Cardiovascular Department Research Articles

Environmental justice analysis of wildfire-related PM2.5 exposure using low-cost sensors in California

The increasing number and severity of wildfires is negatively impacting air quality for millions of California residents each year. Community exposure to PM2.5 in two main population centers (San Francisco Bay area and Los Angeles County area) was assessed using the low-cost PurpleAir sensor network for the record-setting 2020 California wildfire season. Estimated PM2.5 concentrations in each study area were compared to census tract-level environmental justice vulnerability indicators, including environmental, health, and demographic data. Higher PM2.5 concentrations were positively correlated with poverty, cardiovascular emergency department visits, and housing inequities. Sensors within 30 km of actively burning wildfires showed statistically significant increases in indoor (~800 %) and outdoor (~540 %) PM2.5 during the fires. Results indicate that wildfire emissions may exacerbate existing health disparities as well as the burden of pollution in disadvantaged communities, suggesting a need to improve monitoring and adaptive capacity among vulnerable populations.

Patterns and outcomes of cardiovascular emergency department encounters for men and women in the USA

Abstract Aims We described sex-differential disease patterns and outcomes of over 20.6 million cardiovascular emergency department (ED) encounters in the USA. Methods and results We analysed primary cardiovascular encounters from the Nationwide Emergency Department Sample (between 2016–2018). We grouped the documented cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; average age was 67 [54,78] years. Men had greater overall baseline co-morbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common ED encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation (AF)/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (AMI, 10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, AF/flutter, supraventricular tachycardia, pulmonary embolism, or ischaemic stroke. Men were more likely to present with AMI or cardiac arrest. In logistic regression models adjusted for baseline covariates, women with intracranial haemorrhage had higher risk of hospitalisation and death. Women with ischaemic stroke had higher risk of hospitalisation and death in ED. Women presenting with pulmonary embolism were less likely to be hospitalised but were more likely to die. Women with aortic aneurysm/dissection had higher risk of hospitalisation and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, AF/flutter, AMI, or cardiac arrest. Conclusion In this large nationally representative sample of cardiovascular ED presentations, we demonstrate significant sex differences in disease distribution, hospitalisation, and death. Funding Acknowledgement Type of funding sources: None.

THE EFFECT OF NURSE PRACTITIONER-LED CARE IN TERTIARY CARE ON HEALTH-RELATED QUALITY OF LIFE IN ADULT PATIENTS WITH ATRIAL FIBRILLATION- RESULTS OF A RANDOMIZED CONTROLLED TRIAL

THE EFFECT OF NURSE PRACTITIONER-LED CARE IN TERTIARY CARE ON HEALTH-RELATED QUALITY OF LIFE IN ADULT PATIENTS WITH ATRIAL FIBRILLATION- RESULTS OF A RANDOMIZED CONTROLLED TRIAL

MPN-196 Unusual Association Case of Janus Kinase 2 Mutation and BCR-ABL Transcripts: Successful Treatment With Hydroxyurea

It is well known that mutations (like JAK2) are mutually exclusive events in myeloproliferative neoplasms (MPN). The presence of mutations (like JAK2) is seen in BCR-ABL1-negative MPN, but its presence with chronic myeloid leukemia (CML) is a rare finding; only a few cases have been reported (1). In this case, we describe patients who had both mutations (BCR-ABL and JAK2 V617F). We present the case of a 37-year-old man referred to our clinical department in 2017 for thrombocytosis. He had a history of arterial hypertension, was a chronic smoker and occasional alcoholic, and had a right fifth toe amputation in 2013. We discovered an asthenic patient with no splenomegaly and amputation of the third toe on the right foot on clinical examination. A complete blood count revealed that the patient was thrombocythemic (platelet [PL] counts of 1,783,000/mm3), had neutrophil leukocytosis (21,300/L), and had a hemoglobin level of 12 g/L. JAK2 V617 mutation was positive, and transcript BCR-ABL (M-bcr) was found by RT-PCR quantification to be 0.082%. However, karyotype analysis revealed that he was 46 years old, XY. His bone marrow was hypercellular with an increased number of megakaryocytes. The patient was followed in the cardiovascular department for his microangiopathy, which resulted in a second amputation of the right third toe in 2017. When he did not achieve complete hematological remission after one month on imatinib mesylate 400 mg daily, the dose was increased to 600 mg/J. Due to treatment failure with PL counts around 100,000 after 6 months, the treatment was changed to hydroxyurea (1 g/J) and imatinib was discontinued. The patient had been in complete hematologic remission for the previous 3 years. Several cases of concomitant JAK2 myeloproliferative disorders and BCR-ABL transcript have been reported. This hybrid disease is more likely to be misdiagnosed because it is underdiagnosed. Patients with association had a poor response to imatinib (3), which was also the case in our patient, who had a good hematological response to hydroxyurea but a poor response to imatinib.

