Preoperative Ejection Fraction Research Articles

Impact of left ventricular ejection fraction on hospital and long term outcomes after coronary artery bypass graft surgery

Abstract Background Coronary artery bypass surgery is recommended for patients with extensive coronary artery disease and severely impaired left ventricular ejection fraction (LVEF). Short term clinical outcomes improved due to advanced surgical techniques and perioperative management. Objective To study the impact of pre-operative left ventricular ejection fraction (LV EF) on clinical outcomes during postoperative hospitalization and for 5 years follow up. Methods The study was a retrospective analysis of patients underwent CABG at our tertiary care hospital between January 2016 and August 2020.The primary outcome was mortality and the secondary outcomes included acute cerebrovascular stroke, length of hospitalization, subsequent revascularization, and heart failure. Results The study included 410 patients with a median age of 60 (55–68) years, a hospital mortality of 2.7%, postoperative stroke of 7.6%, acute kidney injury (AKI) of 25.6% and new need dialysis of 5.9%. The patients were divided into 4 groups: 75 (18.3%) patients had LV EF less than 35%, 88 (21.5%) had LV EF 35–45%, 106 (25.9%) had LV EF 45–55% and 141 (34.4%) had LV EF more than 55% with significant differences in frequencies of chronic kidney disease (29.3% vs. 40.9% vs. 23.6% vs. 24.1%, p=0.026), prior cerebral stroke (9.3% vs. 11.4% vs. 8.5% vs. 1.4%, p=0.015), Peripheral vascular disease (8% vs. 18.2% vs. 4.7% vs. 12.1%, p=0.019) respectively. The hospital mortality occurred in (6.7% vs. 0% vs. 0.9% vs. 3.5%, p=0.03), acute cerebrovascular stroke occurred in (14.7% vs. 6.8% vs. 3.8% vs. 7.1%, p=0.031), AKI occurred in (36% vs. 43.2% vs. 17.9% vs. 14.9%, p<0.001), new dialysis was used in (12% vs. 5.7% vs. 1.9% vs. 5.7%, p=0.04), ICU stay was [5 (3–7) vs. 4 (3–11) vs. 4 (3–5) vs. 3 (2–5), p<0.001], post ICU stay was [6 (3–10) vs. 5 (4–8) vs. 4 (3–6) vs. 4 (3–6), p=0.009] in patients with LV EF <35%, LV EF 35–45%, LV EF 45–55% and LV EF >55% respectively. Mortality during follow up occurred in (20% vs. 4.5% vs. 2.8% vs.4.3%, p<0.001), stroke occurred in (8% vs. 4.5% vs.0.9 5% vs. 2.8%, p=0.031), revascularization was done in (2.7% vs. 23.9% vs. 18.9% vs. 12.8%, p=0.009) and readmission with heart failure occurred in (52% vs. 34.1% vs. 10.4% vs. 4.3%, p<0.001) in patients with LV EF <35%, LV EF 35–45%, LV EF 45–55% and LV EF >55% respectively. Conclusion Reduced LV EF was associated with increased hospital mortality, frequent morbidities, and prolonged hospitalization after CABG with higher composite rate of death, stroke, heart failure at 5 years compared with normal or mildly reduced LV EF. Funding Acknowledgement Type of funding sources: None.

Surgical treatment of coronary artery lesions in children with Kawasaki disease.

This study aimed to explore the efficacy of different surgical treatment for coronary artery lesions (CALs) caused by Kawasaki disease (KD) in children. We retrospectively analyzed the records of children with KD who presented with CALs to our hospital between 2015 and 2022. The patients were aged 126 ± 44.3 months (range: 84-180 months), and their body weight was 37.1 ± 18.6 kg (range: 17-60 kg). All patients were diagnosed with KD and were treated with standard medications. The patients had CALs for an average of 78 months (range: 24-156 months). All children underwent surgical treatment. In addition, one patient underwent cardiac defibrillator implantation, two underwent coronary artery bypass grafting (CABG), and one underwent heart bypass transplantation. The internal thoracic artery was used as the source of the left anterior descending branch bridge tube. The no-touch technique was used to obtain the free right thigh great saphenous vein as the bridge tube of the right coronary artery. All four patients had good postoperative recovery and the cardiac ultrasonography showed improved cardiac function and smooth coronary artery blood flow. The preoperative left ventricular ejection fraction was 44 ± 23.4%, which was significantly improved to 61.4 ± 14.0% postoperatively (p > .05). The preoperative left ventricle size was 5.6 ± 1.6 cm, which was significantly improved to 4.0 ± 0.6 cm postoperatively (p > .05). The two patients who underwent CABG received oral aspirin (5 mg/kg) and clopidogrel (1 mg/kg) antiplatelet therapy. The patients received oral tacrolimus antirejection drugs after the heart transplantation. The postoperative cardiac function was above grade II, and there were no symptoms of cardiac insufficiency, such as syncope, chest tightness, and orthopnea. Patients with CALs due to KD should be treated in a timely manner. The selection of an appropriate surgical treatment leads to prolonged survival and improved quality of life of patients.

