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General Thoracic and Cardiovascular... Oct 2023
Review
Topics: Humans; East Asian People; Japan; Societies, Medical; Thoracic Surgery; Thoracic Surgical Procedures; Cardiovascular Surgical Procedures
PubMed: 37470949
DOI: 10.1007/s11748-023-01945-4 -
Circulation Journal : Official Journal... Jun 2009Batista introduced the partial left ventriculectomy (PLV), which is based on physics alone. With experience, it has been found that the extent of myocardial disease and... (Review)
Review
Batista introduced the partial left ventriculectomy (PLV), which is based on physics alone. With experience, it has been found that the extent of myocardial disease and viability of retained muscle is an important determinant of early and late survival. Although the PLV has been almost abandoned in many countries following the negative message from the Cleveland Clinic, it is still alive in Japan with a refined concept, surgical technique and patient selection. In a series of 63 patients undergoing PLV for idiopathic dilated cardiomyopathy since 1996, operative mortality was 9.5%, and 1-, 3- and 5-year survival rates were 71.1%, 56.2% and 45.9%, respectively. Improved survival has obtained by using appropriate patient selection and concomitant restrictive mitral annuloplasty (1-, 3- and 5-year survival rate =86.5%, 78.6% and 59.4%, respectively, in the most recent 33 patients). Because of insufficient availability of donors for heart transplantation, nontransplant cardiac surgery for medically refractory heart failure is important. Ventricular restoration procedures, including PLV, should be seriously considered as an important option for endstage heart failure.
Topics: Cardiomyopathy, Dilated; Cardiovascular Surgical Procedures; Heart Failure; Heart Ventricles; Humans; Japan; Mitral Valve Annuloplasty; Patient Selection
PubMed: 19461154
DOI: 10.1253/circj.cj-08-1075 -
Interactive Cardiovascular and Thoracic... Nov 2012In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay.... (Meta-Analysis)
Meta-Analysis Review
In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic strategy aiming to increase cardiac output, is helpful in preventing postoperative complications, but studies in the context of cardiovascular surgery have produced conflicting results. The purpose of the present meta-analysis is to determine the effects of perioperative haemodynamic goal-directed therapy on mortality and morbidity in cardiac and vascular surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched until July 2011. Randomized controlled trials reporting on adult cardiac or vascular surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included. Primary outcome measures were mortality and morbidity. Data synthesis was obtained by using odds ratio (OR) with 95% confidence interval (CI) by a random effects model. An OR <1 favoured GDT. Statistical heterogeneity was assessed by Q and I(2) statistics. Eleven articles (five cardiac surgery and six vascular procedures), enrolling a total sample of 1179 patients, were included in the analysis. As compared with routine haemodynamic practice, perioperative GDT did not reduce mortality in either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02; statistical power 64%). GDT significantly reduced the number of cardiac patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P = 0.58). Perioperative GDT prevents postoperative complications in cardiac surgery patients, while it has no effect in vascular surgery. The different characteristics and comorbidities of the population enrolled could explain these conflicting results. More trials conforming to the characteristics of low-risk-of-bias studies and enrolling a larger and well-defined population of patients are needed to better clarify the effect of GDT in the specific setting of cardiovascular surgery.
Topics: Cardiac Output; Cardiac Surgical Procedures; Cardiovascular Diseases; Chi-Square Distribution; Comorbidity; Hemodynamics; Humans; Monitoring, Intraoperative; Odds Ratio; Perioperative Care; Postoperative Complications; Risk Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 22833509
DOI: 10.1093/icvts/ivs323 -
The Journal of Thoracic and... May 2020
Topics: Aorta; Blood Vessel Prosthesis Implantation; Cardiac Surgical Procedures; Replantation
PubMed: 31303320
DOI: 10.1016/j.jtcvs.2019.05.055 -
Renal Failure Dec 2022Increased polyclonal free light chains (FLCs) are found in inflammatory conditions. Inflammation is recognized in the progression of acute kidney injury (AKI). This...
OBJECTIVES
Increased polyclonal free light chains (FLCs) are found in inflammatory conditions. Inflammation is recognized in the progression of acute kidney injury (AKI). This study was aimed to determine whether polyclonal combined FLC (cFLC) was associated with prognosis of AKI patients.
