Postpericardiotomy Syndrome Research Articles

Colchicine in Cardiovascular Disease: In-Depth Review.

Inflammation plays a prominent role in the development of atherosclerosis and other cardiovascular diseases, and anti-inflammatory agents may improve cardiovascular outcomes. For years, colchicine has been used as a safe and well-tolerated agent in diseases such as gout and familial Mediterranean fever. The widely available therapeutic has several anti-inflammatory effects, however, that have proven effective in a broad spectrum of cardiovascular diseases as well. It is considered standard-of-care therapy for pericarditis, and several clinical trials have evaluated its role in postoperative and postablation atrial fibrillation, postpericardiotomy syndrome, coronary artery disease, percutaneous coronary interventions, and cerebrovascular disease. We aim to summarize colchicine's pharmacodynamics and the mechanism behind its anti-inflammatory effect, outline thus far accumulated evidence on treatment with colchicine in cardiovascular disease, and present ongoing randomized clinical trials. We also emphasize real-world clinical implications that should be considered on the basis of the merits and limitations of completed trials. Altogether, colchicine's simplicity, low cost, and effectiveness may provide an important addition to other standard cardiovascular therapies. Ongoing studies will address complementary questions pertaining to the use of low-dose colchicine for the treatment of cardiovascular disease.

Diaphragmatic Hernia after Thoracoabdominal Trauma - Laparoscopic Surgical Repair with Mesh

Traumatic diaphragmatic hernia (TDH) is an uncommon disease, with an incidence of about 0.5% and is usually associated with penetrating or blunt thoracoabdominal trauma (1). It is often associated with other thoracoabdominal, brain and musculoskeletal injuries, being a diagnostic and therapeutic challenge (2). These injuries worsen the prognosis, with a mortality of up to 31% (2, 3). Chest X-rays with bowel contrast studies and CT scans of the chest and the abdomen are a useful diagnostic tool for detecting TDH, being the latter more specific (4). The treatment involves repair of the diaphragmatic defect with or without a mesh, using a transthoracic and/or transabdominal approach (1). The recurrence of diaphragmatic hernia can occur due to primary hernia repair without tension-free suture, incorrect attachment of the mesh without the necessary overlap or failure in the host-prosthesis interface (5). Hanna WC et al. demonstrated that recurrence may also be related to the use of absorbable suture to close the defect (4). The aim of this video is to illustrate the key steps for the surgical technique of a recurrent diaphragmatic hernia repair with mesh through laparoscopic approach. We present a 20-year-old male with a history of hereditary hyperferritinemia and hypertension. In 2019, due to a car accident, he suffered multiple traumas including rib fractures, descending aortic dissection, hemothorax, hemoperitoneum, and diaphragmatic laceration with the migration of the stomach to an intrathoracic position. The patient underwent thoracotomy, replacing the descending aorta isthmus with a graft, suture of the diaphragm defect, and chest drainage. Later, due to complications, he was hospitalized with a post-pericardiotomy syndrome – Dressler's syndrome - with pericardial and pleural effusion. He had a recurrence of the diaphragmatic hernia in 2021, initially small and asymptomatic, later increasing in size and becoming symptomatic. The thoraco-

Postpericardiotomy Syndrome: A Rare Complication Following Double Arcus Aorta Operation

Postpericardiotomy Syndrome: A Rare Complication Following Double Arcus Aorta Operation

Importance of LV Venting after ECMO Implantation in Post-Cardiotomy Syndrome: A Case Report

Prolonged cardiorespiratory support can be achieved with ECMO that may provide time for myocardial recovery, prevent multiorgan dysfunction and reduce mortality. Left ventricle (LV) distension can worsen already distended and hypocontractile heart. Early recognition and aggressive management of LV distension are essential for the treatment of patients with low cardiac output. The case report presented intends to show advantages of left ventricular venting on ECMO after post-cardiotomy shock. With direct flow measurements on bypass-grafts before and after the vent implantation, it was possible to clearly demonstrate the importance of venting for myocardial perfusion.

