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.

Cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

Study of the intensive care unit activity scale in the early rehabilitation of patients after direct cardiac surgery

BACKGROUND Direct cardiac surgery often necessitates intensive post-operative care,and the intensive care unit(ICU)activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery.AIM To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery.METHODS One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method.The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale.The control group was assessed in accordance with the routine rehabilitation activities,and the postoperative rehabilitation indexes of the patients in both groups were compared(time of tracheal intubation,time of ICU admission,occurrence of complications,and activity scores before ICU transfer).The two groups were compared according to postoperative rehabilitation indicators(time of tracheal intubation,length of ICU stay,and occurrence of complications)and activity scores before ICU transfer.RESULTS In the observation group,tracheal intubation time lasted for 18.30±3.28 h and ICU admission time was 4.04±0.83 d,which were significantly shorter than the control group(t-values:2.97 and 2.038,respectively,P<0.05).The observation group also had a significantly lower number of complications and adverse events compared to the control group(P<0.05).Before ICU transfer,the observation group(6.7%)had few complications and adverse events than the control group(30.0%),and this difference was statistically significant(P<0.05).Additionally,the activity score was significantly higher in the observation(26.89±0.97)compared to the control groups(22.63±1.12 points)(t-value;-17.83,P<0.05).CONCLUSION Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Cardiac Surgery at Yaoundé General Hospital by a Local Team: Activity Report from September 2022 to January 2024

Introduction: The practice of cardiac surgery (CS) in sub-Saharan Africa faces a number of challenges. We report on the surgical activities of the first 17 months of the program launched at the Yaoundé General Hospital (YGH), describing the types of interventions and the early results. Patients and Methods: This was a descriptive cross-sectional study including patients who underwent CS from September 2022 to January 2024 at the YGH. Clinical, operative and postoperative data were collected and analysed retrospectively by R software. Results: A total of 37 patients underwent CS during the study period, divided into 23 (62.2%) open-heart and 14 (37.8%) closed-heart cases. Males predominated (sex ratio 1.17). The median age and interquartile range (IQR) were 36 years (9 - 51). Isolated valve surgery, in 15 (40.5%) cases, was the most common procedure in open-heart surgery cases. Closed-heart surgery involved closure of the patent ductus arteriosus in 9 (24.3%) cases, coronary artery bypass grafting in 3 (8.1%) cases, and pericardectomy in 2 (5.4%) cases. The median duration of extracorporeal circulation and aortic cross-clamping was 101 min (IQR 84 - 143) and 74 min (IQR 54 - 112) respectively. The median duration of mechanical ventilation was 2 hours (IQR 2 - 3). The median intensive care unit stay and median hospital stay were 2 days (IQR 2 - 3) and 7 days (IQR 5 - 8) respectively. Operative mortality was 2 (5.4%). Conclusion: Cardiac surgery remains a major challenge for African populations. The early results achieved by the local team are satisfactory. An increase in surgical activity should be strongly encouraged to facilitate local training and ensure the sustainability of the activity.

Incidence and Risk Factors of Sub-syndromal Delirium in Patients after Cardiac Surgery

[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.AIM To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.METHODS This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome.Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.RESULTS After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Early Cardiac Catheterizations within 30 Days Post Congenital Heart Surgery in Children

Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.

Application progress of nursing intervention in cardiac surgery

As a stressor,cardiac surgery affects the physiology and psychology of patients,as well as their postoperative recovery.Patients tend to worry about cognitive deficiency,pain,discomfort,the risk of death,sleep,complications,and other factors,resulting in stress and anxiety.Moreover,serious adverse events,such as circulatory and respiratory dysfunction and infection,tend to occur after cardiac surgery and increase the economic burden on patients.Therefore,appropriate nursing interventions should be selected to strengthen patients’cognitive levels,compliance,and postoperative practices to accelerate their recovery,reduce complications,and shorten hospital stays so as to contribute to patients’lives and health.

Short- and Long-Term Outcomes of Cardiac Surgery in Kidney Transplant Recipients: A Review—Kidney Transplant and Cardiac Surgery

Background: Cardiovascular diseases remain the leading cause of death in kidney transplant patients and increasing proportion of these patients are referred to cardiac surgery. Data on short- and long-term outcomes of these patients are limited to single center reports with no randomized trials and no prospective studies published previously. The aim of this review was to report both short- and long-term outcomes of these patients. Methods: Literature review was conducted using three databases from inception to June 2022. Multiple search terms were used and limited to English language. Thirty-one relevant articles were included. Outcomes of interest were short-term mortality, long-term survival, renal allograft failure and infection in kidney transplant patients undergoing cardiac surgery. Results: Cardiac risk factors (diabetes mellitus, hypertension, hyperlipidemia) were prevalent in kidney transplant patients. 30-days mortality ranged across the studies from zero to 18.8%. The 1-year survival ranged from 71% - 97% and 5-years survival ranged from 31% - 95.7%. Commonest causes of death were cardiac and sepsis. Multiple predictors of mortality were reported. Postoperative acute kidney injury ranged from 0 - 74% with most of them being transient. Kidney graft failure ranged from 0 - 45% with 5-year kidney graft survival rates ranged between 37% - 80%. Post-operative infection rates ranged from 1% - 25% and the most common sites were pneumonia followed by septicemia and surgical site infections. Conclusion: Cardiac surgery can be performed in kidney transplant patients with good short- and long-term results.

