The Effects of Norepinephrine Infusion on the Circulating Lymphocyte Counts of Post–Open Heart Surgery Patients

In this retrospective study employing chart reviews, 75 open heart surgery patients (OHSPs) were divided into 3 groups of 25 patients. Group 1 received no intravenous (IV) norepinephrine (NE) after surgery. Group 2 and group 3 received a minimum of 0.028 mcg/kg/min of IV NE for 6-24 h and greater than 24 h, respectively. In the 3 groups, preoperative lymphocyte counts were compared to counts obtained on postoperative days 1 and 2. The results showed lower lymphocyte counts on postoperative day 2 in group 3 subjects, who received NE for 24 h or more, compared to subjects of the other groups who received no NE or 6-24 h of NE (p < 0.05). There was also evidence that preoperative use of beta-blocking agents significantly affected the change in lymphocyte counts from day 1 to day 2 in both groups receiving NE. Furthermore, postoperative infections were more prevalent in group 3 than the other 2 groups (p < 0.05). The lower lymphocyte counts and higher infection rate, however, may be linked to lower postoperative blood pressure and increased number of intensive care unit days in group 3. Further investigation is warranted to elucidate the effects of IV NE administration on the lymphocyte counts of OHSPs and to reduce infections in those receiving NE.

Download Full-text

Adding tricuspid repair to standard open heart surgery does not increase risk but improves right ventricular function

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz106 ◽

2019 ◽

Vol 29 (3) ◽

pp. 416-421 ◽

Cited By ~ 1

Author(s):

Clarence Pingpoh ◽

Sarah Nuss ◽

Sami Kueri ◽

Maximillian Kreibich ◽

Martin Czerny ◽

...

Keyword(s):

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Group 2 ◽

Repair Group ◽

Tricuspid Repair ◽

Group 1

Abstract OBJECTIVES To evaluate outcome of concomitant tricuspid annuloplasty in mild or moderate regurgitation on perioperative outcome and on right ventricular function in patients undergoing major cardiac surgery. METHODS Among 14 500 patients who underwent cardiac surgery at our institution between January 2000 and April 2016, 1023 patients had a documented history of tricuspid regurgitation (TR). Of those patients, 324 patients were diagnosed with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) and composed the study population. The decision to perform concomitant annuloplasty was subjected to the individual decision of the treating surgeon. Our analysis focused on a comparison between patients with concomitant TR-repair (group 1, n = 184) and patients without concomitant TR-repair (group 2, n = 140) after propensity score matching. RESULTS Following a preliminary data preprocessing, we observed a mean age of 73.8 years, mean logistic EuroSCORE of 10.5%. Perioperative mortality was 4.4% in group 1 and 5.7% in group 2. There was no significant difference in mid-term mortality. TR after surgery was significantly higher in group 2. After propensity score matching regression analysis, patients who had a repaired tricuspid valve (group 1) had better right ventricle (RV) function than those without TR-repair (group 2) (P > 0.05 at 95% confidence interval following Kolmogorov–Smirnov Goodness of fit Test). CONCLUSIONS Adding tricuspid valve repair in patients with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) to standard open heart surgery does not increase perioperative risk but improves right ventricular function. Therefore, standard tricuspid repair in this subgroup might be considered on a routine basis.

Download Full-text

Cholelithiasis in children with CHD: is it a problem?

Cardiology in the Young ◽

10.1017/s1047951116000846 ◽

2016 ◽

Vol 27 (4) ◽

pp. 630-633

Author(s):

Simon Kargl ◽

Roland Gitter ◽

Wolfgang Pumberger

Keyword(s):

