Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

Arafat, Amr A.; Hassan, Essam; Alfonso, Juan J.; Alanazi, Ebtesam; Alshammari, Ahmed S.; Mahmood, Asif; Alotaibi, Khaled; Adam, Adam I; Algarni, Khaled D.; Pragliola, Claudio

doi:10.1186/s43057-021-00061-4

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Low EF is associated with increased postoperative morbidity and mortality in cardiac surgery patients. 10,11 Additionally, low EF was found as a risk factor for 30-day mortality in patients undergoing aortic valve replacement for severe aortic stenosis. 12 Despite that, SAVR was associated with good long-term outcomes with the recovery of ventricular function and functional class.…”

Section: Discussionmentioning

confidence: 99%

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

et al. 2022

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Currently, there is no preference for surgical (SAVR) vs transcatheter (TAVR) aortic valve replacement in patients with low ejection fraction (EF). The present study retrospectively compared the outcomes of SAVR vs TAVR in patients with EF ≤40% (70 SAVR and 117 TAVR patients). Study outcomes were survival and the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission. The patients who had TAVR were older (median: 75 (25-75th percentiles: 69-81) vs 51 (39-66) years old; P < .001) with higher EuroSCORE II (4.95 (2.99-9.85) vs 2 (1.5-3.25); P < .001). Postoperative renal impairment was more common with SAVR (8 (12.5%) vs 4 (3.42%); P = .03), and they had longer hospital stay [9 (7-15) vs 4 (2-8) days; P < .001). There was no difference between groups in stroke, reintervention, and readmission (Sub-distributional Hazard ratio: .95 (.37-2.45); P = .92). Survival at 1 and 5 years was 95% and 91% with SAVR and 89% and 63% with TAVR. Adjusted survival was comparable between groups. EF improved significantly (β: .28 (.23-.33); P < 0.001) with no difference between groups ( P = .85). In conclusion, TAVR could be as safe as SAVR in patients with low EF.

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Section: Discussionmentioning

confidence: 99%

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

et al. 2022

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“…2 Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt. 3 • thorough peer review by experienced researchers in your field…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Cardioplegia is an essential component of cardiac surgery that allows surgery on the arrested heart with preservation of the myocardium [1][2][3]. Despite years of investigations, the optimal cardioplegic solution for pediatric cardiac surgery has not been reached, and there is wide variability in practice worldwide [4,5].…”

Section: Introductionmentioning

confidence: 99%

Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial

Elmahrouk,

Shihata,

AL-Radi

et al. 2023

Eur J Med Res

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Background Blood-based cardioplegia is the standard myocardial protection strategy in pediatric cardiac surgery. Custadiol (histidine-tryptophan-ketoglutarate), an alternative, may have some advantages but is potentially less effective at myocardial protection. This study aimed to test whether custadiol is not inferior to blood-based cardioplegia in pediatric cardiac surgery. Methods The study was designed as a randomized controlled trial with a blinded outcome assessment. All pediatric patients undergoing cardiac surgery with cardiopulmonary bypass and cardioplegia, including neonates, were eligible. Emergency surgery was excluded. The primary outcome was a composite of death within 30 days, an ICU stay longer than 5 days, or arrhythmia requiring intervention. Secondary endpoints included total hospital stay, inotropic score, cardiac troponin levels, ventricular function, and extended survival postdischarge. The sample size was determined a priori for a noninferiority design with an expected primary outcome of 40% and a clinical significance difference of 20%. Results Between January 2018 and January 2021, 226 patients, divided into the Custodiol cardioplegia (CC) group (n = 107) and the blood cardioplegia (BC) group (n = 119), completed the study protocol. There was no difference in the composite endpoint between the CC and BC groups, 65 (60.75%) vs. 71 (59.66%), respectively (P = 0.87). The total length of stay in the hospital was 14 (Q2–Q3: 10–19) days in the CC group vs. 13 (10–21) days in the BC group (P = 0.85). The inotropic score was not significantly different between the CC and BC groups, 5 (2.6–7.45) vs. 5 (2.6–7.5), respectively (P = 0.82). The cardiac troponin level and ventricular function did not differ significantly between the two groups (P = 0.34 and P = 0.85, respectively). The median duration of follow-up was 32.75 (Q2–Q3: 18.73–41.53) months, and there was no difference in survival between the two groups (log-rank P = 0.55). Conclusions Custodial cardioplegia is not inferior to blood cardioplegia for myocardial protection in pediatric patients. Trial registration The trial was registered in Clinicaltrials.gov, and the ClinicalTrials.gov Identifier number is NCT03082716 Date: 17/03/2017

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Applying machine learning methods to predict operative mortality after tricuspid valve surgery

Arafat,

Alamro,

AlRasheed

et al. 2023

Cardiothorac Surg

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Background EuroSCORE stratifies surgical risk in cardiac surgery; however, it is not explicitly for tricuspid valve surgery. Therefore, we aimed to apply machine learning (ML) methods to predict operative mortality after tricuspid valve surgery and compare the predictive ability of these models to EuroSCORE. This retrospective analysis included 1161 consecutive patients who underwent tricuspid valve surgery at a single center from 2009 to 2021. The study outcome was operative mortality (n=112), defined as mortality occurring within 30 days of surgery or the same hospital admission. Random forest, LASSO, elastic net, and logistic regression were used to identify predictors of operative mortality. Results EuroSCORE was significantly higher in patients who had operative mortality [8.52 (4.745–20.035) vs.4.11 (2.29–6.995), P<0.001] [AUC=0.73]. Random forest identified eight variables predicting operative mortality with an accuracy of 92% in the test set (age≥70 years, heart failure, emergency surgery, chronic kidney disease grade IV, diabetes mellitus, tricuspid valve replacement, hypertension, and redo surgery). The classification error rate in the training data was 9%, and in the testing data, it was 4.8%. Logistic regression identified eight variables with an AUC of 0.76. LASSO identified 13 variables with an AUC of 0.78, and elastic net identified 17 variables (AUC=0.795). The AUCs of the elastic net (P=0.048) and random forest (P<0.001) models were significantly higher than that of EuroSCORE. Conclusions ML effectively predicted TV surgery mortality more accurately than the traditional risk-scoring method. Incorporating ML in cardiac surgery risk scoring with comprehensive inclusion of all possible variables is recommended.

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Del Nido versus warm blood cardioplegia in adult patients with a low ejection fraction

Cited by 3 publications

References 17 publications

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial

Applying machine learning methods to predict operative mortality after tricuspid valve surgery

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