Open Heart Valve Surgery Research Articles

Comparison of six percent hydroxyethyl starch 130/0.4 and ringer's lactate as priming solutions in patients undergoing isolated open heart valve surgery: A double-blind randomized controlled trial.

Colloids are added to the priming solution of the cardiopulmonary bypass (CPB) pump to maintain colloid osmotic pressure and prevent fluid overload. This study aimed to compare the effects of 6% hydroxyethyl starch (HES) 130/0.4 and ringer's lactate (RL) priming solution on patients' outcomes undergoing isolated heart valve surgery with CPB. This randomized clinical trial included one hundred and 20 patients undergoing heart valve surgery, and those were allocated into two groups. Patients in the RL group received 1500mL of RL, and those in the RL + HES group were given 500mL of HES and 1000mL of RL. The patients' median age was 52 (IQR 42-60) and 50 (IQR 40-61) years in the RL + HES and the RL group, respectively (p = .71). The number of cases that required blood product transfusion in both the operating room and intensive care unit was also significantly higher in the RL + HES group compared to the RL group (RR 2.04, 95% CI 1.50-2.76; p < .01 and RR 1.42, 95% CI 1.01-2.01; p = .05, respectively). Declines in postoperative creatinine levels and platelet counts were higher in the RL + HES compared to the RL group (between-subjects effect p = .007 and p = .038, respectively), while the incidence of acute kidney injury was comparable between groups (RR 0.66, 95% CI 0.13-3.30; p = .55). Among patients undergoing heart valve surgery with CPB, 6% HES added to RL for priming compared with only RL increased the risk of the need for blood product transfusion over the hospitalization period.

Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates: insights from a single-centre, single-surgeon study conducted in Bosnia and Herzegovina

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt; To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. &amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt; This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). &amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt; The mean duration of the surgical procedures was 3.9&amp;amp;plusmn;1.3 hours, with conventional open-heart surgery requiring an average of 3.6&amp;amp;plusmn;1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2&amp;amp;plusmn;1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2&amp;amp;plusmn;4.5 days) and MICS (8.7&amp;amp;plusmn;7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9&amp;amp;plusmn;2.8 days and MICS patients of 4.2&amp;amp;plusmn;4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. &amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt; Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.&amp;lt;/p&amp;gt;

Efficacy and safety of carbon dioxide insufflation for brain protection for patients undergoing planned left-sided open heart valve surgery: protocol for a multicentre, placebo-controlled, blinded, randomised controlled trial (the CO2 Study)

IntroductionBrain injury is common following open heart valve surgery. Carbon dioxide insufflation (CDI) has been proposed to reduce the incidence of brain injury by reducing the number of air microemboli...

Delirium in cardiac surgery: epidemiology, pathogenesis and prevention highlights (Review)

Symptomatic delirium of the early postoperative period is a qualitative disorder (clouding) of consciousness that is deferred, occurs under mainly vascular, inflammatory and metabolic alterations, manifests by variant behavioral disorders. Three clinical studies were conducted to assess the state of the brain after the most frequent elective cardiac surgery coronary bypass surgery, open-heart valve surgery, open-heart and endovascular aortic valve surgery. 306 patients were included in the listed studies, the controls included the results of the examination of 120 patients who underwent elective eversion carotid endarterectomy and 15 patients who underwent elective abdominal aortic prosthetics. Thus, 441 patients underwent perioperative neurological examination according to a single algorithm. According to the results of the conducted studies, the frequency of symptomatic delirium of the early postoperative period during elective cardiac surgery is 1214%. Symptomatic delirium of the early postoperative period commonly develops 13 days after surgery, the average duration is from 1 to 3 days. Symptomatic delirium of the early postoperative period also increases the likelihood of subsequent development of other clinical types of postoperative cerebral dysfunction perioperative stroke and deferred cognitive impairment. Most of the symptomatic delirium of the early postoperative period risk factors are preoperative and have vascular origin. Combined use of CAM-ICU and RASS scales is recommended for screening diagnostics of symptomatic delirium of the early postoperative period. The increase of the number of cardiac surgeries demonstrates the necessity of the further improvement of perioperative cerebroprotection, the main directions are promptly diagnosis and correction of risk factors, as well as the use of non-pharmacological and pharmacological methods of brain protection, including the original four-component (inosine, nicotinamide, riboflavin, succinic acid) neuroprotector with cytoprotective and antihypoxic effects, as well as meglumine sodium succinate with antihypoxic and anti-inflammatory effects.

