Heart Surgery Patients Research Articles

ĐÁNH GIÁ TÌNH TRẠNG SẢNG SAU PHẪU THUẬT TIM MỞ VỚI TUẦN HOÀN NGOÀI CƠ THỂ

Introduction: Postoperative delirium is a common complication. The appearance of delirium in heart surgery patients affects the volume of nursing work and negatively impacts the patient's treatment outcome such as prolonged hospital stays, increased mortality, prolonged cognitive decline. Objective: Describe the characteristics and evaluate some riskfactors of delirium after open heart surgery with cardiopulmonary bypass. Methods: Cohort studies on open heart surgery patients with cardiopulmonary bypass that ≥18 years old in Cardiovascular Surgery Unit_ BachMai Hospital, a diagnostic tool is CAM-ICU, assesses delirium twice a day for the first 4 days after surgery. Results: Of the 285 patients included in the study, 56 were diagnosed with CAM-ICU, accounting for 19.6%; Independent risk factors identified as advanced age, history of cerebrovascular accident, prolonged cardiopulmonary bypass time, postoperative atrial fibrillation, opioid use > 3 days. Conclusions: Delirium is a common complication after open heart surgery with cardiopulmonary bypass. The identification of risk factors of postoperative delirium helps doctors and nurses have the right attitude to approach and handle during surgery, anesthesia resuscitation for patients, thereby preventing the bad consequences of delirium after surgery. Keywords: delirium, open heart surgery, risk factors

818 Impaired clinical outcome and increased postoperative complications in COVID-19 patients undergoing cardiopulmonary bypass

ObjectivePrevious studies reported unfavorable results in COVID-19 patients who underwent cardiac surgery. Complications most frequently observed were respiratory failure and higher incidence of thromboembolic events. We present our single-center experience in patients with perioperative diagnosis of COVID-19 infection undergoing cardiac surgery with extracorporeal circulation.MethodsIn this observational matched case-control (propensity match 1:2) study, we collected data of patients undergoing open heart cardiac surgery from January 2020 to May 2021, having positive perioperative diagnosis of COVID-19 infection confirmed by polymerase Chain Reaction-PCR (study group). Patients were compared with 56 corresponding controls (control group) who matched for age, sex, body mass index (BMI) and Euro-Score II.ResultsIn the study period 1060 patients underwent cardiac surgery with cardiopulmonary bypass (CPB). Among them, 28 consecutive patients, aged 70.1±9.3 years, had perioperative diagnosis of COVID-19 infection. Four (14%) patients underwent emergency surgery for type-A aortic dissection, 2 (7%) patients died in the Intensive Care Unit for severe respiratory failure, shock and multiple organ failure. Significant bleeding complications occurred in 14 (50%) patients in the study group (vs 6% in the control group, p=<0.05). In the study group, 11 (39%) patients required early surgical reexploration for bleeding, 5 presented cardiac tamponade, 5 (18%) underwent multiple surgical revisions for recurrent bleeding. Three (11%) patients required late chest drainage of a massive sero-hemorrhagic pleural effusion, 1 (4%) presented late postoperative intracranial hemorrhage. Fourteen (50%) patients had severe thrombocytopenia (vs 9% in the control group, p=<0.05). In the study group blood components transfusion and procoagulant drugs administration increased (79% and 78% vs 18% and 11% in the control group, respectively, p=<0.05). In the study group 6 (21%) patients presented postoperative acute renal failure (2% in the control group, p=<0.05), 7 (25%) acute respiratory failure (p=<0.05) requiring prolonged postoperative orotracheal intubation. Sternal dehiscence was observed in 4 (14%) patients in the study group (vs 4% in the control group, p=< 0.05). Complications significantly influenced hospital stay length (20 ± 3.1 vs 8.1 ± 3.9 days, p=< 0.05). In the multivariable logistic regression model the SARS-CoV-2 infection and renal failure were independent factors associated with severe postoperative complications (p=<0.01).ConclusionsClinical outcome of open heart cardiac surgery patients with perioperative COVID-19 infection appears significantly impaired in terms of mortality and postoperative complications. CPB-related inflammatory reaction could likely exacerbate the deleterious effect of COVID-19 on the respiratory and renal systems, as well as on the coagulation pathways. Early and late hemorrhagic complications were very frequent with significantly increased surgical reexplorations for bleeding, a higher incidence of severe thrombocytopenia, of blood components transfusion and procoagulant drugs administration. The increased surgical risk should suggest a cautious attitude in indicating open heart surgery in patients with perioperative COVID-19 infection and surgery should be limited to not postponable or to urgent cases.

