Postoperative Ejection Fraction Research Articles

Perioperative Modulation of Left Ventricular Systolic Performance: A Retrospective Study on Ionized Calcium and Vitamin D in Cardiac Surgery Patients.

Background: The perioperative impact of calcium and vitamin D on left ventricular (LV) performance during major cardiac surgery remains unexplored. We aimed to assess the relation of calcium and vitamin D measured at different time points with the LV ejection fraction (EF), and to investigate whether changes in EF correlate with postoperative outcomes. Methods: We enrolled 83 patients, in whom ionized calcium was measured before, during, and after surgery (until discharge), vitamin D preoperatively, and EF pre- and postoperatively at 24 h. The postoperative outcomes were cardiopulmonary bypass (CPB) time, aortic cross-clamp time, mechanical ventilation time, vasoactive inotropic score (VIS) (intraoperative, day 0, day 1), and ICU stay time. Results: The mean age was 64.9 ± 8.5 years, with 21 of the patients (25%) having an EF < 50%. The median change from preoperative to postoperative EF was -2.0 (-10.0-0.0) % (p < 0.001). At the baseline, the EF < 50% group had significantly lower preoperative vitamin D levels than the EF ≥ 50% group (p = 0.048). The calcium trend did not differ across the groups. Preoperative EF was significantly associated with CPB time (r = 0.22, p = 0.044) and aortic cross-clamp time (r = 0.24, p = 0.031). Postoperative EF was significantly and inversely associated with intraoperative VIS (r = -0.28, p = 0.009), VIS day 0 (r = -0.25, p = 0.020), VIS day 1 (r = -0.23, p = 0.036), and ICU length of stay (r = -0.22, p = 0.047). Finally, the change in ejection fraction was significantly and inversely associated with CPB time (r = -0.23, p = 0.037), aortic cross-clamp time (r = -0.22, p = 0.044), intraoperative VIS (r = -0.42, p < 0.001), VIS day 0 (r = -0.25, p = 0.024), mechanical ventilation time (r = -0.22, p = 0.047), and ICU length of stay (r = -0.23, p = 0.039). Conclusions: The fluctuations in perioperative ionized calcium levels were not associated with the evolution of LVEF, although preoperative vitamin D levels may affect those with low EF. Correspondingly, a reduced EF significantly impacted all the studied postoperative outcomes. Further investigation into biomarkers affecting cardiac inotropic function is warranted to better understand their significance.

Echocardiographic Predictors of Readiness for Double Switch Operation and Postoperative Ejection Fraction in Patients With Congenitally Corrected Transposition of the Great Arteries Undergoing Left Ventricular Retraining

In patients with congenitally corrected transposition of the great arteries (ccTGA), assessment of readiness for the double switch operation (DSO) after pulmonary arterial band (PAB) placement involves cardiac magnetic resonance imaging (cMRI) to measure left ventricular ejection fraction (LVEF) and mass and cardiac catheterization (catheterization) to assess the ratio of left ventricular to right ventricular pressure (LV:RVp). The aims of this study were to describe the relationships between echocardiographic and catheterization and cMRI measures of readiness for DSO and to develop risk factors for left ventricular (LV) dysfunction after DSO on the basis of echocardiographic measures of ventricular-arterial coupling (VAC). Patients with ccTGA undergoing LV retraining at a DSO referral center were reviewed. LVEF measured by echocardiography was compared with that measured by cMRI, and LV:RVp measured by echocardiography was compared with that measured by catheterization using Bland-Altman analysis. The relationship between preoperative VAC markers and postoperative echocardiography was analyzed using ventricular end-systolic elastance (EES) and a novel marker consisting of the product of LVEF and LV:RVp (EFPR). Thirty-one patients with 56 evaluations for DSO were included, 24 of whom underwent DSO. Echocardiographic LVEF correlated well with cMRI LVEF (r=0.79), and Bland-Altman analysis slightly overestimated cMRI LVEF (mean difference,+3%). Echocardiographic LVEF had a moderate ability to identify normal cMRI LVEF (area under the curve, 0.80) and at an optimal cut point of echocardiographic LVEF threshold of 61%, there was 71% sensitivity and 76% specificity to detect cMRI LVEF≥55%. Echocardiographic LV:RVp correlated well with LV/RVp by catheterization (r=0.77) and slightly underestimated the catheterization value (mean difference, -0.11). Echocardiographic LV:RVp had a good ability to identify adequate LV:RVp by catheterization (area under the curve, 0.95) and at an optimal echocardiography cut point of 0.75 had 100% sensitivity and 85% specificity to detect a catheterization LV:RVp >0.9. Echocardiography-based criteria for DSO readiness (echocardiographic LVEF of 61% and LV:RVp of 0.75) demonstrated specificity of 97% and positive predictive value of 96% for published criteria of DSO readiness (cMRI LVEF of 55% and catheterization LV:RVp of 0.9). EES and EFPR correlated with post-DSO LVEF (ρ=0.72 and ρ=0.60, respectively). EFPR of 0.51 demonstrated 78% sensitivity and 100% specificity for post-DSO LV dysfunction (LVEF<55%). Age at first PAB also strongly correlated with post-DSO LVEF (ρ=0.75). No patient with first PAB at <1year of age exhibited post-DSO LV dysfunction. Echocardiographic measures of LVEF and LV:RVp are reliable indicators of reference standard modalities and can guide management during retraining. The preoperative VAC markers EES and EFPR may be useful markers of post-DSO LV dysfunction. Values of echocardiographic LV:RVp >0.75 are likely to meet pressure-generation criteria for DSO and should be considered for referral to catheterization and cMRI evaluation for DSO. PAB placement before 1year of life may optimize LV outcomes in patients considered for DSO.

