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The Effect of Onset Time on In-Hospital Mortality in Patients with Acute Type A Aortic Dissection of Different Gender: A Retrospective Cohort Study. 不同性别急性A型主动脉夹层患者发病时间对住院死亡率的影响:一项回顾性队列研究
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-28 DOI: 10.59958/hsf.5609
Yanchun Peng, Hong Ni, Qiong Pan, Lingyu Lin, Sailan Li, Liangwan Chen, Yanjuan Lin

Background: Although the research on gender in acute type A aortic dissection (AAAD) patients has increased in recent years, the results are still controversial. The effect of time of onset on in-hospital mortality in patients with AAAD of different gender is unclear. The purpose of this study was to investigate the effect of onset time on in-hospital mortality of patients with AAAD of different gender.

Methods: In this retrospective observational study, patients with AAAD were selected from June 2013 to March 2020. Patients' information was extracted from electronic medical records. Based on the onset time, the patients were categorized into four groups: group one (00:00-05:59), group two (6:00-11:59), group three (12:00-17:59), and group four (18:00-23:59).

Results: A total of 760 subjects were included in our study. There were 591 (77.8%) males and 169 (22.2%) females. In male patients, 79 cases died, in female patients, 19 cases died (p < 0.05). We conducted subgroup analysis according to gender, univariate Cox regression analysis of male patients showed that compared with the patients at onset time of 0:00-5:59, patients at onset time of 12:00-17:59 and 18:00-23:59 were associated with an increased risk of in-hospital mortality. Multivariate Cox regression analysis of male patients showed that the onset time of 18:00-23:59 remained as the significant risk factor of in-hospital mortality of male patients hazard ratio (HR) = 4.396 (p < 0.05).

Conclusions: This analysis demonstrated that in-hospital mortality of AAAD patients was similar in different genders. In male patients, the onset time of 18:00-23:59 was significantly associated with an increased risk of in-hospital mortality.

背景:虽然近年来对急性A型主动脉夹层(AAAD)患者性别的研究有所增加,但结果仍存在争议。发病时间对不同性别AAAD患者住院死亡率的影响尚不清楚。本研究旨在探讨发病时间对不同性别AAAD患者住院死亡率的影响。方法:本研究为回顾性观察性研究,选取2013年6月至2020年3月期间的AAAD患者。患者的信息是从电子病历中提取的。根据发病时间将患者分为1组(00:00-05:59)、2组(6:00-11:59)、3组(12:00-17:59)、4组(18:00-23:59)。结果:本研究共纳入受试者760例。男性591例(77.8%),女性169例(22.2%)。男性死亡79例,女性死亡19例(p < 0.05)。我们按性别进行亚组分析,对男性患者进行单因素Cox回归分析显示,与发病时间为0:00-5:59的患者相比,发病时间为12:00-17:59和18:00-23:59的患者住院死亡风险增加。男性患者多因素Cox回归分析显示,发病时间18:00-23:59仍是男性患者院内死亡的显著危险因素,危险比(HR) = 4.396 (p < 0.05)。结论:本分析表明,不同性别AAAD患者的住院死亡率相似。在男性患者中,发病时间为18:00-23:59与院内死亡风险增加显著相关。
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引用次数: 0
The Outcome of Congenital Cardiac Surgery in Patients with Down Syndrome: Single-Center Experience. 唐氏综合征患者先天性心脏手术的结果:单中心经验。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-24 DOI: 10.59958/hsf.5795
Abdulhameed A Alnajjar, Sherif S Salem, Luna S Baangood, Mansour B Al-Mutairi, Mohamed F Morsy, Mustafa Al-Muhaya, Alassal A Alkodami, Merhamer L Sabtirul, Mohamed S Hussein, Eman W Altommeihi, Ahmed M Shaban, Mohamed Alashwal, Ayman R Abdelrehim

Objectives: This study aimed to describe the outcomes of Down syndrome patients who underwent cardiac surgery for congenital heart defects and to develop risk prediction models for in-hospital mortality, recurrent hospital admission, and the need for catheter intervention among a cohort of patients.

Methods: This single-centre retrospective cohort study included consecutive Down syndrome patients who underwent cardiac surgery for congenital heart defects between January 2018 and December 2021. We reviewed the electronic medical records. Two hundred patients fulfilled the eligibility criteria with complete data reporting. The patients' perioperative data and outcomes were recorded.

