A five year retrospective study on maternal and perinatal outcome in pregnancy after cardiac surgery

Background: Pregnancy is a hypercoaguable state with physiological haemodynamic changes occurring during pregnancy. There is a progressive increase in intravascular volume in second trimester of pregnancy and increase in cardiac output. Pregnancy makes a significant impact on cardiovascular system. It is important to evaluate and study the effect of pregnancy on women with surgically corrected heart conditions so as to preempt potential complications.Methods: This is a retrospective study of patients with prior history of cardiac surgery and their pregnancy outcomes in a tertiary center of Southern India over a period of five years from January 2011 to December 2016.Results: In this study, descriptive statistical analysis was done in 87 women with pregnancy following cardiac surgery. 58.6% were nulliparous. Around 52% had associated obstetric risk factors. The most common cardiac surgery in this population was Mitral valve replacement (40.2%) and Atrial septal defect closure (37.9%). Women belonged to NYHA class I in 90.8% of cases. 58.6% had vaginal delivery and 36.8% had caesarean section. 6 women had postpartum haemorrhage which was medically managed, and 6 women needed ICU care.74.7% women had term deliveries. 18.4 % of the babies were less than 2.5 kg weight at birth. 13 babies required Neonatal ICU care.Conclusions: Maternal and neonatal outcome mainly depends on the functional cardiac status of women before conception. In this study we emphasize on the importance of multidisciplinary team approach involving cardiologist, obstetrician and neonatologist in the management of women with prior cardiac surgery.

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A retrospective study on maternal and perinatal outcome in pregnancy requiring DJ stent and PCN during pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194351 ◽

2019 ◽

Vol 8 (10) ◽

pp. 3903

Author(s):

Liji David ◽

Swati Rathore ◽

Neeraj Kulkarni ◽

Batiston Decruse Waanbah ◽

Benedict Paul Samuel ◽

...

Keyword(s):

Retrospective Study ◽

Perinatal Outcome ◽

Symptom Relief ◽

Percutaneous Nephrostomy ◽

Severe Form ◽

Gravid Uterus ◽

Team Approach ◽

Tertiary Center ◽

Dj Stent ◽

In Pregnancy

Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.

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The Use of Alveolar Dead Space Fraction to Predict Postoperative Outcomes after Pediatric Cardiac Surgery: A Retrospective Study

Pediatric Cardiology ◽

10.1007/s00246-021-02674-2 ◽

2021 ◽

Author(s):

Imran A. Sayed ◽

Scott Hagen ◽

Victoria Rajamanickam ◽

Petros V. Anagnostopoulos ◽

Marlowe Eldridge ◽

...

Keyword(s):

Cardiac Surgery ◽

Retrospective Study ◽

Dead Space ◽

Pediatric Cardiac Surgery ◽

Postoperative Outcomes ◽

Alveolar Dead Space

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Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery - the INFLACOR study.

Acta Biochimica Polonica ◽

10.18388/abp.2017_2361 ◽

2018 ◽

Vol 65 (2) ◽

pp. 241-250 ◽

Cited By ~ 3

Author(s):

Maciej Michał Kowalik ◽

Romuald Lango ◽

Piotr Siondalski ◽

Magdalena Chmara ◽

Maciej Brzeziński ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Genetic Association ◽

Biochemical Parameters ◽

Cox Regression ◽

Association Studies ◽

Nyha Class ◽

Genetic Association Studies ◽

Chronic Obstructive

There is increasing evidence that genetic variability influence patients’ early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFlAmmation in Cardiac OpeRations) cohort.In a series of prospectively recruited 518 adult Polish Caucasians who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFa, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their associations with 30-day and 5-year mortality.The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. The serum levels of IL-6 and ICAM-1 measured three hours after operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance.Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should adjust for the identified chronic and acute postoperative risk factors.

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PP-287 Outcomes of Elective Percutaneous Coronary Interventions of a Tertiary Center without Cardiac Surgery

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.01.315 ◽

2014 ◽

Vol 113 (7) ◽

pp. S122

Author(s):

C. Mansuroğlu ◽

E. Örnek ◽

E. Kızıltunç ◽

H. Kundi ◽

A. Balun ◽

...

Keyword(s):

Cardiac Surgery ◽

Percutaneous Coronary Interventions ◽

Coronary Interventions ◽

Percutaneous Coronary ◽

Tertiary Center

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One-year outcome after cardiac surgery of patients with cancer: an observational monocentric retrospective study.

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.11.014 ◽

2021 ◽

Author(s):

Hadrien Portefaix ◽

Grégory Papin ◽

Elie Kantor ◽

Bernard Iung ◽

Philippe Montravers ◽

...

Keyword(s):

Cardiac Surgery ◽

Retrospective Study ◽

Patients With Cancer ◽

One Year

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Abstract 2140: Infrequent Need for Pacing Following Implantable Cardioverter-Defibrillator Shocks: Analysis of the Sudden Cardiac Death in Heart Failure Trial

Circulation ◽

10.1161/circ.118.suppl_18.s_674 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jordan M Prutkin ◽