Abstract 14609: Exposure to Any Hospitalization and Specific Invasive Procedures Post Open Heart Valve Surgery Increases the Risk of Endocarditis

Introduction: Infective endocarditis (IE) after cardiac valve surgery is associated with high morbidity and mortality. Nosocomial exposure is a growing cause of IE in general. We investigated the risk of post valve surgery endocarditis (PVE) in patient who had any hospitalization and specific nosocomial exposures after open heart valve surgery. Methods: We identified all ≥18yo patients who had their first open heart cardiac valve surgery between 2001-2017 in New South Wales, Australia from the Admitted Patient Data Collection (APDC) registry. Patients with prior/current IE diagnosis at time of index valve surgery were excluded. Follow up was until 31 Dec 2018 with mortality and morbidity tracked from the respective death and APDC registries. Analyses based on Cox regression modelling included age, sex, background diagnoses and features of index valve surgery as time independent covariates, with any hospitalization (separately for specific invasive procedures) post index valve surgery as time dependent exposure covariates for risk of PVE within 6 months of exposure. Results: In total 23747 patients (median age [IQR] 73yo [65-79yo, 63% male) had cardiac valve surgery: 60% isolated aortic valve (n=15065), 28% isolated mitral valve (n=6702), 10% multiple valves (n=2385) and 1.5% right sided valves (n=357). 5.4% (n=1293) of patients experienced PVE at a median 2.9 years (IQR 0.7-6.2) after index valve surgery, with 65% (n=838) occurring within 6 months of any hospitalization. Any hospitalization exposure was associated with an adjusted hazard ratio of 4.0 for developing PVE (95% confidence interval 3.5-4.5). In addition, specific invasive procedures including repeat valve surgery were associated with an elevated risk for PVE (Figure). Conclusions: PVE is significantly more common after any hospitalization with specific invasive procedures carrying differential risk. Care should be taken to avoid unnecessary hospitalizations and procedures in these patients.

Exercise-based cardiac rehabilitation for adults after heart valve surgery.

The impact of exercise-based cardiac rehabilitation (CR) following heart valve surgery is uncertain. We conducted an update of this systematic review and a meta-analysis to assess randomised controlled trial evidence for the use of exercise-based CR following heart valve surgery. To assess the benefits and harms of exercise-based CR compared with no exercise training in adults following heart valve surgery or repair, including both percutaneous and surgical procedures. We considered CR programmes consisting of exercise training with or without another intervention (such as an intervention with a psycho-educational component). We searched the Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane Library; MEDLINE (Ovid);Embase(Ovid); the Cumulative Index to Nursing and Allied Health Literature(CINAHL; EBSCO);PsycINFO (Ovid);Latin American Caribbean Health Sciences Literature(LILACS; Bireme);and Conference Proceedings Citation Index-Science (CPCI-S) on the Web of Science (Clarivate Analytics) on10January 2020. We searched for ongoing trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health Organization International Clinical Trials Registry Platform on 15 May 2020. We included randomised controlled trials that compared exercise-based CR interventions with no exercise training. Trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and had received heart valve replacementor heart valve repair. Both percutaneous and surgical procedures were included. Two review authors independently extracted data. We assessed the risk of systematic errors ('bias') by evaluating risk domains using the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical heterogeneity. We performed meta-analyses using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence for primary outcomes (all-cause mortality, all-cause hospitalisation, and health-related quality of life). We included six trials with a total of 364 participants who have had open or percutaneous heart valve surgery. For this updated review, we identified four additional trials (216 participants). One trial had an overall low risk of bias, and we classified the remaining five trials as having some concerns. Follow-up ranged across included trials from 3 to 24 months. Based on data at longest follow-up, a total of nine participants died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence interval (CI)0.26 to 2.68; 2 trials, 131 participants; GRADE quality of evidencevery low). No trials reported on cardiovascular mortality. One trial reportedone cardiac-related hospitalisation in the CR group and none in the control group (RR 2.72, 95% CI0.11 to 65.56; 1 trial, 122 participants; GRADE quality of evidencevery low). We are uncertain abouthealth-related quality of life at completion of the intervention in CR compared to control (Short Form (SF)-12/36 mental component: mean difference (MD) 1.28, 95% CI-1.60 to 4.16; 2 trials, 150 participants;GRADE quality of evidencevery low; and SF-12/36 physical component: MD 2.99, 95% CI-5.24 to 11.21; 2 trials, 150 participants; GRADE quality of evidencevery low), or at longest follow-up (SF-12/36 mental component: MD -1.45, 95% CI-4.70 to 1.80; 2 trials, 139 participants; GRADEquality of evidencevery low; and SF-12/36 physical component: MD -0.87, 95% CI-3.57 to 1.83; 2 trials, 139 participants; GRADE quality of evidencevery low). AUTHORS' CONCLUSIONS: Dueto lack of evidence and the very low quality of available evidence, this updated review is uncertain aboutthe impact of exercise-CR in this population in terms of mortality, hospitalisation, and health-related quality of life. High-quality (low risk of bias) evidence on the impact of CR is needed to inform clinical guidelines and routine practice.