The Influence of Preoperative Hematocrit Levels on Early Outcomes in Patients undergoing Cardiac Surgery

Background: Anemia is a common risk factor for cardiovascular disease. The impact of preoperative anaemia is unclear in cardiac surgery. Preoperative anaemia affects early findings in patients undergoing cardiac surgery. Aim and Objective: The main objective of current research was to investigate the impact of preoperative anaemia on early outcomes in heart surgery patients. Material and Methods: A prospective randomized clinical research was undertaken after obtaining written informed consent from patients for cardiac surgery at the PIC, Lahore between Apr 2020 and Feb 2021. A total of 120 individuals between the ages of 20 and 60 were chosen for the research. Preoperative anaemia was described as Hb levels of &lt;13 g/dl for males and &lt;12 g/dl in female patients undergoing cardiac surgery. Results: Total 120 patients were enrolled and stratified into two groups (60 patients each) with average age 5 ± 5.75 years. Early outcomes after surgery such as postoperative stroke (6.67 % versus 1.6 %), AF (37 % versus32 %), and duration of hospital stay &gt; 7 days (50 % vs 41.67 %) were found to be different between anaemic and normal Hb groups. Conclusion: Preoperative anaemia can be increased risk of morbidity and mortality in patients after surgery. Low preoperative Hb found as advanced risk factor for death, renal impairment, stroke, AF and long hospital stay in our research. Keywords: Anemia, CABG, AF, MI, IABP, CPB

A multi-centre survey on hospital malnutrition: result of PNSI study

BackgroundDisease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f.MethodsPersian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA).ResultsIn total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10).ConclusionThis study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue.

Machine learning identification of specific changes in myeloid cell phenotype during bloodstream infections

The early identification of bacteremia is critical for ensuring appropriate treatment of nosocomial infections in intensive care unit (ICU) patients. The aim of this study was to use flow cytometric data of myeloid cells as a biomarker of bloodstream infection (BSI). An eight-color antibody panel was used to identify seven monocyte and two dendritic cell subsets. In the learning cohort, immunophenotyping was applied to (1) control subjects, (2) postoperative heart surgery patients, as a model of noninfectious inflammatory responses, and (3) blood culture-positive patients. Of the complex changes in the myeloid cell phenotype, a decrease in myeloid and plasmacytoid dendritic cell numbers, increase in CD14+CD16+ inflammatory monocyte numbers, and upregulation of neutrophils CD64 and CD123 expression were prominent in BSI patients. An extreme gradient boosting (XGBoost) algorithm called the “infection detection and ranging score” (iDAR), ranging from 0 to 100, was developed to identify infection-specific changes in 101 phenotypic variables related to neutrophils, monocytes and dendritic cells. The tenfold cross-validation achieved an area under the receiver operating characteristic (AUROC) of 0.988 (95% CI 0.985–1) for the detection of bacteremic patients. In an out-of-sample, in-house validation, iDAR achieved an AUROC of 0.85 (95% CI 0.71–0.98) in differentiating localized from bloodstream infection and 0.95 (95% CI 0.89–1) in discriminating infected from noninfected ICU patients. In conclusion, a machine learning approach was used to translate the changes in myeloid cell phenotype in response to infection into a score that could identify bacteremia with high specificity in ICU patients.

