Cardiac Surgery Centers Research Articles

P160 RIGHT SISTEMIC VENTRICLE AND PREGNANCY

Abstract Patient with complex congenital heart disease: situs inversus with dextrocardia and transposition of the great vessels (D–TGA), right aortic arch and inferior cava agenesis with azygos continuation; at 4 months Mustard atrial switch (intratrial baffle for redirection of the systemic venous circulation in the left subpulmonary left ventricle and of the pulmonary venous circulation in the right subaortic systemic ventricle). At 22 years, 1st pregnancy without complications, caesarean section, birth weight 2.2 kg. Two pregnancies spontaneously terminated in the firts trimester. At 29 years echocardiography: right systemic ventricle hypertrophic, dilated and slightly hypokinetic with tricuspid (systemic) valve with mild to moderate insufficiency; Mustard circuit normally functioning on the systemic side, mild stenosis of the pulmonary buffle (Gmax 6mmHg). At 33 years monochorionic biamniotic twins pregnancy; the risk linked to pregnancy for the patient on the basis of her heart disease was included in a WHO class III worsened by twinning. Because of the high probability of maternal and fetal complications related to the continuation of pregnancy, it was necessary to recommend a selective interruption of the pregnancy of the fetus affected by severe selective underdevelopment with signs of twin to twin transfusion at the 20th week of gestation. Maternal clinical and haemodynamic conditions have been stable during pregnancy. At the 24th week of gestation echocardiography: worsening of the systemic right function ventricle, moderate tricuspid insufficiency and increased gradients in the Mustard circuit (systemic Gmax 13mmHg and pulmonary venous Gmed 8mmHg). After the pregnancy team‘s discussion, a delivery plan was proposed to transfer the patient to a third level cardiac surgery center with experience in congenital heart disease adult between the 35th and 36th week. This was not possible because the patient at 32th week presented preterm labor with caesarean section without maternal and newborn complications (birth weight 1,650 kg). In the puerperium ehocardiography: hypertrophic, dilated and moderately hypokinetic systemic right ventricle with moderate tricuspid insufficiency; Mustard circuit: systemic baffle max gradient 16mmHg and pulmonary venous medium gradient 9mmHg. 7 years after this pregnancy at the last visit: stable clinical and echocardiographic situation with persistence of moderate dysfunction of the systemic right ventricle.

P42 ASCENDING AORTIC DISEASE: IS CURRENT GENERAL PERCEPTION UPDATED TO CURRENT GUIDELINES ??

Abstract Backgroud Thoracic aorta diseases represent a frequent cause of hospitalization and up to 15% of workload of a modern Cardiac Surgery centre. To allow for an accurate monitoring of such activity a dedicated thoracic aorta diseases clinic was launched in January 2019 at our Division. Clinic was open for all new referrals (both by general pratictioner and different specialities clinic) as well as for follow–up of operated on patients. Here we report our analysis of new referrals during past 30 months. Materials and Metods 237 overall patients were seen at clinic. 68 patients (29%) were new referrals; 23 patients (10%) were preoperative follow up and 145 (61%) were postoperative follow up. New referrals were divided in urgent referral (42 pts 62%) and scheduled referral (26 patients 38%). Out of 168 follow up, 22 (12%) were requested as urgent follow up. Majority of urgent new referral were from general pratictioner (21 pts 50%). Results Only 5 patients (2 urgent referral) had surgical indication at time of clinic assessment, according current guidelines. 23 patients (6 urgent referral) were in the so–called grey zone and required close follow–up). 40 patients (34 urgent referral) had no significant aortic diseases to require neither urgent specialist consultation or close follow–up. Out of 181 postoperative follow up, 12 patients required surgical re–intervention none of these were referred with matter of urgency. Despite 56% of new referral did not have recent CT scan evaluation, majority of new referral clearly showed moderate aortic dilatation especially in urgent referral (Fig 1). When considering indexed–dilatation, proportion of patient with moderate dilation raised even more (Fig 2). Conclusions Current perception of clinical severity of thoracic aorta diseases is still sub–optimal. Majority of patients are indeed referred as a matter of urgency despite non–significant aortic ectasia. On other hands, potentially dangerous situation are underestimated by the general practitioner and/or medical specialist. An accurate territorial policy of sensitization and updating about these pathologies is therefore essential to try to reduce the risks of acute aortic syndromes in our country.

