Cardiac Surgery Hospital Research Articles

Prognostic value of coronary calcification detected via non-electrocardiogram-gated computed tomography in patients with cardiovascular disease: A retrospective cohort study

BackgroundThe correlation between coronary artery calcification (CAC) detected via electrocardiogram-gated computed tomography (ECG-gated CT) and future cardiovascular events has been well-established. Non-ECG-gated CT is simple and widely used, making it suitable for screening. However, the correlation between CAC observed via non-ECG-gated CT and cardiovascular and non-cardiovascular events remains unclear. Therefore, we examined the association between coronary calcification detected via non-ECG-gated CT and prognosis. MethodsThis non-randomized, retrospective cohort study included 353 consecutive patients with cardiovascular diseases (male/female 229/124; mean age, 68.6 ± 12.7 years) who underwent non-ECG-gated CT between October 1, 2017 and May 31, 2021. Correlations between the Agatston score and cardiovascular and non-cardiovascular events were evaluated. The Agatston scores were divided into three tertiles (low, intermediate, and high) and compared. The primary endpoint was composite cardiovascular events, including cardiac death, myocardial infarction, hospitalization for congestive heart failure, stroke, and unplanned cardiac surgery. The secondary endpoint was composite non-cardiovascular events, including non-cardiovascular death, cancer development, and hospitalization for a non-cardiovascular worsening event. ResultsDuring the median follow-up period of 16.9 (interquartile range, 2.2–38.6) months, 83 patients reached the primary endpoint, while 81 patients reached the secondary endpoint. Kaplan–Meier analysis indicated that patients with high Agatston scores had a significantly higher incidence of cardiovascular and non-cardiovascular events than those with low Agatston scores (p < 0.001). ConclusionsIn this study, the Agatston score obtained using non-ECG-gated CT predicted cardiovascular and non-cardiovascular events. Non-ECG-gated CT can be easily performed, aiding early detection in patients with high event rates.

Practical experience in developing and implementing standard operating procedures for preventing patient falls in the hospital in the activities of medical staff

Today, the quality of nursing care directly depends on the level of training and competence of the staff, new forms of care, practical experience and skills in working with modern technologies. Target. To study the experience of improving innovations in the work of nurses-anesthesiologists of the anesthesiology and resuscitation department in connection with high-tech open-heart surgeries, in particular, during the implantation of mechanical left ventricular bypasses and orthotopic heart transplantation. Results. Nurses-anesthesiologists play a key role in providing high-quality care to patients in a cardiac surgery hospital. Innovations help the nurse improve monotonous and routine tasks, speed up and facilitate patient care, ensure safety during manipulations, increase the speed and quality of the treatment and diagnostic process, reduce staff labor costs, save the nurse’s time. Much attention in the center is paid to training, continuous professional development of highly qualified personnel. Conclusion. Improvements in the work of mid-level medical personnel, in particular, nurse anesthetists, are a key area for improving the quality and safety of medical care in a cardiac surgery hospital. Further development of competencies, training, implementation of new technologies and strengthening of teamwork will optimize the work of the entire treatment process.

Comparing health care outcomes before and after employing nurse practitioners in cardiovascular hospitals in Japan: A retrospective chart review.

There are approximately 872 certified nurse practitioners (NPs) in Japan as of April 2024. However, research on the results of their specific activities is still scarce. This study aimed to compare health care outcomes before (i.e., 2019) and after (i.e., 2021) employing NPs in cardiovascular hospitals in Japan. We conducted a retrospective chart review and analyzed 114 patients who underwent cardiac surgery in Hospital A and 381 patients who received pacemaker implantation/replacement in Hospital B. Hospital A hired one NP for cardiac surgery service, and Hospital B hired one NP for pacemaker device service. The NPs assisted in the surgical procedures and provided postsurgical management. In Hospital A, the median length of hospitalization and intubation were shorter in 2021 than in 2019 ( p = .02 and .01, respectively). In Hospital B, medical fee reimbursement was lower in 2021 ( p < .001) than in 2019, and the median procedure duration was shorter ( p = .01), which remained statistically significant after controlling for age, comorbidities, and device types. Some outcomes improved following the employment of NPs, whereas others remained unchanged. Nurse practitioners managed surgical patients well and contributed to the quality care of cardiovascular medicine. The employment of NPs in Japan is encouraged because even a single NP can have a positive, although not large, impact on patients and organizations.

