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Role of Right Ventricular-Pulmonary Arterial Coupling Measured by Echocardiography in Predicting Right Ventricular Dysfunction after cardiac surgery

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World Journal of Cardiovascular surgery 2025年第1期15卷 1-11页

作者： Ismail Nasr El-Sokkary Esam Ahmed Khalil Mohammed Fawzy Eltaweel Ahmed Alherazi Mohammed Samy Bahaa Abdelgawad Elkhonezy Mohamed El Sayed Moussa Mohamed Ahmed Mosaad Zaki Ibrahim Abdel Fattah Yassin Mohamed Kamal Rehan Department of Cardiothoracic surgery Faculty of Medicine Al-Azhar University Cairo Egypt Department of Cardiology Al-Azhar University Faculty of Medicine Cairo Egypt Department of Cardiothoracic surgery Faculty of Medicine Menoufia University Shibin El Kom Egypt Department of Cardiothoracic surgery Faculty of Medicine Alexandria University Alexandria Egypt Department of Internal Medicine Faculty of Medicine Beni Suef University Cairo Egypt

Background: The tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is an indirect estimate of right ventricular-pulmonary arterial (RV-PA) coupling that has been shown to correlate with invasive measures. We aimed to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PASP) as a measure for RV-PA coupling to predict the development of RV dysfunction after cardiac surgery. Methods: This prospective study was conducted on 100 patients with ischemic heart disease and undergoing cardiac surgery (coronary artery bypass graft (CABG)) with normal preoperative right ventricular function, classified according to RV function outcomes into 2 groups: Normal RV group (65 patients) and RV dysfunction group (35 patients). All cases underwent per and postoperative transthoracic echocardiography. Results: By using receiver operating characteristic curve analysis, pre-operative TAPSE/PASP ratio could significantly predict the RV dysfunction (P 0.58, with AUC of 94%, 88.6% sensitivity, and 89.2% specificity. Post-operative TAPSE/PASP Ratio could significantly predict the RV dysfunction (P 0.39, with AUC of 84%, 100% sensitivity, and 76.9% specificity. Pre-operative TAPSE/PASP ratio could significantly predict mortality (P Conclusion: The TAPSE/PASP ratio is an excellent tool for CABG patients for its ability to detect and predict the development of RV dysfunction after cardiac surgery, along with the prediction of mortality in post-operative CABG patients.

关键词： Right Ventricular Pulmonary Arterial Coupling Echocardiography cardiac surgery

Innovations in Pediatric and Congenital cardiac surgery

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Congenital Heart Disease 2022年第1期17卷 1-3页

作者： Vladimiro Vida Pediatric and Congenital cardiac surgery Unit Department of CardiacThoracic and Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly

cardiac surgery is one of the youngest surgical *** a century ago the heart and great vessels were not surgically approachable,and any pathology affecting these structures that needed surgery inevitably led to a poor prognosis[1].The turning point came with the introduction of modern anesthesia and,above all,with the invention of extracorporeal cardiopulmonary circulation.

关键词： surgery anesthesia cardiac

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

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World Journal of Clinical Cases 2023年第16期11卷 3791-3801页

作者： Stavros Dimopoulos Georgios Zagkotsis Charalambia Kinti Niki Rouvali Magda Georgopoulou Mariantzela Mavraki Androniki Tasouli Efterpi Lyberopoulou Antonios Roussakis Ioannis Vasileiadis Serafim Nanas Andreas Karabinis Department of cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece Department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect *** To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical *** This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with *** and multivariate logistic regression analysis was performed to assess predictor variables for AKI *** After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

关键词： Acute kidney injury Renal failure cardiac surgery Predisposing factors Prognosis Outcome

Sonographic muscle mass assessment in patients after cardiac surgery

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World Journal of Cardiology 2020年第7期12卷 351-361页

作者： Stavros Dimopoulos Vasiliki Raidou Dimitrios Elaiopoulos Foteini Chatzivasiloglou Despoina Markantonaki Efterpi Lyberopoulou Ioannis Vasileiadis Katerina Marathias Serafeim Nanas Andreas Karabinis Department of cardiac surgery ICU Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty,experience frequently higher rates of post-operative morbidity,mortality and prolonged hospital length of *** mass wasting seems to play important role in prolonged mechanical ventilation(MV)and consequently in intensive care unit(ICU)and hospital *** To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of *** In this observational study,we enrolled consecutively all patients,following their admission in the cardiac surgery ICU within 24 h of cardiac *** ultrasound scans,for the assessment of quadriceps muscle thickness,were performed at baseline and every 48 h for seven days or until ICU *** strength was also evaluated in parallel,using the Medical Research Council(MRC)*** Of the total 221 patients enrolled,ultrasound scans and muscle strength assessment were finally performed in 165 patients(patients excluded if ICU staycardiac surgery post-ICU admission and is associated with prolong

