Background: Renal dysfunction is a global health burden with a rising prevalence and increased morbidity and mortality. Since the complex and multifactorial pathophysiology of this disease and its consequences is not entirely understood, novel mechanisms are currently under investigation, one being oxidative stress. Malondialdehyde is a product of lipid peroxidation and has been widely utilised as an indirect biomarker of oxidative stress. The aim of this study was to investigate the perioperative oxidative stress in patients with preoperative renal dysfunction undergoing on-pump cardiac surgery. Methods: In 115 patients scheduled for on-pump cardiac surgery, serum concentrations of malondialdehyde were obtained pre-, intra- and postoperatively. The patients were enrolled into two study groups regarding their preoperative renal function, and the malondialdehyde concentrations were compared between the study groups. Results: Patients with preoperative renal dysfunction were older and had a higher mean EuroSCORE II score. On postoperative days 1, 2 and 3, the serum malondialdehyde levels were significantly higher in patients with preoperative renal dysfunction compared to those with normal kidney function. Using regression analysis, preoperative renal dysfunction was shown to be an independent predictor of higher postoperative malondialdehyde levels at all tested time points. Conclusions: In a pioneering study correlating cardiopulmonary bypass and oxidative stress biomarker malondialdehyde, patients with preoperative renal dysfunction were found to exhibit more pronounced and prolonged oxidative stress resulting in protracted lipid peroxidation in the early postoperative period compared to patients with normal kidney function.
背景：肾功能障碍是一个全球性的健康负担，发病率不断上升，发病率和死亡率也在增加。由于这种疾病复杂的多因素病理生理学及其后果尚不完全清楚，目前正在研究新的机制，其中之一就是氧化应激。丙二醛是脂质过氧化的产物，已被广泛用作氧化应激的间接生物标志物。本研究的目的是调查接受体外循环心脏手术的术前肾功能不全患者围手术期的氧化应激情况。研究方法在 115 名计划接受泵上心脏手术的患者中，分别在术前、术中和术后采集血清中丙二醛的浓度。根据患者术前的肾功能将其分为两个研究组，并比较研究组之间的丙二醛浓度。研究结果术前肾功能不全的患者年龄较大，平均 EuroSCORE II 评分较高。术后第 1、2 和 3 天，术前肾功能不全患者的血清丙二醛水平明显高于肾功能正常的患者。通过回归分析表明，术前肾功能不全是所有测试时间点术后丙二醛水平较高的独立预测因素。结论：在一项将心肺旁路和氧化应激生物标志物丙二醛相关联的开创性研究中发现，与肾功能正常的患者相比，术前肾功能不全的患者在术后早期会表现出更明显、更持久的氧化应激，导致脂质过氧化反应持续时间更长。
{"title":"Oxidative Stress after on-Pump Cardiac Surgery in Patients with Preoperative Renal Dysfunction","authors":"Miha Antonic, A. Djordjević, Jus Ksela","doi":"10.59958/hsf.6997","DOIUrl":"https://doi.org/10.59958/hsf.6997","url":null,"abstract":"Background: Renal dysfunction is a global health burden with a rising prevalence and increased morbidity and mortality. Since the complex and multifactorial pathophysiology of this disease and its consequences is not entirely understood, novel mechanisms are currently under investigation, one being oxidative stress. Malondialdehyde is a product of lipid peroxidation and has been widely utilised as an indirect biomarker of oxidative stress. The aim of this study was to investigate the perioperative oxidative stress in patients with preoperative renal dysfunction undergoing on-pump cardiac surgery. Methods: In 115 patients scheduled for on-pump cardiac surgery, serum concentrations of malondialdehyde were obtained pre-, intra- and postoperatively. The patients were enrolled into two study groups regarding their preoperative renal function, and the malondialdehyde concentrations were compared between the study groups. Results: Patients with preoperative renal dysfunction were older and had a higher mean EuroSCORE II score. On postoperative days 1, 2 and 3, the serum malondialdehyde levels were significantly higher in patients with preoperative renal dysfunction compared to those with normal kidney function. Using regression analysis, preoperative renal dysfunction was shown to be an independent predictor of higher postoperative malondialdehyde levels at all tested time points. Conclusions: In a pioneering study correlating cardiopulmonary bypass and oxidative stress biomarker malondialdehyde, patients with preoperative renal dysfunction were found to exhibit more pronounced and prolonged oxidative stress resulting in protracted lipid peroxidation in the early postoperative period compared to patients with normal kidney function.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"110 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140449891","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}
Yanmei Song, Bingxin Tang, J. Che, Kangyin Chen, Yanmin Xu, Qingmiao Shao, Zhiqiang Zhao, Guangping Li, Tong Liu, Xiaowei Zhang