A study of the efficacy of sacubitril/valsartan plus dapagliflozin combination treatment in pulmonary arterial hypertension due to left heart disease.

To determine the efficacy of sacubitril/valsartan plus dapagliflozin in the treatment of patients with pulmonary arterial hypertension (PAH) due to left heart disease and to explore new treatment regimen for PAH due to left heart disease. This study is a randomized controlled trial (RCT) study of 120 patients with PAH due to left heart disease admitted to the cardiovascular department of our hospital from Dec. 2019 to Dec. 2021. The patients were randomized 1:1 to the study group and control group. All patients were given baseline treatments targeting left heart disease and symptoms of PAH. In addition to the baseline treatments, patients in the control group were given sacubitril/valsartan tablets, while patients in the study group were given sacubitril/valsartan tablets plus dapagliflozin tablets. After 6 months of treatment, parameters including left heart function and exercise tolerance, Hemodynamics (left ventricular end systolic diameter [LVSED], left ventricular end diastolic diameter [LVEDD], left ventricular ejection fraction [LVEF], 6 min walk distance (6MWD), mean pulmonary artery pressure (mPAP) and pulmonary artery systolic pressure (PASP)), vascular endothelial function (plasma endothelin (ET) -1 and nitric oxide [NO]), heart failure markers (plasma N-terminal pro-brain natriuretic peptide (NT-proBNP)], inflammatory factors (serum C reactive protein [CRP], interleukin (IL)-6, and tumor necrosis factor (TNF)-α], and adverse drug reactions (ADRs) were assessed in both groups. Both groups had reduced LVESD and LVEDD, increased LVEF, and extended 6MWD after 6 months of treatment. The improvements in these parameters were significantly greater in the study group than in the control group (all P < 0.05). In addition, both the mPAP and PASP showed a decrease, and the mPAP and PASP in the study group were lower than those in the control group (p<0.05). Furthermore, both groups had decreased plasma ET-1 and NT-proBNP but increased plasma NO after 6 months of treatment. The improvements in these parameters were significantly greater in the study group than in the control group (all P < 0.05). Serum CRP, IL-6 and TNF-α levels were decreased in both groups after 6 months of treatment, and were significantly lower in the study group than in the control group (all P < 0.05). There was no significant difference in the overall incidence of ADRs between the two groups (P > 0.05). Sacubitril/valsartan plus dapagliflozin in the treatment with PAH due to left heart disease can improve left heart function of patients by improving vascular endothelial functions and alleviating inflammation, which helps to reduce the PAH process. Therefore, this combination treatment is safe and effective in PAH due to left heart disease.

Acute Coronary Syndrome in Egyptian Women during their Reproductive Age Period

Background: Young women have low risk of acute coronary syndrome (ACS) during their reproductive period, mainly due to the physiologically protective effect of estrogen hormone on the coronary endothelium. The purpose of this study was to assess the risk factors of ACS in the Egyptian women patients during their reproductive age period, who admitted to Tanta University Cardiovascular department hospital.&#x0D; Results: Obesity, hypertension, diabetes mellitus, chronic kidney disease, systemic lupus erythematosus, myocardial bridge, cushion syndrome and radiotherapy for breast cancer were significantly independently ACS risk factors that correlated to the SYNTAX score. There is significance of coefficient of the independent variable in the risk factors (Group A, group B, group C separately and groups A, B, C together) on the severity and level of SYNTAX score in ACS. The regression analysis was significant in groups A and B of ACS risk factors separately. While the regression analysis was significant and there was a clear relationship between ACS risk factors- groups A, B, C. together and SYNTAX score.&#x0D; Conclusions: There was a positive relationship between the increase total number of ACS risk factors subgroups (Traditional, Nontraditional and Gynecological) and the severity of coronary artery stenosis that assessed by SYNTAX scorer.

