Patients Undergoing Heart Surgery Research Articles

Activated factor X stimulates atrial endothelial cells and tissues to promote remodeling responses through AT1R/NADPH oxidases/SGLT1/2.

Atrial fibrillation (AF), the most common cardiac arrhythmia favoring ischemic stroke and heart failure involves left atrial remodeling, fibrosis and a complex interplay between cardiovascular risk factors. This study examined whether activated factor X (FXa) induces pro-remodeling and pro-fibrotic responses in atrial endothelial cells (AECs) and human atrial tissues and determined the underlying mechanisms. AECs were from porcine hearts and human right atrial appendages (RAA) from patients undergoing heart surgery. Protein expression levels were assessed by Western blot and immunofluorescence staining, mRNA levels by RT-qPCR, formation of reactive oxygen species (ROS) and NO using fluorescent probes, thrombin and angiotensin II generation by specific assays, fibrosis by Sirius red staining and senescence by senescence-associated beta-galactosidase (SA-β-gal) activity.In AECs, FXa increased ROS formation, senescence (SA-β-gal activity, p53, p21), angiotensin II generation and the expression of pro-inflammatory (VCAM-1, MCP-1), pro-thrombotic (tissue factor), pro-fibrotic (TGF-β and collagen-1/3a) and pro-remodeling (MMP-2/9) markers whereas eNOS levels and NO formation were reduced. These effects were prevented by inhibitors of FXa but not thrombin, protease-activated receptors antagonists (PAR-1/2) and inhibitors of NADPH oxidases, ACE, AT1R, SGLT1/SGLT2. FXa also increased expression levels of ACE1, AT1R, SGLT1/2 proteins which was prevented by SGLT1/2 inhibitors. Human RAA showed tissue factor mRNA levels that correlated with markers of endothelial activation, pro-remodeling and pro-fibrotic responses and SGLT1/2 mRNA levels. They also showed protein expression levels of ACE1, AT1R, p22phox, SGLT1/2, and immunofluorescence signals of nitrotyrosine and SGLT1/2 colocalized with those of CD31. FXa increased oxidative stress levels which were prevented by inhibitors of the AT1R/NADPH oxidases/SGLT1/2 pathway. FXa promotes oxidative stress triggering premature endothelial senescence and dysfunction associated with pro-thrombotic, pro-remodeling and pro-fibrotic responses in AECs and in human RAA involving the AT1R/NADPH oxidases/SGLT1/2 pro-oxidant pathway. Targeting this pathway may be of interest to prevent atrial remodeling and the progression of atrial fibrillation substrate.

NURSING CARE FOR PATIENTS UNDERGOING HEART SURGERY

INTRODUCTION: Nursing care for patients undergoing heart surgery is extremely important, as it is possible to avoid risks, as well as the manifestation of various complications. With regard to cardiac surgeries, surgical interventions have the possibility of reducing mortality and thus improving the quality of life of patients, as it favors the development and improvement of assistance itself. OBJECTIVE: To identify nursing care for patients undergoing cardiac surgery in the literature. METHODOLOGY: this study is an integrative review of the literature, based on the following guiding question: what is the nursing care provided to patients undergoing cardiac surgery? Data collection took place between the months of January and February 2024 through the databases Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Databases (BDENF), making use of the descriptors in health sciences (DeCS): nursing, cardiac surgery and patient. For the inclusion criteria, the following were adopted: articles published between the years 2019 and 2023, articles available in Portuguese for free, which addressed the topic and which were available in full, duplicate articles were excluded, that is, those present in more of a database, incomplete articles, and those that deviated from the study proposal. RESULTS AND DISCUSSIONS: It is worth noting that the postoperative period of cardiac surgeries, a period during which the patient recovers from post-anesthetic and post-surgical stress, is marked by the destabilization of the patient’s clinical condition, and is therefore , full of specificities, and critical care. Therefore, the postoperative period of cardiac surgery requires continued attention, resoluteness, and highly complex care from the nursing team. Therefore, it is possible to minimize various complications, such as changes in blood pressure levels, as well as compensation of organic systems. CONCLUSION: It is concluded, therefore, that the assistance of the nursing team to patients undergoing cardiac surgery is essential, as it makes it possible to carry out a continuous investigation, as well as to determine human responses, as well as to elaborate possible nursing diagnoses.