Risk Factors ◽

Ursodeoxycholic Acid ◽

Heart Surgery ◽

Open Heart Surgery ◽

Aetiological Factor ◽

Open Heart ◽

Biliary Surgery ◽

Group 2 ◽

A Minor ◽

Group 1

AbstractBackgroundAn association of heart disease and its treatment with biliary calculi is popularly accepted. We sought determine the prevalence and risk factors of paediatric gallstone disease in the presence of CHD and analyse the treatment options. We evaluated the role of open-heart surgery in the development of gallstones in patients with CHD.Patients and methodsIn a 10-year, retrospective, chart review (2005–2014), patients with CHD and cholelithiasis were identified and reviewed.ResultsIn all, 19 of 4729 children with CHD had cholelithiasis (0.4%); eight patients underwent cardiac surgery before diagnosis of cholelithiasis (group 1), whereas 11 of them had not (group 2). The prevalence was 0.3% in group 1 and 0.5% in group 2.In nine asymptomatic patients, gallstones were found incidentally. Children with cholecystolithiasis (n=17) received ursodeoxycholic acid. A resolution of gallstones was found in four cases; two patients underwent biliary surgery, and the others (15/17) were successfully managed non-operatively.ConclusionDespite an accumulation of risk factors, prevalence of gallstones is not as high as expected in children with CHD. Open-heart surgery with a heart–lung machine plays a minor role as an aetiological factor. In about half of the cases, cholelithiasis is an incidental finding and patients stay asymptomatic. Prophylactic administration of ursodeoxycholic acid is not indicated in children undergoing open-heart surgery for CHDs. Biliary surgery is reserved for patients with recurrent symptoms or cholestasis.In children with CHD, cholelithiasis is a minor and manageable co-morbid condition.

Download Full-text

Evaluation of Systemic Inflammatory Response in Cardiovascular Surgery via Interleukin-6, Interleukin-8, and Neopterin

The Heart Surgery Forum ◽

10.1532/hsf98.2013267 ◽

2014 ◽

Vol 17 (1) ◽

pp. 13 ◽

Cited By ~ 2

Author(s):

Ihsan Sami Uyar ◽

Suleyman Onal ◽

Ayhan Uysal ◽

Ugur Ozdemir ◽

Oktay Burma ◽

...

Keyword(s):

Inflammatory Response ◽

Valve Replacement ◽

Interleukin 6 ◽

Heart Surgery ◽

Open Heart Surgery ◽

Beating Heart ◽

Systemic Inflammatory Response ◽

The Other ◽

Open Heart ◽

Group 3

Aim: The aim of this study was to evaluate the serum levels of interleukin-6 (IL-6), IL-8, and neopterin as a sign of systemic inflammatory response syndrome after open-heart surgery. In this study, we evaluated the influences on the levels of IL-6, IL-8, and neopterin of coronary artery bypass grafting (CABG) and valve replacement surgeries with and without the use of extracorporeal circulation (ECC).Materials and Methods: This prospective study was performed in 30 patients. In this study, we evaluated patients who underwent valve replacement surgery (group 1, n = 10), CABG with ECC (group 2, n = 10), or CABG using the beating-heart technique (group 3, n = 10). With the Human Investigation Ethics Committee consent, blood samples were obtained from the patients before the surgery (T0) and after 1 hour (T1), 4 hours (T2), 24 hours (T3), and 48 hours (T4) of protamine injection. IL-6, IL-8, and neopterin levels were measured using commercial enzyme-linked immunosorbent assay kits.Results: The demographic data and preoperative and operative characteristics of the patients were similar. Neopterin IL-6 and IL-8 levels significantly increased first at the fourth hour after the surgery. When compared to the levels before the surgery, this increase was statistically significant. Unlike the other 2 groups of patients, those who experienced CABG with the beating-heart technique (group 3) had decreased neopterin levels at the first hour after the surgery, but this decrease was not statistically significant. Neopterin levels increased later in the OPCAB group, but these increased levels were not as high as the neopterin levels of groups 1 and 2. Neopterin reached maximum levels at the 24th hour and, unlike groups 1 and 2, in group started to decrease at the 48th.Conclusions: Complement activation, cytokine production, and related cellular responses are important factors during open-heart surgery. It is certain that ECC activates the complement systems, and activated complement proteins cause the production of several cytokines. In our study, neopterin levels in patients who underwent beating-heart method surgery were lower than those in the other groups, and these levels started to decrease at the 48th hour. These data suggest that the systemic inflammatory response was less activated in that patient group. The beating-heart method might be an important alternative in CABG surgery to minimize the complications and mortality related to surgery.

Download Full-text

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

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.6 ◽

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.

