Duration Of Inotropic Support Research Articles

Вплив якісних та кількісних змін поповнення крововтрати на прояви синдрому поліорганної недостатності при політравмі

У роботі наведені результати аналізу 53 історій хвороб постраждалих із політравмою мирного та воєнного часу, яким проводили поповнення крововтрати за ліберальною стратегією, та обстеження 16 постраждалих, яким застосовували рестриктивну стратегію поповнення крововтрати. Обмеження інфузійно-трансфузійної терапії до 70 мл/кг не знизило її протишокового ефекту і в той же час дозволило зменшити позитивний водний баланс, скоротити тривалість вазопресорної підтримки та штучної вентиляції легень, зменшити кількість пневмоній та інших ускладнень, уникнути різких коливань гемоглобіну, гематокриту та загального білка в 1-шу добу, знизити кількість повторних трансфузій, зменшити летальність.

Perioperative effect of acetylsalicylic acid stoppage duration before coronary artery bypass grafting

ObjectiveTo assess the effect of timing of preoperative cessation of aspirin therapy on perioperative morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery.BackgroundAspirin is used for primary or secondary prevention of thrombotic complications. It inhibits platelet function and so there is an increased risk of hemorrhage among patients undergoing CABG. Aspirin discontinuation time before CABG surgery has been a controversy for years. We aimed at assessing the effect of timing of preoperative cessation of aspirin therapy on perioperative morbidity and mortality in patients undergoing CABG surgery.Patients and methodsSixty patients having coronary artery disease and indicated for CABG surgery were included. Patients were randomly allocated into two groups: group A (32 patients) patients received 100 mg (enteric coated aspirin)/day till the day of surgery and group B (28 patients) patients received aspirin 100 mg daily until 5 days before surgery. We followed postoperative hemodynamics, morbidity, and mortality for 30 days after surgery.ResultsGroup A had significantly lesser ICU stay, duration of inotropic support, and duration of mechanical ventilation than the other group. However, the need of intraoperative and postoperative blood transfusion, reopening for bleeding, postoperative myocardial infarction, and 30 days mortality were similar between the two groups.ConclusionsLate use of aspirin till the day of surgery in small doses was associated with less ICU stay and earlier weaning from mechanical ventilation and was not associated with increased risk of bleeding, increased need for blood transfusion nor increased rates of reoperation for bleeding. Hence, we can conclude that late aspirin use is recommended especially in high-risk patients

Impact of Overt Hypothyroidism on Early Outcomes of Coronary Artery Surgery.

The association between preoperative overt hypothyroidism and early outcomes after coronary artery bypass grafting (CABG) is unclear. This study aimed to evaluate the influence of overt hypothyroidism on the outcomes of CABG. The series included 189 overt hypothyroid patients, who underwent CABG at Fuwai Hospital. These patients were 1:4 matched with 737 euthyroid patients using propensity score matching. The early postoperative outcomes were compared. After propensity score matching, the incidences of impaired wound healing, reintubation, and the total complications were higher in hypothyroid patients than euthyroid patients (11.8% vs. 0.9%, P < 0.001; 2.1% vs. 0.4%, P = 0.03; 39.6% vs. 30.3%, P = 0.015, respectively). Multivariate analysis showed overt hypothyroidism was significantly associated with the occurrence of impaired wound healing (odds ratio [OR]=12.29, P < 0.001), reintubation (OR=5.71, P = 0.047), and the total complications (OR=1.31, P = 0.049). The OR of the total complications was 1.43 (P = 0.03) in hypothyroid patients with abnormal thyroid-stimulating hormone compared with euthyroid patients. The proportions of the use of dopamine, adrenaline, milrinone, and dobutamine in hypothyroid patients were higher than euthyroid patients (75.4% vs. 67.6%, P = 0.038; 10.7% vs. 6.1%, P = 0.028; 3.2% vs. 0.3%, P = 0.001; 4.8% vs. 1.2%, P = 0.004, respectively). The total duration of inotropic support and mechanical ventilation time in hypothyroid patients were longer than euthyroid patients (median duration: 4 days vs. 3 days, P = 0.003; 17 hours vs. 15 hours, P < 0.001, respectively). CABG in overt hypothyroid patients is associated with a higher incidence of postoperative complications, stronger postoperative inotropic support, and longer mechanical ventilation time.

