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Incidence of Subclinical Hypothyroidism in Cardiac Surgery Patients. Comparison of Presentation Characteristics, Hospital and Medium-Term Outcomes with Euthyroid Patients

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World Journal of Cardiovascular Surgery 2012年第3期2卷 54-59页

作者： aarne jyrala Nicole M Gatto Gregory L Kay Department of Cardiothoracic Surgery Good Samaritan Hospital Los Angeles USA Department of Epidemiology UCLA School of Public Health Los Angeles USA

Subclinical hypothyroidism (SCHT) is common, with an occurrence of up to 10% of the adult population and defined biochemically only by elevated TSH and normal T4. SCHT affects negatively on lipid and carbohydrate metabolism increasing the risk of ischemic heart disease, affects negatively on cardiac performance and have a close correlation with renal function. The aim of this study is to compare presentation characteristics and outcomes between euthyroid pts and pts with SCHT who underwent cardiac surgery. Methods: 474 pts from June 2003 through September 2004 had TSH and T4 measured. 365 pts were euthyroid (Group 1), 41 pts had SCHT (Group 2). Groups were compared by demographics and EuroSCORE (ES) risk profiles. Operative and hospital outcomes were compared as was follow-up mortality up to 96 months. Results: There were more females in Group 2, p = 0.04, more pts with CHF and number of NYHA III-IV pts (p < 0.05). More pts in Group 2 had elevated s-crea (p < 0.0001) and atrial fibrillation (p = 0.007). Comparing the Groups by EuroSCORE (ES) showed higher risk scores in Group 2 pts (Additive ES 6.8 vs 8.5 and Logistic ES 12.3% vs 18.1%, p = 0.01 and 0.03). Hospital mortality was higher in Group 2 (12.2% vs 4.1%, p = 0.04) and the number of pts needing extended care was higher in Group 2 (p = 0.01). Follow up mortality was doubled in Group 2 pts up to 96 months compared to Group 1 (p < 0.0001). Conclusions: Presentation characteristics and risk scores are different and worse in SCHT pts compared with euthyroid pts. Hospital and follow-up mortality are increased in SCHT pts.

关键词： Hypothyroidism Cardiac Surgery Outcomes

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Changes in presentation and outcomes in cardiac surgery patients aged 70 to 79 years versus patients 80 years or older

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World Journal of Cardiovascular Diseases 2012年第3期2卷 141-147页

作者： aarne jyrala Nicole M. Gatto Gregory L. Kay Department of Biostatistics School of Public Health University of Los Angeles Los Angeles USA Department of Cardiothoracic Surgery Heart Institute at Good Samaritan Hospital Los Angeles USA

Background: To establish which variables between cardiac surgery pts aged 70 - 79 years and 80 years or over are individually different for age group status. Methods: Group 1, 70 - 79 years, n = 351 and Group 2, age 80 or over n = 94. Demographics, operative and hospital outcomes were identified and EuroSCORE (ES) scores applied. Logistic regression uni- and mul-tivariate analysis was used to detect pre- and postop-erative variables which might be independently different between the Groups. Results: Difference (p < 0.05) was noted in (higher in Group 2) patients with CHF, NYHA class, atrial fibrillation, aortic valve disease, both ES algorithms. Group 2 pts had lower ejection fraction and less coronary artery disease. Group 1 had more pts with diabetes. Operative mortality was low (1.7% total) with no difference between the Groups. Length of stay in the postoperative intensive care unit and total hospitalization was equal but Group 2 pts needed more often prolonged stay. Group 2 pts had more postoperative renal failure (p = 0.002) and were more often not discharged home (p = 0.03). Hospital mortality did not reach statistical significance (Group 1 18/5.2%, Group 2 10/10.7%, p = 0.06). Univariate analysis detected 12 pre- and post-operative variables which identified Group status. Multivariate analysis using univariate results detected only diabetes (for Group 1 status) and additive ES (for Group 2 status) to be independently different between the Groups. Conclusions: Elderly pts may be operated with low operative and hospital mortality. Only diabetes and additive ES (=comorbidities) were independently different between the Groups.

