Early Postoperative Mortality Research Articles

Comparative risk stratification for prediction of early postoperative morbidity and mortality after open fixation of periarticular lower extremity fractures

IntroductionThe identification of patients at higher risk of early postoperative adverse events has implications for quality improvement, preoperative medical optimization, and cost reduction through bundled payments. The purpose of the present study was to develop points-based risk stratification systems for predicting 30-day adverse events (AEs) and mortality after open fixation of periarticular hip, knee, and ankle fractures. MethodsQuery of the NSQIP database yielded 65,529 patients who underwent periarticular lower extremity repair from 2010 to 2019. To generate our risk stratification systems, 60% of patients were randomly analyzed with multivariable regression plus bootstrap modeling to identify independent risk factors for early AE or mortality. A nomogram analysis was then conducted to assign scores for each risk factor. To validate our models, the systems were tested for predictive ability using the remaining 40% of patients. ResultsIn total, 13,212 patients (20.2%) experienced any AE and 3613 patients (5.5%) mortality within 30 days of fracture fixation. Patients were assigned points for the following in both risk stratification systems: fracture type, male gender, age, functional dependence, anemia, pulmonary disease, congestive heart failure, and end-stage renal disease. Corticosteroid use, hypertension, and insulin-dependent diabetes were additional predictors for only AEs. The AE and mortality models had maximum scores of 27 and 17 points, and Harrell C statistics of 0.66 and 0.75, respectively. The estimated risk of developing early AE ranged from 3.4 to 79.5% and mortality from 0.08 to 54.4%. ConclusionFracture type and preoperative characteristics can be used in the prediction of early AE or mortality following open fixation of periarticular lower extremity fractures, with a marked disparity in estimated risks depending on the number of risk factors possessed by a patient. Level of EvidenceTherapeutic IV.

Wrapping of the ascending aorta: history and prospects

Historically, exoprosthetics is one of the first surgical procedures used for aneurysmal dilatation of such great vessels as the aorta. Despite the acceptable results of this method it is not widespread now because of the possible negative consequences of aortic wall wrapping (rupture or dissection). According to the latest guidelines, it is necessary to consider prosthetics of the ascending aorta by the patients with aortic valve surgery and aneurysmal dilatation of the ascending aorta more than 45 mm. However, early postoperative mortality reaches 20 % by elderly patients with severe comorbidities. In such situations, it is worth to choose a less traumatic surgical approach. Exoprosthetics of the aorta reduces the invasiveness of procedure, time of artificial circulation and aortic occlusion thereby taking down the risks of early postoperative complications. The purpose of this literature review is to analyze the current data on the technique of exoprosthetics of the aorta by the patients with moderate ascending aorta dilatation. The Scopus, Web of Science, PubMed databases were used for searching and selecting literature sources. The results demonstrate that aortic wrapping is a safe method causing rapid and permanent aortic remodeling. The technique has comparable long-term results with prosthetics of the ascending aorta despite the presence of histological changes in the aortic wall with a changing in its mechanical properties. Received 28 September 2021. Revised 19 January 2022. Accepted 20 January 2022. Funding: This work was carried out within the framework of the state task of Ministry of Health of Russian Federation No. 121032300337-5. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: S.A. Alsov, D.A. SirotaDrafting the article: V.A. AkulovCritical revision of the article: S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. ChernyavskiyFinal approval of the version to be published: V.A. Akulov, S.A. Alsov, D.A. Sirota, M.M. Lyashenko, A.M. Chernyavskiy

Massive intraoperative red blood cell transfusion during lung transplantation is strongly associated with 90-day mortality

BackgroundThe effect of red blood cell (RBC) transfusion on mortality after lung transplantation (LT) was assessed in some retrospective studies, with contradictory results. The first aim of this study was to assess the 90-day survival of LT recipients according to massive intraoperative transfusion (MIOT). MethodsThis prospective, observational, single-centre study analysed the intraoperative transfusion (IOT) of all consecutive LT recipients between January 2016 and February 2019. MIOT was defined as transfusion of 5 RBC units or more. The results are presented as the median [IQR] and absolute numbers (proportions) and were analysed using χ2, Fisher, and Mann–Whitney tests (p < 0.05 as significance). Multivariate analyses were performed to identify independent risk factors for MIOT, 90-day and one-year mortality and grade 3 PGD at day 3. Ninety-day and one-year survivals were studied (Kaplan–Meier curves, log rank test). The Paris-North-Hospitals Institutional Review Board approved the study. ResultsOverall, 147 patients were included in the analysis, 27 (18%) of them received MIOT. In multivariate analysis, predictive factors of MIOT included preoperative ECMO support (p = 0.017), and bilateral LT (p = 0.023). The SOFA score on ICU admission after LT was higher in cases with MIOT (p < 0.001). MIOT was an independent risk factor for 90-days and one-year mortality (p = 0.002 and 0.008 respectively). The number of RBCs unit transfused during surgery was an independent risk factor for grade 3 PGD at day 3 (OR 1.14, 95% CI [1.00–1.29], p = 0.040). ConclusionIncreased preoperative severity of recipients predicts MIOT. MIOT is associated with increased early postoperative morbidity and mortality rates.

