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1.
J Cardiothorac Surg ; 15(1): 25, 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969173

RESUMO

BACKGROUND: Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5-10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery. METHODS: In this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis. RESULTS: Among 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3-47.8) vs. 69.0 h (47.8-110.3), p < 0.001) and ICU stay (122.0 h (80.8-155.0) vs 179.5 h (114.0-258.0), p < 0.001). There were no significant between-group differences in mortality, complications, or length of hospital stay. CONCLUSIONS: In this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.


Assuntos
Aneurisma Dissecante/cirurgia , Broncodilatadores/administração & dosagem , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Hipóxia/tratamento farmacológico , Óxido Nítrico/administração & dosagem , Administração por Inalação , Adulto , Aneurisma Dissecante/complicações , Cuidados Críticos , Feminino , Humanos , Hipóxia/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Pontuação de Propensão , Respiração Artificial , Estudos Retrospectivos
2.
Georgian Med News ; (295): 89-93, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804206

RESUMO

Purpose - to improve the results of reconstructive interventions on the aorta by improving methods for treating respiratory distress syndrome. The study included 15 men and 4 women, the median age was 48 ±4 years. In all patients, on the basis of a clinical and instrumental study and in accordance with the AECC criteria, acute lung injury syndrome (ALIS) was diagnosed, and in fourteen patients (73,7%), the severity corresponded to acute respiratory distress syndrome (ARDS). The diagnosis of ARDS was established on the basis of generally accepted criteria: acute onset; the presence of bilateral infiltrates on the chest radiograph; a decrease in the PaO2/FiO2 index of less than 300 mm hg. art.; the absence of signs of left ventricular failure. To maintain normal oxygen delivery values, we ensured a hemoglobin level of at least 100 g / l. In cases of heart failure (HF), inotropic support was performed. Basic therapy provided for the maintenance of adequate oxygen delivery, for this a hemoglobin level of at least 100 g/l was provided, and in the development of HF, inotropic support was provided. When analyzing the timing of administration and the effectiveness of surfactant therapy, there is a tendency to a more significant increase in the PaO2/FiO2 index with the early introduction of surfactant. When using surfactant, mortality in cases of ARDS was 25,0-40,0%, and the time of respiratory support in patients was 136±57 hours. Endobronchial administration of a surfactant agent is a pathogenically reasonable pharmacological method of intensive therapy of acute respiratory distress syndrome in the postoperative period following aortic interventions. Administration of surfactant therapy leads to a significant reduction in the terms of recovery of oxygenation, respiratory therapy and the stay of patients in the ICU.


Assuntos
Lesão Pulmonar Aguda , Aorta , Procedimentos Cirúrgicos Cardiovasculares , Síndrome do Desconforto Respiratório do Adulto , Adulto , Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto/etiologia
3.
Khirurgiia (Mosk) ; (12): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825337

RESUMO

The review is devoted to analysis of current trends in interdisciplinary approach to the differential diagnosis of patients' conditions on the first day after cardiac, ascending aortic and aortic arch surgery and repair of internal carotid arteries (neurological disorders, delirium, cognitive dysfunction, psycho-emotional disorders, postoperative sedation). This approach is valuable to determine the prognosis and timely treatment. The basic concepts reflecting the discussion between neurologists, cardiovascular surgeons, anesthetists, radiation diagnostics specialists and rehabilitators are summarized. The authors concluded that timely and correct differential diagnosis of the states on the first postoperative day using current tests and interdisciplinary approach to the treatment of patients with postoperative impaired consciousness or neurological/psycho-emotional dysfunction can improve their quality of life and efficiency of medical care.