Laser Lead Extraction During Venoarterial ECMO support.

The treatment of valvular endocarditis in patients with cardiac implantable electrophysiological device (CIED) includes valvular surgery and lead extraction. This can be challenging in patients with severely reduced left ventricular ejection fraction (LVEF). Reduced LVEF in combination with sepsis and cardioplegic cardiac arrest can make weaning from cardiopulmonary bypass difficult. Some of these patients require venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy syndrome. Lead extraction by manual traction is often not possible in cases with a long lead dwell time. Therefore, a lead extraction procedure with powered sheaths is required during the VA-ECMO support. We describe our technique for laser lead extraction during VA-ECMO support in a 64-year-old patient with triple valve endocarditis and lead vegetations.

ФАКТОРЫ РИСКА РАЗВИТИЯ ПОСТКАРДИОТОМНОГО СИНДРОМА МАЛОГО СЕРДЕЧНОГО ВЫБРОСА У ПАЦИЕНТОВ ПОСЛЕ АОРТОКОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ

Aim. To determine the risk factors for postcardiotomy syndrome of low cardiac output in patients after on-pump coronary artery bypass grafting. Methods. The study included 157 patients who underwent on-pump coronary artery bypass grafting. Intraoperatively and in the early postoperative period, 25 patients developed postcardiotomy low cardiac output syndrome (PLCOS), which was refractory to drug therapy and followed by mechanical circulatory support (MCS). 132 patients did not develop PLCOS and did not require MCS (comparison group). Results. A retrospective, observational case-control study was carried out. Based on a univariate analysis, risk factors for the development of PLCOS were identified: preoperative left ventrical ejection fraction (LVEF) (B-mode) < 45%, OR = 4.7 (95% CI 1.9–11.5, p = 0.001), open heart surgery during the acute period of myocardial infarction (10 days) OR = 20.5 (95% CI 3.8-109, p = 0.001), aorta reclumping OR = 5.8 (95% CI 1.1 – 30.9, p = 0.049), dysfunction of coronary bypass grafts detected by bypass imaging in the early postoperative period OR = 54.7 (95% CI 13.6-219, p = 0.001). Conclusions. Postcardiotomy syndrome of low cardiac output is a severe complication after open-heart surgery, leading to multiple organ failure due to systemic hypoperfusion of organs and tissues and is characterized by a high hospital mortality rate of up to 80%. Mechanical support of blood circulation (MCS) in this case is the only method of treatment for this cohort of patients.

Pharmacologic treatment of acute and recurrent pericarditis: a systematic review and meta-analysis of controlled clinical trials.

Recurrence is the most frequent complication following acute pericarditis and may occur in 30% patients, rising to 50% in case of multiple recurrences, lack of colchicine treatment or use of glucocorticoids. Available treatments include aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, anti-interleukin-1 (IL-1) agents. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of pharmacological treatments for acute and recurrent pericarditis. Bibliographic databases were searched (PubMed, MEDLINE, Embase, Scopus, and the Cochrane Library) using the terms "acute pericarditis" or "recurrent pericarditis" and "colchicine" or "NSAIDs" or "glucocorticoids" or "immunosuppressive agents" or "immunoglobulins" or "anti-IL1 agents." Random-effects meta-analysis was used to assess the risk of recurrent pericarditis. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. Eleven RCTs assessed the efficacy of pharmacological treatments for acute and recurrent pericarditis (colchicine and anti-interleukin-1 agents). Colchicine, assessed in nine RCTs, was effective in the reduction of recurrent pericarditis, compared with standard treatment (17% vs .34%, RR=0.50; 95% CI 0.42-0.60, P<0.001), without any differences according to clinical setting (i.e. acute pericarditis, recurrent pericarditis, post-pericardiotomy syndrome; P=0.58). Anti-interleukin-1 agents (anakinra, rilonacept), assessed in two RCT, were effective in the reduction of recurrences, compared with placebo (10% vs.78%, RR=0.14; 95% CI 0.05-0.35, P<0.001). A correct pharmacological management of pericarditis is key to prevent recurrences. Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs.

