Cardiac Valvular Surgery Research Articles

Lupus anticoagulant and valvular cardiac surgery.

Despite its name, lupus anticoagulant (LAC) neither exclusively occurs in lupus nor induces anticoagulation. It is an antiphospholipid antibody found in 2%-4% of the population that promotes clot formation by targeting phospholipid-protein complexes in cell membranes. However, in vitro, LAC exhibits paradoxical effects, prolonging clotting times in phospholipid-dependent assays such as Activated Partial Thromboplastin Time (APTT). This unpredictability extends to point-of-care tests like Activated Clotting Time (ACT), which are frequently used to monitor anticoagulation during cardiac surgeries involving cardiopulmonary bypass (CPB). High doses of unfractionated heparin (UFH) are administered in these procedures, but the presence of LAC complicates ACT measurements, creating challenges for both anesthesiologists and surgeons. This case report highlights the clinical implications of LAC in perioperative management, underscoring the difficulties in ensuring adequate anticoagulation during CPB.

Low Frequency Ventilation During Cardiopulmonary Bypass to Protect Postoperative Lung Function in Cardiac Valvular Surgery: The PROTECTION Phase II Randomized Trial.

Cardiac surgery with cardiopulmonary bypass (CPB) triggers pulmonary injury. In this trial we assessed the feasibility, safety, and efficacy of low frequency ventilation (LFV) during CPB in patients undergoing valvular surgery. Patients with severe mitral or aortic valve disease were randomized to either LFV or usual care. Primary outcomes included release of generic inflammatory and vascular biomarkers and the lung-specific biomarker sRAGE (soluble receptor for advance glycation end products) up to 24 hours postsurgery. Secondary outcomes included pulmonary function tests and 6-minute walking test up to 8 weeks postdischarge. Sixty-three patients were randomized (33 LFV versus 30 usual care). Mean age was 66.8 years and 30% were female. LFV was associated with changes of sRAGE (soluble receptor for advance glycation end products) levels (geometric mean ratio, 3.05; [95% CI, 1.13-8.24] 10 minutes post CPB, and 1.07 [95% CI, 0.64-1.79], 0.84 [95% CI, 0.55-1.27], 0.67 [95% CI, 0.42-1.07], and 0.62 [95% CI, 0.45-0.85] at 2, 6, 12, and 24 hours post CPB respectively). No changes were observed for any of the generic biomarkers. Respiratory index soon after surgery (mean difference, -0.61 [95% CI, -1.24 to 0.015] 10 minutes post end of CPB), forced expiratory volume after 1 second/forced vital capacity ratio (0.050 [95% CI, 0.007-0.093] at 6 to 8 weeks pos-surgery), Forced vital capacity alone (95% CI, -0.191 L [-0.394 to 0.012]) and 6-minute walking test score at discharge (63.2 m [95% CI, 12.9-113.6]) were better preserved in the LFV group. No other differences were noted. The use of LFV during CPB in patients undergoing valvular surgery was feasible and safe and was associated with changes in sRAGE levels along with better preserved lung function and walking performance. These observations warrant further investigation in larger future studies. URL: https://www.isrctn.com; Unique Identifier: ISRCTN75795633.

Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial.

Cardiovascular diseases (CVD) are a group of illnesses that include coronary heart disease, cerebrovascular disease, congenital heart disease and deep vein thrombosis. Major surgery is often chosen as the treatment of choice for CVD. The concept of fast-track rehabilitation after surgery appeared in the 1970s. Participation in these exercise-based prehabilitation programmes may decrease postoperative complications and length of hospital stay. The primary aim of the present study is to evaluate whether the implementation of an additional resistance training (RT) prehabilitation protocol within cardiac exercises based prehabilitation can reduce intensive care unit (ICU) length of stay, postoperative complications and hospital length of stay (LOS). A protocol of a prospective, parallel, randomised clinical trial includes 96 adult patients diagnosed with valvular pathology and who have been scheduled for surgery. The participants will be randomly assigned to two groups of 48. Control group will be treated with ventilatory and strengthening of respiratory muscles, and aerobic exercise. Experimental group, in addition, will be treated with RT of peripheral muscles. Both hospital stay and ICU stay will be assessed as main variables. Other secondary variables such as exercise capacity, quality of life and respiratory values will also be assessed. Quantitative variables will be analysed with a T-Test or ANOVA, or Mann Witney if the distribution is non-parametric. This will be the first controlled clinical study focused on adding strength exercise as an additional treatment during prehabilitation. The results of this study will focus on helping to improve rehabilitation and prehabilitation protocols, considering that it is essential to maintain pulmonary training, as well as the inclusion of peripheral exercises that help people with heart disease to be in a better physical condition in order to increase their participation and sense of quality of life.

Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

COMPARATIVE EVALUATION OF SEVOFLURANE AND ISOFLURANE IN FAST TRACK ANAESTHESIA FOR VALVULAR CARDIAC SURGERY: A RANDOMIZED STUDY

Objective: Contemporary valvular cardiac surgery has evolved with the adoption of expedited postoperative recovery, known as fast-tracking. This paradigm shift results from advancements in anaesthetic agents, surgical techniques, and myocardial protection strategies. Fast-track anaesthesia aims to reduce intensive care unit (ICU) stays and overall hospital length of stay (LOS), optimizing resource utilization. Cardioprotective properties of volatile anaesthetic agents, especially in mitigating ischemic myocardial damage, have garnered attention.
 Methods: A hospital-based, randomized, comparative study was conducted at the Department of Anaesthesiology, S. M. S Medical College, Jaipur. 70 undergoing valvular heart surgery under general anaesthesia, were randomly assigned to two groups: Group A (Sevoflurane) and Group B (Isoflurane). Inclusion criteria encompassed ASA grade II to IV patients aged 20 to 50 y, with a body weight of 30-65 kg, and willingness to provide written consent. Anaesthesia induction and maintenance involved the administration of Sevoflurane or Isoflurane based on group allocation. Hemodynamic parameters were recorded at various surgical stages.
 Results: Heart rate, systolic blood pressure, and cardiac output were statistically insignificant between groups at different surgical stages (p>0.05). Intraoperative variables demonstrated no significant differences, except for a transient decrease in systolic blood pressure post-induction in both groups.
 Conclusion: The study underscores the comparable efficacy of Sevoflurane and Isoflurane in valvular cardiac surgery, supported by similar hemodynamic profiles. Understanding the nuances of volatile anaesthetic agents is crucial for their optimal clinical application, considering challenges like beta-blocker usage and perioperative hyperglycemia.

Enterococcal endocarditis management and relapses.

Enterococcus faecalis is the third micro-organism causing endocarditis and is associated with a significant relapse rate. The objective of this study was to describe the management of patients with Enterococcus faecalis endocarditis (EE) and its implication for relapses. We conducted a monocentric, retrospective analysis of all patients hospitalized for EE including endocarditis or infection of cardiac implantable electronic device defined by the modified ESC 2015 Duke criteria in a referral centre in Paris, France. Between October 2016, and September 2022, 54 patients with EE were included, mostly men (n = 40, 74%) with a median age of 75 [68-80] years. A high risk for infective endocarditis (IE) was found in 42 patients (78%), including 14 (26%) previous histories of IE, and 32 (59%) histories of valvular cardiac surgery. The aortic valve was the most frequently affected (n = 36, 67%). Combination therapy was mainly amoxicillin-ceftriaxone during all the curative antibiotic therapy duration (n = 31, 57%). Surgery was indicated for 40 patients (74%), but only 27 (50%) were operated on, mainly due to their frailty. Among the 17 deaths (32%), six (11%) happened during the first hospitalization for EE. A suppressive antibiotic treatment was initiated in 15 (29%) patients, mostly because of not performing surgery. During the 6-year study period an EE relapse occurred in three (6%) patients. EE is a worrying disease associated with a high risk of relapse and significant mortality. Suppressive antibiotic therapy could be a key treatment to limit the occurrence of relapses.

