Predictors of rhythm disorders following cardiac surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
TD Danilevych ◽  
LV Rasputina ◽  
YM Mostovoy ◽  
AV Belinskyi
Keyword(s):  
Cardiac Surgery ◽  
Mitral Regurgitation ◽  
Postoperative Period ◽  
Average Duration ◽  
Heart Defects ◽  
Early Postoperative Period ◽  
Functional Class ◽  
Funding Sources ◽  
Risk Patients ◽  
Heart Arrhythmias

Abstract Funding Acknowledgements Type of funding sources: None. Background. Identification of high-risk patients and  predictors for cardiac arrhythmias allows the development of preventive measures that will improve the postoperative period and rehabilitation of patients following cardiac surgery. Purpose. To determine probable predictors of arrhythmias in patients following cardiac surgery in the early postoperative period (up to 7 days). Methods. 56 patients were examined, including 19 (33.9%) men (p = 0.02). The average age of the patients was 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The average duration of the operations was 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 vs. 355.47, p = 0.34). Assessment of arrhythmias was performed during the first 7 days after cardiac surgery. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Predictors of arrhythmias in early postoperative period are: operation with bypass r = 0,332 [1,06-3,03], p = 0,01; the size of left atrium (LA)> 40 mm r =0,296  [1,01-3,31], p = 0,03; presence of coronary artery (CA) stenosis r = 0,139 [1,11-2,69], p = 0,04; atrial fibrillation (AF) in the history r = 0,607  [1,99-5,58], p = 0,001. AF dominates in the structure of arrhythmias – in 17 (30.4%) patients, among them – in 11 (64.7%) was paroxysmal,  6 (35.3%) patients - persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. The predictors of AF are: operation with bypass r = 0.451 [1.63-9.76], p= 0.0001; the size of the LA> 40 mm r = 0.303 [1.04-7.58], p = 0.02; left ventricle (LV) ejection fraction (EF) <40% r = -0.207 [1.23-1.82], p = 0.05; mitral regurgitation r = 0.314 [1.05-10.04], p = 0.02. Also registered ventricular ventricular prematute beats (VPB) – in 12 (21.4%) patients, among them VPB 1st Laun class  - in 8 (66.7%), 2nd Laun class – in 2 (16.7%), 3rd Laun class – in 1 (8.3%), 4A Laun class – in 1 (8.3%) patient, respectively. Predictors of VPB are: chronic heart failure (CHF) 4 functional class (FC) r = 0.258 [2.94-8.48,], p = 0.05; CA stenosis r = 0,282 [1,04-40,54], p = 0,04; LV EF <50% r = -0.344 [1,3-9,42], p = 0,009, stroke in the anamnesis r = 0,262 [1,33-9,37], p = 0,05.  Conclusions The prevalence of arrhythmias in the early postoperative period (up to 7 days) following cardiac surgery is 48.2%. The predictors of arrhythmias are: operation with bypass, the size of LA> 40 mm, presence of CA stenosis and any form of AF in the history. AF dominates in the structure of heart arrhythmias (30.4%). The predictors of AF are: operation with bypass, the size of the LA> 40 mm, LV EF <40%, mitral regurgitation according to echocardiography; predictors of VPB are: CHF 4 FC, CA stenosis, LV EF <50%, stroke in the history.

scholarly journals Cognitive disorders in patients after cardiac surgery

2021 ◽  
pp. 26-32
Author(s):  
A. V. Belinskyi ◽  
L. V. Rasputina ◽  
Y. M. Mostovoy ◽  
O. P. Mostova ◽  
T. D. Danilevych
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Period ◽  
Cognitive Functions ◽  
Heart Defects ◽  
Cognitive Disorders ◽  
Statistical Processing ◽  
Early Postoperative Period ◽  
Cognitive Test ◽  
Before And After ◽  
Prolonged Recovery