关键词： Intensive care unit-acquired weakness cardiac surgery Skeletal muscle wasting Muscle ultrasound Quadriceps femoris Muscle mass

Postoperative jaundice after cardiac surgery

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 383-387页

作者： Aikaterini Mastoraki Emmanouil Karatzis Sotiria Mastoraki Ioannis Kriaras Petros Sfirakis Stefanos Geroulanos Department of Surgical Intensive Care Unit Onassis Cardiac Surgery Center356 Sygrou Ave17674 AthensGreece

BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation,to analyze the determinants,and to identify the clinical significance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a cardiac surgery Center,Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting(CABG),group B 31 patients who were subjected to aortic valve replacement(AVR)+CABG and group C 47 patients who underwent mitral valve replacement(MVR)+CABG. Aminotransferases,alkaline phosphatase,gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission,24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS:Hyperbilirubinemia developed in 34 patients(26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-passtime(P<0.001),aortic cross-clamping time(P<0.001),the use of intra aortic balloon pumping(P<0.001),the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin. CONCLUSIONS:Although hyperbilirubinemia seems to be multifactorial,the type of operation,the preoperative hepatic dysfunction due to advanced heart failure(NYHA Ⅱ-Ⅲ) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.

关键词： jaundice conjugated bilirubin cardiac surgery prognosis

Quality of life and functional capacity in patients after cardiac surgery intensive care unit

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World Journal of Cardiology 2024年第8期16卷 436-447页

作者： Vasiliki Raidou Katerina Mitete Christos Kourek Michael Antonopoulos Theodora Soulele Kyriaki Kolovou Ioannis Vlahodimitris Ioannis Vasileiadis Stavros Dimopoulos Clinical Ergospirometry Exerciseand Rehabilitation LaboratoryDepartment of First Critical Care MedicineEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide,leading to morbidity and *** artery bypass grafting(CABG)and surgical aortic valve replacement(SAVR)have therapeutic benefits,including improved postoperative quality of life(QoL)and enhanced patient functional capacity which are key indicators of cardiac surgery *** this article,we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac *** standardized instruments are used to evaluate QoL and functional *** health status,age,length of intensive care unit stay,operative risk,type of procedure,and other pre-,intra-,and postoperative factors affect postoperative *** patients experience impaired physical status soon after cardiac surgery,but it improves in the following *** and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long *** rehabilitation improves patient functional capacity,QoL,and frailty following cardiac surgery.

关键词： Quality of life Health-related quality of life Functional capacity cardiac rehabilitation cardiac surgery Coronary artery bypass grafting Heart valve surgery Heart valve replacement

Effect of Cardioplegia for Myocardial Protection in Pediatric cardiac surgery:A Network Meta-Analysis

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Congenital Heart Disease 2021年第6期16卷 609-645页

作者： Ke Zhou Dongyu Li Xintong Zhang Wensheng Wang Shusen Li Guang Song Department of cardiac surgery Shengjing Hospital of China Medical UniversityShenyangChina Department of Ultrasound Shengjing Hospital of China Medical UniversityShenyangChina

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery;however,which cardioplegia solution has the best protective effect has not been ***,we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac *** databases were searched to identify the relevant randomized controlled trials.A network meta-analysis with a Bayesian framework was *** outcomes included the following biochemical and clinical outcomes:serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively;cardiac troponin I(cTnI)at 4,12,and 24 h postoperatively;spontaneous beating after declamping;postoperative arrhythmias;inotropic support percentage and duration;mechanical ventilation hours;intensive care unit stay in days;hospital stay in days;and *** group treated with cold crystalloid cardioplegia(cCCP)was chosen as the control *** 22 studies involved 1529 *** types of cardioplegia solutions were described in these studies,including cold blood cardioplegia,cCCP,del Nido,histidine-tryptophan-ketoglutarate(HTK),terminal warm blood cardioplegia,and warm blood cardioplegia(wBCP).The serum concentrations of the 24-h cTnI with wBCP(MD=−2.52,95%CI:−4.74 to−0.27)was significantly lower than *** serum concentrations of the 24-h cTnI with HTK(MD=4.91,95%CI:2.84–7.24)was significantly higher than *** was no significant difference in other biochemical and clinical outcomes when compared to *** conclusion,wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

