Cardiosurgical Interventions Research Articles

Multiple Organ Dysfunction After Cardiosurgical Interventions

Objective: to study the clinical efficiency of introducing an algorithm for organ-protective intensive care. Materials and methods. 3278 case histories of patients admitted to the clinic in 2000—2009 for surgical treatment (under extracorporeal circulation) for coronary heart disease (CHD) and acquired heart defects (AHD) were retrospectively analyzed. Throughout the analyzed period, the patients operated on for CHD and AHD were 2068 (63.1%) and 1210 (36.9%), respectively; the postoperative incidence of multiple organ dysfunction (MOD) among all the patients was 11.8% (378 patients); mortality in MOD was 3.75% (n=123) of the operated patients (included into the study) or 32.5% of all the patients with MOD. Conclusion. The incidence of MOD is in proportion to the number of surgical interventions and depends on their specific features (recurrence, baseline severity, comorbidity, or multifocal atherosclerosis). Preventive intensive therapy for MOD reduced mortality and altered its syndromic pattern towards a preponderance of pyoseptic complications. Key words: cardiosurgery, extracorporeal circulation, multiple organ dysfunction.

Inkretine: Gibt es kardiovaskuläre Effekte?

The physiological effects of the incretin hormone glucagon-like peptide-(GLP-)1 have contributed to the important role that incretin-based therapies with GLP-1 analogs or dipeptidyl peptidase-(DPP-)4 inhibitors already play in type 2 diabetes treatment. This development is not only due to the glucose-dependent insulinotropic effect of GLP-1 as well as the positive effects on beta cell function and, probably, beta cell mass, but also to the beneficial effects on body weight.Lately, the data on positive cardiovascular effects of GLP-1 have been growing. In animal models, GLP-1 improves left ventricular function and diminishes myocardial defects in ischemia models. In clinical studies with GLP-1 analogs, a normalization of blood pressure was observed and some of the data from animal studies after myocardial infarction or after invasive cardiologic or cardiosurgical interventions were also found under clinical conditions in humans. Additionally, an improvement of cardiovascular surrogate parameters was observed with incretin-based therapies. This review gives an overview on the cardiovascular effects of GLP-1 and incretin-based therapies.

Comparative Estimation of Tracheostomy Time and Procedures in Patients with Multiple Organ Dysfunction after Cardiosurgical Interventions

Objective: to comparatively evaluate the efficiency of tracheostomy by various methods in different artificial ventilation periods in patients with multiple organ dysfunction after cardiosurgical intervention. Subjects and methods. In the first stage, the patients in whom tracheostomy was performed in a classical surgical manner (a control group; n=15) not earlier than 7 days after arterial ventilation (AV) were compared. A study group comprised 19 patients in whom tracheostomy was carried out on days 3—4 after AV. In the second stage of the study, tracheostomy was made not later than 4 days following AV: by the puncture-dilatation method in study group 2 (n=28) and by the classical surgical procedure in control group 2 (n=49). Results. The time and procedures of an intervention were found to have an impact on the bacteriological profile of a patient, the duration of switch to spontaneous respiration, and the tracheobronchial tree. The advantages and disadvantages of the puncture-dilatation technique of tracheostomy were noted from the standpoint of hemodynamics, gas transport, possible complications, and long-term Results. Conclusion. Early tracheostomy caused a reduction in the number of infectious complications of the tracheobronchial tree, early decannulation with switch to spontaneous breathing. The puncture-dilatation procedure of tracheostomy is characterized by the minimum hypoxic period at cannula installation and ensures prompt healing in the absence of purulent complications. The classical surgical tracheostomy remains to be the method of choice during massive anticoagulant therapy. The accumulation of long-term results should be continued. Key words: tracheostomy, multiple organ dysfunction, cardiac surgery.

