Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study

ObjectivesRheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.MethodsClinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.ResultsSurvival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.ConclusionsCardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.

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The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.78557 ◽

2021 ◽

Author(s):

Murat Aksun ◽

Saliha Aksun ◽

Mehmet Ali Çoşar ◽

Elif Neziroğlu ◽

Senem Girgin ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Experience ◽

Heart Surgery ◽

Blood Product ◽

Open Heart Surgery ◽

Control Group ◽

Open Heart ◽

Blood Products ◽

Product Use ◽

The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

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Abstract 3044: The Preoperative Utilization of Levosimendan (Preoperative Optimization) Reduced Mortality and Low Output Syndrome After Cardiac Surgery in Patients With Low Ejection Fraction (EF<25%).

Circulation ◽

10.1161/circ.116.suppl_16.ii_682-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ricardo L Levin ◽

Marcela A Degrange ◽

Rafael Porcile ◽

Flavio Salvagio ◽

Norberto Blanco ◽

...

Keyword(s):

Cardiac Surgery ◽

Ejection Fraction ◽

Heart Surgery ◽

Open Heart Surgery ◽

Control Group ◽

Placebo Control ◽

P Value ◽

Open Heart ◽

Preoperative Optimization ◽

Low Ejection Fraction

Background: Patients with low ejection fraction (EF<25%) present high-risk of mortality and development of low output state (LOS) after cardiac surgery. The objective of this research was to evaluate the preoperative use of the calcium sensitizer Levosimendan (Levo) in patients with EF<25%, underwent open heart surgery. Thirty-day mortality and development of postoperative LOS were the primary end-points of the study. Methods: Patients with EF<25% and hemodynamic parameters of LOS (cardiac index<2.2 L/min/m2 and pulmonary artery occlusion pressure>15 mm Hg), underwent coronary bypass surgery between 12/01/2002 and 02/01/2007 were randomized to: preoperative infusion of Levo 0.1 mcg/Kg/min, 24 hours before surgery (Levo group-preoperative optimization), or placebo (Control group). LOS postoperative was defined for the same hemodynamic variables. A P value < 0.05 was considered significant Results: Two-hundred and twenty one patients fulfilled the inclusion criteria, being randomized 111 of them to Levo, and 110 patients to placebo. Both groups were comparable in their general and surgical characteristics. No withdrawal of Levo was required during the preoperative administration, with 8 patients showing hypotension episodes which was resolved with fluid infusions. There were not ventricular arrhythmias, supraventricular arrhythmias (with heart rate over 125) or preoperative ischemic events. The 30-day mortality was 3 patients in the Levo group (2.7%) versus 12 patients in the Control group (10.9%, P value 0.001, OR 0.23, IC95 0.05– 0.90). Seven patients in the Levo group developed postoperative LOS (6.3%) against 20 patients in the Control group (18.2%, P value <0.001, OR 0.30, IC95 0.11– 0.80) Conclusion: The preoperative optimization with Levosimendan reduced the operative mortality and the development of postoperative LOS in patients with EF<25% underwent open heart surgery. The infusion was safety no needing to withdraw it in any case. These findings could represent a new strategy to reduce the operative risk in this group of patients.:

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Intraoperative Low-volume Acute Normovolemic Hemodilution in Adult Open-heart Surgery

Anesthesiology ◽

10.1097/00000542-200208000-00013 ◽

2002 ◽

Vol 97 (2) ◽

pp. 367-373 ◽

Cited By ~ 37

Author(s):

Valter Casati ◽

Giovanni Speziali ◽

Cesare D'Alessandro ◽

Clara Cianchi ◽

Maria Antonietta Grasso ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Postoperative Bleeding ◽

Open Heart Surgery ◽

Valve Surgery ◽

Control Group ◽

Open Heart ◽

Acute Normovolemic Hemodilution ◽

Normovolemic Hemodilution ◽

Low Volume

Background Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery. Methods Two hundred four consecutive adult patients undergoing cardiac surgery were prospectively randomized in a nonblinded manner into two groups: ANH group (103 patients), where 5-8 ml/kg of blood was withdrawn before systemic heparinization and replaced with colloid solutions, and a control group, where no hemodilution was performed (101 patients). Procedures included single and multiple valve surgery, aortic root surgery, coronary surgery combined with valve surgery, or partial left ventriculectomy. The purpose of the study was to evaluate the efficacy of ANH in reducing the need for allogeneic blood components. Routine hematochemical evaluations, perioperative blood loss, major complications, and outcomes were also recorded. Results No differences were found between the groups regarding demographics, baseline hematochemical data, and operative characteristics. There was no difference in the amount of transfusions of packed red cells, fresh frozen plasma, platelet concentrates, total number of patients transfused (control group, 36% vs. ANH group, 34.3%; P = 0.88), and amount of postoperative bleeding (control group, 412 ml [313-552 ml] vs. ANH group, 374 ml [255-704 ml]) (median [25th-75th percentiles]); P = 0.94. Further, perioperative complications, postoperative hematochemical data, and outcomes were not different. Conclusions In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding.

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The Incidence and Clinical Outcome of Cardiac Tamponade Following an Open Heart Surgery in a Developing Country

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2.1.5 ◽

2012 ◽

Vol 2 (1) ◽

pp. 23-27

Author(s):

Abdalla Misbah ◽

Koteswara R. Pothineni ◽

Eman Elshiekh ◽

Yassir H. Yousif Ali

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Cardiac Tamponade ◽

Rheumatic Heart Disease ◽

Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Mechanical Valve ◽

Open Heart ◽

Rheumatic Heart

Introduction: Pericardial effusion is not uncommon following an open heart surgery, thus, it may progress to cardiac tamponade. This is a retrospective cross-sectional analysis evaluates the incidence, the potential perioperative and surgical risk factors causing cardiac tamponade following an open-heart surgery of patients during the period 2001-2006 at Ahmed Gasim Cardiac Center in Khartoum, North Sudan. Methods: Diagnosis of cardiac tamponade was based on clinical and echocardiographic findings. Univariate analysis was performed to assess possible risk factors related to both, early and late cardiac tamponade. Results: Among the 890 patients who underwent open heart surgery in this study, 47(5%) patients developed tamponade (early 49% or 51%). Early cardiac tamponade was found to be present with significant cardiac compromise and can easily be detected using echocardiography. In contrast the presentation of late cardiac tamponade, atypical and echocardiography was inconclusive. The mean age of patients was 31 ± 12 with slight female predominance. The main indication for the operation was rheumatic heart disease (89%), mainly mechanical valve replacement of the mitral valve. Eight (17%) patients were receiving warfarin preoperatively. Oozing wounds and blocked drains were encountered in 27% and 37%, respectively. About 6% of the patients recollect tamponade after decompression and one in-hospital death directly related to the cardiac tamponade. Conclusion: Significant cardiac tamponade was associated with preexisting rheumatic heart disease, (preoperative warfarin use), mechanical valve replacement in the mitral position, oozing wounds and blocked drain. Echocardiography was reliable in early diagnosis, but not late, hemodynamically significant cardiac tamponade.

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