Search

Abstract- Today, there is a growing number of monitoring Equipment accessible. These equipments ranging invasive to non-invasive. Choosing suitable monitoring methods depends on their benefits, drawbacks, and expenses. Overall, non-invasive brain monitoring is growing in importance because of its precision in performance and increased stability in output. Like the assessment of regional brain oxygen levels and the assessment of anesthesia depth using the BIS device, whose specific role in guidelines remains undefined. Many patients who undergo heart surgeries including valvular, dissection and CABG have various comorbidities. To add details, according to literatures about CVA 28% of patients had (Cerebrovascular Accident), 74% IHD (Ischemic Heart Disease), 82% HTN (Hypertension), 52% DM (Diabetes Mellitus), 61% Smoking History, 36% CKD (Chronic Kidney Disease) and 42% CHF (Congestive Heart Failure). Current study delves into the correlation of short-term complications after cardiac operations with cerebral oximetry alterations and the space under the curve (duration of rSo2 drop) to take the best advantages of cerebral oximetry for heart surgery in the future. This prospective observational study was conducted among 101 patients undergoing cardiac surgery at Imam Khomeini Hospital in Tehran between 2019 and 2020. Following admission to the operating room, standard monitoring of vital signs, including non-invasive blood pressure (NIBP), electrocardiogram (ECG), central venous pressure (CVP), oxygen saturation (SpO2), and end-tidal carbon dioxide (ETCO2), was established. Prior to anesthesia induction, cerebral oxygen saturation (rSO2) was continuously monitored using the INVOS 5100c cerebral oximeter. Patients were followed for 7 days postoperatively, with documentation of intubation duration, intensive care unit (ICU) stay, and complications such as renal failure, cerebrovascular accident (CVA), and mortality. Data analysis was performed using SPSS 25.0 statistical software, with a P of less than 0.05 considered statistically significant. This study investigated rSO2 levels, as measured by a cerebral oximeter, in patients aged 19 to 79 undergoing cardiac surgery. Data were collected from both the right and left sides of the forehead during the operative period. Overall, these findings highlight the importance of rSO2 monitoring during cardiac surgery, particularly in patients with underlying cardiovascular conditions. Further research is needed to elucidate the specific mechanisms underlying these observations and to explore potential strategies for optimizing cerebral oxygenation in this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is frequently observed after cardiac surgery, and duration of Bypass Time (CPB) is an independent risk factor for postoperative atrial fibrillation (POAF). The main objective of the current study was to compare new onset Postoperative Atrial Fibrillation (POAF) in patients undergoing coronary artery bypass graft with and without long CPB time. Methods: A prospective comparative study design was used and conducted at the Cardiac Surgery Department in Bahawalpur- Pakistan which is a tertiary care health centre for the period of April 2020 to February 2021, a total of 110 patients were enrolled after getting institutional approval and informed consent from patients. The ethical protocol was followed throughout the study period. Data was entered and analyzed using SPSS version 25.0 and p-value <0.05 taking the level of significance. Results: A total of 110 patients were enrolled for the research, the average age of patients was 48.56±3.11 (age range 30-70), and there were 38 (34.55%) & 72 (65.45%) male and female patients observed respectively. The atrial fibrillation developed in 3 (5.45) patients in without a long CPB time group as compared with the long CPB time group as 8(14.54%) with a statistically significant p-value of 0.043, postoperative IABP support with an insignificant p-value of 0.234. Conclusion: Postoperative atrial fibrillation in patients undergoing coronary artery bypass graft is significantly higher with long CPB time as compared with without long CPB time. [ABSTRACT FROM AUTHOR]

Retained foreign bodies are dreadful events associated with invasive procedures. Their occurrence implicate physical complications as well as serious professional and medico-legal consequences. Cases of retained surgical items, in the pericardial space, following cardiothoracic surgery are rare and their management is delicate as the risks of their removal must be thoroughly weighed against the complications of leaving them inside the chest. We report the case of a retained foreign body, discovered in an asymptomatic patient, on a routine medical check-up, 4 years after cardiac surgery. Clinical and paraclinical manifestations of retained surgical foreign bodies are nonspecific. The progress of cardiac imaging means makes it possible to identify these rare foreign bodies with greater precision, and allows, with extreme caution, to monitor patients who are perfectly asymptomatic and who are reluctant to undergo surgery. [ABSTRACT FROM AUTHOR]

The article provides guidelines for the prevention of adult cardiac surgery-associated acute kidney injury (CSA-AKI). It discusses various strategies to prevent and mitigate AKI after adult cardiac surgery, including goal-directed oxygen delivery, adopting the Kidney Disease Improving Global Outcomes (KDIGO), minimally invasive extracorporeal circulation (MiECC) techniques, and avoiding the use of dopamine infusion and mannitol. It further provides information on the rates of CSA-AKI.

Postoperative infections occur in approximately 10% of pediatric cardiac surgeries, involving Staphylococcus species in most cases. Nasal decontamination of Staphylococcus with mupirocin has been reported to reduce postoperative Staphylococcus infections after cardiac surgery in adults, but the effect of preoperative decontamination in children undergoing cardiac surgery has not been sufficiently studied to reach consensus. We conducted a single-center retrospective study to evaluate the impact of systematic preoperative decolonization with intranasal mupirocin application and skin-washing with chlorhexidine soap on postoperative Staphylococcus infection in children undergoing cardiac surgery. Our population was divided into three groups according to decolonization protocol (group N: no decolonization; group T: targeted decolonization in Staphylococcus aureus [SA] carriers only; and group S: systematic decolonization). A total of 393 children were included between October 2011 and August 2015 (122 in group N, 148 in group T, and 123 in group S). The Staphylococcus infection rate significantly decreased in group S compared to group N (0.8% vs. 7.7%; p < 0.05) and tended to decrease in group S compared to group T (0.8% vs. 4.7%; p = 0.06). Systematic decontamination also significantly reduced the rate of infections starting from the skin (including surgical site infections and bloodstream infections) compared to targeted decolonization or lack of decolonization, but had no effect on the rate of pulmonary infections. The results of our study suggest that systematic preoperative skin and nasal decontamination, regardless of SA carriage status, could reduce the rate of postoperative Staphylococcus infections after cardiac surgery in children. [ABSTRACT FROM AUTHOR]

