scholarly journals Outcomes of Infants Undergoing Modified Blalock-Taussig Shunt Procedures in Oman

2021 ◽  
Author(s):  
Samiuddin Shaikh ◽  
Khaloud S Al-Mukhaini ◽  
Abdul Hakeem Al-Rawahi ◽  
Omer Al-Dafie
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Cardiopulmonary Bypass ◽  
Hospital Mortality ◽  
Heart Diseases ◽  
Significant Risk ◽  
Patient Outcome Assessment ◽  
Early Mortality ◽  
Infants And Children ◽  
Shunt Procedure

Objectives: A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed. Methods: This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival. Results: A total of 50 infants and children were included in the study. The in-hospital mortality and inter-stage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR]: 3.00, 95% confidence interval [CI]: 1.98–4.76; P = 0.007) and cardiopulmonary bypass (OR: 4.09, 95% CI: 2.44–6.85; P = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0–34.0 months). Conclusion: The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality. Keywords: Pediatrics; Heart Diseases, congenital; Cardiovascular Surgical Procedures; Modified Blalock-Taussig Procedure; Patient Outcome Assessment; Hospital Mortality; Risk Factors; Oman.

scholarly journals Mortality Rates in Mechanically Ventilated Patients with COVID-19

2020 ◽  
Vol 3 ◽  
Author(s):  
Jonathan Class ◽  
Sikandar Khan ◽  
Babar Khan
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Mortality Rates ◽  
Study Cohort ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background/Objective:   High mortality rates among mechanically ventilated COVID-19 intensive care unit (ICU) patients have raised concerns regarding use of mechanical ventilation in management of patients with COVID-19. Additional data is needed in this discussion to better understand treatment strategies for this vulnerable population. We conducted a study to examine length of stay, duration of mechanical ventilation, mortality, and risk factors for death in critically ill patients with COVID-19.    Methods:  Observational study in patients admitted to Eskenazi Health and Indiana University Health Methodist ICUs. Participants were 18 years and older patients admitted to the ICU from March 1 2020 to April 27, 2020 who tested positive for COVID-19. Primary outcomes for this study were in-hospital mortality, duration of mechanical ventilation, and the length of stay in the ICU.     Results:  The study cohort was made up of 242 patients. The mortality rate was 19.8% (48/242) for the overall cohort and 20.5% (38/185) for mechanically ventilated patients. Age was a significant risk factor for in-hospital mortality [increased hazard in in-hospital mortality: age 65-74 years (HR: 3.1, 95%Cl=1.2-7.9, p=0.021), age 75+ (HR: 4.1, 95%CI=1.6-10.5, p=0.003) compared to those younger than 65]. In our Cox’s proportional hazard model, ESRD (HR:5.9, 95%CI=1.3-26.9, p=0.021) along with age were the only risk factors with statistical significance. The median duration of mechanical ventilation in the overall cohort was 9.3 days (IQR=-5.7-13.7). In patients that died, median ICU length of stay was 8.7 days (IQR=4.0-14.9), compared to 9.2 days (IQR=4.0-14.0) in those discharged alive.    Conclusion/Clinical Impact:  We found lower mortality rates and longer length of stays in our cohort than in previous studies. While more data is needed, this study supports continued use of mechanical ventilation ARDS recommendations for treating patients with ARDS from COVID-19. Further, this data potentially shows a benefit to not having a strained healthcare system.   

Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

2021 ◽  
Vol 74 (6) ◽  
Author(s):  
Caroline Gonçalves Pustiglione Campos ◽  
Aline Pacheco ◽  
Maria Dagmar da Rocha Gaspar ◽  
Guilherme Arcaro ◽  
Péricles Martim Reche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Statistical Tests ◽  
Significant Risk ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

Preoperative in-hospital mortality in neonates with critical CHD

2021 ◽  
pp. 1-7
Author(s):  
Dennis R. Delany ◽  
Shahryar M. Chowdhury ◽  
Corinne Corrigan ◽  
Jason R. Buckley
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Patient Care ◽  
Multivariable Analysis ◽  
Health Information System ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Interrupted Aortic Arch ◽  
Administrative Dataset ◽  
Care Improvement

Abstract Objective: Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. Study design: The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. Results: Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0–20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8–2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0–4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2–2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. Conclusion: Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.