Comparison of ََQuality of Life and Treatment Satisfaction among Sample of Iraqi Patients Using Anticoagulant Therapy (Warfarin or Non-Vitamin K Antagonist Oral Anticoagulants)

Background: Oral anticoagulation medication, warfarin and non-vitamin k antagonist oral anticoagulants (NOAC) may require long term use which may affect patients’ satisfaction with their treatment and their quality of life (QOL). Objective: To compare the quality of life and treatment satisfaction among groups of patients using different anticoagulant therapies (warfarin and NOAC). Patients and methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital for cardiac surgery in Baghdad in the period between December 2022 to May 2023. The study population included a convenient sample of patients receiving either warfarin or non-vitamin k antagonist oral anticoagulants treatment. The Arabic version of the short form 12 (SF-12) questionnaire and the Anti-Coagulant Treatment Satisfaction Scale (ACTS) questionnaire were used to assess the quality of life and satisfaction with treatment respectively. Results: The study included 181 patients in total. The mean physical and mental quality of life scores for study participants were 42.3±9.92 and 52.6±10.36 respectively. There was no significant difference in the QOL between patients taking warfarin and those on non-vitamin k antagonist oral anticoagulants treatment. The mean total satisfaction score was 65.4±6.73. Patients receiving non-vitamin k antagonist oral anticoagulants had significantly higher satisfaction compared to those receiving warfarin (P=0.000). The physical score correlated significantly with gender, educational level, employment status, number of chronic medications and number of chronic diseases. The total satisfaction score correlated significantly with gender, number of chronic medications, number of side effects and duration of anticoagulation. There was a significant correlation between the QOL and treatment satisfaction (P=0.000). Conclusion: Treatment with non-vitamin k antagonist oral anticoagulants showed comparable QOL and higher treatment satisfaction than that of warfarin. Better treatment satisfaction can improve patients’ QOL which may ultimately enhance their adherence to treatment.

Preparation and Characterization of Isradipine as Surfactant-Free Dry Emulsion

Background: Oral anticoagulation medication, warfarin, and non-vitamin K antagonist oral anticoagulants (NOAC) may require long-term use which may affect patients’ satisfaction with their treatment and their quality of life (QOL). Objective: To compare the quality of life and treatment satisfaction among groups of patients using different anticoagulant therapies (warfarin and NOAC). Methods: A cross-sectional study was performed at Ibn Al-Bitar Hospital for cardiac surgery in Baghdad in the period from December 2022 to May 2023. The study population included a convenient sample of patients receiving either warfarin or non-vitamin k antagonist oral anticoagulants treatment. The Arabic version of the short form 12 (SF-12) questionnaire and the Anti-Coagulant Treatment Satisfaction Scale (ACTS) questionnaire were used to assess the quality of life and satisfaction with treatment respectively. Results: The study included 181 patients in total. The mean physical and mental quality of life scores for study participants were 42.3±9.92 and 52.6±10.36 respectively. There was no significant difference in the QOL between patients taking warfarin and those on non-vitamin k antagonist oral anticoagulant treatment. The mean total satisfaction score was 65.4±6.73. Patients receiving non-vitamin k antagonist oral anticoagulants had significantly higher satisfaction compared to those receiving warfarin. The physical score correlated significantly with gender, educational level, employment status, number of chronic medications, and number of chronic diseases. The total satisfaction score correlated significantly with gender, number of chronic medications, number of side effects, and duration of anticoagulation. There was a significant correlation between the QOL and treatment satisfaction. Conclusion: Treatment with non-vitamin K antagonist oral anticoagulants showed comparable QOL and higher treatment satisfaction than that of warfarin. Better treatment satisfaction can improve patients’ QOL which may ultimately enhance their adherence to treatment.

Exogenous Insulin Effect on the Initiation of Breast Cancer in Type 2 Diabetes Mellitus Patients

Background: Growing evidence has indicated that women with type 2 diabetes mellitus are at an increased risk of developing breast cancer. However, as a major adjuvant treatment, the influence of hormone therapy such as exogenous insulin on type 2 diabetes mellitus in primary breast-cancer remains controversial. Objective: To explore the relationship between different types of hypoglycemic medications for diabetes and the factors that may contribute to the initiation of breast cancer. Methods: The study included 80 blood samples taken from 80 females recruited from Ibn Al-Bitar Center for Cardiac Surgery Hospital in Baghdad, Iraq, between November 2022 and February 2023. They were within the age range of 40 to 70 years. They were divided into three groups according to the treatment strategy and duration of disease as follows: Group 1: (20) patients who take insulin only, Group 2: (20) patients who take metformin with insulin, and G 3: (40) patients on metformin only for less than one year. An enzymatic oxidation technique was used to test the following biochemical parameters for all research groups: Total cholesterol, triglycerides, fasting blood glucose, and high-density lipoprotein cholesterol. Using the Friedewald formula, the very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol were determined. Using an enzymatic process, Insulin levels and Insulin like growth factor-1(IGF-1), Estrogen receptor alpha (ERα) levels, and breast cancer susceptibility protein 1 (BRCA1) were measured with an enzyme-linked immunosorbent assay (ELISA). Glycated hemoglobin (HbA1c) level was measured with a sandwich immunodetection method. Finally, The Homeostasis Model Assessment for insulin resistance (HOMA-IR) was calculated according to the specific formula. Results: The values for HbA1C%, FBS, and lipid profile showed non-significant differences when compared between study groups. While BRCA-1, estrogen receptor alpha (ERα), insulin, insulin growth factor IGF-1, and HOMA IR All showed significant differences among all groups. Conclusion: Taking metformin only for less than one year seemed to contribute to higher levels of BRCA-1.

