Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Origin of and therapeutic approach to cardiac syndrome X:Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

AIM: To investigate the frequency of gastroen-terological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP). METHODS: We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group. RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantifi ed the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%)with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%). CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

Use of Impella cardiac axial flow pump for cardiogenic shock(A newer alternative)-How good is the evidence?

The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.

The cardiac assistant effect of extra-aortic balloon pump on animals

Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced,and to observe its effectiveness and feasibility. Methods Twelve animal models of myocardia,1 infarction were established with the method of left

串联型心脏辅助装置Hemopump的仿真研究

目的研究Hemopump的辅助效果。 方法以理论分析和实验数据为基础 ,建立Hemopump动态的数学模型。将建立的泵模型植入到原有的犬的循环系统模型中 ,研究血泵和心血管系统的相互作用。结果Hemopump辅助可以提高心输出量 ,增加心脏的血氧供给 ,同时降低心肌的血氧消耗量。与主动脉内气囊反搏 (IABP)改善心肌供血平衡的机制不同 ,Hemopump主要通过降低左心室的前负荷来减少心肌的耗氧量。在一定范围内加快泵转速可以提高辅助效果。但是 ,泵的转速过高会影响泵的入流状况 ,导致辅助效果降低。结论仿真结果与动物实验及体外循环的测试结果一致。

Efficacy of IABP in patients awaiting cardiac transplantation

Intra-aortic balloon pump (IABP)support is used in severalclinical situations.To determine its efficacy in patients with severe heartfailure awaiting cardiac transplantation,the experience at the Universityof Pittsburgh from May 1986 to October 1989 was reviewed.Of 392 patientson the waiting list,(16.3%) required IABP.All had previously been oninotropic support for varying periods of time.The ability to stabilize andto sustain the patient to cardiac transplantation was 75%.Twenty patients(31.3% of group) required and were provided more extensive mechanicalzsupport with either total artificial heart (n=ll) or left ventrieular assistdevice (n =9).Twenty-nine patients (45% of entire gronp) were able tohave the IABP removed prior to transplantation.Seventeen patients(26.6%)parameters demonstrated improvement with IABP.These data support IABPas a bridge to transplantation in patients with severe heart failure who havenot been stabilized on inotropie agents alone.These data also demonstratethat IABP support may only be required temporarily in a subgroup of pa-tients awaiting cardiac transplantation.

Cardiac Immobilization in Beating Heart Surgery Using Pericardial Bands

A novel technique of stabilization of the coronary targets with autogenous pericardial bands is described in off pump coronary revascularizations. Pericardial bands are placed across the coronary targets and snared to the pericardial well for local cardiac immobilization. This technique can be used as an alternate to mechanical stabilizers for immobilization of the coronary targets.

Off-Pump CABG for Mulitvessel Coronary Artery Disease-Safe Incorporation into Surgical Practice

Introduction: Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion re0 quirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon`s service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique.

Cardiovascular Function during First 24 Hours after Off-Pump and On-Pump CABG—A Prospective Observational Comparative Study

Purpose: Myocardial revascularization by coronary artery bypass grafting (CABG) in ischemic heart disease patients has direct impact on hemodynamic parameters in the immediate post-operative period. The peri-operative cardiovascular functioning is an important determinant for outcome of surgery. In On-Pump CABG (ONCAB), the cardiopulmonary bypass has a negative effect on myocardium. Off-Pump CABG (OPCAB) avoids the effect of CPB but complete revascularization with difficult positioning of heart is technically demanding. This study is aimed to compare the cardiovascular functioning in the immediate post-operative period after OPCAB and ONCAB. Methods: Total 106 patients were operated for CABG from January 2015 to June 2016, of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison, hemodynamic parameters were measured during anesthesia before surgery, postoperatively after 1 and 4 hours (h) in the ICU, and in the morning after surgery, approximately after 20 h. Results: The time-dependent rise of hemodynamic parameters like Cardiac Output (CO), Cardiac Index (CI), Stroke volume (SV) and Left Ventricular Stroke Work Index (LVSWI) in the immediate post-operative hours (1 h and 4 h) are more predominant in OPCAB group than ONCAB group although the difference is eliminated mostly at 20 h. The better peripheral vasodilation after OPCAB causes immediate fall of Systemic Vascular Resistance Index (SVRI) after OPCAB. Conclusion: Better cardiovascular functioning immediately after OPCAB than ONCAB may be important for better hemodynamic stability. The difference is however eliminated after 24 hours indicating little significance in long term outcome.

