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Background: Delayed extubation with mechanical ventilation after cardiac valve surgery is an important clinical challenge. Early extubation can improve the survival rate and prognosis of patients. The study aims to explore the predictive value of a chest X-ray pulmonary edema imaging score on the first day after surgery for delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass. Method: Retrospective analysis of the clinical data of patients undergoing cardiac valve surgery under extracorporeal circulation admitted to the intensive care unit of Zhongshan Hospital Affiliated with Fudan University (Xiamen) from January 2020 to October 2023. The patients were divided into an early extubation group according to the postoperative mechanical ventilation time (time: <24 h) and a delayed extubation group (time: ≥24 h). The radiographic assessment of lung edema (RALE) score was performed on the chest X-ray of the patient on the first day after surgery to analyze the correlation between delayed extubation of mechanical ventilation and the chest radiograph RALE score on the first day after surgery and to verify its predictive performance. Results: Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, PaCO2, and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation (p = 0.013, 0.001, 0.034, <0.001, <0.001,<0.001,<0.001,<0.001, 0.014, and <0.001, respectively). No significant differences were observed in the proportion of males and the lactate level after the first 24 h between the two groups (p = 0.792 and 0.191, respectively). The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant (p<0.001). Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively. Conclusions: The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value. [ABSTRACT FROM AUTHOR]

Objective To evaluate the improvement in the quality of early postoperative recovery in patients undergoing cardiac valve surgery with remimazolam-based fast - track anesthesia, and to provide a reference for the clinical optimization of fast - track anesthesia and Enhanced Recovery After Surgery (ERAS) protocols. Methods We selected elective surgery patients undergoing median sternotomy for cardiac valve replacement and/or repair under general anesthesia with extracorporeal circulation. Based on routine anesthesia assessment and fast-track anesthesia suitability assessment, a total of 228 patients were strictly enrolled according to the inclusion and exclusion criteria and randomly divided into two groups: the Remimazolam group (n = 114) and the Propofol group (n = 114) . Patients in the Remimazolam group were induced and maintained with remimazolam for anesthesia, while patients in the control group were administered propofol. We recorded the general information and surgical data of the patients, the QoR-15 scores before surgery (1 day preoperatively), 1 day postoperatively, 3 days postoperatively, and 1 day before discharge, as well as hemodynamic parameters at key time points after admission, the incidence of hypotension and bradycardia after anesthesia, the duration of surgery, anesthesia duration, postoperative mechanical ventilation time, ICU stay, postoperative hospital stay, and the incidence of perioperative cardiovascular adverse events and the incidence of early postoperative complications. Results There was no statistically significant difference in general data and QoR-15 scores between the two groups 1 day before surgery (P > 0.05) . The QoR-15 score of the Remimazolam group 1 day before discharge was higher than that of the Propofol group, with a statistically significant difference (P < 0.05), but the difference was less than the minimum clinically important difference, which is less than 8, indicating no significant clinical benefit. One minute after intubation and one minute after skin incision, the heart rate in the Propofol group slowed down and the Mean Arterial Pressure (MAP) significantly decreased, with a statistically significant difference between the groups (P < 0.05), there was no statistically significant difference in heart rate and MAP at other times. The incidence of intraoperative hypotension and bradycardia was lower in the Remimazolam group than in the Propofol group, with a statistically significant difference (P < 0.05) . The duration of postoperative mechanical ventilation, ICU stay, postoperative hospital stay, and the rate of re-intubation were all shorter in the Remimazolam group than in the Propofol group, and the success rate of fast-track anesthesia was higher in the Remimazolam group, with a statistically significant difference (P < 0.05) . There was no statistically significant difference in the incidence of perioperative complications between the two groups. Conclusions Compared with the commonly used intravenous anesthetic propofol, the remimazolam-based fast-track anesthesia regimen did not significantly improve the postoperative recovery quality scores in patients undergoing cardiac valve surgery. However, remimazolam had advantages in maintaining hemodynamic stability, increasing the success rate of fast-track anesthesia, shortening postoperative ICU stay and hospital stay, and is a viable intravenous anesthetic option for cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Abstract Background Previous models for predicting delirium after cardiac surgery remained inadequate. This study aimed to develop and validate a machine learning-based prediction model for postoperative delirium (POD) in cardiac valve surgery patients. Methods The electronic medical information of the cardiac surgical intensive care unit (CSICU) was extracted from a tertiary and major referral hospital in southern China over 1 year, from June 2019 to June 2020. A total of 507 patients admitted to the CSICU after cardiac valve surgery were included in this study. Seven classical machine learning algorithms (Random Forest Classifier, Logistic Regression, Support Vector Machine Classifier, K-nearest Neighbors Classifier, Gaussian Naive Bayes, Gradient Boosting Decision Tree, and Perceptron.) were used to develop delirium prediction models under full (q = 31) and selected (q = 19) feature sets, respectively. Result The Random Forest classifier performs exceptionally well in both feature datasets, with an Area Under the Curve (AUC) of 0.92 for the full feature dataset and an AUC of 0.86 for the selected feature dataset. Additionally, it achieves a relatively lower Expected Calibration Error (ECE) and the highest Average Precision (AP), with an AP of 0.80 for the full feature dataset and an AP of 0.73 for the selected feature dataset. To further evaluate the best-performing Random Forest classifier, SHAP (Shapley Additive Explanations) was used, and the importance matrix plot, scatter plots, and summary plots were generated. Conclusions We established machine learning-based prediction models to predict POD in patients undergoing cardiac valve surgery. The random forest model has the best predictive performance in prediction and can help improve the prognosis of patients with POD.