A 30-year experience with mixed-type total anomalous pulmonary venous connection: a word of caution

2016 ◽  
Vol 27 (5) ◽  
pp. 870-876 ◽  
Author(s):  
Brian Kogon ◽  
Jan Fernandez ◽  
Subhadra Shashidharan ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Vein ◽  
Mixed Type ◽  
Significant Risk ◽  
Pulmonary Vein Stenosis ◽  
Clinical Records ◽  
Vein Stenosis ◽  
Anomalous Pulmonary Venous Connection

AbstractBackgroundPatients with total anomalous pulmonary venous connection can be problematic, particularly those with mixed-type pathology. We aimed to describe a cohort of patients with mixed-type anomalous drainage, highlighting the treatment challenges, and identifying risk factors for poor outcome.MethodsWe reviewed the clinical records of patients who underwent repair for mixed-type total anomalous pulmonary venous connection between 1986 and 2015.ResultsA total of 19 patients were identified. The median age and weight of patients at surgery were 18 days (with a range from 1 to 185) and 3.4 kg (with a range from 1.9 to 6.5), respectively. Venous anatomy included a combination of duplicate supracardiac (four), supracardiac and cardiac (11), and supracardiac and infracardiac (four) drainage. Out of 19 patients, six (32%) died within 30 days or the initial hospital stay; two additional patients died from progressive pulmonary vein stenosis at 72 and 201 days, respectively, resulting in 42% mortality within the 1st year. Follow-up data were available for 8/11 long-term survivors. The median follow-up period was 7.3 years (with a range from 1.8 to 15.7). Only one patient underwent re-intervention for recurrent pulmonary vein stenosis. For surgical mortality, no statistically significant risk factors were identified, although the risk trended to be higher (p⩽0.1) with lower age and weight, an infracardiac component, and prolonged cardiopulmonary bypass. For 1-year mortality, the risk became significant (p⩽0.05) with a lower weight (p=0.01), an infracardiac component (p=0.03), and prolonged cardiopulmonary bypass (p=0.04).ConclusionThe surgical and 1-year mortality in patients with mixed-type total anomalous pulmonary venous connection is high. On the other hand, among patients who survive past the 1st year, most have good outcomes without subsequent sequelae.

scholarly journals Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chen Ke ◽  
Hao Wu ◽  
Min Xi ◽  
Wei Shi ◽  
Qihong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Renal Insufficiency ◽  
Hospital Mortality ◽  
Acute Aortic Dissection ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Factors Affecting ◽  
Cardiopulmonary Bypass Time ◽  
The Mean

Abstract Background To investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate. Methods The demographic and clinical data were retrospectively collected and analyzed from 118 AAD patients admitted to the Affiliated Hospital of Hangzhou Normal University from June 2016 to April 2019. All patients underwent surgical treatment and were grouped into death and survival groups. The risk factors affecting postoperative in-hospital death were analyzed using multivariate logistic regression analysis. Results The male to female ratio in the patients was 3.8:1 and the mean age was 50.11 ± 9.91 years. The patient’s main comorbidities were hypertension (70.33%) and coronary heart disease (10.17%). The main symptoms included chest pain and back pain (72.89%). The highest incidence of complications was pericardial effusion (48.31%), followed by pleural effusion (22.88%). The mean systolic blood pressure, white blood cell count and D-dimer in the patients were over the ranges of normal people. The incidences of cardiac and renal insufficiency were 18.64% and 16.95% respectively, and the postoperative in-hospital mortality rate was 12.71%. Univariable analysis showed that age, renal insufficiency, cardiac insufficiency, D-dimer level, cardiopulmonary bypass time, operation time, blood transfusion volume and postoperative hemostasis were significant factors leading to the death (P < 0.05). Multivariate logistic regression analysis showed that age > 65, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis were independent risk factors for the death (P < 0.05). Conclusions AAD patients frequently have underlying diseases with pain as the main symptom. Age > 65 years, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis are significantly risk factors for postoperative mortality.

