| 21. |
- Nozohoor, Shahab, et al.
(author)
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Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficiency.
- 2010
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In: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 37, s. 133-138
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Journal article (peer-reviewed)abstract
- Objective: The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency. Methods: In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status. Results: The incidence of PPM (EOAi
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| 22. |
- Nozohoor, Shahab, et al.
(author)
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Postoperative Increase in B-Type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery.
- 2011
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In: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; Okt, s. 469-475
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Journal article (peer-reviewed)abstract
- OBJECTIVE:: To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:: A retrospective analysis of prospectively collected clinical data. SETTING:: Cardiothoracic surgery and an intensive care unit (ICU) in a university hospital. PARTICIPANTS:: The present study included a total of 407 consecutive patients undergoing cardiac surgery. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: BNP concentrations were measured on admittance to the ICU (D0) and at day 1 after surgery. Patients were divided into quintiles according to their BNP level on admittance to the ICU. The predictive value of absolute changes in BNP levels during the first 24 hours postoperatively was analyzed with Kaplan-Meier estimates of survival and Cox multivariate proportional analysis. Prognostic factors for impaired midterm survival included elevation of the BNP level (HR, 7.3/ log10(x); 95% confidence interval, 1.8-29, p = 0.005). The BNP levels of patients undergoing isolated valve surgery or valve and concomitant CABG surgery were significantly higher (p = 0.012 and p = 0.032, respectively) than those undergoing isolated coronary artery bypass graft surgery. Patients in higher quintiles required ventilation for a longer time (p < 0.001), and prolonged inotropic support (p < 0.001). The mean plasma BNP concentration of 172 pg/mL (median, 64; interquartile range, 172) on arrival at the ICU had a sensitivity of 75% and a specificity of 74% for predicting 1-year mortality. CONCLUSIONS:: Elevated BNP levels on admittance to the ICU and postoperatively increasing BNP levels are associated with adverse postoperative outcome and are predictive of impaired late survival. Sequential postoperative BNP monitoring facilitates the early identification of patients at an increased risk of heart failure and may be used as an adjunct for clinical decision making and optimized patient management.
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| 23. |
- Nozohoor, Shahab, et al.
(author)
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The influence of patient-prosthesis mismatch on in-hospital complications and early mortality after aortic valve replacement
- 2007
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In: Journal of Heart Valve Disease. - 0966-8519. ; 16:5, s. 475-482
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Journal article (peer-reviewed)abstract
- Background and aim of the study: The study aim was to analyze the relationship between patient-prosthesis mismatch (PPM) and in-hospital complications and mortality after aortic valve replacement (AVR). Methods: AVR was performed in 1,819 patients between January 1996 and July 2006. Follow up investigations were performed after a mean of 4.3 years (range: 0 days to 10.6 years). Univariate and multivariate analysis were used to evaluate risk factors for in-hospital complications and mortality in patients with prosthesis mismatch. Actuarial statistics were used to calculate survival rates. Results: Multivariate analysis showed that PPM (defined as indexed effective orifice area 0.85 cm(2)/m(2)) was associated with an increased risk of postoperative neurological events (OR 2.26, 95% Cl 1.05-4.83, p = 0.037). There were no significant differences in 30-day mortality between the PPM and nonPPM groups. Neither was any significant difference found between the two groups regarding long-term survival adjusted for significant risk factors for death after AVR. Conclusion: The results suggest PPM to be an independent predictor of postoperative neurological complications in patients undergoing AVR. However, PPM did not negatively influence either short- or long-term survival. PPM may play an important role in selected categories of patients, and should be considered in order to avoid postoperative neurological complications.
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| 24. |
- Nozohoor, Shahab, et al.
(author)
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Validation of a modified EuroSCORE risk stratification model for cardiac surgery: the Swedish experience.
- 2011
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In: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 40:1, s. 185-191
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Journal article (peer-reviewed)abstract
- Objective: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is used to identify patients at high risk for aortic valve replacement (AVR) in whom alternative procedures, such as trans-catheter aortic valve implantation (TAVI), may be appropriate. The aim of the present study was to calibrate and validate the EuroSCORE for different cardiac surgery procedures to improve patient selection for valve surgery. Methods: The study included 46516 patients undergoing open cardiac surgery during 2001-2007. A fivefold cross-validation technique was used to calibrate four different models. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve and model calibration by the Hosmer-Lemeshow (H-L) test. Results: The actual and predicted 30-day mortality was 3.2%. The discrimination (ROC area) of the calibrated 30-day mortality prediction models was 0.79 for coronary bypass surgery, 0.77 for mitral valve surgery (MVS), and 0.75 for miscellaneous procedures, compared with 0.78 (p=0.199), 0.74 (p=0.077), and 0.72 (p=0.001), respectively, for the original EuroSCORE. The discrimination for AVR was the same for the calibrated and the original EuroSCORE model (0.70). The H-L test gave a p-value of 0.104 for the calibrated and <0.001 for the original EuroSCORE model. Conclusions: A calibration of EuroSCORE resulted in an acceptable predictive capacity for 30-day mortality, and improved discrimination and calibration for MVS and miscellaneous procedures. However, the poor discriminatory for the AVR procedure suggests that the EuroSCORE may not be satisfying for assessing risk prior to TAVI and that more optimized risk stratification models may be needed.
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