Jeanne E Poole ◽

George Johnson ◽

Jill Anderson ◽

Daniel B Mark ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Nyha Class ◽

Prior History ◽

Baseline Heart Rate ◽

Implantable Cardioverter Defibrillators ◽

Heart Failure Trial ◽

Post Shock

Background: Implantable cardioverter-defibrillators (ICD) are routinely programmed to pace after a shock to prevent possible asystole. In those with no prior history of bradycardia, there is little data regarding the prevalence and characteristics of those who use post-shock pacing (PSP). Methods: We analyzed the occurrence of pacing within the first nine beats after the first successful ICD shock for ventricular tachycardia (VT) or ventricular fibrillation (VF) in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). All ICDs were single lead with the first PSP delivered at 1400msec and all subsequent stimuli delivered at 1200msec. We excluded patients with pacing during pre-shock rhythms and those who had pacing rates different than the protocol default rate of 50bpm (1200 msec). Results: There were 2521 patients enrolled in SCD-HeFT, of which 811 received an ICD. A total of 153 shock events were examined; 36 (23.5%) had at least one of the first nine beats paced post-shock, though only 4 (2.5%) had greater than 4 out of the 9 beats paced. No subjects needed pacing for all nine beats and only 8 (5.2%) paced for greater than 5 seconds. There were no differences in age, gender, etiology of cardiomyopathy, or NYHA class between those with PSP or not. The prevailing heart rate pre-shock was predictive of PSP; the mean cycle length of the baseline rhythm pre-shock was longer (slower rate) for those who used PSP (735 ± 228msec vs. 624 ± 158msec, P=0.001). More often, VF (vs. VT) was the rhythm shocked in those using PSP (P=0.015). A trend also was seen toward increased frequency of PSP in those receiving 30J shocks (16 of 49) versus ≤20J shocks (20 of 104, P=0.068). Conclusion: Patients infrequently require multiple paced beats post-shock for VT or VF. Patients using PSP have a slower baseline heart rate and are more likely to have VF as the shocked rhythm. While 1 or 2 paced beats out of the first nine occurred occasionally, these patients also had rapid return of their native rhythm for which the hemodynamic contribution of 1 or 2 paced beats is unclear. These data suggest that for most patients receiving a primary prevention ICD programmed for shock-only therapy, the need for PSP is limited. PSP use may reflect convention and the assumption that minor post-shock pauses are detrimental.

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Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data

BMJ ◽

10.1136/bmj.324.7332.261 ◽

2002 ◽

Vol 324 (7332) ◽

pp. 261-261 ◽

Cited By ~ 50

Author(s):

D. J Spiegelhalter

Keyword(s):

Cardiac Surgery ◽

Retrospective Study ◽

Routinely Collected Data ◽

Paediatric Cardiac Surgery

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Depression and anxiety at time of implantable cardioverter defibrillator implantation and the biological link with cardiovascular disease

EP Europace ◽

10.1093/europace/euab116.331 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

ACJ Van Der Lingen ◽

MT Rijnierse ◽

AM Hooghiemstra ◽

S Elshout ◽

VP Van Halm ◽

...

Keyword(s):

Psychological Distress ◽

Autonomic Function ◽

Nyha Class ◽

Functional Class ◽

Depression And Anxiety ◽

Icd Implantation ◽

Symptoms Of Depression ◽

Nyha Functional Class ◽

Inflammatory Status ◽

Cardiac Status

Abstract Funding Acknowledgements Type of funding sources: None. Background Psychological distress, such as symptoms of anxiety and depression, are frequently present in patients receiving an implantable cardioverter defibrillator (ICD) and they are associated with adverse outcomes. Multiple pathophysiological mechanisms may explain the link between psychological distress and cardiovascular disease, such as autonomic dysfunction, neuro-endocrine alterations and chronic inflammation. Purpose The present study aims to examine the prevalence of psychological distress at time of ICD implantation and evaluates the complex interplay between psychological distress, autonomic function, neuro-endocrine alterations and inflammatory status in ICD patients. Methods We conducted a prospective study that included ICD patients receiving an ICD for primary and secondary prevention of sudden cardiac death. Prior to implantation, patients underwent extensive psychological evaluation, including validated questionnaires for depression, anxiety and personality traits. Cardiac status was evaluated by left ventricular ejection fraction (LVEF) assessment, New York Heart Association (NYHA) functional class evaluation, 6-minute walk test (6MWT), and 24-hour Holter monitoring for heart rate variability (HRV). Thyroid function, catecholamine levels and inflammatory status were also evaluated. Results Of 178 patients included (age 64 ± 12, 79% male, LVEF 35 ± 13%), 35% had symptoms of depression and 32% had symptoms of anxiety. Symptoms of depression and anxiety increased significantly with higher NYHA functional class (P < 0.001). Depressive symptoms were associated with a reduced 6MWT (411 ± 128 m versus 488 ± 89 m, P < 0.001), lower LVEF (29 ± 9% versus 36 ± 13%, P = 0.03), higher heart rate (74 ± 13 bpm versus 70 ± 13 bpm, P = 0.02), higher thyroid stimulating hormone levels (1.8 [1.3-2.8] mU/L versus 1.5 [1.0-2.2] mU/L, P = 0.04) and multiple HRV parameters, indicating reduced HRV. Anxiety symptoms were only associated with a reduced 6MWT (433 ± 112 m versus 477 ± 102, P = 0.02). Symptoms of depression or anxiety were not correlated with c-reactive protein, NT-proBNP or catecholamine levels. Conclusion A substantial part of ICD patients has symptoms of depression and anxiety at time of ICD implantation. Depression was correlated with a higher NYHA class, reduced exercise capacity, reduced LV-function and alterations in autonomic function, suggesting a biological link between depression and cardiac status. Whether depression and anxiety leads to an increase in ventricular arrhythmias will be determined during further follow-up. Abstract Figure. NYHA class and psychological distress

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