Preoperative Echocardiographically Derived Mean dP/dTic Predicts Early Post-operative Dysfunction in Children Undergoing Mitral Valve Surgery.

Mean dP/dtic is a quantitative measurement of ventricular function that can be obtained noninvasively by echocardiography. In adults with mitral regurgitation (MR), it has been shown to be a more sensitive predictor of postoperative left ventricular ejection fraction (EF). The utility of dP/dtic in pediatric congenital heart diseases with MR has been underexplored. Patients (0 to ≤ 19years) with MR who underwent mitral valve (MV) repair or replacement from 2015 to 2021 were included. Echocardiographically derived mean dP/dtic, Tei index, and EF were used to assess and compare ventricular function prior to, shortly after, and late after MV surgery. Study cohort included 61 patients (age 4.5 [IQR 0.14, 18.7] years, 89% MV repair, 11% MV replacement). Median time intervals between surgery and preoperative, early postoperative, and late postoperative echocardiograms were 6days, 6days, and 350days, respectively. Median EF was 62% (z-score -0.40) preoperatively, 56% (z-score -1.40) early postoperatively, and 61% (z-score -0.60) late postoperatively. Median dP/dtic was 1393 (IQR 1029, 1775) mmHg/s preoperatively, 1178 (IQR 886, 1946) mmHg/s early postoperatively, and 1270 (IQR 791, 1765) mmHg/s late postoperatively. Preoperative median dP/dtic correlated with early and late postoperative EF. Preoperative EF was not significantly correlated with early postoperative EF, but was correlated with late postoperative EF. Mitral valve intervention in pediatric patients is associated with an initial decline but subsequent recovery of systolic function. Non-invasively derived mean dP/dtic may offer advantages over other preoperative echocardiographic indices to predict postoperative systolic function.

Left Ventricular Reconstruction after Dor-Sailing Close to the Wind?

Postinfarction left ventricular aneurysm (LVA) still remains a complication after myocardial infarction with a poor prognosis. Its incidence has decreased due to improved treatment, however, it may have experienced a renaissance due to the coronavirus disease 2019 pandemic. In this retrospective, single-center cohort study, we analyzed n = 17 patients who underwent left ventricular reconstruction after Dor. The results show a mean intensive care unit stay of 8 ± 16 days and a 30-day mortality rate of 6%. Mean postoperative ejection fraction was 44 ± 8% indicating an increase in all but three cases. This suggests that patients with an LVA can be successfully treated, and it is safe when performed by experienced surgeons. Therefore, they should still be considered for surgery early on.

Del Nido vs. Cold Blood Cardioplegia for High-Risk Isolated Coronary Artery Bypass Grafting in Patients with Reduced Ventricular Function.