Post-pericardiotomy syndrome: insights into neglected postoperative issues.

Pericardial effusion is a common complication after cardiac surgery, both isolated and in post-pericardiotomy syndrome (PPS), a condition in which pleuropericardial damage triggers both a local and a systemic inflammatory/immune response. The goal of this review was to present a complete picture of PPS and pericardial complications after cardiac surgery, highlighting available evidence and gaps in knowledge. A literature review was performed that included relevant prospective and retrospective studies on the subject. PPS occurs frequently and is associated with elevated morbidity and significantly increased hospital stays and costs. Nevertheless, PPS is often underestimated in clinical practice, and knowledge of its pathogenesis and epidemiology is limited. Several anti-inflammatory drugs have been investigated for treatment but with conflicting evidence. Colchicine demonstrated encouraging results for prevention. Wider adoption of standardized diagnostic criteria to correctly define PPS and start early treatment is needed. Larger studies are necessary to better identify high-risk patients who might benefit from preventive strategies.

CIRCULATING BIOMARKERS OF SYSTEMIC INFLAMMATORY RESPONSE IN THE ASSESSMENT OF POSTPERICARDIOTOMY SYNDROME IN PATIENTS AFTER CARDIAC SURGERY

Postpericardiotomy syndrome (PCTS) is one of the most frequent cardiac surgery complications seen in 9-65% of patients. Despite its widespread occurrence, the mechanisms of the development of PCTS are still understudied. drug. The use of colchicine in cardiac surgery patients is of particular interest. Due to the ability of this drug the colchicine mechanisms of action are able to inhibit the mobilization of the NLRP3 inflammasome assembly, to suppress the activation of caspase-1. As a result, it can prevent the release of proinflammatory cytokines, namely IL-1β and IL-18. There are conflicting data on the effect of colchicine on the PCTS progression within the systemic inflammatory response after cardiac surgery. In this regard, it was important to study the dynamics of serum levels of IL-6, IL-10, IL-1β, and TNFα in patients before coronary artery bypass grafting (T1), 6 hours (T2), and 10 days (T3) after surgery, and to evaluate the effect of colchicine on the development of PCTS. The results of our research showed a significant increase of IL-10 in both groups 6 hours after surgery. However, on the 10th day, the increase in the level of IL-10, compared with the initial values, was higher in the 1stgroup – 2 times, compared with the 2nd group. In both groups, showed significant increase in serum concentration of IL-6 after 6 h surgery, with a subsequent decrease in the expression at the stage of T3, while the IL-6 levels in the 2ndgroup was statistically notably higher than T1. The incidence of pleurisy was lower in the group of patients taking colchicine. Only in the 1st group IL-6 levels were directly associated with IL-10. In patients with pleurisy, the level of released IL-10 and TNFα was significantly higher in the 2nd group. There were no significant intergroup differences in serum levels of IL-1β and TNFα, as well as significant changes in IL-1β between the stages of observation. Analysis of TNFα expression revealed significant differences in TNFα content in the 1stgroup between the T1-T3 and T2-T3 stages. In both groups, multiple positive associations were found between the studied indicators. Thus, data were obtained indicating the antiinflammatory effect of colchicine in cardiac surgery patients. This was clinically expressed in a tendency to a lower incidence of pleurisy, and was accompanied by increased expression of IL-10, which has an antiinflammatory and immunomodulatory effect against the background of the drug in the postoperative period.

Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery?

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (p < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

Pericardiocentesis in children: 20-year experience at a tertiary children's hospital.

