Bayesian Analysis for Repeated Measurements Adopting a More Informative New Prior for Updating Predicted Mortality Rate After the Cardiac Surgery Activity

Abstract OBJECTIVES Globally congenital heart disease mortality is declining, yet the proportion of infant deaths attributable to heart disease rises in Colombia and other middle-sociodemographic countries. We aimed to assess the accessibility of paediatric cardiac surgery (PCS) to children <18 years of age in 2016 in the South American country of Colombia. METHODS In Bogotá, Colombia, a multi-national team used cross-sectional and retrospective cohort study designs to adapt and evaluate 4 health system indicators at the national level: first, the population with timely geographic access to an institution providing PCS; second, the number of paediatric cardiac surgeons; third, this specialized procedure volume and its national distribution; and fourth, the 30-day perioperative mortality rate after PCS in Colombia. RESULTS Geospatial mapping approximates 64% (n = 9 894 356) of the under-18 Colombian population lives within 2-h drivetime of an institution providing PCS. Twenty-eight cardiovascular surgeons report performing PCS, 82% (n = 23) with formal training. In 2016, 1281 PCS procedures were registered, 90% of whom were performed in 6 of the country’s 32 departments. National non-risk-adjusted all-cause 30-day perioperative mortality rate after PCS was 2.73% (n = 35). CONCLUSIONS Colombia’s paediatric population had variable access to cardiac surgery in 2016, largely dependent upon geography. While the country may have the capacity to provide timely, high-quality care to those who need it, our study enables future comparative analyses to measure the impact of health system interventions facilitating healthcare equity for the underserved populations across Colombia and the Latin American region.

Download Full-text

Relationships of Adiponectin with Markers of Systemic Inflammation and Insulin Resistance in Infants Undergoing Open Cardiac Surgery

Mediators of Inflammation ◽

10.1155/2013/187940 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Yukun Cao ◽

Ting Yang ◽

Shiqiang Yu ◽

Guocheng Sun ◽

Chunhu Gu ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Systemic Inflammation ◽

Insulin Requirement ◽

Glycaemic Index ◽

Repeated Measurements ◽

Inverse Association ◽

Necrosis Factor Alpha ◽

Blood Samples

Background. Insulin resistance and systemic inflammation frequently occur in infants undergoing cardiac surgery with cardiopulmonary bypass, while adiponectin has been demonstrated to have insulin-sensitizing and anti-inflammatory properties in obesity and type 2 diabetes mellitus. In this prospective study, we aimed to investigate the association of adiponectin with insulin resistance and inflammatory mediators in infants undergoing cardiac surgery with cardiopulmonary bypass.Methods and Results. From sixty infants undergoing open cardiac surgery, blood samples were taken before anesthesia, at the initiation of cardiopulmonary bypass and at 0, 6, 12, 24, and 48 hours after the termination of cardiopulmonary bypass. Plasma interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and adiponectin levels were assessed in blood samples. Insulin resistance was measured by assessment of the insulin requirement to maintain euglycaemia and repeated measurements of an insulin glycaemic index. Insulin glycaemic index, IL-6, and TNF-αincreased up to 3–8-fold 6 h after the operation. Adiponectin is negatively correlated with markers of systemic inflammation 6 h after CPB.Conclusions. Although the level of serum adiponectin decreased significantly, there was a significant inverse association of adiponectin with markers of systemic inflammation and insulin resistance in infants undergoing open cardiac surgery.

Download Full-text

The infective endocarditis of synthetic patch after left ventricle reconstruction (Dor procedure)

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-8- ◽

2019 ◽

pp. 104-106

Author(s):

I. I. Chernov ◽

S. T. Enginoev ◽

D. Y. Kozmin ◽

D. G. Tarasov

Keyword(s):

Cardiac Surgery ◽

Infective Endocarditis ◽

Mortality Rate ◽

Left Ventricle ◽

Clinical Case ◽

Significant Problem ◽

The Past ◽

Artificial Materials ◽

Dor Procedure ◽

Made In

Infective endocarditis (IE) has become an increasingly significant problem in cardiology and cardiac surgery over the past 30 years. Despite the noticeable progress made in the diagnosis and treatment of IE, the prognosis for this condition is still poor and the mortality rate reaches 15-30% [1, 2]. The risk of developing IE is especially high in patients with «intracardiac» artificial materials (artificial valves, prostheses of any type, implantable antiarrhythmic devices). This article presents a rare clinical case of IE of synthetic patch after left ventricle reconstruction (Dor procedure).

