Preoperative Ejection Fraction Research Articles

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.

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery.

Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients. A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment. The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions. This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions.

The effect of surgical aortic valve replacement on the quality of life of patients with aortic valve stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The increasing efficacy of transcatheter aortic valve implantation (TAVI) justifies a renewed assessment of quality of life (QOL) after surgical aortic valve replacement (SAVR). Purpose The aim of this study was to evaluate long-term QOL in elderly patients undergoing isolated SAVR. Methodology 60 patients with severe aortic stenosis (AS) enrolled in our study (mean age 70.25±8.76, n=21 women). Clinical and QOL data collected pre surgery and at 1 year. For the assessment of QOL we used the instruments SF-36 (36-Item Short Form Health Survey Questionnaire), Euro-QOL 5 Dimensions (EQ-5D) and the visual analogue scale (VAS). Bivariate and multiple logistic regression analyses were performed. Results QoL is significantly improved 1 year after SAVR according to the three assessment tools. The physical health score (PCS) was 58±10% preoperatively and 80±10% (p<.001) after 1 year. Similarly, mental health score (MCS) improved (55±6% vs 77±9%, p<.001). Multivariate analysis showed that patients with a biological or Perceval valve and a preoperative EF <50% had greater improvement in PCS 1 year after SAVR than patients who received a mechanical valve or had a preoperative EF >50%. Conclusions The perceived QOL of patients with AS improved significantly 1 year after SAVR. The results could be useful in informing future patients and giving them realistic expectations.

Prediction model of atrial fibrillation recurrence after Cox-Maze IV procedure in patients with chronic valvular disease and atrial fibrillation based on machine learning algorithm.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia, and Cox-maze IV procedure (CMP-IV) is a commonly employed surgical technique for its treatment. Currently, the risk factors for atrial fibrillation recurrence following CMP-IV remain relatively unclear. In recent years, machine learning algorithms have demonstrated immense potential in enhancing diagnostic accuracy, predicting patient outcomes, and devising personalized treatment strategies. This study aims to evaluate the efficacy of CMP-IV on treating chronic valvular disease with AF, utilize machine learning algorithms to identify potential risk factors for AF recurrence, construct a CMP-IV postoperative AF recurrence prediction model. A total of 555 patients with AF combined with chronic valvular disease, who met the criteria, were enrolled from January 2012 to December 2019 from the Second Xiangya Hospital of Central South University and the Affiliated Xinqiao Hospital of the Army Medical University, with an average age of (57.95±7.96) years, including an AF recurrence group (n=117) and an AF non-recurrence group (n=438). Kaplan-Meier method was used to analyze the sinus rhythm maintenance rate, and 9 machine learning models were developed including random forest, gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), bootstrap aggregating, logistic regression, categorical boosting (CatBoost), support vector machine, adaptive boosting, and multi-layer perceptron. Five-fold cross-validation and model evaluation indicators [including F1 score, accuracy, precision, recall, and area under the curve (AUC)] were used to evaluate the performance of the models. The 2 best-performing models were selected for further analyze, including feature importance evaluation and Shapley additive explanations (SHAP) analysis, identifying AF recurrence risk factors, and building an AF recurrence risk prediction model. The 5-year sinus rhythm maintenance rate for the patients was 82.13% (95% CI 78.51% to 85.93%). Among the 9 machine learning models, XGBoost and CatBoost models performed best, with the AUC of 0.768 (95% CI 0.742 to 0.786) and 0.762 (95% CI 0.723 to 0.801), respectively. Feature importance and SHAP analysis showed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-to-lymphocyte ratio, preoperative left atrial diameter, preoperative heart rate, and preoperative white blood cell were important factors for AF recurrence. Conclusion: Machine learning algorithms can be effectively used to identify potential risk factors for AF recurrence after CMP-IV. This study successfuly constructs 2 prediction model which may enhance individualized treatment plans.