Background Post-operative stroke increases morbidity and mortality after cardiac surgery. Data on characteristics and outcomes of stroke after heart transplantation (HTx) are limited. Methods and results We conducted a retrospective analysis of the United Network for Organ Sharing (UNOS) database from 2009 to 2020 to identify adults who developed stroke after orthotropic HTx. Heart transplant recipients were divided according to the presence or absence of post-operative stroke. The primary endpoint was all-cause mortality. A total of 25 015 HT recipients were analysed, including 719 (2.9%) patients who suffered a post-operative stroke. The stroke rates increased from 2.1% in 2009 to 3.7% in 2019, and the risk of stroke was higher after the implantation of the new allocation system [odds ratio 1.29, 95% confidence intervals (CI) 1.06–1.56, P = 0.01]. HTx recipients with post-operative stroke were older (P = 0.008), with higher rates of prior cerebrovascular accident (CVA) (P = 0.004), prior cardiac surgery (P < 0.001), longer waitlist time (P = 0.04), higher rates of extracorporeal membrane oxygenation (ECMO) support (P < 0.001), left ventricular assist devices (LVADs) (P < 0.001), mechanical ventilation (P = 0.003), and longer ischaemic time (P < 0.001). After multivariable adjustment for recipient and donor characteristics, age, prior cardiac surgery, CVA, support with LVAD, ECMO, ischaemic time, and mechanical ventilation at the time of HTx were independent predictors of post-operative stroke. Stroke was associated with increased risk of 30 day and all-cause mortality (hazard ratio 1.49, 95% CI 1.12–1.99, P = 0.007). Conclusions Post-operative stroke after HTx is infrequent but associated with higher mortality. Redo sternotomy, LVAD, and ECMO support at HTx are among the risk factors identified. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences of Kocaeli University / Kocaeli Üniversitesi Sağlık Bilimleri Dergisi is the property of Institute of Health Sciences of Kocaeli University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients.Objective: To evaluate the management of POAF in a cardiac surgery department, characterize the extent of its variability, and develop a standardized protocol.Methods: This was an observational retrospective study with data from patients who underwent cardiac surgeries with subsequent POAF between January 1, 2017, and June 1, 2018. We assessed the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy, and both among different hospital units. We also assessed the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation.Results: Data from 97 patients were included in this study. The POAF management strategy differed significantly among the 3 types of hospital units (P = 0.001). Considering all POAF episodes (including all recurrences), 83 of the 97 patients (85.6%) received amiodarone as part of the RhC strategy. Anticoagulation was used in 58 (59.8%) patients and was suboptimal according to the study criteria in 29.5% of the patients included. Based on these results, a hospital working group developed a standardized protocol for POAF management.Conclusions and Relevance: POAF management was heterogeneous at our institution. This article highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices. [ABSTRACT FROM AUTHOR]

Background/Aim: Ischemia-reperfusion injury is associated with transient contractility disorders and lethal arrhythmias. The main reason for this is the increase in the oxidants and the decrease in the antioxidants. This study aimed to investigate the relationship between albumin, known to have antioxidant properties, and arrhythmias seen in the early postoperative period in patients undergoing open heart surgery. Methods: Adult patients undergoing open heart surgery with cardiopulmonary bypass within 5 years were included in this single-center, retrospective cohort study. The relationship of arrhythmias within the first 24 hours after the operation with the albumin levels obtained within 6 hours before the operation and within 4 hours after the operation was investigated. The difference between preoperative and postoperative albumin levels was evaluated using the Wilcoxon test and the relationship between albumin levels and arrhythmias, using the Mann-Whitney U test. The relationship between the results was evaluated by Pearson's correlation analysis, and the interaction of the results with correlations was evaluated by regression analysis. Results: A total of 56 patients were included in the study. The average age of the patients was 63.07 years (11.24) (range, 42-89). The mean preoperative and postoperative albumin levels were 4.04 (0.51) g/dL, and 3.21 (0.45) g/dL, respectively. The mean postoperative albumin level was significantly lower than the preoperative mean albumin level (P<0.001). In the analyses performed to find the relationship between albumin levels and postoperative arrhythmias, the effects of postoperative albumin levels on postoperative arrhythmias were significant (P=0.016). In the regression analysis, there was an interaction between postoperative albumin levels and preoperative albumin levels (P<0.001), postoperative arrhythmia status (P=0.005), postoperative sinus tachycardia status (P=0.002), and postoperative lactate levels (P=0.005). Conclusion: The present study suggests that high albumin levels may have a protective effect against postoperative arrhythmias. For all that, prospective studies may be planned with more patients and by examining the biochemical mechanism more comprehensively. [ABSTRACT FROM AUTHOR]

Background: Bleeding as a complication is associated with poorer results in cardiac surgery. There is increasing evidence that the use of blood products is an independent factor of increased morbidity, mortality, and hospital costs. Dyke et al. established the universal definition of perioperative bleeding (UDPB). This classification is more precise defining mortality in relation to the degree of bleeding. Methods: A descriptive and analytical retrospective study of a database of patients underwent cardiac surgery from January 1, 2016, to December 31, 2017, was performed. The primary objective of the study was to look at mortality associated with the degree of bleeding using the UDPB. Results: A total of 918 patients who went to cardiac surgery were obtained. Most of the population was classified as insignificant bleeding class (n = 666, 72.9%), and for massive bleeding the lowest proportion (n = 25, 2.7%). For the primary outcome of 30-day mortality, a significant difference was found between the groups, observing that it increased to a higher degree of bleeding. This was corroborated by multivariate logistic regression analysis that was adjusted to EuroScore II and cardiopulmonary bypass (CPB) duration, finding an independent association of the bleeding class with 30-day mortality (OR, 95%, 5.82 [2.22-15.26], p = 0.0001). Conclusions: We found that the higher the degree in UDPB was associated with higher mortality independently to EuroScore II and CPB duration for adult patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Our objectives were to identify the risk factors for postoperative complications after paediatric cardiac surgery, develop a tool for predicting postoperative complications and compare it with other risk adjustment tools of congenital heart disease. METHODS A total of 2308 paediatric patients who had undergone cardiac surgeries with cardiopulmonary bypass support in a single centre were included in this study. A univariate analysis was performed to determine the association between perioperative variables and postoperative complications. Statistically significant variables were integrated into a synthetic minority oversampling technique-based XGBoost model which is an implementation of gradient boosted decision trees designed for speed and performance. The 7 traditional risk assessment tools used to generate the logistic regression model as the benchmark in the evaluation included the Aristotle Basic score and category, Risk Adjustment for Congenital Heart Surgery (RACHS-1), Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STS-EACTS) mortality score and category and STS morbidity score and category. RESULTS Our XGBoost prediction model showed the best prediction performance (area under the receiver operating characteristic curve = 0.82) when compared with these risk adjustment models. However, all of these models exhibited a relatively lower sensitivity due to imbalanced classes. The sensitivity of our optimization approach (synthetic minority oversampling technique-based XGBoost) was 0.74, which was significantly higher than the average sensitivity of the traditional models of 0.26. Furthermore, the postoperative length of hospital stay, length of cardiac intensive care unit stay and length of mechanical ventilation duration were significantly increased for patients who experienced postoperative complications. CONCLUSIONS Postoperative complications of paediatric cardiac surgery can be predicted based on perioperative data using our synthetic minority oversampling technique-based XGBoost model before deleterious outcomes ensue. [ABSTRACT FROM AUTHOR]