缩窄性心包炎患者行心包剥脱术后的心功能维护

目的促进缩窄性心包炎患者行心包剥脱术后心功能恢复。方法针对33例行心包剥脱术的缩窄性心包炎患者术后出现的心功能不全甚至急性心力衰竭,以及困难脱机等临床表现,实施精细化管理出入量,合理使用正性肌力药物及机械装置,保持气道通畅,加强急性心功能不全的救护等措施。结果术后发生右心功能不全12例,低心排综合征10例,再次气管插管4例。本组患者呼吸机使用时间4~943 h(中位数45 h),ICU停留时间1~42 d(中位数4 d)。31例康复出院,2例因再次心脏手术后并发严重并发症自动转院。结论缩窄性心包炎患者心包剥脱术后易并发心功能不全,术后全方位综合护理有利于患者心功能恢复。

主动脉内球囊反搏在复杂高危有指征患者病变介入治疗中的临床应用研究

目的:观察主动脉内球囊反搏在复杂高危有指征患者(CHIP)病变介入治疗中的临床疗效。方法:选取62例CHIP病变介入治疗的患者资料进行回顾分析。将经皮冠状动脉介入治疗(PCI)术前保护性植入主动脉内球囊反搏的50例患者设为试验组,未植入主动脉内球囊反搏的12例患者设为对照组,比较两组术中及术后的临床情况。结果:试验组患者术中只有1例发生无复流,1例发生下肢血栓,对照组患者术中有2例发生急性左心衰,1例发生心脏骤停,1例发生无复流。术后试验组N端脑钠肽前体(NT-proBNP)水平较对照组显著降低,且心功能较对照组明显上升,差异均具有统计学意义(均P<0.05)。结论:主动脉内球囊反搏辅助支持下对CHIP病变介入治疗可提高患者的手术安全性,减少手术并发症,有效改善患者心功能。

全麻诱导前静脉泵注右美托咪定在老年髋部手术患者中的应用

目的探究全麻诱导前静脉泵注右美托咪定在老年髋部手术患者中的应用效果。方法选取广州市荔湾中心医院2022年7月—2023年1月期间收治的89例老年髋部手术患者作为研究对象。根据随机数字表法分为观察组(n=45)与对照组(n=44)。观察组患者在全麻诱导前10 min静脉泵注右美托咪定1.0μg/kg,对照组患者于全麻诱导前10 min静脉泵注0.9%氯化钠溶液1.0μg/kg。比较2组患者围手术期[静脉泵注右美托咪定或生理盐水使用前(T0)、负荷剂量输注后(T1)、手术完成时(T2)、进入麻醉恢复室(post anesthesia care unit,PACU)后1 h(T3)、术后1 d(T4)]无创心排血量(noninvasive cardiac output,NICO)、手术时间、术中出血量、术中液体输注量以及不良反应。结果观察组患者在T1、T2时的NICO分别为(4.16±0.34)L/min、(4.39±0.45)L/min,每搏输出量(stroke volume,SV)分别为(59.86±10.74)mL、(61.89±8.75)mL,以及心指数(cardiac index,CI)分别为(3.46±0.32)min·m^(2)、(3.69±0.37)min·m^(2),均高于对照组,差异均有统计学意义(P<0.05);2组患者手术时间、术中出血量、液体输注量比较,差异无统计学意义(P>0.05)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论全麻诱导前静脉泵注右美托咪定对老年髋部手术患者围手术期的NICO影响较小,且不会增加液体输注量,具备安全性。

