1
|
Brigham RC, Mattson AR, Iaizzo PA. Ventricular Epicardial Adipose Distribution on Human Hearts: 3-Dimensional Reconstructions and Quantitative Assessments. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10505-x. [PMID: 38625670 DOI: 10.1007/s12265-024-10505-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
Epicardial interventions have forged new frontiers in cardiac ablation and device therapies. Healthy human hearts typically present with significant adipose tissue layers superficial to the ventricular myocardium and may hinder success or increase the complexities of epicardial interventions. We quantitatively evaluated the distribution of epicardial adipose tissue on the surface of human hearts and provided high-fidelity 3-dimensional reconstructions of these epicardial adipose tissue layers. The regional thickness of adipose tissues was analyzed at 51 anatomical reference points surrounding both ventricles and compared to specific patient demographics. Adipose deposits on the human hearts displayed characteristic patterns, with the thickest accumulations along the interventricular septa (anterior, 9.01 ± 0.50 mm; posterior, 6.78 ± 0.50 mm) and the right ventricular margin (7.44 ± 0.57 mm). We provide one of the most complete characterizations of human epicardial adipose location and relative layer thickness. These results are considered fundamental for an underlying anatomic understanding when performing procedures within the pericardial space.
Collapse
Affiliation(s)
- Renee C Brigham
- Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, MN, USA
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alexander R Mattson
- Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, MN, USA
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
- Medtronic, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Departments of Biomedical Engineering and Surgery, University of Minnesota, Minneapolis, MN, USA.
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
2
|
Owodunni OP, Courville EN, Peter-Okaka U, Ricks CB, Schmidt MH, Bowers CA. Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic. Int J Obes (Lond) 2024; 48:360-369. [PMID: 38110501 DOI: 10.1038/s41366-023-01423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity is a global health challenge that affects a large proportion of adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects. Therefore, we sought to compare the discriminatory thresholds of the risk analysis index (RAI), 5-factor modified frailty index (m-FI-5) and patient age for the primary endpoint of postoperative mortality. SUBJECTS/METHODS We included spine surgery patients ≥18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classified as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for postoperative mortality. Proportional hazards risk-adjusted regressions were performed, and Hazard ratios and corresponding 95% Confidence intervals (CI) are reported. RESULTS Overall, there were 149 163 patients evaluated, and in the ROC analysis for postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95%CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95%CI 0.650-0.691), and patient age C-statistic 0.686 (95%CI 0.666-0.707). Risk-adjusted analyses were performed, and the RAI had a stepwise increasing effect size across frailty strata: typical patients HR 2.55 (95%CI 2.03-3.19), frail patients HR 3.48 (95%CI 2.49-4.86), and very frail patients HR 4.90 (95%CI 2.87-8.37). We found increasing postoperative mortality effect sizes within Clavein-Dindo complication strata, consistent across obesity categories, exponentially increasing with frailty, and multiplicatively enhanced within CD, frailty and obesity strata. CONCLUSION In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.
Collapse
Affiliation(s)
- Oluwafemi P Owodunni
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA.
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
| | - Evan N Courville
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Uchenna Peter-Okaka
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Christian B Ricks
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| |
Collapse
|
3
|
Sabe SA, Zhao A, Kononov MA, Sabra M, Li J, Ehsan A, Feng J, Sellke FW. Increased Coronary Contraction to Thromboxane A2 in Cardiac Surgery Patients With Poorly Controlled Hypertension. J Surg Res 2024; 294:249-256. [PMID: 37925953 PMCID: PMC10842473 DOI: 10.1016/j.jss.2023.10.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Cardioplegia and cardiopulmonary bypass (CP/CPB) alters coronary arteriolar response to thromboxane A2 (TXA2) in patients undergoing cardiac surgery. Comorbidities, including hypertension (HTN), can further alter coronary vasomotor tone. This study investigates the effects of HTN on coronary arteriolar response to TXA2 pre and post-CP/CPB and cardiac surgery. MATERIALS AND METHODS Coronary arterioles pre and post-CP/CPB were dissected from atrial tissue samples in patients with no HTN (NH, n = 9), well-controlled HTN (WC, n = 12), or uncontrolled HTN (UC, n = 12). In-vitro coronary microvascular reactivity was examined in the presence of TXA2 analog U46619 (10-9-10-4M). Protein expression of TXA2 receptor in the harvested right atrial tissue samples were measured by immunoblotting. RESULTS TXA2 analog U46619 induced dose-dependent contractile responses of coronary arterioles in all groups. Pre-CPB contractile responses to U46619 were significantly increased in microvessels in the UC group compared to the NH group (P < 0.05). The pre-CP/CPB contractile responses of coronary arterioles were significantly diminished post-CP/CPB among the three groups (P < 0.05), but there remained an increased contractile response in the microvessels of the UC group compared to the WC and NH groups (P < 0.05). There were no significant differences in U46619-induced vasomotor tone between patients in the NH and WC groups (P > 0.05). There were no differences in expression of TXA2R among groups. CONCLUSIONS Poorly controlled HTN is associated with increased contractile response of coronary arterioles to TXA2. This alteration may contribute to worsened recovery of coronary microvascular function in patients with poorly controlled HTN after CP/CPB and cardiac surgery.