Results: Females constituted 56.5%. Most (78.5%) patients showed accepted recovery. The incidence of all-cause in-hospital mortality was 3.0%. The rates of the need for a second operation, heart failure management, and permanent pacemaker insertion were 3.0%, 2.0%, and 2.5%, respectively. Only 8 (4.0%) patients stayed in the hospital for a long duration after chylothorax or tracheostomy (if intubated more than 2 weeks). The model had an accuracy of 99% and included the intraoperative transesophageal echocardiography (TEE) abnormalities (residual heart lesions) (adjusted odds ratio [AOR]: 26.541, p = 0.033), the duration of mechanical ventilation following the operation (AOR: 1.152, p = 0.009), and the occurrence of postoperative heart block (AOR: 76.447, p = 0.005).

Conclusion: Surgical treatment of congenital heart defects in Down syndrome patients had good outcomes with accepted recovery (without intra-hospital or during follow-up mortality or morbidity) of 78.5% and a 3% incidence of in-hospital mortality. Though, the occurrence of chylothorax was considerably high, and resulted in a long hospital stay (more than 10 days). Repair of tetralogy of Fallot and coarctation of the aorta were associated with an increased likelihood of catheter intervention following the operation.

目的:本研究旨在描述因先天性心脏缺陷接受心脏手术的唐氏综合征患者的预后,并在一组患者中开发住院死亡率、复发性住院和导管干预需求的风险预测模型。方法:这项单中心回顾性队列研究包括2018年1月至2021年12月期间因先天性心脏缺陷接受心脏手术的连续唐氏综合症患者。我们查阅了电子病历。200名患者通过完整的数据报告符合资格标准。记录患者的围手术期数据和结果。结果:女性占56.5%,大多数(78.5%)患者恢复良好。全因住院死亡率为3.0%。需要第二次手术、心力衰竭管理和永久性起搏器植入的比率分别为3.0%、2.0%和2.5%。只有8名(4.0%)患者在乳糜胸或气管切开术后(如果插管超过2周)长期住院。该模型的准确率为99%,包括术中经食管超声心动图(TEE)异常(残余心脏病变)(调整比值比[AOR]:26.541,p=0.033)、术后机械通气的持续时间(AOR:1.152,p=0.009),以及术后心脏传导阻滞的发生率(AOR:76.447,p=0.005)。结论:唐氏综合征先天性心脏缺陷的外科治疗效果良好,可接受的康复率(无院内或随访死亡率或发病率)为78.5%,院内死亡率为3%。然而,乳糜胸的发生率相当高,并导致住院时间长(超过10天)。法洛四联症和主动脉缩窄的修复与术后导管介入的可能性增加有关。
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引用次数: 0
3D Printing-Assisted versus Conventional Extracorporeal Fenestration Tevar for Stanford Type B Arteries Dissection with Undesirable Proximal Anchoring Zone: Efficacy Analysis. 3D打印辅助与传统体外开窗Tevar治疗伴有不良近端锚定区的Stanford B型动脉夹层:疗效分析
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-23 DOI: 10.59958/hsf.5885
Rongyi Zheng, Fangtao Zhu, Cunwei Cheng, Weihua Huang, Haojie Zhang, Xin He, Qianqian Lu, Huayuan Xi, Kailin Shen, Haibin Yu

Background: To compare the outcomes of two Thoracic Endovascular Aortic Repair (TEVAR) techniques of Left Subclavian Artery (LSA) reconstruction for Stanford Type B Aortic Dissection (TBAD) patients with undesirable proximal anchoring zone.

Methods: We retrospectively reviewed 57 patients with TBAD who underwent either three dimensional (3D)-printing-assisted extracorporeal fenestration (n = 32) or conventional extracorporeal fenestration (n = 25) from December 2021 to January 2023. We compared their demographic characteristics, operative time, technical success rate, complication rate, secondary intervention rate, mortality rate, and aortic remodeling.

Results: Compared with the conventional group, the 3D-printing-assisted group had a significantly shorter operative time (147.84 ± 33.94 min vs. 223.40 ± 65.93 min, p < 0.001), a significantly lower rate of immediate endoleak (3.1% vs. 24%, p = 0.048) and a significantly higher rate of true lumen diameter expansion in the stent-graft segment (all p < 0.05), but a significantly longer stent graft modification time (37.63 ± 2.99 min vs. 28.4 ± 2.12 min, p < 0.001). There were no significant differences in other outcomes between the two groups (p > 0.05). The degree of false lumen thrombosis was higher in the stent-graft segment than in the non-stent-graft segment in both groups and the difference was statistically significant (X2 = 5.390, 4.878; p = 0.02, 0.027).

Conclusions: Both techniques are safe and effective for TBAD with an undesirable proximal landing zone. The 3D-printing-assisted extracorporeal fenestration TEVAR technique has advantages in operative time, endoleak risk, and aortic remodeling, while the traditional extracorporeal fenestration TEVAR technique has advantages in stent modification.

