Open Heart Surgery Patients Research Articles

Effectiveness of Virtual Reality Glasses on Surgical Fear and Anxiety in Patients Before Open-heart Surgery: A Double-blind Randomized Controlled Trial

PurposeFear and anxiety in open-heart surgery patients can adversely affect their physiological well-being and recovery. Although virtual reality glasses (VR-G) have been advanced for preoperative anxiety management, their effectiveness specifically for open-heart surgery patients remains under-researched. This study aims to evaluate the efficacy of watching a video through VR-G on surgical fear and anxiety levels of patients undergoing open-heart surgery. DesignA randomized controlled and double-blind study. MethodsIn total, 90 patients were randomly assigned to the VR-G intervention group or control group. On the surgery morning, intervention group patients watched a 360-degree video with nature sounds through VR-G before being transferred to the operating theater. The surgical fear and anxiety levels of the patients were evaluated at three stages using the Surgical Fear Questionnaire and Visual Analog Scale-Anxiety: initial evaluation in the morning, second evaluation before being transferred, and third evaluation in the waiting room of the operating theater. FindingsThe surgical fear level of the intervention group at the third evaluation was significantly lower than the control group (P < .000). There was no significant difference between the anxiety levels of the study groups (P > .05). ConclusionsWatching a 360-degree video with nature sounds through VR-G is an effective intervention in reducing surgical fear levels of patients before undergoing open-heart surgery. Use of VR-G interventions may be a practical and fast-resulting nursing strategy to manage patients’ surgical fear in the preoperative period. RegistrationNCT06165861

Preoperative Protein Profiling Among Postoperative Cognitive Dysfunction (POCD) Patients Following Open-Heart Surgery: A Systematic Review and Integrated Bioinformatic Analysis.

The inability to accurately predict the occurrence of postoperative cognitive dysfunction (POCD) among open-heart surgery patients leads to concerning increases in POCD cases. Preoperative circulating biomarkers are important to identify as they are non-invasive and could provide an early prediction of POCD development, allowing for earlier and more strategized interventions. However, to date, no robust circulating biomarkers have proven effective for preoperative POCD prediction. This systematic review aims to synthesize current evidence on preoperative protein profiling among POCD patients following open-heart surgery. Thus, a thorough literature search employing PubMed, EBSCOhost, Scopus, and Science Direct was carried out. This combination of keywords was used as part of the search strategy: ("Postoperative cognitive decline" OR "Postoperative cognitive disorders" OR "Postoperative cognitive dysfunction" OR "Postoperative cognitive complications") AND ("Thoracic Surgery" OR "Cardiac Surgery" OR "Heart Surgery") AND ("Protein expression" OR proteomic OR "Protein profiling"). Eight hundred and twenty-nine studies were retrieved and only clinical studies reporting the circulating preoperative differentially expressed Proteins (DEPs) in the POCD patients were selected. Six studies were selected following the inclusion and exclusion criteria. Only one preoperative DEP and four immediate postoperative DEPs were extracted from the studies. All four proteins were selected for analysis using DAVID, STRING, and Cytoscape software. Due to the very low number of proteins, no clusters have been identified. This systematic review demonstrates the lack of POCD preoperative biomarkers for open-heart-surgery patients. Thus, it is suggested that more studies can be conducted to fill this gap.

The effect of an open-heart surgery patient care protocol on post-sternotomy pain, anxiety and quality of care: A randomized controlled trial.