Evaluation of some biochemical parameters in Iraqi Patients with cardiomyopathy

Cardiomyopathy is an affliction of the heart muscle that can result in heart failure.It comes in a variety of phenotypes, such as dilated, hypertrophic, and restricted. This study was aimed to investigate the level of physiological and biochemical parameters in Cardiomyopathy patients. Eighty two diagnosed cardiomyopathy adult patients with age range between (20-70) years, and thirty healthy with same range, were involved in this study during their attendance at Ibn Al-Bitar Center for Cardiac Surgery. The patients were diagnosed by an expert cardiologists based on ECG changes, Echocardiogram, chest x ray. The study was conducted from October 2020 to March 2021, and approved by ethical committees: Ref.: CSEC/0920/0052, September 15, 2020 of department of Biology, College of Science, University of Baghdad. Blood samples were collected the levels of biochemical parameters like troponin T, creatine kinase - MB (CK-MB), C-reactive protein (CRP), lactate dehydrogenase (LDH), Urea creatinine and electrolytes (Na+, Ca++, K+ and Mg+) were determined for the patients and control. The levels LDH, CRP) and CK-MB showed a highly significant (P<0.01) increase in patients compared with control, While the level of Troponin T showed non-significant (P≥ 0.05) differences.

Effectiveness of educational program toward patients knowledge about risk factors of coronary heart disease at AL-Najaf center for cardiac surgery and trans theory

Introduction: Coronary illness can regularly be without indication yet individuals with CHD have an expanded danger of angina (chest torment or uneasiness), cardiovascular failure, cardiovascular breakdown, and heart arrhythmias. Angina and respiratory failures are brought about by decreased or hindered blood stream to the heart. Methods: The current study used a quasi-experimental study design consist of two assessments (Pre-program, and exams after program) for study and also control group. The study done during the period from (23rd September 2019 to 4th July 2021) by applying an educational program on patient’s knowledge regarding risk factors of coronary heart disease at (NCCS&TCT)Al-Najaf Al-Ashraf city. A purposive, non-probability sample was selected for the patient who was reviewed for the Najaf Center for Cardiac Surgery and Interventional Catheterization.The sample consists of 74 patients who attend the periodic treatment schedule at the Najaf Center for Cardiac Surgery and Catheter Intervention.The data wascollected through the use of the questionnaire and data analysis by SPSS version 25. Results: The study showed that the A majority of patients participating in the program were males, about 70.8%. The average age of the participating patients ranges between (young adults and old adults).

Assessment of patient's knowledge about risk factors of coronary heart disease at AL-Najaf center for cardiac surgery

Introduction: Coronary heart disease (CHD) is a significant reason for death around the world. Researchers have demonstrated a hold with decrease of coronary heart disease danger agents, for example, raised pulse, elevated lipid levels, abundance of body size, cigarette also absence from activity be able to add to a decrease of coronary heart disease (CHD) death of approximately 40-60%. Methods: A purposive, non-probability sample was selected for the patient who was reviewed for the Najaf Center for Cardiac Surgery and Interventional Catheterization.The selected sample of the target population who fulfilled the specified criteria during a specified period of time. The sample consists of 48 patients who attend the periodic treatment schedule at the Najaf Center for Cardiac Surgery and Catheter Intervention, who have previously been diagnosed with coronary artery disease, and who are subject to continuous treatment and follow-up by the medical and nursing staff in the center. The data was collected through the use of the questionnaire and data analysis by SPSS version 22. Results: The study showed that Level of knowledge during the study groups were not significantly , 31 participants (64.45%) had poor knowledge, 11 (22.91%) had fair and only 6 (12.5%) had good knowledge.

Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial.

BackgroundAnimal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG.Methods and findingsA prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG ± valve procedure and had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat.We studied 303 patients (age 74 ± 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 ± 5,396 ng/L versus 6,452 ± 5,215 ng/L; p = 0.086). One patient died ≤30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed.A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 ± 4,846 ng/L versus 6,824 ± 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data.The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation.ConclusionsInfusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation.Trial registrationClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02592824.European Union Drug Regulating Authorities Clinical Trials Database (Eudra CT number 2011-006241-15).