Coronary endarterectomy in myocardial revascularization

Aim. To compare the immediate outcomes of combined coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) and isolated CABG.Material and methods. This retrospective study included 192 patients with stable angina who underwent myocardial revascularization in the period from January 2016 to August 2018. The patients were divided into 2 groups. Group 1 included patients who underwent combined CABG and CE, while group 2 — patients who underwent isolated CABG. Patients in both groups did not differ in the main preoperative characteristics, with the exception of the incidence of obesity and right coronary artery disease.Results. In-hospital mortality in group 1 was 2,2% (n=2), in group 2 — 2% (n=2). The incidence of perioperative myocardial infarction in group 1 was 1% (n=1) and in group 2 — 0%. There were no significant differences between groups in the following postoperative parameters: in-hospital mortality, perioperative myocardial infarction, need and duration of inotropic support, duration of mechanical ventilation (MV) and need for long-term mechanical ventilation, stroke, arrhythmias, resternotomy for bleeding. In group 1, encephalopathy (11,8%) and respiratory failure (12,9%) were significantly more common.Conclusion. Combined CABG and CE is a safe technique for achieving complete myocardial revascularization in diffuse coronary artery disease, since, in comparison with isolated CABG, there is no increase in the incidence of death and perioperative myocardial infarction. However, in this category of patients, an increase in the incidence of non-lethal, non-disabling cerebral and pulmonary complications should be expected.

Calcium administration In patients undergoing CardiAc suRgery under cardiopulmonary bypasS (ICARUS trial): Rationale and design of a randomized controlled trial

IntroductionWeaning from cardiopulmonary bypass (CPB) is a critical step of any cardiac surgical procedure and often requires pharmacologic intervention. Calcium ions are pivotal elements for the excitation-contraction coupling process of cardiac myocytes. Thus, calcium administration might be helpful during weaning from CPB. MethodsWe describe a multicenter, placebo-controlled, double blind randomized clinical trial to assess the effect of calcium chloride on the need for inotropic support among adult patients during weaning from CPB. The experimental group (409 patients) will receive 15 mg/kg of calcium chloride. The control group (409 patients) will receive an equivalent volume of 0.9% sodium chloride. Both drugs will be administered intravenously as a bolus at the beginning of weaning from CPB. ResultsThe primary outcome will be the need for inotropic support between termination of CPB and completion of surgery. Secondary outcomes will be: duration of inotropic support, vasoactive-inotropic score 30 min after transfer to intensive care unit and on postoperative day 1, plasma alpha-amylase on postoperative day 1, plasma Ca2+ concentration immediately before and 10–15 min after calcium chloride administration, non-fatal myocardial infarction, blood loss on postoperative day 1, need for transfusion of red blood cells, signs of myocardial ischemia on electrocardiogram after arrival to intensive care unit, all-cause mortality at 30 days or during hospital stay if this is longer than 30 days. DiscussionThis trial is designed to assess whether intravenous calcium chloride administration could reduce the need for inotropic support after cardiopulmonary bypass weaning among adults undergoing cardiac surgery.

Palliative arterial switch and pulmonary banding for complex intra cardiac repair in transposition of the great arteries

Transposition of the great arteries (TGA) associated with ventricular septal defect (VSD) could present an intracardiac anatomy making the neonatal repair very challenging: multiple/apical VSD, straddling, tortuous intraventricular tunnel repair. To delay the repair, the isolated pulmonary artery banding (PAB) has the disadvantage to endanger the future aortic valve and to create a double obstacle in the frequent association with aortic annulus and arch hypoplasia. We propose a 2-step strategy with an initial palliative arterial switch operation (ASO) associated with PAB (± aortic arch repair) and, later, an intracardiac repair with debanding. The Aim of this retrospective study is to compare this strategy to a classic isolated PAB. Among the 715 neonatal TGA admitted in our institution between 2007 and 2018, 10 complex TGA benefited either from a palliative ASO with PAB (group A, n = 5) or a PAB (group B, n = 5). At palliation, the duration of inotropic support and the length of stay in intensive care unit were significantly shorter in group A (respectively 4.75 ± 1.7 and 5.5 [4.25–6.75] days versus 13 ± 6.9 and 16 [10.5–30] days in group B; P = 0,029 and P = 0,008). At complete repair, age and weight were significantly higher in group A ( P = 0,018) and the aortic cross-clamping and bypass times were shorter ( P = 0,018). No patient required a delayed sternal closure in group A. Mean length of stay in intensive care unit and hospital duration were respectively of 2 ± 1 days and 5.6 ± 1.53 days in group A versus 21.4 ± 16.9 days and 24.5 ± 19.9 days in the group B ( P = 0.018 and P = 0.029), showing reduced morbidity. Differing the neonatal repair for TGA is exceptional. When we should consider it due to particular intracardiac anatomy, it seems legitimate to practice a palliative ASO rather than the classic isolated PAB.