Implementation of an epicardial implantable MEMS sensor for continuous and real-time postoperative assessment of left ventricular activity in adult minipigs over a short- and long-term period.

The sensing of left ventricular (LV) activity is fundamental in the diagnosis and monitoring of cardiovascular health in high-risk patients after cardiac surgery to achieve better short- and long-term outcome. Conventional approaches rely on noninvasive measurements even if, in the latest years, invasive microelectromechanical systems (MEMS) sensors have emerged as a valuable approach for precise and continuous monitoring of cardiac activity. The main challenges in designing cardiac MEMS sensors are represented by miniaturization, biocompatibility, and long-term stability. Here, we present a MEMS piezoresistive cardiac sensor capable of continuous monitoring of LV activity over time following epicardial implantation with a pericardial patch graft in adult minipigs. In acute and chronic scenarios, the sensor was able to compute heart rate with a root mean square error lower than 2 BPM. Early after up to 1 month of implantation, the device was able to record the heart activity during the most important phases of the cardiac cycle (systole and diastole peaks). The sensor signal waveform, in addition, closely reflected the typical waveforms of pressure signal obtained via intraventricular catheters, offering a safer alternative to heart catheterization. Furthermore, histological analysis of the LV implantation site following sensor retrieval revealed no evidence of myocardial fibrosis. Our results suggest that the epicardial LV implantation of an MEMS sensor is a suitable and reliable approach for direct continuous monitoring of cardiac activity. This work envisions the use of this sensor as a cardiac sensing device in closed-loop applications for patients undergoing heart surgery.

Effect of Cross Clamp Duration on GFR and Creatinine Values Due to Renal Flow in Valve Patients Undergoing Open Heart Surgery

Effect of Cross Clamp Duration on GFR and Creatinine Values Due to Renal Flow in Valve Patients Undergoing Open Heart Surgery

Effect of a Nurse-Led Cognitive-Behavioral Therapy on Sleep Quality in Patients Undergoing Open Heart Surgery: A Prospective Randomized Clinical Trial

Background: Sleep disorders are one of the most common complications in patients undergoing open-heart surgery. Cognitive-behavioral therapy (CBT-I) is used as a way to improve sleep quality. Objectives: This study aimed to determine the effect of a nurse-led CBT-I on sleep quality among patients undergoing open-heart surgery. Methods: This prospective randomized clinical trial was conducted on 90 patients undergoing open-heart surgery in both intervention and control groups (N = 45). The control group received routine care. The intervention group received 10-12 sessions of nurse-led CBT-I. The demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. The data was analyzed in SPSS v. 22 software using X2, independent sample t test, analysis of covariance (ANCOVA), and paired t test. Results: The majority of samples were in the age range of 31 - 40 years (33.33%) and male (53.33%). The results of the independent t test showed that the mean total PSQI score in the 2 groups before the intervention was not significantly different (P = 0.245). Also, the results of ANCOVA showed that the mean total PSQI score after the intervention has a significant difference in the 2 groups (P = 0.0001). Conclusions: Nurse-led CBT-I intervention helps to improve the sleep quality of patients after open-heart surgery by reducing their automatic thoughts that affect behavior. Thus, it is recommended that training in nurse-led CBT-I be included in the nurses' academic training program, as well as in continuing education programs for nurses working in heart surgery wards.

Síndrome de Edwards e Patau em um hospital universitário: além do paliativo

ABSTRACT Objective: To describe the newborn population with Patau (T13) and Edwards Syndrome (T18) with congenital heart diseases that stayed in the Intensive Care Unit (ICU) of a quaternary care hospital complex, regarding surgical and non-surgical medical procedures, palliative care, and outcomes. Methods: Descriptive case series conducted from January/2014 to December/2018 through analysis of records of patients with positive karyotype for T13 or T18 who stayed in the ICU of a quaternary hospital. Descriptive statistics analysis was applied. Results: 33 records of eligible patients were identified: 27 with T18 (82%), and 6 T13 (18%); 64% female and 36% male. Eight were preterm infants with gestational age between 30–36 weeks (24%), and only 4 among the 33 infants had a birth weight >2500 g (12%). Four patients underwent heart surgery and one of them died. Intrahospital mortality was 83% for T13, and 59% for T18. The majority had other malformations and underwent other surgical procedures. Palliative care was offered to 54% of the patients. The median hospitalization time for T18 and T13 was 29 days (range: 2–304) and 25 days (13–58), respectively. Conclusions: Patients with T13 and T18 have high morbidity and mortality, and long hospital and ICU stays. Multicentric studies are needed to allow the analysis of important aspects for creating protocols that, seeking therapeutic proportionality, may bring better quality of life for patients and their families.