Collapse
Affiliation(s)
- Sharif A Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Amy Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Martin A Kononov
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mohamed Sabra
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Janelle Li
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jun Feng
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
| |
Collapse
|
4
|
Hayajneh AA, Alhusban IM, Rababa M, Al-sabbah S, Bani-Hamad D, Al-Mugheed K, Al-Nusour EA, Alsatari ES. The association of traditional obesity parameters with the length of stay among patients with coronary artery disease: A cross-sectional study. Medicine (Baltimore) 2023; 102:e36731. [PMID: 38134084 PMCID: PMC10735059 DOI: 10.1097/md.0000000000036731] [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] [Received: 04/15/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
There is a strong association between obesity and coronary artery disease (CAD). Obesity is measured using traditional obesity parameters, such as body mass index, body adiposity index, waist circumference (WC), and hip circumference. The aim of this study is to explore the association between traditional obesity parameters and the length of stay (LOS) among hospitalized CAD patients. An original correlative descriptive study was carried out using secondary data analysis, in which 220 hospitalized Jordanian CAD patients were recruited from Jordan northern and middle regions. Age, WC, triglycerides, and high- sensitivity C-reactive protein were all positive predictors of the total hospital LOS among hospitalized patients with CAD. The WC, age, triglycerides, and high-sensitivity C-reactive protein levels were significantly positively associated with total LOS. Healthcare providers, including nurses, should take into account these significant positive predictors of LOS to achieve better health outcomes and improve patient satisfaction.
Collapse
Affiliation(s)
- Audai A. Hayajneh
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam M. Alhusban
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Rababa
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Shatha Al-sabbah
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Dania Bani-Hamad
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid Al-Mugheed
- Adult Health Nursing Department, College of Nursing, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Esraa A. Al-Nusour
- Prince Al Hussein Bin Abdullah II Academy for Civil Protection, AlBalqa Applied University, King Saud University Medical City, Amman, Jordan
| | | |
Collapse
|
5
|
Elliott A, Gibson S, Bauer J, Cardamis A, Davidson Z. Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting-A Point Prevalence Study. Nutrients 2023; 15:nu15102315. [PMID: 37242200 DOI: 10.3390/nu15102315] [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] [Received: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.
Collapse
Affiliation(s)
- Andrea Elliott
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Simone Gibson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Judy Bauer
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Anna Cardamis
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Zoe Davidson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| |
Collapse
|
6
|
Muacevic A, Adler JR, Ferreira T, Gonzalez J, Iacobellis G. Weight Loss Effects of Glucagon-Like Peptide-One Receptor Analog Treatment in a Severely Obese Patient During Hospital Admission. Cureus 2023; 15:e34331. [PMID: 36865977 PMCID: PMC9972903 DOI: 10.7759/cureus.34331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
Obesity is considered an independent risk factor for increased hospital length of stay and can be an obstacle to a safe discharge. Although typically prescribed in the outpatient setting, initiating glucagon-like peptide-one receptor agonists (GLP-1RAs) in the inpatient setting can be efficacious in reducing weight and increasing functional status. We report the use of GLP-1RA therapy with liraglutide and subsequent transition to subcutaneous semaglutide weekly in a 37-year-old female with severe obesity, weighing 694 lbs (314 kg) with a body mass index (BMI) of 108 kg/m2. Multiple medical and socioeconomic factors impaired the patient from being safely discharged and ultimately led to prolonged hospitalization. The patient received 31 consecutive weeks of GLP-1RA therapy in the inpatient setting along with a very low-calorie diet (800 kcal/day). Initiation and up-titration doses were completed using liraglutide for a total of five weeks. Subsequently, the patient was transitioned to receive weekly semaglutide and completed 26 weeks of therapy. At the end of week 31, the patient's weight decreased by 174 lbs (79 kg), or 25% of baseline weight, and BMI decreased from 108 to 81 kg/m2. GLP-1RAs offer a promising avenue for weight loss interventions in patients with severe obesity in addition to lifestyle modifications. The weight loss observed in our patient at the halfway point of the total treatment duration is a milestone in the pathway to gaining functional independence and meeting the criteria for future bariatric surgery. Semaglutide, a GLP-1RA, can be an effective intervention for severely obese patients with BMI greater than 100 kg/m2.
Collapse
|
7
|
Orlandi BMM, Mejia OAV, Sorio JL, de Barros E Silva P, Oliveira MAP, Nakazone MA, Tiveron MG, Campagnucci VP, Lisboa LAF, Zubelli J, Normand SL, Jatene FB. Performance of a novel risk model for deep sternal wound infection after coronary artery bypass grafting. Sci Rep 2022; 12:15177. [PMID: 36071086 DOI: 10.1038/s41598-022-19473-1] [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: 11/02/2021] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
Clinical prediction models for deep sternal wound infections (DSWI) after coronary artery bypass graft (CABG) surgery exist, although they have a poor impact in external validation studies. We developed and validated a new predictive model for 30-day DSWI after CABG (REPINF) and compared it with the Society of Thoracic Surgeons model (STS). The REPINF model was created through a multicenter cohort of adults undergoing CABG surgery (REPLICCAR II Study) database, using least absolute shrinkage and selection operator (LASSO) logistic regression, internally and externally validated comparing discrimination, calibration in-the-large (CL), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), trained between the new model and the STS PredDeep, a validated model for DSWI after cardiac surgery. In the validation data, c-index = 0.83 (95% CI 0.72–0.95). Compared to the STS PredDeep, predictions improved by 6.5% (IDI). However, both STS and REPINF had limited calibration. Different populations require independent scoring systems to achieve the best predictive effect. The external validation of REPINF across multiple centers is an important quality improvement tool to generalize the model and to guide healthcare professionals in the prevention of DSWI after CABG surgery.