Airway and Anaesthetic Management of Adult Patients with Mucopolysaccharidoses Undergoing Cardiac Surgery.

Background: Mucopolysaccharidoses (MPSs) are rare congenital lysosomal storage disorders due to a deficiency of enzymes metabolising glycosaminoglycans, leading to their accumulation in tissues. This multisystem disease often requires surgical intervention, including valvular cardiac surgery. Adult MPSs have complex airways making anaesthesia risky. Methods: We report novel three-dimensional (3D) modelling airway assessments and multidisciplinary peri-operative airway management. Results: Five MPS adults underwent cardiac surgery at the national MPS cardiac centre (type I = 4, type II = 1; ages 20, 24, 33, 35, 37 years; two males, three females). All had complex airway abnormalities. Assessments involved examination, nasendoscopy, imaging, functional studies, 3D reconstruction, virtual endoscopy, virtual reality and simulation using computerised, physical modelling. Awake oral fibre-optic intubation was achieved via airway conduit. Staged extubation was performed on the first post-operative day under laryngo-tracheoscopic guidance. The post-operative period involved chest physiotherapy and occupational therapy. All patients had safe intubation, ventilation and extubation. Four had good cardiac surgical outcomes, one (MPS type I; age 35 years) was inoperable due to endocarditis. None had post-operative airway complications. Conclusions: Expertise from cardiovascular-heart team, multidisciplinary airway management, use of novel techniques is vital. Traditional airway assessments are insufficient, so ENT input, radiology and computerised methods to assess and simulate the airway in 3D by collaboration with clinical engineering is essential.

Predictive Role of Preoperative Nutritional Status on Early Postoperative Outcomes in Different-Aged Patients Undergoing Heart Valve Surgery

The authors sought to elucidate the role and predictive effects of preoperative nutritional status on postoperative outcomes across different age groups undergoing heart valve surgery. A retrospective study with intergroup comparison, receiver operating characteristic curve analysis, and logistic regression analysis. A hospital affiliated with a medical university. Three thousand nine hundred five patients undergoing heart valve surgery between October 2016 and December 2020. None. Patients were categorized into 3 age subgroups: young (aged 18-44 years), middle-aged (aged 45-59 years), and older (aged ≥60 years) adults. The Nutritional Risk Index (NRI), Prognostic Nutritional Index, and Controlling Nutritional Status scores were evaluated. Young adults with an NRI <99 experienced a significantly higher rate of prolonged intensive care unit stay (28.3% v 4.1%, p < 0.001), with a relative risk of 4.58 (95% CI: 2.04-10.27). Similarly, young adults with an NRI <97 had a significantly increased occurrence of mortality within 30 days after surgery (6.3% v 0.2%, p < 0.001), with a relative risk of 41.11 (95% CI: 3.19-529.48). In patients who undergo heart valve surgery, early postoperative outcomes can be influenced by nutritional status before the surgery. In the young-adult group, NRI <99 and NRI <97 effectively could predict prolonged intensive care unit stay and 30-day mortality, respectively.

Effect of Retrograde Autologous Priming on Coagulation Assessed by Rotation Thromboelastometry in Patients Undergoing Valvular Cardiac Surgery