MO358: Analysis of Acute Kidney Injury Incidence in Patients After Left Ventricle Assist Device Implantation

Abstract BACKGROUND AND AIMS Chronic heart failure (CHF) in the terminal stage is a crucial issue of medicine. Heart transplantation is still the best treatment option. Lack of donors, long waiting time make heart transplantation almost impossible. Implantation of left ventricular assist device—LVAD) in patients with CHF is a bridge to transplantation. Nevertheless, the LVAD implantation procedure is time-consuming, requires significant material costs, and leads to numerous complications in the postoperative period. Acute kidney injury (AKI) is one of the most common and dangerous complications. Issues of AKI in patients with LVAD should be carefully taught. The aim of the study is to examine the incidence of postoperative renal failure after the implantation of LVAD and its relationship to outcomes. In addition, we want to share with our experience of AKI management in patients with LVAD. METHOD A retrospective analysis of 265 medical records of patients after surgical implantation of LVAD who were hospitalized to the National Research Cardiac Surgery Center, Nur-Sultan city, Kazakhstan. Period of hospitalization from 01.2015 to 10.2021 year. The Kidney Disease Improving Global Outcome (KDIGO) criteria were used to define AKI. RESULTS Total number of patients 265 after LVAD implantation. Male—85.66% and female—14.34%. Mean ICU stay of patient without severe AKI—7.17±5.47 days. Mean ICU stay of patient with severe AKI—11.82±7.47 days. Patients with severe AKI and blood purification—59 patients (24.9%), male—61–92.4%, femal—-5–7.6%. Total number of LVAD patients—265. ICU Mortality rate of patients after LVAD implantation—11 patients (4.15%). Severe AKI—59 patients (22.3%). Recovery of AKI—47 patients (79.66%). Transformation to terminal stage of chronic renal disease (CRD) with chronic dialysis—1 patient (1.69%). ICU Mortality rate of patients with severe AKI—11 (18.64%). CONCLUSION AKI is a common complication in the immediate postoperative period after LVAD implantation. AKI negatively affects the outcome of the disease. The mortality rate of LVAD patients with renal insufficiency exceeds by 14% the mortality of patients with renal insufficiency. Blood purification is the effective method of severe AKI therapy.

An Analysis of 400 Sternal Wound Reconstructions at a Single Institution: Bacterial Pathogens Vary With Time.

Sternal wound (SW) infection and dehiscence after median sternotomy from cardiac surgery remain challenging complications with high morbidity. Knowledge of common pathogen types and variance with time from cardiac surgery can simplify the choice of antibiotics while awaiting definitive culture results. Records of 505 patients undergoing SW reconstruction by the senior author from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. The most common indications for reconstruction were SW infection and dehiscence. At surgery, all patients underwent removal of sternal hardware, thorough debridement, and closure with bilateral pectoralis major myocutaneous advancement flaps. Deep tissue and bone cultures were sent in nearly all cases. Patients were split into group 1 or group 2 based on timing of flap reconstruction after initial cardiac surgery: 0 to 30 days and longer than 30 days, respectively. Complete data were available for 400 SW procedures performed during this period. Group 1 included 203 patients, and group 2 had 197 patients, with a mean time to SW surgery of 16.3 and 138.1 days, respectively. Intraoperative cultures were positive in 147 of 203 (72.4%), and 122 of 197 (61.9%) patients, respectively. Forty-four patients grew polymicrobial cultures. There was a significant difference in culture positivity rates in the 2 groups (P = 0.0004). The most common bacteria cultured in group 1 was Staphylococcus epidermidis (54 of 203 vs 21 of 197; P < 0.0001), whereas methicillin-sensitive Staphylococcus aureus was most common in group 2 (15 of 203 vs 22 of 197; P = 0.23). Methicillin-resistant S. aureus was relatively common in both groups (17 of 203 vs 21 of 197; P = 0.50). Although not statistically significant, Pseudomonas, Klebsiella, and Candida were all found in a higher percentage of patients in group 2 (p = 0.11, 0.20, 0.20). Microbial species cultured in SW flap reconstruction vary over time. Staphylococcus epidermidis is the most common infectious agent in patients having reconstruction within 30 days of cardiac surgery, whereas methicillin-sensitive S. aureus is most common after 30 days. The trend toward a higher incidence of Gram-negative and fungal organisms after 30 days may indicate a need for broader initial anti-infective coverage in this patient group. Awareness of these pathogen patterns can better inform antibiotic selection while awaiting culture data.