Open-heart surgery patients face many problems because of post-sternotomy pain. Care protocols can eliminate pain and pain-related problems by providing holistic care. The aim of this study was to examine the effect of an open-heart surgery patient care protocol developed in the study on post-sternotomy pain, anxiety and quality of care. The study was carried out as a double-blind randomized controlled trial. The sample size was calculated. Considering some attrition, the sample size was increased by 10% for each group, and a total of 68 participants, including 34 in each group, were included in the sample. Data were collected using a 'Patient Information Form', a 'Post-Sternotomy Pain Follow-up Form', the 'Numeric Rating Scale', the 'State Anxiety Inventory' and the 'Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire'. The patients in the experimental group were given care in accordance with the protocol, which was developed in the study, on postoperative days 0, 1 and 2. The statistical evaluation showed a significant difference between the mean scores of the experimental (F = 7.28; p < .001) and control groups (F = 2.42; p < .05) on the pain assessment scale. It was determined that the number of analgesics used in the experimental group was statistically significantly lower than in the control group. Intra-group comparisons showed that there was a difference between the mean pre-test and post-test state anxiety scale scores of the groups (p < .001). The experimental group had higher mean scores on the Strategic and Clinical Quality Indicators in Postoperative Pain Management Questionnaire than that of the control group (p < .001). The protocol developed in the study was found to be effective in reducing pain, the use of NSAIDs and opioids, and anxiety levels and increasing the level of quality of care. The protocol was original and feasible in that it included independent nursing interventions to improve the quality of care by reducing pain and anxiety. Particularly, the use of protocols in intensive care units was nurses' strongest resource in patient care management. Thus, the protocol, which was prepared for intensive care patients who most frequently experience pain and anxiety, was promising for nurses in improving the quality of care by reducing pain and anxiety. However, it is necessary to conduct further studies involving longitudinal follow-up in samples and institutions with similar conditions.

Machine Learning Analysis of Predictors for Inhaled Nitric Oxide Therapy Administration Time Post Congenital Heart Disease Surgery: A Single-Center Observational Study.

Background Congenital heart disease (CHD) is a structural deformity of the heart present at birth. Pulmonary hypertension (PH) may arise from increased blood flow to the lungs, persistent pulmonary arterial pressure elevation, or the use of cardiopulmonary bypass (CPB) during surgical repair. Inhaled nitric oxide (iNO) selectively reduces high blood pressure in the pulmonary vessels without lowering systemic blood pressure, making it useful for treating children with postoperative PH due to heart disease. However, reducing or stopping iNO can exacerbate postoperative PH and hypoxemia, necessitating long-term administration and careful tapering. This study aimed to evaluate, using machine learning (ML), factors that predict the need for long-term iNO administration after open heart surgery in CHD patients in the postoperative ICU, primarily for PH management. Methods We used an ML approach to establish an algorithm to predict 'patients with long-term use of iNO' and validate its accuracy in 34 pediatric postoperative open heart surgery patients who survived and were discharged from the ICU at Kagoshima University Hospital between April 2016 and March 2019. All patients were started on iNO therapy upon ICU admission. Overall, 16 features reflecting patient and surgical characteristics were utilized to predict the patients who needed iNO for over 168 hours using ML analysis with AutoGluon. The dataset was randomly classified into training and test cohorts, comprising 80% and 20% of the data, respectively. In the training cohort, the ML model was constructed using the important features selected by the decrease in Gini impurity and a synthetic oversampling technique. In the testing cohort, the prediction performance of the ML model was evaluated by calculating the area under the receiver operating characteristics curve (AUC) and accuracy. Results Among 28 patients in the training cohort, five needed iNO for over 168 hours; among six patients in the testing cohort, one needed iNO for over 168 hours. CPB, aortic clamp time, in-out balance, and lactate were the four most important features for predicting the need for iNO for over 168 hours. In the training cohorts, the ML model achieved perfect classification with an AUC of 1.00. In the testing cohort, the ML model also achieved perfect classification with an AUC of 1.00 and an accuracy of 1.00. Conclusion The ML approach identified that four factors (CPB, in-out balance, aortic cross-clamp time, and lactate) are strongly associated with the need for long-term iNO administration after open heart surgery in CHD patients. By understanding the outcomes of this study, we can more effectively manage iNO administration in postoperative open heart surgery in CHD patients with PH, potentially preventing the recurrence of postoperative PH and hypoxemia, thereby contributing to safer patient management.

Psychometric Properties of the Persian Version of the Intensive Care Experience Questionnaire (ICE-Q).

