The clinical characteristics and surgical prognosis of Beh?et′s disease with heart valve involvement and literature review / 中华风湿病学杂志

Objective:To investigate the clinical characteristics and treatment of Beh?et′s disease complicated with cardiac valve involvement.Methods:We searched the wanfang medical database and Medline database to reviewed the domestic and foreign literature reports on cardiac Beh?et′s disease and analyzed their clinical features and therapeutic strategies. Chi-squared test was used for data analysis.Results:It was shown that Beh?et′s disease with cardiac valve involvement mainly affect men. The male to female ratio was 3.86∶1 in China and 2.50∶1 in foreign patients( χ2=1.32, P=0.251). The preoperative diagnosis rate was not high(60.3% in China, 57.1% abroad) ( χ2=0.13, P=0.716). Aortic valve and perivalvular lesions were the most common involved sites, of which aortic regurgitation was the most frequenty occurred, followed by mitral valve lesions. Glucocorticoids was still the main means treatment for medical(93/235 in China, 28/420 abroad), cyclophosphamide was more widely used in China(28/235), azathioprine was more widely used in foreign countries (12/42). Aortic replacement (AVR) was the mainly surgical approach, followed by artificial aortic valve replacement and left ventricular outflow tract plasty (Bentall).The incidence of postoperative perivalvular leakage or valve prolapse was higher with AVR than with Bentall(AVR 76.3%/Bentall 21.8% at home, χ2=32.60, P<0.001, AVR 71.4%/Bentall 0 abroad, χ2=13.84, P<0.001). Conclusions:Cardiac valve involvement is a severe complication of Beh?et′s disease. Heart involvement are more common, and the preoperative diagnosis rate is lower in China. The incidence of perivalve leakage (PVL) or valve prolapse (PD) after operation is higher with AVR than with Bentall surgery.The Bentall operation could improve prognosis and the postoperative complications abroad are lower than domestic.

Development and validation of a mobile application based on a machine learning model to aid in predicting dosage of vitamin K antagonists among Indian patients post mechanical heart valve replacement

Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.

Aortic valve repair: An exciting journey / Reparación valvular aórtica: una experiencia emocionante

Abstract Aortic valve repair has become an attractive alternative to aortic valve replacement in most of the patients with aortic insufficiency. To improve reproducibility and durability "geometric anatomy" of the valve has been developed to guide the repair. Expert centers were able to publish remarkable short- and long-term results for aortic valve sparing procedures. Therefore, data comparing composite valve grafting and aortic valve sparing procedures revealed similar early mortality. Also, late mortality, thromboembolism, stroke and bleeding risks were significantly lower in patients undergoing aortic valve repair and late durability was equivalent1. However, the complexity of the procedures makes aortic valve repair difficult to be adopted into daily surgical practice. Accordingly, starting your own aortic valve repair program requires conviction, training, facilities, quality control and a well structured heart valve team to let your program succeed.

Resumen La reparación valvular aórtica se ha convertido en una alternativa atractiva al reemplazo, en la mayoría de pacientes con insuficiencia aórtica. Para mejorar la reproducibilidad y la durabilidad, se ha desarrollado una "anatomía geométrica" de la válvula para guiar la reparación. Los centros expertos han publicado resultados notables a corto y largo plazo en preservación valvular aórtica. Además, los estudios que compararon el cambio valvular por tubo valvulado con los procedimientos de preservación valvular, mostraron una mortalidad temprana similar, con riesgos de mortalidad tardía, como tromboembolia pulmonar, accidente cerebrovascular y hemorragia, significativamente menores en los pacientes sometidos a reparación valvular aórtica, con una durabilidad tardía equivalente1. Sin embargo, la complejidad de los procedimientos dificulta la adopción de la reparación valvular aórtica en la práctica diaria. En consecuencia, comenzar un programa de reparación valvular aórtica requiere convicción, capacitación, instalaciones, control de calidad y un equipo bien estructurado para que sea exitoso.

