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Ishibashi H, Enomoto Y, Takaoka S, Aoki K, Nagai H, Yamagata K, Ishibashi-Kanno N, Uchida F, Fukuzawa S, Tabuchi K, Bukawa H, Suzuki Y, Yanagawa T. Analysis of predictors of fever after aortic valve replacement: Diabetic patients are less likely to develop fever after aortic valve replacement, a single-centre retrospective study. J Perioper Pract 2024:17504589241232503. [PMID: 38590001 DOI: 10.1177/17504589241232503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Postoperative temperature dysregulation affects the length of hospital stay and prognosis. This study evaluated the factors that influence the occurrence of fever in patients after aortic valve replacement surgery. METHODS Eighty-seven consecutive patients who underwent aortic valve replacement surgery were included. Patients' age, sex and body mass index; presence of diabetes mellitus; operation time; blood loss; blood transfusion volume; preoperative and postoperative laboratory findings; presence or absence of oral function management; and fever >38°C were retrospectively analysed through univariate and multiple logistic regression analyses. RESULTS Among the variables, only diabetes mellitus status was significantly associated with fever ⩾38°C. Postoperatively, patients with diabetes mellitus were significantly less likely to develop fever above 38°C and a fever rising to 38°C. CONCLUSIONS This study shows that the presence of comorbid diabetes mellitus decreases the frequency of developing fever >38°C after aortic valve replacement surgery.
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Affiliation(s)
- Hiroshi Ishibashi
- Doctoral program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
- Department of Cardiology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Yoshiharu Enomoto
- Department of Cardiovascular Surgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Shohei Takaoka
- Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kazuhiro Aoki
- Department of Cardiology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hiroki Nagai
- Department of Oral and Maxillofacial Surgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kenji Yamagata
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naomi Ishibashi-Kanno
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumihiko Uchida
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Fukuzawa
- Department of Oral and Maxillofacial Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Katsuhiko Tabuchi
- Department of Molecular and Cellular Physiology, School of Medicine, Shinshu University, Matsumoto, Japan
| | - Hiroki Bukawa
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
- Department of Cardiovascular Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toru Yanagawa
- Department of Oral and Maxillofacial Surgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
- Department of Oral and Maxillofacial Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Wang L, Wu K, Ou W, Su X, Sun G, Wang W, Xu Q, Wang B. Transcatheter aortic valve implantation for patients with heyde syndrome: A literature review of case reports. Heliyon 2023; 9:e17952. [PMID: 37539190 PMCID: PMC10395290 DOI: 10.1016/j.heliyon.2023.e17952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Objective A systematic review of international case reports of patients with Heyde syndrome (HS) treated by transcatheter aortic valve implantation (TAVI) was conducted to explore the clinical characteristics of this group of patients and sirgical success. Methods: Electronic databases, including PubMed, Embase and CNKI, were searched with combinations of the search terms, Heyde syndrome, gastrointestinal bleeding, aortic stenosis, angiodysplasia and transcatheter aortic valve replacement. All case reports were screened according to inclusion criteria, and HS patient data was summarized. Results A total of 31 case reports concerned patients with a history of aortic stenosis and repeated gastrointestinal bleeding. Ultrasonic cardiograms (UCG) were recorded for 27 cases, including those with critical aortic stenosis (n = 26). Gastrointestinal sequelae were reported in 22 cases with duodenal and jejunal being the most common (n = 9). High-molecular-weight multimers of von Willebrand Factor (vWF-HMWM) were measured in 17 cases with the majority being lower (n = 15) and the minority normal (n = 2). All patients experienced recurrent bleeding after medication and endoscopic therapy and symptoms improved after TAVI (31/31). vWF was at normal levels in 11/12 cases post-TAVI. Twenty-five patients were followed up and 22 had no recurrence of symptoms giving an efficacy rate of 88% for TAVI in HS patients. Conclusions HS is characterized by angiodysplasia, aortic stenosis and von Willebrand disease with frequent recurrence of bleeding after drug and endoscopic treatment. TAVI is an effective therapy with an 88% resolution rate.
