Duration Of Postoperative Mechanical Ventilation Research Articles

Neutrophil extracellular traps are not produced in pediatric patients with one-lung ventilation: a prospective, single-center, observational study.

BackgroundOne-lung ventilation (OLV) may cause lung injury and induce pulmonary pro-inflammation; this ventilator-induced lung injury is associated with neutrophil infiltration. The infiltrated neutrophils release neutrophil extracellular traps (NETs), which are associated with tissue damage. It is not known whether NETs are involved in the pathogenesis of one-lung injury and if they could be a potential therapeutic target. In the present study, we quantified NETs in bronchoalveolar lavage fluid from pediatric patients who underwent OLV and assessed their relationship with prognosis.MethodsEighteen patients with congenital pulmonary cysts or pulmonary sequestration were enrolled in this prospective monocentric study. Myeloperoxidase (MPO) levels, NET markers [i.e., citrullinated histone-3 (CH-3) and free double-stranded DNA (dsDNA)], and inflammatory cytokine levels in bronchoalveolar lavage fluid were assessed. Continuous variables were compared using the paired t-test. The association of NET concentration in bronchoalveolar lavage fluid and clinical parameters was assessed using linear regression analyses.ResultsdsDNA concentration in bronchoalveolar lavage fluid was higher after OLV than before OLV in both the affected lung (0.23±0.30 vs. 0.97±1.05, P<0.05) and the healthy lung (0.28±0.19 vs. 2.45±2.23, P<0.05). However, there were no significant differences in concentrations of MPO, CH-3, and inflammatory cytokines before and after OLV. Serum interleukin (IL)-6 concentration was higher after OLV than before (t=–3.222, P=0.007). Moreover, no associations between dsDNA concentration in bronchoalveolar lavage fluid and the duration of postoperative mechanical ventilation, postoperative hospital stay, and chest high-resolution computed tomography score were observed. The durations of OLV, anesthesia, and operation, as well as the amount of blood loss, had no significant influence on postoperative dsDNA concentration in bronchoalveolar lavage fluid.ConclusionsNETs in bronchoalveolar lavage fluid are not involved in patients who undergo OLV.

Echocardiography-guided transcatheter closure of perimembranous ventricular septal defects without arterial access:a fluoroscopy-free technique for alternative use in children

Abstract Background Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and potential arterial complications. The feasibility of another alternative surgical repair technique for closure of VSDs by percardiac device has been proven. However, the disadvantages of surgical trauma and incision in the inferior sternum cannot avoid. Purpose In an effort to avoid radiation exposure, arterial access, surgical incision and complications, we established a novel technique for transcatheter VSD closure via the femoral vein approach under the guidance of transesophageal echocardiography (TEE) without fluoroscopy. And the feasibility and safety of this new strategy have been assessed. Methods From January 2015 to June 2019, a total of 48 PmVSD patients (mean age, 7.5±2.4 years [range, 4.3– 12.0 years]; mean body weight 24.6±6.8 kg [range, 16.5–38.5 kg]; VSD diameter, 4.3±0.6 mm [range, 3.2–5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy. Results The transcatheter occlusion procedure under TEE guidance was successful in 46 (95.8%) patients. Surgery was necessary in 2 (4.2%) patients. The mean procedural duration, post-operative mechanical ventilation duration, intensive care unit (ICU) residence, and in-hospital durations were 27.2±7.4 min (range, 12.0–42.0 min), 63.2±5.3 min (range, 56.0–78.0 min), 2.1±0.1 h (mean, 2.0–2.4 h), and 2.7±0.3 d (range, 2.5–3.0 d), respectively. One patient had immediate post-operative trivial residual shunt and four patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 2 cases were noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1–36 months follow-up. Conclusion Echocardiography-guided percutaneous device closure of PmVSDs solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision. Procedure of percutaneous closure PmVSD Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry.

