European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Nov 2011
Body mass index predicts new-onset atrial fibrillation after cardiac surgery.
New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased morbidity and mortality. Since obesity is becoming increasingly prevalent, identifying body mass index (BMI) as a risk factor for POAF could be of importance. The aim of our study is to investigate the effect of BMI on POAF, independent of other risk factors. ⋯ Body mass index, age, undergoing valve surgery and male gender, are independent risk factors for POAF.
-
Eur J Cardiothorac Surg · Nov 2011
The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure.
Optimisation of Norwood physiology, with focus on systemic perfusion, has beneficial effects on haemodynamic stability and perioperative mortality following the Norwood procedure for hypoplastic left heart syndrome. Early identification of high-risk patients during the postoperative phase might allow for institution of alternative management strategies with the possibility of avoiding poor outcome. Several studies have suggested that arterial blood lactate level, as an index of systemic perfusion and oxygen delivery, can to some extent predict mortality following paediatric cardiac surgery, though these studies have included heterogeneous groups of patients with only few Norwood patients. We sought to determine whether the blood lactate profile could be used to derive a simple, clinically applicable decision algorithm to direct therapy in a pre-emptive manner and perhaps identify patients for elective extracorporeal life support following the Norwood procedure. ⋯ We have identified minimum blood lactate level within the first 24h after the Sano-Norwood procedure as a highly discriminatory predictor of perioperative mortality. These patients might benefit from elective institution of early mechanical circulatory support.
-
Eur J Cardiothorac Surg · Nov 2011
Meta AnalysisAortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with?
Co-existent mitral regurgitation may adversely influence both morbidity and mortality in patients undergoing aortic valve replacement for severe aortic stenosis. Whilst it is accepted that concomitant mitral intervention is required in severe, symptomatic mitral regurgitation, in cases of mild-moderate non-structural mitral regurgitation, improvement may be seen following aortic valve replacement alone, avoiding the increased risk of double-valve surgery. The exact benefit of such a conservative approach is, however, yet to be adequately quantified. ⋯ No significant change was seen in left-ventricular end-systolic diameter (p=0.10), septal thickness (p=0.17) or left atrial area (p=0.23). We conclude that despite reverse remodelling, concomitant moderate-severe mitral regurgitation adversely affects both early and late mortality following aortic valve replacement. Concomitant mitral intervention should therefore be considered in the presence of moderate mitral regurgitation, independent of the aetiology.
-
Eur J Cardiothorac Surg · Nov 2011
Prediction of postoperative left ventricular systolic function in patients with chronic mitral regurgitation undergoing valve surgery--the role of deformation imaging.
Preoperative left ventricular systolic function is an important prognostic factor in patients undergoing mitral valve surgery. Preoperative myocardial deformation may be impaired without reduction in conventional indices such as ejection fraction (EF). Strain rate (SR) imaging is very sensitive in detecting regional systolic abnormalities and might allow diagnosis of subclinical changes in systolic left ventricular (LV) function before surgery. We aimed to investigate the value of preoperative regional myocardial peak systolic SR as a predictor of postoperative LV systolic function in patients with severe mitral regurgitation (MR) undergoing surgery. ⋯ SR imaging (corrected for geometry) can detect abnormalities in LV function at subclinical levels in patients with severe mitral regurgitation.