背景:比较两种胸椎血管内主动脉修复(TEVAR)技术对近端锚定区不良的Stanford B型主动脉夹层(TBAD)患者左锁骨下动脉(LSA)重建的效果。方法:我们回顾性分析了从2021年12月至2023年1月接受三维(3D)打印辅助体外开窗术(n = 32)或常规体外开窗术(n = 25)的57例TBAD患者。我们比较了他们的人口学特征、手术时间、技术成功率、并发症发生率、二次干预率、死亡率和主动脉重塑。结果:与常规组相比,3d打印辅助组手术时间明显缩短(147.84±33.94 min vs. 223.40±65.93 min, p < 0.001),即刻内漏率明显降低(3.1% vs. 24%, p = 0.048),支架段真腔直径扩张率明显提高(p < 0.05),支架修复时间明显延长(37.63±2.99 min vs. 28.4±2.12 min, p < 0.001)。两组其他指标比较差异无统计学意义(p > 0.05)。两组假腔血栓形成程度在支架段均高于非支架段,差异有统计学意义(X2 = 5.390, 4.878;P = 0.02, 0.027)。结论:这两种技术对于近端着陆区不良的TBAD是安全有效的。3d打印辅助体外开窗TEVAR技术在手术时间、内漏风险、主动脉重塑等方面具有优势,而传统的体外开窗TEVAR技术在支架修饰方面具有优势。
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引用次数: 0
A Retrospective Study of the No-Contact Technique to Obtain Radial Arteries for Coronary Artery Bypass Grafting. 冠状动脉旁路移植术中无接触获取桡动脉的回顾性研究。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-23 DOI: 10.59958/hsf.5531
Yi Zhao, Xiaodi Zhang, Yang Song, Yu Xia, Derong Huang, Jian Zhang, Daxing Liu, Dengshen Zhang

Background: To retrospectively study the experience with application of no-touch technique in radial artery (RA)-based coronary artery bypass grafting (CABG).

Methods: Clinical data of patients who underwent RA-based multi- (n = 45) or full-arterial CABG (n = 27) between January 2019 and June 2022 in the Affiliated Hospital of ZunYi Medical University were collected. The incidence of main cardiovascular events at 30-day follow-up, the antebrachial union condition and the vessel patency rate were analyzed.

Results: A total of 66 RAs were harvested and 70 RAs used as grafts. The number of RA used per patient was 1.46. Delayed antebrachial union occurred in 1 patient (1.45%). There was no death, cerebral infarction, myocardial infarction or revascularization at follow-up. Early coronary computed tomography (CT) after surgery revealed occlusion in 1 RA, with the patency rate being 98.57%.

Conclusions: The No-touch RA harvesting technique, preservation and postoperative management applied in this study are effective and rational, and the application of RA as the graft in CABG is safe.

背景:回顾性研究无接触技术在桡动脉(RA)基冠状动脉旁路移植术(CABG)中的应用经验。方法:收集2019年1月至2022年6月在遵义医学院附属医院行基于ra的多动脉冠脉搭桥(n = 45)或全动脉冠脉搭桥(n = 27)患者的临床资料。随访30 d,分析两组主要心血管事件发生率、肱前关节愈合情况及血管通畅率。结果:共收获RAs 66个,移植RAs 70个。每位患者使用的RA数量为1.46个。臂前愈合延迟1例(1.45%)。随访无死亡、脑梗死、心肌梗死或血运重建术。术后早期冠状动脉CT显示1例RA闭塞,通畅率为98.57%。结论:本研究采用的无接触RA采集技术、保存及术后处理是有效合理的,RA作为移植物应用于冠状动脉搭桥是安全的。
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引用次数: 0
Preoperative Levosimendan Administration in Heart Transplant Patients with Severe Hepatic and Renal Impairment: A Retrospective Study. 左西孟旦在严重肝肾损害心脏移植患者术前应用的回顾性研究。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-14 DOI: 10.59958/hsf.5433
Qiang Zheng, Hongwen Lan, Qiannan Guo, Chenghao Li, Tixiusi Xiong, Jing Zhang, Guohua Wang, Nianguo Dong, Jiawei Shi

Background: The cardio-renal syndrome and hepatic impairment play a critical role in end-stage heart failure (HF). Levosimendan is an effective inotropic agent used to maintain cardiac output similar to classic cardiotonic like dobutamine/dopamine. This current research aims to investigate the clinical outcomes of levosimendan and dobutamine/dopamine in Chinese heart transplant awaiting patients with severe hepatic or renal impairment.