Methodology and immediate results of selective controlled cerebral and myocardial perfusion for aortic arch obstruction in children

Highlights. Congenital heart defects in combination with aortic arch hypoplasia or coarctation of aorta are quite common in cardiac surgeon’s practice. The protection of internal organs is an important point in the treatment of these defects. Several methods have been proposed from hypothermic arrest to selective perfusion of various vascular regions. Given the variety of techniques, the effectiveness and advantages of each one are still a topic of debates. The article reflects the experience of using cerebro-myocardial perfusion in children with surgical correction of the aortic arch pathology.Aim. To analyze the prospects of regional selective controlled cerebral and myocardial perfusion method in surgical correction of aortic arch obstruction in children.Methods. A retrospective single-center analysis of the treatment in 29 pediatric patients was carried out and immediate results of cerebral-myocardial perfusion used in children with surgical correction of aortic arch obstruction in the period from 2016 to 2020 are presented. Median age was 6 days (1 day – 15 years old). Median weight was 3.6 kg (1.8–47 kg). 15 patients were girls, 14 patients were boys. The inclusion criteria for all the patients were cerebro-myocardial perfusion for aortic arch reconstruction.Results.Cardiopulmonary bypass time median was 78 minutes (43–206 minutes). The average time of cerebro-myocardial perfusion was 22.4 + –6.4 min (12–35 min). The median duration of the surgery was 3.1 hours (2.25–5.5 hours). The median time for mechanical ventilation was 101 hours (6–744 hours), in the ICU – 8.5 days (1–31 days). The average time of hospital stay was 18.2 days + –6.7 days (7–31 days). Early postoperative mortality was 3.4%. Renal replacement therapy was required for 2 newborns (7%). Operational risks, according to the Aristotle Score, were significantly higher in newborns (χ2 = 3.9277, df = 1, p-value = 0.0475). There were no cardiac events associated with myocardial perfusion. The type of cardioplegia (blood or “Kustadiol”) did not significantly affect the pumping function of the heart, assessed by transthoracic echocardiography on day 1 after the surgery (χ2 = 0.27273, df = 1, p-value = 0.6015). Acute ischemic cerebrovascular accident occurred in 1 patient (3.5%).Conclusion. The technique of controlled selective cerebro-myocardial perfusion is reproducible without any additional resource costs. We can confidently say that the time of surgery and cardiopulmonary bypass is much shorter than in case of using deep hypothermic arrest or isolated selective cerebral perfusion, as soon as there is less time needed for cooling and re-warming the body. Also, the time of cardiac arrest was reduced or completely eliminated (with isolated reconstruction of the aortic arch). The technique is effective and safely reproducible in both newborns and older children. The results for mortality and complications are encouraging but must be further evaluated and compared.

Comparison of early-stage stenosis and regurgitation results among patients who underwent aortic valve repair.

This study aimed to analyse the results of paediatric aortic valve repairs in our institution. The data of 57 patients under 18 years of age who underwent aortic valve repair between 2014 and 2019 were retrospectively analysed. Early postoperative reoperation and hospital mortality rates were evaluated based on the ages of the patients, their preoperative diagnoses, and the surgical techniques used. Survival curves for groups of patients were calculated by Kaplan-Meier analysis. The rate of reoperation was 14% (n = 8), and there were no significant differences regarding valve pathologies and preoperative diagnoses (p > 0.05). Among the repair techniques, tricuspidisation was considered to be a risk factor for reoperation (p < 0.05). Augmentation, the material used (0.1 PTFE or pericardium), and the number of cusps were not found to have significant effects on reoperation or mortality. The mean follow-up period was 29.86 ± 21.30 months. The survival rates of the patients were 88%, 100%, and 88.2% for those with aortic stenosis, aortic insufficiency, and mixed disease, respectively, and no significant difference was found when these rates were evaluated with the log-rank test (p > 0.05). The mortality rate was 8.8% (n = 5), and undergoing surgery before the age of 1 year was found to be significant in terms of mortality (p = 0.032, p < 0.05). The bicuspid aortic valve group had the lowest mortality risk, while the Shone complex group had the highest. With its acceptable reoperation and mortality rates, aortic valve repair should be the first choice of treatment in the paediatric age group. Early results were satisfactory in all groups.

