Cardiovascular diagnosis and therapy最新文献

{"title":"Sirolimus coated balloon for the treatment of femoropopliteal lesions: the new kid on the block is getting older 'step by step'.","authors":"Konstantinos P Donas, Christos Rammos, Grigorios Korosoglou","doi":"10.21037/cdt-24-406","DOIUrl":"10.21037/cdt-24-406","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1015-1019"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting quality of animal research in journals that published the ARRIVE 1.0 or ARRIVE 2.0 guidelines: a cross-sectional analysis of 943 studies.","authors":"Yao Lin, Fanghui Yang, Binghan Shang, John E Speich, Yu-Jui Yvonne Wan, Hiroki Hashida, Tobias Braun, Ali Sadoughi, Thomas Puehler, Tom F Lue, Kaiping Zhang","doi":"10.21037/cdt-24-413","DOIUrl":"10.21037/cdt-24-413","url":null,"abstract":"<p><strong>Background: </strong>The adherence to the Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines across the journals that initially published the guidelines and if adherence has improved since the guidelines update, remains unknown. We aimed to quantify the level of adherence and analyze factors that might influence reporting quality among these journals.</p><p><strong>Methods: </strong>This cross-sectional study retrospectively analyzed interventional animal experiments published in journals that released ARRIVE 1.0 and 2.0 guidelines in three periods: 5 years before (Pre-ARRIVE 1.0) and after (Post-ARRIVE 1.0) the publication of ARRIVE 1.0, and 1 year after the publication of ARRIVE 2.0 (Post-ARRIVE 2.0). Reviewers independently assessed adherence to the ARRIVE guidelines. Basic information and potential influencing factors were extracted. Adherence data were presented as frequency (percentages). Statistical factors influencing reporting quality were evaluated using the Chi-square test or Fisher's exact test.</p><p><strong>Results: </strong>215, 330, and 398 experiments were included during Pre-ARRIVE 1.0, Post-ARRIVE 1.0 and Post-ARRIVE 2.0 periods, respectively. None of the included 943 studies reported all 38 subitems, showing only 0%, 0%, and 0.25% studies had an \"excellent\" reporting quality across the three periods. The overall reporting quality was significantly improved among Pre-ARRIVE 1.0, Post-ARRIVE 1.0 and Post-ARRIVE 2.0 (P<0.001). The rate of studies with \"average\" reporting quality increased sequentially from 53.95% to 73.94% and then to 90.20%, and those with \"poor\" reporting quality decreased sequentially from 46.05% to 26.06% and then to 9.55% across the three periods. Specifically, 15 out of 38 (39.5%) subitems and 11 out of 27 (40.7%) similar and comparable subitems demonstrated a significant higher percentage of \"fully reported\" in Post-ARRIVE 1.0 compared to Pre-ARRIVE 1.0 and in Post-ARRIVE 2.0 compared to Post-ARRIVE 1.0, respectively (P<0.05). Country and journal indexing did not significantly affect reporting quality (both P>0.05). However, significant differences in reporting quality were found among the mandatory adherence to the ARRIVE guidelines in the author's instructions and reference to ARRIVE in the manuscript (both P<0.001).</p><p><strong>Conclusions: </strong>In the journals that initially published the ARRIVE guidelines, compliance with the guidelines still has room for improvement, though it has increased sequentially since introducing the guidelines. Implementing mandatory adherence requirements in the author's instructions and explicitly recognizing adherence to ARRIVE in articles could enhance the reporting quality of interventional animal experiments.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1070-1082"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus-coated balloons for peripheral arterial disease: walking free into the future of endovascular treatment.","authors":"Riccardo M Fumagalli, Stefano Barco","doi":"10.21037/cdt-24-484","DOIUrl":"10.21037/cdt-24-484","url":null,"abstract":"","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"987-990"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interlinking pathways: a narrative review on the role of IL-6 in cancer and atherosclerosis.","authors":"Riccardo Cau, Luca Saba","doi":"10.21037/cdt-24-344","DOIUrl":"10.21037/cdt-24-344","url":null,"abstract":"<p><strong>Background and objective: </strong>Interleukin-6 (IL-6) plays multifaceted roles in cancer and atherosclerosis. Initially recognized for its role in immune response and inflammation, IL-6 promotes tumor progression via the JAK-STAT and MAP kinase pathways and is associated with poor cancer prognoses. In atherosclerosis, IL-6 contributes to endothelial dysfunction and plaque formation. This review highlights the shared inflammatory mechanisms of IL-6 in both diseases and explores the regulatory dynamics of IL-6 signaling, including gene polymorphisms and epigenetic modifications.