Rui Jing, Kun Zhang, Tao Chen, Huan Luo, Yuming Li
Objective: The use of second-generation cryoballoon (CB2) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation therapy is common. This study aimed to compare the safety and efficacy of CB2 ablation for PVI in AF patients aged 75 years and older to those under 75 years old. Methods: A retrospective, observational study was conducted, including AF patients who underwent CB2 for PVI between January 2018 and December 2020 at our center. The patients were divided into two groups based on age: those aged 75 years and older (elderly group) and those under 75 years (control group). Procedural characteristics, complications, and one-year follow-up outcomes were compared between the two groups using Student's t-test or the chi-square test for univariate analysis. Results: A total of 156 AF patients treated with CB2 for PVI were included in the study, with 78 patients aged 75 years and older (elderly group, mean age = 78 years) and 78 patients aged under 75 years (control group, mean age = 66 years). The PVI procedure duration was 86.2 ± 25.8 minutes for the elderly group and 83.2 ± 20.8 minutes for the control group (p = 0.413). The elderly group showed a higher trend of complications (8/78, 10.3%) compared to the control group (2/78, 2.6%) (p = 0.049), although no serious complications were observed. One-year follow-up revealed that approximately 80% of patients in both groups did not experience AF recurrence (p = 0.656). Conclusion: CB2 ablation for PVI appears to be safe and effective in AF patients aged 75 years and older, with outcomes comparable to those in younger patients. However, special attention should be given to venous puncture in elderly patients.
{"title":"Safety and Efficacy of Second-Generation Cryoballoon Ablation in Patients Aged over 75 Years","authors":"Rui Jing, Kun Zhang, Tao Chen, Huan Luo, Yuming Li","doi":"10.59958/hsf.7483","DOIUrl":"https://doi.org/10.59958/hsf.7483","url":null,"abstract":"Objective: The use of second-generation cryoballoon (CB2) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation therapy is common. This study aimed to compare the safety and efficacy of CB2 ablation for PVI in AF patients aged 75 years and older to those under 75 years old. Methods: A retrospective, observational study was conducted, including AF patients who underwent CB2 for PVI between January 2018 and December 2020 at our center. The patients were divided into two groups based on age: those aged 75 years and older (elderly group) and those under 75 years (control group). Procedural characteristics, complications, and one-year follow-up outcomes were compared between the two groups using Student's t-test or the chi-square test for univariate analysis. Results: A total of 156 AF patients treated with CB2 for PVI were included in the study, with 78 patients aged 75 years and older (elderly group, mean age = 78 years) and 78 patients aged under 75 years (control group, mean age = 66 years). The PVI procedure duration was 86.2 ± 25.8 minutes for the elderly group and 83.2 ± 20.8 minutes for the control group (p = 0.413). The elderly group showed a higher trend of complications (8/78, 10.3%) compared to the control group (2/78, 2.6%) (p = 0.049), although no serious complications were observed. One-year follow-up revealed that approximately 80% of patients in both groups did not experience AF recurrence (p = 0.656). Conclusion: CB2 ablation for PVI appears to be safe and effective in AF patients aged 75 years and older, with outcomes comparable to those in younger patients. However, special attention should be given to venous puncture in elderly patients.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972643","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}
Yu Liu, Fenglin Ye, Jingjing Liu, Jiaming Yu, Limei Fan, Qin Yang
Background: Kinesiophobia is highly prevalent among postoperative cardiac patients. Early identification of kinesiophobia in patients who have undergone coronary artery bypass grafting (CABG) can improve their ability to participate in physical activities. However, there is limited research on the factors influencing kinesiophobia in older patients during the early stages after CABG. To investigate the factors influencing early kinesiophobia in older patients after coronary artery bypass grafting and to examine the correlation between these factors and social support and rehabilitation exercise self-efficacy. Methods: Using convenience sampling, 117 older patients who underwent coronary artery bypass grafting in the cardiac surgery ward of a tertiary grade A hospital in Bengbu City from October 2022 to September 2023 were analyzed. The survey was conducted on-site using a general information questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI), the Social Support Rating Scale (SSRS), and the pain assessment scale. Single-factor analysis, multifactor regression analysis, and Spearman's correlation analysis were employed. Results: Among the 117 older patients in the early postoperative phase following coronary artery bypass grafting, the incidence of kinesiophobia was 73.5%. Single-factor analysis revealed that education level, medical expense coverage, place of residence, and pain scores were significantly associated with kinesiophobia (p < 0.05). Multifactor regression analysis identified age and monthly income as factors influencing cardiac exercise self-efficacy (p < 0.05). Age, education level, medical expense coverage, and monthly income affected patient social support (p < 0.05). Spearman's correlation analysis revealed significant negative correlations among cardiac exercise self-efficacy, social support, and kinesiophobia level (p < 0.001). Conclusion: The incidence of early kinesiophobia is relatively high among older patients after coronary artery bypass grafting. Educational level, medical expense coverage, place of residence, and postoperative pain were influential factors. Both cardiac exercise self-efficacy and social support have a significant impact on kinesiophobia in patients. Therefore, clinical healthcare professionals should prioritize older patients undergoing postcoronary artery bypass grafting with lower educational levels and monthly incomes. Effective and evidence-based clinical interventions can be tailored based on these influencing factors and their correlations to promote active participation in rehabilitation exercises and improve patient outcomes in the early postoperative phase.