Immediate results of surgical myocardial revascularisation in COVID-19 survivors

The novel coronavirus infection (COVID-19) is caused by the SARS-CoV-2 virus. First registered at the end of December 2019 in Wuhan, China. Due to the high contagiousness of the virus, the infection quickly spread throughout the world, and on March 11, 2020, the World Health Organization announced the beginning of the COVID-19 pandemic. During the pandemic, the number of cardiac surgeries was sharply reduced due to the repurposing of hospitals to receive and treat patients with COVID-19. Today, however, diseases of the circulatory system remain the leading cause of death in the developed world. At the same time, there are more and more reports of extremely unfavorable outcomes of cardiac surgery in patients with active infection. Unfavorable outcomes were associated with the development of acute respiratory distress syndrome in the early postoperative period and high hospital mortality. Two years after the beginning of the COVID-19 pandemic, 98 % of the patients had an infection, and today this group of patients is increasingly common in cardiac surgery practice. At the same time, there is evidence that the transferred COVID-19 has long-term adverse effects, including pathological effects on the cardiovascular and respiratory systems. This retrospective study was aimed at studying and analyzing the immediate results of surgical myocardial revascularization, namely coronary artery bypass grafting on a beating heart, in patients with COVID-19 convalescents with coronary heart disease.

Colorectal cancer with diabetes. Early and late postoperative rehabilitation

Annotation. Today, colorectal cancer is one of the most commonly diagnosed malignancies of the gastrointestinal tract, that caused by a number of factors, including metabolic disorders, which include diabetes. The aim of the study is to analyze early and late postoperative rehabilitation in patients with colorectal cancer on the background of diabetes. The study included two groups of patients: group I – patients with colorectal cancer with diabetes and group II – patients with colorectal cancer without diabetes. The study evaluated the following indicators: age, sex, presence of comorbid conditions, duration of surgery, early postoperative complications, length of hospital stay, mortality, survival, which were assessed separately for each group of patients. Assessment of comorbid conditions was performed using the Charlson Index. Postoperative complications were assessed according to the Clavien-Dindo classification. Database formation and statistical analysis were performed using Microsoft Excel and STATISTICA v 10.0 (Statsoft Inc., USA) according to Student's criteria at p⩽0.05. The calculation of postoperative survival was performed by the Kaplan-Mayer method. The results of the research show that patients with diabetes have a higher risk of severe non-surgical postoperative complications, as well as more complex early and late postoperative periods, and higher rates of early and late postoperative mortality. Therefore, studying the impact of diabetes on all body systems, as well as ensuring its sustainable compensation in patients with colorectal cancer, will reduce the levels of severe postoperative complications and postoperative mortality.

Impact of PCO2 gap protocol application on early postoperative mortality and organ failure in high risk surgical patients undergoing major abdominal surgeries

Background: high risk surgical patients undergoing major abdominal surgeries still have higher rate of mortality and organ failure rates in the early postoperative period. Objective: We aimed to assess PCO2 gap protocol application in the intraoperative and early post-operative (first 12 hours) on postoperative mortality and organ failure in high risk surgical patients undergoing major abdominal surgeries compared to a classical goal directed therapy protocol (GDT) targeting mean arterial blood pressure (MAP), mixed venous oxygen saturation (SvO2), central venous pressure (CVP), Haematocrite value (Hct) and urine output (UOP). Patients and Methods: Guided by Shoemacker et al score 80 high risk surgical patients undergoing major abdominal surgeries were divided into two groups group A PCO2 gap algorithm was applied intraoperative and 12 h postoperative end point PCO2 gap 2-6mm Hg ,group B goal directed therapy protocol targeting MAP &gt; 65mmHg, CVP between 8-12cmH2O , Haematocrite value more than 30, Svo2 &gt;75% and urine output more than &gt;0.5 ml/kg/hr an applied intraoperative and 12 postoperative end point . Postoperative organs dysfuctions were assessed using the Sequential Organ Failure Assessment (SOFA) score recorded daily ICU discharge then every three days till discharge home.

