scholarly journals The Clinical Characteristics of Acute Myocardial Infarction with Ventricular Septal Perforation and the Prognosis Comparison of Different Treatment Methods

2021 ◽  
Vol 24 (4) ◽  
pp. E757-E763
Author(s):  
Chun Fu ◽  
Qing Gao ◽  
Zhou Zhao ◽  
Yu ◽  
Jian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Complete Revascularization ◽  
Septal Perforation ◽  
Survival Group ◽  
Term Survival ◽  
Related Risk ◽  
Incomplete Revascularization ◽  
Independent Risk Factors

Objective: To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR), the prognosis comparison of different treatment methods, and analysis of related risk factors. Methods: From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the People's Hospital of Peking University were selected as the study group. Among them, 16 cases were male (55.2%), 13 cases were female (44.8%), and the average age was 64.69 ± 10.32 years old. They were divided into two groups: the survival group (N = 16) and non-survival group (N = 13), according to whether they survived within 30 days of surgical or drug conservative treatment. The clinical characteristics, coronary angiography, and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed. Results: There was no significant difference in the basic clinical characteristics between the two groups (P > 0.05). Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel, which was a simple anterior descending branch in the non-survival group, was higher than that in the survival group. There was a statistical difference between the two groups (P < 0.05). The perioperative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass, and recanalization of culprit vessels in the survival group was significantly higher than that in the non-survival group (P < 0.05). However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05). Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009) and recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30-day mortality. Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization. There was a statistical difference between the two groups (P < 0.05). Conclusion: Complete revascularization and recanalization of culprit vessels are independent risk factors for 30-day mortality in patients with AMI and VSR. The long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.

scholarly journals The Clinical Characteristics of Acute Myocardial Infarction with Ventricular Septal Perforation and the Prognosis Comparison of Different Treatment Methods

2020 ◽  
Author(s):  
Chun Fu ◽  
Zhou Zhao ◽  
Yu Chen ◽  
Youzhong An ◽  
Jian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Complete Revascularization ◽  
Septal Perforation ◽  
Survival Group ◽  
Term Survival ◽  
Related Risk ◽  
Incomplete Revascularization ◽  
Independent Risk Factors

Abstract Background: To explore the clinical characteristics of acute myocardial infarction (AMI) with ventricular septal perforation (VSR) and the prognosis comparison of different treatment methods, as well as the analysis of related risk factors.Methods: From January 2006 to February 2020, 29 patients with AMI and VSR diagnosed in the people's Hospital of Peking University were selected as the study object, among them, 16 cases were male (55.2%), 13 cases were female (44.8%), the average age was 64.69 ± 10.32 years old, and they were divided into survival group (n=16) and non-survival group (n=13) according to whether they survive within 30 days of surgical or drug conservative treatment.The clinical characteristics, coronary angiography and treatment of the two groups were summarized, and the prognosis and related risk factors were analyzed.Results: There was no significant difference in the basic clinical characteristics between the two groups(P>0.05)；Compared with the results of coronary angiography in the two groups, the proportion of the culprit vessel which was a simple anterior descending branch in the non-survival group was higher than that in the survival group, there was a statistical difference between the two groups(P<0.05)；The peri-operative data of the two groups showed that the proportion of patients with complete revascularization, simultaneous bypass and recanalization of culprit vessels in the survival group was significantly higher than that in the non- survival group (P < 0.05)；However, the incidence of postoperative low cardiac output and mortality during hospitalization in the survival group were significantly lower than those in the non-survival group (P < 0.05)；Logistic regression analysis showed that complete revascularization (OR = 0.021, 95% CI 0.001-0.374, P = 0.009), recanalization of culprit vessels (OR = 0.045, 95% CI 0.004-0.548, P = 0.015) were independent risk factors for 30 day mortality。Kaplan-Meier survival curve showed that during the follow-up period, the long-term survival rate of patients with operation and complete revascularization was significantly higher than that of patients with drug conservative treatment and incomplete revascularization, there was a statistical difference between the two groups (P < 0.05).Conclusions: Whether complete revascularization and recanalization of culprit vessels or not are independent risk factors for 30 day mortality in patients with AMI and VSR；the long-term survival rate of patients after surgery and complete revascularization is significantly higher than that of patients with conservative medical treatment and incomplete revascularization. Surgery and complete revascularization are important factors affecting the long-term prognosis of patients with AMI and VSR.