First Malian series of surgery for rheumatic valve disease: opening of the centre, clinical features and peri-operative realities.

Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali. This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019. The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%. Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

The Role of 2-Dimensional Speckle Tracking Echocardiography in prediction of significant coronary artery

Background: Speckle tracking echocardiography is new technique to evaluate left ventricular function.Objective: To evaluate sensitivity and specificity of two dimension global longitudinal strain ( 2D-GLS) estimated by speckle tracking echocardiography (2D-STE) to predict the diagnosis and degree of severity of CAD( coronary artery disease) in patient suspected to have stable ischemic heart diseases (IHD).Patients and Methods: An observational cross-sectional study, patients underwent echocardiography (TTE), left ventricular (LV)systolic function were estimate initially, (calculate LVEF) then assessment of LV global and regional longitudinal strain (GLS) were calculated next.All patient underwent coronary angiography in the catheterization unite and according to the result of coronary angiography, we separated patients into two groups: one how have significant (≥70%) coronary arteries stenosis (group A),and another group with non- significant(&lt;70%) coronary arteries stenosis (group B). The study was done in echocardiography unit and catheterization lab in Ibn-Albitar center of cardiac surgery, the study carried out from April 2018 to May 2019. Results: This study 93 patients were included , there is mean ages was (60.2 ±6.3) years, majority of cases were males (72.0%), 47.3% of all cases had ≥3 risk factors, and according to angiography study (67.7%) had significant CAD .The frequency of DM, dyslipidemia, and the occurrence of ≥3 risk factors were significantly elevated in group A(patients with significant coronary artery stenosis ) in comparison to the group B. Mean EF and GLS were considerably lower in group A related to group B. There was not much difference in GLS between single and two vessels involvement, however, the GLS value in three vessels was significantly lower compared to single and two vessels involvement. GLS were independent predictor of significant coronary artery stenosis, independent of the effect DM, dyslipidemia, and the presence of ≥3 concomitant risk factor. Conclusion: Assessment (GLS) value by 2D speckle tracking echocardiography is good test for predicating diagnostic and severity of coronary arteries diseases, global longitudinal strain had positive relationship with increasing number of stenotic coronary arteries, and provides high quantitative diagnostic information for detection of the CAD. Keywords: Echocardiography, significant coronary artery disease

Comparison of free arterial and saphenous vein grafting in outcomes after coronary bypass surgery

Objectives. The goal of this study was to examine whether the use of free arterial grafts could reduce the need for repeated revascularization and all-cause mortality in patients undergoing coronary artery grafting. Design. The cohort study included 17,354 consecutive adults with isolated coronary artery grafting from 2000 to 2016 in three cardiac surgery centers. Data were obtained from the Western Denmark Heart Registry. Propensity matching with 24 factors was used to establish comparable groups of patients receiving either vein grafts (n = 1019) or free arterial grafts (n = 1019) for outcome analysis. Results. The need for repeated revascularization and all-cause mortality was similar in both graft groups at 10 years of follow-up. Creatine-Kinase MB Isoenzyme >100 μg/L increased the risk of repeated revascularization rate after 1, 5 and 10 years. Conclusions. Long-term outcomes in revascularization and survival are comparable after free arterial or saphenous vein grafting.

Feasibility of Transcatheter Closure of Large Secundum Atrial Septal Defect with Absent Superior or Inferior Rim.