Effects of patient participation decision aid on decision conflict and risk perception of patients undergoing cardiac valve replacement / 中国实用护理杂志

Objective:To explore the effects of application of the patient participation decision aid in patients undergoing cardiac valve replacement.Methods:A total of 38 patients hospitalized for cardiac valve replacement from June to November, 2020 in the First Affiliated Hospital of Nanjing Medical University, were enrolled as the control group, and 38 patients admitted from January to May, 2020, were recruited as the experimental group by convenient sampling method. The control group was given routine nursing intervention, while the experimental group was carried out patient participation decision aid assistant program on the basis of routine nursing. The effects of intervention were assessed by Decision Conflict Sale (DCS), Preparation for Decision Making (PrepDM) and Risk Perception Questionnaire for patients with chronic diseases at admission and one day before operation.Results:There was no significant difference in the scores of DCS, PrepDM and Risk Perception Questionnaire for patients with chronic diseases at admission between the two groups( P>0.05). At one day before operation, the information& values scores dimension, support and valid decision dimension scores, decision uncertainty dimension scores and total scores of DCS were (12.37 ± 4.11) , (12.50 ± 4.65) , (3.74 ± 1.17), (28.61 ± 7.07) points in the experimental group, lower than those in the control group (15.11 ± 3.62) , (17.84 ± 4.25), (4.37 ± 1.30), (37.32 ± 6.57) points, the differences were statistically significant between the two groups( t values were 2.22-5.56, all P<0.05). At one day before operation, the score of PrepDM was (73.58 ± 5.32) points in the experimental group, higher than that in the control group (67.82 ± 4.89) points, the difference was statistically significant ( t=4.92, P<0.05). At one day before operation, the scores of economic risk dimension, physical and medical risk dimension, psychosocial risk dimension scores and total scores of Risk Perception Questionnaire for patients with chronic diseases were (11.45 ± 3.94), (12.39 ± 3.64), (7.21 ± 4.09), (31.05 ± 6.11) points in the experimental group, lower than those in the control group (13.50 ± 3.73), (15.82 ± 5.18), (9.32 ± 3.59), (38.63 ± 7.27) points, the differences were statistically significant ( t values were 2.33-4.92, all P<0.05). Conclusions:Patient participation decision aid program can effectively decrease decision conflict, promote preparation for decision making and alleviate risk perception of patients undergoing cardiac valve replacement.

Recent advances in exercise training in cardiac rehabilitation of patients after cardiac valve surgery / 中国实用护理杂志

Patients after cardiac valve surgery generally suffered from low exercise capacity, and lack of exercise can cause impaired exercise tolerance, reduced quality of life, and prolonged length of hospital stay, increased the risk of death. Exercise, as the core of cardiac rehabilitation, played an irreplaceable role in improving the cardiopulmonary function, exercise capacity, and health-related quality of life of patients after cardiac valve surgery. This article mainly reviewed the types and methods of exercise training after cardiac valve surgery, and the strategies for promoting exercise intervention, so as to provide references for medical staff to perform exercise interventions for patients after cardiac valve surgery.

Dual-Valve Repair in Dextrocardia and Situs Inversus Totalis / 日本心臓血管外科学会雑誌

A 59-year-old man, diagnosed with severe mitral regurgitation, moderate tricuspid regurgitation, and chronic atrial fibrillation with situs inversus totalis, was referred to our hospital. A median sternotomy approach was performed. The surgeon operated from the left side of the operating table, and had an excellent exposure to the mitral and tricuspid valves during the operation. The mitral valve was repaired with the posterior cusp plication technique and ring annuloplasty. The tricuspid valve was repaired with ring annuloplasty. We use a conventional semi rigid ring turned over, because the tricuspid valve has an asymmetric configuration. FullMAZE, and left atrial appendage closure were performed, too. The postoperative course was uneventful.

Practice and nursing care of early activity program for patients after cardiac valve replacement / 中国实用护理杂志

Objective:To summarize the practical and nursing experience of early activity program for patients after cardiac valve replacement.Methods:Totally 156 patients after cardiac valve replacement from December 2018 to June 2019 were selected. Refer to the seven-steps of cardiac rehabilitation recommended by American Heart Association with daily activity training and Guidelines for cardiovascular rehabilitation and secondary prevention in China, an early activity program based on corrected modified early warning score (MEWS) was offered to the patients, than its effect was evaluated.Results:All the 156 patients were successfully extubated, no adverse events such as pressure ulcers, pipe slip-off and wound dehiscence occurred.Conclusion:On the basis of the correct evaluation of the patient's condition after heart valve replacement, early activities can promote the recovery of cardiopulmonary function and accelerate the recovery of the patient.