Objective: This study examined the relationship between CHA2DS2-VASc score, fibrinogen (FIB), and neutrophil-to-lymphocyte ratio (NLR) with in-stent restenosis (ISR) in patients with severe kidney disease (SKD). Methods: Between January 2017 and January 2022, patients with SKD who underwent coronary stent implantation at the Second Hospital of Tianjin Medical University were retrospectively analyzed. According to whether ISR occurred within 2 years of postoperative follow-up, 164 patients were categorized into the ISR group (n = 62) and the non-ISR group (n = 102). According to the Modification of Diet in Renal Disease (MDRD) formula, SKD is defined as an estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). Angiographic ISR was defined as a stented coronary artery segment with more than 50% constriction during the follow-up angiography. Relevant clinical data and laboratory parameters were obtained from the hospital's medical records. Results: In total, 164 patients were included (mean age: 67.1 [10.2] years, 65.2% men), grouped into 62 patients with ISR and 102 patients without. A significant difference was found in the age, previous strokes, congestive heart failure (CHF), NLR, platelet-to-lymphocyte ratio (PLR), fibrinogen, CHA2DS2-VASc score, and risk classification of CHA2DS2-VASc score of patients in the ISR group as compared to those in the non-ISR group. In a multivariable logistic regression analysis, the CHA2DS2-VASc score, fibrinogen, and NLR were identified as independent predictors of ISR. The analysis of the receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) value was 0.714 (95% confidence interval (CI): 0.634–0.793) for the CHA2DS2-VASc score and 0.652 (95% CI: 0.565–0.739) for FIB, 0.707 (95% CI: 0.627–0.788) for NLR, and 0.797 (95% CI: 0.725–0.868) for the combination of CHA2DS2-VASc score, FIB and NLR. Conclusions: The combination of CHA2DS2-VASc score, FIB, and NLR can more accurately predict the occurrence of ISR in SKD patients.
{"title":"CHA2DS2-VASc Score, Fibrinogen, and Neutrophil to Lymphocyte Ratio as Predictors of In-Stent Restenosis in Patients with Severe Kidney Disease","authors":"Yanmei Song, Bingxin Tang, J. Che, Kangyin Chen, Yanmin Xu, Qingmiao Shao, Zhiqiang Zhao, Guangping Li, Tong Liu, Xiaowei Zhang","doi":"10.59958/hsf.7065","DOIUrl":"https://doi.org/10.59958/hsf.7065","url":null,"abstract":"Objective: This study examined the relationship between CHA2DS2-VASc score, fibrinogen (FIB), and neutrophil-to-lymphocyte ratio (NLR) with in-stent restenosis (ISR) in patients with severe kidney disease (SKD). Methods: Between January 2017 and January 2022, patients with SKD who underwent coronary stent implantation at the Second Hospital of Tianjin Medical University were retrospectively analyzed. According to whether ISR occurred within 2 years of postoperative follow-up, 164 patients were categorized into the ISR group (n = 62) and the non-ISR group (n = 102). According to the Modification of Diet in Renal Disease (MDRD) formula, SKD is defined as an estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). Angiographic ISR was defined as a stented coronary artery segment with more than 50% constriction during the follow-up angiography. Relevant clinical data and laboratory parameters were obtained from the hospital's medical records. Results: In total, 164 patients were included (mean age: 67.1 [10.2] years, 65.2% men), grouped into 62 patients with ISR and 102 patients without. A significant difference was found in the age, previous strokes, congestive heart failure (CHF), NLR, platelet-to-lymphocyte ratio (PLR), fibrinogen, CHA2DS2-VASc score, and risk classification of CHA2DS2-VASc score of patients in the ISR group as compared to those in the non-ISR group. In a multivariable logistic regression analysis, the CHA2DS2-VASc score, fibrinogen, and NLR were identified as independent predictors of ISR. The analysis of the receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) value was 0.714 (95% confidence interval (CI): 0.634–0.793) for the CHA2DS2-VASc score and 0.652 (95% CI: 0.565–0.739) for FIB, 0.707 (95% CI: 0.627–0.788) for NLR, and 0.797 (95% CI: 0.725–0.868) for the combination of CHA2DS2-VASc score, FIB and NLR. Conclusions: The combination of CHA2DS2-VASc score, FIB, and NLR can more accurately predict the occurrence of ISR in SKD patients.