Pericardiocentesis is the invasive percutaneous procedure for acute and chronic excessive accumulation of pericardial fluid. There is a paucity of data on the effectiveness and safety of pericardiocentesis in children. To evaluate the effectiveness and safety of pericardiocentesis and factors associated with acute procedural failure and adverse events. This was a single-centered retrospective study to describe all the children aged ≤20 years who underwent pericardiocentesis. Data on demographics, etiologies of pericardial effusion, and repeat intervention at follow-up were collected. A total of 127 patients underwent 153 pericardiocentesis. The median age was 6.5 years (1 day-20 years) with weight of 17 kg (0.5-125). Most common etiology was post-pericardiotomy syndrome (n = 56, 44%), followed by infectious (12%), malignant (10%), and iatrogenic (9%). Pericardiocentesis was performed more commonly in the catheterisation laboratory (n = 86, 59%). Concurrent pericardial drain placement was performed in 67 patients (53%). Acute procedural success was 92% (141/153). Repeat intervention was performed in 33 patients (22%). The incidence of adverse events was 4.6% (7/153): hemopericardium requiring emergent surgery (n = 2); hemopericardium with hypotension (n = 2); seizure with anesthesia induction (n = 1); and right ventricle puncture with needle (n = 2). Pericardiocentesis at the bedside had a higher rate of acute procedural failure than that in the catheterisation lab (17 versus 1%, p < 0.01). No identifiable risk factors were associated with adverse events. Pericardiocentesis was life-saving in children with its high effectiveness and safety even in urgent situations. Although initial pericardiocentesis was effective, one of five patients required re-intervention for recurrent pericardial effusion.

Palliative Care for Extracorporeal Life Support: Insights From the National Inpatient Sample.

Providing temporary cardiopulmonary support, extracorporeal membrane oxygenation (ECMO) carries a high risk of mortality. Palliative care (PC) may facilitate a patient-centered approach to end-of-life care in order to aid symptom management and provide psychosocial support to families. The present study aimed to identify factors associated with PC consultation and its impact on resource utilization in ECMO. All adults placed on ECMO at a PC capable center were identified in the 2006-2017 National Inpatient Sample. Indications for ECMO were identified using diagnosis codes and classified into postcardiotomy syndrome, respiratory failure, cardiogenic shock, mixed cardiopulmonary failure, and transplant related. Of 41122 patients undergoing ECMO, 20514 (49.9%) died in the same hospitalization. Of those, 3951 (19.3%) received a PC consult. Use of PC consults increased significantly from 5.5% in 2006 to 22.8% in 2017 (nptrend<.001). After multivariable risk adjustment, PC consults did not affect costs (β: -$7341, 95% CI: -22572 to +7888) or duration of hospitalizations (β: -.37days, 95% CI: -2.76 to +2.02). Utilization of PC does not appear to negatively influence resource utilization among non-survivors of ECMO. Increased adaptation of PC in ECMO may improve end-of-life care, a factor that deserves future study.

Expanding the potential benefits of colchicine for preventing postpericardiotomy syndrome and atrial fibrillation complications after cardiac surgery: meta-analysis of randomized controlled trials

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Postpericardiotomy syndrome (PPS) and atrial fibrillation (AF) are complications occurred in one-third of cardiac surgery patients that increase morbidity and mortality. Colchicine is an anti-inflammatory drug for treating acute pericarditis and pericardial effusion. Previous studies suggested that colchicine also may prevent PPS and AF after cardiac surgery although the results were still inconsistent. Purpose This study intends to determine the efficacy of colchicine for preventing PPS and AF in post-cardiac surgery patients. Methods We conducted comprehensive literature searching in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies until November 2020. We included all randomized controlled trials (RCTs) that access the incidence of PPS and AF after cardiac surgery in patients who received colchicine before cardiac surgery compared with placebo. We use revised Cochrane risk-of-bias tool (RoB 2) for accessing the bias risk of included studies. We performed analysis to provide pooled risk ratio (RR) with 95% confidence interval (CI) using fixed-effect heterogeneity test. Results We included 9 RCTs with total of 2,372 participants met our inclusion criteria. The administration of colchicine before cardiac surgery decreases the incidence of PPS significantly (pooled RR = 0.55, 95% CI 0.43 – 0.71, p &amp;lt; 0.00001. I² = 0%). Besides, colchicine also significantly lowers the incidence of postoperative AF compared with placebo (pooled RR = 0.79, 95% CI 0.65 – 0.96, p = 0.02. I² = 20%). Conclusions Colchicine showed potential benefits for preventing PPS and AF after cardiac surgery. However, further trials are needed to establish the efficacies.

