| 1. |
- Taha, Amar, 1978, et al.
(författare)
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Cardiopulmonary bypass management and risk of new-onset atrial fibrillation after cardiac surgery.
- 2023
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Ingår i: Interdisciplinary cardiovascular and thoracic surgery. - 2753-670X. ; 37:3
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Tidskriftsartikel (refereegranskat)abstract
- Cardiopulmonary bypass management may potentially play a role in the development of new-onset atrial fibrillation after cardiac surgery. The aim of this study was to explore this potential association.Patients who underwent coronary artery bypass grafting and/or valvular surgery during 2016-2020 were included in an observational single-centre study. Data collected from the SWEDEHEART Registry, and a local Cardiopulmonary bypass database were merged. Associations between individual cardiopulmonary bypass variables (Cardiopulmonary bypass and aortic clamp times, arterial and central venous pressure, mixed venous oxygen saturation, blood flow index, bladder temperature, and haematocrit) and new-onset atrial fibrillation were analysed using multivariable logistic regression models adjusted for patient characteristics, comorbidities, and surgical procedure.Out of 1,999 patients, 758 (37.9%) developed new-onset atrial fibrillation. Patients with new-onset postoperative atrial fibrillation were older, had a higher incidence of previous stroke, worse renal function and higher EuroSCORE II and CHA2DS2-VASc scores, and more often underwent valve surgery. Longer cardiopulmonary bypass time (adjusted odds ratio (aOR) 1.05 per 10min (95% confidence interval (CI) 1.01-1.08); p=0.008) and higher flow index (aOR 1.21 per 0.2L/m2 (95% CI 1.02-1.42); p=0.026) were associated with an increased risk for new-onset atrial fibrillation, while the other variables were not. A sensitivity analysis only including patients with isolated coronary artery bypass grafting supported the primary analyses.Cardiopulmonary bypass management following current guideline recommendations appears to have minor or no influence on the risk of developing new-onset atrial fibrillation after cardiac surgery.
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| 2. |
- Hellsén, Gustaf, et al.
(författare)
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Predicting recurrent cardiac arrest in individuals surviving Out-of-Hospital cardiac arrest
- 2023
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 184
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite improvements in short-term survival for Out-of-Hospital Cardiac Arrest (OHCA) in the past two decades, long-term survival is still not well studied. Furthermore, the contribution of different variables on long-term survival have not been fully investigated. Aim: Examine the 1-year prognosis of patients discharged from hospital after an OHCA. Furthermore, identify factors predicting re-arrest and/or death during 1-year follow-up. Methods: All patients 18 years or older surviving an OHCA and discharged from the hospital were identified from the Swedish Register for Car-diopulmonary Resuscitation (SRCR). Data on diagnoses, medications and socioeconomic factors was gathered from other Swedish registers. A machine learning model was constructed with 886 variables and evaluated for its predictive capabilities. Variable importance was gathered from the model and new models with the most important variables were created. Results: Out of the 5098 patients included, 902 (-18%) suffered a recurrent cardiac arrest or death within a year. For the outcome death or re-arrest within 1 year from discharge the model achieved an ROC (receiver operating characteristics) AUC (area under the curve) of 0.73. A model with the 15 most important variables achieved an AUC of 0.69. Conclusions: Survivors of an OHCA have a high risk of suffering a re-arrest or death within 1 year from hospital discharge. A machine learning model with 15 different variables, among which age, socioeconomic factors and neurofunctional status at hospital discharge, achieved almost the same predictive capabilities with reasonable precision as the full model with 886 variables.
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| 3. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Pacemaker implantation following tricuspid valve annuloplasty.
- 2023
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Ingår i: JTCVS open. - 2666-2736. ; 16, s. 276-289
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Tidskriftsartikel (refereegranskat)abstract
- Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases.By using data from multiple Swedish mandatory national registries, all patients (n=1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression.The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8±10.3years vs 67.5±12.4years, P=.012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03).This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.
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| 4. |
- Rezk, Mary, et al.
(författare)
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Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement.
- 2023
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X. ; 63:5
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Tidskriftsartikel (refereegranskat)abstract
- Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early-initiated oral anticoagulation (OAC), and long-term outcome after SAVR and combined SAVR+CABG.This is a retrospective, population-based study including all isolated SAVR (n=7038) and combined SAVR and CABG patients (n=3854) without a history of preoperative atrial fibrillation in Sweden 2007-2017. Individual patient data was merged from four nationwide registries. Inverse Probability of Treatment Weighting (IPTW) adjusted Cox regression models were employed separately in SAVR and SAVR+CABG patients. Median follow-up time was 4.7years (range 0-10years).POAF occurred in 44.5% and 50.7% of SAVR and SAVR+CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06-1.37)], ischaemic stroke [aHR 1.32 (1.08-1.59)], any thromboembolism, heart failure hospitalization, and recurrent atrial fibrillation. In SAVR+CABG, POAF was associated with death [aHR 1.31 (1.14-1.51)], recurrent atrial fibrillation, and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84-1.29)] or thromboembolism. OAC was dispensed within 30days after discharge to 67.0% and 65.9% respectively of SAVR and SAVR+CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients.POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.
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| 5. |
- Törngren, Charlotta, et al.
(författare)
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Medical therapy after surgical aortic valve replacement for aortic regurgitation.
- 2023
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Ingår i: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. - : Oxford University Press (OUP). - 1873-734X. ; 63:5
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Tidskriftsartikel (refereegranskat)abstract
- Current clinical guidelines have no specific recommendations regarding medical therapy after surgical aortic valve replacement in patients with aortic regurgitation. We studied the association between medical therapy with RAS inhibitors, statins and beta-blockers, and long-term major adverse cardiovascular events.All patients undergoing valve replacement due to aortic regurgitation between 2006-2017 in Sweden and alive six months after discharge were included. Time-dependent multivariable Cox regression models adjusted for age, sex, patient characteristics, comorbidities, other medications, and year of SAVR were used. Primary outcome was a composite of all-cause mortality, myocardial infarction, and stroke. Subgroup analyses based on age, sex, heart failure, low ejection fraction, hyperlipidaemia, and hypertension were performed.A total of 2,204 patients were included (median follow-up 5.0 years (range 0.0-11.5)). At baseline, 68% of the patients were dispensed RAS inhibitors, 80% beta-blockers, and 35% statins. Dispense of RAS inhibitors and beta-blockers declined over time, especially during the first year after baseline, while dispense of statins remained stable. Treatment with RAS inhibitors or statins was associated with a reduced risk of the primary outcome (aHR 0.71, 95%CI 0.57-0.87 and aHR 0.78, 95%CI 0.62-0.99, respectively). The results were consistent in subgroups based on age, sex, and comorbidities. Beta-blocker treatment was associated with an increased risk for the primary outcome (aHR 1.35, 95%CI 1.07-1.70).The results indicate a potential beneficial association of RAS inhibitors and statins as part of a secondary preventive treatment regime after aortic valve replacement in patients with aortic regurgitation. The role of beta-blockers needs to be further investigated.
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