Risk factors for respiratory failure after heart surgery

IntroductionStudy of risk factors for prolonged mechanical ventilation and causes of respiratory failure after heart surgery with cardiopulmonary bypass.MethodsTo identify risk factors for postoperative respiratory failure, an analysis of 1,440 medical histories of cardiac surgery patients operated on in 2016 was carried out (a retrospective monocenter study). The selected medical histories were divided into the study group (with duration of hospitalization after surgery in the postoperative ICU of more than 2 days) and the control group (with duration of hospitalization in ICU less than one day). Patients of the study group were divided into 2 subgroups (with duration of CPB more than 90 minutes andless than 90 minutes). A separate statistical analysis of the effect of concomitant pathology on the duration of postoperative mechanical ventilation was performed.ResultsThe most frequent pulmonary complication after heart surgery was atelectasis (39%). A significant increase in the duration of postoperative mechanical ventilation and hospitalization in ICU is associated with both comorbidities (arterial hypertension and cerebrovascular disease) and the duration of cardiopulmonary bypass more than 90 minutes. The cardiopulmonary bypass lasting more than 90 minutes requires reliable greater infusion load during the surgery, which led to an increase in the duration of postoperative mechanical ventilation and deterioration of oxygenation. These factors increase the duration of treatment in the intensive care unit.DiscussionConservative infusion therapy may reduce the duration of postoperative respiratory support. Study of risk factors for prolonged mechanical ventilation and causes of respiratory failure after heart surgery with cardiopulmonary bypass. To identify risk factors for postoperative respiratory failure, an analysis of 1,440 medical histories of cardiac surgery patients operated on in 2016 was carried out (a retrospective monocenter study). The selected medical histories were divided into the study group (with duration of hospitalization after surgery in the postoperative ICU of more than 2 days) and the control group (with duration of hospitalization in ICU less than one day). Patients of the study group were divided into 2 subgroups (with duration of CPB more than 90 minutes andless than 90 minutes). A separate statistical analysis of the effect of concomitant pathology on the duration of postoperative mechanical ventilation was performed. The most frequent pulmonary complication after heart surgery was atelectasis (39%). A significant increase in the duration of postoperative mechanical ventilation and hospitalization in ICU is associated with both comorbidities (arterial hypertension and cerebrovascular disease) and the duration of cardiopulmonary bypass more than 90 minutes. The cardiopulmonary bypass lasting more than 90 minutes requires reliable greater infusion load during the surgery, which led to an increase in the duration of postoperative mechanical ventilation and deterioration of oxygenation. These factors increase the duration of treatment in the intensive care unit. Conservative infusion therapy may reduce the duration of postoperative respiratory support.

Risk factors and long-term outcomes of elderly patients complicating with acute kidney injury after type A acute aortic dissection surgery: a retrospective study.

BackgroundTo identify risk factors and long-term outcomes for acute kidney injury (AKI) in elderly patients who underwent type A acute aortic dissection (TA-AAD) emergency surgeries.MethodsThis retrospective study enrolled 214 consecutive patients who underwent TA-AAD emergency surgeries between January 2014 to December 2018 in Nanjing Drum Tower hospital. The diagnosis of AKI was made based on the Kidney Disease: Improving Global Outcomes definition (KDIGO) criteria. Multivariable regression analysis was performed to identify risk factors for postoperative AKI. Kaplan-Meier curves were generated to compare the long-term outcomes between patients with and without AKI complication after TA-AAD surgeries.ResultsAmong all enrolled patients, 114 (53.3%) developed AKI during postoperative period. The median age of patients with or without AKI was 68.0 (64.0, 74.0) and 66.0 (62.0, 72.8) years respectively. Renal replacement therapy (RRT) was required in 43 patients (20.1%). The 30-day mortality rate was 21.5% in all enrolled patients with 26.3% in AKI group and 16.0% in non-AKI group (P=0.067) respectively. Longer mechanical ventilation duration was identified as the only independent risk factor for developing AKI by multivariable logistic regression analysis. In addition, our data suggested that the long-term cumulative survival rate was different between two groups.ConclusionsPostoperative AKI after TA-AAD surgeries was common and associated with worsened long-term mortality in elderly patients. Longer postoperative mechanical ventilation duration was identified as the only independent risk factor for the development of AKI.

Perioperative nutritional prehabilitation in malnourished children with congenital heart disease: A randomized controlled trial

ObjectiveThe poor preoperative nutritional state of children with congenital heart disease (CHD) is often exacerbated postoperatively. The aim of this study was to evaluate the effect of perioperative 1- versus 2-wk nutritional prehabilitation programs on growth and surgical outcomes in malnourished children with CHD. MethodsForty malnourished infants scheduled for elective CHD surgery were randomized to receive either 1 or 2 wk of a nutritional prehabilitation program. Pre- and postoperative anthropometric parameters and feeding characteristics, feeding tolerance, duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS) and total hospital LOS were documented. ResultsThe 2-wk prehabilitation group showed higher weight-for-age z-score and body mass index than the 1-wk group both preoperatively postnutritional, and postoperatively with significantly higher weight gain postoperatively. The 2-wk prehabilitation group had a shorter duration of postoperative mechanical ventilation, ICU LOS, and total hospital LOS. ConclusionThe 2-wk prehabilitation program was associated with better anthropometric measurements, shorter ICU LOS postoperatively, and shorter duration of hospitalization and mechanical ventilation. The preoperative nutritional status of children with CHD had a negative effect on ICU LOS and duration of mechanical ventilation.