Lymphocytes have become the target of cancer interventions through engineering or immune checkpoint antibodies. We previously found decreased lymphocyte counts to be a predictor of mortality and complications in trauma and cardiac surgery patients. We hypothesized lack of lymphocyte count recovery postoperatively would predict outcomes in esophagectomy patients. A retrospective review of all patients undergoing esophagectomy for adenocarcinoma performed over 13 y at our center by a single surgeon after institutional review board approval was performed. Patients were grouped by postoperative lymphocytes counts: never low, low with recovery, and low without recovery. Resolution of lymphopenia was assessed by day 4. Primary end points were overall and recurrence-free survival. In total, 198 patients were included with a minimum 6-mo follow-up. Collectively the 5-y recurrence and overall survival rates were 36% and 50%, respectively. Recurrence was significantly higher at 5 y in patients with persistent lymphopenia (43%) compared with those who recovered (14% P = 0.0017) and those who never dropped (0% P = 0.0009). The persistent lymphopenia group had significantly lower survival (45%) compared with the two other groups (67% P = 0.0232). There is a significant decrease in the overall and recurrence-free survival in those patients whose lymphocyte count drops without recovery after their esophagectomy. These data imply differences in immune responses to the stress of surgery that can be measured with routine postoperative laboratory values and are indicative of overall outcomes. [ABSTRACT FROM AUTHOR]

Cardiac surgery can be accompanied by postoperative complications, which are associated with increased postoperative morbidity and mortality. Therefore, it is necessary to investigate the effect of prophylactic noninvasive ventilation (NIV) after extubation versus conventional pulmonary care on complications after cardiac surgery. An electronic search of PubMed, Cochrane Library, Ovid, and EMBASE was conducted to find randomized controlled trials which compared the effect of prophylactic NIV with controlled strategies on complications and which were published before April 2018. Ten studies (1011 patients) were included in the final analysis. The atelectasis rate was 32.6% in the prophylactic-NIV group, which was lower than that in the control group (48.71%). Prophylactic NIV could lower the rate of atelectasis, reintubation, and other respiratory complications (pleural effusion, pneumonia, and hypoxia) (odds ratio = 0.43, 0.33, and 0.45; 95% confidence interval: 0.21-0.88, 0. 13-0.84, 0.27-0.75; P = 0.02, 0.02, and 0.002, respectively). The effect on cardiac and distal organ complications (P = 0.07) and hospital mortality (P = 0.62) might be limited. Prophylactic NIV is associated with a lower rate of postoperative pulmonary complications. The effect on the other complications and hospital mortality might be limited. Further evidence with randomized controlled trials can discern the benefits. [ABSTRACT FROM AUTHOR]

The article discusses a study by M. Gaudino et al on sex differences in outcomes after coronary artery bypass grafting (CABG). Topics include the reasons for the misperception that women were more protected than men against coronary heart disease, why women lose their natural advantage compared with men following a myocardial infarction, and factors that may contribute to higher complication rates of CABG in women, such as sex differences in artery size and pattern of vascular calcification.

The literature review presents an analysis of publications on the use of a selective α2-adrenergic receptor agonist (α2-AR) dexmedetomidine as a cardioprotector in cardiosurgical interventions. It summarizes historical aspects of the introduction of α2-AR agonists in the intensive care practice. It analyzes possible mechanisms of the cardioprotective effect of dexmedetomidine (central sympatholysis, favorable effects on the coronary circulation and relief of the coronary steal syndrome in originally ischemized areas of the myocardium, antiinflammatory and antioxidant effects, and prevention of apoptosis activation). Data from experimental studies of dexmedetomidine cardioprotection were analyzed. Results of clinical studies, including data of metanalyses, were discussed. It dwells on data on the favorable effect of dexmedetomidine on various parameters of the postoperative period, including a decreased risk of delirium, general complications of cardiosurgical interventions, and the mortality rate in patients. It presents data on cardioprotective properties of dexmedetomidine in surgical patients who undergo noncardiac interventions, particularly vascular ones, including high risk surgeries in the aorta. A comparative analysis of results of clinical trials studying the dexmedetomidine cardioprotection during surgeries with extracorporeal circulation was performed. A range of pharmacological effects of dexmedetomidine during anesthesiological support of cardiac surgeries, including those in elderly and senile patients, was described. It has been concluded that the dexmedetomidine cardioprotection in the various fields of surgery is obviously very promising.

