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World Journal of Clinical Cases 2024年第5期12卷 973-979页

作者： Yao-Bang Bai Feng Zhao Zhen-Hua Wu Guo-Ning Shi Nan Jiang Intensive Care Unit Department of Cardiac SurgeryTianjin Chest HospitalTianjin 300222China department of cardiac surgery Tianjin Chest HospitalTianjin 300222China

BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.

关键词： Venoarterial extracorporeal membrane oxygenation Left ventricular thrombosis Cerebral embolism Magnetic Resonance Imaging Therapy Case report

Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of Transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis Dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece Heart Transplantation Unit Onassis Cardiac Surgery CenterAthens 17674Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

关键词： Heart transplantation Multi drug resistant organisms Transplantation complications Transplantation outcome

Clinical application and management of temporary mechanical circulatory support: A clinical consensus

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中华医学杂志(英文版) 2024年第10期137卷 2023 Dec 26页

作者： Dong Nianguo Chen Liangwan Chen Xin Wang Huishan Xiao Yingbin Wang Xianqiang Huang Jinsong Yan Yang Bonde Pramod Sodha Neel Atluri Pavan Maureira Juan Pablo Vincentelli André Yanase Masanobu Wang Yixuan Zhang Haitao Hou Xiaotong Takami Yoshijuki Leprince Pascal Folliguet Thierry Sellke Frank W Chinese Society for Thoracic and Cardiovascular surgery Chinese Association of Cardiovascular Surgeons cardiac Critical Care Professional Committee of Chinese Medical Association Chinese Society of Extracorporeal Life Support European Society of Cardiovascular and Endovascular surgery French Society of Thoracic and Cardiovascular surgery Japanese Society for Cardiovascular surgery Japanese Society of Artificial Organs department of Cardiothoracic surgery Alpert Medical School Brown University Rhode Island Hospital Providence RI USA department of Cardiovascular surgery Department of Surgery University of Pennsylvania Philadelphia PA USA department of Cardiovascular surgery and Transplantation University Hospital of Nancy University of Lorraine Vandoeuvre-lès-Nancy France department of Cardiovascular surgery University Hospital of Lille University of Lille Lille France department of Cardiology Fujita Health University School of Medicine Toyoake Aichi-1192 Japan department of Adult Surgical Intensive Care Unit Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China department of cardiac Intensive Care Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Anzhen Hospital Capital Medical University Beijing China department of Cardiovascular surgery Fujita Health University School of Medicine Toyoake Aichi-1192 Japan department of Cardiovascular surgery Groupe Hospitalier Pitié-Salpêtrière University Pierre et Marie Curie APHP Paris France department of cardiac surgery APHP H?pitaux Universitaires Henri Mondor Créteil F-94010 France department of Cardiovascular surgery Union Hospital of Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China department of Cardiovascular surgery Fujian Medical University Union Hospital Fuzhou Fujian China department of Thoracic and Cardiovascular surgery Nanjing First Hospital Nanjing Medical University Nanjing Jiangsu China department of Cardiovascular surgery General Hospital of Northern Theater Command Shenyang Liaoning China department of Cardiovascular surgery Xinqiao Hospital Third Military Medical University Chongqing China department of Cardiovascular surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing Chi

cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

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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 life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early 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 exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By 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

Effects of combined aerobic,resistance and inspiratory training in patients with pulmonary hypertension:A systematic review

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World Journal of Critical Care Medicine 2024年第2期13卷 168-179页

