| 1. |
- Johansson, Malin, et al.
(författare)
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Prediction of 30-day Mortality after Transcatheter Aortic Valve Implantation: A Comparison of Logistic EuroSCORE, STS score, and EuroSCORE II
- 2014
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Ingår i: Journal of Heart Valve Disease. - 0966-8519. ; 23:5, s. 567-574
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim of the study: The logistic EuroSCORE and STS score have been used for the selection of suitable TAVI patients, but their predictive ability is unsatisfactory. The study aim was to evaluate the performance of the EuroSCORE II in predicting 30-day mortality after TAVI in comparison to the logistic EuroSCORE and STS scoring systems. Methods: Between January 2008 and April 2013, a total of 123 consecutive patients underwent TAVI (transapical, n = 85; transfemoral, n = 38) at the authors' institution. Calibration and discriminatory ability was evaluated for three risk scores models (logistic EuroSCORE, STS score, and EuroSCORE II), and compared for the prediction of 30-day mortality using the Hosmer-Lemeshow test for goodness-of-fit and receiver operating characteristics curve analysis. Results: The overall 30-day mortality was 4.1% (5/123). Predicted mortality was 25.0 +/- 15.7% by logistic EuroSCORE, 7.3 +/- 6.9% by STS score, and 7.8 +/- 8.7% by EuroSCORE II. The observed/expected mortality ratio was 0.16 for logistic EuroSCORE, 0.56 for STS score, and 0.52 for EuroSCORE II. The area under the curve was 0.69 (95% CI 0.54-0.84) for the logistic EuroSCORE, 0.60 (95% CI 0.38-0.82) for the STS score, and 0.66 (95% CI 0.46-0.86) for the EuroSCORE II. Conclusion: In the present study, the EuroSCORE II was found to predict 30-day mortality more accurately for the TAVI cohort than did the more established logistic EuroSCORE, and also to compare (at present) on a par with the STS score. However, there were no differences in discriminatory power between the models. It is believed that, in the absence of a more TAVI-oriented risk stratification system, the EuroSCORE II may be a valuable adjunct in the clinical setting.
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| 2. |
- Novén, Johan, et al.
(författare)
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Exercise Echocardiography following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy
- 2022
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Ingår i: The Thoracic and Cardiovascular Surgeon. - : Georg Thieme Verlag KG. - 0171-6425 .- 1439-1902. ; 70:1, s. 18-25
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography. Methods This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. Perioperative clinical data and echocardiography measurements were reviewed retrospectively. Patients (n = 36) who were alive and living in Sweden were invited for exercise echocardiography to evaluate exercise capacity and hemodynamics, of whom 19 patients performed exercise echocardiography. Results Overall survival was 100% at 1 year and 96% at 5 years following surgery. Preoperative median resting peak LVOT (left ventricular outflow tract) gradient was 80 mm Hg. Septum thickness was reduced from 22 ± 4 mm preoperatively to 16 ± 3 mm postoperatively (p < 0.001). During exercise echocardiography, the peak LVOT gradient was 8 mm Hg at rest, and increased to 13 mm Hg during exercise echocardiography (p = 0.002). None of the patients had dynamic LVOT obstruction during exercise echocardiography, and there was no clinically significant systolic anterior motion or severe mitral insufficiency during exercise. Conclusions Long-term survival following septal myectomy is very good. At long-term follow-up, LVOT gradients were low and exercise echocardiography demonstrated good hemodynamics.
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| 3. |
- Nozohoor, Shahab, et al.
(författare)
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B-Type Natriuretic Peptide as a Predictor of Postoperative Heart Failure After Aortic Valve Replacement.
- 2009
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; 23, s. 161-165
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: B-type natriuretic peptide (BNP) has been established as a biomarker for heart failure. The objective was to evaluate BNP measured on arrival in the intensive care unit (ICU) as a predictor for heart failure defined as need for inotropic support or IABP beyond 24 hours postoperatively after aortic valve replacement. DESIGN: A prospective, observational study. SETTING: A cardiothoracic surgery unit at a tertiary level hospital. PARTICIPANTS: One hundred sixty-one patients undergoing aortic valve replacement. MEASUREMENTS AND MAIN RESULTS: Two levels of BNP were evaluated: the median (BNP >133 pg/mL) and a cutoff (BNP >82 pg/mL) based on receiver-operating characteristic (ROC) analysis. Uni- and multivariate analysis were performed to identify predictors of postoperative heart failure. Patients with postoperative heart failure (n = 37) showed a more than 10-fold increase in 30-day mortality (8.1%, 3/37) compared with patients without postoperative heart failure (0.8%, 1/124) (p = 0.038). Elevated postoperative BNP levels were identified as an independent predictor of postoperative heart failure: BNP >82 pg/mL (p = 0.004) and BNP >133 pg/mL (p = 0.013). The area under the ROC curve for BNP as a predictor of postoperative heart failure was 0.69. CONCLUSION: Postoperative heart failure after aortic valve replacement is still a very serious condition with increased early mortality. The results of the present study suggest that an elevated BNP level on arrival in the ICU is an independent predictor of postoperative heart failure after aortic valve replacement. In the authors' opinion, an increased BNP level on arrival in the ICU may support early diagnosis and allow optimal management of heart failure after aortic valve replacement.