{"title":"Study of Factors Influencing Early Kinesiophobia in Older Patients after Coronary Artery Bypass Grafting in China","authors":"Yu Liu, Fenglin Ye, Jingjing Liu, Jiaming Yu, Limei Fan, Qin Yang","doi":"10.59958/hsf.7377","DOIUrl":"https://doi.org/10.59958/hsf.7377","url":null,"abstract":"Background: Kinesiophobia is highly prevalent among postoperative cardiac patients. Early identification of kinesiophobia in patients who have undergone coronary artery bypass grafting (CABG) can improve their ability to participate in physical activities. However, there is limited research on the factors influencing kinesiophobia in older patients during the early stages after CABG. To investigate the factors influencing early kinesiophobia in older patients after coronary artery bypass grafting and to examine the correlation between these factors and social support and rehabilitation exercise self-efficacy. Methods: Using convenience sampling, 117 older patients who underwent coronary artery bypass grafting in the cardiac surgery ward of a tertiary grade A hospital in Bengbu City from October 2022 to September 2023 were analyzed. The survey was conducted on-site using a general information questionnaire, the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Cardiac Exercise Self-Efficacy Instrument (CESEI), the Social Support Rating Scale (SSRS), and the pain assessment scale. Single-factor analysis, multifactor regression analysis, and Spearman's correlation analysis were employed. Results: Among the 117 older patients in the early postoperative phase following coronary artery bypass grafting, the incidence of kinesiophobia was 73.5%. Single-factor analysis revealed that education level, medical expense coverage, place of residence, and pain scores were significantly associated with kinesiophobia (p < 0.05). Multifactor regression analysis identified age and monthly income as factors influencing cardiac exercise self-efficacy (p < 0.05). Age, education level, medical expense coverage, and monthly income affected patient social support (p < 0.05). Spearman's correlation analysis revealed significant negative correlations among cardiac exercise self-efficacy, social support, and kinesiophobia level (p < 0.001). Conclusion: The incidence of early kinesiophobia is relatively high among older patients after coronary artery bypass grafting. Educational level, medical expense coverage, place of residence, and postoperative pain were influential factors. Both cardiac exercise self-efficacy and social support have a significant impact on kinesiophobia in patients. Therefore, clinical healthcare professionals should prioritize older patients undergoing postcoronary artery bypass grafting with lower educational levels and monthly incomes. Effective and evidence-based clinical interventions can be tailored based on these influencing factors and their correlations to promote active participation in rehabilitation exercises and improve patient outcomes in the early postoperative phase.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"54 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972536","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 aimed to explore the influencing factors analysis of late readmission after patients with acute myocardial infarction received percutaneous coronary intervention (PCI). Methods: A total of 368 patients with acute myocardial infarction who received PCI treatment in West China Hospital, Sichuan University/West China School of Nursing, Sichuan University from January 2018, to January 2021, were selected for the study. Among them, 110 subjects were excluded, and 258 subjects were finally included, of which 124 were readmitted and 134 were not readmitted. The baseline data and clinical characteristics of the patients were collected, and the influencing factors of readmission were analyzed by logistic regression analysis. The readmitted patients were followed up for 12 months. The Kaplan–Meier method was used to analyze the survival of patients with delayed readmitted and calculate the survival rate. Results: Significant differences were found between readmitted patients and non-readmitted patients in terms of age, chronic obstructive pulmonary disease (COPD), history of early coronary heart disease, history of hypertension, history of oral anticoagulant drugs, and left ventricle ejection fraction (LVEF, p < 0.05). No significant differences were observed in gender, body mass index, family history of acute myocardial infarction, history of chronic kidney disease, history of diabetes, history of smoking, history of drinking, and the number of implanted stents and diseased vessels (p > 0.05). Binary logistic regression analysis showed that age, COPD, history of premature coronary heart disease, history of oral anticoagulant drugs, and LVEF were important influencing factors of delayed readmission after PCI (all p < 0.05). Follow-up results showed that 125 patients survived and nine died among the delayed non-readmission patients after PCI. Among the patients with delayed readmission, 95 survived and 29 died. Kaplan–Meier survival analysis showed that the survival time of patients with delayed non-readmission was longer than that of patients with delayed readmission, and the difference was statistically significant (χ2 = 17.696, p < 0.001). Conclusion: Age, COPD, history of oral anticoagulant drugs, and LVEF are important influencing factors of delayed readmission after PCI, and the survival time of patients with delayed non-readmission is longer than that of patients with delayed readmission.