Employment status before and after open heart valve surgery: A cohort study.

Detachment from the workforce following open heart valve surgery is a burden for the patient and society. The objectives were to examine patterns of employment status at different time points and to investigate factors associated with a lower likelihood of returning to the workforce within six months. A cohort study of patients aged 18-63 undergoing valvular surgery at a Danish tertiary centre from 2013-2017. Return to the workforce was defined as being employed, unemployed (still capable of working) or receiving paid leave of absence. The association between demographic-, clinical characteristics (including a surgical risk evaluation, EuroScore), and return to the workforce were investigated with a multivariable logistic regression model. In total, 1,395 consecutive patients underwent surgery, 347 were between 18 and 63 years and eligible for inclusion. Of those, 282 were attached to the workforce before surgery and included in the study. At the time of surgery, 79% were on paid sick leave. After six months, 21% of the patients (being part of the workforce before surgery), were still on sick leave. In the regression model, prolonged sick leave prior to surgery (OR 0.43, 95% CI 0.23-0.79) and EuroScore ≥ 2.3 (OR 0.39, 95% CI 0.21-0.74) significantly reduced the likelihood of returning to the workforce. One-fifth of patients in the working-age were on sick leave six months after surgery. Prolonged sick leave prior to surgery and a EuroScore ≥2.3 were associated with a lower likelihood of returning to the workforce.

Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery.

PurposeStudies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear.Patients and MethodsWe retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality.ResultsWe divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31–5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51–7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14–4.75, P=0.832).ConclusionPreoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.

Illness Perception After Heart Valve Surgery: Differences Among Men and Women.

Illness perception is composed of thoughts, ideas, and beliefs about illness, and a negative illness perception is known to be associated with poor outcomes. Among men and women, clinical outcomes after heart valve surgery are known to differ, but knowledge about differences in illness perception is sparse. The aim of this study is to describe the differences in illness perception among men and women after open heart valve surgery and to identify sociodemographic and clinical characteristics associated with worse illness perception in men and women. In a national cross-sectional study combined with register-based clinical and sociodemographic information, data on illness perception were collected with the Brief Illness Perception Questionnaire.Worse illness perception was defined as the worst quartile of each item of the Brief Illness Perception Questionnaire. Multiple logistic regression analyses were conducted to explore characteristics associated with worse illness perception. Of 1084 eligible patients, 32% (n = 349) completed the questionnaire (67% men; mean age, 68 years). Compared with men, women reported significantly worse scores of illness perception in 6 of 8 items. Furthermore, being female, age, length of stay, and comorbidity were associated with worse illness perception (worse quartile of scores). Age, higher educational level, and comorbidity were found to be associated with worse illness perception for men and length of stay for women. After open heart valve surgery, illness perception differs among men and women, with women having worse illness perception. Among the total population, being female, age, a longer length of stay, and comorbidity were also associated with worse illness perception.