Respiratory-Kinesiological Rehabilitation in the Early Periods after Cardiosurgical Interventions

Objective: to substantiate an algorithm for early respiratory-kinesiological rehabilitation used in the multimodality treatment of cardiosurgical patients developing multiple organ dysfunction syndrome (MODS). Subjects and methods. A randomized study was performed in 90 cardiosurgical patients with postoperatively evolving MOD, who were mechanically ventilated. In addition to conventional intensive therapy, these patients received an original complex of early respiratory-kinesiological rehabilitation. Results and Conclusion. The study has demonstrated the impact of respiratory and kinesiological rehabilitation on the course of a postoperative period: normalization of autonomic status-evaluating tests (from Д13±1.7 to Д7.5±4.9), endurance coefficient (21.8±9.9 to 16.5±7.2) in the study group versus 20.5±10.2 to 18.3±6.5 in the control group), adaptation potential (from the poor values 3.3±2.7 to the tension ones 2.9±2.2 scores since day 2; this trend was observed in the control group since postoperative day 5); improvement of gas transport parameters during exercises and within at least 6 hours after this, without changing artificial ventilation (AV) modes (improvement of the values of DO2I (by 12.3±4.5% of the baseline value), VO2I (by 8.8±5.3% of the baseline value), O2ER (by 16.5±8.5% of the baseline value); accelerated switching to assisted ventilation modes (78.6±18.3 hours (the start of assisted AV modes) in the study group versus 92.1±22.7 hours in the control one); a shorter length of stay in an intensive care unit (9.55±4.3 versus 14.2±5.5 days). The positive result from a primary pharmacoeconomic analysis for surviving patients is shown. Key words: rehabilitation, multiple organ dysfunction, cardiac surgery.

Cardiac Surgery in the Elderly Patient: Cognitive Impairments After Bypass Surgery

With regard to the overall results of cardiosurgical interventions and the quality of life of affected patients, postoperative cognitive impairments are enormously important. Substantial impairments to patients’ cognitive functioning are found in the immediate postoperative period as well as in the longer term after the intervention. Newman et al reported early postoperative incidence rates of cognitive impairments of more than 50%, and of 24% even after 6 months after bypass surgery. Impairments to cognitive functioning occurred in elderly people who had no such impairments before the procedure, and deteriorations of cognitive status were noted in patients with pre-existing impairments (1, 2). While it has been proved that elderly patients benefit from surgical myocardial revascularization with regard to improving cardiac function, Philipps-Bute showed that impairments to neurocognitive functioning as a consequence of cardiac surgery have negative effects on patients’ quality of life in the medium and long term: in 36% of patients, any benefits derived from the improvement in cardiac function are negated by the cognitive deterioration. Interestingly, the use of the heart-lung machine (pump-oxygenator; cardiopulmonary bypass pump) itself does not seem to negatively affect a patient’s neurocognitive status after cardiac surgery. “Off-pump” surgical techniques have not shown measurable risk reductions (2, 3). The older the patient is in whom surgery is planned, the more important for the overall result it is to consider his or her preoperative comorbidities, especially impairments to cognitive function and to mobility. In the context of the preoperative stratification of risk factors in older patients about to have cardiac surgery, clinically manifest or latent cognitive deficits should be detected, and timely intervention should be planned for the eventuality of postoperative delirium, so as to reduce postoperative cognitive deterioration in as far as is possible. Older patients with heart disease benefit from an interdisciplinary approach, and the importance of individual comorbidities needs to be balanced, in an interdisciplinary fashion, against quality of life in the long term.

Arrhythmogenic Right Ventricular Cardiomyopathy as Lethal Complication Factor after Cardiac Surgery

In patients with arrhythmogenic right ventricular dysplasia (ARVD), the right ventricular myocardium histologically discloses atrophy paralleled by fibrofatty or fatty replacement. Apoptosis is believed to be a putative major pathogenetic mechanism. Altogether, our knowledge of genetics, etiology and pathophysiology of ARVD has increased impressively in the last few years, and effective genetic tests now principally would be possible. Nevertheless, due to often uncharacteristic or even lacking symptoms, clinical diagnosis may be very difficult and could not be made during lifetime of patient presented here, partly due to additional, independent cardiac problems. The question of an effective preoperative diagnostic regimen for cardiosurgical interventions remains and seems to be currently open.

Early Extracorporeal Detoxification after Cardiosurgical Interventions

Objective: to substantiate a need for early use of extracorporeal homeostatic correction techniques during cardiosurgical intensive care. Subjects and methods: A non-randomized study was conducted in 63 cardiosurgical patients with postoperatively evolving multiple organ dysfunction. The clinical efficiency and economic expediency of the early initiation of homeostatic correction were estimated by continuous low-flow venovenous hemofiltration on a Prisma apparatus. Results. The study has demonstrated the advantages of early (within the 36-hour postoperative period) initiation of a procedure by the time of organ dysfunction recovery, the length of stay on a resuscitation bed, and pharmacoeconomic indices. Conclusion. The early (at the stage of dysfunction, until hemostasis becomes stable and in the absence of drainage volume losses) initiation of hemofiltration in the development of multiple organ dysfunction after surgical interventions has been clinically and economically warranted. Key words: extracorporeal homeostatic correction, multiple organ dysfunction, cardiac surgery.

