Impact Of Cardiac Surgery Research Articles

Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations

ObjectiveThe best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10–15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length...

Impact of cardiac surgery and neurosurgery patients on variation in severity-adjusted resource use in intensive care units.

The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use. Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015-2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery. Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15-19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased. Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.

Impact of cardiac surgery with cardiopulmonary bypass on symptom progression in the early postoperative period in patients with peripheral arterial disease.

This study aims to examine whether cardiac surgery with cardiopulmonary bypass (CPB) leads to symptom progression in the early postoperative period in patients with the peripheral arterial disease (PAD) undergoing coronary artery bypass grafting surgery (CABG). This retrospective study included one hundred fifty consecutive adult patients with PAD at Fontaine stage 2b (pain-free walking distance less than 100 m) undergoing CABG. The control group comprised 150 consecutive adult patients undergoing CABG with a normal ankle-brachial index (ABI). Symptom progression was defined as the development of ischemic rest pain (Fontaine stage 3). In the first week after surgery, 91 of 150 patients (60.6%) had symptom progression in the PAD group. Rest pain resolved in most of these patients on the 15th postoperative day. At the end of the second month, rest pain resolved in all patients. Logistic regression analysis revealed that ABI (<0.5), CPB time (≥100 mins), nadir hct levels (≤25 %) on CPB, and postoperative nadir hct levels (<25%) were independently associated with postoperative symptom progression. Our results suggest that cardiac surgery with CPB may lead to symptom progression in patients with severe claudication in the early postoperative period.

Impact of minimally invasive mitral valve surgery on sexual dysfunction in male patients

BackgroundSexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations.MethodsPatients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire.ResultsThere were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health.ConclusionsIn our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.

Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery.

BackgroundHandgrip strength (HGS), lung function and health-related quality of life (HRQoL) are relevant indicators of future cardiovascular risk and mortality. The impact of cardiac surgery on these predictive variables has been under-explored. The aim of this study was to determine the acute (within hospital) changes in HGS, lung function and HRQoL, and their relationships, in adults undergoing elective cardiac surgery. Further, the study examined the relationship between these variables and the predictors for lung function and HRQoL in these patients.MethodsThe study was a prospective cohort study that involved 101 patients who completed pre-operative (1–2 days before surgery) and physiotherapy discharge (5–7 days after surgery) assessments. Handgrip strength, lung function and HRQoL were assessed using JAMAR dynamometers, Vitalograph-Alpha or EasyOne spirometer, and Short-Form 36 questionnaire, respectively. Changes in these variables and their relationships were analysed using paired t-test and Pearson correlation coefficients, respectively. Prediction of lung function and HRQoL using HGS and other co-variates was conducted using regression analysis.ResultsAt the time of physiotherapy discharge, lung function, HGS and the physical component of HRQoL were significantly (<0.001) reduced compared to their pre-operative values. Significant (<0.001) and moderate correlations were identified between HGS and lung function at pre-operation and physiotherapy discharge. Handgrip strength was a significant predictor of lung function pre-operatively but not at physiotherapy discharge. Pre-operative lung function and HRQoL, as well as other variables, were significant predictors of lung function and HRQoL during physiotherapy discharge.ConclusionsUndergoing cardiac surgery acutely and significantly reduced lung function, HGS and physical component of HRQoL in adults with cardiac disease. Assessment of HGS at physiotherapy discharge may be a poor indicator of operative changes in lung function and HRQoL. Clinicians may consider HGS as an inadequate tool in predicting lung function and HRQoL following cardiac surgery.

Cardiac Surgery and Postoperative Renal Allograft Failure

Although cardiac surgery among renal allograft recipients is relatively safe, less is known about the impact of cardiac surgery on the functioning renal allograft. This study assessed postoperative renal failure among renal transplant recipients undergoing cardiac surgery. The study population was identified by matching medical record numbers from the United Network for Organ Sharing Kidney Transplant Database to a cardiovascular surgery database and The Society of Thoracic Surgeons Adult Cardiac Surgery Database for the authors' institution from January 1992 through August2018. One hundred seventy-nine renal transplant recipients with a functioning allograft underwent cardiac surgery a mean of 6.4 ± 5.6 years after renal transplantation. Thirty (17.6%) of the 170 patients either died or had allograft failure during the first postoperative year. Receiver-operating characteristics curve analysis using Cox regression demonstrated an optimal cutoff point for preoperative serum creatinine predicting postoperative allograft loss is 1.9 mg/dL (hazard ratio 3; 95% confidence interval, 1.5 to 6.9) with a model C statistic of 0.642. The current study affirms findings in the literature that cardiac surgery in renal transplant recipients carries acceptable perioperative morbidity and mortality. Renal transplant recipients who underwent cardiac surgery had a constant hazard of renal allograft loss similar to that of the general transplant population. A preoperative serum creatinine value greater than 1.9 mg/dL increases the risk for long-term renal allograft loss after cardiac surgery.