METHODS
This prospective cohort included 145 adults with hospital-acquired AKI following cardiovascular surgery between 2014 and 2016, according to the KDIGO creatinine criteria. The primary end point of the study was all-cause death during follow-up.
RESULTS
The median of serum cFLC concentration in the cohort was 42.0 (31.9-60.3 mg/L) and levels of cFLC in patients with AKI stage 3 were higher than those in AKI stage 1 and stage 2. cFLC levels correlated significantly with renal function biomarkers, high sensitivity C-reactive protein (hsCRP), and sequential organ failure assessment (SOFA) score. Patients were organized into the following two groups: the low-cFLC group (cFLC <43.3 mg/L) and the high-cFLC group (cFLC ≥ 43.3 mg/L). A total of 17 (11.0%) patient deaths occurred within 90 d, 13 (18.8%) in the high-cFLC group. Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-d survival (log-rank = .012), and Cox regression analysis showed that an cFLC level ≥43.3 mg/L was significantly associated with a 5.0-fold increased risk of death (adjusted hazard ratio [HR], 5.95; 95% confidence interval [CI], 1.04- 33.91; = .045) compared with an cFLC level <43.3 mg/L.
CONCLUSIONS
Serum cFLC levels were significantly elevated and might be an independent predictor of mortality in patients with AKI following cardiovascular surgery.
Topics: Acute Kidney Injury; Adult; Aged; Biomarkers; C-Reactive Protein; Cardiovascular Surgical Procedures; Cause of Death; Creatinine; Female; Humans; Immunoglobulin Light Chains; Male; Middle Aged; Postoperative Complications; Prognosis; Prospective Studies; Risk Factors; Severity of Illness Index; Survival Analysis
PubMed: 35086423
DOI: 10.1080/0886022X.2021.2013886 -
The Cochrane Database of Systematic... Jul 2015Fresh frozen plasma (FFP) is a blood component containing procoagulant factors, which is sometimes used in cardiovascular surgery with the aim of reducing the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fresh frozen plasma (FFP) is a blood component containing procoagulant factors, which is sometimes used in cardiovascular surgery with the aim of reducing the risk of bleeding. The purpose of this review is to assess the risk of mortality for patients undergoing cardiovascular surgery who receive FFP.
OBJECTIVES
To evaluate the risk to benefit ratio of FFP transfusion in cardiovascular surgery for the treatment of bleeding patients or for prophylaxis against bleeding.
SEARCH METHODS
We searched 11 bibliographic databases and four ongoing trials databases including the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2015), MEDLINE (OvidSP, 1946 to 21 April 2015), EMBASE (OvidSP, 1974 to 21 April 2015), PubMed (e-publications only: searched 21 April 2015), ClinicalTrials.gov, World Health Organization (WHO) ICTRP and the ISRCTN Register (searched 21 April 2015). We also searched the references of all identified trials and relevant review articles. We did not limit the searches by language or publication status.
SELECTION CRITERIA
We included randomised controlled trials in patients undergoing major cardiac or vascular surgery who were allocated to a FFP group or a comparator (no plasma or an active comparator, either clinical plasma (any type) or a plasma-derived blood product). We included participants of any age (neonates, children and adults). We excluded studies of plasmapheresis and plasma exchange.
DATA COLLECTION AND ANALYSIS
Two authors screened all electronically derived citations and abstracts of papers identified by the review search strategy. Two authors assessed risk of bias in the included studies and extracted data independently. We took care to note whether FFP was used therapeutically or prophylactically within each trial.