Assuntos
Aorta/cirurgia , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Doenças do Sistema Nervoso/diagnóstico , Transtornos Neurocognitivos/diagnóstico , Aorta Torácica/cirurgia , Artéria Carótida Interna/cirurgia , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso/etiologia , Transtornos Neurocognitivos/etiologia , Prognóstico , Fatores de Tempo
4.
Arch. argent. pediatr ; 117(6): 557-567, dic. 2019. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1046289

RESUMO

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica.Población y métodos:Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos.Resultados.Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas.Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA


Introduction. Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the post-operative course.Population and methods. This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output.Results. A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications.Conclusion. In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Fatores de Risco , Lesão Renal Aguda/epidemiologia , Pediatria , Estudos Retrospectivos , Lesão Renal Aguda/diagnóstico
5.
J Thorac Cardiovasc Surg ; 158(5): 1446-1455, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31395365

RESUMO

OBJECTIVE: There is an increased risk of mortality in patients in whom acute kidney injury and fluid accumulation develop after cardiothoracic surgery, and the risk is especially high when renal replacement therapy is needed. However, renal replacement therapy remains an essential intervention in managing these patients. The objective of this study was to identify risk factors for mortality in surgical patients requiring renal replacement therapy in a pediatric cardiac intensive care unit. METHODS: We performed a retrospective review of patients requiring renal replacement therapy for acute kidney injury or fluid accumulation after cardiothoracic surgery between January 2009 and December 2017. Survivors and nonsurvivors were compared with respect to multiple variables, and a multivariable logistic regression analysis was performed to identify independent risk factors associated with mortality. RESULTS: The mortality rate for the cohort was 75%. Nonsurvivors were younger (nonsurvivors: 0.8 years; interquartile range, 0.1-8.2; survivors: 14.6 years; interquartile range, 4.2-19.7; P = .002) and had a lower weight-for-age z-score (nonsurvivors: -1.5; interquartile range, -3.1 to -0.4; survivors: -0.5; interquartile range, -0.9 to 0.3; P = .02) compared with survivors. There was no difference with respect to fluid accumulation. In multivariable analysis, a longer duration of stage 3 acute kidney injury before initiation of renal replacement therapy was independently associated with mortality (adjusted odds ratio, 1.39; 95% confidence interval, 1.05-1.83; P = .021). CONCLUSIONS: Mortality in patients requiring renal replacement therapy after congenital heart disease surgery is high. A longer duration of acute kidney injury before renal replacement therapy initiation is associated with increased mortality.


Assuntos
Lesão Renal Aguda , Procedimentos Cirúrgicos Cardiovasculares , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/terapia , Terapia de Substituição Renal , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Adolescente , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/classificação , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Criança , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Estado de Hidratação do Organismo , Complicações Pós-Operatórias/fisiopatologia , Terapia de Substituição Renal/efeitos adversos , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
6.
Khirurgiia (Mosk) ; (8): 5-11, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31464267

RESUMO

OBJECTIVE: To evaluate incidence, causes and outcomes of acute respiratory failure (ARF) in patients after cardiac and aortic surgery. MATERIAL AND METHODS: A retrospective trial included 3972 patients after elective cardiovascular procedures for the period 2013-2017. Inclusion criterion: sustained reduction of pulmonary function (PaO2/FiO2<300 mm Hg) in the postoperative period required mechanical ventilation or non-invasive positive pressure mask ventilation for at least 24 h. RESULTS: ARF developed in 138 (3.5%) cases. It was observed after aortic surgery as a rule (11.2%). Other operations were followed by ARF in 1-3.5% of cases. Incidence of ARF was less after off-pump coronary artery bypass surgery compared with on-pump interventions (1.6 vs. 3.5%, p=0.0469). Acute respiratory distress syndrome was the main reason of ARF (n=37, 26.8%). ARF as a consequence of neurological complications were observed in 25 (18.1%) patients. Exacerbation of COPD and bronchial asthma occurred in 23 (16.1%) patients, paresis of the diaphragm - in 15 (11.7%). In 15 (10.8%) patients, ARF was caused by pneumonia, in 12 (8.7%) cases - pulmonary congestion, in 10 (7.2%) patients - lung injury and haemothorax. Overall ARDS-associated mortality was 21.6%; 15.1% of patients with mild and moderate ARDS died. Severe ARDS was followed by unfavorable outcome in 75% of patients. Nosocomial pneumonia was found in 40.6%, there were no fatal outcomes from this complication. CONCLUSION: Acute respiratory failure developed in 3.5% of cardiac patients and was common thoracic and thoracoabdominal aortic surgery. The leading cause of mortality was ARDS (mortality rate 15.1% in mild and moderate syndrome, 75% in severe course of ARDS). Nosocomial pneumonia was diagnosed in 1.4% of patients and was not fatal.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/mortalidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Doença Aguda , Aorta/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/mortalidade , Humanos , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/mortalidade
7.
Pediatr Cardiol ; 40(6): 1296-1303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31342114