Causes and characteristics associated with early and late readmission after open-heart valve surgery.

The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause-specific readmissions after open-heart valve surgery. A single-center, retrospective cohort of 980 patients undergoing open-heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause-specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18-2.88), male gender (HR: 1.85; CI: 1.11-3.09), high alcohol intake (HR: 1.99; CI: 1.22-3.24) and mitral valve procedures (HR: 1.86; CI: 1.11-3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53-5.63), mitral valve procedures (HR: 2.10; CI: 1.23-3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03-2.85) were associated with atrial fibrillation/flutter readmissions. Predicting overall readmissions after open-heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause-specific readmissions.

What to expect after open heart valve surgery? Changes in health-related quality of life.

To (i) describe changes in health-related quality of life (HRQoL) pre-operatively, at discharge, and 4 weeks after discharge following open heart surgery, (ii) compare the performance of the EuroQol Questionnaire (EQ-5D 5L) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) against an anchor-based approach, and to (iii) investigate the association between HRQoL and 180-day readmission. A prospective, consecutive cohort (single-center study) of 291 patients completed the EQ-5D 5L and KCCQ pre-operatively, at discharge and 4 weeks post-discharge. Changes in HRQoL over time were evaluated, and the performance of the instruments was investigated. The association between HRQoL and readmission were investigated with Cox Proportional Hazard models. Scores of the EQ-5D Index and VAS decreased significantly from the pre-operative assessment to discharge and improved from discharge to 4 weeks after. The KCCQ scores significantly improved from baseline to 4 weeks after. Minimal clinically important improvements from before surgery to 4 weeks after were seen among 24% (EQ-5D Index), 45% (EQ-5D VAS), and 57% (KCCQ). More than one-third experienced worse HRQoL 1 month after discharge. Area under the curve (AUC) (performance of the instruments) demonstrated the following: EQ-5D Index AUC 0.622 (95% CI 0.540-0.704), VAS AUC 0.674 (95% CI 0.598-0.750), and KCCQ AUC 0.722 (95% CI 0.65-0.792). None of the HRQoL measurements were associated with 180-day readmission. This study revealed that HRQoL measured with the EQ-5D is significantly worse at discharge compared to before surgery, but scores increases within the first month measured with the EQ-5D and the KCCQ. The EQ-5D and KCCQ have a moderate correlation with an anchor-based approach but were not associated with readmission.

Early follow-up after open heart valve surgery reduces healthcare costs: a propensity matched study

ObjectivesThe objective was to assess differences in healthcare costs within 180 days after discharge from open heart valve surgery in an intervention group receiving early, individualised and intensified follow-up compared...

P3678Pulmonary artery ablation during open mitral valve surgery for pulmonary artery hypertension: a prospective randomized study

Abstract Purpose Recent investigations of pulmonary artery (PA) ablation into the treatment of idiopathic pulmonary artery hypertension (PAH) have suggested improvement of functional capacity, and hemodynamics. We investigated the impact of PA ablation in patients with PAH due to left heart disease (Dana Point, 2008) scheduled for open-heart mitral valve surgery. Methods Fifty patients aged 52±10 with mitral valve disease complicated severe PAH (mean PAP &gt;40mm Hg) were randomly assigned to mitral valve surgery with or without PA ablation procedure. Eligible criteria: positive reactive test with nitric oxide inhalation (decrease of mean PAP more than 10 mm Hg without decrease of cardiac output). There were no between group differences in preoperative characteristics. Surgical procedure After bypass is establishedthe fibrous fold of pericardiumand the ligamentum arteriosum are dissected out, and the branches of the right and left pulmonary artery are mobilized well out into the hilum of the lungs bilaterally. PA ablation was performed epicardially at the bifurcation of the main PA, and 10 mm distal to the right and left PA's using AtriCure Isolator®multifunctional pen. Serial assessment of echocardiography, right heart catheterization (catheter Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital stay. The primary endpoints were the change of meanpulmonary artery pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality, freedom from PADN-related complication: PA perforation, PA dissection, and PA thrombosis (MDCT assessment). Results There were no early deaths. No procedure-related complications were observed. On first day after surgery patients from ablation group showed significant reduction of mean PAP (from 50.6±5.3to 34.6±9.9 mm Hg, p&lt;0.001), and significant improvement of 6MWT at discharge (from 229±34 m to 475±21 m, p&lt;0.001). On first day after surgery patients from control group also showed significant reduction of mean PAP (from 51.3±6.3to 47.2±8.5 mm Hg, p=0.011), and significant improvement of 6MWT at discharge (from 249±32 m to 335±18 m, p&lt;0.001). Nevertheless, there was significant between group difference in mean PAP on first day after surgery (34.6±9.9 mm Hg, vs 47.2±8.5 mm Hg, p=0.005). Moreover there was significant differences in 6MWT at discharge (475±21 m vs 335±18 m, p=0.002) with benefit to ablation group. Epicardial pulmonary artery ablation Conclusions We report for the first time the effect and superiority of PA ablation on functional capacity and hemodynamics in patients with mitral valve disease complicated PAH. Epicardial PA ablation for the treatment PAH can be effectively and safely performed during open heart surgery. Acknowledgement/Funding None

