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cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

World Journal of Cardiology 2024年第2期16卷 67-72页

作者： Christos Kourek Stavros Dimopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece cardiac Surgery Intensive Care unit Onassis Cardiac Surgery CenterAthens 17674Greece Clinical Ergospirometry Exercise&Rehabilitation Laboratory1st Critical Care Medicine DepartmentEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of *** complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality *** the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac *** and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle *** mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance *** exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise *** the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac *** incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

关键词： cardiac rehabilitation cardiac surgery Cardiopulmonary exercise testing Early mobilization Treatment Technology

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Surgery for Residual Inferior Left-to-Right Atrial Shunt

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Congenital Heart Disease 2021年第1期16卷 39-43页

作者： Francesco Bertelli Claudia Cattapan Alvise Guariento Vladimiro L.Vida Paediatric and Congenital cardiac Surgery unit Department of CardiacThoracicVascular Sciences and Public HealthUniversity of PaduaPaduaItaly Department of Cardiovascular Surgery The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

We report the case of three female patients who were scheduled for surgical correction of residual left-to-right shunt after initial repair of sinus venosus atrial septal defect(SV-ASD)during *** excluding the possibility of an hemodynamic intervention,all three patients underwent a successful surgical closure through a right mini sub-axillary approach by using total peripheral cannulation for cardiopulmonary bypass and leaving the inferior vena cava completely un-snared allowing for an optimal visualization of the residual atrial septal communication and avoiding extensive dissection of mediastinal structures.

关键词： Residual sinus venosus-ASD un-snared vena cavae minimally invasive cardiac surgery inferior ASD

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Perfusionist strategies for blood conservation in pediatric cardiac surgery

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World Journal of Cardiology 2010年第2期2卷 27-33页

作者： Yves Durandy Perfusion and Intensive Care unit Pediatric Cardiac SurgeryInstitut Hospitalier Jacques CartierMassy 91300France

There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved ***-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and *** techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous *** three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any ***,these three techniques can be used for all the patients,including emergencies and small *** every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.

关键词： Autologous blood predonation Blood conservation Cardiopulmonary bypass Cell-salvage Microplegia Pediatric open-heart surgery Prime volume reduction Retrograde autologous priming Ultrafiltration Vacuum-assisted venous drainage

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Risk factors for sudden cardiac death to determine high risk patients in specific patient populations that may benefit from a wearable defibrillator

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World Journal of Cardiology 2019年第3期11卷 103-119页

作者： Hilal Mohammed Khan Stephen J Leslie cardiac unit Raigmore Hospital Department of Diabetes and Cardiovascular Science University of the Highlands and Islands The Centre for Health Science

BACKGROUND There is a high risk for sudden cardiac death(SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator(ICD) *** conditions such as hypertrophic cardiomyopathy(HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction(MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such *** To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators(WCD).METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction(LVSD), HCM, long QT syndrome(LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table *** We extracted data on relative risk for SCD of specific variables such as age,gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio(HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia(Relative risk 3.50), in LQTS was a prolonged QTc(HR36.53) and in patients with HCM was LVH greater than 20 mm(HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCDCONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.

关键词： Sudden cardiac death Wearable cardiac defibrillators Myocardial infarction Hypertrophic cardiomyopathy Left ventricular systolic dysfunction

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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

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Cardiovascular rehabilitation in patients aged 70-year-old or older:benefits on functional capacity,physical activity and metabolic profile in younger *** patients

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Journal of Geriatric Cardiology 2020年第9期17卷 544-553页

作者： Marta Fontes-Oliveira Maria Trêpa Patrícia Rodrigues Preza Fernandes Sandra Magalhães Sofia Cabral Mário Santos Severo Torres Cardiology Department University Hospital Centre of PortoPortoPortugal cardiac Rehabilitation unit Cardiology DepartmentUniversity Hospital Centre of PortoPortoPortugal Pulmonary Vascular Disease unit University Hospital Centre of PortoPortoPortugal

Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been *** aim was to assess the impact of EBCR in³70-years-old *** post-AMI *** We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 *** evaluated changes in several outcomes based on pre-and post-CRP *** Of a total of 1607 patients,333(21%)were³*** the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in *** the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on *** As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.

关键词： Aging Cardiovascular prevention Exercise-based cardiac rehabilitation

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Prognostic factors in heart failure patients with cardiac cachexia

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Journal of Geriatric Cardiology 2020年第1期17卷 26-34页

作者： Yu Sato Akiomi Yoshihisa Yusuke Kimishima Tetsuro Yokokawa Satoshi Abe Takeshi Shimizu Tomofumi Misaka Shinya Yamada Takamasa Sato Takashi Kaneshiro Masayoshi Oikawa Atsushi Kobayashi Takayoshi Yamaki Hiroyuki Kunii Yasuchika Takeishi Department of Cardiovascular Medicine Fukushima Medical UniversityFukushimaJapan Department of Advanced cardiac Therapeutics Fukushima Medical UniversityFukushimaJapan

Objective To clarify whether cardiac cachexia(CC)alters the prognostic impact of other general risk factors in patients with heart failure(HF).Methods This was an observational *** was defined as the combination of a body mass index of5 mg/L;hemoglobincardiac event and all-cause *** The presence of CC showed significant interactions with other risk factors including cancer,estimated glomerular filtration rate(eGFR),and sodium in predicting these *** Cox proportional analysis revealed that use of a blockers[hazard ratio(HR)=1.900,95%confidence interval(CI):1.045–3.455,P=0.035]and eGFR(HR=0.989,95%CI:0.980–0.998,P=0.018)were independent predictors of cardiac event in the CC group,while age(HR=1.020,95%CI:1.002–1.039,P=0.029)and hemoglobin(HR=0.844,95%CI:0.734–0.970,P=0.017)were independent predictors of all-cause *** survival classification and regression tree analysis showed the optimal cut-off points for cardiac event(eGFR:59.9 m L/min per 1.73 m^2)and all-cause death(age,83 years old;hemoglobin,10.1 g/dL)in the CC *** In predicting prognosis,CC showed interactions with several risk *** function,age,and hemoglobin were pivotal markers in HF patients with CC.

