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You Will Be Held For Questioning: The Secrets of Multiple-Choice Test Makers & Test Takers. 你将被扣押提问:多选题考试命题者和应试者的秘密。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-28 DOI: 10.59958/hsf.6931
Alex Wisniewski, Curt Tribble

No abstract present.

无摘要。
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引用次数: 0
Effects of Anesthetics on Cardiac Repolarization in Adults: A Network Meta-Analysis of Randomized Clinical Trials. 麻醉剂对成人心脏复极化的影响:随机临床试验的网络 Meta 分析。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-28 DOI: 10.59958/hsf.6969
Yongheng Cai, Zongping Yi, Hanwen Ou, Yong Dou, He Huang, Bing Chen

Objectives: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome.

Methods: Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970).

Results: Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI): 16.10, 33.54) and desflurane (95% CI: 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI: 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI: 17.78, 29.63), halothane (95% CI: 11.29, 41.24), desflurane (95% CI: 23.79, 39.88), and isoflurane (95% CI: 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI: 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%), halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct meta-analysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI: 23.12, 57.86). Other secondary outcomes showed no conclusive findings.

Conclusions: This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence.

目的:心脏复极化延长,尤其是心率校正QT(QTc)间期延长,与危及生命的心律失常有关。本研究旨在确定延长心脏复极化风险最低的麻醉剂,为心脏病或长 QT 综合征患者的麻醉管理提供指导:在多个数据库中搜索了比较麻醉剂对心脏复极化指数影响的随机对照试验(RCT)。主要结果为 QTc,次要结果为其他再极化指数。采用频数主义方法进行了网络荟萃分析,并在国际系统综述前瞻性注册(PROSPERO)数据库(CRD42022304970)进行了注册:结果:共纳入了13项研究,调查了953名QTc间期正常且无心血管疾病的成人。直接荟萃分析发现,丙泊酚对QTc延长的影响小于七氟醚(95% 置信区间(CI):16.10, 33.54)和地氟烷(95% CI:4.85, 35.36),七氟醚对QTc延长的影响小于地氟烷(95% CI:6.96, 19.39)。网络分析发现,丙泊酚对 QTc 延长的影响小于七氟醚(95% CI:17.78,29.63)、氟烷(95% CI:11.29,41.24)、地氟烷(95% CI:23.79,39.88)和异氟烷(95% CI:20.11,46.10),七氟醚对 QTc 延长的影响小于地氟烷(95% CI:0.43,15.82)。累积排名曲线分析的排名顺序为丙泊酚(100%)、七氟烷(63.8%)、氟烷(49.5%)、地氟烷(21.1%)和异氟烷(15.6%)。直接荟萃分析发现,异丙酚对 QT 延长的影响小于七氟醚(95% CI:23.12, 57.86)。其他次要结果没有得出结论性结论:这项荟萃分析发现,在 QTc 间期正常且无心血管疾病的成人中,丙泊酚对 QTc 延长的影响最小,其次是七氟醚和地氟醚。对于患有长 QT 综合征或心脏病的成人患者来说,丙泊酚是最好的麻醉剂,但仍需要更有力的证据。
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引用次数: 0
Hospital Care for Adult Patients with Congenital Heart Diseases. 先天性心脏病成人患者的住院治疗。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6833
Alicia J Johnson, Lidija B McGrath, Abigail M Khan, Craig S Broberg, Yoshio Otaki, Irving Shen, Ashok Muralidaran, Castigliano M Bhamidipati

Objective: The ideal type of hospital to care for adult congenital heart disease (ACHD) patients is not well known. Hospital competitiveness, clinical volume and market structure can influence clinical outcomes. We sought to understand how hospital competitiveness affects clinical outcomes in ACHD patients in the era prior to the Adult Congenital Heart Association accreditation program.

Methods: Patient discharges with ACHD diagnosis codes were filtered between 2006-2011 from an all-payer inpatient healthcare database. Hospital-level data was linked to market structure patient flow. A common measure of market concentration used to determine market competitiveness-the Herfindahl-Hirschman Index (HHI)-was stratified into: more competitive (HHI ≤25th percentile), moderately competitive (HHI 25th to <75th percentile), and less competitive (HHI ≥75th percentile) hospital. Any complication, home discharge and mortality were analyzed with clustered mixed effects logistic regression. The combined impact of HHI and any complication on mortality by interaction was assessed.