RESUMO

Dysphagia and vocal cord dysfunction are frequent complications after congenital heart surgery. Both are risk factors for aspiration, which can lead to pneumonia, progressive lung disease, and respiratory arrest. A protocol was implemented to promote early detection of aspiration in a high-risk cohort of patients. Retrospective data were collected on all patients under 120 days old who underwent the Norwood procedure, aortic arch repair, Blalock-Taussig shunt placement, or cervical cannulation for extracorporeal membrane oxygenation from 10/2012 to 05/2016 at a single institution. Patients underwent an assessment of symptoms, fiberoptic endoscopic evaluation of swallowing (FEES), and modified barium swallow (MBS) study in the postoperative period prior to initiating oral feeds. Patients with and without aspiration were compared. Of the 96 patients included in the study, one-third (33%) of patients had evidence of vocal cord dysfunction by FEES and just over half (51%) had evidence of aspiration by FEES or MBS. Most (73%) of the patients with aspiration were asymptomatic and a majority (53%) of patients with aspiration had normal vocal cord function. Aspiration is common after congenital heart surgery, and an assessment of vocal cord or swallow function in isolation may lead to underdiagnosis. A comprehensive protocol including MBS and FEES is necessary for the early detection of vocal cord dysfunction and aspiration and may prevent adverse outcomes in high-risk postoperative patients.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Aspiração Respiratória/diagnóstico , Estudos de Casos e Controles , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia
8.
Heart Surg Forum ; 22(3): E183-E190, 2019 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-31237540

RESUMO

BACKGROUND: Gastrointestinal hemorrhage (GH) is one of the most serious complications after cardiovascular surgery. The aim of the study was to provide an optimal therapeutic strategy for preventing postoperative GH in high-risk patients. METHODS: This retrospective case-control study included 188 adult patients at high risk of postoperative GH. These patients were divided into two groups based on a strategy for preventing postoperative GH: Group A (n = 97) received continuous intravenous infusion of proton-pump inhibitor (PPI) combined with early enteral nutrition, and Group B (n = 91) received a bolus intravenous infusion of PPI combined with late enteral nutrition. The clinical features of the groups were examined. RESULTS: The incidence of postoperative GH in the patients of group A was significantly lower than the patients in group B. The duration from the end of surgery to eating for the first time in the patients of group A was significantly shorter than in the patients of group B. A descending trend in 30-day mortality was observed in the patients of group A compared with group B, but no significant difference was found between the two groups. CONCLUSION: Continuous intravenous infusion of PPI combined with early enteral nutrition could effectively prevent GH and reduce 30-day mortality after cardiovascular surgery in high-risk patients.


Assuntos
Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Nutrição Enteral , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida
9.
BMC Anesthesiol ; 19(1): 88, 2019 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-31138135