Background and Purpose: It is important to assess the experience of patients who have been admitted to an intensive care unit to provide the best treatment and nursing care possible. Therefore, a valid and reliable tool is necessary for measurement. This study aimed to determine the psychometric properties of the Persian version of the Intensive Care Experience Questionnaire (ICEQ) for open-heart surgery patients. Methods: The study was conducted in four steps: translation, face and content validity, confirmatory factor analysis, and reliability assessment. The adapted questionnaire was administered to 200 Iranian cardiac surgery patients who had received treatment in an intensive care unit within the past month. Results: In the final Persian version of ICEQ, there are 4 factors and 21 items. Following the translation and cultural adaptation process, the content validity was evaluated. Three items had content validity ratio < 0.6, so they were deleted. Scale-level content validity index/Average was 0.81 and more than 0.7 for each item on the scale. This scale was validated through confirmatory factor analysis using fit indicators (comparative fit index, normalized fit index, root mean square error of approximation, and chi-square). There was Cronbach's alpha of 0.71-0.85, and intraclass correlation coefficients were 0.82-0.93 for subscales. Conclusions: The Persian version of ICEQ showed appropriate psychometric properties. This scale may be useful to inform the development of effective interventions to improve subsequent outcomes for Iranian open-heart surgery patients.

Comparative Analysis of Sternal Closure Methods Following CABG Surgery: A Study from the Tehran Heart Center

Abstract: This study examined 204 patients undergoing CABG surgery at Tehran Heart Center between Ordibehesht 1402 and Ordibehesht 1403 for postoperative complications. Objective: Investigation and Comparison of Complications in Single-Wire and Double-Wire Sternal Closure Methods Following Open Heart Surgery in Patients Referred to Tehran Heart Center from May 2023 to May 2024 Methods: Patients were divided into two groups of 102 each, with Group 1 undergoing sternal closure using a single-wire method and Group 2 using a double-wire method. Results: All patients were discharged after surgery and followed up for one year. The age range was 44 to 75, with 21 patients aged 45-55 (10%), 133 patients aged 55-65 (65%), and 50 patients aged 65-75 (24%). Both groups had similar age distributions. Of the total patients, 78 were female (38.2%) and 126 were male (61.8%), indicating a higher prevalence of cardiovascular disease in males.

Exploring factors associated with bleeding events after open heart surgery in patients on dialysis − effects of the presence or absence of warfarin therapy

BackgroundPerioperative management of patients on dialysis is critical for controlling bleeding and thrombotic risk, in addition to infection control. Postoperative anticoagulation is often difficult to control, and different institutions have different policies. Therefore, in this study, we aimed to investigate factors associated with postoperative bleeding events and whether warfarin (WF) therapy affects the incidence of postoperative bleeding events, total mortality, and stroke.MethodsPatients who were admitted to the cardiovascular surgery department and underwent valve replacement or plasty were included, and those who underwent mechanical valve introduction were excluded. Thirty-nine patients were included in the study. The primary endpoint was to identify factors associated with the composite endpoint of postoperative bleeding events, and the secondary endpoint was to determine the effect size of WF therapy on postoperative bleeding events, all-cause mortality, and stroke and the strength of association between the crossed endpoints. The strength of the association between the crossed items was examined.ResultsLow body weight (p = 0.038) was identified as a factor associated with the primary endpoint of postoperative bleeding events. The secondary endpoint of whether or not patients received WF therapy was largely unrelated to bleeding events, all-cause mortality, and postoperative stroke up to 90 days after surgery.ConclusionsPreliminary studies suggest that low body weight is a risk factor for postoperative bleeding events in patients on dialysis, although further exploration of other factors will be necessary with the accumulation of similar cases.

Peri-operative fever and LVAD: SIRS or impaired right ventricular strain?

An inflammatory milieu after left ventricular assist device (LVAD) implantation is associated with multi-organ dysfunction and pre-operative heightened inflammatory state is associated with right ventricular failure after LVAD implantation. We performed a retrospective analysis of 30 LVAD patients in our institution within the last 2 years for the development of fever and compared them to 30 non-LVAD open-heart surgery patients. Our results suggest that patients undergoing LVAD implantation are more likely to develop fever in the immediate post-operative period compared to other open-heart surgeries. This is independent of pharmacological treatment, age, or ethnical background. Females and obese patients were more likely to develop fever. Patients with right ventricular dysfunction, as demonstrated by elevated central venous pressure (CVP), had the strongest correlation with fever development. These results pose the question if there is a systemic inflammatory response-like phenomenon driven by increased right ventricular dysfunction.

