Heart Surgery Forum最新文献

Objective: To investigate the predictive value of soluble growth stimulation expressed gene 2 (sST2) for the development of Cardiorenal syndrome type 1 (CRS1) in patients with acute myocardial infarction during hospitalization.

Methods: A retrospective study included 202 patients with acute myocardial infarction, divided into the CRS1 group (n = 61) and the Non-CRS1 group (n = 141) by the CRS1 occurrence. A logistic regression analysis was applied to find independent predictors of the CRS1 occurrence during hospitalization. Receiver operating characteristic (ROC) curves were applied to analyze the predictive values of sST2, N-terminal pro-B type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR).

Result: The multivariate logistic regression analysis revealed that sST2, NT-proBNP, eGFR, Multivessel coronary artery disease, and diuretic use were independent predictors of the CRS1 occurrence during hospitalization. Application of ROC curve analysis displayed that sST2 had the largest area under the curve (AUC) value of 0.874, sensitivity of 0.770, and specificity of 0.894; sST2, eGFR, and NT-proBNP as combined predictors had an AUC value of 0.908, sensitivity of 0.820, and specificity of 0.908. The ROC curves of sST2 and the combined predictive indices were compared using MedCalc software (version 19.6.3), and no statistically significant difference was found between the two (p = 0.142). The cutoff values of the three indicators were determined by the maximum Youden index. When sST2 ≥61.8 ng/mL, eGFR ≤80.6 mL/min/1.73 m2 and NT-proBNP ≥1525 pg/mL were classified as abnormal range, it was found that more number of abnormal indicators may be more advantageous of risk stratification in CRS1.

Conclusions: sST2 can be used as a novel predictor of the CRS1 occurrence in patients with acute myocardial infarction during hospitalization. sST2, eGFR, and NT-proBNP combined may have better predictive value.

Objective: Based on the logistic regression model, analyze the risk factors for high degree atrioventricular block after transcatheter aortic valve replacement (TAVI) surgery and further analyze its predictive value.

Methods: 402 patients who underwent TAVI surgery at Henan Thoracic Hospital for "aortic stenosis" between January 2020 and January 2023 were selected as the study subjects. The study subjects were divided into A group (N = 89) and B group (N = 313) based on whether high degree atrioventricular block occurred after surgery. The age, biochemistry and other general data of patients were systematically collected through inpatient cases, and the preoperative Right bundle branch block, I degree atrioventricular block, QRS duration, and indoor block were collected through our hospital's electrocardiogram (ECG) system, Calcification integral of Aortic valve was calculated by computed tomography (CT) results. Logistic regression analysis was performed on the clinical data, and the predictive value of related factors was further analyzed through the Receiver operating characteristic.

Results: The preoperative QRS wave duration in the A group (165.06 ± 61.25) was significantly higher than that in the B group (108.30 ± 16.30), and the difference was statistically significant (p < 0.05). Compared with the B group, the incidence of Right bundle branch block in the A group was significantly higher before operation. The calcification score of Aortic valve in the A group (97.58 ± 61.25) was significantly higher than that in the B group (43.59 ± 7.56), with a statistically significant difference (p < 0.05). Further multivariate logistic regression analysis showed that the duration of QRS wave before operation and Aortic valve calcification score were independent risk factors for high atrioventricular block after TAVI (p < 0.05). Through Receiver operating characteristic analysis, it was found that preoperative QRS wave duration and Aortic valve calcification score had a high predictive value for the occurrence of high atrioventricular block after TAVI. The optimal cutoff value of QRS wave duration for predicting high atrioventricular block was 152, area under curve (AUC): 0.780 (95% CI: 0.718-0.841, p < 0.001). The optimal cutoff value for predicting high degree atrioventricular block with aortic calcification score is 61.5, AUC: 0.997 (95% CI: 0.992-1.000, p < 0.001).

Conclusions: Preoperative QRS wave duration and Aortic valve calcification score are independent risk factors for high degree atrioventricular block after TAVI, and they have high predictive value. In clinical work, risk factors should be found early and responded in time.

Background: Acute renal failure after extracorporeal cardiac surgery under general anesthesia is high and unpredictable, but machine learning algorithms could change this. A feasible approach is to use machine learning models to construct models to predict acute kidney injury after extracorporeal cardiac surgery (CSA-AKI) and screen for the best predictive model.

Method: From January 2014 to December 2021, 2187 patients undergoing extracorporeal cardiac surgery at the third hospital of Hebei Medical University and the first medical centre of Chinese PLA General Hospital were collected in this study. After excluding 923 patients who did not meet the inclusion criteria, a dataset of 1264 patients with 125 clinical indexes was constructed. After screening the feature variables using Least absolute shrinkage (LASSO) regression, the dataset was randomly divided into a training set (70%), test set (30%), and six machine learning algorithms, including extreme gradient boosting (XGBoost), logistic regression (LRC), light gradient boosting machine (LGBM), random forest classifier (RFC), adaptive boosting (AdaBoost), and K-nearest neighbor (KNN), were used in training set for predicting the CSA-AKI. The machine learning model with the best predictive performance was selected to complete external validation of the test set. The SHapley Additive exPlanations (SHAP) algorithm was used to interpret the model.

