Preoperative Pulmonary Hypertension Research Articles

(956) - Relationship Between Use of Preoperative Pulmonary Hypertension Therapy and Need for Postoperative Therapy in Patients Undergoing Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

(956) - Relationship Between Use of Preoperative Pulmonary Hypertension Therapy and Need for Postoperative Therapy in Patients Undergoing Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Protocol for venoarterial ExtraCorporeal Membrane Oxygenation to reduce morbidity and mortality following bilateral lung TransPlantation: the ECMOToP randomised controlled trial

IntroductionLung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite...

Association between preoperative hemoglobin with length of hospital stay among non-cardiac and non-obstetric surgery patients: a secondary analysis of a retrospective cohort study

BackgroundPrevious studies concerning the association between preoperative Hemoglobin (HB) level and the Length Of hospital Stay (LOS) in patients with non-cardiac surgery and non-obstetric surgery remain inconclusive. Herein, the objective of this study was to analyze whether and to what extent the preoperative HB level was connected with the LOS in non-cardiac and non-obstetric surgery patients.MethodsThis retrospective cohort study was performed at a single institution, involving patients who underwent elective non-cardiac, non-obstetric surgery from April 2007 to September 2013. Clinical characteristics of patients such as demographics, comorbidities, preoperative HB level, LOS, mortality, procedure length, and pulmonary hypertension (PHTN) Severity Class data were collected. A univariate analysis was used to determine the association between clinical characteristics and LOS. Multivariate regression analysis was conducted to investigate the relationship between preoperative HB level and LOS.Results and discussionIn this study, 311 patients were included. We observed that compared with the LOS > 7 days group, the average HB level of patients in the LOS ≤ 7 days group was higher (12.04 ± 2.20 g/dl vs. 10.92 ± 2.22 g/dl, p < 0.001). In addition, there were fewer patients with moderate-to-severe anemia in LOS ≤ 7 days group than the LOS > 7 days group (32.74% vs 58.82%, p < 0.001). In addition, we found that patients with LOS ≤ 7 days were accompanied with lower mortality (0.44% vs. 7.06%, p < 0.001) and lower mean combined pulmonary artery systolic pressure (PASP) and right ventricular systolic pressure (RVSP) than that in patients with LOS > 7 days (42.56 ± 11.97 vs. 46.00 ± 12.37, p < 0.05). After controlling for relevant confounders, we discovered a nonlinear association between preoperative HB level and LOS as well as a threshold effect based on LOS. Specifically, when preoperative HB level was less than 11.9 g/dL, LOS decreased by 2 days for each 1 g/dL increase in HB level. However, LOS did not alter substantially with the rise of preoperative HB level when it was higher than 11.9 g/dL.ConclusionOur study showed a close non-linear association between preoperative HB level and LOS in patients with non-cardiac surgery and non-obstetric surgery. In particular, for patients with preoperative HB less than 11.9 g/dL, increasing the preoperative HB level can help shorten the LOS after operation.

Is Cardiac Surgery Safe in Patients with Previous Liver Transplantation? A Narrative Review

Background Liver transplant patients have increased risk of developing cardiovascular disease and the outcome of these patients following cardiac surgery has been reported in small series of patients. The aim of this review was to examine and report safety outcomes of liver transplant patients undergoing cardiac surgery. Methods Literature review was conducted using three databases from inception to June 2023. Multiple search terms were used and limited to English language. Nine relevant articles were included. Outcomes of interest were short-term mortality, long-term survival, liver graft failure, major morbidity and infection in liver transplant recipients undergoing cardiac surgery. Results Cardiac risk factors (diabetes mellitus, hypertension, hyperlipidemia) were prevalent in liver transplant patients. 30-days mortality ranged across the studies from zero to 23.8%. 1-year survival ranged from 74-91% and 5-years survival ranged from 33-69%. Commonest causes of death were cardiac and sepsis. Predictors of mortality were preoperative encephalopathy, pulmonary hypertension, blood transfusion and postoperative increase in creatinine and bilirubin levels. Liver allograft rejection ranged from zero to 4.7% with no predictors reported. Liver dysfunction was seen in 33-46% of patients, and all were transient with recovery at the time of hospital discharge. Major morbidities were commonly reported and included respiratory and renal failure. Infection rates ranged from zero to 38% and the most common reported sites were pneumonia, sepsis, and surgical site infections. Conclusion Cardiac surgery can be performed in liver transplant patients with good short- and long-term results and acceptable morbidities.