Feasibility and effectiveness of left bundle branch area pacing after TAVR: the single center experience

Abstract Introduction Transcatheter aortic valve replacement (TAVR) is a safe alternative to open-heart surgery in patients with symptomatic severe aortic stenosis and high surgical risk due to multiple comorbidities, advanced age, and severe left ventricle dysfunction. Due to anatomical considerations of the atrioventricular node, conduction abnormalities requiring the implantation of a pacemaker are common findings after TAVR. High-grade atrioventricular block and new-onset left bundle branch block (LBBB) are the most commonly reported conduction abnormalities after TAVR. Purpose The aim of our study was to assess the feasibility, success rates, and effectiveness of LBBAP in patients requiring pacing after TAVR. Methods A total of 302 patients underwent the TAVR procedure in our institution in the period from January 2022 to November 2023. In this cohort, 38 patients required ventricular pacing in the postoperative period. 16 patients who underwent permanent pacing using LBBAP were included in this observational study. Patients undergoing traditional right ventricular pacing biventricular pacing or leadless pacemaker implantation were excluded from the study. Results LBBAP was successfully performed in 16 patients (89%). 2 patients underwent conventional CRT implantation (1 cardiac resynchronization therapy pacemaker and 1 cardiac resynchronization therapy defibrillator) in order to severe calcification and presence of fibrotic tissue in the target area. The mean age was 60.5±2.74 years, and 10 patients (62.5%) were women. According to the patient’s medical history, 14 patients (84%) had hypertension; coronary artery disease – 2 (12.5%), 2 (12.5%) patients had atrial fibrillation and atrial flutter, and 7 (43.5%) patients had diabetes mellitus. The mean left ventricle ejection fraction (LVEF) was 46.2±14.7%. Interventricular septal thickness 11.8 ± 1.9 mm. Type of conduction diseases: Infranodal AV block and LBBB were present in 9 (56.5%) patients. 5 (31,25%) patients had persistent complete AV block and 2 (12,25%) had Mobitz II AV block. In 2 patients we observed congestive heart failure combined with LBBB. Pre-TAVR QRS morphology was normal in 15 (93%), and RBBB morphology in 1 (7%). The mean QRS duration at baseline was 105±20 ms. Pre-implant QRS duration 135±52 ms. The single-chamber pacemaker was implanted in 1 patient, dual-chamber pacemaker - 13 patients, and cardiac resynchronization therapy defibrillators in 2 patients. Procedural duration and fluoroscopy times were 105. ± 31.9 min and 18 ± 11 min, respectively. Conclusion Complete AV block and new-onset LBBB after TAVR is still an important issue. LBBB correction using conduction system pacing technology is an effective strategy for this type of patient. LBBAP is one of the most exciting developments in pacing therapy over the last few years. Long-term clinical outcomes and safety of physiological pacing data are limited and require further investigations

Angiotensin Receptor-Neprilysin Inhibitor Suppresses Renin-Angiotensin-Aldosterone System Activation After Cardiac Surgery Using Cardiopulmonary Bypass.

Sacubitril/valsartan, being both a neprilysin inhibitor and angiotensin receptor blocker, exhibits a renin-angiotensin-aldosterone system (RAAS) inhibitory effect. However, no study has investigated the administration of sacubitril/valsartan in patients early after surgery using cardiopulmonary bypass. This was a prospective observational study of 63 patients who underwent open heart surgery and were treated with sacubitril/valsartan. No serious adverse events occurred. Among the 63 patients, sacubitril/valsartan was discontinued in 13 due to hypotension (n=10), renal dysfunction (n=2), and dizziness (n=1). Atrial natriuretic peptide concentrations increased significantly from Day 3 of treatment (P=0.0142 vs. Postoperative Day 1) and remained high thereafter. In contrast, plasma renin activity was significantly suppressed from Day 3 onwards (P=0.00206 vs. Postoperative Day 1). A decrease in creatinine concentrations and an increase in the estimated glomerular filtration rate were observed on Day 3; this improvement in renal function was not observed in the historical control group, in which patients did not receive sacubitril/valsartan. New postoperative atrial fibrillation was less frequent in the study group compared with the historical control (12.7% vs. 38.0%; P=0.0034). Sacubitril/valsartan administration was safe immediately after open heart surgery in patients without postoperative hypotension. It enhanced serum atrial natriuretic peptide concentrations and suppressed RAAS activation.