Use of virtual reality in preoperative education of cardiac surgery patients – A feasibility study

ObjectiveA Virtual Patient Tour (VPT) was developed to inform cardiac surgery patients about their hospitalization from the admission to their postoperative stay on the ward. The objective of our study was to assess the feasibility and acceptability of this VPT following the framework of the Virtual Reality Clinical Outcomes Research Experts Committee. MethodsIn this single-centre cross-sectional study, adult patients admitted to the hospital for elective cardiac surgery were included. Acceptability, usability, and tolerability were measured by the validated questionnaires Unified Theory of Acceptance and Use of Technology (acceptability), System Usability Scale (usability), and Virtual Reality Sickness Questionnaire (tolerability). Descriptive statistics were used for the analysis. ResultsTwenty-eight participants used the VPT. Results showed high acceptability (mean 16.7 ± 1.5), acceptable usability (mean 86.7 ± 9.3), and high tolerability (sickness score, median 7.1 % [0–17.1 %]). ConclusionThe use of the VPT is a feasible and promising technique. The next step is to optimize the content and technique of the VPT based on the suggestions of the participants. Practice implicationsWe recommend incorporating the VPT into preoperative patient education in addition to the routine information in cardiac surgery patients.

Continuous Glucose Monitoring and the Effect of Liraglutide in Cardiac Surgery Patients: A Substudy of the Randomized Controlled GLOBE Trial

ObjectivesFirstly, to evaluate the accuracy and reliability of continuous glucose monitoring (CGM) in patients undergoing cardiac surgery and, secondly, to assess the impact of preoperative liraglutide administration on perioperative glucose control as captured by CGM. DesignProspective, single-center, pre-specified analyses of the GLOBE trial, a randomized controlled trial comparing preoperative liraglutide treatment to placebo in patients undergoing cardiac surgery. SettingA single center academic hospital in the Netherlands. ParticipantsTwenty-five patients undergoing cardiac surgery, recruited from the hospital's cardiac surgery department. InterventionsParticipants received the Dexcom G5 CGM system from the day before surgery until discharge from the Intensive Care Unit after surgery. Additionally, participants were randomized to receive either preoperative liraglutide or placebo. Measurements and Main ResultsArterial blood gas (ABG) glucose measurements were collected as reference and matched to CGM readings to assess accuracy and reliability. In 240 paired CGM–ABG glucose measurements, the mean absolute relative difference (MARD) was 14.4±12.5%. Temporary sensor interruption occurred mainly intraoperatively (92% of patients). The median duration of intraoperative sensor interruption was 65 (48-95) minutes. Liraglutide increased glycemic time in range, 72% vs 47% in the control group (absolute difference 25%, 95% CI -41.4 to -8.9, p = .004). ConclusionsDespite intraoperative sensor interruption, CGM seems an accurate method to use as a semi-invasive, real-time assessment of blood glucose levels. CGM can provide a detailed observation of the pre- and postoperative glycemic trajectory, demonstrating increased time in range following perioperative liraglutide treatment compared to placebo.

Impact of photoplethysmography-based smartphone rhythm monitoring on atrial fibrillation detection and management after cardiac surgery: a pragmatic randomized trial

