scholarly journals The effects of levosimendan on renal functions in open-heart surgery patients with a low ejection fraction

2021 ◽  
Vol 6 (2) ◽  
pp. 121-130
Author(s):  
Süleyman Yazıcı ◽  
◽  
Mehmet N. Karabulut ◽  
Ayşe Baysal ◽  
Rahmi Zeybek
Keyword(s):  
Ejection Fraction ◽  
Serum Creatinine ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Renal Functions ◽  
Preoperative Serum ◽  
Group 2 ◽  
Low Ejection Fraction ◽  
Group 1

Purpose. This study investigated the effects of levosimendan on renal functions in patients with a preoperative low ejection fraction undergoing open-heart surgery and cardiopulmonary bypass (CPB). Materials and Methods. The study retrospectively evaluated 64 patients with a diagnosis of mitral valve insufficiency and left ventricular dysfunction undergoing open-heart surgery with CPB. Patients were divided depending on the preoperative blood creatinine level less (Group 1) or more than 1.2 mg/dL (Group 2). A bolus dose of levosimendan was administered through the aortic arch at the end of the CPB, preceding an infusion of levosimendan intravenously in all patients. Demographic data, preoperative and 48-hour postoperative echocardiographic studies were done. The blood urea and creatinine levels were collected preoperatively and on postoperative days 1, 3, and 10. The use of inotropic support, intra-aortic balloon pump, and complications were recorded. Results. The demographic data were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p=0.01, p<0.001, respectively). The aortic cross-clamp and cardiopulmonary bypass times were similar between groups (p>0.05). Preoperative serum creatinine levels were higher in Group 1 in comparison to Group 2 (p<0.001). On postoperative day 1, serum creatinine levels of Group 1 were significantly lower than Group 2 (p<0.001). On postoperative days 3 and 10, no differences were observed regarding serum creatinine levels between groups (p>0.05). Complications were similar between groups (p>0.05). Conclusions. In patients with low ejection fraction undergoing open-heart surgery, the use of levosimendan intraoperatively and 24 hours postoperatively prevents deterioration of renal functions in patients with or without preoperative disturbance in serum creatinine level.

scholarly journals Adding tricuspid repair to standard open heart surgery does not increase risk but improves right ventricular function

2019 ◽  
Vol 29 (3) ◽  
pp. 416-421 ◽  
Author(s):  
Clarence Pingpoh ◽  
Sarah Nuss ◽  
Sami Kueri ◽  
Maximillian Kreibich ◽  
Martin Czerny ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Group 2 ◽  
Repair Group ◽  
Tricuspid Repair ◽  
Group 1

Abstract OBJECTIVES To evaluate outcome of concomitant tricuspid annuloplasty in mild or moderate regurgitation on perioperative outcome and on right ventricular function in patients undergoing major cardiac surgery. METHODS Among 14 500 patients who underwent cardiac surgery at our institution between January 2000 and April 2016, 1023 patients had a documented history of tricuspid regurgitation (TR). Of those patients, 324 patients were diagnosed with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) and composed the study population. The decision to perform concomitant annuloplasty was subjected to the individual decision of the treating surgeon. Our analysis focused on a comparison between patients with concomitant TR-repair (group 1, n = 184) and patients without concomitant TR-repair (group 2, n = 140) after propensity score matching. RESULTS Following a preliminary data preprocessing, we observed a mean age of 73.8 years, mean logistic EuroSCORE of 10.5%. Perioperative mortality was 4.4% in group 1 and 5.7% in group 2. There was no significant difference in mid-term mortality. TR after surgery was significantly higher in group 2. After propensity score matching regression analysis, patients who had a repaired tricuspid valve (group 1) had better right ventricle (RV) function than those without TR-repair (group 2) (P > 0.05 at 95% confidence interval following Kolmogorov–Smirnov Goodness of fit Test). CONCLUSIONS Adding tricuspid valve repair in patients with mild or moderate secondary TR with a dilated annulus (≥40 mm or >21 mm/m2) to standard open heart surgery does not increase perioperative risk but improves right ventricular function. Therefore, standard tricuspid repair in this subgroup might be considered on a routine basis.

scholarly journals The Effects of Norepinephrine Infusion on the Circulating Lymphocyte Counts of Post–Open Heart Surgery Patients

2000 ◽  
Vol 1 (3) ◽  
pp. 199-209
Author(s):  
Wanda Zziwambazza ◽  
Carrie J. Merkle ◽  
Ida M. Moore ◽  
Jean Davis
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
The Other ◽  
Open Heart ◽  
Postoperative Infections ◽  
Norepinephrine Infusion ◽  
Beta Blocking ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

In this retrospective study employing chart reviews, 75 open heart surgery patients (OHSPs) were divided into 3 groups of 25 patients. Group 1 received no intravenous (IV) norepinephrine (NE) after surgery. Group 2 and group 3 received a minimum of 0.028 mcg/kg/min of IV NE for 6-24 h and greater than 24 h, respectively. In the 3 groups, preoperative lymphocyte counts were compared to counts obtained on postoperative days 1 and 2. The results showed lower lymphocyte counts on postoperative day 2 in group 3 subjects, who received NE for 24 h or more, compared to subjects of the other groups who received no NE or 6-24 h of NE (p < 0.05). There was also evidence that preoperative use of beta-blocking agents significantly affected the change in lymphocyte counts from day 1 to day 2 in both groups receiving NE. Furthermore, postoperative infections were more prevalent in group 3 than the other 2 groups (p < 0.05). The lower lymphocyte counts and higher infection rate, however, may be linked to lower postoperative blood pressure and increased number of intensive care unit days in group 3. Further investigation is warranted to elucidate the effects of IV NE administration on the lymphocyte counts of OHSPs and to reduce infections in those receiving NE.