Background: Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. Methods: We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010. Results: During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2–3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9–12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4–10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8–8.3, p < 0.001). Conclusion: Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation. [ABSTRACT FROM AUTHOR]

Background: Re-evaluation of reconstructive possibilities in the correction of degenerative mitral valve disease is of great clinical necessity nowadays. Material and methods: Analyzing the nature of the pathologies that determined the development mechanism of valve insufficiency, 136 cases of anterior cusp prolapse and 152 cases of posterior cusp prolapse were determined. Results: Cord rupture was established in 79 (58.9%) patients, cusp defects (”Cleft”) were appreciated in positions A1, A2, A3 – 15 cases (5.9%) and in P1, P2, P3 – in 92 (86.6%) cases. The surgical techniques performed were separated into: (1) resection – for the anterior and posterior cusps – 45 cases and accompanied by the slide – in 30 cases; (2) with Gore-Tex neo-chordal implantation – 115 cases, with cord transfer – 30; (3) Cusp enlargement with autologous pericardium – 5 cases, Alfieri procedure – 8. Implantation of a support ring required 130 (97.0%) patients. The correction of the associated valve disease required 125 patients (De Vega – 89.1%, ring – 8). Coronary bypass was required – 16 patients. There were no postoperative fatal cases. Conclusions: Based on the data obtained, reconstructive repair surgery can be can recommend for valves of degenerative, post-traumatic, ischemic, post-endocardial etiology as effective and sustainable techniques over time, being a superior alternative to replacement with prosthetic valves.

A totally endoscopic minimally invasive approach is widely used for cardiac valve surgery in normal adults. However, minimally invasive cardiac surgery during pregnancy is rarely reported. In addition to traditional median thoracotomy, totally endoscopic minimally invasive approaches can now be used for pregnant patients. We describe our experience with totally endoscopic cardiac valve surgery (TECVS) during pregnancy, which is safe for both mothers and fetuses.

Abstract Objectives To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS). Methods Data were collected from 259 patients who underwent CVS due to valvular heart disease and were admitted to the hospital with CHF from January 2018 to December 2020. The patients were divided into Group A (treatment with sacubitril/valsartan) and Group B (treatment without sacubitril/valsartan). The duration of treatment and follow-up was 6 months. The two groups’ prior and clinical characteristics, post-treatment data, mortality, and follow-up data were analysed. Results The effective rate of Group A was higher than that of Group B (82.56% versus 65.52%, P

Objectives: To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS). Methods: Data were collected from 259 patients who underwent CVS due to valvular heart disease and were admitted to the hospital with CHF from January 2018 to December 2020. The patients were divided into Group A (treatment with sacubitril/valsartan) and Group B (treatment without sacubitril/valsartan). The duration of treatment and follow-up was 6 months. The two groups' prior and clinical characteristics, post-treatment data, mortality, and follow-up data were analysed. Results: The effective rate of Group A was higher than that of Group B (82.56% versus 65.52%, P < 0.05). The left ventricular ejection fraction (LVEF, %) was improved in both groups. The final value minus the initial value was (11.14 ± 10.16 versus 7.15 ± 11.18, P = 0.004). The left ventricular end-diastolic/-systolic diameter (LVEDD/LVESD, mm) in Group A decreased more than in Group B. The final value minus the initial value was (-3.58 ± 9.21 versus − 0.27 ± 14.44, P = 0.026; -4.21 ± 8.15 versus − 1.14 ± 12.12, P = 0.016, respectively). Both groups decreased the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP, pg/ml). The final value minus initial value was [-902.0(-2226.0, -269.5) versus − 535.0(-1738, -7.0), P = 0.029]. The systolic and diastolic blood pressure (SBP/DBP, mmHg) in Group A decreased more than in Group B. The final value minus the initial value was (-13.13 ± 23.98 versus − 1.81 ± 10.89, P < 0.001; -8.28 ± 17.79 versus − 2.37 ± 11.41, P = 0.005, respectively). Liver and renal insufficiency, hyperkalaemia, symptomatic hypotension, angioedema, and acute heart failure had no statistical differences between the two groups. Conclusions: Sacubitril/valsartan can effectively improve the cardiac function of patients with CHF after CVS by increasing LVEF and reducing LVEDD, LVESD, NT-proBNP, and BP, with good safety. [ABSTRACT FROM AUTHOR]

Abstract Background Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist. Methods We included patients with first-time IE (1999–2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999–2003, 2004–2008, 2009–2013, 2014–2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression. Results We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P =

BackgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, which is associated with age and massive bleeding. However, whether thyroid hormone (TH) level can affect POAF remains controversial.AimTo investigate the occurrence and risk factors of POAF, in particular, the preoperative TH level of patients was introduced into this study as a variable for analysis, and a column graph prediction model of POAF was constructed.MethodsPatients who underwent valve surgery in Fujian Cardiac Medical Center from January 2019 to May 2022 were retrospectively analyzed and divided into POAF group and NO-POAF group. Baseline characteristics and relevant clinical data were collected from the two groups of patients. Independent risk factors for POAF were screened using univariate analysis and binary logistic regression analysis, and a column line graph prediction model was established based on the regression analysis results, and the diagnostic efficacy and calibration of the model were evaluated using the Receiver Operating Characteristic Curve (ROC) and calibration curve.ResultsA total of 2,340 patients underwent valve surgery, excluding 1,751 patients, a total of 589 patients were included, including 89 patients in POAF group and 500 patients in NO-POAF group. The total incidence of POAF was 15.1%. The results of the Logistics regression analysis showed that gender, age, leukocytes and TSH were risk factors of POAF. The area under the ROC curve of the nomogram prediction model for POAF was 0.747 (95% CI: 0.688–0.806, P 0.05, the calibration curve was well fitted.ConclusionThe results of this study show that gender, age, leukocyte and TSH are risk factors of POAF, and the nomogram prediction model has a good prediction effect. Due to the limited sample size and included population, more studies are needed to validate this result.

