Journal of Cardiac Surgery最新文献

{"title":"Short- and Midterm Outcomes of Off- and On-Pump Coronary Artery Bypass in Patients with a Mean Age of 65 or More: Systematic Review and Meta-Analysis","authors":"Jake E. Trotman,&nbsp;Toluwalase F. Eboka,&nbsp;Neil A. Smart,&nbsp;Nicola King","doi":"10.1155/2024/3616580","DOIUrl":"https://doi.org/10.1155/2024/3616580","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Advancing age is a nonmodifiable risk factor for the development of coronary artery disease. Furthermore, patients &gt;65 years old are considered at high risk for coronary artery bypass grafting (CABG). The aim of this study was to investigate whether there were any differences in clinical outcomes for patients with a mean age ≥65 undergoing CABG on or off pump. <i>Methods</i>. Systematic searches were conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL). The key search terms used were “cardiopulmonary bypass” OR “On pump” AND “off pump” OR “beating heart” AND “coronary artery bypass grafting” OR “CABG” AND “age.” This was followed by a meta-analysis assessing the primary outcomes mortality, myocardial infarction, renal failure, and stroke in the short—(30 days) and midterm (12–44 months) and repeat revascularisation at midterm follow up. Secondary outcomes investigated included postoperative atrial fibrillation, number of units of blood transfused, ventilation time, length of intensive care unit stay, and length of hospital stay. <i>Results</i>. 14 studies involving 10,260 participants, 5,141 of whom had on-pump CABG and 5,119 of whom had off-pump CABG were identified. There was a significantly greater need for repeat revascularisation in the off-pump group (risk ratio 1.47, 95% confidence interval 1.07 to 2.01, <i>I</i>² = 0%, <i>p</i> = 0.02) at midterm follow up. The off-pump group also had a shorter hospital stay. All other comparisons were insignificant. <i>Conclusion</i>. A number of different factors contribute to whether the increased need for repeat revascularisation for off-pump patients is truly clinically significant. This requires further investigation in meta-analysis based on longer-term trials in patients with a mean age ≥65. Otherwise, the similarity in clinical outcomes for patients in this age group suggests the choice to carry out CABG on or off pump should continue to be at the surgeon’s discretion.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3616580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Donor Coronary Artery Disease on Recipient Outcomes in Heart Transplantation","authors":"Aakash Shah,&nbsp;Justin Robinson,&nbsp;Corbin E. Goerlich,&nbsp;Chetan Pasrija,&nbsp;Bartley P. Griffith","doi":"10.1155/2024/4957703","DOIUrl":"https://doi.org/10.1155/2024/4957703","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Efforts to expand the heart donor pool have included the use of extended criteria donors (e.g., advanced age or comorbid conditions). Another potential avenue is donor hearts with pre-existing coronary artery disease (CAD). <i>Methods</i>. A retrospective cohort study was performed using the Organ Procurement and Transplantation Network database between 10/1/1987 and 12/3/2020. Postoperative complications, graft failure, and survival were examined between recipients of donor hearts with abnormal (CAD donor) versus normal (non-CAD donor) coronary angiogram. Analysis was performed in unmatched cohorts as well as after propensity score matching. <i>Results</i>. A total of 12,230 heart transplant recipients were identified, of which 940 (7.6%) had an abnormal donor coronary angiogram. There were no differences between CAD and non-CAD donor groups in acute rejection, stroke, or dialysis prior to discharge or treatment for rejection &lt;1 year. However, the CAD donor group had a greater pacemaker incidence (5.2% vs. 3.6%, <i>P</i> = 0.02). After matching, 785 patients were in each group and there were no differences in perioperative outcomes or treatment for rejection &lt;1 year. There was no difference in 10-year freedom from graft failure (53.1% vs. 54.6%, log rank = 1.03, and <i>P</i> = 0.31) or cumulative survival (54.7% vs. 55.8%, log rank = 0.63, and <i>P</i> = 0.43) between the matched CAD and non-CAD donor groups. <i>Conclusion</i>. The presence of CAD may not be a contraindication to transplantation. Carefully selected donor hearts with CAD may have equivalent postoperative and long-term outcomes to donor hearts without CAD. Further study in this area may expand the pool of donors.