{"title":"Influencing Factors and Survival Analysis of Late Readmission after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction","authors":"Lingjuan Zhou, Shoufang Pu, Jiaojiao Chen","doi":"10.59958/hsf.7475","DOIUrl":"https://doi.org/10.59958/hsf.7475","url":null,"abstract":"Objective: This study aimed to explore the influencing factors analysis of late readmission after patients with acute myocardial infarction received percutaneous coronary intervention (PCI). Methods: A total of 368 patients with acute myocardial infarction who received PCI treatment in West China Hospital, Sichuan University/West China School of Nursing, Sichuan University from January 2018, to January 2021, were selected for the study. Among them, 110 subjects were excluded, and 258 subjects were finally included, of which 124 were readmitted and 134 were not readmitted. The baseline data and clinical characteristics of the patients were collected, and the influencing factors of readmission were analyzed by logistic regression analysis. The readmitted patients were followed up for 12 months. The Kaplan–Meier method was used to analyze the survival of patients with delayed readmitted and calculate the survival rate. Results: Significant differences were found between readmitted patients and non-readmitted patients in terms of age, chronic obstructive pulmonary disease (COPD), history of early coronary heart disease, history of hypertension, history of oral anticoagulant drugs, and left ventricle ejection fraction (LVEF, p < 0.05). No significant differences were observed in gender, body mass index, family history of acute myocardial infarction, history of chronic kidney disease, history of diabetes, history of smoking, history of drinking, and the number of implanted stents and diseased vessels (p > 0.05). Binary logistic regression analysis showed that age, COPD, history of premature coronary heart disease, history of oral anticoagulant drugs, and LVEF were important influencing factors of delayed readmission after PCI (all p < 0.05). Follow-up results showed that 125 patients survived and nine died among the delayed non-readmission patients after PCI. Among the patients with delayed readmission, 95 survived and 29 died. Kaplan–Meier survival analysis showed that the survival time of patients with delayed non-readmission was longer than that of patients with delayed readmission, and the difference was statistically significant (χ2 = 17.696, p < 0.001). Conclusion: Age, COPD, history of oral anticoagulant drugs, and LVEF are important influencing factors of delayed readmission after PCI, and the survival time of patients with delayed non-readmission is longer than that of patients with delayed readmission.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"35 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975527","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: In this study, to address the failure of mitral valve repair surgery, a novel valve-in-ring model for an artificial mitral valve annuloplasty ring and a new double-layer mitral valve were established. A suitable number and length of ventricular fixation struts within the annuloplasty ring, as well as the implantation depth, result in variations in stress and strain for the inner and outer stent layers. Methods: The compression and self-expansion model of the stent was established via finite element analysis. The changes in stress and strain were analyzed by setting the length and number of the ventricular fixed struts and implantation depth. Results: When only affected by factors such as blood pressure, the maximum stresses of stent structures with three and six ventricular fixed struts are 476 and 222 MPa, respectively, in the right posterior annular region. At implantation depths of 0, 0.5, 1, and 2 mm, the maximum stresses are located in the left posterior annular region of the outer stent and are 740, 697, 709, and 742 MPa, respectively, and the maximum displacements of the inner stent are all in the right posterior ventricular fixed strut region of the posterior annulus and are 3.71, 3.10, 2.48, and 1.87 mm, respectively. In the three and six ventricular fixed strut stents, when the ventricular fixed strut length is 3, 4, and 5 mm, the maximum stresses are 570, 557, and 621 MPa and 674, 666, 644 MPa, respectively. Conclusions: Appropriately increasing the number of ventricular fixed struts can effectively reduce damage to the stent inside the body, and the damage to the stent is relatively consistent across different implantation depths; however, the right side of the stent's posterior annulus is particularly susceptible to damage. However, if the implantation depth is lower, the impact on the inner stent will be more significant. As the number of ventricular fixed struts increases, the strut length variation has a relatively stable impact on stent damage.