The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient. The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed. Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051). The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.

Rates and Predictors of Structural Valve Degeneration and Failure of Trifecta Bioprosthetic Valve Over a 5-year Follow-up Period: A Single-center Experience.

The Trifecta bioprosthetic valve has been commonly used for surgical aortic valve replacement (SAVR). Multiple studies have been done to define the rate of structural valve degeneration (SVD) and failure (SVF), but the outcomes are still debatable. Therefore, we aim to conduct this single-center study to estimate the rate and predictors of SVD/SVF. This retrospective observational cohort single-center study was conducted between 2014 and 2019 among Trifecta SAVR patients. Data were patient's characteristics collected from electronic medical records at baseline and follow-up (3-5 years). Statistical analysis was performed with a significance level of P ≤ 0.05. A total of 271 eligible patients were identified. Most of our sample were males (57.9%), with a mean age of 71.1 ± 10.6 years. The mean baseline preoperative ejection fraction (EF) was 53.0%, with no change (P = 0.88) in the immediate postoperative EF (53.6%). A most recent follow-up EF revealed a significant increase of EF (55.2%), P = 0.01. Furthermore, there was a significant increase from peak velocity to PVMRE (mean difference [MD] ± standard error of mean (SEM) [0.15 ± 0.04], P < 0.01), an increase in pressure gradient (PGIPE) to PGMRE (MD ± SEM [1.70 ± 0.49], P < 0.01), and a decrease in Doppler velocity index (DVIIPE) to DVIMRE (MD ± SEM [-0.037 ± 0.01], P = 0.01). Regarding the SVF rate, 13 (4.8%) patients had failed valves requiring replacement throughout the study period. Over a 5-year follow-up period, 4.8% had SVF with an SVD of 23.2%, with the majority of SVD not being clinically significant except in six patients. These results corroborate with a previously published study suggesting a bad clinical outcome of Trifecta valve placement.

Comparison of platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems

Aim: The aim of this study was to compare platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems. Material and Methods: Our study is a retrospective study and a total of 116 patient data were obtained. Patients were divided into two groups as conventional extracorporeal and mini extracorporeal system bypass patients. Equal numbers of patients (n=58) were included in both groups. The data of patients who underwent coronary bypass surgery with conventional and mini extracorporeal systems between January 2022 and December 2022 were included in the study. Results: In our study, no significant difference was found between patients bypassed with conventional and mini extracorporeal system in terms of pump time and cross-clamp time. Although the duration of intensive care unit stay and total hospitalization were found to be shorter in patients bypassed with the mini-extracorporeal (MECC) system than those bypassed with the conventional method, the difference between the groups was not significant. As a result of our study, it was observed that postoperative ejection fraction (EF) values significantly increased and hematocrite (HTC), hemoglobin (Hb), platelet (PLT) and procalcitonin (PCT) values significantly decreased in both groups of patients who underwent bypass with conventional and MECC system, and no significant difference was found between pre- and postoperative mean platelet volume (MPV) and platelet distribution width (PDW) values. As a result of our study, postoperative PLT and PCT values in the MECC group were found to be significantly higher than those in patients who underwent bypass with the conventional method. Conclusion: Considering the results obtained in our study, it is seen that the values in patients bypassed with the MECC system are more favorable than those bypassed with the standard method, but more studies on the subject are needed.

N-terminal pro-B type natriuretic peptide as a predictor for myocardial preservation in cases of isolated severe Aortic stenosis