RESUMO

BACKGROUND: Although serum creatinine concentration has been traditionally used as an index of renal function in clinical practice, it is considered relatively inaccurate, especially in patients with mild renal dysfunction. This study investigated the usefulness of preoperative estimated glomerular filtration rate (eGFR) in predicting complications after cardiovascular surgery in patients with normal serum creatinine concentrations. METHODS: This study included 2208 adults undergoing elective cardiovascular surgery. Preoperative eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equations. The relationships between preoperative eGFR and 90 day postoperative composite major complications were analyzed, including 90 day all-cause mortality, major adverse cardiac and cerebrovascular events, severe acute kidney injury, respiratory and gastrointestinal complications, wound infection, sepsis, and multi-organ failure. RESULTS: Of the 2208 included patients, 185 (8.4%) had preoperative eGFR < 60 mL/min/1.73 m2 and 328 (14.9%) experienced postoperative major complications. Multivariable logistic regression analyses showed that preoperatively decreased eGFR was independently associated with an increased risk of composite 90 day major postoperative complications (adjusted odds ratio: 1.232; 95% confidence interval [CI]: 1.148-1.322; P <  0.001). eGFR was a better discriminator of composite 90 day major postoperative complications than serum creatinine, with estimated c-statistics of 0.724 (95% CI: 0.694-0.754) for eGFR and 0.712 (95% CI: 0.680-0.744) for serum creatinine (P = 0.008). CONCLUSIONS: Decreased eGFR was significantly associated with an increased risk of major complications after cardiovascular surgery in patients with preoperatively normal serum creatinine concentrations.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/tendências , Creatinina/sangue , Taxa de Filtração Glomerular/fisiologia , Complicações Pós-Operatórias/sangue , Cuidados Pré-Operatórios/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento
10.
Med Sci Monit ; 25: 3288-3297, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054221

RESUMO

BACKGROUND Cold-inducible RNA-binding protein (CIRP) has been identified as an inflammatory mediator that exerts its function in inflammatory diseases. However, the roles of CIRP in patients who received cardiovascular surgery necessitating cardiopulmonary bypass (CPB) are still unknown. The aim of this study was to examine CIRP levels and attempt to evaluate whether CIRP could serve as a predictor for lung dysfunction after cardiovascular surgery. MATERIAL AND METHODS Plasma CIRP levels were detected by ELISA in 31 patients who received cardiovascular surgery at different time points. Selective inflammatory cytokines (TNF-alpha, IL-6, IL-10, and TLR4) and mediators (Ang II, PAI-1, and soluble E-selectin) were also detected. Selective laboratory and clinical parameters were recorded at scheduled time points. RESULTS Compared with pre-operation levels, CIRP levels significantly increased 6 h after cardiovascular surgery with CPB. Multiple linear regression analysis showed that the length of CPB time contributed to CIRP production (P=0.013). Furthermore, CIRP was associated with Ang II (r=0.438, P=0.016), PAI-1 (r=0.485, P=0.006), and soluble E-selectin (r=0.470, P=0.008), which partly reflected lung injuries. Multiple linear regression analysis showed that CIRP levels were independently associated with PaO2/FiO2 ratios (P=0.021). CONCLUSIONS The length of CPB time contributed to the upregulation of CIRP in patients who received cardiovascular surgery with CPB. CIRP levels could serve as a biomarker to predict the onset of lung injury induced by cardiovascular surgery.


Assuntos
Ponte Cardiopulmonar/métodos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Lesão Pulmonar/sangue , Proteínas de Ligação a RNA/sangue , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Citocinas/sangue , Feminino , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Testes de Função Respiratória
11.
Gen Thorac Cardiovasc Surg ; 67(11): 917-924, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30953315

RESUMO

OBJECTIVE: Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. METHODS: Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale. RESULTS: The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014). CONCLUSIONS: Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.


