1
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). Asian Cardiovasc Thorac Ann 2024:2184923241259191. [PMID: 38872357 DOI: 10.1177/02184923241259191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, USA
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, PA, USA
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria
- Department of Cardiothoracic Surgery, University Clinic St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women's Hosp. and Mass General Hospital, Harvard University, Boston, MA, USA
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2
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Karthikeyan G, Ntsekhe M, Islam S, Rangarajan S, Avezum A, Benz A, Cabral TTJ, Changsheng M, Chillo P, Gonzalez-Hermosillo JA, Gitura B, Damasceno A, Dans AML, Davletov K, Elghamrawy A, ElSayed A, Fana GT, Gondwe L, Haileamlak A, Kayani AM, Lwabi P, Maklady F, Molefe-Baikai OJ, Musuku J, Ogah OS, Paniagua M, Rusingiza E, Sharma SK, Zuhlke L, Connolly S, Yusuf S. Mortality and Morbidity in Adults With Rheumatic Heart Disease. JAMA 2024:2819427. [PMID: 38837131 PMCID: PMC11154374 DOI: 10.1001/jama.2024.8258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/18/2024] [Indexed: 06/06/2024]
Abstract
Importance Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries. Objective To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD. Design, Setting, and Participants Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs. Main Outcomes and Measures The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models. Results Between August 2016 and May 2022, a total of 13 696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12 967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41 478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors. Conclusions and Relevance Mortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
- Translational Health Science and Technology Institute, Faridabad, India
| | - Mpiko Ntsekhe
- Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Alexander Benz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Philly Chillo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Bernard Gitura
- Kenyatta National Teaching & Referral Hospital, Department of Cardiology, Nairobi, Kenya
| | | | | | - Kairat Davletov
- Asfendiyarov Kazakh National Medical University, Health Research Institute, Almaty, Kazakhstan
| | | | | | | | | | - Abraham Haileamlak
- College of Medicine and Health Sciences, University of Rwanda, Kigali
- Jimma University Medical Center, Jimma, Ethiopia
| | | | | | - Fathi Maklady
- Department of Cardiology, Suez Canal University, Ismailia, Egypt
| | | | - John Musuku
- University Teaching Hospital, Lusaka, Zambia
| | - Okechukwu Samuel Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Maria Paniagua
- College of Medicine Sciences, National University of Concepción, Concepción, Paraguay
| | | | | | - Liesl Zuhlke
- Medical Research Council of South Africa, Division of Pediatric Cardiology, Department of Pediatrics, Red Cross Children’s Hospital Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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3
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a Difference: 5 Years of Cardiac Surgery Intersociety Alliance (CSIA). Ann Thorac Surg 2024:S0003-4975(24)00336-9. [PMID: 38864803 DOI: 10.1016/j.athoracsur.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 06/13/2024]
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of "assisting only." In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its "Seal of Approval" for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, New York
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria; Department of Cardiothoracic Surgery, University Hospital St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women's Hospital and Mass General Hospital, Harvard University, Boston, Massachusetts
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4
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). Eur J Cardiothorac Surg 2024; 65:ezae048. [PMID: 38856237 PMCID: PMC11163458 DOI: 10.1093/ejcts/ezae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 02/15/2024] [Indexed: 06/11/2024] Open
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programmes that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of 'assisting only'. In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its 'Seal of Approval' for the sustainability of endorsed programmes in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programmes could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY, USA
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, PA, USA
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand and, Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria
- Department of Cardiothoracic Surgery, University Hospital St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women’s Hosp. and Mass General Hospital, Harvard University, Boston, MA, USA
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5
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Vilyte G, Butler J, Ives-Deliperi V, Pretorius C. Medical and psychiatric comorbidities, somatic and cognitive symptoms, injuries and medical procedure history in patients with functional seizures from a public and a private hospital. Seizure 2024; 119:110-118. [PMID: 38851095 DOI: 10.1016/j.seizure.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE Patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds may differ, however, this remains a gap in current literature. Comorbidities can play both a precipitating and a perpetuating role in FS and are important in the planning of individual treatment for this condition. With this study, we aimed to describe and compare the reported medical and psychiatric comorbidities, injuries, somatic and cognitive symptoms, and medical procedures among patients with FS from a private and a public epilepsy monitoring unit (EMU) in Cape Town, South Africa. METHODS This is a retrospective case-control study. We collected data on the comorbidity and medical procedure histories, as well as symptoms and clinical signs reported by patients with video-electroencephalographically (video-EEG) confirmed FS without comorbid epilepsy. We used digital patient records starting with the earliest available digital record for each hospital until the year 2022. RESULTS A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Public hospital patients had higher odds of reporting intellectual disability (aOR=15.58, 95% CI [1.80, 134.95]), circulatory system disease (aOR=2.63, 95% CI [1.02, 6.78]) and gait disturbance (aOR=8.52, 95% CI [1.96, 37.08]) compared to patients with FS attending the private hospital. They did, however, have fewer odds of reporting a history of an infectious or parasitic disease (aOR=0.31, 95% CI [0.11, 0.87]), respiratory system disease (aOR=0.23, 95% CI [0.06, 0.82]), or medical procedures in the past (aOR=0.32, 95% CI [0.16, 0.63]). CONCLUSION The study presents prevalence and comparative data on the medical profiles of patients with FS from different socioeconomic backgrounds which may inform future considerations in FS diagnosis and treatment.
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Affiliation(s)
- Gabriele Vilyte
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - James Butler
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Victoria Ives-Deliperi
- Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chrisma Pretorius
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
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6
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Ng RRG, Desai SR, Chu FSW, Sim MA, Chee SWL, Fuh JYH, Ti LK, Chew STH. Feasibility of continuous non-invasive delivery of oxygen monitoring in cardiac surgical patients: a proof-of-concept preliminary study. BMC Anesthesiol 2024; 24:187. [PMID: 38796436 PMCID: PMC11127411 DOI: 10.1186/s12871-024-02561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/14/2024] [Indexed: 05/28/2024] Open
Abstract
PURPOSE Oxygen delivery (DO2) and its monitoring are highlighted to aid postoperative goal directed therapy (GDT) to improve perioperative outcomes such as acute kidney injury (AKI) after high-risk cardiac surgeries associated with multiple morbidities and mortality. However, DO2 monitoring is neither routine nor done postoperatively, and current methods are invasive and only produce intermittent DO2 trends. Hence, we proposed a novel algorithm that simultaneously integrates cardiac output (CO), hemoglobin (Hb) and oxygen saturation (SpO2) from the Edwards Life Sciences ClearSight System® and Masimo SET Pulse CO-Oximetry® to produce a continuous, real-time DO2 trend. METHODS Our algorithm was built systematically with 4 components - machine interface to draw data with PuTTY, data extraction with parsing, data synchronization, and real-time DO2 presentation using a graphic-user interface. Hb readings were validated. RESULTS Our algorithm was implemented successfully in 93% (n = 57 out of 61) of our recruited cardiac surgical patients. DO2 trends and AKI were studied. CONCLUSION We demonstrated a novel proof-of-concept and feasibility of continuous, real-time, non-invasive DO2 monitoring, with each patient serving as their own control. Our study also lays the foundation for future investigations aimed at identifying personalized critical DO2 thresholds and optimizing DO2 as an integral part of GDT to enhance outcomes in perioperative cardiac surgery.
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Affiliation(s)
- Roderica R G Ng
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Suneel R Desai
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
- Departments of Surgical Intensive Care and Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Felicia S W Chu
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Ming Ann Sim
- Department of Anaesthesia, National University Health System, Singapore, Singapore
| | - Sheryl W L Chee
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y H Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore, Singapore
| | - Lian-Kah Ti
- Department of Anaesthesia, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sophia T H Chew
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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7
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Bolman RM, Zilla P, Beyersdorf F, Boateng P, Bavaria J, Dearani J, Pomar J, Kumar S, Chotivatanapong T, Sliwa K, Eisele JL, Enumah Z, Podesser B, Farkas EA, Kofidis T, Zühlke LJ, Higgins R. Making a difference: 5 years of Cardiac Surgery Intersociety Alliance (CSIA). J Thorac Cardiovasc Surg 2024:S0022-5223(24)00377-5. [PMID: 38864805 DOI: 10.1016/j.jtcvs.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 02/15/2024] [Indexed: 06/13/2024]
Abstract
Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of "assisting only." In Rwanda, Team Heart, a US and Rwanda-based nongovernmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its "Seal of Approval" for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.
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Affiliation(s)
- R M Bolman
- Division of Cardio-Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
| | - P Zilla
- Christiaan Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - F Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
| | - P Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai (ISMMS) Medical Center, New York, NY
| | - J Bavaria
- Division of Cardiovascular Surgery, Penn Medicine and Heart and Vascular Center, University of Pennsylvania, Philadelphia, Pa
| | - J Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - J Pomar
- Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain
| | - S Kumar
- Department of Cardiovascular and Thoracic Surgery, All India Institute for Medical Sciences, Delhi, India
| | - T Chotivatanapong
- Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, and Bangkok Heart Center, Bangkok, Thailand
| | - K Sliwa
- Cape Heart Institute and Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - J L Eisele
- World Heart Federation (WHF), Geneva, Switzerland
| | - Z Enumah
- Department of General Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - B Podesser
- Center for Biomedical Research and Translational Medicine, University of Vienna, Vienna, Austria; Department of Cardiothoracic Surgery, University Clinic St. Pölten, St. Pölten, Austria
| | - E A Farkas
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - T Kofidis
- Department of Cardiac-, Thoracic- and Vascular Surgery, National Univ. Hospital of Singapore, Singapore
| | - L J Zühlke
- South African Medical Research Council, Cape Town, South Africa
| | - R Higgins
- Brigham and Women's Hosp. and Mass General Hospital, Harvard University, Boston, Mass
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8
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Faleiro MD, Fernandez MG, Feitosa KIB, Vervoort D. Global Cardiac Surgery in Brazil: A Call to Action. Braz J Cardiovasc Surg 2024; 39:e20230408. [PMID: 38748621 PMCID: PMC11093282 DOI: 10.21470/1678-9741-2023-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 05/19/2024] Open
Abstract
Global Cardiac Surgery is an innovative initiative with a focus on improving health outcomes and achieving healthcare equity for individuals worldwide affected by cardiac surgical conditions or in need of cardiac surgical care. Considering the existing disparities in access to cardiac surgery and the substantial burden of cardiac conditions amenable to surgical procedures in Brazil, it is imperative to support and scale Global Cardiac Surgery initiatives and leave no Brazilian patient behind. Here, we advocate for national initiatives within this field and highlight opportunities and challenges to support their development.