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"17 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450750","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 thoracoscopic surgery under spontaneous respiration, patients could breathe spontaneously during surgery without the need for mechanical ventilation via tracheal intubation. This technique can effectively avoid the injuries caused by tracheal intubation and mechanical ventilation and the side effects of muscle relaxants, thus reducing postoperative complications and benefitting patients. This study aims to explore the application of thoracoscopic surgery under spontaneous respiration in the elderly with primary spontaneous pneumothorax (PSP) and its effect on inflammatory indices and postoperative complications. Methods: The medical records of 181 elderly patients with PSP who underwent thoracoscopic surgery in our hospital from June 2021 to June 2022 were chosen for retrospective analysis. After excluding 15 patients who did not meet inclusion criteria, 80 patients receiving spontaneous respiration via laryngeal mask ventilation were included in the study group and 86 patients undergoing pulmonary ventilation via single-lumen tracheal intubation were included in the control group in accordance with the different schemes used in the surgery. Preoperative anaesthesia induction, surgical and hospitalisation times were compared, and the haemodynamics and inflammatory indices and complication incidences of the two groups were analysed. Results: Recovery time and hospitalisation time significantly differed between the two groups (p < 0.001). Compared with the control group, the study group had significantly lower mean arterial pressure at T2 and faster heart rates at T2 and T3 (p < 0.001). At T5, T6 and T7, the levels of interleukin-6, interleukin-8 and C-reactive protein in the study group were significantly lower than those in the control group (p < 0.05). The incidence of intraoperative and postoperative complications did not significantly differ between the two groups (p > 0.05). Conclusion: Thoracoscopic surgery under spontaneous respiration is safe and effective in the treatment of elderly patients with PSP. It reduces the levels of inflammatory factors and accelerates postoperative rehabilitation, showing certain value for clinical promotion.
{"title":"Effect of Thoracoscopic Surgery under Spontaneous Respiration on Inflammatory Indicators and Postoperative Complications in Elderly Patients with Primary Spontaneous Pneumothorax","authors":"Fangjie Xiao, Yan Xia","doi":"10.59958/hsf.6977","DOIUrl":"https://doi.org/10.59958/hsf.6977","url":null,"abstract":"Background: In thoracoscopic surgery under spontaneous respiration, patients could breathe spontaneously during surgery without the need for mechanical ventilation via tracheal intubation. This technique can effectively avoid the injuries caused by tracheal intubation and mechanical ventilation and the side effects of muscle relaxants, thus reducing postoperative complications and benefitting patients. This study aims to explore the application of thoracoscopic surgery under spontaneous respiration in the elderly with primary spontaneous pneumothorax (PSP) and its effect on inflammatory indices and postoperative complications. Methods: The medical records of 181 elderly patients with PSP who underwent thoracoscopic surgery in our hospital from June 2021 to June 2022 were chosen for retrospective analysis. After excluding 15 patients who did not meet inclusion criteria, 80 patients receiving spontaneous respiration via laryngeal mask ventilation were included in the study group and 86 patients undergoing pulmonary ventilation via single-lumen tracheal intubation were included in the control group in accordance with the different schemes used in the surgery. Preoperative anaesthesia induction, surgical and hospitalisation times were compared, and the haemodynamics and inflammatory indices and complication incidences of the two groups were analysed. Results: Recovery time and hospitalisation time significantly differed between the two groups (p < 0.001). Compared with the control group, the study group had significantly lower mean arterial pressure at T2 and faster heart rates at T2 and T3 (p < 0.001). At T5, T6 and T7, the levels of interleukin-6, interleukin-8 and C-reactive protein in the study group were significantly lower than those in the control group (p < 0.05). The incidence of intraoperative and postoperative complications did not significantly differ between the two groups (p > 0.05). Conclusion: Thoracoscopic surgery under spontaneous respiration is safe and effective in the treatment of elderly patients with PSP. It reduces the levels of inflammatory factors and accelerates postoperative rehabilitation, showing certain value for clinical promotion.