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@#Objective To compare and analyze the effect of myocardial protection between HTK and del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries. Methods The clinical data of 208 neonates with complete transposition of the great arteries in our institution from 2014 to 2020 were retrospectively analyzed. According to the cardioplegia solutions utilized in the operations, the patients were divided into two groups: a HTK group and a del Nido group. Propensity score matching was conducted to eliminate the biases. The cardiopulmonary bypass time, aortic cross-clamping time, total amount of cardioplegia solutions, transfusion frequency of cardioplegia, ICU stay time, mechanical support time, inotropic score, hospital stay, left ventricular ejection fraction, N-terminal proBNP and troponin I were compared and analyzed between the two groups after matching. Results After 1:1 propensity score matching, a total of 54 patients were analyzed with 27 patients in each group. In the HTK group, there were 22 males and 5 females with a median age of 7.0 (2.0, 11.0) d. In the del Nido group, there were 23 males and 4 females with a median age of 8.0 (3.0, 11.0) d. A total of 3 children died after the surgery: 2 (7.4%) patients in the HTK group and 1 (3.7%) patient in the del Nido group. There was no significant difference in hospital mortality between the two groups (P=1.000). The total amount of cardioplegia solutions in the HTK group was significantly higher than that of del Nido group (P<0.001). Transfusion frequency of cardioplegia in del Nido group was significantly higher than that of the HTK group (P=0.043). There was no significant difference in the postoperative ICU time, mechanical support time, length of hospital stay, inotropic score, left ventricular ejection fraction, N-terminal B-type natriuretic peptide precursor or troponin I between the two groups (P>0.05). Conclusion For neonates with surgeries for complete transposition of the great arteries, HTK cardioplegia solutions can provide effective and safe myocardial protection, which is similar to del Nido cardioplegia solutions.
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Objectives:Cardioplegia is essential for adequate myocardial protection. There continues to remain ambiguity regarding the ideal cardioplegia for adequate myocardial protection in congenital heart surgery. This study compares clinical outcomes using St Thomas II solution and Del Nido cardioplegia in neonates undergoing cardiac surgery. Methods: All neonates (<30 days) from 2011 to 2017 who underwent surgery requiring cardioplegic arrest were analyzed retrospectively. We divided the cohort into two groups depending on cardioplegia received, as group A (Blood cardioplegia with St Thomas II solution, n = 56) and group B (Del Nido cardioplegia, n = 48). Various demographic, intraoperative, early postoperative, and discharge variables were analyzed. Results: Two groups were similar in age, gender, pre?operative diagnosis, and risk category. Cardiopulmonary bypass (CPB) time (P = 0.002), aortic cross?clamp (ACC) time (P = 0.018), and the number of doses of cardioplegia (P < 0.001) were significantly lower with Del Nido group. Though vasoactive inotropic score (VIS) (P = 0.036) was high during the first 24 h in the immediate postoperative period in group A, there was no difference in early mortality among both groups (P = 0.749). Both groups did not show significant differences related to various postoperative and discharge variables. Conclusion: When compared to St. Thomas solution, the use of Del Nido cardioplegia solution in neonates is associated with a significant decrease in CPB and ACC times and VIS in the first 24 h after surgery. The choice of cardioplegia (St Thomas/Del Nido) in neonates does not affect early mortality and early postoperative clinical outcomes.
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RESUMO Objetivo: Identificar como idosos integrantes do Projeto Universidade da Maturidade do Amapá (UMAP) vivenciam o fenômeno da Síndrome do Ninho Vazio. Material e Método: Trata-se de estudo exploratório e descritivo, com abordagem qualitativa. A coleta de dados ocorreu com sete idosos, com idades entre 63 e 83 anos, por meio de entrevista semiestruturada, contemplando uma questão central: conte-me como foi a sua experiência mediante a saída dos filhos de casa? Para análise dos dados adotou-se a análise de conteúdo de Bardin, subsidiada pelo software ATLAS.ti versão 8.0 que por meio de uma matriz de análise originou três categorias temáticas. Resultados: As categorias resultaram de um processo analítico e explicativo da experiência vivenciada pelos idosos e compreenderam três momentos: A vida sendo invadida pela solidão, Beneficiando se da liberdade e Alçando novos voos. Conclusão: Em resposta ao objetivo do estudo, foi possível identificar que a experiência do ninho vazio vivenciada pelos idosos perpassou por diferentes fases, entretanto o convívio na UMAP viabilizou superar a solidão e transformar esta experiência em oportunidade de fortalecimento e crescimento.