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Affiliation(s)
- Matheus Daniel Faleiro
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
| | - Miguel Godeiro Fernandez
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador,
Bahia, Brazil
| | - Kawanna Izabella Buzzo Feitosa
- International Student Surgical Network (InciSioN), Belo Horizonte,
Minas Gerais, Brazil
- Faculdade de Medicina, Universidade Positivo, Curitiba,
Paraná, Brazil
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto,
Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University
of Toronto, Toronto, Ontario, Canada
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9
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Tong Z, Xie Y, Li K, Yuan R, Zhang L. The global burden and risk factors of cardiovascular diseases in adolescent and young adults, 1990-2019. BMC Public Health 2024; 24:1017. [PMID: 38609901 PMCID: PMC11010320 DOI: 10.1186/s12889-024-18445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To provide details of the burden and the trend of the cardiovascular disease (CVD) and its risk factors in adolescent and young adults. METHODS Age-standardized rates (ASRs) of incidence, mortality and Disability-Adjusted Life Years (DALYs) were used to describe the burden of CVD in adolescents and young adults. Estimated Annual Percentage Changes (EAPCs) of ASRs were used to describe the trend from 1990 to 2019. Risk factors were calculated by Population Attributable Fractions (PAFs). RESULTS In 2019, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of CVD were 129.85 per 100 000 (95% Confidence interval (CI): 102.60, 160.31), 15.12 per 100 000 (95% CI: 13.89, 16.48) and 990.64 per 100 000 (95% CI: 911.06, 1076.46). The highest ASRs were seen in low sociodemographic index (SDI) and low-middle SDI regions. The burden was heavier in male and individuals aged 35-39. From 1990 to 2019, 72 (35.29%) countries showed an increasing trend of ASIR and more than 80% countries showed a downward trend in ASMR and ASDR. Rheumatic heart disease had the highest ASIR and Ischemic Heart Disease was the highest in both ASMR and ASDR. The main attributable risk factor for death and DALYs were high systolic blood pressure, high body-mass index and high LDL cholesterol. CONCLUSIONS The burden of CVD in adolescent and young adults is a significant global health challenge. It is crucial to take into account the disparities in SDI levels among countries, gender and age characteristics of the population, primary types of CVD, and the attributable risk factors when formulating and implementing prevention strategies.
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Affiliation(s)
- Zhuang Tong
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Henan Academy of Medical Big Data, Zhengzhou, China
| | - Yingying Xie
- Department of Scientific Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Kaixiang Li
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Henan Academy of Medical Big Data, Zhengzhou, China
| | - Ruixia Yuan
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
- Henan Academy of Medical Big Data, Zhengzhou, China.
| | - Liang Zhang
- Department of Cardiovascular Surgery, Rhe First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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10
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Wong CWY, Li PWC, Yu DSF, Ho BMH, Chan BS. Estimated prevalence of frailty and prefrailty in patients undergoing coronary artery or valvular surgeries/procedures: A systematic review and proportional meta-analysis. Ageing Res Rev 2024; 96:102266. [PMID: 38462047 DOI: 10.1016/j.arr.2024.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The aging population has led to an increasing number of older patients undergoing cardiac surgeries/procedures. Frailty and prefrailty have emerged as important prognostic indicators among these patients. This proportional meta-analysis estimated the prevalence of frailty and prefrailty among patients undergoing cardiac surgery. METHODS We searched seven electronic databases for observational studies that used validated measure(s) of frailty and reported prevalence data on frailty and/or prefrailty in older patients undergoing coronary artery or valvular surgeries or transcatheter procedures. Meta-analyses were performed using a random-effects model. RESULTS One hundred and one articles involving 626,863 patients were included. The pooled prevalence rates of frailty and prefrailty were 28% (95% confidence interval [CI]: 23%-33%) and 40% (95% CI: 31%-50%), respectively, for patients scheduled for open-heart surgeries and 40% (95% CI: 36%-45%) and 43% (95% CI: 34%-53%), respectively, for patients undergoing transcatheter procedures. Frailty measured using a multidimensional approach identified a higher proportion of frail patients when compared with measures solely focused on physical frailty. Older age, female sex, and lower body mass index and hemoglobin concentrations were significantly associated with higher frailty prevalence. Moreover, countries with higher gross domestic product spent on healthcare exhibited a higher frailty prevalence. CONCLUSION Frailty represents a considerable health challenge among patients undergoing cardiac surgeries/procedures. Routine screening for frailty should be considered during perioperative care planning.
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Affiliation(s)
- Cathy W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong.
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Benjamin M H Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
| | - Bernice Shinyi Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong
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11
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Tadege M, Tegegne AS, Dessie ZG. Post-surgery survival and associated factors for cardiac patients in Ethiopia: applications of machine learning, semi-parametric and parametric modelling. BMC Med Inform Decis Mak 2024; 24:91. [PMID: 38553701 PMCID: PMC10979627 DOI: 10.1186/s12911-024-02480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Living in poverty, especially in low-income countries, are more affected by cardiovascular disease. Unlike the developed countries, it remains a significant cause of preventable heart disease in the Sub-Saharan region, including Ethiopia. According to the Ethiopian Ministry of Health statement, around 40,000 cardiac patients have been waiting for surgery in Ethiopia since September 2020. There is insufficient information about long-term cardiac patients' post-survival after cardiac surgery in Ethiopia. Therefore, the main objective of the current study was to determine the long-term post-cardiac surgery patients' survival status in Ethiopia. METHODS All patients attended from 2012 to 2023 throughout the country were included in the current study. The total number of participants was 1520 heart disease patients. The data collection procedure was conducted from February 2022- January 2023. Machine learning algorithms were applied. Gompertz regression was used also for the multivariable analysis report. RESULTS From possible machine learning models, random survival forest were preferred. It emphasizes, the most important variable for clinical prediction was SPO2, Age, time to surgery waiting time, and creatinine value and it accounts, 42.55%, 25.17%,11.82%, and 12.19% respectively. From the Gompertz regression, lower saturated oxygen, higher age, lower ejection fraction, short period of cardiac center stays after surgery, prolonged waiting time to surgery, and creating value were statistically significant predictors of death outcome for post-cardiac surgery patients' survival in Ethiopia. CONCLUSION Some of the risk factors for the death of post-cardiac surgery patients are identified in the current investigation. Particular attention should be given to patients with prolonged waiting times and aged patients. Since there were only two fully active cardiac centers in Ethiopia it is far from an adequate number of centers for more than 120 million population, therefore, the study highly recommended to increase the number of cardiac centers that serve as cardiac surgery in Ethiopia.
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Affiliation(s)
- Melaku Tadege
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
- Regional Data Management Center for Health (RDMC), Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia.
| | | | - Zelalem G Dessie
- College of Science, Bahir Dar University, Bahir Dar, Ethiopia
- School of Mathematics, Statistics and Computer Science, University of KwaZulu- Natal, Durban, South Africa
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12
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Afifi A, Mahgoub A, Yacoub M. Toward Excellence in Managing Transposition of the Great Arteries in the Community. Ann Thorac Surg 2024; 117:549-550. [PMID: 37804912 DOI: 10.1016/j.athoracsur.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Ahmed Afifi
- Department of Cardiothoracic Surgery, The Magdi Yacoub Institute, Harefield Hospital, Hill End Rd, Harefield, Middlesex UB9 6JH, United Kingdom
| | - Ahmed Mahgoub
- Department of Cardiothoracic Surgery, The Magdi Yacoub Institute, Harefield Hospital, Hill End Rd, Harefield, Middlesex UB9 6JH, United Kingdom
| | - Magdi Yacoub
- Department of Cardiothoracic Surgery, The Magdi Yacoub Institute, Harefield Hospital, Hill End Rd, Harefield, Middlesex UB9 6JH, United Kingdom.
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13
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Zilla P, Human P, Pennel T. Mechanical valve replacement for patients with rheumatic heart disease: the reality of INR control in Africa and beyond. Front Cardiovasc Med 2024; 11:1347838. [PMID: 38404722 PMCID: PMC10884232 DOI: 10.3389/fcvm.2024.1347838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
The majority of patients requiring heart valve replacement in low- to middle-income countries (LMICs) need it for rheumatic heart disease (RHD). While the young age of such patients largely prescribes replacement with mechanical prostheses, reliable anticoagulation management is often unattainable under the prevailing socioeconomic circumstances. Cases of patients with clotted valves presenting for emergency surgery as a consequence of poor adherence to anticoagulation control are frequent. The operative mortality rates of reoperations for thrombosed mechanical valves are several times higher than those for tissue valves, and long-term results are also disappointing. Under-anticoagulation prevails in these regions that has clearly been linked to poor international normalised ratio (INR) monitoring. In industrialised countries, safe anticoagulation is defined as >60%-70% of the time in the therapeutic range (TTR). In LMICs, the TTR has been found to be in the range of twenty to forty percent. In this study, we analysed >20,000 INR test results of 552 consecutive patients receiving a mechanical valve for RHD. Only 27% of these test results were in the therapeutic range, with the vast majority (61%) being sub-therapeutic. Interestingly, the post-operative frequency of INR tests of one every 3-4 weeks in year 1 had dropped to less than 1 per year by year 7. LMICs need to use clinical judgement and assess the probability of insufficient INR monitoring prior to uncritically applying Western guidelines predominantly based on chronological age. The process of identification of high-risk subgroups in terms of non-adherence to anticoagulation control should take into account both the adherence history of >50% of patients with RHD who were in chronic atrial fibrillation prior to surgery as well as geographic and socioeconomic circumstances.
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Affiliation(s)
- Peter Zilla
- Christiaan Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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14
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Hinton JV, Fletcher CM, Perry LA, Greifer N, Hinton JN, Williams-Spence J, Segal R, Smith JA, Reid CM, Weinberg L, Bellomo R. Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients. PLoS One 2024; 19:e0296726. [PMID: 38232077 DOI: 10.1371/journal.pone.0296726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Platelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown. METHODS We conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005-2021 across 58 sites were included. The primary outcome was operative mortality. RESULTS Of 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; P<0.001) and 1-year (RR, 1.50; 95% CI, 1.32 to 1.71; P<0.001) mortality. FFP was associated with increased rates of 4-hour chest drain tube output (Adjusted mean difference in ml, 28.37; 95% CI, 19.35 to 37.38; P<0.001), AKI (RR, 1.13; 95% CI, 1.01 to 1.27; P = 0.033) and readmission to ICU (RR, 1.24; 95% CI, 1.09 to 1.42; P = 0.001). CONCLUSION In perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting.