Low cardiac output syndrome after cardiac surgery with extracirculatory at cardiovascular center, E hospital

Background: Low cardiac output syndrome is one of the most severe complications after cardiac surgery, associated with 38% mortality, increased rates of respiratory complications, myocardial infarction, stroke, and heart failure. kidney and re-surgery. If the signs are detected early and diagnosed in time, the treatment will give better results.
 Objectives: Description of clinical, subclinical characteristics and evaluation of early results of treatment of patients with low cardiac output syndrome after cardiac surgery at Cardiovascular Center, E hospital.
 Methods: Retrospective report of 3 cases of low cardiac output syndrome with confirmed diagnosis, treatment and comparison with the literature.
 Results: From January 2022 to May 2023, 3 patients with low cardiac output syndrome were confirmed at the cardiovascular center, E hospital .The mortality rate is 66.7 % , mean age was 57.3 ±9.3 , mean preoperative EF 62 ±13.7 , mean postoperative cardiac index 1.5 ±0.2 l/ minute /m 2 , mean extracorporeal circulation time 172 ±63.4 minutes , mean aortic cross-clamp time 107 ±28.4 minutes
 Conclusion: Low cardiac output syndrome after surgery is a serious complication with high mortality risk. Doctors need to know the early signs for timely diagnosis and proper treatment to help patients recover best.

Outcomes of preoperative fragmented QRS detection on operative and postoperative events in patients undergoing elective coronary artery bypass grafting

Objectives: This study aims to investigate the preoperative electrocardiographic data of patients who were candidates for elective coronary artery bypass grafting (CABG) in terms of fragmented QRS (fQRS) presence and to evaluate short-term outcomes of fQRS on operative and postoperative courses. Patients and methods: Between January 2019 and April 2022, a total of 178 patients (137 males, 41 females; mean age: 61.4±9.3 years; range, 39 to 85 years) who underwent elective CABG were retrospectively analyzed. Preoperative electrocardiographic examinations were performed to detect fQRS. The patients were divided into two groups according to presence of fQRS as the fQRS+ (n=35) and fQRS– (n=143) group. Demographic, clinical, laboratory, operative, and postoperative data of both groups were evaluated. Results: The mean duration of cardiopulmonary bypass (p=0.017) and number of CABG (p=0.026) in the fQRS group were found to be significantly higher, while the mean preoperative left ventricular ejection fraction values were lower in this group (p<0.001). There was a significant increase in the left ventricular ejection fraction values at the postoperative third month in the fQRS+ group (p<0.001). Mortality encountered in 5.7% in the fQRS+ group, while this rate was 2.7% in the fQRS– group (p=0.336). Conclusion: Preoperative detection of QRS fragmentations on admission electrocardiograms may have an additional value in predicting postoperative cardiac status and short-term prognosis in patients undergoing CABG.

Perioperative Application of Levosimendan Optimizes Postoperative Renal Function and Organ Perfusion in Patients with Severe Heart Failure.

Background: Renal dysfunction and impaired organ perfusion are common concerns following cardiac surgery. Levosimendan, a calcium sensitizer inotropic drug, is investigated in this study for its potential to improve postoperative renal function and organ perfusion in patients with low preoperative ejection fraction and severe myocardial dysfunction after cardiac surgery. Methods: A retrospective analysis was conducted on 314 patients with preoperative heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while 130 patients with similar characteristics received conventional treatment. Results: The perioperative administration of levosimendan resulted in a significantly lower need for renal replacement therapy (p < 0.001) and improvements in the serum creatinine levels, glomerular filtration rate, and creatinine clearance. Similarly, the C-reactive protein levels, blood pH, and lactic acid levels showed comparable improvements. Conclusions: The use of levosimendan was associated with a significant enhancement in postoperative renal function and a reduction in the need for renal replacement therapy. Furthermore, it resulted in a decrease in the extent of organ malperfusion. Postoperative inflammatory reactions and metabolic balance also exhibited improvements.

