Clinical risk score for postoperative pneumonia following heart valve surgery

Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study.Patients were randomly assigned to the derivation and validation sets at 1:1 ratio.A prediction model was developed with multivariable logistic regression analysis in the derivation set.Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients(8.2%).Multivariable analysis identified ten significant predictors for POP in the derivation set,including older age,smoking history,chronic obstructive pulmonary disease,diabetes mellitus,renal insufficiency,poor cardiac function,heart surgery history,longer cardiopulmonary bypass,blood transfusion,and concomitant coronary and/or aortic surgery.A 22-point risk score based on the multivariable model was then generated,demonstrating good discrimination(C-statistic:0.81),and calibration(Hosmer-Lemeshowχ^(2)=8.234,P=0.312).The prediction rule also showed adequate discriminative power(C-statistic:0.83)and calibration(Hosmer-Lemeshowχ^(2)=5.606,P=0.691)in the validation set.Three risk intervals were defined as low-,medium-,and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS,which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org,ChiCTR1900028127;http://www.chictr.org.cn/showproj.aspx?proj=46932.

Is the European System for Cardiac Operative Risk Evaluation useful in Chinese patients undergoing heart valve surgery？

Background The European System for Cardiac Operative Risk Evaluation （EuroSCORE） is one of the most widely used risk models for the predicting mortality after cardiac surgery. The aim of this study was to validate the EuroSCORE model for predicting operative mortality in heart valve surgery on a Chinese multicenter database and comparing the performance of EuroSCORE with our new risk stratification system, the Sino System for Coronary Operative Risk Evaluation （SinoSCORE）. Methods Data from patients undergoing heart valve surgery between January 2007 and December 2008 were retrospectively collected, from 43 hospitals in China. The EuroSCORE and the SinoSCORE were calculated for each patient. Mortality was defined as any in-hospital death. Area under the receiver operating characteristics curve （AUC） was used to study the discriminatory abilities of the models. The Hosmer-Lemeshow （H-L） goodness-of-fit test was used to study the calibration of the predictive models. Results A total of 15 367 patients were analyzed. For the entire cohort, the observed mortality was 2.34%, the predicted mortality was 3.71% （additive）, 3.19% （logistic） and 3.66% （SinoSCORE）. AUC was 0.747 for SinoSCORE, 0.699 additive and 0.696 for logistic EuroSCORE. Calibration of SinoSCORE and additive EuroSCORE was good （H-L： P=-0.250 and P=0.051, respectively）, but the logistic EuroSCORE model had a poor calibration （H-L： P〈0.05）. The discriminatory ability and calibration of the SinoSCORE were good in low- and high-risk patients, However, the discriminatory ability of the EuroSCORE model was poor in all risk deciles. Conclusions The EuroSCORE does not accurately predict mortality in Chinese patients with heart valve surgery, and the SinoSCORE is superior to the EuroSCORE at predicting in-hospital mortality in Chinese heart valve surgery patients.

Vacuum sealing drainage technique in the treatment of poor healing wounds after heart valve surgery:experience in cardiac nursing

Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.

Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China

Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation （FuwaiSCORE）, the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery （the STS model）, the European System for Cardiac Operative Risk Evaluation （EuroSCORE） and the initial Parsonnet＇s score （the Parsonnet model） in predicting prolonged intensive care unit （ICU） stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow （H-L） goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic （ROC） curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P 〉0.1. The area under ROC curve of the FuwaiSCORE was 0.81 （95%C/0.78-0.84）. Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.

Infective Endocarditis-induced Crescentic Glomerulonephritis Dramatically Improved after Removal of Vegetations and Valve Replacement

Infective endocarditis （IE） is associated with poor prognosis and higher mortality. IE-induced glomerulonephritis, especially crescentic glomerulonephritis （IE-CGN） with renal dysfunction, is an independent risk factor for mortality For the treatment of IE-CGN, many therapeutic strategies including antibiotics alone, antibiotics combined with corticosteroid, immunosuppressive agents, plasmapheresis, or cardiac surgery have been applied and obtained various results.C21 Here, we reported a case of CGN with progressive renal failure secondary to IE in which the renal function was dramatically improved by the treatment of surgical valve replacement and antibiotics.

A Seven-year Experience for The Surgical Radiofrequency Ablation in Patients With Atrial Fibrillation

Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.