</p><p><strong>Methods: </strong>Google Scholar, Scopus, and PubMed were searched for English-language articles on IL-6 and those reporting shared pathogenic mechanisms of IL-6 in cancer and atherosclerosis from their inception through June 2024.</p><p><strong>Key content and findings: </strong>The investigation into IL-6's mechanisms in cancer and atherosclerosis reveals the intricate and interconnected nature of inflammatory processes in chronic diseases. The role of IL-6 in both conditions underscores its centrality in disease pathology, particularly through its involvement in inflammation, immune modulation, and cellular proliferation. This commonality highlights IL-6 as a key player linking these seemingly distinct diseases.</p><p><strong>Conclusions: </strong>Given the shared pathogenic mechanism of IL-6 in cancer and atherosclerosis, this narrative review concludes by emphasizing the therapeutic potential of modulating IL-6 in treating both cancer and atherosclerosis. It advocates for personalized treatment strategies that combine targeted therapies with lifestyle modifications. This holistic approach is considered crucial for effective disease management, given the diverse and complex roles IL-6 plays in these widespread conditions.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 6","pages":"1186-1201"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L-shaped association between gamma-glutamyl transferase-to-albumin ratio and dabigatran-related bleeding in non-valvular atrial fibrillation patients: a multicenter cohort study.","authors":"Chao Yu, Tao Wang, Lingjuan Zhu, Wei Zhou, Huihui Bao, Xiaoshu Cheng","doi":"10.21037/cdt-24-258","DOIUrl":"https://doi.org/10.21037/cdt-24-258","url":null,"abstract":"<p><strong>Background: </strong>The correlation between the gamma-glutamyl transferase-to-albumin ratio (GAR) and the risk of bleeding in patients with non-valvular atrial fibrillation (NVAF) undergoing treatment with the dabigatran anticoagulant is poorly understood. This study aims to explore whether GAR is associated with bleeding events among patients with NVAF receiving dabigatran anticoagulant therapy.</p><p><strong>Methods: </strong>We conducted a multicenter, observational cohort study in 12 Chinese hospitals from six provinces, including Beijing, Shanghai and Guangzhou, to evaluate the effectiveness and safety of dabigatran (110 mg) treatment in NVAF patients who were consecutively enrolled during February 2015 and December 2017. All patients had completed a 3-month follow-up period. The baseline variable of interest was the GAR, and the outcome variable was the occurrence of bleeding events. Both univariate and multivariate Cox proportional hazard models were used to evaluate the relationship between GAR and bleeding outcome.</p><p><strong>Results: </strong>This prospective cohort study included a total of 834 patients (mean age 65.6±11.1 years; 56.8% male). Overall, 82 subjects experienced bleeding. The patients were categorized based on the tertiles of the GAR. Participants in tertile 2 (0.59-1.03) [hazard ratio (HR): 0.28; 95% confidence interval (CI): 0.14-0.55; P<0.001] and tertile 3 (≥1.04) (HR: 0.47; 95% CI: 0.25-0.89; P=0.02) exhibited a lower rate of bleeding compared to the reference group (T1: ≤0.58). Multivariable models with restricted cubic splines demonstrated a nonlinear relationship between GAR and bleeding outcome, with a GAR inflection point of 0.68. The HR (95% CI) was 0.05 (0.01-0.31) (P=0.002) for GAR values <0.68 and 0.96 (0.70-1.31) (P=0.78) for GAR values ≥0.68. Moreover, the correlation between decreased GAR and an increase in bleeding events remained consistent across various subgroups.</p><p><strong>Conclusions: </strong>GAR is a prevalent, independent predictor of dabigatran-related bleeding in NVAF patients. Moreover, a significant L-shaped association between GAR and bleeding events has been observed.