Collapse
|
8
|
Yeung E, Smith S, Scharf M, Wung C, Harsha S, Lawson S, Rockwell R, Reitknecht F. BMI disparities in coronary artery bypass grafting outcomes: A single center Society of Thoracic Surgeons (STS) database analysis. Surgery in Practice and Science 2022. [DOI: 10.1016/j.sipas.2022.100110] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
9
|
Sabe SA, Kononov MA, Bellam KG, Sodha N, Ehsan A, Jackson WF, Feng J, Sellke FW. Poorly controlled hypertension is associated with increased coronary myogenic tone in patients undergoing cardiac surgery with cardiopulmonary bypass. J Thorac Cardiovasc Surg 2022; 165:e256-e267. [PMID: 36008180 PMCID: PMC9892360 DOI: 10.1016/j.jtcvs.2022.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Cardioplegia and cardiopulmonary bypass dysregulate coronary vasomotor tone, which can be further affected by common comorbidities in patients undergoing cardiac surgery. This study investigates differences in coronary myogenic tone and vasomotor responses to phenylephrine before and after cardioplegia and cardiopulmonary bypass based on hypertension history. METHODS Coronary arterioles before and after cardioplegia and cardiopulmonary bypass were dissected from atrial tissue samples in patients with no hypertension, well-controlled hypertension, or uncontrolled hypertension, as determined by documented history of hypertension, antihypertensive agent use, and clinical blood pressure measurements averaged over 1 year. Myogenic tone in response to stepwise increases in intraluminal pressure was studied between pressure steps. Microvascular reactivity in response to phenylephrine was assessed via vessel myography. Protein expression was measured with immunoblotting. RESULTS Coronary myogenic tone was significantly increased in the uncontrolled hypertension group compared with the no hypertension and well-controlled hypertension groups before cardioplegia and cardiopulmonary bypass at higher intraluminal pressures, and after cardioplegia and cardiopulmonary bypass across all intraluminal pressures (P < .05). Contractile responses to phenylephrine were significantly enhanced in patients in the uncontrolled hypertension group compared with the well-controlled hypertension group before cardioplegia and cardiopulmonary bypass, and in the uncontrolled hypertension group compared with the no hypertension and well-controlled hyertension groups after cardioplegia and cardiopulmonary bypass (P < .05). There were no differences in myogenic tone or phenylephrine-induced reactivity between the no hypertension and well-controlled hypertension groups (P > .05). There was increased expression of phosphorylated protein kinase C alpha in the uncontrolled hypertension group after cardiopulmonary bypass compared with before cardiopulmonary bypass and increased phosphorylated extracellular signal-regulated kinase 1/2 in the uncontrolled hypertension compared with the no hypertension group after cardiopulmonary bypass (P < .05). CONCLUSIONS Uncontrolled hypertension is associated with increased coronary myogenic tone and vasoconstrictive response to phenylephrine that persists after cardioplegia and cardiopulmonary bypass.
Collapse
Affiliation(s)
- Sharif A. Sabe
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - Martin A. Kononov
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - Krishna G. Bellam
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - Neel Sodha
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - Afshin Ehsan
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - William F. Jackson
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, United States
| | - Jun Feng
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| | - Frank W. Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, RI
| |
Collapse
|
10
|
Liu X, Chu H, Ji Y, Bosnjak Z, Ao H, Li T. Which BMI for Diabetes Patients is Better? From the View of the Adipose Tissue Macrophage-Derived Exosome. Diabetes Metab Syndr Obes 2022; 15:141-153. [PMID: 35046685 PMCID: PMC8763208 DOI: 10.2147/dmso.s345890] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/24/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Diabetes, as a group of metabolic diseases, can elevate blood glucose, thus leading to the development of life-threatening complications. It is difficult to define the outcome for diabetics with different BMI. This review will illustrate the adipose tissue macrophage-derived exosome in the diabetics with different BMI. PATIENTS AND METHODS Insulin resistance in peripheral tissues can cause diabetes. The peripheral tissues include liver, muscle, or the adipose depots. Communication between these organs is fatal to the maintenance of glucose homeostasis. This review will illustrate this communication. Obesity is closely linked with diabetes. There are different changes in fat distribution in diabetic patients. Adipose tissue macrophages can secrete various hormones, including adiponectin, leptin, resistin and other classical cytokines, such as TNF-α and IL-6. Studies illustrated that exosomes from the adipose tissue, can modulate inter-organ cross-talk by regulating gene expression in other tissues. RESULTS Adipose tissue macrophages exosomes links thin and fat individuals in the development of diabetes. CONCLUSION The molecular pathways initiated by exosomes such as miRNA in the situations of metabolic stress could help us gain a deeper knowledge of the pathophysiology of diabetes.