Results: A total of 67,434 patient discharges were isolated. More competitive hospitals discharged the least number of patients (N = 15,270, 22.6%) versus moderately competitive (N = 36,244, 53.7%) and less competitive (N = 15,920, 23.6%) hospitals. The adjusted odds of any complication or home discharge were not associated with hospital competitiveness strata. Compared to more competitive hospitals, mortality at moderately competitive hospitals (Adjusted Odds Ratio (AOR) 0.79, 95% CI: 0.66-0.94) and less competitive hospitals (AOR 0.79, 95% CI: 0.63-0.98) were lower (p = 0.025). Age, race, elective admission, transfer status, and payer mix were all significantly associated with adjusted odds of any complication, home discharge and mortality (p ≤ 0.05). Having any complication independently increased the adjusted odds of mortality more than 6-fold (p < 0.001), and this trend was independent of HHI strata. Failure to rescue an ACHD patient from mortality after having any complication is highest at less competitive hospitals. Sensitivity analysis which excluded the transfer status variable, showed that any complication (p = 0.047) and mortality (p = 0.01) were independently associated with HHI strata.

Conclusions: Whether lower competition allow hospitals to focus more on quality of care is unknown. Hospital competitiveness and outcome seem to have an inverse trend relationship among ACHD patients. Since medical care is frequently provided away from the home area, hospital selection is an important issue for ACHD patients. Further research is needed to determine why competitiveness is linked to surgical outcomes in this population.

目的:治疗成人先天性心脏病(ACHD)患者的理想医院类型尚不十分清楚。医院竞争力、临床量和市场结构都会影响临床结果。我们试图了解在成人先天性心脏病协会认证计划之前,医院竞争力如何影响 ACHD 患者的临床治疗效果:方法:我们从所有付费者住院医疗数据库中筛选出 2006-2011 年间带有 ACHD 诊断代码的出院患者。医院层面的数据与市场结构患者流量相关联。市场集中度是衡量市场竞争力的常用指标--赫芬达尔-赫希曼指数(HHI)--被分为:竞争力较强(HHI ≤25百分位数)、竞争力中等(HHI 25分位数至结果:共分离出 67,434 例出院患者。竞争力较强的医院与竞争力一般的医院(N = 36,244, 53.7%)和竞争力较弱的医院(N = 15,920, 23.6%)相比,出院患者人数最少(N = 15,270, 22.6%)。任何并发症或出院回家的调整后几率与医院竞争力层级无关。与竞争力较强的医院相比,竞争力一般的医院(调整后的几率比(AOR)0.79,95% CI:0.66-0.94)和竞争力较弱的医院(AOR 0.79,95% CI:0.63-0.98)的死亡率较低(P = 0.025)。年龄、种族、择期入院、转院状态和支付方组合均与任何并发症、居家出院和死亡率的调整后几率显著相关(p ≤ 0.05)。出现任何并发症都会使调整后的死亡率几率增加 6 倍以上(p < 0.001),而且这一趋势与 HHI 分层无关。在竞争力较弱的医院中,发生任何并发症后未能抢救成功的 ACHD 患者死亡率最高。敏感性分析排除了转院状态这一变量,结果显示任何并发症(p = 0.047)和死亡率(p = 0.01)均与 HHI 阶层独立相关:结论:较低的竞争是否会使医院更加注重医疗质量尚不清楚。在 ACHD 患者中,医院竞争力与治疗效果似乎呈反向关系。由于医疗服务经常在家庭所在地以外的地区提供,因此医院的选择对于 ACHD 患者来说是一个重要问题。需要进一步研究,以确定竞争力为何与这一人群的手术效果有关。
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引用次数: 0
Long-Term Survival Benefits of Porcine versus Pericardial Bioprostheses in Elderly Patients Undergoing Isolated Aortic Valve Replacement: A 32-Year Study. 猪生物瓣膜与心包生物瓣膜在接受孤立主动脉瓣置换术的老年患者中的长期生存优势:一项为期 32 年的研究。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6917
George Ebra, Ernest A Traad, Paul A Kurlansky

Background: The elderly population is growing at an unprecedented rate. Aortic valve disease increases with age. Bioprostheses are the valves of choice for older patients; however, the optimal tissue valve remains undetermined. The purpose of this investigation was to perform a life-of-patient survival comparison of the prototypical porcine and pericardial prostheses in elderly patients.