Cardiac Biomarkers and Prediction of Early Outcome After Heart Valve Surgery: A Prospective Observational Study

Circulating cardiac biomarkers may improve the prediction of long-term outcomes after cardiac surgery. The authors sought to assess if cardiac biomarkers also help better predict short-term morbidity. Prospective observational study. Single academic hospital. A total of 250 patients undergoing aortic or mitral valve surgery with or without associated coronary artery bypass grafts. None MEASUREMENT AND MAIN RESULTS: Relationships between preoperative plasma concentrations of four cardiac biomarkers (sST2, Galectin-3, GDF-15, and NT-proBNP) and postoperative outcome were assessed using logistic regressions and Cox proportional hazards models. The primary outcome was a composite of 30-day mortality, an inotropic support longer than 48 hours and an initial length of stay in the intensive care >five days. Secondary outcome measures were postoperative acute kidney injury, inotropic support duration, lengths of intensive care unit and hospital stays, and 30-day and one-year mortality. No association was observed between any of the four cardiac biomarkers and the primary outcome. The preoperative levels of Galectin-3 (hazard ratio=1.2; p < 0.001) and sST2 (hazard ratio=1.01, p < 0.001) were significantly associated with one-year survival, and their addition to the EuroSCORE II significantly improved the prediction of one-year mortality (p < 0.001). Similarly, Galectin-3 was associated with postoperative acute kidney injury (odds ratio=1.15, p=0.001) and improved the prediction of this complication when added to the EuroSCORE II (p=0.002). These results suggested that the ability of cardiac biomarkers to predict short-term outcome after cardiac surgery, though of interest, appears limited. Conversely, cardiac biomarkers may have the potential to refine the prediction of long-term outcome. Admittedly, all positive results were obtained on secondary outcomes and must be regarded with caution.

Study results suggest less invasive HeartMate 3 implantation is a safe and effective approach for obese patients

Historically, obesity was considered a relative contraindication to left ventricular assist device (LVAD) implantation with less invasive surgery (LIS). The present study aimed to compare the outcomes of obese patients who underwent LVAD implantation through LIS with those who received full sternotomy (FS) implantation. We retrospectively reviewed all patients implanted with HeartMate 3 LVAD in our institution between September 2015 and June 2020. Obese patients (BMI ≥ 30 kg/m2) were included and dichotomized based on surgical approach into the FS or LIS cohort. Of 231 implanted patients, 107 (46%) were obese and included in the study. FS was performed in 26 (24%) patients and LIS approach in 81 (76%) patients. Preoperative patient characteristics were similar between the cohorts. Postoperatively, patients in LIS cohort had less bleeding (p=0.029), fewer transfusions (p=0.042), shorter duration of inotropic support (p=0.049), and decreased incidence of severe RV failure (11.1% vs 30.8%, p=0.028). Survival to discharge for the obese population was 87.5% overall and did not differ based on an approach (91.4% LIS vs 76.9% FS, p=0.079). More LIS patients were discharged home (60.0% vs 82.4%, p=0.041) rather than to rehabilitation center. Our results showed that the LIS approach in obese patients is associated with fewer postoperative complications and a trend towards better short-term survival. These results suggest that less invasive LVAD implantation is a safe and effective approach for obese patients. Future prospective randomized trials are required to substantiate these results.

Asymmetric dimethylarginine: Is it a risk facgtor in the repair of aortic coarctation?

Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, causes endothelial dysfunction which is an important risk factor for mortality in adult cardiovascular diseases. We aimed to investigate whether there was a relationship between the aortic cross-clamping (ACC) time and serum ADMA level in aortic coarctation surgery and importance of the serum ADMA level as a marker of mortality and morbidity. Twenty-two patients undergoing surgery for aortic coarctation in the neonatal and early infant period were included in the study, and the patients were divided into two groups according to the aortic cross-clamping time (Group I: <20-min, Group II: >20-min). In Group I, preoperative and postoperative mean ADMA values of the patients were 0.57 ± 0.78 and 0.54 ± 0.83 µmol/L, respectively. In Group II, preoperative and postoperative mean ADMA values of the patients were 0.69 ± 0.93 and 1.10 ± 0.30 µmol/L, respectively. Preoperative-postoperative change of ADMA correlates with ACC time (r = .802, p < .005) and duration of postoperative inotropic support (r = .719, p < .05). Also a high correlation has been found between the ACC time and duration of inotropic support in both groups (r = .689, p < .05). Perioperative serum ADMA levels could be used as a prognostic bio-marker in the patients undergoing aortic coarctation repair. Treatments to reduce serum ADMA levels can be valuable for preventing mortality and morbidity which develop after surgeries in a transient ischemia setting by clamping the aorta.

Association of inotrope use with neurodevelopmental outcomes in infants

Objective The primary objective was to compare neurodevelopmental (ND) outcomes at 18–24 months in preterm infants <29 weeks gestational age (GA) who received versus those who did not receive inotropes in the first week of life. The secondary objective was to assess ND outcomes according to the duration of inotropic support in the first week of life (≤3 or >3 days). Study design Retrospective population-based cohort study of preterm infants <29 weeks GA admitted to participating neonatal intensive care units (NICUs) of the Canadian Neonatal Network (CNN) from January 2010 to September 2011 with follow-up data available at 18–24 months. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Long-term outcomes were categorized as neurodevelopmental impairment (NDI) and significant neurodevelopmental impairment (sNDI), and effect modification due to other neonatal morbidities including receipt of antenatal steroids, GA, small for gestational age (SGA) status, sex, score for neonatal acute physiology (SNAP-II) >20, postnatal steroids, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) grade ≥3/periventricular leukomalacia (PVL), early- and late-onset sepsis, retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC) was assessed. Maternal and infant demographic characteristics and short- and long-term outcomes were compared using Pearson’s Chi-square test for categorical variables and Student’s t-test or the Wilcoxon rank test for continuous variables. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using multivariable regression analysis. Results Of the 491 (18.7%) eligible preterm infants who received inotropes during the first week of life, 314 (64%) survived to NICU discharge and 245 (78%) had ND outcome data available. A total of 1775 eligible preterm infants did not receive inotropes in the first week of life; 1647 (92.7%) survived to NICU discharge and 1149 (70%) had ND outcome data. Maternal and infant characteristics associated with infants receiving inotropes included: younger maternal age, clinical chorioamnionitis, no antenatal steroids, outborn, lower GA, BW and Apgar scores at both one and five minutes; and higher SNAP-II scores (p < .05). Infants who received inotropes in the first week of life were more likely to be require postnatal steroids, had higher rates of BPD, IVH grade ≥3/PVL, early- and late-onset sepsis, ROP, NEC and mortality (p < .05). Infants who received inotropes in the first week of life also had higher rates of sensorineural or mixed hearing loss with an AOR (95% CI) of 1.99 (1.13, 3.49). After adjusting for confounding variables, there was no difference in the risk of NDI or sNDI between infants who did and did not receive inotropes in the first week of life. Of the infants with neurodevelopmental outcome data available, 186 received inotropes for ≤3 days and 59 for >3 days. After adjusting for confounding variables there was no difference in the risk of NDI or sNDI. Infants who received inotropes for >3 days were more likely to have lower BSID-III cognitive [AOR 2.43 95% CI (1.03, 5.76)] and motor scores <85 [AOR 2.38 95% CI (1.07, 5.30)] respectively. Conclusions In this large, population-based cohort, infants who received inotropes in the first week of life were at increased risk for sensorineural or mixed hearing loss. There was no difference in NDI or sNDI after adjusting for confounding variables. A longer duration of inotrope use in the first week of life was associated with lower BSID-III cognitive and motor scores, but no difference in overall NDI or sNDI.