Methods: We performed a retrospective analysis of 568 heart transplant awaiting individuals with severe hepatic or renal impairment who treated with levosimendan or dobutamine/dopamine in our institution between January 2015 and December 2020. Univariate Cox proportional hazard models and Kaplan-Meier survival curves were applied. The primary endpoint was defined as death included inhospital mortality and the mortality at 30 days, 90 days, 180 days and 1 year after heart transplantation.

Results: There were no significant differences in mortality rate at 30, 90, 180 days and 1 years after heart transplantation between the levosimendan and non-levosimendan groups, or between subgroups of patients with severe hepatic impairment or renal impairment. The results were consistent before and after propensity score matching.

Conclusions: In the population with advanced heart failure awaiting heart transplantation, levosimendan did not increase short- or long-term mortality rates after surgery compared to dobutamine/dopamine, regardless of their hepatic or renal function. Severe hepatic or renal impairment were not necessarily considered a contraindication for levosimendan in these patients.

背景:心肾综合征和肝功能损害在终末期心力衰竭(HF)中起关键作用。左西孟旦是一种有效的肌力药物,用于维持心输出量,类似于经典的强心剂,如多巴酚丁胺/多巴胺。本研究旨在探讨左西孟旦和多巴酚丁胺/多巴胺在中国心脏移植等待严重肝肾损害患者中的临床效果。方法:我们对2015年1月至2020年12月在我院接受左西孟旦或多巴酚丁胺/多巴胺治疗的568例等待心脏移植的严重肝肾损害患者进行了回顾性分析。采用单因素Cox比例风险模型和Kaplan-Meier生存曲线。主要终点定义为死亡,包括住院死亡率和心脏移植后30天、90天、180天和1年的死亡率。结果:左西孟旦组与非左西孟旦组,重度肝肾损害患者亚组间,心脏移植术后30、90、180天、1年的死亡率均无显著差异。倾向评分匹配前后结果一致。结论:在等待心脏移植的晚期心力衰竭患者中,与多巴酚丁胺/多巴胺相比,左西孟旦不会增加术后短期或长期死亡率,无论其肝肾功能如何。在这些患者中,严重的肝脏或肾脏损害并不一定被认为是左西孟旦的禁忌症。
{"title":"Preoperative Levosimendan Administration in Heart Transplant Patients with Severe Hepatic and Renal Impairment: A Retrospective Study.","authors":"Qiang Zheng,&nbsp;Hongwen Lan,&nbsp;Qiannan Guo,&nbsp;Chenghao Li,&nbsp;Tixiusi Xiong,&nbsp;Jing Zhang,&nbsp;Guohua Wang,&nbsp;Nianguo Dong,&nbsp;Jiawei Shi","doi":"10.59958/hsf.5433","DOIUrl":"https://doi.org/10.59958/hsf.5433","url":null,"abstract":"<p><strong>Background: </strong>The cardio-renal syndrome and hepatic impairment play a critical role in end-stage heart failure (HF). Levosimendan is an effective inotropic agent used to maintain cardiac output similar to classic cardiotonic like dobutamine/dopamine. This current research aims to investigate the clinical outcomes of levosimendan and dobutamine/dopamine in Chinese heart transplant awaiting patients with severe hepatic or renal impairment.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 568 heart transplant awaiting individuals with severe hepatic or renal impairment who treated with levosimendan or dobutamine/dopamine in our institution between January 2015 and December 2020. Univariate Cox proportional hazard models and Kaplan-Meier survival curves were applied. The primary endpoint was defined as death included inhospital mortality and the mortality at 30 days, 90 days, 180 days and 1 year after heart transplantation.</p><p><strong>Results: </strong>There were no significant differences in mortality rate at 30, 90, 180 days and 1 years after heart transplantation between the levosimendan and non-levosimendan groups, or between subgroups of patients with severe hepatic impairment or renal impairment. The results were consistent before and after propensity score matching.</p><p><strong>Conclusions: </strong>In the population with advanced heart failure awaiting heart transplantation, levosimendan did not increase short- or long-term mortality rates after surgery compared to dobutamine/dopamine, regardless of their hepatic or renal function. Severe hepatic or renal impairment were not necessarily considered a contraindication for levosimendan in these patients.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 4","pages":"E346-E357"},"PeriodicalIF":0.6,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10188676","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
Prognosis Analysis of Children with Interrupted Aortic Arch Complicated with Ventricular Septal Defect and Other Associated Intracardiac Defects after One-Stage Radical Surgery. 主动脉弓中断合并室间隔缺损及其他相关心内缺损患儿一期根治性手术后的预后分析。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-13 DOI: 10.59958/hsf.5577
Hailong Song, Lijing Cao, Huijun Zhang

Background: High rates of mortality and aortic arch stenosis have been reported for one-stage radical surgery of interruption of aortic arch (IAA) with ventricular septal defect (VSD) and other associated intracardiac defects, but the sample size of the study is relatively small, and the credibility of the study is not high. The risk factors of death and aortic arch stenosis will be analyzed in a large sample size of infants with IAA, VSD and other associated intracardiac defects after one-stage radical resection.