Background Myocardial hypertrophy is a common pathologic finding in the natural history of severe aortic stenosis. A hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis. Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. However, fewer studies have been carried out on patients affected by left ventricular (LV) hypertrophy, where the choice of type, and temperature of cardioplegia remains controversial. Aim The study investigates preoperative N-terminal pro-B type natriuretic peptide (NT pro-BNP), its relation to Troponin I levels, and whether it can predict a preferred cardioplegic solution by comparing the short-term outcomes of the two commonly used blood and Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegic solutions in patients undergoing aortic valve replacement for severe aortic stenosis. Patients and methods A total of 72 patients will be randomly allocated into two groups; group (A=36) received HTK solution, and group (B=36) received blood cardioplegia. All anesthesia protocols are unified among all patients. All surgical procedures were conducted on a cardioplegic arrested heart via standard median sternotomy, utilizing full Cardiopulmonary bypass (CPB) via aorto-atrial cannulation and LV venting through a left atrial catheter under moderate hypothermia (28–32°C) by topical cooling. Results There was no statistically significant difference found between group A and group B regarding post-operative ejection fraction (EF) and newly developed postoperative Regional wall motion abnormalities (RWMA). There was no statistically significant difference found between group A and group B regarding the percentage of patients with atrial fibrillation, ventilation hours, and exploration while there was a statistically significant increase in troponin, I level in group B than group A. There was a statistically significant negative correlation between NT pro-BNP preoperative and aortic valve area (AVA) and also with ejection fraction preoperative while there was a statistically significant positive correlation found between NT pro-BNP and troponin I preoperative and postoperative. Conclusion HTK solution and Blood cardioplegia both offer sufficient protection for the myocardium. NT pro-BNP serves as a sensitive indicator for predicting the results and effectiveness of different cardioplegia types

Cardiac magnetic resonance imaging for myocardial viability assessment: Optimizing surgical revascularization in ischemic heart disease.

Patients with poor ejection fraction undergoing coronary artery bypass grafting carry higher operative risk and have poor long-term survival. Cardiac magnetic resonance is a useful modality to assess viability which can identify patients likely to benefit most from revascularization. In this study, we aimed to assess the outcome in patients selected for surgical revascularization by cardiac magnetic resonance imaging and identify predictors associated with poor outcomes. The study included patients with severely impaired left ventricular function but with at least six viable segments. Patients requiring emergency surgery, undergoing combined procedures, or where cardiopulmonary bypass was required were excluded. Cardiac magnetic resonance was carried out both preoperatively and at six months postoperatively by the same radiologist in all cases. Late gadolinium enhancement was used for the evaluation of myocardial viability. Amongst a total of 493 segments studied, there were 89 (18.1%) non-viable, 117 (23.7%) hibernating and 287 (58.2%) viable segments. At six months, the number of non-viable segments changed from 89 (18.1%) to 97 (19.7%), with an increase in viable segments from 287 (58.2%) to 374 (75.8%) and a corresponding reduction of hibernating segments from 117 (23.7%) to 22 (4.5%). There was improvement in ejection fraction from 28 ± 5.54 to 37 ± 5.86 (p < 0.0001) in the entire cohort at six months. Overall mortality was 1 (3.2%). Preoperative left ventricular end-systolic volume had the strongest negative correlation with post-operative ejection fraction. Cardiac magnetic resonance aided revascularization is associated with low mortality. Preoperative left ventricular end-systolic volume is an important determinant of postoperative ejection fraction.

Evaluation of left ventricular function after coronary artery bypass graft surgery in patients with type 2 diabetes

Objectives: Study factors affecting the change of left ventricular function after CABG in patients with type 2 diabetes at Ha Noi heart hospital from 8/2021 to 8 /2022. Subjects and methods: a cross-sectionnal observational study in 46 patients with type 2 diabetes and coronary artery bypass graft surgery from 8/2021 to 8/2022 at Hanoi Heart Hospital. Results: Mean age 66±8.73; the male/female ratio is 2.83/1; 43.5% of patients smoked; 65.2% had dyslipidemia; non STEMI accounted for 41%. 100% of patients had anterior interventricular artery damage and elective surgery accounted for 80.4% of patients. Echocardiographic results: The rate of regional movement disorders before and 6 months after surgery is 56.5% and 30%; the number of disturbance areas before and after surgery were 3.52±5.39 and 1.84±4.18, EF 6 months before and after surgery was 55,33 ± 11,49% and 59,13,98 ± 10,05%, respectively. 39%. The percentage of patients with EF improved after 6 months of surgery accounted for 52%, patients with unchanged EF accounted for 28%, 20% of patients with EF decreased after 6 months of surgery, on univariate analysis: Preoperative ejection fraction, regional movement disorder and preoperative left ventricular diastolic dysfunction are factors associated with the change of left ventricular function after surgery. On multivariate analysis: Preoperative ejection fraction was an independent predictor of improvement in postoperative ejection fraction. Conclusion: Preoperative ejection fraction, regional movement disorder and preoperative left ventricular diastolic dysfunction are factors related to the change of left ventricular function after surgery, among which preoperative ejection fraction was an independent predictor of postoperative improvement in ejection fraction.