Temporary circulatory support with surgically implanted microaxial pumps in postcardiotomy cardiogenic shock following coronary artery bypass surgery

ObjectivesPatients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) surgery may develop postcardiotomy cardiogenic shock. In these cases, implantation of an Impella 5.0 or 5.5 microaxial pump offers full hemodynamic support while simultaneously unloading of the left ventricle. MethodsPreoperative, perioperative, and postoperative data of all patients receiving postoperative support with an Impella 5.0 or 5.5 after CABG surgery between September 2017 and October 2022 were retrospectively collected. Cohort built-up was performed according to the timing of Impella implantation, either simultaneous during CABG surgery or delayed. ResultsA total of n = 42 patients received postoperative Impella support, of whom 27 patients underwent simultaneous Impella implantation during CABG surgery and 15 patients underwent delayed Impella therapy. Preoperative left ventricular ejection fraction was similarly low in both groups (26.7 ± 0.7% vs 24.8 ± 11.3%; P = .32). In the delayed cohort, Impella implantation was performed after a median of 1 (1; 2) days after CABG surgery. Survival after 30 days (75.6% vs 47.6%, P = .04) and 1 year (69.4% vs 29.8%, P = .03) was better in the cohort receiving simultaneous Impella implantation. ConclusionsThe combined advantages of hemodynamic support and LV unloading with microaxial pumps may lead to a favorable survival in patients with left ventricular failure following CABG surgery. Early implantation during the initial surgery shows a trend toward a more favorable survival as compared with patients receiving delayed support.

Extubation in the Operating Room After Coronary Artery Bypass Graft Surgery Reduces Hospital Stay

The aim of this analysis was to compare the effect of extubating in the operating room (OR) versus and the intensive care unit (ICU) among patients undergoing coronary artery bypass grafting (CABG). A retrospective cohort analysis. Ten cardiac referral hospitals in Latin America; participants of the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). The database included a total of 4,015 patients who underwent primary and isolated CABG surgery and were ≥18 years old, of whom 205 patients were extubated in the OR. The analysis was made after a propensity score matching (PSM) adjustment in the population sample of patients extubated in the OR and ICU by the following variables: sex, age, body mass index, smoking, type of surgery, chronic obstructive pulmonary disease, preoperative atrial fibrillation, cardiopulmonary bypass time, preoperative creatinine, and preoperative left ventricular ejection fraction. This study focused on the analysis of the ICU and hospital length of stay, need for reintubation, morbidity, and mortality. After PSM, 402 patients were analyzed. Both groups had similar baseline characteristics, such as age (p=0.132), sex (p=1.00), and estimated risk of prolonged ventilation (>24 hours, p=0.168); however, the median ventilation time was significantly shorter in the group extubated in the OR compared to the ICU group (5.67 hours v 17.55 hours, p < 0.001). The group of patients extubated in the ICU had a longer postoperative stay (7.54 ± 3.40 days v 6.41 ± 2.91 days, p < 0.001) and longer total hospitalization time (11.49 ± 5.70 days v 10.36 ± 5.72, p=0.013) compared to those extubated in the OR. The authors did not observe a significant difference in the need for reintubation, morbidity, or mortality rates among the evaluated groups. In the REPLICCAR II database, extubation performed in the OR was associated with a reduced length of postoperative and total hospital stays compared to extubation in the ICU.

Mortality After Total Thyroidectomy for Amiodarone-Induced Thyrotoxicosis According to Left Ventricular Ejection Fraction.

To report cardiac outcomes after total thyroidectomy for amiodarone-induced thyrotoxicosis according to the baseline left ventricular ejection fraction in a tertiary referral center. Retrospective, monocentric. The tertiary health care system. Patients who underwent total thyroidectomy for amiodarone-induced thyrotoxicosis between 2010 and 2020 with age >18 and available preoperative left ventricular ejection fraction were included in this study. Patients were dichotomized into: group 1 with left ventricular ejection fraction ≥40% (mildly reduced/normal ejection fraction), and group 2 with left ventricular ejection fraction <40% (reduced ejection fraction). There were 34 patients in group 1 and 17 to group 2. The latter were younger (median 58.4 [Q1-Q3 48.0-64.9] vs. 69.8 years in group 1 [59.8-78.3], p = .0035) and they presented more cardiomyopathy (58.8 vs. 26.5%, p = .030). Overall, the median time until surgery referral was 3.1 [1.9-7.1] months and 47.1% underwent surgery after restoration of euthyroidism. Surgical complications accounted for 7.8%. In group 2, the median left ventricular ejection fraction was significantly improved after surgery (22.5 [20.0-25.0] vs. 29.0% [25.3-45.5], p = .0078). Five-year cardiac mortality was significantly higher in group 2 (p < .0001): 47.0% died of cardiac causes versus 2.9% in group 1. A baseline left ventricular ejection fraction <40% and a longer time until surgery referral were significantly associated with cardiac mortality (multivariable Cox regression analysis, p = .015 and .020, respectively). These results reinforce the idea that surgery, if chosen, should be performed quickly in patients with left ventricular ejection fraction <40%.