Effect of early, individualised and intensified follow-up after open heart valve surgery on unplanned cardiac hospital readmissions and all-cause mortality

BackgroundUnplanned readmissions after heart valve surgery are common, and constitute a significant burden for the patient and the health care system. The objective was to investigate the effect of individualised follow-up after open heart valve surgery on a composite endpoint of first unplanned cardiac hospital readmission or all-cause mortality within 180 days of discharge. MethodsThe study is a prospective cohort study comparing the composite endpoint in patients undergoing early, individualised and intensified follow-up after heart valve surgery with a propensity matched historical control group. A total of 308 consecutive patients were enrolled in the prospective cohort study, 980 consecutive patients comprised the control group. The propensity matched group consisted of n = 300 (intervention) and n = 580 (controls).Time to first event was analysed using uni- and multivariable Cox proportional hazard analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival without readmission. ResultsAfter 180 days, the proportion of patients experiencing the composite endpoint was significantly lower in the intervention group compared with the controls for the overall, unmatched population (23% vs. 38%; HR 0.55; 95% CI, 0.42 to 0.73; P < 0.001). The effect did not change in the propensity matched population (HR 0.57; 95% CI 0.43;0.75, P < 0.001). The difference was related to reduction in readmission rates, whereas death rates were similar in intervention and control group (1.6% vs. 1.8%). ConclusionAn intervention consisting of early, individualised and intensified follow-up after open heart valve surgery reduced the risk of a composite endpoint of first, unplanned cardiac hospital readmission or all-cause mortality within 180 days.

Prognostic Value of the 6-Min Walk Test After Open-Heart Valve Surgery

This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery. One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT. After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively. In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events.

Risk Factors and Outcomes Associated With Sepsis After Coronary Artery Bypass and Open Heart Valve Surgeries.

Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post-cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014. Patient-based and surgery-based parameters were analyzed for risk factors and outcomes reported in the 30 days postoperatively. The association between sepsis and patient outcomes was assessed in a propensity-matched cohort using univariable logistic regression. Modifiable and nonmodifiable patient characteristics, including age >80, poor preoperative functional status, chronic diseases such as diabetes mellitus, congestive heart failure, chronic kidney disease with serum creatinine ⩾1.5, as well as serum albumin <3.5 and emergent nature of the case were associated with post-cardiac surgery sepsis. Surgical outcomes associated with sepsis included mortality (15.4% vs 4.5%), unplanned intubation (29.8% vs 8.2%), transfusion (53.4% vs 48.4%), acute kidney injury (7.1% vs 1.4%), postoperative dialysis (18.8% vs 3.5%), and return to the operating room (29.8% vs 8.2%). We identified multiple patient and surgical characteristics as well as postoperative outcomes associated with postoperative sepsis development in the high-risk population of patients undergoing cardiac surgery. Early identification of patients who are at high risk for postoperative sepsis can facilitate early treatment interventions.