Problem of Brain Injury during Cardiosurgical Interventions Under Extracorporeal Circulation

The paper analyzes today’s concepts on the causes of cerebral dysfunction at surgery under extracorporeal circulation. It considers the medical measures promoting the prevention of brain lesion and the ways of working out new cerebral protective strategies. Key words: psychoneurological complications, extracorporeal circulation.

Use of Recombinant Activated Protein C in Therapy for Sepsis in Children after Cardiosurgical Interventions

Sepsis is the principal cause of hospital death among children and ranks fourth among all causes of death in infants under 1 year of age and second in 1-to-14-year-old children. Objective: to assess whether activated protein C (APC) infusion may be incorporated into the complex intensive therapy for sepsis in babies of the first year of life. Subjects and methods. In January 2005 to April 2007, APC was used in the complex intensive therapy for sepsis in 36 infants of the first year of life. APC therapy was initiated in the first 24 hours after the occurrence of organ dysfunction in 29 (80%) patients and in the first 48 hours in others cases. Results. Status stabilization and multiple organ dysfunction (MOD) regression were noted in most patients during APC infusion. Ten (28%) patients died; mortality rates in the groups of patients with early and late infusion were 17 and 71%, respectively. The baseline APC level failed to affect 28-day survival. By the end of infusion, the mean level of protein C was much higher in the group of survivors than that in the deceased. Conclusion. APC as a part of the complex intensive therapy for sepsis should be given to infants of the first year of life who had multiple organ dysfunctions within the first 24 hours after the occurrence of organ dysfunction. Key words: pediatric sepsis, activated a-drotrecogin, multiple organ dysfunction.

Catabolic Processes in Cardiosurgical Patients

Objective: to evaluate catabolic and anabolic processes in cardiosurgical patients during heart operations under extracorporeal circulation. Subjects and methods. Seventy-one patients with coronary heart disease (CHD) and acquired cardiac defects (ACD), who had been operated on under extracorporeal circulation, were examined. The plasma levels of cortisol, adrenaline, insulin, growth hormone, and albumin were measured. For determination of daily nitrogen excretion, blood and diurnal urine were sampled at the following stages: 1) before surgery; 2) postoperative (PO) day 1; 3) PO day 3; 4) PO day 7; 5) PO day 14; 6) PO day 21. Results. The preoperative daily nitrogen excretion in CHD patients was 10.4±1.0 g/day. By PO day 3, there was a significant increase in nitrogen excretion by 66%, up to 17.3±1.6 g/day (p<0.01). In ACD patients, the baseline daily urinary nitrogen excretion was 11.9±1.7 g/day. By PO day 3, there was a 1.4-fold increase in this index — up to 16.3±2.0 g/day. Daily nitrogen excretion significantly increased up to 17.1±1.2 g/day by the end of the first PO week (p<0.05), by exceeding the baseline values by 44%. Nitrogen excretion peaked by the end of PO days 14 (17.2±1.6 g/day (p<0.05). By hospital discharge, nitrogen excretion was 23% greater than its baseline preoperative level (p>0.05). In cardiosurgical patients, an increase in daily nitrogen excretion occurred with the elevated concentrations of the stress hormones cortisol and adrenaline. Conclusion. The magnitude of catabolic reactions after cardiosurgical interventions depends on the type of cardiac disease. In patients with CHD, the maximum catabolic reactions were recorded on PO day 3 whereas in those with ACD, they continued within three weeks postoperatively.