{"title":"Mechanical Analysis of the Connection Structure of a Double-Layered Valve Stent within an Annuloplasty Ring","authors":"Ke Dong, Zhaoming He","doi":"10.59958/hsf.7399","DOIUrl":"https://doi.org/10.59958/hsf.7399","url":null,"abstract":"Background: In this study, to address the failure of mitral valve repair surgery, a novel valve-in-ring model for an artificial mitral valve annuloplasty ring and a new double-layer mitral valve were established. A suitable number and length of ventricular fixation struts within the annuloplasty ring, as well as the implantation depth, result in variations in stress and strain for the inner and outer stent layers. Methods: The compression and self-expansion model of the stent was established via finite element analysis. The changes in stress and strain were analyzed by setting the length and number of the ventricular fixed struts and implantation depth. Results: When only affected by factors such as blood pressure, the maximum stresses of stent structures with three and six ventricular fixed struts are 476 and 222 MPa, respectively, in the right posterior annular region. At implantation depths of 0, 0.5, 1, and 2 mm, the maximum stresses are located in the left posterior annular region of the outer stent and are 740, 697, 709, and 742 MPa, respectively, and the maximum displacements of the inner stent are all in the right posterior ventricular fixed strut region of the posterior annulus and are 3.71, 3.10, 2.48, and 1.87 mm, respectively. In the three and six ventricular fixed strut stents, when the ventricular fixed strut length is 3, 4, and 5 mm, the maximum stresses are 570, 557, and 621 MPa and 674, 666, 644 MPa, respectively. Conclusions: Appropriately increasing the number of ventricular fixed struts can effectively reduce damage to the stent inside the body, and the damage to the stent is relatively consistent across different implantation depths; however, the right side of the stent's posterior annulus is particularly susceptible to damage. However, if the implantation depth is lower, the impact on the inner stent will be more significant. As the number of ventricular fixed struts increases, the strut length variation has a relatively stable impact on stent damage.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"112 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986840","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}
Y. Kamikawa, S. Matsushita, S. Miyazaki, Ryoko Morimoto, Kenji Kuwaki, H. Inaba, Tohru Minamino, Atsushi Amano, Minoru Tabata
Background: Some surgeons have previously advocated for a more aggressive concomitant septal myectomy to address left ventricular outflow tract obstruction; however, concerns about the surgical complications of post-septal myectomy remain. Here, we aimed to assess the clinical, echocardiographic, and pathological findings following concomitant septal myectomy with surgical aortic valve replacement. Methods: We reviewed 21 patients who underwent surgical aortic valve replacement and concomitant septal myectomy from April 2014 to September 2019. The global and regional left ventricular ejection fraction changes between the perioperative periods were analyzed using two-dimensional speckle-tracking echocardiography. The resected myocardium was pathologically assessed. Results: No operative mortality was observed during the study period. Transthoracic echocardiography showed no significant differences in preoperative and postoperative left ventricular ejection fraction (68.1 ± 9.9% vs. 68.6 ± 6.0%, p = 0.82) or interventricular septum thickness (11.9 ± 1.4 mm vs. 11.5 ± 1.5 mm, p = 0.23). Interventricular septum thickness at the end-systolic phase, which is the maximum septal wall thickness, was significantly reduced postoperatively (27.7 ± 9.3 mm vs. 22.6 ± 5.5 mm, p < 0.05). The basal, mid, and apical septal areas improved with septal myectomy by 80%, 230%, and 27%, respectively, compared to perioperative echocardiography (basal septal, 80 ± 23%; mid septal, 230 ± 830%; apical septal, 27 ± 350%). Pathological examination of the resected myocardium revealed marked endocardial thickness (mean, 914 µm) with focal fibrosis. Conclusions: In aortic valve stenosis patients with septal hypertrophy, concomitant septal myectomy with surgical aortic valve replacement improved regional myocardial function and eliminated left ventricular outflow tract obstruction by removing thickened endocardium and prominent fibrosis.