Assuntos
Reabilitação Cardíaca , Procedimentos Cirúrgicos Cardiovasculares/reabilitação , Lista de Checagem , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/reabilitação , Feminino , Idoso Fragilizado , Fragilidade/complicações , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Músculos Psoas , Albumina Sérica/metabolismo , Fatores de Tempo , Teste de Caminhada
12.
Eur J Vasc Endovasc Surg ; 57(5): 619-625, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940430

RESUMO

OBJECTIVES: Stroke after carotid endarterectomy (CEA) has been assessed widely. However, factors enhancing non-ipsilateral stroke risk are poorly defined. The aim of this study was to identify drivers of 30 day non-ipsilateral stroke after CEA in the Vascular Quality Initiative (VQI) and assess long-term survival based on laterality of post-operative stroke. METHODS: The VQI was queried between April 1, 2003, and March 31, 2017, for all CEA. Bilateral carotid procedures within 30 days were excluded. Thirty day non-ipsilateral strokes were identified. Factors were examined to discriminate between patients with and without non-ipsilateral stroke. Univariable analysis followed by multivariable logistic regression was performed. Kaplan-Meier and log rank methods were used to estimate and compare survival. RESULTS: During this 14 year period, 80,230 CEA in 74,928 patients met the criteria. The average age was 70.3 ± 9.3 years. Most were male (48,506; 60%), Caucasian (73,967; 92%), smokers (60,543; 76%), and asymptomatic (43,074; 54%). Contralateral stenosis ≥70% was present in 8033 (10%) with 2239 (3%) having contralateral occlusion. In 491 (0.6%) patients, peri-operative non-ipsilateral stroke occurred. After characterising univariable associations, logistic regression identified independent drivers of non-ipsilateral stroke after CEA. Operative urgency (p = .001), symptomatic disease (p < .001) and contralateral occlusion (p = .001) were pre-operative drivers. Operative predictors included shunt use (p = .008), CEA with cardiac surgery (p = .013), and CEA with concomitant proximal ipsilateral endovascular intervention (p = .01). Use of dextran (p = .005) and anti-angiotensin therapy (p = .03) were protective. Reperfusion syndrome (p < .001), re-exploration (p < .001), myocardial infarction (p < .001), and intravenous treatment of hypotension (p < .001) or hypertension (p < .001) were post-operative correlates. Non-ipsilateral stroke 30 day mortality was less than ipsilateral stroke (6.1% vs. 10.3%; p = .007). Five year survival after non-ipsilateral stroke was 73%, and no different from ipsilateral stroke 76% (p = .16). Both were worse than without stroke (88%; p < .001). CONCLUSION: Non-ipsilateral stroke after CEA is rare. Features driving risk surround global disease burden, combined procedures, and haemodynamic fluctuations. Contralateral occlusion independently increases non-ipsilateral stroke risk. Regardless of laterality or location, effects of stroke after CEA on long-term survival are similar.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Acidente Vascular Cerebral/etiologia , Idoso , Angiotensinas/antagonistas & inibidores , Anticoagulantes/uso terapêutico , Dextranos/uso terapêutico , Feminino , Hemodinâmica , Humanos , Estimativa de Kaplan-Meier , Masculino , Complicações Pós-Operatórias , Indicadores de Qualidade em Assistência à Saúde , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle
14.
Ann Thorac Surg ; 108(1): 122-129, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30885849

RESUMO

BACKGROUND: Pulmonary venous obstruction after repair of total anomalous pulmonary venous connection (TAPVC) results in substantial morbidity and mortality. Risk factors for postoperative obstruction remain ambiguous. In addition, the existing literature has no standard definition for preoperative obstruction, making patient counseling difficult. METHODS: All patients undergoing repair of TAPVC at our institution from January 1, 2006, to October 23, 2017, were identified. The primary outcome was the development of postoperative obstruction, analyzed as a time-to-event outcome. Clinical information was extracted to assess risk factors. Degrees of preoperative obstruction were defined based on echocardiographic, catheterization, and clinical findings. Univariable and multivariable Cox proportional hazard regression methods were used to identify factors associated with the primary outcome. RESULTS: During the study interval, 119 patients underwent repair of TAPVC (40% single ventricle), and postoperative obstruction developed in 25 patients (21%). Risk factors associated with obstruction were heterotaxy syndrome, single-ventricle heart disease, additional procedures at the time of vein repair, mixed-type TAPVC, and preoperative obstruction. Having even mild preoperative obstruction (≥1.2 m/s by Doppler echocardiography) was predictive of postoperative obstruction. A multivariable model showed mixed-type TAPVC and the presence of preoperative obstruction were associated with a more than twofold greater hazard of obstruction. CONCLUSIONS: TAPVC in the setting of heterotaxy and a single ventricle remains challenging, with high rates of postoperative obstruction. Mixed-type TAPVC is an independent risk factor for postoperative obstruction, particularly in patients with isolated TAPVC. Even mild preoperative obstruction is a risk factor for postoperative obstruction. These results may help risk-stratify TAPVC patients.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Síndrome de Cimitarra/cirurgia , Estenose de Veia Pulmonar/etiologia , Ecocardiografia Doppler , Feminino , Seguimentos , Átrios do Coração/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/patologia , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Fatores de Risco , Síndrome de Cimitarra/diagnóstico por imagem , Grau de Desobstrução Vascular
15.
BMC Neurol ; 19(1): 28, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782140