Characteristics, Risk Factors, and Outcome of New-onset Systolic Heart Failure After Liver Transplantation: A Single-center Cohort.

This study included 528 adult patients with preoperative LV ejection fraction ≥ 55% who underwent LT between 2016 and 2020. The primary outcome was new-onset systolic HF, defined by the presence of clinical signs, symptoms, and echocardiographic evidence of reduced LVejection fraction <50% and RV dysfunction within the first year after LT. Thirty-one patients (6%) developed systolic HF within a median of 9 d (1-364). Of those, 23% of patients had ischemic HF, whereas 77% had nonischemic HF. Nonischemic HF was caused by stress (11), sepsis (8), or other factors (5). Nonischemic HF was secondary to isolated LV failure in 58% of patients or RV ± LV failure in 42% of patients. Recursive partitioning identified subgroups with varying risks and uncovered interaction between variables. HF risk increased from 4.2% to 13% when epinephrine and/or norepinephrine drips were used intraoperatively (P < 0.01). When no epinephrine and/or norepinephrine were used, HF risk increased from 3.1% to 38.5% if baseline hemoglobin was <7.2 g/dL (P < 0.01). When baseline hemoglobin was ≥7.2 g/dL, HF risk increased from 0% to 5.2% when ≥3500 mL crystalloid was used intraoperatively (P < 0.01). Posttransplant first-year survival and reversibility of HF depended on the etiology (stress, sepsis, ischemia, etc) and cardiac chamber involvement (isolated LV or RV ± LV). RV dysfunction was associated with inferior recovery of cardiac function and poorer survival than nonischemic isolated LV dysfunction (50% versus 70%, respectively). Posttransplant new-onset HF is mostly nonischemic in nature and is associated with increased morbidity and mortality.

Factors associated with long-term mechanical ventilation in patients undergoing cardiovascular surgery

BackgroundOne of the main therapy for coronary artery disease is surgery. Prolonged mechanical ventilation in patients with cardiac surgery is associated with high mortality. This study aimed to determine the factors related to long-term mechanical ventilation (LTMV) in patients undergoing cardiovascular surgery.MethodsThe present study was a descriptive-analytical study in which the records of 1361 patients who underwent cardiovascular surgery and were on a mechanical ventilator during 2019–2020 at the Imam Ali Heart Center in Kermanshah city were examined. The data collection tool was a three-part researcher-made questionnaire including demographic characteristics, health records, and clinical variables. Data analysis was done using descriptive and inferential statistical tests and SPSS Version 25 software.ResultsIn this study, of the 1361 patients, 953 (70%) were male. The results indicated that 78.6% of patients had short-term mechanical ventilation, and 21.4% had long-term mechanical ventilation. There was a statistically significant relationship between the history of smoking, drug use, and baking bread with the type of mechanical ventilation (P < 0.05). Also, based on the regression test, some parameters, such as the history of respiratory conditions, could predict the prolongation of mechanical ventilation. Creatinine levels before surgery, chest secretions after surgery, central venous pressure after surgery, and the status of cardiac enzymes before surgery also affect this issue.ConclusionThis study investigated some factors related to prolonged mechanical ventilation in patients undergoing heart surgery. For optimizing the care and therapeutic measures, It is suggested, healthcare workers have a detailed assessment on patients with factors such as the history of baking bread, history of obstructive pulmonary disease, history of kidney disease, use of an intra-aortic pump, number of respirations and systolic blood pressure 24 h after surgery, creatinine level 24 h after surgery, chest secretions after surgery, and the amount of pre-operative ejection fraction and cardiac enzymes (CK-MB).