A clinical study of genetic testing to guide the dosing of warfarin after heart valve replacement / 中华胸心血管外科杂志

Objective:To explore the role of genetic testing of VKORC1 and CYP2C9 in determining the dosage of warfarin after aortic valve replacement.Methods:A total of 172 patients receiving warfarin after aortic valve replacement were divided into a control group(86 cases) and an experimental(86 cases) group based on acceptance of genetic testing. In the experimental group, three loci of VKORC1 and CYP2C9 were tested by polymerase chain reaction-restriction fragment length polymorphism technique, and the initial dose of warfarin was determined based on the genetic testing results and warfarin oral-dose table recommended by U. S. Food and Drug Administration(FDA). In the control group, warfarin(3 mg/d) was used as the initial dose. The international normalized ratio(INR) of each patient was continuously monitored after medication. The percentages of patients meeting the target INR in the two groups at specific time points and at 3-month follow-up after discharge from the hospital were monitored, and the incidence of various adverse events was compared between the groups.Results:Based on the results of genetic testing, 68 patients received 3 mg/d(79.1%), 10 patients received 1.5 mg/d(11.6%), and eight patients received 6 mg/d(9.3%) as the initial dosages of warfarin in the experimental group. The percentages of the patients meeting the target INR on the third and sixth day of postoperative medication were 45.3% and 73.3%, respectively, in the experimental group, and 29.8% and 58.3%, respectively, in the control group( P<0.05). The INR critical values during hospitalization occurred in 2.3% in the experimental group and in 7.1% in the control group, while the percentage of the patients meeting the target INR after 3 months was 86.1% in the experimental group and 83.1% in the control group. Conclusion:Genetic testing may guide the selection of the initial dose of warfarin after heart valve replacement to rapidly achieve a stable dose.

Advances in diagnosis and surgical treatment of infective endocarditis / 中国胸心血管外科临床杂志

@#Infective endocarditis (IE) is a disease with severe complications and high mortality. It is heterogeneous in etiology, clinical manifestations, and course. At the same time, there are many disputes on the clinical practice of antibiotic treatment, surgical indications and timing. In this review, we discuss the epidemiology, diagnosis, treatment, and prevention of IE, especially the latest advances in surgical treatment after the release of European Society of Cardiology and American Heart Association guidelines in 2015.

Early Outcomes of Modified De Vega Annuloplasty for Functional Tricuspid Regurgitation at a Brazilian Hospital

Abstract Background: Right valve diseases are not benign, the tricuspid regurgitation has a significant impact on morbidity and mortality of patients. Objectives: This study aimed to report the short-term results of tricuspid annuloplasty using the De Vega technique modified by Manuel Antunes. Methods: A descriptive-analytical study was performed to evaluate the results of the tricuspid valvuloplasty performed at the Instituto de Medicina Integral Professor Fernando Figueira between 2012 and 2017. Data were collected by reviewing charts and databases of the Department of Cardiology and Cardiovascular Surgery of the institution. Those with rheumatic diseases or infective endocarditis with tricuspid valve involvement, or reoperation of the tricuspid valve were excluded. Student's t-test and McNemar's were used for statistical analysis. A p-value < 0.05 was considered statistically significant. Results: A total of 87 patients were studied, most of them were women (56.3%). The most associated heart valve diseases were mitral regurgitation (27.6%) and aortic regurgitation (20.7%). There was a significant decrease in the degree of tricuspid regurgitation in the postoperative period, with 83.3% of patients with none or mild regurgitation and only 1.1% with severe regurgitation (p = 0.0077). Conclusions: In the current study, tricuspid valve annuloplasty using the modified De Vega technique was shown to be effective in the short term. Further studies are needed to evaluate the long-term results.

Clinical study of Perioperative Use of Levosimendan in Patients Undergoing Heart Valve Replacement

Objective To investigate the clinical effect of levosimendan in perioperative aortic and/or mitral valvereplacement. Methods Patients undergoing open heart aortic and/or mitral valve replacement in our hospitalfrom January 2018 to December 2019 were enrolled. 45 patients in the control group received routineperioperative treatment based on dopamine, while 45 patients in the research group received continuousperioperative administration of levosimendan injection for 24h on the basis of routine treatment. The leftventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd) and left ventricular end-systolicdiameter (LVDs) were evaluated by color doppler echocardiography before and one week after surgery.Postoperative mechanical ventilation weaning time, length of ICU stays, number of vasoactive drugs used andwithdrawal time; indexes of liver and kidney function before and on the day after surgery to 10 days after surgery;use of in vitro support techniques such as aortic balloon pulsation (IABP), continuous renal replacement therapy(CRRT) and extracorporeal membrane oxygenation (ECMO) within 5 days of perioperative period. Results Theimprovement of LVDs and LVEF in the study group using levosimendan one week after the operation wassignificantly better than that in the control group (P value was 0.013 and 0.001, respectively), and fewer kinds ofvasoactive drugs were needed (P<0.001), and the risk of postoperative AKI in the study group was significantlylower than that in the control group (P=0.047). Conclusion The perioperative use of levosimendan can effectivelypromote the recovery of cardiac systolic function and reduce the risk of postoperative AKI.