Association of Obesity with Increased Rate of Postoperative Superficial Sternal Wound Infection after Coronary Artery Bypass Grafting Surgery

Objective: The objective of this study was to find association of obesity with postoperative superficial sternal wound infection after CABG. Study Design: This was a prospective comparative study. Place and Duration: This study was conducted at the Cardiac surgery Department, PIC, Jail Road, Lahore from 1st July 2020 to 31st Dec 2020. Methodology: Non probability / purposive sampling technique was used. A total of 140 patients (70 in each group) following inclusion criteria were enrolled in this study. Quantitative and qualitative variables were filled to the predesigned performa. A detailed social and demographic profile (age, gender, height, weight, BMI). Clinical history, i.e. (Diabetes Mellitus, Smoking, Hypertension) and clinical trials were assessed, i.e. preoperative EF (percent) was calculated. Using SPSS Version 24.0.0, statistical analysis was carried out. Qualitative variables such as gender, risk factors such as DM, HTN, smoking, and superficial sternal infection were represented as percentages, whereas quantitative variables such as age, height and weight were described as mean ± standard deviation. Chi-square test was used to determine the association of obesity with infection of sternal wound. P value≤0.05 was considered as significant. Results: The mean age of cases in this study in obese and non-obese group was 47.80 ± 9.79 years and 51.23 ± 9.36 years. There were 70(50%) obese patients and 70(50%) non-obese patients in our study. There were 59(84.29%) cases in obese group and 15 (21.43%) case in non-obese group who had developed post-operative infection, p-value was <0.001 which was highly significant showing strong association between postoperative infection and obesity. Conclusion: Sternal wound infection was a significant outcome in our research. We found strong association of obesity with post-operative sternal wound infection. Keywords: CABG, Diabetes, Obesity, Post-operative infection

Smaller left ventricular end-systolic diameter and lower ejection fraction at baseline associated with greater ejection fraction improvement after revascularization among patients with left ventricular dysfunction.

ObjectivesTo investigate the predictive roles of pre-operative left ventricular (LV) size and ejection fraction (EF) in EF improvement and outcome following revascularization in patients with coronary artery disease (CAD) and LV dysfunction.BackgroundRevascularization may improve EF and long-term outcomes of patients with LV dysfunction. However, the determinants of EF improvement have not yet been investigated comprehensively.Materials and methodsPatients with EF measurements before and 3 months after revascularization were enrolled in a cohort study (No. ChiCTR2100044378). All patients had baseline EF ≤ 40%. EF improvement was defined as absolute increase in EF > 5%. According to LV end-systolic diameter (LVESD) (severely enlarged or not) and EF (≤35% or of 36–40%) at baseline, patients were categorized into four groups.ResultsA total of 939 patients were identified. A total of 549 (58.5%) had EF improved. Both LVESD [odds ratio (OR) per 1 mm decrease, 1.05; 95% CI, 1.04–1.07; P < 0.001] and EF (OR per 1% decrease, 1.06; 95% CI, 1.03–1.10; P < 0.001) at baseline were predictive of EF improvement after revascularization. Patients with LVESD not severely enlarged and EF ≤ 35% had higher odds of being in the EF improved group in comparison with other three groups both in unadjusted and adjusted analysis (all P < 0.001). The median follow-up time was 3.5 years. Patients with LVESD not severely enlarged and EF ≤ 35% had significantly lower risk of all-cause death in comparison with patients with LVESD severely enlarged and EF ≤ 35% [hazard ratio (HR), 2.73; 95% CI, 1.28–5.82; P = 0.009], and tended to have lower risk in comparison with patients with LVESD severely enlarged and EF of 36–40% (HR, 2.00; 95% CI, 0.93–4.27; P = 0.074).ConclusionAmong CAD patients with reduced EF (≤ 40%) who underwent revascularization, smaller pre-operative LVESD and lower EF had greatest potential to have EF improvement and better outcome. Our findings imply the indication for revascularization in patients with LV dysfunction who presented with lower EF but smaller LV size.