Abstract Introduction Postoperative atrial fibrillation (POAF) occurring after cardiac surgery is common and associated with adverse outcomes. Systematic monitoring of POAF beyond discharge is cumbersome. The emergence of photoplethysmography (PPG)-based rhythm monitoring with digital consumer devices could potentially mitigate these hurdles. Selected smartphone applications leveraging this technology have demonstrated excellent usability and accuracy for the detection of atrial fibrillation (AF). However, the impact of PPG-detected POAF on real-life clinical practice remains uncertain. Purpose To determine whether intermittent PPG-based smartphone rhythm monitoring, after being discharged home following cardiac surgery, impacts AF management. Methods The SURGICAL-AF 2 study is a pragmatic, investigator-initiated, open-label, multicenter, randomized clinical trial, conducted in three Belgian centers. The intervention group performed one-minute rhythm checks three times daily with a smartphone-based PPG application after hospitalization for cardiac surgery until the first follow-up visit with a cardiologist, scheduled at 21 – 91 days. Rhythm monitoring was not mandated in the usual care group. The primary endpoint was a composite of initiation of oral anticoagulation (OAC), cardioversion, up-titration or initiation of antiarrhythmic drugs (Vaughan-Williams class I or III) or implantation of a cardiac implantable electronic device (CIED). Secondary endpoints were incidence of POAF and actionable POAF, defined as a detection in patients with CHA2DS2-VASc score ≥2 for women or ≥1 for men who are not treated with OAC. Results Of the 450 patients randomized (238 patients in the intervention group and 212 patients in the usual care group; mean [SD] age, 64.1 [9.2] years; 96 women [21.3%]; 130 patients with AF before inclusion [28.9%]; 103 patients on OAC [22.9%], median [interquartile range] CHA2DS2-VASc score, 2 [1-3]), 98.7% completed the trial. In the intent-to-treat analysis, the primary end point occurred in 24 patients (10.3%) in the intervention group versus 5 patients (2.4%) in the usual care group (odds ratio (OR) 4.7, 95% CI, 1.8 - 12.6; P =.002). POAF was detected in 44 patients (18.8%) in the intervention group and was actionable in 25 patients (10.7%) versus 4 patients (1.9%) in the usual care group and actionable in 2 patients (0.9%). (POAF detection, OR 12.0, 95% CI, 4.2 - 34.5; P &amp;lt; .001; actionable POAF, OR 12.5, 95% CI, 2.9 - 52.6; P &amp;lt; .001) Conclusions In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more POAF which led to changes in AF management (OAC initiation, rhythm control therapy or CIED insertion). Longer follow-up is needed to determine whether these changes will lead to improved outcomes.

Microbiological and molecular genetic characteristics of Klebsiella pneumoniae isolates, extracted under conditions of cardiac surgery hospital

Klebsiella pneumoniae is one of the main causative agents of healthcare-associated infections (HAI) worldwide. The study was aimed at molecular characterization of beta-lactam antibiotic resistance in K. pneumoniae isolated in the cardiac surgery hospital, identify hypervirulent isolates and assess isolate genetic relatedness. K. pneumoniae isolated from the clinical material of patients (n = 50) at cardiac surgery departments as well as anesthesiology and reanimation department treated at the cardiovascular surgery hospital in Perm from July 2021 to December 2022 were analyzed. Bacteriological studies were performed on an automatic analyzer WalkAway-96Plus (Beckman Coulter, USA). The sensitivity to thirteen antimicrobials, production of extended-spectrum beta-lactamases (ESBL) and multidrug resistance (MDR) phenotype were assessed. The string test was used to screen hypermucoviscous K. pneumoniae. Isolate relatedness (ERIC-PCR), presence of beta-lactamase genes (blaTEM, blaCTX-M, blaSHV, blaOXA, blaKPC, blaVIM-2, blaIMP-1, blaNDM-1), as well as genes associated with hypervirulence (prmpA, iucA, peg-344, wzyK2, magA) were analyzed by PCR. Amplifications were performed in a DNA Engine Dyad Thermal Cycler (Bio-Rad, USA). Gel documentation system Gel-Doc XR (Bio-Rad, USA) was used for band visualization and data documentation. According to the study results, it was found that carbapenem-resistant isolates accounted for almost 76% of all isolates, the ESBL-phenotype had 90%, and MDR-phenotype — 88% of studied isolates. According to the string test results, 8% of K. pneumoniae isolates had a hypermucoviscous phenotype. As for genes associated with hypervirulence, it was shown that the iucA gene was the most common, amplified in 54% of isolates, prmpA was detected in 38% of isolates, 48% of isolates had wzyK2 or magA genes encoding capsular type K1/K2. Almost a third of K. pneumoniae samples contained a combination of the rmpA and iucA genes, and they were isolated more often in the group of patients with active infection. Only carbapenem-sensitive microorganisms had hypermucoviscous phenotype, K1 capsular type, and a combination of prmpA, iucA, peg-344 genes, whereas the K2 capsular type was most common among carbapenem-resistant K. pneumoniae. Based on molecular genetic typing, it was found that 24% of K. pneumoniae isolates were assigned to four genome groups of identical cultures, 76% of the isolates had individual profiles. Closely related isolates were found among patients from different departments that indicates a potential pathogen circulation in the closed circuit “surgery department–department of anesthesiology” and “reanimation–surgery department”.