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Affiliation(s)
- Jake V Hinton
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | - Calvin M Fletcher
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Noah Greifer
- Harvard University Institute for Quantitative Social Science, Cambridge, MA, United States of America
| | | | - Jenni Williams-Spence
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Reny Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Julian A Smith
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Australia
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
- Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Parkville, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
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15
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Kliot T, Holloway A, Spillman K, Moss J, Davis NL, Ayalew A, Bhutta A, Ejigu YM. Remote Didactic Education Effectively Increases Cardiac Critical Care Nursing Staff Knowledge in Low-Resource Settings. World J Pediatr Congenit Heart Surg 2024; 15:74-80. [PMID: 37654191 DOI: 10.1177/21501351231186419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: While progress has been made to decrease mortality in children under age five, there continues to be a need for improvement in the treatment of children with congenital heart disease. Many of these patients require surgical correction and live in areas without the expertise of surgical teams. Research has shown that appropriate training is critical to ensure the best clinical outcomes. The Ethiopian government has identified the need for increased training of health care professionals as a method to improve hospital outcomes. Methods: Twenty-five cardiac critical nurses participated in a remote didactic education curriculum over the course of multiple months. We used a pre- and post-test model to evaluate knowledge acquisition and retention after the curriculum. Nurses completed post-tests at 1-, 3-, 6-, and 12-month intervals to monitor knowledge retention over time. Results: We found a significant increase in nursing knowledge that was retained over the course of 12 months. Nursing knowledge on pre- and post-tests was impacted by experience level. However, after completion of the curriculum experience was not a significant factor. Conclusion: Virtual curriculum delivered via remote didactic education is an inexpensive and effective way to increase nursing knowledge in cardiac critical care. It encourages bidirectional learning and allows the sharing of expertise from individuals who may otherwise be limited by travel or finances. Our approach is generalizable and further research needs to be done to evaluate the effectiveness of this type of curriculum in other environments.
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Affiliation(s)
- Tamara Kliot
- Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Adrian Holloway
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine Spillman
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Julianne Moss
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Natalie Louise Davis
- Division of Neonatology, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Abebech Ayalew
- Children's Cardiac Center of Ethiopia, Addis Abba, Ethiopia
| | - Adnan Bhutta
- Division of Critical Care Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore, MD, USA
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16
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Pandey A, Okaj I, Ichhpuniani S, Tao B, Kaur H, Spence JD, Young J, Healey JS, Devereaux PJ, Um KJ, Benz AP, Conen D, Whitlock RP, Belley-Cote EP, McIntyre WF. Risk Scores for Prediction of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 209:232-240. [PMID: 37922611 DOI: 10.1016/j.amjcard.2023.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023]
Abstract
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and is associated with poor clinical outcomes. The objective of this systematic review and meta-analysis was to assess the performance of risk scores to predict POAF in cardiac surgery patients. We searched MEDLINE, Embase, and Cochrane CENTRAL for studies that developed/evaluated a POAF risk prediction model. Pairs of reviewers independently screened studies and extracted data. We pooled area under the receiver operating curves (AUCs), sensitivity and specificity, and adjusted odds ratios from multivariable regression analyses using the generic inverse variance method and random effects models. Forty-three studies (n = 63,847) were included in the quantitative synthesis. Most scores were originally developed for other purposes but evaluated for predicting POAF. Pooled AUC revealed moderate POAF discrimination for the EuroSCORE II (AUC 0.59, 95% confidence interval [CI] 0.54 to 0.65), Society of Thoracic Surgeons (AUC 0.60, 95% CI 0.56 to 0.63), EuroSCORE (AUC 0.63, 95% CI 0.58 to 0.68), CHADS2 (AUC 0.66, 95% CI 0.57 to 0.75), POAF Score (AUC 0.66, 95% CI 0.63 to 0.68), HATCH (AUC 0.67, 95% CI 0.57 to 0.75), CHA2DS2-VASc (AUC 0.68, 95% CI 0.60 to 0.75) and SYNTAX scores (AUC 0.74, 95% CI 0.71 to 0.78). Pooled analyses at specific cutoffs of the CHA2DS2-VASc, CHADS2, HATCH, and POAF scores demonstrated moderate-to-high sensitivity (range 46% to 87%) and low-to-moderate specificity (range 31% to 70%) for POAF prediction. In conclusion, existing clinical risk scores offer at best moderate prediction for POAF after cardiac surgery. Better models are needed to guide POAF risk stratification in cardiac surgery patients.
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Affiliation(s)
- Arjun Pandey
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Iva Okaj
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Brendan Tao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hargun Kaur
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Jack Young
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Kevin J Um
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | | | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Emilie P Belley-Cote
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - William F McIntyre
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
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17
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Fredericks S, Bae T, Sochaniwskyj M, Sanders J, Martorella G, Wynne R. Creating a social media strategy for an international cardiothoracic research network: a scoping review. Eur J Cardiovasc Nurs 2023; 22:751-757. [PMID: 36802352 DOI: 10.1093/eurjcn/zvad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023]
Abstract
AIMS A cardiac surgery international nursing and allied professional research network titled CONNECT was created to strengthen collaborative cardiac surgery research through shared initiatives including supervision, mentorship, workplace exchange programs, and multi-site clinical research. As with any new initiative, there is a need to build brand awareness to enhance user familiarity, grow membership, and promote various opportunities offered. Social media has been used across various surgical disciplines; however, their effectiveness in promoting scholarly and academic-based initiatives has not been examined. The aim of this scoping review was to examine the different types of social media platforms and strategies used to promote cardiac research initiatives for CONNECT. METHODS AND RESULTS A scoping review was undertaken in which a comprehensive and thorough review of the literature was performed. Fifteen articles were included in the review. Twitter appeared to be the most common form of social media used to promote cardiac initiatives, with daily posts being the most frequent type of engagement. Frequency of views, number of impressions and engagement, link clicks, and content analysis were the most common types of evaluation metrics that were identified. CONCLUSION Findings from this review will inform the design and evaluation of a targeted Twitter campaign aimed at increasing brand awareness of CONNECT, which will include the use of @CONNECTcardiac Twitter handle, hashtags, and CONNECT-driven journal clubs. In addition, the use of Twitter to disseminate information and brand initiatives related to CONNECT will be evaluated using the Twitter Analytics function. REGISTRATION Open Science Framework: osf.io/q54es.
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Affiliation(s)
- Suzanne Fredericks
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Tammy Bae
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Mark Sochaniwskyj
- Daphne Cockwell School of Nursing, Toronto Metropolitan University - M5B 2K3, 350 Victoria St., Toronto, ON, Canada
| | - Julie Sanders
- St. Bartholomew Hospital - W Smithfield, Barts Health NHS Trust and Clinical Professor of Cardiovascular Nursing, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, Queen Mary University - Mile End Rd, Bethnal Green, London E1 4NS, UK
| | - Geraldine Martorella
- College of Nursing, Florida State University; Office 104F-Vivian M. Duxbury Hall; TMH Center for Research and Evidence-Based Practice, 98 Varsity Way, 32306 Tallahassee, FL, USA
| | - Rochelle Wynne
- Cardiothoracic Surgery, The Royal Melbourne Hospital, 300 Grattan Street (corner of Royal Parade), Parkville, Victoria 3050, Australia
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18
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Zheng Y, Zhang L, Ma S, Wu B, Chen P, Xu Y, Tan W, Li H, Wu Q, Zheng J. Care intervention on psychological outcomes among patients admitted to intensive care unit: an umbrella review of systematic reviews and meta-analyses. Syst Rev 2023; 12:237. [PMID: 38098025 PMCID: PMC10720116 DOI: 10.1186/s13643-023-02372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Numerous studies have explored care interventions to improve the psychological outcome of intensive care unit (ICU) patients, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. This umbrella review aimed to analyze the relationship between care intervention and psychological outcomes of ICU patients based on existing systematic reviews. METHODS An umbrella review of evidence across systematic reviews and meta-analyses published between 1987 and 2023 was undertaken. We systematically searched reviews that examined the association between care intervention and the improvement of adverse psychological outcomes in ICU patients using PubMed, EMBASE, Web of Science, Cochrane Library, and manual reference screening. The measurement tool (AMSTAR 2) was applied to evaluate the methodological quality of included studies. The excess significance bias, between-study heterogeneity expressed by I2, small-study effect, and evidence class were estimated. RESULTS A total of 5110 articles were initially identified from the search databases and nine of them were included in the analysis. By applying standardized criteria, only weak evidence was observed in 13 associations, even though most included reviews were of moderate to high methodological quality. These associations pertained to eight interventions (music therapy, early rehabilitation, post-ICU follow-up, ICU diary, information intervention, preoperative education, communication and psychological support, surrogate decision-making) and five psychological outcomes (post-intensive care syndrome, transfer anxiety, post-traumatic stress disorder, anxiety, and depression). Weak or null association was shown among the rest of the associations (e.g., weak association between music therapy and maternal anxiety or stress level). CONCLUSIONS The evidence of these eight supporting interventions to improve the adverse psychological outcomes of ICU patients and caregivers was weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.
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Affiliation(s)
- Yafang Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Lijuan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Shihong Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Bian Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Peipei Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Yan Xu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Wenting Tan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Hanzhan Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Qiaomei Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
| | - Jingxia Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
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19
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Weich H, Botes L, Doubell A, Jordaan J, Lewies A, Marimuthu P, van den Heever J, Smit F. Development and testing of a transcatheter heart valve with reduced calcification potential. Front Cardiovasc Med 2023; 10:1270496. [PMID: 38124891 PMCID: PMC10731034 DOI: 10.3389/fcvm.2023.1270496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Patients from developing countries who require heart valve surgery are younger and have less access to open heart surgery than those from developed countries. Transcatheter heart valves (THVs) may be an alternative but are currently unsuitable for young patients because of their inadequate durability. We developed and tested a THV utilizing two new types of decellularized bovine pericardial leaflets in an ovine model. Methods The two decellularized tissues [one with a very low dose (0.05%) of monomeric glutaraldehyde (GA) fixation and detoxification (DF) and the other without glutaraldehyde (DE)] were compared to an industry standard [Glycar-fixed with the standard dose (0.625%) of glutaraldehyde]. THVs were manufactured with the three tissue types and implanted in the pulmonary position of nine juvenile sheep for 180 days. Baseline and post-explantation evaluations were performed to determine the hemodynamic performance of the valves and their dynamic strength, structure, biological interaction, and calcification. Results Heart failure occurred in one animal due to incompetence of its Glycar valve, and the animal was euthanized at 158 days. The gradients over the Glycar valves were higher at the explant than at the implant, but the DE and DF valves maintained normal hemodynamic performance throughout the study. The DF and DE tissues performed well during the mechanical testing of explanted leaflets. Glycar tissue developed thick pannus and calcification. Compared to Glycar, the DF tissue exhibited reduced pannus overgrowth and calcification and the DE tissue exhibited no pannus formation and calcification. All tissues were endothelialized adequately. There was a striking absence of host ingrowth in the DE tissue leaflets, yet these leaflets maintained integrity and mechanical function. Conclusion In the juvenile sheep THV model, Glycar tissue developed significant pannus, calcification, and hemodynamic deterioration. Using a very low dose of monomeric GA to fix the decellularized bovine pericardium yielded less pannus formation, less calcification, and better hemodynamic function. We postulate that the limited pannus formation in the DF group results from GA. Bovine pericardium decellularized with our proprietary method resulted in inert tissue, which is a unique finding. These results justify further development and evaluation of the two decellularized tissue types in THVs for use in younger patients.