Methods: The study population (N = 1480) consisted of patients 65 years of age and older who underwent isolated aortic valve replacement from 1990 through 2005 with a Carpentier-Edwards Porcine (n = 650) or Pericardial (n = 830) bioprosthesis. Propensity score-matched groups were created.

Results: Valve selection was not associated with operative mortality. Survival estimates at 10 years were better for Pericardial (41.8%; 95% CI: 37.9 to 45.7) than Porcine (32.6%; 95% CI: 28.8 to 36.3); and 5.2% (95% CI: 3.2 to 7.1) versus 2.0%; (95% CI: 0.8 to 3.2) at 20 years (p < 0.001). E-value analysis found minimal influence of unknown study confounders. Factors associated with long-term mortality were porcine valve (p < 0.001), age (p < 0.001), diabetes mellitus (p < 0.001), preop renal insufficiency (p < 0.001), peripheral artery disease (p = 0.011), congestive heart failure (p = 0.003), New York Heart Association Class III or IV (p = 0.004), surgical history-reoperation (p = 0.012), transient ischemic attack (p = 0.009), prolonged ventilation (p = 0.010), postop renal insufficiency (p < 0.001), and atrial fibrillation (p = 0.009). The indexed Effective Orifice Area (EOAi) was assessed and did not influence observed long-term survival differences.

Conclusions: This unusual lifetime study provided substantial evidence for the superiority of the pericardial over the porcine bioprosthesis in the aortic position in elderly patients. It demonstrated enhanced long-term survival benefits for elderly patients without any increase in perioperative mortality. It is intended to inform future investigation into aortic valve design.

背景:老年人口正以前所未有的速度增长。主动脉瓣疾病随着年龄的增长而增加。生物假体是老年患者的首选瓣膜,但最佳的组织瓣膜仍未确定。这项研究的目的是比较猪原型假体和心包假体在老年患者中的存活率:研究对象(N = 1480)包括 1990 年至 2005 年期间接受过 Carpentier-Edwards 猪(n = 650)或心包(n = 830)生物假体孤立主动脉瓣置换术的 65 岁及以上患者。结果显示:瓣膜选择与手术风险无关:结果:瓣膜选择与手术死亡率无关。心包生物瓣膜(41.8%;95% CI:37.9 至 45.7)的 10 年生存率估计值优于猪生物瓣膜(32.6%;95% CI:28.8 至 36.3);20 年生存率估计值为 5.2%(95% CI:3.2 至 7.1)对 2.0%;(95% CI:0.8 至 3.2)(P < 0.001)。E值分析发现,未知研究混杂因素的影响极小。与长期死亡率相关的因素有猪瓣膜(p < 0.001)、年龄(p < 0.001)、糖尿病(p < 0.001)、术前肾功能不全(p < 0.001)、外周动脉疾病(p = 0.011)、充血性心力衰竭(p = 0.003)、纽约心脏协会 III 级或 IV 级(p = 0.004)、手术史-再手术(p = 0.012)、短暂性脑缺血发作(p = 0.009)、通气时间延长(p = 0.010)、术后肾功能不全(p < 0.001)和心房颤动(p = 0.009)。对有效气道面积(EOAi)进行了评估,结果显示,有效气道面积并不影响观察到的长期存活率差异:这项不寻常的终生研究提供了大量证据,证明在老年患者的主动脉位置,心包生物假体比猪生物假体更有优势。该研究表明,老年患者的长期生存率提高了,而围术期死亡率却没有增加。该研究旨在为今后的主动脉瓣设计研究提供参考。
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引用次数: 0
Effects of Home-based Remote Cardiac Rehabilitation on Left Ventricular Function and Fear of Exercise in Patients after Percutaneous Coronary Intervention (PCI): A Retrospective Cohort Study. 家庭远程心脏康复对经皮冠状动脉介入治疗 (PCI) 患者左心室功能和运动恐惧的影响:一项回顾性队列研究
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6827
Xizhen Gao, Lan Zhang, Zhengbo Chen

Aim: This study aims to explore the effects of home-based remote cardiac rehabilitation on left ventricular function and exercise fear in patients after percutaneous coronary intervention (PCI).

