scholarly journals Hypogammaglobulinemia as a Predictive Factor of Postoperative Complications in Pediatric Cardiac Surgery

2021 ◽  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Heart Defects ◽  
Blood Stream ◽  
Neonatal Unit ◽  
Pediatric Cardiac Surgery ◽  
Impact On Survival ◽  
Group 2 ◽  
Attending Physician ◽  
Group 1

Hypogammaglobulinemia, developed as a result of cardiac surgery accompanied by cardiopulmonary bypass (CPB), may be caused by hemodilution, destruction of immunoglobulin, extravasation into the interstitial space related to systemic inflammation, and capillary leak syndrome. Therefore, to address this gap, we analyzed the characteristics of the infants who developed hypogammaglobulinemia after cardiac surgery and could benefit from Immunoglobulin supplementation. Methods: This is a retrospective study evaluating infants undergoing surgery for repair of congenital heart defects from October 1, 2019 to June 30th, 2020 in the neonatal unit of our institution. Due to its retrospective design, informed consent was not required. Patients were divided in two groups: Group 1 (IgG >= 340mg/dL) and Group 2 (IgG < 340mg/dL). The value cut point was defined taking into consideration p10 level of Immunoglobulin according to Fujimura. Results: From October 1, 2019 to June 30th, 2020, 62 children were born or admitted in our neonatal unit. Among them, 19 (30%) have their IgG dosed, according to attending physician decision. Among patients with hypogammaglobulinemia, Pseudomonas sp was present in 87.5% of blood stream and/or tracheal secretion cultures. Regarding survival analysis, mortality was not different between Group 1 and 2. Conclusion: Hypogammaglobulinemia has proved to be a predictor factor of postoperative complications in pediatric cardiac surgery. However, prospective trials are needed to determine the incidence of this problem, its real impact on survival, and the appropriate therapy.

scholarly journals Adiponectin and its receptors in patients with cardiovascular disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Belik ◽  
OV Gruzdeva ◽  
YUA Dyleva ◽  
EG Uchasova ◽  
MYU Sinitsky ◽  
...  
Keyword(s):  
Heart Defects ◽  
Post Translational Modification ◽  
Fat Depots ◽  
Funding Sources ◽  
Adiponectin Mrna ◽  
Fat Stores ◽  
Group 2 ◽  
High Level ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Aim to determine the features of adiponectin expression, secretion of adiponectin and its receptors in local fat depots in CVD. Materials and methods The study included 90 patients with СAD (Group 1) and 60 patients with heart defects (Group 2). Adipocytes were isolated from samples of subcutaneous (SAT), epicardial (EAT) and perivascular (PVAT) adipose tissue obtained during CABG or heart valve replacement. The expression of adiponectin was determined by qPCR using TaqManTM Gene Expression Assays (Applied Biosystems, USA) in the ViiA 7 Real-Time PCR System (Applied Biosystems, USA), the levels of expression products was determined using enzyme immunoassay (Bender MedSystems GmbH, Vienna, Austria). The data were analyzed using the statistical software Statistica 9.0. Results EAT adipocytes were characterized by the lowest adiponectin expression relative to adipocytes of other localization both in Group 1 and Group 2. In patients Group 1 adiponectin expression in EAT was reduced relative in SAT and PVAT (by 1.2 and 1.5 times). In Group 2, the adiponectin mRNA in the EAT was lower than in the SAT and PVAT (1.4 and 1.5 times). The expression of adiponectin in EAT in Group 2 exceeded the same indicator in Group 1 by 1.2 times. The maximum expression of adiponectin was observed in the PVAT culture in patients of both groups. For Group 2, this indicator exceeded the values of Group 1 by 1.2 times. The content of adiponectin in the culture EAT was lower than in the SAT, both in Group 1 and Group 2 (by 1.3 and 1.13 times). The level of this indicator in Group 2 was 1.4 times higher than in Group 1. PVAT adipocytes of patients with CAD were characterized by the lowest level of adiponectin secretion in comparison with adipocytes of other localization. The adiponectin level in the PVAT of Group 2 exceeded that of fat stores of other localization and in Group 1 patients by 1.8 times. There were no statistically significant differences in the expression and concentration of adiponectin in the culture of adipocytes of the SAT between the groups of patients. In Group 1, the lowest level of AdipoR1 was found in the adipocyte culture of the PVAT. Noteworthy is the decrease in the level of AdipoR1 in Group 1 compared to the level of Group 2, observed in the SAT and PVAT: 1.3 and 1.5 times. There were no significant differences in the concentration of the AdipoR1 in the EAT, as well as AdipoR2 in all types of AT between the groups of patients. Conclusion: in CVD the EAT is characterized by minimal expression and secretion of adiponectin, regardless of nosology. In CAD despite the high level of expression of adiponectin, the adipocytes of the PVAT were found to have the lowest content in comparison with adipocytes of other localization. Dysregulation of the adiponectin/AdipoR axis is observed in PVAT, which may be due to low expression of adiponectin receptors and long-term processes of its post-translational modification and oligomerization in CAD.