背景：一些外科医生曾主张同时进行更积极的室间隔瓣膜切除术，以解决左室流出道梗阻问题；然而，人们对室间隔瓣膜切除术后的手术并发症仍心存疑虑。在此，我们旨在评估同时进行室间隔黏膜切除术和主动脉瓣置换术后的临床、超声心动图和病理结果。方法我们回顾了 2014 年 4 月至 2019 年 9 月期间接受外科主动脉瓣置换术并同时进行室间隔瓣膜切除术的 21 例患者。使用二维斑点追踪超声心动图分析了围手术期之间整体和区域左室射血分数的变化。对切除的心肌进行病理评估。结果：研究期间未发现手术死亡率。经胸超声心动图显示，术前和术后左室射血分数（68.1 ± 9.9% vs. 68.6 ± 6.0%，p = 0.82）或室间隔厚度（11.9 ± 1.4 mm vs. 11.5 ± 1.5 mm，p = 0.23）无明显差异。收缩末期的室间隔厚度（即室间隔壁的最大厚度）在术后明显减少（27.7 ± 9.3 mm vs. 22.6 ± 5.5 mm，p < 0.05）。与围手术期超声心动图相比，室间隔肌层切除术后室间隔基底部、中部和顶部面积分别改善了 80%、230% 和 27%（室间隔基底部，80 ± 23%；室间隔中部，230 ± 830%；室间隔顶部，27 ± 350%）。切除心肌的病理检查显示心内膜厚度明显增厚（平均为 914 微米），并伴有灶性纤维化。结论是对于室间隔肥厚的主动脉瓣狭窄患者，在进行主动脉瓣置换手术的同时进行室间隔黏膜切除术可改善区域心肌功能，并通过切除增厚的心内膜和突出的纤维化消除左室流出道梗阻。
{"title":"Improvement in Left Ventricular Function of the Resected Myocardium after Septal Myectomy in Patients with Aortic Valve Replacement","authors":"Y. Kamikawa, S. Matsushita, S. Miyazaki, Ryoko Morimoto, Kenji Kuwaki, H. Inaba, Tohru Minamino, Atsushi Amano, Minoru Tabata","doi":"10.59958/hsf.7275","DOIUrl":"https://doi.org/10.59958/hsf.7275","url":null,"abstract":"Background: Some surgeons have previously advocated for a more aggressive concomitant septal myectomy to address left ventricular outflow tract obstruction; however, concerns about the surgical complications of post-septal myectomy remain. Here, we aimed to assess the clinical, echocardiographic, and pathological findings following concomitant septal myectomy with surgical aortic valve replacement. Methods: We reviewed 21 patients who underwent surgical aortic valve replacement and concomitant septal myectomy from April 2014 to September 2019. The global and regional left ventricular ejection fraction changes between the perioperative periods were analyzed using two-dimensional speckle-tracking echocardiography. The resected myocardium was pathologically assessed. Results: No operative mortality was observed during the study period. Transthoracic echocardiography showed no significant differences in preoperative and postoperative left ventricular ejection fraction (68.1 ± 9.9% vs. 68.6 ± 6.0%, p = 0.82) or interventricular septum thickness (11.9 ± 1.4 mm vs. 11.5 ± 1.5 mm, p = 0.23). Interventricular septum thickness at the end-systolic phase, which is the maximum septal wall thickness, was significantly reduced postoperatively (27.7 ± 9.3 mm vs. 22.6 ± 5.5 mm, p < 0.05). The basal, mid, and apical septal areas improved with septal myectomy by 80%, 230%, and 27%, respectively, compared to perioperative echocardiography (basal septal, 80 ± 23%; mid septal, 230 ± 830%; apical septal, 27 ± 350%). Pathological examination of the resected myocardium revealed marked endocardial thickness (mean, 914 µm) with focal fibrosis. Conclusions: In aortic valve stenosis patients with septal hypertrophy, concomitant septal myectomy with surgical aortic valve replacement improved regional myocardial function and eliminated left ventricular outflow tract obstruction by removing thickened endocardium and prominent fibrosis.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"124 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140986081","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 aimed to examine the potential factors that contribute to the occurrence of delayed high-grade atrioventricular block (DHAVB) following transcatheter aortic valve replacement (TAVR). Methods: A retrospective analysis was conducted on the clinical data of 115 patients who underwent TAVR at Jiaozhou Central Hospital of Qingdao Hospital between January 2018, and June 2023. A follow-up period of 30 days post-operation was observed for all patients. The patients were categorized into two groups on the basis of the occurrence of DHAVB: DHAVB group (n = 35) and control group (n = 80). The general clinical data preoperative and postoperative heart disease characteristics of the groups were compared. The risk factors associated with DHAVB after TAVR were analyzed. Results: The mean systolic blood pressure (SBP) level of the DHAVB group significantly increased compared with that of the control group, whereas the heart rate (HR) level significantly reduced (p < 0.05). The average preoperative left ventricular ejection fraction (LVEF) was significantly lower in the DHAVB group than in the control group (p < 0.05). The control group exhibited a significantly higher prevalence of preoperative QRS wave broadening, severe calcification of the aortic valve, and right bundle branch block than the control group (p < 0.05). Spearman's correlation and logistic regression analyses identified increased SBP, decreased HR, diminished LVEF, the presence of preoperative and postoperative right bundle branch block, and thickened interventricular septum were as risk factors for DHAVB in patients undergoing TAVR (p < 0.05). Conclusion: Close surveillance of blood pressure, heart rate, and cardiac function is recommended for individuals undergoing TAVR. Pre-operative and post-operative electrocardiography and echocardiography are valuable tools in identifying potential risk factors for DHAVB, offering a solid foundation for effective patient prognostic management.