Methods: A total of 232 patients with coronary heart disease after PCI treated in Tianshan Traditional Chinese Medicine Hospital from January 2020 to December 2022 were retrospectively analyzed. The patients were divided into the remote rehabilitation group (169 cases) and the routine group (63 cases) according to the exposure factor (home-based remote cardiac rehabilitation). Changes in left ventricular function and sports phobia Tampa Scale in patients with coronary heart disease after PCI were compared using propensity score matching to reduce selection bias and confounding factors.

Results: After the intervention, the scores of patients in the tele-rehabilitation group were significantly higher than those in the conventional group in terms of fear of movement, perception of danger, fear of movement, avoidance of movement, and dysfunction (p-value < 0.05). Left heart function was compared between the tele-rehabilitation group and the conventional group. Patients in the tele-rehabilitation group had significantly higher peak mitral valve blood flow in the early diastolic period (E), peak mitral valve blood flow in the late diastolic period (A), six-minute walk test (6MWT), and ratio of the peak mitral valve blood flow in the early diastolic period to the peak mitral valve blood flow in the late diastolic period (E/A) than those in the conventional group (p-value < 0.05). However, the peak deceleration time and isovolumic diastolic time in the early mitral valve diastolic period were significantly higher in the tele-rehabilitation group than in the conventional group (p-value < 0.05).

Conclusions: Home-based remote cardiac rehabilitation instruction can improve the heart function and exercise fear state of patients after PCI.

目的:本研究旨在探讨家庭远程心脏康复对经皮冠状动脉介入治疗(PCI)后患者左心室功能和运动恐惧的影响:回顾性分析2020年1月至2022年12月在天山中医院接受治疗的232例PCI术后冠心病患者。根据暴露因素(家庭远程心脏康复)将患者分为远程康复组(169 例)和常规组(63 例)。为了减少选择偏差和混杂因素,采用倾向得分匹配法比较了PCI后冠心病患者左心室功能和运动恐惧症坦帕量表的变化:干预后,远程康复组患者在运动恐惧、危险感知、运动恐惧、运动回避和功能障碍方面的得分明显高于常规组(P值<0.05)。远程康复组与传统组的左心功能进行了比较。远程康复组患者的舒张早期二尖瓣血流峰值(E)、舒张晚期二尖瓣血流峰值(A)、六分钟步行测试(6MWT)以及舒张早期二尖瓣血流峰值与舒张晚期二尖瓣血流峰值之比(E/A)均明显高于传统组患者(P值<0.05)。然而,远程康复组二尖瓣舒张早期的峰值减速时间和等容舒张时间明显高于常规组(P值<0.05):基于家庭的远程心脏康复指导可改善PCI术后患者的心脏功能和运动恐惧状态。
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引用次数: 0
Factors Influencing the Incidence of Pneumonia after Coronary Artery Bypass Grafting. 影响冠状动脉旁路移植术后肺炎发病率的因素。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6865
Yanbing Zhang, Pengyu Zhang, Han Li, Haitao Chi, Nan Zheng, Xu Pan, Chuzhong Tang

Objective: This study aimed to explore and analyze the factors affecting the incidence of pneumonia after coronary artery bypass grafting (CABG) to provide reference for the prevention of such situation.

Methods: A total of 500 patients who underwent CABG in a hospital were selected. From March 2019 to March 2022, 410 patients without pneumonia and 90 patients with pneumonia were divided into groups A and B. The influencing factors and pathogen composition of postoperative pneumonia were discussed and analyzed.

Results: Univariable analysis results showed that age, cardiac function grade, occurrence of smoking, operation time, tracheal intubation time, suspended red-blood-cell transfusion and hospital stay in group B were higher than those in group A. Multivariable logistic analysis results showed that operation time, smoking history, and tracheal intubation time were risk factors for pneumonia after CABG. Among the 90 patients with postoperative pneumonia, 90 had pathogens, 81 had Gram-negative bacteria, 4 had Gram-positive bacteria, and 5 had fungi.

Conclusions: Patients after CABG were more likely to develop pneumonia. Operation time, smoking history, and tracheal intubation time were the risk factors of pneumonia after CABG. Most of these patients had Gram-negative bacteria. Patient intervention based on the influencing factors can effectively prevent the occurrence of postoperative pneumonia.