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| 4. |
- Nozohoor, Shahab, et al.
(författare)
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Influence of prosthesis-patient mismatch on diastolic heart failure after aortic valve replacement.
- 2008
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 85:4, s. 1310-1318
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bioprostheses for supraannular placement have been developed to optimize the hemodynamic performance after aortic valve replacement. To evaluate the potential benefit of this design, we analyzed the influence of prosthesis-patient mismatch on diastolic function and left ventricular mass regression and evaluated the clinical performance of the Sorin Soprano and Medtronic Mosaic in the aortic position. METHODS: A total of 372 patients underwent aortic valve replacement between July 2004 and February 2007, receiving either a Sorin Soprano (n = 235) or a Medtronic Mosaic (n = 137) prosthetic valve. Echocardiographic and clinical data were collected prospectively, and follow-up was performed in April 2007. Multivariate analyses were used to identify differences in hemodynamic performance, diastolic function, left ventricular mass regression, and predictors of impaired survival. Kaplan-Meier survival curves and log-rank tests were used to compare postoperative outcomes. RESULTS: The 30-day mortality was 1.7% (4 of 235 patients) in the Sorin Soprano group and 2.9% (4 of 137 patients) in the Medtronic Mosaic group (p = 0.473). Neither prosthesis-patient mismatch nor type of prosthesis was a significant predictor of early or late mortality. Diastolic heart failure was a predictor of poor survival (p = 0.004); however, the recovery of diastolic function was not significantly influenced by prosthesis-patient mismatch. Neither moderate (indexed effective orifice area < 0.85 cm(2)/m(2)) nor severe (indexed effective orifice area < 0.65 cm(2)/m(2)) prosthesis-patient mismatch resulted in a significantly impaired left ventricular mass regression. CONCLUSIONS: Prosthesis-patient mismatch was not an independent predictor of poor survival, impaired left ventricular mass regression, or recovery of diastolic function. The Sorin Soprano and the Medtronic Mosaic bioprostheses demonstrated comparable hemodynamic performance and excellent clinical outcome without signs of structural valve deterioration during follow-up.
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| 5. |
- Nozohoor, Shahab, et al.
(författare)
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Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficiency.
- 2010
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 37, s. 133-138
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Tidskriftsartikel (refereegranskat)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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| 6. |
- Nozohoor, Shahab, et al.
(författare)
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Postoperative Increase in B-Type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery.
- 2011
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier BV. - 1532-8422 .- 1053-0770. ; Okt, s. 469-475
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Tidskriftsartikel (refereegranskat)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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| 7. |
- Nozohoor, Shahab, et al.
(författare)
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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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Ingår i: Journal of Heart Valve Disease. - 0966-8519. ; 16:5, s. 475-482
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Tidskriftsartikel (refereegranskat)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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| 8. |
- Nozohoor, Shahab, et al.
(författare)
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Validation of a modified EuroSCORE risk stratification model for cardiac surgery: the Swedish experience.
- 2011
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Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press (OUP). - 1010-7940. ; 40:1, s. 185-191
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Tidskriftsartikel (refereegranskat)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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| 9. |
- Sjögren, Johan, et al.
(författare)
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Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-days mortality in 176 patients with deep sternal wound infection.
- 2011
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 12:2, s. 117-120
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Tidskriftsartikel (refereegranskat)abstract
- Negative-pressure wound therapy (NPWT) has been used for the treatment of deep sternal wound infection (DSWI) with promising results. However, questions have been raised regarding the potential risk of right ventricle (RV) rupture during treatment. In the present study, we evaluate our clinical experience of NPWT focusing on RV rupture and major bleeding complications and its potentially negative impact on 30-day mortality during an 11-year period. Serious bleeding complications during NPWT were reviewed for 176 patients treated for DSWI between January 1999 and April 2010. The 30-day mortality following DSWI was 1.1% (2/176). Four patients (2.3%) suffered bleeding from the RV rupture during NPWT of the sternal wound (two spontaneous and two debridement related). Furthermore, two patients had debridement-related bleedings from the venous bypass grafts during wound dressing change. The very low 30-day mortality (1.1%) following DSWI supports the use of NPWT. Overall, even if major bleeding complications may occur, the risk of RV rupture seems to be outweighed by the benefit of superior infection control. However, surgical experience is recommended when debriding sternal wounds and we recommend the use of a wound dressing, such as paraffin gauze, in order to protect the RV from direct contact with the polyurethane foam. Keywords: Wound infection; Sternum; Negative-pressure wound therapy; Outcome.
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| 10. |
- Bjursten, Henrik, et al.
(författare)
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Once after a full moon : acute type A aortic dissection and lunar phases
- 2022
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Ingår i: Interactive Cardiovascular and Thoracic Surgery. - : Oxford University Press. - 1569-9293 .- 1569-9285. ; 34:1, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD.METHODS: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period).RESULTS: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated.CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.
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