{"title":"Risk Factors for Delayed Atrioventricular Block after Aortic Valve Surgery: A Retrospective Study","authors":"Qiaoyun Wang, Yuhuan Tian, Yuping Jiang","doi":"10.59958/hsf.7325","DOIUrl":"https://doi.org/10.59958/hsf.7325","url":null,"abstract":"Objective: This study aimed to examine the potential factors that contribute to the occurrence of delayed high-grade atrioventricular block (DHAVB) following transcatheter aortic valve replacement (TAVR). Methods: A retrospective analysis was conducted on the clinical data of 115 patients who underwent TAVR at Jiaozhou Central Hospital of Qingdao Hospital between January 2018, and June 2023. A follow-up period of 30 days post-operation was observed for all patients. The patients were categorized into two groups on the basis of the occurrence of DHAVB: DHAVB group (n = 35) and control group (n = 80). The general clinical data preoperative and postoperative heart disease characteristics of the groups were compared. The risk factors associated with DHAVB after TAVR were analyzed. Results: The mean systolic blood pressure (SBP) level of the DHAVB group significantly increased compared with that of the control group, whereas the heart rate (HR) level significantly reduced (p < 0.05). The average preoperative left ventricular ejection fraction (LVEF) was significantly lower in the DHAVB group than in the control group (p < 0.05). The control group exhibited a significantly higher prevalence of preoperative QRS wave broadening, severe calcification of the aortic valve, and right bundle branch block than the control group (p < 0.05). Spearman's correlation and logistic regression analyses identified increased SBP, decreased HR, diminished LVEF, the presence of preoperative and postoperative right bundle branch block, and thickened interventricular septum were as risk factors for DHAVB in patients undergoing TAVR (p < 0.05). Conclusion: Close surveillance of blood pressure, heart rate, and cardiac function is recommended for individuals undergoing TAVR. Pre-operative and post-operative electrocardiography and echocardiography are valuable tools in identifying potential risk factors for DHAVB, offering a solid foundation for effective patient prognostic management.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":" 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140990190","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 explore the risk factors of hyperbilirubinemia after acute type A aortic dissection (ATAAD). Methods: Retrospective analysis of the data of 150 patients with ATAAD surgery in the First Affiliated Hospital of Gannan Medical University from 2021 to 2023. There were 117 males and 33 females. They were divided into patients according to the highest postoperative plasma total bilirubin level. Two groups, 85 cases in the hyperbilirubinemia group (HB group) total bilirubin (TBIL) >51.3 µmol/L; 65 cases in the non-hyperbilirubinemia group (NHB group) (TBIL <51.3 µmol/L). Two independent samples t-test was used to compare the two groups of samples, binary logistic regression analyzed the risk factors leading to postoperative HB, and the receiver operating characteristic (ROC) curve analyzed the critical values of the risk factors. Result: The incidence of postoperative HB was 56.7%. The preoperative plasma TBIL had an odds ratio (OR) of 1.213 (95% confidence interval (CI): 1.044–1.410, p = 0.012). The operation time had an OR of 1.019 (95% CI: 1.008–1.030, p = 0.001). The cardiopulmonary bypass (CPB) time had an OR of 1.053 (95% CI: 1.019–1.087, p = 0.022). The aortic cross-clamp time had an OR of 1.030 (95% CI: 1.006–1.055, p = 0.015). ROC curve analysis revealed critical values for preoperative plasma TBIL, operation time, CPB time, and aortic cross-clamp time as 12.95 µmol/L, 387.5 min, 190.5 min, and 117.5 min, respectively. Conclusion: HB is a frequently observed complication after surgery in patients with ATAAD, and it is associated with a poor prognosis. Several risk factors contribute to the increased occurrence of HB, including preoperative serum TBIL levels, operation time, CPB time, and aortic cross-clamp time.
{"title":"Risk Factors of Hyperbilirubinemia after Acute Type A Aortic Dissection","authors":"Wenbo Yu, Yuan Liang, Junjian Yu, Jianfeng Gao, Wentong Li, Chennan Tian, Xuehong Zhong, Peijun Li, Ziyou Liu, Jianxian Xiong","doi":"10.59958/hsf.7199","DOIUrl":"https://doi.org/10.59958/hsf.7199","url":null,"abstract":"Objective: To explore the risk factors of hyperbilirubinemia after acute type A aortic dissection (ATAAD). Methods: Retrospective analysis of the data of 150 patients with ATAAD surgery in the First Affiliated Hospital of Gannan Medical University from 2021 to 2023. There were 117 males and 33 females. They were divided into patients according to the highest postoperative plasma total bilirubin level. Two groups, 85 cases in the hyperbilirubinemia group (HB group) total bilirubin (TBIL) >51.3 µmol/L; 65 cases in the non-hyperbilirubinemia group (NHB group) (TBIL <51.3 µmol/L). Two independent samples t-test was used to compare the two groups of samples, binary logistic regression analyzed the risk factors leading to postoperative HB, and the receiver operating characteristic (ROC) curve analyzed the critical values of the risk factors. Result: The incidence of postoperative HB was 56.7%. The preoperative plasma TBIL had an odds ratio (OR) of 1.213 (95% confidence interval (CI): 1.044–1.410, p = 0.012). The operation time had an OR of 1.019 (95% CI: 1.008–1.030, p = 0.001). The cardiopulmonary bypass (CPB) time had an OR of 1.053 (95% CI: 1.019–1.087, p = 0.022). The aortic cross-clamp time had an OR of 1.030 (95% CI: 1.006–1.055, p = 0.015). ROC curve analysis revealed critical values for preoperative plasma TBIL, operation time, CPB time, and aortic cross-clamp time as 12.95 µmol/L, 387.5 min, 190.5 min, and 117.5 min, respectively. Conclusion: HB is a frequently observed complication after surgery in patients with ATAAD, and it is associated with a poor prognosis. Several risk factors contribute to the increased occurrence of HB, including preoperative serum TBIL levels, operation time, CPB time, and aortic cross-clamp time.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":" 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994908","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}