Methods: A retrospective analysis was performed on 152 children with IAA, VSD and other associated intracardiac defects from January 2006 to January 2017 who had undergone one-stage radical resection, including 95 cases of type A and 57 cases of type B. January 2006-December 2011 as the early period, and January 2012-January 2017 as the late period. Cox proportional hazards regression model was used to analyze the risk factors for mortality and aortic arch stenosis after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software.

Results: 22 cases (14.47%) died, 27 cases (17.76%) developed aortic arch stenosis. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year survival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (Hazard Ratio (HR) = 0.551, 95% Confidence Interval (CI): 0.320-0.984, p = 0.004), low body weight (HR = 0.632, 95% CI: 0.313-0.966, p = 0.003), large ratio of VSD diameter/aortic diameter (VSD/AO) (HR = 2.547, 95% CI: 1.095-7.517, p = 0.044), long duration of cardiopulmonary bypass (HR = 1.374, 95% CI: 1.000-3.227, p = 0.038), and left ventricular outflow tract obstruction (LVOTO) (HR = 3.959, 95% CI: 1.123-9.268, p = 0.015) were independent risk factors for postoperative death. The surgical period (January 2006-December 2011) (HR = 0.439, 95% CI: 0.109-0.964, p = 0.046) and the addition of pericardial anastomosis to the anterior aortic wall (HR = 0.398, 95% CI: 0.182-0.870, p = 0.021) were independent risk factors for postoperative aortic arch stenosis.

Conclusions: Children with low age, low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOTO, the surgical period (January 2006-December 2011) and pericardial anastomosis with anterior aortic wall have poor prognosis.