Impact of Cardiac Surgery With a Minimal Invasive Extracorporeal Circuit οn Coagulation: Data From Point of Care Devices

Impact of Cardiac Surgery With a Minimal Invasive Extracorporeal Circuit οn Coagulation: Data From Point of Care Devices

Impact of cardiac surgery on the expression of CD40, CD80, CD86 and HLA-DR on B cells and monocytes.

We measured and compared changes in the percentage of cells expressing CD80, CD86, CD40, HLA-DR and the expression of these molecules on B cells and monocytes of patients who underwent either on-pump, mini on-pump or off-pump cardiac surgery. Blood samples from patients who underwent either on-pump, mini on-pump or off-pump cardiac surgery were collected before surgery, instantly after surgery and on the 1(st), 3(rd) and 7(th) days after surgery. Surface expression of CD80, CD86, CD40 and HLA-DR molecules was determined by flow cytometry. Our results show that all three surgical techniques altered the expression of these molecules, as well as the percentage relative number of specific cell populations. We identified statistically significant differences when comparing different surgical techniques. On-pump surgery revealed a more pronounced impact on the phenotype of immune system cells than the other techniques. Therefore, it is likely that the function of immune cells is changed the most by on-pump surgery. We found a lower decrease in the number of CD80(+) monocytes and a lower drop in the CD40 expression on monocytes in off-pump patients in comparison with on-pump patients. All the types of cardiac surgical techniques, off-pump, on-pump and modified mini-invasive on-pump, are associated with changes in CD80, CD86, CD40 and HLA-DR expression. We found several significant differences in the expression of the selected molecules when we compared all three groups of patients.

Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study

BackgroundAbdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. MethodsA retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. ResultsMean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) ConclusionsIn the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Neurological Complications of Infective Endocarditis

Background— The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery. Methods and Results— This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91), Staphylococcus aureus as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications; P &lt;0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery). Conclusions— Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.

The impact of cardiac surgery on the long-term psychosocial development of children - a preliminary study

The impact of cardiac surgery on the long-term psychosocial development of children - a preliminary study

P74 IS TRIPLE THERAPY NECESSARY IN STAPHYLOCOCCAL PROSTHETIC VALVE ENDOCARDITIS?

P74 IS TRIPLE THERAPY NECESSARY IN STAPHYLOCOCCAL PROSTHETIC VALVE ENDOCARDITIS?

P24 ASSOCIATION BETWEEN VALVULAR SURGERY AND MORTALITY AMONG PATIENTS WITH INFECTIVE ENDOCARDITIS COMPLICATED BY SEVERE SEPSIS AND SEPTIC SHOCK

Severe sepsis and septic shock are common complications of infective endocarditis (IE). A prospective, single-center observational study in patients with definite native or prosthetic valve IE admitted between January 1, 2000 and December 31, 2011. The main objective of the study was estimate the safety of valve replacement in patients with severe sepsis and/or septic shock and its impact on patients' outcome. We compared clinical characteristics and outcome (in-hospital mortality)in surgically and only medically treated patients stratified on the severity of sepsis. The cohort included 294 patients with definite IE known septic status enrolled. Patients were stratified into two groups. There were 95 (32.3%) patients with severe sepsis and/or septic shock (SSS) and 199 (67.7%) with sepsis (S). Valve replacement was performed in 37(38.9%) patients in the SSS group, and 71 (35.7%) in the S group, p=0.587. APACHE II score was significantly higher among medically treated patients. The mortality in SSS group was significantly higher in medically treated patients, 39/58 (67.2%) vs. 5/37 (13.4%), p<0.001. After adjusting for APACHE II score, SOFA score, age, and congestive heart failure, the beneficial impact of cardiac surgery remained significant. Cardiac surgery decreased the risk of in-hospital death about five times in SSS group, OR=0.096, 95%CI 0.027-0.335. Even in the most severe septic patients with IE, cardiac surgery improves patients' outcome. SOFA score is a better predictor of patients' outcome than APACHE II score, and should be included in the evaluation of IE patients.