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"848-858"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary mitral regurgitation surgical management: a narrative review.","authors":"Sarah R Eapen, Mina H Zaky, Megan P Kostibas, Michael P Robich","doi":"10.21037/cdt-24-6","DOIUrl":"https://doi.org/10.21037/cdt-24-6","url":null,"abstract":"<p><strong>Background and objective: </strong>The most common valvular heart disease in the US is moderate to severe mitral regurgitation (MR). Function MR or secondary MR comprises many of these cases. Moderate and severe secondary MR are independently associated with increased all-cause mortality and rehospitalization for heart failure. Both ischemic and nonischemic cardiomyopathy can cause secondary MR via similar pathophysiology that leads to inadequate valve leaflets coaptation. The management of secondary MR is complex. The optimal treatment strategy for secondary MR remains controversial, reflected in the vast array of treatment options and the complexity of therapeutic decision-making. Several surgical mitral valve repair techniques have been described in the literature. Many of these aims to facilitate adequate valve leaflet coaptation. In this review, the pathophysiology of MR is described with a focus on evaluating and managing secondary MR.</p><p><strong>Methods: </strong>A literature review was performed using PubMed and Google Scholar. Clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews were considered from January 1, 1995 through December 31, 2022. Articles published in languages other than English with limited text availability were excluded.</p><p><strong>Key content and findings: </strong>Optimal therapeutic approach in severe secondary MR is complex and several patient factor should be considered. We provide a framework for the surgical management of secondary MR based on echocardiographic parameters, the presence of ischemia, and myocardial viability.</p><p><strong>Conclusions: </strong>Further study is needed to guide the selection of patients most likely to benefit from mitral valve repair or replacement in the setting of secondary MR.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"958-973"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary hypertension in adults with congenital heart defects (ACHDs) in light of the 2022 ESC PAH guidelines-part II: supportive therapy, special situations (pregnancy, contraception, non-cardiac surgery), targeted pharmacotherapy, organ transplantation, special management (shunt lesion, left ventricular disease, univentricular hearts), interventions, intensive care, ACHD follow-up, future perspective.","authors":"Harald Kaemmerer, Gerhard Paul Diller, Ingo Dähnert, Stephan Achenbach, Christina A Eichstaedt, Andreas Eicken, Annika Freiberger, Sebastian Freilinger, Ralf Geiger, Matthias Gorenflo, Ekkehard Grünig, Alfred Hager, Michael Huntgeburth, Ann-Sophie Kaemmerer-Suleiman, Rainer Kozlik-Feldmann, Astrid E Lammers, Nicole Nagdyman, Sebastian Michel, Kai Helge Schmidt, Mathieu Suleiman, Anselm Uebing, Fabian von Scheidt, Ulrike Herberg, Christian Apitz","doi":"10.21037/cdt-24-167","DOIUrl":"https://doi.org/10.21037/cdt-24-167","url":null,"abstract":"<p><p>The number of adults with congenital heart defects (ACHDs) is steadily increasing and is about 360,000 in Germany. Congenital heart defect (CHD) is often associated with pulmonary hypertension (PH), which sometimes develops early in untreated CHD. Despite timely treatment of CHD, PH not infrequently persists, redevelops in older age, and is associated with significant morbidity and mortality. The revised European Society of Cardiology (ESC)/European Respiratory Society (ERS) 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of \"adults with congenital heart defects\" is treated only relatively superficially in this context. After the first part commenting on a broad range of topics like definition, epidemiology, classification, diagnostics, genetics, risk stratification and follow-up, and gender aspects, the second part focuses on supportive therapy, special situations (pregnancy, contraception, non-cardiac surgery), targeted pharmacotherapy, organ transplantation, special management [shunt lesion, left ventricular (LV) disease, univentricular hearts], interventions, intensive care, ACHD follow-up, and future perspective. In the present article, therefore, this topic is commented on from the perspective of congenital cardiology. By examining these aspects in detail, this article aims to fill the gaps in the existing guidelines and provide a more thorough understanding from the perspective of congenital cardiology.