5 research outputs found
Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality.
Permanent pacemaker implantation (PPI) represents a rare complication after cardiac
surgery, with no uniform agreement on timing and no information on follow-up. A multicenter
retrospective study was designed to assess pacemaker dependency (PMD) and longterm
mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients
from 18 centers were followed. Time-to-event data were evaluated with semiparametric
regression Cox models and semiparametric Fine and Gray model for competing risk
framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6
months. PMD showed higher mortality compared with PMI (10-year survival 80.1% §
2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard
ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted
hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative
incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and
12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and
37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus
rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas
coronary artery bypass grafting and aortic valve replacement were independently associated
with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to
0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate
of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term
Cardiac surgery practice during the COVID-19 outbreak: a multicentre national survey.
OBJECTIVES: Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak.
Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities.
Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe
the changes in cardiac surgery practices during the health emergency at the national level.
METHODS: A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical
practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019.
RESULTS: All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of
dedicated cardiac intensive care unit beds (-35.4%) and operating rooms (-29.2%), along with healthcare personnel reallocation to COVID
departments (nurses -15.4%, anaesthesiologists -7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734
procedures vs 3447; P < 0.001), with a significant drop in elective procedures [580 (33.4%) vs 2420 (70.2%)].
CONCLUSIONS: This national survey found major changes in cardiac surgery practice as a response to the COVID-19 pandemic. This experience
should lead to the development of permanent systems-based plans to face possible future pandemics. These data may effectively
help policy decision-making in prioritizing healthcare resource reallocation during the ongoing pandemic and once the healthcare emergency
is over