scholarly journals The impact of the recurrent laryngeal nerve injury on prognosis after McKeown esophagectomy for ESCC

2020 ◽  
Author(s):  
Rirong Qu ◽  
Dehao Tu ◽  
Wei Ping ◽  
Qi Wang ◽  
Ni Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Term Survival ◽  
Laryngeal Nerve Injury ◽  
Independent Risk Factors ◽  
Mckeown Esophagectomy ◽  
The Impact

Abstract Background: The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis.Methods: Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed.Results: RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI,patients with RNLI have longer operation time,more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN LN metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion: RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.

Coagulopathy on the first postoperative day predicting the long-term survival of traumatic brain injury patients

2020 ◽  
Author(s):  
Wenxing Cui ◽  
Shunnan Ge ◽  
Yingwu Shi ◽  
Xun Wu ◽  
Jianing Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Independent Risk Factors ◽  
The Relationship ◽  
Underlying Risk

Abstract Objective: The purpose of this study was to identify the relationship between coagulopathy during the perioperative period (before the operation and on the first day after the operation) and the long-term survival of TBI patients undergoing surgery, as well as to explore the predisposing risk factors that may cause perioperative coagulopathy.Methods: This retrospective study included 447 TBI patients who underwent surgery from January 1, 2015 to April 25, 2019. Clinical parameters, including patient demographic characteristics, biochemical tests, perioperative coagulation function tests (before the operation and on the first day after the operation) and intraoperative factors were collected. Log-rank univariate analysis and Cox regression models were conducted to assess the relationship between perioperative coagulopathy and the long-term survival of TBI patients. Furthermore, univariate and multivariate analyses were performed to identify the underlying risk factors for perioperative coagulopathy.Results: Multivariate Cox regression analysis identified age, AIS(head) = 5, GCS ≤ 8, systolic pressure at admission < 90 mmHg and postoperative coagulopathy (all P < 0.05) as independent risk factors for survival following TBI; we were the first to identify postoperative coagulopathy as an independent risk factor. According to multivariate logistic regression analysis, for the first time, abnormal ALT and RBC at admission, preoperative coagulopathy, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL (all P < 0.005) were identified as independent risk factors for postoperative coagulation following surgery after TBI.Conclusions: Those who suffered from postoperative coagulopathy due to TBI had a higher hazard for poor prognosis than those who did not. Closer attention should be paid to postoperative coagulopathy and more emphasis should be placed on managing the underlying risk factors.

Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction Procedures

Gerontology ◽  
2020 ◽  
pp. 1-13
Author(s):  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Luca Segreti ◽  
Maria Grazia Bongiorni ◽  
Andrzej Kutarski
Keyword(s):  
Risk Factors ◽  
Cardiac Resynchronization Therapy ◽  
The Elderly ◽  
Cardiac Resynchronization ◽  
Lead Extraction ◽  
Resynchronization Therapy ◽  
Term Survival ◽  
Long Term Survival ◽  
Related Risk