Predictors and associated clinical outcomes of low cardiac output syndrome following cardiac surgery: insights from the LEVO-CTS trial.

High-risk cardiac surgery is commonly complicated by low cardiac output syndrome (LCOS), which is associated with high mortality. There are limited data derived from multi-centre studies with adjudicated endpoints describing factors associated with LCOS and its downstream clinical outcomes. The Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial evaluated prophylactic levosimendan vs. placebo in patients with a reduced ejection fraction undergoing coronary artery bypass grafting (CABG) and/or valve surgery. We conducted a pre-specified analysis on LCOS, which was characterized by a four-part definition. We constructed a multivariable logistical regression model to evaluate risk factors associated with LCOS and performed Cox proportional hazards modelling to determine the association of LCOS with 90-day mortality. A total of 186 (22%) of 849 patients in the LEVO-CTS trial developed LCOS. The factors most associated with a higher adjusted risk of LCOS were pre-operative ejection fraction [odds ratio (OR) 1.26; 95% confidence interval (CI): 1.08-1.46 per 5% decrease] and age (OR 1.13; 95% CI: 1.04-1.24 per 5-year increase), whereas isolated CABG surgery (OR 0.44, 95% CI: 0.31-0.64) and levosimendan use (OR 0.65; 95% CI: 0.46-0.92) were associated with a lower risk of LCOS. Patients with LCOS had worse outcomes, including renal replacement therapy at 30-day (10 vs. 1%) and 90-day mortality (16 vs. 3%, adjusted hazard ratio of 5.04, 95% CI: 2.66-9.55). Low cardiac output syndrome is associated with a high risk of post-operative mortality in high-risk cardiac surgery.

Rosendaal linear interpolation method appraising of time in therapeutic range in patients with 12-week follow-up interval after mechanical heart valve replacement.

BackgroundThe objective of this study was to evaluate the quality of anticoagulation by the time in therapeutic range (TTR) for patients with 12-week INR follow-up interval.Materials and methodsFrom January 2018 to December 2020, a selective group of patients who underwent mechanical valve replacement and followed up at our anticoagulation clinic for adjustment of warfarin dose were enrolled. The incidences of complications of anticoagulation therapy were reported by linearized rates. TTR was calculated by the Rosendaal linear interpolation method.ResultsTwo hundred and seventy-four patients were eligible for this study. The mean age of these patients was 52.8 ± 12.7 years, and 65.7% (180 cases) of them were females. The mean duration of warfarin therapy was 16.7 ± 28.1 months. A total of 1309 INR values were collected, representing 66789 patient days. In this study, the mean TTR was 63.7% ± 18.6%, weekly doses of warfarin were 20.6 ± 6.0 mg/weekly, and the mean monitoring interval for the patient was 53.6 ± 27.1 days. There were 153 cases in good TTR group (TTR ≥ 60%) and 121 cases in poor TTR group (TTR < 60%). The calculated mean TTR in both groups was 42.6% ± 22.1% and 74.8% ± 10.4%, respectively. Compared with the TTR ≥ 60% group, the TTR < 60% group exhibited a more prevalence of female gender (p = 0.001), atrial fibrillation (p < 0.001), NYHA ≥ III (p < 0.001), and lower preoperative left ventricular ejection fraction (LVEF, p = 0.032). In multivariate analysis, female gender (p = 0.023) and atrial fibrillation (p = 0.011) were associated with TTR < 60%. The incidence of major bleeding and thromboembolic events was 2.7% and 1.1% patient-years, respectively. There was one death which resulted from cerebral hemorrhage. The incidence of death was 0.5% patient-years. The difference in anticoagulation-related complications between the TTR < 60% group and the TTR ≥ 60% group was not statistically significant.ConclusionFor patients with stable international normalized ratio monitoring results who are follow-up at anticoagulation clinics, a 12-week monitoring interval has an acceptable quality of anticoagulation. The female gender and atrial fibrillation were associated with TTR < 60%.

Prediction of stroke reconvalescence after coronary bypass surgery indicated by CT scan parameters.