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140451881","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-stent restenosis (ISR) is one of the key causes of ischemic events after coronary stent implantation, and endothelial cell death and inflammation are considered to be important mechanisms. Pyroptosis is a proinflammatory type of programmed cell death, the effects and underlying mechanisms of endothelial cell (EC) pyroptosis in ISR remains unclear. Method: According to our previous work, an ISR rabbit model was established. Rabbits were divided into sham operation group and stent group. Serum was collected at 0, 4, 8, and 12 weeks to detect interleukin (IL)-1β and IL-18 levels. Rabbits' vascular EC was collected to detect NLRP3, Caspase1, GSDMD and P65 expression by western blot. NLRP3 inhibitor (MCC950) and P65 inhibitor (Helenalin) were used to pretreat EC, cell viability, lactate dehydrogenase (LDH) level of supernatant and pyroptosis related protein expression were measured in different groups. Results: The serum levels of IL-1β and IL-18 gradually increased with time, and the levels at the site of stent implantation were higher than the peripheral level. EC viability decreased significantly in the stent group, and protein levels of NLRP3, caspase1 and GSDMD were higher than those in the sham group. MCC950 and P65 inhibitors can reverse these effects. Conclusions: EC pyroptosis mediated by P65/NLRP3 inflammasome axis may promote ISR, our results provide a potential intervention target for the treatment of ISR.
{"title":"P65/NLRP3 Inflammasome Mediated Endothelial Cells Pyroptosis: A Novel Mechanism of In-Stent Restenosis","authors":"Baihe Han, Gang Wang, Jingbo Hou","doi":"10.59958/hsf.6845","DOIUrl":"https://doi.org/10.59958/hsf.6845","url":null,"abstract":"Background: In-stent restenosis (ISR) is one of the key causes of ischemic events after coronary stent implantation, and endothelial cell death and inflammation are considered to be important mechanisms. Pyroptosis is a proinflammatory type of programmed cell death, the effects and underlying mechanisms of endothelial cell (EC) pyroptosis in ISR remains unclear. Method: According to our previous work, an ISR rabbit model was established. Rabbits were divided into sham operation group and stent group. Serum was collected at 0, 4, 8, and 12 weeks to detect interleukin (IL)-1β and IL-18 levels. Rabbits' vascular EC was collected to detect NLRP3, Caspase1, GSDMD and P65 expression by western blot. NLRP3 inhibitor (MCC950) and P65 inhibitor (Helenalin) were used to pretreat EC, cell viability, lactate dehydrogenase (LDH) level of supernatant and pyroptosis related protein expression were measured in different groups. Results: The serum levels of IL-1β and IL-18 gradually increased with time, and the levels at the site of stent implantation were higher than the peripheral level. EC viability decreased significantly in the stent group, and protein levels of NLRP3, caspase1 and GSDMD were higher than those in the sham group. MCC950 and P65 inhibitors can reverse these effects. Conclusions: EC pyroptosis mediated by P65/NLRP3 inflammasome axis may promote ISR, our results provide a potential intervention target for the treatment of ISR.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"10 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140452185","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}
John Duggan, Alex S Peters, Sarah Halbert, Jared Antevil, Gregory D. Trachiotis
Background: Surgical ablation for atrial fibrillation (AF) is strongly recommended in patients undergoing mitral valve (MV) surgery but is underutilized. Left atrial appendage occlusion (LAAO) in patients with AF undergoing cardiac surgery is a matter of debate, and it is not clear which patients derive long-term benefit. This issue has not been investigated in United States Veterans. Methods: We performed a retrospective review of 1289 patients with pre-operative AF who underwent MV surgery between 2010–2020. Patients were grouped based on whether their procedure included ablation and LAAO, LAAO without ablation, or neither. Cox proportional hazard models, adjusted for covariates, were used to calculate risk for stroke, myocardial infarction (MI), and death based on intervention. Results: Ablation was performed in 645/1289 (50.0%) of patients and LAAO without ablation was performed in 186/1289 (14.4%) patients. Mean follow-up was 4.1 ± 3.1 years. Patients who underwent ablation had a 62% lower long-term risk of stroke (0.38, 95% CI: 0.22–0.67, p < 0.001) and 20% lower long-term mortality risk (adjusted hazard ratios (aHR) 0.80, 95% CI: 0.66–0.95, p = 0.012), but no difference in risk of MI (aHR 0.67, 95% CI: 0.38–1.16, p = 0.15). LAAO was not associated with differences in long-term risk of stroke, MI, or death. There were no differences in perioperative complications between groups. Conclusions: In veterans with AF undergoing MV surgery, ablation was inversely and independently associated with long-term stroke risk and long-term mortality, with no increased risk of perioperative complications. LAAO did not reduce long-term stroke risk.