关键词： Cardioplegia pediatric cardiac surgery cardiac troponin I meta-analysis

Short- and Long-Term Outcomes of cardiac surgery in Kidney Transplant Recipients: A Review—Kidney Transplant and cardiac surgery

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World Journal of Cardiovascular surgery 2023年第12期13卷 181-200页

作者： Nael Al-Sarraf Department of cardiac surgery Dabbous Cardiac Center Adan Hospital Kuwait City Kuwait

Background: Cardiovascular diseases remain the leading cause of death in kidney transplant patients and increasing proportion of these patients are referred to cardiac surgery. Data on short- and long-term outcomes of these patients are limited to single center reports with no randomized trials and no prospective studies published previously. The aim of this review was to report both short- and long-term outcomes of these patients. Methods: Literature review was conducted using three databases from inception to June 2022. Multiple search terms were used and limited to English language. Thirty-one relevant articles were included. Outcomes of interest were short-term mortality, long-term survival, renal allograft failure and infection in kidney transplant patients undergoing cardiac surgery. Results: cardiac risk factors (diabetes mellitus, hypertension, hyperlipidemia) were prevalent in kidney transplant patients. 30-days mortality ranged across the studies from zero to 18.8%. The 1-year survival ranged from 71% - 97% and 5-years survival ranged from 31% - 95.7%. Commonest causes of death were cardiac and sepsis. Multiple predictors of mortality were reported. Postoperative acute kidney injury ranged from 0 - 74% with most of them being transient. Kidney graft failure ranged from 0 - 45% with 5-year kidney graft survival rates ranged between 37% - 80%. Post-operative infection rates ranged from 1% - 25% and the most common sites were pneumonia followed by septicemia and surgical site infections. Conclusion: cardiac surgery can be performed in kidney transplant patients with good short- and long-term results.

关键词： Kidney Transplant cardiac surgery Graft Failure Dialysis Immunosuppression

cardiac surgery in Octogenarians and Beyond: Single Center Experience

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Open Journal of Thoracic surgery 2013年第2期3卷 51-56页

作者： Reda E. Al-Refaie Hashem Aliter Ricardo Gallo Ali Youssef Mushabab Al-Murayeh Edwin Ravikumar Department of cardiac surgery and Car- diology Armed Forces Hospitals Southern Region Khamis Mushayt KSA Department of Cardiothoracic surgery Mansoura University Hospitals Mansoura Egypt

Background: Increasing numbers of octogenarians and improvements in surgical techniques and postoperative care have resulted in increasing cardiac operations in this age. The aim is to analyze our experience of cardiac surgery on octogenarians and beyond concerning postoperative morbidities and mortality. Methods: 67 octogenarians and nonagenarians underwent open heart surgery in our hospital between 2001 to 2009 were retrospectively reviewed. Data included baseline preoperative status, intraoperative and perioperative course, and immediate outcomes. Results: The mean age was 86.22 ± 6.1 years. 86.6% patients were males. Symptoms were dyspnea;Class II in 13.4%, Class III in 55.2%, Class IV in 31.4% patients;angina in 82.1%, and CHF in 25.4% patients. The mean EF was 37.8% ± 10. Risk factors include smoking in 52.2%, DM in 37.3%, hypertension in 28.4%, obesity in 25.4%, previous MI in 22.4%, COPD in 17.9%, renal insufficiency in 11.9%, pulmonary hypertension in 7.5%, PVD in 6%, and cerebrovascular disease in 3% patients. The procedures were isolated CABG in 73%, AVR in 9%, MVR in 6%, CABG/valve in 9%, and MVR and AVR in 3% patients. Complications were 18%. It included renal impairment in 18%, arrhythmias in 14.9%, bleeding in 6%, prolonged ventilation in 13.4%, CHF in 4.5%, gastrointestinal bleeding in 4.5%, wound infection in 7.5%, and cerebrovascular accident in 3%. Hospital mortality was 9% patients. Conclusions: cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenarians and beyond. Early referral and proper selection of patients are mandatory to improve immediate postoperative survival.

关键词： Coronary Artery Bypass Graft Valve Octogenarians Nonagenarian