Stroke in the postoperative time course after heart surgery remains a serious risk. Cranial computer tomography (CCT) is the first line option to detect severe intracranial damage. However, only few data are available to predict neurological outcome. Using visual rating scales (VRSs), this study addresses reliability and effectivity to indicate neurological status and likelyhood of improvement. In a single-center retrospective evaluation, 3719 patients underwent coronary bypass surgery. Because of a delayed recovery phase and neurologic deficits after cardiac surgery 109 patients had a cranial CT scan in the early postoperative period. The incidence of clinically relevant findings within the imaging was rated by an experienced neuroradiologist using two VRS,that is, the age-related white matter changes (ARWMCs) and the Mendes-Ribeiro visual rating scale (MRVRS). Both are computer-assisted measurement schemes to detect stroke-related intracranial damage. Follow-up was investigated with regard to clinical outcome and patient-related risk profiles. Of 109 patients with postoperative cranial CT scans due to prolonged recovery phases or proven neurological damage 44.5% had one cerebral defect in CCT imaging scans only. The others showed multiple defects. During hospital stay,92.3% experienced neurological improvement exposing reduced ARWMC, while 7.1% had no improvement and correlating high scores. Of both scales, the ARWMC-VRS demonstrated superior accuracy and discrimination. The preoperative ejection fraction (EF), arteriosclerotic degeneration of carotid arteries, and reduced glomerular filtration ratewere found to have a high correlation (r = 0.0005) with the latter group. In-hospital mortality of this cohort was 8.18%. Both the ARWMC and MRVRS were found to be appropriate. They reliably discriminate the groups of stroke patients after coronary artery bypass grafting (CABG) in the analysis of CCT images. When applied at the onset of neurological symptoms both scales are able to predict neurological reconvalescence upon hospital dismission. The ARWMC scale appeared superior as it demonstrated better accuracy and discrimination. The use of both VRS in patients with suspected stroke after CABG surgery can give insightful information toward a progression of neurological dysfunction or postoperative improvement.

A nomogram for reduced cardiac function in postoperative acute type A aortic dissection patients with acute kidney injury undergoing continuous renal replacement therapy.

BackgroundThis study aimed to develop a nomogram to predict reduced cardiac function for acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) after acute type A aortic dissection (ATAAD) surgery.MethodsThis study was a retrospective analysis. ATAAD patients with preoperative normal ejection fraction (EF) and postoperative AKI with CRRT admitted between January 2014 and November 2021 were included. The reduced cardiac function was defined as EF <50%. The data were analyzed by the univariate and multivariate logistic regression analyses. A diagnostic model was established by a nomogram, and its discriminative performance was validated by the received operating characteristic (ROC) curve and concordance (C) statistic. The calibration of the diagnostic model was tested by calibration curves and the HosmerLemeshow test. The clinical utility was evaluated by the decision curve analysis (DCA).ResultIn total, 208 patients were eligible for analysis, of which 98 patients with reduced cardiac function. The logistic regression analyses showed age ≥60 years old, history of coronary atherosclerotic disease, preoperative pericardial tamponade, and cardiopulmonary bypass time were risk factors for reduced cardiac function, which were further employed in the nomogram. As results, nomogram revealed a high predictive power (C statistic = 0.723, 0.654–0.792; the bootstrap-corrected concordance C statistic = 0.711, the area under the ROC curve = 0.723). The calibration curves showed good consistency between the predicted and the actual probabilities (calibration curve: Brier points = 0.208, Emax = 0.103, Eavg = 0.021; Hosmer-Lemeshow test, P = 0.476). DCA showed that the nomogram could augment net benefits and exhibited a wide range of threshold probabilities in the prediction of EF reduction.ConclusionThis nomogram is an effective diagnostic model for predicting the reduced cardiac function in postoperative ATAAD patients with AKI undergoing CRRT and can be used to protect postoperative renal functions and facilitate patient-specific care after ATAAD surgery.

Predictive Value of Heart Rate Variability Indexes for 2-year Prognosis of the Patients after Transcatheter Aortic Valve Replacement.