scholarly journals Role of toll-like receptors in complications of cardiac surgery for congenital heart defects in children

2021 ◽  
Vol 25 (3) ◽  
pp. 34
Author(s):  
A. V. Tsepokina ◽  
A. A. Anikeenko ◽  
S. A. Shmulevich ◽  
A. V. Ponasenko ◽  
A. V. Shabaldin
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Gene Interaction ◽  
Infectious Complications ◽  
Toll Like Receptors ◽  
Cytokines And Chemokines ◽  
Polymorphic Variants

<p><strong>Background.</strong> Cardiac surgery in combination with hypothermia, ischaemia and reperfusion leads to an inflammatory response causing postoperative complications. Toll-like receptors are signalling molecules through which some functions of innate immunity can be activated, and polymorphic variants in the TLR-family genes can be predictors of complications after cardiac surgery.<br /><strong>Aim.</strong> To study the associations of TLR-family genes with infectious and non-infectious complications of cardiac surgery for congenital heart defects.<br /><strong>Methods.</strong> The study included 89 children (44 girls and 45 boys) with congenital heart defects who underwent cardiac surgery. Complications occurred in 47 children 47 days after cardiac surgery. There were no complications in 42 children. Genotyping was performed by real-time PCR using TaqMan probes.<br /><strong>Results.</strong> A two-locus model of gene-gene interaction between <em>TLR1</em> rs5743551 and <em>TLR2</em> rs3804099 was the best fit, accounting for 4.01% of phenotypic entropy. The <em>TLR2</em> gene polymorphic variant rs5743708 had the highest predictive potential (2.59%).<br /><strong>Conclusion.</strong> The development of postoperative complications of cardiac surgical treatment for congenital heart defects can be due to the synergistic effect of the polymorphic variants rs5743551 in the <em>TLR1</em> gene and rs3804099 in the <em>TLR2</em> gene. This effect occurs through the features of <em>TLR1</em> and <em>TLR2</em> transcription, the subsequent expression of receptors on cells and signalling which activates the synthesis of proinflammatory cytokines and chemokines.</p><p>Received 25 February 2021. Revised 11 May 2021. Accepted 12 May 2021.</p><p><strong>Funding:</strong> The work is supported by the complex program of fundamental research of the Siberian Branch of the Russian Academy of Sciences (No. 0554-2019-0002).</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.V. Shabaldin, A.V. Ponasenko, A.V. Tsepokina<br />Data collection and analysis: A.A. Anikeenko, A.V. Tsepokina, S.A. Shmulevich<br />Statistical analysis: A.V. Shabaldin, A.V. Tsepokina<br />Drafting the article: A.V. Shabaldin, A.V. Tsepokina, A.V. Ponasenko<br />Critical revision of the article: A.V. Tsepokina<br />Final approval of the version to be published: A.V. Tsepokina, A.A. Anikeenko, S.A. Shmulevich, A.V. Ponasenko, A.V. Shabaldin</p>

Safety of a 2-Day Antibiotic Regimen After Delayed Chest Closure Post Pediatric Cardiac Surgery

2018 ◽  
Vol 35 (8) ◽  
pp. 805-809 ◽  
Author(s):  
Joseph Philip ◽  
Christian Kegg ◽  
Dalia Lopez-Colon ◽  
Brian J. Kelly ◽  
Robert M. Lawrence ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Stream ◽  
Prophylactic Antibiotics ◽  
Pediatric Cardiac Surgery ◽  
Study Group ◽  
Wound Infections ◽  
Cardiac Intensive Care Unit ◽  
End Points ◽  
Cardiac Intensive Care ◽  
Sternal Wound Infections

Background: There is no consensus for the length of prophylactic antibiotics after delayed chest closure (DCC) postcardiac surgery in pediatrics. In September 2014, our institution’s pediatric cardiac intensive care unit changed the policy on length of prophylactic antibiotics after DCC from 5 days (control) to 2 days (study group). The objective of the study was to determine whether a 2-day course of antibiotics is as effective as a 5-day course in preventing blood stream and sternal wound infections in pediatric DCC. Methods: Retrospective and prospective study. Primary end points included incidence of sternal wound infections and positive sternal imaging for infection. Surrogate markers of infection were collected at 4 time points. Results: During the study period, 139 patients had DCC postcardiac surgery of which 110 patients were included for analysis, 54 patients in the control and 56 in the study group. There was no difference in total number of positive wound cultures/chest computed tomography (CT) findings (4/54 [7.5%] control vs 5/56 [8.9%] study group, P = .3), positive blood cultures ( P = .586), median postsurgical length of stay ( P = .4), or readmissions within 30 days postsurgery ( P = .6). All secondary end points were similar in both groups except peak heart rate between weeks 2 and 4 ( P = .041). Conclusion: Two days of prophylactic antibiotics is not inferior to 5 days of prophylactic antibiotics after DCC following pediatric cardiac surgery.