<b><i>Introduction:</i></b> Transvenous lead extraction (TLE) has become a frequently used tool for the management of complications related to pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices. However, it is still a matter of debate whether the lead extraction procedure is a safe treatment choice in the elderly. <b><i>Methods:</i></b> We collected the clinical information from 3,810 patients undergoing TLE in 2 high-volume centers (Poland and Italy) between 2006 and 2017. We tested risk factors, effectiveness, safety and long-term survival in 3 groups of patients: those aged 80–89.99 years, ≥90 years and 30–79.99 years. <b><i>Results:</i></b> Lower BMI, lower levels of hemoglobin and more comorbidities characterized the patients, whose ages ranged from 80 to 89.99 years. Those aged ≥90 years most often had single-chamber pacemakers. Octogenarians and nonagenarians were more often undergoing TLE due to infectious indications (57.19 and 74.29 vs. 45.35% in younger individuals). Lead age and the number of leads extracted were comparable in the 3 groups. In octogenarians, leads were more often removed using standard extraction techniques: simple traction and mechanical dilatators, whereas in nonagenarians TLE was more complex. The duration of the procedure was shorter in older patients, while clinical and procedural effectiveness was similar to that in younger individuals. The rate of major complications related to TLE did not differ between octogenarians and younger subjects (2.0 vs. 1.38%, <i>p</i> = ns), and the number of procedure-related risk factors was smaller in older people. Nonagenarians did not develop any major complication related to TLE. Long-term mortality after TLE was similar among octogenarians and nonagenarians (39.67 and 40.00%) but higher than in younger patients (24.41; <i>p</i> &#x3c; 0.001 and 0.05). <b><i>Conclusions:</i></b> Lead extraction procedures appear effective and safe in octogenarians and nonagenarians, comparable to younger individuals. Procedure-related risk in the elderly is not associated with most of the typical risk factors encountered in younger subjects, but only with the higher number of pacemaker, implantable cardiac defibrillator and cardiac resynchronization therapy device procedures before TLE. Long-term survival after TLE was found to be similar among octogenarians and nonagenarians being about 60% at over 3 years of follow-up. Age alone should not be considered a risk factor for the occurrence of major complications or procedure-related death, and therefore it should not prevent candidacy for TLE.

scholarly journals Perioperative risk factors for survival outcomes in elective colorectal cancer surgery: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xing-Xing Liu ◽  
Jun Su ◽  
Yuan-yuan Long ◽  
Miao He ◽  
Zhao-Qiong Zhu
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Cohort Study ◽  
Lymphovascular Invasion ◽  
Laparoscopic Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Factors Affecting ◽  
Independent Risk Factors

Abstract Background Surgical resection remains the best option for long-term survival in colorectal cancer (CRC); however, surgery can lead to tumor cell release into the circulation. Previous studies have also shown that surgery can affect cancer cell growth. The role of perioperative factors influencing long-term survival in patients presenting for CRC surgery remains to be investigated. Methods This retrospective single–center cohort study was conducted to collect the clinical data of patients who underwent elective laparoscopic resection for CRC from January 2014 to December 2015, namely clinical manifestations, pathological results, and perioperative characteristics. Survival was estimated using the Kaplan–Meier log-rank test. Univariable and multivariable Cox regression models were used to compare hazard ratios (HR) for death. Results A total of 234 patients were eligible for analysis. In the multivariable Cox model, tumor-node-metastasis (TNM) stage (stage IV: HR 30.63, 95% confidence interval (CI): 3.85–243.65; P = 0.001), lymphovascular invasion (yes: HR 2.07, 95% CI 1.09–3.92; P = 0.027), inhalational anesthesia with isoflurane (HR 1.96, 95% CI 1.19–3.21; P = 0.008), and Klintrup–Makinen (KM) inflammatory cell infiltration grade (low-grade inflammation: HR 2.03, 95% CI 1.20–3.43; P = 0.008) were independent risk factors affecting 5-year overall survival after laparoscopic resection for CRC. Conclusions TNM stage, lymphovascular invasion, isoflurane, and KM grade were independent risk factors affecting CRC prognosis. Sevoflurane and high-grade inflammation may be associated with improved survival in CRC patients undergoing resection.

scholarly journals Obesity and Non-Obesity Obstructive Sleep Apnoea Hypertension Syndromes (OOHS & NOOHS): New Clinical Discoveries

2021 ◽  
Author(s):  
Chunsong Hu ◽  
Qinghua Wu ◽  
Juxiang Li ◽  
Yanqing Wu ◽  
Menghong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnoea ◽  
Clinical Characteristics ◽  
Sleep Apnoea ◽  
Major Adverse Cardiovascular Events ◽  
Related Risk ◽  
Obstructive Sleep ◽  
Long Term Follow Up