Download Full-text

Biological age and its role in stratification of cardiac risk

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-1-17-20 ◽

2019 ◽

Vol 178 (1) ◽

pp. 17-20

Author(s):

N. N. Shikhverdiev ◽

D. I. Ushakov ◽

A. S. Peleshok ◽

V. A. Krivopalov ◽

V. A. Sizenko

Keyword(s):

Cardiac Surgery ◽

Mortality Rate ◽

Elderly Patients ◽

Blood Circulation ◽

Cardiac Risk ◽

Biological Age ◽

Qualitative Assessment ◽

Elective Cardiac Surgery ◽

Prediction Of Mortality ◽

Extracorporeal Blood Circulation

Risk stratification in elderly patients is very important, as none of the applied models for the prediction of mortality in cardiac surgery does not take into account the whole complex of physiological features of the aging organism.Theobjectivewas to analyze the effectiveness of the method of qualitative assessment of biological age.Material and methods.Our study included 127 patients (87 male and 40 female) aged 65 to 84 years (mean age – 72.2±4.7 years) who underwent elective cardiac surgery. Perioperative factors were analyzed. The primary endpoint of the study was a 30-day mortality rate.Results.The total 30-day mortality rate was 13.4 % (17 patients). Perioperative predictors of 30-day mortality rate were the calculated values of the CAF scale (p=0.006), the surgery volume (p=0.044), the use of extracorporeal blood circulation (p=0.048).Conclusion.The use of qualitative assessment of biological age allows to more accurate predict the mortality in cardiac elderly patients.

Download Full-text

The Impact of Dedicated Cardiac Intensive Care Units on Outcomes in Pediatric Cardiac Surgery: A Virtual Pediatric Systems Database Analysis

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714718 ◽

2020 ◽

Author(s):

Dayanand N. Bagdure ◽

Jason W. Custer ◽

Cortney B. Foster ◽

William C. Blackwelder ◽

Vladimir Mishcherkin ◽

...

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Mortality Rate ◽

Intensive Care Units ◽

Risk Category ◽

Database Analysis ◽

Cardiac Intensive Care ◽

Outcomes For Children ◽

The Impact ◽

Risk Categories

AbstractCare of children undergoing cardiac surgery occurs in dedicated cardiac intensive care units (CICU) or mixed intensive care units. We analyzed data from Virtual Pediatric Systems (VPS, LLC) database (2009–2014) for children < 18 years of age undergoing cardiac surgery, classified according to Society of Thoracic Surgery–European Association of Cardiothoracic Surgery (STS-EACTS) risk category. We had 25,052 (52%) patients in 53 mixed units (mortality rate, 2.99%), and 22,762 (48%) patients in 19 dedicated CICUs (mortality rate, 2.62%). There was a direct relationship between STS-EACTS risk category and death rate in both units. By multivariable logistic and linear regression, there was no difference in mortality between mixed unit and CICU death rates within STS-EACTS risk categories. We found no difference in outcomes for children undergoing cardiac surgery based on the unit type (dedicated CICU or mixed unit).

Download Full-text

Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery

PLoS ONE ◽

10.1371/journal.pone.0246299 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246299

Author(s):

Kristina Boss ◽

Michael Jahn ◽

Daniel Wendt ◽

Zaki Haidari ◽

Ender Demircioglu ◽

...

Keyword(s):