Prognosis and related risk factors analysis of total anomalous pulmonary venous connection correction

This study was performed to analyze the surgical outcomes of our center biventricular correction with total anomalous pulmonary venous connection (TAPVC) and to explore the risk factors associated with postoperative mortality and postoperative pulmonary venous obstruction (PVO). In total, 104 patients diagnosed with TAPVC and underwent biventricular correction from January 1, 2009 to December 31, 2021, in Beijing Children's Hospital Affiliated with Capital Medical University were included. The primary endpoints were early and late postoperative mortality and postoperative pulmonary vein obstruction. Multivariable analysis indicated that prolonged cardiopulmonary bypass (CPB) time was the only independent risk factor for early postoperative mortality. Emergency surgery, preoperative moderate, and severe pulmonary hypertension (PH), and prolonged CPB time were independent risk factors for postoperative PVO. According to ROC curve analysis, the cut-off value of CPB time for predicting early mortality was 148 min (AUC = 0.916, 95% CI 0.811-1.000). In the past 12 years, with surgical technique and perioperative management advancement, the prognosis of children treated with TAPVC biventricular correction in our center has generally improved. However, surgical repair remains challenging, and early mortality remains high in children with prolonged CPB time during surgery. Postoperative PVO often occurs in children who underwent emergency surgery, combined with moderate and severe PH and prolonged CPB time.

Radical versus local surgical excision for early rectal cancer: A systematic review and meta-analysis.

3622 Background: Colorectal cancer is the third common cancer worldwide. Radical excision (RE) as total mesorectal excision for rectal cancer carries a higher risk of mortality and morbidity, while local excision (LE) could decrease these postoperative risks. However, the long-term oncologic outcomes of LE are still debatable. We aim to study the effect of LE versus RE in T1 and T2 rectal cancer. Methods: We conducted a systematic review and meta-analysis. We searched PubMed and CENTRAL databases, using an optimized search-strategy from inception until 15 June 2021, without restriction on publication date or status. We included only cohort and randomized controlled trials (RCTs). Two authors independently screened the title, abstracts, and full-text manuscripts for inclusion and data extraction. All included trials contained at least one of the primary outcomes. We used RevMan 5.4 tool for data analysis. We calculated both hazards ratio (HR) and risk ratio (RR) for the 5-years survival analyses, with their 95% confidence intervals (CI). We assessed both clinical and statistical heterogeneity of the studies; I2 &gt;75% was considered highly heterogeneous. We used random effect model (REM). We used standardized mean difference (SMD) for hospitalization days. We conducted a subgroup analysis of patients with T1-only without adjuvant chemo/radiotherapy (CRT). Results: We retrieved from the search a total of 1243 reports. A total of 18 studies were included for final meta-analysis (4 RCTs and 14 retrospective cohorts). Nine studies were multi-central while ten were unicentral studies. We did not find any difference in risk ratio (RR) between overall survival (OVS) and disease-free survival (DFS). But there were higher HRs in OVS and DFS with LE as compared to RE. A higher recurrence rate was also seen with LE. Six studies showed absent 30-days postoperative mortality in both groups so we used peto-odds ratio. Postoperative mortality and morbidity were lower with LE rather than RE. Conclusions: LE for early stage rectal cancer has a higher risk of decreased 5-year OVS and DFS than RE, with higher local recurrence rate. However, LE is associated with lower early postoperative mortality, morbidity, and hospitalization days, as compared to RE. Patient selection is key to balance these risks for the optimal outcome. [Table: see text]

Outcomes of bariatric surgery in elderly patients: A registry-based cohort study with 3-year follow-up