Tomografía por emisión de positrones en endocarditis infecciosa asociada a dispositivos y válvulas protésicas / Positron emission tomography in infective endocarditis associated with intracardiac devices and prosthetic valves

La endocarditis infecciosa (EI) es una enfermedad grave y potencialmente letal. La capacidad diagnóstica de los criterios de Duke modificados es alta para válvulas nativas, pero decae en el caso de EI de válvulas protésicas o EI asociadas a dispositivos. El ecocardiograma y los hallazgos microbiológicos son fundamentales para el diagnóstico, pero pueden resultar insuficientes en este grupo de pacientes. Nuestro objetivo fue evaluar la utilidad de la tomografía por emisión de positrones y fusión con tomografía computarizada (PET/TC) en pacientes con sospecha de EI, portadores de válvulas protésicas o dispositivos intracardiacos. Se estudiaron 32 pacientes, a los cuales se les realizó un PET/CT con 18F-Flúor desoxiglucosa (18F-FDG). Se consideraron sugestivos de infección aquellos con captación intensa de tipo focal y/o heterogénea con un punto de corte de Standard Uptake Value (SUV) mayor o igual a 3.7. Los diagnósticos iniciales según los criterios de Duke modificados, se compararon con el diagnóstico final establecido por la Unidad de Endocarditis institucional. El agregado del PET/CT a esos criterios, proporcionó un diagnóstico concluyente en 22 de los 32 casos iniciales, reclasificando a 11 casos en EI definitivas y a otros 5 casos como negativos para ese diagnóstico. La EI continúa siendo un grave problema clínico. En aquellos casos donde los criterios de Duke no son suficientes para establecer el diagnóstico y la sospecha clínica persiste, el PET/CT puede ser una herramienta complementaria útil para aumentar la sensibilidad diagnóstica.

Infective endocarditis (IE) is a serious and potentially lethal condition. The diagnostic capacity of the modified Duke criteria is high for native valves, but it declines in the case of EI of prosthetic valves or EI associated with devices. Echocardiography and microbiological findings are essential for diagnosis but may be insufficient in this group of patients. Our objective was to evaluate the usefulness of positron emission tomography and fusion with computed tomography (PET / CT) in patients with suspected IE, carriers of prosthetic valves or intracardiac devices; 32 patients were studied, who underwent PET / CT with 18F-Fluorine deoxyglucose (18F-FDG). Those with intense focal and/or heterogeneous uptake with a Standard Uptake Value (SUV) cut-off point greater than or equal to 3.7 were considered suggestive of infection. The initial diagnoses according to the modified Duke criteria were compared with the final diagnosis established by the Institutional Endocarditis Unit. The addition of PET / CT to these criteria, provided a conclusive diagnosis in 22 of the 32 initial cases reclassifying 11 cases in definitive EI; another 5 cases were negative for that diagnosis. EI continues to be a serious clinical problem. In those cases where the Duke criteria are not sufficient to establish the diagnosis and clinical suspicion persists, PET / CT can be a useful complementary tool to increase the diagnostic sensitivity.

Cardiac valve calcification in patients with end stage renal disease and its correlation with left ventricular function / 医学研究生学报