Effect of Age on Estimated Glomerular Filtration Rate and the Relationship between eGFR and Extubation Time in Patients Undergoing Open Heart Surgery

Effect of Age on Estimated Glomerular Filtration Rate and the Relationship between eGFR and Extubation Time in Patients Undergoing Open Heart Surgery

Practices of Physical Therapist Regarding Chest Physiotherapy for Patients Undergoing Open Heart Surgery in Karachi

Background: Despite the critical role of chest physiotherapy in the recovery process post open-heart surgery, there is a paucity of data on the practices of physical therapists in Karachi. With the high incidence of cardiovascular surgeries and the significant burden of postoperative complications, understanding current physiotherapy practices is essential for improving patient outcomes. Objective: The objective of this study was to evaluate the current practices of physical therapists regarding chest physiotherapy for patients undergoing open-heart surgery in Karachi and to identify potential areas for standardization and improvement. Methods: A cross-sectional study was conducted using a questionnaire survey among 40 physiotherapists working in cardiothoracic units across six major hospitals in Karachi. Participants were selected through non-probability convenient sampling, and data on preoperative and postoperative physiotherapy practices were collected. The survey included both open-ended and close-ended questions, with an emphasis on the types of treatments administered during the first five postoperative days. Statistical analysis was performed using SPSS version 25. Results: The mean age of the physiotherapists was 31.20 (SD = 6.8) years with an average working experience of 7.592 (SD = 6.7) years. On the day of surgery, physiotherapy was provided routinely by 7.5%, as needed by 62.5%, and was never provided by 30% of the respondents. From the first to the fifth postoperative day, routine physiotherapy was administered by an increasing majority, peaking at 100% on the second day. Written guidelines for the management of extubated and intubated patients were accessible to 35% and 10% of participants, respectively. Conclusion: There is a substantial engagement in chest physiotherapy post open-heart surgery among physiotherapists in Karachi. However, the variability in practice and the lack of standardized guidelines point towards a need for the development and implementation of standardized protocols to ensure consistent and evidence-based care.

Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06–1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00–1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.

Hemoglobin levels and clinical outcomes after extracorporeal circulation auxiliary to open heart surgery: a retrospective cohort study

BackgroundExtracorporeal circulation auxiliary to open heart surgery is a common procedure used to treat heart diseases. However, the optimal transfusion strategy for patients undergoing this surgery remains a subject of debate. This study aims to investigate the association between hemoglobin levels and clinical outcomes in patients undergoing extracorporeal circulation auxiliary to open heart surgery, with the ultimate goal of improving surgical success rates and enhancing patients' quality of life.MethodsA retrospective analysis was conducted on data from the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database, including 4144 patients. The patients were categorized into five groups based on their minimum hemoglobin levels during hospitalization. Baseline characteristics, clinical scores, laboratory results, and clinical outcome data were collected. Statistical analyses utilized descriptive statistics, ANOVA or Kruskal-Wallis tests, Kaplan-Meier method, and Log-rank test.ResultsThe results revealed a significant correlation between hemoglobin levels and in-hospital mortality, as well as mortality rates at 30 days, 60 days, and 180 days (p < 0.001). Patients with lower hemoglobin levels exhibited higher mortality rates. However, once hemoglobin levels exceeded 7g/dL, no significant difference in mortality rates was observed (p = 0.557). Additionally, lower hemoglobin levels were associated with prolonged hospital stay, ICU admission time, and mechanical ventilation time (p < 0.001). Furthermore, hemoglobin levels were significantly correlated with complication risk, norepinephrine dosage, and red blood cell transfusion volume (p < 0.001). However, there was no significant difference among the groups in terms of major complications, specifically sepsis (p > 0.05).ConclusionThe study highlights the importance of managing hemoglobin levels in patients undergoing heart surgery with extracorporeal circulation. Hemoglobin levels can serve as valuable indicators for predicting clinical outcomes and guiding treatment decisions. Physicians should carefully consider hemoglobin levels to optimize transfusion strategies and improve postoperative patient outcomes. Further research and intervention studies are warranted to validate and implement these findings in clinical practice.

