Postoperative acute kidney injury in major noncardiac surgery. Narrative review / Lesión renal aguda posoperatoria en cirugía mayor no cardiaca. Revisión narrativa

Abstract Postoperative acute kidney injury is an underdiagnosed condition. Its incidence is variable and depends on demographic, clinical, and surgical stress-associated factors; hence the pathophysiology is multifactorial. It is extremely important to acknowledge those risk factors early and use tools to estimate the risk of developing the condition, in order to adopt perioperative measures to mitigate its occurrence and impact. Some of the complications resulting from this condition include prolonged ICU stay, higher susceptibility for infections, hospitalization-related complications, progression to acute and chronic kidney failure, and even the need for transient or permanent renal replacement therapies (RRT) in addition to diseases that increase the cardiovascular risk, such as systemic high blood pressure and/or coronary heart disease that result in increased comorbidities and mortality, with subsequent increases in healthcare costs, lower quality of life and increased burden of the disease in the short and long term. A systematic search of the literature was conducted in PubMed, Google Schoolar, and Lilacs, under the terms MeSh and DeCs using Boolean operators; a review was conducted of the summary of the articles identified and 57 of them were selected for their comprehensive reading. This narrative review summarizes the relevant information on this pathology for prevention and identification purposes, for the adequate management of patients undergoing major non-cardiac surgery.

Resumen La lesión renal aguda posoperatoria es una entidad subdiagnosticada. Su incidencia es variable y depende de factores demográficos, clínicos y los inherentes al estrés quirúrgico; por ende, la fisiopatología es multifactorial. Es de vital importancia reconocer precozmente dichos factores de riesgo durante la valoración preanestésica y hacer uso de herramientas para calcular el riesgo de desarrollarla para, de esta forma, adoptar medidas perioperatorias para mitigar su aparición e impacto. Entre las complicaciones derivadas de esta entidad se encuentran la estancia en unidades de cuidado intensivo prolongadas, mayor susceptibilidad de infecciones, complicaciones derivadas de la hospitalización, progresión a enfermedad renal aguda y crónica e incluso necesidad de terapias de reemplazo renal (TRR) transitorias o permanentes, además de enfermedades que aumentan el riesgo cardiovascular como hipertensión arterial sistémica y/o enfermedad coronaria, lo que genera aumento en morbimortalidad, con aumento en costos asociado a la atención en salud, menor calidad de vida y mayor carga de la enfermedad a corto y largo plazo. Se realizó una búsqueda sistemática de la literatura en bases de datos PubMed, Google Schoolar, Lilacs, bajo los términos MeSh y DeCs, usando los operadores booleanos, se revisó el resumen de los artículos encontrados y se seleccionaron 57 artículos para su lectura completa. Esta revisión narrativa sintetiza la información relevante sobre esta patología que permita prevenirla y reconocerla para el manejo adecuado de los pacientes que van a cirugía mayor no cardiaca.

Acceso a la cirugía cardíaca en Colombia: un análisis situacional / Access to cardiac surgery in Colombia: a situational analysis

Resumen Introducción: Aproximadamente el 33% de los pacientes con enfermedades cardiovasculares requerirán cirugía cardíaca al menos una vez en la vida; sin embargo, menos de una cuarta parte de la población mundial tiene acceso a la atención quirúrgica cardíaca cuando la necesita. A pesar del progreso que ha tenido Colombia en cuanto a la prestación de atención quirúrgica cardíaca en las últimas décadas, se sabe poco sobre el acceso a la atención cardíaca en todo el país. Por lo tanto, la cirugía global busca estudiar y construir sobre la situación actual en áreas de acceso limitado a la atención médica quirúrgica y fortalecer los sistemas de salud. Objetivo: Describir la situación actual en Colombia en términos de personal quirúrgico y de infraestructura disponible, para entender mejor las brechas existentes en el acceso a la atención quirúrgica cardíaca para las poblaciones necesitadas. Materiales y método: Los datos sobre la fuerza laboral de la cirugía cardiaca se obtuvieron a partir de una encuesta a cirujanos registrados en el directorio de cirugía cardíaca y la Red de Cirugía Cardiotorácica de Colombia, en tanto que los de procedimientos del 2018 al 2019, se obtuvieron de los datos del gobierno nacional. Resultados: En Colombia había 110 cirujanos cardíacos o 1.8 cirujanos cardíacos por millón de habitantes, de los cuales el 85% eran hombres. Las densidades en cada uno de los 32 departamentos de Colombia variaron desde 4.6 cirujanos por millón de habitantes (Bogotá), a ningún cirujano en 14 departamentos. Se registraron 52 instituciones, con una mediana de 250 camas (rango intercuartílico 130-350). Uno de cada cinco departamentos de cirugía cardíaca ofreció un programa de subespecialidad en cirugía cardíaca. La revascularización miocárdica fue el procedimiento realizado con mayor frecuencia. Conclusiones: Este estudio identificó datos sobre la situación actual de la cirugía cardíaca en Colombia. A pesar de la disponibilidad relativamente favorable de mano de obra quirúrgica cardíaca en Colombia, la variación geográfica y los factores sociales y económicos apuntan a una necesidad urgente de evaluar las políticas de calidad de atención relacionadas con la atención quirúrgica cardíaca en poblaciones desatendidas.