PurposeThis study examined whether alterations in Doppler parameters of superior mesenteric artery (SMA) are associated with prolonged mechanical ventilation (PMV) in patients who underwent cardiac valve surgery.MethodsHemodynamic and SMA Doppler parameters were collected at intensive care unit(ICU) admission. The duration of mechanical ventilation was monitored. PMV was defined as mechanical ventilation ≥96 h.ResultsA total of 132 patients admitted to ICU after cardiac valve surgery were evaluated for enrollment, of whom 105 were included. Patients were assigned to the control (n = 63) and PMV (n = 42) groups according to the mechanical ventilation duration. The pulsatility index(SMA-PI) and resistive index of SMA (SMA-RI) were 3.97 ± 0.77 and 0.88 (0.84–0.90) in the PMV group after cardiac valve surgery, which was lower than the SMA-PI (2.95 ± 0.71, p

Background: As the proportion of elderly patients increases, higher incidence of malnutrition is found among patients with valvular heart disease. Sarcopaenia is one of the main manifestations of malnutrition. Studies have shown the certain predictive effect of sarcopaenia on the clinical outcome in different cases. This study aims to clarify the impact of computed tomography (CT)-derived thoracic sarcopaenia on clinical outcomes of patients who underwent cardiac valve surgery.Methods: The clinical data of 216 patients who underwent cardiac valve surgery from December 2015 to June 2020 were retrospectively collected. Skeletal muscle mass at 12th thoracic vertebra level was measured to diagnose thoracic sarcopaenia. Postoperative complications and follow-up data were collected. Medium follow-up was 3.2 years.Results: The prevalence of thoracic sarcopaenia was 16.7% in this study. The incidence of total complications and in-hospital mortality were higher in thoracic sarcopaenia group (p=0.024 and p=0.014, respectively). Multivariate analysis revealed that thoracic sarcopaenia is a significant predictor for postoperative complications (OR 2.319; 95% CI 1.003-5.366; p=0.049). Decreased long-term survival was observed in patients with thoracic sarcopaenia. Thoracic sarcopaenia (HR 4.178; 95% CI 2.062-8.465; p<0.001) was determined to be an independent risk factor for late mortality.Conclusion: Thoracic sarcopaenia defined by chest CT was independently associated with higher incidence of postoperative complications and long-term mortality. Routine preoperative evaluation of thoracic sarcopaenia deserves further consideration to enhance the predictive performance for operation risk. [ABSTRACT FROM AUTHOR]

Background: Delayed extubation with mechanical ventilation after cardiac valve surgery is an important clinical challenge. Early extubation can improve the survival rate and prognosis of patients. The study aims to explore the predictive value of a chest X-ray pulmonary edema imaging score on the first day after surgery for delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass., Method: Retrospective analysis of the clinical data of patients undergoing cardiac valve surgery under extracorporeal circulation admitted to the intensive care unit of Zhongshan Hospital Affiliated with Fudan University (Xiamen) from January 2020 to October 2023. The patients were divided into an early extubation group according to the postoperative mechanical ventilation time (time: <24 h) and a delayed extubation group (time: ≥24 h). The radiographic assessment of lung edema (RALE) score was performed on the chest X-ray of the patient on the first day after surgery to analyze the correlation between delayed extubation of mechanical ventilation and the chest radiograph RALE score on the first day after surgery and to verify its predictive performance., Results: Significant differences in age, the incidence of hypertension, body mass index (BMI), left ventricular ejection fraction (LVEF), pump time, RALE score, ventilation time, oxygenation index, P a CO 2 , and brain natriuretic peptide (BNP) levels after the first 24 h were seen between patients who were extubated before and 24 h post operation ( p = 0.013, 0.001, 0.034, <0.001, <0.001, <0.001, <0.001, <0.001, 0.014, and <0.001, respectively). No significant differences were observed in the proportion of males and the lactate level after the first 24 h between the two groups ( p = 0.792 and 0.191, respectively). The time of mechanical ventilation was positively correlated with the RALE score in all patients, and the correlation coefficient was 0.419; the difference was statistically significant ( p < 0.001). Multivariate binary logistic regression analysis with stepwise regression was performed on each research factor, and it was found that RALE score, pump time, oxygenation index, and postoperative BNP were independent risk factors for predicting delayed extubation in patients undergoing cardiac surgery on cardiopulmonary bypass. A 10-fold cross-validation revealed that the mean accuracy, sensitivity, specificity, and area under the curve (AUC) of the regression model were 0.737, 0.749, 0.741, and 0.825, respectively., Conclusions: The RALE score on the chest radiograph on the first day after surgery is an independent risk factor for predicting delayed extubation in patients after cardiac valve surgery on cardiopulmonary bypass and has good predictive value., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 The Author(s). Published by IMR Press.)

Background: Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist.Methods: We included patients with first-time IE (1999-2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999-2003, 2004-2008, 2009-2013, 2014-2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression.Results: We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999-2003 to 2014-2018. Compared with 1999-2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96-1.35), OR = 1.20 (95% CI: 1.02-1.42), and OR = 1.10 (95% CI: 0.93-1.29) in 2004-2008, 2009-2013, and 2014-2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999-2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65-1.41), HR = 0.43 (95% CI: 0.28-0.67), and HR = 0.55 (95% CI 0.37-0.83) in 2004-2008, 2009-2013, and 2014-2018, respectively.Conclusions: On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased. [ABSTRACT FROM AUTHOR]