Value of Atrial Fibrillation Prophylaxis after Coronary Artery Bypass Graft Surgery

Background: Heart surgery patients who develop acute and new-onset AF (postoperative atrial fibrillation, POAF) are among the most common postoperative complications, affecting around 35 percent of those who undergo the procedure. Objective: To assess the effectiveness of amiodarone in prophylaxis of AF post coronary artery bypass surgery (CABG). Patients and Methods: Our work represents a randomized clinical trial, which was carried out at National Heart Institute and Zagazig University from the period of August 2020 to June 2021. 68 patients, admitted for CABG and had high risk score according to POAF score, were included in our study. Results: Regarding mean left ventricular ejection fraction (LVEF), in group I was 47.52±5.85 while in group II it was 49.85±6.25. There was a statistically non-significant difference between the groups with a P value of 0.414. Mean Intensive Care Unit (ICU) period was 4.42±1.35 in group I, and group II was 2.73±0.95. The difference between the groups was statistically significantly shorter among group II (prophylaxis group) (P <0.01). Regarding development of POAF, in group I, the incidence of POAF was 85.3% while in group II, it was 38.2%. Difference among the two studied groups was statistically significantly lower in the group II (prophylaxis group). Conclusion: A prophylactic amiodarone strategy dramatically decreased incidence of POAF risk. All previous estimations of POAF risk reduction using prophylactic amiodarone were found to be accurate. Amiodarone was more effective in preventing postoperative atrial fibrillation with no serious side effects and it decreased postoperative ICU stay.

Impact of Medicare Eligibility on Informal Caregiving for Surgery and Stroke

Research ObjectiveOver 40 million older Americans rely on informal care (unpaid assistance for personal care such and instrumental support, including toileting, bathing, and shopping). Prior work illustrates 68–230% greater spending on post‐acute care after surgery for Medicare beneficiaries compared to older commercial insurance enrollees. Such enhanced access to post‐acute care may reduce the need for family and friend caregiving support for rehabilitation following acute medical events. While use of informal care is substantial among older Americans, little is known about informal support for patients after acute medical events, and how formal post‐acute care influences its use.Study DesignWe used 1998 to 2018 Health and Retirement Study (HRS) data to assess changes in weekly hours of informal care received by individuals experiencing acute events before and after Medicare eligibility. We created two similar cohorts of individuals near the Medicare eligibility age: pre‐Medicare, or individuals ages 59–66 and not covered by Medicare; and Medicare, or individuals ages 67–74. We used a threshold of 67, rather than 65, for the Medicare cohort to account for the two‐year lookback period used in HRS survey questions. The cohorts were matched using inverse probability treatment weights. A regression discontinuity design assessed three types of caregiving – the proportion of respondents receiving care, intensity of care among care recipients, and care intensity among all respondents – before and after Medicare eligibility. We estimated generalized linear models with a log link and gamma distribution that regressed informal care on Medicare status, a centered age variable, and an interaction between Medicare status and centered age. Sensitivity analyses included stratification by surgery type and by sex.Population Studied4264 Health and Retirement Study participants near the age of Medicare eligibility in one of three self‐reported acute medical cohorts: stroke, heart surgery, or joint surgery.Principal FindingsAmong near‐retirement individuals, 2031 (47.6%) had a stroke, 1038 (24.3%) underwent heart surgery, and 1038 (28.0%) underwent joint surgery. Of the 937 (22.3%) of patients who reported receiving care from an informal caregiver, average care measured 34.0 (SD: 49.2) weekly hours. Mean (SD) weekly informal caregiving hours were 7.5 (27.0) overall, and 12.1 (34.7), 3.8 (18.5), and 2.9 (14.1) for stroke, heart surgery, and joint surgery patients, respectively. In adjusted analyses, the proportion of stroke patients receiving informal care decreased from 39.5% to 28.6% (or by 28%) and the average weekly amount of care decreased from 21.0 to 10.3 hours (or 51%) after Medicare enrollment. Non‐significant decreases were observed for the other medical cohorts. There was a non‐significant average decrease of 22.8 hours (or 40%) in the intensity of care received by men after one of three events.ConclusionsAccess to Medicare coverage was associated with a 51% reduction in informal care received by older Medicare stroke patients, potentially by increasing access to post‐acute services.Implications for Policy or PracticePost‐acute care is increasingly targeted for cost savings under Medicare policies, which may restrict access to post‐acute care and rehabilitation, impacting demand for informal care for older adults with stroke.