关键词： Cardiac Surgery in Elderly Differences Outcomes

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Single Dose Inamrinone in Terminal Warm Cardioplegia in On-Pump Coronary Artery Bypass Patients

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Open Journal of Thoracic Surgery 2012年第1期2卷 5-9页

作者： aarne jyrala Nicole M. Gatto Gregory L. Kay School of Public Health Department of Biostatistics University of California Los Angeles USA. The Heart institute at Good Samaritan Hospital Department of Cardiothoracic Surgery Los Angeles USA

Background: Phosphodiesterase inhibitors (PDI) are used in cardiac surgery to improve and stabilize cardiac function after surgery. The aim of this study is to evaluate changes in hemodynamics and early outcomes when PDI (Inocor/inamrinone) is given in terminal warm blood cardioplegia to on-pump CABG only patients and compare results with patients who did not receive the drug. Material and methods: From April 2003 through September 2004 241 pts underwent elective on-pump CABG only surgery. 141 pts received Inocor in the terminal warm blood cardioplegia (Group 1) and 100 pts did not (Group 2). Results: Demographic data, preoperative EuroSCORE risk scores and operative details were similar. Of pts preoperatively in sinus rhythm (SR) 80.15% in Group 1 and 69.79% in Group 2 regained spontaneous SR (p = 0.07) after release of crossclamp. Inotropic support was needed in 5 pts in Group 1 and in 12 pts in Group 2, p = 0.02. Post cardiopulmonary by-pass (CPB) IABP support was needed for 4 pts in Group 2 and none for Group 1 pts, p = 0.01. There was no operative mortality in either Group and hospital/30 day mortality was similar (3/2.13% vs 3/3.00%, p = 0.69). There were no statistical difference in stay in postoperative intensive care unit (p = 0.15), total hospital stay (p = 0.07), appearance of postoperative atrial fibrillation (p = 0.23) or appearance of postoperative kidney injury (p = 0.27). Post CPB cardiac index improved 16.90% in Group1but decreased 1.49% in Group 2, p < 0.0001. Mean arterial pressure decreased 7.46%in Group 1 pts and 5.08% in Group 2 pts, p = 0.002, but no pts in either Group needed medication for too low blood pressure. Systemic vascular resistance decreased 28.40% in Group 1 and 9.02% in Group 2, p < 0.0001. Conclusions: Inamrinone in terminal warm blood cardioplegia (hot shot) is safe and effective way to improve and stabilize cardiac function after on-pump CABG surgery but does not affect short-term outcomes.

关键词： Phosphodiesterase Inhibitors Postoperative Cardiac Function

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Is Hypothyroidism Overlooked in Cardiac Surgery Patients?

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Open Journal of Thoracic Surgery 2012年第2期2卷 29-35页

作者： aarne jyrala Robert E. Weiss Robin A. Jeffries Gregory L. Kay Heart Institute Department of Cardiothoracic Surgery Good Samaritan Hospital Los Angeles Heart Institute Department of Cardiothoracic Surgery Good Samaritan Hospital Los Angeles USA School of Public Medicine Department of Biostatistics University of California Los Angeles USA

Objectives: to analyze adequacy of preoperative thyroid screening of cardiac surgery patients (pts) with hypothyroidism (HT) and compare with pts without HT by demographic data, EuroSCORE (ES) scores, early and late outcomes. Patients: From 1000 cardiac surgery pts from Jan 1999 through May 2000 pts with HT were identified (Group 1, n = 80). 920 pts (Group 2) had no HT. Results Group 1 pts were older (p 60 years (p = 0.004), more females (p < 0.0001) and higher number of other than CABG surgery pts (p = 0.01) in Group 1. 47 (58.8%) had adequate laboratory tests. 15 (18.8%) had no tests and 18 (22.5%) inadequate tests. 10 (12.5%) pts had no replacement therapy. There was no operative mortality in Group 1 and 14 (1.5%) in Group 2 (p = 0.70). Hospital mortality was higher in Group 1 (6/7.5% vs 37/4.5%), p = 0.03. Stay in postoperative intensive care unit and hospital were similar (p = 0.66 and 0.53). More pts in Group 1 needed prolonged ICU and LOS (p < 0.0001 for both). Occurrence of postoperative AF was higher in Group 1, p < 0.02. Seventeen pts (23.0%) were not discharged home in Group 1 and 87 (10.2%) in Group 2, (p = 0.002). Follow-up mortality was higher in Group 1 (45/58.1% vs 378/43.5%, p = 0.02). Conclusions HT is overlooked in cardiac surgery patients. Long-term mortality is higher in pts with HT. Resource utilization is higher in pts with HT.

关键词： Hypothyroidism Cardiac Surgery Outcome Differences

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