Abstract Introduction: Approximately 33% of patients with cardiovascular diseases will require heart surgery at least once in their lifetime; yet, less than a quarter of the world’s population has access to cardiac surgical care when needed. Despite Colombia’s progress in cardiac surgical care delivery in recent decades, little is known regarding access to cardiac care across the country. Therefore, global surgery seeks to study and build upon the current situation in areas of limited access to surgical healthcare and to strengthen health systems. Objetive: Describe the current situation in Colombia in terms of surgical personnel and available infrastructure, to better understand the existing gaps in access to cardiac surgical care for populations in need. Materials and method: Data on the cardiac surgical workforce were obtained from a survey of surgeons registered in the cardiac surgery directory and the Cardiothoracic Surgery Network in Colombia. Procedural data from 2018-2019 were obtained from national government data. Results: There were 110 cardiac surgeons or 1.8 cardiac surgeons per million inhabitants in Colombia, of which 85.0% were male. Densities in each of the 32 departments of Colombia varied from 4.6 surgeons per million inhabitants (Bogotá) to no surgeons in 14 departments. There were 52 institutions registered, with a median of 250 beds (interquartile range 130-350). One in five cardiac surgery departments offered a certified cardiac surgery fellowship program. Coronary artery bypass grafting was the most frequently performed procedure. Conclusions: This study identified data regarding the current situation of cardiac surgery in Colombia. Despite relatively favorable cardiac surgical workforce availability in Colombia, geographical variation and social and economic factors point to an urgent need to evaluate the quality-of-care policies related to cardiac surgical care in underserved populations.

Adição da Troponina Ultrassensível à Avaliação de Risco Perioperatório Melhora a Capacidade Preditiva de Morte em Pacientes Submetidos à Cirurgia Não Cardíaca / Addition of High-Sensitivity Troponin to Perioperative Risk Assessment Improves the Predictive Ability of Death in Non-Cardiac Surgery Patients

Resumo Fundamento A estratificação ode risco é uma importante etapa na avaliação perioperatória. No entanto, os principais escores de risco não incorporam biomarcadores em seus conjuntos de variáveis. Objetivo Avaliar o poder incremental da troponina à estratificação de risco tradicional. Métodos Um total de 2230 pacientes admitidos na unidade de terapia intensiva após cirurgia não cardíaca foram classificados de acordo com três tipos de risco: Risco Cardiovascular (RCV), Índice de Risco Cardíaco Revisado (IRCR), e Risco Inerente da Cirurgia (RIC). O principal desfecho foi mortalidade por todas as causas. A regressão de Cox foi usada, assim como a estatística C antes e após a adição de troponina ultrassensível (pelo menos uma medida até três dias após a cirurgia). Finalmente, o índice de reclassificação líquida e a melhoria de discriminação integrada foram usadas para avaliar o poder incremental da troponina para a estratificação de risco. O nível de significância usado foi de 0,05. Resultados A idade média dos pacientes foi 63,8 anos e 55,6% eram do sexo feminino. A prevalência de lesão miocárdica após cirurgia não cardíaca (MINS) foi 9,4%. Pacientes com um RCV elevado apresentaram uma maior ocorrência de MINS (40,1% x 24,8%, p<0,001), bem como pacientes com alto RIC (21,3 x 13,9%, p=0,004) e aqueles com IRCR≥3 (3,0 x 0,7%, p=0,009). Pacientes sem MINS, independentemente do risco avaliado, apresentaram taxa de mortalidade similar. A adição de troponina à avaliação de risco melhorou a capacidade preditiva de mortalidade em 30 dias e de mortalidade em um ano em todas as avaliações de risco. Conclusão A prevalência de MINS é mais alta na população de alto risco. No entanto, sua prevalência na população de risco mais baixo não é desprezível e causa um maior risco de morte. A adição da troponina ultrassensível melhorou a capacidade preditiva da avaliação de risco em todos os grupos.