背景:有报道称主动脉弓中断(IAA)合并室间隔缺损(VSD)及其他相关心内缺损的一期根治性手术死亡率和主动脉弓狭窄率较高,但本研究样本量较小,研究可信度不高。对一期根治术后IAA、VSD及其他相关心内缺损的婴儿进行大样本研究,分析其死亡和主动脉弓狭窄的危险因素。方法:回顾性分析2006年1月至2017年1月行一期根治术的IAA、VSD及其他相关心内缺损患儿152例,其中A型95例,b型57例。前期为2006年1月至2011年12月,后期为2012年1月至2017年1月。采用Cox比例风险回归模型分析术后死亡率和主动脉弓狭窄的危险因素,Kaplan-Meier法分析总生存率,采用GraphPad Prism 8软件绘制生存曲线。结果:死亡22例(14.47%),发生主动脉弓狭窄27例(17.76%)。1个月、3个月、6个月、1年、3年、5年生存率分别为85.53%、85.53%、85.53%、84.21%、78.95%、75.66%。低年龄(风险比(人力资源)= 0.551,95%可信区间(CI): 0.320 - -0.984, p = 0.004),低体重(HR = 0.632, 95%置信区间CI: 0.313 - -0.966, p = 0.003),大型房间隔缺损直径/主动脉直径的比例(房间隔缺损/ AO) (HR = 2.547, 95%置信区间CI: 1.095 - -7.517, p = 0.044),长时间的心肺旁路(HR = 1.374, 95%置信区间CI: 1.000 - -3.227, p = 0.038),和左心室流出道梗阻(LVOTO) (HR = 3.959, 95%置信区间CI: 1.123 - -9.268, p = 0.015)术后死亡的独立危险因素。手术时间(2006年1月~ 2011年12月)(HR = 0.439, 95% CI: 0.109 ~ 0.964, p = 0.046)和主动脉前壁加心包吻合(HR = 0.398, 95% CI: 0.182 ~ 0.870, p = 0.021)是术后主动脉弓狭窄的独立危险因素。结论:年龄小、体重低、VSD/AO比值大、体外循环时间长、LVOTO、手术时间(2006年1月- 2011年12月)及心包吻合主动脉前壁患儿预后较差。
{"title":"Prognosis Analysis of Children with Interrupted Aortic Arch Complicated with Ventricular Septal Defect and Other Associated Intracardiac Defects after One-Stage Radical Surgery.","authors":"Hailong Song,&nbsp;Lijing Cao,&nbsp;Huijun Zhang","doi":"10.59958/hsf.5577","DOIUrl":"https://doi.org/10.59958/hsf.5577","url":null,"abstract":"<p><strong>Background: </strong>High rates of mortality and aortic arch stenosis have been reported for one-stage radical surgery of interruption of aortic arch (IAA) with ventricular septal defect (VSD) and other associated intracardiac defects, but the sample size of the study is relatively small, and the credibility of the study is not high. The risk factors of death and aortic arch stenosis will be analyzed in a large sample size of infants with IAA, VSD and other associated intracardiac defects after one-stage radical resection.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 152 children with IAA, VSD and other associated intracardiac defects from January 2006 to January 2017 who had undergone one-stage radical resection, including 95 cases of type A and 57 cases of type B. January 2006-December 2011 as the early period, and January 2012-January 2017 as the late period. Cox proportional hazards regression model was used to analyze the risk factors for mortality and aortic arch stenosis after surgery, the overall survival rate was analyzed by the Kaplan-Meier method, and the survival curve was drawn by GraphPad Prism 8 software.</p><p><strong>Results: </strong>22 cases (14.47%) died, 27 cases (17.76%) developed aortic arch stenosis. The 1-month, 3-month, 6-month, 1-year, 3-year, and 5-year survival rates were 85.53%, 85.53%, 85.53%, 84.21%, 78.95% and 75.66%, respectively. Low age (Hazard Ratio (HR) = 0.551, 95% Confidence Interval (CI): 0.320-0.984, p = 0.004), low body weight (HR = 0.632, 95% CI: 0.313-0.966, p = 0.003), large ratio of VSD diameter/aortic diameter (VSD/AO) (HR = 2.547, 95% CI: 1.095-7.517, p = 0.044), long duration of cardiopulmonary bypass (HR = 1.374, 95% CI: 1.000-3.227, p = 0.038), and left ventricular outflow tract obstruction (LVOTO) (HR = 3.959, 95% CI: 1.123-9.268, p = 0.015) were independent risk factors for postoperative death. The surgical period (January 2006-December 2011) (HR = 0.439, 95% CI: 0.109-0.964, p = 0.046) and the addition of pericardial anastomosis to the anterior aortic wall (HR = 0.398, 95% CI: 0.182-0.870, p = 0.021) were independent risk factors for postoperative aortic arch stenosis.</p><p><strong>Conclusions: </strong>Children with low age, low body weight, large ratio of VSD/AO, long duration of cardiopulmonary bypass, LVOTO, the surgical period (January 2006-December 2011) and pericardial anastomosis with anterior aortic wall have poor prognosis.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 4","pages":"E336-E345"},"PeriodicalIF":0.6,"publicationDate":"2023-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10211069","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
Starting Pediatric VAD Program: Transforming Challenges into Opportunities; A Case Series of a Single Center. 启动儿科VAD项目:化挑战为机遇单中心的案例系列。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-09 DOI: 10.59958/hsf.5545
Matija Bakoš, Milivoj Novak, Dalibor Šarić, Dorotea Bartoniček, Dražen Belina, Željko Đurić, Darko Anić, Željko Čolak, Sanja Konosić, Marina Mihalec, Filip Rubić, Toni Matić, Goran Međimurec, Mislav Planinc

Background: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach.

Methods: We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy.

Results: The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients.

Conclusions: To establish a VAD program, numerous specialties must be included with adequate training and learning for all team members.

背景:儿童和成人心力衰竭的患病率都在不断上升。对药物治疗无反应的儿童终末期心力衰竭的治疗选择有限。手术选择包括心脏移植或植入持久心室辅助装置(VADs)。为了启动VAD计划,有必要培训核心团队成员,邀请有经验的监考人员并调整组织方法。方法:我们介绍了我们的第一个7例接受VAD植入的儿科患者,主要指征是终末期扩张型心肌病。结果:种植体的中位年龄为4岁半,VAD支持的中位持续时间为39天,3例患者实现长期生存。死亡原因为多器官衰竭、血栓栓塞事件、败血症和低心输出量综合征。缺血性卒中是两例患者在VAD支持期间神经干预成功的原因。结论:要建立VAD计划,必须包括许多专业,并为所有团队成员提供充分的培训和学习。
{"title":"Starting Pediatric VAD Program: Transforming Challenges into Opportunities; A Case Series of a Single Center.","authors":"Matija Bakoš,&nbsp;Milivoj Novak,&nbsp;Dalibor Šarić,&nbsp;Dorotea Bartoniček,&nbsp;Dražen Belina,&nbsp;Željko Đurić,&nbsp;Darko Anić,&nbsp;Željko Čolak,&nbsp;Sanja Konosić,&nbsp;Marina Mihalec,&nbsp;Filip Rubić,&nbsp;Toni Matić,&nbsp;Goran Međimurec,&nbsp;Mislav Planinc","doi":"10.59958/hsf.5545","DOIUrl":"https://doi.org/10.59958/hsf.5545","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach.</p><p><strong>Methods: </strong>We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy.</p><p><strong>Results: </strong>The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients.</p><p><strong>Conclusions: </strong>To establish a VAD program, numerous specialties must be included with adequate training and learning for all team members.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 4","pages":"E326-E335"},"PeriodicalIF":0.6,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10198283","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
Successful Surgical Treatment of Mitral Valve Endocarditis Caused by Brucella: A Case Report. 布氏菌所致二尖瓣心内膜炎手术治疗成功1例。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-09 DOI: 10.59958/hsf.5857
Jianmao Hong, Bijun Xu, Ximing Qian, Fan He