Explainable machine-learning predictions for complications after pediatric congenital heart surgery

The quality of treatment and prognosis after pediatric congenital heart surgery remains unsatisfactory. A reliable prediction model for postoperative complications of congenital heart surgery patients is essential to enable prompt initiation of therapy and improve the quality of prognosis. Here, we develop an interpretable machine-learning-based model that integrates patient demographics, surgery-specific features and intraoperative blood pressure data for accurately predicting complications after pediatric congenital heart surgery. We used blood pressure variability and the k-means algorithm combined with a smoothed formulation of dynamic time wrapping to extract features from time-series data. In addition, SHAP framework was used to provide explanations of the prediction. Our model achieved the best performance both in binary and multi-label classification compared with other consensus-based risk models. In addition, this explainable model explains why a prediction was made to help improve the clinical understanding of complication risk and generate actionable knowledge in practice. The combination of model performance and interpretability is easy for clinicians to trust and provide insight into how they should respond before the condition worsens after pediatric congenital heart surgery.

Biomarkers in low cardiac output syndrome after open cardiac surgery in children

Background Corrective cardiac surgery is the standard management for complex congenital heart disease. Cardiopulmonary bypass surgery and post-surgical intensive care may lead to low cardiac output syndrome (LCOS), as a major complication after open heart surgery. To diagnose early LCOS, lactate level, pCO2 gap, and mixed venous oxygen saturation (SvO2) are parameters reported to have correlations with decreased cardiac output, morbidity, and post-cardiac surgery mortality. Objective To determine the usefulness of lactate level, pCO2 gap (arterial-vein), and SvO2 for early detection of LCOS in children post-open heart surgery. Methods This prospective cohort study was done from August to October 2017 in the ICU of the Integrated Cardiac Center, Dr. Cipto Mangunkusumo Hospital, Jakarta. Subjects were pediatric patients who underwent cardiac surgery. After surgery, patients underwent monitoring in the ICU for clinical signs of LCOS and examinations for lactate levels, pCO2 gap, and SvO2 at 15 minutes, 4 hours and 8 hours. Results Thirty-three open heart surgery patients were the subjects. Lactate level at 4 hours and 8 hours post-operative were significantly higher in the LCOS group compared to non-LCOS group. For the pCO2 gap, only the 4-hour post-operative results were significantly higher in LCOS group compared to non-LCOS groups. In addition, only SvO2 at 4 hours after surgery was significantly lower in LCOS group compared to non-LCOS group. Conclusion Elevated lactate, high pCO2 gap, as well as decreased SvO2 at 4 hours post-operatively are the most reliable markers of LCOS after pediatric open heart surgery.

Assessment of Patients' Needs Pre and Post Open Heart surgery

Background: Assessment of Bio-psychosocial needs of patient pre and post open heart surgery are very important aspect of patient centered care. Aim: was to assess patients' needs pre and post Open Heart Surgery. Design: -A descriptive exploratory design was utilized in this study. Settings: This study was conducted at Cardio-Thoracic Intensive Care Unit of Educational Tanta University Hospital. Subjects: A convenience sample of (100) open heart surgery patients that had been admitted to Cardio-Thoracic Intensive Care unit and meeting the inclusion criteria. Tools of the study: Two tools was used in this study for data collection: Tool I:A structured Interview Schedule Tool II:Bio psychosocial Needs Interview Questionnaire which included three parts; part (1): Physical Needs for Patients undergoing Open Heart Surgery, part(2): Psychological Assessment for Patients with Open Heart Surgery and part (3) Social Dysfunction Rating Scale for Patients with Open Heart Surgery. Results: There was highly significant positive correlation between total Social Dysfunction of the studied patients and their total score of pain score and total score of psychological needs at (P= < 0.01). In addition, there were significant positive correlation between total score of pain score of the studied patients and their total score of psychological needs and total score of Social Dysfunction at (P= < 0.01). Conclusion: The study concluded that, three-quarters of the studied patient had unsatisfactory level of total knowledge about heart surgeries. Also, there was a marked increase in total patients’ dependency in Activities of Daily Living level at post heart surgery. Recommendations: Routine pre and postoperative assessment of patients who are undergoing open heart surgery is recommended to identify the different patient's biopsychosocial needs and consequently any risk factor and reduced the post-operative complications.

