Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery

Background: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of sudden cardiacarrest (SCA) in patients undergoing valve surgery is currently unknown.Methods: A prospective study was conducted on a group of 815 consecutive patients with significantvalvular heart disease that underwent elective valve surgery. The primary end-point was postoperative SCA.Results: The postoperative SCA occurred in 26 patients. At multivariate analysis of hs-TnT measuredimmediately after surgery (hs-TnT I) and age remained independent predictors of the primary end-point.Conclusions: Elevated postoperative hs-TnT was associated with a higher risk of postoperative SCA

Anisocytosis predicts postoperative renal replacement therapy in patients undergoing heart valve surgery

Background: Acute kidney injury (AKI) is one of the serious postoperative complications in patients undergoing heart valve surgery. The aim of the present study was to identify selected biomarkers to predict AKI requiring renal replacement.Methods: A prospective study was conducted on a group of 751 patients undergoing heart valve surgery. The data on risk factors, preoperative complete blood count, course of operations and postoperative period was assessed. The primary endpoint at the 30-day follow-up was postoperative AKI requiring renal replacement therapy. The secondary end-point was death from all causes in patients with postoperative AKI requiring renal replacement.Results: The primary endpoint occurred in 46 patients. At multivariate analysis: age, red cell distribution width (RDW) and C-reactive protein remained independent predictors of the primary endpoint. Hemoglobin and RDW were associated with an increased risk of death.Conclusions: Elevated RDW is associated with a higher risk of postoperative AKI and death in patients with AKI

The usefulness of selected biomarkers in aortic regurgitation

Background: The aim of the study was to investigate the prognostic value of selected biomarkers inpatients with aortic regurgitation undergoing valve surgery. Methods: A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic regurgitation that underwent elective aortic valve surgery. The primary endpoint was 30-day mortality and any major adverse event within 30 days. Results: The study group included 205 consecutive patients who underwent replacement or repair of the aortic valve. The primary endpoint occurred in 72 patients. At multivariate analysis red cell distribution width (RDW; p = 0.03) and high-sensitivity troponin T (hs-TnT; p = 0.02) remained independent predictors of the major complications including death. Conclusions: Elevated preoperative RDW and hs-TnT were associated with a poorer outcome followingaortic valve surgery

Factors associated with the presence of tricuspid valve regurgitation in patients with systemic right ventricles following atrial switch

Background: The development of significant tricuspid regurgitation (TR) is associated with an unfavorable clinical outcome in patients with systemic right ventricles. Increased knowledge about the factors contributing to its presence would help prevent its progression. Methods: This was a retrospective analysis of the factors predictive of significant TR in 60 patients with systemic right ventricles following an atrial switch procedure for complete transposition of the great arteries. Data from echocardiographic examinations, exercise radionuclide angiography, and myocardial perfusion imaging were analyzed. Results: Significant TR was present in 20% of patients. Compared to patients without significant TR, patients with significant TR were older at the time of surgery (p ≤ 0.001), with a higher body mass index (p ≤ 0.005), lower right ventricular ejection fraction (RVEF; p ≤ 0.01), higher exercise perfusion abnormalities score on radionuclide angiography (p ≤ 0.03), and higher systolic blood pressure (p ≤ 0.02). At univariate logistic regression analysis systolic blood pressure (p = 0.03), increasing age at surgery (p = 0.01), and RVEF (p = 0.02), were predictors of significant tricuspid regurgitation. The latter two remained significant at multivariate analysis. Conclusions: Patients operated upon later in life, with decreased RVEF and higher blood pressure, are at risk of significant tricuspid regurgitation and therefore warrant special attention. Prospective studies are needed to ascertain whether appropriate pharmacological intervention would prevent the development and/or progression of TR in these patients. (Cardiol J 2010; 17, 1: 29-34

Literature-based considerations regarding organizing and performing cardiac surgery against the backdrop of the coronavirus pandemic

Background: The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic. Methods Key recommendations were extracted from recent literature concerning cardiac surgery. RESULTS: Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams. Conclusions There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients' clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays

Raised red cell distribution width as a prognostic marker in aortic valve replacement surgery