RESUMO

BACKGROUND: Periodic alternating ping-pong gaze (PPG) is a rare disease with few reports. To our knowledge, there was no report on anti GQ1b antibody syndrome accompanied by PPG. This paper reported a case of anti GQ1b antibody syndrome with Bickerstaff's Encephalitis (BBE) overlapping classic Guillain-Barre Syndrome (GBS) after aortic valve replacement, accompanied by an excessive PPG in the course of diagnosis and treatment, this was indeed rarely. CASE PRESENTATION: A 55-year-old male patient was admitted to our hospital with intermittent chest tightness for 3 months, and his condition has worsened in the past 10 days. Aortic valve replacement was performed because of the existence of the moderate and severe stenosis of aortic valve. Horizontal movement of the eyeball was involuntarily slow. The eyeball hovered and returned from one side to the other horizontally for 3-4 s per cycle. In combination with the patient's typical clinical and laboratory tests, the final diagnosis was anti GQ1b antibody syndrome BBE combined with GBS, accompanied by saccadic ping pong gaze. Intravenous immunoglobulin (0.4 g/kg) was given for immunomodulation, methylprednisolone (1000 mg) therapy and symptomatic treatment were performed in the patient. CONCLUSIONS: The patients were discharged from hospital on the thirtieth day because of economic reasons. After 6 months of follow up, the patients left behind a lack of fluency in speech and limb mobility, but the basic life can be taken care of by himself.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Encefalite/imunologia , Gangliosídeos/imunologia , Síndrome de Guillain-Barré/imunologia , Transtornos da Motilidade Ocular/imunologia , Estenose da Valva Aórtica/cirurgia , Autoanticorpos/imunologia , Encefalite/complicações , Encefalite/tratamento farmacológico , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/tratamento farmacológico , Próteses Valvulares Cardíacas , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade
16.
Medicine (Baltimore) ; 98(7): e14383, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762739

RESUMO

We assessed whether perioperative fluid management with balanced solutions and a limited volume of hydroxyethyl starch (renal-protective fluid management [RPF] strategy) could improve renal outcomes after cardiovascular surgery.For this retrospective observational study, we evaluated 2613 patients who underwent cardiovascular surgery from January 1, 2010 to December 31, 2013. The control group were given intravenous fluids with saline-based solutions and unlimited volumes of hydroxyethyl starch solutions and the RPF group were given intravenous fluids with RPF. The primary outcome was the incidence of acute kidney injury (AKI) and chronic dialysis within 12 months after cardiovascular surgery. Multivariable regression and propensity analyses were performed to evaluate the association between perioperative fluid management strategy and postoperative renal outcomes.Postoperative AKI and chronic dialysis occurred in 213 (21.2%) and 5 (0.5%) patients in the RPF group compared with 696 (43.2%) and 38 (2.4%) patients in the control group, respectively. After adjustment, the RPF group was linked to a decreased risk of postoperative AKI, severe AKI, persistent AKI, use of renal replacement therapy, chronic kidney disease, chronic dialysis, and a shorter postoperative extubation time and intensive care unit, and hospital stay duration.The perioperative fluid management strategy with balanced solutions and a limited volume of hydroxyethyl starch was related to improved acute and 1-year renal and clinical outcomes after cardiovascular surgery. These findings indicate the need for further definitive clinical trials on perioperative fluid management strategy.