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/4957703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141967781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Branch-First Technique of Aortic Arch Replacement: A Systematic Review and Meta-Analysis","authors":"Lubna Bakr,&nbsp;Tharushi Wijesena,&nbsp;Ravi De Silva,&nbsp;Jason M. Ali","doi":"10.1155/2024/1869656","DOIUrl":"https://doi.org/10.1155/2024/1869656","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. Aortic arch replacement is a major surgical intervention. This meta-analysis aims to combine the international literature on the branch-first technique to describe its outcomes and offer a comparison to the standard techniques. <i>Methods</i>. PubMed and Cochrane were searched for studies on the branch-first technique in aortic arch surgery including those comparing this technique with the conventional ones. Mortality, neurological complications, bleeding, and renal replacement therapy were the major endpoints of interest. Subgroup analysis was performed for both single- and double-armed studies. Odds ratios with 95% confidence interval were used as summary estimates. The random-effects model was used for all outcomes. <i>Results</i>. Ten studies from three countries with a total of 498 patients were included. Proportional analysis of the branch-first technique estimated mortality of (3%, 95% CI [0.02–0.05]), neurological complications of (8%, 95% CI [0.03–0.13]), re-exploration for bleeding of (9%, 95% CI [0.05–0.13]), and renal replacement therapy of (9%, 95% CI [0.05–0.12]). This meta-analysis revealed no significant differences between the branch-first technique and the conventional technique in mortality (5% vs. 15%, OR = 0.32, 95% CI [0.08–1.18], <i>p</i> = 0.09, <i>I</i>2 = 40%), neurological complications (10% vs. 16%, OR = 0.53, 95% CI [0.24–1.21], <i>p</i> = 0.13, <i>I</i>2 = 0%), or renal replacement therapy (12% vs. 14%, OR = 0.72, 95% CI [0.33–1.59], <i>p</i> = 0.41, <i>I</i>2 = 0%). <i>Conclusions</i>. Branch-first technique provides a promising alternative approach in aortic arch surgery with no different surgical risks and potentially reduced operative complexity. Randomised controlled trials are needed to further investigate the safety and advantages of this technique.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/1869656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141966880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Serum CIRP in Acute Kidney Injury after Total Aortic Arch Replacement","authors":"Ke Chen,&nbsp;Dongxu Wang,&nbsp;Minhua Fang,&nbsp;Pengyu Wang,&nbsp;Peng Hou,&nbsp;Yu Liu,&nbsp;Liming Yu,&nbsp;Zijun Zhou,&nbsp;Juan Gao,&nbsp;Yong Zhang","doi":"10.1155/2024/4814978","DOIUrl":"https://doi.org/10.1155/2024/4814978","url":null,"abstract":"<div>\u0000 <p><i>Objectives</i>. To investigate the predictive value of serum cold-inducible RNA-binding protein (CIRP) and postoperative acute kidney injury (AKI) after total aortic arch replacement. <i>Methods</i>. Eighty-six patients with acute Stanford type A aortic dissection (ATAAD) admitted to hospital from October 2019 to February 2021 were retrospectively selected as the study subjects. All patients underwent total aortic arch replacement under moderate hypothermic circulatory arrest (MHCA) with selective antegrade cerebral perfusion (SACP). Detection of the level of serum CIRP after admission and perioperative clinical data of patients were collected and analyzed. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to stage renal function. Patients were divided into a non-AKI-3 group (<i>n</i> = 70) and an AKI-3 group (<i>n</i> = 16) according to the stage of postoperative renal function. The risk factors for postoperative AKI KDIGO stage 3 were analyzed by a multivariate logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy. <i>Results</i>. In 86 patients, postoperative AKI-3 stage accounted for 18.6% (16/86). Compared with the non-AKI-3 group, the AKI-3 group had a higher preoperative BMI index, C-reactive protein, and CIRP level; a longer intraoperative cooling time, cardiopulmonary bypass time, and aortic cross-clamping time; and a higher intraoperative coronary artery bypass ratio (all <i>P</i> &lt; 0.05). Multivariate logistic regression results showed that CIRP (OR = 1.001, 95% CI: 1.000–1.002, <i>P</i> = 0.012) was an independent risk factor for postoperative AKI KDIGO stage 3. <i>Conclusion</i>. The serum CIRP is associated with postoperative acute kidney injury after total aortic arch replacement in ATAAD patients and may serve as a predictive indicator for early detection and intervention to improve the prognosis.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/4814978","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141966632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Thoracic Aortic Graft Infection: A Comprehensive Review of Diagnosis and Treatment Options with a Management Strategy Algorithm","authors":"Katie E. O’ Sullivan,&nbsp;Laura Casey,&nbsp;Pushpinder Sidhu,&nbsp;Alastair Graham,&nbsp;Christopher Austin,&nbsp;Michael Hunter","doi":"10.1155/2024/2821237","DOIUrl":"https://doi.org/10.1155/2024/2821237","url":null,"abstract":"<div>\u0000 <p>As surveillance and the diagnosis of pathology grow, increasing numbers of patients are undergoing major aortic interventions globally. As a result, surgeons and physicians will encounter thoracic aortic graft infections with increasing frequency. These infections are extremely challenging, high-risk problems to deal with. This article provides a comprehensive overview of the pathogenesis, diagnosis, and management both medical and surgical of this high-risk complication. We provide proposed diagnostic criteria and suggested algorithm for the management of this important group of patients.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2821237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141968377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donation after Circulatory Death Does Not Worsen Survival after Heart Transplant for Patients with a Durable Left Ventricular Assist Device","authors":"Erin M. Schumer,&nbsp;Kukbin Choi,&nbsp;Doug A. Gouchoe,&nbsp;Divyaam Satija,&nbsp;Andrew N. Rosenbaum,&nbsp;Sudhir Kushwaha,&nbsp;Atta Behfar,&nbsp;Mauricio A. Villavicencio,&nbsp;Philip J. Spencer","doi":"10.1155/2024/5578819","DOIUrl":"https://doi.org/10.1155/2024/5578819","url":null,"abstract":"<div>\u0000 <p>Heart transplantation from donors after circulatory death (DCD) has demonstrated increased primary graft dysfunction. Durable mechanical circulatory (MCS) recipients have slightly higher perioperative risk but excellent long-term survival. We sought to determine if the use of DCD donors impacted outcomes for patients with MCS. The United Network for Organ Sharing database was queried from 2019 to 2023 for all adult recipients who underwent heart transplant with a durable left ventricular assist device (LVAD). Outcomes were compared for recipients of DBD and DCD donors. Kaplan–Meier analysis was used to compare survival. A total of 3449 recipients underwent heart transplant who met the study criteria. The number of DCD and DBD donors was 288 (8.4%) and 3161 (92.6%). There was no difference in the length of stay, postoperative dialysis, pacemaker, stroke rate, or in-hospital mortality. Recipients with durable LVADs of DCD donors had a higher rate of treatment for rejection within the first year. Overall survival was not different between DBD and DCD donors (<i>p</i> = 0.153). Postoperative and survival outcomes for DCD donation remain similar between patients with and without MCS. These findings may help decrease waitlist time for patients with durable MCS.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5578819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in Advanced Coronary Artery Bypass Surgery in the United Kingdom","authors":"Jeremy Chan,&nbsp;Shubhra Sinha,&nbsp;Daniel P. Fudulu,&nbsp;Tim Dong,&nbsp;Pradeep Narayan,&nbsp;Gianni D. Angelini","doi":"10.1155/2024/2140060","DOIUrl":"https://doi.org/10.1155/2024/2140060","url":null,"abstract":"<div>\u0000 <p><i>Objective</i>. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off-pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. <i>Methods</i>. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. <i>Results</i>. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (<i>n</i> = 79759/327025). Trainees performed 27.10% (63934/235920) on-pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, <i>p</i> &lt; 0.001) and aortic cross-clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, <i>p</i> &lt; 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, <i>p</i> &lt; 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, <i>p</i> &lt; 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in-hospital mortality (1.0% vs 0.9%, <i>p</i> = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), <i>p</i> = 0.33), return to theatre (4.2% vs 4.47%, <i>p</i> = 0.089), postoperative renal dialysis (1.4% vs 1.1%, <i>p</i> = 0.076), and deep sternal wound infection (0.6% vs 0.6%, <i>p</i> = 0.87). Trainees performed 17.17% (8661/41778) off-pump cases. Consultants had a higher in-hospital mortality (1.2% vs 0.9%, <i>p</i> = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), <i>p</i> = 0.27), return to theatre (3.8% vs 3.9%, <i>p</i> = 0.69), postoperative renal dialysis (2.0% vs 1.6%, <i>p</i> = 0.059), and deep sternal wound infection (1.0% vs 0.8%, <i>p</i> = 0.66). <i>Conclusion</i>. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients’ safety.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2140060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141430313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer-Term Outcomes of the Yacoub versus Bentall Procedure in a Nationwide Propensity-Matched Comparison","authors":"Jan Gofus,&nbsp;Jiri Jarkovsky,&nbsp;Anna Klechova,&nbsp;Jaroslav Hlubocky,&nbsp;Stepan Cerny,&nbsp;Martin Urban,&nbsp;Pavel Zacek,&nbsp;Jan Vojacek","doi":"10.1155/2024/7595067","DOIUrl":"https://doi.org/10.1155/2024/7595067","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Aortic root replacement with a composite mechanical valve graft (Bentall procedure) has been a recommended strategy in patients with aortic root aneurysm with or without aortic regurgitation. Aortic root remodeling (Yacoub procedure) has emerged as a valve-sparing alternative although there is only scarce multicenter evidence. The aim of our study was to provide nationwide comparison of these two strategies. <i>Methods</i>. This was a retrospective study of data from national registry of cardiac surgery. Using propensity-score matching, we compared all the patients undergoing the Bentall procedure in the Czech Republic between 2010 and 2021 with patients after the Yacoub procedure from four experienced centers. <i>Results</i>. During the study period, 199 patients underwent Yacoub and 526 had Bentall procedure. Of those, 166 pairs were selected and compared. There was no significant difference in perioperative outcomes and in mortality (<i>p</i> = 0.96) over the follow-up of 5.7 vs. 6.4 years. The Bentall procedure was associated with a higher risk of major bleeding or thromboembolism (<i>p</i> &lt; 0.001), and the Yacoub procedure led to a higher risk of rehospitalizations for valve failure (<i>p</i> = 0.01). <i>Conclusions</i>. In a nationwide propensity-matched study, Bentall and Yacoub procedures yield similar longer-term survival. Yacoub offers better freedom from thromboembolism or bleeding at the cost of higher risk of valve failure.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/7595067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microaxial Flow Pumps for Cardiogenic Shock: Effects on Hemodynamics, Hemolysis, and End-Organ Recovery","authors":"Lauren E. Parker,&nbsp;Lillian Kang,&nbsp;Carmelo A. Milano,&nbsp;Alejandro A. Lobo,&nbsp;Julie W. Doberne,&nbsp;Muath Bishawi,&nbsp;Christopher. W. Jensen,&nbsp;Chetan B. Patel,&nbsp;Adam D. DeVore,&nbsp;Stuart D. Russell,&nbsp;Jason N. Katz,&nbsp;Jacob N. Schroder","doi":"10.1155/2024/3584383","DOIUrl":"https://doi.org/10.1155/2024/3584383","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. The Impella 5.5 offers a less invasive transvalvular approach to left ventricular mechanical support. End-organ recovery and hemolysis have been well-studied with durable left ventricular assist devices but effects of