Noninvasive Ventilation in Cardiosurgical Patients with Acute Respiratory Distress Syndrome

Objective: to evaluate the efficiency of the combined use of traditional respiratory support and noninvasive ventilation (NV) in the therapy of acute respiratory distress syndrome (ARDS) after cardiosurgical interventions. Subjects and materials. The study included 31 patients. The basis for ARDS therapy was respiratory support that met with the principles of safe artificial ventilation (AV); a natural surfactant was endobronchially administered in all cases. The condition for study continuation and randomization was the achievement of the oxygenation index (PaO2/FiO2) up to 200 during assisted ventilation (AV) in the pressure support (PS) + continuous positive airway pressure (CPAP) mode. After simple randomization, the study group patients (n=16) underwent extubation, followed by transfer for NV. Traditional assisted PS+CPAP ventilation was continued in the control group patients (n=15). Results. In both study and control groups, adequate gas exchange, central hemodynamic, and oxygen delivery values could be maintained at all stages of the study. The duration of traditional AV/AV was significantly higher in the control group (128.9±22.4 versus 67.6±12.5 hours; p<0.01). In the study group, retransfer for AV was required in 3 cases (reintubation rate 18.8%). In the control group, 13 (86.7%) patients were transferred for spontaneous respiration); however, 3 patients were further intubated again (reintubation rate 23.1%). In this group, there were 4 (26.6%) cases of ventilator-associated pneumonia; in the study group, infectious complications were absent. Transfer for NV promoted a reduction in the time of treatment in an intensive care unit (152.3±16.5 versus 185.6±10.1 hours in the control group; p<0.01). The study revealed no significant differences in mortality rates (18.8 and 33.3% in the study and control groups, respectively; p<0.05), which is likely to be associated with a small number of observations. Conclusion. The use of NV as a component of respiratory support in ARDS in patients after cardiac intervention makes it possible to maintain adequate gas exchange and tissue oxygen transport, to reduce the frequency and severity complications due to respiratory support and the length of stay in an intensive care unit. NV does not increase the rate of tracheal intubation. Key words: acute respiratory distress syndrome, respiratory support, noninvasive ventilation.

Active dynamic thermography in cardiosurgery

The aim of this study is development and analysis of applicability of new tools for continuous inspection of open-heart cardio-surgical interventions, suitable in clinical environment. Our notice is concentrated on IR-thermal imaging for monitoring of invasive surgical interventions as CABG in treatment of ischaemia and other heart malfunctions. In this presentation preliminary results of in-vivo experiments on animals with the use of IR thermal camera and newly developed procedures of active dynamic thermography are discussed.

Developing Educational Materials to Facilitate Adherence: Pediatric Thrombosis as a Case Illustration

Developing Educational Materials to Facilitate Adherence: Pediatric Thrombosis as a Case Illustration

Treatment with sertraline(asentra) in patients with cardio-vascular difficulties after cardio-surgical interventions

Treatment with sertraline(asentra) in patients with cardio-vascular difficulties after cardio-surgical interventions

Different Profile of Antioxidative Capacity Results in Pulmonary Dysfunction and Amplified Inflammatory Response After CABG Surgery

Respiratory complications after cardiosurgical interventions are frequent and cause severe problems, postoperatively. The present study addresses the question for group-specific release of radical oxygen species (ROS) by extracorporeal circulation (ECC) with emphasis on pulmonary function. Fifty-one patients who had undergone bypass surgery were evaluated for serum antioxidative capacity (AOC). Blood gas analysis, leukocyte counts, C-reactive protein (CRP), and hemodynamic data cardiac output (CO), pulmonary capillary wedge pressure (PCWP) arterial-alveolar gradient (AaDO(2)), and Murray scores were measured after ECC up to 48 h. According to AOC levels at baseline before ECC, patients were divided into two groups (group A: "high" AOC equal to or above median of the whole sample; n=26; versus group B: "low" AOC below median; n=25). A different time course in AOC could be detected between both groups. Both groups had an improvement in postoperative cardiac output evaluation, but in group A (high AOC) the PCWP was reduced (P=0.015). In this group, an increased AaDO(2) and elevated Murray score were seen 12 h postoperatively (P<0.001), suggesting reduced oxygen uptake. Moreover, increased CRP values and a trend to reduced leukocyte counts indicate differences in amplified inflammatory response to ECC. Free radical production after ECC is not a uniform process. Preoperative differences in AOC indicate interindividual variations. The surgical trauma results in a clear decrease of AOC in group A, while in group B AOC showed no major changes. As shown for reduced PCWP, release of ROS can affect pulmonary function. Therefore, AOC may be a useful parameter for prediction of postoperative complications.

