The clinical characteristics, treatment, and prognosis of the three groups were summarized, and the severity of the patients could be predicted and the related risk factors affecting prognosis were analyzed. RESULTS There were significant statistical differences in respiratory rate, syncope as the first symptom, bilateral pulmonary embolism, and APACHE-II score among the three groups (P < 0.05). There were significant statistical differences in the laboratory indexes, such as BNP, cTnI and D-dimer before and immediately after APE among the three groups (P < 0.05). There were significant statistical differences in cTnI and D-dimer among the three groups (P < 0.05). By pairwise comparison, it was found that there were significant statistical differences between the high-risk and low-risk groups in the immediate test indexes of APE, such as BNP, D-dimer, lower extremity vascular ultrasound abnormalities, and ECG abnormalities (P < 0.05), while there was no significant statistical difference between the medium-risk and low-risk groups in the immediate test indexes of APE (P > 0.05). However, in the medium-risk group, the laboratory indexes tended to increase, in terms of treatment and outcome, thrombolysis rate, and inferior vena cava filter implantation rate. ICU stay (> 2 weeks) of the high-risk group was significantly higher than those of the other two groups, with significant statistical difference (P < 0.05). Logistic regression analysis showed that respiratory rate (or = 1.778,95% CI 1.043-3.032, P = 0.034), D-Dimer (or = 1,95% CI 1.0-1.0, P = 0.006), and APACHE-II score (or = 1.879,95% CI 1.398-2.527, P = 0.000) were independent risk factors for predicting the severity of APE patients in the ICU ward. CONCLUSION Acute pulmonary embolism (APE) is a critical disease in ICU. By monitoring BNP, cTnI and D-dimer, we can identify critical patients with APE early. In addition, we found that respiratory rate, D-dimer, and APACHE-II score were independent risk factors for predicting the severity of APE patients in the ICU. Clinically, APE can be identified early. The diagnosis, treatment rate, and prognosis can be improved by monitoring these indicators.
目的调查重症监护病房(ICU)急性肺栓塞的发生情况，分析预测其严重程度的相关危险因素。方法选取2016年1月~ 2020年12月北京大学人民医院重症监护室收治的急性肺栓塞患者83例为研究对象，其中男性34例(40.96%)，女性49例(59.04%)，平均年龄62.06±16.83岁。根据美国ASH 2020年发布的急性肺栓塞诊疗指南，将患者分为高危组(N = 31)、中危组(N = 32)和低危组(N = 20)。总结三组患者的临床特点、治疗方法及预后，预测患者病情严重程度，分析影响预后的相关危险因素。结果三组患者呼吸频率、首发症状为晕厥、双侧肺栓塞、APACHE-II评分比较，差异均有统计学意义(P < 0.05)。三组患者APE前后BNP、cTnI、d -二聚体等实验室指标比较，差异均有统计学意义(P < 0.05)。三组患者cTnI、d -二聚体水平比较，差异均有统计学意义(P < 0.05)。两两比较发现，高危组与低危组在BNP、d -二聚体、下肢血管超声异常、心电图异常等APE即时检测指标上差异有统计学意义(P < 0.05)，而中危组与低危组在APE即时检测指标上差异无统计学意义(P > 0.05)。而中危组在治疗和转归、溶栓率、下腔静脉滤器植入率等实验室指标均有升高的趋势。高危组ICU住院时间(> 2周)显著高于其他两组，差异有统计学意义(P < 0.05)。Logistic回归分析显示，呼吸频率(or = 1.778,95% CI 1.043 ~ 3.032, P = 0.034)、d -二聚体(or = 1,95% CI 1.0 ~ 1.0, P = 0.006)、APACHE-II评分(or = 1.879,95% CI 1.398 ~ 2.527, P = 0.000)是预测ICU病房APE患者严重程度的独立危险因素。结论急性肺栓塞(APE)是ICU危重疾病。通过监测BNP、cTnI和d -二聚体，我们可以早期识别APE危重患者。此外，我们发现呼吸频率、d -二聚体和APACHE-II评分是预测ICU APE患者严重程度的独立危险因素。临床上，APE可早期发现。通过监测这些指标，可以提高诊断、治愈率和预后。
{"title":"Analysis of the Occurrence of Acute Pulmonary Embolism in the ICU Ward and Related Risk Factors Predicting Its Severity.","authors":"Chun Fu, Yuan-Yuan Chen, F. Zhu, Jian Liu","doi":"10.1532/hsf.4525","DOIUrl":"https://doi.org/10.1532/hsf.4525","url":null,"abstract":"OBJECTIVE\u0000To investigate the occurrence of acute pulmonary embolism in the intensive care unit (ICU) and analyze the related risk factors for predicting its severity.\u0000\u0000\u0000METHODS\u0000From January 2016 to December 2020, 83 patients with acute pulmonary embolism in the intensive care unit of Peking University People's Hospital were selected as the research subjects, including 34 males (40.96%) and 49 females (59.04%), with an average age of 62.06±16.83 years. The patients were divided into a high-risk group (N = 31), medium-risk group (N = 32), and low-risk group (N = 20), according to the guidelines for diagnosis and treatment of acute pulmonary embolism issued by ASH in 2020. The clinical characteristics, treatment, and prognosis of the three groups were summarized, and the severity of the patients could be predicted and the related risk factors affecting prognosis were analyzed.\u0000\u0000\u0000RESULTS\u0000There were significant statistical differences in respiratory rate, syncope as the first symptom, bilateral pulmonary embolism, and APACHE-II score among the three groups (P < 0.05). There were significant statistical differences in the laboratory indexes, such as BNP, cTnI and D-dimer before and immediately after APE among the three groups (P < 0.05). There were significant statistical differences in cTnI and D-dimer among the three groups (P < 0.05). By pairwise comparison, it was found that there were significant statistical differences between the high-risk and low-risk groups in the immediate test indexes of APE, such as BNP, D-dimer, lower extremity vascular ultrasound abnormalities, and ECG abnormalities (P < 0.05), while there was no significant statistical difference between the medium-risk and low-risk groups in the immediate test indexes of APE (P > 0.05). However, in the medium-risk group, the laboratory indexes tended to increase, in terms of treatment and outcome, thrombolysis rate, and inferior vena cava filter implantation rate. ICU stay (> 2 weeks) of the high-risk group was significantly higher than those of the other two groups, with significant statistical difference (P < 0.05). Logistic regression analysis showed that respiratory rate (or = 1.778,95% CI 1.043-3.032, P = 0.034), D-Dimer (or = 1,95% CI 1.0-1.0, P = 0.006), and APACHE-II score (or = 1.879,95% CI 1.398-2.527, P = 0.000) were independent risk factors for predicting the severity of APE patients in the ICU ward.\u0000\u0000\u0000CONCLUSION\u0000Acute pulmonary embolism (APE) is a critical disease in ICU. By monitoring BNP, cTnI and D-dimer, we can identify critical patients with APE early. In addition, we found that respiratory rate, D-dimer, and APACHE-II score were independent risk factors for predicting the severity of APE patients in the ICU. Clinically, APE can be identified early. The diagnosis, treatment rate, and prognosis can be improved by monitoring these indicators.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116667841","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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