Cardioplegia Solution Related Ventricular Pacing Following Orthotopic Heart Transplantation

<h3>Purpose</h3> Multiple solutions are used for heart allograft preservation. University of Wisconsin (UW) remains the most widely used, although there has been increased utilization of histidine-tryptophan-ketoglutarate (HTK). This study investigated differences in the use of postoperative ventricular pacing (VP) at a single center following a change in allograft preservation from UW to HTK . <h3>Methods</h3> We conducted a retrospective study of 42 consecutive patients who underwent orthotopic heart transplantation between January 2017 and December 2018. 21 patients received UW-preserved allografts followed by 21 patients who received HTK-preserved allografts. Patient characteristics, comorbidities and complications were reviewed. Duration of VP and inotropic infusions in the postoperative period were compared between the two groups, UW and HTK. <h3>Results</h3> Table 1 shows pretransplant use of anti-arrhythmics and mechanical support and duration of inotropic support posttransplantation. Figure 1 graphs the number of patients requiring VP from postoperative day 0 to 15. Despite supplemental inotropy in all patients, there was a higher incidence of VP in the first 24 hours in the HTK group compared to UW (43% vs 5%, p=0.01). Preoperative amiodarone use did not correlate with incidence of VP. No patients required a permanent pacemaker. <h3>Conclusion</h3> Multiple studies have been performed investigating the impact of preservation solutions on heart transplant outcomes with mixed results. This hypothesis generating study suggests a higher incidence of bradyarrhythmias requiring VP in HTK-preserved allografts, warranting validation in larger datasets.

Impact of subclinical hypothyroidism on outcomes of coronary bypass surgery.

Subclinical hypothyroidism (SCH) is characterized by an elevated thyroid-stimulating hormone and normal free thyroxine. This study aimed to evaluate the influence of SCH on the recovery of patients after coronary artery bypass grafting (CABG). From January 2015 to December 2018, 548 SCH patients and 6718 euthyroid patients who underwent CABG were identified. Propensity score matching was used to create two cohorts with similar baseline characteristics (n = 545 in each group). The early postoperative outcomes were compared. After CABG, there was no difference in the incidence of postoperative atrial fibrillation between the two groups (20.4% in the SCH group and 20.6% in the euthyroidism group; odds ratio: 0.99; 95% confidence interval: 0.74-1.33; p = 0.94). Subgroup analyses did not indicate an effect in any category of patients. The proportions of the use of dopamine and noradrenaline in the SCH group were higher than those in the euthyroid patients (76.7% vs. 68.6%, p = 0.003; 56.5% vs. 49.0%, p = 0.01, respectively). The total duration of inotropic support in the SCH group was longer than that in the euthyroid patients (median duration: 4vs. 3 days, p = 0.002). The incidence of impaired wound healing was higher in the SCH group than in the euthyroid group (3.7% vs. 1.1%, p = 0.005). Compared with euthyroidism, SCH is not associated with an increased risk of atrial fibrillation in patients undergoing CABG. It is associated with an increased risk of several minor perioperative problems, which should be anticipated and preemptively managed.

THE RISK FACTORS FOR POSTOPERATIVE OUTCOMES IN NEONATAL CARDIAC SURGERY

In the last three decades a neonatal cardiac surgery has improved the aproach and methods for adequate treatment of complex congenital heart defects. Although we have advances in fetal cardiac imaging and improved perioperative cardiac procedures, the postoperative outcomes in neonates are still present. We present our experience of operated neonates with congenital heart defects in a tertiary referral center, University Clinic for Pediatric Diseases, Neonatal Intensive Care Unit (NICU) in Skopje N. Macedonia. This is a retrospective study including neonates who underwent surgical intervention between January 2013 and December 2015. We analyzed perioperative and postoperative variables, duration of cardiopulmonaly bypass (CPB), &nbsp;and x-cross of aorta, duration of mechanical ventilation, intensive care unit stay and postoperative complications. Out of a total of 85 children, 15/85 (17.6 %) were neonates; the overall mortality was 1/15% (6.6%).There were 13/15 (86.6%) corrective procedures and 2/15 (13.3%) palliative ones. The mean duration of CPB was 46.6 min.,&nbsp; duration of x-cross of aorta was 17.5 min. The mean duration of mechanical ventilation was 3.4 days, duration of inotropic support was 4.2 days, and ICU stay 5.8 days. Postoperative complications were confirmed in 3 neonates. Due to adequate cardiac surgery, signicant technological advances, devices and increasing experience in neonatal cardiac surgery we have improved&nbsp; postoperative outcomes. Keywords: cardiac surgery, neonates, cardiopulmonaly bypass, inotropic support&nbsp;