Impact of Naples Prognostic Score on the development of surgical reexploration in open heart surgery patients

Impact of Naples Prognostic Score on the development of surgical reexploration in open heart surgery patients

Impact of Foot Reflexology on Physiological Indicators and Pain among Open-Heart Surgery Patients

Impact of Foot Reflexology on Physiological Indicators and Pain among Open-Heart Surgery Patients

Open-heart surgery in patients with cirrhosis: Variables associated with survival outcomes

BackgroundUnderstanding the risks of performing open-heart surgery in patients with cirrhosis is of critical importance given increased risks of morbidity and mortality. We analyzed the variables and risk scoring systems associated with survival and postoperative outcomes among patients with cirrhosis after open-heart surgery. MethodsThis is a single-center retrospective study of 32 patients with cirrhosis who underwent open-heart surgery at our institution between August 2020 – September 2022. Patients were stratified by mortality status to compare demographic and clinical variables. Survival was assessed using Kaplan-Meier curves and log-rank tests for the following variables: Model for End-Stage Liver Disease (MELD) score (<11 vs ≥11), Child-Turcotte-Pugh (CTP) class (A vs B vs C), Society of Thoracic Surgeons (STS) score (predicted mortality <4 vs 4 to 8 vs ≥8), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (<3.3 vs ≥3.3), and cardiopulmonary bypass (off pump vs on pump). ResultsOverall survival for our patient cohort was 93.8% at 30 days, 81.3% at 1 year, and 78.1% at 2 years postoperatively. Increased preoperative creatinine (p = 0.049), preoperative total bilirubin (p = 0.017), intraoperative blood products (p = 0.016), and intensive care unit length of stay (p = 0.001) were significantly associated with decreased survival. Among the risk scoring systems, only CTP class was significantly associated with survival (p < 0.0001). ConclusionsWe demonstrated high short-term and long-term survival among patients with cirrhosis after open-heart surgery, suggesting that select patients may be operative candidates. Among risk-scoring systems, only CTP was significantly associated with survival, which may guide future risk stratification strategies.

Assessing the Relationship between Indexed Epicardial Adipose Tissue Thickness, Oxidative Stress in Adipocytes, and Coronary Artery Disease Complexity in Open-Heart Surgery Patients.

Background and Objectives: This cross-sectional study conducted at the Timișoara Institute of Cardiovascular Diseases, Romania, and the Centre for Translational Research and Systems Medicine from "Victor Babeș" University of Medicine and Pharmacy of Timișoara, Romania, investigated the relationship between indexed epicardial adipose tissue thickness (EATTi) and oxidative stress in epicardial adipose tissue (EAT) adipocytes in the context of coronary artery disease (CAD) among open-heart surgery patients. The objective was to elucidate the contribution of EATTi as an additional marker for complexity prediction in patients with CAD, potentially influencing clinical decision-making in surgical settings. Materials and Methods: The study included 25 patients undergoing cardiac surgery, with a mean age of 65.16 years and a body mass index of 27.61 kg/m2. Oxidative stress in EAT was assessed using the ferrous iron xylenol orange oxidation spectrophotometric assay. The patients were divided into three groups: those with valvular heart disease without CAD, patients with CAD without diabetes mellitus (DM), and patients with both CAD and DM. The CAD complexity was evaluated using the SYNTAX score. Results: The EATTi showed statistically significant elevations in the patients with both CAD and DM (mean 5.27 ± 0.67 mm/m2) compared to the CAD without DM group (mean 3.78 ± 1.05 mm/m2, p = 0.024) and the valvular disease without CAD group (mean 2.67 ± 0.83 mm/m2, p = 0.001). Patients with SYNTAX scores over 32 had significantly higher EATTi (5.27 ± 0.66 mm/m2) compared to those with lower scores. An EATTi greater than 4.15 mm/m2 predicted more complex CAD (SYNTAX score >22) with 80% sensitivity and 86% specificity. The intra- and interobserver reproducibility for the EATTi measurement were excellent (intra-class correlation coefficient 0.911, inter-class correlation coefficient 0.895). Conclusions: EATTi is significantly associated with CAD complexity in patients undergoing open-heart surgery. It serves as a reliable indicator of more intricate CAD forms, as reflected by higher SYNTAX scores. These findings highlight the clinical relevance of EATTi in pre-operative assessment, suggesting its potential utility as a prognostic marker in cardiac surgical patients.