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"921-934"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence machine learning based evaluation of elevated left ventricular end-diastolic pressure: a Cleveland Clinic cohort study.","authors":"Bo Xu, Michelle Z Fang, Yadi Zhou, Krishna Sanaka, Lars G Svensson, Richard A Grimm, Brian P Griffin, Zoran B Popovic, Feixiong Cheng","doi":"10.21037/cdt-24-128","DOIUrl":"https://doi.org/10.21037/cdt-24-128","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular end-diastolic pressure (LVEDP) is a key indicator of cardiac health. The gold-standard method of measuring LVEDP is invasive intra-cardiac catheterization. Echocardiography is used for non-invasive estimation of left ventricular (LV) filling pressures; however, correlation with invasive LVEDP is variable. We sought to use machine learning (ML) algorithms to predict elevated LVEDP (>20 mmHg) using clinical, echocardiographic, and biomarker parameters.</p><p><strong>Methods: </strong>We identified a cohort of 460 consecutive patients from the Cleveland Clinic, without atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography within 24 hours of elective heart catheterization between January 2008 and October 2010. We included patients' clinical (e.g., heart rate), echocardiographic (e.g., E/e'), and biomarker [e.g., N-terminal brain natriuretic peptide (NT-proBNP)] profiles. We fit logistic regression (LR), random forest (RF), gradient boosting (GB), support vector machine (SVM), and K-nearest neighbors (KNN) algorithms in a 20-iteration train-validate-test workflow and measured performance using average area under the receiver operating characteristic curve (AUROC). We also predicted elevated tau (>45 ms), the gold-standard parameter for LV diastolic dysfunction, and performed multi-class classification of the patients' cardiac conditions. For each outcome, LR weights were used to identify clinically relevant variables.</p><p><strong>Results: </strong>ML algorithms predicted elevated LVEDP (>20 mmHg) with good performance [AUROC =0.761, 95% confidence interval (CI): 0.725-0.796]. ML models showed excellent performance predicting elevated tau (>45 ms) (AUROC =0.832, 95% CI: 0.700-0.964) and classifying cardiac conditions (AUROC =0.757-0.975). We identified several clinical variables [e.g., diastolic blood pressure, body mass index (BMI), heart rate, left atrial volume, mitral valve deceleration time, and NT-proBNP] relevant for LVEDP prediction.</p><p><strong>Conclusions: </strong>Our study shows ML approaches can robustly predict elevated LVEDP and tau. ML may assist in the clinical interpretation of echocardiographic data.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"788-797"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between daytime napping, sleep duration, and depression and 15 cardiovascular diseases: a Mendelian randomization study.","authors":"Yilin Li, Parveen K Garg, Jing Wu","doi":"10.21037/cdt-24-313","DOIUrl":"https://doi.org/10.21037/cdt-24-313","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies have documented the effects of daytime napping, sleep duration, and depression on cardiovascular diseases (CVDs). However, the evidence has been gleaned from observational studies that might be riddled with confounding variables and the possibility of reverse causation bias. Therefore, the present study employed a Mendelian randomization (MR) methodology to meticulously explore the relationships between daytime napping, sleep duration, and depression, and the risk profiles of CVDs.</p><p><strong>Methods: </strong>Genome-wide significant genetic variants associated with daytime napping, sleep duration, and depression were used as the instrumental variables (IVs). Data on the genetic correlations between these IVs and 15 CVDs were derived from the United Kingdom (UK) Biobank, Finnish Genome Studies, and other large-scale collaborations. We conducted both univariate and multivariate MR analyses to assess the overall effects and mediated relationships after adjusting for potential confounders, including body mass index (BMI), smoking status, and type 2 diabetes. The effect sizes were estimated using inverse variance-weighted (IVW) regression.