Clinical and Autopsy Analysis of Delayed Diagnosis and Missed Injuries in Trauma Patients

2006 ◽  
Vol 72 (2) ◽  
pp. 174-179
Author(s):  
Om P. Sharma ◽  
Diane M. Scala-Barnett ◽  
Michael F. Oswanski ◽  
Amy Aton ◽  
Shekhar S. Raj
Keyword(s):  
Health Care Providers ◽  
Negative Impact ◽  
Delayed Diagnosis ◽  
P Value ◽  
Care Providers ◽  
Missed Injuries ◽  
Impact On Survival ◽  
Group 2 ◽  
Trauma Deaths ◽  
Group 1

Delayed diagnosis of injury (DDI) during hospitalization and missed injuries (MI) on autopsy in trauma deaths result in untoward outcomes. Autopsy is an effective educational tool for health care providers to evaluate trauma care. A retrospective study of trauma registry patients and coroner's records was categorized into groups 1 (alive patients) and 2 (trauma deaths) and analyzed. DDI incidence was similar in group 1 (1.8%) and group 2 (1.9%). Autopsy analysis (163 patients) yielded 139 MI in 94 patients (57.6%), <3 per cent of MI had negative impact on survival. Bony injuries comprised 68 per cent of DDI and 19 per cent of MI. Group 1 DDI patients were sicker with higher injury severity score (ISS: 16.07) than their cohorts (ISS 7.13, P value <0.05). These patients had higher Glasgow Coma Scale (14.41) and lower ISS (16.07) as compared with group 2 MI patients (ISS: 33.49, GCS: 6.45, P value <0.05). Autopsy rate was 99.5 per cent in trauma deaths, 57 per cent for nontrauma deaths, and 79 per cent for all deaths. Less than 3 per cent of MI had negative impact on survival. Routine ongoing patient assessment with pertinent diagnostic workup is essential in reducing DDI. Trauma autopsies reveal MI, which aid performance improvement (PI).

scholarly journals Impact of Renal Function on the Surgical Outcomes of Displaced Femoral Neck Fracture in Elderly Patients

2019 ◽  
Vol 8 (8) ◽  
pp. 1149 ◽  
Author(s):  
Kwon ◽  
Lim ◽  
Yang ◽  
Lee ◽  
Jeon ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Femoral Neck ◽  
Renal Impairment ◽  
Femoral Neck Fracture ◽  
Bipolar Hemiarthroplasty ◽  
Neck Fracture ◽  
Group 3 ◽  
Group 2 ◽  
Complications And Mortality ◽  
Group 1

Background: The aim of this study was to investigate the relationship between estimated glomerular filtration rate (eGFR) and outcomes of bipolar hemiarthroplasty for femoral neck fracture in elderly patients, and to compare postoperative complications and mortality among groups according to eGFR. Methods: A total of 181 patients who underwent bipolar hemiarthroplasty for displaced femoral neck fracture were divided into three groups according to eGFR. Data were retrospectively analyzed. Group 1 had 96 patients with eGFR greater than or equal to 60 mL/min/1.73 m2; Group 2 had 54 patients with eGFR greater than or equal to 30 mL/min/1.73 m2 and lower than 60 mL/min/1.73 m2; and Group 3 had 31 patients with eGFR lower than 30 mL/min/1.73 m2. Postoperative complications and mortality were compared between groups at a minimum 2-year follow-up. Results: Patients in Group 3 had the longest hospital stay of the three groups (p = 0.001). The rates of medical complications did not differ significantly among groups. However, Group 2 and 3 had higher rates of surgical complications (p = 0.001) and mortality (p = 0.043) than Group 1. Severe renal impairment was associated with increased risk of postoperative complications compared to mild renal impairment (odds ratio (95% confidence interval) = 4.33 (1.32–13.19), p = 0.015). Conclusion: Patients with moderate or severe decreased eGFR associated with chronic kidney disease (CKD) could have higher postoperative complications and mortality after bipolar hemiarthroplasty compared to patients with CKD stage 1 or 2.