Differential Patterns and Outcomes of 20.6 Million Cardiovascular Emergency Department Encounters for Men and Women in the United States

Background We describe sex-differential disease patterns and outcomes of >20.6million cardiovascular emergency department encounters in the United States. Methods and Results We analyzed primary cardiovascular encounters from the Nationwide Emergency Department Sample between 2016 and 2018. We grouped cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; median age was 67 (interquartile range, 54-78) years. Men had greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common emergency department encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, atrial fibrillation/flutter, supraventricular tachycardia, pulmonary embolism, or ischemic stroke. Men were more likely to present with acute myocardial infarction or cardiac arrest. In logistic regression models adjusted for baseline covariates, compared with men, women with intracranial hemorrhage had higher risk of hospitalization and death. Women presenting with pulmonary embolism or deep vein thrombosis were less likely to be hospitalized. Women with aortic aneurysm/dissection had higher odds of hospitalization and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, atrial fibrillation/flutter, acute myocardial infarction, or cardiac arrest. Conclusions In this large nationally representative sample of cardiovascular emergency department presentations, we demonstrate significant sex differences in disease distribution, hospitalization, and death.

Coronary endarterectomy – A way to complete revascularization

Background and Aim of the Study: Coronary endarterectomy (CE) is performed adjacent to coronary artery bypass grafting (CABG) grafting to aid complete revascularization. However, the purpose of CE in surgical management of diffuse coronary artery disease (CAD) is controversial. The objective of this study was to highlight the operative outcomes, safety, and complications associated with CE. Methods: An observational, prospective research was carried out in the Department of Cardiovascular and Thoracic Surgery at our institute. All patients undergoing isolated CABG + CE from 2019 till 2021 were evaluated. Patients undergoing urgent, emergency, or elective CABG + CE off-pump/on-pump surgery were enrolled. Results: One hundred patients with CABG + CE were evaluated based on symptomatology with sequential electrocardiogram monitoring and blood samples for cardiac biomarkers. The blood samples were taken 6, 12, 24, 48, and 72 h following surgery. Eighty-five patients required single CE and 15 patients required double CE. We noticed a rising trend of cardiac markers in the first 6 h, reaching its peak level at 24 h, and downward trend following 72 h following surgery. Although patients had a tremendous rise in the cardiac biomarker values, clinically patients were stable with operative mortality of 5%. Conclusions: We believe CE helps in complete revascularization in patients with diffuse CAD. CE should be given due consideration in an era where it has been neglected due to its complexities and accompanying myths. CE is an important and integral weapon in a surgeon's armamentarium, and we should not hesitate to perform CE due to associated myths.

The Effects of a Therapeutic Strategy Guided by Lung Ultrasound on 6-Month Outcomes in Patients with Heart Failure: Results from the EPICC Randomized Controlled Trial.

Background: Pulmonary congestion (PC) is associated with an increased risk of hospitalization and death in patients with heart failure (HF). Lung ultrasound is highly sensitive for detecting PC. The aim of this study is to evaluate whether lung ultrasound-guided therapy improves 6-month outcomes in patients with HF. Methods: A randomized, multicenter, single-blind clinical trial in patients discharged after hospitalization for decompensated HF. Participants were assigned 1:1 to receive treatment guided according to the presence of lung ultrasound signs of congestion (semi-quantitative evaluation of B lines and the presence of pleural effusion) versus standard of care (SOC). The primary endpoint was the combination of cardiovascular death, readmission, or emergency department or day hospital visit due to worsening HF at 6 months. In September 2020, after an interim analysis, patient recruitment was stopped. Results: A total of 79 patients were randomized (mean age 81.2 +/− 9 years) and 41 patients (51.8%) showed a left ventricular ejection fraction >50%. The primary endpoint occurred in 11 patients (29.7%) in the SOC group and in 11 patients (26.1%) in the LUS group (log-rank = 0.83). Regarding nonserious adverse events, no significant differences were found. Conclusions: LUS-guided diuretic therapy after hospital discharge due to ADHF did not show any benefit in survival or a need for intravenous diuretics compared with SOC.