Wellens Syndrome: prevalence, risk factors and coronary angiographic variation. A cross-sectional study.

Wellens syndrome complicates acute coronary syndrome and, if unmanaged, can lead to immanent myocardial infarction. This study aimed towards determining the prevalence of Wellens syndrome among acute coronary syndrome patients while focusing on both types and identifying the associated risk factors, then exploring the variation in affected coronary arteries within patients fulfilling Wellens syndrome criteria. Implementing a descriptive cross sectional hospital based observational study design, at Ahmed Gasim Teaching Hospital for Cardiac Surgery and Renal Transplantation in Khartoum North, Sudan, the study was conducted following using a non probability convenience sampling of patients fitting the inclusion criteria. Data was collected using closed ended structured questionnaires. Ethical clearance was obtained from relevant authorities. Statistical analysis was done using descriptive and comparative data analysis with the aid of the SPSS software, and STROBE guidelines were followed. A total of 120 patients were included, 70 males and 50 females, majority in their fifth decade. 14 patients had no documented risk factors. 42.5% had STEMI, 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%), 55.6% of them were type A and 44.4% were type B. Most frequently encountered risk factor among Wellens syndrome patients was Diabetes (50%). Out of 16 Wellens syndrome patients who underwent coronary angiography, 50% had mid LAD involvement, most were type A; 25% had proximal LAD involvement and 25% had normal coronary angiography. There was some association between Wellens syndrome and NSTEMI, but no significant association with any specific risk factor. Wellens syndrome complicates 15% of acute coronary syndrome patients with a 55.6% possibility of becoming type A, it can present even without a specific predisposing risk factor and coronary angiographic variation other than the proximal part of the LAD artery may occur, including multiple vessels involvement. This is a descriptive cross sectional study conducted at Ahmed Gasim Teaching Hospital in Sudan, to determine the prevalence and risk factors of Wellens syndrome. Data was collected using questionnaires and analyzed with the SPSS software. Out of 120 patients, 14 patients had no documented risk factors. 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%). The commonest risk factor among Wellens syndrome patients was Diabetes (50%). 50% of Wellens syndrome patients had mid LAD involvement. The study concluded that Wellens syndrome is not rare, it can present without specific risk factor and coronary angiographic variation other than the proximal LAD artery can occur.

Salivary Diurnal Cortisol Predicts Post-Traumatic Stress Symptoms in Parents of Infants With Congenital Heart Disease.

Parents of infants born with congenital heart disease (CHD) who require open heart surgery after birth are at risk for prolonged psychological distress. Even after their infants are discharged, parents may experience anxiety, depressive, and post-traumatic stress (PTS) symptoms; yet, it is unclear which parents are at greater risk for ongoing symptoms. The purpose of this study was to explore whether measures of the biomarker cortisol in parents during their infants' postoperative period were associated with subsequent psychological distress symptoms at three-month post discharge. This was a prospective, longitudinal exploratory study of 40 parents of infants with CHD after open heart surgery using consecutive enrollment. Parents provided diurnal saliva samples for two consecutive days in the postoperative period. Six predictors were summarized and generated including waking cortisol, bedtime cortisol, cortisol awaking response, area under curve with respect to the ground (AUCg), cortisol index, and cortisol slope. Self-report outcome measures on anxiety, depressive, and PTS symptoms were collected three-months post-discharge. Linear mixed models examined the associations between each predictor and each outcome while accounting for within-dyad variance using an unstructured covariance matrix. Cortisol AUCg was a predictor of PTS at three-months post-discharge (β = .34, p = .03, Cohen's d = 2.05). No significant relationships were found with the other cortisol measures. Findings suggest that cortisol area under curve may help to identify parents at risk for increased PTS in the months following their infants' hospitalization for cardiac surgery, serving as a foundation for future study in this area.