作者： Christos Kourek Antonia Zachariou Eleftherios Karatzanos Michalis Antonopoulos Theodora Soulele Andreas Karabinis Serafim Nanas Stavros Dimopoulos department of Clinical Ergospirometry Exercise and Rehabilitation Laboratory1^(st)Department of Critical Care MedicineEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece department of Cardiology 417 Army Share Fund Hospital of AthensAthens 11521Greece cardiac surgery ICU Onassis Cardiac Surgery centerAthens 17674AtticaGreece cardiac surgery ICU Onassis Cardiac Surgery CenterAthens 17674Greece 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 Pulmonary hypertension(PH)is a serious progressive disorder of the modern world,characterized by endothelial dysfunction and impaired vasoreactivity.Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity.Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities.However,data regarding the effects of combined exercise training programs in patients with PH still remains limited.AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH.METHODS Our search included all available randomized controlled trials(RCTs)regarding combined aerobic,resistance and inspiratory training programs in patients with PH in 4 databases(Pubmed,PEDro,Embase,CINAHL)from 2012 to 2022.Five RCTs were included in the final analysis.Functional capacity,assessed by peak VO_(2)or 6-min walking test(6MWT),as well as quality of life,assessed by the SF-36 questionnaire,were set as the primary outcomes in our study.RESULTS Peak VO_(2)was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs.Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs(P<0.05).Quality of life was measured in 4 out of 5 RCTs.Although patients improved their quality of life in each group,however,only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls.CONCLUSION By this systematic review,we have demonstrated that combined aerobic,resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH.Such exercise training regimen may be part of the therapeutic strategy of the syndrome.

关键词： Pulmonary hypertension Exercise training Peak VO2 Functional capacity Quality of life

Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors

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World Journal of Critical Care Medicine 2024年第2期13卷 7-10页

作者： Irini Patsaki Stavros Dimopoulos department of Physiotherapy University of West AttikaAthens 12243Greece cardiac surgery Intensive Care Unit Onassis Cardiac Surgery CentreAthens 17674Greece

In this editorial we comment on the detrimental consequences that post-intensive care syndrome(PICS)has in the quality of life of intensive care unit(ICU)survivors,highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU.Although,the syndrome was identified and well described early in 2012,more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 ICU survivors.It is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical,cognitive,or mental health as consequence of critical illness.PICS was described in order:(1)To raise awareness among clinicians,researchers,even the society;(2)to highlight the need for a multilevel screening of these patients that starts from within the ICU and continues after discharge;(3)to present preventive strategies;and(4)to offer guidelines in terms of rehabilitation.An early multidisci-plinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.

关键词： Intensive care unit acquired weakness Physical impairment Quality of life Mental Cognitive function

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

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World Journal of Emergency Medicine 2024年第1期15卷 3-9页

作者： Rashed Alremeithi Quincy K.Tran Megan T.Quintana Soroush Shahamatdar Ali Pourmand department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Center for Trauma and Critical Care Department of Surgerythe George Washington University School of Medicine&Health SciencesWashington DC 20037USA

BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arres

关键词： Traumatic cardiac arrest Emergency thoracotomy Resuscitative endovascular balloon occlusion of the aorta

Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

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中华医学杂志(英文版) 2024年第9期137卷 1069-1077页

作者： Wang Juncheng Liu Hanning Yue Chao Yang Limeng Yang Kai Zhao Yan Ren Huan Zhang Ying Zheng Zhe National Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China department of Cardiovascular surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China department of Vascular surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China department of cardiac surgery Wuhan Asia Heart Hospital Wuhan Hubei China

Background: Patients who undergo coronary artery bypass grafting (CABG) are known to be at a significant risk of experiencing long-term adverse events, emphasizing the importance of regular assessments. Evaluating health-related quality of life (HRQoL) serves as a direct method to gauge prognosis. Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 36 (SF-36) health survey in CABG patients.Methods: The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013. SF-36 assessments were conducted during both the hospitalization period and follow-up. The primary endpoint of the study was all-cause mortality, while the secondary outcome was a composite measure including death, myocardial infarction, stroke, and repeat revascularization. We assessed the relationships between the PCS and MCS at baseline, as well as their changes during the first 6 months after the surgery (referred to as ΔPCS and ΔMCS, respectively), and the observed outcomes.Results: The patients were followed for an average of 6.28 years, during which 35 individuals (35/433, 8.1%) died. After adjusting for clinical variables, it was observed that baseline MCS scores (hazard ratio [HR] for a 1-standard deviation [SD] decrease, 1.57; 95% confidence interval [CI], 1.07–2.30) and ΔMCS (HR for a 1-SD decrease, 1.67; 95% CI, 1.09–2.56) were associated with all-cause mortality. However, baseline PCS scores and ΔPCS did not exhibit a significant relationship with all-cause mortality. Notably, there was a dose-response relationship observed between ΔMCS and the likelihood of all-cause mortality (HRs for the 2nd, 3rd and 4th quartiles compared to the 1st quartile, 0.33, 0.45 and 0.11, respectively).Conclusions: Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG. Better mental health status and recovery indicated better