Association of Preoperative Pneumonia With Postsurgical Morbidity and Mortality in Children.

Pneumonia is a common lower respiratory tract infection (LRI) and the leading cause of pediatric hospitalization in the United States. Given its frequency, children with pneumonia may require surgery during their hospital course. This poses serious anesthetic and surgical challenges because preoperative pulmonary status is among the most important risk factors for postoperative complications. Although recent adult data indicated that preoperative pneumonia was associated with poor surgical outcomes, comparable data in children are lacking. Therefore, our objective was to investigate the association of preoperative pneumonia with postoperative mortality and morbidity in children. Using the National Surgical Quality Improvement Program database, we assembled a retrospective cohort of children (<18 years) who underwent inpatient surgery between 2012 and 2015. Our primary outcome was the time to all-cause 30-day postoperative mortality that we evaluated using Cox proportional hazards regression models. For the secondary outcomes, including 30-day postoperative morbidity events, we used Fine-Gray models to account for competing risk by mortality. We also evaluated the association of preoperative pneumonia with duration of postoperative mechanical ventilation and postoperative hospital length of stay. We used propensity score weighting methods to adjust for potential confounding factors, whose distributions differ across the pneumonia groups. Among 153,242 children who underwent inpatient surgery, 0.7% (n = 867) had preoperative pneumonia. Compared with those without preoperative pneumonia, children with preoperative pneumonia had a higher risk of mortality throughout the 30-day postoperative period (hazard ratio [HR], 4.10; 95% confidence intervals [CI], 2.42-6.97; P < .001). Although not statistically significant, children with preoperative pneumonia were twice as likely to develop cardiovascular complications compared to children without preoperative pneumonia (HR, 2.10; 95% CI, 1.17-3.75; P = .012). Furthermore, children with preoperative pneumonia had longer duration of postoperative ventilation (incidence rate ratio, 1.47; 95% CI, 1.26-1.71; P < .001). Finally, children with preoperative pneumonia were estimated to be 56% less likely to be discharged within the 30 days following surgery, compared to children without preoperative pneumonia (HR, 0.44; 95% CI, 0.40-0.47; P < .001). Preoperative pneumonia was strongly associated with increased incidence of postoperative mortality and complications in children. Clinicians should make concerted efforts to screen for preoperative pneumonia and consider whether proceeding with surgery is the most expedient course of action. Our findings may be helpful in preoperative discussions with parents of children with preoperative pneumonia for risk stratification and postoperative resource allocation purposes.

Reoperation after total correction of fallot

Background: Reoperations after tetralogy of Fallot repair is common. This study aimed to report our indications, surgical procedures, and the clinical outcomes of patients undergoing reoperation after surgical correction of TOF. Patient and Methods: We included 40 patients who underwent reoperations after total TOF repair between 2015 and 2019. We included patients who had symptomatic right ventricular failure, patients with residual ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), and tricuspid or pulmonary valve regurgitation. Results: The median age was 5.5(3.5–12.5) years, and 28(70%) were males. The median age at the time of primary repair was 2 (1-6) years. The end-systolic right ventricular (RV) volume estimated by MRI was 110.33±4.93 cc, and the end-diastolic volume was 208 ±10.08 cc. Twenty-two patients had VSD closure (55%), a transannular patch in 6 patients (15%), and RVOT resection in 14 patients(35%). Pulmonary valve replacement was performed in 6 patients(15%) and tricuspid valve repair in 4 patients (10%). The duration of postoperative mechanical ventilation was 11.5 (9-16.5) hours, and two patients had operative mortality (5%). Two patients (5%) had residual RVOT pressure gradient, and four patients had tiny residual VSD(10%). After six months of follow-up, four patients had moderate pulmonary regurgitation (PR), and four patients had residual VSD (10%). After one year follow-up, two patients had moderate PR(5%). Conclusion: A residual ventricular septal defect is a common indication for reoperation after the primary repair of tetralogy of Fallot. The results of reoperations are good with the accepted incidence of postoperative morbidity and mortality.