Status of adult outpatients with congenital heart disease in Japan: The Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease Registry

BackgroundThe Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease (JNCVD-ACHD) was founded in 2011 for the lifelong care of adult patients with congenital heart disease (ACHD patients). This network maintains the first Japanese ACHD registry. Methods and resultsFrom 2011 to 2019, the JNCVD-ACHD registered 54 institutions providing specialized care for ACHD patients in 32 of the 47 prefectures in Japan. The registry collected data on the disease profile for 24,048 patients from 50 institutions and the patient characteristics for 9743 patients from 24 institutions. The most common ACHDs were atrial septal defect (20.5 %), ventricular septal defect (20.5 %), tetralogy of Fallot (12.9 %), and univentricular heart (UVH)/single ventricle (SV; 6.6 %). ACHD patients without biventricular repair accounted for 37.0 % of the population. Also examined were the serious anatomical and/or pathophysiological disorders such as pulmonary arterial hypertension (3.0 %) including Eisenmenger syndrome (1.2 %), systemic right ventricle under biventricular circulation (sRV-2VC; 2.8 %), and Fontan physiology (6.0 %). The sRV-2VC cases comprised congenitally corrected transposition of the great arteries without anatomical repair (61.9 %) and transposition of the great arteries with atrial switching surgery (38.1 %). The primary etiology (86.4 %) for Fontan physiology was UVH/SV. In addition, developmental/chromosomal/genetic disorders were heterotaxy syndromes (asplenia, 0.9 %; polysplenia, 0.7 %), trisomy 21 (4.0 %), 22q11.2 deletion (0.9 %), Turner syndrome (0.2 %), and Marfan syndrome (1.1 %). ConclusionsAlthough the specific management of ACHD has systematically progressed in Japan, this approach is still evolving. For ideal ACHD care, the prospective goals for the JNCVD-ACHD are to create local networks and provide a resource for multicenter clinical trials to support evidence-based practice.

Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis

BackgroundIn this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure.MethodsAggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50).ResultsA total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year.ConclusionsED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.Graphical abstract

Clinical Effect of Renal Arterial Sympathetic Radiofrequency Ablation on Secondary Hypertension.

Sympathetic hyperactivity is one of the main mechanisms of secondary hypertension. Reducing renal sympathetic activity through surgery can effectively reduce blood pressure. Many cases have shown that renal denervation (RDN) can selectively block renal artery sympathetic nerve activity to control refractory hypertension. This surgery is a minimally invasive surgery, and the risk of surgery-related adverse events is significantly reduced compared with surgery. Therefore, the purpose of this study is to explore the efficacy of radiofrequency ablation of renal artery sympathetic nerve in the treatment of secondary hypertension. Eight patients with secondary hypertension diagnosed by the cardiovascular department of our hospital and treated with RDN were followed up for 3-18 months, of which 5 cases were followed up for more than 12 months and 8 cases were followed up for more than 3 months. Eight patients were treated with radiofrequency ablation of renal artery catheter. The parameters such as preoperative blood pressure, antihypertensive drugs, organ function, intraoperative ablation resistance, power, time, and temperature were determined. The related changes of blood pressure, antihypertensive drugs, and visceral function and the occurrence of side effects at 1 week and 1, 3, 6, and 12 months after operation were related to the operation. In conclusion, RDN has a significant clinical effect in the treatment of refractory hypertension, with stable postoperative blood pressure drop, reduced drug dosage, and less side effects.

Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Background: An atrial septal defect (ASD) is a persistent interatrial communication. It is distinct from a patent foramen ovale wherein there is a flap with intermittent communication. The aim of this work was to assess prevalence of mitral valve regurge or prolapse and left atrial volume in patients with secundum type ASD.&#x0D; Methods: This prospective study was carried out at the cardiovascular department, Tanta University Hospitals on 140 patients either adult or children who were diagnosed as atrial septal defect by 2-D echocardiography. They were subjected to detailed history, detailed clinical examination, chest x-ray and echocardiography (2-D echo &amp; Doppler).&#x0D; Results: 95% of patients were trivial or mild mitral regurgitation, 3.6% were moderate and 1.4% were severe. Cause of mitral valve regurgitation was 2.86% prolapse, 1.43% rheumatic and 0.71 dysplastic. Left atrial enlargement was found in 2.1% of patients. Mean LA diameter was 34.68 ± 3.9 mm, mean LA volume was 45.75 ± 3.44 ml and mean LA volume index was 24.14 ± 2.97 ml/m2. 1.43% of patients have history of rheumatic fever. 51.4% of patients presented with fatigue, 45.7% presented with palpitation, 41.4% of the patients presented with exertional dyspnea and 22.8% presented with tachypnea.&#x0D; Conclusions: The prevalence of mitral regurgitation is low in secundum ASD. Mitral regurgitation associated with secundum atrial septal defect could exist as a coexistent lesion, its recognition is important and most of them could be repaired with satisfactory results. Also, the left atrial volume was not affected except in sever mitral regurgitation.

Clinical and Echocardiographic Predictor of Atrial Fibrillation in Patient with Rheumatic Mitral Valve Disease

Background: Rheumatic fever principally influences kids in developing states, particularly where deficiency is common. Atrial fibrosis is a mutual characteristic of clinical atrial fibrillation (AF) and is accompanying with AF in a diversity of experiment sittings,&#x0D; Aim and Objectives: The current work aimed to assess whether there are any clinical or echo-cardiographic parameters that expect the existence of AF among cases with rheumatic mitral valve disorder (RMVD),&#x0D; Subjects and Methods: The current study was a comparative cross-sectional was conducted on 100 RMVD cases at cardio-vascular medicine department Tanta university hospitals within 6-mths starting from September 2019. Cases have been allocated into 2 groups: Group-I: 50 cases with sinus rhythm. Group-II: 50 cases with AF,&#x0D; Results: A significant change was found among study groups regarding Fibrosis characteristics, There is a highly significant difference between the three different types regarding mitral valve area (MVA), LA-diameter, LA volume, LA-diameter/BSA and LA volume index, Age, area of mitral valve, LA-diameter and LA volume were found to be significant predictors for AF,&#x0D; Conclusion: Echo-cardiography factors could recognize cases at higher danger of advancing AF among RMVD cases who may benefit from preventive measures.

The Fear of Surgery and Coronavirus in Patients Who Will Undergo a Surgical Intervention

PurposeThe aim of this study was to determine the fear of surgery and Coronavirus in patients who will undergo a surgical intervention.DesignA descriptive cross-sectional study.MethodsThis study was carried out with 103 patients who were hospitalized in the thoracic and cardiovascular surgery departments of a university hospital between July and December 2021 and underwent elective cardiac/thoracic surgery for various indications. The Patient Information Form, Surgical Fear Questionnaire, and Coronavirus (COVID-19) Fear Scale were used to collect data. One hundred three patients were reached within the scope of the study. Data were analyzed with the Mann Whitney U and Kruskal Wallis tests and Spearman's correlation analysis in IBM SPSS (V.22.0) program.FindingsThe mean age of the participants was 57.8 ± 14.0 years (19-82), 68.0% (n = 70) were male, and 78.7% (n = 81) underwent thoracic surgery. The total mean score of the patients on the Surgical Fear Scale was 26.9 ± 20.5 while the total mean score on the Coronavirus Fear Scale was 18.2 ± 7.5. A weak positive correlation was identified between the patients' total score averages on the Surgical Fear Scale and the Coronavirus Fear Scale (COVID-19) (P < .001).ConclusionsPatients undergoing cardiothoracic surgery had a low fear of surgery and a close to moderate fear of Coronavirus. Patients' fears of surgery and Coronavirus should be determined before surgery, and psychological support should be provided to patients with high levels of fear.