Abstract Objective Elderly patients undergo bariatric surgery less frequently than younger patients. Short- and medium-term outcomes after bariatric surgery in the elderly population remain largely unknown. The objective of the present retrospective, registry-based cohort study was to compare short- and medium-term outcomes between patients &amp;lt;65 and ≥65 years undergoing bariatric surgery, hypothesizing similar outcomes between groups. Methods In this retrospective, registry-based cohort study, the Ontario Bariatric Registry was used to compare data of patients &amp;lt;65 and ≥65 years who underwent Roux-en-Y gastric bypass and sleeve gastrectomy between January 2010 and August 2019 in all accredited bariatric centers of excellence in Ontario, Canada. Primary outcomes were overall postoperative complications. Secondary outcomes included early (&amp;lt;30 days) complications, readmissions, reoperations, mortality, weight loss and comorbidities improvement at 1 and 3 year after surgery. Results Data of 22,981 patients &amp;lt;65 and 532 patients ≥65 years were analyzed. Overall postoperative complications were similar between patients &amp;lt;65 and ≥65 years (3388/22,981 [14.7%] vs. 73/532 [13.7%], p = 0.537). Early (&amp;lt;30 days) postoperative complications, readmissions, reoperations, and mortality rates were also similar between groups. Both groups had significant weight loss and comorbidities improvement at 1- and 3-year follow-up. Patients &amp;lt;65 years had superior weight loss (+3.5%, 95% CI: 1.6–5.4, p &amp;lt; 0.001) and higher rates of remission for diabetes mellitus (63.8% vs. 39.3%, p &amp;lt; 0.001), hypertension (37.9% vs. 14.5%, p &amp;lt; 0.001), dyslipidemia (28.2% vs. 9.5%, p &amp;lt; 0.001) and gastroesophageal reflux (65.1% vs. 24.0%, p &amp;lt; 0.001) compared to patients ≥65 years at 3 year. Conclusion Patients &amp;lt;65 and ≥65 years had similar perioperative morbidity and mortality after bariatric surgery. Even though patients &amp;lt;65 years had overall better medium-term outcomes, bariatric surgery is safe and yields significant weight loss and comorbidities improvement in patients ≥65 years.

Early outcomes of lung resections in non-small cell lung cancer after COVID-19 pneumonia

ObjectiveThere is limited literature on patients with a history of COVID-19 pneumonia who underwent anatomical lung resection for non-small cell lung cancer (NSCLC). This study was aimed to share the early postoperative outcomes in patients who underwent lung resection after COVID-19 pneumonia. Materials and methodsWe retrospectively evaluated 30 patients who underwent lobectomy with thoracotomy and systematic mediastinal lymph node dissection due to NSCLC in a single center between November 2018 and September 2021. The patients were divided into two groups regarding COVID-19 pneumonia history; the COVID-19 group consisted of 14 patients (46.7%) and the non-COVID-19 group 16 (53.3%) patients. The patients’ age, gender, comorbidity, Charlson Comorbidity Index (CCI) score, forced expiratory volume in 1 s (FEV1) value, tumor type and size, resection type, postoperative air leak duration, total drainage volume, drain removal time, postoperative complications, and length of stay (LOS) were recorded. Results9 (30%) patients were female, and 21 (70%) were male. The mean age was 62.1 ± 8.91 years. Our comparison of postoperative air leak duration, total drainage volume, time to drain removal, postoperative complications, and LOS between the COVID-19 and non-COVID-19 groups revealed no statistically significant difference. ConclusionAnatomical lung resection can be performed safely in NSCLC patients with a history of COVID-19 pneumonia without significant difference in early postoperative morbidity and mortality.

Increased early mortality after total knee arthroplasty using conventional instrumentation compared with technology-assisted surgery: an analysis of linked national registry data

ObjectivesThis study aims to compare early mortality after total knee arthroplasty (TKA) using conventional intramedullary instrumentation to TKA performed using technology-assisted (non-intramedullary) instrumentation.DesignComparative observational study. Using data from a large...

Outcomes of colorectal cancer resection in patients with inflammatory bowel disease: a national population-based analysis in England and Wales.

The aim was to compare early postoperative outcomes and 2-year cancer-specific mortality following colorectal cancer (CRC) resection in patients with and without inflammatory bowel disease (IBD) in England and Wales. Records for patients in the National Bowel Cancer Audit who had major CRC resection between April 2014 and December 2017 were linked to routinely collected hospital level administrative datasets and chemotherapy and radiotherapy datasets. Multivariable regression models were used to compare outcomes with adjustment for patient and tumour characteristics. In all, 63 365 patients were included. 1285 (2.0%) had an IBD diagnosis: 839 (65.3%) ulcerative colitis, 435 (33.9%) Crohn's disease and 11 (0.9%) were indeterminate. IBD patients were younger, had more advanced cancer staging and a higher proportion of right-sided tumours. They also had a higher proportion of emergency resection, total/subtotal colectomy, open surgery and stoma formation at resection, with longer hospital admissions and higher rates of unplanned readmission and reoperation. Fewer rectal cancer patients with IBD received neoadjuvant radiotherapy (24.8% vs. 36.0%, P= 0.005) whilst similar proportions of Stage III colon cancer patients received adjuvant chemotherapy. Ninety-day postoperative mortality was similar, but unadjusted 2-year cancer-specific mortality was significantly higher in patients with IBD (subdistribution hazard ratio 1.35, 95% CI 1.18-1.55). Risk adjustment for patient and tumour factors reduced this association (adjusted subdistribution hazard ratio 1.22, 95% CI 1.05-1.43). Patients with IBD and CRC are a distinct patient group who develop CRC at a younger age and undergo more radical surgery. They have worse cancer survival, with the difference in prognosis appearing after the early postoperative period.