Abstract Background Risk stratification is an important step in perioperative evaluation. However, the main risk scores do not incorporate biomarkers in their set of variables. Objective Evaluate the incremental power of troponin to the usual risk stratification Methods A total of 2,230 patients admitted to the intensive care unit after non-cardiac surgery were classified according to three types of risk: cardiovascular risk (CVR), Revised Cardiac Risk Index (RCRI); and inherent risk of surgery (IRS). The main outcome was all-cause mortality. Cox regression was used as well as c-statistics before and after addition of high-sensitivity troponin (at least one measurement up to three days after surgery). Finally, net reclassification index and integrated discrimination improvement were used to assess the incremental power of troponin for risk stratification. Significance level was set at 0.05. Results Mean age of patients was 63.8 years and 55.6% were women. The prevalence of myocardial injury after non-cardiac surgery (MINS) was 9.4%. High CVR-patients had a higher occurrence of MINS (40.1 x 24.8%, p<0.001), as well as high IRS-patients (21.3 x 13.9%, p=0.004) and those with a RCRI≥3 (3.0 x 0.7%, p=0.009). Patients without MINS, regardless of the assessed risk, had similar mortality rate. The addition of troponin to the risk assessment improved the predictive ability of death at 30 days and at 1 year in all risk assessments. Conclusion The prevalence of MINS is higher in the high-risk population. However, its prevalence in lower-risk population is not negligible and causes a higher risk of death. The addition of high-sensitivity troponin increased the predictive ability of risk assessment in all groups.

Seguimiento a 5 años de pacientes octogenarios post cirugía cardíaca / A five year follow up of octogenarians following cardiac surgery

Introducción: El aumento significativo de la esperanza de vida en el grupo de octogenarios en Chile ha generado preocupación sobre la eficacia y la necesidad de cirugías cardíacas mayores en esta población incluso cuando el 85 % de ellos llega a dicha edad en condiciones de salud favorables. Objetivos: Este estudio se propuso evaluar la mortalidad hospitalaria y a mediano plazo, así como identificar complicaciones postoperatorias en pacientes octogenarios sometidos a cirugía cardíaca en Chile. Métodos: Se llevó a cabo un estudio observacional retrospectivo en el Hospital Las Higueras de Talcahuano entre enero de 2014 y diciembre de 2022, con una muestra de 79 pacientes. Resultados: Se encontró que el 86% de los procedimientos utilizaron circulación extracorpórea, y el 84% fueron electivos, principalmente cirugías coronarias (54%). La mortalidad intrahospitalaria fue 9%, con el uso preoperatorio de Balón Contrapulsación Intraaórtico identificado como un factor de mal pronóstico. Complicaciones postoperatorias como la Fibrilación Auricular afectaron al 17%, mientras que solo Neumonía y Falla Renal influyeron significativamente en la mortalidad. La supervivencia a 1, 3 y 5 años fue 81%, 76% y 73%, respectivamente. Conclusión: La cirugía cardíaca en octogenarios en Chile presenta resultados comparables a nivel mundial, destacando la importancia del análisis individual por un equipo multidisciplinario al considerar cirugías mayores en pacientes frágiles. El uso de técnicas mínimamente invasivas podría mejorar la calidad de vida, aunque se requieren estudios adicionales con más pacientes para confirmar esta hipótesis.

Background: Background: The significant increase in life expectancy among octogenarians in Chile has raised concerns about the efficacy and need of major cardiac surger in this population, even as 85% of them reach this age in favorable health conditions. Objectives: This study aimed to evaluate in-hospital and medium-term mortality and identify postoperative complications in octogenarian patients undergoing cardiac surgery in Chile. Methods: An observational retrospective study was conducted at Hospital Las Higueras de Talcahuano between January 2014 and December 2022, involving a sample of 79 patients. Results: 86% of procedures utilized extracorporeal circulation, and 84% were elective, predominantly coronary artery surgeries (54%). In-hospital mortality was 9%. Preoperative Intra-Aortic Balloon Pump use identified as a poor prognostic factor. Postoperative complications such as Atrial Fibrillation affected 17%, while only Pneumonia and Renal Failure significantly influenced mortality. Survival at 1, 3, and 5 years was 81%, 76%, and 73%, respectively. Conclusion: Cardiac surgery in octogenarians in Chile yields comparable outcomes to those worldwide, emphasizing the importance of individual assessment by a multidisciplinary team when considering major surgeries in frail patients. The use of minimally invasive techniques may enhance quality of life, although further studies with larger patient cohorts are needed to confirm this hypothesis.