Yasuhiro Kawase, Masahiro Fujii, R. Bessho, Yosuke Ishii
Background: Aquaporin 7 (AQP7), a member the aquaglyceroporin subgroup of the AQP family, is a water channel that controls transport of glycerol and water in heart tissues. It facilitates the uptake of glycerol, a substrate for cardiac energy production, in cardiomyocytes. St. Thomas' Hospital cardioplegic solution No. 2 has cardio-protective effect even in AQP7-deficient hearts. Here, we aimed to determine whether nicorandil or del Nido cardioplegia (DNC) solution can protect AQP7-deficient hearts. Methods: The hearts of male AQP7 knockout (KO) and wild-type (WT) C57/B6N mice (age >15 weeks) were aerobically perfused using the Langendorff technique, and cardiac function was measured as left ventricular diastolic pressure (LVDP) throughout the study. Troponin T was measured as an indicator of myocardial damage after reperfusion for 60 min. We compared WT and KO controls subjected to 25 min of global ischemia as well as WT and KO groups infused with nicorandil (100 µM) for 10 min followed by 25 min of global ischemia. We also compared WT-DNC and KO-DNC hearts administered with DNC for 2 min followed by 23 min of global ischemia (Study 2). Results: The final recovery rates of LVDP were 20.8 ± 7.0%, 28.1 ± 7.6%, 40.0 ± 8.4%, and 38.7 ± 4.7% in the WT control, KO control, WT nicorandil, and KO nicorandil groups, respectively. The LVDP recovered faster in the hearts treated with DNC and reached a significantly higher plateau in the KO than in the WT hearts. Troponin T values were 2144 ± 493 and 1313 ± 717 in the WT and KO groups, respectively (p = 0.041). Conclusion: The Langendorff perfusion model revealed similar myocardial protective effects of nicorandil in AQP7-deficient mice as in WT mice. AQP7 deficiency did not impair the cardioprotective effects of DNC solution.
{"title":"Association between Aquaporin 7 Expression and Myocardial Protection with Nicorandil or Del Nido Cardioplegia: An Experimental Study","authors":"Yasuhiro Kawase, Masahiro Fujii, R. Bessho, Yosuke Ishii","doi":"10.59958/hsf.7129","DOIUrl":"https://doi.org/10.59958/hsf.7129","url":null,"abstract":"Background: Aquaporin 7 (AQP7), a member the aquaglyceroporin subgroup of the AQP family, is a water channel that controls transport of glycerol and water in heart tissues. It facilitates the uptake of glycerol, a substrate for cardiac energy production, in cardiomyocytes. St. Thomas' Hospital cardioplegic solution No. 2 has cardio-protective effect even in AQP7-deficient hearts. Here, we aimed to determine whether nicorandil or del Nido cardioplegia (DNC) solution can protect AQP7-deficient hearts. Methods: The hearts of male AQP7 knockout (KO) and wild-type (WT) C57/B6N mice (age >15 weeks) were aerobically perfused using the Langendorff technique, and cardiac function was measured as left ventricular diastolic pressure (LVDP) throughout the study. Troponin T was measured as an indicator of myocardial damage after reperfusion for 60 min. We compared WT and KO controls subjected to 25 min of global ischemia as well as WT and KO groups infused with nicorandil (100 µM) for 10 min followed by 25 min of global ischemia. We also compared WT-DNC and KO-DNC hearts administered with DNC for 2 min followed by 23 min of global ischemia (Study 2). Results: The final recovery rates of LVDP were 20.8 ± 7.0%, 28.1 ± 7.6%, 40.0 ± 8.4%, and 38.7 ± 4.7% in the WT control, KO control, WT nicorandil, and KO nicorandil groups, respectively. The LVDP recovered faster in the hearts treated with DNC and reached a significantly higher plateau in the KO than in the WT hearts. Troponin T values were 2144 ± 493 and 1313 ± 717 in the WT and KO groups, respectively (p = 0.041). Conclusion: The Langendorff perfusion model revealed similar myocardial protective effects of nicorandil in AQP7-deficient mice as in WT mice. AQP7 deficiency did not impair the cardioprotective effects of DNC solution.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140997057","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}
Kui Wu, Siyuan Yang, Xuanyi Hu, Cong Ye, Xuejun Li
Aorto-bronchial fistula (ABF) is a rare but life-threatening complication that can occur after thoracic endovascular aortic repair (TEVAR). The ABF clinical diagnosis can be challenging due to its insidious symptoms and potential for misdiagnosis. Managing endobronchial hemoptysis caused by ABF during cardiopulmonary bypass (CPB) is challenging due to limited clinical experience. We present a case of a patient who was previously treated with TEVAR for a thoracic aortic dissection and endovascular abdominal aortic aneurysm repair for an abdominal aortic aneurysm. The patient was admitted with intermittent hemoptysis over 1 year and chest pain for 3 days. Aortic computed tomography angiography (CTA) showed a recurrent dissection of the aortic arch. We encountered endotracheal hemoptysis during total arch replacement combined with a stented frozen elephant trunk under CPB. Due to the patient's prior history of TEVAR, the ABF was eventually diagnosed during the procedure; however, with the implementation of a series of measures, we were able to successfully resuscitate the patient. The literature suggests that this may be an exceedingly rare case of ABF successfully treated during CPB. Currently, there are no established clinical guidelines or consensus for the diagnosis and treatment of ABF after TEVAR due to the lack of case reports with extensive data. Timely identification of the bleeding bronchus, early activation of blood cell salvage, early neutralization of heparin activity, and timely resection of the diseased lobe are key to treating patients with ABF during CPB.