Objectives: It has been reported that bacteria associated with infective endocarditis originate from the oral cavity in 26–45% of cases. However, little is known on the counts and species of periodontal microbiota in infected heart valves. The aim of this study was to identify these aspects of periodontal microbiota in infective endocarditis and to potentially initiate a dental extraction concept for periodontally compromised teeth concerning patients requiring heart valve surgery. Materials and methods: The retrospective study group consisted of tissue samples from infected heart valves of 683 patients who had undergone heart valve surgery. Before patients had undergone cardiac surgery, the following laboratory tests confirmed the occurrence of endocarditis in all patients: blood cultures, echocardiography, electrocardiography, chest X-ray, and electrophoresis of the serum proteins. The specimens were aseptically obtained and deep frozen immediately following surgery. Microbiological diagnosis included proof of germs (dichotomous), species of germs, and source of germs (oral versus other). Results: Microbiota was detected in 134 (31.2%) out of 430 enrolled patients. Oral cavity was supposed to be the source in 10.4% of cases, whereas microbiota of the skin (57.5%) and gastrointestinal tract (GIT, 24.6%) were detected considerably more frequently. Moreover, periodontal bacteria belonged mostly to the Streptococci species and the yellow complex. None of the detected bacteria belonged to the red complex. Conclusion: Most frequently, the skin and GIT represented the site of origin of the microbiota. Nevertheless, the oral cavity represented the source of IE in up to 10%. Consequently, it needs to be emphasized that a good level of oral hygiene is strongly recommended in all patients undergoing heart valve surgery in order to reduce the bacterial load in the oral cavity, thereby minimizing the hematogenous spread of oral microbiota. The prerequisites for conservative dental treatment versus radical tooth extraction must always be based on the patient's cooperation, and the clinical intraoral status on a sense of proportion in view of the overall clinical situation due to the underlying cardiac disease. Clinical relevance: The oral cavity is a source of oral microbiota on infected heart valves. Patients requiring heart valve surgery should always undergo a critical evaluation of dental treatment affecting periodontally compromised teeth, favoring a systematic, conservative-leaning recall. [ABSTRACT FROM AUTHOR]

Abstract Background Delirium is an acute status of brain dysfunction that commonly occurs in patients who have undergone cardiac surgery, and increases morbidity and mortality. It is associated with risk factors, such as older age, use of narcotics, cardiopulmonary bypass, and hypothermia. Dexmedetomidine infusion might exert a neuroprotective effect. However, the effect of perioperative administration of dexmedetomidine on the incidence of postoperative delirium (POD) in patients undergoing cardiac or non-cardiac surgery is yet controversial. The present study aimed to reveal the effect of intraoperative dexmedetomidine administration on the incidence of delirium in adult patients following cardiac surgery. Methods This single-center, randomized, double-blinded, and placebo-controlled trial consisted of 652 patients randomly divided into two groups: dexmedetomidine and placebo. 0.6 μg/kg dexmedetomidine will be infused 10 min after central vein catheterization, followed by a continuous infusion at a speed of 0.4 μg/kg/h until the end of surgery in the dexmedetomidine group, while normal saline will be administered at the same rate in the placebo group. The primary outcome is the incidence of POD during the first 7 days post-surgery. The secondary outcomes include duration of mechanical ventilation after surgery, duration of stay in the intensive care unit and the hospital after surgery, incidence of hypotension during or after dexmedetomidine infusion, acute kidney injury and sudden arrhythmia during the hospital stay postoperatively, and all-cause mortality in 30 and 90 days after surgery, respectively. Discussion This study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences Fuwai Hospital on 6 March 2019 (2019-1180). The results will be disseminated at academic conferences and submitted to peer-reviewed publications. Either positive or negative results will provide guidance for clinical practice. Trial registration The Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR1900022583. Registered on 17 April 2019.

Background: Model for end-stage liver disease (MELD) is an effective predictive marker for renal, hepatic, and cardiac dysfunctions. In this study, we explore the correlation between MELD scores and the outcomes of patients undergoing cardiac valve surgery., Methods: We conducted a retrospective analysis of clinical data from patients who underwent cardiac valve surgery, encompassing procedures on the aortic valve, mitral valve, and tricuspid valve, using the Informative Surgical Patient dataset for Innovative Research Environment (INSPIRE) database, we conducted receiver operating characteristic (ROC) analyses on the study participants and chose MELD as the primary scoring tool for our study due to its optimal area under the curve (AUC), patients were stratified into high (MELD ≥18) and low (MELD <18) groups based on the determined cutoff value. The perioperative clinical data of the two groups were compared., Results: The analysis revealed 751 patients in the low MELD group (75.5%) and 244 patients (24.5%) in the high MELD group. Patients in the high MELD group exhibited a lower body mass index (BMI) compared to those in the low MELD group. In comparison to the low MELD group, the high MELD group exhibited a higher rate of emergency surgery (10.66% vs . 5.99%, P=0.01), along with prolonged anesthesia time, surgery time, and cardiopulmonary bypass (CPB) time. Regarding clinical prognosis, the high MELD group demonstrated a higher 28-day mortality rate (10.66% vs . 0.8%, P<0.001), as also observed in the analysis of three valve subgroups. Additionally, the high MELD group experienced longer hospitalization and intensive care unit (ICU) stay, and a higher proportion of patients requiring mechanical circulatory support, including intra-aortic balloon pump (IABP) assist (14.75% vs . 3.86%, P<0.001), extracorporeal membrane oxygenation (ECMO) assist (7.38% vs . 0.8%, P<0.001), and continuous renal replacement therapy (CRRT) (27.87% vs . 1.46%, P<0.001) post-surgery. The Kaplan-Meier survival curves illustrated a significantly lower mortality rate in the low MELD group compared to the high MELD group, with highly significant statistical differences (P<0.001)., Conclusions: The MELD score demonstrates a robust predictive value for clinical outcomes following cardiac valve surgery, underscoring its utility as a viable metric for disease stratification research., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-242/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Background: We aimed to demonstrate whether the preoperative transthoracic echocardiography index (TTEI) could improve the predictive value of clinical parameters for cardiac valve surgery-associated acute kidney injury (CVS−AKI). Methods: A total of 213 patients who underwent surgical CVS at Renmin Hospital of Wuhan University were consecutively recruited in this retrospective study. TTE assessments were performed within 7 days before surgery and logistic regression was used to determine TTEI. A nomogram was constructed by integrating TTEI and clinical features, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to evaluate the improvement in TTEI for CVS−AKI. Results: Among them, 66 patients (30.9%) developed CVS−AKI. The TTEI was calculated as follows: −6.579 + 0.068 × pulmonary artery systolic pressure (mmHg) −0.742 × LVEF (>55%, yes or no) + 0.346 × left ventricle posterior wall thickness (mm). The nomogram based on the TEEI and other clinical factors possessed excellent performance (C-index = 0.880), had great calibration and discrimination, and was clinically useful. Furthermore, NRI (0.07, 95% confidence interval, 95%CI, 0.01–0.12, p = 0.02) and IDI (0.08, 95%CI, 0.01–0.20, p = 0.02) indicated that TTEI could significantly improve the predictive value of clinical features for CVS−AKI. Conclusions: As a simple access and cost-effective parameter, the preoperative TTEI may be a reliable and useful factor for CVS−AKI.