ObjectiveCardiovascular calcification is a highly common complication in patients with end stage renal disease. The aim of this study was to explore the effect of cardiac valve calcification (VC) on left ventricular function and morphology in patients with end stage renal disease by echocardiography. Methods Echocardiography results of 137 patients with end stage renal disease who underwent hemodialysis in the general hospital of the eastern theater of war from June 2013 to August 2013 were retrospectively analyzed. The morphological structure and function parameters of the left ventricle were measured by echocardiography and tissue doppler imaging to assess cardiovascular calcification. Logistic regression analysis was used to investigate the independent risk factors of cardiac valve calcification.Results VC was found in 55 patients (40.1%) in this study. The age [(52.7±11.1) vs (42.6±12.3)], low density lipoprotein [(2.7±0.8)mg/dL vs (2.2±0.6)mg/dL], cholesterol [(5.2±1.1)mg/dL vs (4.5±0.9)mg/dL] levels were higher, while serum creatinine [(10.7±2.7)mg/dL vs (13.2±8.5)mg/dL] was lower in patients with VC than patients without VC (P<0.05). Logistic regression analysis showed that the older age, longer dialysis time and higher mean value of mitral annular systolic values were the independent risk factors for VC. The morphological and structural parameters of the left ventricle of the group with VC were higher than those of the group without VC (P<0.05), while the parameters of left ventricular diastolic function of the group with VC were lower than those of the group without VC (P<0.05).ConclusionVC diagnosed by echocardiography in patients with end stage renal disease may indicate significantly higher incidence of left ventricular hypertrophy and reduction of left ventricular diastolic function in comparison to those without VC.

Regulation of signaling pathways associated with cardiac valve development / 国际儿科学杂志

Congenital heart disease is the most common birth defect in China,of which heart valve dysplasia is an important phenotype.Heart valve development is an important process of embryonic development,which is regulated by a variety of signaling pathways.If the process of proliferation,differentiation or migration of endothelial cells and cardiomyocytes is abnormal,the heart valve will develop abnormally and the valvular heart disease may occur.Tissue explant systems and various animal model experiments have demonstrated that multiple signaling pathways interact to form a vast regulatory network that collectively regulates the development of heart valves.This review will highlight the nost intensively studied signaling pathways in epithelial-mesenchymal transition,including VEGF,NFATc1,Notch,Wnt,TGF-β,ErbB,and NF1 signaling pathways.

Effects of neutrophils-to-lymphocytes ratio on heart valve calcification in maintenance hemodialysis patients / 医学研究生学报

ObjectiveCardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with hemodialysis (HD) end-stage renal disease (ESRD). This paper analyzes and discusses the relationship between neutrophils-to-lymphocytes ratio (NLR) and heart valve calcification (CVC) in maintenance hemodialysis (MHD) patients to provide theoretical basis for the prevention and treatment of CVC.MethodsThe demographic data, relevant clinical indicators and laboratory examination results of 135 patients with MHD in the Second Hospital of Anhui Medical University were retrospectively analyzed to calculate the NLR value. Echocardiography was used to detect the incidence of CVC in the patients, and they were divided into calcification group and non-calcification group. The correlation between NLR value and CVC in MHD patients was analyzed, and the independent risk factors of CVC were discussed by using Logistic regression.ResultsAmong the 135 MHD patients, CVC was found in 59 cases (43.7%). Compared with the non-calcification group, patients in the calcification group showed significant increases in age, dialysis age, high-sensitivity c-reactive protein (HsCRP), ALP and NLR, with statistically significant differences (P5.02 (OR=17.709, P=0.046) were independent risk factors for heart valve calcification in MHD patients.ConclusionThe incidence of heart valve calcification is high in MHD patients, and NLR is an independent risk factor for it.

Regulation of signaling pathways associated with cardiac valve development / 国际儿科学杂志

Congenital heart disease is the most common birth defect in China, of which heart valve dysplasia is an important phenotype.Heart valve development is an important process of embryonic development, which is regulated by a variety of signaling pathways.If the process of proliferation, differentiation or migration of endothelial cells and cardiomyocytes is abnormal, the heart valve will develop abnormally and the valvular heart disease may occur.Tissue explant systems and various animal model experiments have demonstrated that multiple signaling pathways interact to form a vast regulatory network that collectively regulates the development of heart valves.This review will highlight the nost intensively studied signaling pathways in epithelial-mesenchymal transition, including VEGF, NFATc1, Notch, Wnt, TGF-β, ErbB, and NF1 signaling pathways.