Abstract Obesity, obstructive sleep apnoea (OSA) and hypertension are common clinical risk factors. Their coexistence is termed Obesity and Non-Obesity OSA Hypertension Syndromes (OOHS & NOOHS) due to high linkage. This study reported the clinical characteristics of OOHS and NOOHS. A total of 163 patients, aged 23–74 years, were randomly enrolled at the outpatients department who were either obese or non-obese, suffered OSA and hypertension. Subjects with a Body Mass Index (BMI) of ≥25 (Chinese criteria), of ≥27 (criteria of this study), and of ≥30 (WHO criteria) were defined as obese or non-obese, respectively. Cases with snoring were classified as mild, moderate and severe OSA by using the Apnoea-Hypopnoea Index where mild is 5–15, moderate is 15–30, and severe is > 30. Daytime blood pressure (BP) was measured to assess any correlation. Data from those with isolated obesity, OSA, hypertension, and metabolic syndrome were compared. Long-term follow-up was carried out. 7 typical cases with OOHS and NOOHS were assessed and included general patient information, initial diagnosis, medical history, related risk factors, BMI, and BP. 163 cases with OOHS and NOOHS often have similar or different clinical characteristics. Both potentially suffer from major adverse cardiovascular events (MACEs) which are associated with increased BMI, OSA, and increased BP. Long-term follow-up showed the outcomes consistently linked to their lifestyle and adherence to treatment. Our new clinical discoveries suggest that both OOHS and NOOHS are high risk conditions in MACEs. There is an urgent need for early lifestyle interventions and related treatments.

scholarly journals Impact of postoperative complications on long-term survival of gastric cancer patients: results from a high-volume institution in China

2020 ◽  
Author(s):  
Hua-Yang Pang ◽  
Hui Wang ◽  
Lin-Yong Zhao ◽  
Xiao-Long Chen ◽  
Kai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Prognostic Factor ◽  
Postoperative Complications ◽  
Pulmonary Infection ◽  
Independent Prognostic Factor ◽  
Term Survival ◽  
Long Term Survival ◽  
Independent Risk Factors

Abstract BackgroundThis study was aimed to evaluate the impact of postoperative complications (POCs) on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1667 GC patients with curative gastrectomy were analyzed. Patients with any complications Clavien–Dindo (CD) grade II or higher were divided into complication group. Independent risk factors for the development of POCs and the relationship between POCs and long-term survival (excluding death within 90 days after surgery) were analyzed.ResultsOverall POCs CD ≥ 2 were diagnosed in 285 (17.10%) patients including infectious complications (ICs) in 231 (13.9%) and noninfectious complications (NICs) in 78 (4.68%) patients. Age ≥ 65 (P = 0.003), presence of comorbidity (P = 0.019), extensive lymphadenectomy (P = 0.027) and perioperative blood transfusion (P = 0.040) were independent risk factors of POCs. Multivariate analysis identified that presence of POCs (P < 0.001) was an independent prognostic factor and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P = 0.007) rather than NICs (P = 0.075), moreover, among all complications, pulmonary infection (P < 0.001) was the only significant prognostic factor.ConclusionPOCs may be an independent prognostic factor for long-term survival of GC patients and the risk is mainly driven by ICs, particular pulmonary infection.

scholarly journals Mortality-related risk factors and long-term survival after 4460 liver resections in Sweden—a population-based study

2016 ◽  
Vol 402 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Stefan Gilg ◽  
Ernesto Sparrelid ◽  
Bengt Isaksson ◽  
Lars Lundell ◽  
Greg Nowak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Based ◽  
Term Survival ◽  
Population Based Study ◽  
Long Term Survival ◽  
Liver Resections ◽  
Related Risk

scholarly journals Hepatic dysfunction in patients who received acute DeBakey type I aortic dissection repair surgery: incidence, risk factors, and long-term outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhigang Wang ◽  
Min Ge ◽  
Cheng Chen ◽  
Lichong Lu ◽  
Lifang Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Hepatic Dysfunction ◽  
Type I ◽  
Acute Type ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
Independent Risk Factors