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Affiliation(s)
- Lilan Wang
- School of Medicine, Xiamen University. Xiamen 361005, China. Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Kaimin Wu
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Weimei Ou
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Xin Su
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Guangfeng Sun
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Weimin Wang
- School of Medicine, Xiamen University. Xiamen 361005, China. Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Qiaoru Xu
- School of Medicine, Xiamen University. Xiamen 361005, China. Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
| | - Bin Wang
- School of Medicine, Xiamen University. Xiamen 361005, China. Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, 361000, China
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Lu C, Zhang Y. Gastrointestinal bleeding during the transcatheter aortic valve replacement perioperative period: A Review. Medicine (Baltimore) 2022; 101:e31953. [PMID: 36482568 PMCID: PMC9726417 DOI: 10.1097/md.0000000000031953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With the aging of the population, the incidence of senile degenerative valvular heart disease is expected to increase. Transcatheter aortic valve replacement (TAVR) has been used for patients at lower surgical risk with symptomatic severe aortic valve stenosis. Because of the improvements in TAVR technology and increasing experience of the operators, TAVR is regarded as a safe and feasible procedure. Bleeding events during the TAVR perioperative period, especially gastrointestinal (GI) bleeding, have been proven to be related to the long-term prognosis and mortality. Elderly patients with valvular heart disease are susceptible to GI bleeding because of their use of antithrombotic drugs, physical damage of coagulation factors, and GI angiodysplasia. Frequent GI bleeding and low levels of preoperative hemoglobin increase the risk of TAVR, especially for elderly patients. Because of these risks, which are easily overlooked, we should focus more attention on the perioperative management of TAVR. Reasonable screening tools, including blood examinations, risk evaluation scales, and endoscopy, are beneficial to the prevention of complications that can occur during the perioperative period. Additionally, medical therapy can safely help patients at high-risk for bleeding patients throughout the perioperative period. This study aimed to characterize the pathology of TAVR patients and discuss treatment strategies for GI bleeding during the perioperative period.
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Affiliation(s)
- Chuan Lu
- From the Second Hospital of Dalian Medicial University, Shahekou District, Dalian City, China
| | - Yue Zhang
- From the Second Hospital of Dalian Medicial University, Shahekou District, Dalian City, China
- * Correspondence: Yue Zhang, From the Second Hospital of Dalian Medicial University, 467 Zhongshan Road, Shahekou District, Dalian city, China (e-mail: )
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Jamil D, Tran HHV, Mansoor M, Bbutt SR, Satnarine T, Ratna P, Sarker A, Ramesh AS, Munoz Tello C, Mohammed L. Multimodal Treatment and Diagnostic Modalities in the Setting of Heyde’s Syndrome: A Systematic Review. Cureus 2022; 14:e28080. [PMID: 36127959 PMCID: PMC9477546 DOI: 10.7759/cureus.28080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022] Open
Abstract
Heyde’s syndrome encompasses the triad of aortic stenosis (AS), angiodysplasia, and acquired Von Willebrand's disease (aVWD). The disease itself is a rare association that affects a small subset of patients who suffer from aortic stenosis. Nonetheless, it represents a vital area of clinical interest and is woefully underreported in the literature. Patients with Heyde’s syndrome develop gastrointestinal bleeding (GI) as a result of angiodysplasia and due to lack of adequate hemostasis, they tend to be positively predisposed toward developing gastrointestinal hemorrhage. Due to the glaring lack of comprehensive literature on Heyde's syndrome, this systematic review aims to bridge the gap by elucidating the various diagnostic and treatment options available to clinicians for Heyde’s syndrome patients as well as to give a detailed account of the pathophysiology of the disease. This systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Google Scholar, Gulf Medical University (GMU) e-library, and PubMed were thoroughly searched for studies done in the last 10 years, which corresponds with our outlined inclusion and exclusion criteria. Relevant studies were then selected on the basis of their abstracts and titles. These studies then underwent a comprehensive quality assessment in which any papers which did not meet this study’s eligibility criteria were omitted. Overall, 18 studies fulfilled the criteria of this systematic review.