Quality-of-Life Measures for Cardiac Surgery Practice and Research: A Review and Primer

Declining mortality and major morbidity rates after cardiac surgery have led to increasing focus on patient quality of life (QOL). Beyond longevity, the impact of cardiac surgery on day-to-day functioning is incredibly salient to patients, their spouses, and families. As such, QOL measures are a welcome and sometimes necessary addition to clinical trials. However, how does one navigate the expansive market of QOL questionnaires, which QOL measures are applicable to cardiac surgery units, and how can they be used meaningfully in clinical practice? Because nearly two decades have passed since QOL measures were reviewed for relevance to cardiac surgery settings, an overview is provided of various generic (Short Form Health Survey [SF-36], Sickness Impact Profile, Nottingham Health Profile) and disease-specific QOL measures (Duke Activity Status Index, Seattle Angina Questionnaire, MN Living with Heart Failure Questionnaire; Heart-QOL) with examples from cardiac surgery studies. Recommendations are provided for the application of QOL measures to clinical trials and the impact on clinical decision-making is discussed. The paucity of methodologically sound QOL studies highlights the necessity for further rigorous empirical data to better inform treatment efficacy studies and clinical decision-making.

Impact of cardiac surgery on heart failure serum factor mediated suppression of cord blood mesenchymal stem cells

Objective: The regenerative capacity of autologuous stem cells from heart failure (HF) patients is limited by age and disease. We sought to investigate the behaviour of neonatal cord blood mesenchymal stem cells (CB-MSC) in the presence of serum factors from patients with severe HF. The impact of cardiac surgery on the molecular composition of HF serum and its effect on CB-MSC response was studied.

The impact of cardiac surgery in patients with trisomy 18 and trisomy 13 in Japan

Congenital heart defects (CHD) are very common in patients with trisomy 18 (T18) and trisomy 13 (T13). The surgical indication of CHD remains controversial since the natural history of these trisomies is documented to be poor. To investigate the outcome of CHD in patients with T18 and T13, we collected and evaluated clinical data from 134 patients with T18 and 27 patients with T13 through nationwide network of Japanese Society of Pediatric Cardiology and Cardiac Surgery. In patients with T18, 23 (17%) of 134 were alive at this survey. One hundred twenty-six (94%) of 134 patients had CHDs. The most common CHD was ventricular septal defect (VSD, 59%). Sixty-five (52%) of 126 patients with CHD developed pulmonary hypertension (PH). Thirty-two (25%) of 126 patients with CHD underwent cardiac surgery and 18 patients (56%) have survived beyond postoperative period. While palliative surgery was performed in most patients, six cases (19%) underwent intracardiac repair for VSD. Operated patients survived longer than those who did not have surgery (P < 0.01). In patients with T13, 5 (19%) of 27 patients were alive during study period. Twenty-three (85%) of 27 patients had CHD and 13 (57%) of 27 patients had PH. Atrial septal defect was the most common form of CHD (22%). Cardiac surgery was done in 6 (26%) of 23 patients. In this study, approximately a quarter of patients underwent surgery for CHD in both trisomies. Cardiac surgery may improve survival in selected patients with T18.

The impact of cardiac surgery in native valve infective endocarditis: Can euroSCORE guide patient selection?

Background Decision making regarding surgical intervention in native valve endocarditis (NVE) is often complex and surgery is withheld in a number of patients either because medical treatment is considered the best treatment or because the risk of operation is considered too high. The objective of this study was to investigate the outcome of surgical treatment and to validate the ability of euroSCORE to predict operative mortality in NVE patients. Methods Prospective cohort study including 323 consecutive NVE patients. Patients were divided into 3 groups based on treatment strategy and indication/contraindication for surgery. The additive and logistic euroSCORE was calculated and the observed and predicted mortality was compared. Results Cardiac surgery was associated with a good prognosis, in-hospital and after 12 months, compared to conservative treatment. After adjustment for confounders surgery was associated with a survival benefit (hazard ratio (HR) 0.45, 95% CI: 0.27–0.76%; p = 0.003). When propensity score was used in regression adjustment, cardiac surgery was still associated with a better outcome after 12 months (HR 0.41, 95% CI: 0.25–0.68; p < 0.001). Observed mortality for patients receiving surgical treatment was 11% compared to a mean logistic euroSCORE mortality of 16% (NS). The discriminating ability of euroSCORE was good, area under the ROC curve 0.74 (95% CI: 0.64–0.84; p < 0.001) logistic model and 0.75 (95% CI: 0.65–0.86; p < 0.001) additive model. Conclusions Cardiac surgery was associated with a good prognosis when indicated regardless of euroSCORE, and surgery should only be withheld after thorough consideration. EuroSCORE remains a valuable tool to identify high-risk IE patients when surgery is considered.