Incidence and Outcomes of Surgical Site Infections after Adult Cardiac Surgery: A Single-Center Experience

Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.

Overall approaches to cardiac tumors:Still an unsolved enigma?

Cardiac tumors are neoplasms involving heart structures at any level,meaning the myocardium,valves,and cardiac chambers.When considering cardiac masses,it is not uncommon for surgeons to be surprised when they diagnose one.The real incidence of this complex group of diseases has been explored only after cardiac diagnostic tools became more appropriate.Despite differential diagnosis being relevant,surgical indication is usually requested for all malignant cardiac tumors and also for many types of benign tumors.The development of cardiac imaging techniques,therefore,has been the key point for a better understanding of the history of cardiac tumors and especially of the relevance of surgical indication in such conditions.Systematic and combined applications of echocardiography,cardiac computed tomography and magnetic resonance allow in the majority of case a clear definition of the nature of a newly discovered cardiac mass.The presence of a Li-Fraumeni syndrome seems to be the trigger aspect in accelerating the propensity of developing a cardiac tumor.Despite the revolutionary usefulness of the cardiac imaging techniques available,it is still considered a hazard to diagnose a malignant cardiac mass just with radiological imaging;the mainstay of the final diagnosis stands in surgical excision of the mass and histopathological report.

Effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following cardiac stent implantation

BACKGROUND Coronary stent implantation is usually used to treat unstable angina to alleviate stenosis or occlusion,promoting blood flow restoration and alleviating symptoms such as myocardial ischemia.And postoperative cardiac rehabilitation is essential for enhancing recovery and prognosis.Nevertheless,conventional rehabilitation lacks specificity,particularly for elderly patients with multiple comorbidities and poor compliance,rendering it less effective.AIM To investigate the effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following coronary stenting intervention.METHODS A retrospective enrollment was conducted comprising fifty-four elderly patients with unstable angina pectoris who underwent systematic cardiac rehabilitation training after receiving coronary intervention as the rehabilitation group,while fifty-three elderly patients who received basic nursing and rehabilitation guidance measures after coronary intervention were assigned to the control group.Differences in Seattle Angina Questionnaire scores,survival quality(SF-36)scores,cardiopulmonary exercise function assessment index,echocardiographic cardiac function index,and adverse cardiovascular events were compared between the two groups.RESULTS After intervention,the rehabilitation group observed greater VO2 Max,maximum metabolic equivalent,eft ventricular ejection fraction,left ventricular end-diastolic diameter and smaller left ventricular end-systolic diameter.And the rehabilitation group observed greater scores of physical activity limitation,stable angina pectoris,treatment satisfaction,and SF-36 score.The incidence of adverse cardiovascular events in the two groups,showed no significant difference.CONCLUSION Systematic cardiac rehabilitation following coronary stenting in elderly patients with unstable angina pectoris can enhance cardiac function recovery,consequently enhancing both quality of life and cardiopulmonary exercise tolerance.

Application of Deep Inspiration Breath Hold Technique in Radiotherapy After Breast- Conserving Surgery for Left Breast Cancer and Its Improvement on Cardiac Dose

Objective:To analyze the application of deep inspiration breath hold technique in radiotherapy after breast-conserving surgery for left breast cancer and the improvement of cardiac dose.Methods:A total of 45 patients with left breast cancer treated in our hospital after breast-conserving surgery were selected,and the selection time was set from January 2020 to August 2022.All patients received radiotherapy.The right breast,heart,and lung volumes,and dose parameters of the heart,lungs,right breast,and left anterior descending coronary artery were compared under free breathing(FB)and deep inspiration breath hold(DIBH)technical modes.Results:The heart volume of the DIBH group was smaller than that of the FB group,and the left and right lung volumes were significantly larger than those of the FB group.In the DIBH group,the heart dose parameters V5,proper lung dose parameters,and left anterior descending coronary artery dose parameters were found lower than that of the FB group,and the differences were statistically significant(P<0.05).Conclusion:Compared with FB,the DIBH technique can reduce the heart’s size and increase the lung volume when used for radiotherapy after breast-conserving surgery for left breast cancer.It also reduces the dose to the heart,right lung,and left anterior descending coronary artery,thus protecting the heart and lungs.