The occurrence of cognitive disorders is a common problem after surgery. The degree of worsening of cognitive functions after surgery and anesthesia has a significant impact on the patient's health and is significantly associated with prolonged recovery in the hospital, increased morbidity and delayed functional recovery. The aim of the study was to increase the effectiveness of the diagnosis of moderate cognitive impairment and to determine its gender and age characteristics in patients before and after cardiac surgery in the early postoperative period (3 and 7 days). We examined 56 patients who underwent cardiac surgery for coronary heart disease in 37 (66.1 %) and valvular heart defects in 19 (33.9 %) patients. Assessment of cognitive functions was performed before surgery, on the 3rd and 7th day of the postoperative period. Testing was performed using the Montreal Cognitive Test. Statistical processing of the obtained data was performed on a personal computer using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods. It was found that presence of cognitive disorders before surgery was registered in 37 (66.1 %) patients, mostly among the age of group of 60-74 years and had no gender difference. It was found that in the early postoperative period there is a significant worsening of cognitive functions in patients after cardiac surgery on 3rd day – in 45 (80.4 %), on 7th day – in 44 (78.6 %) patients, respectively.

Frequency and structure of cardiac arrhythmias in the early postoperative period following cardiac surgery

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
TD Danilevych ◽  
LV Rasputina ◽  
YM Mostovoy ◽  
AV Belinskyi
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Period ◽  
Cardiac Arrhythmias ◽  
Heart Defects ◽  
Statistical Processing ◽  
Early Postoperative Period ◽  
Av Block ◽  
Paroxysmal Tachycardia ◽  
Anterior Branch ◽  
St Segment

Abstract Funding Acknowledgements Type of funding sources: None. Background. Cardiac arrhythmias occupy one of the key places in the structure of complications of the early postoperative period following cardiac surgery. According to various literature sources, they range from 10% to 40% and often determine the course of the postoperative period. Purpose. To determine the frequency and structure of cardiac arrhythmias in the early postoperative period in the patients following cardiac surgery (up to 7 days). Methods. 56 patients were examined, among them 19 (33.9%) men and 37 (66,1%) women (p = 0.02). The age of patients ranged from 31 to 79 years, averaging 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The duration of the operation ranged from 240 to 600 minutes, averaging 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 ± 116.88 vs. 355.47 ± 86.16, p = 0.34). Assessment of cardiac arrhythmias was performed during the first 7 days after cardiac surgery. Statistical processing was performed by SPSS 12.0 for Windows. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days of the postoperative period, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Analysis of age structure showed that the patients <45 years didn’t have arrhythmias, 45-59 years - 8 (14.2%), 60-74 - 17 (30.4%), 75-90 - 2 (3,6%) of the patients have rhythm disorders, respectively. Atrial fibrilation (AF) dominates in the structure of arrhythmias - 17 (30.4%) patients, among them – in 11 (64.7%) patients was paroxysmal,  in 6 (35.3%) – persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. Also registered atrial flutter –  in 3 (5.4%), atrial tachycardia –  in 2 (3.6%), supraventricular paroxysmal tachycardia –  in 1 (1.8%), frequent supraventricular premarute beats (PB) – in 11 (19.6%) ), ventricular PB – in 12 (21.4%), among them ventricular PB 1st Laun class  - 8 (66.7%), 2nd class - 2 (16.7%), 3rd class - 1 (8.3%), class 4A - 1 (8.3%) patients, respectively. Among the heart blocks were registered left bundle branch (LBB) block – in 4 (7.1%), anterior branch block of LBB – in 10 (17.9%), right bundle branch block – in 6 (10.7%), atrio-ventricular (AV) block 1 degree – in 4 (7.1%), complete AV block – in 8 (14.3%) patients, respectively. The implantation of the pacemaker was performed in 9 (16.1%) patients. Disorders of repolarization flattening / inversion of the T wave – in 31 (55.4%), elevation of the ST segment – in 5 (8.9%), depression of the ST segment – in 16 (28.6%), pathological Q wave – in 5 (8.9%) patients, respectively. Conclusions The prevalence of arrhythmias in the early postoperative period (7 days) following cardiac surgery is 48.2%, equally common in men and women. AF dominated in the structure of cardiac arrhythmias (30,4%).