{"title":"Surgical Ablation for Atrial Fibrillation in Mitral Valve Surgery: Improved Survival and Stroke Risk in US Veterans","authors":"John Duggan, Alex S Peters, Sarah Halbert, Jared Antevil, Gregory D. Trachiotis","doi":"10.59958/hsf.6715","DOIUrl":"https://doi.org/10.59958/hsf.6715","url":null,"abstract":"Background: Surgical ablation for atrial fibrillation (AF) is strongly recommended in patients undergoing mitral valve (MV) surgery but is underutilized. Left atrial appendage occlusion (LAAO) in patients with AF undergoing cardiac surgery is a matter of debate, and it is not clear which patients derive long-term benefit. This issue has not been investigated in United States Veterans. Methods: We performed a retrospective review of 1289 patients with pre-operative AF who underwent MV surgery between 2010–2020. Patients were grouped based on whether their procedure included ablation and LAAO, LAAO without ablation, or neither. Cox proportional hazard models, adjusted for covariates, were used to calculate risk for stroke, myocardial infarction (MI), and death based on intervention. Results: Ablation was performed in 645/1289 (50.0%) of patients and LAAO without ablation was performed in 186/1289 (14.4%) patients. Mean follow-up was 4.1 ± 3.1 years. Patients who underwent ablation had a 62% lower long-term risk of stroke (0.38, 95% CI: 0.22–0.67, p < 0.001) and 20% lower long-term mortality risk (adjusted hazard ratios (aHR) 0.80, 95% CI: 0.66–0.95, p = 0.012), but no difference in risk of MI (aHR 0.67, 95% CI: 0.38–1.16, p = 0.15). LAAO was not associated with differences in long-term risk of stroke, MI, or death. There were no differences in perioperative complications between groups. Conclusions: In veterans with AF undergoing MV surgery, ablation was inversely and independently associated with long-term stroke risk and long-term mortality, with no increased risk of perioperative complications. LAAO did not reduce long-term stroke risk.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139802889","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}
John Duggan, Alex S Peters, Sarah Halbert, Jared Antevil, Gregory D. Trachiotis
Background: Surgical ablation for atrial fibrillation (AF) is strongly recommended in patients undergoing mitral valve (MV) surgery but is underutilized. Left atrial appendage occlusion (LAAO) in patients with AF undergoing cardiac surgery is a matter of debate, and it is not clear which patients derive long-term benefit. This issue has not been investigated in United States Veterans. Methods: We performed a retrospective review of 1289 patients with pre-operative AF who underwent MV surgery between 2010–2020. Patients were grouped based on whether their procedure included ablation and LAAO, LAAO without ablation, or neither. Cox proportional hazard models, adjusted for covariates, were used to calculate risk for stroke, myocardial infarction (MI), and death based on intervention. Results: Ablation was performed in 645/1289 (50.0%) of patients and LAAO without ablation was performed in 186/1289 (14.4%) patients. Mean follow-up was 4.1 ± 3.1 years. Patients who underwent ablation had a 62% lower long-term risk of stroke (0.38, 95% CI: 0.22–0.67, p < 0.001) and 20% lower long-term mortality risk (adjusted hazard ratios (aHR) 0.80, 95% CI: 0.66–0.95, p = 0.012), but no difference in risk of MI (aHR 0.67, 95% CI: 0.38–1.16, p = 0.15). LAAO was not associated with differences in long-term risk of stroke, MI, or death. There were no differences in perioperative complications between groups. Conclusions: In veterans with AF undergoing MV surgery, ablation was inversely and independently associated with long-term stroke risk and long-term mortality, with no increased risk of perioperative complications. LAAO did not reduce long-term stroke risk.