ABSTRACT Objective: To identify how elderly members who participate of the Project University of Maturity (UMAP), of the Federal University of Amapá in Brazil, experience the Empty Nest Syndrome phenomenon. Materials and Methods: Qualitative, exploratory and descriptive study, using narratives to understand the story of the participants. Data collection took place with seven elderly people, aged between 63 and 83 years, through semi-structured interviews, an focusing on a central question: How was your experience when your children grew up and left home? For data analysis, Bardin's content analysis was adopted, supported by the software ATLAS. ti version 8.0. To guarantee methodological rigor, the principles of credibility, reliability, confirmability and transferability were respected. Results: The resulting categories emerged from an analytical and explanatory process of the experience lived by the elderly and consisted of three moments: life invaded by loneliness, benefiting from freedom and taking new chances. Conclusion: The study shows that the empty nest experience undergoes different phases. However, the experience at UMAP made it possible to overcome loneliness and transform this experience into an opportunity for strengthening and growth.
RESUMEN Objetivo: Identificar cómo los adultos mayores que participan en el Proyecto Universidad de Madurez de Amapá (UMAP) experimentan el fenómeno del Síndrome del Nido Vacío. Material y Método: Estudio con enfoque cualitativo, exploratorio y descriptivo, que a través de la narrativa buscó comprender el relato de los participantes. La recopilación de datos se llevó a cabo con siete personas mayores, de edades comprendidas entre 63 y 83 años, a través de entrevistas semiestructuradas, contemplando una pregunta central: cuénteme ¿cómo fue su experiencia cuando sus hijos crecieron y se fueron de casa? Se adoptó el análisis de contenido de Bardin, subsidiado por el software ATLAS.ti versión 8.0. Para garantizar el rigor metodológico se cumplieron los principios de credibilidad, confiabilidad, confirmabilidad y transferibilidad. Resultados: Las tres categorías originadas resultaron de un proceso analítico y explicativo de la experiencia vivida por los ancianos y comprendió tres momentos: la vida invadida por la soledad, el beneficio de la libertad y la toma de nuevos vuelos. Conclusión: La experiencia del nido vacío experimentada por las personas mayores pasó por diferentes fases, sin embargo, la experiencia en UMAP permitió superar la soledad y transformar esta experiencia en una oportunidad de fortalecimiento y crecimiento.
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Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group.
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Introduction: It is not uncommon in patients, havingrheumatic mitral and aortic valve disease, to undergo mitralvalve replacement with aortic valve replacement that is,double valve replacement (DVR) operation who oftenhave severe cardiac dysfunction optimized with medicalmanagement before surgery. In this retrospective studywe investigated 60 such patients, who underwent DVRoperation with either conventional cold blood cardioplegiawith St Thomas 2 solution (STH), or del Nido cardioplegia(DN) over five years and compared the effects of the twotypes of cardioplegia during perioperative and postoperativeperiod with simultaneous comparative study betweenchanges of cardiac performances in the patients with largerleft ventricle as compared to those with less enlargedones.Material and methods: For this retrospective study, the dataof 60 patients of DVR over five years, in Medical College,Kolkata, India, were retrieved for study. The cases wereplaced into 2 groups: STH and DN according to cardioplegiaused during DVR. Demographic, echocardiographic, andseveral perioperative and postoperative data of the two groupsof patients, were collected. Differences between perioperativebehaviour between STH and DN groups and post operativechanges in the echocardiographic parameters betweenpredominantly mitral stenosis (MS) and mitral regurgitation(MR) patients, were analyzed.Results: The aortic cross clamp (CC) and cardiopulmonarybypass (CPB) time in both predominant MS and MR patientswas shorter in the DN than the STH groups. There was lessarrhythmia, less inotropic and ventilator support in the DNgroup. There was 10% mortality in the series with majoritybeing in the STH and MR predominant patients. Postoperativeimprovement of LVEF, reduction of LVIDS and LVIDDwere also observed in MS predominant in comparison toMR predominant patients after DVR in both STH and DNgroups.Conclusion: Use of DN has been found to have a betteroutcome and survival when compared to STH cardioplegiasolution. DVR could reversely remodel depressed heartswith relatively smaller LV volume and restore LV functionof relatively smaller LV of predominant MS patients betterin comparison to MR predominant patients with relativelydilated hearts.