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Affiliation(s)
- Hellmuth Weich
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Bloemfontein, South Africa
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Johan Jordaan
- Department of Cardiothoracic Surgery, Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Angelique Lewies
- Department of Cardiothoracic Surgery, Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Prennie Marimuthu
- Department of Cardiothoracic Surgery, Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Johannes van den Heever
- Department of Cardiothoracic Surgery, Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Francis Smit
- Department of Cardiothoracic Surgery, Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
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20
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Jufar AH, May CN, Booth LC, Evans RG, Cochrane AD, Marino B, Birchall I, Hood SG, McCall PR, Sanders RD, Yao ST, Ortega-Bernal V, Skene A, Bellomo R, Miles LF, Lankadeva YR. Effects of dexmedetomidine on kidney and brain tissue microcirculation and histology in ovine cardiopulmonary bypass: a randomised controlled trial. Anaesthesia 2023; 78:1481-1492. [PMID: 37880924 DOI: 10.1111/anae.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/27/2023]
Abstract
Cardiac surgery requiring cardiopulmonary bypass is associated with postoperative acute kidney injury and neurocognitive disorders, including delirium. Intra-operative inflammation and/or impaired tissue perfusion/oxygenation are thought to be contributors to these outcomes. It has been hypothesised that these problems may be ameliorated by the highly selective α2 -agonist, dexmedetomidine. We tested the effects of dexmedetomidine on renal and cerebral microcirculatory tissue perfusion, oxygenation and histology in a clinically relevant ovine model. Sixteen sheep were studied while conscious, after induction of anaesthesia and during 2 h of cardiopulmonary bypass. Eight sheep were allocated randomly to receive an intravenous infusion of dexmedetomidine (0.4-0.8 μg.kg-1 .h-1 ) from induction of anaesthesia to the end of cardiopulmonary bypass, and eight to receive an equivalent volume of matched placebo (0.9% sodium chloride). Commencement of cardiopulmonary bypass decreased renal medullary tissue oxygenation in the placebo group (mean (95%CI) 5.96 (4.24-7.23) to 1.56 (0.84-2.09) kPa, p = 0.001), with similar hypoxic levels observed in the dexmedetomidine group (6.33 (5.33-7.07) to 1.51 (0.33-2.39) kPa, p = 0.002). While no differences in kidney function (i.e. reduced creatinine clearance) were evident, a greater incidence of histological renal tubular injury was observed in sheep receiving dexmedetomidine (7/8 sheep) compared with placebo (2/8 sheep), p = 0.041. Graded on a semi-quantitative scale (0-3), median (IQR [range]) severity of histological renal tubular injury was higher in the dexmedetomidine group compared with placebo (1.5 (1-2 [0-3]) vs. 0 (0-0.3 [0-1]) respectively, p = 0.013). There was no difference in cerebral tissue microglial activation (neuroinflammation) between the groups. Dexmedetomidine did not reduce renal medullary hypoxia or cerebral neuroinflammation in sheep undergoing cardiopulmonary bypass.
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Affiliation(s)
- A H Jufar
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - C N May
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - L C Booth
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - R G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - A D Cochrane
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - B Marino
- Cell Saving and Perfusion Resources, Melbourne, Australia
| | - I Birchall
- Neurohistology Laboratory, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - S G Hood
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - P R McCall
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - R D Sanders
- Central Clinical School and NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - S T Yao
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - V Ortega-Bernal
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - A Skene
- Department of Anatomical Pathology, Austin Health, Melbourne, Australia
| | - R Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - L F Miles
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Y R Lankadeva
- Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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21
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Lababidi H, Salerno PRVO, Wass SY, Shafiabadi Hasani N, Bourges-Sevenier B, Al-Kindi S. The Global Burden of premature cardiovascular disease, 1990-2019. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200212. [PMID: 37876911 PMCID: PMC10590819 DOI: 10.1016/j.ijcrp.2023.200212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023]
Abstract
Aims Premature cardiovascular disease (pCVD) definition varies in literature, with age cut-offs ranging from 50-65 years. While there is some literature available on pCVD in North America, comprehensive data on its global burden is still lacking which hinders the development of efficient strategies for early detection and prevention. In this study we aimed to investigate the global trends in pCVD related morbidity and mortality from 1990 to 2019. Methods The 1990-2019 Global Burden of Disease (GBD) database was utilized to examine global trends in cardiovascular disease-related total mortality, mortality rates, and Disability-Adjusted Life Years (DALYs) within individuals aged 15-49 years. The findings were further analyzed based on factors such as age, sex, and Socio-Demographic Index (SDI). Results From 1990 to 2019, the number of global annual pCVD deaths increased by 25%, from 992,067 (95% UI 1,042,261 - 946,383) to 1,241,484 (95% UI 1,339,193 -1,146,252). The rate of associated mortality decreased by 13%. Metabolic conditions were the most significant risk factors for pCVD mortality. Ischemic heart disease and stroke are the leading causes of death across all age groups. pCVD mortality presented progressive widening between high and low SDI regions. Additionally, sex-specific disparities in CVD mortality were significantly greater in the premature age group as compared to all-age groups. Conclusion pCVD is an increasingly significant global cause of morbidity and mortality that disproportionately affects males and individuals living in less privileged regions. Furthermore, ischemic heart disease and stroke were identified as the main drivers of pCVD global burden.
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Affiliation(s)
- Hossam Lababidi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Pedro RVO. Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sojin Youn Wass
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Neda Shafiabadi Hasani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brendan Bourges-Sevenier
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
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22
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Rwebembera J, Chang AY, Kitooleko SM, Kaudha G, de Loizaga S, Nalule M, Ahabwe K, Zhang W, Okello E, Sinha P, Mwambu T, Sable C, Beaton A, Longenecker CT. Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda. Glob Heart 2023; 18:62. [PMID: 38028964 PMCID: PMC10655755 DOI: 10.5334/gh.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Background Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. Objectives To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. Methods We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Results Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteen-year survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). Conclusions There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations.
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Affiliation(s)
| | - Andrew Y. Chang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, USA
- Center for Innovation in Global Health, Stanford University, USA
| | | | | | - Sarah de Loizaga
- Stanford Cardiovascular Institute, Stanford University, USA
- Cincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229, USA
| | | | | | | | - Emmy Okello
- Uganda Heart Institute, Kampala, Uganda
- School of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Pranava Sinha
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Craig Sable
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea Beaton
- Stanford Cardiovascular Institute, Stanford University, USA
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chris T. Longenecker
- Pediatric Cardiology, Children’s National Hospital, Washington, District of Columbia, USA
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23
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Ohno T, Suenaga H, Yamawaki-Ogata A, Kanie K, Kato R, Uto K, Ebara M, Ito H, Narita Y, Usui A, Mutsuga M. Development of novel waxy bone haemostatic agents composed of biodegradable polymers with osteogenic-enhancing peptides in rabbit models. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad170. [PMID: 37930044 PMCID: PMC10639036 DOI: 10.1093/icvts/ivad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The use of bone wax (BW) is controversial for sternal haemostasis because it increases the risk of wound infection and inhibits bone healing. We developed new waxy bone haemostatic agents made from biodegradable polymers containing peptides and evaluated them using rabbit models. METHODS We designed 2 types of waxy bone haemostatic agents: peptide wax (PW) and non-peptide wax (NPW), which used poly(ε-caprolactone)-based biodegradable polymers with or without an osteogenesis-enhancing peptide, respectively. Rabbits were randomly divided into 4 groups based on treatment with BW, NPW, PW or no treatment. In a tibial defect model, the bleeding amount was measured and bone healing was evaluated by micro-computed tomography over 16 weeks. Bone healing in a median sternotomy model was assessed for 2 weeks using X-ray, micro-computed tomography, histological examination and flexural strength testing. RESULTS The textures of PW and NPW (n = 12 each) were similar to that of BW and achieved a comparable degree of haemostasis. The crevice area of the sternal fracture line in the BW group was significantly larger than that in other groups (n = 10 each). The PW group demonstrated the strongest sternal flexural strength (n = 10), with complete tibial healing at 16 weeks. No groups exhibited wound infection, including osteomyelitis. CONCLUSIONS Waxy biodegradable haemostatic agents showed satisfactory results in haemostasis and bone healing in rabbit models and may be an effective alternative to BW.
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Affiliation(s)
- Tsukasa Ohno
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Hiroto Suenaga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Aika Yamawaki-Ogata
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Kei Kanie
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
- Department of Biotechnology and Chemistry, Kindai University, Higashi-Hiroshima, Japan
| | - Ryuji Kato
- Department of Basic Medicinal Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
- Division of Micro-Nano Mechatronics, Institute of Nano-Life-Systems, Institutes of Innovation for Future Society, Nagoya University, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Koichiro Uto
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science (NIMS), Tsukuba, Japan
| | - Mitsuhiro Ebara
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science (NIMS), Tsukuba, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Tokai National Higher Education and Research System, Nagoya, Japan
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Vervoort D, Babar MS, Sabatino ME, Riaz MMA, Hey MT, Prakash MPH, Mathari SE, Kpodonu J. Global Access to Cardiac Surgery Centers: Distribution, Disparities, and Targets. World J Surg 2023; 47:2909-2916. [PMID: 37537360 DOI: 10.1007/s00268-023-07130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Global data on cardiac surgery centers are outdated and survey-based. In 1995, there were 0.7 centers per million population, ranging from one per 120,000 in North America to one per 33 million in sub-Saharan Africa. This study analyzes the contemporary distribution of cardiac surgery centers and proposes targets relative to countries' cardiovascular disease (CVD) burdens. METHODS Medical databases, gray literature, and governmental reports were used to identify the most recent post-2010 data that describe the number of centers performing cardiac surgery in each nation. The 2019 Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool provided national CVD burdens. One-third of the CVD burden was assumed to be surgical. Center targets were proposed as the average or half of the average of centers per million surgical CVD patients in high-income countries. RESULTS 5,111 cardiac surgery centers were identified across 230 nations and territories with available data, equaling 0.73 centers per million population. The median (interquartile range) number of centers ranged from 0 (0-0.06) per million in low-income countries to 0.75 (0-1.44) in high-income countries. Targets were 612.2 (optimistic) or 306.1 (conservative) centers per million surgical CVD incidence. In 2019, low-income, lower-middle-income, and upper-middle-income countries possessed 34.8, 149.0, and 271.9 centers per million surgical CVD incidence. CONCLUSION Little progress has been made to increase cardiac surgery centers per population despite growing CVD burdens. Today's global cardiac surgical capacity remains insufficient, disproportionately affecting the world's poorest regions.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, ON M5T 3M6, Canada.