Download Full-text

Long-term outcome of endocardial-only versus combined endocardial-epicardial homogenization of the scar for treatment of ventricular tachycardia in patients with ischemic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0364 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Mohanty ◽

C Trivedi ◽

D G Della Rocca ◽

C Gianni ◽

B MacDonald ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Ischemic Cardiomyopathy ◽

Heart Surgery ◽

Open Heart Surgery ◽

Long Term Outcome ◽

Obstructive Sleep ◽

Number Of Patients ◽

Group 2 ◽

Group 1

Abstract Introduction We investigated the ablation success of scar homogenization with combined (epicardial + endocardial) versus endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Method Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial scar homogenization and group 2: endocardial +epicardial scar homogenization. Patients with previous open heart surgery were excluded. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue >1.5 mV and severe scar <0.5 mV. Non-inducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up twice a year for 5 years with implantable device interrogations. Results A total of 361 (Group 1: 291 and group 2: 70) patients were included in the study (mean age: 67 years, male: 88.4%). At 5 years, significantly higher number of patients from group 2 remained arrhythmia-free (figure 1). Of those patients, 87 (45%) and 51 (89%) from group 1 and 2 respectively were off-anti-arrhythmic drugs (AAD) (p<0.001). After adjusting for age, gender, hypertension, diabetes, and obstructive sleep apnea, scar homogenization using endo-epicardial approach was associated with 51% less recurrence compared to the endocardial ablation strategy (Hazard Ratio: 0.49, 95% CI: 0.27–0.89, p: 0.02). Conclusion In this series of patients with ischemic cardiomyopathy and VT, endo-epicardial scar homogenization was associated with a lower need for AAD and a significantly lower recurrence rate at 5-years of follow-up compared to the endocardial ablation alone. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Download Full-text

Hyaluronan affects extravascular water in lungs of unanesthetized rabbits

Journal of Applied Physiology ◽

10.1152/jappl.1989.66.6.2595 ◽

1989 ◽

Vol 66 (6) ◽

pp. 2595-2599 ◽

Cited By ~ 30

Author(s):

J. Bhattacharya ◽

T. Cruz ◽

S. Bhattacharya ◽

B. A. Bray

Keyword(s):

Body Weight ◽

Water Content ◽

Extravascular Lung Water ◽

Volume Expansion ◽

The Other ◽

Lung Water ◽

Intravenous Saline ◽

Group 3 ◽

Group 2 ◽

Group 1

We have determined whether changes in lung hyaluronan content affect extravascular water in lungs of unanesthetized rabbits. Three groups of experiments were performed. In group 1 (n = 12), no infusions were given; in group 2, nine pairs of rabbits received either intravenous hyaluronidase (750 U.kg-1.min-1) or an equivalent volume of saline; in group 3, nine pairs of rabbits received either hyaluronidase or saline, followed by intravenous saline infusion amounting to 24% of body weight. At the end of each experiment, one lung was analyzed for extravascular lung water by the wet-dry method. Except for group 3, in all animals the other lung was analyzed for hyaluronan content by a method that involved hydrolyzing lung hyaluronan with fungal hyaluronidase to release reducing N-acetyl glucosamine groups, which were quantified. In group 1, lung hyaluronan, which varied from 50 to 159 micrograms/g dry wt (mean 106 +/- 35 micrograms/g dry wt), significantly correlated with variation in extravascular lung water (mean 4.2 +/- 0.3 g/g dry wt). In group 2 rabbits given hyaluronidase, lung hyaluronan was 40% lower and extravascular lung water was 14.6% lower than in paired controls (P less than 0.01). In group 3, volume expansion did not affect lung water, except after hyaluronidase when lung water was 47% higher than paired controls. We conclude that in the lung the content of hyaluronan is one of the determinants of extravascular water content.

Download Full-text

Intensive hyperglycemia control reduces postoperative infections after open heart surgery

Heart International ◽

10.4081/hi.2006.49 ◽

2006 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Fabio Capuano ◽

Antonino Roscitano ◽

Caterina Simon ◽

Gianluca Sclafani ◽

Umberto Benedetto ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Postoperative Infections

Download Full-text

A clinical study of postoperative infections following open-heart surgery: Occurrence and microbiological findings in 782 cases

Surgery Today ◽

10.1007/bf00308824 ◽

1992 ◽

Vol 22 (3) ◽

pp. 207-212 ◽

Cited By ~ 8

Author(s):

Hiroyuki Orita ◽

Takao Shimanuki ◽

Manabu Fukasawa ◽

Kiyoshige Inui ◽

Satoshi Goto ◽

...