Impella 5.5 on these parameters are less well described. <i>Methods</i>. All Impella 5.5 recipients between August 2020 and June 2023 were reviewed from a single institution. Hemodynamics and laboratory values were compared between preimplant and prior to device removal. Hemolysis was defined as postoperative lactate dehydrogenase &gt;1000 IU/L with concurrent plasma-free hemoglobin &gt;50 mg/dL. Paired Wilcoxon tests compared the median of differences between preimplant and pre-explant values. <i>Results</i>. We studied 127 consecutive implants of the Impella 5.5. Thirty-one patients had concomitant VA-ECMO, and one received Impella 5.5 after durable LVAD explant; these cases were excluded. Our final cohort included 95 patients, with an average age of 55.29 ± 14.5 years. Median implant duration was 11 days (IQR:6–16 days). To avoid confounding hemodynamic factors, we restricted hemodynamic analysis to the 37 patients who received isolated Impella 5.5, excluding those with prior IABP, Impella CP, acute MI, or prior cardiac surgery. These patients experienced improvements from baseline in pulmonary vascular resistance (−77.03 dynes/sec/cm⁻⁵, <i>p</i> &lt; 0.01) and wedge pressure (−6.5 mmHg, <i>p</i> &lt; 0.01). Furthermore, cardiac index improved from baseline (+1.3, <i>p</i> &lt; 0.01). In the total cohort (<i>n</i> = 95), pre-explant creatinine (−0.2 mg/dL, <i>p</i> &lt; 0.01) and ALT (−9.0 mg/dL, <i>p</i> &lt; 0.01) decreased relative to values before the implant. Twenty-three (24%) met criteria for hemolysis; however, none underwent device removal for clinically significant hemolysis. Takeback was required in 25 patients, 22 of which were for axillary hematoma. <i>Conclusions</i>. Impella 5.5 support acutely improved markers of end-organ function and hemodynamics, including PVR.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3584383","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141264579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Propafenone on Postoperative Atrial Fibrillation in Adult Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials","authors":"Jin-He Deng,&nbsp;Jing Li,&nbsp;Fan-Rong He,&nbsp;Yun-Tai Yao,&nbsp; The Evidence in Cardiovascular Anesthesia (EICA) Group","doi":"10.1155/2024/5579727","DOIUrl":"10.1155/2024/5579727","url":null,"abstract":"<div>\u0000 <p><i>Background</i>. Previous research has only conducted a restricted amount of investigations on the effectiveness of propafenone in preventing and treating of atrial fibrillation (AF) after cardiac surgery. Hence, a comprehensive evaluation and meta-analysis were performed to evaluate the effectiveness and safety of propafenone in individuals undergoing cardiac surgery for postoperative atrial fibrillation (POAF). <i>Methods</i>. A meta-analysis of randomized controlled trials was conducted. Until September 15th, 2023, various databases were searched. The main focal points consisted of the presence of POAF, transition from AF to sinus rhythm, and reappearance of AF. The odds ratios (ORs) for treatment effects on dichotomous variables were calculated. <i>Results</i>. The analysis of data included 9 controlled trials that were randomized and had 1014 patients. The findings indicated that propafenone has a significant impact on reducing the occurrence of POAF in adult patients who undergo cardiac surgery (OR, 0.52; 95% CI: 0.30, 0.89; <i>P</i> = 0.02). In addition, it was observed that propafenone significantly increase the rate of conversion to sinus rhythm from AF within 20 min (OR, 5.39; 95% CI: 2.25, 12.91; <i>P</i> = 0.0002) and 1 hour (OR, 2.89; 95% CI: 1.50, 5.57; <i>P</i> = 0.002) after administration. Surprisingly, the administration of propafenone treatment did not have a significant impact on the rate of conversion to sinus rhythm from AF within 24 hours (OR, 0.63; 95% CI: 0.38, 1.04; <i>P</i> = 0.07) after administration. <i>Conclusions</i>. The present study suggests that the postoperative administration of propafenone to adult cardiac surgery patients is both safe and effective for preventing and treating POAF.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/5579727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141021694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}