Strategies to rare primary cardiac lipomas in the left ventricle in a patient: case report

BackgroundPrimary cardiac tumors are rare in all age groups and are usually benign. Symptoms are usually related to tumor size, location, invasiveness, number, and growth rate. While histologically benign, cardiac arrest may be caused by blocked inflow or outflow or malignant ventricular arrhythmia. Surgical resection of left ventricular tumors, especially those involving the outflow tract, is challenging.Case presentationHerein, we present a rare case of an asymptomatic, 39-year-old woman who was referred to our cardiovascular department for a huge left ventricular cardiac mass incidentally discovered during the physical examination. Images showed a huge mass that quasi-circular low-density focus with a clear boundary and regular shape in the left ventricular cavity and fortunately had no significant effect on the peripheral valves and hemodynamics.ConclusionsThis illustrative report highlights the exact surgical management of a cardiac tumor depends largely on the site and extent of the mass. Mechanical compromise and not the neoplastic potential should be considered. A conservative approach and follow-up regularly are advocated to ensure that the patient gets the best diagnosis and treatment, however, surgery is indicated only for severely symptomatic patients with hemodynamic compromise.

RETRACTED ARTICLE: The role of acute care surgeons in treating rib fractures—a retrospective cohort study from a single level I trauma center

BackgroundRib fractures are the most common thoracic injury in patients who sustained blunt trauma, and potentially life-threatening associated injuries are prevalent. Multi-disciplinary work-up is crucial to achieving a comprehensive understanding of these patients. The present study demonstrated the experience of an acute care surgery (ACS) model for rib fracture management from a single level I trauma center over 13 years.MethodsData from patients diagnosed with acute rib fractures from January 2008 to December 2020 were collected from the trauma registry of Chang Gung Memorial Hospital (CGMH). Information, including patient age, sex, injury mechanism, Abbreviated Injury Scale (AIS) in different anatomic regions, injury severity score (ISS), index admission department, intensive care unit (ICU) length of stay (LOS), total admission LOS, mortality, and other characteristics of multiple rib fracture, were analyzed. Patients who received surgical stabilization of rib fractures (SSRF) were analyzed separately, and basic demographics and clinical outcomes were compared between acute care and thoracic surgeons.ResultsA total of 5103 patients diagnosed with acute rib fracture were admitted via the emergency department (ED) of CGMH in the 13-year study period. The Department of Trauma and Emergency Surgery (TR) received the most patients (70.8%), and the Department of Cardiovascular and Thoracic Surgery (CTS) received only 3.1% of the total patients. SSRF was initiated in 2017, and TR performed fixation for 141 patients, while CTS operated for 16 patients. The basic demographics were similar between the two groups, and no significant differences were noted in the outcomes, including LOS, LCU LOS, length of indwelling chest tube, or complications. There was only one mortality in all SSRF patients, and the patient was from the CTS group.ConclusionsAcute care surgeons provided good-quality care to rib fracture patients, whether SSRF or non-SSRF. Acute care surgeons also safely performed SSRF. Therefore, we propose that the ACS model may be an option for rib fracture management, depending on the deployment of staff in each institute.

Supervision by direct observation with video recording in the operating room: educational tool for learning and formative evaluation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Directly observed supervision with video recording (DOSVR) is used as a learning method in several countries. This technique has proven itself, but remains little used in Tunisia. On the other hand, the use of DOSVR in surgery is rarely described. The objectives of our work were to describe the development and experimental implementation of DOSVR in surgery and to evaluate the feedback from residents and teachers. Methods This is a prospective, observational and descriptive study concerning the experimentation of DOSVR in five surgical procedures performed by residents of cardiovascular surgery department. These video recordings were followed by a backscatter with self and heteroevaluation. We based ourselves on the methodology of teaching by simulation for the design of the protocol: the Briefing, the scenario and then the debriefing. Results A total of ten took part in this experiment. The average age was 28.5 years [26 -33 years] with a sex ratio F/M of 4. All residents declared that the protocol provided was easy to understand and apply. After obtaining the consent of the patients, five interventions were filmed in whom three were in emergency. Seven residents said that using a smartphone to vdeo recording was not easy and 8 easily got rid of the presence of the camera. All the learners denied having to change their operating techniques because they were being filmed. All the residents agreed that a minimum number of six DOSVR sessions in each residency year is appropriate and praised the technique as a powerful tool for the development of their practical training. Conclusions Our study showed that the application of Directly observed supervision with video recording in vascular surgery is feasible. It is a promising educational tool for the practical learning of residents as well as a tool for the continuous formative evaluation of their progress.

