Search Results (123)

Congenital heart diseases (CHDs) lead to psychological and social repercussions for parents of affected children: the diagnosis, screenings, surgeries, and hospitalization, as well as ongoing difficulties bring with them stress, anxiety, fear, stigmatization, and isolation. Studies investigating parents’ direct perspective on these issues lack in the field literature. Our research aims to leverage parents’ narratives in order to explore how they describe their role as parents of a child with CHD and the impact of its social and clinical repercussions on their lives. We recruited 45 parents and analyzed their narratives through the MADIT approach, focusing on the discursive modalities and content cores employed. Parents describe and judge their role as ‘worried-protective’, ‘heroic’, ‘normal-untroubled’, and ‘unfortunate’, in a way that strongly characterizes the person, leaving limited possibilities for assuming different features. The clusters ‘state of ordeal’, ‘state of alert-overprotection’, and ‘personal identity changes’ are connoted as inevitable and established component of parents’ lives, while ‘limitation of life experiences’ is less monolithic and more open to change. Current narratives assume a totalizing form in the life of these parents, that can lead to stigma and exacerbate the already present difficulties and challenges, that need targeted psychological intervention by field professionals. Full article

Cardiac surgery-related acute kidney injury (CS-AKI) is a decrease in kidney function after open-heart surgery, affecting up to 50% of patients. The pathophysiology of CS-AKI involves ischemia–reperfusion injury, inflammation, and oxidative stress. Ubiquinone is a potent antioxidant, and we hypothesized that it could decrease both the incidence and severity of CS-AKI. The intervention group received ubiquinone (8 mg/kg/day) divided into three daily doses, while the control group received a placebo. The primary outcome was the incidence of CS-AKI, which was manifested as an increase in creatinine ≥26.5 µmol/L or a urine output below 0.5 mL/kg/h for 6 h. Out of 73 patients, 39.7% (N = 29) developed CS-AKI, including 35.3% of the ubiquinone group and 43.6% of the placebo group (X²(1,N = 73) = 0.4931, p = 0.4825). The secondary outcomes revealed that the ubiquinone group experienced reduced postoperative bleeding, with a median (IQR) drainage of 320 mL (230–415) compared to the drainage of 420 mL (242.5–747.5) in the placebo group (t(35.84) = 2.055, p = 0.047). The median hs-TnI level in the ubiquinone group was 239.5 ng/mL (113.25–382.75) after surgery compared to a level of 366 (234.5–672.5) ng/mL in the placebo group (p = 0.024). In conclusion, there was no significant difference in the incidence of CS-AKI between groups. Postoperative hs-TnI and bleeding were significantly reduced among patients receiving ubiquinone. Full article

Background and Objectives: Research on the effectiveness of different exercise programs on reducing fall risk and improving gait parameters among frail patients after open heart surgery is scarce. Therefore, the aim of this study was to evaluate and compare the effects of different exercise interventions on fall risk and gait parameters in frail patients after open heart surgery during inpatient rehabilitation. Materials and Methods: A prospective randomized study was conducted at Kulautuva Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, from July 2021 to November 2023. A total of 105 pre-frail and frail patients were randomized into three groups: control (CG, n = 35), intervention 1 (IG-1, n = 35), and intervention 2 (IG-2, n = 35). All three groups completed a conventional rehabilitation program that included aerobic training tailored based on each person’s health status six times/week. The IG-1 additionally received multicomponent dynamic aerobic balance and strength training three times/week, and the IG-2 received a combined computer-based interactive program three times/week. The overall stability index, as an outcome of fall risk, Short Physical Performance Battery (SPPB) score, and gait parameters (geometry, stance, and timing) were assessed before and after rehabilitation. Results: Of the 105 patients, 87 completed the study. The median age of the patients was 71 years (range: 65–88); 64.76% were male. After rehabilitation, within-group comparisons showed a significant improvement in the overall stability index, SPPB, and all phase gait parameters in all groups. Of all geometry gait parameters, none of the groups showed a significant improvement in step width, and foot rotation was significantly reduced only in the IG-2. All timing gait parameters improved in the CG and IG-2 after rehabilitation, while in the IG-1, only gait speed was significantly improved. Between-group comparisons after rehabilitation revealed significant differences in the overall stability index among the groups and in all phase gait parameters except for stance phase between the IG-1 and the IG-2. The greatest significant difference was documented for the double stance phase between the IG-1 and the IG-2, and the smallest was recorded for the single limb support phase. Significantly greater differences in step time and stride time were found in the IG-1 and the IG-2 than in the CG. Conclusions: All applied interventions were effective in reducing fall risk based on the overall stability index. However, interactive exercise interventions decreased fall risk based on the overall stability index by one-fifth as compared to the conventional rehabilitation program. The incorporation of interactive exercise interventions in rehabilitation resulted in improved double stance phase, stride time, and step time parameters, but did not have any effect on gait speed as compared to other exercise interventions. Full article

Chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic pulmonary hypertension (CTEPH) are debilitating complications of acute pulmonary embolism (PE) that are characterized by fibrosis and organization of the thrombotic material within pulmonary artery branches. This pathology leads to increased right ventricular afterload and dead space ventilation, posing a risk of progressive pulmonary hypertension, right-sided heart failure, and potentially death if left untreated. Pulmonary endarterectomy (PTE) is a technically complex open-heart surgery considered to be a first-line treatment as it is a potentially curative therapy. Although PTE is highly successful in proximal disease, it may not reach the very distal branches. On the other hand, pulmonary vasodilator therapy is very effective in improving microvasculopathy but does not address the obstructive fibrotic component of the larger vessels. Balloon pulmonary angioplasty (BPA) is a novel percutaneous revascularization therapy in which traditional angioplasty techniques are used to relieve obstruction in the pulmonary arteries. This review discusses the currently accepted indications, patient selection, technical considerations, outcomes, and complications of contemporary BPA. This review will address knowledge gaps and future perspectives in BPA research. Full article

Background/Objectives: According to Watson’s Human Care Theory, an improved environment influences patients’ care processes. The purpose of this study was to examine the effect of an improved environment, according to Watson’s Human Care Theory, on sleep quality, anxiety, and depression in patients undergoing open heart surgery. Methods: Upon admission to the ward from the postoperative intensive care unit, the experimental group underwent environmental remediation for three days. The environmental arrangements ensured that the patient’s room maintained an appropriate temperature range of 18–26 °C and humidity values of 30–50%. Monitoring took place at 21:00, 22:00, and 23:00 on Days 1, 2, and 3, at which times, the brightness of the patient rooms gradually decreased. On the morning of the fourth day, the patients were interviewed face to face, and research questionnaires were filled out (ClinicalTrials.gov identifier of the manuscript: NCT06744023). Results: After the implementation of an improved environment in accordance with Watson’s Human Care Theory, the sleep duration of the patients in the experimental group (5.91 h) was higher than that of the control group (4.1 h). At the same time, the mean sleep quality score was measured as 300 ± 15.33 in the experimental group and 116.33 ± 14.94 in the control group. In addition, anxiety and depression levels were lower in the experimental group (5.63 ± 0.59; 4.53 ± 0.42) compared with the control group (12.03 ± 0.85; 10.03 ± 0.82). Conclusions: We recommend implementing improved environmental arrangements in accordance with Watson’s Human Care Theory to improve sleep quality and reduce anxiety and depression levels in patients undergoing open heart surgery. Full article

Background: The importance of liver dysfunction in predicting mortality in patients undergoing cardiovascular surgery is an important topic due to the general desire to improve current risk scores such as EUROSCORE II (European System for Cardiac Operative Risk Evaluation), with EUROSCORE III being currently under development. The model for End-Stage Liver Disease (MELD) Score has already proven its utility in predicting outcomes for patients undergoing abdominal, cardiovascular or urological surgery. In the present study, we want to see its usefulness in proving the postoperative mortality in patients undergoing coronary artery bypass surgery. Methods: This was a retrospective study, and it included 185 patients, with 93 survivors being randomly chosen from a total of 589 surviving patients using age, emergency and the weight of cardiac procedures as criteria to match the 92 deceased patients during hospitalization in the postoperative period who underwent coronary artery bypass grafting (CABG) alone or CABG and other concomitant cardiovascular interventions during a 10-year period of time. We calculated for all these patients, at the time of admission, the MELD Score and EUROSCORE II, and we analyzed the predictive performance of the two scores and their constituents. Results: In the multivariable model, patients with a MELD Score ≥ 5.54 had a 2.38-fold increased risk of death (95% C.I.: 1.43–3.96, p = 0.001), while those with a EUROSCORE ≥ 10.37 had a 8.66-fold increased risk of death (95% C.I.: 3.09–24.29, p < 0.001). After combining the two scores, the conditional scenario achieved a high overall accuracy of 84.32% (p < 0.001) in predicting mortality. Conclusions: Patients with a MELD Score ≥ 5.54, had good sensitivity and a very good specificity in terms of mortality prediction, but the conditional scenario, leveraging both risk scores, i.e., the MELD Score and EUROSCORE, offers the highest utility in terms of enhancing mortality prediction regarding these patients. Full article