Keyword(s):

Clinical Study ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Postoperative Infections

Download Full-text

Evaluation of Mandibular First Molars’ Axial Inclination and Alveolar Morphology in Different Facial Patterns: A CBCT Study

European Journal of Dentistry ◽

10.1055/s-0040-1709932 ◽

2020 ◽

Vol 14 (02) ◽

pp. 250-259 ◽

Cited By ~ 1

Author(s):

Marcos Cezar Ferreira ◽

Karina Maria Salvatore de Freitas ◽

Francyle Simões Herrera-Sanches ◽

Patrícia Bittencourt dos Santos ◽

Daniela Garib ◽

...

Keyword(s):

The Other ◽

Cone Beam ◽

Bone Morphology ◽

Mandibular Molar ◽

Significant Difference ◽

Mandibular Body ◽

Facial Pattern ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Objective The purpose of this study was to evaluate and compare the axial inclination of the mandibular first molars and their respective bone morphology among individuals with different facial patterns. Materials and Methods The sample comprised the cone beam computed tomographies (CBCTs) of 58 subjects divided into three groups according to the facial patterns: 18 brachyfacial (Group 1), with a mean age of 21.58 years; 23 mesofacial (Group 2), with a mean age of 19.14 years; and 17 dolichofacial subjects (Group 3), with a mean age of 19.09 years. Eight variables were evaluated on CBCT scans of each subject: buccal and lingual mandibular height, cervical and middle mandibular width, inclination of mandibular body, inclination of the mandibular molar buccal surface, molar width, molar angulation and tooth/bone angle. Intergroup comparisons were performed with one-way analysis of variance followed by Tukey tests. Results Buccal mandibular height presented statistically significant difference in the three facial patterns. Lingual mandibular height and mandibular inclination showed to be statistically and significantly smaller in brachyfacial subjects than in the other two groups. Mandibular width presented a statistically significant difference between brachyfacial and mesofacial groups. Negative correlations could be observed between the facial pattern and the buccal and lingual mandibular heights and inclination of the mandibular body. Conclusion Buccal mandibular height was significantly and progressively larger in brachyfacial, mesofacial, and dolichofacial subjects. Lingual mandibular height was significantly smaller in brachyfacial than in mesofacial and dolichofacial subjects. Mandibular width was significantly thicker in brachyfacial than in mesofacial subjects. Brachyfacial subjects had smaller mandibular inclination than mesofacial and dolichofacial subjects.

Download Full-text

Treatment of ovarian cysts in sows – a field trial

Veterinární Medicína ◽

10.17221/1995-vetmed ◽

2008 ◽

Vol 52 (No. 9) ◽

pp. 413-418 ◽

Cited By ~ 9

Author(s):

S. Cech ◽

R. Dolezel

Keyword(s):

The Other ◽

Ovarian Cysts ◽

Control Group ◽

Initial Examination ◽

Interval Group ◽

Group 4 ◽

Group 3 ◽

Group 5 ◽

Group 2 ◽

Group 1

Different procedures of treatment of large follicular ovarian cysts in 177 sows using GnRH, hCG and PGF2α are evaluated in this study. Ovarian cysts were diagnosed by transcutaneous ultrasonography, which was a part of routine pregnancy diagnosis. No treatment was performed in the control group (Group 1, n = 29); the method of treatment used in the other groups immediately after the diagnosis was intramuscular administration of lecirelin in doses 50 µg (Group 2, n = 28), 100 µg (Group 3, n = 27) and 200 µg divided into 2 equal doses administered at a 12-hour interval (Group 4, n = 25) and of hCG in doses 1 500 IU (Group 5, n = 23), 3 000 IU (Group 6, n = 21), and 250 µg of cloprostenol (Group 7, n = 24). Insemination rate (IR), conception rate (CR) in inseminated sows, pregnancy rate (PR = recovery rate), treatment-insemination interval (TII) and treatment-pregnancy interval (TPI) within 42 days after the initial examination were evaluated. In addition PR in groups of sows divided according to parity (1–3, 4–6 and ≥ 7) were also evaluated. IR and PR were higher in Group 4 (84.0% and 44.0%) and lower in Group 1 (17.2% and 6.9%) in comparison with the other groups (P < 0.001 and P < 0.05). CR, TII and TPI did not differ between the experimental groups. PR were similar in sows with different parity. The study proved a positive response in sows with large follicular ovarian cysts to the treatment consisting of 2 administrations of 100 µg GnRH at a 12-hour interval.

Download Full-text