MAIN RESULTS
We included 15 trials, with a total of 755 participants for analysis in the review. Fourteen trials compared prophylactic use of FFP against no FFP. One study compared therapeutic use of two types of plasma. The timing of intervention varied, including FFP transfusion at the time of heparin neutralisation and stopping cardiopulmonary bypass (CPB) (seven trials), with CPB priming (four trials), after anaesthesia induction (one trial) and postoperatively (two trials). Twelve trials excluded patients having emergency surgery and nine excluded patients with coagulopathies.Overall the trials were small, with only four reporting an a priori sample size calculation. No trial was powered to determine changes in mortality as a primary outcome. There was either high risk of bias, or unclear risk, in the majority of trials included in this review.There was no difference in the number of deaths between the intervention arms in the six trials (with 287 patients) reporting mortality (very low quality evidence). There was also no difference in blood loss in the first 24 hours for neonatal/paediatric patients (four trials with 138 patients; low quality evidence): mean difference (MD) -1.46 ml/kg (95% confidence interval (CI) -4.7 to 1.78 ml/kg); or adult patients (one trial with 120 patients): MD -12.00 ml (95% CI -101.16 to 77.16 ml).Transfusion with FFP was inferior to control for preventing patients receiving any red cell transfusion: Peto odds ratio (OR) 2.57 (95% CI 1.30 to 5.08; moderate quality evidence). There was a difference in prothrombin time within two hours of FFP transfusion in eight trials (with 210 patients; moderate quality evidence) favouring the FFP arm: MD -0.71 seconds (95% CI -1.28 to -0.13 seconds). There was no difference in the risk of returning to theatre for reoperation (eight trials with 398 patients; moderate quality evidence): Peto OR 0.81 (95% CI 0.26 to 2.57). Only one included study reported adverse events as an outcome and reported no significant adverse events following FFP transfusion.
AUTHORS' CONCLUSIONS
This review has found no evidence to support the prophylactic administration of FFP to patients without coagulopathy undergoing elective cardiac surgery. There was insufficient evidence about treatment of patients with coagulopathies or those who are undergoing emergency surgery. There were no reported adverse events attributable to FFP transfusion, although there was a significant increase in the number of patients requiring red cell transfusion who were randomised to FFP. Variability in outcome reporting between trials precluded meta-analysis for many outcomes across all trials, and there was evidence of a high risk of bias in most of the studies. Further adequately powered studies of FFP, or comparable pro-haemostatic agents, are required to assess whether larger reductions in prothrombin time translate into clinical benefits. Overall the evidence from randomised controlled trials for the safety and efficacy of prophylactic transfusion of FFP for cardiac surgery is insufficient.
Topics: Adult; Blood Loss, Surgical; Cardiovascular Surgical Procedures; Child; Elective Surgical Procedures; Erythrocyte Transfusion; Hemostasis, Surgical; Humans; Infant, Newborn; Plasma; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 26171897
DOI: 10.1002/14651858.CD007614.pub2 -
Journal of the American College of... May 2018Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been... (Review)
Review
Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been developed to substantially reduce the incidence of stroke after traditional cardiovascular procedures such as coronary artery bypass grafting, isolated valve surgery, and carotid endarterectomy. Subsequently, with the advent of minimally invasive technologies including percutaneous coronary intervention, carotid artery stenting, and transcatheter valve therapies, operators were faced with a new host of procedural risk factors, and efforts again turned toward identifying novel ways to reduce the risk of stroke. Fortunately, by understanding the procedural factors unique to these new techniques and applying many of the lessons learned from prior experiences, we are seeing significant improvements in the safety of these new technologies. In this review, the authors: 1) carefully analyze data from different cardiac procedural experiences ranging from traditional open heart surgery to percutaneous coronary intervention and transcatheter valve therapies; 2) explore the unique risk factors for stroke in each of these areas; and 3) describe how these risks can be mitigated with improved patient selection, adjuvant pharmacotherapy, procedural improvements, and novel technological advancements.
Topics: Cardiovascular Surgical Procedures; Humans; Postoperative Complications; Stroke
PubMed: 29699618
DOI: 10.1016/j.jacc.2018.02.065 -
The Journal of Thoracic and... Jul 2011
Review
Topics: Animals; Cardiopulmonary Bypass; Cardiovascular Surgical Procedures; Haptoglobins; Hemoglobins; Hemolysis; Humans; Ischemia; Microcirculation; Nitric Oxide; Regional Blood Flow; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 21570697
DOI: 10.1016/j.jtcvs.2011.02.012 -
Brain and Behavior Oct 2019Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to...
OBJECTIVES
Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS.
METHODS
We performed a cross-sectional community-based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively.
RESULTS
0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99-1.98, p = .0572).
CONCLUSIONS
Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.
Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Surgical Procedures; China; Cross-Sectional Studies; Emergency Medical Services; Female; Humans; Intention; Male; Middle Aged; Patient Acceptance of Health Care; Risk Factors; Stroke
PubMed: 31515973
DOI: 10.1002/brb3.1405 -
Brazilian Journal of Cardiovascular... Dec 2020
Topics: Academies and Institutes; Brazil; Cardiovascular Surgical Procedures
PubMed: 33306310
DOI: 10.21470/1678-9741-1-2020-0631