Results: Of all 1264 patients, 372 (29.43%) patients presented with CSA-AKI. The LASSO regression eliminated 22 feature variables out of 125 before model development. Among the six prediction models, the RFC prediction model has the best prediction performance, with an Area Under Curve (AUC) value of 0.778 (95% CI: 0.726-0.830) in the test set and the best net benefit compared to the other tools. SHAP explained the impact of different feature variables on the predicted outcome, where the three most influential feature variables were creatinine clearance (CRC), intraoperative urine output (mL/kg/h) and age.

Conclusion: We developed an RFC prediction model to predict the CSA-AKI, which has good predictive performance and can explain the factors affecting the prediction results of cases by integrating the SHAP method.

Objective: To investigate the effect of a NNN-linked care model applied in elderly patients with coronary heart disease.

Methods: A total of 120 elderly patients with coronary heart disease admitted to the hospital from January, 2023 to May, 2023 were randomly divided into two groups of 60 cases respectively. The control group received routine intervention, and the observation group received the NNN-linked care model. Changes in cardiac function, the ability for self-care, and quality of life were recorded between the groups before and after the intervention.

Results: Indices of cardiac function in the observation group were higher than those of the control group after 3 weeks (p < 0.05). Compared with the control group, the total score for the ability for self-care and the scores of each dimension of the observation group were higher after 3 weeks of intervention (p < 0.05). The scores of quality of life of the observation group were higher in comparison with the control group after 3 weeks of intervention (p < 0.05).

Conclusion: The application of the NNN-linked care model to elderly patients with coronary heart disease can improve the ability for self-care, increase cardiac function and improve the quality of life.

Objectives: To determine whether sex-based differences exist following surgery for degenerative mitral valve disease.

Methods: Using a national database, we analysed data on mitral valve surgery for degenerative disease (n = 22,658) between January 2000 and March 2019 in the UK. We split the cohort into men (n = 14,681) and women (n = 7977) and compared background characteristics, intraoperative variables and early postoperative outcomes. Our primary outcome was hospital mortality; secondary outcomes included re-exploration for bleeding, prolonged admission (>10 days) and mitral replacement. We used binary logistic regression models for all outcomes, with multiplicative interaction terms to determine the nature of any differences.

Results: Women presented older (70 ± 11 years vs. 67 ± 11 years, p < 0.001) with worse symptom profiles (New York Heart Association Class III-IV 57% vs. 44%, p < 0.001). They had higher rates of preoperative atrial fibrillation (39% vs. 35%, p < 0.001) and tricuspid disease requiring surgery (21% vs. 15%, p < 0.001). They had lower repair rates (66% vs. 76%, p < 0.001), higher mortality (3% vs. 2%, p < 0.001) and were more likely to have a prolonged admission (48% vs. 40%, p < 0.001). Female sex was an independent predictor of mortality (odds ratio (OR): 1.52, 95% CI: 1.21-1.90, p < 0.001). Age and Canadian Cardiovascular Society (CCS) score showed significant interactions with sex. The relationship between advancing age and mortality was found to be more pronounced in women.

Conclusions: (1) Female sex is an independent predictor of hospital mortality, prolonged hospital admission and mitral valve replacement. (2) The relationship between female sex and mortality is exacerbated by worsening CCS score and advancing age. (3) Women have significantly lower repair rates.

Objectives: Pecto-intercostal fascial block (PIFB) and rectus sheath block (RSB) have been combined to offer better analgesia for cardiac surgery patients, but safety of the analgesic protocol with a large volume of ropivacaine is uncertain.

Methods: This is a prospective observational study at Peking University People's Hospital to investigate the pharmacokinetic profile of ropivacaine after combined regional blocks. Patients undergoing elective cardiac surgery by a median sternotomy were enrolled to receive bilateral PIFB and RSB with 70 mL 0.3% ropivacaine (total dose 210 mg). Blood was sampled at 5, 10, 15, 30, 60, 90 and 120 mins after blocks. Total blood concentration of ropivacaine for patients were measured.

Results: Ten patients were enrolled and analyzed. The peak total ropivacaine concentration varied from 0.67 to 2.42 µg/mL. Time to reach the peak values mainly located between 10 and 30 mins after the performance. No patients had ropivacaine concentration values above toxic threshold (4.3 µg/mL), and there were no systemic toxicity symptoms during the perioperative period.