关键词： Coronary artery bypass grafting Coronary artery disease Prognosis Quality of life Short-Form 36 Risk factor Serial measurements

Isogeometric Analysis of Hyperelastic Material Characteristics for Calcified Aortic Valve

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Computer Modeling in Engineering & Sciences 2024年第6期139卷 2773-2806页

作者： Long Chen Ting Li Liang Liu Wenshuo Wang Xiaoxiao Du Wei Wang School of Mechanical Engineering University of Shanghai for Science and TechnologyShanghai200093China department of cardiac surgery Zhongshan HospitalFudan UniversityShanghai200093China School of Mechanical Engineering and Automation Beihang UniversityBeijing100191China

This study explores the implementation of computed tomography(CT)reconstruction and simulation techniques for patient-specific valves,aiming to dissect the mechanical attributes of calcified valves within transcatheter heart valve replacement(TAVR)procedures.In order to facilitate this exploration,it derives pertinent formulas for 3D multi-material isogeometric hyperelastic analysis based on Hounsfield unit(HU)values,thereby unlocking foundational capabilities for isogeometric analysis in calcified aortic valves.A series of uniaxial and biaxial tensile tests is executed to obtain an accurate constitutive model for calcified active valves.To mitigate discretization errors,methodologies for reconstructing volumetric parametric models,integrating both geometric and material attributes,are introduced.Applying these analytical formulas,constitutive models,and precise analytical models to isogeometric analyses of calcified valves,the research ascertains their close alignment with experimental results through the close fit in displacement-stress curves,compellingly validating the accuracy and reliability of the method.This study presents a step-by-step approach to analyzing themechanical characteristics of patient-specific valves obtained fromCT images,holding significant clinical implications and assisting in the selection of treatment strategies and surgical intervention approaches in TAVR procedures.

关键词： Calcified aortic valves tensile test constitutive relations CT reconstruction isogeometric hyperelastic analysis

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump cardiac surgery Patients: A Single-Center Investigation in Bangladesh

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World Journal of Cardiovascular Diseases 2024年第6期14卷 363-373页

作者： Md. Ahaduzzaman Md. Abir Tazim Chowdhury Munama Magdum Md. Saiful Islam Khan Satyajit Sharma Monoj Tiwari Md. Abul Bashar Maruf Md. Alauddin Omar Sadeque Khan Md. Mostafizur Rahman Mirza Md. Nazmus Saquib department of Cardiothoracic and Vascular surgery Evercare Hospital Dhaka Dhaka Bangladesh department of Preventive and Social Medicine National Institute of Preventive and Social Medicine Dhaka Bangladesh department of Cardiothoracic Anesthesia Evercare Hospital Dhaka Dhaka Bangladesh department of cardiac surgery National Heart Foundation Hospital & Research Institute Dhaka Bangladesh department of Cardiovascular and Thoracic surgery B.P. Koirala Memorial Cancer Hospital Bharatpur Chitwan Nepal department of cardiac surgery United Hospital Limited Dhaka Bangladesh department of cardiac surgery Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh department of cardiac surgery Ibrahim Cardiac Hospital & Research Institute Dhaka Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cyst

关键词： Acute Kidney Injury (AKI) On-Pump cardiac surgery Serum Cystatin C Serum Creatinine Diagnostic Biomarkers Early Detection Cardiopulmonary Bypass Single-Center Study Bangladesh