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Comparison of the prognostic value of frailty assessment tools in patients aged≥65 years hospitalized in a cardiac care unit with acute coronary syndrome

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Journal of Geriatric Cardiology 2022年第5期19卷 343-353页

作者： Wojciech Nowak Ilona Kowalik Małgorzata Kuzin Agnieszka Krauze Anna Mierzyńska Ewa Sadowy Kamil Marcinkiewicz Janina Stępińska Department of Intensive cardiac Therapy National Institute of CardiologyWarsawPoland Clinical Research Support Center National Institute of CardiologyWarsawPoland Department of Coronary Artery Disease and cardiac Rehabilitation National Institute of CardiologyWarsawPoland

BACKGROUND Frailty is associated with adverse events in elderly patients with acute coronary syndrome(ACS).Our aim was to compare the prognostic value of four frailty scales in patients aged≥65 years hospitalized with ACS in a cardiac care unit(CCU).METHODS Patients aged≥65 years with ACS were *** was assessed using the Fried frailty scale(reference standard),the Edmonton Frail Scale(EFS),the FRAIL scale,and the Clinical frailty scale(CFS).The primary end point was all-cause mortality and the secondary end point was unscheduled *** One hundred and seventy four patients aged≥65 years with ACS were *** median follow-up was 637.5 *** was identified in 41.4%,40.2%,39.1%and 36.3%patients by the Fried frailty scale,EFS,FRAIL scale and CFS,*** agreement coefficients were 0.88,0.86,and 0.79 for the FRAIL scale,EFS and CFS,*** the Cox regres-sion model,frailty was associated with all-cause mortality regardless of the scale used(univariate:hazard ratio[HR]95%CI=10.5,2.4-46.8 Fried frailty scale;12.0,2.7-53.4 FRAIL scale;7.1,2.0-25.2 EFS;8.3,2.4-29.6 ***:HR=5.1,1.1-23.8 Fried frailty scale;5.7,1.2-26.8 FRAIL scale;3.7,1.0-14.0 EFS;4.2,1.1-15.9 CFS).The FRAIL scale had the highest *** the uni-variate analysis,frailty was associated with unscheduled rehospitalization(HR=3.2,1.7-6.0 Fried frailty scale;3.4,1.8-6.3 FRAIL scale;3.5,1.8-6.6 EFS;3.1,1.7-5.8 CFS).In the multivariate analysis,only the EFS independently predicted unscheduled rehospit-alization(HR=2.2,1.1-4.63).CONCLUSIONS Frailty assessed by the Fried frailty scale,FRAIL scale,EFS and CFS is associated with all-cause mortality and unscheduled rehospitalization in elderly patients hospitalized in a CCU with *** adjusted HR of the FRAIL scale for all-cause mortality was the highest among the scales compared,whereas the EFS was an independent predictor of unscheduled *** data should be taken into consider

关键词： patients mortality coronary

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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

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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

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Mycobacterium chimaera infections following cardiac surgery in Treviso Hospital, Italy, from 2016 to 2019: Cases report

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World Journal of Clinical Cases 2019年第18期7卷 2776-2786页

作者： Walter O Inojosa Mario Giobbia Giovanna Muffato Giuseppe Minniti Francesco Baldasso Antonella Carniato Francesca Farina Gabriella Forner Maria C Rossi Stefano Formentini Roberto Rigoli Pier G Scotton Infectious Diseases unit Treviso HospitalTreviso 31100Italy Microbiology unit Treviso HospitalTreviso 31100Italy cardiac Surgery unit Treviso HospitalTreviso 31100Italy Health Management unit Treviso HospitalTreviso 31100Italy

BACKGROUND An epidemic of Mycobacterium chimaera (M. chimaera) infections following cardiac surgery is ongoing worldwide. The outbreak was first discovered in 2011, and it has been traced to a point source contamination of the LivaNova 3T heater-cooler unit, which is used also in Italy. International data are advocated to clarify the spectrum of clinical features of the disease as well as treatment options and outcome. We report a series of M. chimaera infections diagnosed in Treviso Hospital, including the first cases notified in Italy in 2016. CASE SUMMARY Since June 2016, we diagnosed a M. chimaera infection in nine patient who had undergone cardiac valve surgery between February 2011 and November 2016. The time between cardiac surgery and developing symptoms ranged from 6 to 97 mo. Unexplained fever, psychophysical decay, weight loss, and neurological symptoms were common complaints. The median duration of symptoms was 32 wk, and the longest was almost two years. A new cardiac murmur, splenomegaly, choroidoretinitis, anaemia or lymphopenia, abnormal liver function tests and hyponatremia were common findings. All the patients presented a prosthetic valve endocarditis, frequently associated to an ascending aortic pseudoneurysm or spondylodiscitis. M. chimaera was cultured from blood, bioprosthetic tissue, pericardial abscess, vertebral tissue, and bone marrow. Mortality is high in our series, reflecting the poor outcome observed in other reports. Three patients have undergone repeat cardiac surgery. Five patients are being treated with a targeted multidrug antimycobacterial regimen. CONCLUSION Patients who have undergone cardiac surgery in Italy and presenting with signs and symptoms of endocarditis must be tested for M. chimaera.