Escalas TRACK y TRUST como predictoras de riesgo transfusional en cirugía cardiovascular en población mexicana / TRUCK and TRUST scales as transfusional risk predictors in cardiovascular surgery in Mexican population

Resumen: Introducción: La transfusión conlleva complicaciones y mortalidad en cirugía cardíaca, con incidencia de 40-90%. Existen escalas que predicen riesgo transfusional; sin embargo, difieren en el número y tipo de variables; además, pocas han sido comparadas en la población mexicana. Objetivo: Evaluar las escalas Transfusion Risk Understanding Scoring Tool (TRUST) y Transfusion Risk and Clinical Knowledge (TRACK) para riesgo de transfusión en cirugía cardiovascular en población mexicana. Material y métodos: Estudio observacional, retrospectivo, comparativo. Incluyó 300 pacientes sometidos a cirugía cardiovascular electiva mayores de 18 años. Se evaluó mediante curva ROC el área bajo la curva (AUC) de los puntajes TRACK y TRUST y su relación con la variable hemotransfusión. La estadística inferencial fue mediante t de Student y χ2. Resultados: Fueron 83 mujeres (27.7%) y 217 hombres (72.3%). Se transfundieron 227 pacientes (75.7%); la mayoría con hematocrito > 35% (82.2%). La sensibilidad, especificidad y AUC para identificar pacientes de riesgo alto y muy alto de la escala TRACK fueron: 76%, 50% y 0.702, respectivamente; para la escala TRUST fueron: 68%, 57% y 0.69, respectivamente. Conclusiones: Las escalas TRACK y TRUST son útiles para la estratificación de riesgo de transfusión en cirugía cardíaca electiva en nuestra población.

Abstract: Introduction: Transfusion leads to complications and mortality in cardiac surgery, with an incidence of 40-90%. There are scales that predict transfusion risk, however, they differ in the number and type of variables; furthermore, few have been compared in Mexican population. Objective: To evaluate the Transfusion Risk Understanding Scoring Tool (TRUST) and Transfusion Risk and Clinical Knowledge (TRACK) scales for risk of transfusion in cardiovascular surgery in the Mexican population. Material and methods: Observational, retrospective, comparative study. It included 300 patients older than 18 years who underwent elective cardiovascular surgery. The area under the curve (AUC) of the TRACK and TRUST scores and their relationship with the transfusion variable were evaluated using the ROC curve. The inferential statistics implemented were Student's t and χ2. Results: There were 83 women (27.7%) and 217 men (72.3%). 227 Patients (75.7%) were transfused; the majority with hematocrit > 35% (82.2%). Sensitivity, specificity, and AUC to identify high and very high risk patients of the TRACK scale were: 76%, 50% and 0.702, respectively; for the TRUST scale were: 68%, 57% and 0.69, respectively. Conclusions: The TRACK and TRUST scales are useful for transfusion risk stratification in elective cardiac surgery in our population.

Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Factores predictivos negativos para hemorragia mayor en posoperados de cambio valvular aórtico por minitoracotomía / Negative predictors of major bleeding in postoperative aortic valve replacement via mini-thoracotomy

Resumen Introducción: La estenosis aórtica es la valvulopatía más común y requiere tratamiento quirúrgico. Las técnicas quirúrgicas mínimamente invasivas han surgido como alternativas a la esternotomía media tradicional. Objetivo: Analizar los posibles factores de riesgo asociados a la hemorragia mayor a lo habitual en pacientes sometidos a cambio valvular aórtico por minitoracotomía anterior derecha, y compartir los resultados encontrados en nuestro centro. Materiales y método: Se llevó a cabo un estudio observacional, longitudinal y retrospectivo con pacientes operados por minitoracotomía anterior derecha entre julio de 2015 a diciembre de 2022. Se recopilaron datos demográficos y clínicos, así como información sobre las variables generales y quirúrgicas relevantes. Resultados: Se observó una edad media de 58 años en los pacientes estudiados, con una mayor presencia de hombres menores de 65 años. De los pacientes estudiados, solo 3 (4.47%) presentaron hemorragia mayor a lo habitual. Se encontró una asociación entre la edad avanzada y el tiempo de circulación extracorpórea (minutos) con hemorragia mayor a lo habitual. Conclusiones: Los resultados del estudio indican que la incidencia de hemorragia mayor a lo habitual fue baja en la cirugía mínimamente invasiva realizada. La edad avanzada y el tiempo prolongado de circulación extracorpórea se identificaron como factores de riesgo significativos para hemorragia mayor a lo habitual. Sin embargo, se destaca la necesidad de realizar estudios con una muestra más amplia para comprender mejor estos factores y la seguridad de la cirugía mínimamente invasiva.