Revisión de la evidencia de estudios de supervivencia de pacientes con prótesis valvular biológica / Review of the evidence in survival studies of patients with a biological valve replacement

Resumen Introducción: las modificaciones en las características estructurales/funcionales de las prótesis valvulares han derivado en un aumento en las curvas de sobrevida/supervivencia de los pacientes, dada la reducción de las tasas de morbilidad y mortalidad posteriores a intervenciones quirúrgicas de las válvulas cardíacas y los cambios sustanciales en la relación costo-efectividad y costo-beneficio de estos procedimientos. Objetivo: conocer la supervivencia de pacientes mayores de 60 años de edad, con prótesis valvular biológica. Materiales y métodos: revisión de estudios de seguimiento publicados en los cuales se evaluó la supervivencia de los pacientes sometidos a reemplazo valvular. Se hizo una búsqueda de artículos científicos registrados en la base de datos PubMed, de acuerdo con los descriptores seleccionados como palabras clave − Prótesis Valvulares Cardíacas/Heart Valve Prosthesis, Bioprótesis/Bioprosthesis, Supervivencia/Survival − en el programa de gestión de referencias EndNote. Se valoró la fuerza de evidencia científica de cada uno de los artículos seleccionados con la escala de McMaster para estudios cuantitativos. Resultados: se obtuvieron 12 referencias y se descartaron 5 (41,7%); calificación global de "fuerte" con la escala de McMaster 7 (58,3%). El tiempo promedio de seguimiento fue de 13,7 años y la razón de masculinidad de 1:0,8. La edad promedio de los pacientes fue 67,2 (rango 60,0-78,5) años. La supervivencia promedio a diez años fue del 65%. Conclusiones: se observa mayor supervivencia entre los pacientes sometidos a reemplazo valvular mecánico versus biológico; sin embargo, la literatura plantea como opción razonable el uso de prótesis biológicas en pacientes mayores de 60 años. Se reconoce, así mismo, la necesidad de hacer más estudios que puedan corroborar los hallazgos.

Abstract Introduction: The modifications in the structural / functional features of replacement valves have led to an increase the survival curves of the patients. This can be seen in the reduction in morbidity and mortality rates after the surgical intervention of the cardiac valves, as well as the substantial changes in the cost-effectivity and cost-benefit ratio of these procedures. Objective: To determine the survival of patients over 60 years of age with a biological valve replacement. Materials and methods: A review of follow-up published studies that evaluated the survival of patients subjected to a valve replacement. A search was made of the scientific articles registered in the PubMed databases, using the selected descriptors as Key words: Heart Valve Prosthesis, Bioprosthesis, Survival, in the references management program-EndNote. The strength of the scientific evidence in each of the selected articles was assessed using the McMaster scale for quantitative studies. Results: A total of 12 references were found and 5 (41.7%) were discarded, and 7 (58.3%) had an overall "strong" score with the McMaster scale. The mean follow-up time was 13.7 years, and the male ratio was 1:0.8. The mean age of the patients was 67.2 (range: 60.0-78.5) years. The mean survival rate at 10 years was 65%. Conclusions: A higher survival was observed between the patients fitted with a mechanical versus a biological valve. However, the literature has established the use of a biological replacement valve as a reasonable option in patients over 60 years of age. It is also recognised that more studies are needed that can corroborate the findings.

Risk factors of postoperative acute kidney injury and the impact on outcome in non-senile patients undergoing cardiac valvular surgery / 中华心血管病杂志