Assuntos
Lesão Renal Aguda/prevenção & controle , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Hidratação/métodos , Derivados de Hidroxietil Amido/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Administração Intravenosa , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos
17.
Curr Neurol Neurosci Rep ; 19(2): 6, 2019 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739219

RESUMO

PURPOSE OF REVIEW: Neurological complications are common during cardiac procedures. The type of procedure influences the profile of neurological complications and their management. In this article, we review the different neurological complications encountered following cardiac procedures, and treatment strategies for managing those complications. RECENT FINDINGS: Recent clinical trials have expanded the time window of eligibility for mechanical thrombectomy and intravenous thrombolysis. As a result, more options are now available for the treatment of periprocedural strokes. Early recognition of neurological complications, particularly stroke, will allow more patients to be treated effectively. The expanded window for intravenous thrombolysis and mechanical thrombectomy using advanced neuroimaging for selection provides more opportunities for treatment of periprocedural stroke. There is a paucity of data on the management of cerebrovascular complications, such as ischemic and hemorrhagic strokes, in the setting of left ventricular assist device or mechanical valve.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Acidente Vascular Cerebral/etiologia , Isquemia Encefálica/etiologia , Humanos , Hemorragias Intracranianas , Neuroimagem , Organofosfatos , Trombectomia , Resultado do Tratamento
18.
PLoS One ; 14(1): e0211429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703146

RESUMO

The long-term prognosis of patients with postoperative acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiovascular surgery is unclear. We aimed to investigate long-term renal outcomes and survival in these patients to determine the risk factors for negative outcomes. Long-term prognosis was examined in 144 hospital survivors. All patients were independent and on renal replacement therapy at hospital discharge. The median age at operation was 72.0 years, and the median pre-operative estimated glomerular filtration rate (eGFR) was 39.5 mL/min/1.73 m2. The median follow-up duration was 1075 days. The endpoints were death, chronic maintenance dialysis dependence, and a composite of death and chronic dialysis. Predictors for death and dialysis were evaluated using Fine and Gray's competing risk analysis. The cumulative incidence of death was 34.9%, and the chronic dialysis rate was 13.3% during the observation period. In the multivariate proportional hazards analysis, eGFR <30 mL/min/1.73 m2 at discharge was associated with the composite endpoint of death and dialysis [hazard ratio (HR), 2.1; 95% confidence interval (CI), 1.1-3.8; P = 0.02]. Hypertension (HR 8.7, 95% CI, 2.2-35.4; P = 0.002) and eGFR <30 mL/min/1.73 m2 at discharge (HR 26.4, 95% CI, 2.6-267.1; P = 0.006) were associated with dialysis. Advanced age (≥75 years) was predictive of death. Patients with severe CRRT-requiring AKI after cardiovascular surgery have increased risks of chronic dialysis and death. Patients with eGFR <30 mL/min/1.73 m2 at discharge should be monitored especially carefully by nephrologists due to the risk of chronic dialysis and death.


Assuntos
Lesão Renal Aguda/mortalidade , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Diálise Renal/mortalidade , Terapia de Substituição Renal/mortalidade , Sobreviventes/estatística & dados numéricos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
19.
Artigo em Russo | MEDLINE | ID: mdl-30724882