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.

To compare the effects of Histidine-Tryptophan-Ketoglutarate Solution and Cold blood cardioplegia in valve surgery, and provide evidence for clinical myocardial protection perfusion strategy. A retrospective analysis of singlecenter data was used to select 529 patients with valve surgery who underwent cardiopulmonary bypass (CPB) from May 2015 to August 2018. Divided into cold blood cardioplegia group (n=326) and HTK solution group (n=203). Propensity score matching was used to adjust for differences between the two groups, and 73 matched pairs were identified. The primary end point was CPB time, aortic block time, ICU (intensive care unit) length of stay (LOS), and intraoperative changes in serum sodium concentration. Secondary end point included postoperative ventilator assist time, the use of IABP (Intraaortic ballon pump) and new dialysis, 30-day mortality and major postoperative complications. For the matched, the average aortic block time and CPB time of the cold blood cardioplegia group was longer than HTK solution group, and the difference was statistically significant (P<0.05). There was acute transient hyponatremia in the HTK group (P<0.05), and there was no significant difference in ICU LOS and other clinical outcomes. During cardiac valve surgery, both cardioplegia techniques were consistent in the early clinical results, which can be selected according to the surgical procedure and the patient's economic level. [ABSTRACT FROM AUTHOR]

Background: Delirium is an acute status of brain dysfunction that commonly occurs in patients who have undergone cardiac surgery, and increases morbidity and mortality. It is associated with risk factors, such as older age, use of narcotics, cardiopulmonary bypass, and hypothermia. Dexmedetomidine infusion might exert a neuroprotective effect. However, the effect of perioperative administration of dexmedetomidine on the incidence of postoperative delirium (POD) in patients undergoing cardiac or non-cardiac surgery is yet controversial. The present study aimed to reveal the effect of intraoperative dexmedetomidine administration on the incidence of delirium in adult patients following cardiac surgery.Methods: This single-center, randomized, double-blinded, and placebo-controlled trial consisted of 652 patients randomly divided into two groups: dexmedetomidine and placebo. 0.6 μg/kg dexmedetomidine will be infused 10 min after central vein catheterization, followed by a continuous infusion at a speed of 0.4 μg/kg/h until the end of surgery in the dexmedetomidine group, while normal saline will be administered at the same rate in the placebo group. The primary outcome is the incidence of POD during the first 7 days post-surgery. The secondary outcomes include duration of mechanical ventilation after surgery, duration of stay in the intensive care unit and the hospital after surgery, incidence of hypotension during or after dexmedetomidine infusion, acute kidney injury and sudden arrhythmia during the hospital stay postoperatively, and all-cause mortality in 30 and 90 days after surgery, respectively.Discussion: This study was approved by the Ethics Committee of the Chinese Academy of Medical Sciences Fuwai Hospital on 6 March 2019 (2019-1180). The results will be disseminated at academic conferences and submitted to peer-reviewed publications. Either positive or negative results will provide guidance for clinical practice.Trial Registration: The Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR1900022583. Registered on 17 April 2019. [ABSTRACT FROM AUTHOR]

Purpose: Odontogenic infection sources represent a predisposing risk factor for patients with cardiac valvular disease (CVD) awaiting cardiac valve replacement procedures.Study Design: The incidence and quality of odontogenic infection sources (foci) were evaluated on 152 consecutive patients (study group, SG) undergoing cardiac valve replacement and were compared to 150 age-, gender- and residence-matched non-cardiac patients (control group, CG). Clinical and radiographic examinations were used to evaluate the incidence of odontogenic infection sources, grouped into potential (high risk) and facultative foci (possible risk), and the presence/severity of periodontal disease (PD). Foci and PD were compared among the overall SG and the CG and also among a sophisticated subdivision of the study group, especially with respect to aortic valve (AVR) and mitral valve replacement (MVR).Results: Overall, 218 potential and 116 facultative odontogenic foci were found in 87 (58.3%) and in 79 (51.9%) patients of the SG respectively. The overall incidence of odontogenic infection sources and the incidence and severity of PD did not differ between the SG and the CG. However, in comparison with the CG (48%), the incidence of potential odontogenic infection foci was significantly higher in patients scheduled for AVR than in those scheduled to undergo MVR (70.4% vs. 25.0%, p < 0.01). Additionally, in patients scheduled for AVR, a significantly higher number (p < 0.01) of individual potential dentogenic infection foci (1.7 vs. 0.8 foci/valve) and a higher prevalence of PD (60.2%) was seen than for patients scheduled for MVR (31.8%) or for patients without CVD (1.0 foci/valve; 39.3%; p < 0.05).Discussion: Although the overall incidence of odontogenic infection sources did not differ between the patients with and without CVD, a sophisticated subdivison of CVD may be crucial, demonstrating that patients with AVR differ significantly from those with MVR and with the healthy CG. Cardiologists and cardiac surgeons play an important role in organising oral rehabilitation of patients scheduled for valve replacement. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore the relationship between elevated B-type natriuretic peptide (BNP) levels and the prognosis of patients with infective endocarditis (IE) undergoing cardiac surgery. Methods: In total, 162 IE patients with recorded BNP levels upon admission were included in the present study. The primary end point was all-cause mortality. Results: Multivariate Cox analysis revealed a significant association between log BNP and all-cause mortality. Kaplan-Meier analysis revealed a poorer prognosis for patients with BNP levels ≥ the 75th percentile. Furthermore, the linear trend test indicated a significant link between BNP quartiles and the primary end point within the models. Conclusion: Elevated BNP levels upon admission could predict all-cause mortality in IE patients undergoing cardiac surgery.