Re-Dosing del Nido cardioplegia in adult cardiac surgery: Perfusion characteristics and outcomes--Is there an optimal redosing strategy?

del Nido cardioplegia is utilized for myocardial protection in adult patients undergoing cardiac surgery; however, no standardized re-dosing protocol exists. We describe perfusion characteristics and clinical outcomes in adult cardiac surgery patients who were re-dosed with del Nido cardioplegia. Chart review was performed for adult patients undergoing cardiac surgery (specific inclusion/exclusion criteria below) who received exactly two doses of del Nido cardioplegia from 2012 to 2019; n = 542 patients. The main outcome was a composite endpoint comprised of operative mortality, myocardial infarction, post-operative cardiac support device (CSD), and postoperative decrease in ejection fraction (EF), which was analyzed via multivariable logistic regression (MVLR). A secondary analysis evaluated postoperative vasoactive-inotropic scores (VIS) via gamma log link regression (GLLR) as a more physiologic indication of myocardial recovery. MVLR demonstrated that increased total cardiopulmonary bypass (CPB) time was associated with a positive composite outcome (p < .001), whereas time between doses (p = .237) and the volume of each dose was not (p = .626). GLLR also demonstrated that prolonged CBP, decreased EF, congestive heart failure at time of surgery, and low hematocrit at the start of the surgery were all associated with higher VIS. In this retrospective study, variations in re-dosing strategy for del Nido cardioplegia do not affect postoperative outcomes and increased CPB time is associated with increased operative mortality, myocardial infarction, need for post-operative CSDs, and reduced postoperative EF, and increased VIS, irrespective of the re-dosing strategy. Further studies are warranted to to identify additional patient and operative characteristics that predispose to complications.

Iron Deficiency Might Impair the Recovery of Left Ventricular Function after Surgical Revascularization in Diabetic Patients: A Retrospective Study.

Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting public health. Studies show that ID affects the prognosis of patients with heart disease, including heart failure, coronary artery disease and myocardial infarction. However, there is limited information regarding the impact of ID on patients undergoing cardiac surgery. This study aimed to evaluate the influence of preoperative ID on the prognosis of type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG). In the Glycemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDEME) study, patients with T2DM undergoing CABG were prospectively recruited. In this study, only those patients with preoperative iron metabolism results were enrolled. Patients were grouped based on the presence of preoperative ID. The primary endpoint was defined as the significant improvement of follow-up ejection fraction (EF) compared to postoperative levels (classified according to the 75th percentile of the change, and defined as an improvement of greater than or equal to 5%). Univariable logistic regression was performed to explore the potential confounders, followed by multiple adjustment. A total of 302 patients were enrolled. No deaths were observed during the study period. A higher incidence of the primary endpoint was observed in the ID group (25.4% vs 12.9%, p = 0.015). The postoperative and follow-up EF were similar beween the two groups. In the regression analysis, ID was noticed to be a strong predictor against the significant improvement of EF in both univariable (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22-0.86, p = 0.017) and multivariable (OR: 0.43, 95% CI: 0.24-0.98, p = 0.043) logistic regression. In the subgroup analysis, ID was a predictor of significant improvement of EF in age 60 years, male, EF 60%, and on-pump CABG patients. In T2DM patients undergoing CABG, ID might negatively affect the early recovery of left ventricular systolic function in terms of recovery of EF 3-6 months after surgery, especially in patients age 60 years, males, EF 60% and in those undergoing on-pump CABG.