Objective@#To investigate the risk factors of postoperative acute kidney injury (AKI) in patients aged between 40 and 50 years old undergoing cardiac valvular surgery and the impact on outcome.@*Methods@#The clinical data of 286 patients aged between 40 and 50 years old undergoing cardiac valve surgery in Guangdong Provincial People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. Preoperative coronary angiography was performed in all patients. All patients enrolled were divided into AKI group and non-AKI group according to the existence or not of postoperative AKI. Patients with AKI were further divided into AKI stage 1, stage 2, and stage 3 groups according to KDIGO guideline. Demographic characteristics, preoperative clinical data including serum creatinine, estimated glomerular filtration rate, hemoglobin, uric acid, urinary protein, presence or absence of chronic kidney disease, left ventricular ejection fraction, pulmonary artery pressure, New York Heart Association (NYHA) functional classification, preoperative co-morbidity (hypertension, diabetes, anemia, cerebrovascular disease, peripheral artery disease), preoperative medication(vasoactive drugs, diuretic, renin-angiotensin system inhibitor (RASI), surgical data (contrast dosage in coronary angiography, type of cardiac valve surgery) were recorded and analyzed in this retrospective study. The risk factors for postoperative AKI and its impact on clinical outcomes (mortality, hospitalization expenses and Intensive Care Unit stay duration) were evaluated. Logistic regression analysis was used to determine the risk factors for postoperative AKI and the adjusted variables with P<0.2 were selected for the multivariate logistic regression analysis to define the independent determinants for AKI.@*Results@#AKI was defined in 106 out of 286 enrolled patients, including 96 patients with AKI stage 1, 10 patients with AKI stage 2 and no patients with AKI stage 3. The proportion of coexisting cerebrovascular diseases was higher in AKI group than in non-AKI group (9(8.49%) and 5(2.78%), χ2=4.677, P=0.031), while there was no difference among other baseline data between the two groups. Multivariate logistic regression analysis showed that preoperative complications of cerebral vascular disease was an independent risk factor of postoperative AKI (OR=3.578, 95%CI 1.139-11.242, P=0.029). Five out of 106 AKI patients died during hospitalization while there was only 1 patient died among 180 patients without AKI. Patients with AKI after cardiac valve operation experienced higher mortality than patients without AKI (χ2=5.625, P=0.028). Further analysis showed that there was no difference in hospitalization mortality between patients with AKI stage 2 and stage (χ2=0.686, P=0.408) while the hospitalization mortality in patients with AKI stage 2 was higher than those without AKI (χ2=8.113, P=0.004). The hospitalization expenses in patients with AKI were 10.38(8.59,12.54) ×104 RMB, significantly higher than that in patients without AKI (9.72(8.03,11.93) ×104 RMB)(P=0.043). There was no difference in hospitalization expenses between patients with AKI stage 1 and without AKI (P=0.635). The hospitalization expenses in patients with AKI stage 2 was higher than those without AKI (P=0.023). Intensive Care Unit stay duration in patients with AKI was 3(1,4) days, significantly higher than those without AKI (P=0.044). There was no difference in Intensive Care Unit stay duration in patients with AKI stage 1 and without AKI (P=0.978), while Intensive Care Unit stay duration in patients with AKI stage 2 was significantly longer than those without AKI (P=0.006).@*Conclusions@#Preoperative complications of cerebral vascular disease is an independent risk factor of postoperative AKI. Non-senile patients with AKI after cardiac valvular surgery is associated with a higher proportion of mortality, hospitalization expenses and Intensive Care Unit stay duration as compared patients without postoperative AKI.

Comparison of different anticoagulation methods during perioperative period for noncardiac surgery in patients after cardiac valve replacement / 中国胸心血管外科临床杂志

@#Objective To summarize the efficacy of different anticoagulation methods during perioperative period of non-cardiac surgery after cardiac valve replacement and to compare the postoperative bleeding-related complications and embolization-related complications. Methods Retrospective analysis of clinical data of 56 patients who underwent non-cardiac surgery after cardiac valve replacement in our hospital from January 2016 to January 2018 was conducted. There were 27 males and 29 females, aged 19-75 (53.56±13.94) years. According to different anticoagulation methods during perioperative period, the patients were divided into a bridging group (32 patients) and a non-bridging group (24 patients). The postoperative hospital stay, the number of patients needing postoperative blood transfusions, bleeding-related complications and embolization-related complications were compared between the two groups. According to the patient’s perioperative embolization risk, each group of patients were divided into a high-risk subgroup, middle-risk subgroup, and low-risk subgroup, and the bleeding-related complications and embolization-related complications in each subgroup were compared. Results The postoperative hospital stay in the bridging group was significantly longer than that in the non-bridging group (P<0.05), but there was no significant difference in the number of patients needing postoperative blood transfusions, overall bleeding-related complications and embolization-related complications between the two groups (P>0.05). Subgroup analysis was performed according to the degree of embolization risk in the perioperative period. The incidence of bleeding-related complications of the non-bridging group in the high-risk subgroup was significantly higher than that in the high-risk subgroup of the bridging group (P<0.05). The incidence of bleeding-related complications in the bridging group was similar to that of embolization-related complications, while the rate of bleeding-related complications in the non-bridging group was 7 times higher than that of embolization-related complications. Conclusion Bridging anticoagulation increases the length of postoperative hospital stay, but for patients with high risk factors for embolization, it is more beneficial than continuing oral warfarin during the perioperative period. The incidence of bleeding-related complications associated with continued warfarin therapy is significantly higher than that of embolization-related complications, and hemostatic drugs can be given necessarily.

Correlation analysis between homocysteine level and acute kidney injury after cardiac valve replacement surgery / 中华肾脏病杂志

Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age≥18 years, no renal replacement therapy before surgery, non - renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87 ± 3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95% CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95% CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95% CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.