Introduction Surgical closure of a large secundum atrial septal defect (ASD) with an absent superior or inferior rim is the standard method of management, but transcatheter closure of such a defect is possible and feasible. Objectives To evaluate the feasibility, effectiveness, and safety of transcatheter closure of large secundum ASD with an absent superior or inferior rim through implantation of a cheatham platinum (CP) stent at the entrance of the superior vena cava (SVC) or inferior vena cava (IVC) into the right atrium (RA) to create a suitable rim for subsequent complete closure of the defect using a septal occluder. Patients and Methods. This case series was carried out at Ibn Al-Bitar Center for Cardiac Surgery, Baghdad, Iraq from 2014 to 2019, five patients underwent such transcatheter approach for closure of large secundum ASD with the absent superior or inferior rim by implantation of CP stent at the entrance of vena cave into the RA. Result The ages and weights of patients who were enrolled in this study ranged from 9–31 years (15.2 ± 9 years) and 31.5–62 kg (42.6 ± 12 kg). Three patients had absent superior rims, and the other two had absent inferior rims. The Qp/Qs was ranged from 1.9–3.2 (2.78 ± 0.29), and the mean pulmonary arterial pressure ranged from 22–29 mmHg (25.4 ± 3 mmHg). The defects with an absent superior rim were closed successfully by implantation of CP stents of 45, 45, and 39 mm to create a rim which supported the left atrial disc of 30, 38, and 32 mm atrial septal occluder (ASO), respectively, while large secundum ASD with an absent inferior rim could be effectively closed by implantation of two overlapping bare CP stents of 45 mm to create an IVC rim that supported 34 mm and 30 mm atrial septal occluder. Conclusion and recommendation. Transcatheter closure of large secundum ASD with absent superior or inferior rim is possible and effective by implantation of covered and bare CP stents at the entrance of SVC and IVC, respectively. Although these procedures are relatively difficult and challenging, especially in the closure of large defects associated with absent inferior rim, they carry a high risk of stent migration (8 zig, 45 mm), so we recommend using a CP-stent (10 zig, 60 mm).

The First Multidisciplinary Heart Failure Clinic in Sudan: A Descriptive Report

Outcomes for patients with heart failure (HF) remain suboptimal worldwide, despite the national and international guidelines. A disease management program such as a multidisciplinary (MD) team HF clinic proved to be one of the effective strategies to improve patients’ outcomes. In June 2018, the first MD-HF clinic was opened at Ahmed Gasim Cardiac Surgery and Renal Transplantation Center, Khartoum, Sudan. This focused report aims to share our experience and pave the way for such an approach for cardiac and other specialty services that may require MD-specialized clinics. We provide a detailed report of the MD team, structure, facilities, and plans of the HF clinic, which may be considered as a nucleus for an advanced HF program and heart transplant in Sudan.

Розроблення українських версій анкет для оцінки терапевтичного альянсу та задоволеності фізичною терапією на підставі опитувань кардіохірургічних пацієнтів

The purpose of the study is to conduct intercultural adaptation of the questionnaires for the assessment of the therapeutic alliance, satisfaction with physical therapy in the Ukrainian language and verification of the validity and reliability of these versions of the tools. Materials and methods. The study involved 250 patients (32.4% – women; Me (25%; 75%) values of age 63 (56; 69) years) who underwent heart surgery on the basis of the State Institution "Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine” (Kyiv), as well as 10 employees of the Department of Physical Therapy and Occupational Therapy of the National University of Physical Education and Sport of Ukraine. Three tools were used in the work. The first one was the Working Alliance Inventory for the patient, namely the SR Hatcher Client form (WAI-SR-C). The Hatcher Therapist form (WAI-S-T), which consists of 10 items, was used for specialists (physical therapists). An adapted version questionnaire of the Scale patient satisfaction with physical therapy (SPSPT) adapted by Ampiah P. K. and co-authors was taken for translation into Ukrainian. The questionnaire includes 17 items. Results and discussion. The proposed versions of the questionnaires went through all stages of translation and intercultural adaptation, which meets international standards. A sufficient number of translators, a science editor and a group of patients were involved in the process to conduct cognitive interviews. The test of statistical hypotheses to confirm the content validity (including face validity) found sufficient relevance and completeness of the questions of all questionnaires, as all completed questionnaires did not contain blank items, and the minimum and maximum scores (floor and ceiling effects) for the overall score were less than 15%. A sufficient level of construct validity was also confirmed, as no differences were found in the overall scores of the questionnaires between the groups of patients who were formed by sex and age. At the same time, the verification of discriminant validity found that the items of all three questionnaires have a sufficiently high resolution property, and the instruments have a high discriminant validity. Ukrainian versions of the questionnaires have high levels of internal consistency, which indicates their reliability. The analysis of the results of the test-retest procedure confirmed the high reliability of the questionnaires. There are three factors in the structure of each tool. Conclusion. The developed Ukrainian versions of the questionnaires can be used to assess the level of therapeutic alliance and patient satisfaction in the field of physical therapy and occupational therapy

Meta-Analysis and Systematic Review of Coagulation Disbalances in COVID-19: 41 Studies and 17,601 Patients.

