Evaluation of Outcomes in Patients with Previous Stroke History following Cardiac Surgery: A Single-Center Study.

Background: The aim of the study to analyze the risk of complications, including neurological sequelae, alongside early and late mortality among patients with antecedent stroke subjected to cardiac surgical interventions with extracorporeal support. Material and methods: A single-center retrospective study was conducted on 10,685 patients who underwent cardiac surgery with extracorporeal circulation at the Department of Cardiac Surgery. The first group comprised all patients eligible for cardiac surgery with extracorporeal circulation. The second group consisted of patients with a preoperative history of stroke. Results: In the study, a statistically significant association was observed between preoperative stroke and the occurrence of postoperative pneumonia (OR = 1.482, p = 0.006), respiratory failure (OR = 1.497, p = 0.006), renal failure (OR = 1.391, p = 0.019), 30-day mortality (OR = 1.528, p = 0.026), 90-day mortality (OR = 1.658, p < 0.001), and one-year mortality (OR = 1.706, p < 0.001). Conclusions: Patients with a history of preoperative stroke more frequently experienced renal failure and respiratory-system complications such as pneumonia and respiratory failure. The survival time of patients with a history of preoperative stroke was shorter compared to that of the control group during the analyzed 30-day, 90-day, and one-year observation periods.

The Rate of Postoperative Mortality and Renal and Respiratory Complications are Increased in Patients with Extreme Obesity Undergoing Cardiac Surgery - A Retrospective Observational Cohort Study of 8848 Patients.

Introduction: The importance of obesity as a potential risk factor in open heart surgery is well known. The epidemic of extreme obesity is an increasing public health concern and raises alerts regarding postoperative complications and mortality in patients undergoing cardiac surgery. The study aimed to analyze the impact of extreme obesity (BMI≥40) on the frequency of postoperative complications, as well as early and delayed mortality compared to patients with a lower body mass. Materials and Methodology: This retrospective observational cohort study involved patients, over the age of 18, undergoing cardiac surgery with cardiopulmonary bypass at the Cardiac Surgery Department of the Pomeranian Medical University in Szczecin, Poland between January 1st, 2010 and December 31st, 2018. The patients included in the study were allocated into two subgroups depending on the BMI index (Group I BMI≥40 vs Group II BMI<40). Results: A total of 8848 adult patients of both genders were included. Baseline characteristics for Group I and Group II were mean age 64.07±7.76 vs 65.10±9.68 years (p=0.123), mean BMI 42.13±2.44 vs 28.55±4.23 (p<0.001), with more females in Group I (58.04% vs 29.06%) and more males in Group II (70.94% vs 29.06%), p<0.001. The predicted perioperative risk using the EuroScore Logistics scale was higher in a group with BMI≥40 (p<0.001). Regression analysis with adjustment for confounding factors showed a statistically significant relationship between BMI≥40 and postoperative respiratory failure (OR=1.760, p=0.043), acute kidney injury AKIN2 (OR=2.082, p=0.044) and AKIN3 (OR=2.743, p=0.039). 30-day mortality in the univariate analysis showed a statistically significant relationship, however, after modifying the results with interfering factors, no statistical significance was obtained. Conclusion: The risk of postoperative acute respiratory failure and acute renal injury was increased in patients with BMI≥40. The probability of 30-day survival of patients after cardiac surgery was much lower in people with extreme obesity, although it was related to the dominant comorbidities. The 10-year survival was comparable in both groups.

The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting.

Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.

Thoracic aorta aneurysm successfully operated on during pregnancy.

We present the case of an asymptomatic 26-year-old female patient with a huge thoracic aneurysm discovered at a routine echo screening. The patient had previously been operated on for coarctation of the aorta in childhood and also had diagnosed bicuspid aortic valve. The operation was carried out in extracorporeal circulation at the 22(nd) week of gestation without any complications. A few months later in the 38(th) week of pregnancy a baby girl was delivered by cesarean section with an Apgar score of 10. The patient is scheduled for implantation of a stent graft to the descending aorta, because the CT of the chest done a few months after delivery confirmed presence of a significant aneurysm located just below the left subclavian artery.