To explore the prognostic value of the heart rate variability (HRV) index in the patients undergoing transcatheter aortic valve replacement (TAVR). A cohort study. Department of Cardiology, Subei people's Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China, from April 2018 to April 2021. Patients with severe symptomatic aortic stenosis (AS), who were treated with TAVR, were enrolled. All the patients had completed a 24-hour ambulatory electrocardiogram (AECG), and detected HRV within one week before TAVR. All-time domain and frequency domain indexes were analysed. According to the standard deviation of NN intervals (SDNN), the patients were divided into the high HRV group (H-HRV), and the low HRV group (L-HRV). Postoperative cardiac function and major adverse cardiovascular events (MACEs) were observed on follow-up for 24 months. Compared with the H-HRV group, the L-HRV group had a lower preoperative left ventricular ejection fraction (LVEF) [49.0 (42.5, 60.0) vs. 59.5 (51.0, 62.3), p = 0.028] and higher preoperative cardiac troponin I (cTnI) [0.03(0.02, 0.10) vs. 0.02 (0.02, 0.02), p = 0.007]. The incidence of MACEs after TAVR in the L-HRV group was significantly higher than that in the H-HRV group (45.5% vs. 13.6%, p = 0.021). The results of the Kaplan-Meier survival curve also showed that the prognosis of the L-HRV group was worse than that of the H-HRV group (Log Rank = 4.975, p = 0.026). After adjusting for preoperative standard deviation of the average NN intervals (SDANN) or preoperative low-frequency (LF) domain / high-frequency (HF) domain (LF/HF), preoperative HRV still was an independent risk factor for MACEs in AS patients undergoing TAVR [HR 3.718, 95% CI (1.020, 13.548), p = 0.047]. The receiver operating characteristic (ROC) curve suggested that HRV <61.0ms may be a predictor of MACEs in AS patients undergoing TAVR. The sensitivity and specificity were 83.9% and 76.9%, respectively. Preoperative HRV had a good short-term predictive value in AS patients undergoing TAVR. Heart rate variability, Aortic stenosis, Transcatheter aortic valve replacement, Ambulatory electrocardiogram.

Clinical Presentation of Pleural Effusion Among Patients after CABG and its Prevalence

Objective: Pleural effusion often occurs after CABG. Usually, this effusion is slight and asymptomatic. There is also high symptomatic effusion, but in a small percentage of patients. Pleural effusion after CABG may be associated with significant morbidity and prolonged hospital stay. Early diagnosis and treatment can reduce morbidity of patients and extent of hospital stay. Aim: The aim of the study is to determine the risk factors and the severity of pleural effusion in patients after CABG. Place and Duration: In the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera for six-months duration from July 2020 to December 2020. Material and methods: The study was held among 120 patients after meeting the inclusion criteria and selected for the study. Patients were included in study population before referral for CABG from QHAMC to multicenters of Khyber Pakhtunkhwa. Their records were closely followed during admissions for CABG and post CABG and also assessed on various follow up visits. The study procedure was described to the patient and informed consent was obtained. Demographics, name, age, gender, surgery details, comorbidities such as COPD, EF and smoking were recorded on the attached form. The patients stayed in the intensive cardiac surgery unit for at least 7 days. The presence and severity of pleural effusion was assessed on the CXR. A chest x-ray was done on daily basis and evaluated by a chest specialist in the morning round. The amount of effusion in CXR was classified as follows: low effusion covering less than half of the chest, high effusion covering more than half of the chest. Possible risk factors for the development of pleural effusion in post-CABG patients have been reported. Results: The majority 99(82.5%) of the 120 subjects who had pleural effusion done with CABG were male. The patients mean age was 55.28 ± 10.47 years. Most patients 93(77.5%) had left pleurotomy. LIMA harvesting was reported in 98(81.7%) of patients. Most patients 100(83.3%) had left sided pleural effusions and 5(4.2%) had right sided and bilateral pleural effusions in 15(12.5%) of cases. A total of 102 patients (85%) had low (less than half of the chest) pleural effusion and large symptomatic pleural effusion in 18(18%) (more than half of the chest). 104 patients (86.7%) required pleural aspiration. Most of the patients 110(91.7%) had decreased serum albumin. Of the patients requiring effusion aspiration, 46 (38.3%) had dyspnea, 18 (15.0%) cough, 34 (28.3%) ABGs abnormalities, and 8 (7.7%) had atelectasis. Preoperative EF was normal in 80 (66.7%) patients, but poor EF was present in 50 (33.3%) patients on the 7th postoperative day. Conclusion: A slight left-sided effusion developed in the majority of patients after CABG. There was also large size of pleural effusion, but occurs in small extent. The effusion mainly causes some respiratory symptoms that require pleural aspiration. LIMA harvesting, pleurotomy and hypoalbuminemia were the main risk factors for pleural effusion in patients after CABG. Keywords: CABG = coronary artery bypass grafting, LIMA = Left internal mammary artery, CXR = chest X-ray, ICU = intensive care unit, COPD = chronic obstructive pulmonary disease and EF = ejection fraction.