Peculiarity of clinical course of postpericardiotomy syndrome in different methods of surgery and postoperative antithrombotic therapy.

Aim To compare features of the disease course and the effectiveness of nonsteroidal anti-inflammatory drug (NSAID) treatment of postpericardiotomy syndrome (PPS) in patients after coronary bypass (CB) surgery who were treated with antiplatelet drugs and in patients after surgical correction of heart valve disease (CHVD) who received the anticoagulant warfarin for prevention of thrombotic complications.Material and methods This study included 89 patients of whom 53 patients had underwent CB and 36 patients had underwent CHVD. At 15 [13; 15] days after surgery, the severity of inflammatory response, the state of coagulation hemostasis, and hematocrit were studied. At 5 days after the first test, blood count and measurement of C-reactive protein were repeated. Echocardiography was used to determine the presence and volume of pleural effusion. For prevention of thrombotic complications, antiplatelet drugs were administered after CB and warfarin was administered after CHVD. PPS was detected in 35 (66 %) patients after CB and 18 (50 %) patients after CHVD. The ibuprofen treatment (600 mg twice a day) was administered to all patients with PPS. If positive changes in inflammatory markers were absent during the NSAID treatment, ibuprofen was replaced with prednisolone 0.5 mg/kg body weight with subsequent laboratory and instrumental monitoring.Results Patients after CHVD treated with warfarin had higher values of international normalized ratio (INR) and activated partial thromboplastin time (aPPT) and lower values of prothrombin index (PTI), fibrinogen (p&lt;0.001 for all), hemoglobin (p=0.0016), and hematocrit (p=0,0032) than patients after CB treated with antiplatelet drugs. 21 (40 %) patients with PPS required changing the anti-inflammatory therapy from ibuprofen to prednisolone. These patients displayed hypocoagulation, which was evident as reduced PTI (p=0.0023) and fibrinogen (p=0.0209), increased INR (p=0.0291) and aPPT (p=0.0416), and a higher incidence of pericardial effusion (p=0.0080). The insufficient effectivity of NSAIDs that required administration of prednisolone was more frequently observed in patients after CHVD (61 % vs. 29 %, р=0.037).Conclusion Hypocoagulation observed in patients after CHVD due to the anticoagulant treatment with warfarin was associated with more severe course of PPS and lower effectiveness of the NSAID treatment compared to patients after CB. This results in more frequent replacement of NSAIDs with glucocorticoids in the treatment of patients after CHVD.

Steroids for the prevention of postpericardiotomy syndrome: a meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Postpericardiotomy syndrome (PPS) can occur in up to 40% of patients after cardiac surgery. Corticosteroid therapy has long been used for pericarditis and pericardial effusion due to its anti-inflammatory proprieties. The benefit of corticosteroids for the prevention of post pericardiotomy syndrome (PPS) in not consensual. Purpose We performed a systematic review and meta-analysis of trials assessing the efficacy of corticosteroids to prevent PPS in patients submitted to cardiac surgery. Methods We searched MEDLINE, Google Scholar and the Cochrane Library databases using the key terms "corticosteroids" and "post pericardiotomy syndrome" without language or date restriction. Articles were considered for inclusion in the analysis if they comprised a population of patients submitted to cardiac surgery and a comparison between patients treated with corticosteroids for the prevention of PPS and those who were not. Three studies were identified, comprehending a total of 1268 patients. The primary endpoint was the occurrence of PPS. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated based on a random effects meta-analysis and were obtained from the pooled adjusted OR of primary studies. Results Studies included in the analysis comprehend a controlled randomized trial in children (1 mg/kg methylprednisolone pre-operative and four additional doses over 24h vs placebo); a controlled randomized trial in adults (1 mg/kg dexamethasone intra-operative vs placebo) and a retrospective study in adults (1 mg/kg intra-operative methylprednisolone vs standard care). Of the total 1268 patients included, 641 received glucocorticoids for the prevention of PPS. Main reason for surgery was correction of a congenital heart defect in 19% of the patients; coronary artery bypass graft in 15% and valvular disease in 66% of the cases. 217 patients had PPS during the follow-up time; 15% in the corticosteroid prophylaxis group and 18% in the placebo/standard care group. Overall, corticosteroid prophylaxis was not useful for the prevention of PPS compared to placebo/standard care (pooled OR: 0.78, 95% CI: 0.51–1.20, I2 = 46%) – Figure 1. Conclusion According to our data, steroid therapy has no role as a preventive therapy of post-pericardiectomy syndrome. Abstract Figure 1 - Pooled analysis