心脏外科手术后脑梗死的临床分析和影像学特点

目的:通过分析体外循环与非体外循环心脏外科手术后脑梗死的临床及影像学特点,探讨其发病机制。方法:将心脏外科手术术后脑梗死患者45例分为非体外循环与体外循环2组。非体外循环组30例,体外循环组15例。比较2组术后脑梗死临床及影像学特点。结果:非体外循环组拔管时间及ICU时间明显短于体外循环组〔P<0.05,(22.8±16.6)h与(50.9±32.6)h,(25.6±14.0)h与(52.6±30.0)h〕;非体外循环组早发脑梗死、大面积脑梗死及双侧脑梗死的发生率明显低于体外循环组(P<0.05,6.7%与40.0%,21.7%与64.3%,4.4%与35.7%);非体外循环组皮层脑梗死的发生率43.5%明显高于体外循环组的7.1%(P<0.05);2组分水岭脑梗死及多发脑梗死的发生率均较高。结论:体外循环手术后易发生早发脑梗死,常为双侧与大面积脑梗死,症状较重;非体外循环手术后脑梗死常为迟发脑梗死,皮层梗死较多;2者分水岭梗死均较多。说明2者脑梗死的发病机制不同,但均与栓塞和低灌注有关。

急性ST段抬高型心肌梗死患者急诊PCI术后I期心脏康复护理研究

目的探讨I期心脏康复七步训练法用于急性ST段抬高型心肌梗死急诊PCI术后患者的效果。方法将100例急性ST段抬高型心肌梗死直接PCI术后患者随机分为观察组52例和对照组48例,对照组给予急性心肌梗死PCI术后常规护理,观察组在对照组的基础上实施I期心脏康复七步法护理。结果两组住院期间心律失常发生率比较,差异无统计学意义(均P>0.05),观察组CCU监护时间、住院时间显著短于对照组,PCI术后首次排便时间显著早于对照组(均P<0.01)。结论对急性ST段抬高型心肌梗死直接PCI术后患者实施个体化的I期心脏康复护理有利于缩短CCU监护时间及住院时间,预防便秘发生,促进患者安全。

IABP治疗重度主动脉瓣狭窄瓣膜置换术后低心排血量综合征

目的 探讨主动脉内球囊反搏（IABP）治疗重度主动脉瓣狭窄（AS）瓣膜置换术后低心排血量综合征（LCOS）的疗效.方法 2007年1月至2013年1月,沈阳军区总医院心血管外科对20例重度AS患者因瓣膜置换术后出现LCOS行IABP辅助治疗.比较IABP置入前后血流动力学、尿量变化及多巴胺用量情况.结果 全组无围术期死亡,均治愈出院.应用IABP后血流动力学指标明显改善（P〈0.05或P〈0.01）,尿量明显增加（P〈0.01）,多巴胺用量明显减少（P〈0.01）.结论 IABP治疗重度主动脉瓣狭窄瓣膜置换术后LCOS有效.

山麦冬水溶性提取物对麻醉猫血液动力学的影响

给麻醉猫静脉注射山麦冬水溶性提取物1.75g/kg,其LV dp/dt max增加86%,t-dp/dtmax缩短28%。CO,CI,SI,和LVWI分别增加146%,151%,150%和194%。心率轻度减慢,SVR降低48%。本品0.7g/kg,iv,LV dp/dt max增加38%,CO增加44%,t-dp/dt max缩短20%,SVR降低20%。结果提示,本品有正性肌力作用,并能改善心脏泵功能。