Brucellosis endocarditis is a rare but life-threatening complication of brucellosis, involving congenital, prosthetic and even native valves. Its diagnosis and treatment is a great challenge for doctors. The patient's prognosis requires prompt diagnosis and continuous evaluation of treatment plans to assess the need for either surgical intervention of the infected valves or continuation of antibiotic therapy alone. We present a patient with brucellosis endocarditis, predominantly involving the mitral valve, presenting with vegetations and prolapse of the anterior leaflet of the mitral valve with moderate to severe regurgitation. The patient was treated with triple antibiotic therapy before surgery. After the patient's blood culture results were negative, we removed the infected mitral valve vegetations and performed a mitral valve replacement. The patient was successfully extubated 4 hours after surgery and discharged 11 days after surgery. After discharge, the patient continued to receive triple antibiotic therapy for 2 months and was followed up at the cardiac surgery and infectious disease outpatient clinics.

布鲁氏菌病心内膜炎是一种罕见但危及生命的布鲁氏菌病并发症,涉及先天性、假体甚至天然瓣膜。它的诊断和治疗对医生来说是一个巨大的挑战。患者的预后需要及时诊断和持续评估治疗方案,以评估是否需要对感染瓣膜进行手术干预或继续单独使用抗生素治疗。我们报告一位患有布鲁氏菌病心内膜炎的患者,主要累及二尖瓣,表现为二尖瓣前部小叶的赘生物和脱垂,伴有中度至重度的反流。患者术前接受三联抗生素治疗。在患者的血培养结果为阴性后,我们切除了感染的二尖瓣植被并进行了二尖瓣置换术。患者术后4小时成功拔管,术后11天出院。出院后,患者继续接受三联抗生素治疗2个月,并在心脏外科和传染病门诊随访。
{"title":"Successful Surgical Treatment of Mitral Valve Endocarditis Caused by Brucella: A Case Report.","authors":"Jianmao Hong,&nbsp;Bijun Xu,&nbsp;Ximing Qian,&nbsp;Fan He","doi":"10.59958/hsf.5857","DOIUrl":"https://doi.org/10.59958/hsf.5857","url":null,"abstract":"<p><p>Brucellosis endocarditis is a rare but life-threatening complication of brucellosis, involving congenital, prosthetic and even native valves. Its diagnosis and treatment is a great challenge for doctors. The patient's prognosis requires prompt diagnosis and continuous evaluation of treatment plans to assess the need for either surgical intervention of the infected valves or continuation of antibiotic therapy alone. We present a patient with brucellosis endocarditis, predominantly involving the mitral valve, presenting with vegetations and prolapse of the anterior leaflet of the mitral valve with moderate to severe regurgitation. The patient was treated with triple antibiotic therapy before surgery. After the patient's blood culture results were negative, we removed the infected mitral valve vegetations and performed a mitral valve replacement. The patient was successfully extubated 4 hours after surgery and discharged 11 days after surgery. After discharge, the patient continued to receive triple antibiotic therapy for 2 months and was followed up at the cardiac surgery and infectious disease outpatient clinics.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 4","pages":"E322-E325"},"PeriodicalIF":0.6,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10198280","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: 1
Giant Solitary Fibrous Tumor of the Ascending Aortic Wall Causing Reversible Heart Failure: A Case Report and Review of the Literature. 升主动脉壁巨大孤立性纤维性肿瘤引起可逆性心力衰竭1例报告及文献复习。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-08-03 DOI: 10.59958/hsf.5513
Ping Guo, Shichao Liu, Ezaldin M I Abuheit, Xingtai Jia, Liguo Jian, Yan Wang

A 56-year-old woman was admitted to our hospital with a 2-week history of chest tightness and fatigue, and an echocardiogram revealed a massive polyserous cavity effusion. A massive (13.5 cm maximum diameter) intrapericardial mass was discovered using computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI) in the ascending aortic wall. A pericardial biopsy was performed and diagnosed as a solitary fibrous tumor (SFT). After successful mass resection, an immunohistochemical test was positive for CD34, STAT-6, CD34, and Bcl2, which indicates a giant benign solitary fibrous tumor of the ascending aortic wall. After three years of follow-up, the patient is symptom-free, and histological indications of malignancy were absent. A giant benign solitary fibrous tumor is extremely rare in the heart, especially from the ascending aorta wall, and experience with this tumor location is limited, so close follow-up at regular intervals is considered necessary. We present this case, followed by a literature review on SFTs involving the heart and management approaches.