Arterial revascularisation using in situ or Y-composite conduits of internal thoracic arteries: Early results

Aim. This study aimed to research the early results of arterial revascularisation using in situ or Y-composite conduits of internal thoracic arteries.Methods. The study included 76 patients with coronary heart disease who underwent coronary artery bypass surgery between March 2018 and March 2020. Two groups of patients were selected. In the first group, autoarterial conduits from the internal thoracic arteries were used according to the in situ technique (n = 39). In the second group, autoarterial conduits were used with the formation of a Y-composite structure from the internal thoracic arteries (n = 37).Results. The general characteristics and frequency of postoperative complications for most events were comparable in both groups. The usage of on-pump coronary artery bypass graft was significantly more frequent in the in situ group than in the Y-composite group (28.2 and 3.0 %, respectively; p &lt; 0.003). The duration of inotropic support was significantly shorter in the in situ group and was 3.72 ± 8.60 hours versus 8.0 ± 9.6 hours in the Y-composite group (p &lt; 0.007). No significant difference was found between the main adverse cardiac and cerebral events throughout the hospital follow-up period.Conclusion. The low incidence of perioperative complications, the absence of perioperative myocardial infarction and the low hospital mortality indicate that bilateral mammary coronary bypass surgery is safe. Despite the absence of differences in the early postoperative period, we expect that in the long-term period there will be a statistically significant difference in major adverse cardiac events between Y-composite structures and in situ conduits from internal thoracic arteries. Received 23 June 2020. Revised 14 September 2020. Accepted 1 October 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: A.K. SabetovData collection and analysis: A.K. Sabetov, M.O. ZhulkovStatistical analysis: D.S. Khvan, A.K. SabetovDrafting the article: A.K. SabetovCritical revision of the article: D.A. Sirota, D.S. Khvan, A.M. ChernyavskiyFinal approval of the version to be published: A.K. Sabetov, D.A. Sirota, D.S. Khvan, M.O. Zhulkov, A.M. Chernyavskiy

A randomized controlled trial comparing controlled reoxygenation and standard cardiopulmonary bypass in paediatric cardiac surgery.

OBJECTIVESControlled reoxygenation on starting cardiopulmonary bypass (CPB) rather than hyperoxic CPB may confer clinical advantages during surgery for congenital cyanotic heart disease.METHODSA single-centre, randomized controlled trial was carried out to compare the effectiveness of controlled reoxygenation (normoxia) versus hyperoxic CPB in children with congenital cyanotic heart disease undergoing open-heart surgery (Oxic-2). The co-primary clinical outcomes were duration of inotropic support, intubation time and postoperative intensive care unit (ICU) and hospital stay. Analysis of the primary outcomes included data from a previous trial (Oxic-1) conducted to the same protocol.RESULTSNinety participants were recruited to Oxic-2 and 79 were recruited to the previous Oxic-1 trial. There were no significant differences between the groups for any of the co-primary outcomes: inotrope duration geometric mean ratio (normoxia/hyperoxic) 0.97, 95% confidence interval (CI) (0.69–1.37), P-value = 0.87; intubation time hazard ratio (HR) 1.03, 95% CI (0.74–1.42), P-value = 0.87; postoperative ICU stay HR 1.14 95% CI (0.77–1.67), P-value = 0.52, hospital stay HR 0.90, 95% CI (0.65–1.25), P-value = 0.53. Lower oxygen levels were successfully achieved during the operative period in the normoxic group. Serum creatinine levels were lower in the normoxic group at day 2, but not on days 1, 3–5. Childhood developmental outcomes were similar. In the year following surgery, 85 serious adverse events were reported (51 normoxic group and 34 hyperoxic group).CONCLUSIONSControlled reoxygenation (normoxic) CPB is safe but with no evidence of a clinical advantage over hyperoxic CPB.Clinical trial registration numberCurrent Controlled Trials—ISRCTN81773762.