Comparison of the short and medium term efficacy of ortholox UHMWPE sternal cerclage band system and figure-of-8 wire sternum closure technique in patients at risk for sternal dehiscence

Aim: In this retrospective study, it was aimed to compare the short and medium term efficacy of Sternal Cerclage Band System and Figure-of-8 wire closure technique in open heart surgery patients with risk for sternal dehiscence. Material and Methods: In total, 320 open heart surgery patients with risk for sternal dehiscenceattempting to Kahramanmaraş Sütçü Imam University Medical Faculty Hospital between 28.12.2017 and 11.12.2021were subjected to this restrospective study. Since the study is retrospective, randomization and randomization procedures are not in question.The patients included in the study were divided into 2 groups as Steel Wire (standard procedureFigure 8 wiretechnique), and the Sternal Cerclage (sternum was closed with the Ortholox® Sternal Cerclage Band System). Baseline characteristics and outputs of patient groups were compared. Results: Age and body mass index (BMI) means were significantly higher in Cerclage Band group (p&lt;0.05). 53.8% of Cerclage Band group and 38.1% of Steel Wire group had obesity, and the difference was significant (p&lt;0.05). Diabetes mellitus (DM) rate was 36.3% in Steel Wire group and 48.4% in Cerclage Band with statistically significant differences (p&lt;0.05). In Cerclage Band group, 42.5% of patients were smoker, whereas 3.8% of Steel Wire group were smokers (p&lt;0.05). Length of hospital stay, sternal stability and infection after surgery rates were similar between patient groups with statistically insignificant differences (p&gt;0.05). Conclusion: Although there are differences between Cerclage Band and Steel Wire, results and outputs were similar, and showed that Sternal Cerclage Band System is a safe and useful technique in open heart surgery patients with risk for sternal dehiscence.

The effect of using virtual reality technology on anxiety and vital signs before surgery in patients undergoing open heart surgery

IntroductionPreoperative anxiety is one of the most common psychological problems in open-heart surgery patients. Not controlling this problem can negatively the operation outcome and the patient’s physical condition. Among various training methods and tools introduced to deal with this issue, the ideal method still remains unknown. Therefore, the present study was to determine the effect of using virtual reality technology on preoperative anxiety in patients undergoing open heart surgery.Materials and methodsThe participants of this interventional-educational study included 60 patients who were candidates for open heart surgery. The samples were randomly divided into two groups virtual reality(n = 30)and ordinary video (n = 30). For the virtual reality group, a virtual reality film and for the ordinary video group, an ordinary video of the physical space and operating room staff were displayed the day before the operation. Patients’ anxiety in both groups was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) before and after the intervention. Data analysis was performed using the SPSS software version 25.ResultsThe mean anxiety score before the intervention was 55.8 and 58.33 in the virtual reality group and the ordinary video group, respectively. After the intervention, it reached 38.60 in the virtual reality group and 45.13 in the control group. There was no statistically significant difference between the anxiety scores of the subjects in the virtual reality and ordinary video groups before the intervention (p > 0.05). However, the difference between the anxiety scores of the subjects in the virtual reality and ordinary video groups after the intervention was significant (p < 0.05).ConclusionAlthough virtual reality and ordinary video interventions effectively reduce anxiety in heart surgery patients, virtual reality seems to lower anxiety in heart surgery patients by diverting attention from external stimuli and immersing the person in the virtual world more than ordinary video.

Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs.

The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.

High FABP4, associated with low-voltage areas, increases the epicardial fibrosis and its glucose metabolism

Abstract Background High plasma levels of FABP4 were associated with epicardial fat volume on persistent AF patients. FABP4 can be released by differentiated adipocytes and macrophages, which can be involved in fibrosis. Purpose Our main objective was to study the association between FABP4 and epicardial fibrosis, which can explain low-voltage areas (LVA) and atrial fibrillation (AF) recurrence. Material and methods Peripheral levels of FABP4 and Galectin-3 were analysed on AF patients undergoing pulmonary vein isolation (PVI) (n=299) and signed informed consent. During the intervention, LVA was evaluated by invasive electroanatomic voltage mapping (EAM). Epicardial (EAT) (n=6) and subcutaneous adipose tissue (SAT) (n=5) were obtained from undergoing open heart surgery patients. Stromal cells were isolated by collagenase digestion, cultured and treated with and without FABP4 100 ng/mL and/or galectin-3 30 ng/mL for 24 hours. The proliferation and migration rate were measured by wound healing assay; mitochondrial activity was studied by MTT assay; and glucose and lactate consumption were detected by colorimetric and fluorescence enzymatic assays, respectively. Gene expression levels were assessed by real-time PCR. Results Regression analysis determined that the main independent predictors of LVA were age, left atrial area and FABP4 levels. Preclinical "in vitro" studies have shown that FABP4 100 ng/mL induced fibrosis in epicardial stromal cells (p=0.0039) and subcutaneous stromal cells (p=0.0009), evidenced by wound healing assay and by the increment of associated fibroblast genes (COL1A2, VIM, TGF-β1). Moreover, the high FABP4 concentration modulates the protein levels and metabolic genes expression (CPT1, FASN, ATGL, related to transport, synthesis and degradation of fatty acids, respectively) on EAT stromal cells. Glucose metabolism without lactate production was also incremented after FABP4 treatment (p&amp;lt;0.0001). Even, on SAT cells, released lactate was reduced after FABP4 treatment (p=0.0218). Conclusions Plasma FABP4 was a predictor of LVA. Our results suggest that this association might be explained by the fibrotic and metabolic role of FABP4 in epicardial cells. Future studies will shed light on the benefits on atrial remodelling with FABP4 modulators.Figure 1Figure 2

Effect of Nursing Procedures Related Pain on Post Open Heart Surgery Patients’ Clinical Outcomes

Effect of Nursing Procedures Related Pain on Post Open Heart Surgery Patients’ Clinical Outcomes

A Retrospective Review of 30-Day Hospital Readmission Risk After Open Heart Surgery in Patients With Atrial Fibrillation.

Introduction Readmission rates after open heart surgery (OHS) remain an important clinical issue. The causes are varied, with identifying risk factors potentially providing valuable information to reduce healthcare costs and the rate of post-operative complications. This study aimed to characterize the reasons for 30-day hospital readmission rates of patients after open heart surgery. Methods All patients over 18 years of age undergoing OHS at a community hospital from January 2020 through December 2020 were identified. Demographic data, medical history, operative reports, post-operative complications, and telehealth interventions were obtained through chart review. Descriptive statistics and readmission rates were calculated, along with a logistic regression model,to understand the effects of medical history on readmission. Results A total of 357 OHS patients met the inclusion criteria for the study. Within the population, 8.68% of patients experienced readmission, 10.08% had an emergency department (ED) visit, and 95.80% had an outpatient office visit. A history of atrial fibrillation (AFib) significantly predicted 30-day hospital readmissions but not ED or outpatient office visits. Telehealth education was delivered to 66.11% of patients. Conclusion The study investigated factors associated with 30-day readmission following OHS. AFib patients were more likely to be readmitted than patients without atrial fibrillation. No other predictors of readmission, ED visits, or outpatient office visits were found. Patients reporting symptoms of tachycardia, pain, dyspnea, or "other" could be at increased risk for readmission.