FIBER: enabling flexible retrieval of electronic health records data for clinical predictive modeling.

ObjectivesThe development of clinical predictive models hinges upon the availability of comprehensive clinical data. Tapping into such resources requires considerable effort from clinicians, data scientists, and engineers. Specifically, these efforts are focused on data extraction and preprocessing steps required prior to modeling, including complex database queries. A handful of software libraries exist that can reduce this complexity by building upon data standards. However, a gap remains concerning electronic health records (EHRs) stored in star schema clinical data warehouses, an approach often adopted in practice. In this article, we introduce the FlexIBle EHR Retrieval (FIBER) tool: a Python library built on top of a star schema (i2b2) clinical data warehouse that enables flexible generation of modeling-ready cohorts as data frames.Materials and MethodsFIBER was developed on top of a large-scale star schema EHR database which contains data from 8 million patients and over 120 million encounters. To illustrate FIBER’s capabilities, we present its application by building a heart surgery patient cohort with subsequent prediction of acute kidney injury (AKI) with various machine learning models.ResultsUsing FIBER, we were able to build the heart surgery cohort (n = 12 061), identify the patients that developed AKI (n = 1005), and automatically extract relevant features (n = 774). Finally, we trained machine learning models that achieved area under the curve values of up to 0.77 for this exemplary use case.ConclusionFIBER is an open-source Python library developed for extracting information from star schema clinical data warehouses and reduces time-to-modeling, helping to streamline the clinical modeling process.

Initial experience with del Nido cardioplegia solution at a Pediatric and Congenital Cardiac Surgery Program in Brazil.

The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients. Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality. Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance. In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.

Preoperative Sucrosomial Iron Supplementation Increases Haemoglobin and Reduces Transfusion Requirements in Elective Heart Surgery Patients: A Prospective Randomized Study

Background: Low preoperative haemoglobin is frequently observed in heart surgery patients and is associated with a significant decrease in haemoglobin between post-operative days 2 and 3, known as haemoglobin drift. Overall, these patients tend to receive many RBC transfusions. Since iron homeostasis is often impaired in these patients, restoration of iron availability might override iron-restricted erythropoiesis. However, reduced tolerance to oral iron salts has limited this strategy to intravenous iron administration. Study Design and Methods: The purpose of this study was to assess whether preoperative supplementation with oral sucrosomial iron, a new iron-delivery technology with improved tolerance and bioavailability, might be an effective strategy for this patient population. One thousand consecutive patients were randomized and received either a one-month course of sucrosomial iron (60 mg/day) or no treatment prior to elective heart surgery at a single high-volume centre (ClinicalTrials.gov NCT03560687). Primary end-points were haemoglobin concentration on the day of hospital admittance and number of blood transfusions. Secondary end-points were haemoglobin drift, tolerance of treatment and cost-effectiveness of sucrosomial iron administration. Results: Baseline haemoglobin in the treatment group was higher (by 0.67 g/dL; p&lt;0.001) than that in the control group. The percentage of patients in the treatment group who required transfusion (35.4%) was half that in the control group (64.6%). The average number of transfused units per operation was 0.95 vs. 2.03 in the treatment and control groups, respectively. Haemoglobin drift was substantially similar in the two groups, and the tolerability of treatment was excellent (98%). The overall cost of treatment was 156 Euros less in the treatment group, expressed as a raw cost of transfusion. Conclusion: In elective heart surgery, routine preoperative sucrosomial iron administration seems to be a safe, well-tolerated and cost-effective strategy to increase preoperative haemoglobin and reduce the need for allogeneic blood transfusions.