目的本研究旨在探讨和分析冠状动脉旁路移植术(CABG)术后肺炎发生率的影响因素,为预防此类情况的发生提供参考:选取在某医院接受CABG手术的患者共500例。从2019年3月至2022年3月,将410例无肺炎患者和90例肺炎患者分为A、B两组,探讨分析术后肺炎的影响因素和病原体构成:单变量分析结果显示,B组患者的年龄、心功能分级、吸烟史、手术时间、气管插管时间、暂停输注红细胞和住院时间均高于A组。在90名术后肺炎患者中,90人的病原体为革兰氏阴性菌,81人的病原体为革兰氏阳性菌,4人的病原体为革兰氏阳性菌,5人的病原体为真菌:结论:心血管造影术后的患者更容易患肺炎。手术时间、吸烟史和气管插管时间是 CABG 术后肺炎的危险因素。这些患者大多感染革兰氏阴性菌。根据影响因素对患者进行干预可有效预防术后肺炎的发生。
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引用次数: 0
On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization. 关于需要紧急血管重建的患者的泵打心脏冠状动脉手术。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6923
Yasin Kilic, Izatullah Jalalzai, Ebubekir Sonmez, Bilgehan Erkut

Background: When acute coronary syndrome patients necessitate immediate revascularization, heart-on-pump coronary artery bypass grafting may be regarded as a viable substitute for conventional on-pump surgery. Our clinical experience and initial outcomes of heart-on-pump coronary surgery in patients with acute coronary syndrome are detailed in this article.

Method: This research endeavor was a retrospective analysis that spanned the years March 2011 to August 2023. The sample size comprised 2816 patients who had undergone coronary artery surgery. During this period, the same surgical team performed coronary artery bypass surgery on 411 of these patients, who underwent beating heart surgery while on cardiopulmonary bypass support and without cardioplegic arrest; this was done under emergency conditions.

Result: 9.3 ± 2.2 hours elapsed between the initiation of acute myocardial infarction and the commencement of coronary artery bypass grafting (CABG). A mean of 4.0 grafts was applied (2.2 ± 1.1). Mortality in hospitals was calculated for sixteen patients. Following surgery, twenty-six patients developed an inadequate cardiac output syndrome. Despite having renal dysfunction, none of the eight individuals needed hemodialysis. The mean duration of stay in intensive care was 3.2 (2.2 ± 1.1) days, while the mean length of hospitalization was 9.2 (4.3 ± 2.4) days.

Conclusion: We believe that for high-risk patients with multivascular coronary artery disease who require an emergency coronary artery bypass graft, on-pump beating heart revascularization could be a viable option.

背景:当急性冠状动脉综合征患者需要立即进行血管重建时,泵上心脏冠状动脉旁路移植术可被视为传统泵上手术的可行替代方案。本文详细介绍了我们对急性冠状动脉综合征患者实施泵上心脏冠状动脉手术的临床经验和初步结果:这项研究工作是一项回顾性分析,时间跨度为 2011 年 3 月至 2023 年 8 月。样本量包括 2816 名接受冠状动脉手术的患者。结果:从急性心肌梗死开始到冠状动脉旁路移植术(CABG)开始之间的时间为 9.3±2.2 小时。平均移植时间为 4.0 小时(2.2 ± 1.1)。计算了 16 名患者的住院死亡率。手术后,26 名患者出现了心输出量不足综合征。尽管存在肾功能障碍,但八名患者都不需要进行血液透析。重症监护的平均住院时间为 3.2(2.2 ± 1.1)天,平均住院时间为 9.2(4.3 ± 2.4)天:我们认为,对于需要紧急进行冠状动脉旁路移植手术的多血管冠状动脉疾病高危患者来说,泵上心脏跳动再通术是一种可行的选择。
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引用次数: 0
Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement. 在接受二尖瓣置换术的患者中比较德尔尼多心脏麻痹和微静脉麻醉的临床效果。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6381
Erhan Hafız, Özgür Altınbaş, Işık Betil Kutlu, Mehmet Moda, Mehmet Adnan Celkan

Background: Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this study, we aimed to compare the effects of del Nido cardioplegia and microplegia, which were mostly used in our clinic for intraoperative and postoperative processes among patients who underwent elective mitral valve replacement. As a result, the comparison could be performed in a specific patient group without additional valvular or coronary disease, and cardioplegia distribution could be achieved more efficiently.

Methods: Between 2018 and 2023, a total of 120 patients who underwent elective mitral valve replacement via sternotomy with del Nido cardioplegia or microplegia were included in the study. Patients were divided into two groups; group 1 (del Nido, n = 64) and group 2 (microplegia, n = 56). Preoperative characteristics, intraoperative and postoperative early clinical data as primary outcomes, and postoperative mortality rates and intensive care costs as secondary outcomes were compared statistically.