Conclusions: PIFB combined with RSB in a general injection of 70 mL 0.3% ropivacaine does not give rise to toxic levels, and it is an effective and safe analgesic protocol for cardiac surgery patients.

Background: This bioinformatics report attempts to explore the cross-talk genes, transcription factors (TFs), and pathways related to myocardial ischemia-reperfusion injury (MIRI) as well as the gut microbiome.

Method: The datasets GSE61592 (three MIRI and three sham samples) and GSE160516 (twelve MIRI and four sham samples) were selected in the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) identification (p < 0.05 and |log FC (fold change)| ≥1) together with functional annotation (p < 0.05) was implemented. The Cytoscape platform established the protein-protein interaction (PPI) network. Genes associated with gut microbiome disorder were extracted based on the DisGeNET database, and those associated with MIRI were overlapped. The Recursive Feature Elimination (RFE) algorithm was adopted for selecting features, and cross-talk genes were predicted by the Support Vector Machine (SVM) models. A network encompassing cross-talk genes along with the TFs was thereby established.

Result: The MIRI datasets comprised 138 shared DEGs, with 101 showing up-regulation whereas 37 showing down-regulation. Notably, the PPI interwork for MIRI contained 2517 edges along with 1818 nodes. By using RFE and SVM methods, six feature genes with the highest prediction were identified: B2m, VCAM-1, PDIA4, Ptgds, Mlxipl, and ACADS. Among these genes, B2m and PDIA4 were most highly expressed in MIRI and the gut microbiome disorder.

Conclusion: B2m and PDIA4 were identified to be significantly correlated with candidate cross-talk genes of MIRI with gut microbiome disorder, implying a similarity between MIRI and Gut microbiome disorder (GMD). These genes can serve as an experimental research basis for future studies.

Objective: The purpose of this study was to compare pulmonary arterial (PA) growth and morbidity, mortality, reintervention and complete repair rates after modified transannular patching palliation (mTAP) versus modified Blalock-Taussig-Thomas shunt (mBTS) for palliation in infants with severe tetralogy of Fallot (TOF) with diminutive pulmonary arteries.

Methods: This was a retrospective case review study of 107 patients (64 males) with severe TOF who underwent staged repair with either mTAP (n = 55) or mBTS (n = 52) over an 8-year period. Procedure-related PA growth and morbidity, mortality, reintervention and complete repair rates were compared.

Results: Two deaths occurred in the mBTS group due to sudden cardiac arrest, and five patients needed reintervention after the mBTS procedure because of shunt thrombosis or stenosis. Postoperative complications of mBTS included sudden cardiac arrest, shunt thrombosis/stenosis, vocal cord palsy and diaphragmatic palsy. Unlike in the mBTS group, no death, severe complications or reintervention occurred in the mTAP group. Oxygen saturations post mTAP and mBTS were significantly higher, which improved from 67.73 ± 4.36% to 94.33 ± 2.19% in the mTAP group and from 68.24 ± 3.87% to 86.87 ± 3.38% in the mBTS group. The increase in oxygen saturation and pulmonary artery growth (from pre- to post palliation) was significantly better with mTAP than with mBTS palliation (p < 0.01). All 55 patients showed complete repair after mTAP, and the time from palliation to complete repair was significantly shorter in the mTAP group.

Conclusions: In a severe form of TOF with the hypoplastic PA tree, mTAP seems to be a better strategy that is safe and better facilitates satisfactory pulmonary arterial growth until complete repair than the mBTS procedure.

Background: RNA N6-methyladenosine (m6A) is the most common type of modification in eukaryotic mRNA. The relationship between m6A modification and disease has been studied extensively, but there have been few studies on chronic heart failure (CHF). This study investigated a possible role for m6A in the diagnosis of CHF.

Methods: Seven candidate m6A regulators (writers: WTAP and ZC3H13; readers: YTHDF3, FMR1, IGFBP1, and ELAVL1; eraser: FTO) were identified using a random forest (RF) model and the GSE5406 dataset from the Gene Expression Omnibus database. A nomogram model was developed to predict the risk of CHF, while consensus clustering methodology assigned CHF samples into two m6A patterns (cluster A and cluster B) according to the 7 candidate m6A regulators. Principal component analysis was used to calculate an m6A score for each sample and to quantify m6A patterns.

Results: Decision curve analysis and the nomogram model were used to obtain predictions that may be of clinical use. Patients in cluster B had higher m6A scores than patients in cluster A. Cluster B patients also had higher expression levels (ELs) of IL-4, IL-5, IL-10 and IL-13 than patients in cluster A, whereas cluster A patients had a higher EL for IL-33. The m6A cluster B pattern likely represents the ischemic heart failure (HF) disease group.

Conclusion: m6A regulators are important in the pathogenesis of CHF associated with ischemic and idiopathic dilated cardiomyopathy, and may prove useful for the diagnosis and treatment of CHF.