|
1
|
Taghizadeh-Waghefi A, Petrov A, Arzt S, Alexiou K, Tugtekin SM, Matschke K, Kappert U, Wilbring M. Clinical Outcomes after Multivalve Surgery in Octogenarians: Evaluating the Need for a Paradigm Shift. J Clin Med 2024; 13:745. [PMID: 38337441 PMCID: PMC10856504 DOI: 10.3390/jcm13030745] [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: 12/01/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: this study addresses the lack of comprehensive research on outcomes in octogenarians undergoing cardiac surgery for multivalvular disease, emphasizing the need for a critical examination of the intervention's overall worth in this aging population. (2) Methods: By analyzing short-term and mid-term data from 101 consecutive octogenarian patients undergoing multivalve surgery, the study identifies predictors for in-hospital and one-year mortality. (3) Results: In-hospital mortality increased fourfold with the occurrence of at least one postoperative complication. Octogenarians undergoing multivalve surgery experienced an in-hospital mortality rate of 13.9% and an overall one-year mortality rate of 43.8%. Postoperative delirium was identified as an independent risk factor, contributing to elevated risks of both in-hospital and one-year mortality. Prolonged surgical procedure time emerged as an independent risk factor associated with increased in-hospital mortality. Continuous veno-venous hemodialysis showed an independent impact on in-hospital mortality. Both re-intubation and the transfusion of packed red blood cells were identified as independent risk factors for one-year mortality. (4) Conclusions: This study urges a critical examination of the justification for multivalve surgeries in high-risk elderly patients, emphasizing a paradigm shift. It advocates for interdisciplinary collaboration and innovative strategies, such as staged hybrid procedures, to improve therapeutic approaches for this challenging patient group to achieve a better therapeutic outcome for these patients.
Collapse
Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Sems-Malte Tugtekin
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| |
Collapse
|
|
2
|
Saha S, Mladenova R, Radner C, Horke KM, Buech J, Schnackenburg P, Ali A, Peterss S, Juchem G, Luehr M, Hagl C, Joskowiak D. Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis. J Clin Med 2022; 11:jcm11133599. [PMID: 35806881 PMCID: PMC9267565 DOI: 10.3390/jcm11133599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.
Collapse
Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
- Correspondence: author:
| | - Ralitsa Mladenova
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
| | - Caroline Radner
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Konstanze Maria Horke
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| |
Collapse
|
|
3
|
Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era. J Clin Med 2022; 11:jcm11123418. [PMID: 35743488 PMCID: PMC9225107 DOI: 10.3390/jcm11123418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.
Collapse
|
|
4
|
Effect of Different Nursing Interventions on Discharged Patients with Cardiac Valve Replacement Evaluated by Deep Learning Algorithm-Based MRI Information. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6331206. [PMID: 35360270 PMCID: PMC8960021 DOI: 10.1155/2022/6331206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
This study was aimed to explore the application of cardiac magnetic resonance imaging (MRI) image segmentation model based on U-Net in the diagnosis of a valvular heart disease. The effect of continuous nursing on the survival of discharged patients with cardiac valve replacement was analyzed in this study. In this study, the filling completion operation, cross entropy loss function, and guidance unit were introduced and optimized based on the U-Net network. The heart MRI image segmentation model ML-Net was established. We compared the Dice, Hausdorff distance (HD), and percentage of area difference (PAD) values between ML-Net and other algorithms. The MRI image features of 82 patients with valvular heart disease who underwent cardiac valve replacement were analyzed. According to different nursing methods, they were randomly divided into the control group (routine nursing) and the intervention group (continuous nursing), with 41 cases in each group. The Glasgow Outcome Scale (GOS) score and the Self-rating Anxiety Scale (SAS) were compared between the two groups to assess the degree of anxiety of patients and the survival status at 6 months, 1 year, 2 years, and 3 years after discharge. The results showed that the Dice coefficient, HD, and PAD of the ML-Net algorithm were (0.896 ± 0.071), (5.66 ± 0.45) mm, and (15.34 ± 1.22) %, respectively. The Dice, HD, and PAD values of the ML-Net algorithm were all statistically different from those of the convolutional neural networks (CNN), fully convolutional networks (FCN), SegNet, and U-Net algorithms (P < 0.05). Atrial, ventricular, and aortic abnormalities can be seen in MRI images of patients with valvular heart disease. The cardiac blood flow signal will also be abnormal. The GOS score of the intervention group was significantly higher than that of the control group (P < 0.01). The SAS score was lower than that of the control group (P < 0.05). The survival rates of patients with valvular heart disease at 6 months, 1 year, 2 years, and 3 years after discharge were significantly higher than those in the control group (P < 0.05). The abovementioned results showed that an effective segmentation model for cardiac MRI images was established in this study. Continuous nursing played an important role in the postoperative recovery of discharged patients after cardiac valve replacement. This study provided a reference value for the diagnosis and prognosis of valvular heart disease.
Collapse
|