Abstract Background Hepatic dysfunction (HD) increases the morbidity and mortality rates after cardiac surgery. However, few studies have investigated the association between HD and acute DeBakey type I aortic dissection (ADIAD) surgery. This retrospective study aimed to identify risk factors for developing HD in patients who received acute type I aortic dissection repair and its consequences. Methods A total of 830 consecutive patients who received ADIAD surgery from January 2014 to December 2019 at our center were screened for this study. The End-Stage Liver Disease (MELD) score more than 14 was applied to identify postoperative HD. Logistic regression model was applied to identify risk factors for postoperative HD, Kaplan–Meier survival analysis and Cox proportional hazards regression assay were conducted to analyze the association between HD and postoperative long-term survival. Results Among 634 patients who eventually enrolled in this study, 401 (63.2%) experienced postoperative HD with a 30-Day mortality of 15.5%. Preoperative plasma fibrinogen level (PFL) [odds ratio (OR): 0.581, 95% confidence interval (CI): 0.362–0.933, P = 0.025], serum creatinine (sCr) on admission (OR: 1.050, 95% CI 1.022–1.079, P < 0.001), cardiopulmonary bypass (CPB) time (OR: 1.017, 95% CI 1.010–1.033, P = 0.039), and postoperative mechanical ventilation (MV) duration (OR: 1.019, 95% CI 1.003–1.035, P = 0.020) were identified as independent risk factors for developing postoperative HD by multivariate analyses. In addition, the Kaplan–Meier analysis indicated that the long-term survival rate was significantly different between patients with or without postoperative HD. However, the hazard ratios of long-term survival for these two groups were not significantly different. Conclusions HD was a common complication after ADIAD surgery and associated with an increasing 30-Day mortality rate. Decreased PFL, elevated sCr, prolonged CPB duration, and longer postoperative MV time were independent risk factors for postoperative HD.

scholarly journals The Clinical Characteristics of ARDS in Children With Hematological Neoplasms

2021 ◽  
Vol 9 ◽  
Author(s):  
Qiao Zhang ◽  
Wen-ting Hu ◽  
Fan Yin ◽  
Han Qian ◽  
Ying Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Clinical Characteristics ◽  
Length Of Hospital Stay ◽  
Fluid Volume ◽  
Survival Group ◽  
Total Length ◽  
Hematological Neoplasms ◽  
Independent Risk Factors ◽  
Overall Mortality

In order to explore the clinical characteristics of pediatric patients admitted to the pediatric intensive care unit (PICU) who suffered from hematological neoplasms complicated with acute respiratory distress syndrome (ARDS), we retrospectively analyzed 45 ARDS children with hematological neoplasms who were admitted to the PICU of Shanghai Children's Medical Center from January 1, 2014, to December 31, 2020. The 45 children were divided into a survival group and a non-survival group, a pulmonary ARDS group and an exogenous pulmonary ARDS group, and an agranulocytosis group and a non-agranulocytosis group, for statistical analysis. The main clinical manifestations were fever, cough, progressive dyspnea, and hypoxemia; 55.6% (25/45) of the children had multiple organ dysfunction syndrome (MODS). The overall mortality rate was 55.6% (25/45). The vasoactive inotropic score (VIS), pediatric critical illness scoring (PCIS), average fluid volume in the first 3 days and the first 7 days, and the incidence of MODS in the non-survival group were all significantly higher than those in the survival group (P &lt; 0.05). However, total length of mechanical ventilation and length of hospital stay and PICU days in the non-survival group were significantly lower than those in the survival group (P &lt; 0.05). The PCIS (OR = 0.832, P = 0.004) and the average fluid volume in the first 3 days (OR = 1.092, P = 0.025) were independent risk factors for predicting death. Children with exogenous pulmonary ARDS were more likely to have MODS than pulmonary ARDS (P &lt; 0.05). The mean values of VIS, C-reactive protein (CRP), and procalcitonin (PCT) in children with exogenous pulmonary ARDS were also higher (P &lt; 0.05). After multivariate analysis, PCT was independently related to exogenous pulmonary ARDS. The total length of hospital stay, peak inspiratory pressure (PIP), VIS, CRP, and PCT in the agranulocytosis group were significantly higher than those in the non-agranulocytosis group (P &lt; 0.05). Last, CRP and PIP were independently related to agranulocytosis. In conclusion, children with hematological neoplasms complicated with ARDS had a high overall mortality and poor prognosis. Children complicated with MODS, positive fluid balance, and high VIS and PCIS scores were positively correlated with mortality. In particular, PCIS score and average fluid volume in the first 3 days were independent risk factors for predicting death. Children with exogenous pulmonary ARDS and children with agranulocytosis were in a severely infected status and more critically ill.

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