RESUMO

The ever increasing number of the patients presenting with the cardio-surgical problems referred for surgery emphasizes the importance of the treatment of the cases of post-operative complications based on the personalized approach. The present article was designed to report a clinical case of the successful surgical treatment and rehabilitation of a patient presenting with the dysfunction of the bioprosthetic mitral valve and complications of the post-operative course in the form of polyorgan insufficiency with the predominance of respiratory failure. Special attention is given to the post-operative complications among which the respiratory insufficiency prevailed that made necessary the long period of artificial pulmonary ventilation. The specific features of the intense personalized approach to the physical rehabilitation of the given severely ill patient based at the intensive care unit are considered, the description of the methods applied for the purpose is presented, and their effectiveness from the perspective of clinical and functional parameters is evaluated. The study has demonstrated that the application of the intensive personalized approach in the given case turned out to be a safe and effective method of rehabilitation. The use of the proposed approach allowed to shorten the duration of the post-operative rehabilitation period, facilitated the patient's transfer to autonomous breathing and expansion of the motor activity under conditions of the intensive care unit. In addition, the use of the continuity principle and continuation of rehabilitation measures based at the cardiac surgery department provided the opportunity for the further expansion of the motor activity.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Complicações Pós-Operatórias/reabilitação , Humanos , Reabilitação/métodos , Índice de Gravidade de Doença
20.
Am J Kidney Dis ; 73(4): 504-512, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30660405

RESUMO

RATIONALE & OBJECTIVE: Studies of humans and animals have suggested that endogenous ouabain (EO) and related genes are mediators of acute (AKI) and chronic kidney injury. We sought to examine the relationship among EO levels, genetic variants in lanosterol synthase (LSS; an enzyme that catalyzes synthesis of cholesterol, a precursor of EO), and both AKI and chronic kidney injury. STUDY DESIGN: 2 prospective observational cohort studies and a cross-sectional study of kidney tissue. SETTING & PARTICIPANTS: (1) A prospective cohort study of patients undergoing cardiovascular surgery, (2) measurement of EO concentration in kidney tissue removed because of an adjacent tumor, and (3) a prospective cohort study of patients with newly diagnosed essential hypertension. EXPOSURE: Missense variant in LSS (A instead of C allele at rs2254524), which leads to a valine to leucine substitution at amino acid 642. OUTCOMES: Development of postoperative AKI in the cardiovascular surgery cohort, EO concentration in kidney tissue, and estimated glomerular filtration rate (eGFR) reductions in the essential hypertension cohort. ANALYTICAL APPROACH: Logistic regression for analysis of postoperative AKI, analysis of variance for EO concentration in kidney tissue, and generalized linear models for changes in eGFR over time. RESULTS: AKI incidence following cardiovascular surgery was greater among those with the LSS rs2254524 AA genotype (30.7%) than in those with the CC genotype (17.4%; P=0.001). LSS rs2254524 AA kidneys had higher EO concentrations than CC kidneys (2.14±0.29 vs 1.25±0.08ng/g; P<0.001). In the longitudinal study of patients with essential hypertension (median follow-up, 4 years; range, 1-15 years), eGFR decline was greater among the LSS rs2254524 AA genotype group (-4.39±1.18mL/min/1.73m2 per year) than in the AC or CC genotype groups (-1.07±0.55 and -2.00±0.45mL/min/1.73m2 per year respectively; P = 0.03). LIMITATIONS: These associations do not necessarily represent causal relationships; LSS rs2254524 variants may have effects on other steroid hormones. CONCLUSIONS: These findings support the potential value of LSS rs2254524 genotype-based risk stratification to identify patients at high risk for AKI before cardiovascular surgery, as well as predict accelerated eGFR in the setting of hypertension. These findings also suggest that LSS may in part drive EO-mediated kidney damage. EO may represent a new potential therapeutic target for the prevention of AKI and slowing of kidney damage in the setting of hypertension.


Assuntos
Lesão Renal Aguda/metabolismo , Transferases Intramoleculares/metabolismo , Ouabaína/metabolismo , Complicações Pós-Operatórias , Insuficiência Renal Crônica/metabolismo , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/genética , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estudos Transversais , Feminino , Seguimentos , Variação Genética , Humanos , Transferases Intramoleculares/genética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radioimunoensaio , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/genética , Adulto Jovem
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