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
| | | | | | | | - Matthew T Hey
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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Vu T, Smith JA. The pathophysiology and management of depression in cardiac surgery patients. Front Psychiatry 2023; 14:1195028. [PMID: 37928924 PMCID: PMC10623009 DOI: 10.3389/fpsyt.2023.1195028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background Depression is common in the cardiac surgery population. This contemporary narrative review aims to explore the main pathophysiological disturbances underpinning depression specifically within the cardiac surgery population. The common non-pharmacological and pharmacological management strategies used to manage depression within the cardiac surgery patient population are also explored. Methods A total of 1291 articles were identified through Ovid Medline and Embase. The findings from 39 studies were included for qualitative analysis in this narrative review. Results Depression is associated with several pathophysiological and behavioral factors which increase the likelihood of developing coronary heart disease which may ultimately require surgical intervention. The main pathophysiological factors contributing to depression are well characterized and include autonomic nervous system dysregulation, excessive inflammation and disruption of the hypothalamic-pituitary-adrenal axis. There are also several behavioral factors in depressed patients associated with the development of coronary heart disease including poor diet, insufficient exercise, poor compliance with medications and reduced adherence to cardiac rehabilitation. The common preventative and management modalities used for depression following cardiac surgery include preoperative and peri-operative education, cardiac rehabilitation, cognitive behavioral therapy, religion/prayer/spirituality, biobehavioral feedback, anti-depressant medications, and statins. Conclusion This contemporary review explores the pathophysiological mechanisms leading to depression following cardiac surgery and the current management modalities. Further studies on the preventative and management strategies for postoperative depression in the cardiac surgery patient population are warranted.
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Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 143] [Impact Index Per Article: 143.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Molinari Veloso da Silveira L, Costa Fuchs S, Brendel Blum G, Grabinski Bottino L, Danni Fuchs F. Association between preoperative blood pressure and outcomes in cardiac surgery: results of a prospectively planned cohort study. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:548-554. [PMID: 37255492 DOI: 10.23736/s0021-9509.23.12581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND It is unknown whether unwitnessed BP (UBP) measurement or ambulatory BP (ABP) monitoring improves the prediction of adverse events estimated by risk scores. We intended to study associations between preoperative BP measured through these two methods and the incidence of adverse outcomes in patients undergoing cardiac surgery. METHODS We included a cohort of 167 patients undergoing elective or urgent cardiac surgeries. Preoperative BP was measured by UBP and 24-hour ABP. Primary outcome was the combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery. The associations between preoperative BP and surgical outcomes were tested using the Chi-square test and Analysis of Variance. A generalized linear model with a logistic link function and a robust estimator was used to adjust for the EuroScore-II risk estimation. RESULTS The incidence of the primary outcome increased in parallel with the quartiles of the 24-hour ABP in participants submitted to CABG: 10% in the first quartile, 13% in the second, 37% in the third, and 53% in the fourth quartile (P for trend<0.01). Quartiles of overnight ABP were also significantly associated with postoperative complications in patients undergoing CABG (P=0.04). The risks in CABG patients were independent of the EuroScore-II. There was no association between BP and outcomes in patients submitted to other surgeries. CONCLUSIONS High preoperative BP measured by ABP monitoring is a risk factor for postoperative complications in patients submitted to CABG.
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Affiliation(s)
- Lucas Molinari Veloso da Silveira
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Division of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, Brazil
| | - Sandra Costa Fuchs
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gabriela Brendel Blum
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Flávio Danni Fuchs
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil -
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Vervoort D, Yilgwan CS, Ansong A, Baumgartner JN, Bansal G, Bukhman G, Cannon JW, Cardarelli M, Cunningham MW, Fenton K, Green-Parker M, Karthikeyan G, Masterson M, Maswime S, Mensah GA, Mocumbi A, Kpodonu J, Okello E, Remenyi B, Williams M, Zühlke LJ, Sable C. Tertiary prevention and treatment of rheumatic heart disease: a National Heart, Lung, and Blood Institute working group summary. BMJ Glob Health 2023; 8:e012355. [PMID: 37914182 PMCID: PMC10619050 DOI: 10.1136/bmjgh-2023-012355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/14/2023] [Indexed: 11/03/2023] Open
Abstract
Although entirely preventable, rheumatic heart disease (RHD), a disease of poverty and social disadvantage resulting in high morbidity and mortality, remains an ever-present burden in low-income and middle-income countries (LMICs) and rural, remote, marginalised and disenfranchised populations within high-income countries. In late 2021, the National Heart, Lung, and Blood Institute convened a workshop to explore the current state of science, to identify basic science and clinical research priorities to support RHD eradication efforts worldwide. This was done through the inclusion of multidisciplinary global experts, including cardiovascular and non-cardiovascular specialists as well as health policy and health economics experts, many of whom also represented or closely worked with patient-family organisations and local governments. This report summarises findings from one of the four working groups, the Tertiary Prevention Working Group, that was charged with assessing the management of late complications of RHD, including surgical interventions for patients with RHD. Due to the high prevalence of RHD in LMICs, particular emphasis was made on gaining a better understanding of needs in the field from the perspectives of the patient, community, provider, health system and policy-maker. We outline priorities to support the development, and implementation of accessible, affordable and sustainable interventions in low-resource settings to manage RHD and related complications. These priorities and other interventions need to be adapted to and driven by local contexts and integrated into health systems to best meet the needs of local communities.
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Affiliation(s)
- Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Annette Ansong
- Outpatient Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | | | - Geetha Bansal
- Division of International Training and Research, John E Fogarty International Center, Bethesda, Maryland, USA
| | - Gene Bukhman
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey W Cannon
- Department of Global Health and Population, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Marcelo Cardarelli
- Pediatric Heart Surgery, Inova Children Hospital, Falls Church, Virginia, USA
| | | | - Kathleen Fenton
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Melissa Green-Parker
- National Institutes of Health Office of Disease Prevention, Bethesda, Maryland, USA
| | | | - Mary Masterson
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Salome Maswime
- Global Surgery, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - George A Mensah
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Ana Mocumbi
- Non Communicable Diseases, Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Emmy Okello
- Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
| | - B Remenyi
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory of Australia, Australia
| | - Makeda Williams
- National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Liesl J Zühlke
- South African Medical Research Council, Tygerberg, South Africa
- Department of Medicine, Red Cross War Memorial Children's Hospital, Rondebosch, Western Cape, South Africa
| | - Craig Sable
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
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Carrel T, Vogt PR, Obrist D, Schaff H. Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery. Front Cardiovasc Med 2023; 10:1220633. [PMID: 37840955 PMCID: PMC10570810 DOI: 10.3389/fcvm.2023.1220633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
The aortic valve is the most frequently diseased valve and aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. The diseased native aortic valve can be replaced by either a biological or mechanical valve prosthesis. The main concerns relate to durability, the need for oral anticoagulants and the incidence of complications related to this medication. Experimental, computational and biomolecular blood flow studies have demonstrated that the systolic forward flow but also the reverse flow phase at the end of the systole and leakage during the diastolic phase is mainly responsible for platelet activation and thrombosis. Better design of mechanical prosthetic heart valves must ensure smooth closing during flow deceleration and must eliminate high-shear hinge flow during diastole to prevent life-threatening thrombosis. A novel tri-leaflet valve should combine the favorable hemodynamics and the durability of existing mechanical heart valves and eliminate the less favorable characteristics, including the extremely rapid closing. In this paper, we discuss some issues of current mechanical heart valve prostheses and present a new valve design with the potential for significant innovation in the field. The TRIFLO Heart Valve, is a rigid, three-leaflet central flow heart valve prosthesis consisting of an alloyed titanium housing, and three rigid polymer (PEEK) cusps. This valve has a physiological operating mode. During the forward flow phase, the intraventricular pressure opens the leaflets so that blood can freely flow through with little obstruction, and with the deceleration of the blood flow, the leaflets close early and smoothly, minimizing blood flow regurgitation, blood cell damage, and activation of the coagulation cascade. Pre-clinical studies have shown pretty favorable results and a first-in-man study should start very soon.
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Affiliation(s)
- Thierry Carrel
- Department of Cardiac Surgery, University Hospital Basel, Switzerland
| | | | - Dominique Obrist
- ARTORG Center for Biomedical Research, University of Bern, Bern, Switzerland
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Weich H, Herbst P, Smit F, Doubell A. Transcatheter heart valve interventions for patients with rheumatic heart disease. Front Cardiovasc Med 2023; 10:1234165. [PMID: 37771665 PMCID: PMC10525355 DOI: 10.3389/fcvm.2023.1234165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent. Is it time to consider less invasive alternatives to conventional valve surgery? Several anatomical and pathological differences exist between degenerative and rheumatic valves, including percutaneous valve landing zones. These are poorly documented and may require dedicated solutions when considering percutaneous intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for severe mitral stenosis (MS) but is reserved for patients with suitable valve anatomy without significant mitral regurgitation (MR), the commonest lesion in RHD. Valvuloplasty also rarely offers a durable solution for patients with rheumatic aortic stenosis (AS) or aortic regurgitation (AR). MR and AR pose unique challenges to successful transcatheter valve implantation as landing zone calcification, so central in docking transcatheter aortic valves in degenerative AS, is often lacking. Surgery in young RHD patients requires mechanical prostheses for durability but morbidity and mortality from both thrombotic complications and bleeding on Warfarin remains excessively high. Also, redo surgery rates are high for progression of aortic valve disease in patients with prior mitral valve replacement (MVR). Transcatheter treatments may offer a solution to anticoagulation problems and address reoperation in patients with prior MVR or failing ventricles, but would have to be tailored to the rheumatic environment. The high prevalence of MR and AR, lack of calcification and other unique anatomical challenges remain. Improvements in tissue durability, the development of novel synthetic valve leaflet materials, dedicated delivery systems and docking stations or anchoring systems to securely land the transcatheter devices, would all require attention. We review the epidemiology of RHD and discuss anatomical differences between rheumatic valves and other pathologies with a view to transcatheter solutions. The shortcomings of current RHD management, including current transcatheter treatments, will be discussed and finally we look at future developments in the field.