Identification of risk factors for delirium, cognitive decline, and dementia after cardiac surgery (FINDERI—find delirium risk factors): a study protocol of a prospective observational study

BackgroundPostoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing postoperative delirium. Gold standard assessments or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available.MethodsThe FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aim is to validate a delirium risk assessment in context of cardiac surgery. Our secondary aims are to identify specific preoperative and perioperative factors associated with delirium, cognitive decline, and accelerated dementia after cardiac surgery, and to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in patients undergoing cardiac surgery.DiscussionThis prospective, observational study might help to identify patients at high risk for delirium prior to cardiac surgery, and to identify important biological mechanisms by which cardiac surgery is associated with delirium. The predictive value of a delirium screening questionnaire in cardiac surgery might be revealed. Finally, the identification of specific blood biomarkers might help to predict delirium, cognitive decline, and dementia in patients undergoing cardiac surgery.Trial registration: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in the German Clinical Trials Register (DRKS; https://www.drks.de) (DRKS00025095) on April 19th, 2021.

The Prevalence and Characteristics of Mitral Regurgitation in Heart Failure: A Chart Review Study.

Mitral regurgitation (MR) is one of the common complications of heart failure (HF). The prevalence and characteristics of MR are rarely investigated, especially in the Chinese population. The purpose of this study was to determine the prevalence and characteristics of non-organic MR in HF patients and subgroups defined by ejection fraction. A single-center, hospital-based, and retrospective chart review study included patients with heart failure admitted to the cardiovascular department from January 2017 to April 2020. Demographic characteristics, laboratory results, and echocardiogram results before discharge were analyzed in different groups defined by left ventricular ejection fraction (EF) using logistic regression and adjusted for confounders. Finally, 2418 validated HF patients (age 67.2 13.5 years; 68.03% men) were included. The prevalence of MR was 32.7% in HF, 16.7% in HF with preserve EF patients, 28.4% in HF with mid-range EF patients and 49.7% in HF with reduced EF (HFrEF) patients. In the HF with preserved EF group, multivariable logistic regression showed that 4 factors associated with MR including EF (odds ratio (OR) 0.954 (0.928-0.981), p = 0.001), left ventricular posterior wall thickness in diastolic phase (LVPWd) (OR 0.274 (0.081-0.932), p = 0.038), left atrium (LA) dimension (OR 2.049 (1.631-2.576), p 0.001) and age (OR 1.024 (1.007-1.041), p = 0.007). In the HF with midrange EF group, multivariable logistic regression showed that 3 factors associated with MR including LA dimension (OR 2.009 (1.427-2.829), p 0.001), triglycerides (TG) (OR 0.552 (0.359-0.849), p = 0.007) and digoxin (OR 2.836 (1.624-4.951), p 0.001). In the HFrEF group, multivariable logistic regression showed that 7 factors associated with MR including EF (OR 0.969 (0.949-0.990), p = 0.004), (OR 0.161 (0.067-0.387), p 0.001), LA dimension (OR 2.289 (1.821-2.878), p 0.001), age (OR 1.016 (1.004-1.027)), p = 0.009), TG (OR 0.746 (0.595-0.936), p = 0.011), diuretics (OR 0.559 (0.334-0.934), p = 0.026) and ICD (OR 1.898 (1.074-3.354), p = 0.027). HF patients had a high burden of MR, particularly in the HFrEF group. Worsen cardiac structure (LA dimension and LVPWd) and function (EF), age, and medical treatment strategy played essential roles in MR.