Is del Nido cardioplegia safe in isolated coronary bypass surgery? It may be possible with this method

Objectives: This study aimed to share the early results of the del Nido (DN) solution used with a different method in patients who underwent isolated coronary bypass. Patients and methods: The retrospective study included 150 patients (123 males, 27 females; mean age: 59.8±9.7 years; range, 38 to 84 years) who underwent isolated coronary bypass operation between January 2020 and May 2022. The DN solution was applied differently from the practice in the literature. Seventy-five percent of the dose calculated according to the body weight of the patients was administered at the first moment. The remaining amount was continued to be given through the saphenous veins as distal anastomoses were made. When the cross-clamp was lifted, all grafts were tied to the aorta cannula, and the coronary vascular bed was cleared. Follow-up of patients was done routinely. Results: The mean preoperative ejection fraction was 49.9±5.6, and the mean postoperative ejection fraction value was 50.3±5.0 (p=0.079). A statistically significant difference was found between the preoperative troponin level and the postoperative troponin level at 6 h (p&lt;0.001). However, there was no significant difference between the postoperative 6 h and the postoperative 24 h. Spontaneous rhythm occurred at the termination of cardiopulmonary bypass in most of the patients (97%). No permanent pacing was required in any patient. An intra-aortic balloon pump was used in nine patients, and extracorporeal membrane oxygenation was used in two patients. Two patients died in the early period. Conclusion: The use of DN with this method seems to be a reliable alternative to eliminate hesitations in isolated coronary bypass surgery.

Left internal mammary on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased left anterior descending artery

Background: Several operative techniques were described to reconstruct the diffusely diseased left anterior descending coronary artery (LAD). The superiority of the left internal mammary artery (LIMA) vs. the saphenous vein patch is controversial in LAD reconstruction. Thus, this study compared LIMA on-lay patch vs. saphenous vein patch in reconstructing diffusely diseased LAD artery.&#x0D; Methods: This study was conducted between June 2020 and May 2022 including 60 patients with a diffusely diseased LAD. LIMA patch was used in 30 patients (Group I) and saphenous vein patch in 30 patients (Group II) without endarterectomy. Males presented 85%; the mean age was 56.68 ± 6.44 years. The mean patch length in the LIMA group was 4.48±0.87 cm and 4.60± 0.93 cm in the saphenous vein group.&#x0D; Results: The mean aortic cross-clamp and cardiopulmonary bypass times were 66.80± 19.93 and 108.00± 25.74 minutes in the LIMA group and 84.40± 30.65 and 132.53± 45.41 minutes in the venous Group (P= 0.011 and 0.013, respectively). The mean intensive care unit stay was 50.40 ± 38.65 hours in Group I and 92.00± 51.62 hours in Group II (P˂ 0.001). Four patients (13.3%) needed an intra-aortic balloon pump (IABP) in Group I, and 11 patients (36.7%) in Group II (P= 0.037). Postoperative low cardiac output occurred in 13.3% of Group I and 53.3% in Group II (P= 0.001). Postoperative atrial fibrillation occurred in 13.3% of Group I, while in Group II was 33.3% (P= 0.067). The renal complications were 3.3% in Group I and 16.7% in Group II (P= 0.085). Two patients (6.7%) were complicated with bleeding in Group I, and nine (30.0%) in Group II (P= 0.02). The postoperative ejection fraction was 58.17± 5.25% in Group I and 53.3± 5.23% in Group II (P= 0.001). On the first postoperative day, the creatine kinase-myoglobin binding level was 61.73± 30.19 IU/L in Group I and 92.63± 45.88 IU/L in Group II (P= 0.004). Hospital mortality occurred in one patient (3.3%) in Group I and two in Group II (6.7%) (P˃ 0.99).&#x0D; Conclusion: LAD reconstruction using the LIMA patch could have better early outcomes than the saphenous vein patch.

Challenging a dogma: left ventriculotomy can be used safely in children.

We aimed to discuss our unit's experience performing left ventriculotomies on children. Between 2000 and 2022, we identified paediatric patients who required left ventriculotomy. Relevant information was gathered retrospectively. There were eight patients who underwent surgical procedure including left ventriculotomy. The range of weight and age was between 4.5 and 50 kg and 5 months to 17 years, respectively. Left ventriculotomy was primarily performed for the excision of cardiac masses in all but one who had pseudoaneurysm repair. There were no deaths that occurred early or late. Pre-operative and post-operative ejection fractions and fractional shortening values were comparable. There was no arrhythmia detected post-operatively. We conclude that an apical left ventriculotomy does not compromise the function of the left ventricle, even in young infants. In selected patients, it may be used safely for surgical access to the left ventricle.

Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal rupture? A monocenter retrospective study.