P293 MULTI–DIMENSIONAL EVALUATION IN PATIENTS WITH AORTIC STENOSIS CANDIDATE FOR CARDIAC SURGERY

Abstract In patients with severe aortic stenosis, the presence of left ventricular systolic dysfunction is one of the main predictors of adverse events after valve replacement surgery. However, more and more patients are being referred for surgery early and have preserved systolic function at the time of surgery. Within this category, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling after cardiac surgery. Our study aims to identify the variation of Global longitudinal strain (GLS) in patients undergoing aortic valve replacement and any differences compared to classes of diastolic dysfunction. Methods From June 2020 to June 2022 we analyzed patients with severe aortic stenosis with an indication for cardiac surgery treatment admitted to the cardiac surgery department of our AOU. All patients underwent an echocardiogram immediately before surgery and in the early postoperative period (mean 7 days). In all cases, the GLS of the left ventricle was calculated and patients were divided into four classes according to the degree of diastolic dysfunction (0–III) according to the most recent international guidelines. The data were analyzed with SPSS 28 software. Analysis of variance was performed with a t–test and ANOVA test. Results In the final analysis, 63 patients were included, with a mean age of 70.5±8.2%, of whom 28 were women (44.4%) and 35 were men (55.6%). In 12 patients (19%) ischaemic heart disease with an indication for coronary revascularization was also present. The mean preoperative ejection fraction was 59±9.5%. The mean GLS values before surgery were 15.26±4.3% vs. early postoperative 12.52±2.6%, p&amp;lt;0.0001. GLS values were comparable within the various classes of diastolic dysfunction and preoperative examination (0 14.54±3.6%; I 16.04± 4.1%; II 15.27±4.7%; III 9.27%, p=0.39) and postoperative (0 12.28± 3.2%; 12.81±1.7%; II 12.53±2.9%; III 9.97%, p=0.73). Conclusions In our case series, patients with severe aortic stenosis undergoing aortic valve replacement with or without myocardial revascularization show a significant early reduction in GLS regardless of the degree of diastolic dysfunction. An extension of follow–up is needed to assess any differences in the intervention‘s benefit in different diastolic dysfunction subgroups.

Concomitant intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock.

We aimed to compare the outcomes of ECMO with and without IABP for postcardiotomy cardiogenic shock. The study included 103 patients who needed ECMO for postcardiotomy cardiogenic shock. Patients were grouped according to the use of IABP into ECMO without IABP (n = 43) and ECMO with IABP (n = 60). The study endpoints were hospital complications, successful weaning, and survival. Patients with IABP had lower preoperative ejection fraction (p = 0.002). There was no difference in stroke (p = 0.97), limb ischemic (p = 0.32), and duration of ICU stay (p = 0.11) between groups. Successful weaning was non-significantly higher with IABP (36 (60%) vs 19 (44.19%); p = 0.11). Predictors of successful weaning were inversely related to the high pre-ECMO lactate levels (OR: 0.89; p = 0.01), active endocarditis (OR: 0.06; p = 0.02), older age (OR: 0.95; p = 0.02), and aortic valve replacement (OR: 0.26; p = 0.04). There was no difference in survival between groups (p = 0.80). Our study did not support the routine use of IABP during ECMO support.

Outcome of Coronary Artery Bypass Graft Surgery with Low Preoperative Ejection Fraction: A Cross-sectional study

Background: Coronary artery bypass graft (CABG) surgery has been proven in several trials to have excellent outcomes in patients with coronary artery disease who have reasonably preserved cardiac function. Nonetheless, determining the value of coronary artery bypass grafting (CABG) in patients with low left ventricular ejection faction (shown as left ventricular ejection fraction 40B) has been challenging due to worries about increased operating mortality and decreased long-term survival.&#x0D; Objective: Our main goal is to evaluate the Outcome of Coronary Artery Bypass Graft Surgery with Low Preoperative Ejection Fraction.&#x0D; Methods: This cross-sectional study carried out at tertiary hospital from June 2021 to June 2022. Where 100 patients who underwent coronary artery bypass graft (CABG) surgery in the Department of Cardiac Surgery were included in the study. The patients were divided into 2 groups as follows: Group—I, EF &lt; 40% (n = 50) and Group-ll EF&gt;40% (n = 50).&#x0D; Results: During the study, where 55% were belong to 50-60 years age group and majority were male. In both group majority had diabetes and hypertension. All of the co—morbidities/risk factors were almost equally distributed between groups (p &gt; 0,05). Except incidence of bleeding, which was significantly higher in Croup—I than that in Group—II (p = 0.01 0). In addition to that, in group 1 Heart failure seen in 1.5% cases followed by 2.3% had pneumonia, prolonged ventilation seen in 13.5%. Where as in group 2 Heart failure seen in 0.5% cases followed by 1.8% had pneumonia, prolonged ventilation seen in 11%.&#x0D; Conclusion: Lastly, the current study's large sample size suggests that CABG may be performed on patients with low EF &lt;40% with outcomes (in terms of morbidity and death) that are equivalent to those of patients with EF &gt; 40.