How Refined Surgical Technical Solutions Can Make Bentall Operation a Low-Risk Procedure: 20-Year Personal Experience at the “Root” of the Aortic Diseases—It Is Time to Change Surgical Guidelines

(1) Objective: Twenty years’ experience of Bentall–De Bono operations by one surgeon. (2) Methods: From January 2003 to September 2023, four-hundred-and-two patients aged 65.9 ± 15 years underwent a Bentall operation. The EuroScore-2 was 5.0% ± 3.8%. Associated procedures were performed on 113 patients (28.1%). Results: Operative mortality was 1.2% (n = 5), in particular 0.69% (n = 2/289) for isolated Bentall operation, 2.65% (n = 3/113) for combined procedures (p &lt; 0.05). Postoperative acute heart failure occurred in 38 patients (9.45%). Preoperative pulmonary hypertension (44 ± 14 vs. 33 ± 7 mmHg), cardiopulmonary bypass time (169 ± 61 min. vs. 124 ± 42 min.) and aortic cross-clamp time (133 ± 45 min. vs. 107 ± 34 min.) have been recognized as independent predictors of mortality and cardiac complications (p &lt; 0.05). Conclusions: In our experience, the Bentall operation was associated with low operative mortality and low rate of complications. For this reason, in agreement with the patients, we have modified surgical indication for ascending aortic aneurysms and now we think that it is time to change surgical guidelines.

Pulmonary Hypertension in Left Ventricular Valvular Diseases: A Comprehensive Review on Pathophysiology and Prognostic Value.

Left ventricular (LV) valvular diseases, make up one of the most common etiologies for pulmonary hypertension (PH), and it is not well understood how and at which degree it affects prognosis. The aim of the present study was a comprehensive review of the pathophysiologic mechanism of PH in patients with LV valvular diseases and the prognostic value of baseline and post-intervention PH in patients undergoing interventional treatment. The pathophysiology of PH in patients with LV valvular diseases involves gradual elevation of left ventricular filling pressure and left atrial pressure, which are passively transmitted to the pulmonary circulation and raise pulmonary artery systolic pressure (PASP). A long-lasting exposure to elevated PASP progressively leads to initially functional and thereafter irreversible structural changes in the pulmonary vasculature, leading up to high pulmonary vascular resistance. Surgical treatment of severe LV valvular diseases is highly effective in patients without resting PH or those with exercise-induced PH (EIPH) before intervention. In the case of pre-operative PH, successful interventional therapy decreases PASP, but the post-operative cardiac and all-cause mortality remain higher compared to patients without pre-operative PH. Hence, it is of paramount importance to detect patients with severe LV valvulopathies before the development of PH, since they will get greater benefits from early intervention.

Super-massive transfusion during liver transplantation.

Massive hemorrhage and transfusion during liver transplantation (LT) present great challenges. We aimed to investigate the incidence and risk factors for super-massive transfusion (SMT) and survival outcome and factors that negatively affect survival in patients who received SMT during LT. We included adult patients undergoing LT from 2004 to 2019. SMT was defined as transfusion of ≥50 units of red blood cells (RBC) during LT. Independent risk factors were identified by multivariable logistic regression. Ninety-day survival was recorded and factors that negatively affected survival were analyzed by the Cox survival test. Of 2772 patients, 158 (5.6%) received SMT during LT. Mean RBC transfusion was 72.6 (±23.4) units with a maximum of 168 units. Four variables (MELD-Na score, previous upper abdominal surgery, portal vein thrombosis, and remote retransplant) were independent risk factors for SMT (odds ratio 1.800-8.274, 95% CI 1.008-16.685, all p < .005). The 90-day survival rate in SMT patients was 81.6%. Preoperative pulmonary hypertension and massive postreperfusion transfusion negatively affected 90-day survival (hazard ratio 2.658-4.633, 95% CI 1.144-10.130, and all p < .05). In this large retrospective study, we found that SMT occurred in a small percentage of patients and was associated with relatively satisfactory short-term survival. Identification of preoperative risk factors for SMT and factors that negatively affect survival improve our understanding of this unique LT patient population.