IntroductionCoagulation parameters are important determinants for COVID-19 infection. We conducted meta-analysis to assess the association between early hemostatic parameters and infection severity.MethodsElectronic search was made for papers that addressed clinical characteristics of COVID-19 patients and disease severity. Results were filtered using exclusion and inclusion criteria and then pooled into a meta-analysis to estimate the standardized mean difference (SMD) with 95% confidence interval (CI) for D-dimers, fibrinogen, prothrombin time, platelet count (PLT), activated partial thromboplastin time. To explore the heterogeneity and robustness of our fundings, sensitivity and subgroup analyses were conducted. Publication bias was assessed with contour-enhanced funnel plots and Egger's test by linear regression. Coagulation parameters data from retrospective cohort study of 451 patients with COVID-19 at National Research Center for Cardiac Surgery were included in meta-analysis of published studies.ResultsOverall, 41 original studies (17,601 patients) on SARS-CoV-2 were included. For the two groups of patients, stratified by severity, we identified that D-dimers, fibrinogen, activated partial thromboplastin time, and prothrombin time were significantly higher in the severe group [SMD 0.6985 with 95%CI (0.5155; 0.8815); SMD 0.661 with 95%CI (0.3387; 0.9833); SMD 0.2683 with 95%CI (0.1357; 0.4009); SMD 0.284 with 95%CI (0.1472; 0.4208)]. In contrast, PLT was significantly lower in patients with more severe cases of COVID-19 [SMD −0.1684 with 95%CI (−0.2826; −0.0542)]. Neither the analysis by the leave-one-out method nor the influence diagnostic have identified studies that solely cause significant change in the effect size estimates. Subgroup analysis showed no significant difference between articles originated from different countries but revealed that severity assessment criteria might have influence over estimated effect sizes for platelets and D-dimers. Contour-enhanced funnel plots and the Egger's test for D-dimers and fibrinogen revealed significant asymmetry that might be a sign of publication bias.ConclusionsThe hemostatic laboratory parameters, with exception of platelets, are significantly elevated in patients with severe COVID-19. The two variables with strongest association to disease severity were D-dimers and fibrinogen levels. Future research should aim outside conventional coagulation tests and include analysis of clotting formation and platelet/platelet progenitors characteristics.

Impact of the 2009 ESC Guideline Change on Surgically Treated Infective Endocarditis

BackgroundIn 2009, updated European Society of Cardiology guidelines on the prevention, diagnosis, and treatment of infective endocarditis (IE) were released and restricted the use of antibiotic prophylaxis to high-risk patients only. The aim of this study was to analyze the effect of the restrictive antibiotic regimen on the incidence and manifestations of surgically treated IE before and after the guideline change. MethodsThis study retrospectively analyzed data of 4917 patients who underwent valve surgical procedures for IE between 1994 and 2018 in 6 German cardiac surgery centers. Potential risk factors for 30-day mortality were assessed using logistic regression. Interrupted time series regression was used to evaluate the effect of the guideline change on the manifestation of IE. ResultsA total of 2014 patients (41%) underwent surgical procedures before the guideline change, and 2903 patients (59%) underwent surgical procedures after the change. After 2009, patients were older (67.0 years [interquartile range, 56.0-74.0 years] vs 64.0 years [interquartile range, 52.0-71.0 years]; P < .001), and they presented with more comorbidities, such as hypertension (56.9% vs 41.7%; P < .001), diabetes (27.4% vs 24.4%; P = .020), peripheral artery disease (8.5% vs 6.5%; P = .011), and preoperative acute kidney injury (42.8% vs 31.9%; P < .001). Patients had worse clinical outcomes with respect to 30-day mortality (18.1% vs 14.3%; P = .001) and 1-year mortality (37.1% vs 29.1%; P < .001). An increase in Streptococcus-related IE (P = .002) and an increase in mitral valve IE (P = .035) were observed after the guideline change. ConclusionsSince 2009, there has been a significant increase in the incidence of mitral valve IE and Streptococcus-related IE. Patients undergoing surgical procedures for IE present with more comorbidities, which contribute to high mortality rates.

Wearable cardioverter defibrillator multicentre experience in a large cardiac surgery cohort at transient risk of sudden cardiac death.

OBJECTIVESThe wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare.METHODSRetrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data.RESULTSA total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57–73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7–23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22–32%) before WCD prescription to 35% (IQR 28–42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD.CONCLUSIONSThe risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF.