Routine versus selective plasma exchange before thymectomy in myasthenia gravis

Background: Prethymectomy plasma exchange may improve the outcome of surgery; however, the technique is associated with an increased risk of complications. Therefore, the objective of this study was to compare selective versus routine plasma exchange before thymectomy in patients with myasthenia gravis.&#x0D; Method: We conducted a prospective multi-center cohort study to compare two protocols for plasma exchange before thymectomy. We compared the routine plasma exchange in all patients undergoing thymectomy for myasthenia gravis (group I; n= 30) versus selective exchange (Group II; n= 30). Endpoints were the duration of postoperative mechanical ventilation, plasma exchange, and operative complications.&#x0D; Results: There was no difference in age between both groups (30± 10.1 vs. 29± 9.2 years in Group I and II, respectively; p= 0.69). There were 17 females in Group I (56.67%) vs. 16 in group II (53.33%) (p= 0.8). Comorbidities are comparable between groups. All patients preoperative pyridostigmine, and 27 patients (90%) in Group I and 26 patients (87%) in Group II received glucocorticoids. There was no difference in pulmonary function tests between groups. Plasma exchange related complications were not different between groups. Immediate extubation was achieved in 29 patients (97%) in Group II, and after 6 hours in one patient (3.33%). In Group I, 28 patients (93%) extubated immediately, and two patients were ventilated for 7-12 hours. The mean ICU stay was 1.5 days in Group I and 1.4 days in group II (p= 0.615). The mean hospital stay was 8.5 days in Group I and 9.2 days in group II (p= 0.118). There was no significant difference in pathology between groups (p= 0.137).&#x0D; Conclusion: Selective plasma exchange is feasible before thymectomy for myasthenia gravis. Selective plasma exchange may decrease exchange related complications without affecting the operative outcomes.

Anesthesia for bilateral pulmonary banding as part of hybrid stage I approach palliating neonates with hypoplastic left heart syndrome.

Neonatal management of patients with hypoplastic left heart syndrome and complex remains a challenging task, whereby the "hybrid" palliation is often reserved for high-risk patients as a "rescue" procedure. This study documents the anesthetic challenges and potential complications associated with the Giessen hybrid stage I approach. The Giessen hybrid stage I approach is focused on surgical bilateral pulmonary artery banding. Retrospective perioperative data were analyzed. Contrary to a stable group A, inotropic treatment before surgery for treatment of postnatal shock classified patients as unstable (Group B). Clinical outcomes considered were inhospital mortality, duration of postoperative mechanical ventilation, postoperative time at the intensive care unit, perioperative vasoactive medication requirements, and red blood cell transfusion. From June 1998 to December 2015, 185 patients were allocated to Group A (n=165) and Group B (n=20). The inhospital mortality was 2.2% with no difference between the groups. There was also no difference in the postoperative time on mechanical ventilation and the time in the intensive care unit. Vasoactive medication was more often required in Group B (100%) compared to Group A (19%). In Group B, more red blood cells were transfused 6.0±8.3 vs 2.0±5.8mL/kg in Group A (P<.05, 95% CI 0.0 - 2.6). Considering a learning curve, anesthesia for surgical bilateral pulmonary artery banding palliating patients with hypoplastic left heart syndrome and complex can safely be performed, independent from the preoperative clinical status.

Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly.

Background In this study, patients who underwent cesarean section and had placenta previa and placenta accreta were examined and compared in terms of haemorrhagic indicators and perioperative anesthetic management. Methods A retrospective study was conducted in a university hospital in Kahramanmaras, Turkey. It included 95 pregnant women who had placental anomaly and underwent cesarean section between December 15, 2014, and February 15, 2016. Results The pregnant women were divided into two groups: Group P (previa) (n = 67) and Group A (accreta) (n = 28). The types of anesthesia administered were general anesthesia (GA), which was administered to 50 patients (74.6%) in Group P and 27 patients (96.4%) in Group A, and spinal anesthesia (SA), which was administered to 17 patients (25.4%) in Group P and one patient (3.6%) in Group A.. The mean blood loss was 685.82 ± 262.82 in Group P and 1582.14 ± 790.71 in Group A, and the given amount of crystalloid was higher in Group A with an average of 1628.57 ± 728.19 ml. The use of erythrocyte and fresh frozen plasma solution was higher in Group A than Group P. Eleven patients were intubated and taken to the Intensive Care Unit (ICU) in Group A. Postoperative mechanical ventilation duration was significantly higher in Group A (75.14 ± 43.84 h) (p < 0.001). ICU stay was longer in Group A with 2.80 ± 1.13 days. (p < 0.001). Conclusion The intraoperative management and the availability of postoperative ICU conditions are important in placental anomalies cases. The communication between operation team with regard to the development of a standard protocol for these cases will be of great benefit in reducing morbidity and mortality.