Results: There were no statistically significant differences in terms of preoperative characteristics between the two groups. Duration of cross clamp differences between group 1 versus group 2 (45 ± 16 vs. 57 ± 19 min), cardiopulmonary bypass (56 ± 17 vs. 65 ± 21 min), intensive care length of stay (18.04 ± 7.41 vs. 22.37 ± 6.86 h), requirement of intraoperative defibrillation (n = 5 vs. n = 13), and intensive care costs were found to be statistically significantly lower in del Nido group.

Conclusion: Either del Nido or microplegia solutions can be used safely in mitral valve replacement operations, however, del Nido cardioplegia has some advantages over intraoperative processes, such as lowering the cross clamp and cardiopulmonary bypass time. Furthermore, patients who received del Nido cardioplegia had shorter intensive care stay and required less intraoperative defibrillation compared with the microplegia group. Therefore, less exposure to anesthesia, the prevention of infection due to shortened operation duration, and greater cost-effectiveness can be achieved by using del Nido cardioplegia instead of microplegia.

背景:心脏麻痹溶液用于保护心肌免受心肺旁路术造成的缺血性损伤,目前已有各种类型的心脏麻痹溶液用于心脏手术。在这项研究中,我们的目的是比较德尔尼多心脏麻痹和微静脉麻醉的效果,这两种麻醉方法在我们的临床中主要用于择期二尖瓣置换术患者的术中和术后过程。因此,可以在没有其他瓣膜或冠状动脉疾病的特定患者群体中进行比较,并且可以更有效地实现心麻分布:在2018年至2023年期间,共有120名通过胸骨切开术行择期二尖瓣置换术的患者被纳入研究,并使用del Nido心脏麻痹或微瘫。患者分为两组:第1组(德尔尼多,64人)和第2组(微镇痛,56人)。将术前特征、术中和术后早期临床数据作为主要结果,术后死亡率和重症监护费用作为次要结果,并进行统计比较:结果:两组患者的术前特征差异无统计学意义。德尔尼多组的交叉钳夹时间(45±16 分钟对 57±19 分钟)、心肺旁路时间(56±17 分钟对 65±21 分钟)、重症监护住院时间(18.04±7.41 小时对 22.37±6.86 小时)、术中除颤需求(n = 5 对 n = 13)和重症监护费用均显著低于德尔尼多组:结论:二尖瓣置换术中可安全使用德尔尼多或微静脉麻醉溶液,但德尔尼多心脏麻痹与术中过程相比具有一些优势,如减少交叉钳夹和心肺旁路时间。此外,与微静脉注射组相比,接受德尔尼多心脏麻痹的患者重症监护时间更短,术中除颤需求更少。因此,使用德尔尼多心脏麻痹替代微静脉注射可以减少麻醉暴露,缩短手术时间以防止感染,并提高成本效益。
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引用次数: 0
Development and Validation of a Novel Nomogram for Predicting Perioperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting Surgery. 开发并验证用于预测孤立的非泵冠状动脉旁路移植手术后围手术期急性肾损伤的新提名图。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6939
Shoulei Chen, Cheng Luo, Chen Fang, Yugui Li, Xiongwei Cai, Guoxing Ling, Haitao Song, Sida Fan, Linsheng Mi, Sai Zheng, Baoshi Zheng

Background: The aim of this work was to create a novel model for predicting acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCABG).

Methods: The individuals who underwent OPCABG were randomly separated into a derivation group and a validation group, at a 7:3 ratio. The primary outcome was AKI under the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. To optimize feature selection and construct a nomogram, both least absolute shrinkage and selection operator regression (LASSO) and logistic regression analysis were utilized. The nomogram was assessed in various ways: with the C-index, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA).

Results: The use of an intra-aortic balloon pump (IABP), systolic blood pressure, smoking and baseline serum creatinine were identified as independent impact factors. The C-index of the nomogram was 0.733 (95% confidence interval (CI) = 0.669-0.791) and 0.786 (95% CI = 0.693-0.878) in the training and validation groups, respectively. The area under the curve (AUC) of the internal validation was 0.715 using bootstrapping with 1000 replicates. The calibration plot revealed that the predicted outcomes aligned well with the observations. DCA and CICA suggested that the model had clinical benefit.