Prognostic Implication of Pulmonary Arterial Pressure in Surgical Repair of Predominantly Congenital Mitral Valve Regurgitation-Based Intracardiac Abnormalities

Introduction: Knowledge is limited regarding the significance of pulmonary arterial pressure (PAP) in predominantly congenital mitral valve regurgitation (MR)-based intracardiac abnormalities. Methods: From a prospective cohort, we included 200 patients with congenital MR regardless of other associated intracardiac abnormalities (mean age 60.4 months, 67% female, systolic PAP (sPAP) 54.2 mm Hg) surgically repaired in 2012–2019 and followed up to 2020 (median 30.0 months). Significant pulmonary hypertension (PH) was defined as sPAP >50 mm Hg at rest or mean PAP >25 mm Hg on right heart catheterization. By perioperative sPAP changes, patients were stratified as group I (pre-normotension to post-normotension), group II (pre-hypertension to post-normotension), or group III (pre-hypertension to post-hypertension). Primary outcomes were the recurrence of MR (defined as the regurgitation grade of moderate or greater) and the progression of MR (defined as any increase in the magnitude of regurgitation grade after surgery). Cox proportional hazard and Kaplan-Meier curve were performed. Results: There was no association between preoperative PH and the recurrent MR (adjusted hazard ratios [aHR]: 1.146 [95% CI: 0.453–2.899]) and progressive MR (aHR: 1.753 [95% CI: 0.807–3.804]), respectively. There were no significant differences among group I, group II, and group III in the recurrent MR but in the progressive MR. A dose dependency was identified for preoperative sPAP with recurrent MR (aHR: 1.050 [95% CI: 1.029–1.071]) and progressive MR risks (aHR: 1.037 [95% CI: 1.019–1.055]), respectively. Conclusions: Preoperative higher sPAP is associated with worse outcomes, warranting heightened attention to the identification of perioperative sPAP.

Short-term outcomes following congenital heart surgery in children with Down syndrome

Background Children with Down syndrome (DS) differ from typical children because of many genetic-related aspects that may affect outcomes after congenital heart surgery. To date, there have been no studies on outcomes after congenital heart surgery on pediatric DS patients in Indonesia.&#x0D; Objective To determine outcomes and mortality in DS patients who underwent heart surgery at Dr. Cipto Mangunkusumo Hospital, Jakarta.&#x0D; Methods A prospective and retrospective cohort study was conducted in DS patients aged &lt;15 years who underwent heart surgery from July 2007 to April 2015. The control group were patients in the same age range without DS who underwent heart surgery for various types of heart defects.&#x0D; Results There were 57 DS and 43 non-DS patients during study period. The types of heart defects found in DS patients were atrioventricular septal defect (AVSD) and ventricular septal defect (VSD) in 18/57 (31.6%) patients each, tetralogy of Fallot (12/57; 21%), atrial septal defect (ASD) (4/57; 7%), patent ductus arteriosus (PDA) (4/57; 7%) and transposition of the great arteries with VSD (TGA-VSD) (1/57; 1.8%). DS patients showed an increased incidence of preoperative PH (63.1%) compared to non-DS patients (25.6%). Median duration of surgery was longer in DS [2.9 (range 0.5-5.8) hours] than in non-DS [2.2 (range 0.7-4.7) hours]. DS patients have a longer mean cardiopulmonary bypass duration [79.5 (SD 33.9) minutes] compared to non-DS [59.9 (SD 23.6) minutes], longer mean aortic cross-clamp duration [45.3 (SD 23.7) minutes] compared to non-DS [34.8 (SD 15.7)]. There were significant differences in the incidence of preoperative pulmonary hypertension, surgical time, duration of cardiopulmonary bypass (CPB), and length of the aortic cross-clamp in DS patients compared to non-DS (P&lt;0.05). Median length of ICU stay was 1.9 (range 0.6 to 34) days in DS and 1 (range 0.3 to 43) day in non-DS patients (P=0.373). Median duration of mechanical ventilation [19.9 (range 3-540) vs. 8 (range 3-600) hours (P=0.308)], rate of pulmonary complications [14/57 (24.6%) vs. 6/43 (14%) patients (P=0.216)], and incidence of sepsis [16/57 (28.1%) vs. 6/43 (14%) patients (P=0.143)] were not significantly different between DS and non-DS patients. However, complete atrioventricular (AV) block only occurred in DS patients [6/57 (10.5%)]. In the DS group, 5/57 (8.8%) patients died. There was no mortality in the non-DS group.&#x0D; Conclusion Morbidity and mortality after cardiac surgery in were higher in DS than in non-DS patients. DS patients may have problems related to preoperative PH, AV block, longer surgical time, duration of CPB, and aortic cross-clamp compared to non-DS.

Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery.

To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression. A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support. Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not.

Association between intraoperative pulmonary artery pressure and cardiovascular complications after off-pump coronary artery bypass surgery: a single-center observational study

BackgroundThe impact of intraoperative pulmonary hemodynamics on prognosis after off-pump coronary artery bypass (OPCAB) surgery remains unknown. In this study, we examined the association between intraoperative vital signs and the development of major adverse cardiovascular events (MACE) during hospitalization or within 30 days postoperatively.MethodsThis retrospective study analyzed data from a university hospital. The study cohort comprised consecutive patients who underwent isolated OPCAB surgery between November 2013 and July 2021. We calculated the mean and coefficient of variation of vital signs obtained from the intra-arterial catheter, pulmonary artery catheter, and pulse oximeter. The optimal cut-off was defined as the receiver operating characteristic curve (ROC) with the largest Youden index (Youden index = sensitivity + specificity – 1). Multivariate logistic regression analysis ROC curves were used to adjust all baseline characteristics that yielded P values of < 0.05.ResultsIn total, 508 patients who underwent OPCAB surgery were analyzed. The mean patient age was 70.0 ± 9.7 years, and 399 (79%) were male. There were no patients with confirmed or suspected preoperative pulmonary hypertension. Postoperative MACE occurred in 32 patients (heart failure in 16, ischemic stroke in 16). The mean pulmonary artery pressure (PAP) was significantly higher in patients with than without MACE (19.3 ± 3.0 vs. 16.7 ± 3.4 mmHg, respectively; absolute difference, 2.6 mmHg; 95% confidence interval, 1.5 to 3.8). The area under the ROC curve of PAP for the prediction of MACE was 0.726 (95% confidence interval, 0.645 to 0.808). The optimal mean PAP cut-off was 18.8 mmHg, with a specificity of 75.8% and sensitivity of 62.5% for predicting MACE. After multivariate adjustments, high PAP remained an independent risk factor for MACE.ConclusionsOur findings provide the first evidence that intraoperative borderline pulmonary hypertension may affect the prognosis of patients undergoing OPCAB surgery. Future large-scale prospective studies are needed to verify the present findings.

Preoperative pulmonary artery hypertension as a risk factor: the tip of the iceberg

Preoperative pulmonary artery hypertension as a risk factor: the tip of the iceberg

Airway Hemorrhage Complicating Pulmonary Thromboendarterectomy: Risk Factors and Outcomes