PERIOPERACINIS MIOKARDO INFARKTAS

2013 ◽  
Vol 23 (6) ◽  
pp. 29-34
Author(s):  
Andrius Macas ◽  
Giedrė Bakšytė ◽  
Laura Šilinskytė ◽  
Jūratė Petrauskaitė
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Oxygen Supply ◽  
Plaque Rupture ◽  
Perioperative Period ◽  
Vascular Complication ◽  
Early Postoperative Period ◽  
Hospital Length Of Stay ◽  
Perioperative Myocardial Infarction ◽  
Risk Patients

Perioperative myocardial infarction (PMI) is defined as myocardial infarction (MI) during perioperative period (24-72 hours after non cardiac surgery). Worldwide, over 200 million adults have major non-cardiac surgery each year, and several million experience a major vascular complication (e.g.: nonfatal myocardial infarction). The prevalence of PMI for low risk patients without ischemic heart disease is from 0.3 to 3%, while for medium and high risk patients with coronary artery disease increases to 30%. It is believed that plaque rupture and myocardial oxygen supply-demand imbalance is the main reason of perioperative myocardial infarction. Mostly oxygen supply-demand imbalance predominates in the early postoperative period. Plaque rupture appears to be a more random event, distributed over the entire perioperative admission. Most patients with a perioperative MI do not experience ischemic symptoms, because of sedation and analgesia during surgery procedure. This is the reason why routine monitoring of troponin levels and electrocardiography in at-risk patients are needed after surgery to detect most MI. In 90% of cases troponin level inceases during the first 24 hours after surgery. Risk factors detection, serial troponin evaluation and specialised treatment can reduce hospital length of stay, treatment costs and PMI mortality.

Incidence and risk factors for impaired mobility in older cardiac surgery patients during the early postoperative period

2014 ◽  
Vol 15 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Lurdes Tse ◽  
John B Bowering ◽  
Stephan K W Schwarz ◽  
Randell L Moore ◽  
Richard Sztramko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Impaired Mobility

scholarly journals Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?

2018 ◽  
Vol 11 (2) ◽  
pp. 85-92
Author(s):  
Yuriy Yu Kulyabin ◽  
Ilya A Soynov ◽  
Alexey V Zubritskiy ◽  
Alexey V Voitov ◽  
Nataliya R Nichay ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Septal Defect ◽  
Postoperative Period ◽  
Septal Defect ◽  
Early Postoperative Period ◽  
Valve Repair ◽  
Significant Difference

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR). METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months. RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037). CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients

Heart ◽  
2018 ◽  
Vol 105 (21) ◽  
pp. 1622-1628 ◽  
Author(s):  
Saibal Kar ◽  
Ted Feldman ◽  
Atif Qasim ◽  
Alfredo Trento ◽  
Samir Kapadia ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Regurgitation ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Class ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Risk Patients

ObjectivesThis study evaluates the 5-year clinical outcomes of transcatheter mitral valve (MV) repair with the MitraClip device in patients at high risk for MV surgery treated in the Endovascular Valve Edge-to-Edge Repair (EVEREST) II High Risk Study (HRS).MethodsPatients with mitral regurgitation (MR) 3+ or 4+ and predicted surgical mortality risk ≥12% or surgeon assessment based on prespecified high-risk factors were enrolled. Patients prospectively consented to 5 years of follow-up.ResultsAt 5 years, clinical follow-up was achieved in 90% of 78 enrolled patients. The rate of postprocedural adverse events declined from 30 days to 1 year follow-up and was stable thereafter through 5 years. Two patients (2.6%) developed mitral stenosis (MS). Two patients underwent MV surgery, including one due to MS. A total of 42 deaths were reported through 5 years. Effectiveness measures at 5 years showed reductions in MR severity to ≤2+ in 75% of patients (p=0.0107), left ventricular (LV) end-diastolic volume (−38.2 mL; 95% CI −55.0 to –21.4; p<0.0001) and LV end-systolic volume (−14.6 mL; 95% CI −27.7 to −1.5; p=0.0303) compared with baseline. The New York Heart Association (NYHA) functional class improved from baseline to 5 years (p<0.005), and septal-lateral annular dimensions remained stable with no indication of mitral annular dilation through 5 years.ConclusionsThe EVEREST II HRS demonstrated long-term safety and efficacy of MitraClip in high-surgical-risk patients through 5 years. The observed mortality was most likely a consequence of the advanced age and comorbidity profile of the enrolled patients, while improvements in NYHA class in surviving patients were durable through long-term follow-up.Trial registration numberNCT01940120.

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