关键词： Body mass index Cachexia Heart failure Mortality Prognosis

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cardiac atrioventricular conduction improved by autologous transplantation of mesenchymal stem cells in canine atrioventricular block models

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Journal of Geriatric Cardiology 2007年第4期4卷 238-243页

作者： Xiaoqing Ren Jielin Pu Shu Zhang Liang Meng Fangzheng Wang cardiac Arrhythmia Center Cardiovascular Institute and Fuwai HospitalCAMS and PUMCBeijing 100037China

Objective Atrioventricular block(AVB)is a common and serious *** present,there is no perfect method of treatment for this kind of *** purpose of this study was to regenerate cardiac atrioventricular conduction by autologous transplantation of bone marrow mesenchymal stem cells(MSCs),and explore new methods for therapy of atrioventricular *** Eleven Mongrel canines were randomized to MSCs transplantation(n=6)or control(n=5)*** models of permanent and complete AVB in 11 canines were established by ablating His bundle with radiofrequency *** 4 weeks after AVB,bone marrow was aspirated from the iliac *** were isolated and culture-expanded by means of gradient centrifugal and adherence to growth technique,and differentiated by 5-azacytidine in *** MSCs(1ml,1.5×10^(7)cells)labeled with BrdU were autotransplanted into His bundle area of canines by direct injection in the experimental group,and 1ml DMEM in the control *** 1-12 weeks after operation,the effects of autologous MSCs transplantation on AVB models were evaluated by electrocardiogram,pathologic and immunohistochemical staining *** Compared with the control group,there was a distinct improvement in atrioventricular conduction function in the experimental *** transplanted in His bundle were differentiated into analogous conduction system cells and endothelial cells in vivo,and established gap junction with host *** The committed-induced MSCs transplanted into His bundle area could differentiate into analogous conduction system cells and improve His conduction function in canine AVB models.

关键词： mesenchymal stem cells His bundle cell transplantation differentiation 5-azacytidine

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Left ventricular pseudoaneurysm formation: Two cases and review of the literature

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World Journal of Clinical Cases 2014年第10期2卷 581-586页

作者： Emmanouil Petrou Vasiliki Vartela Anna Kostopoulou Panagiota Georgiadou Irene Mastorakou Nektarios Kogerakis Petros Sfyrakis George Athanassopoulos George Karatasakis Division of Cardiology Onassis Cardiac Surgery Center Imaging Department Onassis Cardiac Surgery Center Third Department of cardiac Surgery and Transplantation Services Onassis Cardiac Surgery Center

Left ventricular wall rupture(LVWR) comprises a complication of acute myocardial infarction(AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI,and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.

关键词： Pseudoaneurysm Left ventricle rupture Myocardial infarction

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Left main coronary stenosis as a late complication of percutaneous angioplasty:an old problem,but still a problem

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Journal of Geriatric Cardiology 2009年第1期6卷 26-30页

作者： Giuseppe Faggian Gianluca Rigatelli Francesco Santini Giuseppe Petrilli Paolo Cardaioli Loris Roncon Alessandro Mazzucco Division of cardiac Surgery University of Verona Medical School Verona Italy Interventional Cardiology Unit Division of Cardiology Rovigo General Hospital Rovigo Italy Division of Cardiac Surgery University of Verona Medical School Verona Italy Division of Cardiac Surgery University of Verona Medical School Verona Italy Interventional Cardiology Unit Division of Cardiology Rovigo General Hospital Rovigo Italy Interventional Cardiology Unit Division of Cardiology Rovigo General Hospital Rovigo Italy Division of Cardiac Surgery University of Verona Medical School Verona Italy

Objective Accelerated left main coronary stenosis (LMCS) is a known potential late complication of coronary artery catheter procedures. The aim of this study was to assess the current occurrence of LMCS as a delayed complication of percutaneous angioplasty (PTCA) of the left coronary branches in our institution. Methods The medical records of patients referred for coronary artery by-pass surgery from the same Cardiology unit in the January 2003 to December 2006 period and presenting a significant (> 50%) LMCS as a new finding following a PTCA of the left coronary artery branches, were reviewed. Patients with retrospective evidence of any LMCS at previous coronary angiographies preceding the percutaneous procedure were excluded. Results Thirty-seven patients (5 females, mean age 71.1±8.6 years) out of 944 (4%) having undergone a PTCA, fulfilled the inclusion criteria, 19 (51%) after a procedure also involving the LAD coronary artery. Extraback-up guiding catheters were used in most cases. Use of multiple wires or balloons was observed in 3 cases (8%). Rotablator and proximal occlusion device were used in one case respectively (3%). Twenty patients (54%) have had more than one percutaneous coronary intervention on the left coronary branches. The mean time elapsed from the first angioplasty and surgical intervention was 18.1±7.8 months. Conclusions The potential occurrence of LMCS following a percutaneous intervention procedure, especially when complicated and repeated, should not be underestimated in the current era. This evidence may offer the rationale to schedule non-invasive imaging tests to monitor left main coronary patency after the procedure as well as to fuel further research to develop less traumatic materials.

关键词： angioplasty coronary angiography surgery interventional coronary artery disease

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