Healthcare-associated infections in cardiac surgery: epidemiological features

Aim. To identify the epidemiological features of HAIs in all patients admitted for surgery from 2018 to 2022. in a cardiac surgery hospital for the implementation of a risk-based prevention strategy.Materials and Methods. A descriptive retrospective epidemiological study of the HAI epidemic process was performed from 2018 to 2022. in patients of a large cardiac surgery hospital (n = 6179). Stratified indicators were calculated. To display unknown relationships and make a forecast, Fourier spectral analysis was performed, followed by the use of artificial intelligence technology - neural networks. The STATISTICA Automated Neural Networks (SANN) tool was used, as well as the StatTech v. 3.0.5.Results. The average rate of HAIs incidence over a 5-year period was 4.22 per 1000 patient days. We revealed decreasing trend of HAIs. Incidence of HCAI cardiopulmonary bypass surgery (CBS) was 3 times higher than without CBS (4.68 and 1.51 per 1000 patient-days, respectively). Fourier analysis revealed 10, 20, 30 cyclicity due to the dominant Klebsiella pneumoniae without the same time-series for other pathogens. The technology of neural network modeling did not reveal neural networks suitable for describing the forecast. Klebsiella pneumoniae showed properties typical of the hospital population and caused 35.49% of all cases of HAIs, had multidrug resistance to antibiotics in 74.45% of cases, with more than half of the strains having extended resistance, and 10.21% were pan-resistant. Acinetobacter baumanii also showed high epidemic activity, causing almost a fifth of all cases of HAIs, although its antimicrobial resistance characteristics were less pronounced than those of Klebsiella pneumoniae.Conclusion. The epidemiological characteristics of the epidemic process of HCAI is one of the mandatory components of risk identification. The identified features of the dynamics of the epidemic process of HCAI in a cardiac surgery hospital, risk groups and time, the structure and characteristics of the microbiota should be taken into account in the HCAI risk management system.

Study on the association of Glutathione S-transferase Mu 1 (GSTM1) gene polymorphism with acute decompensated heart failure with reduced ejection fraction

The most frequent cause of hospitalization in adults over 65 in Western nations is acute decompensation of heart failure (ADHF). Due to the high death rate, it places a heavy load on healthcare systems as well as people. The present study’s objective was to ascertain the connection between polymorphisms in the Glutathione S-transferase Mu 1 (GSTM1) gene and heart-failure-reduced ejection fraction (HFrEF) patients. Sixty patients with a mean age of 25–94 were taken from both genders after the clinical diagnosis by a specialist to cases who were referred to the Ibn Al-Baitar Specialized Center for Cardiac Surgery and Ramadi Teaching Hospital, and thirty apparently healthy people were taken as a control. Blood and serum containing EDTA were drawn from sick and healthy people to extract DNA for multiplex PCR detection of the GSTM1 polymorphism. The GSTM1 genotype was found in 23 (38.33%) and the null gene in 37 (61.66%) of the 60 ADHF patients. Of 30 healthy people, 8 (26.66%) had the GSTM1 gene and 22 (73.33%) had the null gene. According to the present study, the etiology of acute decompensated heart failure (ADHF) and the antioxidant null gene (GSTM1) are related. The present study has been achieved to determine the relationship between the presence of the antioxidant gene (GSTM1) and the incidence of ADHF with reduced ejection fraction for research and therapeutic purposes, which opens new spaces in the treatment of the mentioned condition.

INVESTIGATION INTO THE ORGANIZATION OF MEDICAL CARE PROVISION IN CARDIOVASCULAR SURGERY DURING MARTIAL LAW

The aim of this study is to examine the organization of cardio-surgical medical care during martial law for offering qualified medical assistance to servicemen classified as temporary casualties, through bed allocation planning and bed-day calculation. Materials and methods: This research encompassed military personnel actively engaged in combat operations (n=473), with an average age of 44.1±2.2. The primary data source for analysis was the foundational medical records, including medical histories and initial medical records. Results. The article presents the results of the analysis of the needs aimed at providing a cardiac surgery hospital with an adequate number of inpatient beds and substantiates the duration of treatment - inpatient stay (bed days). Determining these factors holds exceptional importance as it facilitates the delivery of high-quality specialized treatment to the ill and/or injured, ensuring their timely rehabilitation and return to active duty within the Armed Forces of Ukraine. It was observed that the study groups exhibited no significant distinctions in terms of nosological categories of circulatory system diseases, average age, and the number of bed-days, with no statistical significance identified. The analysis revealed that during the full-scale invasion of the Russian Federation into Ukraine's territory in 2022, the demand for cardiac surgery hospital beds surged by 266.3% when compared to the 2014 bed capacity. Notably, the number of bed-days saw only a modest 6.3% increase during inpatient treatment for servicemen. Conclusions. The study has shown that the number of bed days did not increase significantly in the inpatient treatment of military personnel, only by 6.3%. Due to the increase in the number of patients/wounded, the State Institution "Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine" opened a Military Cardiac and Major Vessel Surgery Department. This department specializes in providing highly specialized medical care to servicemen with combat-related heart injuries, major vessel wounds, and chest trauma.

Exploring the potential harm of varied blood storage on patients undergoing cardiovascular surgery.