Objectives: After elective cardiac surgery a postoperative anticoagulation is obligatory. With critically ill patients the conventional anticoagulation standard heparin is sometimes impossible, e.g. based on HIT II. Then, argatroban is currently a possible alternative, however, due to its impaired metabolism in critically ill patients, anticoagulation effect is harder to anticipate, thus resulting in higher bleeding risk. Furthermore, to date no antidote is available. Hence, severe postoperative bleeding incidents under anticoagulation are commonly mono-causal attributed to the anticoagulation itself. This study concentrates on the number of well-defined postoperative bleeding incidents before any anticoagulation started, then actually under argatroban as well as compared to those under heparin (or switched from heparin to argatroban).Material and Methods: Retrospective study including 215 patients undergoing elective cardiac surgery with a postoperative stay in ICU ≥48 h. Postoperative bleeding complications before and after start of anticoagulation were evaluated. Definition of bleeding complications were: decrease of hemoglobin by more than 2 g/dl without dilution (mean value of volume balance plus one standard deviation) and/or increased need of red blood cell transfusion/day (average transfusion rate + 2 standard deviations).Results: Within the study group of 215 patients, 143 were treated with heparin, 43 with argatroban, 29 switched from heparin to argatroban. Overall, 26.5% (57/215) postoperative bleeding complications occurred. In 54.4% (31/57) bleeding complications occurred before start of anticoagulation; in 43.6% (26/57) after. Of these, 14 bleeding incidents occurred under heparin 9.8% (14/143), 6 under argatroban 14% (6/43) and 6 switched 20.7% (6/29). Higher bleeding complications before start of anticoagulation was related to concomitant factors influencing the overall bleeding risk; e.g. score of severity of illness. These observations further correlate with postoperative, but not anticoagulation induced mortality rate of 2.8% of then given heparin, 20.9% then argatroban, 20.7% then switched.Conclusions: Postoperative bleeding complications cannot simply be attributed to anticoagulation since occurring often before anticoagulation was started. The risk for bleeding complications after start of anticoagulation was quite comparable for argatroban and heparin. Accordingly, the influence of argatroban on bleeding complications in the postoperative period may be less significant than previously thought. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common post-operative complication and tends to be the most common arrhythmia after cardiac surgery. The etiology and risk factors for post-operative AF are poorly understood, but older age, large left atrium, diffuse coronary artery disease, a history of AF paroxysms and in general, pre-existing cardiac conditions that cause restricting and susceptibility towards inflammation have been consistently linked with post-operative atrial fibrillation (POAF). It has been traditionally thought that post-operative AF is transient, well-tolerated, benign to the patient and self-limiting complication of cardiac surgery that was temporary and easily treated. However, recent evidence suggests that POAF may be more "malignant" than previously thought, associated with follow-up mortality and morbidity. Several minimally invasive approaches, including the right parasternal approach, upper and lower mini-sternotomy (MS), V-shaped, Z-shaped, inverse-T, J-, reverse-C and reverse-L partial MS, transverse sternotomy and right mini-thoracotomy, have been developed for cardiac surgery operations since 1993 and have been associated with better outcomes and lower perioperative morbidity compared to full sternotomy (FS). The common goal of several minimally invasive approaches is to reduce invasiveness and surgical trauma. According to a statement from the American Heart Association (AHA), the term "minimally invasive" refers to a small chest wall incision that does not include a FS. This review is aimed to evaluate the use of minimally invasive techniques like mini-sternotomy, mini-thoracotomy and hybrid techniques versus conventional techniques which are used in cardiac surgery and to compare the frequency of post-operative AF and its effect on post-operative complications, morbidity and mortality, after cardiac surgery operations with FS versus cardiac surgery operations with the use of minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Background: Post‐pump chorea and progressive‐supranuclear palsy (PSP)–like syndrome after aortic surgery are 2 distinct movement disorders following major cardiac surgeries. Cases: We herein report 3 patients with movement disorders that developed after major cardiac surgeries. Two patients developed post‐pump chorea after pulmonary endarterectomy, and 1 further case developed PSP‐like syndrome after aortic replacement surgery. The 2 conditions share several common aspects. Both are preceded by surgeries that undergo cardiopulmonary bypass and deep hypothermia circulatory arrest procedures. Most cases present with biphasic course. However, post‐pump chorea occurs in all age populations after any surgeries that undergo deep hypothermia circulatory arrest, whereas PSP‐like syndrome is reported exclusively in the adult population after aortic surgery. Conclusions: Post‐pump chorea and PSP‐like syndrome are neurologic complications of major cardiac surgeries that should not be underrecognized. Further reports to establish their common pathogenic mechanism should be encouraged. View Supplementary Video 1 View Supplementary Video 2 View Supplementary Video 3 [ABSTRACT FROM AUTHOR]

Objectives: Postoperative pulmonary complications increase mortality, length, and cost of hospitalization. A better diaphragmatic strength may help face an increased work of breathing postoperatively. We, therefore, sought to determine if a low preoperative diaphragm thickening fraction (TFdi) determined by ultrasonography helped predict the occurrence of postoperative pulmonary complications after cardiac surgery independently of indicators of frailty, sarcopenia, and pulmonary function.Design: Prospective observational cohort study.Setting: Montreal Heart Institute, an academic cardiac surgery center in Canada.Patients: Adults undergoing nonemergency cardiac surgery.Interventions: We measured the preoperative thickness of the right and left hemidiaphragms at their zone of apposition at end-expiration (Tdi,ee) and peak-inspiration (Tdi,ei) with ultrasonography. Maximal thickening fraction of the diaphragm during inspiration (TFdi,max) was calculated using the following formula: TFdi,max = (Tdi,ei-Tdi,ee)/Tdi,ee. We also evaluated other potential risk factors including demographic parameters, comorbidities, Clinical Frailty Scale, grip strength, 5-meter walk test, and pulmonary function tests. We repeated TFdi,max measurements within 24 hours of extubation. The primary composite outcome of this study was the occurrence of postoperative pulmonary complications, defined as pneumonia, clinically significant atelectasis, or prolonged mechanical ventilation (> 24 hr).Measurement and Main Results: Of the 115 patients included, 34 (29.6%) developed postoperative pulmonary complications, including two with pneumonia, four with prolonged mechanical ventilation, and 32 with clinically significant atelectasis. Those with postoperative pulmonary complications had prolonged ICU and hospital length of stays. They had a lower TFdi,max (37% [interquartile range, 31-45%] vs 44% [interquartile range, 33-58%]; p = 0.03). In multiple logistic regression, a TFdi,max less than 38.1% was associated with postoperative pulmonary complications (odds ratio, 4.9; 95% CI, 1.81-13.50; p = 0.002). All patients who developed pneumonia or prolonged mechanical ventilation had a TFdi,max less than 38.1%. Respiratory rate and diabetes were also independently associated with postoperative pulmonary complications, while pulmonary function tests and the assessed indicators of frailty and sarcopenia were not.Conclusions: A low preoperative TFdi,max can help to identify patients at increased risk of postoperative pulmonary complications after cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: 3-factor prothrombin complex concentrate (3F-PCC) may provide a valuable treatment option for coagulopathy in cardiac surgery patients. However, it may expose patients to increased risk of thromboembolic events. Accordingly, we compared the incidence of thromboembolic events between patients exposed to 3F-PCC and those receiving conventional therapy.Methods: Demographic, operative and postoperative data was obtained in a cohort of consecutive patients exposed to 3F-PCC and a contemporaneous control population. Propensity-score matching was performed for risk adjustment. Unadjusted and adjusted patient demographics and incidence of thromboembolism were compared.Results: Patients receiving 3F-PCC (PCC) were younger (mean age PCC: 64±14.2 vs. No PCC: 67.6±11.6, p=0.022), and less likely to have diabetes or previous myocardial infarction. PCC patients experienced more prolonged aortic cross clamp times (mean time in minutes PCC: 119.9±58.8 vs. No PCC: 92.3±54), more complex cardiac surgeries and were more likely to have received more fresh frozen plasma (FFP), cryoprecipitate and red blood cells. Despite this, both unadjusted and adjusted 30-day mortality and readmission rates were similar between groups. There were 9 (9.2%) and 34 (6.8%) (p=0.40) thromboembolic events in the unadjusted PCC and control groups respectively. Adjusted risk for thromboembolic event rates was also comparable (Odds ratio: 1.512, 95% Confidence Interval 0.401-5.7, p=0.541).Conclusions: 3-factor prothrombin complex concentrate was administered to patients at greater risk of complications including bleeding. Our initial experience suggests that the use of PCC does not appear to increase thromboembolic risks compared to conventional treatment. [ABSTRACT FROM AUTHOR]

Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury is a serious complication following cardiac surgery associated with mortality. Restricted oxygen delivery is a potential risk factor for acute kidney injury. The aim of this study was to investigate the impact of the duration of low oxygen delivery (<272 mL  min-1  m-2 ), during cardiopulmonary bypass on kidney function.Methods: Patients undergoing coronary artery bypass graft surgery ± valve repair were included n = 1968. Oxygen delivery was monitored during cardiopulmonary bypass. Data were explored using multiple regression analyses regarding association between low oxygen delivery and renal replacement therapy (RRT), acute kidney injury (AKI) and post-operative peak serum creatinine (PPSC).Results: Post-operative peak serum creatinine, incidence of acute kidney injury, and need for dialysis increased in a dose-dependent manner in relation to duration of a mean oxygen delivery <272 mL  min-1  m-2 . Using multiple regression analyses, only exposure for at least 30 minutes was independently associated with increased PPSC and AKI. In contrast, both short (1-5 min, OR: 2.58 [1.20, 5.54]; P = .015) and at least 30-minute (OR: 2.85 [1.27-6.41]; P = .011) exposure to low DO2 were both independently associated with the need for RRT.Conclusion: A low oxygen delivery during cardiopulmonary bypass was in a dose-dependent manner associated with an increased risk of renal injury. [ABSTRACT FROM AUTHOR]

Purpose: Data on the benefit or or harmful effects of oxygen level on ischemic reperfusion injuries in cardiac surgery are insufficient. We hypothesized that hyperoxia during cardiopulmonary bypass decreases the incidence of postoperative atrial fibrillation (POAF) and ventricular fibrillation, and therefore decreases cardiovascular morbidity (CARDIOX study).Methods: An open-label, randomized clinical trial including adults undergoing elective cardiac surgery, i.e. cardiopulmonary bypass (CPB) randomized 1:1 to an intervention group or standard group at two French University Hospitals from June 2016 to October 2018. The intervention consisted in delivering of an inspired fraction of oxygen of one to one during CPB. The standard care consisted in delivering oxygen to achieve a partial arterial blood pressure less than 150 mmHg. The primary endpoint was the occurrence of POAF and/or ventricular tachycardia/ventricular fibrillation (VT/VF) within the 15 days following cardiac surgery. The secondary endpoint was the occurrence of major adverse cardiovascular events (MACCE: in-hospital mortality, stroke, cardiac arrest, acute kidney injury, and mesenteric ischemia).Results: 330 patients were randomly assigned to either the intervention group (n = 161) or the standard group (n = 163). Mean PaO2 was 447 ± 98 mmHg and 161 ± 60 mmHg during CPB, for the intervention and standard group (p < 0.0001) respectively. The incidence of POAF or VT/VF were similar in the intervention group and the standard group (30% [49 of 161 patients] and 30% [49 of 163 patients], absolute risk reduction 0.4%; 95% CI, - 9.6-10.4; p = 0.94). MACCE was similar between groups with, an occurrence of 24% and 21% for the intervention group and the standard groups (absolute risk reduction 3.4%; 95% CI, - 5.7-12.5; p = 0.47) respectively. After adjustment, the primary and secondary endpoints remained similar for both groups.Conclusion: Hyperoxia did not decrease POAF and cardiovascular morbidity following cardiac surgery with CPB. CLINICALTRIAL.Gov Identifier: NCT02819739. [ABSTRACT FROM AUTHOR]

Background and Aim: Malnutrition is the central component of frailty that has an adverse influence on the prognosis of patients undergoing cardiac surgery. The relationship between malnutrition and postoperative complications was evaluated in a retrospective cohort study.Methods: In 287 patients undergoing elective cardiac surgery, nutritional status was assessed by using the Geriatric Nutritional Risk Index (GNRI). Then the patients were divided into a malnutrition group (GNRI <91) and a nonmalnutrition group (GNRI ≥91), after which the postoperative course was compared.Results: There were 51 patients (17.8%) in the malnutrition group. Nine patients died after surgery and the operative mortality rate was significantly higher in the malnutrition group than the nonmalnutrition group (five deaths [9.8%] vs four deaths [1.8%]; P = .003). In addition, the duration of intensive care unit stay and hospital stay were both significantly longer in the malnutrition group compared with the nonmalnutrition group. Multivariate analysis showed that malnutrition was an independent predictor of hospitalization for longer than 1 month (odds ratio [OR]: 3.428; 95% confidence interval [CI]:1.687-6.964; P = .001) and a postoperative bedridden state (OR: 7.377; 95% CI:1.874-29.041; P = .004).Conclusions: Preoperative evaluation of the nutritional status using the GNRI seems to be valuable for predicting the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: Acute Kidney Injury (AKI) development is not a rare complication after cardiac surgery, and is often associated with a high risk of morbidity and mortality. In-hospital mortality rates of patients in need of dialysis can reach up to 70%. Our aim was to determine the risk factors for the development of AKI and the results of AKI development by examining the cases of AKI developed after cardiac surgeries performed in our hospital in a 8 year- period. Method: A total of 594 patients who underwent cardiovascular surgery between January 2010- September 2018 were retrospectively included in the study. Demographic data, preoperative risk factorsi, intraoperative variables, intensive care unit data, and mortality rates were recorded. Clinically important ones among the significant data were again divided into three groups according to duration of AKI in days: 1-3 days AKI (Group 1), 3-7 days AKI (Group 2) and ≥7 days AKI (Group 3). Results: AKI was observed in 31.1% of the patients. Duration of intubation (p<0.001), intensive care unit (ICU) (p<0.001), and hospital stay (p<0.001) and average time to exitus (p<0.001) were significantly longer in this patient group., in all subgroups except for Group 1. Mean time to exitus was longer only in Group 3 (p=0.002). Conclusion: Development of AKI after cardiac surgery is one of the important factors affecting mortality and morbidity after cardiac surgery. It is directly proportionate not only to AKI development after cardiac surgery, but also fundamentally to duration of AKI, duration of ICU, hospital stay and mortality. [ABSTRACT FROM AUTHOR]