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Aim To assess the hemodilution during mitral valve surgery performed using St Thomas cardioplegia versus Del Nido cardioplegia. We also compared the volume of cardioplegia required, cross clamp time and cardiopulmonary bypass (CPB) time in each group. Methods and Materials Patients admitted between the period of January 2015 to June 2018 for mitral valve disease were included in this retrospective study. Patients were divided into two groups each comprising of 50 patients according to type of cardioplegia received during surgery. Results The hemodilution was much lesser in the patients who underwent mitral valve surgery using St Thomas cardioplegia (Haematocrit 26.3 ± 2.5%) as compared to those patients underwent the same surgery using del Nido Cardioplegia (Haematocrit 24.8 ± 2.2%). The volume of cardioplegia, cross clamp time and cardiopulmonary bypass time was less with del Nido cardioplegia as compared to St. Thomas cardioplegia (922.6 ± 95.4 vs 1854 ± 228.1 ml; 65.5 ± 8.2 vs 71.52 ± 8.8 minutes and 99.3 ± 13.1 vs 110.6 ± 14.6 minutes respectively). Conclusion The use of St Thomas Cardioplegia in patients during mitral valve replacement surgery has less hemodilution on CPB as compared to del Nido cardioplegia. But the patients who received del Nido cardioplegia has less requirement of number and volume of cardioplegia required during surgery with shorter cross clamp and CPB time
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@#Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39 vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
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@#Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactiveinotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponinI and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduces hemodilution and perioperative blood transfusion.
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A fin de conocer la estrategia reproductiva de Geochelone carbonaria en cuanto a la producción de huevos y su relación con la talla corporal, se seleccionaron tres grupos (I, II, III) de 12 hembras cada uno, con promedios de 364,50; 303,75 y 254,66mm respectivamente, de largo lineal de caparazón. Los especimenes seleccionados fueron mantenidos bajo las mismas condiciones de alimentación y densidad, y su reproducción se evaluó entre mayo 1997 y marzo 1998. Se encontró muy poca variación en el promedio de nidos por grupo, sin observarse tendencia alguna según el tamaño la hembra. El total de huevos por hembra por temporada aumentó con el tamaño de la hembra. En los tres grupos se encontraron diferencias estadísticamente significativas en el tamaño del huevo (largos máximo y mínimo, y volumen) y en el tamaño de la nidada, aumentado estas variables con el tamaño de la hembra. La duración de la temporada reproductiva de los tres grupos (I, II y III) fue de 160, 207 y 191 días, respectivamente, sugiriendo que los animales grandes mejoran su aptitud al reducir el tiempo del periodo de anidación. No se encontraron diferencias significativas en el tiempo de incubación según el tamaño del huevo. Los resultados corroboran que esta especie no cumple con la teoría del óptimo tamaño de huevo. Se reporta un récord máximo de ocho nidadas por temporada y un tamaño récord de nidada de 13 huevos.
In order to determine the reproductive strategy of Goechelone carbonaria, inasmuch egg production and its relationship with body size, three groups (I, II, III) of 12 females each were selected, with averages of 364.50, 303.75 and 254.66mm, respectively, in lineal size of the carapace. The selected specimens were kept under similar nutritional and density conditions. The observations were made between May 1997 and March 1998. Very few variations were found with respect to the average number of nests per group, without any tendency in relation to the size of the female. The total number of eggs per female per season increased with female size. Statistically significant differences were found between the three groups with respect to egg size (maximal length, minimal lenght and volume) and nest size, all of which increased together with the female size. The duration of the reproductive season of groups I, II and III was 160, 207 and 191 days, respectively, suggesting that larger animals improve their performance with a reduced nesting season. There were no significant differences in the incubation time according to egg size. The results corroborate that this species does not behave according to the theory of the optimum egg size. A record maximum of 8 nests per season and a record nest size of 13 eggs are reported.
Com o fim de conhecer a estratégia reprodutiva de Geochelone carbonaria quanto à produção de ovos e sua relação com o tamanho corporal, se selecionaram três grupos (I, II, III) de 12 fêmeas cada um, com médias de 364,50; 303,75 e 254,66mm respectivamente, de comprimento lineal da carcaça. Os espécimes selecionados foram mantidos sob as mesmas condições de alimentação e densidade, e sua reprodução se avaliou entre maio 1997 e março 1998. Encontrou-se muito pouca variação na média de ninhos por grupo, sem observar-se tendência alguma segundo o tamanho da fêmea. O total de ovos por fêmea por temporada aumentou com o tamanho da fêmea. Nos três grupos se encontraram diferenças estatisticamente significativas no tamanho do ovo (comprimentos máximo e mínimo, e volume) e no tamanho da ninhada, aumentado estas variáveis com o tamanho da fêmea. A duração da temporada reprodutiva dos três grupos (I, II e III) foi de 160, 207 e 191 dias, respectivamente, sugerindo que os animais grandes melhoram sua atitude ao reduzir o tempo do período de nidificação. Não se encontraram diferenças significativas no tempo de incubação segundo o tamanho do ovo. Os resultados comprovam que esta espécie não cumpre com a teoria do ótimo tamanho de ovo. Relata-se um recorde máximo de oito ninhadas por temporada e um tamanho recorde de ninhada de 13 ovos.