Collapse
Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
- Departments of Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Haichen Chu
- Department of Anesthesiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
| | - Yuzhi Ji
- Obstetrics, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
| | - Zeljko Bosnjak
- Departments of Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hushan Ao
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Hushan Ao Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, People’s Republic of ChinaTel/Fax +86-10-68006210 Email
| | - Tianjun Li
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People’s Republic of China
- Tianjun Li Department of Oncology, Affiliated Hospital of Qingdao University, No. 59 Haier Road, Laoshan District, Qingdao, Shandong Province, People’s Republic of ChinaTel/Fax +86-10-82913035 Email
| |
Collapse
|
11
|
Sabatino ME, Yang N, Soliman FK, Chao JC, Ikegami H, Lemaire A, Russo MJ, Lee LY. Outcomes of minimally invasive aortic valve replacement in patients with obese body mass indices. J Card Surg 2021; 37:117-123. [PMID: 34791705 DOI: 10.1111/jocs.16092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive heart valve surgery has previously been shown to be safe and feasible in obese patients. Within this population, we investigated the effect of obesity class on the patient outcomes of minimally invasive aortic valve replacement (mini-AVR). METHODS A single-center retrospective cohort study of consecutive patients with obese body mass indices (BMIs) who underwent mini-AVR between 2012 and 2020. Patients were stratified into three groups according to Centers for Disease Control and Prevention adult obesity classifications: Class I (BMI: 30.0-<35.0), Class II (BMI: 35.0-<40.0), and Class III (BMI ≥ 40.0). The primary outcomes were postoperative length of stay (LOS), 30-day mortality, and direct cost. RESULTS Among 206 obese patients who underwent mini-AVR, LOS (Class I 5 [3-7] vs. Class II 6 [5-7] vs. Class III 6 [5-7] days; p = .056), postoperative 30-day mortality (Class I 2.44% [n = 3] vs. Class II 4.44% [n = 2] vs. Class III 7.89% [n = 3]; p = .200), and costs (Class I $24,118 [$20,237-$29.591] vs. Class II $22,215 [$18,492-$28,975] vs. Class III $24,810 [$20,245-$32,942] USD; p = .683) did not differ between obesity class cohorts. CONCLUSIONS Mini-AVR is safe and feasible to perform for obese patients regardless of their obesity class. Patients with obesity should be afforded the option of minimally invasive aortic valve surgery regardless of their obesity class.
Collapse
Affiliation(s)
- Marlena E Sabatino
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - NaYoung Yang
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Fady K Soliman
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joshua C Chao
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Hirohisa Ikegami
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anthony Lemaire
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mark J Russo
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Leonard Y Lee
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| |
Collapse
|
12
|
de Kort BJ, Koch SE, Wissing TB, Krebber MM, Bouten CVC, Smits AIPM. Immuno-regenerative biomaterials for in situ cardiovascular tissue engineering - Do patient characteristics warrant precision engineering? Adv Drug Deliv Rev 2021; 178:113960. [PMID: 34481036 DOI: 10.1016/j.addr.2021.113960] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
In situ tissue engineering using bioresorbable material implants - or scaffolds - that harness the patient's immune response while guiding neotissue formation at the site of implantation is emerging as a novel therapy to regenerate human tissues. For the cardiovascular system, the use of such implants, like blood vessels and heart valves, is gradually entering the stage of clinical translation. This opens up the question if and to what extent patient characteristics influence tissue outcomes, necessitating the precision engineering of scaffolds to guide patient-specific neo-tissue formation. Because of the current scarcity of human in vivo data, herein we review and evaluate in vitro and preclinical investigations to predict the potential role of patient-specific parameters like sex, age, ethnicity, hemodynamics, and a multifactorial disease profile, with special emphasis on their contribution to the inflammation-driven processes of in situ tissue engineering. We conclude that patient-specific conditions have a strong impact on key aspects of in situ cardiovascular tissue engineering, including inflammation, hemodynamic conditions, scaffold resorption, and tissue remodeling capacity, suggesting that a tailored approach may be required to engineer immuno-regenerative biomaterials for safe and predictive clinical applicability.
Collapse
|
13
|
Fusco K, Thompson C, Woodman R, Horwood C, Hakendorf P, Sharma Y. The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study. J Clin Med 2021; 10:4382. [PMID: 34640400 DOI: 10.3390/jcm10194382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18-79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m2 admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5-29.9 kg/m2), obese (BMI 30-39.9 kg/m2) and morbidly-obese (BMI ≥ 40 kg/m2). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02-1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11-1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.
Collapse
|
14
|
Sirard S, Nault V, Langlois MF, Perron J, Valiquette L. Impact of a hospital-wide computerised approach to optimise the quality of antimicrobial prescriptions in patients with severe obesity: a quasi-experimental study. BMC Infect Dis 2021; 21:972. [PMID: 34537005 PMCID: PMC8449866 DOI: 10.1186/s12879-021-06682-8] [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: 04/09/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022] Open
Abstract
Background Rates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity. Methods This quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption. Results Overall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, −0.8% per 2-month period [95% CI −1.1 to −0.5], p < 0.001; intercept, 11.3% [95% CI 8.2 to 14.5], p < 0.001), which led to a reduction of 35% over an eight-year period (from pre-intervention level of 19.1%). Intervention 1 resulted in a downward trend in antimicrobial consumption, followed by an increasing trend after intervention 2. In these patients, the most frequent interventions made by pharmacists targeted posology (46%). Conclusions Antimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06682-8.
Collapse
Affiliation(s)
- Stéphanie Sirard
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Vincent Nault
- Medical Division, Lumed Inc., Sherbrooke, Québec, J1H 5C7, Canada
| | - Marie-France Langlois
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Québec, J1H 5N4, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, J1H 5N4, Canada
| | - Julie Perron
- Medical Division, Lumed Inc., Sherbrooke, Québec, J1H 5C7, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, J1H 5N4, Canada.