{"title":"Effective Strategies for Managing Sudden Hemoptysis Caused by Aorto-Bronchial Fistula during Cardiopulmonary Bypass: A Case Report","authors":"Kui Wu, Siyuan Yang, Xuanyi Hu, Cong Ye, Xuejun Li","doi":"10.59958/hsf.6889","DOIUrl":"https://doi.org/10.59958/hsf.6889","url":null,"abstract":"Aorto-bronchial fistula (ABF) is a rare but life-threatening complication that can occur after thoracic endovascular aortic repair (TEVAR). The ABF clinical diagnosis can be challenging due to its insidious symptoms and potential for misdiagnosis. Managing endobronchial hemoptysis caused by ABF during cardiopulmonary bypass (CPB) is challenging due to limited clinical experience. We present a case of a patient who was previously treated with TEVAR for a thoracic aortic dissection and endovascular abdominal aortic aneurysm repair for an abdominal aortic aneurysm. The patient was admitted with intermittent hemoptysis over 1 year and chest pain for 3 days. Aortic computed tomography angiography (CTA) showed a recurrent dissection of the aortic arch. We encountered endotracheal hemoptysis during total arch replacement combined with a stented frozen elephant trunk under CPB. Due to the patient's prior history of TEVAR, the ABF was eventually diagnosed during the procedure; however, with the implementation of a series of measures, we were able to successfully resuscitate the patient. The literature suggests that this may be an exceedingly rare case of ABF successfully treated during CPB. Currently, there are no established clinical guidelines or consensus for the diagnosis and treatment of ABF after TEVAR due to the lack of case reports with extensive data. Timely identification of the bleeding bronchus, early activation of blood cell salvage, early neutralization of heparin activity, and timely resection of the diseased lobe are key to treating patients with ABF during CPB.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"100 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003554","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}
A 51-year-old female patient suffered facial burns during her youth. Following the healing of the wound, a skin expander was implanted on 7 December 2021 to address scar contracture. The preoperative electrocardiogram (ECG) indicated sinus rhythm within the normal range. Color Doppler ultrasound revealed no abnormalities. The patient had no history of hypertension, heart disease, diabetes, arrhythmia, or other cardiovascular and cerebrovascular conditions. On 16 June 2022, the skin expander was removed, and facial scar resection was performed. The routine ECG showed ventricular premature beats. During the operation, when the surgeon pulled and compressed the neck dilator, significant arrhythmia was observed, with the heart rate dropping below 50 beats per minute and frequent ventricular premature beats occurring. The surgeon promptly halted the procedure, resulting in immediate relief of the patient's pain. Subsequently, the ventricular premature beats ceased, and normal sinus rhythm was restored. Once the heart rate exceeded 60 beats per minute, the surgeon resumed the operation, but ventricular premature beats persisted. After removing the dilator, the heart rate gradually returned to normal, and no further arrhythmia occurred. The patient recovered smoothly post-operation, with stable vital signs and no reported discomfort. She safely returned to the ward. It was determined that the patient's arrhythmia was caused by the compression of the carotid sinus due to the stretching of the neck dilator.
{"title":"A Case Report of Arrhythmia Caused by Skin Expander Implantation","authors":"Qiong Liu, Bing Jiang, Hui Jiang, Bin Nie","doi":"10.59958/hsf.6705","DOIUrl":"https://doi.org/10.59958/hsf.6705","url":null,"abstract":"A 51-year-old female patient suffered facial burns during her youth. Following the healing of the wound, a skin expander was implanted on 7 December 2021 to address scar contracture. The preoperative electrocardiogram (ECG) indicated sinus rhythm within the normal range. Color Doppler ultrasound revealed no abnormalities. The patient had no history of hypertension, heart disease, diabetes, arrhythmia, or other cardiovascular and cerebrovascular conditions. On 16 June 2022, the skin expander was removed, and facial scar resection was performed. The routine ECG showed ventricular premature beats. During the operation, when the surgeon pulled and compressed the neck dilator, significant arrhythmia was observed, with the heart rate dropping below 50 beats per minute and frequent ventricular premature beats occurring. The surgeon promptly halted the procedure, resulting in immediate relief of the patient's pain. Subsequently, the ventricular premature beats ceased, and normal sinus rhythm was restored. Once the heart rate exceeded 60 beats per minute, the surgeon resumed the operation, but ventricular premature beats persisted. After removing the dilator, the heart rate gradually returned to normal, and no further arrhythmia occurred. The patient recovered smoothly post-operation, with stable vital signs and no reported discomfort. She safely returned to the ward. It was determined that the patient's arrhythmia was caused by the compression of the carotid sinus due to the stretching of the neck dilator.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"21 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005839","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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