Early Postoperative Complications and Mortality in Patients Undergoing Colorectal Cancer Surgery, Co-Relation with Nutritional Status, Stage of Disease and Presentation

Background: Early postoperative outcome of colorectal cancer being worsen by various factors like advanced disease stage, emergency presentation, poor nutritional status of the patient etc. To aim of this study was to evaluate the relationship between nutritional status, disease stage, its presentation with short term outcome like mortality and morbidity after colorectal cancer surgery. Methods: A total 44 number of colorectal cancer patients enrolled in this observational study. These patients underwent colorectal cancer surgery in different surgery unit of Dhaka Medical College hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled during the period of March 2014 to march 2015.Patients who developed early postoperative morbidity or mortality were compared with those who followed a healthy course after surgery in relation to nutritional status, disease stage and presentation. Total sample were divided into Group A, who developed postoperative complications and Group B, where patients had uneventful outcome. Results: Among 44 patients, in hospital death rate found nil and the overall postoperative morbidity rate was 34%. Most of the patients (33/44) was with normal BMI (17-24.9). Histopathologically found adenocarcinaoma and 56% was found TNM stage. Early postoperative outcome was significantly associated with preoperative hypoalbuminemia (16/36), medium to high risk of malnutrition (22/44), immediate surgery for acute disease state (2/15). Conclusion: In colorectal cancer, malnourished, high risk of malnutrition, hypoalbuminemia significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience

BackgroundCytoreductive surgery is currently the main treatment for advanced epithelial ovarian cancer (OC), and several surgical maneuvers, including colorectal resection, are often needed to achieve no residual disease. High surgical complexity carries an inherent risk of postoperative complications, including anastomosis leakage (AL). Albeit rare, AL is a life-threatening condition. The aim of this single-center retrospective study is to assess the AL rate in patients undergoing colorectal resection and anastomosis during primary surgery for advanced epithelial OC through a standardized surgical technique and to evaluate possible pre/intra- and postoperative risk factors to identify the population at greatest risk.MethodsA retrospective analysis of clinical and surgical characteristics of 515 patients undergoing colorectal resection and anastomosis during primary or interval debulking surgery between December 2011 and October 2019 was performed. Several pre/intra- and postoperative variables were evaluated by multivariate analysis as potential risk factors for AL.ResultsThe overall anastomotic leakage rate was 2.9% (15/515) with a significant negative impact on postoperative course. Body mass index < 18 kg/m2, preoperative albumin value lower than 30 mg/dL, section of the inferior mesenteric artery at its origin, and medium–low colorectal anastomosis (< 10 cm from the anal verge) were identified as independent risk factors for AL on multivariate analysis.ConclusionsAL is confirmed to be an extremely rare but severe postoperative complication of OC surgery, being responsible for increased early postoperative mortality. Preoperative nutritional status and surgical characteristics, such as blood supply and anastomosis level, appear to be the most significant risk factors.

Surgical Remodeling of the Left Ventricle in Patients with Post-Infarction Dilation and Heart Failure