Abstract Introduction: Aortic stenosis is the most common valvular heart disease requiring surgical treatment. Minimally invasive surgical techniques have emerged as alternatives to traditional median sternotomy. Objective: To analyze the possible risk factors associated with major bleeding in patients undergoing aortic valve replacement via right anterior mini-thoracotomy and to share the results found in our center. Materials and methods: A retrospective, observational, longitudinal study was conducted in patients undergoing right anterior mini-thoracotomy from July 2015 to December 2022. Demographic and clinical data, as well as relevant surgical and echocardiographic variables, were collected. Results: The mean age of the study population had a mean age of 58 years, with a predominance of men under 65 years of age. Only three patients experienced major bleeding 4.47%. Advanced age and extracorporeal circulation time (minutes) were associated with bleeding. No significant differences were found in other variables analyzed. Conclusions: The study results indicate a low rate of postoperative bleeding in minimally invasive surgery. Advanced age and prolonged extracorporeal circulation time were identified as significant risk factors for major bleeding. However, further studies with a larger sample size are needed to better understand these factors and the safety of minimally invasive surgery.

Research progress of blood protection strategies during cardiopulmonary bypass in pediatric cardiac surgery / 临床麻醉学杂志

Perioperative blood loss in pediatric cardiac surgery is related to the significant increase of blood transfusion,which leads to adverse events of blood transfusion and worsens the prognosis.Perioper-ative blood protection has important clinical significance in reducing adverse reactions to blood transfusion and alleviating blood supply tension.Cardiopulmonary bypass plays an important role in the management of perioperative blood protection practices.This article reviews the latest progress for blood protection in perfu-sion and blood product infusion strategies during cardiopulmonary bypass,providing reference for physicians to transfuse blood in children undergoing cardiopulmonary bypass during pediatric heart surgery.

Effect of desflurane post-conditioning on myocardial protection in patients undergoing cardiac surgery under cardiopulmonary bypass / 实用医学杂志

Objective To observe and evaluate the protective effect of desflurane post-conditioning on myocardial injury during cardiopulmonary bypass and its influence on patients'postoperative recovery.Methods A total of 200 patients in need of cardiac surgery were selected as the experimental subjects,who were aged from 20 to 65 years old,and divided into ASA Ⅱ-Ⅲ and NYHA Ⅱ-Ⅲ by endotracheal intubation and extracorporeal circulation method under general anesthesia.The patients were randomly divided into desflurane post-treatment group(experi-mental group,group D)and control group(group C)after selection.With the successive opening of the aorta and superior vena cava,group D were given 5%desflurane by inhalation with mechanical ventilation.While group C inhaled pure oxygen without inhaling desflurane.The depth of intraoperative anesthesia was maintained between 40～50 during the operation.Radial artery blood was collected from patients in 24 h before surgery(T0),immediately after intubation(T1),and 1 h(T2),6 h(T3),12 h(T4)and 24 h(T5)after aortic opening to achieve the determi-nation of troponin I(cTnI)and creatine kinase isoenzyme MB(CK-MB).On the premise of obtaining the informed consent of the patient,about 50 mg of right atrial appendage tissue was collected before aortic intubation(T1.5)and 1 hour after aortic opening(T2)to determine the apoptosis rate.Results(1)cTnI in group C at the time of T2,T3,T4 and T5 was apparently higher than group D(P<0.05).(2)CK-MB in group C at the time of T3 was apparently higher than group D(P<0.05).(3)The myocardial tissue results showed that there was a lower apoptosis rate in experimental group at the time of T2(P<0.05).Conclusion Desflurane post-conditioning has a myocardial protec-tive effect during cardiac surgery under cardiopulmonary bypass.