| |
Collapse
|
15
|
Senay S, Cacur O, Bastopcu M, Gullu AU, Kocyigit M, Alhan C. Robotic mitral valve operations can be safely performed in obese patients. J Card Surg 2021; 36:3126-3130. [PMID: 34148263 DOI: 10.1111/jocs.15758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/19/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Robotic cardiac surgery offers mitigated risks for obese patients requiring mitral valve surgery. We aimed to study the safety of robotic mitral surgery in the obese patient population by analyzing the outcomes of mitral surgery patients in our center for robotic cardiac surgery. METHOD This study retrospectively included 123 consecutive patients who underwent robotic mitral valve operations in a single center for robotic cardiac surgery. Patients with body mass index (BMI) ≥ 30 were compared against patients with BMI < 30 for demographic and operative parameters as well as postoperative outcomes. RESULTS Mean BMI was 33.9 ± 2.8 in the obesity group (n = 87) and 25.4 ± 2.7 in the no-obesity group (n = 36). Female gender (80.6% vs. 52.9%, p = .004), diabetes (25.0% vs. 10.3%, p = .036), and hypertension (48.6% vs. 26.4%, p = .018) were more common in patients with obesity. The obesity group was operated with similar cardiopulmonary bypass and total operative times with the no-obesity group. Postoperative drainage and blood transfusion requirements were similar between the groups. Mechanical ventilation times (6.1 ± 2.2 vs. 8.0 ± 4.4 h, p = .003) and intensive care unit stay (20.4 ± 1.6 vs. 29.4 ± 3.7, p = .027) were shorter in the obesity group. Other postoperative outcomes of infection, atrial fibrillation, hospital stay duration, and readmission rates were similar between the groups. CONCLUSION Robotic mitral surgery is safe to perform in obese patients. Obesity should not be a contraindication for robotic mitral surgery as obese patients have outcomes similar to nonobese patients despite increased challenges and risk-factors.
Collapse
Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Orkun Cacur
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Murat Bastopcu
- Department of Cardiovascular Surgery, Tatvan State Hospital, Tatvan, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| |
Collapse
|
16
|
Atik FA, Pegado HM, de Brito LMR, Macedo MT, França EP, Dias AKA, Barzilai VS, Chaves RB, Biondi RS, Monte GU, da Cunha CR. Does the anthropometric profile influence infection morbidity after coronary artery bypass grafting? J Card Surg 2021; 36:1194-1200. [PMID: 33469924 DOI: 10.1111/jocs.15334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Infection after cardiovascular surgery is multifactorial. We sought to determine whether the anthropometric profile influences the occurrence of infection after isolated coronary artery bypass grafting (CABG). METHODS Between January 2011 and June 2016, 1777 consecutive adult patients were submitted to isolated coronary artery bypass grafting. Mean age was 61.7 ± 9.8 years and 1193 (67.1%) were males. Patients were divided into four groups according to the body mass index (BMI) classification: underweight (BMI < 18.5 kg/m2 ; N = 17, 0.9%), normal range (BMI: 18.5-24.99 kg/m2 ; N = 522, 29.4%), overweight (BMI: 25-29.99 kg/m2 ; N = 796, 44.8%), and obese (BMI > 30 kg/m2 ; N = 430, 24.2%). In-hospital outcomes were compared and independent predictors of infection were obtained through multiple Poisson regression with a robust variation. RESULTS Independent predictors of any infection morbidity were female sex (relative ratio [RR], 1.47; p = .002), age > 60 years (RR, 1.85; p < .0001), cardiopulmonary bypass > 120 min (RR, 1.89; p = .0007), preoperative myocardial infarction < 30 days (RR, 1.37; p = .01), diabetes mellitus (RR, 1.59; p = .0003), ejection fraction < 48% (RR, 2.12; p < .0001), and blood transfusion (RR, 1.55; p = .0008). Among other variables, obesity, as well as diabetes mellitus, were independent predictors of superficial and deep sternal wound infection. CONCLUSIONS Other factors rather than the anthropometric profile are more important in determining the occurrence of any infection after CABG. However, surgical site infection has occurred more frequently in obese patients. Appropriate patient selection, control of modifiable factors, and application of surgical bundles would minimize this important complication.
Collapse
Affiliation(s)
- Fernando A Atik
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Hélio M Pegado
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Larissa M R de Brito
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Murilo T Macedo
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Edilson P França
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Adhamys K A Dias
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Vitor S Barzilai
- Department of Cardiology, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil.,Department of Intensive Care Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Renato B Chaves
- Department of Cardiology, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Rodrigo S Biondi
- Department of Intensive Care Medicine, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Guilherme U Monte
- Department of Cardiology, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| | - Claudio R da Cunha
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasilia, Distrito Federal, Brazil
| |
Collapse
|
17
|
Brunet A, N'Guyen Y, Lefebvre A, Poncet A, Robbins A, Bajolet O, Saade Y, Ruggieri VG, Rubin S. Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia? Vasc Health Risk Manag 2020; 16:553-559. [PMID: 33364774 PMCID: PMC7751291 DOI: 10.2147/vhrm.s264415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Obesity remains statistically associated with coronary artery disease, for which coronary artery bypass graft surgery (CABG) remains the standard of care. However, obesity is also associated with sternal wound infection (SWI) which is a severe complication of CABG despite advances in surgery and in infection prevention and control. Strategies to reduce the incidence of SWI are still being investigated, and we therefore conducted a retrospective study to revisit factors other than obesity associated with SWI after CABG. Patients and Methods Data were extracted from the medical records of 182 patients who underwent elective on-pump CABG using one or both pedicled internal mammary artery grafts in Reims University Hospital between May 2015 and May 2016. All preoperative or perioperative variables with a p value<0.10 in univariate analysis were entered into a stepwise logistic regression model. Results Among the 182 patients (145 male (79.6%), median age 68.0 [45.0-87.0] years), 138 (75.8%) underwent CABG using bilateral internal mammary artery grafts. Median BMI was 27.7 [18.7-50.5] kg/m2, and there were 51 (28.0%) and 79 (43.4%) patients with obesity and overweight, respectively. Twenty-three out of the 182 patients (12.6%) developed SWI. In-hospital mortality was not statistically different between patients with and without SWI but the median length of stay was (6.0 [2.0-38.0] versus 5.0[3.0-21.0] days in the intensive care unit, p=0.03, and 26.0 [9.0-134.0] versus 9.0 [7.0-51.0] days in hospital, p<0.0001). Obesity and preoperative anaemia were independently associated with SWI, as was the number of red blood cell (RBC) units transfused (OR 14.61 [2.64-80.75], OR 4.64 [1.61-13.34] and OR 1.27 [1.02-1.58], respectively). Conclusion The independent association of SWI with the number of RBC units transfused and the existence of preoperative anaemia and obesity suggests a mechanism of thoracic wall ischemia in SWI after CABG, thus leaving insufficient perfusion of the thoracic wall in patients with obesity. Medical strategies are warranted to try to prevent this costly complication.