BackgroundAirway hemorrhage is a known complication of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension. Predisposing factors for postoperative airway hemorrhage have not been well described. The aims of this study were to determine the incidence and outcomes of airway hemorrhage after PTE and to identify potential risk factors. MethodsThis was a retrospective chart review of subjects undergoing PTE between 2015 and 2019. Postoperative airway hemorrhage was defined as significant endobronchial bleeding requiring withholding anticoagulation, bronchial blocker placement, and/or extracorporeal membrane oxygenation (ECMO). ResultsOf 877 subjects who underwent PTE, 58 subjects (6.6%) developed postoperative airway hemorrhage. Subjects with hemorrhage were more likely to be women (60% vs 45%, P = .03), to be older (57.8 vs 54.0 years, P = .04), and to have a higher incidence of preoperative hemoptysis (19.0% vs 7.6%, P = .006) compared with control subjects (subjects without airway hemorrhage). Those with hemorrhage had significantly higher preoperative right atrial pressure (P = .002) and pulmonary vascular resistance (P < .001) and a higher incidence of residual pulmonary hypertension (P = .005). Airway hemorrhage management included ECMO with bronchial blocker (n = 2), bronchial blocker without ECMO (n = 26), or withholding anticoagulation alone until bleeding subsided (n = 30). Mortality was significantly higher in those with airway hemorrhage compared with control subjects (13.8% vs 1.2%, P < .001). ConclusionsThe incidence of postoperative airway hemorrhage is low but associated with significant mortality. Older age, female sex, preoperative hemoptysis, and worse preoperative pulmonary hypertension were associated with an increased risk of developing postoperative airway hemorrhage.

Paediatric pulmonary arterial hypertension following congenital heart defect repair: enhanced risk stratification and outcomes in a national cohort

Abstract Introduction Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD). PAH following CHD repair (repaired PAH-CHD) is an emerging population with increased morbidity and mortality [1–3]. Risk scores that are widely used in the adult PAH population have not been validated and may not be applicable in young children with repaired PAH-CHD. Purpose To characterize the 20-year cohort of the UK National Paediatric PH Service, focusing on peri-operative characteristics and outcomes of children with repaired PAH-CHD, and develop a tailored risk stratification tool. Methods We included consecutive children presenting to our specialist service between 2001 and 2021 with a diagnosis of repaired PAH-CHD. Patients with univentricular physiology, segmental pulmonary hypertension (PH), and PH primarily due to abnormal development of the pulmonary vasculature were excluded. Univariable Cox regression analysis was performed in children with PAH present ≥3 months after CHD repair, with an outcome of death or transplantation. Time-dependent ROC analysis was used to evaluate the risk model. Results Overall, 178 patients were included (age 3.2 [1.3–7.9] years, 58.4% female). Most children (73.0%) were referred following CHD repair. Complex CHD was present in 61.2%, and 48.9% had combined pre- and post-tricuspid shunts. Down syndrome was present in 33.1%. At the first post-operative PH assessment, 53.1% of patients had symptoms, mainly breathlessness. On echocardiographic evaluation, 30.9% had moderate-severe right ventricular dilatation and 23.7% had right ventricular systolic impairment. Over a median follow-up of 6.0 [2.4–11.0] years, 30 (19.2%) patients died and 5 (3.2%) patients underwent lung transplantation. Transpant-free survival at 1, 5, and 10 years was 94.7% (95% CI: 91.2–98.3%), 85.9% (95% CI: 80.3–91.9%), and 80.1% (95% CI: 73.1–87.7%), respectively. Cox analysis identified several clinical variables associated with death or transplantation, of which the following variables assessed post-repair were used to develop the risk score: absence of pre-operative PH, breathlessness, right ventricular dysfunction, and pulmonary vascular resistance index &amp;gt;14 WU m2 or lesion at high risk of causing PH (Figure 1). This novel, simple risk score performed well (AUC &amp;gt;80% at 1, 3, 5 and 10 years) and was well-calibrated in our cohort (Figure 2, D'Agostino-Nam p=0.76). Conclusions In this national cohort of children with repaired PAH-CHD, mortality is significant. This novel, simple risk score performed well in our population and could be used in clinical practice at the time of post-operative assessment to predict outcome and direct management but requires further validation. Funding Acknowledgement Type of funding sources: None.

Middle to long-term outcomes of surgical repair for atrioventricular septal defect: a single-center study.