Prognostic value of central venous oxygen saturation during anesthesia for cardiac surgery.

Background:During cardiac surgery, CPB machine pumps blood instead of the heart affecting blood flow and hence blood perfusion of all tissues. One important marker of blood perfusion is central venous oxygen saturation. Relationship between central venous oxygen saturation and patient morbidity and mortality is an indicator for the reliability of blood lactate as a perfusion marker.Methods:In a prospective observational study, 66 patients admitted to Sohag university hospital and Sohag Heart Institute in the period between October 2017 and April 2019 for open cardiac surgery were enrolled. Immediately after induction of anesthesia, the first sample of venous blood gas was obtained from central venous catheter. For measuring of central venous oxygen saturation, the next samples were obtained just before CPB weaning, the next after 24 hours of staying ICU and the last sample were obtained after 48 hours of staying ICU.Results:Central venous oxygen saturation in correlation to ICU length of stay showed significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative duration of mechanical ventilation showed significant change in central venous oxygen saturation in patients with favorable outcome. Central venous oxygen saturation in correlation to postoperative complications showed significant change in central venous oxygen saturation in patients with favorable outcome.Conclusion: Measuring ScvO2 at 4 points during and after open-heart surgery showed their prognostic value, regarding results for ScvO2: ICU length of stay, duration of mechanical ventilation and complications.

Heart transplantation in 47 children: single-center experience from China

BackgroundTo perform a retrospective analysis of 47 cases of pediatric heart transplantation in a single Chinese center.MethodsThe study included 47 cases of heart transplantation under 18 years old, completed between Sep 1st, 2008 and Dec 31st, 2018. We carried out statistical analysis of the clinical features of the donors and recipients, perioperative information, postoperative complications and short- and mid-term survival.ResultsThe study included 24 males and 23 females. The average age on transplantation was 10.34±4.80 years (minimum 3 months, median 11.00 years). Preoperative diagnosis included 36 cases of cardiomyopathy, 9 cases of complex congenital heart disease (CHD), and 2 cases of cardiac tumor. Four patients received cardiac surgery before. The donors’ average age was 20.89±11.84 years, including 19 donors under 18 years old and 28 donors over 18 years old. The mean donor/recipient body weight ratio was 1.58±0.58. The mean duration of intraoperative cardiopulmonary bypass (CPB) was 119.00±53.47 minutes, in which the mean CPB-assist time was 79.71±48.21 minutes. The average duration of postoperative mechanical ventilation was 32.00 (18.50–54.00) hours, and the average intensive care unit (ICU) stay was 7.00 (4.94–11.28) days. Postoperative complications occurred in 20 cases (42.55%). The 1-year, 3-year, and 5-year survival rate after operation was 95.74%, 93.01%, and 93.01% respectively.ConclusionsHeart transplantation is an effective means for end-stage heart disease in children. The clinical outcome of pediatric heart transplantation in our center is satisfactory, with low incidence of postoperative complications and high short- and mid-term survival rates.

Impact of perioperative course during cardiac surgery on outcomes in patients 80 years and older

ObjectiveTo describe the associations among preoperative characteristics, intraoperative and postoperative factors, and mortality and morbidity after open-heart surgery in patients age ≥80 years. MethodsThis retrospective multicenter register study was based on prospectively collected data of all patients age ≥80 years undergoing open-heart surgery in western Denmark between 1999 and 2016. Logistic regression was used to estimate the associations among preoperative characteristics, intraoperative and postoperative factors, and morbidity and mortality. Bonferroni correction was used for multiple comparisons. ResultsThe study population included 2342 patients age ≥80 years undergoing open-heart surgery. We observed an association between severely impaired preoperative renal function and death within 1-year postsurgery (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.7-7.2). Furthermore, renal clearance <40 mL/min and prolonged cardiopulmonary bypass time of >180 minutes were associated with a >50% probability of death within 1 year. The adjusted OR for death within 1 year was increased significantly with a postoperative length of stay in intensive care of ≥3 days (OR, 5.9; 95% CI, 4.1-8.6) and a duration of postoperative mechanical ventilation ≥2 days (OR, 7.5; 95% CI, 4.1-13.9). Various preoperative and intraoperative characteristics were associated with in-hospital dialysis, in particular cardiopulmonary bypass time >180 minutes (OR, 11.6; 95% CI, 4.7-28.5). ConclusionsOur findings emphasize the importance of careful referral regarding the procedural burden for very elderly patients and may provide support for informed patient discussions about prognosis and recovery.