Background: Steel wires are often inadequate for sternal closure for patients at high risk of sternal complications. This study compares a novel sternal closure system to conventional steel wires to assess its potential to reduce sternal complication rates and improve clinical outcomes. Methods: A retrospective study was conducted on 300 consecutive patients undergoing cardiac surgery via median sternotomy. A total of 150 patients underwent steel wire sternal closure, while 150 underwent suture tape closure. Preoperative, intraoperative, and postoperative data were collected and analyzed for both groups. Results: Rates of sternal wound infections (1% vs. 5%, p = 0.0363) and sternal dehiscence (0% vs. 5%, p = 0.0297) were lower in the suture tape group. Suture tape patients had significantly less pain at 14 and 30 days (p = 0.0002 and 0.0071). The requirement for sternal protection adjuncts was eliminated with suture tape closure. Sternal closure time was significantly shorter in the suture tape group (11 vs. 19 min, p < 0.0001). Conclusions: Suture tapes proved safe, feasible, and effective for sternal closure, demonstrating significant advantages for sternal closure over steel wires, with reduced rates of sternal dehiscence, infection, postoperative incisional pain, and closure time. These superior outcomes and the elimination of sternal protection adjuncts can potentially reduce healthcare costs. Our experiences suggest that this novel sternal closure system has significant potential, with larger prospective studies warranted to optimize sternal closure strategies. Full article

Background/Objectives: Cardiopulmonary bypass can lead to hemodilution, causing a fluid shift to the interstitial space. Albumin helps counteract the intravascular fluid movement to the extravascular space and reduces the risk of complications associated with fluid imbalance. Our main objective was to evaluate the effectiveness of albumin addition in the cardiopulmonary bypass priming solution compared to standard priming, focusing on its role in reducing pleural effusion development. Methods: This was a single-center randomized controlled trial conducted at a tertiary care hospital specializing in cardiology and cardiac surgery. It involved 70 individuals scheduled for elective open-heart surgery. All cases were randomly assigned into two groups of 35 patients. The study group replaced 100 mL of standard CPB priming solution with 100 mL of 20% human albumin. We measured serum albumin levels before and after the surgery, 6 and 12 h after, and calculated colloid oncotic pressure. Thorax CT scans were performed on the first postoperative day to measure and calculate pleural effusion volume. Results: Albumin addition to cardiopulmonary bypass priming solution led to a significant reduction in pleural effusion development after CPB. An albumin level <35 g/L after the surgery showed a significant increase in pleural effusion development, and 100 mL of 20% albumin was sufficient to maintain serum albumin levels > 35 g/L. Conclusions: Our study suggests a link between postoperative hypoalbuminemia and the early development of pleural effusion after CPB, as well as the possible benefits of adding 100 mL of 20% albumin compared to standard crystalloid CPB priming to minimize postoperative pleural effusion development. Full article

Ovariohysterectomy (OVH) is a common procedure in bitches, where ovarian suspensory ligament (OSL) rupture facilitates hemostasis but may also have adverse effects. Given the importance of minimizing the surgical stress response, this study aimed to evaluate the impact of OSL rupture in 20 healthy bitches undergoing elective open OVH; a celiotomy via the ventral midline was performed, and hemostasis achieved using bipolar coagulation, either with OSL rupture (OSL-R) or without (OSL-NR). Pain was assessed over 24 h post-surgery using the Visual Analogue Scale and the Short Form of the Glasgow Composite Measure Pain Scale. The physical parameters, complete blood count, glucose levels, erythrocyte sedimentation rate, and neutrophil oxidative and phagocytic functions were evaluated pre-surgery and at 6, 12, 24, and 48 h, as well as 10 days after. Oxidative metabolism was assessed through vitamin C and protein thiols, reduced glutathione, and thiobarbituric acid reactive substances. No differences in trans- and postoperative pain were observed between techniques, except for analgesic rescue rates. Differences were noted in the heart rate, total leukocyte count, segmented neutrophils, eosinophils, and monocytes. Both techniques resulted in low oxidative and phagocytic changes. Overall, OSL rupture appears to elicit a slightly more intense surgical stress response than the non-rupture technique. Full article

