3. The impact of elevated HbA1c on Surgical Site Infection and other infectious morbidities after isolated coronary artery bypass surgery

Wound infection is an important cause of morbidity and mortality after coronary artery bypass surgery (CABG). Patients with diabetes represent a high risk group for patients undergoing CABG. Glycosylated hemoglobin (HbA1c), a measure of hyperglycemia, is a sensitive and reliable marker of impaired glucose metabolism. The aim of the study is to compare the impact of the elevated (HbA1c), on the post-operative risk of Surgical Site Infection (SSI) and other infectious morbidities and mortality after isolated CABG. Patients & methods: Two hundred and fifty patients (190 males, 65 females; mean age 62.69 ± 11.00; range 38–85 years) who underwent coronary artery bypass surgery at our center between January and December 2012 were enrolled in this study. All patients including the non-diabetics were managed with a specialized hospital protocol for glycemic control in the perioperative period. Results: Out of the 255 patients, 169 patients (66.3%) had elevated preoperative HbA1c and 183 (71.8%), were diabetics. Surgical Site infection were observed in 26 patients with elevated HbA1c and 2 patients in the normal HbA1c group respectively (15. 3% vs 3.6%, p = 0.002), Pneumonia, were observed in 11 in the elevated and 3 in the normal HbA1c respectively (6.5% vs 5.5%), Furthermore, Septicemia was observed in 3 patients (1.8%) with elevated HbA1c. The 30 days mortality was Zero in both groups. Conclusion: Our cohorts of patients have a high incidence of diabetes, and 66.3% of the patients have elevated HbA1c at the time of surgery. Patients with elevated HbA1c, undergoing isolated coronary artery bypass surgery have a significantly higher risk of surgical site infection and may have a higher risk of other infectious complications, but have no impact on early mortality

Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair

International audienceBackground: Although >150,000 mitral TEER procedures have been performed worldwide, the impact of MR etiology on MV surgery after TEER remains unknown.Objectives: The authors sought to compare outcomes of mitral valve (MV) surgery after failed transcatheter edge-to-edge repair (TEER) stratified by mitral regurgitation (MR) etiology.Methods: Data from the CUTTING-EDGE registry were retrospectively analyzed. Surgeries were stratified by MR etiology: primary (PMR) and secondary (SMR). MVARC (Mitral Valve Academic Research Consortium) outcomes at 30 days and 1 year were evaluated. Median follow-up was 9.1 months (IQR: 1.1-25.8 months) after surgery.Results: From July 2009 to July 2020, 330 patients underwent MV surgery after TEER, of which 47% had PMR and 53.0% had SMR. Mean age was 73.8 ± 10.1 years, median STS risk at initial TEER was 4.0% (IQR: 2.2%-7.3%). Compared with PMR, SMR had a higher EuroSCORE, more comorbidities, lower LVEF pre-TEER and presurgery (all P < 0.05). SMR patients had more aborted TEER (25.7% vs 16.3%; P = 0.043), more surgery for mitral stenosis after TEER (19.4% vs 9.0%; P = 0.008), and fewer MV repairs (4.0% vs 11.0%; P = 0.019). Thirty-day mortality was numerically higher in SMR (20.4% vs 12.7%; P = 0.072), with an observed-to-expected ratio of 3.6 (95% CI: 1.9-5.3) overall, 2.6 (95% CI: 1.2-4.0) in PMR, and 4.6 (95% CI: 2.6-6.6) in SMR. SMR had significantly higher 1-year mortality (38.3% vs 23.2%; P = 0.019). On Kaplan-Meier analysis, the actuarial estimates of cumulative survival were significantly lower in SMR at 1 and 3 years.Conclusions: The risk of MV surgery after TEER is nontrivial, with higher mortality after surgery, especially in SMR patients. These findings provide valuable data for further research to improve these outcomes