Routine use of del Nido cardioplegiacompared with blood cardioplegia in all types of adult cardiac surgery procedures.

Several studies reported the safety and potential benefits of single-dose Del Nido cardioplegia (DNC) in selected adult cardiac surgery (ACS) procedures. However, studies are scarce on routine use of DNC in more complex procedures and patients with a high risk profile. We sought to compare DNC with cold blood cardioplegia (BC) in all types of ACS including complex procedures. Data for 305 consecutive unselected patients who underwent ACS procedures (July/2017 to November/2019) were included. DNC was routinely used whenever is available (n = 231) and if not available, cold BC is used (n = 74). All categories of ACS procedures (primary or redo) were included. Repeated measures analysis was performed to compare baseline, peak, and trough Troponins levels in both groups. Linear regression analysis was used to identify independent predictors of peak Troponins level. The two groups were comparable in baseline characteristics including euro score (ES II), risk profile, and surgical complexity. DNC was associated with lower cardiopulmonary bypass (CPB) and cross-clamp times, cardioplegia volume, and number of cardioplegia doses (p < .001). Importantly, DNC was associated with lower postoperative Troponin level (p = .001), shorter duration of inotropic support (p = .02), and shorter intensive care unit stay (p = .04). On linear regression analysis, DNC was an independent predictor of lower postoperative peak Troponin (t = -3.5, p < .001). Routine use of DNC in all types of ACS procedures compared with BC was associated with significantly shorter CPB and clamp times, significantly lower postoperative troponin release, and shorter duration of inotropic support.

Functional state of the cardiorespiratory system after orthotopic heart transplantation with prolonged cold ischemia time

Objective: to assess the functional state of the cardiorespiratory system in the long term after orthotopic heart transplantation (HT) with prolonged cold ischemia time. Materials and methods. The results of 60 orthotopic HTs performed at Meshalkin National Medical Research Center were analyzed. A comparison was made of the immediate and long-term outcomes of HTs in the group with cold ischemia time lasting for less than 240 minutes and in those with farther distance between donor and recipient sites with cold ischemia time of 240 minutes or more. In the long-term follow-up after HT, all patients underwent cardiopulmonary exercise testing, body plethysmography, assessment of the diffusing capacity of the lungs, and quality of life assessment. Results. Prolonged cold ischemia showed a negative effect on the early postoperative period – decreased myocardial contractility on postoperative day 1 and longer duration of inotropic support. At the same time, the survival rate and incidence of graft rejection reactions in the early and late post-HT periods in the studied groups did not differ significantly. Peak oxygen consumption in the general group in the long term after HT was 17 (14.7–21.0) mL/kg/min, VE/ VCO2 slope was 30 (29–36) at 100 (90–120) W threshold load power. All the parameters of pulmonary function tests did not differ significantly depending on cold ischemia duration. Quality of life also did not show significant differences depending on the duration of graft ischemia in terms of both physical and psycho-emotional health components of the SF-36 questionnaire. Conclusion. Long-term cold ischemia of the graft did not show any negative impact on the functional state of the cardiorespiratory system and quality of life in the long term after HT. The studied group of recipients was characterized by high efficiency of pulmonary ventilation and gas exchange, as well as high tolerance to physical activity in the long-term post-HT period.

Sequential Organ Failure Assessment Score As a Predictor of Outcome in Sepsis in Pediatric Intensive Care Unit.