Abstract 3044: The Preoperative Utilization of Levosimendan (Preoperative Optimization) Reduced Mortality and Low Output Syndrome After Cardiac Surgery in Patients With Low Ejection Fraction (EF<25%).

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ricardo L Levin ◽  
Marcela A Degrange ◽  
Rafael Porcile ◽  
Flavio Salvagio ◽  
Norberto Blanco ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Control Group ◽  
Placebo Control ◽  
P Value ◽  
Open Heart ◽  
Preoperative Optimization ◽  
Low Ejection Fraction

Background: Patients with low ejection fraction (EF<25%) present high-risk of mortality and development of low output state (LOS) after cardiac surgery. The objective of this research was to evaluate the preoperative use of the calcium sensitizer Levosimendan (Levo) in patients with EF<25%, underwent open heart surgery. Thirty-day mortality and development of postoperative LOS were the primary end-points of the study. Methods: Patients with EF<25% and hemodynamic parameters of LOS (cardiac index<2.2 L/min/m2 and pulmonary artery occlusion pressure>15 mm Hg), underwent coronary bypass surgery between 12/01/2002 and 02/01/2007 were randomized to: preoperative infusion of Levo 0.1 mcg/Kg/min, 24 hours before surgery (Levo group-preoperative optimization), or placebo (Control group). LOS postoperative was defined for the same hemodynamic variables. A P value < 0.05 was considered significant Results: Two-hundred and twenty one patients fulfilled the inclusion criteria, being randomized 111 of them to Levo, and 110 patients to placebo. Both groups were comparable in their general and surgical characteristics. No withdrawal of Levo was required during the preoperative administration, with 8 patients showing hypotension episodes which was resolved with fluid infusions. There were not ventricular arrhythmias, supraventricular arrhythmias (with heart rate over 125) or preoperative ischemic events. The 30-day mortality was 3 patients in the Levo group (2.7%) versus 12 patients in the Control group (10.9%, P value 0.001, OR 0.23, IC95 0.05– 0.90). Seven patients in the Levo group developed postoperative LOS (6.3%) against 20 patients in the Control group (18.2%, P value <0.001, OR 0.30, IC95 0.11– 0.80) Conclusion: The preoperative optimization with Levosimendan reduced the operative mortality and the development of postoperative LOS in patients with EF<25% underwent open heart surgery. The infusion was safety no needing to withdraw it in any case. These findings could represent a new strategy to reduce the operative risk in this group of patients.:

Cholelithiasis in children with CHD: is it a problem?

2016 ◽  
Vol 27 (4) ◽  
pp. 630-633
Author(s):  
Simon Kargl ◽  
Roland Gitter ◽  
Wolfgang Pumberger
Keyword(s):  
Risk Factors ◽  
Ursodeoxycholic Acid ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Aetiological Factor ◽  
Open Heart ◽  
Biliary Surgery ◽  
Group 2 ◽  
A Minor ◽  
Group 1

AbstractBackgroundAn association of heart disease and its treatment with biliary calculi is popularly accepted. We sought determine the prevalence and risk factors of paediatric gallstone disease in the presence of CHD and analyse the treatment options. We evaluated the role of open-heart surgery in the development of gallstones in patients with CHD.Patients and methodsIn a 10-year, retrospective, chart review (2005–2014), patients with CHD and cholelithiasis were identified and reviewed.ResultsIn all, 19 of 4729 children with CHD had cholelithiasis (0.4%); eight patients underwent cardiac surgery before diagnosis of cholelithiasis (group 1), whereas 11 of them had not (group 2). The prevalence was 0.3% in group 1 and 0.5% in group 2.In nine asymptomatic patients, gallstones were found incidentally. Children with cholecystolithiasis (n=17) received ursodeoxycholic acid. A resolution of gallstones was found in four cases; two patients underwent biliary surgery, and the others (15/17) were successfully managed non-operatively.ConclusionDespite an accumulation of risk factors, prevalence of gallstones is not as high as expected in children with CHD. Open-heart surgery with a heart–lung machine plays a minor role as an aetiological factor. In about half of the cases, cholelithiasis is an incidental finding and patients stay asymptomatic. Prophylactic administration of ursodeoxycholic acid is not indicated in children undergoing open-heart surgery for CHDs. Biliary surgery is reserved for patients with recurrent symptoms or cholestasis.In children with CHD, cholelithiasis is a minor and manageable co-morbid condition.