Endocarditis Caused by Staphylococcus aureus

Staphylococcus aureus is the leading cause of infectious endocarditis and its mortality has remained high despite better diagnostic and therapeutic procedures over time. We conducted a retrospective review of 133 cases of definite S. aureus endocarditis seen at a single tertiary care hospital over 22 years to assess changes in the epidemiology and incidence of the infection, manifestations, outcome, risk factors for mortality, and impact of cardiac surgery on prognosis.Patients were classified into 2 groups: 1) right-sided endocarditis (64 patients) and 2) left-sided endocarditis (69 patients). While the number of cases of left-sided endocarditis remained steady at 1-3 cases per 10,000 admissions, the incidence of right-sided endocarditis, after a peak in the early 1990s, declined to almost disappear in 2001. Among the cases of right-sided endocarditis, we found 2 subsets of patients with different clinical features and prognosis: the first subset comprised 53 intravenous drug abusers, and the second subset comprised 11 patients with catheter-associated S. aureus bacteremia and endocarditis. Fifty-one patients were human immunodeficiency virus (HIV)-positive drug abusers, most of whom (80.3%) had right-sided endocarditis. We did not find differences in mortality between HIV-positive and HIV-negative individuals; mortality seemed to depend more on the site of the heart involved than on HIV status.Among the cases of left-sided endocarditis, the mitral valve was more commonly involved than the aortic valve (61% vs. 30%). Overall, 74% of patients with left-sided endocarditis developed 1 or more cardiac or extracardiac complication. In comparison, only 23.4% of patients with right-sided endocarditis developed complications.Prosthetic valve endocarditis (PVE) was hospital-acquired more frequently than native valve endocarditis (NVE). Patients with PVE had a shorter duration of symptoms until diagnosis and presented with or developed cardiac murmurs less frequently than patients with NVE. Cardiac failure (49%), renal failure (43%) and central nervous system (CNS) events (35%) were frequently observed in patients with both PVE and NVE. Valve replacement was more frequently needed and more rapidly performed in patients with PVE than in their counterparts with NVE.The overall mortality of patients with right-sided endocarditis was 17%. While the mortality of right-sided endocarditis in injection drug users was 3.7%, the mortality of patients with right-sided endocarditis associated with infected intravenous catheters was 82% (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.001-0.07). For left-sided endocarditis mortality was 38% and was not significantly different in patients with NVE or PVE (OR, 0.65; 95% CI, 0.23-1.87). CNS complications were associated with mortality in both NVE (OR, 6.55; 95% CI, 1.78-24.04) and PVE (OR, 32; 95% CI, 2.63-465.40). Development of 2 or 3 complications was associated with an increased risk of mortality (OR, 5.59; 95% CI, 1.08-28.80 and OR, 9.25; 95% CI, 1.36-62.72 for 2 vs. 1 complication and for 3 vs. 2 complications, respectively).Surgical treatment did not significantly influence mortality in cases of NVE, (OR, 3.19; 95% CI, 0.76-13.38) but significantly improved the prognosis of patients with PVE (OR, 69; 95% CI, 2.89-1647.18).S. aureus endocarditis is an aggressive, often fatal, infection. The results of the current study suggest that valve replacement will improve the outcome of infection, particularly in patients with PVE.

The impact of cardiac surgery on cognition

AbstractThis brief review focuses on coronary artery bypass grafting (CABG) and valve surgery and their post‐operative effects on cognitive domains. Despite the substantial technical advances in cardiac surgery over the past few decades, the incidence of permanent cognitive impairment remains alarmingly high: 20–70 per cent of patients exhibit cognitive impairment during the first week after surgery, with the incidence declining to 10–40 per cent after 6 weeks and remaining at this level thereafter. We find that language, concentration and motor control are most consistently reported to be affected, while memory, attention and executive function are more variably affected. Valve surgery is generally associated with a worse outcome than CABG surgery. It remains unclear whether the use of the cardio‐pulmonary bypass machine adversely affects cognitive outcome. There is an urgent need to identify the risk factors and surgical techniques that influence post‐operative cognitive impairment, yet it is difficult to reach meaningful conclusions from the present data due to a lack of concordance in experimental design and data analysis. To address this challenge, future research will need to control for confounds such as mood state, post‐operative pain, learning effects, and anaesthesia and will need to compare a wide range of cognitive domains and surgical procedures within large multi‐centre studies. Copyright © 2008 John Wiley &amp; Sons, Ltd.