The exact incidence and predictors of mortality and left atrioventricular valve (LAVV) re-operation in congenital atrioventricular septal defect (AVSD) repair are still unclear. This study analyzed the middle to long-term outcomes of surgical repair for AVSD. A total of 150 patients (69 males and 81 females) who underwent AVSD repair at Children's Hospital of Fudan University from January 2013 to December 2021 were divided into complete defect group (C-group, 67 cases), transitional defect group (T-group, 26 cases), and partial defect group (P-group, 57 cases). Outcomes during the peri-operative and 10-year follow-up periods were evaluated. The total mortality was 5.33% (8/150), including seven early deaths (10.4%) and no late deaths in the C-group, no early deaths (0%) and one late death (1.8%) in the P-group, and no early or late deaths in the T-group. Up to the last follow-up, severe LAVV regurgitation had occurred in 27 patients, including 16 in the C-group, four in the T-group, and seven in the P-group. In total, 12 (12/150, 8.0%) patients received LAVV re-operation, including seven in the C-group, three in the T-group, and two in the P-group. Cox regression analysis showed that pre-operative severe pulmonary hypertension (P=0.006) and severe LAVV regurgitation within 24 hours after the first surgery (P=0.023) were independent risk factors for mortality. ≥ Moderate LAVV regurgitation within the first 24 hours after surgery (P=0.014) was an independent risk factor for LAVV re-operation. Complete AVSD repair increased the risk of early death, severe LAVV regurgitation and re-operation. Pre-operative severe pulmonary hypertension and residual severe LAVV regurgitation indicated high risk for mortality. ≥ Moderate LAVV regurgitation within 24 hours after the first surgery predicted a high probability of LAVV re-operation.

THE EFFECT OF INHALED MILRINONE ON PULMONARY ARTERIAL PRESSURE IN PATIENTS UNDERGOING CARDIAC SURGERY

ABSTRACT&#x0D; Objective: To find out the effect of inhaled Milrinone on pulmonary arterial pressure in patients undergoing cardiac surgery.&#x0D; Methods: A randomized controlled trial was done at Peshawar Institute of Cardiology in 78 patients who had preoperative pulmonary hypertension and had undergone cardiac surgery between the ages of 3 months and 60 years. Divided into 2, group 1 received Intravenous (IV) Milrinone and group 2 received Inhalational (IN) Milrinone. MANOVA was used to compare the difference between two groups across six dependent variables i.e., Heart rate (HR), systolic arterial pressure (SAP), Central venous pressure (CVP), Systolic pulmonary arterial pressure (SPAP), Diastolic pulmonary arterial pressure (DPAP) and Diastolic pulmonary arterial pressure (MPAP) at three stages; baseline, end of nebulization, and after cardiopulmonary bypass (labeled as stages 1,2 and3).&#x0D; Intraoperative complications like weaning from cardiac bypass (CBP) machine, use of vasopressor, insertion of intra-aortic balloon pump (IABP), and cardiopulmonary re-initiation were also observed in both the groups. Analysis of the data was done through SPSS-23.&#x0D; Results: In a total of 78 patients (39 in each group), an insignificant change was observed regarding the effects of IN Milrinone on HR, SAP, and CVP whereas significant effects of Inhaled Milrinone on SPAP, DPAP, and MPAP were observed (P-values &lt;0.05).&#x0D; Conclusion: The use of inhaled Milrinone was beneficial in patients with pulmonary hypertension in the prevention of Intraoperative complications like difficulty in weaning from CPB, insertion of IABP, and use of vasopressors, while CPB re-initiation was observed less in patients with inhalational milrinone as compared with intravenous administration while reducing their length of stay in ICU.&#x0D; Key Words: inhaled Milrinone, pulmonary artery pressure, cardiac surgery.&#x0D; &#x0D; &#x0D;