ObjectivesTo investigate the effect of retrograde autologous priming (RAP) on coagulation function using rotation thromboelastometry (ROTEM) in patients undergoing valvular heart surgery. DesignProspective, randomized, patient- and outcome assessor-blinded study. SettingSingle-center university hospital. ParticipantsPatients aged 20 years or more undergoing valvular heart surgery. Interventions104 patients were allocated to the RAP or control group (1:1 ratio). In the RAP group, the prime was displaced into the collection bag before bypass initiation. ROTEM was performed at the induction of anesthesia, at the beginning of rewarming, and after the reversal of heparinization. Allogeneic plasma products and platelet concentrates were transfused according to ROTEM-based algorithms. Measurements and Main ResultsAn average volume of 635 ± 114 mL was removed using RAP (from the 1,600 mL initial prime volume). The hematocrit 10 min after CPB was 24.7 ± 3.5% in the control group and 26.1 ± 4.1% in the RAP group (P=0.330). ROTEM including EXTEM, INTEM, and FIBTEM showed prolonged clotting time and decreased maximal clot firmness after CPB in both groups, without intergroup differences. The number of patients who received intraoperative erythrocyte (27% vs. 25%, control vs. RAP, P=0.823), fresh frozen plasma (14% vs. 8%, control vs. RAP, P=0.339), cryoprecipitate (21% vs. 12%, control vs. RAP, P=0.185), or platelet concentrate transfusion (19% vs. 12%, control vs. RAP, P=0.277) did not differ between the groups. ConclusionsCPB induced impaired coagulation function on ROTEM. However, RAP did not improve coagulation function when compared with conventional priming in patients undergoing valvular heart surgery.

Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis

Rationale & ObjectiveWe sought to compare outcomes of dialysis patients post cardiothoracic surgery based on dialysis modality (intermittent hemodialysis (HD) vs peritoneal dialysis (PD)). Study DesignRetrospective Analysis Setting & Participants590 patients with kidney failure receiving intermittent HD or PD undergoing Coronary Artery Bypass Graft (CABG) and/or valvular cardiac surgery at Cleveland Clinic. ExposurePeritoneal Dialysis versus Hemodialysis (Intermittent or Continuous) OutcomesOur primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay (LOS), days in the ICU, number of intra-operative blood transfusions, post-surgical pericardial effusion, and sternal wound infection, and the composite of 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection. Analytical ApproachChi-square, Fisher’s exact, Wilcoxon rank-sum, and t-tests, Kaplan-Meier survival, and plots. ResultsAmong 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. 30-day Kaplan-Meier survival was 95.7% (95% CI: 93.9, 97.5) for HD and 98.2% (95% CI: 94.7, 100) for PD (P=0.30). 75 (14.2%) HD and 1 (1.6%) PD had composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) (P=0.005). Out of 62 PD patients, 16 (26%) were converted to HD. LimitationsRetrospective analyses are prone to residual confounding. We lacked details about nutritional data. ICU length of stay was used as a surrogate for volume status control. Patients have been followed in a single health care system. The HD cohort outnumbers the PD cohort significantly. ConclusionsWhen compared to PD, HD does not appear to improve outcomes of patients with kidney failure undergoing cardiothoracic surgery. Patients receiving PD had a lower incidence of a composite outcome of 4 in-hospital events: (death, cardiac arrest, pericardial effusion, and sternal wound infections).

Protocol for the PORT study: short-term perioperative rehabilitation to improve outcomes in cardiac valvular surgery – a randomised control trial

IntroductionPerioperative rehabilitation (PORT) has shown a positive effect on patients undergoing cardiac surgery. However, there are minimal data on the impact of short-term PORT in cardiac surgery, which is associated...

Predictors of short-term survival in cardiac valvular surgery patients with intra-aortic balloon pump implantation.

Intro-aortic balloon pump (IABP) is widely used in cardiac surgery patients nowadays. This study aimed to analyze the predictor of short-term survival in cardiac valvular surgery patients with intra-aortic balloon pump implantation. This was a retrospective study and a total of 102 cardiac valvular surgery patients who received intra-aortic balloon pump implantation were consecutively included. We retrospectively collected the baseline characteristics and short-term outcomes. Baseline characteristics were compared between survivors with non-survivors, and logistic regression was performed to identify predictors for short-term mortality. Among all the patients, there were 71 (69.6%) patients successfully weaned from IABP and survived to discharge, the other 31 (30.4%) patients failed to wean from IABP and died within the first 30days after surgery. When compared with non-survivors, survivors had a higher proportion of males (62% vs 32.3%, p = 0.006), a lower rate of Atrial fibrillation (38% vs 62%, p < 0.03). After IABP implantation, vasoactive drug use was significantly lower in survivors compared with non-survivors, and survivors showed significant improvements in cardiac function and urine volume. Univariate and multivariate logistic regression analysis indicated that atrial fibrillation and combined use of continuous renal replacement therapy (CRRT) were significant independent predictors for short-term mortality. Timely implantation of IABP can improve patients' cardiac and renal function and reduce the dosage of vasoactive drugs. Atrial fibrillation and combined use of CRRT are independent predictors for short-term mortality in patients who underwent cardiac valvular surgery with IABP implantation.