The Usage of Endobiliary Stents with Antiseptic Coating in the Treatment of Choledocholithiasis

2020 ◽  
Vol 17 (9) ◽  
pp. 4751-4754
Author(s):  
Angela V. Gnashko ◽  
Vladimir F. Kulikovskiy ◽  
Andrey L. Yarosh ◽  
Aleksandr A. Karpachev ◽  
Aleksandr V. Soloshenko ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Plastic Stents ◽  
Biliary Stenting ◽  
Biliary Stents ◽  
Aged Patients ◽  
Actual Problem ◽  
Septic Complications ◽  
Group 2 ◽  
Group 1

Introduction: Choledocholithiasis is still an actual problem of treatment of complicated forms of cholelithiasis. The difficulties in treatment of this pathology are caused by the predominance of elderly and senile aged patients whom biliary stenting in most cases can be used as the only method of treatment. The purpose of the study is to justify the usage of endobiliary prostheses with antiseptic coating in the treatment of patients with choledocholithiasis. Material and methods: We analyzed the results of 95 patients’ treatment with “difficult” choledocholithiasis and in these casesbiliary endoprostheses were used at the first stage of curing. In 56 cases (group 1–58.4%), stenting was performed with “traditional” plastic prostheses without special coating, 39 stentings (group 2–41.6%) were performed with plastic stents, the surfaces of which were modified with 10% betadin solution. Results: The frequency of patient’s postoperative complications of the 1st group was 19.64% and 7.69% in the 2nd group. The decrease of specific complications such as early stent obturation and the development of purulent cholangitis was identified. The rate of complications in cases of endobiliary uncoated stenting using was 7.14% and 5.36% and these complications occurred in 2.56% and 2.56% in the group where Betadine coating was used. The term of serving of the biliary stents in the 2nd group (182.3±37.1 days) was significantly higher than the term of the uncoated stents (125.8±33.9 days). Conclusion: The usage of the antiseptic coating reduces the risk of developing of purulent-septic complications and increases the duration of functioning of biliary stents in patients with “difficult” choledocholithiasis.

Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

2012 ◽  
Vol 22 (8) ◽  
pp. 812-817 ◽  
Author(s):  
Rodrigo Leal Alves ◽  
André Luiz Aragão e Silva ◽  
Nadja Cecília de Castro Kraychete ◽  
Guilherme Oliveira Campos ◽  
Marcelo de Jesus Martins ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Pediatric Cardiac Surgery ◽  
Lactate Levels

scholarly journals Effect of cardiac surgery on maternal and perinatal outcome in rheumatic heart disease with pregnancy: a comparative study

2018 ◽  
Vol 7 (3) ◽  
pp. 1123
Author(s):  
Vikas Yadav ◽  
J. B. Sharma ◽  
Garima Kachhawa ◽  
Alka Kriplani ◽  
Reeta Mahey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Valve Replacement ◽  
Perinatal Outcome ◽  
Surgery Group ◽  
Group 3 ◽  
Group 2 ◽  
Rheumatic Heart ◽  
Group 1

Background: Rheumatic heart disease remains the commonest heart disease in India with mitral stenosis being the most common lesion and is associated with significant maternal and perinatal mortality and morbidity. The objective of this study was to compare maternal and perinatal outcome in women with rheumatic heart valvular disease who had no surgery or had percutaneous balloon mitral valvuloplasty (PBMV) or had valvular replacement surgery.Methods: It was a retrospective study in 113 women with rheumatic heart disease with various valvular lesion admitted in the hospital in previous 10 years. There were 58 (51.35%) patients without cardiac surgery (Group 1), 24 (21.23%) with PTMC (Group 2) and 31 (27.43%) with valve replacement surgery (Group 3). Maternal and perinatal outcome were compared in three groups.Results: The baseline characteristics were similar in the three group. In cardiac complications New York Heart Association (NYHA) deterioration was significantly higher (24.1%) in non-operated group (Group 1) as compared to Group 2 (12.3%) and Group 3 (16.1%). There was no difference in Group 2 and Group 3. Need of cardiac medication (digoxin) was also highest (67.2%) in Group 1 as compared to Group 2 (24.6%) (p = 0.002) and Group 3 (38.7%) (p = 0.001) but no difference in Group 2 and Group 3. Anticoagulant were given to significantly higher number (54.8% of cases in Group 3 (valve replacement) as compared to Group 1 (3.4%) and Group 2 (12.5%). There was no significant difference in obstetric events and mode of delivery in the three groups. Similarly, there was no difference in fetal outcome in the three groups as regard to mean birth weight, APGAR score, fetal growth restriction, fetal or neonatal death or congenital anomalies in the three groups.Conclusions: Cardiac surgery before or during pregnancy did not significantly improve maternal or perinatal outcome. Only cardiac events and need of medication was reduced with surgery. Hence surgery should be performed judiciously in selected cases.

scholarly journals Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Serdar Gunaydin ◽  
Craig Robertson ◽  
Ali Baran Budak ◽  
Terence Gourlay
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Cells ◽  
Randomized Study ◽  
White Blood Cells ◽  
Cell Saver ◽  
Blood Salvage ◽  
Group 2 ◽  
Intraoperative Blood Salvage ◽  
Group 1

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content.

Sign in / Sign up

Export Citation Format

Share Document