Ventricular septal rupture (VSR) is an uncommon but life-threatening complication of acute myocardial infarction. Extra corporeal life support (ECLS) use in the preoperative setting allows hemodynamic stabilization for a delayed surgery. We aimed to assess the role of ECLS in the preoperative period of post infarction VSR surgery. We retrospectively analyzed all consecutive patients operated for VSR between January 2007 and August 2019. We assessed baseline characteristics, pre and post-operative clinical status and the use of ECLS in the peri-operative period. A total of 39 patients were included. Mean age was 69.8 years. In-hospital mortality was 48.7%. Survivors and non-survivor patients had similar characteristics except for lower postoperative ejection fraction (32% vs. 42%, P=0.02) and more acute renal failure (71.4% vs. 10%, P=0.0005) in the non-survivor group. Patients who received ECLS preoperatively were younger (72 vs. 65, P=0.02) and had more preoperative invasive ventilation (16% vs. 50%, P=0.04). Cardiopulmonary bypass (CPB, 140 min vs. 75 min, P=0.0008) and cross clamping times (94 min vs. 52 min, P=0.0026) were significantly higher in the ECLS group. There were more bleeding complications in the ECMO group (45.4% vs. 0%, P=0.0019) and more need for reintervention (63.3% vs. 13%, P=0.015). There was no difference in mortality between the two groups. There was no difference in postoperative characteristics between urgent and delayed surgery. In our study, post-operative ECLS use was associated with more bleeding complications and need for reintervention. Although mortality was similar, bleeding complications remain a major limitation for the systematic use of ECLS in the post-operative period.

Abstract 13346: Long Term, Synergistic Benefit of Transmyocardial Laser Revascularization and Platelet Rich Plasma - Significant Improvement of Global Longitudinal Strain in Coronary Artery Bypass Graft Patients

Introduction: Transmyocardial revascularization (TMR) is a procedure designed to treat patients with end-stage coronary artery disease (CAD). TMR creates myocardial micropores which undergo endothelialization and redistribute ischemic stress, thereby improving regional wall motion. Autologous platelet rich plasma (PRP) growth factors contribute to endothelialization and neovascularization. In this study, we evaluate the effectiveness of TMR combined with PRP to improve cardiac function in patients undergoing CABG using echocardiograms. Methods: A single-center, single surgeon retrospective analysis of CABG patients was performed (2019-2021). Patients in the TMR group had ten channels (7 Watts/channel) created in the infero-lateral wall of the left ventricle (LV) and those in the PRP group had autologous PRP extract injected(1ml, without calcium) in the same area. In patients treated with both TMR and PRP, ten channels were made in the inferolateral LV with PRP extract injected in the peri-TMR zone, 5mm adjacent to the channels. Post-operative ejection fraction (EF) and global longitudinal strain (GLS) were measured using speckle tracking up to one year. Results: Fifty-two patients (71% men, mean age 66y ±9.04y) were enrolled in the study and randomized to four experimental groups: CABG only (n=16); CABG/TMR (n=17); CABG/PRP (n=10); and CABG/TMR/PRP (n=9). At one-year follow-up, patients treated with both TMR and PRP had a significant improvement in average GLS (-15.96, p= 0.02) compared to TMR alone (-13.78, p= 0.26) and PRP alone (-15.79, p= 0.08). Patients treated with TMR and PRP also had a significant rise in post-operative EF (57.78%, SD +/- 6.18) compared to TMR alone (55.0%, SD +/- 6.85) and PRP alone (49.5%, SD +/- 11.65). Conclusions: TMR with PRP extract treatment at the time of CABG confers a significant one year improvement in cardiac function as measured by LVEF and GLS. These outcome metrics highlight cardiac remodeling and can mitigate the incidence of heart failure readmissions. With further prospective trials and longer follow-up periods, concomitant adjunctive TMR with PRP extract therapy at time of CABG may have durable and significant cardiac scar remodeling benefits leading to heart recovery in CABG patients.