Post-transplant Diabetes Mellitus in Kidney Transplant Recipients in Sudan: A Comparison Between Tacrolimus and Cyclosporine-Based Immunosuppression.

Hyperglycemia is a common complication among transplant patients without a history of diabetes mellitus (DM). Although new and potent immunosuppressants have improved short and long-term outcomes after transplantation, these drugs themselves may be associated with a greater risk of hyperglycemia. The present study aimed to determine the prevalence of post-transplant diabetes mellitus (PTDM) in post renal transplant patients in Sudan, and compare the effect of cyclosporine and tacrolimus-based immunosuppressive regimens. All adult kidney transplant recipients without pre-transplant diabetes who attended the transplant clinic at Ahmed Gasim Cardiac Surgery and Renal Transplant Center in Sudan were included. A total of 100 cases with functioning kidney allografts were enrolled in this study. The majority of cases were in the age range between 20 and 60 years (92%). Males and females were nearly equally distributed (56% vs 44%). Fifty-two percent of patients were on cyclosporine and 48% on tacrolimus. Overall, 18% of patients suffered from post-transplant diabetes mellitus. There was no statistically significant difference between tacrolimus and cyclosporine with regards to the prevalence of hyperglycemia (16.6% versus 13.4%; p>0.05).

Early result of minimally invasive left atrial myxoma resection at Cardiovascular Center - E hospital

Objectives: The study aimed to evaluate clinical and paraclinical characteristics of left atrial myxoma and the early result of minimally invasive left atrial myxoma resection at E hospital.&#x0D; Patients and methods: This is retrospective, descriptive study of consecutive patients, who underwent minimally invasive left atrial myxoma rejection, using total or video-assisted endoscopic technique from October 2016 to March 2021 at E hospital. There were 31 patients, consisting of 27 females and 04 males. The mean age was 53 ± 13 years old (range [17-74]).&#x0D; Results: Preoperative clinical manifestations were diverse. Asymptomatic form was in 3 patients (9.7%), hemodynamic symptoms were in 26 patients (83.9%), embolism were presented in 4 patients (12.9%), systemic symptoms were in 8 patients (25.8%). Anemia and elevated erythrocyte sedimentation rates were observed in 45.2% and 74.2%, respectively. Echocardiography results: the average tumor size was 4.2 ± 1.7 cm (range [1.7-8]), the site of attachment was mainly in the atrial septum (77.4%). Cardiopulmonary bypass time was 158 ± 43 minutes (range [100-252]), cross-clamp time was 84 ± 34.2 minutes (range [42-153]), ventilation time was 10,8 ± 7,0 hours (range [3-30]), intensive care unit stay was 1,5 ± 1,0 days (range [0.5-4]), and in-hospital stay was 9.5 ± 5.0 days (range [3-30]). There was no hospital mortality. Cerebrovascular accident was presented in one (3.2%), femoral artery stenosis was in one (3.2%), atrial fibrillation after surgery was in one(3.2%).There was no bleeding, that require reoperation, and no other serious complications.&#x0D; Conclusions: Initial results of left atrial myxoma resection, using minimally invasive total or video-assisted technique wassafe and effectivewith low complications, could be recommended toapply routinely in cardiac surgery centers.

Devising a pro forma for dental screening of patients before invasive cardiac surgery.

Certain types of invasive cardiac surgery can place patients at risk of developing infective endocarditis from dental pathology or dental treatment. University Hospital Bristol and Weston NHS Foundation Trust is the regional centre for cardiac surgery in the South West of the UK and is part of the South Wales and South West Congenital Heart Disease Network. As part of this network, the Special Care Dental Department within Bristol Dental Hospital provides dental screening for patients pending invasive cardiac surgery. These are conducted to identify dental pathology in individuals who will be at risk of infective endocarditis, so where possible, they are rendered dentally fit before their surgery.Presented is the information that led to the creation of a screening pro forma, for the dental assessment of patients before invasive cardiac surgery, suitable for use in primary or secondary care. This was produced following an audit, to ensure that along with identifying sources of dental pathology, the dental screening is also documenting the risk of dental pathology and modifiable risk factors. This enables tailored preventative advice which is important to help reduce a patient's lifetime risk of infective endocarditis from dental pathology. Other information used to help develop the pro forma taken from the audit, regional and national guidance is also discussed.