Abstract P013: Validating The Utility Of Plasma Biomarkers In The Prediction Of Readmission Or Mortality Following Congenital Heart Surgery

Introduction: Unplanned readmission is associated with higher risks of complications, death, and increased costs. Accurate statistical models to stratify the risk of 30-day readmission or death after congenital heart surgery could help clinical teams focus care on those patients at highest risk. We hypothesized biomarkers could improve prediction for readmission or mortality. Methods: Levels of pre- and postoperative ST2, Galectin-3, NT-proBNP and GFAP were measured in plasma samples from 162 pediatric congenital heart surgery patients from Johns Hopkins Hospital with external validation in 360 pediatric patients from an international multi-center TRIBE-AKI cohort. A model based on clinical variables from the Society of Thoracic Surgery Congenital database (STS-CHSD) was developed in the Hopkins cohort. We tested and externally validated the clinical models and biomarker panels in the TRIBE-AKI cohort using AUROC statistics and Kaplan-Meier cox hazard regression models. Results: There were 55 patients (10.5%) that experienced unplanned readmission or died within 30 days after congenital heart surgery. The STS-CHSD clinical model resulted in an AUROC of 0.617 (95% CI: 0.47 - 0.76). The derivation cohort with the biomarker augmented STS-CHSD clinical model resulted in a significantly improved AUROC of 0.802 (95%CI: 0.72 - 0.89; p=0.003). External validation of the biomarker augmented STS-CHSD clinical model showed limited improvement (AUROC: 0.60; 95% CI: 0.49-0.72; p value= 0.47). Conclusions: Our findings indicate that these biomarkers can be used for early identification of children at increased risk of readmission or death after pediatric congenital heart surgery. While the addition of biomarkers improve prediction in our derivation cohort, external validation was poor. Our findings suggest there are other potential biomarkers and factors to be explored to improve prediction of readmission or mortality for children following congenital heart surgery.

Perioperative Psychological Interventions in Heart Surgery–Opportunities and Clinical Benefit.

Heart surgery is a source of high levels of emotional distress for the patient. If the stress experience is not adequately compensated, it can have a negative impact on postoperative recovery, as can untreated comorbid mental disorders. A selective literature review on emotional distress and mental comorbidities in heart surgery patients and a scoping review on the spectrum and effectiveness of perioperative psychological interventions to compensate and reduce the stress experience. Mental factors such as depressive symptoms or anxiety disorders are associated with an elevated risk of postoperative morbidity and mortality in patients treated for heart disease. Mental comorbidities occur more frequently in these patients than in the general population. Following the manifestation of chronic heart disease (CHD), for example, 15-20% of the patients display severe depressive disorders. A few psychotherapeutic interventions to reduce anxiety and depression, emotional distress, consumption of analgesics, and extubation time have been found effective, with low to moderate evidence quality. Many different psychological interventions have proved useful in clinical practice, including multimodal, multiprofessional interventions incorporating medications, education, sports, and exercise as well as psychosocial therapy including stress management. Individual psychotherapy during the period of acute inpatient treatment after myocardial infarction is also effective. Because psychosocial factors are important, the current guidelines recommend systematic screening for mental symptoms and comorbidities in advance of heart transplantation or the implantation of ventricular assist devices (VAD). Acute psychotherapeutic interventions to reduce mental symptoms can be offered in the perioperative setting.

Sternotomy with electrocautery and sternal wound infection in congenital heart surgery in patients under 1 year of age.

The present study aimed to compare the rate of wound site infection in patients <1 year of age who underwent sternotomy using electrocautery, a routinely performed procedure in our clinic, with those reported in the literature. This double-center study included patients <1 year of age who underwent cardiac surgery via sternotomy performed with electrocautery for congenital heart disease between January 2017 and June 2019. Patient's data were retrospectively obtained from the hospital records. In our study, seven patients developed SSI, which was superficial in six (1.3%) patients and in the form of mediastinitis in one (0.2%) patient. Sternotomy with electrocautery, which we consider an easy and safe method, was also not found to be statistically different from the other methods in terms of SWI.