scholarly journals Parental risk factors associated with congenital heart disease in a Thai population: multivariable analysis

2021 ◽  
Vol 15 (6) ◽  
pp. 267-276 ◽  
Author(s):  
Chayamon Suwansumrit ◽  
Worawan Jittham
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Cigarette Smoke ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Maternal Exposure ◽  
Factors Associated ◽  
History Of

Abstract Background Congenital heart diseases (CHDs) are the most common types of birth defects and contribute to a large proportion of infant morbidities and mortalities worldwide. These defects may require multiple surgical interventions impacting the infant's quality of life. Objectives To identify risk factors associated with CHD in a population of Thai children. Methods We conducted a case–control study of patients attending the Pediatric Clinic, Naresuan University Hospital, Thailand. We included data from pediatric patients diagnosed with CHDs as cases, and patients without cardiovascular abnormalities as controls. Risk data were collected from July 2019 to April 2020 using face-to-face interviews. Multiple logistic regression was used to analyze parental factors associated with CHDs. Results We included 249 cases classified into 2 groups according to severity and 304 patients as controls. For those less-severely affected (155 patients, 62.2%), ventricular septal defect (27.7%) was the most prevalent, whereas for those with severe CHDs, tetralogy of Fallot was the most prevalent (14.0%). There was no difference in sex distribution or maternal obstetric history between the groups. In multivariable analysis, a family history of CHDs (adjusted odds ratio [AOR] 4.67, 95% confidence interval (CI) 1.61–13.57, P = 0.005) and maternal exposure to second-hand cigarette smoke (AOR 1.58, 95% CI 1.03–2.42, P = 0.002) were identified as significant risk factors for CHDs. Conclusion A family history of CHDs and maternal exposure to second-hand cigarette smoke are associated with having offspring with CHDs in the population studied. These findings help us to encourage affected parents to obtain a fetal echocardiogram.

scholarly journals Predictors of In-Hospital Mortality in Isolated Total Anomalous Pulmonary Venous Connection

2019 ◽  
Vol 22 (3) ◽  
pp. E191-E196
Author(s):  
Eslam Elamry ◽  
Hesham Mostafa Alkady ◽  
Yasser Menaissy ◽  
Osama Abdalla
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Early Mortality ◽  
Pulmonary Venous Obstruction ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Anomalous Pulmonary Venous Connection ◽  
Postoperative Mechanical Ventilation

Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome.  Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included. Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardiac output syndrome (OR: 1.060; 95% CI: 1.008-1.116) and prolonged postoperative mechanical ventilation (OR: 1.772; 95% CI: 1.141-2.751) were independent factors of in-hospital mortality. Conclusion: Surgical repair of TAPVC is now performed with acceptable results. According to our study, postoperative low cardiac output syndrome and prolonged postoperative mechanical ventilation were the most significant predictors for early mortality.

scholarly journals Clinical Characteristics in Patients with Hospital-Acquired Pneumonia Caused by Extensively Drug-Resistant Acinetobacter baumannii, A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Yujun Li ◽  
Xiaomei Huang ◽  
Yuyao Wang ◽  
Chuzhi Pan ◽  
Zexun Mo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drug Resistant ◽  
Central Venous ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Lactamase Inhibitor

Abstract Background Extremely drug-resistant (XDR) Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

scholarly journals Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

2021 ◽  
Vol 10 (19) ◽  
pp. 4599
Author(s):  
Filipe Marques ◽  
Joana Gameiro ◽  
João Oliveira ◽  
José Agapito Fonseca ◽  
Inês Duarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Risk Of Mortality ◽  
Number Of Patients ◽  
Acute Kidney Disease ◽  
Risk Patients ◽  
Stage 1

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

scholarly journals Management of infective endocarditis in patients with post-stroke brain damages

2019 ◽  
pp. 84-96
Author(s):  
V. V. Fedko ◽  
S. P. Spysarenko ◽  
T. O. Malysheva ◽  
D. V. Pochynock
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Ischemic Stroke ◽  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Neurological Impairment ◽  
Neurological Complications ◽  
Cerebrovascular Complications ◽  
Management Protocol

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis. The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved. Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation. Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment. The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications. In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

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