Conclusion: The nomogram that relied on clinical characteristics proved to be a dependable instrument to predict AKI after OPCABG. This model is conveniently applicable in clinical settings and will be a valuable resource for assessing timely medical measures to mitigate risk.

背景:这项研究的目的是建立一个新模型,用于预测体外循环冠状动脉搭桥术(OPCABG)后的急性肾损伤(AKI):这项研究的目的是建立一个新模型,用于预测非体外循环冠状动脉搭桥术(OPCABG)后的急性肾损伤(AKI):方法:将接受 OPCABG 手术的患者按 7:3 的比例随机分为推导组和验证组。主要结果是肾脏疾病:改善全球预后(KDIGO)标准下的 AKI。为了优化特征选择和构建提名图,采用了最小绝对收缩和选择算子回归(LASSO)和逻辑回归分析。对提名图进行了多种评估:C 指数、校准曲线、决策曲线分析(DCA)和临床影响曲线分析(CICA):结果:使用主动脉内球囊反搏泵(IABP)、收缩压、吸烟和基线血清肌酐被确定为独立的影响因素。训练组和验证组的提名图 C 指数分别为 0.733(95% 置信区间 (CI) = 0.669-0.791)和 0.786(95% CI = 0.693-0.878)。使用 1000 次重复的引导法,内部验证的曲线下面积(AUC)为 0.715。校准图显示,预测结果与观测结果非常吻合。DCA和CICA表明该模型具有临床益处:依赖临床特征的提名图被证明是预测 OPCABG 术后 AKI 的可靠工具。该模型可方便地应用于临床环境,并将成为评估及时采取医疗措施以降低风险的宝贵资源。
{"title":"Development and Validation of a Novel Nomogram for Predicting Perioperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting Surgery.","authors":"Shoulei Chen, Cheng Luo, Chen Fang, Yugui Li, Xiongwei Cai, Guoxing Ling, Haitao Song, Sida Fan, Linsheng Mi, Sai Zheng, Baoshi Zheng","doi":"10.59958/hsf.6939","DOIUrl":"10.59958/hsf.6939","url":null,"abstract":"<p><strong>Background: </strong>The aim of this work was to create a novel model for predicting acute kidney injury (AKI) after off-pump coronary artery bypass graft (OPCABG).</p><p><strong>Methods: </strong>The individuals who underwent OPCABG were randomly separated into a derivation group and a validation group, at a 7:3 ratio. The primary outcome was AKI under the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. To optimize feature selection and construct a nomogram, both least absolute shrinkage and selection operator regression (LASSO) and logistic regression analysis were utilized. The nomogram was assessed in various ways: with the C-index, calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CICA).</p><p><strong>Results: </strong>The use of an intra-aortic balloon pump (IABP), systolic blood pressure, smoking and baseline serum creatinine were identified as independent impact factors. The C-index of the nomogram was 0.733 (95% confidence interval (CI) = 0.669-0.791) and 0.786 (95% CI = 0.693-0.878) in the training and validation groups, respectively. The area under the curve (AUC) of the internal validation was 0.715 using bootstrapping with 1000 replicates. The calibration plot revealed that the predicted outcomes aligned well with the observations. DCA and CICA suggested that the model had clinical benefit.</p><p><strong>Conclusion: </strong>The nomogram that relied on clinical characteristics proved to be a dependable instrument to predict AKI after OPCABG. This model is conveniently applicable in clinical settings and will be a valuable resource for assessing timely medical measures to mitigate risk.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E832-E841"},"PeriodicalIF":0.6,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Efficacy of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Coronary Heart Disease Patients with SYNTAX Score ≥33 and Euro Score ≥6: A Single-Center Retrospective Analysis. SYNTAX评分≥33分且欧洲评分≥6分的冠心病患者接受分数血流储备引导的经皮冠状动脉介入治疗的临床疗效:一项单中心回顾性分析。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-12-27 DOI: 10.59958/hsf.6839
Zhiyong Wu, Xuanlan Chen, Yizhong Zhou, Nanping Gong, Zhitang Chang

Objective: To observe clinical efficacy of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary heart disease patients with SYNTAX scores (SS) ≥33 and Euro Scores (ES) ≥6 who are unsuitable for or have declined coronary artery bypass graft (CABG).