Cirugía de reparación valvular mitral en el canal auriculoventricular completo

Introduction and objectivesComplete atrio-ventricular septal defect accounts for 3% of congenital heart disease. Its prognosis depends on the status of the left atrio-ventricular valve after repair. We will analyse our results in terms of morbidity and mortality, and need for reoperation. MethodsRetrospective observational study, including patients who underwent a complete surgical correction of atrio-ventricular septal defect in our centre between January 2008 and July 2021. Results57 patients were treated. Median age and weight were 6 months and 5.8kg respectively (interquartile range 4-7 months and 4.8-6.7kg). Inhospital mortality was 3 patients (5.3%). Of the patients, 7.2% required early reoperation to the left atrio-ventricular valve. Overall survival was 88.6% (median follow-up of 4.7 years; interquartile range: 1.5-10.9; complete follow-up in 93% of patients). Freedom from reoperation to the left atrioventricular valve was 83.7%. The left atrioventricular valve showed regurgitation lower than III / IV in 90.2% of the patients at the end of follow-up. Surgery before 3 months (p=.001), preoperative pulmonary hypertension (p=.007), and postoperative left atrio-ventricular valve stenosis (p=.001) were risk factors for mortality. Weight less than 4kg (p<.0001), age less than 3 months (p<.0001), no closure of the cleft (p=.033), and postoperative valve stenosis (p<.0001) were risk factors for valve reoperation. ConclusionsSurgical correction of atrioventricular septal defect between 3 and 6 months shows good morbidity and mortality results.Closure of the cleft prevents the need for reoperation to the left atrioventricular valve.

Association Between the Presence of Pulmonary Hypertension Before Cardiovascular Surgery and the Nephroprotective Effect of Carperitide: A Retrospective Cohort Study.

IntroductionWe hypothesized that the nephroprotective and diuretic effects of carperitide are effective in patients with pulmonary hypertension. We examined the presence of preoperative pulmonary hypertension and the effects of carperitide.MethodsIn this retrospective cohort study, we included patients aged 20 years or older who received carperitide during cardiovascular surgery and were admitted to the postoperative intensive care unit. We used hospital data from March 2019 to September 2021. The outcomes were the incidence of acute kidney injury, the number of patients using renal replacement therapy in the intensive care unit, urine volume in the first 24 hours after surgery, and the difference in serum creatinine concentrations between before and after surgery. After adjusting for confounding factors by multivariate analysis, we compared the difference in outcomes with and without preoperative pulmonary hypertension (systolic pulmonary artery pressure ≥36 mmHg).ResultsThe study included 244 patients, with 72 (29.5%) in the pulmonary hypertension group and 172 (70.5%) in the control group. Acute kidney injury occurred in eight (11.1%) patients in the pulmonary hypertension group and in 18 (10.5%) patients in the control group, with no significant difference by logistic regression analysis (odds ratio 1.40, 95% confidence interval 0.54-3.62, p=0.49). Additionally, the use of renal replacement therapy, urine volume at 24 hours postoperatively, and the difference in serum creatinine concentrations were not different between the two groups.ConclusionsOur results suggest that the effect of carperitide during cardiovascular surgery is not affected by the presence or absence of pulmonary hypertension.

Clinical Nomogram for Predicting the Prognosis of Patients With Pulmonary Venous Obstruction After Total Anomalous Pulmonary Venous Connection Repair

BackgroundThe aim of this study was to establish a nomogram to quantify the risk of postoperative pulmonary venous obstruction (PVO) and to make a scientific decision through the decision curve.MethodsIn total, 151 PVO patients with total anomalous pulmonary venous connection (TAPVC) repair in our hospital from December 2008 to December 2015 were involved in this study. A nomogram was generated based on the contribution weights of variables, which were found out by logistic analysis. The optimal clinical decision point was determined by the decision analysis and clinical impact curve, which could assess the net benefit between the nomogram and each independent risk factor for postoperative PVO.ResultPulmonary venous obstruction with TAPVC repair was found to be positively and independently correlated with preoperative pulmonary hypertension, surgical methods, and preoperative pulmonary venous stenosis.Conclusion(s)The study introduced a novel model to aid in clinical decisions making for the patients with TAPVC individually, which may shed light on the evaluation of PVO risk.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.