Acute kidney injury is a common complication after cardiac surgery that is associated with high postoperative morbidity and mortality. Levels of hemolysis are associated closely with the incidence and severity of kidney injury after cardiac surgery. Hemolysis is caused by prolonged surgical procedures and blood transfusions from cell-saver devices and is associated with the use of cardiopulmonary bypass. Plasma oxyhemoglobin is released into the circulation by damaged red blood cells that, via a dioxygenation reaction, depletes vascular nitric oxide (NO), a potent vasodilator molecule responsible for modulating organ perfusion and vascular homeostasis. Depleted plasma NO and increased levels of plasma oxyhemoglobin in the bloodstream lead to impairment of organ perfusion, inflammation, oxidative stress, and direct tubular injury, which, together, contribute to the development of renal injury after cardiac surgery. The administration of NO, a gas originally approved to treat pulmonary hypertension, maintains organ perfusion by preventing vascular NO depletion. In addition, this treatment improves cardiac output by reducing pulmonary vascular resistance and right heart workload. The clinical evidence of renal protection of NO gas therapy is supported by preclinical animal studies exploring the extrapulmonary protective effects of NO. Recent clinical trials showed a significant reduction of postoperative acute kidney injury when NO gas was administered during and after cardiac surgery. [ABSTRACT FROM AUTHOR]

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed. [ABSTRACT FROM AUTHOR]

Background: Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post-operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used.Methods: This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients' charts were reviewed for evidence of infection, post-operative complications or death.Results: During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post-operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin-dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty-two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30-day mortality rate in the patient cohort was 3.2%.Conclusions: The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative pulmonary dysfunction has been associated with increased operative mortality and morbidity after cardiac surgery. This study aimed to determine whether values for the diffusing capacity of the lung for carbon monoxide (DLCO) could predict postoperative complications after cardiac surgery. Methods: This study included 408 consecutive patients who underwent cardiac surgery between June 2008 and December 2015. DLCO was routinely determined in all patients. A reduced DLCO was clinically defined as %DLCO < 70%. %DLCO was calculated as DLCO divided by the predicted DLCO. The association between %DLCO and in-hospital mortality was assessed, and independent predictors of complications were identified by a logistic regression analysis. Results: Among the 408 patients, 338 and 70 had %DLCO values of ≥ 70% and < 70%, respectively. Complications were associated with in-hospital mortality (P < 0.001), but not %DLCO (P = 0.275). A multivariate logistic regression analysis with propensity score matching identified reduced DLCO as an independent predictor of complications (OR, 3.270; 95%CI, 1.356–7.882; P = 0.008). Conclusions: %DLCO is a powerful predictor of postoperative complications. The preoperative DLCO values might provide information that can be used to accurately predict the prognosis after cardiac surgery. Clinical trial registration number: UMIN000029985. [ABSTRACT FROM AUTHOR]

Background: Deep sternal wound infection is a significant complication of open cardiac surgery associated with increased mortality and morbidity. The use of muscle flaps, such as the pectoralis major advancement flap, in deep sternal wound infection reconstruction reduces hospital stay and mortality. However, the lower end of the sternum is remote from the vascular supply and cover is therefore problematic in many cases. Methods: This study aimed to determine the distance (cm) and surface area (cm2) of sternum covered when the pectoralis major muscle is sequentially dissected from the sternocostal origin and humeral insertion using 10 cadaveric specimens. Results: The largest proportion of sternum was covered when both the origin and insertion were divided, allowing the flap to be islanded on its vascular pedicle. There was a statistically significant difference when the pectoralis major was divided from the origin and insertion compared to division of the origin alone (P < 0.01). The average area covered with sternocostal origin division alone was 55.43 cm2 compared to 85.36 cm2 after division of both the origin and insertion. Conclusion: Division of both the sternocostal origin and humeral insertion of the pectoralis major muscle represents an effective means to increase sternal coverage. This study describes the average distance and area covered by sliding pectoralis major muscle advancement flaps. These measurements could better inform plastic surgeons when evaluating reconstructive options in sternal defects. [ABSTRACT FROM AUTHOR]

Background: Brain injury and cognitive dysfunction are serious complications after cardiac surgery. In the perfusion pressure cerebral infarcts (PPCI) trial, we allocated cardiac surgery patients to a mean arterial pressure of either 70-80 mm Hg (high-target) or 40-50 mm Hg (low-target) during cardiopulmonary bypass. In this secondary analysis, we aimed to assess potential differences in domain-specific patterns of cognitive deterioration between allocation groups and to investigate any associations of postoperative cognitive dysfunction (POCD) with diffusion-weighted magnetic resonance imaging (DWI)-detected brain lesions.Methods: Of the 197 patients randomized in the PPCI trial, 89 in the low-target group and 80 in the high-target group had complete DWI datasets, and 92 and 80 patients had complete data for an evaluation of cognitive function at discharge respectively. Cognitive function was assessed prior to surgery, at discharge and at 3 months. DWI was obtained at baseline and on postoperative days 3 to 6.Results: We found no statistically significant differences between the two groups when comparing the proportion of patients with a domain-specific deterioration over the pre-defined critical level in seven individual test variables at discharge. Significant deterioration was most common in tests thought to assess cognitive flexibility and interference susceptibility and least common in the memory test. POCD at discharge was more frequent in patients with DWI-positive brain lesions (OR adjusted for age and group allocation: 2.24 [95% CI 1.48-3.00], P = 0.036).Conclusions: Domain-specific patterns of POCD were comparable between groups. A significant association was seen between DWI-positive brain lesions and POCD. [ABSTRACT FROM AUTHOR]

Copyright of Advances in Clinical & Experimental Medicine is the property of Wroclaw Medical University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Aims: Cardiac surgery associated acute kidney injury (CSA-AKI) is serious complication after cardiac surgery. The time interval between coronary angiography (CAG) to coronary artery bypass surgery (CABG) is proposed as modifiable risk factor for reduction of CSA-AKI. The aim of this study was to assess influence of time interval between CAG to off-pump CABG (OPCABG) on incidence of CSA-AKI. Methods: This was a retrospective observational study of 900 consecutive OPCABG patients who were classified into 2 groups based on time interval between CAG and OPCABG: ≤7 days or longer. Results: The incidence of CSA-AKI was 24% (214/900) by Kidney Disease: Improving Global Outcomes (KDIGO) definition. The incidence of CSA-AKI was not significantly different in two groups (22% in >7 days groupvs. 28% in ≤7 days group, P = 0.31). The factors independently associated with CSA-AKI were: Age (OR 1.04; P = 0.002), baseline creatinine (OR 1.99,; P = 0.03), moderate LV dysfunction (OR 1.64,; P = 0.007) and blood transfusion (OR 3.3,; P < 0.001), but not the time interval between CAG and OPCABG. The incidence of CSA-AKI was highest in patients with creatinine clearance (CC) <50 mL/min when OPCABG was performed ≤7 days of CAG (16/38; 42%, OR 2.7, 1.4-5.4; P = 0.005) compared to lowest incidence of CSA-AKI in patients with CC >50 mL/min and OPCABG performed >7 days of CAG (114/543; 21%). Conclusion: This study demonstrated that there is no increased incidence of CSA-AKI if OPCABG is performed ≤7 days of CAG; but we recommend to postpone OPCABG for seven days if CC is <50 mL/min and there is no urgent indication for OPCABG in order to reduce incidence of CSA-AKI. [ABSTRACT FROM AUTHOR]