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Affiliation(s)
- Hellmuth Weich
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip Herbst
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Francis Smit
- Robert W.M. Frater Cardiovascular Research Centre, University of the Free State, Bloemfontein, South Africa
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Xiao MZX, Khan JS, Dana E, Rao V, Djaiani G, Richebé P, Katz J, Wong D, Clarke H. Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort Study. Anesthesiology 2023; 139:309-320. [PMID: 37192204 DOI: 10.1097/aln.0000000000004621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Chronic postsurgical pain is a common complication of surgery. The role of psychologic risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. The authors hypothesize that baseline psychologic vulnerabilities have a negative influence on chronic postsurgical pain. METHODS The authors prospectively collected demographic, psychologic, and perioperative factors in a cohort of 1,059 patients undergoing cardiac surgery at the Toronto General Hospital between 2012 and 2020. Patients were followed and completed chronic pain questionnaires at 3, 6, and 12 months after surgery. RESULTS The study included 767 patients who completed at least one follow-up questionnaire. The incidence of postsurgical pain (more than 0 out of 10) at 3, 6, and 12 months after surgery was 191 of 663 (29%), 118 of 625 (19%), and 89 of 605 (15%), respectively. Notably, among patients reporting any pain, the incidence of pain compatible with a neuropathic phenotype increased from 56 of 166 (34%) at 3 months to 38 of 97 (39%) at 6 months and 43 of 67 (64%) at 12 months. Factors associated with postsurgical pain scores at 3 months include female sex, pre-existing chronic pain, previous cardiac surgery, preoperative depression, baseline pain catastrophizing scores, and moderate-to-severe acute pain (4 or more out of 10) within 5 postoperative days. CONCLUSIONS Nearly one in three patients undergoing cardiac surgery reported pain at 3 months of follow-up, with approximately 15% reporting persistent pain at 1 yr. Female sex, pre-existing chronic pain, and baseline depression were associated with postsurgical pain scores across all three time periods. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Maggie Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Elad Dana
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivek Rao
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Research Center of the Integrated University Health and Social Services Center of the East-Island of Montreal, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Canada
| | - Joel Katz
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Department of Psychology, York University, Toronto, Canada; Transitional Pain Service, Toronto General Hospital, Toronto, Canada
| | - Dorothy Wong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Transitional Pain Service, Toronto General Hospital, Toronto, Canada
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Chiew JK, Low CJW, Zeng K, Goh ZJ, Ling RR, Chen Y, Ti LK, Ramanathan K. Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Anesth Analg 2023; 137:587-600. [PMID: 37220070 DOI: 10.1213/ane.0000000000006532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Research on fast-track recovery protocols postulates that thoracic epidural anesthesia (TEA) in cardiac surgery contributes to improved postoperative outcomes. However, concerns about TEA's safety hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the benefits and risks of TEA in cardiac surgery. METHODS We searched 4 databases for randomized controlled trials (RCTs) assessing the use of TEA against only general anesthesia (GA) in adults undergoing cardiac surgery, up till June 4, 2022. We conducted random-effects meta-analyses, evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Primary outcomes were intensive care unit (ICU), hospital length of stay, extubation time (ET), and mortality. Other outcomes included postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit. RESULTS Our meta-analysis included 51 RCTs (2112 TEA patients and 2220 GA patients). TEA significantly reduced ICU length of stay (-6.9 hours; 95% confidence interval [CI], -12.5 to -1.2; P = .018), hospital length of stay (-0.8 days; 95% CI, -1.1 to -0.4; P < .0001), and ET (-2.9 hours; 95% CI, -3.7 to -2.0; P < .0001). However, we found no significant change in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU length of stay, hospital length of stay, and ET, suggesting a clinical benefit. TEA also significantly reduced pain scores, pooled pulmonary complications, transfusion requirements, delirium, and arrhythmia, without additional complications such as epidural hematomas, of which the risk was estimated to be <0.14%. CONCLUSIONS TEA reduces ICU and hospital length of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications such as epidural hematomas. These findings favor the use of TEA in cardiac surgery and warrant consideration for use in cardiac surgeries worldwide.
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Affiliation(s)
- John Keong Chiew
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Christopher Jer Wei Low
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kieran Zeng
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhi Jie Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ryan Ruiyang Ling
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Ying Chen
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Agency of Science, Technology and Research, Singapore
| | - Lian Kah Ti
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Anaesthesia, National University Hospital, National University Health System, Singapore
| | - Kollengode Ramanathan
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Singapore
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Zhang L, Tong Z, Han R, Li K, Zhang X, Yuan R. Spatiotemporal trends in global burden of rheumatic heart disease and associated risk factors from 1990 to 2019. Int J Cardiol 2023; 384:100-106. [PMID: 37149003 DOI: 10.1016/j.ijcard.2023.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The aim of this study was to estimate the burden of rheumatic heart disease (RHD) and its trends in different countries, regions, genders and age groups globally. METHODS Data were obtained from the Global Burden of Disease 2019 study. Age-standardized rates (ASRs) and the estimated annual percentage changes (EAPCs) in the ASRs were used to describe the burden of disease and its trends. Pearson's correlation was used to evaluate the correlation between sociodemographic index (SDI) values and the observed trends. RESULTS In 2019, the ASRs of the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of RHD were 37.39/105 (95%UI, 28.59/105 to 46.74/105), 513.68/105 (95%UI, 405.01/105 to 636.25/105), 3.85/105 (95%UI, 4.29/105 to 3.29/105) and 132.88/105 (95%UI, 115.02/105 to 150.34/105), respectively. From 1990 to 2019, the incidence and prevalence of RHD showed upward trends and the mortality and DALYs showed downward trends. Countries or regions in Africa, South America and South Asia had a greater burden of RHD. The burden of RHD was greater in women, where as men showed more obvious increasing trends in the incidence and prevalence. The incidence of RHD was highest in adolescents, and the prevalence was highest in young and middle-aged. The mortality and DALYs rate associated with RHD increased with age. The EAPCs in the ASRs were negatively correlated with the SDI value. CONCLUSION Although the ASRs of mortality and DALYs attributable to RHD are decreasing globally, RHD remains an important public health problem that needs to be addressed urgently, especially in certain low- and middle-income countries and regions.
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Affiliation(s)
- Liang Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuang Tong
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruizheng Han
- Department of Ultrasound, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Kaixiang Li
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Ruixia Yuan
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Banceu C, Harpa M, Brinzaniuc K, Tilea I, Varga A, Gliga ML, Voidazan S, Neagu N, Szabo DA, Banceu D, Cristutiu D, Balmos IA, Puscas A, Oprean M, Suciu H. The Gender Gap in Aortic Dissection: A Prospective Analysis of Risk and Outcomes. J Crit Care Med (Targu Mures) 2023; 9:178-186. [PMID: 37588179 PMCID: PMC10425927 DOI: 10.2478/jccm-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
Aortic dissection (AD) is a severe cardiovascular condition that could have negative consequences. Our study employed a prospective design and examined preoperative, perioperative, and postoperative data to evaluate the effects of gender on various medical conditions. We looked at how gender affected the results of aortic dissection (AD). In contrast to female patients who had more systemic hypertension (p=0.031), male patients had higher rates of hemopericardium (p=0.003), pulmonary hypertension (p=0.039), and hemopericardium (p=0.003). Dobutamine administration during surgery significantly raised the mortality risk (p=0.015). There were noticeably more women patients (p=0.01) in the 71 to 80 age group. Significant differences in age (p=0.004), eGFR at admission (p=0.009), and eGFR at discharge (p=0.006) were seen, however, there was no association between gender and mortality. In conclusion, our findings highlight that gender may no longer be such an important aspect of aortic dissection disease as we previously thought, and this information could have an important contribution for surgeons as well as for anesthesiologists involved in the management of acute aortic dissection.
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Affiliation(s)
- Cosmin Banceu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- I.O.S.U.D George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marius Harpa
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Klara Brinzaniuc
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Ioan Tilea
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Andreea Varga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Mirela Liana Gliga
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Septimiu Voidazan
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Nicolae Neagu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Dan Alexandru Szabo
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Diana Banceu
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Daiana Cristutiu
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Ionut Alexandru Balmos
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Alexandra Puscas
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
| | - Marvin Oprean
- Dimitrie Cantemir University of Targu Mures, Romania
| | - Horatiu Suciu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
- Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
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Massoth C, Küllmar M, Pajares Moncho A, Susana GS, Grigoryev E, Ivkin A, von Dossow V, Ott S, Rau N, Meersch M, Zarbock A. Implementation of the Kidney Disease Improving Global Outcomes guidelines for the prevention of acute kidney injury after cardiac surgery: An international cohort survey. Eur J Anaesthesiol 2023; 40:418-424. [PMID: 37052046 DOI: 10.1097/eja.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Increasing evidence from randomised controlled trials supports the implementation of a six-measure care bundle proposed by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in patients at high risk for acute kidney injury (AKI) to reduce its incidence after cardiac surgery. OBJECTIVE To assess compliance with the KDIGO bundle in clinical practice. DESIGN Prospective observational multinational study. SETTING Six international tertiary care centres, from February 2021 to November 2021. PATIENTS Five hundred and thirty-seven consecutive patients undergoing cardiac surgery during a 1-month observational period. INTERVENTIONS All patients were assessed for the postoperative implementation of the following measures: avoidance of nephrotoxic medication and radiocontrast agents whenever possible, strict glycaemic control, close monitoring of renal function, optimisation of haemodynamic and volume status and functional monitoring of haemodynamic status. MAIN OUTCOME MEASURES The primary endpoint was the proportion of patients receiving fully compliant care. Secondary outcomes were occurrence of AKI and major adverse kidney event rate at day 30. RESULTS The full care bundle was applied to 0.4% of patients. There was avoidance of nephrotoxic drugs in 15.6%, radiocontrast agents in 95.3% and hyperglycaemia in 39.6%. Close monitoring of urine output and serum creatinine was achieved in 6.3%, 57.4% underwent optimisation of volume and haemodynamic status, and 43.9% received functional haemodynamic monitoring. 27.2% developed AKI within 72 h after surgery. The average number of implemented measures was 2.6 ± 1.0 and did not differ between AKI or non-AKI patients ( P = 0.854). CONCLUSION Adherence with the KDIGO bundle was very low in cardiac surgery patients. Initiatives to improve guideline compliance might provide a strategy to mitigate the burden of AKI. TRIAL REGISTRATION www.drks.de DRKS00024204.
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Affiliation(s)
- Christina Massoth
- From the Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany (CM, MK, MM, AZ), Department of Anaesthesiology, La Fe University and Polytechnic Hospital Valencia (APM), Department of Anaesthesiology, University Hospital Vall d ́Hebron Barcelona, Spain (SGS), Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia (EG, AI), Institute of Anaesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, Ruhr- University (VvD), Department of Cardiac Anaesthesiology and Intensive Care Medicine, German Heart Center Berlin (SO, NR), Department of Cardiac Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (SO) and Department of Intensive Care Medicine, University Hospital Vall d'Hebron Barcelona, Spain
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Argaw S, Genetu A, Vervoort D, Agwar FD. The state of cardiac surgery in Ethiopia. JTCVS OPEN 2023; 14:261-269. [PMID: 37425461 PMCID: PMC10328795 DOI: 10.1016/j.xjon.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/11/2023]
Abstract
Objectives Six billion people globally do not have access to cardiac surgical care. In this study, we aimed to describe state of cardiac surgery in Ethiopia. Methods Data on status of local cardiac surgery collected from surgeons and cardiac centers. Medical travel agents were interviewed about number of cardiac patients who were assisted to travel abroad for surgery. Historical data and number of patients treated by non-governmental organizations were collected via interviews and by accessing existing databases. Results Patients access cardiac care via 3 avenues: mission-based, abroad referral, and care at local centers. Traditionally, the first 2 have been the main mode of access; however, since 2017, an entirely local team has begun performing heart surgery in the country. Currently, surgical cardiac care is provided at 4 local centers: a charity organization, a tertiary public hospital, and 2 for-profit centers. Procedures at the charity center are provided for free, whereas in others, patients mostly pay out of pocket. There are only 5 cardiac surgeons for 120 million people. More than 15,000 patients are on waitlist for surgery, mainly because of lack of consumables and limited numbers of centers and workforce. Conclusions There is a change in the trend from non-governmental mission- and referral-based care toward care in local centers in Ethiopia. The local cardiac surgery workforce is growing but still insufficient. The number of procedures is limited with long wait lists due to limited workforce, infrastructure, and resources. All stakeholders should work on training more workforce, providing consumables, and creating feasible financing schemes.