Preoperative NT-proBNP and LVEF for the prediction of acute kidney injury after noncardiac surgery: a single-centre retrospective study

BackgroundAcute kidney injury (AKI) is one of the most common postoperative complications in noncardiac surgical patients, has an important impact on prognosis and is difficult to predict. Whether preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and left ventricular ejection fraction (LVEF) levels can predict postoperative AKI in noncardiac surgical patients is unclear.MethodsWe included 3,314 patients who underwent noncardiac surgery and had measurements of preoperative NT-proBNP concentrations and LVEF levels at a tertiary academic hospital in China between 2008 and 2018. Multiple logistic regression analysis was used to construct a postoperative AKI risk prediction model for this cohort. Then, NT-proBNP concentrations and LVEF levels were included in the abovementioned model as independent variables, and the predictive ability of these two models was compared.ResultsPostoperative AKI occurred in 223 (6.72%) patients within 1 week after surgery. Preoperative NT-proBNP concentrations and LVEF levels were independent predictors of AKI after adjustment for clinical variables. The area under the receiver operating characteristic curve (AUROC) of the AKI risk predictive model established with clinical baseline variables was 0.767 (95% CI: 0.732, 0.802). When NT-proBNP concentrations and LVEF levels were added to the base model, the AUROC was 0.811 (95% CI: 0.779, 0.843). The addition of NT-proBNP concentrations and LVEF levels improved reclassification by 22.9% (95% CI 10.5–34.4%) for patients who developed postoperative AKI and by 36.3% (95% CI 29.5–43.9%) for those who did not, resulting in a significant overall improvement in net reclassification (NRI: 0.591, 95% CI 0.437–0.752, P < 0.000). The integral discrimination improvement was 0.100 (95% CI: 0.075, 0.125, P < 0.000).The final postoperative AKI prediction model was constructed, and had a good discriminative ability and fitted to the dataset.ConclusionsPreoperative NT-proBNP concentrations and LVEF levels were independently associated with the risk of AKI after noncardiac surgery, and they could improve the predictive ability of logistic regression models based on conventional clinical risk factors.Trial registrationThe protocol was preregistered in the Chinese Clinical Trial Registry (ChiCTR1900024056).

Long-term Outcomes of Coronary Artery Bypass Surgery According to the Presence or Absence of Left Main Coronary Artery Disease

Background: Coronary artery bypass grafting (CABG) has modified the natural evolution of patients with left main coronary artery (LMCA) disease. There is little information in our setting regarding the mid- and long-term follow-up of operated patients. Objective: The aim of this study was to evaluate the implication of LMCA disease in the long-term evolution of patients operated on with CABG, and to assess the mortality and incidence of myocardial infarction (AMI) and/or stroke. Results: Follow-up was completed in 438 patients (95.6%) with a median of 58 months [interquartile range (IQR) 35-88 months]. Actuarial survival at 10 years was 91.8% for the entire population, with no significant differences between the LMCA group (91.57%) vs. the non-LMCA group (91.86%), HR 1,008 95% CI 0.38-2.65, p=0.98. In multivariate analysis, preoperative left ventricular ejection fraction (HR = 0.95; 95% CI 0.93-0.97; p &lt; 0.001), age (HR 1.1, 95% CI 1.04-1.13, p&lt;0.001) and non-elective priority of surgery (HR=3.71; 95% CI 1.3-10.35; p=0.01) were independent predictors of long-term mortality. AMI-free survival was 96.8% (LMCA 94% vs. non-LMCA 97.4%, p=0.8) and freedom from stroke was 98% (LMCA 97.8% vs. non-LMCA 98.1 %, p=0.8). Conclusion: In patients undergoing CABG, the presence of LMCA disease did not increase the rate of hard events (death, AMI, and stroke) at the long-term follow-up. The results obtained in this series of patients are similar to those published in the international literature used to develop myocardial revascularization guidelines

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.

Early surgery: a favorable prognosticator in amiodarone-induced thyrotoxicosis-a single-center experience with 53 cases.

Fewer than 100 cases of amiodarone-induced thyrotoxicosis (AIT) managed surgically have been reported worldwide. This study aims to assess the outcome of thyroidectomy under general anesthesia in a relatively large case series. A retrospective analysis of the clinical records of 53 patients who underwent thyroidectomy for AIT between 1995 and 2019 was conducted. There were 48 (90%) males and 5 females with an average age of 63.7years. Type 1 and 2 AIT were present in 35 (66%) and 18 (34%) of patients, respectively. The mean preoperative ejection fraction (EF) was 45 ± 13%. Salvage surgery was performed in 6 (11%) patients due to decompensating heart failure and/or malignant arrhythmias. 35 (66%) patients underwent urgent surgery due to a predicted late response to medical therapy and/or the need to discontinue it. Elective surgery was performed in the remainder. A considerable improvement in mean EF occurred 12months post-surgery (44% vs. 49%; p < 0.001). The overall survival rate following thyroidectomy was 96% at 12months, and 83% at 5years. No survival differences were observed based on systolic function. Cardiac-specific mortality was 11%, and these patients demonstrated a considerably shorter survival post-surgery compared to those who died of a non-cardiac cause (27 ± 18 vs. 77.5 ± 54months; p < 0.05). Total thyroidectomy can be safely performed under general anesthesia despite severe cardiac disease. It considerably improves cardiac function and confers a survival advantage. Therefore, it should be considered early in the treatment plan of select cases.