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In recent years, wearable devices have seen a booming development, and the integration of wearable devices with clinical settings is an important direction in the development of wearable devices. The purpose of this study is to establish a prediction model for postoperative pulmonary complications (PPCs) by continuously monitoring respiratory physiological parameters of cardiac valve surgery patients during the preoperative 6-Minute Walk Test (6MWT) with a wearable device. By enrolling 53 patients with cardiac valve diseases in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, the grouping was based on the presence or absence of PPCs in the postoperative period. The 6MWT continuous respiratory physiological parameters collected by the SensEcho wearable device were analyzed, and the group differences in respiratory parameters and oxygen saturation parameters were calculated, and a prediction model was constructed. The results showed that continuous monitoring of respiratory physiological parameters in 6MWT using a wearable device had a better predictive trend for PPCs in cardiac valve surgery patients, providing a novel reference model for integrating wearable devices with the clinic.

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of the renal dysfunction (RD) type and change of postoperative cardiac function on the risk of developing acute kidney injury (AKI) in patients who underwent cardiac valve surgery.Method: Reversible renal dysfunction (RRD) was defined as preoperative RD in patients who had not been initially diagnosed with chronic kidney disease (CKD). Cardiac function improvement (CFI) was defined as postoperative left ventricular ejection function - preoperative left ventricular ejection function (ΔEF) >0%, and cardiac function not improved (CFNI) as ΔEF ≤0%.Results: Of the 4,805 (94%) cardiac valve surgery patients, 301 (6%) were RD cases. The AKI incidence in the RRD group (n=252) was significantly lower than in the CKD group (n=49) (36.5% vs 63.3%, P=0.018). The AKI and renal replacement therapy incidences in the CFI group (n=174) were significantly lower than in the CFNI group (n=127) (33.9% vs 50.4%, P=0.004; 6.3% vs 13.4%, P=0.037). After adjustment for age, gender, and other confounding factors, CKD and CKD + CFNI were identified as independent risk factors for AKI in all patients after cardiac valve surgery. Multivariate logistic regression analysis showed that the risk factors for postoperative AKI in preoperative RD patients were age, gender (male), hypertension, diabetes, chronic heart failure, cardiopulmonary bypass time (every 1 min added), and intraoperative hypotension, while CFI after surgery could reduce the risk.Conclusion: For cardiac valve surgery patients, preoperative CKD was an independent risk factor for postoperative AKI, but RRD did not add to the risk. Improved postoperative cardiac function can significantly reduce the risk of postoperative AKI. [ABSTRACT FROM AUTHOR]

Severe insulin resistance (IR) promotes the development of Alzheimer disease. IR and postoperative cognitive dysfunction (POCD) are a common complication during the cardiac perioperative period. The authors hypothesized that IR of individuals with cardiac valve surgery would have increased the risk of POCD. The purpose of the study was to analyze the association of IR and POCD after cardiac valve surgery. Total 131 patients who underwent valve replacement via cardiopulmonary bypass (CPB) were included. Cognitive function was assessed by a series of neuropsychological measurements at 1 day before and 7 days after the surgery. 40 healthy volunteers as the control group also completed the neuropsychological assessment at the same time point. POCD was identified using the “Z score” method. Fasting blood glucose and insulin levels were detected before anesthesia and at 6 h and 7 days post-operation. Additionally serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) were measured at 6 h post-operation. The insulin resistance index was calculated by “homeostasis model assessment 2” (HOMA2) software. The relationship between IR and POCD or TNF-α, IL-6 was then analyzed. At 7 days after surgery, the incidence of POCD was 43.8%. The levels of HOMA2-IR in patients with POCD were significantly higher than those of patients without POCD at 6 h and 7 days after operation ( P < 0.05).The levels of serum IL-6 and TNF- α were positively correlated with HOMA2-IR value at 6 h after operation (RIL-6 = 0.426, P < 0.01; RTNF-a = 0.381, P < 0.01). POCD was correlated with the patients’ education age (OR = 1.062), CPB time (OR = 1.018), self-rating depression scale (SDS) score after operation (OR = 1.082), HOMA2-IR at 6 h (OR = 1.110) and 7 days (OR = 13.762) after operation, IL-6 (OR = 1.036) and TNF-α (OR = 1.039) at 6 h after operation. Our study suggests that IR is correlated with the incidence of POCD and the increase of inflammatory factors. [ABSTRACT FROM AUTHOR]

