POSTOPERATIVE MANAGEMENT OF ARRHYTHMIAS AND LOW CARDIAC OUTPUT IN PATIENTS UNDERGOING AORTIC VALVE SURGERY

Background Recent work suggests that having aortic valve surgery in the morning increases risk for cardiac-related complications. This study therefore explored whether mortality and cardiac complications, specifically low cardiac output syndrome, differ for morning and afternoon cardiac surgeries. Methods The study included adults who had aortic and/or mitral valve repair/replacement and/or coronary artery bypass grafting from 2011 to 2018. The components of the in-hospital composite outcome were in-hospital mortality and low cardiac output syndrome, defined by requirement for at least two inotropic agents at 24 to 48 h postoperatively or need for mechanical circulatory support. Patients who had aortic cross-clamping between 8 and 11 am (morning surgery) versus between 2 and 5 pm (afternoon surgery) were compared on the incidence of the composite outcome. Results Among 9,734 qualifying operations, 0.4% (29 of 6,859) died after morning, and 0.7% (20 of 2,875) died after afternoon surgery. The composite of in-hospital mortality and low cardiac output syndrome occurred in 2.8% (195 of 6,859) of morning patients and 3.4% (97 of 2,875) of afternoon patients: morning versus afternoon confounder-adjusted odds ratio, 0.96 (95% CI, 0.75 to 1.24; P = 0.770). There was no evidence of interaction between morning versus afternoon and surgery type (P = 0.965), and operation time was statistically nonsignificant for surgery subgroups. Conclusions Patients having aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting with aortic cross-clamping in the morning and afternoon did not have significantly different outcomes. No evidence was found to suggest that morning or afternoon surgical timing alters postoperative risk. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Aortic Annulus Enlargement: Early and Long-Terms Results

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.006 ◽

2017 ◽

Vol 5 (1) ◽

pp. 23-26

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Laureta Dibra ◽

Vera Beca ◽

Saimir Kuci ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Complications ◽

Valve Surgery ◽

Aortic Annulus ◽

Aortic Valve Surgery ◽

Low Cardiac Output ◽

Valve Pathology ◽

Severe Patient

AIM: Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country.METHODS: During the period January 2010 –January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch.Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge.RESULTS: In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose.In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42.We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology.The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow-up, we had no death, and all patients had very good quality of life.CONCLUSIONS: Aortic valve annulus enlargement can be used with very good early and late results with the final goal to increase the potential benefit of the patient from surgery of aortic valve.

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Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.108 ◽

2014 ◽

Vol 3 (4) ◽

pp. 624-629

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Andi Kacani ◽

Laureta Dibra ◽

Elizana Petrela ◽

...

Keyword(s):

Aortic Valve ◽

Perioperative Complications ◽

Pulmonary Complications ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Low Cardiac Output ◽

Early Results ◽

Patient Prosthesis Mismatch ◽

Study Population

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery.METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery.RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch.CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery.

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