Johnsonshapiro7448

Truncus arteriosus is associated with coronary anomalies. We identified coronary artery lesions in patients undergoing repair of truncus arteriosus, defined the impact of lesions on mortality, and studied the effect of surgical intervention of coronary lesions.

Retrospective review identified 107 patients with truncus repair (1995-2019). Coronary lesions were categorized as ostial stenosis, intramural, juxtacommissural origin, and single coronary. Survival analysis characterized survival after truncus repair and studied association of coronary lesions and mortality.

Among 107 patients with truncus repair, 34 patients had at least one coronary lesion. Median follow-up time was 7 years, with 85% 5-year survival. Coronary lesions included ostial stenosis, intramurality, and juxtacommissural origin were associated with increased mortality, while single coronaries did not impact survival. Eleven patients had 1 coronary lesion and 6 patients with 2 coronary lesions had similar (80% and 83%) 5-year survival. Eight patients with 3 coronary lesions had 24% 5-year survival (p=0.0003). Among patients with 1 or 2 lesions, surgical intervention on the coronaries tended to be associated with longer 5-year survival (100% vs 62%, p=0.06). All patients with 3 lesions underwent coronary artery intervention, with 24% 5-year survival.

Impact of coronary lesions on mortality after truncus repair increases with number of lesions. Coronary artery intervention may be associated with improved time-related survival among patients with 1 or 2 lesions. Patients with the most complex anomalies (3 lesions), have poor survival and warrant ongoing study of repair techniques.

Impact of coronary lesions on mortality after truncus repair increases with number of lesions. Coronary artery intervention may be associated with improved time-related survival among patients with 1 or 2 lesions. Patients with the most complex anomalies (3 lesions), have poor survival and warrant ongoing study of repair techniques.

Severe gastrointestinal (GI) complications (GICs) after cardiac surgery are associated with poor outcomes. Herein, we characterize the severe forms of GICs and associated risk factors of mortality.

We retrospectively analyzed the clinically significant postoperative GICs after cardiac surgical procedures performed at our institution from January 2010 to April 2017. Multivariable analysis was used to identify predictors for in-hospital mortality.

Of 29,909 cardiac surgical procedures, GICs occurred in 1037 patients (3.5% incidence), with overall in-hospital mortality of 14% compared with 1.6% in those without GICs. GICs were encountered in older patients with multiple comorbidities who underwent complex prolonged procedures. The most lethal GICs were mesenteric ischemia (n= 104), hepatopancreatobiliary (HPB) dysfunction (n= 139), and GI bleeding (n= 259), with mortality rates of 45%, 27%, and 17%, respectively. In the mesenteric ischemia subset, coronary artery disease (odds ratio [OR], 4.57; P= .002], coronary bypass grafting (OR, 6.50; P= .005), reoperation for bleeding/tamponade (OR, 12.07; P= .01), and vasopressin use (OR, 11.27; P < .001) were predictors of in-hospital mortality. In the HPB complications subset, hepatic complications occurred in 101 patients (73%), pancreatitis in 38 (27%), and biliary disease in 31 (22%). GI bleeding occurred in 20 patients (31%) with HPB dysfunction. In the GI bleeding subset, HPB disease (OR, 10.99; P < .001) and bivalirudin therapy (OR, 12.84; P= .01) were predictors for in-hospital mortality.

Although relatively uncommon, severe forms of GICs are associated with high mortality. Early recognition and aggressive treatment are mandatory to improve outcomes.

Although relatively uncommon, severe forms of GICs are associated with high mortality. Selleckchem H-1152 Early recognition and aggressive treatment are mandatory to improve outcomes.A 51-year-old male was diagnosed with hypertrophic obstructive cardiomyopathy with left ventricular outflow tract obstruction at subaortic and midventricular level in combination of mitral systolic anterior motion (SAM) and SAM related mitral regurgitation. The mildly-thickened basal and non-thickened midventricular anteroseptum combined with the predominantly-hypertrophic basal and midventricular inferoseptum have made this case anatomically complex. Thoracoscopic transmitral myectomy plus fibrillation radiofrequency ablation were conducted to eliminate those lesions. The patient was discharged successfully and showed an improved hemodynamic and functional status at the 3-months' follow-up.

An increasing body of evidence suggests that packed red blood cell (PRBC) transfusion may be associated with increased morbidity and mortality following transcatheter (TAVR) and surgical aortic valve replacement (SAVR). It remains unclear if PRBC transfusion is a surrogate marker or truly an independent risk factor for mortality following aortic valve replacement in different populations.

The SURTAVI trial randomized 1660 patients with symptomatic, severe aortic stenosis at intermediate risk for operative death to TAVR or SAVR. Baseline characteristics and outcomes including all-cause and cardiovascular mortality at 30 days and thereafter were compared between participants with and without PRBC transfusion. Cox proportional hazard models with time-varying covariates were fitted to estimate the effect of PRBC transfusion on mortality after adjustment for comorbidities and procedural complications.

Patients receiving PRBC were older, more commonly female and frail, with more comorbidities. Baseline STS PRo a risk factor for postprocedural mortality.

The prevalence of heparin-induced thrombocytopenia (HIT) varies by population and the type and duration of heparinoid exposure; however, the association with unfractionated heparin (UFH) dose, route, timing, and duration has not been evaluated in cardiac surgery patients.

A retrospective case-control study matched HIT-positive adult cardiac surgery patients (positive platelet factor 4 immunoglobulin G and serotonin release assays) 11 with HIT-negative controls. Total UFH dose, route, timing, and duration were compared between groups.

The study included 124 patients, 92(74%) males, with mean(standard deviation) age 65(11) years. Significantly more HIT-positive patients received intravenous UFH preoperatively and/or postoperatively compared to patients without HIT [55(88.7%) vs. 23(37.1%), p<0.001]. There were no significant differences regarding intraoperative or subcutaneous UFH dose or duration. When controlling for obesity and cardiopulmonary bypass duration using multivariable conditional logistic regression, the odds of HIT were increased ten-fold in patients who received preoperative and/or postoperative IV UFH continuous infusion (odds ratio 10.