Changes in ubiquitylated proteins in atrial fibrillation associated with heart valve disease: proteomics in human left appendage tissue

Abstract Background Posttranslational modifications have been shown to be associated with atrial fibrillation (AF). However, the relationship between ubiquitylated proteins and AF in patients with valvular heart disease remains unclear. Purpose To investigate the ubiquitination profiles in the left atrial appendage of patients with AF and valvular heart disease using LC-MS/MS analysis. Methods Eighteen subjects who underwent cardiac valvular surgery were included in this study, with nine in sinus rhythm and nine with AF. Ubiquitination profiles were analyzed using LC-MS/MS, and upregulated and downregulated ubiquitination sites were identified using quantification ratios. Results A total of 271 upregulated and 467 downregulated ubiquitination sites were identified in 162 and 156 proteins, respectively. The ubiquitylated proteins in AF were enriched in proteins associated with ribosomes, hypertrophic cardiomyopathy (HCM), glycolysis, and endocytosis. The study also revealed significant differences in the ubiquitination levels of ribosome-related and HCM-related proteins, including titin (TTN) and myosin heavy chain 6 (MYH6), between AF and sinus rhythm. Conclusions This study provides insights into the ubiquitination profiles in the left atrial appendage of patients with AF and valvular heart disease. Our findings suggest that ribosome-related and HCM-related proteins, especially TTN and MYH6, are differentially ubiquitinated in AF, which may provide a more feasible strategy against AF.Motif analysis of ubiquitylated proteinsUbiquitylated PPI network analysis

Abstract 17014: Differences in the Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients With Ischemic versus Non-Ischemic Cardiomyopathy

Background: Catheter ablation is an effective tool to reduce ventricular tachycardia (VT) burden. There is a lack of robust data studying the characteristics and outcomes of VT ablation in patients with ischemic (ICM) versus non-ischemic cardiomyopathy (NICM). Aims: The aim of this study was to assess the impact of ICM vs NICM on outcomes of VT ablation. Methods: A single-center, retrospective study of patients undergoing catheter ablation for VT was conducted. Results: A total of 168 patients, undergoing 200 VT ablation procedures, were included in this study. NICM group (112 procedures) was compared to ICM group (88 procedures). Patients in the ICM group were older (66.6 ± 13.4 vs 58.9 ± 14.4 years) and had higher rates of prior myocardial infarction (65.9% vs 3.6) and coronary artery bypass graft surgery (40.9% vs 1.8%). Overall, ICM group had more comorbidities like hypertension (80.7% vs 52.7%), diabetes mellitus (23.9% vs 12.5%), chronic kidney disease (45.5% vs 35.7%), stroke (17% vs 7.1%), and lower left ventricular ejection fraction (36.8 ± 13.2% vs 43.1 ± 14.7%). The ICM group had lower incidence of prior cardiac valvular surgery (9.1% vs 29.5%). The inducibility of VT (93% vs 93.5%; p= 1.0) and the number of different VT morphologies induced during the case (1.9 ± 1.5 vs 2.3 ± 2.5; p=0.19) was similar between the two groups. There was no acute mortality in either group. There was a non-significant trend towards greater VT recurrence in the NICM group (43.2% vs 33.3%, p= 0.19). However, patients with NICM had a lower VT-free survival as determined by Kaplan-Meier analysis (p=0.05) [Figure]. Long term mortality was higher in ICM group when compared to NICM group (18.2% vs 8.9%, p&lt;0.01). Conclusion: Patients undergoing VT ablation in the NICM group when compared to the ICM group were noted to be younger, had fewer comorbidities, and lower long-term mortality. However, they had significantly less VT-free survival, likely owing to more challenging substrate responsible for VT.