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Virk ZM, Song AB, Badran YR, Al-Samkari H. Systemic bevacizumab as salvage therapy for persistent severe bleeding and anemia in heyde syndrome following aortic valve replacement. J Thromb Thrombolysis 2022; 54:255-259. [PMID: 35829837 DOI: 10.1007/s11239-022-02677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
Heyde syndrome is characterized by the co-occurrence of aortic stenosis and bleeding gastrointestinal angiodysplasias, often with acquired von Willebrand syndrome. Current management for bleeding includes hematologic support with red cell transfusion and intravenous iron and correction of aortic stenosis with valve replacement. However, persistent Heyde syndrome after valve replacement occurs in a significant minority of cases, and there is no accepted therapy for these patients. Given that the pathophysiology of angiodysplasia formation in Heyde syndrome involves dysregulated angiogenesis, targeting angiogenesis may be an effective therapeutic option. We describe two cases of persistent Heyde syndrome with severe bleeding and anemia in patients following aortic valve replacement who were treated with systemic bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor. In both cases, treatment was successful, with resolution of bleeding, liberation from hematologic support, and normalization of hemoglobin. In addition to responding to therapy, neither patient had treatment-related adverse events (and both had recurrent anemia upon treatment discontinuation, further evidence of the therapeutic impact of bevacizumab). Additional investigation into the use of systemic antiangiogenic therapy for treatment of Heyde syndrome is warranted.
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Affiliation(s)
| | - Andrew B Song
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yousef R Badran
- Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Hanny Al-Samkari
- Harvard Medical School, Boston, MA, USA.
- Division of Hematology, Massachusetts General Hospital, Suite 118, Room 112, Zero Emerson Place, Boston, MA, 02114, USA.
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Brown JA, Sultan I, Lewis J, Thoma F, Kliner D, Serna-gallegos D, Sanon S, Mulukutla S, Navid F, Toma C. Impact of Transcatheter Aortic Valve Implantation on Severe Gastrointestinal Bleeding in Patients With Aortic Stenosis. Am J Cardiol 2022. [DOI: 10.1016/j.amjcard.2022.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/18/2022]
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Ali H, Bolick NL, Pamarthy R, Farooq MF, Farooq MH, Eslam A. Inpatient outcomes of Dieulafoy’s lesions in the United States. Proc AMIA Symp 2022; 35:291-296. [DOI: 10.1080/08998280.2022.2043806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | | | - Rahul Pamarthy
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | - Muhammad Fahd Farooq
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, North Carolina
| | | | - Ali Eslam
- Department of Gastroenterology, East Carolina University/Vidant Medical Center, Greenville, North Carolina
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Reardon B, Pasalic L, Favaloro EJ. The Intriguing Relationships of von Willebrand Factor, ADAMTS13 and Cardiac Disease. J Cardiovasc Dev Dis 2021; 8:jcdd8090115. [PMID: 34564132 PMCID: PMC8468839 DOI: 10.3390/jcdd8090115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 12/26/2022] Open
Abstract
von Willebrand factor (VWF) is an adhesive protein involved in primary hemostasis and facilitates platelet adhesion to sites of vascular injury, thereby promoting thrombus formation. VWF exists in plasma as multimers of increasing size, with the largest (high molecular weight; HMW) expressing the greatest functional activity. A deficiency of VWF is associated with a bleeding disorder called von Willebrand disease (VWD), whereas an excess of VWF, in particular the HMW forms, is associated with thrombosis. ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif-13), also known as VWF-cleaving protease, functions to moderate the activity of VWF by cleaving multimers of VWF and limiting the expression of the largest multimers of VWF. A deficiency of ADAMTS13 is therefore associated with an excess of (HMW forms of) VWF, and thus thrombosis. Indeed, any disturbance of the VWF/ADAMTS13 ratio or ‘axis’ may be associated with pathophysiological processes, including prothrombotic tendency. However, both thrombosis or bleeding may be associated with such disturbances, depending on the presenting events. This review evaluates the relationship of VWF and ADAMTS13 with cardiac disease, including cardiac failure, and associated pathophysiology.
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Affiliation(s)
- Benjamin Reardon
- Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW 2145, Australia; (B.R.); (L.P.)
| | - Leonardo Pasalic
- Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW 2145, Australia; (B.R.); (L.P.)
- NSW Health Pathology, Westmead, NSW 2145, Australia
- Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Emmanuel J. Favaloro
- Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Westmead, NSW 2145, Australia; (B.R.); (L.P.)
- NSW Health Pathology, Westmead, NSW 2145, Australia
- Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW 2145, Australia
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia
- Correspondence: ; Tel.: +61-2-8890-6618
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