Minimally Invasive Heart Valve Surgery Reduces Length of Hospital Stay and Costs: A Single Tertiary Centre Experience

Introduction: Minimally invasive valve surgery is a safe and often preferred alternative to open heart valve surgery. Western centres show reducted costs for these patients. We aim to demonstrate similar results in our mixed Asian population.

Population trends in mitral valve surgery in Finland between 1997 and 2014: the finnish CVD register

Objectives. Contemporary, nationwide data on trends in mitral valve surgery are scarce. Our aim was to investigate changes in procedure rates, patient selection, and post-procedural prognosis of open-heart mitral valve surgery in Finland. Design. We combined data from three nationwide administrative registers with compulsory reporting. We identified patients who had undergone first-ever open-heart mitral valve surgery between 1997 and 2014 and followed them for adverse events. We examined trends in mitral valve surgery over three six-year time periods (1997-2002, 2003-2008, and 2009-2014). Results. 3684 mitral valve procedures (mean age: 67.0 ± 10.9 years, 42.6% women) were performed in 1997–2014 in Finland. During this period, mitral valve repair operations became more common than replacements and we observed an increasing trend in the use of bioprosthetic valves. Between 1997-2002 and 2009-2014, the mean age of patients undergoing mitral valve surgery and the proportion of urgent surgeries increased (p < .001 for both). The proportion of women undergoing surgery decreased while the share of patients with hypertension (p = .023) or diabetes (p = .026) increased. The multivariable-adjusted risk of 28-day (hazard ratio, 0.55; 95% confidence interval, 0.37–0.83) and 6-year (hazard ratio, 0.80; 95% confidence interval, 0.67–0.97) post-operative mortality was lower in the last six-year period than in 1994-1998. Conclusions. Short- and long-term mortality of mitral valve surgery patients in Finland has decreased from 1997 to 2014 despite the patients being older and having more comorbidities. Understanding the changing characteristics and prognosis of these patients is important for the interpretation of previous and future cohort studies and trials.

The association between the transfusion of small volumes of leucocyte-depleted red blood cells and outcomes in patients undergoing open-heart valve surgery.

The relationship between the transfusion of red blood cell (RBC) units and outcomes in patients undergoing cardiac surgery is the subject of intense debates. In this study, we investigated the relationship between the transfusion of 1-2 leucocyte-depleted (LD) RBC units and outcomes in patients undergoing open-heart valve surgery. The investigation encompassed consecutive patients undergoing open-heart valve surgery at our institution between July 2009 and March 2015 who received no (RBC- group) or 1-2 units of LD RBC (RBC+ group). End-points were 30-day mortality (primary), the incidence of in-hospital major organ dysfunctions and 1-year mortality (secondary). Propensity score (PS)-adjusted statistical analysis was used to assess the effect of RBC transfusion on end-points. Thirty-day mortality rate was 0.2% (3/1485) in the RBC- group and 0.4% (6/1672) in the RBC+ group, with a PS-adjusted odds ratio (OR) for 30-day mortality of 1.00 (95% CI: 0.21-4.83;P = 0.99). The two groups showed no significant differences in PS-adjusted ORs for major complications, such as stroke, low cardiac output syndrome, thoracic wound infection and prolonged mechanical ventilation (>24 h). The PS-adjusted ORs for prolonged intensive care unit stay (>48 h) were, however, significantly higher in the RBC+ group (OR = 1.34 [95%CI: 1.04-1.72; P = 0.02]) than in the RBC- group. One-year mortality was comparable between groups (PS-adjusted hazard ratio for the RBC+ group: 0.85 [95% CI: 0.42-1.72; P = 0.65]). Our data do not provide evidence that in patients undergoing valve surgery with cardiopulmonary bypass, transfusion of 1-2 units of LD RBC increases operative mortality, the incidence of postoperative complications or 1-year mortality.

Associations between the Transfusion of 1 and 2 Units of Leukocyte-depleted Red Blood Cells and Outcomes in Patients Undergoing Open Heart Valve Surgery

Associations between the Transfusion of 1 and 2 Units of Leukocyte-depleted Red Blood Cells and Outcomes in Patients Undergoing Open Heart Valve Surgery