Background and aim: Several studies have reported that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with coronary artery disease, chronic heart failure and aortic stenosis following transcatheter aortic valve replacement. Their prognostic utility in patients undergoing aortic valve replacement (AVR) surgery is unknown. Methods: We prospectively evaluated the prognostic value of RDW in a group of 191 consecutive patients with severe symptomatic aortic stenosis undergoing AVR. The pre-defined primary endpoint at the 30-day follow-up was composed of: all cause mortality, perioperative myocardial infarction, perioperative renal failure, prolonged mechanical ventilation, stroke, heart failure, successfully resuscitated cardiac arrest, the occurrence of multiple-organ failure, and the need for additional surgery for any reason. The secondary endpoint was total mortality. Results: The composite endpoint occurred in 54 patients. In univariate analysis RDW (p < 0.0001), haemoglobin level (p = 0.005), haematocrit (p = 0.01), red blood cell count (RBC; p = 0.002), glomerular filtration rate (p = 0.003), New York Heart Association classification (p = 0.02), atrial fibrillation (p = 0.0044), and pulmonary blood pressure (p = 0.004) were associated with the occurrence of the composite endpoint. RDW (p = 0.0005), haemoglobin level (p = 0.004), haematocrit (p = 0.004), RBC (p = 0.0009) and mean corpuscular volume (p = 0.01) were associated with an increased risk of death. In multivariate analysis, RDW (OR 3.274; 95% CI 1.285–8.344; p = 0.0003) and RBC (OR 0.373; 95% CI 0.176–0.787; p = 0.0097) remained independent predictors of the composite endpoint. Receiver operating characteristic analysis determined a cut-off value of RDW for the prediction of the occurrence of the combined endpoint at 14.1%. Conclusions: Elevated RDW is associated with a worse outcome following AVR, independent of RBC.  Wstęp: W dotychczasowych badaniach wykazano, że podwyższone wartości rozkładu objętości erytrocytów (RDW) są związane z gorszym rokowaniem u osób z chorobą wieńcową, niewydolnością serca czy ciężką stenozą aortalną leczoną przezcewnikowym wszczepieniem zastawki aortalnej. Znaczenie RDW u pacjentów poddawanych operacji chirurgicznej wymiany zastawki aortalnej jest nieznane. Cel: Celem niniejszej pracy była ocena wartości prognostycznej RDW u chorych poddawanych operacyjnemu leczeniu ciężkiej stenozy aortalnej. Metody: Prospektywne badanie przeprowadzono w grupie kolejnych 191 pacjentów z ciężką objawową stenozą aortalną poddawanych operacyjnemu leczeniu wymiany zastawki aortalnej. Na z góry zdefiniowany pierwszorzędowy złożony punkt końcowy w obserwacji 30-dniowej składało się wystąpienie następujących powikłań: zgonu z wszystkich przyczyn, okołozabiegowego zawału serca, okołooperacyjnej niewydolności nerek, przedłużonej wentylacji mechanicznej, udaru ośrodkowego układu nerwowego, skutecznie resuscytowanego zatrzymania akcji serca, niewydolności wielonarządowej i konieczności reoperacji z jakiejkolwiek przyczyny. Drugorzędowym punktem końcowym była śmiertelność. Wyniki: Pierwszorzędowy złożony punkt końcowy w obserwacji 30-dniowej zaobserwowano u 54 pacjentów. W analizie jednoczynnikowej predyktorami wystąpienia pierwszorzędowego punktu końcowego były: RDW (p < 0,0001), hemoglobina (p = 0,005), hematokryt (p = 0,01), liczba erytrocytów (p = 0,002), wskaźnik przesączania kłębuszkowego (p = 0,003), stopień niewydolności serca wg klasyfikacji NYHA (p = 0,02), migotanie przedsionków (p = 0,0044) i ciśnienie w tętnicy płucnej (p = 0,004). Wartości RDW (p = 0,0005), hemoglobiny (p = 0,004), hematokrytu (p = 0,004), liczba erytrocytów (p = 0,0009) i średnia objętość erytrocytów (p = 0.01) wiązały się ze zwiększonym ryzykiem wystąpienia zgonu. Analiza wieloczynnikowa potwierdziła znaczenie RDW (OR 3.274; 95% Cl 1,285–8,344; p = 0,0003) jako niezależnego predyktora wystąpienia pierwszorzędowego złożonego punktu końcowego. Przy użyciu statystyki krzywej ROC wyznaczono punkt odcięcia RDW dla wystąpienia złożonego punktu końcowego na poziomie 14,1% (pole pod krzywą 0,07; p = 0,008). Wnioski: Wyższe wartości RDW są związane z gorszym rokowaniem u pacjentów poddawanych operacji wymiany zastawki aortalnej, niezależnie od liczby erytrocytów.

Lead extraction: The road to successful cardiac resynchronization therapy

Background: Still increasing life expectancy in patients with implanted devices and large number of leads more and more often induce the need to cure the treatment complications or to change especially to cardiac resynchronization therapy (CRT). In order to prevent further complications, the possibility of damaged or redundant leads extraction should be taken into consideration. The aim of the paper was to assess the effectiveness and safety of transvenous lead extraction (TLE) with co-implantation of resynchronization systems. Methods and results: Between 2008 and March 2013, the system removal with TLE was conducted in 246 patients. In 38 patients (11 women, 28.9%), aged 43–79 (mean 65 years), it was combined with co-implantation of CRT-pacemaker or defibrillator (CRT-P/D). Indica­tions for TLE covered: lead failure in 21 (55.3%) patients, redundant leads in 6 (15.8%), and the occluded venous system in 7 (18.4%). The up-grade of the pacemaker or defibrillator system to CRT-D was performed in 19 cases, CRT-P/D revision in next 19. Together 32 defibrillation leads and 42 pacing leads (27 left ventricular leads, and 1 epicardial lead) were implanted. The intended clinical target — an effective resynchronization therapy — was obtained in all patients. There was no case of death or severe complications. In 2 cases of venous occlusion, the implantation on the contralateral side was required. Conclusions: TLE enables effective resynchronization therapy also in the case of the presence of too many leads, occlusion of the venous system or lead failure. Significant technical problems can occur especially in patients with venous system occlusion