Status Analysis of Unplanned Reoperation in Cardiac Surgery Department of a Provincial Grade A Tertiary General Hospital / 中国医院管理

Objective To analyze the current situation of unplanned reoperation in cardiac surgery and to discuss the management measures of unplanned reoperation.Methods The information of patients undergoing cardiac surgery in a class A tertiary comprehensive hospital during 2018-2022 was collected to analyze the incidence of unplanned reoperation,major ca uses,disease types,surgica l moda lities and Complications.Results A tota l of 3902 patients underwent surgery,of whom 73(1.87%)underwent unplanned reoperation.The main cause of unplanned reoperation was bleeding(50%).The disease types with the highest unplanned reoperation composition ratio were coronary heart disease(38.4%),and the disease types with the highest incidence were dilated cardiomyopathy(11.1%).The average hospitalization cost,the average length of hospitalization,mortality rate and medical dispute rate of patients who had unplanned reoperation were significantly higher than those who did not have unplanned reoperation,the difference was statistically significant(P=0.001).Conclusion The hospital should strengthen the perioperative management of cardiac surgery,focus on supervising disease types and surgical modalities with high incidence of unplanned reoperation,and strictly implement the system of operation classification and the system of reporting unplanned reoperation to ensure the quality of patient surgery.

Effect of patent foramen ovale on development of post-operative stroke in patients undergoing non-cardiac surgery: a meta-analysis / 中华麻醉学杂志

Objective:To evaluate the effect of patent foramen ovale on the development of post-operative stroke in the patients undergoing non-cardiac surgery using a meta-analysis approach.Methods:A comprehensive search was conducted across multiple databases including PubMed, Embase, Web of Science, CINAHL, Cochrane Library, China Biomedical Literature Database, Wanfang Data Knowledge Service Platform, and China Journal Full Text Database.The inclusion criteria encompassed studies assessing the correlation between patent foramen ovale and post-operative stroke.The primary outcome measure focused on the incidence of post-operative stroke, and secondary outcome measures comprised mortality, myocardial infarction rate, and readmission rate within 30 days after surgery. The quality of literature meeting the inclusion criteria was evaluated and data were extracted, and then meta-analysis was conducted using RevMan 5.4 software.Results:Eight retrospective cohort studies involving 21 142 237 patients were included.The results of meta-analysis showed that patent foramen ovale was associated with post-operative stroke and readmission within 30 days after surgery.There were no significant differences in all-cause mortality and myocardial infarction rates between patent foramen ovale group and mon-patent foramen ovale group ( P>0.05). Conclusions:Patent foramen ovale can increase the risk of post-operative stroke in the patients undergoing non-cardiac surgery.

Impact of Intraoperative Plasma Infusion Dose on the Clinical Prognosis of Cardiac Surgery Patients / 中山大学学报(医学科学版)

ObjectiveTo assess the impact of intraoperative plasma infusion dose and coagulation test value INR on the clinical prognosis of patients undergoing cardiac surgery， providing a basis for guiding rational blood use during cardiac surgery. MethodsThe clinical data of 305 surgical patients who received fresh frozen plasma transfusion during cardiac surgery were collected in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2014 to December 2022. The patients were divided into low-dose group （plasma infusion dose <15 mL/kg， n = 214） and high-dose group （plasma infusion dose ≥15 mL/kg， n = 91） based on the intraoperative plasma dose. Univariate analysis， correlation analysis and logistic multivariate regression analysis were used to analyze the relationship between plasma infusion dose， changes in INR before and after plasma transfusion， and the clinical prognosis of patients undergoing cardiac surgery. ResultsThe median plasma infusion dose for all patients was 11.11 （8.17-19.05） mL/kg， while the median plasma infusion dose in the high-dose group and the low-dose group was 17.78 （15.69-20.91） mL/kg and 9.52 （7.77-11.43） mL/kg， respectively， with a statistically significant difference （P <0.001）. The median INR decrease in the high-dose and low-dose groups was 0.98 （0.60-1.26） and 0.50 （0.35-0.76）， respectively， with a statistically significant difference （P<0.001）. Logistic multivariate regression analysis revealed that abnormally elevated preoperative INR values increased the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P<0.001）， with an OR 95%CI of 6.757（3.068， 14.822）. Additionally， it also increased the risk of postoperative in-hospital mortality （P< 0.001）， with an OR 95%CI of 5.441 （2.193， 13.499）. INR decrease reduced the risk of postoperative red blood cell transfusion within 24 hours in cardiac surgery patients （P=0.001）， with an OR 95%CI of 0.244（0.107， 0.558）. Correlation analysis showed positive correlation between plasma infusion dose and postoperative ICU days （rs=0.569， P<0.001） and hospital days （rs=0.302， P<0.001） in cardiac surgery patients. ConclusionAmong patients undergoing cardiac surgery who receive intraoperative plasma transfusion， high plasma infusion dose and abnormally elevated preoperative INR values are associated with poorer clinical outcomes， while patients who show a greater degree of INR correction after plasma transfusion exhibit better clinical results.