一名56岁女性因胸闷和疲劳病史2周入院,超声心动图显示大量多浆液腔积液。经CT及MRI检查,在升主动脉壁发现一巨大的心包内肿块(最大直径13.5 cm)。经心包活检诊断为孤立性纤维性肿瘤(SFT)。肿块切除成功后,免疫组化检测CD34、STAT-6、CD34和Bcl2阳性,提示升主动脉壁巨大良性孤立性纤维性肿瘤。经过三年的随访,患者无症状,没有恶性肿瘤的组织学指征。巨大的良性孤立性纤维性肿瘤在心脏极其罕见,尤其是来自升主动脉壁的肿瘤,而且对这种肿瘤位置的经验有限,因此定期密切随访是必要的。我们介绍了这个病例,然后对涉及心脏和管理方法的SFTs进行了文献回顾。
{"title":"Giant Solitary Fibrous Tumor of the Ascending Aortic Wall Causing Reversible Heart Failure: A Case Report and Review of the Literature.","authors":"Ping Guo,&nbsp;Shichao Liu,&nbsp;Ezaldin M I Abuheit,&nbsp;Xingtai Jia,&nbsp;Liguo Jian,&nbsp;Yan Wang","doi":"10.59958/hsf.5513","DOIUrl":"https://doi.org/10.59958/hsf.5513","url":null,"abstract":"<p><p>A 56-year-old woman was admitted to our hospital with a 2-week history of chest tightness and fatigue, and an echocardiogram revealed a massive polyserous cavity effusion. A massive (13.5 cm maximum diameter) intrapericardial mass was discovered using computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI) in the ascending aortic wall. A pericardial biopsy was performed and diagnosed as a solitary fibrous tumor (SFT). After successful mass resection, an immunohistochemical test was positive for CD34, STAT-6, CD34, and Bcl2, which indicates a giant benign solitary fibrous tumor of the ascending aortic wall. After three years of follow-up, the patient is symptom-free, and histological indications of malignancy were absent. A giant benign solitary fibrous tumor is extremely rare in the heart, especially from the ascending aorta wall, and experience with this tumor location is limited, so close follow-up at regular intervals is considered necessary. We present this case, followed by a literature review on SFTs involving the heart and management approaches.</p>","PeriodicalId":51056,"journal":{"name":"Heart Surgery Forum","volume":"26 4","pages":"E316-E321"},"PeriodicalIF":0.6,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10195058","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
Impella Implantation as a Bridge to Surgery for Repair of Aorto-Right Ventricular Fistula Following Prosthetic Valve Endocarditis: A Case Report. 心内膜炎瓣膜置换术后主动脉-右室瘘修复的桥梁植入一例。
IF 0.6 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-07-04 DOI: 10.59958/hsf.5519
Masahiko Narita, Masahiro Tsutsui, Ryohei Ushioda, Yuta Kikuchi, Tomonori Shirasaka, Hiroyuki Kamiya

For patients with cardiogenic shock, delaying surgery with mechanical circulatory support is reported to yield better outcomes than emergency surgery. We report on an 82-year-old man diagnosed with vertebral osteomyelitis with concomitant infective endocarditis. Chest radiographs revealed a growing abscess, which resulted in an aorto-right ventricular fistula. Providing Impella support allowed for hemodynamic stabilization prior to surgery. The patient had an uneventful postoperative course and reported to be well in a follow-up 1 year later. Impella support can be used as a bridge to surgery for repairing fistulous tract formation in patients in cardiogenic shock.

据报道,对于心源性休克患者,采用机械循环支持的延迟手术比急诊手术效果更好。我们报告一个82岁的男性诊断为椎体骨髓炎合并感染性心内膜炎。胸部x光片显示一个不断扩大的脓肿,导致主动脉-右心室瘘。在手术前提供Impella支持以稳定血流动力学。患者术后进展顺利,1年后随访情况良好。在心源性休克患者中,Impella支架可作为手术修复瘘道形成的桥梁。
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引用次数: 0
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Heart Surgery Forum
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