scholarly journals Long-term outcome of endocardial-only versus combined endocardial-epicardial homogenization of the scar for treatment of ventricular tachycardia in patients with ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Long Term Outcome ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Abstract Introduction We investigated the ablation success of scar homogenization with combined (epicardial + endocardial) versus endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Method Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial scar homogenization and group 2: endocardial +epicardial scar homogenization. Patients with previous open heart surgery were excluded. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue &gt;1.5 mV and severe scar &lt;0.5 mV. Non-inducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up twice a year for 5 years with implantable device interrogations. Results A total of 361 (Group 1: 291 and group 2: 70) patients were included in the study (mean age: 67 years, male: 88.4%). At 5 years, significantly higher number of patients from group 2 remained arrhythmia-free (figure 1). Of those patients, 87 (45%) and 51 (89%) from group 1 and 2 respectively were off-anti-arrhythmic drugs (AAD) (p&lt;0.001). After adjusting for age, gender, hypertension, diabetes, and obstructive sleep apnea, scar homogenization using endo-epicardial approach was associated with 51% less recurrence compared to the endocardial ablation strategy (Hazard Ratio: 0.49, 95% CI: 0.27–0.89, p: 0.02). Conclusion In this series of patients with ischemic cardiomyopathy and VT, endo-epicardial scar homogenization was associated with a lower need for AAD and a significantly lower recurrence rate at 5-years of follow-up compared to the endocardial ablation alone. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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

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.

Patients with poor preoperative ejection fraction have a higher plasma response of adrenomedullin in response to open heart surgery

1999 ◽  
Vol 43 (8) ◽  
pp. 829-833 ◽  
Author(s):  
J. A. Amado ◽  
I. Fidalgo ◽  
M. T. García-Unzueta ◽  
C. Montalbán ◽  
I. Del Moral ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Plasma Response

Social Function of Adults with Isolated Ventricular Septal Defects

1986 ◽  
Vol 14 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Jan Erik Otterstad ◽  
Ingunn Tjore ◽  
Per Sundby
Keyword(s):  
Educational Level ◽  
Heart Surgery ◽  
Surgical Repair ◽  
Open Heart Surgery ◽  
Social Function ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Higher Educational ◽  
Group 2 ◽  
Group 1

Possible long-term deterioration of social function has been studied in adults over 30 years of age with congenital, isolated ventricular septal defects (VSD). This deterioration may possibly have been caused by brain damage connected with open heart surgery performed after age 10 years. Thirty-five patients with a mean age of 39 (range 31–61) years have been followed up for an average of 15 (3–21) years when restudied after surgical repair of VSD performed at a mean age of 23 (10–51) years (Group 1). Their social status was compared with 61 non-operated subjects with basically smaller defects, mean age 43 (31–73) years, who had been followed up for an average of 14 (3–21) years. Group 1 had a higher educational level, were less stressed at work, had a higher gross income (NS) and were less physically disabled ( p<0.01). Both groups had a higher educational level than normal 40-year-old Norwegians. The percentages receiving disablement pension were 12% in group 1 and 13% in group 2. Despite a higher abortion rate (33% vs. 18%), group 1 females had a higher number of liveborn babies than those in group 2 (NS). Regular medical check-ups were attended by 45% and 60% in groups 1 and 2 respectively, and about half took antibiotics prophylactically. Unlike when initially investigated, group 1 had a better cardiac condition than group 2. Compared with the non-operated group, the operated patients had suffered no detrimental effects on their social function. We therefore advocate a liberal policy for surgical repair of VSD after age 10 years.

Acute renal failure following open heart surgery: risk factors and prognosis

Perfusion ◽  
2005 ◽  
Vol 20 (6) ◽  
pp. 317-322 ◽  
Author(s):  
Ilknur Bahar ◽  
Ahmet Akgul ◽  
Mehmet Ali Ozatik ◽  
Kerem M Vural ◽  
Ali E Demirbag ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
High Morbidity ◽  
Open Heart ◽  
Preoperative Serum

Background: Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity. Methods: Out of 14 437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis. Possible perioperative risk factors, and the prognosis of this dreadful, often fatal complication were investigated. Results: The mortality rate in this group was 79.7% (134 patients). The risk factors associated with postoperative ARF were advanced age (p-0.000), diabetes mellitus (p-0.000), hypertension (p-0.000), high preoperative serum creatinine levels (p-0.004), impaired left ventricular function (p-0.002), urgent operation (p-0.000) or reoperation (p-0.007), prolonged cardiopulmonary bypass (CPB) (p-0.000) and aortic cross-clamp (ACC) (p-0.000) periods, level of hypothermia (p-0.000), concomitant procedures (p-0.000), low cardiac output state (p-0.000), re-exploration for bleeding or pericardial tamponade (p-0.000), and deep sternal or systemic infection (p-0.000). Of those who could be discharged from hospital, renal functions were restored in 21 patients (12.5%); however, eight patients (4.7%) became hemodialysis dependent. The mean follow-up period was 5.79/3.2 years (range: 4 months to 13 years; a total of 195 patient-years), and 10-year survival was 58.69/10.2% in the discharged patients. Conclusions: ARF development after cardiac surgery often results in high morbidity and mortality. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.

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