Debate exists surrounding the optimal duration of red blood cell (RBC) storage. A hypothesis emerging from previous research suggests that exposure to fresh blood may be harmful to patients undergoing cardiac surgery. This study uses a large transfusion medicine database to explore the association between in-hospital mortality and red cell storage duration. This is an exploratory retrospective cohort study of all adult patients at Hamilton, Canada, over a 14-year period that received at least one allogeneic red cell transfusion during their hospitalization for cardiac surgery requiring bypass. The primary outcome for the study was in-hospital death. Analysis was performed using multivariate Cox regression modelling with time-dependent and time-independent covariates and stratification variables. Five models with varying definitions for short, intermediate and prolonged duration of RBC storage were tested. From March 2004 to December 2017, 11,205 patients met the inclusion criteria and were included in the regression analyses. No significant effect of short-duration red storage on patient mortality was observed in all statistical models, with the red cells stored for the longest duration as the reference group. When patients who received exclusively fresh (hazard ratio [HR] 1.040, 95% confidence interval [CI] 0.588-1.841, p-value = 0.893) and older aged (HR 1.038, 95% CI 0.769-1.1.402, p-value = 0.0801) RBCs were compared with those who received exclusively mid-age red cells as the reference, statistical significance was similarly not reached. Red cells stored for the shortest duration are not associated with increased risk of mortality among cardiac surgery patients.

Neutrophil extracellular traps as a promising marker of poor prognosis in operated patients with infective endocarditisarditis.

Aim. To assess the prognostic value of the formation of neutrophil extracellular traps (NETs) in blood smears of operated patients with infective endocarditis (IE).Material and methods. We prospectively included 46 patients with verified IE and 50 patients with valvular heart disease without IE, hospitalized in a cardiac surgery hospital in 2021-2022 (Moscow), comparable by sex and age. In all patients, NETs were determined upon admission and 7 days after surgery using the MECOS-Ts2 automated microscope (Russia). Patients included in the study were prospectively followed during the in-hospital period (ME [IQR] 30,0 [21,0-41,0] days) for the primary composite endpoint (in-hospital all-cause mortality, embolic, intracardiac, infectious complications) and its individual components.Results. Patients with IE were predominantly male (n=37, 80,4%) with a median age of 55,5 [44,0-70,0] years. The primary combined endpoint was recorded in 76,1% (n=35) of those examined with IE. The NET level after 7 days was significantly higher in patients with IE who had primary combined endpoint events than in the group of operated patients with heart defects without IE (Me [IQR] 4,4 [0,6-26,6] vs 2,9 [1,1-4,3], respectively, p&lt;0,05). Patients with IE who died in the hospital had a significantly higher NET level compared with surviving patients with IE and the control group as at admission (9,2 [1,8-18,9] vs 4,2 [0,3-28 ,5] and 3,4 [1,76,9], respectively, p&lt;0,05), and in dynamics (18,2 [5,2-26,6] vs 4,0 [1, 0-26,6] and 2,9 [1,1-4,3], respectively, p&lt;0,001). The threshold value of dynamic NET ≥11,2% predicted in-hospital death with high accuracy (sensitivity 80,0%, specificity 90,0%, positive predictive value 66,7%, negative predictive value 100,0%, area under the curve 0,915, p=0,003) and the development of postoperative sepsis (sensitivity 75,0%, specificity 88,0%, positive predictive value 60,0%, negative predictive value 100,0%, area under the curve 0,884, p=0,01). The obtained cut-off values significantly predicted the death (OR 23,9 (95% CI 1,7-344,8, p=0,02)) and sepsis (OR 22,0 (95% CI 1,9-256,8, p=0,01)) in the hospital in operated patients with IE.Conclusion. The NET level in blood smears of operated patients with IE is a new promising marker for predicting the disease complicated course. NETs ≥11,2% in operated patients with IE increase the probability of hospital mortality by 24 times and postoperative sepsis by 22 times.

Frequency of isolation of nosocomial pneumonia pathogens from the respiratory tract of cardiac surgery hospital patients who are under extended artificial lung ventilation and efficiency of oral cavity sanitation with chlorhexidine solution

