Influence of biomarkers level during follow-up when operating under cardiopulmonary bypass

Systemic inflammatory response was first determined in 1980 and cardiac surgeons turned to it in 1996. At present, there are a lot of publications on this issue, however, the extent of operation and duration of CPB are considered in clinical practice as crucial indicators of severity of patient's condition following cardiac surgery. In our study we tried to look at this problem from a different perspective and draw a parallel between the severity of patient's condition resulting from operational trauma and CPB. We included 48 patients who under-went cardiac surgery under CPB. Plasma levels of procalcitonin (PCT), lactate and interleukin-6 were investigated before the operation, after CPB and at 24 hours. Also revealed was the relationship between the plasma levels of IL-6, lactate and PCT (r = 0.53; p = 0.000 in both cases). The level of PCT at the 3rd stage was found to relate to the duration of CPB (r = 0.4; p = 0.005), ALV (r = 0.44; p = 0.001) and length of stay at ICU (r = 0.53; p = 0.000). We didn't manage to find any relationship between the length of stay at ICU and the duration of CPB. Correlation between the PCT plasma level and the duration of intensive care indicates the importance of dynamics of the given biomarker for early prediction of follow-up course after open-heart surgery.

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Effects of Obesity on Mortality and Morbidity in High-Risk Open Heart Surgery Patients

Annals of Cardiology and Vascular Medicine ◽

10.33582/2639-4383/1044 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Hulya Yilmaz Ak ◽

◽

Yasemin Ozsahin ◽

Mehmet Ali Yesiltas ◽

Ismail Haberal ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Heart Surgery ◽

Open Heart Surgery ◽

Obese Group ◽

Open Heart ◽

Mortality And Morbidity ◽

High Risk Patients ◽

Risk Patients

Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI <30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p> 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.

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Leadless pacemaker implant in patients with a history of open heart surgery: experience with the Micra transcatheter pacemaker

European Heart Journal ◽

10.1093/ehjci/ehaa946.0773 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Garweg ◽

S Iacopino ◽

M.F El-Chami ◽

C Veltmann ◽

N Clementy ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Open Heart Surgery ◽

Major Complication ◽

Valve Surgery ◽

Funding Source ◽

Open Heart ◽

Surgery Group ◽

History Of

Abstract Background The Micra transcatheter pacemaker has demonstrated a favorable safety and efficacy profile relative to transvenous pacing. Patients with a history of open heart surgery have a higher risk of complications with transvenous pacemakers during follow-up. The experience with leadless pacemakers among a large cohort of patients with a history of open heart surgery has not been reported. Objective To report outcomes in patients with a history of open heart surgery undergoing Micra implant. Methods Patients undergoing Micra implant from the Micra Transcatheter Pacing Post-Approval Registry (PAR) were included in the analysis. Baseline and procedural characteristics, major complications, and electrical performance were compared among patients with vs. without history of cardiac surgery. Results A total of 331 out of 1815 (18.2%) patients had a history of open heart surgery, underwent Micra implant, and were followed for 19.4±10.4 months. The mean age was 74.6±13.5 years, 40% were female. The most common cardiac surgery was aortic valve surgery (71%) followed by mitral valve surgery (39%). Patients with prior open-heart surgery were more likely to have contraindications to transvenous pacing, were more likely to be on oral anticoagulants, and had more co-morbidities including atrial fibrillation, heart failure, and coronary artery disease (all p<0.005). Implantation was successful in 327 of 331 patients (98.8%) with a median procedure time of 29 minutes. Mean pacing capture thresholds (PCTs) at implant were 0.66±0.51V and remained stable through follow-up. There were 11 major complications in 10 cardiac surgery patients, with no device or procedure-related infections reported. The major complication rate was 3.1% (Figure) and was not significantly different than that of patients without a history of open heart surgery (HR: 0.85, P=0.640). There was 1 cardiac perforation (with no intervention required) in the open heart surgery group (0.3%) and there were 14 cardiac perforations (0.94%, P=0.332) in the non-open heart surgery group of which 10 required intervention. Conclusion The Micra transcatheter pacemaker can be safely implanted in patients with a history of open heart surgery, with a similar long-term safety profile to patients without a history of open heart surgery. Importantly, there were no device-related infections reported in either group. Risk of Major Complication Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic, Inc.

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P-37 The evaluation of European system for cardiac operative risk evaluation and cardiac surgery scoring system to predict morbidity and mortality in open heart surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2011.03.130 ◽

2011 ◽

Vol 25 (3) ◽

pp. S49

Author(s):

Bayram Karatas ◽

Bilge Çelebioglu ◽

Banu Ayhan ◽

Meral Kanbak ◽

Ülkü Aypar

Keyword(s):

Cardiac Surgery ◽

Scoring System ◽

Risk Evaluation ◽

Heart Surgery ◽

Open Heart Surgery ◽

Morbidity And Mortality ◽

Operative Risk ◽

Open Heart ◽

European System ◽

Cardiac Operative Risk Evaluation

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Neuropsychomotor development before and after open-heart surgery in infants

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000300016 ◽

2009 ◽

Vol 67 (2b) ◽

pp. 457-462 ◽

Cited By ~ 1

Author(s):

Taís Sica da Rocha ◽

Ana Guardiola ◽

Jefferson Pedro Piva ◽

Cláudia Pires Ricachinevski ◽

Aldemir Nogueira

Keyword(s):

Heart Surgery ◽

Intensive Care Unit Discharge ◽

Open Heart Surgery ◽

Open Heart ◽

Neurodevelopmental Outcomes ◽

Early Improvement ◽

Before And After ◽

Neurological Exam ◽

Brazilian Studies

There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67 ± 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.