{"title":"Surgical Ablation for Atrial Fibrillation in Mitral Valve Surgery: Improved Survival and Stroke Risk in US Veterans","authors":"John Duggan, Alex S Peters, Sarah Halbert, Jared Antevil, Gregory D. Trachiotis","doi":"10.59958/hsf.6715","DOIUrl":"https://doi.org/10.59958/hsf.6715","url":null,"abstract":"Background: Surgical ablation for atrial fibrillation (AF) is strongly recommended in patients undergoing mitral valve (MV) surgery but is underutilized. Left atrial appendage occlusion (LAAO) in patients with AF undergoing cardiac surgery is a matter of debate, and it is not clear which patients derive long-term benefit. This issue has not been investigated in United States Veterans. Methods: We performed a retrospective review of 1289 patients with pre-operative AF who underwent MV surgery between 2010–2020. Patients were grouped based on whether their procedure included ablation and LAAO, LAAO without ablation, or neither. Cox proportional hazard models, adjusted for covariates, were used to calculate risk for stroke, myocardial infarction (MI), and death based on intervention. Results: Ablation was performed in 645/1289 (50.0%) of patients and LAAO without ablation was performed in 186/1289 (14.4%) patients. Mean follow-up was 4.1 ± 3.1 years. Patients who underwent ablation had a 62% lower long-term risk of stroke (0.38, 95% CI: 0.22–0.67, p < 0.001) and 20% lower long-term mortality risk (adjusted hazard ratios (aHR) 0.80, 95% CI: 0.66–0.95, p = 0.012), but no difference in risk of MI (aHR 0.67, 95% CI: 0.38–1.16, p = 0.15). LAAO was not associated with differences in long-term risk of stroke, MI, or death. There were no differences in perioperative complications between groups. Conclusions: In veterans with AF undergoing MV surgery, ablation was inversely and independently associated with long-term stroke risk and long-term mortality, with no increased risk of perioperative complications. LAAO did not reduce long-term stroke risk.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"170 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139862909","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}
The combination of constrictive pericarditis (CP) and atrial septal defect (ASD) is a rare medical condition. Surgical intervention is typically considered the superior treatment option for patients with this condition. In this report, we present a rare case where a patient presented both a large ASD and severe tuberculous CP. The role of anesthesia is crucial in surgical procedures involving this complex cardiac conditions. Factors such as hemodynamic stability, fluid management, and preservation of cardiac function must be carefully considered. The utilization of transesophageal echocardiography (TEE) proved highly advantageous in this case, as it guided the medical team through various phases of treatment. By closely monitoring cardiac function with TEE, changes and improvements be accurately evaluated over time. This case report discusses the anesthetic management issues of this complex disease.
{"title":"Anaesthetic Management of a Large Atrial Septal Defect with Severe Tuberculous Constrictive Pericarditis: A Case Report","authors":"Mao Ye, Lu Li, Hui Yang","doi":"10.59958/hsf.5833","DOIUrl":"https://doi.org/10.59958/hsf.5833","url":null,"abstract":"The combination of constrictive pericarditis (CP) and atrial septal defect (ASD) is a rare medical condition. Surgical intervention is typically considered the superior treatment option for patients with this condition. In this report, we present a rare case where a patient presented both a large ASD and severe tuberculous CP. The role of anesthesia is crucial in surgical procedures involving this complex cardiac conditions. Factors such as hemodynamic stability, fluid management, and preservation of cardiac function must be carefully considered. The utilization of transesophageal echocardiography (TEE) proved highly advantageous in this case, as it guided the medical team through various phases of treatment. By closely monitoring cardiac function with TEE, changes and improvements be accurately evaluated over time. This case report discusses the anesthetic management issues of this complex disease.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"28 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139866960","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}
The combination of constrictive pericarditis (CP) and atrial septal defect (ASD) is a rare medical condition. Surgical intervention is typically considered the superior treatment option for patients with this condition. In this report, we present a rare case where a patient presented both a large ASD and severe tuberculous CP. The role of anesthesia is crucial in surgical procedures involving this complex cardiac conditions. Factors such as hemodynamic stability, fluid management, and preservation of cardiac function must be carefully considered. The utilization of transesophageal echocardiography (TEE) proved highly advantageous in this case, as it guided the medical team through various phases of treatment. By closely monitoring cardiac function with TEE, changes and improvements be accurately evaluated over time. This case report discusses the anesthetic management issues of this complex disease.