Methods: A total of 117 patients with SS ≥33 and Euro Score (ES) ≥6 who were unsuitable for and/or who had declined CABG between Jan 2021 and June 2022 were enrolled in this retrospective analysis. All patients accepted optimal medical therapy and some accepted an FFR-guided PCI procedure. Patients who only underwent optimal medical therapy were divided into the optimal medical therapy group (OMT group) and patients who simultaneously underwent FFR-guided PCI procedure were divided into the PCI group in this retrospective analysis. All patients accepted follow-up for at least 12 months after discharge.

Results: SS and ES in the two groups were not statistically different (p > 0.05). Patients with chronic total occlusion accounted for a greater proportion in the PCI subgroup (31.3%, 5/16) than in other subgroups. Eighteen (18.6%, 18/97) cases in the PCI group developed major adverse cardiac and cerebrovascular events (MACCEs). There were 12 (60%, 12/20) cases of MACCEs in the OMT group, which was statistically different from the PCI group (p < 0.05).

Conclusions: Based on optimal medical therapy, FFR-guided PCI can still have clinical benefit to coronary artery disease patients with SS ≥33 who were not suitable for CABG.

目的观察分数血流储备(FFR)引导的经皮冠状动脉介入治疗(PCI)对SYNTAX评分(SS)≥33分、欧洲评分(ES)≥6分且不适合或拒绝冠状动脉搭桥术(CABG)的冠心病患者的临床疗效:在2021年1月至2022年6月期间,共有117名SS≥33且欧洲评分(ES)≥6的患者不适合和/或拒绝接受冠状动脉旁路移植术(CABG)。所有患者都接受了最佳药物治疗,部分患者接受了 FFR 引导下的 PCI 手术。在本次回顾性分析中,仅接受最佳药物治疗的患者被分为最佳药物治疗组(OMT 组),同时接受 FFR 引导的 PCI 手术的患者被分为 PCI 组。所有患者均接受出院后至少12个月的随访:两组患者的 SS 和 ES 无统计学差异(P>0.05)。与其他亚组相比,PCI 亚组(31.3%,5/16)中慢性全闭塞患者的比例更高。PCI 组中有 18 例(18.6%,18/97)发生了重大不良心脑血管事件(MACCE)。OMT组有12例(60%,12/20)发生MACCE,与PCI组相比有统计学差异(P<0.05):结论:在最佳药物治疗的基础上,FFR引导的PCI对SS≥33且不适合CABG的冠心病患者仍有临床益处。
{"title":"Clinical Efficacy of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Coronary Heart Disease Patients with SYNTAX Score ≥33 and Euro Score ≥6: A Single-Center Retrospective Analysis.","authors":"Zhiyong Wu, Xuanlan Chen, Yizhong Zhou, Nanping Gong, Zhitang Chang","doi":"10.59958/hsf.6839","DOIUrl":"10.59958/hsf.6839","url":null,"abstract":"<p><strong>Objective: </strong>To observe clinical efficacy of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in coronary heart disease patients with SYNTAX scores (SS) ≥33 and Euro Scores (ES) ≥6 who are unsuitable for or have declined coronary artery bypass graft (CABG).</p><p><strong>Methods: </strong>A total of 117 patients with SS ≥33 and Euro Score (ES) ≥6 who were unsuitable for and/or who had declined CABG between Jan 2021 and June 2022 were enrolled in this retrospective analysis. All patients accepted optimal medical therapy and some accepted an FFR-guided PCI procedure. Patients who only underwent optimal medical therapy were divided into the optimal medical therapy group (OMT group) and patients who simultaneously underwent FFR-guided PCI procedure were divided into the PCI group in this retrospective analysis. All patients accepted follow-up for at least 12 months after discharge.</p><p><strong>Results: </strong>SS and ES in the two groups were not statistically different (p > 0.05). Patients with chronic total occlusion accounted for a greater proportion in the PCI subgroup (31.3%, 5/16) than in other subgroups. Eighteen (18.6%, 18/97) cases in the PCI group developed major adverse cardiac and cerebrovascular events (MACCEs). There were 12 (60%, 12/20) cases of MACCEs in the OMT group, which was statistically different from the PCI group (p < 0.05).</p><p><strong>Conclusions: </strong>Based on optimal medical therapy, FFR-guided PCI can still have clinical benefit to coronary artery disease patients with SS ≥33 who were not suitable for CABG.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 6","pages":"E817-E825"},"PeriodicalIF":0.6,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Heart Surgery Forum
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