Objective. To assess the frequency and degree of bacterial contamination of the respiratory tract in patients of cardiac surgery hospital, who are on prolonged mechanical ventilation, and to evaluate the efficiency of sanitation of the oral cavity with a solution of chlorhexidine. Materials and methods. A comparative analysis of the oral and tracheobronchial tract microbiota in operated patients of cardiac surgery hospital undergoing prolonged (4872 hours) artificial lung ventilation (ALV) was carried out. Microbiological assessment of the effectiveness of the oral cavity sanation with 0.1 % aqueous chlorhexidine solution is given. Results. The oral and tracheobronchial microbiota of cardiac surgery patients undergoing prolonged ALV are represented by gram-positive (S. epidermidis) and gram-negative (K. pneumoniae, P. aeruginosa, A. baumannii) microorganisms as well as Candida fungi. It was found out that the indices of the frequency and intensity of microbial isolation from the samples of the lower parts of the respiratory tract content were comparable with those of the oral cavity. The exception was S. epidermidis, the number of which in the lower airways compared to the upper ones was low. There was a statistically significant decrease in the intensity of microbial contamination of the oral cavity in patients on ALV after the sanation procedure with an aqueous chlorhexidine solution. Conclusions. Frequency and intensity indices of opportunistic microorganisms (K. pneumoniae, P. aeruginosa, A. inaumannii, Candida fungi) isolation from the oral cavity and lower respiratory tract in patients of cardiac surgical hospital under prolonged ALV have no statistically significant differences. The exception is S. epidermidis, whose numbers in the lower airways are low compared to the upper ones. The microbiological effectiveness of 0.1 % aqueous chlorhexidine solution in the process of sanitation of the oral cavity in patients on prolonged ALV has been established.

The effect of Teach-back Method during discharge on the stress and anxiety of mothers of babies undergoing open heart surgery

Background and aims: The research investigated the effect of care training during discharge on the stress and anxiety levels of mothers whose babies are undergoing open heart surgery. Parents of children with CHD experience high levels of stress and anxiety starting from the time of diagnosis, throughout the hospitalization for cardiac surgery, and even in the months and years that follow. Methods: In this quasi-experimental study, 60 mothers of children undergoing open heart surgery referred to the Tehran Children’s Medical Center Hospital entered the study through lottery sampling in 2019. Then, the Teach-back Method program was implemented for the intervention group in four sessions. Data were collected before and immediately after the intervention using a Questionnaire measuring parents’ stress and the Spielberger anxiety questionnaire. It was then analyzed using SPSS software version 16. Results: The study found that following the intervention, there was a significant decrease in the average scores of states and trait anxiety compared to the initial scores (P=0.006 and P=0.007, respectively). Additionally, the average stress score after the intervention was significantly lower than the initial score (P=0.001). Conclusion: The findings of this study suggest that offering oral instructions to mothers during the discharge phase of their children’s open-heart surgery can lead to positive outcomes by reducing post-operative anxiety and stress. These results highlight the need for further research to explore the long-term effects of post-operative oral education in various clinical settings.

Statewide data on surgical ablation for atrial fibrillation: The data provide a path forward

ObjectiveAtrial fibrillation (AF), if left untreated, is associated with increased intermediate and long-term morbidity/mortality. Surgical treatment for AF is lacking standardization in patient selection and lesion set, despite clear support from multi-society guidelines. The aim of this study was to analyze a statewide cardiac surgery registry to establish whether or not there is an association between center volume and type of index procedure with performance of surgical ablation (SA) for AF, the lesion set chosen, and ablation technology used. MethodsAdult, first-time, nonemergency patients with preoperative AF between 2014 and 2022 excluding standalone SA procedures from a statewide registry of Society of Thoracic Surgeons data were included (N = 4320). AF treatment variability by hospital volume (ordered from smallest to largest) and surgery type were examined with χ2 analyses. Hospital-level Spearman correlations compared hospital volume with proportion of AF patients treated with SA. ResultsOverall, 37% of patients with AF were ablated at the time of surgery (63% of mitral procedures, 26% of non-mitrals) and 15% had left atrial appendage management only. There was a significant temporal trend of increasing performance of SA for AF over time (Cochran-Armitage = 27.8; P < .001). Hospital cardiac surgery volume did not correlate with the proportion of AF patients treated with SA (rs = 0.19; P = .603) with a rate of SA below the state average for academic centers. Of cases with SA (n = 1582), only 43% had a biatrial lesion set. Procedures that involved mitral surgery were more likely to include a biatrial lesion set (χ2 = 392.3; P < .001) for both paroxysmal and persistent AF. Similarly, ablation technology use was variable by type of concomitant operation (χ2 = 219.0; P < .001) such that radiofrequency energy was more likely to be used in non-mitral procedures. ConclusionsThese results indicate an increase in adoption of SA for AF over time. No association between greater hospital volume or academic status and performance of SA for AF was established. Similar to national data, the type of index procedure remains the most consistent factor in the decision to perform SA with a disconnect between AF pathophysiology and decision making on the type of SA performed. This analysis demonstrates a gap between evidence-based guidelines and real-world practice, highlighting an opportunity to confer the benefits of concomitant SA to more patients.