ABSTRACT
@#Objective To provide experience for clinical diagnosis and treatment through exploring the perioperative characteristics and short-term treatment outcomes of adult cardiac surgery in patients with prior coronavirus disease-2019 (COVID-19). Methods A retrospective analysis was performed on patients undergoing coronary artery bypass grafting (CABG) or valve surgery in the Department of Cardiac Surgery of Beijing Anzhen Hospital from December 26, 2022 to December 31, 2022, and previously diagnosed with COVID-19 before surgery. Results Finally 108 patients were collected, including 81 males and 27 females, with an average age of 60.73±8.66 years. Two (1.9%) patients received emergency surgery, and the others received elective surgery. The 86.1% of patients had been vaccinated, and the duration of COVID-19 was 5.0 (4.0, 7.0) days. The time from COVID-19 to operation was 15.0 (12.0, 17.8) days. Eighty-nine patients received CABG, of which off-pump CABG was dominant (92.1%). Nineteen patients received valve surgery. The rate of delayed extubation of ventilator was 17.6%. The ICU stay was 21.0 (17.3, 24.0) hours, and the postoperative hospital stay was 7.0 (6.0, 8.0) days. Three (2.8%) patients were treated with intra-aortic balloon pump (IABP), one (0.9%) patient was treated with extracorporeal membrane oxygenation (ECMO), one (0.9%) patient was treated with continuous renal replacement therapy (CRRT) due to acute renal insufficiency, three (2.8%) patients were treated with temporary pacemaker, and one (0.9%) patient underwent rethoracotomy. In terms of postoperative complications, the incidence of cerebrovascular accident, acute renal insufficiency, gastrointestinal bleeding and septicemia was 0.9%, respectively, and the incidence of acute heart failure, lung infection, and liver insufficiency was 1.9%, respectively. All patients recovered and were discharged from hospital, and no in-hospital death occurred. Conclusion The utilization rate of postoperative IABP, ECMO, CRRT, temporary pacemaker and the incidence of serious complications in patients with prior COVID-19 are not higher than those of normal patients, and the short-term treatment outcome is good.
ABSTRACT
Objective: The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery. Design: The study was a double-blinded randomized study. Setting: This study was conducted at a cardiac center. Patients: The study included 250 patients. Intervention: The study included two groups (each = 125): Group M – the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C – the patients who received an equal amount of normal saline. Measurements: The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support. Main Results: The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C (P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C (P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C (P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C (P < 0.05). Conclusion: The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.
ABSTRACT
Aims and Objectives: To validate European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for predicting mortality and STS risk-score for predicting morbidity in Indian patients after cardiac surgery. Materials and Methods: EuroSCORE II and STS risk-scores were obtained pre-operatively for 498 consecutive patients. The patients were followed for mortality and various morbidities. The calibration of the scoring systems was assessed using Hosmer-Lemeshow test. The discriminative capacity was estimated by area under receiver operating characteristic (ROC) curves. Results: The mortality was 1.6%. For EuroSCORE II and STS risk-score C-statics of 5.43 and 6.11 were obtained indicating satisfactory model fit for both the scores. Area under ROC was 0.69 and 0.65 for EuroSCORE II and STS risk-score with P values of 0.068 and 0.15, respectively, indicating poor discriminatory power. Good fit and discrimination was obtained for renal failure, long-stay in hospital, prolonged ventilator support and deep sternal wound infection but the scores failed in predicting risk of reoperation and stroke. Mortality risk was correctly estimated in low (< 2%) and moderate (2-5%) risk patients, but over-estimated in high-risk (> 5%) patients by both scoring systems. Conclusions: EuroSCORE II and STS risk-scores have satisfactory calibration power in Indian patients but their discriminatory power is poor. Mortality risk was over-estimated by both the scoring systems in high-risk patients. The present study highlights the need for forming a national database and formulating risk stratification tools to provide better quality care to cardiac surgical patients in India.