关键词： Mycobacterium chimaera Prosthetic valve endocarditis Spondylodiscitis cardiac surgery infections Case report

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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

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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

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Institutional re-evolution of mitral valve procedures

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Journal of Geriatric Cardiology 2022年第7期19卷 551-554页

作者： Matteo Ponzoni Alessandro Fiocco Raphael Caraffa Matteo Nadali Lorenzo Longinotti Nicola Pradegan Olimpia Bifulco Laura Besola Luca Nai Fovino Giuseppe Tarantini Andrea Colli Gino Gerosa cardiac Surgery unit Department of CardiacThoracicVascular Sciences and Public HealthUniversity of PaduaItaly Interventional Cardiology unit Department of CardiacThoracicVascular Sciences and Public HealthUniversity of PaduaItaly cardiac Surgery unit Department of SurgicalMedical and Molecular Pathology and Critical Care MedicineUniversity of PisaItal

The introduction of transcatheter aortic va-lve replacement changed our approach for those patients with a high-to-prohibitive risk profile,and,more recently,for those with an in-termediate-to-low risk profile.[1]Similarly,patients with mitral valve regurgitation(MVR)can now be-nefit from various transcatheter technologies,whose indications and recommendations are the subject of intense clinical investigation.

关键词： mitral patients transcatheter

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A case report of chylous ascites after cardiac surgery

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Emergency and Critical Care Medicine 2024年第1期4卷 42-45页

作者： Shuaishuai Yuan Pailing Xie Xiantao Liu Peijun Li The University of Hong Kong-Shenzhen Hospital Cardiovascular Medicine Center cardiac Intensive Care unit ShenzhenGuangdongChina.

Background:Chylous ascites(CA),an emulsion rich in triglycerides,is a rare type of ascites,especially after cardiac ***,there are few reports of the occurrence of CA after mitral valve replacement,aortic valve replacement,tricuspid valvuloplasty,and coronary artery bypass *** presentation:We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence,aortic incompetence,tricuspid incompetence,and coronary atherosclerotic heart *** days after surgery,3000 mL of milky-yellow ascites appeared in the abdominal cavity,diagnosed as CA by laboratory *** ascites gradually disappeared after being drained,and the patients *** curative was objective,but the exact cause is not ***:Although CA is rare,it may occur during the surgical intervention in cardiac surgery.

关键词： cardiac intensive care unit cardiac valve replacement Case report Chylous ascites Coronary artery bypass graft Department of cardiac surgery

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3D Non-Fluoroscopic Cryoablation of Right-Sided Accessory Pathways in Children:Monocentric Study and Literature Review

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Congenital Heart Disease 2021年第6期16卷 561-572页

作者： Fabrizio Drago Irma Battipaglia Pietro Paolo Tamborrino Luigina Porco Camilla Calvieri Mario Salvatore Russo Vincenzo Pazzano Romolo Remoli Massimo Stefano Silvetti Pediatric Cardiology and cardiac Arrhythmias unit Department of Pediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly

Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our *** aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping *** and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our ***(14.7%)patients had previously undergone catheter *** procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications *** follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had *** were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the *** rates are not high and patients can be retreated with cryo-energy with higher success rates.

关键词： 3D Mapping accessory pathway children cryoablation pediatric tachyarrhythmias

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Arrhythmic Risk in Paediatric Patients Undergoing Surgical Repair for Pulmonary Atresia with Intact Ventricular Septum

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Congenital Heart Disease 2021年第1期16卷 85-94页

作者： Pietro Paolo Tamborrino Corrado Di Mambro Cecilia Marcolin Walter Vignaroli Giulia Cafiero Gianluca Brancaccio Sonia Albanese Massimo Stefano Silvetti Adriano Carotti Fabrizio Drago Paediatric Cardiology and cardiac Arrhythmia unit Department of Paediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly European Reference Network for Rare and Low Prevalence Complex Disease of the Heart Paediatric cardiac Surgery unit Department of Paediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly Sport Medicine unit Department of Paediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly

Introduction:While previous studies only focused on the arrhythmic risk associated with specific correction strategies,this study evaluates this risk in a large cohort of paediatric patients with all phenotypes of PA-IVS after surgical ***:In this single centre observational cohort study,we retrospectively evaluated 165 patients with a diagnosis of PA-IVS and we excluded those with an exclusively percutaneous treatment,patients lost or with insufficient follow-up and those affected by other arrhythmic *** history and clinical outcomes were ***:86 patients were included in the study(54 male[62.8%],mean age 16.4±6.1 years),with median follow-up from definitive repair of 12.8 years(6.4–18.9 years).They underwent three different final repairs:23 patients(26.7%)univentricular palliation,43(50%)biventricular correction,and 20(23.3%)one and a half ventricle *** patients(15%)developed arrhythmia:6 patients(all the subgroups)sinus node disfunction(SND);2(biventricular repair)premature ventricular complexes;2(one and a half ventricle repair)non-sustained ventricular tachycardia;1(biventricular repair)intra-atrial re-entrant tachycardia;1(one and a half ventricle repair)supraventricular tachyarrhythmia;1(biventricular repair)atrial *** patients with SND needed a pacemaker *** Fontan circulation showed an association with SND,while the other two groups heterogeneous types of ***:The low arrhythmic risk is related to surgical repair,it does not appear to be associated with native cardiomyopathy,and it appears to increase with length of follow *** follow-up in specialized centres is necessary to make an early diagnosis and to manage the potential haemodynamic impact at medium-long term.

关键词： Pulmonary atresia with intact ventricular septum arrhythmic risk univentricular palliation Fontan circulation biventricular repair one and a half repair

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