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Affiliation(s)
- Salem Argaw
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Abraham Genetu
- Department of Surgery, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
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Elsaafien K, Sloan JM, Evans RG, Cochrane AD, Marino B, McCall PR, Hood SG, Yao ST, Korim WS, Bailey SR, Jufar AH, Peiris RM, Bellomo R, Miles LF, May CN, Lankadeva YR. Associations Between Systemic and Cerebral Inflammation in an Ovine Model of Cardiopulmonary Bypass. Anesth Analg 2023; 136:802-813. [PMID: 36928157 DOI: 10.1213/ane.0000000000006379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraoperative inflammation may contribute to postoperative neurocognitive disorders after cardiac surgery requiring cardiopulmonary bypass (CPB). However, the relative contributions of general anesthesia (GA), surgical site injury, and CPB are unclear. METHODS In adult female sheep, we investigated (1) the temporal profile of proinflammatory and anti-inflammatory cytokines and (2) the extent of microglia activation across major cerebral cortical regions during GA and surgical trauma with and without CPB (N = 5/group). Sheep were studied while conscious, during GA and surgical trauma, with and without CPB. RESULTS Plasma tumor necrosis factor-alpha (mean [95% confidence intervals], 3.7 [2.5-4.9] vs 1.6 [0.8-2.3] ng/mL; P = .0004) and interleukin-6 levels (4.4 [3.0-5.8] vs 1.6 [0.8-2.3] ng/mL; P = .029) were significantly higher at 1.5 hours, with a further increase in interleukin-6 at 3 hours (7.0 [3.7-10.3] vs 1.8 [1.1-2.6] ng/mL; P < .0001) in animals undergoing CPB compared with those that did not. Although cerebral oxygen saturation was preserved throughout CPB, there was pronounced neuroinflammation as characterized by greater microglia circularity within the frontal cortex of sheep that underwent CPB compared with those that did not (0.34 [0.32-0.37] vs 0.30 [0.29-0.32]; P = .029). Moreover, microglia had fewer branches within the parietal (7.7 [6.5-8.9] vs 10.9 [9.4-12.5]; P = .001) and temporal (7.8 [7.2-8.3] vs 9.9 [8.2-11.7]; P = .020) cortices in sheep that underwent CPB compared with those that did not. CONCLUSIONS CPB enhanced the release of proinflammatory cytokines beyond that initiated by GA and surgical trauma. This systemic inflammation was associated with microglial activation across 3 major cerebral cortical regions, with a phagocytic microglia phenotype within the frontal cortex, and an inflammatory microglia phenotype within the parietal and temporal cortices. These data provide direct histopathological evidence of CPB-induced neuroinflammation in a large animal model and provide further mechanistic data on how CPB-induced cerebral inflammation might drive postoperative neurocognitive disorders in humans.
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Affiliation(s)
- Khalid Elsaafien
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Integrative Cardiovascular and Metabolic Diseases, Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Jasmine M Sloan
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger G Evans
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia
| | - Bruno Marino
- Cellsaving and Perfusion Resources, Melbourne, Victoria, Australia
| | - Peter R McCall
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australiaand
| | - Sally G Hood
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
| | - Song T Yao
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Willian S Korim
- Cardiovascular Neuroscience Laboratory, Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon R Bailey
- Faculty of Veterinary Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Alemayehu H Jufar
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Rachel M Peiris
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
| | - Rinaldo Bellomo
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australiaand
| | - Lachlan F Miles
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australiaand
| | - Clive N May
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australiaand
| | - Yugeesh R Lankadeva
- From the Pre-Clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health
- Department of Critical Care, Melbourne Medical School, Melbourne, Victoria, Australiaand
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Blaser MC, Kraler S, Lüscher TF, Aikawa E. Network-Guided Multiomic Mapping of Aortic Valve Calcification. Arterioscler Thromb Vasc Biol 2023; 43:417-426. [PMID: 36727519 PMCID: PMC9975082 DOI: 10.1161/atvbaha.122.318334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
Despite devastating clinical sequelae of calcific aortic valve disease that range from left ventricular remodeling to arrhythmias, heart failure, and early death, the molecular insights into disease initiation and progression are limited and pharmacotherapies remain unavailable. The pathobiology of calcific aortic valve disease is complex and comprehensive studies are challenging valvular calcification is heterogeneous and occurs preferentially on the aortic surface, along a fibrocalcific spectrum. Here, we review efforts to study (epi-)genomic, transcriptomic, proteomic, and metabolomic aspects of aortic valve calcification in combination with network medicine-/systems biology-based strategies to integrate multilayered omics datasets and prioritize druggable targets for experimental validation studies. Ultimately, such holistic approach efforts may open therapeutic avenues that go beyond invasive and costly valve replacement therapy.
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Affiliation(s)
- Mark C. Blaser
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Schlieren, CH
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zurich, Schlieren, CH
- Heart Division, Royal Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Hinton JV, Xing Z, Fletcher CM, Perry LA, Karamesinis A, Shi J, Ramson DM, Penny-Dimri JC, Liu Z, Coulson TG, Smith JA, Segal R, Bellomo R. Cryoprecipitate Transfusion After Cardiac Surgery. Heart Lung Circ 2023; 32:414-423. [PMID: 36528546 DOI: 10.1016/j.hlc.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The association of cryoprecipitate transfusion with patient outcomes after cardiac surgery is unclear. We aimed to investigate the predictors of, and outcomes associated with, postoperative cryoprecipitate transfusion in cardiac surgery patients. METHODS We used the Medical Information Mart for Intensive Care III and IV databases. We included adults undergoing cardiac surgery, and propensity score matched cryoprecipitate-treated patients to controls. Using the matched cohort, we investigated the association of cryoprecipitate use with clinical outcomes. The primary outcome was in-hospital mortality. Secondary outcomes were infection, acute kidney injury, intensive care unit length of stay, hospital length of stay, and chest tube output at 2-hour intervals. RESULTS Of 12,043 eligible patients, 283 (2.35%) patients received cryoprecipitate. The median dose was 5.83 units (IQR 4.17-7.24) given at a median first transfusion time of 1.75 hours (IQR 0.73-4.46) after intensive care unit admission. After propensity scoring, we matched 195 cryoprecipitate recipients to 743 controls. Postoperative cryoprecipitate transfusion was not significantly associated with in-hospital mortality (odds ratio [OR] 1.10; 99% confidence interval [CI] 0.43-2.84; p=0.791), infection (OR 0.77; 99% CI 0.45-1.34; p=0.220), acute kidney injury (OR 1.03; 99% CI 0.65-1.62; p=0.876) or cumulative chest tube output (adjusted mean difference 8 hrs post transfusion, 11 mL; 99% CI -104 to 125; p=0.804). CONCLUSIONS Although cryoprecipitate was typically given to sicker patients with more bleeding, its administration was not associated with worse outcomes. Large, multicentred studies are warranted to further elucidate cryoprecipitate's safety profile and patterns of use in cardiac surgery.
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Affiliation(s)
- Jake V Hinton
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia.
| | - Zhongyue Xing
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Calvin M Fletcher
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Vic, Australia
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia
| | - Alexandra Karamesinis
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Jenny Shi
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dhruvesh M Ramson
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia
| | - Jahan C Penny-Dimri
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia
| | - Zhengyang Liu
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Tim G Coulson
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, Monash Health, Melbourne, Vic, Australia
| | - Reny Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Vic, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Vic, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Vic, Australia
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Kim S, Seshadrinathan S, Jenkins KJ, Murala JS. Can the Public-Private Business Model Provide a Sustainable Quality Pediatric Cardiac Surgery Program in Low- and Middle-Income Countries? World J Pediatr Congenit Heart Surg 2023; 14:316-325. [PMID: 36788012 PMCID: PMC10115927 DOI: 10.1177/21501351221151057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Over 90% of the world's children with congenital heart disease do not have access to cardiac care. Although many models provide pediatric cardiac surgery in low- and middle-income countries, sustainability poses a barrier. We explore one model providing care for the underserved in Chennai, India, that came into existence through trial and error over 30 years across three phases. Phase 1 was a Tamilnadu state government-sponsored program that soon became unsustainable with unmet demands. Phase 2 utilized a grassroots foundation of a public-private partnership (PPP) with few donors and a hospital with suboptimal infrastructure. Phase 3 is the ongoing fine-tuning of the PPP model, with upgraded infrastructure and a well-trained team. Through indigenization, an average cardiac surgery costs Rupees (Rs.) 1,80,000 ($2400). The government funds Rs. 60,000 to 80,000 ($800-$1066.67), and the rest is funded through the fund pool. The goal is to perform 100 free surgeries annually by maintaining a fund pool of Rs. 50 lakhs ($66,666.67), which supplements government funds. This ensures equitable distribution of funds with no compromise on resources (disposables, single-use cannulas, etc). Our model ensures the dignity of the patient, fair compensation for workers, and is practical, affordable, and easily adaptable. Thus far, this model provided free cardiac surgery for 357 children from Risk Adjusted Congenital Heart Surgery Score of 1 to 4, with an overall mortality of 2.73%. The prerequisites for this model are having a "spark plug," a dedicated surgical team, a partnership with state-of-the-art infrastructure, and a steady flow of funds.
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Affiliation(s)
- Stephany Kim
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sreemathi Seshadrinathan
- Department of Cardiovascular and Thoracic Surgery, Public Health Centre, Chennai, Tamil Nadu, India
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John S Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Massoth C, Küllmar M, Enders D, Kellum JA, Forni LG, Meersch M, Zarbock A. Comparison of C-C motif chemokine ligand 14 with other biomarkers for adverse kidney events after cardiac surgery. J Thorac Cardiovasc Surg 2023; 165:199-207.e2. [PMID: 33832791 DOI: 10.1016/j.jtcvs.2021.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Outcomes after acute kidney injury are affected by both the severity and the duration of the insult. Patients with persistent acute kidney injury have higher major adverse kidney events, including 90-day mortality, renal replacement therapy, and persistent kidney dysfunction. Methods to identify these patients are urgently needed to improve outcomes. The purpose of this study was to evaluate whether biomarkers, including C-C motif chemokine ligand 14, were able to predict persistent acute kidney injury and major adverse kidney events after cardiac surgery. METHODS This study was a single-center, prospective, observational study. Patients who developed moderate or severe acute kidney injury (Kidney Disease Improving Global Outcomes 2 or 3) within 72 hours after cardiac surgery were enrolled with a primary end point of persistent severe acute kidney injury (Kidney Disease Improving Global Outcomes 3) lasting 72 hours or more. RESULTS A total of 100 patients were available for the primary analysis, and 37 met the primary end point. C-C motif chemokine ligand 14 was the most predictive biomarker for the primary end point with an area under the curve of 0.930 (95% confidence interval, 0.881-0.979). The area under the curve of C-C motif chemokine ligand 14 was significantly higher than the area under the curve for the other biomarkers analyzed. C-C motif chemokine ligand 14 was significantly higher in end point positive patients at enrollment (4.47 ng/mL [2.35-11.5] vs 0.67 ng/mL [0.38-1.07]; P = .001). Sensitivity and specificity were 78% and 95% at a cutoff value of 2.21 ng/mL, respectively. C-C motif chemokine ligand 14 was also highly accurate for predicting renal replacement therapy within 7 days (area under the curve, 0.915; 95% confidence interval, 0.858-0.972; P < .001). CONCLUSIONS Elevated C-C motif chemokine ligand 14 levels predict persistent acute kidney injury in cardiac surgery patients with moderate or severe acute kidney injury. This new biomarker may help stratify patients destined to receive renal replacement therapy and identify patients who may benefit from novel therapeutic approaches to acute kidney injury.