Background: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, which is associated with age and massive bleeding. However, whether thyroid hormone (TH) level can affect POAF remains controversial., Aim: To investigate the occurrence and risk factors of POAF, in particular, the preoperative TH level of patients was introduced into this study as a variable for analysis, and a column graph prediction model of POAF was constructed., Methods: Patients who underwent valve surgery in Fujian Cardiac Medical Center from January 2019 to May 2022 were retrospectively analyzed and divided into POAF group and NO-POAF group. Baseline characteristics and relevant clinical data were collected from the two groups of patients. Independent risk factors for POAF were screened using univariate analysis and binary logistic regression analysis, and a column line graph prediction model was established based on the regression analysis results, and the diagnostic efficacy and calibration of the model were evaluated using the Receiver Operating Characteristic Curve (ROC) and calibration curve., Results: A total of 2,340 patients underwent valve surgery, excluding 1,751 patients, a total of 589 patients were included, including 89 patients in POAF group and 500 patients in NO-POAF group. The total incidence of POAF was 15.1%. The results of the Logistics regression analysis showed that gender, age, leukocytes and TSH were risk factors of POAF. The area under the ROC curve of the nomogram prediction model for POAF was 0.747 (95% CI: 0.688-0.806, P  < 0.001), with a sensitivity of 74.2% and specificity of 68%. Hosmer-Lemeshow test showed χ 2  = 11.141, P  = 0.194 > 0.05, the calibration curve was well fitted., Conclusion: The results of this study show that gender, age, leukocyte and TSH are risk factors of POAF, and the nomogram prediction model has a good prediction effect. Due to the limited sample size and included population, more studies are needed to validate this result., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Li, Zhang, Liao, Yan, Chen, Lin and Peng.)

Background: Previous studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography.Methods: We created a retrospective registry of 1703 consecutive patients who underwent cardiovascular rehabilitation program after cardiac surgery, including CABG, valve surgery and valve + CABG surgery. LAVi was calculated as ratio of left atrium volume to body surface area, in ml/m(2) at discharge; 563 patients with available LAVi data were included in the study.Results: In the whole population LAVi was 36 ± 14 ml/m(2) (mean ± SD) and the follow-up time was 5 ± 1.5 years. Increased LAVi (>34 ml/m(2)) predicted major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 2.1; CI95 %: 1.4-3.1; p < 0.001) and cardiovascular mortality (HR = 2.2; CI95 %: 1.0-4.5; p = 0.032). An increased LAVi remained MACCEs predictor after adjustement for age, gender, diabetes, atrial fibrillation at discharge, echocardiographic E/A ratio and left ventricular ejection fraction (HR = 1.8; CI95 %: 1.0-3.0; p = 0.036). When the study population was split according to increasing LAVi values, left atrium enlargement resulted a predictor of progressively worse adverse outcome.Conclusions: LAVi is a predictor of long-term adverse cardiovascular outcome after cardiac surgery, even after correction for main clinical and echocardiographic variables. The recently recommended LAVi severity cutoffs appear adequate to effectively stratify outcome in patients undergoing rehabilitation after cardiac surgery. [ABSTRACT FROM AUTHOR]

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade. [ABSTRACT FROM AUTHOR]

Purpose: This study examined whether alterations in Doppler parameters of superior mesenteric artery (SMA) are associated with prolonged mechanical ventilation (PMV) in patients who underwent cardiac valve surgery., Methods: Hemodynamic and SMA Doppler parameters were collected at intensive care unit(ICU) admission. The duration of mechanical ventilation was monitored. PMV was defined as mechanical ventilation ≥96 h., Results: A total of 132 patients admitted to ICU after cardiac valve surgery were evaluated for enrollment, of whom 105 were included. Patients were assigned to the control ( n  = 63) and PMV ( n  = 42) groups according to the mechanical ventilation duration. The pulsatility index(SMA-PI) and resistive index of SMA (SMA-RI) were 3.97 ± 0.77 and 0.88 (0.84-0.90) in the PMV group after cardiac valve surgery, which was lower than the SMA-PI (2.95 ± 0.71, p  < 0.0001) and SMA-RI of controls (0.8, 0.77-0.88, p  < 0.0001). SMA-PI at admission had favorable prognostic significance for PMV (AUC = 0.837, p  < 0.0001)., Conclusions: An elevated SMA-PI is common in patients after cardiac valve surgery with PMV. Increased SMA-PI could help predict PMV after cardiac valve surgery. Using point-of-care ultrasound to measure SMA-PI at ICU admission is an acceptable and reproducible method for identifying patients with PMV., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Zhou, He, Cui, Wang, Long and Liu.)

Impact of Prior Valve Surgery in CRT Patients Aims Cardiac valve surgery (CVS) has been implicated as a potential barrier to optimal response after cardiac resynchronization therapy (CRT) though prospective data regarding outcome remains limited. We sought to determine CRT response in patients with a prior history of CVS. Methods and Results We performed a retrospective analysis of a prospectively acquired cohort of CRT patients with history of CVS. Echocardiographic response was evaluated at baseline and 6 months. The coprimary endpoints were time to first heart failure (HF) hospitalization and a composite of all-cause mortality, transplantation and left ventricular assist device (LVAD) assessed over a 3-year follow-up period. The study group consisted of 569 patients undergoing CRT. Of these, 86 patients had a history of CVS (46.5% aortic, 37.2% mitral, 16.3% combined, and tricuspid), and were compared to 483 patients with no history of CVS. Baseline clinical and echocardiographic characteristics were not significantly different between the groups except for a higher incidence of atrial fibrillation (AF; 74.4% vs. 55.3%; P = 0.001), coronary artery bypass surgery (CABG; 58.1% vs. 38.7%; P = 0.001), and longer QRS duration (167.6 ± 29.3 milliseconds vs. 159.4 ± 27.5 milliseconds; P = 0.01) in those with prior CVS. Survival with respect to HF hospitalization and composite outcome was comparable in both groups. Echocardiographic response (improvement in left ventricular ejection fraction of ≥10%) was similar. No difference in clinical or echocardiographic outcome was found by type of valve surgery performed. Conclusion Despite a higher incidence of AF, CABG, and longer QRS duration, history of CVS is not associated with worse clinical or echocardiographic outcome after CRT. [ABSTRACT FROM AUTHOR]