Sternal wound infection (SWI) is one of the potential complications post cardiac surgery, and despite refined surgical techniques such as smaller incisions, antibiotic therapy, and optimised glycaemic control, the incidence rate is between <1% in elective cases with low risk factors and as high as 25% in patients with extensive risk factors. The presence of SWI will increase the perioperative morbidity and mortality rates and prolong the patient's hospital stay, therefore the prevention and diagnosis with appropriate management of such adverse outcomes at an early stage is important to prevent further progression as it can be fatal when the mediastinal structures are affected. Currently, the diagnosis typically consists of three main stages: clinical, biochemical including microbiology studies and imaging studies. In the current health care system, the use of computed tomography (CT) and magnetic resonance imaging (MRI) is valuable to define mediastinal abnormalities and can also help find the source of a descending infection. Management is through methods such as antibiotic therapy, surgical debridement, reconstruction with soft tissue flap coverage, sternal plating, and sternectomy. In this literature review, we aim to summarise current literature evidence behind appropriately diagnosing such a catastrophe. [ABSTRACT FROM AUTHOR]

Cardiopulmonary bypass (CPB) can induce inflammatory lung injury, which is a common complication during cardiac surgery. Nod-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome-induced inflammation plays a crucial role in lung injury after CPB. Previous studies have shown that electroacupuncture (EA) has potential anti-inflammatory activity. However, the role of EA in CPB is poorly understood. The aim of this study was to determine whether EA was associated with CPB-induced inflammatory lung injury. In the present study, rats were treated with EA for 5 days before CPB. Two hours after CPB, the lung tissue, serum, and bronchoalveolar lavage fluid (BALF) were prepared for assessment. Our results showed that the expression of NLRP3 in the lung tissue increased significantly after CPB. The EA pretreatment suppressed NLRP3 inflammasome activation, reduced lung edema, and inhibited IL-1β release into the serum and BALF after CPB. Our findings suggest that EA pretreatment attenuates inflammatory lung injury after CPB by suppressing NLRP3 inflammasome activation. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury constitutes a major complication of cardiac surgery in pediatric patients. The present meta-analysis aims to accumulate current literature and assess the efficacy of pharmacological interventions in preventing postoperative renal dysfunction after congenital heart surgery. Methods: Literature search was conducted using Medline (1966–2018), Scopus (2004–2018), Cochrane Central Register of Controlled Trials CENTRAL (1999–2018), Clinicaltrials.gov (2008–2018), and Google Scholar (2004–2018) databases. Statistical analysis was performed with Review Manager 5.3 and R 3.4.3. Results: Meta-analysis included 14 studies, with a total of 2,625 patients. AKI incidence was significantly lower in the dexmedetomidine (OR 0.49, 95% CI [0.28–0.87]) and acetaminophen (OR 0.43, 94% CI [0.28–0.67]) groups, while no difference was present in patients receiving corticosteroid (OR 1.16, 95% CI [0.69–1.95]), fenoldopam (OR 0.47, 95% CI [0.22–1.02]), or aminophylline (OR 0.98, 95% CI [0.29–3.34]). Network meta-analysis proposed that dexmedetomidine had the greatest probability (44.5%) to rank first, although significant overlap with the other treatments was observed. Conclusions: The present meta-analysis suggests that no firm evidence exists about the protective role of pharmacological interventions in the pediatric population. Future randomized controlled trials should clarify the effectiveness of dexmedetomidine and acetaminophen and indicate the optimal protocol to be applied, to protect renal function in the perioperative setting. [ABSTRACT FROM AUTHOR]

Left ventricular pseudoaneurysm (LV-PSA) is a rare complication following cardiac surgery, let alone in the pediatric population. Other known causes of LV-PSA are trauma, percutaneous cardiac intervention, and infections. This report describes the development of LV-PSA following surgical repair of ventricular septal defect (VSD) and coarctation of aorta (CoA) in an infant. [ABSTRACT FROM AUTHOR]

Importance: Ventilator‐associated pneumonia (VAP) is one of the most common complications after cardiac surgery in children with congenital heart disease (CHD). Early prediction of the incidence of VAP is important for clinical prevention and treatment. Objective: To determine the value of serum C‐reactive protein (CRP) levels and the Pediatric Risk of Mortality III (PRISM III) score in predicting the risk of postoperative VAP in pediatric patients with CHD. Methods: We performed a retrospective review of clinical data of 481 pediatric patients with CHD who were admitted to our pediatric intensive care unit. These patients received mechanical ventilation for 48 hours or longer after corrective surgery. On the basis of their clinical manifestations and laboratory results, patients were separated into two groups of those with VAP and those without VAP. CRP levels were measured and PRISM III scores were collected within 12 hours of admission to the pediatric intensive care unit. The Pearson correlation coefficient was used to evaluate the association of CRP levels and the PRISM score with the occurrence of postoperative VAP. A linear regression model was constructed to obtain a joint function and receiver operating curves were used to assess the predictive value. Results: CRP levels and the PRISM III score in the VAP group were significantly higher than those in the non‐VAP group (P < 0.05). Receiver operating curves suggested that using CRP + the PRISM III score to predict the incidence of VAP after congenial heart surgery was more accurate than using either of them alone (CRP + the PRISM III score: sensitivity: 53.2%, specificity: 85.7%). When CRP + the PRISM III score was greater than 45.460, patients were more likely to have VAP. Interpretation: Although using CRP levels plus the PRISM III score to predict the incidence of VAP after congenial heart surgery is more accurate than using either of them alone, its predictive value is still limited. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a common and severe complication after cardiac surgery. Currently, a series of novel biomarkers have favored the assessment of AKI after cardiac surgery in addition to the conventional indicators. The biomartkers, such as urinary liver fatty acid binding protein (L-FABP), urinary neutrophil gelatinase-associated lipocalin (NGAL), serum L-FABP, heart-type FABP, kidney injury molecule 1 (KIM-1), and interleukin-18 were found to be significantly higher in patients who developed AKI after cardiac surgery than those who did not. Apart from urinary interleukin-18, the novel biomarkers have been recognized as reliable indicators for predicting the diagnosis, adverse outcome, and even mortality of AKI after cardiac surgery. The timing of the renal replacement therapy is a significant predictor relating to patients' prognoses. In patients with AKI after cardiac surgery, renal replacement therapy should be performed as early as possible in order to achieve promising outcomes. In children, AKI after cardiac surgery can be managed with peritoneal dialysis. AKI after cardiac surgery has received extensive attention as it may increase early mortality and impact long-term survival of patients as well. The purpose of this article was to analyze the changes of the pertinent biomarkers, to explore the related risk factors leading to the occurrence of AKI after cardiac surgery, and to provide a basis for the clinical prevention and reduction of AKI. [ABSTRACT FROM AUTHOR]