Risk factors for arrhythmia after robotic cardiac surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. Results A total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.

Effect of Ultrasound-guided Superficial Parasternal Intercostal Plane Block on The Quality of Recovery in Patients Undergoing Sternotomy Cardiac Surgery / 中山大学学报(医学科学版)

ObjectiveThis study aims to explore the effect of ultrasound-guided superficial parasternal intercostal plane block on the quality of recovery and postoperative analgesia in patients undergoing sternotomy cardiac surgery. MethodsA total of 64 patients undergoing sternotomy cardiac surgery were selected for this study. They were randomly divided into two groups： one group received a superficial parasternal intercostal plane block with ropivacaine （the ropivacaine group）， while the other was given normal saline （the normal saline group）. The primary outcome was the Quality of Recovery-15 （QoR-15） score on postoperative day 1 in both groups， accompanied by a comparative analysis of the pain score and opioid usage. ResultsCompared with the normal saline group， the ropivacaine group exhibited a significantly higher QoR-15 score on postoperative day 1［（89.60±13.24） vs （81.18±12.78）， P=0.012］. The numerical rating scale at rest was significantly lower［（3.03±0.72） vs （4.26±0.93）， P<0.001］， and the numerical rating scale during coughing was also significantly reduced ［（4.40±0.89） vs （5.44±1.05）， P<0.001］. Concurrently， the cumulative morphine equivalent consumption during the initial 24 h postoperatively was significantly lower in patients who were administered the ropivacaine ［14.15 （4.95～30.00） mg vs 40.50 （19.25～68.18） mg， P=0.002］， and there was also a notable decrease in the rescue analgesia ［0.00 （0.00～0.00） mg vs 0.00 （0.00～100.00） mg， P=0.007］. ConclusionUltrasound-guided superficial parasternal intercostal plane block can significantly enhance the overall quality of recovery in patients undergoing sternotomy cardiac surgery on postoperative day 1. The technique contributes to improved postoperative analgesic effects and a reduction in opioid usage， thereby facilitating early postoperative recovery.

Risk factors for pulmonary infection after cardiac surgery:a Meta-analysis / 中国感染控制杂志

Objective To systematically evaluate the influencing factors for pulmonary infection after cardiac sur-gery.Methods Literatures were retrieved from PubMed,Embase,Web of Science,the Cochrane Library,CBM,Wanfang,CNKI and VIP databases.The retrieval time was from the establishment of databases to November 22,2022.Meta-analysis was performed with RevMan 5.4 and Stata 15.0 softwares.Results A total of 20 literatures were included in the analysis.Meta-analysis showed that age(≥65 years),mechanical ventilation time(≥5 days),smoking,acute renal damage,perioperative blood transfusion,operation time(≥240 minutes),secondary thora-cotomy,and oxygenation index(PaO2/FiO2≤300 mmHg)were risk factors for postoperative pulmonary infection.Conclusion The existing evidence shows that all of the above 8 factors are risk factors for pulmonary infection after cardiac surgery,which can provide a theoretical basis for health care workers to prevent and treat infection.

Effects of an innovative inspiratory muscle training program on postoperative pulmonary complications in patients with valvular heart disease with limited resources / 中国康复医学杂志