INTRODUCTION The cause of heart failure in patients with coronary artery disease after anterior myocardial infarction may be dilatation of the cavity of the left ventricle (LV) with subsequent unfavorable course of the disease. In the case of early reperfusion, which prevents transmural myocardial necrosis, the damaged segment more often becomes akinetic than dyskinetic. Surgical remodeling of the left ventricle (SRLV) is aimed at reducing the volume and restoring its elliptical shape by eliminating scars in the akinetic and/or dyskinetic segments.AIM OF STUDY To evaluate the survival of patients with chronic heart failure (CHF) who had anterior wall myocardial infarction in the early and late periods after surgical remodeling of the left ventricle, in combination with coronary bypass grafting and/or interventions on the mitral valve.MATERIAL AND METHODS The study included 99 patients with coronary artery disease (CAD) who had myocardial infarction of the anterior LV wall and with severe heart failure, who underwent surgical LV remodeling in the period from 2002 to 2020. The analysis of early and long-term results was carried out. The risk factors influencing lethality were determined.The mean age of the patients was 56.0±10.2 years (from 23 to 81 years). The vast majority of patients (90%) were men. LV ventriculoplasty was combined with coronary bypass grafting in 97 (98%) patients, with mitral valve repair in 2 (2%) patients, with mitral valve replacement in 2 (2%) patients.RESULTS In the early postoperative period, all patients showed an improvement in global LV systolic function. The ejection fraction (EF) of the left ventricle increased from the average preoperative average value of 34.2±3.7% to 43±4.2% in the postoperative period (р&lt;0,001). Left ventricular end systolic volume index (LVESV) decreased from 71.4±15.3 ml/m2 to 43.8±9.6 ml/m2, respectively (р&lt;0,001). In the early postoperative period, 5 (5%) patients used the following means of mechanical hemodynamic support: intra-aortic balloon pump (IABP), non-implantable device for temporary support of the left ventricle (LVAD) and extracorporeal membrane oxygenation (ECMO). The 30-day mortality rate after LVESV was 6%. Prior to surgery, all patients had NYHA functional class (FC) III or IV. In the postoperative period, all patients experienced regression of heart failure symptoms and improved exercise tolerance. NYHA functional class improved to I and II in 100% of cases. Using univariate analysis, it was possible to determine that EF ≤30%, LVESV ≥80 ml/m2 and pulmonary artery pressure (PAP) &gt;60 mm Hg. were risk factors for hospital mortality. The overall fifteen-year survival rate was 59.8±0.13%. The absence of readmission to the hospital due to recurrent angina pectoris, mitral valve dysfunction and progression of heart failure (HF) was 72% among surviving patients.CONCLUSION Surgical remodeling reduces the volume of the dilated left ventricle and restores its elliptical shape in patients with CAD after anterior myocardial infarction. The results of our study demonstrate an improvement in LV systolic function in all patients in the early postoperative period and low mortality, an acceptable fifteen-year survival rate, and a low readmission rate due to the progression of chronic heart failure (CHF).

Aortic arch isolation to reduce cerebral embolic risk during replacement of the atherosclerotic aortic arch

ObjectiveTo analyze the efficacy of isolating the upper body circulation from the lower body (isolation technique) in reducing the risk of embolic stroke during cardiopulmonary bypass in patients with severe atherosclerosis undergoing aortic arch surgery. MethodsBetween 2006 and 2019, 156 patients with severe atherosclerosis undergoing total arch replacement were enrolled. Since 2017, the right axillary or innominate artery and ascending aorta were both cannulated before cardiopulmonary bypass in the isolation group (n = 30). The left common carotid artery was clamped and inserted with a 13-Fr balloon perfusion catheter. The innominate artery was clamped in succession and cardiopulmonary bypass was instituted, establishing a parallel noncommunicating circulation for the upper and lower body. Patients without atherosclerosis that were not considered at high risk of embolic complications were excluded. The no-isolation group was drawn from historically matched control patients undergoing total arch replacement. ResultsThe permanent stroke rate in the isolation and no-isolation groups were 3.3% (n = 1) and 15.9% (n = 15.9), respectively. After inverse-probability-of-treatment-weighting adjustment, the early mortality (P = .043), stroke (P = .044), and composite of early mortality or stroke (P = .005) rates were significantly lower in the isolation group. The logistic regression analysis after inverse-probability-of-treatment-weighting risk adjustment showed a significantly reduced composite risk of early death and stroke in the isolation group (odds ratio, 0.09; 95% confidence interval, 0.01-0.70; P = .023). ConclusionsThe isolation technique was associated with a significant reduction in early postoperative embolic stroke and mortality risks in patients with severe aortic atherosclerosis undergoing total arch replacement.