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Affiliation(s)
- Christina Massoth
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Mira Küllmar
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Dominic Enders
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - John A Kellum
- Center for Critical Care Nephrology, CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Lui G Forni
- Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Melanie Meersch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany.
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Yu J, Wang Z, Bao Q, Lei S, You Y, Yin Z, Xie X. Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019. Front Cardiovasc Med 2022; 9:1003233. [PMID: 36505369 PMCID: PMC9727398 DOI: 10.3389/fcvm.2022.1003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Calcific aortic valve disease (CAVD) was highly prevalent among developed countries and caused numerous deaths. Based on the Global Burden of Disease 2019, this study was designed to present comprehensive epidemiological information, attributable risks, and relevant factors. Methods All data were available online via the Global Health Data Exchange (GHDx). In this study, we analyzed the global incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of CAVD across different regions from 1990 to 2019. We applied the estimated annual percentage changes (EAPCs) to evaluate the change trends and their attributable risks. In addition, we explored several relevant factors. Results From 1990 to 2019, the incidence cases, prevalence cases, CAVD-related deaths, and DALYs of CAVD gradually increased globally. However, the age-standardized death rate (ASDR) was relatively stable, and the age-standardized DALYs rate gradually declined during the past 30 years. Males and elderly individuals were more likely to suffer from CAVD. High systolic blood pressure (SBP) was the predominant attributable risk of disease burden that presented a global downward trend (death: EAPC = -0.68, 95% CI -0.77~-0.59, P < 0.001; DALYs: EAPC = -0.99, 95% CI -1.09 to -0.89, P < 0.001). Alcohol consumption (R = 0.79, P < 0.001), smoking prevalence (R = 0.75, P < 0.001), and calcium (R = 0.72, P < 0.001) showed a positive correlation with the age-standardized incidence rate (ASIR), whereas classic monsoon region (R = -0.68, P < 0.001) and mean temperature (R = -0.7, P < 0.001) showed a negative correlation with age-standardized incidence rate (ASIR). Besides, medical and healthcare resources presented a positive correlation with ASIR. Meanwhile, similar relationships were found in age-standardized prevalence rate (ASPR), ASDR, and age-standardized DALY rate (ASDALYR). Conclusion CAVD displays widely varied spatial distribution around the world, of which high SDI regions have the highest burdens. Age is a powerful factor and hypertension a predominant attributable risk factor. Moreover, controlling blood pressure, avoiding smoking, reducing alcohol consumption, and so on, could effectively reduce the burden of CAVD.
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Hughes C, Djaiani G, Pungsornruk K, Agarwal S. Renal failure in cardiac surgery: in search of the magic bullet. Anaesthesia 2022; 77:1197-1201. [PMID: 36059270 DOI: 10.1111/anae.15857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Affiliation(s)
- C Hughes
- Unit of Academic Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK
| | - G Djaiani
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada
| | - K Pungsornruk
- Department of Anaesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - S Agarwal
- Department of Cardiothoracic Anaesthesia, Manchester University Hospitals, Manchester, UK.,Manchester University, Manchester, UK
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Erba N, Tosetto A, Langer M, Abdallah SA, Giovanella E, Lentini S, Masini F, Mocini A, Portella G, Salvati AC, Squizzato A, Testa S, Lip GYH, Poli D. Oral anticoagulant management of patients with mechanical heart valves at the Salam Centre of Khartoum: Observations on quality of anticoagulation and thrombotic risk. Thromb Res 2022; 219:155-161. [PMID: 36191535 DOI: 10.1016/j.thromres.2022.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Rheumatic heart disease with mechanical heart valve (MHV) replacement is common in Africa. However, MHV requires long-life anticoagulation and managing this can be challenging. METHODS AND RESULTS We report data of a prospective observational study conducted between August 2018 and September 2019 in MHV patients in the Salam Centre for Cardiac Surgery built in Khartoum, by Emergency, an Italian Non-Governmental Organization, to evaluate the quality of anticoagulation control and the risk of thrombotic complications. RESULTS We studied 3647 patients (median age 25.1 years; 53.9 % female). Median Time in Therapeutic Range (TTR) was 53 % (interquartile range 37 % to 67 %) and 70 thrombotic events (rate 1.8 × 100 pt-years [95 % CI 1.38-2.23]) were recorded. Among patients in the first quartile of TTR (≤37 %), we recorded 34/70 (48.6 %) of all thrombotic events (rate 3.7 × 100 pt-years [95 % CI 2.5-5.1]), with a high mortality rate (2.2 × 100 pt-years [95 % CI 1.3-3.3]). In patients with guideline-recommended TTR (≥65 %) the event rate was 0.8 × 100 pt-years for thrombotic events [95 % CI 0.3-1.5] and 0.4 × 100 pt-years for mortality [95 % CI 0.1-0.9]. Multivariable analysis showed that having a TTR in the lowest quartile (≤37 %) and being noncompliant are significantly associated with increased thrombotic risk. Aspirin use or different valve type did not influence the thrombotic risk. Almost 40 % of all thromboembolic complications could have been potentially prevented by further improving VKA management to obtain a TTR > 37 %. CONCLUSION The thrombotic risk of MHV patients on VKAs living in a low-income country like Sudan is associated with low quality of anticoagulation control. Efforts should be made to decrease the number of non-compliant patients and to reach a guideline-recommended TTR of ≥65 %.
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Affiliation(s)
| | | | - Martin Langer
- Medical Division, Emergency, ONG Onlus, Milan, Italy
| | | | | | | | - Franco Masini
- Medical Division, Emergency, ONG Onlus, Milan, Italy
| | | | | | | | - Alessandro Squizzato
- Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
| | - Sophie Testa
- Hemostasis and Thrombosis Center, Laboratory Medicine Department, ASST Cremona, Cremona, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniela Poli
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Zhang D, Zhou Y, Liu J, Zhu L, Wu Q, Pan Y, Zheng Z, Zha Z, Zhang J, Chen Z. Application of patient decision aids in treatment selection of cardiac surgery patients: a scoping review. Heart Lung 2022; 56:76-85. [PMID: 35810676 DOI: 10.1016/j.hrtlng.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The choice of treatment is an unavoidable challenge faced in the day to day medical decision making pertaining to patients with organic heart disease. As a professional discipline, cardiac surgery focuses on creating and using the most advanced evidence-based patient decision aids (PtDAs) to achieve high-quality decision-making. OBJECTIVES To describe the basic situation, influencing factors, and the outcome of indicators of PtDAs among cardiac surgery patients. METHODS Seven electronic databases were systematically searched for relevant reviews on the application of PtDAs among cardiac surgery patients. The methodological framework proposed by Arskey and O'Malley was used to guide the scoping review. The extracted data was analyzed qualitatively and quantitatively. RESULTS After dual, blinded screening of titles and abstracts, 12 articles were included in the review. 10 were quantitative studies, 1 was a mixed study, 1 was a qualitative study. CONCLUSIONS Compared with the burden of heart disease and the huge evidence base, the application of PtDAs in cardiac surgery is obviously insufficient. The published literature mainly provide information about the factors to be solved from the perspective of researchers, and also summarize obstacle factors. This is the basis for the application and construction of PtDAs in cardiac surgery patients.
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Affiliation(s)
- Duo Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanrong Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Juan Liu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lisi Zhu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiansheng Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youmin Pan
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhi Zheng
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengbiao Zha
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Zhang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zelin Chen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Miles LF, Pac Soo V, Braat S, Bade-Boon J, Heritier S, Klein AA, Myles PS, Richards T, Symons J, Burbury KL, Story DA. Associations between non-anaemic iron deficiency and outcomes following elective cardiac surgery (IDOCS): a prospective cohort study. Lancet Haematol 2022; 9:e514-e522. [DOI: 10.1016/s2352-3026(22)00142-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022]
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Screening and diagnostic imaging at centres performing congenital heart surgery in middle-income countries. Cardiol Young 2022; 33:780-786. [PMID: 35684953 DOI: 10.1017/s1047951122001731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting. METHODS An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed. RESULTS Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250-500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes. CONCLUSIONS Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.
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48
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Hoffman JRH, Higa KC, Lin Y, Reece TB, Cleveland JC, Aftab M, Rove JY. Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling. Semin Cardiothorac Vasc Anesth 2022; 26:154-161. [PMID: 35591803 DOI: 10.1177/10892532221101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.
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Affiliation(s)
| | - Kelly C Higa
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
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Saji M, Nanasato M. Transcatheter aortic valve replacement: a gatekeeper for improving global disparities in patients with severe aortic stenosis. Heart 2022; 108:1169-1170. [PMID: 35418485 DOI: 10.1136/heartjnl-2022-320992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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50
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Bouten CVC, Cheng C, Vermue IM, Gawlitta D, Passier R. Cardiovascular tissue engineering and regeneration: A plead for further knowledge convergence. Tissue Eng Part A 2022; 28:525-541. [PMID: 35382591 DOI: 10.1089/ten.tea.2021.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular tissue engineering and regeneration strive to provide long-term, effective solutions for a growing group of patients in need of myocardial repair, vascular (access) grafts, heart valves, and regeneration of organ microcirculation. In the past two decades, ongoing convergence of disciplines and multidisciplinary collaborations between cardiothoracic surgeons, cardiologists, bioengineers, material scientists, and cell biologists have resulted in better understanding of the problems at hand and novel regenerative approaches. As a side effect, however, the field has become strongly organized and differentiated around topical areas at risk of reinvention of technologies and repetition of approaches and across the areas. A better integration of knowledge and technologies from the individual topical areas and regenerative approaches and technologies may pave the way towards faster and more effective treatments to cure the cardiovascular system. This review summarizes the evolution of research and regenerative approaches in the areas of myocardial regeneration, heart valve and vascular tissue engineering, and regeneration of microcirculations and discusses previous and potential future integration of these individual areas and developed technologies for improved clinical impact. Finally, it provides a perspective on the further integration of research organization, knowledge implementation, and valorization as a contributor to advancing cardiovascular tissue engineering and regenerative medicine.
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Affiliation(s)
- Carlijn V C Bouten
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
| | - Caroline Cheng
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology, Department of Cardiology, Thoraxcenter Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ijsbrand M Vermue
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center, Utrecht, The Netherlands
| | - Robert Passier
- Department of Applied Stem Cell Technologies, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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