Collapse
Affiliation(s)
- Aurélie Brunet
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Yohan N'Guyen
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Annick Lefebvre
- Operational Hygiene Team, Robert Debré University Hospital, Reims, France
| | - Anne Poncet
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| | - Ailsa Robbins
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Odile Bajolet
- Operational Hygiene Team, Robert Debré University Hospital, Reims, France
| | - Yves Saade
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| | | | - Sylvain Rubin
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| |
Collapse
|
18
|
Nishioka N, Ichihara N, Bando K, Motomura N, Koyama N, Miyata H, Kohsaka S, Takamoto S, Hashimoto K. Body mass index as a tool for optimizing surgical care in coronary artery bypass grafting through understanding risks of specific complications. J Thorac Cardiovasc Surg 2020; 160:409-420.e14. [DOI: 10.1016/j.jtcvs.2019.07.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 06/17/2019] [Accepted: 07/12/2019] [Indexed: 01/01/2023]
|
19
|
Mancone M, Cavalcante R, Modolo R, Falcone M, Biondi-Zoccai G, Frati G, Spitzer E, Benedetto U, Blackstone EH, Onuma Y, van Geuns RJM, Diletti R, Serruys PW. Major infections after bypass surgery and stenting for multivessel coronary disease in the randomised SYNTAX trial. EUROINTERVENTION 2020; 15:1520-1526. [PMID: 31289019 DOI: 10.4244/eij-d-19-00208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Liu X, Xie L, Zhu W, Zhou Y. Association of body mass index and all-cause mortality in patients after cardiac surgery: A dose-response meta-analysis. Nutrition 2019; 72:110696. [PMID: 32007807 DOI: 10.1016/j.nut.2019.110696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/18/2019] [Accepted: 12/01/2019] [Indexed: 12/26/2022]
Abstract
Ample studies have reported the effect of body mass index (BMI) on the prognosis of patients undergoing cardiac surgery, but the results remain inconsistent. Therefore, we aimed to conduct a dose-response meta-analysis to clarify the relationship between BMI and all-cause mortality in this population. A systematic search was performed in the PubMed and Embase databases through April 2019 for studies that reported the impact of BMI on all-cause mortality in patients after cardiac surgery. Pooled risk ratios (RRs) were calculated using a random-effects model. Non-linear associations were explored with restricted cubic spline models. Forty-one studies with a total of 54,300 cases/1,774,387 patients were included. The pooled RR for all-cause mortality was 0.93 (95% CI 0.89-0.97) for every 5-unit increment in BMI, indicating that higher BMI did not increase the risk of all-cause mortality in patients after cardiac surgery. A U-shaped association with the nadir of risk at a BMI of 25-27.5 kg/m2 was observed, as well as a higher mortality risk for the underweight and the extremely obese patients. The subgroup analysis revealed that this phenomenon remained regardless of mean age, surgery type, geographic location and number of cases. Overall, for patients after cardiac surgery, a slightly higher BMI may be instrumental in survival, whereas underweight and extreme obesity is associated with a worse prognosis.
Collapse
Affiliation(s)
- Xin Liu
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou of Jiangxi, China
| | - Lixia Xie
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yue Zhou
- Department of Pediatric Ophthalmology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China.
| |
Collapse
|
21
|
Liu X, Zhang W, Wang L, Wang S, Yu Y, Chen S, Ao H. Male patients with diabetes undergoing coronary artery bypass grafting have increased major adverse cerebral and cardiovascular events. Interact Cardiovasc Thorac Surg 2019; 28:607-612. [PMID: 30325425 DOI: 10.1093/icvts/ivy287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The role of body mass index (BMI) in the prognosis of patients with diabetes undergoing coronary artery bypass grafting (CABG) has been of great interest for a long time. However, the precise relationship between BMI and major adverse cerebral and cardiovascular events (MACCEs) in these patients is still unclear. The goal of this study was to investigate the outcome of patients with diabetes with different BMIs undergoing CABG and the results from the 5-year follow-up. METHODS This study included 771 patients with diabetes undergoing CABG from 1 January 2003 to 31 December 2009. They were classified based on the Chinese standard for BMI as follows: underweight: <18.5 kg/m2; normal weight: 18.5-23.9 kg/m2; overweight: 24-27.9 kg/m2; and obese: >28 kg/m2. Short-term outcomes and 5-year MACCEs were compared among various BMI groups after surgery. RESULTS Obese and overweight patients with diabetes tended to be younger than normal weight patients [57 years (49-64) vs 62 years (54-68) and 64 years (59-69); P < 0.001]. There were fewer male patients (25.20% vs 17.78% and 16.54%, P = 0.041). More smokers were in the 2 groups (38.8% vs 51.55% and 57.14%, P < 0.001). Glucose concentration was highest in the overweight group [6.40 (5.40-7.80) vs 6.96 (5.69-8.22) and 6.80 (5.90-8.40); P = 0.041)]. Cox regression analysis of the 5-year follow-up data indicated that various BMI groups were not associated with significant differences in 5-year MACCEs; however, male sex was the risk factor for MACCEs (hazard ratio 1.83, 95% confidence interval 1.11-3.04; P = 0.019). CONCLUSIONS The BMI of the patients with diabetes undergoing CABG had no effect on MACCEs. Male sex was the risk factor in these patients.