Septic Shock ◽

Cardiac Surgery ◽

Mortality Rate ◽

Hospital Mortality ◽

Sofa Score ◽

Statistical Significance ◽

Apache Ii ◽

Apache Ii Score ◽

Additional Measure ◽

The Mean

Background Extracorporeal cytokine adsorption is an option in septic shock as an additional measure to treat a pathological immune response. Purpose of this study was to investigate the effects of extracorporeal cytokine adsorption on hemodynamic parameters in patients with acute kidney injury (AKI) on continuous renal replacement therapy (CRRT) and septic shock after cardiac surgery. Methods In this retrospective study, a total of 98 patients were evaluated. Hemoadsorption was performed by the CytoSorb® adsorber. In all patients cytokine adsorption was applied for at least 15 hours and at least one adsorber was used per patient. To compare cumulative inotrope need in order to maintain a mean arterial pressure (MAP) of ≥ 65 mmHg, we applied vasoactive score (VAS) for each patient before and after cytokine adsorption. A paired t-test has been performed to determine statistical significance. Results Before cytokine adsorption the mean VAS was 56.7 points. This was statistically significant decreased after cytokine adsorption (27.7 points, p< 0.0001). Before cytokine adsorption, the mean noradrenalin dose to reach a MAP of ≥ 65 mmHg was 0.49 μg/kg bw/min, the mean adrenalin dose was 0.12 μg/kg bw/min. After cytokine adsorption, significantly reduced catecholamine doses were necessary to maintain a MAP of ≥ 65 mmHg (0.24 μg/kg bw/min noradrenalin; p< 0.0001 and 0.07 μg/kg bw/min adrenalin; p < 0.0001). Moreover, there was a significant reduction of serum lactate levels after treatment (p< 0.0001). The mean SOFA-score for these patients with septic shock and AKI before cytokine adsorption was 16.7 points, the mean APACHE II-score was 30.2 points. The mean predicted in-hospital mortality rate based on this SOFA-score of 16.7 points was 77,0%, respectively 73,0% on APACHE II-score, while the all-cause in-hospital mortality rate of the patients in this study was 59.2%. Conclusion In patients with septic shock and AKI undergoing cardiac surgery, extracorporeal cytokine adsorption could significantly lower the need for postoperative inotropes. Additionally, observed versus SOFA- and APACHE II-score predicted in-hospital mortality rate was decreased.

Download Full-text

(58) Evaluation of Select Perennial Ornamental Cultivars for Potential Roadside Beautification Application

HortScience ◽

10.21273/hortsci.41.4.1042b ◽

2006 ◽

Vol 41 (4) ◽

pp. 1042B-1042

Author(s):

Rodulfo O. Pacumbaba ◽

Catherine Sabota ◽

Rhonda Britton

Keyword(s):

Mortality Rate ◽

Significant Interaction ◽

Repeated Measurements ◽

Weed Competition ◽

Evaluation Period ◽

Knock Out ◽

Growing Seasons ◽

Recovery Potential ◽

Agnus Castus ◽

Experimental Plots

Sixty-six perennial ornamental cultivars were established and then grown under low maintenance, intensive weed competition, and severe mowing conditions. These cultivars were evaluated for their potential application for roadside/median beautification. Experimental plots were cleared with Roundup® prior to planting. During the first 3 weeks of establishment, plants were irrigated as needed. Plants were grown for one season, then pruned back to simulate bush-hog mowing. Plants were grown under low maintenance and no weed control conditions for two growing seasons. Plants were evaluated each season for simulated bush-hog damage recovery potential, survivability under severe weed competition, height, and spread. Two-way analysis of variance with repeated measurements showed that height and spread variation had a significant interaction between plant cultivar and time of evaluation. Several Zephyranthes sp. cultivars performed poorly under severe weed competition and mowing damage resulting in a high mortality rate. Cultivars that did perform well for the 2-year evaluation period include Lagerstroemia indica ×fauriei `Natchez,' Lagerstroemia indica ×fauriei `Muskogee,' Vitex agnus-castus `Shoal Creek,' and Myrica cerifera. Rosa × `Chuckles' and Rosa × `Knock Out' cultivars, with their popular showy appearance, performed moderately well and showed high potential for roadside/median beautification applications.

Download Full-text

PERI-OPERATIVE INJURY AND MYOCARDIAL INFARCTION

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2019-16-2-51-56 ◽

2019 ◽

Vol 16 (2) ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

V. V. Lomivorotov ◽

V. N. Lomivorotov

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiac Surgery ◽

Mortality Rate ◽

Postoperative Period ◽

Operative Mortality ◽

Pain Syndrome ◽

Cardiovascular Pathology ◽

Routine Monitoring ◽

Key Factor

Peri-operative myocardial infarction (MI) is the most severe complication of non-cardiac surgery associated with a high post-operative mortality rate. The main risk factors responsible for the development of this complication include concurrent cardiovascular pathology, as well as intra-operative hypertension and tachycardia. Diagnosis MI in the postoperative period is complicated due to an insignificant pain syndrome because of administration of analgesics and the lack of routine monitoring of troponin levels. Maintaining a balance between myocardial oxygen delivery and consumption is a key factor in the prevention of this complication.

Download Full-text