scholarly journals Del Nido versus HTK cardioplegia for myocardial protection during adult complex valve surgery: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lian Duan ◽  
Guo-huang Hu ◽  
E. Wang ◽  
Cheng-liang Zhang ◽  
Ling-jin Huang ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Myocardial Protection ◽  
Valve Surgery ◽  
Low Cardiac Output ◽  
Protection Effect ◽  
Significant Difference ◽  
Dose Infusion ◽  
Adult Cardiac Surgery ◽  
Spontaneous Rhythm

Abstract Background Histidine-tryptophan-ketoglutarate (HTK) and del Nido (DN) cardioplegia are intracellular-type and extracellular-type solution respectively, both can provide a long period of myocardial protection with single-dose infusion, but studies comparing the two are rare for adult cardiac surgery. This study aims to evaluate whether DN is suitable for cardioplegia in complex and high-risk valve surgery with long-term cardiac ischemia when compared with HTK. Methods The perioperative records of adult patients infused with DN/HTK as a cardioplegic solution who underwent complex valve surgery with an expected myocardial ischaemic duration longer than 90 min between Oct 2018 and Oct 2019 were analysed retrospectively. Results Of the 160 patients who received DN/HTK and underwent complex valve surgery, we propensity matched 73 pairs. Both groups achieved satisfactory cardiac arrest effects, and no significant difference was found in their cTnI and CK-MB levels within 12 to 72 h postoperatively. The DN group had a higher rate of return to spontaneous rhythm (0.88 v 0.52, P < 0.001), a lower frequency of postoperative severe arrythmias (12% v 26%, P = 0.036), a higher postoperative stroke volume (65 v 59 ml, P = 0.011) and a higher cardiac output (6.0 v 4.9 L/min, P = 0.007) as evaluated by echocardiography, fewer transfusions and shorter ICU stays (both P < 0.05). The two groups had similar inotrope usage and similar incidences of low cardiac output, morbidities and mortality. Subgroup analysis showed that when the aortic clamping time was greater than 120 min, the advantages of DN were weakened. Conclusions DN can be safely applied to complex valve surgery, and it has a similar myocardial protection effect as HTK. Further prospective studies are required to verify these retrospective findings. Trial registration retrospectively registered.

Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

2020 ◽  
Vol 58 ◽  
pp. 89-95
Author(s):  
Alberto Zangrillo ◽  
Vladimir V. Lomivorotov ◽  
Antonio Pisano ◽  
Maria Grazia Calabrò ◽  
Alessandro Belletti ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Randomized Trial ◽  
Low Cardiac Output Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Low Cardiac Output ◽  
Multicenter Randomized Trial

Low Cardiac Output Syndrome After Adult Cardiac Surgery

2018 ◽  
Vol 126 (5) ◽  
pp. 1476-1483 ◽  
Author(s):  
Philippe Amabili ◽  
Sabeha Benbouchta ◽  
Laurence Roediger ◽  
Marc Senard ◽  
Marie Bernard Hubert ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Adult Cardiac Surgery

scholarly journals Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery

2021 ◽  
Vol 134 (4) ◽  
pp. 552-561
Author(s):  
Ryan M. Hijazi ◽  
Daniel I. Sessler ◽  
Chen Liang ◽  
Fabio A. Rodriguez-Patarroyo ◽  
Edward G. Soltesz ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Artery Bypass ◽  
Valve Surgery ◽  
Bypass Grafting ◽  
Composite Outcome ◽  
Aortic Valve Surgery ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output

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

scholarly journals Design and training effects of a physical reality simulator for minimally invasive mitral valve surgery

2019 ◽  
Vol 29 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Ahmad-Fawad Jebran ◽  
Shekhar Saha ◽  
Narges Waezi ◽  
Ammar Al-Ahmad ◽  
Heidi Niehaus ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Learning Curves ◽  
Valve Surgery ◽  
Training Effects ◽  
Training Course ◽  
Skill Scores ◽  
Significant Difference

Abstract OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) through an endoscopic right minithoracotomy is a well-established yet complex procedure that has a challenging learning curve. We have developed a simulator for MIMVS and evaluated its short- and long-term training effects. METHODS Trainees without simulator experience or training in MIMVS were divided into 2 groups (10 students and 10 residents) and participated in a 5-day training course after initial instruction. Each trainee performed a ring annuloplasty. Scores were given by a supervisor who assessed 5 skills. The duration of each procedure was also measured. To evaluate the long-term effect of the training course, trainees performed the same procedure 4 weeks after the last session. RESULTS Trainees in the resident group were significantly older compared to those in the student group and had a mean surgical experience of 4.4 ± 0.78 years standard error of the mean. All other demographic data were similar. Significant learning curves could be achieved in both groups over the course of 5 days with regard to total skill scores and total duration. However, when we compared the learning curves of both groups, no significant difference could be seen. Long-term performance in both groups was still significantly better compared to that in the first training session. CONCLUSIONS Training with our simulator provided a significant enhancement of a trainee’s performance. This learning effect was achieved in both groups and was still evident 4 weeks later. We strongly recommend our simulator for simulation-based surgical education of cardiac surgeons interested in MIMVS.