Background: Median sternotomy wound infections are infrequent yet potentially fatal complication following cardiac surgery. The reported incidence of sternal infections ranges from 0.9 to 20%, and the incidence of mediastinitis is 1-2% in most studies. Several studies have examined and identified possible causes and risk factors associated with sternal infections. They include patient-related risk factors, and procedure-related factors. Aim of the study is the assessment of the patient's risk factors related to incidence of infection. Patients and Methods: ninety-eight cardiac surgery patients operated via median sternotomy were included in the study and the role of patient related factors (age, gender, obesity and diabetes mellitus) in the incidence of postoperative superficial and deep sternal wound infection was accessed. Results: Sternal wound infection (SWI) developed in 18 patients (18.36%). 15 patients (15.3%) had superficial SWI while 3 patients (3.06%) had deep SWI. The most common causative organism in our study was staph. aureus especially MRSA. Conclusion: Patient-related risk factors such as age, gender, obesity and diabetes mellitus are important risk factors in the development sternal wound infection. [ABSTRACT FROM AUTHOR]

Introduction: Trans-apical beating heart off-pump mitral valve (MV) repair is a novel surgical technique for treating mitral regurgitation (MR) caused by degenerative flail/prolapse (DLP). Aim: To present early outcomes of a single-center experience with transapical beating heart mitral valve repair with the NeoChord system. Material and methods: Thirty-seven patients with severe symptomatic MR were treated with the NeoChord technique between September 2015 and December 2018 (78% men; mean age: 62.3 ±13.4 years). We evaluated standard cardiac surgery perioperative complications as well as those related to the NeoChord technique as well as early surgical success as defined by the reduction of MR to less than moderate by implantation of at least 2 neochordae. Results: During this series we had no hemodynamic instability due to bleeding or arrhythmia. There were no transapical technique-related adverse events such as a leaflet perforation or tear, a major native chord rupture, which would require implantation of a new chord, ventricular apex rupture, or left atrial perforation. There were no major adverse events including death, stroke or acute myocardial infarction. Nine (24%) patients developed an episode of perioperative atrial fibrillation. We were able to conclude the operation in 98% of our patients with less than moderate MR. One (2%) patient had moderate MR at the conclusion of the operation. Conclusions: Trans-apical off-pump MV repair with the NeoChord system is a safe, minimally invasive procedure, with few minor complications. In well-selected candidates it provides successful treatment of degenerative MR. Results are anatomy dependent, so preoperative patient selection is crucial. [ABSTRACT FROM AUTHOR]

Objetive: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) improved symptoms and increased survival and quality of life in patients with coronary artery disease. However, it should be the main cause of a complex organic systemic inflammatory response that greatly contributes to several postoperative adverse effects. Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined. Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB. Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative delirium (POD) is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. Diabetic patients, especially those with poor diabetes control and long-standing hyperglycemia, may be at risk of developing delirium. The aim of this study was to analyze whether the occurrence of POD in cardiac surgery is associated with diabetes or elevated preoperative glycated hemoglobin (HbA1c) level. Materials and methods: We performed a cohort analysis of prospectively collected data from a register of cardiac surgery department of a university hospital. Delirium assessment was performed twice a day during the first 5 days after the operation based on Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria. Results: We analyzed a cohort of 3,178 consecutive patients, out of which 1,010 (31.8%) were diabetic and 502 (15.8%) were diagnosed with POD. Patients with delirium were more often diabetic (42.03% vs 29.86%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<0.001), no difference was found in patients with insulin treatment. Preoperative HbA1c was elevated above normal (≥6%) in more delirious than nondelirious patients (44.54% vs 33.04%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=0.018). In univariate analysis, the diagnosis of diabetes was associated with an increased risk of developing POD (OR: 1.703, 95% CI: 1.401–2.071, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319–1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161–1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level. Conclusion: More diabetic patients develop POD after cardiac surgery than nondiabetic patients. Elevated preoperative HbA1c level is a risk factor for postcardiac surgery delirium regardless of the diagnosis of diabetes. [ABSTRACT FROM AUTHOR]

Background: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery.Methods: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2.5%). The mean age was 65.3 ± 12.1 years and 60 (65.9%) were male. Variables were compared among study- and matched-patients (n = 113) without neurological deficits.Results: A total of 37/2121 (1.7%) patients had imaging evidence of stroke. Radiological examinations were done 5.72 ± 3.6 days after surgery. Patients with and without imaging evidence of stroke had longer intensive care unit length of stay (LOS) (13.8 ± 14.7 and 12.9 ± 15 days vs. 5.7 ± 12.1 days, respectively (p < 0.001) and hospital LOS (53 ± 72.8 and 35.5 ± 29.8 days vs. 18.4 ± 29.2 days, respectively (p < 0.001) than the control group. The hospital mortality of patients with and without imaging evidence of stroke was higher than the control group (7/37 patients [19%], and 12/54 patients [22%] vs. 4/115 patients [3%], respectively (p < 0.001). Multivariate analysis showed that bilateral internal carotid artery stenosis of any grade (p < .001), and re-do operations (p = .013) increased the risk of postoperative neurological complications.Conclusions: Neurological complications after cardiac surgery increase hospitalization and mortality even in patients without radiologic evidence of stroke. Bilateral internal carotid artery stenosis of any grade, suggesting a diffuse patient propensity toward atherosclerosis, and re-do operations increase the risk of postoperative neurological complications. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery.Methods: We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from the RIPHeart-Study cohort. Patients undergoing non-emergent cardiac surgery were included. Primary endpoint comprises a binary composite complication rate covering atrial fibrillation, delirium, non-fatal myocardial infarction, acute renal failure and/or any new stroke until hospital discharge with a maximum of fourteen days after surgery.Results: A total of 547,644 genotyped markers were available for analysis. Following quality control and adjustment for clinical covariate, one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 × 10- 8) and 139 (adjusted for all other outcomes) SNPs showed promising association with p < 1 × 10- 5 from the GWAS.Conclusions: We identified several potential loci, in particular PHLPP2, BBS9, RyR2, DUSP4 and HSPA8, associated with new-onset of atrial fibrillation, delirium, myocardial infarction, acute kidney injury and stroke after cardiac surgery.Trial Registration: The study was registered with ClinicalTrials.gov NCT01067703, prospectively registered on 11 Feb 2010. [ABSTRACT FROM AUTHOR]