The long-term impact of acute renal failure after aortic arch replacement for acute type A aortic dissection.

To determine the long-term impact of developing acute renal failure (ARF) on survival after open aortic arch reconstruction for acute type A aortic dissection (ATAAD). This was an observational study of consecutive aortic surgeries from 2007 to 2021. Patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by the presence or absence of postoperative ARF (by RIFLE criteria). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed. A total of 601 patients undergoing open surgery for ATAAD were identified, of which 516 (85.9%) did not develop postoperative ARF, while 85 (14.1%) developed ARF, with a median follow-up time of 4.6 years (1.6, 7.9). Baseline characteristics were similar across each group, except for higher rates of branch vessel malperfusion and lower preoperative ejection fraction in the ARF group. Patients with ARF underwent more total arch replacement and elephant trunk procedures, with longer cardiopulmonary bypass and circulatory arrest times than patients without ARF. ARF was associated with worse short-term outcomes, including increased in-hospital mortality, prolonged mechanical ventilation, higher rates of sepsis, more blood transfusions, and longer length of hospital stay. Unadjusted Kaplan-Meier survival estimates were significantly lower in the ARF group, compared to the group without ARF (p < .001, log-rank test). After multivariable adjustment, the development of postoperative ARF was significantly associated with an increased hazard of death over the study's follow-up time-period (hazard ratio: 2.74, 95% confidence interval: 1.95, 3.86, p < .001). ARF is a highly morbid postoperative event that may adversely impact long-term survival after aortic surgery.

The impact of initiating quality of care improvement protocols on intensive care unit length of stay in patients undergoing coronary artery bypass grafting: An insight from a nascent program

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prolonged intensive care unit (ICU) length of stay (LOS) post coronary artery bypass grafting (CABG) constitutes a major challenge for both patients and cardiac surgery teams. While Identifying predictors of prolonged patients’ stay in the ICU can further optimise ICU resource utilization, the role of initiating QOC improvement protocols aimed to reduce ICU LOS for these patients has been widely advocated. Therefore, we aim in our study to evaluate the overtime impact of initiating QOC improvement protocols on ICU LOS and present patient characteristics predicting prolonged ICU stay in patients undergoing CABG in a nascent program. Methods We included consecutive patients (n=976) undergoing CABG at a newly established tertiary centre between June 2015 and September 2021. Data on baseline characteristics and presentation, in addition to intraoperative details and outcomes, were collected retrospectively. Patients with prolonged (≥48h) and short (&amp;lt;48h) ICU LOS were compared by appropriate testing methods. Predictors of prolonged ICU LOS were determined by multivariable logistic regression. Continuous development of ongoing protocols to improve QOC was taken, including but not limited to; enhancing diabetic control, coronary perfusion and renal function. Trends in prolonged ICU LOS were determined using Joinpoint Software of the National Cancer Institute to calculate the average annual percentage change (AAPC). Results QOC improvement protocols initiation was associated with a 33.7% reduction in the proportion of patients having prolonged ICU LOS post- CABG between 2015 to 2021 ( AAPC: -5.3 , 95%CI [-7.7, -2.9], p&amp;lt;0.001) . Overall, 56.4% (551/976) of patients had prolonged ICU LOS. In comparison to individuals with short ICU LOS, patients who overstayed in the ICU were significantly older, females, diabetic, with higher burden of peripheral vascular disease (Table). On presentation, the prolonged LOS group was featured by worse NYHA class, higher rates of acute myocardial infarction (MI), lower ejection fraction (EF), higher serum creatinine and more frequently required preoperative intra-aortic balloon pump (IABP) insertion (Table). Aortic cross-clamp time and type of surgery were comparable between groups. Unfavorable outcomes were noticed in the prolonged ICU LOS group regarding postoperative adverse events and mortality. On multivariable logistic regression, age, female gender, NYHA class ≥II, MI on presentation, preoperative creatinine level, preoperative EF and preoperative IABP placement were independent predictors for prolonged ICU LOS (Figure). Conclusion In this study, initiation of QOC improvement protocols was associated with a significant reduction in prolonged ICU LOS. While multiple risk factors prolonging ICU LOS were identified, future studies are required to further incorporate these risk factors into ongoing protocols aimed to optimise resources utilisation and enhance the QOC in CABG patients.