Impact of Levosimendan on High Sensitivity Cardiac Troponin-T after Valvular Heart Surgery: A Randomized Clinical Trial

Background: Various measures have been used for maintaining adequate cardiac output after valvular heart surgery. The study aimed to evaluate the impact of levosimendan on high-sensitivity cardiac troponin-T after valvular heart surgery.&#x0D; Methods: This prospective randomized clinical trial included 400 patients. All patients above 18 years who underwent elective cardiac valvular surgery were randomly classified into two equal groups. Group A (n= 200) included patients who received levosimendan during weaning from cardiopulmonary bypass, and Group B (n= 200) included patients who did not receive levosimendan.&#x0D; Results: Cardiopulmonary bypass, cross-clamp, reperfusion times, and use of inotropes were insignificant between groups. Troponin levels on days 0, 1, and 2 showed a significant decrease in Group A (P˂0.001). Postoperative ejection fraction was significantly higher in Group A (66.10 ± 4.41 vs. 46.60 ± 3.98; P˂0.001). Duration of mechanical ventilation (4.70± 1.16 vs. 10.70± 0.82; P˂ 0.001), intensive care (1.90 ± 0.57 vs. 5.90 ± 1.29; P˂0.001), and hospital stay (6.90 ± 1.91 vs. 13.40 ± 3.10; P˂0.001) were significantly lower in Group A.&#x0D; Conclusions: Levosimendan could have cardioprotective effects, resulting in a significant reduction of postoperative high sensitivity cardiac troponin-T release after valvular heart surgery. It could be associated with improved left ventricular ejection fraction, short duration of mechanical ventilation, ICU, and hospital stay.

Impact of the degree of tricuspid valve tethering on the early outcome of tricuspid valve repair with the De-Vega technique

Background: Functional tricuspid regurgitation (TR) is usually caused by leaflet tethering, and annuloplasty is usually recommended to repair annulus dilatation. This work aimed to evaluate the impact of the degree of the tricuspid valve (TV) tethering on the early outcome of tricuspid valve repair with the De-Vega technique.&#x0D; Methods: This prospective study included 50 patients with De-Vega tricuspid valve repair. Patients were divided into two groups; Group A (n= 25) included patients with tricuspid valve tethering of 8 mm or less, and Group B (n= 25) included patients with tricuspid valve tethering distance of more than 8 mm.&#x0D; Results: The mean age of Group A was 46.1 ±3.5 years compared to 49.6 ±7 years in Group B. There were significant differences in postoperative ejection fraction (48.7 ±12.5 vs. 39.1 ±9.4 %, P= 0.003), TV tethering distance (0.6 ±0.2 vs. 1.1 ±0.4 cm, P &lt;0.001), and area (1.1 ±0.5 vs. 2.6 ±0.9 cm2; P&lt;0.001), and right ventricle fractional area (32.2± 7.9 vs. 25.4 ±9.7 cm2, P= 0.008) in Group A vs. B, respectively. There were no differences in postoperative complications, ICU, and hospital stay between groups.&#x0D; Conclusion: Residual tricuspid regurgitation after De-Vega annuloplasty could be related to TV tethering distance. Increased TV tethering distance could be associated with reduced postoperative ejection fraction.

Complete Revascularization Showed A Better Cardiac Function Improvement In Patients With Low Ejection Fraction.

This study aimed to compare postoperative ejection fraction (EF) in response to coronary artery bypass grafting (CABG) among patients with preoperative EF <35% and >35%. A retrospective study was conducted in a single institution using clinical data of 660 patients undergoing elective on-pump CABG in 2018-2019. Patients were classified into two groups based on preoperative left ventricle ejection fraction (<35% and >35%). The primary endpoint was the change of postoperative ejection fraction. In this study, 72 patients had preoperative left ventricle ejection fraction <35% (group A) while the other 588 patients had ejection fraction >35% (group B). Among both groups, the duration of cardiopulmonary bypass (CPB) and aortic clamp (AxC) were not significantly different (P > 0.05). The transformation of pre- and postoperative EF in groups A and B was significantly different (2.91+10.31 vs. -0.14+4.57, P < 0.001). There was a significant difference in the duration of ICU stay (73.42+112.55 vs. 34.43+64.99, P < 0.001) and postoperative ventilatory support (25.54+43.92 vs. 16.42+45.87, P < 0.008) between group A and B. Low preoperative EF showed better improvement in cardiac function after surgery. We concluded that the result could be affected by revascularization of hibernating myocardium.