With significantly increasing proportion of high-risk patients undergoing cardiovascular surgery, a quantitative risk stratification system of perioperative patients is needed for cardiovascular surgeons. European system for cardiac operative risk evaluation (EuroSCORE) is a widely-used risk prediction model for adult patients undergoing cardiovascular surgery in the world. Research data from Chinese Cardiac Surgery Registry show that the performance of EuroSCORE in the prediction of postoperative risk of Chinese cardiovascular surgical patients is not satisfactory. Thus, the first Chinese coronary operative risk evaluation model (Sino system for coronary operative risk evaluation,SinoSCORE) is established with latest cardiovascular surgery data by Collaboration Association of Cardiovascular Surgeon in China, and has been widely used in clinical practice. This review focuses on the application and prospect of EuroSCORE and SinoSCORE for the prediction of mortality after cardiovascular surgery in adults.
ObjectiveTo analyze the changes of perioperative thyroid hormone in patients undergoing cardiac surgery under cardiopulmonary bypass, and to provide guidance for postoperative cardiac management.MethodsThe clinical data of 72 patients receiving cardiac surgery under cardiopulmonary bypass in our hospital from January to May 2019 were collected, including 35 males and 37 females, aged 19-72 (52.35±10.40) years. The changes of thyroid hormones before operation, 2 hours and 24 hours after operation were analyzed.ResultsThere was a statistical difference in thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4) and free tetraiodothyronine (FT4) between postoperative 2 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, free triiodothyronine (FT3), T4 and FT4 between postoperative 24 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, FT3 and T4 between postoperative 24 hours and 2 hours (P<0.05). Postoperatively T3 and FT3 decreased, TSH increased and then decreased while T4 and FT4 were within the normal range. Repeated measures analysis of variance showed a statistical difference of time effect in TSH, T3, FT3, T4 and FT4.ConclusionPatients with cardiac surgery under cardiopulmonary bypass have different thyroid hormones postoperatively compared with preoperatively. T3 and FT3 decrease, TSH increases and then decreases, while T4 and FT4 are in the normal range. The results require further large-scale, multi-center, high-quality clinical studies to be confirmed.
Objective To evaluate clinical effects of strict control vs. conventional control of blood glucose in perioperative cardiac surgery. Methods Databases including PubMed, EMbase, HighWire, The Cochrane Library, CBM and VIP were searched to collect the randomized controlled trials (RCTs) on strict control vs. conventional control of blood glucose in perioperative cardiac surgery, published from 2000 to 2011. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data, and assessed quality of the included studies. Then meta-analysis was performed using RevMan 5.1. Results A total of 8 RCTs involving 2 250 patients were included. The results of meta-analysis showed that compared with the conventional group, the strict control of blood glucose could reduce postoperative short-term mortality (OR=0.52, 95% CI 0.30 to 0.91, P=0.02) and postoperative incidence rate of both atrial fibrillation (OR=0.64, 95%CI 0.43 to 0.96, P=0.03) and incision infection (OR=0.30, 95%CI 0.15 to 0.57, P=0.000 2), and shorten hospital stay (MD=1.75, 95%CI –3.18 to –0.32, Plt;0.02) and time of mechanical ventilation (MD=–0.9, 95%CI –1.43 to –0.38, Plt;0.000 8). Conclusion Current evidence shows that the strict control of blood glucose in perioperative cardiac surgery can reduce postoperative short-term mortality and postoperative incidence rate of both atrial fibrillation and incision infection, shorten hospital stay and time of mechanical ventilation, and have important clinical values and social and economic significance. However, this conclusion has to be proved by more high-quality and large-scale RCTs for the limitation of quantity and quality of the included studies.
Acute renal failure(ARF) is a serious complication after cardiac surgery. It is an important influential factor of increasing mortality, extending mechanical ventilation time and intensive care unit time, resulting in cognition functional impairment and respiratory function failure et al, and increasing cost of hospitalization. Extracorporeal circulation, intra-aortic balloon pump, renal inadequacy before surgery, diabetes and peripheral vascular disease are all risk factors of ARF after operation. These factors can lead to ARF by constriction of capacitance vessel, filling defect of renal and ischemia-reperfusion injury et al. Appropriate drug treatment, haemodialysis and hemofiltration could protect renal function and improve prognosis of ARF.