Yeni Bir Merkez, Isparta Şehir Hastanesi Açık Kalp Cerrahisi: İlk 106 Vaka Sonuçları

Introduction: First 106 open heart operation cases evaluated in Isparta City Hospital Cardiovascular Surgery Clinic.&#x0D; Material and Method: One hundred and six open heart surgery patients from may 2018 to june 2019 were evaluated retrospectively. 32 (30.2%) were female and 74 (69.8%) were male with the mean age is 64±10. Totally 5 (4.7%) were valve and 101 (95.3%) were coronary artery bypass grafting, 5 (5%) of these cases were emergent operation.&#x0D; Results: Overall mortality was 5(4.7%). Reoperation rate was 4 (3.8%) ; 2 (1.9%) reoperated for haemorragia, 1 (0.9%) for ventricular arhytmia and 1 (0.9%) reoperated for late sternal dehissence after 1 week of the first operation. Neurologic complication was 4 (3.8%). Glomerular filtration rate, age, ejection fraction, euroSCOREs, intensive care unit follow up days and postoperative discharging days were evaluated. In the presence of chronic obstructive pulmonary disease, intensive care unit and hospital stay periods significiantly increase but they remain normal in the presence of diabetes mellitus.&#x0D; Results: Although our heart center is new onset among the city hospitals, we think that our center has a remarkable success in first 106 patients according to the morbidity and mortality rates and intensive care unit and overall hospital stay days compared to the published databases.

Effects of Obesity on Mortality and Morbidity in High-Risk Open Heart Surgery Patients

Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI &lt;30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p&gt; 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.

O045 / #673: EVALUATION OF THE PERFORMANCE OF VASOACTIVE VENTILATION RENAL SCORE IN PREDICTING THE DURATION OF MECHANICAL VENTILATION AND INTENSIVE CARE HOSPITALIZATION AFTER PEDIATRIC CARDIAC SURGERY

Aims & Objectives: Various methods have been used to evaluate the recovery process after cardiac surgery in children. In here, we aimed to evaluate the vasoactive ventilation renal (VVR) score. Methods: Patients who underwent congenital heart surgery between November 2016 - March 2019 were evaluated prospectively. VVR score was calculated as follows: VIS + ventilation index + (change in serum creatinine level based on baseline value X 10). The VVR score, VIS and serum lactate levels of all patients were recorded at the time of admission, the highest value in the first 24 hours and 48th hour. The relationship between the duration of mechanical ventilation monitoring and ICU stay was evaluated by ROC analysis and threshold values were calculated. Results: The median age of the 94 patients included in the study was 1.1 (range 0.2-17) year, and 12 patients had single ventricular physiology. In the time period corresponding to each study point, the VVR score was higher in area under the ROC curve (AUC) compared to VIS and serum lactate levels, and the 48th hour VVR score was highest in the ROC analysis (AUC 0.851, 95% confidence interval). 0.761-0942 / ICU hospital stay; AUC 0.946, 95% confidence interval 0.885-1 / mechanical ventilation time). The 48th hour VVR score was 9.1 (sensitivity 87%, specificity 97.1%) for the duration of mechanical ventilation, and 6.7 (sensitivity 70%, specificity 92%) for ICU stay. Conclusions: The VVR score is a new and effective predictor of the duration of mechanical ventilation and ICU stay in postoperative congenital heart surgery patients.

A Focus on Congestive Heart Failure-Related Patient Education After Open Heart Surgery: A Quality Improvement Project.

After open heart surgery patients often develop symptoms associated with congestive heart failure (CHF), or fluid volume overload. To prevent heart failure-related symptoms in the postoperative period patients must be educated on heart failure self-care. To decrease the percentage of postoperative open heart surgical patients with CHF-related questions and concerns from 44% to 30% by March 2020. A cardiac surgery educational booklet and an educational electronic health record template were identified to guide a CHF educational pathway. Intensive care staff nurses provided patient education after surgery. PDSA cycles were performed in succession to roll out the quality improvement (QI) initiative. Of patients experiencing postoperative issues, 44% of patients developed symptoms or concerns related to heart failure. Upon implementation of the CHF-focused pathway 15% of patients were exhibiting symptoms or concerns related to CHF, out of all patients with postoperative issues. CHF, and fluid volume overload continues to be a difficult pathology requiring close management and follow up. After open heart surgery, providing concise, CHF-focused education results in reduced CHF-related patient concerns after discharge. By providing a disease-focused patient education nurses can reduce the complications that patients develop after an inpatient hospital.