Change in Functional Status from Preoperative to One Year Postoperative in Patients Who Have Undergone Elective Open-Heart Surgery: A Repeated-Measures Study

Purpose: Although patient-related factors affect surgical outcomes, preoperative functional status is not measured by any cardiac risk score. Functional status can, however, be objectively measured using validated outcome tools such as the Late-Life Function and Disability Instrument (LLFDI). The purpose of this study was to determine 1) if there was a change over time in functional status, as measured by the LLFDI, in patients who underwent elective cardiac surgery, and if so, 2) what specific aspect(s) of functional status changed. Methods: A prospective longitudinal study of one year was conducted on elective cardiac surgery patients (n = 43) using the self-reported LLFDI, which measures Disability Frequency (frequency of participation in social tasks), Disability Limitation (ability to participate in social tasks) and Function Total (ease in performing routine activities). Higher scores indicate increased function and decreased disability. LLFDI scores were compared at three times (preoperative, six-week and one-year postoperative) using repeated measures ANOVA. Post hoc pairwise comparison was conducted for specific interactions. Results: Both Function Total and Disability Frequency significantly changed over time (p = 0.047 and p = 0.013, respectively). Specifically, patients’ function level was significantly higher one-year postoperative compared to preoperative (M difference = +3.48, SE = 1.48, p = 0.026). Likewise, Disability Frequency scores were significantly higher (i.e. more active) at one-year postoperative versus preoperative (M difference= +5.98, SE = 2.19, p = 0.033). Disability Limitation scores were not significantly different between any time points (p > 0.05). Conclusion: By one-year postoperative, patients demonstrated increased ease in their routine physical activities and were more participatory in social life tasks. Individuals who underwent elective cardiac surgery took more than six weeks to detect notable improvement in functional status, which was expected with a sternotomy approach. This study provides support for the use of the LLFDI as an effective tool to capture functional status in the cardiac population. These findings may assist cardiac patients in recovery timeline expectations.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Postoperative jaundice after cardiac surgery

BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation,to analyze the determinants,and to identify the clinical significance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center,Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting(CABG),group B 31 patients who were subjected to aortic valve replacement(AVR)+CABG and group C 47 patients who underwent mitral valve replacement(MVR)+CABG. Aminotransferases,alkaline phosphatase,gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission,24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS:Hyperbilirubinemia developed in 34 patients(26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-passtime(P<0.001),aortic cross-clamping time(P<0.001),the use of intra aortic balloon pumping(P<0.001),the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin. CONCLUSIONS:Although hyperbilirubinemia seems to be multifactorial,the type of operation,the preoperative hepatic dysfunction due to advanced heart failure(NYHA Ⅱ-Ⅲ) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism.Compared to remimazolam,remimazolam benzenesulfonate has a faster effect,is more quickly metabolized,produces inactive metabolites and has weak drug interactions.Thus,remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study.Using a random number table,patients were divided into two anesthesia induction groups of 40 patients each:remimazolam(0.3 mg/kg remimazolam benzenesulfonate)and propofol(1.5 mg/kg propofol).Hemodynamic parameters,inflammatory stress response indices,respiratory function indices,perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTS At pre-anesthesia induction,the remimazolam and propofol groups did not differ regarding heart rate,mean arterial pressure,cardiac index or volume per wave index.After endotracheal intubation and when the sternum was cut off,mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group(P<0.05).After endotracheal intubation,the oxygenation index and the respiratory index did not differ between the groups.After endotracheal intubation and when the sternum was cut off,the oxygenation index values were significantly higher in the remimazolam group than in the propofol group(P<0.05).Serum interleukin-6 and tumor necrosis factor-αlevels 12 h after surgery were significantly higher than before surgery in both groups(P<0.05).The observation indices were re-examined 2 h after surgery,and the epinephrine,cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group(P<0.05).The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group(P<0.05);there were significantly fewer adverse reactions in the remimazolam group(10.00%)than in the propofol group(30.00%;P<0.05).CONCLUSION Compared with propofol,remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations.Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function,thereby reducing anesthesia-related adverse reactions.

Cardiac surgery in patients with liver cirrhosis:Risk factors for predicting mortality

AIM:To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality.METHODS:We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and2012.Child-Turcotte-Pugh(Child)classification and Model for End-Stage Liver Disease(MELD)score were used to assess the severity of liver cirrhosis.The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient.Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery.Multivariate Cox proportional hazard models were applied to estimate the hazard ratios(HR)of predictors for mortality.The Kaplan-Meier method was used to generate survival curves,and the survival rates between groups were compared using the log-rank test.RESULTS:There were 30 patients in Child class A,20in Child B,and five in Child C.The hospital mortality rate was 16.4%.The actuarial survival rates were 70%,64%,56%,and 44%at 1,2,3,and 5 years after surgery,respectively.There were no significant differences in major postoperative complications,and early and late mortality between patients with mild and advanced cirrhosis.Multivariate logistic regression showed preoperative serum bilirubin,the EuroSCORE and coronary artery bypass grafting(CABG)were associated with early and late mortality;however,Child class and MELD score were not.Cox regression analysis identified male gender(HR=0.319;P=0.009),preoperative serum bilirubin(HR=1.244;P=0.044),the EuroSCORE(HR=1.415;P=0.001),and CABG(HR=3.344;P=0.01)as independent risk factors for overall mortality.CONCLUSION:Advanced liver cirrhosis should not preclude patients from cardiac surgery.Preoperative serum bilirubin,the EuroSCORE,and CABG are major predictors of early and late mortality.