</p><p><strong>Results: </strong>The MR analysis revealed that an increased risk of heart failure (HF) [odds ratio (OR): 1.366; 95% confidence interval (CI): 1.013-1.842; P=0.04], coronary atherosclerosis (OR: 1.918; 95% CI: 1.257-2.927; P=0.003), myocardial infarction (MI) (OR: 1.505; 95% CI: 1.025-2.211; P=0.04), and coronary artery disease (CAD) (OR: 1.519; 95% CI: 1.130-2.043; P=0.006) was significantly associated with genetically predicted daytime napping. Prolonged sleep duration was found to be related to a reduced risk of HF (OR: 0.995; 95% CI: 0.993-0.998; P=2.69E-04), peripheral vascular disease (PVD) (OR: 0.984; 95% CI: 0.971-0.997; P=0.02), and CAD (OR: 0.997; 95% CI: 0.994-0.999; P=0.006). Additionally, a statistically significant positive relationship was observed between depressive disorders and the occurrence of atrial fibrillation (AF) (OR: 1.298, 95% CI: 1.065-1.583, P=0.01), indicating a heightened susceptibility. The multivariable MR analyses substantiated the reliability of the observed associations between daytime napping and the incidence of HF and CAD, following adjustments for genetically predicted BMI and smoking. The sensitivity analysis did not reveal any evidence of horizontal pleiotropy or heterogeneity, thus supporting the validity of the study's results.</p><p><strong>Conclusions: </strong>This MR investigation posits a potential causal nexus between daytime napping, sleep duration, and depression, and the genesis of CVDs, offering new perspectives on the prevention and management of CVDs.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"771-787"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-fast-track cardiac anesthesia in minimally invasive cardiac surgery: a retrospective observational study.","authors":"Tian Jiang, Li-Xin Wang, Hao-Kang Teng, Lin-Ting Xu, Xiao-Kan Lou, Yu Wang, Han-Wei Wei, Mei-Juan Yan","doi":"10.21037/cdt-24-175","DOIUrl":"https://doi.org/10.21037/cdt-24-175","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is no uniformity on the safety profile of ultra-fast-track cardiac anesthesia (UFTCA), and there is a lack of research on the postoperative lung function status of patients with UFTCA. This retrospective study was to examine the benefits of UFTCA on the postoperative recovery and pulmonary function of patients undergoing minimally invasive cardiac surgery (MICS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study was performed on patients who underwent MICS at Zhejiang Provincial People's Hospital between January 2022 and July 2023. Patients were retrospectively segregated into two groups: UFTCA group and conventional general anesthesia (CGA group). Primary endpoints encompassed differences in the duration of postoperative intensive care unit (ICU) stay and overall hospital stay. Secondary observations included in-hospital mortality rate, 3-month post-discharge survival rate, oxygenation indexes of preoperative (T0), immediately after extubation (T1), 6 hours after extubation (T2), and 12 hours after extubation (T3), use of high-flow nasal cannula oxygen therapy in the ICU, postoperative total chest drainage volume, and the rate of complications. Group comparisons were performed using grouped &lt;i&gt;t&lt;/i&gt;-tests and repeated measures analysis of variance (ANOVA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The UFTCA group (n=327) demonstrated shorter ICU and hospital stays when compared with the CGA group (n=216) (P=0.001). At the immediately after extubation, the UFTCA group exhibited a decrease in oxygenation index [arterial oxygen partial pressure (PaO&lt;sub&gt;2&lt;/sub&gt;)/fraction of inspired oxygen (FiO&lt;sub&gt;2&lt;/sub&gt;)] accompanied by elevated alveolar-arterial oxygen tension difference [P(A-a)O&lt;sub&gt;2&lt;/sub&gt;] and respiratory index [P(A-a)O&lt;sub&gt;2&lt;/sub&gt;/PaO&lt;sub&gt;2&lt;/sub&gt;] values compared to the CGA group (P=0.001). However, by 12 hours after extubation, the UFTCA group manifested an improved PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; and diminished P(A-a)O&lt;sub&gt;2&lt;/sub&gt;/PaO&lt;sub&gt;2&lt;/sub&gt; values compared to the CGA group. The UFTCA group required high-flow oxygen therapy after extubation with greater frequency than the CGA group (P=0.001). However, neither the UFTCA nor CGA group had patients who needed reintubation (P&gt;0.05). No significant differences were observed in postoperative atelectasis and pulmonary edema rates between the groups (P&gt;0.05), the UFTCA group recorded a diminished total chest drainage volume postoperatively (P=0.001). Incidence of postoperative nausea and vomiting (PONV) was heightened in the UFTCA group (P=0.01), while the incidence of delirium was less frequent when compared with the CGA group (P=0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;UFTCA demonstrates potential benefits in minimizing ICU and postoperative hospital stay in patients undergoing MICS. This approach also contributes to a reduction in postoperative chest drainage volume and a decreased likelihood of postoperative delirium. Despite the initial decline in l","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"740-752"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}