MHCA with SACP versus DHCA in Pediatric Aortic Arch Surgery: A Comparative Study

The safety and efficacy of selective antegrade cerebral perfusion (SACP) in children undergoing aortic arch surgery are unclear. In this retrospective analysis, we compared moderate hypothermic circulatory arrest (MHCA; n = 61) plus SACP vs deep hypothermic circulatory arrest (DHCA; n = 53) in children undergoing aortic arch surgery during a period from January 2008 to December 2017. Demographic characteristics and the underlying anomalies were comparable between the two groups. The MHCA + SACP group had shorter cardiopulmonary bypass (CPB) time (146.9 ± 40.6 vs 189.6 ± 41.2 min for DHCA; p < 0.05) and higher nasopharyngeal temperature (26.0 ± 2.1 vs 18.9 ± 1.6 °C; p < 0.01). The MHCA + SACP group had lower rate of neurologic complications (3/61 vs 10/53 for DHCA; p < 0.05) but not complications in other organ systems. The MHCA + SACP group also had less 24-hour chest drainage (median, interquartile rage: 28.9, 12.6–150.0 vs 47.4, 15.2–145.0 ml/kg for DHCA; p < 0.05), shorter duration of postoperative mechanical ventilation (35.0, 15.4–80.3 vs 94.0, 42.0–144.0 h; p < 0.01), and shorter stay in intensive care unit (3.9, 3.0–7.0 vs 7.7, 5.0–15.0 d; p < 0.05). In regression analysis, in-hospital mortality was associated with longer CPB time. In conclusion, MHCA + SACP is associated with better short-term outcomes in children receiving aortic arch surgery under CPB.

High preoperative pulmonary artery systolic pressure is associated with acute kidney injury and prognosis in patients underwent cardiopulmonary bypass surgery

To observe the relationship between pulmonary artery systolic pressure (PASP) and acute renal injury (AKI) and prognosis after cardiopulmonary bypass (CPB) heart surgery. The clinical data of 9 860 patients who underwent CPB heart surgery in Beijing Anzhen Hospital from January 1st, 2015 to December 31st, 2016 were analyzed retrospectively. The patients were divided into two groups according to whether AKI occurred after operation. The clinical data were obtained from hospital information system (HIS) and DoCare including general information, types of operation, preoperative complication, ejection fraction, serum creatinine (SCr), PASP, intraoperative CPB duration, aortic occlusion duration, fluid balance, blood products and drug usage, postoperative mechanical ventilation duration, length of intensive care unit (ICU) and hospital stay, and perioperative central venous pressure (CVP). Multivariate Logistic regression analysis was used to screen the risk factors of AKI after operation. According to the preoperative PASP level, the patients were divided into ≥ 60 mmHg (1 mmHg = 0.133 kPa) group and < 60 mmHg group, and the incidence of AKI and prognosis after operation were compared between the two groups. All patients were followed up by telephone after discharge, and they were divided into survival group and death group according to the follow-up results, and the clinical data were compared between the two groups. Multivariate Cox regression analysis was used to screen the risk factors of long-term prognosis. Kaplan-Meier survival curve was used to analyze the long-term prognosis of two groups with different preoperative PASP levels. 6 285 patients were enrolled in the final analysis. (1) Among the 6 285 patients, 2 592 patients (41.2%) suffered from AKI after operation, of whom 1 697 (65.5%) were stage 1 according to Kidney Disease: Improving Global Outcomes (KDIGO), which was the main type of AKI. Univariate analysis showed that age, preoperative ejection fraction, SCr, PASP, coronary heart disease, hypertension, diabetes, intraoperative CPB duration, aortic occlusion duration, fluid balance, red blood cell input and norepinephrine, dopamine, epinephrine dosage, postoperative mechanical ventilation duration, the length of ICU and hospital stay, and perioperative CVP might be the risk factors of AKI after operation. Multivariate Logistic regression analysis showed that preoperative PASP was one of independent risk factors for AKI in patients undergoing CPB heart surgery [odds ratio (OR) = 4.753, 95% confidence interval (95%CI) was 1.328-8.417, P = 0.004]. The incidence of AKI after operation in PASP ≥ 60 mmHg group was significantly higher than that in < 60 mmHg group [73.8% (712/965) vs. 35.3% (1 880/5 320), P < 0.01]. (2) After a follow-up of (11±3) months, 237 patients (3.8%) died in 6 285 patients. The mortality of patients in PASP ≥ 60 mmHg group was significantly higher than that in < 60 mmHg group [9.5% (92/965) vs. 2.7% (145/5 320), P < 0.01]. Kaplan-Meier survival curve analysis showed that there was a significant difference between the two groups in cumulative survival rate (Log-Rank test: χ2 = 144.400, P < 0.001). Univariate analysis showed that male, age, preoperative hypertension, ejection fraction, PASP, intraoperative CPB duration, aortic occlusion duration, fluid balance, epinephrine dosage, postoperative mechanical ventilation duration, the length of ICU and hospital stay, and perioperative CVP might be risk factors for long-term death of patients undergoing CPB heart surgery. Multivariate Cox regression analysis showed that for every 1 mmHg increase in preoperative PASP, the long-term mortality increased by 1.126 times [hazard ratio (HR) = 1.126, 95%CI was 1.003-1.604, P = 0.021]. The increase of PASP is related to AKI after CPB heart surgery, which is an independent risk factor for long-term mortality.

