Heart-type fatty acid binding protein (hFABP) and ischemia-modified albumin (IMA) have been put forward as novel biomarkers to detect myocardial injury shortly after onset of ischemia. We compared ...hFABP and IMA with cardiac troponin I (cTnI) for speed and reliability in the diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass graft surgery (CABG).
In all, 210 consecutive patients undergoing isolated CABG with cardiopulmonary bypass were enrolled in a prospective study. Blood samples were taken perioperatively and throughout the first 72 hours after surgery; clinical data and events were recorded. In cohort A, serum concentrations of hFABP and cTnI were measured using a combined quantitative bedside assay. In cohort B, IMA and cTnI serum concentrations were measured using an albumin cobalt binding test. Perioperative myocardial infarction was defined using a cTnI cutoff of greater than 10.5 ng/mL occurring within 24 hours of CABG or new electrocardiographic changes.
In cohort A, 14 patients were identified with PMI (group 1), whereas 94 had no PMI and served as controls (group 2). Both hFABP and cTnI were increased in group 1 as compared with group 2 (p < 0.001). Although cTnI did not differ before 12 hours, hFABP diverged much earlier, at 1 hour postoperatively (p < 0.001). An hFABP concentration of 20 μg/mL at 1 hour detected PMI with an area under the curve of 77.1%. In cohort B, 18 patients were identified with PMI (group 3), and 84 patients served as controls (group 4). No difference in cTnI values could be observed between the groups until 12 hours postoperatively. Ischemia-modified albumin failed to differentiate at any postoperative time point; the low discriminative power of IMA was confirmed with an area under the curve of 53.3% at 1 hour, 48.5% at 6 hours, and 39.3% at 12 hours postoperatively.
Heart-type fatty acid binding protein is a sensitive and rapid biomarker that detected PMI reliably at 1 hour after CABG, much earlier than cTnI. The diagnostic value of IMA for detection of PMI appears to be very limited in this setting.
Abstract
Endovascular stent placement for chronic postthrombotic iliofemoral venous obstructive lesions is an effective therapeutic option and might be complicated by stent migration. We report a ...case of a venous stent that was lost from the iliac vein into the right ventricle rescued by emergent open-heart surgery.
Aim
The quality of the donor heart is known to have a crucial effect on outcome after heart transplantation (HTx). Although leading to brain death in the end, the initial cause of death of the donor ...and its potential influences on organ quality are heterogeneous. However, it is still controversial to which extent the donor cause of death is associated with outcome or survival post‐HTx.
Methods and results
We included all patients undergoing HTx in our centre between September 2010 and June 2021 (n = 218). Recipients were divided in five groups related to their donor cause of death: intracerebral bleeding (‘ICB’, n = 95, 44%), traumatic brain injury (‘trauma’, n = 54, 25%), hypoxic brain damage (‘hypoxic’, n = 34, 16%), cerebrovascular (‘vascular’, n = 15, 7%), or other cause (n = 20, 9%). Baseline characteristics, perioperative parameters, and survival after 30 and 90 days as well as 5 years after transplantation were collected.
Results
Intracerebral bleeding in donors compared with traumatic brain injury is associated with higher probability of need for ECLS post‐HTx (35% vs. 19%, P = 0.04) and significantly reduced survival up to 5 years post‐HTx (i.e. 1 year survival: 61% vs. 95%, P < 0.0001). Although other conditions also show significant changes in outcome and survival, the effect is strongest for ICB, where survival is also reduced compared with all other causes (1 year: 61% vs. 89%, P < 0.0001).
Conclusions
In this retrospective analysis, donor cause of death is associated with differing outcome and survival after HTx. Intracerebral bleeding hereby shows strongest decline in outcome and survival in comparison with all other causes.
Abstract
The choice of prosthetic heart valve type is largely dependent upon patient's age at implantation and on what, in his eyes, seems more pertinent: avoidance of complications associated with ...anticoagulation of mechanical valves or structural valve deterioration of bioprosthetic valves. Long lasting and new promising concepts such as transcatheter aortic valve implantation are promoting the use of bioprosthesis even in younger patients. However, it is up to the individual patient to decide.
The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of ...synchronous combined carotid endarterectomy and CABG as compared with isolated CABG.
Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET North American Symptomatic Carotid Endarterectomy Trial) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG. To avoid unbalanced prognostic factor distributions, randomization was stratified by center, age, sex, and modified Rankin Scale. The primary composite end point was the rate of stroke or death at 30 days.