Outcomes Following Heart Transplantation in Adults with Congenital Heart Disease

<h3>Purpose</h3> The number of adults with congenital heart disease (ACHD) requiring treatment with heart transplant (HT) is growing. Determinants for survival after HT in this challenging population remain unknown. The aim of this study is to investigate the factors associated with outcomes after HT in ACHD. <h3>Methods</h3> We reviewed the UNOS-STAR database and analyzed 35,952 HT from 2000 to 2018. Recipient and donor characteristics, outcomes for patients undergoing HT for ischemic cardiomyopathy (ICM) (n=14,236), nonischemic cardiomyopathy (NICM) (n=20,676), and ACHD (n=1,040) were compared. The mean follow-up for the total study population was 6.20±4.84 years. Kaplan-Meier survival curves with Log-rank statistics as well as Cox-proportional hazards analysis with univariate analysis as well as multivariable regression were used to analyze survival data. Univariable and multivariable forward and reverse binary logistic regression was used to evaluate determinants of hospital mortality. <h3>Results</h3> When compared to the other groups, ACHD recipients had a higher incidence of postoperative stroke, dialysis, and death from acute rejection. Multivariable analysis confirmed that ACHD was associated greater in-hospital death compared to ICM (HR=0.54, P<0.001) and NICM (HR=0.46, P<0.001). Factors associated with increased mortality were history of cerebrovascular disease (HR=1.11, P=0.026), prior history of malignancy (HR=1.12, P=0.006), pre-transplant biventricular support (HR=1.12, P=0.069), postoperative stroke (HR=1.47, P<0.001) and postoperative dialysis (HR=1.71, P<0.001). O blood group donor hearts were also associated with increased in-hospital death compared to blood groups A (HR=0.824, P=0.001), B (HR=0.818, P=0.029), and AB (HR=0.659, P=0.051). In-hospital deaths were less likely with donors who were male (HR=0.851, P=0.011) and with a history of cocaine use (HR=0.826, P=0.012). ACHD patients more likely to receive a subsequent re-transplant. The 5-, 10-, and 15-year survival were 72.3%, 63.4%, and 53.0% for ACHD; 75.8%, 56.1%, and 35.6% for ICM and 79.2%, 64.9%, and 49.0% for NICM. Survival, conditional upon discharge from the hospital was significantly higher in ACHD. <h3>Conclusion</h3> HT in ACHD is associated with a higher early post-operative mortality, better long-term conditional survival, and a higher rate of retransplantation when compared to patients with ICM and NICM.

Основні чинники ризику повторних операцій у дітей з вродженими діафрагмальними грижами

Congenital diaphragmatic hernia (CDH) occurs with a frequency of 3.5 per 10,000 live births and occurs due to a fusion disorder of the closure of the pleuroperitoneal fold and transverse septum during 8-12 weeks of gestation. In an isolated variant of this pathology, mortality is quite high and there are a number of controversial issues. Even in the best specialized prenatal intensive care centers, the mortality rate reaches 30%. The use of new technologies in the treatment of CDH has increased the survival rate of patients, however, against this background, there is an increase in surgical problems associated with CDH. Purpose - to describe the structure and incidence of reoperations in children with CDH, depending on the access, identification of the main risk factors for reoperations, pathogenetic justification of optimal surgical access. Materials and methods. A retrospective cohort study of surgical correction of CDH in 104 infants who were operated on the basis of the NCH «OKHMATDYT» during 2000-2020 was conducted. To homogenize the group and to maximally exclude selection bias in order to identify risk factors, we include a group of patients with left-sided CDH in the study. Correction of the left-sided CDH was performed through the laparotomic approach in 51 patients (61%). Thoracotomy for left-sided EDH was used in 33 (39%) patients. Results. In the study group of patients, 14 (16.7%) reoperations were performed in this group at different times of the long-term period. The indications for reoperations were: adhesive intestinal obstruction - 3 (21.5%), inc. strangulated intestinal obstruction with bowel necrosis - 2 (14%), obstruction caused by malrotation - 1 (7%), gastroesophageal reflux - 4 (29.5%), recurrent hernia - 2 (14%), pectus excavatum - 1 (7%), spleen torsion - 1 (7%). The number of reoperations in the study group during a certain observation period was slightly higher in the thoracotomy group (18% versus 14%, p=0.80). More than half of repeated interventions were associated with acute intestinal obstruction, more often after laparotomy (35.7 versus 7%; p=0.16). In this group, 5 reoperations were performed, the cause of which was intestinal obstruction, in contrast to the thoracic group, where one patient was operated for malrotation. Reoperations for recurrent diaphragmatic hernia occurred only in the thoracotomy group in one patient with agenesis of the left diaphragm dome. Early postoperative mortality was found slightly higher in the laparotomy group (27.4% versus 18.1%; p=0.167). Conclusions. The optimal method of surgical treatment of large defects and agenesis of the dome is surgical correction of the diaphragm through a thoracotomy approach using a synthetic patch and thoracalization of the abdominal cavity. The abdominal approach has a high risk of reoperations, which is associated with the development of the adhesive process and the likelihood of the formation of ventral hernias due to viscero-abdominal imbalance. The indications for the use of thoracic access and patches for plasty of the diaphragm defect should be expanded regardless of the side of the lesion and the size of the defect. The main factors determining the risk of recurrent CDH are the size of the hernial defect and the method of diaphragm correction. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia, reoperations, intestinal obstruction, gastroesophageal reflux, recurrence, malrotation, thoracatomy, laparotomy.