Analysis of direct results of reoperative coronary artery bypass surgery

Aim. To compare the immediate results of treatment of patients after redo coronary artery bypass grafting (reCABG) off pump and with cardiopulmonary bypass.Methods. The retrospective study included 138 patients who underwent isolated reCABG for recurrence of angina pectoris in the period of 2013 to 2019 at the Almazov Research Centre. The operation was performed with cardiopulmonary bypass using isothermal blood cardioplegia in 74 cases (group A). Sixty-four operations were performed without cardiopulmonary bypass (group B). The primary endpoint was a major adverse cardiovascular event (e.g. myocardial infarction, acute cerebrovascular accident, cardiovascular death) during hospitalisation. Secondary endpoints were cardiovascular failure, respiratory failure, renal failure, and wound healing complications during hospitalisation.Results. Redo CABG with cardiopulmonary bypass compared with CABG off pump was more often complicated by cardiovascular failure (39.2% versus 20.3%, p = 0.043), respiratory failure (7.8% versus 2.7%, p = 0.047), and postpericardiotomy syndrome (13.5% versus 0%, p = 0.047). The revascularisation index was higher in the group of reCABG off pump (2.9) compared to the group of reCABG with cardiopulmonary bypass (2.4). In the early postoperative period there was a decrease in the duration of inpatient treatment and stay in the intensive care unit, the duration of surgery, as well as a lower incidence of postoperative complications in group B.Conclusion. Redo CABG showed satisfactory results in the early postoperative period. Performing reCABG off pump was advantageous and was associated with a decrease in the incidence of postoperative complications. Received 23 June 2020. Revised 9 September 2020. Accepted 10 September 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributions Conception and design: I.K. Ismail-zade, V.K. GrebennikData collection and analysis: I.K. Ismail-zade, D.G. Zavarzina, N.R. AbutalimovaDrafting the article: I.K. Ismail-zade, I.Yu. Ivanov, G.I. IshmukhametovCritical revision of the article: V.K. Grebennik, M.l. GordeevFinal approval of the version to be published: M.L. Gordeev, V.K. Grebennik, I.K. Ismail-zade, G.I. Ishmukhametov, I.Yu. Ivanov, N.R. Abutalimova, D.G. Zavarzina

Role of Scoring Systems Calculation in Predicting Extracorporeal Life Support Patients’ Outcomes: A Single Centre Experience

Purpose To investigate the predictive value of Acute Physiology, Age and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores for patient selection and timing to Extracorporeal Life Support (ECLS) as treatment of refractory cardiogenic shock. Methods Retrospective analysis of a prospectively-maintained operative dataset. Results Our study population included 185 patients receiving ECLS at our department between 2006 and 2018. Patient median age was 50.6 years; 62% were male. The most frequent reason for ECLS need, in our subset of patients, was post-cardiotomy syndrome (52.4%) followed by acute decompensation of chronic heart failure (17.5%), isolated right ventricular dysfunction (16.2%), acute myocardial infarction (10.2%) and myocarditis (3.7%). Median duration of ECLS was 8.9 days. Forty-one patients (22.2%) received heart transplantation. In-hospital mortality was 34.6% on ECLS running and 25.9% after ECLS removal. Multivariate regression analysis showed patient age, ECLS duration and bridge to transplantation (BTT) category as indipendent predictors of death (p Conclusion This study confirms the poor prognosis of critically ill patients receiving ECLS support. The APACHE II and SOFA scores, mainly, proved to be a reproducible evaluation tool with high prognostic abilities. In our population, age >65 years, ECLS duration >10 days and BTT ECLS intention appear to impact negatively.

Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation for Post-Cardiotomy Acute Respiratory Distress Syndrome

PurposeAcute lung injury after cardiac surgery portends mortality rates as high as 40-80%. Very limited data are available regarding the utilization of venovenous extracorporeal membrane oxygenation (VV-ECMO) in patients with severe post-cardiotomy acute respiratory distress syndrome (PC-ARDS).MethodsA retrospective review of consecutive patients with PC-ARDS managed with VV-ECMO from 2014-2020 at a single institution was performed. Data were collected from the institutional ELSO registry and supplemented with chart review. Survival to key time-points was assessed.ResultsA total of 22 patients (mean age 60±15 years, 73% male) with PC-ARDS were managed with VV-ECMO during the study period. Their mean Respiratory ECMO Survival Prediction (RESP) score was -5.9±3.5. ECMO support was initiated in 11/22 (50%) patients within 24h of the index operation, and between 2-23 days postoperatively (median 4 days) in the remaining patients. VV-ECMO was the initial cannulation strategy in 16/22 (73%) cases. In the remaining 6/22 (27%) cases, VA-ECMO was initiated and then transitioned to VV-ECMO after median 3 days (range 0.5-13 days). Survival to decannulation and to discharge occurred in 15/22 (68%) and 8/21 (38%) patients, respectively. One patient is still admitted to the hospital and has been decannulated from VV-ECMO. After median follow-up 545 days (range 11-1306 days) among survivors to hospital discharge, 60-day and 1-year survival were 86% and 67%, respectively. Patients surviving to hospital discharge were younger than non-survivors (mean age 50±15 versus 65±13 years, p=0.03), but there was no difference in RESP score among these groups (survivors: -5.8±2.8 versus non-survivors: -6.0±4.8, p=0.90).ConclusionAlthough post cardiotomy ARDS is associated with a high mortality, VV-ECMO should be considered as a potential rescue strategy, especially in younger patients.

Idiopathic recurrent pericarditis - a new orphan autoinflammatory disease? A retrospective analysis of cases of idiopathic recurrent pericarditis and a design of а double-blind, randomized, placebo-controlled study to evaluate the efficacy and safety of RPH-104 treatment in patients with idiopathic recurrent pericarditis.

Aim To analyze cases of idiopathic recurrent pericarditis (IRP) in the structure of pericardial diseases of various origins from patient visits to the Multidisciplinary Federal Center.Material and methods A retrospective analysis of case records was performed for patients admitted to the V.A. Almazov National Medical Research Center from January 1, 2015 through January 1, 2020 for pericardial effusion of different etiologies.Results For the study period, 4 981 new cases of pericardial damage of different etiologies were found. Among these cases, postpericardiotomy syndrome accounted for 4 360 cases and pericarditis for 621 cases. IRP was detected in 34 cases, which amounted to 5.4 %. Based on the study data, the estimated IRP prevalence in the Russian Federation can be 1.1 cases per 100 thousand population.Conclusion IRP should be regarded as a new autoinflammatory disease, the prevalence of which borders on that of adult Still disease and should be addressed within the concept of orphan diseases. Current knowledge of the pathogenesis and data from recent studies demonstrated a great importance of interleukin-1 blockade as a leading mechanism for achieving remission. This has justified conduction of a randomized clinical study at the Center.

Cardiac tamponade following post-pericardiotomy syndrome

SUMMARY Subxyphoid pericardial window (SPW) is performed as both a diagnostic and therapeutic intervention in patients presenting with a penetrating cardiac injury (PCI). Post-pericardiotomy syndrome (PPS) with cardiac tamponade has been reported after penetrating cardiac trauma1 and after transdiaphragmatic pericardial window.2 We describe the first PPS with acute tamponade, weeks after diagnostic SPW for a PCI.