{"title":"Anaesthetic Management of a Large Atrial Septal Defect with Severe Tuberculous Constrictive Pericarditis: A Case Report","authors":"Mao Ye, Lu Li, Hui Yang","doi":"10.59958/hsf.5833","DOIUrl":"https://doi.org/10.59958/hsf.5833","url":null,"abstract":"The combination of constrictive pericarditis (CP) and atrial septal defect (ASD) is a rare medical condition. Surgical intervention is typically considered the superior treatment option for patients with this condition. In this report, we present a rare case where a patient presented both a large ASD and severe tuberculous CP. The role of anesthesia is crucial in surgical procedures involving this complex cardiac conditions. Factors such as hemodynamic stability, fluid management, and preservation of cardiac function must be carefully considered. The utilization of transesophageal echocardiography (TEE) proved highly advantageous in this case, as it guided the medical team through various phases of treatment. By closely monitoring cardiac function with TEE, changes and improvements be accurately evaluated over time. This case report discusses the anesthetic management issues of this complex disease.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"2019 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139807030","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}
Correction to: Heart Surgery Forum https://journal.hsforum.com/index.php/HSF/article/view/5345, published online 3 March 2023. In this article, there are some text corrections that need to be incorporated. The original article has been corrected. The authors wish to make the following corrections to this paper: In the Result section in the Abstract, “Type of the initial repair had no statically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.4).” should instead read “Type of the initial repair had no statistically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.04). And “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statically significant value (p = 0.9).” should instead read “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statistically significant value (p = 0.9)”. The authors confirm that the mistakes do not affect the results and conclusions of the study and apologize for any inconvenience caused by this mistake.
{"title":"Correction: Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair","authors":"M. Elbayomi","doi":"10.59958/hsf.7317","DOIUrl":"https://doi.org/10.59958/hsf.7317","url":null,"abstract":"Correction to: Heart Surgery Forum https://journal.hsforum.com/index.php/HSF/article/view/5345, published online 3 March 2023. \u0000In this article, there are some text corrections that need to be incorporated. The original article has been corrected. The authors wish to make the following corrections to this paper: \u0000In the Result section in the Abstract, “Type of the initial repair had no statically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.4).” should instead read “Type of the initial repair had no statistically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.04). And “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statically significant value (p = 0.9).” should instead read “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statistically significant value (p = 0.9)”. \u0000The authors confirm that the mistakes do not affect the results and conclusions of the study and apologize for any inconvenience caused by this mistake.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"61 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139819840","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}
Correction to: Heart Surgery Forum https://journal.hsforum.com/index.php/HSF/article/view/5345, published online 3 March 2023. In this article, there are some text corrections that need to be incorporated. The original article has been corrected. The authors wish to make the following corrections to this paper: In the Result section in the Abstract, “Type of the initial repair had no statically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.4).” should instead read “Type of the initial repair had no statistically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.04). And “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statically significant value (p = 0.9).” should instead read “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statistically significant value (p = 0.9)”. The authors confirm that the mistakes do not affect the results and conclusions of the study and apologize for any inconvenience caused by this mistake.
{"title":"Correction: Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair","authors":"M. Elbayomi","doi":"10.59958/hsf.7317","DOIUrl":"https://doi.org/10.59958/hsf.7317","url":null,"abstract":"Correction to: Heart Surgery Forum https://journal.hsforum.com/index.php/HSF/article/view/5345, published online 3 March 2023. \u0000In this article, there are some text corrections that need to be incorporated. The original article has been corrected. The authors wish to make the following corrections to this paper: \u0000In the Result section in the Abstract, “Type of the initial repair had no statically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.4).” should instead read “Type of the initial repair had no statistically significant relationship with in-hospital mortality with a p-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (p = 0.04). And “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statically significant value (p = 0.9).” should instead read “The relationship between the type of the initial repair and the need for reoperation didn’t reach a statistically significant value (p = 0.9)”. \u0000The authors confirm that the mistakes do not affect the results and conclusions of the study and apologize for any inconvenience caused by this mistake.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"22 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139879750","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：