Use of Transpulmonary Thermodilution-based Volumetric Monitoring During Cardiosurgical Interventions

Objective. To present currently available information on the use of transpulmonary thermodilution, a new type of volumetric monitoring of hemodynamics. Materials and methods. The data available in the Russian and foreign medical literature on this problem are analyzed. Results. In the past recent years, transpulmonary thermodilution has come into wide use in modern anesthesiology and reanimatology, including during aortocoronary bypass surgery, correction of cardiac defects, and cardiac transplantation. The values obtained by transpulmonary thermodilution correlate with the results of other monitoring methods and can extend the capabilities of diagnosis of systemic and pulmonary hemodynamic disorders. The introduction of therapeutic algorithms based on the results of volumetric monitoring makes it possible to perform intensive therapy of cardio-surgical patients purposefully (infusion load, inotropic and vasopressor support, use of diuretics), which can improve a clinical outcome. Conclusion. The use of transpulmonary thermodilution-based volumetric monitoring during cardiosurgical interventions assures adequate control of the values of preload, myocardial contractility, pulmonary circulation, and vascular tone, which allows one to develop a differential approach to correcting hemodynamics in the perioperative period.

Free radical production by extracorporeal circulation affects pulmonary perfusion and oxygen uptake and amplifies inflammatory response

Introduction: Respiratory complications after cardiosurgical interventions very often cause severe postoperative problems resulting in a prolongation of ICU-stay or even respiratory failure. Present study adresses the release of Radical Oxygen Species (ROS) by extracorporeal circulation (ECC) with focus on respiratory function.

Abstracts from the 7th Leipzig workshop: “Diagnostic value of cell function parameters in cardiosurgical interventions” April 12 – 13, 2002

Cytometry Part B: Clinical CytometryVolume 54B, Issue 1 p. 59-66 AbstractsFree Access Abstracts from the 7th Leipzig workshop: “Diagnostic value of cell function parameters in cardiosurgical interventions” April 12 – 13, 2002 Attila Tárnok, Attila Tárnok Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this authorPeter Schneider, Peter Schneider Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this authorFrank Emmrich, Frank Emmrich Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this author Attila Tárnok, Attila Tárnok Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this authorPeter Schneider, Peter Schneider Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this authorFrank Emmrich, Frank Emmrich Department of Pediatric Cardiology Cardiac Center Leipzig University of Leipzig GermanySearch for more papers by this author First published: 20 June 2003 https://doi.org/10.1002/cyto.b.10019AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume54B, Issue1July 2003Pages 59-66 RelatedInformation

Acute Neuropsychological Functioning Following Cardiosurgical Interventions Associated With the Production of Intraoperative Cerebral Microemboli

Coronary artery bypass graft (CABG) and valve replacement (VR) surgical patients underwent neuropsychological assessment 1–2 days prior to surgery; 7–10 days postsurgery; and 1 month following hospital discharge. A group of matched healthy controls was tested at identical intervals. Cerebral microemboli in both middle cerebral arteries were quantified during surgery using Doppler sonography. Neuropsychological testing results revealed that the CABG and VR groups did not differ from one another at any assessment point. However, surgical patients performed more poorly than healthy controls across all assessments. Surgical patients, as a group, demonstrated a mild decline in attentional functioning and learning efficiency at the 7–10 day follow-up, but these difficulties essentially returned to baseline by the 1-month follow-up. Intraoperative microemboli counts were not significantly associated with postsurgical neuropsychological functioning in either the CABG or VR group.

Infective endocarditis at a Hospital of the University of Kiel, 1958–1987

The clinical courses of 214 patients with infective endocarditis treated between 1958 and 1987 at the First Medical Hospital of the University of Kiel (FRG) were analyzed retrospectively. A decrease in the incidence of endocarditis occurred during the 30-year observation period. The mean age of patients was 48 years, and men were more frequently affected than women. In the course of the investigation, a rise in isolated aortic valve disease was noted, whereas the number of patients with isolated involvement of the mitral valve and combined mitral-aortic valvular defects declined. Streptococci (57%) were the most frequent pathogens isolated; as opposed to their increase, the percentages of Staphylococcus aureus and enterococci decreased. Otolaryngological, dentogenic and urogenital diseases were most frequently held to be responsible for the development of infective endocarditis. Prior cardiosurgical interventions became increasingly significant as a cause of the disease. In this connection, a rising percentage of endocarditis cases was linked with prosthetically replaced heart valves. Complications and concomitant symptoms of endocarditis included the development of heart failure, cerebral embolism and encephalitis, splenomegaly, and renal inflammation. Finally, the marked decrease in mortality contrasted with a simultaneous rise in the number of endocarditis cases achieving full recovery.