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

Identifying High-Risk Patients for Severe Pulmonary Complications after Cardiosurgical Procedures as a Target Group for Further Assessment of Lung-Protective Strategies

ObjectiveIt remains unclear if intraoperative lung-protective strategies can reduce the rate of respiratory complications after heart surgery, partly because low-risk patients have been studied in the past. We established a screening model to easily identify a high-risk group for severe pulmonary complications (i.e., pneumonia or ARDS) that may be the ideal target population for the assessment of potential benefits of such measures. DesignRetrospective observational trial. SettingDepartments of cardiac surgery and cardiac anesthesia of university hospital. Participants: Consecutive patients undergoing heart surgery on cardiopulmonary bypass (CPB) and subsequent treatment at a dedicated cardiosurgical ICU between January 2019 and March 2021. InterventionsNone Measurements and main resultsOf 2572 patients undergoing surgery, 84 patients (3.3%) developed pneumonia/ARDS that significantly impacted outcome (i.e., longer ventilatory support (66 vs. 11%), higher reintubation rate (39 vs. 3%), prolonged length of ICU (33±36 vs. 4±10 days) and hospital stay (10±15 vs. 6±7 days), and higher in-hospital (43 vs. 9%) as well as 30-day (7 vs. 3%) mortality). Our screening model for severe pulmonary complications includes LVEF < 52%, EuroSCOREII > 5.9, CPB time > 123 minutes, left ventricular assist device or aortic repair surgery, and bronchodilatory therapy. A cut-off for the predicted risk of 2.5 % showed optimal sensivity and specificity with an AUC of 0.82. ConclusionWe suggest that future research on intraoperative lung protective measures should focus on this high-risk population and primarily aiming at mitigation of severe forms of postoperative pulmonary dysfunction associated with poor outcome and increased resource consumption.

Influence of minimal invasive extracorporeal circuits on dialysis dependent patients undergoing cardiac surgery.

Cardiac surgery in patients on chronic renal dialysis is associated with significant morbidity and mortality. Minimally invasive extracorporeal circuits (MiECC) have shown a positive impact on patient outcome in different high-risk populations. This retrospective study compares the outcome of these high-risk patients undergoing heart surgery either with a MiECC or a conventional extracorporeal circulation (CECC). This is a single-center experience including 131 consecutive dialysis dependent patients undergoing cardiac surgery between January 2006 and December 2016. A propensity score matching was employed leaving 30 matched cases in each group. After propensity score matching the 30-day mortality was significantly lower in the MiECC group (n = 3 (10%) vs n = 10 (33%) in the CECC group, p = .028). Further, intraoperative transfused units of packed red blood cells were lower in the MiECC group (1.4 ± 1.8 units vs 2.8 ± 1.7, p < .001). There are evident advantages to using MiECC in dialysis dependent patients, especially regarding mortality. These findings necessitate additional research in MiECC usage in high-risk populations.

Increased pro-remodeling and pro-thrombotic responses in the left compared to the right atrial appendage: role of low-grade inflammation and the AT1R/NADPH oxidases/SGLT2 pro-oxidant pathway