From 2010 to 2014, a total of 129 patients were enrolled at 17 centers in Germany and the Czech Republic. Because of withdrawal of funding after insufficient recruitment, enrolment was terminated early. At 30 days, the rate of any stroke or death in the intention-to-treat population was 12/65 (18.5%) in patients receiving synchronous carotid endarterectomy+CABG as compared with 6/62 (9.7%) in patients receiving isolated CABG (absolute risk reduction, 8.8%; 95% confidence interval, -3.2% to 20.8%;
=0.12). Also for all secondary end points at 30 days and 1 year, there was no evidence for a significant treatment-group effect although patients undergoing isolated CABG tended to have better outcomes.
Although our results cannot rule out a treatment-group effect because of lack of power, a superiority of the synchronous combined carotid endarterectomy+CABG approach seems unlikely. Five-year follow-up of patients is still ongoing.
URL: https://www.controlled-trials.com. Unique identifier: ISRCTN13486906.
Zusammenfassung
Seit Anfang des Jahres 2020 die COVID-19-Pandemie weltweit das Leben massiv beeinflusst und auch verändert hat, lassen sich naturgemäß gerade im Gesundheitssektor schwerwiegende ...Konsequenzen beobachten. Diese betreffen Patienten in gleichem Maß wie medizinisches Personal aller Berufsgruppen, sowohl im ambulanten als auch im stationären Bereich. Die Herzchirurgie als eine Disziplin, die wie keine zweite von der vorhandenen Kapazität auf Intensivstationen abhängig ist, war erwartungsgemäß von den Auswirkungen der Pandemie schwer betroffen. Dieser Beitrag gibt einen Überblick über die Konsequenzen für die klinische Versorgung, die Forschung und die Lehre sowie für die herzchirurgische Weiterbildung
Impact of the COVID-19 pandemic on cardiac surgery Boeken, Udo; Holst, Torulv; Hettlich, Vincent ...
Zeitschrift für Herz-, Thorax- und Gefässchirurgie,
01/2022, Letnik:
36, Številka:
5
Journal Article
OBJECTIVESHeart transplant is the treatment of choice for patients with end-stage heart failure who remain symptomatic despite optimal medical therapy. The primary indications for heart transplant ...worldwide have been nonischemic cardiomyopathy and ischemic cardiomyopathy. For the 2 indications, patients differ in underlying pathomechanisms leading to their disease and consecutively in relevant comorbidities. However, the influence of an indication of ischemic or nonischemic cardiomyopathy for heart transplant on recipient outcomes posttransplant remains controversial. Here, we investigated whether ischemic or nonischemic cardiomyopathy indication were associated with patient morbidity and mortality after heart transplant. MATERIALS AND METHODSWe included all patients undergoing heart transplant in our center between September 2010 and June 2021 (n = 218). Recipients were divided into 2 groups related to their indication: ischemic (n = 92; 42%) and nonischemic cardiomyopathy (n = 126; 58%). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival up to 5 years posttransplant. RESULTSAlthough patients with nonischemic cardiomyopathy were significantly younger (51.7 vs 59.1 years; P < .001), had fewer previous cardiac surgeries (56% vs 75%; P = .01), and less frequent severe infections or sepsis (19% vs 32%; P = .03), other outcome-related parameters such as need for extracorporeal life support posttransplant (26% vs 33%), rejection within index stay (7% vs 8%), and survival after 30 days (88% vs 92%), 90 days (85% vs 88%) or 1 year (76% vs 77%) were different. CONCLUSIONSIn this retrospective analysis, although barring different baseline characteristics, ischemic versus nonischemic recipient diagnosis was not associated with outcome or survival after heart transplant.
BackgroundThe pandemic caused by SARS-CoV‑2 (severe acute respiratory syndrome coronavirus type 2) has led to hospitalizations and increased mortality worldwide. With potentially high prevalence and ...severity of COVID-19 in cardiac transplantation, there is a great need to generate data in this at-risk cohort. ObjectiveWe report here our experience with COVID-19 (coronavirus disease 2019) in heart transplant recipients at a German transplantation center longitudinally over the previous pandemic waves and place it in context to published experiences of other centers. Material and methodsAll adult patients who had received a heart transplant at our center and had confirmed COVID-19 infection (n = 12) were included and retrospectively characterized. ResultsThe mean age was 61.5 (49-63) years, and the majority were male (83%). Comorbidities such as diabetes (42%), arterial hypertension (43%), and chronic renal failure (67%) were found. Passive immunization (convalescent plasma/monoclonal antibodies) was performed in 50%. Oxygen administration was required in 33% of patients; only one patient required noninvasive ventilation (8%), and no patient required invasive ventilation or mechanical cardiovascular support (ECMO). No new cardiovascular or thromboembolic events were found. ConclusionWe could longitudinally not detect severe courses or increased mortality of COVID-19 in heart transplant patients. Prospective studies are needed to make better prognostic estimates of COVID-19 in (heart) transplant patients in the future.
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