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 ◽  
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.:

scholarly journals Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 756
Author(s):  
Praveen Dhaulta ◽  
Vikas Panwar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Variable ◽  
Open Heart ◽  
Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

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

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.

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

2002 ◽  
Vol 97 (2) ◽  
pp. 367-373 ◽  
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.

scholarly journals 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

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001706
Author(s):  
Ståle Wågen Hauge ◽  
Havard Dalen ◽  
Mette E Estensen ◽  
Robert Matongo Persson ◽  
Sintayehu Abebe ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Low Income ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Control Group ◽  
First Year ◽  
Open Heart ◽  
Surgical Group ◽  
Rheumatic Heart

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.

scholarly journals Evaluation of the Effect of Lymphocytes, Platelets, Monocytes on the Development of Acute Renal Failure and Atrial Fibrillation After Open Heart Surgery: A Retrospective Study

2021 ◽  
Author(s):  
Fatemeh Javaherforoosh Zadeh ◽  
Mohsen Maleknia ◽  
Marzieh Babazadeh Dezfuly ◽  
Mohammad Reza Javan ◽  
Hashem kazemi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Retrospective Study ◽  
Sensitivity And Specificity ◽  
Heart Surgery ◽  
Hematological Parameters ◽  
Open Heart Surgery ◽  
P Value ◽  
Surgical Trauma ◽  
Open Heart

Abstract BackgroundCardiac surgery is the most well-known treatment for cardiovascular diseases, including coronary artery and valvular heart diseases. Following cardiac surgery, systemic inflammatory responses are induced due to myocardial arrest, surgical trauma and cardiopulmonary bypass (CPB), which lead to greater complications and poorer outcomes in patients. There is growing evidence, that evaluating cellular markers in cardiac surgery patients are promising messengers of inflammation and could predict post-operative inflammatory events. In this study, for the first time, hematological parameters and the ratio of inflammatory cells before, during, and after cardiac surgery are assessed to predict inflammatory complications, such as: acute renal injury (AKI) and atrial fibrillation (AF).Material and MethodsThis retrospective study was performed on patients, who underwent elective open-heart surgery; they referred to Imam Khomeini Hospital in Ahvaz during November 2014 - March 2017. The profiles of 400 cardiac surgery patients, who underwent CABG were scanned to evaluate the relationship between hematological parameters, cellular-inflammatory indexes, and inflammatory events before, during, and after cardiac surgery. In this study, AKI was diagnosed based on KIDGO criteria; Electro Cardiogram (ECG) was also used to diagnose AF. The specificity and sensitivity of biomarkers were assessed through the receiver operating characteristic curve (AUROC).ResultsAccording to the results, the post-operative NLR was significantly associated with AKI (P-Value: 0.03). Serum markers, including BUN and sCr levels were also significantly correlated with AKI and Non-AKI patients in all post-operative periods (P-Value: 0.0001). Hb core related antigen (HbCr) was also associated with AKI as a hematological parameter.ConclusionsThe findings of this study claimed, that post-operative NLR is significantly associated with the occurrence of AKI; it has also the acceptable sensitivity and specificity results. HbCr levels in the postoperative period also has relatively acceptable sensitivity and specificity concerning AKI.

scholarly journals The effects of levosimendan on renal functions in open-heart surgery patients with a low ejection fraction

2021 ◽  
Vol 6 (2) ◽  
pp. 121-130
Author(s):  
Süleyman Yazıcı ◽  
◽  
Mehmet N. Karabulut ◽  
Ayşe Baysal ◽  
Rahmi Zeybek
Keyword(s):  
Ejection Fraction ◽  
Serum Creatinine ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Renal Functions ◽  
Preoperative Serum ◽  
Group 2 ◽  
Low Ejection Fraction ◽  
Group 1

Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p<0.001, respectively). The aortic cross-clamp and cardiopulmonary bypass times were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p<0.001). On postoperative day 1, serum creatinine levels of Group 1 were significantly lower than Group 2 (p<0.001). On postoperative days 3 and 10, no differences were observed regarding serum creatinine levels between groups (p>0.05). Complications were similar between groups (p>0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.

scholarly journals Influence of biomarkers level during follow-up when operating under cardiopulmonary bypass

2015 ◽  
Vol 18 (3) ◽  
pp. 39
Author(s):  
Yu. I. Petrishchev ◽  
A. L. Levit ◽  
I. N. Leyderman
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Plasma Levels ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Cardiac Surgeons ◽  
The Given ◽  
The Relationship

Systemic inflammatory response was first determined in 1980 and cardiac surgeons turned to it in 1996. At present, there are a lot of publications on this issue, however, the extent of operation and duration of CPB are considered in clinical practice as crucial indicators of severity of patient's condition following cardiac surgery. In our study we tried to look at this problem from a different perspective and draw a parallel between the severity of patient's condition resulting from operational trauma and CPB. We included 48 patients who under-went cardiac surgery under CPB. Plasma levels of procalcitonin (PCT), lactate and interleukin-6 were investigated before the operation, after CPB and at 24 hours. Also revealed was the relationship between the plasma levels of IL-6, lactate and PCT (r = 0.53; p = 0.000 in both cases). The level of PCT at the 3rd stage was found to relate to the duration of CPB (r = 0.4; p = 0.005), ALV (r = 0.44; p = 0.001) and length of stay at ICU (r = 0.53; p = 0.000). We didn't manage to find any relationship between the length of stay at ICU and the duration of CPB. Correlation between the PCT plasma level and the duration of intensive care indicates the importance of dynamics of the given biomarker for early prediction of follow-up course after open-heart surgery.

scholarly journals Subclavian Vein Catheterisation for Cardiac Surgery in Children

1980 ◽  
Vol 8 (1) ◽  
pp. 81-83 ◽  
Author(s):  
John L. Poole
Keyword(s):  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Success Rate ◽  
Subclavian Vein ◽  
Heart Surgery ◽  
Venous Pressure ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Central Venous ◽  
Infusion Line

Infraclavicular subclavian vein catheterisation is a useful means of measuring central venous pressure and establishing a central infusion line in children undergoing open heart surgery. In 48 children ranging in age from 15 months to 13 years, there was a high success rate and no morbidity.

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