Long term effects of dopexamine hydrochloride in low cardiac output states following cardiac surgery

1990 ◽  
Vol 4 (6) ◽  
pp. 80 ◽  
Author(s):  
N. Friedel ◽  
G. Matheis ◽  
H. Kuppe ◽  
H. Bittner ◽  
R. Hetzer
Keyword(s):  
Cardiac Output ◽  
Cardiac Surgery ◽  
Long Term Effects ◽  
Low Cardiac Output

Thermodilution measurement of cardiac output in patients with low output: room-temperature versus iced injectate

1998 ◽  
Vol 7 (6) ◽  
pp. 436-438 ◽  
Author(s):  
M Kiely ◽  
LA Byers ◽  
R Greenwood ◽  
E Carroll ◽  
D Carroll
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Room Temperature ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Thermodilution Technique ◽  
Convenience Sample ◽  
Low Cardiac Output ◽  
Significant Difference ◽  
Critically Ill Adults

BACKGROUND: Measurements of cardiac output with the thermodilution technique add to data for clinical decision making and therefore must be valid and reliable. However, the results of studies on the accuracy of values obtained with room-temperature and iced injectates, especially in patients with high or low cardiac output, have been conflicting. OBJECTIVE: To determine the effect of the temperature of the injectate (iced or room temperature) on cardiac output values obtained with the thermodilution technique in critically ill adults with known low cardiac output. METHODS: A convenience sample of 50 subjects (41 men and 9 women) who had a cardiac index of less than 2.5 (calculated as cardiac output in liters per minute divided by body surface area in square meters) before the study had cardiac output measured by using a closed system and manual injections of room-temperature and iced injectates. RESULTS: A paired t test indicated no significant difference between iced and room-temperature injectates for cardiac output (iced, 3.62 L/min; room temperature, 3.71 L/min; t = 0.99; P = .327) and cardiac index (iced, 1.95; room temperature, 1.99; t = 0.71; P = .482). CONCLUSION: The findings support the practice of using room-temperature injectate to measure cardiac output in patients with low cardiac output.

P4730Underweight is associated with unfavourable short- and long-term outcomes after MitraClip therapy: a body mass index derived subgroup analysis of the German Transcatheter Mitral Valve Interventions (

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Kalbacher ◽  
E P Tigges ◽  
P Boekstegers ◽  
M Puls ◽  
B Plicht ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cardiac Output ◽  
Mitral Valve ◽  
Normal Weight ◽  
Long Term Outcomes ◽  
Low Cardiac Output ◽  
Short And Long Term ◽  
Underweight Patients ◽  
Mitraclip Therapy

Abstract Background Underweight and obesity represent classical risk factors for patients undergoing cardiac surgery or interventional treatment. The multicentre German Transcatheter Mitral Valve Interventions (TRAMI) registry comprises a large and prospectively enrolled real-world cohort of patients treated by MitraClip implantation. Aims The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy. Methods and results From 08/2010 until 07/2013, 799 patients (age 75.3±8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicentre, industry-independent German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into four groups: BMI<20 kg/m2 (underweight, n=49), BMI 20.0 to <25.0 kg/m2 (normal weight, n=293), BMI 25.0 to <30.0 kg/m2 (overweight, n=296) and BMI≥30 kg/m2 (obese, n=132). Procedure and radiation time were comparable among all groups. Significant increased rates of procedural failure (12.2% vs. 2.1 [normal weight], p<0.001), transfusion/bleeding (20.8% vs. normal weight: 5.6%, obesity: 7.0%, p<0.01), sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, p<0.01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine≥1.5mg/dl, diabetes, left ventricular ejection fraction<30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR]: 1.58, 95%-confidence interval (CI): 1.01–2.46, p=0.044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55–0.93; p=0.011). Conclusion Underweight patients are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates when undergoing MitraClip implantation and should therefore be carefully discussed within the heart team. Acknowledgement/Funding The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott.

Del Nido cardioplegia for myocardial protection in adult cardiac surgery: a systematic review and update meta-analysis

Perfusion ◽  
2021 ◽  
pp. 026765912110310
Author(s):  
Kerong Zhai ◽  
Xingdong Cheng ◽  
Pengbin Zhang ◽  
Shilin Wei ◽  
Jian Huang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Protection ◽  
Troponin T ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Creatine Kinase Mb ◽  
Significant Difference ◽  
Mean Differences ◽  
Adult Cardiac Surgery

Objective: Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery. Methods: A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020. Results: Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): −0.59, 95% confidence interval (CI): −0.99 to −0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: −9.31, 95% CI: −13.10 to −5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: −7.20, 95% CI: −10.31 to −4.09, p < 0.00001), and cardioplegia volume (SMD: −1.95, 95% CI: −2.46 to −1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC. Conclusion: In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.

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