BackgroundMortality prediction after cardiac procedures is an essential tool in clinical decision making. Although rheumatic cardiac disease remains a major cause of heart surgery in the world no previous study validated risk scores in a sample exclusively with this condition.ObjectivesDevelop a novel predictive model focused on mortality prediction among patients undergoing cardiac surgery secondary to rheumatic valve conditions.MethodsWe conducted prospective consecutive all-comers patients with rheumatic heart disease (RHD) referred for surgical treatment of valve disease between May 2010 and July of 2015. Risk scores for hospital mortality were calculated using the 2000 Bernstein-Parsonnet, EuroSCORE II, InsCor, AmblerSCORE, GuaragnaSCORE, and the New York SCORE. In addition, we developed the rheumatic heart valve surgery score (RheSCORE).ResultsA total of 2,919 RHD patients underwent heart valve surgery. After evaluating 13 different models, the top performing areas under the curve were achieved using Random Forest (0.982) and Neural Network (0.952). Most influential predictors across all models included left atrium size, high creatinine values, a tricuspid procedure, reoperation and pulmonary hypertension. Areas under the curve for previously developed scores were all below the performance for the RheSCORE model: 2000 Bernstein-Parsonnet (0.876), EuroSCORE II (0.857), InsCor (0.835), Ambler (0.831), Guaragna (0.816) and the New York score (0.834). A web application is presented where researchers and providers can calculate predicted mortality based on the RheSCORE.ConclusionsThe RheSCORE model outperformed pre-existing scores in a sample of patients with rheumatic cardiac disease.
Prophylactic tricuspid annuloplasty on the donor heart was able to reduce significantly the degree of valvular insufficiency, even in cardiac transplantation with bicaval anastomosis; however, it did not modify significantly the hemodynamic performance of the allograft during the investigation period. It is very important to extend the observation period and casuistics to verify other benefits that this technique may offer.
Currently there is a progressive increase in the prevalence of diabetes in a
referred for cardiovascular surgery. Benefits of glycemic management (< 180
mg/dL) in diabetic patients compared to patients without diabetes in
perioperative cardiac surgery. The purpose of this study is to present
recommendations based on international evidence and adapted to our clinical
practice for the perioperative management of hyperglycemia in adult patients
with and without diabetes undergoing cardiovascular surgery. This update is
based on the latest current literature derived from articles and guidelines
regarding perioperative management of diabetic patients to cardiovascular
surgery.
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