Background: Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. Methods: A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. Results: The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Conclusions: Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach. Full article

The inability to accurately predict the occurrence of postoperative cognitive dysfunction (POCD) among open-heart surgery patients leads to concerning increases in POCD cases. Preoperative circulating biomarkers are important to identify as they are non-invasive and could provide an early prediction of POCD development, allowing for earlier and more strategized interventions. However, to date, no robust circulating biomarkers have proven effective for preoperative POCD prediction. This systematic review aims to synthesize current evidence on preoperative protein profiling among POCD patients following open-heart surgery. Thus, a thorough literature search employing PubMed, EBSCOhost, Scopus, and Science Direct was carried out. This combination of keywords was used as part of the search strategy: (“Postoperative cognitive decline” OR “Postoperative cognitive disorders” OR “Postoperative cognitive dysfunction” OR “Postoperative cognitive complications”) AND (“Thoracic Surgery” OR “Cardiac Surgery” OR “Heart Surgery”) AND (“Protein expression” OR proteomic OR “Protein profiling”). Eight hundred and twenty-nine studies were retrieved and only clinical studies reporting the circulating preoperative differentially expressed Proteins (DEPs) in the POCD patients were selected. Six studies were selected following the inclusion and exclusion criteria. Only one preoperative DEP and four immediate postoperative DEPs were extracted from the studies. All four proteins were selected for analysis using DAVID, STRING, and Cytoscape software. Due to the very low number of proteins, no clusters have been identified. This systematic review demonstrates the lack of POCD preoperative biomarkers for open-heart-surgery patients. Thus, it is suggested that more studies can be conducted to fill this gap. Full article

Background: While several studies investigate the utility and clinical value of 3D printing in aiding diagnosis, medical education, preoperative planning, and intraoperative guidance of surgical interventions, there is a scarcity of literature regarding concrete applications of mixed reality in the cardiovascular domain due to its nascent stage of study and expansion. This study goes beyond a mere three-dimensional visualization of the cardiac district, aiming to visualize the intracardiac structures within the scope of preoperative planning for cardiac surgery. Methods: The segmentation of the heart was performed through an open-source and a professional software and by applying different procedures. Each anatomical component of the heart, including the aortic valve, was accurately segmented and a 3D model was built to represent the entire heart. Results: Beyond the three-dimensional visualization of the cardiac region, the intracardiac structures were also segmented. A mixed-reality app was implemented with the possibility of exploding the model, interacting with it, and freely sectioning it with a plane. Conclusions: The proposed segmentation methodology allows a segmentation of the valve and the intracardiac structures. Furthermore, the mixed-reality app has confirmed the potential of this technology in diagnostic and preoperative planning, although some limitations should still be overcome. Full article

Background: as transcatheter technologies have advanced, the patient population that is referred to open heart surgeries has shifted. This study’s objective was to evaluate recent trends in the characteristics of patients undergo surgical valvular interventions and coronary revascularizations (CABG) in our center over a period of 14 years. Methods: this is a retrospective analysis of ecological trends in the age, sex, and risk profile (Charlson comorbidity index—CCI) of patients who, from January 2010 to December 2023, underwent CABG, aortic valve replacement (AVR), or mitral valve repair or replacement (with or without tricuspid valve intervention). The data were extracted from electronic clinical files using MD-Clone software. Results: for the CABG procedures, the respective data for 2010 and 2023 were: mean ages 68.0 and 64.6 years; 79.7% and 83.1% males; and mean CCI scores 3.16 and 2.51. The p-values for the cumulative differences over the study period were 0.001, 0.005, and 0.013, respectively. The respective data for isolated AVR were mean ages of 69.2 and 62.9 years; 64.1% and 59.1% males; mean CCI 3.64 and 2.32; p-values: <0.001, 0.229, and 0.019. The respective data for mitral valve procedures were mean ages of 63.6 and 59.8 years, 71.4% and 65.5% males; mean CCI 2.90 and 1.79; p-values: 0.84, 0.422, and 0.318. Conclusions: over a 14-year period, changes were evident in the age, sex distribution, and CCI for operations performed in our center. These changes most likely resulted from accumulated data regarding the advantages and detriments of treatment strategies, mostly of CABG vs. percutaneous coronary intervention; major advancements in transcatheter technologies, mostly in transcatheter AVR; and clinical guidelines facilitating a more collaborative decision-making, open-minded, and personalized approach. Full article