Outcome of concomitant left atrial ablation during valvular heart surgery: an African perspective.

The aim of this study was to determine the success rates of left atrial radiofrequency cardiac ablation for atrial fibrillation during heart valve surgery. This was a three-year retrospective study of 53 patients who had valve surgery and cardio-ablation. Immediate and long-term overall outcomes were analysed at three, six, nine, 12 and 24 months. The results were tested for significance by comparing to a chance outcome (50:50 probability) using the Z-test for the normal approximation of the binomial distribution. A total of 56.9% of patients converted immediately to sinus rhythm, with that number increasing over time. Pre-operative poor ejection fraction was the only predictor of low success rates following ablation. Long-term rhythm was determined by the patient's rhythm between three and six months. Concomitant left atrial ablation during valve surgery is effective in treating atrial fibrillation. Routine use of anti-arrhythmic medication after surgical ablation is not recommended.

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review.

This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end-stage renal disease, preoperative left ventricular ejection fraction<35%. Cardiopulmonary bypass(CPB) time, preoperative/operative intra-aortic balloon pump(IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross-clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH<7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid-binding protein(IFABP) levels were found to be strongly associated with bowel ischemia. This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.

Outcome of patients undergoing isolated tricuspid repair or replacement surgery.

The interest in isolated tricuspid valve disease has rapidly increased recently. However, clinical trials and registry data are rare in the surgical literature. This study aimed to describe the early and long-term outcomes of a real-world experience in isolated tricuspid procedures comparing repair and replacement strategies. The Surgical-Tricuspid study is a multicentre retrospective study that enrolled adult patients who had undergone isolated tricuspid valve surgery at 13 international sites. Propensity score-matched analysis was used to compare repair versus replacement. A cohort of 426 patients was enrolled [mean age: 55 (16) years; 56% female]. After matching, 175 comparable pairs were analysed. Preoperative left ventricular ejection fraction was 55(9) vs 56(9) (P = 0.8) while moderate-severe tricuspid regurgitation was present in 95% of cases. The 30-day mortality rate was 4.0% vs 8.0% in the repair and replacement groups, respectively (P = 0.115). The rates of re-exploration for bleeding (6.9% vs 13.1% P = 0.050), permanent pacemaker implantation (5.1% vs 12.0%; P = 0.022) and blood transfusion (46% vs 62%; P = 0.002) were higher in the replacement group. Cumulative survival rates at 3, 5 and 7 years in the repair group were 84 (3)%, 75 (4)% and 56 (9)% vs 71 (4)%, 66 (5)% and 58 (5)% in the replacement group (P = 0.001) while cumulative incidence for reoperation at 10 years did not differ between groups [repair 10 (1)% vs replacement 9 (1)%; P = 0.469]. The data from the Surgical-Tricuspid study reported a high risk for patients undergoing tricuspid surgery. Isolated valve repair offered reduced early and late mortality with no difference regarding reoperation rate when compared with replacement.

Predictors of survival in paediatric mitral valve surgery: the impact of age at operation at late follow-up.

The aim of this study was to elucidate predictors of death and reintervention after mitral valve (MV) surgery in children. A single-centre retrospective study was performed enrolling 142 patients younger than 18 years who underwent primary index surgical mitral repair or replacement at Bambino Gesù Children's Hospital in Rome from July 1982 to April 2020. Patients with complete, transitional or partial atrioventricular septal defect and patients with single ventricle physiology were excluded. Patients were stratified according to the age group: group 1 (<1 year old), group 2 (1-5 years old) and group 3 (>5 years old). The composite primary outcome was freedom from death or transplant. The secondary outcome was freedom from redo MV surgery. Transplant-free survival was 89% at 5 years and 88% at 10 years. Stratified by age, group 1 had poorer outcome in comparison with other groups (log-rank test P = 0.105). Both univariate and multivariate analyses showed that age <1 year was a significant risk factor for death or transplant (P = 0.044). Age <1 year was associated with increased risk of reoperation (aHR = 3.38, P = 0.009), while the presence of genetic syndrome (aHR = 0.22) and preoperative EF% (aHR = 0.97) were protective factors for reoperation. The overall survival and freedom from reoperation in children undergoing MV surgery still need improvements. Younger age was a significant risk factor for death and reintervention both after repair and replacement of the MV. In particular, infants and neonates have a three-fold risk for death compared to children.