Changes of ubiquitylated proteins in atrial fibrillation associated with heart valve disease: proteomics in human left atrial appendage tissue.

Correlations between posttranslational modifications and atrial fibrillation (AF) have been demonstrated in recent studies. However, it is still unclear whether and how ubiquitylated proteins relate to AF in the left atrial appendage of patients with AF and valvular heart disease. Through LC-MS/MS analyses, we performed a study on tissues from eighteen subjects (9 with sinus rhythm and 9 with AF) who underwent cardiac valvular surgery. Specifically, we explored the ubiquitination profiles of left atrial appendage samples. In summary, after the quantification ratios for the upregulated and downregulated ubiquitination cutoff values were set at >1.5 and <1:1.5, respectively, a total of 271 sites in 162 proteins exhibiting upregulated ubiquitination and 467 sites in 156 proteins exhibiting downregulated ubiquitination were identified. The ubiquitylated proteins in the AF samples were enriched in proteins associated with ribosomes, hypertrophic cardiomyopathy (HCM), glycolysis, and endocytosis. Our findings can be used to clarify differences in the ubiquitination levels of ribosome-related and HCM-related proteins, especially titin (TTN) and myosin heavy chain 6 (MYH6), in patients with AF, and therefore, regulating ubiquitination may be a feasible strategy for AF.

Cardioprotective effect of propofol in cardioplegia compared to systemic propofol in heart valves surgery; a randomized controlled trial

BackgroundMyocardial protection is still a focus of ongoing research. Propofol is used widely during the induction of anaesthesia in cardiac surgery. So, this triggers us to investigate the cardioprotective effect of the propofol when added to the cardioplegia compared to systemic propofol by measuring the troponin T level.MethodsThis clinical randomized controlled trial was carried out on 150 patients operated for elective valvular heart surgery. Patients were assigned into three equal groups: Group 1: received propofol in the cardioplegia, Group 2: received propofol injection in the aortic line before and after the aortic cross-clamp, and Group 3 (control group): patients without propofol in the cardioplegia or aortic line. All patients were subjected to full medical histories, physical examinations, routine tests, and echocardiography. Cardiac troponin T was measured before surgery and 4 times postoperatively.ResultsIn group 1, there was a significant improvement in troponin T level at the last reading compared with the control group (mean ± SD. of group 1 was 246.4 ± 131.4, mean ± SD. of group 3 was 317.0 ± 117.9, p = 0.031), denoting propofol's cardioprotective effect when added as a cardioplegia additive. In group 2, there was a significant improvement of troponin T level at the last reading compared with the group 1 and control group (mean ± SD. of group 2 was 202.54 ± 156.03, mean ± SD. of group 3 was 317.0 ± 117.9, p < 0.001), denoting propofol's more cardioprotective effect when used systemically during cardiopulmonary bypass than when added as a cardioplegia additive.ConclusionsIn valvular cardiac surgery, propofol has an additional cardioprotective effect and a superior cardiac outcome when administered systematically during cardiopulmonary bypass rather than added to cardioplegia.Trial registrationPan African Clinical Trials Register PACTR201907764652028. Registered on 01 July 2019, retrospectively registered, https://pactr.samrc.ac.za/ TrialDisplay.aspx?TrialID = 5726.