Background Minimally invasive extracorporeal circulation (MECC) technology was applied predominantly in coronary surgery. Data regarding the application of MECC in minimally invasive valve surgery are missing largely. Patients and Methods Patients undergoing isolated minimally invasive mitral or aortic valve procedures were allocated either to conventional extracorporeal circulation (CECC) group (n = 63) or MECC group (n = 105), and their prospectively generated data were analyzed. Results Demographic data were comparable between the groups regarding age (CECC vs. MECC: 71.0 ± 7.5 vs. 66.2 ± 10.1 years, p = 0.091) and logistic EuroSCORE I (6.2 ± 2.5 vs. 5.4 ± 3.0, p = 0.707). Hospital mortality was one patient in each group (1.6 vs. 1.0%, p = 0.688). The levels of leukocytes were lower in the MECC group (11.6 ± 3.2 vs. 9.4 ± 4.3 109/L, p = 0.040). Levels of platelets (137.2 ± 45.5 vs. 152.4 ± 50.3 109/L, p = 0.015) and hemoglobin (103.3 ± 11.3 vs. 107.3 ± 14.7 g/L, p = 0.017) were higher in the MECC group. Renal function was better preserved (creatinine: 1.1 ± 0.4 vs. 0.9 ± 0.2 mg/dL, p = 0.019).We were able to validate shorter time of postoperative ventilation (9.5 ± 15.1 vs. 6.3 ± 3.4 h, p = 0.054) as well as significantly shorter intensive care unit (ICU) stay (1.8 ± 1.3 vs. 1.2 ± 1.0 d, p = 0.005) for MECC patients. The course of C-reactive protein did not differ between the groups. Conclusion We were able to prove the feasibility of MECC even in minimally invasive performed mitral and aortic valve procedures. In addition, the use of MECC provides decreased platelet consumption and less hemodilution. The use of MECC in these selected patients lead to a shorter ventilation time and ICU stay. [ABSTRACT FROM AUTHOR]

Purpose: Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. Materials and Methods: We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancreatitis based on serum lipase concentration and clinical symptoms (lipase ≥180 U/L or ≥60 U/L with relevant symptoms). Results: Of the 986 patients who underwent cardiac valve surgery with cardiopulmonary bypass, 58 (5.9%) patients developed post-operative pancreatitis. Post-operative hospital stay was significantly longer (29.7±45.6 days vs. 12.4±10.7 days, p=0.005) and in-hospital mortality rate was higher (15.5% vs. 2.0%, p<0.001) in patients with post-operative pancreatitis than those without. Hypertension, chronic kidney disease, and peri-operative use of norepinephrine were identified as independent risk factors for developing pancreatitis after cardiac valve surgery. Conclusion: We found that acute pancreatitis after cardiac valve surgery requires longer hospitalization and increases the in-hospital mortality rate. Clinicians should be aware that patients could develop pancreatitis after cardiac valve surgery, especially in patients with hypertension and chronic kidney disease treated with norepinephrine. [ABSTRACT FROM AUTHOR]

Background: We aimed to demonstrate whether the preoperative transthoracic echocardiography index (TTEI) could improve the predictive value of clinical parameters for cardiac valve surgery-associated acute kidney injury (CVS−AKI). Methods: A total of 213 patients who underwent surgical CVS at Renmin Hospital of Wuhan University were consecutively recruited in this retrospective study. TTE assessments were performed within 7 days before surgery and logistic regression was used to determine TTEI. A nomogram was constructed by integrating TTEI and clinical features, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to evaluate the improvement in TTEI for CVS−AKI. Results: Among them, 66 patients (30.9%) developed CVS−AKI. The TTEI was calculated as follows: −6.579 + 0.068 × pulmonary artery systolic pressure (mmHg) −0.742 × LVEF (>55%, yes or no) + 0.346 × left ventricle posterior wall thickness (mm). The nomogram based on the TEEI and other clinical factors possessed excellent performance (C-index = 0.880), had great calibration and discrimination, and was clinically useful. Furthermore, NRI (0.07, 95% confidence interval, 95%CI, 0.01−0.12, p = 0.02) and IDI (0.08, 95%CI, 0.01−0.20, p = 0.02) indicated that TTEI could significantly improve the predictive value of clinical features for CVS−AKI. Conclusions: As a simple access and cost-effective parameter, the preoperative TTEI may be a reliable and useful factor for CVS−AKI.

Objective: The aim of the present study was to assess the influence of preoperative statin therapy on postoperative mortality in high-risk patients after isolated valve surgery. Design: An observational cohort study. Setting: A 1,200-bed university hospital. Participants: All consecutive patients undergoing isolated nonemergent valve surgery with cardiopulmonary bypass between November 2005 and December 2007 were included. Intervention: None. Measurements and Main Results: During the period, 772 consecutive patients underwent nonemergent isolated valve surgery. Among them, 430 were high cardiovascular risk (defined by patients with 2 or more cardiovascular risk factors). In the high-risk cardiovascular patients, statin pretreatment was administered in 222 patients (52%). In multivariate analysis, after adjustment with a propensity score analysis, preoperative statin therapy was associated with a significant reduction of postoperative mortality in patients with high risk (odds ratio = 0.41; 95% confidence interval, 0.17-0.97; p = 0.04). Low left ventricular ejection fraction and elevated pulmonary artery pressure also were independently associated with increased postoperative mortality. By contrast, in the low-risk patient group, few patients received preoperative statin therapy (7%). Conclusions: This study suggests that preoperative statin therapy may have a potential beneficial effect on postoperative mortality after isolated cardiac valve surgery in high-risk cardiovascular patients. [ABSTRACT FROM AUTHOR]

Copyright of Der Internist is the property of Springer Nature 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.)