A Sufentanil-Based Rapid Cardiac Anesthesia Regimen in Children Undergoing Percutaneous Minimally-Invasive Intraoperative Device Closure of Ventricular Septal Defect.

ObjectiveTo assess the effectiveness and safety of fast-track cardiac anesthesia using the short-acting opioid sufentanil in children undergoing intraoperative device closure of ventricular septal defect (VSD).MethodsThis retrospective clinical study included 65 children who underwent intraoperative device closure of VSD between January 2017 and June 2017. Patients were diagnosed with isolated perimembranous VSD by transthoracic echocardiography. Then, they were divided into two groups, group F (n=30), whose patients were given sufentanil-based fast-track cardiac anesthesia, and group C (n=35), whose patients were given conventional cardiac anesthesia. Perioperative clinical data were analyzed.ResultsNo significant differences were found between the preoperative clinical parameters and intraoperative hemodynamic indices between the two groups. In group C, compared with group F, the postoperative duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospital stay, and the hospital costs were significantly increased.ConclusionIn this retrospective study at a single center, sufentanil-based fast-track cardiac anesthesia was shown to be a safe and effective technique for minimally-invasive intraoperative device closure of VSD in children, which was performed with reduced in-hospital costs.

Effectiveness of Pre-operative Respiratory Muscle Training versus Conventional Treatment for Improving Post operative Pulmonary Health after Coronary Artery Bypass Grafting.

Objective:To evaluate the Effectiveness of Pre-operative Respiratory Muscle Training versus Conventional Treatment for Improving post-operative pulmonary health after Coronary Artery Bypass Graft Surgery (CABG).Methods:A Prospective Randomized clinical trial was performed on sixty patients who underwent elective CABG at Faisalabad Institute of Cardiology. At the time of admission all patients were subjected to 6-minutes’ walk test (6MWT) as baseline. The subjects were then divided into two groups. The Group-I was subjected to respiratory muscle training whereas the Group-2 received the routine preoperative care. The 6-minute walk test (6MWT) was then repeated a day before surgery (pre-operative) and before discharge (post-operatively). Duration of post-operative mechanical ventilation, oxygen therapy and hospital stay were also noted as outcome measures of this study.Results:The pre-operative and post-operative readings showed that the patients in the interventional group performed better than the control group in their 6MWT with P-value of less than 0.05. Similarly the interventional group had shorter duration of mechanical ventilation, dependence on oxygen therapy and postoperative hospital stay as compared with the control group showing P-values below 0.05.Conclusion:The results showed that respiratory muscle training results in improved postoperative functional capacity and reduces of hospital stay.

Experience of Minimally Invasive Surgery in Neonates with Congenital Malformations in a Tertiary Care Pediatric Hospital.