Sequential organ failure assessment (SOFA) score is used as a predictor of outcome of sepsis in the pediatric intensive care unit. The aim of the study is to determine the application of SOFA scores as a predictor of outcome in children admitted to the pediatric intensive care unit with a diagnosis of sepsis. The design involved is prospective observational study. The study took place at the multidisciplinary pediatric intensive care unit (PICU), tertiary care hospital, South India. The patients included are children, aged 1 month to 18 years admitted with a diagnosis of sepsis (suspected/proven) to a single center PICU in India from November 2017 to November 2019. Data collected included the demographic, clinical, laboratory, and outcome-related variables. Severity of illness scores was calculated to include SOFA score day 1 (SF1) and day 3 (SF3) using a pediatric version (pediatric SOFA score or pSOFA) with age-adjusted cutoff variables for organ dysfunction, pediatric risk of mortality III (PRISM III; within 24 hours of admission), and pediatric logistic organ dysfunction-2 or PELOD-2 (days 1, 3, and 5). A total of 240 patients were admitted to the PICU with septic shock during the study period. The overall mortality rate was 42 of 240 patients (17.5%). The majority (59%) required mechanical ventilation, while only 19% required renal replacement therapy. The PRISM III, PELOD-2, and pSOFA scores correlated well with mortality. All three severity of illness scores were higher among nonsurvivors as compared with survivors ( p < 0.001). pSOFA scores on both day 1 (area under the curve or AUC 0.84) and day 3 (AUC 0.87) demonstrated significantly higher discriminative power for in-hospital mortality as compared with PRISM III (AUC, 0.7), and PELOD-2 (day 1, [AUC, 0.73]), and PELOD-2 (day 3, [AUC, 0.81]). Utilizing a cutoff SOFA score of >8, the relative risk of prolonged duration of mechanical ventilation, requirement for vasoactive infusions (vasoactive infusion score), and PICU length of stay were all significantly increased ( p < 0.05), on both days 1 and 3. On multiple logistic regression, adjusted odds ratio of mortality was elevated at 8.65 (95% CI: 3.48-21.52) on day 1 and 16.77 (95% confidence interval or CI: 4.7-59.89) on day 3 ( p < 0.001) utilizing the same SOFA score cutoff of 8. A positive association was found between the delta SOFA ([Δ] SOFA) from day 1 to day 3 (SF1-SF3) and in-hospital mortality (chi-square for linear trend, p < 0.001). Subjects with a ΔSOFA of ≥2 points had an exponential mortality rate to 50%. Similar association was-observed between ΔSOFA of ≥2 and-longer duration of inotropic support ( p = 0.0006) with correlation co-efficient 0.2 (95% CI: 0.15-0.35; p = 0.01). Among children admitted to the PICU with septic shock, SOFA scores on both days 1 and 3, have a greater discriminative power for predicting in-hospital mortality than either PRISM III score (within 24 hours of admission) or PELOD-2 score (days 1 and 3). An increase in ΔSOFA of >2 adds additional prognostic accuracy in determining not only mortality risk but also duration of inotropic support as well.

Custodiol (Histidine-Tryptophan-Ketoglutarate) Versus Crystalloid (Saint. Thomas) Cardioplegia on Myocardial Protection in Mitral Valve Replacement Surgeries

ABSTRACT Background: Cardioplegia is the solution used to arrest and protect myocardial function during cardiac surgery. Cardioplegia is widely used in open-heart surgery. Myocardial protection is a critical approach to reduce the myocardial complications that occur during and after cardiac surgery. Aim: This study was designed to assess the use of custodial (HTK) versus cold crystalloid cardioplegia (Saint-Thomas) on myocardial protection in mitral valve replacement surgeries. METHODS: A total 50 patients undergoing mitral valve replacement surgeries (MVR) aged 25 to 60 years, ASA class II-III was randomly divided into two equal groups: Custodiol (HTK group, n =25) or cold crystalloid cardioplegia (CCC group, n =25) to produce cardiac arrest. RESULT: No significant difference was identified intraoperatively in (ACC time, CPB time, duration of surgery) but there was a significantly higher number of return to a spontaneous rhythm in the custodiol compared to CCC group (56% versus 28%; p = 0.045) and low volume in the HTK group (1412.1 ± 108.7 vs. 1782.9 ± 214.7; p = 0.0001). There were no significant differences between the two groups in CK-MB and troponin I preoperative or postoperatively, but there was a higher increase in their level at 24 h and 48h postoperative in the CCC group versus HTK group. Duration of inotropic support postoperatively significantly higher in the CCC group. CONCLUSIONS: The use of custodiol is effective than cold crystalloid cardioplegia for myocardial protection in mitral valve replacement surgeries Keywords: Mitral valve surgeries; custodial; crystalloid cardioplegia; myocardial protection.

The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

BackgroundAs an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic review and meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery.MethodsWe performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration.ResultsThe network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences.ConclusionsBased on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.