Age, Gender, and Preoperative LVEF Influence on ICU Length of Stay After CABG

Coronary artery bypass graft (CABG) surgery is a surgical therapy for coronary artery disease (CAD) patients who cannot be solely treated using pharmacological therapy. Patients undergoing CABG surgery require careful postoperative monitoring in the intensive care unit (ICU). This leads to the need for careful selection of patients due to the limited number of ICU beds available. A prolonged stay in ICU could delay surgery for other patients. This retrospective study analyzed how preoperative factors such as age, gender, and preoperative left ventricular ejection fraction (LVEF) may influence patient's length of stay (LOS) in the ICU. For this study, subjects were patients undergoing isolated CABG in Dr. Hasan Sadikin General Hospital Bandung, Indonesia, during the period of January 2019- December 2020 who were selected using the simple random sampling method. The subjects were categorized into &lt;65 years old and ≥65 years old age groups; man and woman gender; preoperative LVEF of &lt;40% and ≥40%; and prolonged ICU LOS (&gt;96 hours) and non-prolonged ICU LOS (&lt;96 hours). Deceased patients in the ICU were excluded. Results of the bivariate and multivariate analyses showed that age was the only factor (p-value of 0.017) that increased the risk of prolonged ICU LOS (OR of 3.34) after CABG surgery that was statistically significant. This study concluded that patient of old age (&gt;65 years old) is at a higher risk of having prolonged ICU LOS after CABG; thus, a careful scheduling of patients for CABG surgery by age is important to prevent prolonged ICU LOS after 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.

Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group.

To evaluate the efficacy of the Cox-Maze IV procedure (CMP-IV) in combination with valve surgery in patients with both atrial fibrillation (AF) and valvular disease and use machine learning algorithms to identify potential risk factors of AF recurrence. A total of 1,026 patients with AF and valvular disease from two hospitals were included in the study. 555 patients received the CMP-IV procedure in addition to valve surgery and left atrial appendage ligation (CMP-IV group), while 471 patients only received valve surgery and left atrial appendage ligation (Non-CMP-IV group). Kaplan-Meier analysis was used to calculate the sinus rhythm maintenance rate. 58 variables were selected as variables for each group and 10 machine learning models were developed respectively. The performance of the models was evaluated using five-fold cross-validation and metrics including F1 score, accuracy, precision, and recall. The four best-performing models for each group were selected for further analysis, including feature importance evaluation and SHAP analysis. The 5-year sinus rhythm maintenance rate in the CMP-IV group was 82.13% (95% CI: 78.51%, 85.93%), while in the Non-CMP-IV group, it was 13.40% (95% CI: 10.44%, 17.20%). The eXtreme Gradient Boosting (XGBoost), LightGBM, Category Boosting (CatBoost) and Random Fores (RF) models performed the best in the CMP-IV group, with area under the curve (AUC) values of 0.768 (95% CI: 0.742, 0.786), 0.766 (95% CI: 0.744, 0.792), 0.762 (95% CI: 0.723, 0.801), and 0.732 (95% CI: 0.701, 0.763), respectively. In the Non-CMP-IV group, the LightGBM, XGBoost, CatBoost and RF models performed the best, with AUC values of 0.738 (95% CI: 0.699, 0.777), 0.732 (95% CI: 0.694, 0.770), 0.724 (95% CI: 0.668, 0.789), and 0.716 (95% CI: 0.656, 0.774), respectively. Analysis of feature importance and SHAP revealed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-lymphocyte ratio, preoperative left atrial diameter and heart rate were significant factors in AF recurrence. CMP-IV is effective in treating AF and multiple machine learning models were successfully developed, and several risk factors were identified for AF recurrence, which may aid clinical decision-making and optimize the individual surgical management of AF.