Aim:The aim of this study is to report the experience with minimally invasive surgery (MIS) in neonates with congenital malformations in a tertiary care pediatric hospital.Materials and Methods:Design: descriptive study. All neonates undergoing MIS from 2013 to 2018 were included in the study. Perinatal data, characteristics of surgery, type and duration of analgesia, postoperative mechanical ventilation duration, postoperative hospitalization, and postoperative morbidity and mortality surgery-related rates were recorded.Results:Seventy-one neonates were included. Gestational age and weight at surgery ranged from 24 to 41 weeks and from 1350 g to 4830 g, respectively. Procedures performed were esophageal atresia/tracheoesophageal fistula repair, congenital diaphragmatic hernia repair, diaphragmatic plication, fundoplication/gastrostomy, intestinal atresia repair, and pancreatectomy. The median follow-up period was 14 months. Five neonates (7%) were converted to open, for surgical difficulties. Nine (12.6%) neonates had intraoperative complications, with decreased oxygen saturation as the most common complication. The median duration of analgesia and postoperative mechanical ventilation was 3 days in most procedures. The morbidity and mortality rates were 36.6% and 2.8%, respectively.Conclusions:In this first experience with MIS in neonates, the duration of analgesia and hospitalization was shorter for some procedures. However, intraoperative and postoperative complications were still high, which was possibly attributed to the learning curve. Thus, it is expected that the frequency of the complications presented in this study will be reduced in future.

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Hanging donors are considered as marginal donors and frequently unsuitable for lung transplantation. However, there is no evidence of higher lung transplantation (LTx) morbidity-mortality with lungs providing by hanging donor. Between January 2010 and July 2015, we performed a retrospective study at Foch hospital. We aimed to assess whether hanging donor grafts are suitable for lung transplantation. A total of 299 LTx were performed. Subjects were allocated to a hanging group (HG) (n=20) and a control group (CG) (n=279). Donor and recipient characteristics did not differ. Primary graft dysfunction (PGD) at 72hours was comparable in both groups (P=.75). The median duration of postoperative mechanical ventilation (1 [range, 0-84] vs 1 [range, 0-410] day, P=.35), the hospital length of stay (31days [20-84] vs 32days [12-435], P=.36) did not differ between the two groups. No statistically significant difference was found in 1-year and 5-year survival between the HG (83% and 78%) and the CG (86% and 75%), P=.85. We believe that hanging donors should be considered as conventional donors with particular caution in the final evaluation of the graft and in perioperative management.

Adenosine as cardioprotective in off-pump coronary artery bypass grafting

ObjectiveTo assess the effect of adenosine as a cardioprotective drug and its role in attenuating ischemia-reperfusion injury during off-pump coronary artery bypass surgery.BackgroundCardioprotective drugs have long been investigated for use during off-pump coronary artery bypass surgery to attenuate ischemia-reperfusion injury and limit hemodynamic instability. Adenosine has been investigated due to its cardioprotective effect that is mediated through A1 and A3 adenosine receptors. Stimulation of these receptors reproduces the infarct-limiting effect of ischemic preconditioning.MethodsAfter approval of the local ethics committee and informed written consent, fifty patients undergoing elective off-pump coronary artery bypass grafting were prospectively studied. The adenosine group received an infusion of Adenoscan at a rate of 50 μg/kg/min for 15 min. The control group received normal saline at the same rate and volume calculated. Pulmonary artery catheter was introduced through the right internal jugular vein. Cardiac output measurements were obtained. Cardiac index, stroke volume, systemic vascular resistance, pulmonary vascular resistance, right ventricular stroke work index, and left ventricular stroke work index were derived. Hemodynamic measurements were recorded together with blood levels of troponin I and CK-MB fraction to detect perioperative myocardial necrosis. Postoperative duration of mechanical ventilation, ICU stay together with inotropic support quantification using inotropic score were recorded.ResultsFifty patients were included in the study. In the adenosine group, the infusion of adenosine resulted in a significant reduction in mean pulmonary artery pressure after stopping drug infusion (18 ± 2.2 mmHg versus 31 ± 4.1 mmHg). There was a recorded increase in cardiac index in the adenosine group that started 15 min after adenosine infusion and lasted for 12 h postoperatively (p < 0.001). Also, adenosine infusion resulted in a reduction in pulmonary vascular resistance that exceeded the reduction in systemic vascular resistance which resulted in a decrease in pulmonary vascular resistance/systemic vascular resistance ratio (0.14 in adenosine group 15 min after injection versus 0.28 in control group) and (0.11 in adenosine group 12 h postoperatively versus 0.26 in control group). The cTroponin I measured 6 h postoperatively was less in the adenosine group compared with the control group (5.8 ± 2.8 ng/ml versus 16.5 ± 3.9 ng/ml).ConclusionAdenosine infusion during off-pump coronary artery surgery may improve cardiac index, reduce the need for inotropes, and have cardioprotective effect.