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Relationship Between Selenium Trace and Patient Outcome After Open-Heart Surgery

Anesthesiology and Pain Medicine ◽

10.5812/aapm.105895 ◽

2020 ◽

Vol 10 (4) ◽

Author(s):

Gohar Eslami ◽

Roya Salehi ◽

Hamidreza Samaee ◽

Vallialah Habibi ◽

Mohammad Shokrzadeh ◽

...

Keyword(s):

Patient Outcome ◽

Heart Surgery ◽

Acute Stress ◽

Open Heart Surgery ◽

Selenium Level ◽

Serum Selenium ◽

Open Heart ◽

Duration Of Surgery ◽

The Relationship ◽

Serum Selenium Level

Background: Acute stress response to heart surgery can cause major morbidity in patients. The trace of selenium is useful for preventing heart damage. Although the trend of selenium changes is of high importance for body balance, the usefulness of routine use and effectiveness of this element for patients under open-heart surgery is still unclear. Objectives: This study aimed at assessing serum selenium level before and after open-heart surgery and the relationship between selenium trace and patient outcome. Methods: This prospective analytical study was performed on 100 patients undergoing open-heart surgery using cardiopulmonary bypass (CPB). In all patients, the serum level was measured at a predetermined time (before surgery and one and two days after surgery). Then, the relationship between serum selenium and patient outcome was assessed. Results: The mean serum selenium level in patients on admission was 72.90 ± 14.62 μg/L, one day after surgery was 71.20 ± 15.84 μg/L, and two days after surgery was 71.54 ± 15.97 μg/L. Serum selenium levels were inversely and significantly associated with age (r = -0.183; P = 0.034, 013) duration of surgery (r = -221 and P = 0.014), duration of intensive care unit stay (r = 0.204, P = 0.021), and duration of CPB (r = 0.223, P = 013). Conclusions: Based on this study’s results, a low level of selenium can affect patients’ outcomes after open-heart surgery.

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Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20192112 ◽

2019 ◽

Vol 6 (3) ◽

pp. 756

Author(s):

Praveen Dhaulta ◽

Vikas Panwar

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Ejection Fraction ◽

Heart Surgery ◽

Open Heart Surgery ◽

Clinical Variable ◽

Open Heart ◽

Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

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The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.78557 ◽

2021 ◽

Author(s):

Murat Aksun ◽

Saliha Aksun ◽

Mehmet Ali Çoşar ◽

Elif Neziroğlu ◽

Senem Girgin ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Experience ◽

Heart Surgery ◽

Blood Product ◽

Open Heart Surgery ◽

Control Group ◽

Open Heart ◽

Blood Products ◽

Product Use ◽

The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

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Synchronous Open Heart Surgery and Laparoscopic Cholecystectomy: An Observational Case Study with 28 Patients

The American Surgeon ◽

10.1177/000313481708300329 ◽

2017 ◽

Vol 83 (3) ◽

pp. 314-321

Author(s):

Mustafa Bilge Erdogan ◽

Mehmet Kaplan ◽

Hakki Kazaz ◽

Bulent Salman

Keyword(s):

Laparoscopic Cholecystectomy ◽

Heart Surgery ◽

Open Heart Surgery ◽

Acalculous Cholecystitis ◽

Tricuspid Valve Repair ◽

Inhospital Mortality ◽

Open Heart ◽

Severe Problem

Acute cholecystitis (AC) may be a severe problem and may increase the mortality rate and hospital stay in patients who undergo open heart surgery (OHS), due to its aggressive course; therefore, AC should be treated as soon as possible. We aimed to present data on our synchronous cardiac and laparoscopic cholecystectomy (LC) operations performed for AC complicating patients with cardiac disease and who were waiting to undergo OHS. Between January 2008 and September 2014, we performed 2773 OHSs in Medical Park Gaziantep Hospital. Among these, 28 (1%) patients underwent concomitant LC in the same session by the same experienced surgeon. The mean age of the patients was 61.4 ± 9.1 years, and the proportion of males was 71.4 per cent. Acalculous cholecystitis was found in 42.9 per cent of the patients. Patients stayed in the intensive care unit for 3.1 ± 1.4 days and were discharged from the hospital after 16.5 ± 6.3 days. Postoperative 2-year follow-up was completed in all patients with a mean follow-up period of 3.4 ± 2.0 years. The overall complication rate was 28.6 per cent. LC-related complications were seen in four patients. No inhospital mortality was observed. Only one patient who underwent mitral valve replacement and tricuspid valve repair died in the second year after the operation due to congestive heart failure. Three patients died due to noncardiac reasons in the follow-up period. By increasing the experiences of surgeons in laparoscopic surgery in critically ill patients, LC can be safely performed concurrently in patients scheduled for OHS.

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Subclavian Vein Catheterisation for Cardiac Surgery in Children

Anaesthesia and Intensive Care ◽

10.1177/0310057x8000800113 ◽

1980 ◽

Vol 8 (1) ◽

pp. 81-83 ◽

Cited By ~ 7

Author(s):

John L. Poole

Keyword(s):

Cardiac Surgery ◽

Central Venous Pressure ◽

Success Rate ◽

Subclavian Vein ◽

Heart Surgery ◽

Venous Pressure ◽

Open Heart Surgery ◽

Open Heart ◽

Central Venous ◽

Infusion Line

Infraclavicular subclavian vein catheterisation is a useful means of measuring central venous pressure and establishing a central infusion line in children undergoing open heart surgery. In 48 children ranging in age from 15 months to 13 years, there was a high success rate and no morbidity.

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