主动脉内球囊反搏术在不同心脏病术后应用效果的比较

目的：通过比较分析３种心脏病术后应用主动脉内球囊反搏术（ＩＡＢＰ）的效果，对于提高抢救成功率有所裨益。方法：１９８２年至１９９４年末，冠心病、风湿性心脏病、先天性心脏病和其他疾病分别有７５、３６、１２和４例因心脏术后严重低心输出量综合征应用ＩＡＢＰ。结果：冠心病、风湿性心脏病和先天性心脏病分别有６１（８１％）、１８（５０％）和２（１６％）例有效并撤除Ｉ－ＡＢＰ，其中５４（７２％）、１２（３３％）和２（１６％）例恢复出院，３种心脏病术后应用ＩＡＢＰ的效果差别非常显著（Ｐ＜０．００５）。冠心病４例桥阻塞，１例再次手术治愈，３例未再手术死亡，先天性心脏病１例左心室发育小，ＩＡＢＰ无效死亡。结论：冠心病效果最佳，风湿性心脏病次之，先天性心脏病较差。如存在严重机械因素，应积极再次手术。

前导叶对轴流泵式心脏辅助装置流体力学特性的影响及改进意义

目的:通过测试近年来研制的两类微型轴流血泵,观察前导叶对轴流泵性能的影响。方法:应用体外模拟循环装置,测定并比较设置或不设置前导叶的两型轴流泵的流体力学特性差异。结果:两型轴流泵的流量输出在13.332kPa后负荷条件下均可达到5L/min流量,满足左心辅助的要求;两型血泵均表现出类似的前、后负荷反应曲线,表明在观测的压力流量范围内,前导叶的设置对该类微型轴流血泵的流体力学特性没有明显影响。结论:在微型轴流泵的结构设计中,可以去除前导叶,以改善血泵的血液相容性。

主动脉球囊反搏在急性心肌梗死所致的心源性休克和心脏破裂中的应用

目的 对采用主动脉内球囊反搏 (IABP)治疗的心源性休克和心脏破裂病人的住院死亡情况进行回顾性分析。方法 对心源性休克和心脏破裂的 2 8例病人 ,均安装IABP ,其中 2 0例进行了冠状动脉造影 ,1 3例接受了冠状动脉成形术 (PTCA)、冠脉旁路移植术 (CABG)或心脏外科手术。结果 1例因急诊血管成形失败而行急诊CABG成功 ,1 1例急诊血管成形 (直接PTCA)开通了梗死相关动脉 (IRA) ,1 2例 (42 9% )存活 ,1 6例死亡 (57 1 % ) :1 1例因休克死亡 ;4例心脏破裂因没有手术干预的时机死亡 ;1例游离壁破裂因心肌坏死面积过大死于手术台上 ;还有 1例病人在出院 7d后死于室颤。在所有无心脏破裂的心源性休克病人中 ,与接受PTCA和CABG的病人相比 ,未接受PTCA和CABG的病人的死亡率较高 (81 8%vs1 6 7% )。所有心脏破裂的病人无一存活 ,死亡率 1 0 0 %。结论 使用IABP对于急性心肌梗死 (AMI)所致的心源性休克有显著的效果 ,但仅使用IABP结合常规治疗而不开通IRA并不能提高这些病人的生存率 ,心脏破裂的病人若不能及时修补缺损 ,使用IABP仅能延长病人的存活时间 。

心脏手术围术期主动脉内球囊反搏的临床应用

目的:探讨主动脉内球囊反搏(IABP)在心脏手术围术期危重患者应用的临床效果。方法:我院2006-01至2009-12对83例心脏外科手术患者实施了IABP,其中术前诊断单纯冠心病62例,冠心病合并瓣膜病6例,冠心病合并室壁瘤2例,瓣膜病8例,法乐四联症2例,房间隔缺损+室间隔缺损1例,慢性缩窄性心包炎2例。术前置入球囊6例,术中共置入球囊67例,术后在监护室置入10例。结果:83例置入IABP患者术后30天内总死亡率30.12%(25/83),其中冠心病死亡率27.14%(19/70),非冠心病死亡率46.15%(6/13),非冠心病死亡率高于冠心病死亡率,差异有统计学意义(P<0.05)。冠心病术前置入IABP死亡1例,术中置入IABP死亡13例,术后置入IABP死亡5例。结论:IABP能明显改善心脏手术围术期低心排患者的血流动力学指标,选择合适的时机应用IABP,能够提高IABP的疗效,降低危重患者的死亡率。