Higher incidence of heart failure and atrial fibrillation in valvular heart disease post-COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Patients with cardiovascular diseases are at higher risk of Coronavirus disease 2019 (COVID-19) complications. The data if post-COVID-19 patients are more susceptible to postoperative cardiac surgery complications are scarce. There are limited pieces of information on the possible consequences for patients with severe valvular disease undergoing valvular cardiac surgery. The study aimed to assess the impact of COVID-19 on patients with severe valvular disease and its postoperative course and outcomes. Methods We retrospectively identified 34 severe valvular disease patients indicated for surgery that underwent cardiac valvular surgery post-COVID-19. Adverse cardiovascular events in post-COVID-19 (heart failure (HF) and paroxysmal atrial fibrillation (AF) were recorded. All patients underwent control echocardiography preoperatively to assess changes in ejection fraction (EF), right ventricular systolic pressure (RVSP), and diastolic filling (E/e’). The patients were also followed for the postoperative course and hospital outcomes. All these data were compared to a historical cohort of 94 non-COVID-19 patients. Results There were no differences in mean age in post-COVID 65.2±11.6 vs. non-COVID-19 group 63.9±11.7, p = 0.57 or sex 74.6% vs. 70.7% of males, p = 0.38 or BMI 28.9± 4.5 vs. 28.2 ± 3.9, p = 0.42, with borderline significance in Euroscore 3 ± 4 vs. 1.6 ± 1.8, p = 0.05. retrospectively. Post-COVID-19 patients had a significantly higher prevalence of symptomatic HF 43.3% vs. 21.4%, p = 0.03, and AF 37.1% vs. 17%, p = 0.02 on admission. There were no significant differences between post-COVID-19 and COVID-19 in EF 56.9 ± 10.2 vs. 53.5 ± 12.6, p = 0.2, RVSP 38.1 ± 13.1 vs. 44.9 ± 12.8, p = 0.1 or E/e’ 13.8 ± 4.4 vs. 56.9 ± 10.2, p = 0.9. There were no significant differences in postoperative outcomes when post-COVID-19 group was compared to the non-COVID-19 group, the incidence of pneumonia was 8.6 vs. 6.9, p = 0.7, sepsis 2.9 vs. 4.3, p = 0.58, stroke 0% vs. 6.4%, p = 0.14, acute kidney failure 2.9 vs. 1.1, p = 0.47, postoperative acute MI 2.9% vs. 0%, p = 0.1, and mortality 0% vs. 1.1%, p = 0.5, retrospectively. There was a significantly higher incidence of transfusion in the post-COVID-19 group 77.1% vs. 41.5%, p &amp;lt; 0.01. Hospital stay for post-COVID-19 patients was 8.8 ± 4.4, vs. 8.7 ± 4 days, p = 0.94, total hospital stay 13 ± 7.4, vs. 11.4 ± 4.5, p = 0.2 and ICU stay 31.4 ± 37.8, vs. 44.4 ± 32.4 hours, p = 0.13. Conclusions Patients with severe valvular heart disease after COVID-19 are prone to develop heart failure and atrial fibrillation. The post-COVID-19 period following cardiac surgery is not associated with increased postoperative complications.

Identification of risk factors for infection after mitral valve surgery through machine learning approaches.

Selecting features related to postoperative infection following cardiac surgery was highly valuable for effective intervention. We used machine learning methods to identify critical perioperative infection-related variables after mitral valve surgery and construct a prediction model. Participants comprised 1223 patients who underwent cardiac valvular surgery at eight large centers in China. The ninety-one demographic and perioperative parameters were collected. Random forest (RF) and least absolute shrinkage and selection operator (LASSO) techniques were used to identify postoperative infection-related variables; the Venn diagram determined overlapping variables. The following ML methods: random forest (RF), extreme gradient boosting (XGBoost), Support Vector Machine (SVM), Gradient Boosting Decision Tree (GBDT), AdaBoost, Naive Bayesian (NB), Logistic Regression (LogicR), Neural Networks (nnet) and artificial neural network (ANN) were developed to construct the models. We constructed receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) was calculated to evaluate model performance. We identified 47 and 35 variables with RF and LASSO, respectively. Twenty-one overlapping variables were finally selected for model construction: age, weight, hospital stay, total red blood cell (RBC) and total fresh frozen plasma (FFP) transfusions, New York Heart Association (NYHA) class, preoperative creatinine, left ventricular ejection fraction (LVEF), RBC count, platelet (PLT) count, prothrombin time, intraoperative autologous blood, total output, total input, aortic cross-clamp (ACC) time, postoperative white blood cell (WBC) count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), PLT count, hemoglobin (Hb), and LVEF. The prediction models for infection after mitral valve surgery were established based on these variables, and they all showed excellent discrimination performance in the test set (AUC > 0.79). Key features selected by machine learning methods can accurately predict infection after mitral valve surgery, guiding physicians in taking appropriate preventive measures and diminishing the infection risk.