Evaluation of Acute Kidney Injury in Postcardiotomy Cardiogenic Shock Patients Supported by Extracorporeal Membrane Oxygenation.

This study sought to evaluate the incidence of acute kidney injury (AKI) defined by the Kidney Disease: Improving Global Outcomes (KDIGO) group in patients supported by veno-arterial extracorporeal membrane oxygenation (VA ECMO) after post-cardiotomy cardiogenic shock (PCS), and to identify the risk factors for AKI 3. Patients with and without AKI 3 were divided into two groups. Potential risk factors for developing AKI 3 were evaluated by univariate logistic regression analysis. Patient risk factors (p 0.1) in the univariate analysis were entered into the multivariable logistic regression model. The tolerance and variance inflation factors (VIF) were calculated to evaluate the collinearity of the potential variables. 136 patients with a mean age of 53.6 13.9 years (66.9% male) were enrolled in the study. 80 patients (58.8%) developed AKI 3. Patients with AKI 3 required significantly longer mechanical ventilation (200.9 [128.0, 534.8] hours vs. 78.9 [13.0, 233.0] hours, p 0.001). The ICU stay and hospital stay of patients with AKI 3 were much longer than patients with AKI 3 (384 [182, 648] hours vs. 216 [48, 456] hours, p = 0.001; 25.0 [15.3, 46.6] days vs. 13.4 [7.4, 38.4] days, p = 0.022, respectively). There was no difference in preoperative risk factors between the two groups. Age, cross-clamp time, cardiopulmonary bypass (CPB) time, the timing of ECMO implantation, mean artery pressure (MAP), lactate concentration before ECMO, and preoperative ejection fraction (EF) were entered into the multivariable analysis. The timing of ECMO implantation was an independent risk factor for AKI 3 (p = 0.036). Intraoperatively implantation of ECMO may decrease the incidence of AKI 3 (odds ratio (OR) = 0.298, 95% confidence interval (CI) = 0.096-0.925). The tolerance and variance inflation factors showed that there was no collinearity among these variables. The incidence of AKI 3 in patients supported by VA ECMO after PCS was 58.8% in our center. Patients with AKI 3 required significantly longer mechanical ventilation and hospital stay. Intraoperative implantation VA ECMO was associated with a decreased incidence of AKI 3.

Aortic Valve Replacement and Concomitant Multi-Vessel Coronary Artery Bypass: The Impact of Using the Bilateral Internal Thoracic Arteries on Early and Late Clinical Outcomes.

The survival benefit of coronary artery bypass grafting (CABG) using the bilateral internal thoracic arteries (BITA) is well known; however, the role of BITA in concomitant aortic valve replacement (AVR) and CABG has not been studied. We retrospectively reviewed patients who underwent concomitant AVR and CABG. Cases not using an internal thoracic artery and less than 2 bypass grafts were excluded. We enrolled 114 patients in this study. The mean follow-up duration was 61.5±43.5 months. Forty patients (35.1%) underwent CABG with a single internal thoracic artery (SITA) and 74 patients (64.9%) underwent CABG with BITA. The preoperative clinical characteristics were not significantly different between the 2 groups, with the exception of a higher prevalence of atrial fibrillation in the SITA group. Postoperative mortality and morbidity were not significantly higher in the BITA group than in the SITA group. In the univariable analysis, the survival of the BITA group was similar to that of the SITA group (p=0.157). Multivariable analysis showed that only mean age was a predictor of death (p=0.042), but using BITA was not an independent predictor (p=0.094). In low-risk patients whose preoperative ejection fraction was >45%, the survival of the BITA group was significantly better than that of the SITA group (p=0.043). BITA use in concomitant AVR and CABG showed no difference in mortality compared to using SITA. Although its impact on long-term survival was inconclusive, BITA use can be considered for low-risk patients.