Collapse
Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, The First affiliated Hospital, Nanchang University, Nanchang, China
| | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- The Department of Information Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
22
|
Michaels AD, Mehaffey JH, Hawkins RB, Kern JA, Schirmer BD, Hallowell PT. Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis. Surg Endosc 2019; 34:2638-2643. [DOI: 10.1007/s00464-019-07036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
|
23
|
Zhang K, Wang J, Yang Y, An R. Adiposity in relation to readmission and all-cause mortality following coronary artery bypass grafting: A systematic review and meta-analysis. Obes Rev 2019; 20:1159-1183. [PMID: 30945439 DOI: 10.1111/obr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
This study systemically reviewed evidence linking adiposity to readmission and all-cause mortality in post-coronary artery bypass grafting (CABG) patients. Keyword/reference search was performed in PubMed, Web of Science, CINAHL, and Cochrane Library for articles published before June, 2018. Eligibility criteria included study designs: experimental/observational studies; subjects: adult patients undergoing CABG; and outcomes: hospital/clinic readmissions, and short-term (≤30 days) and mid-to-long-term (>30 days) all-cause mortality. Seventy-two studies were identified. Meta-analysis showed that the odds of post-CABG readmission among patients with overweight was 30% lower than their normal-weight counterparts and the odds of mid-to-long-term post-CABG mortality among patients with overweight were 20% lower than their normal-weight counterparts. In contrast, no difference in post-CABG readmission rate was found between patients with obesity and their nonobese counterparts; no difference in short-term or in-hospital post-CABG mortality rate was found between patients with overweight or obesity and their normal-weight counterparts; and no difference in mid-to-long-term post-CABG mortality rate was found between patients with obesity and their normal-weight counterparts. In conclusion, patients with overweight but not obesity had a lower readmission and mid-to-long-term mortality rate following CABG relative to their normal-weight counterparts. Preoperative weight loss may not be advised to patients with overweight undergoing CABG.
Collapse
Affiliation(s)
- Kefeng Zhang
- Beijing Aortic Disease Center, Beijing Anzhen Hospital, Beijing, Capital Medical University, Beijing, China
| | - Junjie Wang
- Department of Physical Education, Dalian University of Technology, Dalian, Liaoning, China
| | - Yan Yang
- Cabot Microelectronics, Aurora, Illinois, USA
| | - Ruopeng An
- Guangzhou Sport University, Guangzhou, Guangdong, China.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.,Brown School, Washington University, St. Louis, Missouri, USA
| |
Collapse
|
24
|
Cromhout PF, Berg SK, Moons P, Damgaard S, Nashef S, Thygesen LC. Updating EuroSCORE by including emotional, behavioural, social and functional factors to the risk assessment of patients undergoing cardiac surgery: a study protocol. BMJ Open 2019; 9:e026745. [PMID: 31272975 PMCID: PMC6615815 DOI: 10.1136/bmjopen-2018-026745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Conventional risk assessment in cardiac surgery focus on medical and physiological factors and have been developed to predict mortality. Other relevant risk factors associated with increased risk of poor outcomes are not included. Adding non-medical variables as potential prognostic factors to risk assessments direct attention away from specific diagnoses towards a more holistic view of the patients and their predicament. The aim of this paper is to describe the method and analysis plan for the development and validation of a prognostic screening tool as a supplement to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality, readmissions and prolonged length of admission in patients within 90 days after cardiac surgery, as individual outcomes. METHODS AND ANALYSIS The development of a prognostic screening tool with inclusion of emotional, behavioural, social and functional factors complementing risk assessment by EuroSCORE will adopt the methods recommended by the PROGnosis RESearch Strategy Group and report using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. In the development stage, we will use data derived from three datasets comprising 1143, 3347 and 982 patients for a prospective cohort study of patients undergoing cardiac surgery, respectively. We will construct logistic regression models to predict mortality, prolonged length of admission and 90-day readmissions. In the validation stage, we will use data from a separate sample of 333 patients planned to undergo cardiac surgery to assess the performance of the developed prognostic model. We will produce validation plots showing the overall performance, area under the curve statistic for discrimination and the calibration slope and intercept. ETHICS AND DISSEMINATION The study will follow the requirements from the Ethical Committee System ensuring voluntary participation in accordance with the Helsinki declarations. Data will be filed in accordance with the requirements of the Danish Data Protection Agency.