Infective endocarditis and oral surgery input before cardiac surgery: time to prick the paradigm of pre-cardiac surgery assessments?

Purpose To review current practice regarding oral surgery input for patients awaiting cardiac valvular surgery and who are at risk of infective endocarditis (IE) in the context of the COVID-19 pandemic, and to stimulate debate around the indications for pre-operative oral surgery assessment. It also opens the way to developing a new research-based approach which is patient-centred, safe, effective and efficient.Methods A desk-top based patient review was undertaken between 27 March 2020 and 1 July 2022 to record the outcome of patients undergoing cardiac valvular surgery in Northern Ireland, following the revision of the referral guidelines for oral surgery intervention. Data were collected for all cardiac referrals to the oral surgery on-call service in the Royal Victoria Hospital, Belfast. Complications were recorded at two weeks, two months, and six months post-surgery, using Northern Ireland Electronic Care Records.Results In total, 67 cardiac patients were identified between 27 March 2020 and 1 July 2022: 65.7% of patients were male and had an average age of 68, while the female patients had an average age of 61. The mean interval of date of cardiology referral to surgery date was 9.7 working days, with 36% of patients referred within five days of the planned surgery date. Moreover, 39% had valvular surgery in combination with another type of cardiac surgery. No complications linked to dental aetiology were noted.Conclusions This paper raises questions about the advisability of oral surgery input before cardiac surgery for anything other than pain relief, management of acute dental sepsis, or IE whose source has been identified as an oral commensal. The COVID-19 pandemic has presented an opportunity to review current practice and open the way to developing a new approach which is patient-centred, safe, effective and efficient.

Prevalence and Risk Factors of Carotid Artery Stenosis (CAS) Among Cardiac Surgery Patients.

Cardiac disease and carotid atherosclerosis rates have increased in recent years. Carotid artery stenosis (CAS) has been recognized as a high-risk factor of perioperative stroke among cardiac surgery patients. Aims: The aims of the study are to identify the prevalence and common risk factors of CAS among patients undergoing cardiac surgery that include coronary artery bypass surgery or valvular cardiac surgery. This retrospective cross-sectional study was conducted in the radiology department at Medina Cardiac Center, Al Madinah Al-Munawara. The inclusion criteria for the study were patients aged ≥ 20 years who were scheduled for coronary artery bypass surgery or valvular cardiac surgery and had carotid duplex examination before surgery. A Philips X matrix IU22 linear-array ultrasound probe (Philips,Bothell, WA) was used to scan the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery(ECA), and vertebral artery. Results: Of the 261 patients in this study, 78.5% (n= 205) were male. The mean age of patients was 61.6 ± 11.3 years (median: 62.0; range: 55.5-68.0). The overall prevalence of CAS was 71% (n= 187): 52% (n= 136) with bilateral CAS and 19.5% (n= 51) with unilateral CAS. Age group was significantly associated with bilateral CAS and the severity of CAS (p= 0.001). Diabetes mellitus, hypertension and both diabetes mellitus and hypertension together were significantly associated with CAS status (p< 0.05, for all). A significantly higher proportion of smokers had a mild level of CAS on the left side compared to non-smokers (55.8% vs. 46.5%,p= 0.033). Gender and weight status were not linked to severity of CAS. This study shows a high prevalence of CAS among cardiac surgery patients. In addition, older age, diabetes mellitus, and hypertension were found to be major risk factors for CAS. Gender and weight status were not associated with CAS. Preoperative carotid duplex scan is a useful exam to identify CAS among cardiac surgery patients and, therefore,to predict and reduce postoperative neurological complications.