Objective:To explore the effectiveness and feasibility of strengthening inspiratory muscle training program matching the preoperative waiting time for patients with valvular heart disease in China with limited resources in preventing postoperative pulmonary complications(PPCs). Method:Patients undergoing elective heart valve surgery were randomly divided into control group and inter-vention group,with 65 patients in each group.All the enrolled patients received a routine physical therapy pro-gram before surgery,and the intervention group received an additional 3 days of enhanced inspiratory muscle training program before surgery.The incidence of postoperative complications was recorded for all patients with-in 14 days after surgery,respiratory function and motor capacity(6-minute walking test)were tested for all patients on the day of admission and discharge,and the length of postoperative hospital stay was counted. Result:Compared with the control group,the incidence of PPCs was lower in the intervention group(OR 2.18,95％CI 1.07-4.47,P-0.03),and the walking distance was longer(P=0.01).There was no statistical difference in lung function and length of hospital stay(P＞0.05),and no adverse events occurred during train-ing.There was no significant difference in general demographic characteristics between the two groups before treatment.The incidence of PPCs in the intervention group was lower than that in the control group(P＜0.05),and the 6-minute walking distance at discharge was higher than that in the control group(P＜0.05).There were no statistically significant differences in lung function and postoperative hospital stay between the intervention group and the control group(P＞0.05),and no adverse events occurred during training. Conclusion:Enhanced inspiratory muscle training 3 days before surgery is safe and feasible in patients with elective heart valves and can reduce postoperative pulmonary complications and improve the level of motor function at discharge.

Correlation between nociceptin/orphanin FQ(N/OFQ)and perioperative myocardial injury in elderly patients with coronary heart disease / 中国现代医生

@#Objective To evaluate the relationship between perioperative myocardial injury(PMI)and serum N/OFQ levels in elderly patients with coronary heart disease.Methods Totally 120 elderly patients who underwent hip fracture surgery under general anesthesia from January 2022 to May 2023 were included,including 60 patients with coronary heart disease(CHD group)and 60 patients without coronary heart disease(control group).The venous blood of patients was collected 10 minutes before anesthesia induction(T0),12 hours after surgery(T1)and 24 hours after surgery(T2)to detect the content of N/OFQ and high-sensitivity myocardial troponin I(hs-cTnI)in serum.Record perioperative adverse cardiovascular events(PACE)and the use of vasoactive drugs during surgery.Results Compared with the control group,the N/OFQ and hs cTnI levels at T0 and T1 in the CHD group were significantly increased(P<0.05).There was a positive correlation between N/OFQ and hs-cTnI levels at T1 and T2 in CHD and control group(P<0.05).The use of PACE and intraoperative vasoactive drugs in the CHD group was higher than that in the control group(P<0.05).Conclusion There is a correlation between the increased N/OFQ content and PMI in elderly patients with coronary heart disease after surgery,which may become an early predictive indicator of PMI.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Acute normovolemic hemodilution and intraoperative autotransfusion

Abstract Autologous blood transfusion can be achieved through different techniques, including by the patient donating blood before surgery (pre-deposit), collecting blood from the patient immediately before the operation and replacing the volume with colloids or plasma expanders (acute normovolemic hemodilution) or through the salvage of lost blood, during or immediately after surgery, and its retransfusion after washing (intraoperative or postoperative recovery). We will focus on the two methods used intraoperatively that are of fundamental importance in the management and conservation of the patient's own blood.

The association of hemoglobin with postoperative delirium and atrial fibrillation after cardiac surgery: a retrospective sub-study

Abstract Background: Most cardiac surgery patients experience postoperative anemia. Delirium and Atrial Fibrillation (AF) are common and independent predictors of morbidity and mortality. Few reports examine their association with postoperative anemia. This study aims to quantify the association between anemia and these outcomes in patients undergoing cardiac surgery. Methods: This post-hoc analysis of the DECADE randomized controlled trial ran at six academic US hospitals. Patients aged 18-85 years with heart rate > 50 bpm undergoing cardiac surgery who had daily hemoglobin measurements in the first 5 Postoperative Days (POD) were included. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM - ICU), preceded by the Richmond Agitation and Sedation Scale, with patients excluded from assessment if sedated. Patients had daily hemoglobin measurements, continuous cardiac monitoring plus twice-daily 12-lead electrocardiograms, up to POD4. AF was diagnosed by clinicians blinded to hemoglobin levels. Results: Five hundred and eighty-five patients were included. Mean postoperative hemoglobin Hazard Ratio (HR): 0.99 (95% CI 0.83, 1.19; p = 0.94) per 1 g.dL-1 hemoglobin decrease. 197 (34%) developed AF, mainly on POD = 2.3. Estimated HR = 1.04 (95% CI 0.93, 1.17; p = 0.51) per 1 g.dL-1 hemoglobin decrease. Conclusions: Most patients undergoing major cardiac surgery were anemic in the postoperative phase. AF and delirium occurred in 34% and 12% of patients, respectively, but neither were significantly correlated with postoperative hemoglobin.