Collapse
Affiliation(s)
| | - Selina Kikkenborg Berg
- Heart Centre, Rigshospitalet, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenborg, Gothenborg, Sweden
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
25
|
Doumouras BS, Fan CS, Mueller B, Dipchand AI, Manlhiot C, Stehlik J, Ross HJ, Alba AC. The effect of pre–heart transplant body mass index on posttransplant outcomes: An analysis of the ISHLT Registry Data. Clin Transplant 2019; 33:e13621. [DOI: 10.1111/ctr.13621] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Barbara S. Doumouras
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre University Health Network, University of Toronto Toronto Ontario Canada
| | - Chun‐Po S. Fan
- Cardiovascular Data Management Centre, The Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Brigitte Mueller
- Cardiovascular Data Management Centre, The Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Anne I. Dipchand
- Labatt Family Heart Centre, The Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Cedric Manlhiot
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre University Health Network, University of Toronto Toronto Ontario Canada
- Cardiovascular Data Management Centre, The Hospital for Sick Children University of Toronto Toronto Ontario Canada
| | - Josef Stehlik
- Division of Cardiovascular Medicine University of Utah Health Salt Lake City Utah USA
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre University Health Network, University of Toronto Toronto Ontario Canada
| | - Ana C. Alba
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre University Health Network, University of Toronto Toronto Ontario Canada
| |
Collapse
|
26
|
Dereppe H, Verbeke M, Debruxelles C, Boucq E, Ponzoni L, Cuvelier G. Energy expenditure of household activities and cardiorespiratory fitness in women with obesity. Clin Obes 2018; 8:391-397. [PMID: 30231189 DOI: 10.1111/cob.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- H Dereppe
- Service de Cardiologie, CHWAPI - Centre d'Orthonutrition, Tournai, Belgium
| | - M Verbeke
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - C Debruxelles
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - E Boucq
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - L Ponzoni
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - G Cuvelier
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| |
Collapse
|
27
|
De Santo LS, Moscariello C, Zebele C. Implications of obesity in cardiac surgery: pattern of referral, physiopathology, complications, prognosis. J Thorac Dis 2018; 10:4532-4539. [PMID: 30174906 DOI: 10.21037/jtd.2018.06.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/21/2023]
Abstract
A U-shaped relationship between body mass index (BMI) and outcomes emerged after cardiac surgery. This review analyses the physio pathologic basis of obesity related complications and evaluates prognostic implications. Both leaner and morbid obese should be considered pre-operatively rather than reactively and, when referred for elective surgery, should undergo a focused metabolic status management, and a thorough evaluation of health status. Adherence to sound surgical principles, and tailored patient blood management and perioperative care are mandatory.
Collapse
Affiliation(s)
- Luca Salvatore De Santo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Caesar Moscariello
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| | - Carlo Zebele
- Division of Cardiac Surgery, Casa di Cura Montevergine, GVM Care & Research, Mercogliano, AV, Italy
| |
Collapse
|
28
|
Cromhout PF, Moons P, Thygesen LC, Nashef S, Damgaard S, Berg SK. Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters. Eur J Cardiovasc Nurs 2018; 17:760-766. [DOI: 10.1177/1474515118783835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.
Collapse
Affiliation(s)
- Pernille F Cromhout
- Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Selina Kikkenborg Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| |
Collapse
|
29
|
Litton E, Ridley EJ, Delaney A. Cardiac Surgery and the Low Hanging Fruit of Perioperative Nutritional Interventions. J Cardiothorac Vasc Anesth 2018; 32:1254-1255. [PMID: 29398372 DOI: 10.1053/j.jvca.2017.12.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Edward Litton
- Fiona Stanley Hospital, Perth, WA, Australia; St John of God Hospital, Subiaco, Perth, WA, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre Monash University, Melbourne, Victoria, Australia
| | - Anthony Delaney
- Australian and New Zealand Intensive Care Research Centre Monash University, Melbourne, Victoria, Australia; Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, St Leondards, NSW, Australia
| |
Collapse
|
30
|
Terada T, Forhan M, Norris CM, Qiu W, Padwal R, Sharma AM, Nagendran J, Johnson JA. Differences in Short- and Long-Term Mortality Associated With BMI Following Coronary Revascularization. J Am Heart Assoc 2017; 6:e005335. [PMID: 28411242 PMCID: PMC5533024 DOI: 10.1161/jaha.116.005335] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between obesity and mortality risks following coronary revascularization is not clear. We examined the associations of BMI (kg/m2) with short-, intermediate-, and long-term mortality following coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with different coronary anatomy risks and diabetes mellitus status. METHODS AND RESULTS Data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry were analyzed. Using normal BMI (18.5-24.9) as a reference, multivariable-adjusted hazard ratios for all-cause mortality within 6 months, 1 year, 5 years, and 10 years were individually calculated for CABG and PCI with 4 prespecified BMI categories: overweight (25.0-29.9), obese class I (30.0-34.9), obese class II (35.0-39.9), and obese class III (≥40.0). The analyses were repeated after stratifying for coronary risks and diabetes mellitus status. The cohorts included 7560 and 30 258 patients for CABG and PCI, respectively. Following PCI, overall mortality was lower in patients with overweight and obese class I compared to those with normal BMI; however, 5- and 10-year mortality rates were significantly higher in patients with obese class III with high-risk coronary anatomy, which was primarily driven by higher mortality rates in patients without diabetes mellitus (5-year adjusted hazard ratio, 1.78 [95% CI, 1.11-2.85] and 10-year adjusted hazard ratio, 1.57 [95% CI, 1.02-2.43]). Following CABG, overweight was associated with lower mortality risks compared with normal BMI. CONCLUSIONS Overweight was associated with lower mortality following CABG and PCI. Greater long-term mortality in patients with obese class III following PCI, especially in those with high-risk coronary anatomy without diabetes mellitus, warrants further investigation.
Collapse
Affiliation(s)
- Tasuku Terada
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen M Norris
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
- Department of Surgery, Mazankowski Alberta Heart Institute, Alberta Health Services, Edmonton, Canada
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Raj Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Surgery, Mazankowski Alberta Heart Institute, Alberta Health Services, Edmonton, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|