Tegaserod (1-{[(5-methoxy-1H-indol-3-yl)methyliden]amino}-3-pentylguanidine) is a potent agonist at human recombinant 5-HT₄ serotonin receptors. Consequently, tegaserod is utilized in the treatment of bowel diseases. The objective of this study was to test the hypothesis that tegaserod stimulates human cardiac atrial 5-HT₄-receptors via cyclic adenosine monophosphate (cAMP)-dependent pathways. Tegaserod exerted positive inotropic effects (PIEs) and positive chronotropic effects (PCEs) in isolated left and right atrial preparations, respectively, from mice with cardiac-specific overexpression of the human 5-HT₄ serotonin receptor (5-HT₄-TG) in a concentration- and time-dependent manner. However, no effect was observed in the hearts of littermates of wild-type mice (WT). Western blot analysis revealed that the expression of 5-HT₄ receptors was significantly higher in 5-HT₄-TG mice compared to WT mice. The specificity of the signal for the 5-HT₄ receptor was confirmed by the absence of the signal in the hearts of 5-HT₄ receptor knockout mice. Furthermore, tegaserod increased the force of contraction (at concentrations as low as 10 nM), reduced the time of tension relaxation, and increased the rate of tension development in isolated electrically stimulated (at a rate of 60 beats per minute) human right atrial preparations (HAPs, obtained during open-heart surgery) when administered alone. The potency and efficacy of tegaserod to raise the force of contraction were enhanced in the presence of cilostamide, a phosphodiesterase III inhibitor. The positive inotropic effect of tegaserod in HAPs was found to be attenuated by the 5-HT₄ serotonin receptor antagonist GR 125487 (0.1 µM). The efficacy of tegaserod (10 µM) in raising the force of contraction in HAPs was less pronounced than that of serotonin (10 µM) or isoprenaline (1 µM). Tegaserod shifted the concentration–response curve of the force of contraction to serotonin to the right in HAPs, indicating that it is a partial agonist at 5-HT₄ serotonin receptors in this model. We propose that the mechanism of action of tegaserod in HAPs involves cAMP-dependent phosphorylation of cardiac regulatory proteins. Full article

Background/Objectives: Hyperlactatemia is a common predictive factor for poor post-cardiovascular surgery outcomes. However, it is not well understood whether the rapid postoperative lactate level elevation in a short period of time is associated with patient outcomes. Herein, we investigated the relationship between the degree of change in serum lactate levels and postoperative serious adverse events (PSAEs), including mortality, within 24 h of cardiovascular surgery. Methods: In this retrospective study, we evaluated the relationship between a rapid serum lactate level increase and PSAEs after open-heart and major vascular surgery. We divided the patients into those with and without PSAEs. Univariate and multivariate analyses were performed to evaluate the association between PSAEs and rapid lactate level increases. Results: We enrolled 445 patients; 16% (n = 71) had PSAEs. The peak lactate levels during the first 24 h of intensive care unit (ICU) stay were higher in patients with PSAEs than in those without. The maximum change in lactate levels between two consecutive lactate measurements during the first 24 h after ICU admission was higher in patients with PSAEs than in those without. A multivariate logistic regression analysis revealed that changes in lactate levels of 2 mmol/L or more between two consecutive lactate measurements were associated with PSAEs. ICU peak lactate levels of 3 mmol/L or more were not associated with PSAEs. Conclusions: Rapid serum lactate level increases of 2 mmol/L or more during the first 24 h of ICU admission post-cardiovascular surgery are associated with PSAEs. Full article