Abstract Introduction In atrial fibrillation (AF), there is a complex interplay between arrhythmia burden and cardiovascular risk factors leading to left atrial remodeling, an increased risk of stroke and heart failure. Most thrombi get formed in the atrial appendage. Several studies suggested that sodium-glucose cotransporter 2 inhibitors (SGLT2i), besides showing major benefits on heart failure, might lower the risk of incident AF. Therefore, we examined the expression level of SGLT2 in human right and left atrial appendages (RAA, LAA) and determined its role in pro-oxidant, pro-fibrotic and pro-thrombotic responses. Methods Human RAA and LAA were collected from patients undergoing cardiac surgery at a university hospital. The LAA was cut into a proximal part (low stasis, high shear) and a distal part (high stasis, low shear). The level of reactive oxygen species (ROS) was determined using dihydroethidium, mRNA and protein expression levels by RT-qPCR, and Western blot analysis and immunofluorescence, respectively, and the level of fibrosis by Sirius red staining. Results The distal LAA had higher mRNA levels of ICAM-1 and p53, and protein levels of ICAM-1, AT1R, p53, p21 and tissue factor than the proximal LAA. LAA displayed higher mRNA and protein levels of SGLT2 and SGLT1, pro-adhesive, pro-thrombotic, pro-remodeling, pro-fibrotic and senescence markers, and components of the angiotensin system, in addition to IL-1 mRNA levels and p-p65 NF-kB protein levels compared to RAA. These responses were associated with higher levels of oxidative stress, nitrotyrosine and fibrosis. SGLT2 immunofluorescence signals in distal LAA were colocalized with those of CD31, CD68, TNF-α and troponin T. Oxidative stress levels in distal and proximal LAA and RAA were reduced by inhibitors of NADPH oxidases, ACE1 and SGLT2, an AT1R antagonist, and by a TNF-α neutralizing antibody whereas NG-nitro-L-Arginine methyl ester, the non-selective NO synthase inhibitor, inhibited ROS in distal and proximal LAA without affecting RAA. In addition, the level of TNF-α in LAA was positively correlated to the indexed LA volume indicating a link between inflammation and remodeling. Conclusions The distal part of the LAA of patients undergoing heart surgery showed greater impaired endothelial function and senescence associated with more pronounced pro­-oxidant, pro­-remodeling and pro-­inflammatory responses than the proximal part and the RAA. These responses were associated with an increased expression level of SGLT 2 in endothelial cells, cardiomyocytes, and macrophages in areas showing an inflammatory response. Moreover, the pro-oxidant signal was sensitive to inhibitors of the local angiotensin system, NO synthase, SGLT2 and TNF-α. Thus, the AT1R/NADPH oxidases/SGLT2 pathway appears as an interesting target to blunt the stimulatory pro-oxidant signal in cardiac tissues affected by low-grade inflammation that leads to remodeling and fibrosis.

Factors Affecting Death Anxiety in Patients Undergoing Open Heart Surgery: A Cross-Sectional Study.

After the operation, death anxiety of patients is affected by many factors. This study aims to investigate the factors affecting death anxiety of patients undergoing open heart surgery. A descriptive, cross-sectional study. Data were collected using the 'Introductory Information Form,' the 'Templer's Death Anxiety Scale,' and the 'Spiritual Well-being Scale.' This study was conducted with 313 intensive care patients. The mean scores of the patients on the "Death Anxiety Scale" were moderate (7.96 (4.28)). According to the study findings, age, gender, length of stay in the intensive care unit, and spiritual well-being were found to be important predictors of death anxiety (F (4,308) = 16.149, p < .001). Considering gender differences in nursing care, it is thought that the intensive care period will be shortened, the level of spiritual well-being will increase and death anxiety will decrease.

Factors Affecting the Mortality of Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Morbidity and mortality of patients after cardiac surgery can be influenced in the preoperative, intraoperative, and postoperative periods. This study aimed to explore factors that affect the mortality of patients undergoing open heart surgery with cardiopulmonary bypass at Dr. M. Djamil General Hospital, Padang, Indonesia.&#x0D; Methods: This study is an analytical observational research with a cross-sectional approach and uses secondary data obtained from the medical record installation of Dr. M. Djamil General Hospital, Padang, Indonesia. A total of 57 research subjects participated in this study. Univariate, bivariate, and multivariate analyses were carried out using SPSS software.&#x0D; Results: The final multivariate modeling results show that the variables that influence patient mortality are EuroSCORE II (p-value=0.003) and duration of CPB (p-value=0.003). With an odds ratio of 37.21 groups, EuroSCORE II high risk had a risk of death 37.21 times higher than the low-risk group (CI 3.325 – 416.324). Meanwhile, increasing the duration of CPB by one minute increased the risk of mortality 1.02 times (CI 1.006 – 1.030). Meanwhile, there is no influence of variables (NYHA, LV function, ACC duration) on the incidence of mortality in patients undergoing open heart surgery with a machine cardiopulmonary bypass at Dr. M. Djamil General Hospital, Padang.&#x0D; Conclusion: EuroSCORE II affects the mortality of patients undergoing open heart surgery with CPB. The duration of CPB affects the mortality of patients undergoing open heart surgery with CPB.

Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery.

Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.

Major Adverse Cardiac and Cerebrovascular Events in Patients Undergoing Simultaneous Heart Surgery and Carotid Endarterectomy.

Patients with simultaneous relevant internal carotid artery stenosis and coronary artery heart or valve disease represent a high-risk collective with respect to cerebral or cardiovascular severe events when undergoing surgery. There exist several concepts regarding the timing and modality of carotid revascularization, which are controversially discussed in patients with heart disease. More data regarding outcome predictors and measures are needed to gain a better understanding of the best treatment option of the discussed patient collective. This single-center study retrospectively analyzed n = 111 patients undergoing heart surgery with coronary artery bypass grafting or heart-valve surgery and concomitant carotid surgery due to significant internal carotid artery stenosis. In order to do so, patients were divided into two groups with respect to postoperative major adverse cardiac and cerebrovascular events (MACCE) with thirty-day all-cause mortality, valve related mortality, myocardial infarction, stroke and transitory ischemic attack. Preoperative patient's characteristic in the no-MACCE and MACCE group were mainly balanced, other than higher rates of chronic obstructive pulmonary disease, chronic kidney disease, instable angina pectoris and prior transitory ischemic attack in the MACCE cohort. The analysis of intraoperative characteristics revealed a higher number of intra-aortic balloon pump implantation, which is in line for a higher number of postoperative supports. Besides MACCE, patients suffered significantly more often from postoperative bleeding events and re-thoracotomy, cardiopulmonary reanimation, new onset postoperative dialysis and prolonged intensive care unit stay related complications. Within the reported patient population suffering from MACCE after a simultaneous carotid endarterectomy and heart surgery, a preoperative history of transitory ischemic attack and kidney disease might account for worse outcomes, as severe events were not only neurologically driven but also associated with postoperative cardiovascular complications following heart surgical procedures.

Central venous pressure combined with renal venous impedance index in predicting the acute kidney injury after thoracic and abdominal (non-cardiac) surgery

BackgroundIn the 21st century, 13% of patients undergoing open abdominal surgery, 25% of patients undergoing heart surgery, and 57% of patients admitted to the intensive care unit (ICU) are affected by acute kidney injury (AKI). MethodsThis prospective observational study included patients admitted directly to the ICU between June 2021 and December 2021. ResultsA total of 81 patients were enrolled after thoracic and abdominal (non-cardiac) surgery; 36 patients (44.4%) were diagnosed with AKI occurred within 7 days after surgery. Six-hour postoperative central venous pressure(CVP) was a risk factor for AKI in thoracic and abdominal (non-cardiac) postoperative patients (odds ratio [OR], 1.418; 95% confidence intervals [CI], 1.106–1.819; P = 0.006). Six-hour postoperative vein impedance index(VII) and CVP were significantly positively correlated (P = 0.031). The combination of 6-h postoperative VII with CVP (VII ≥0.34, CVP ≥7.5 mmHg) showed an area under the curve (AUC) of 0.787, In the subgroup analysis of patients with 6-h postoperative CVP <7.5 mmHg, there was a significant statistical difference in 6-h postoperative VII between the groups and those without AKI (P = 0.048). At 6-h postoperative CVP <7.5 mmHg, VII of ≥0.44 had a predictive value for AKI after thoracic and abdominal (non-cardiac) surgery, with an AUC of 0.669, a sensitivity of 41.2%, and a specificity of 94.4%. ConclusionSix-hour postoperative CVP combined with VII can better predict the occurrence of AKI occurred within 7 days after thoracic and abdominal (non-cardiac) surgery but cannot predict the severity of AKI.

The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy

ABSTRACT Background Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy. Aim Of The Study The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation. Patients And Methods 50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision. Results There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation. Conclusion Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.