Objective To investigate the risky factors of ventricular arrhythmias following open heart surgery in patients with giant left ventricle, and offer the basis in order to prevent it’s occurrence. Methods The clinical materials of 176 patients who had undergone the open heart surgery were analyzed retrospectively. There were 44 patients who had ventricular arrhythmia (ventricular arrhythmia group), 132 patients who had no ventricular arrhythmia as contrast (control group). The preoperative clinical data, indexes of types of cardiopathy, ultrasonic cardiogram, electrocardiogram and cardiopulmonary bypass (CPB) etc. were choosed, and tested by using χ2 test,t test and logistic regression to analyse the high endangered factors for incidence of ventricular arrhythmia after open heart surgery. Results Age≥55 years (OR=3.469), left ventricular enddiastolic diameter(LVEDD)≥80 mm (OR=3.927), left ventricular ejection fraction（LVEF）≤55% (OR=2.967), CPB time≥120min(OR=5.170) and aortic clamping time≥80min(OR=4.501) were the independent risk factors of ventricular arrhythmia. Conclusion Ventricular arrhythmia is a severe complication for the patients with giant left ventricle after open heart surgery, and influence the prognosis of the patients. Patient’s age, size of the left ventricle, cardiac function, CPB time and clamping time could influence the incidence of ventricular arrhythmias.
ObjectiveTo explore the effects of perioperative autologous platelet transfusion on postoperative complications and prognosis of adult cardiac surgery patient.MethodsUsing the method of systematic review of Cochrane Collaboration, we searched PubMed, Web of Science, EMbase, The Cochrane Library, CNKI and Wangfang databases, retrieving the literature from January 1970 to June 2020 to collect clinical randomized controlled trials on the effects of autologous platelet transfusion on complications and prognosis of adult cardiac surgery patients. The extracted valid data was analyzed by RevMan5.3 software.ResultsTen studies were included, with a total of 1 083 patients. The results of meta-analysis showed that there were statistical differences in the perioperative blood loss (MD=?195.15, 95%CI ?320.48-?69.83, P=0.002) and perioperative blood transfusion (MD=?0.88, 95%CI ?1.23-?0.52, P<0.001). There was no statistical difference in the death rate 30 days after the operation (RR=0.90, 95%CI 0.48-1.70, P=0.75), reoperations (OR=0.48, 95%CI 0.23-1.02, P=0.06), postoperative myocardial infarction (OR=1.29, 95%CI 0.48-3.51, P=0.61), postoperative infection (OR=1.71, 95%CI 0.89-3.29, P=0.11) or postoperative ICU retention time (MD=?0.31, 95%CI ?0.67-0.05, P=0.09).ConclusionPerioperative autologous platelet transfusion can reduce perioperative blood loss and blood transfusion in adult cardiac surgery patients, but has no significant impact onprognosis and postoperative complications, which indicates that perioperative autologous platelet transfusion is a safe and beneficial blood protection measure for patients undergoing cardiac surgery.
ObjectiveTo systematically evaluate the risk prediction models for postoperative delirium in adults with cardiac surgery. MethodsThe SinoMed, CNKI, Wanfang, VIP, PubMed, EMbase, Web of Science, and Cochrane Library databases were searched to collect studies on risk prediction models for postoperative delirium in cardiac surgery published up to January 29, 2025. Two researchers screened the literature according to inclusion and exclusion criteria, used the PROBAST bias tool to assess the quality of the literature, and conducted a meta-analysis of common predictors in the model using Stata 17.0 software. ResultsA total of 21 articles were included, establishing 45 models with 28733 patients. Age, cardiopulmonary bypass time, history of diabetes, history of cerebrovascular disease, and gender were the top five common predictors. The area under the curve (AUC) of the 45 models ranged from 0.6 to 0.926. Fourteen out of the 21 studies had good applicability, while the applicability of the remaining seven was unclear; 20 studies had a high risk of bias. Meta-analysis showed that the incidence of postoperative delirium in adults with cardiac surgery was 18.6% [95%CI (15.7%, 21.6%)], and age [OR=1.04 (1.04, 1.05), P<0.001], history of cerebrovascular disease [OR=1.76 (1.46, 2.06), P<0.001], gender [OR=1.73 (1.43, 2.03), P<0.001], minimum mental state examination score [OR=1.00 (0.82, 1.17), P<0.001], and length of ICU stay [OR=5.59 (4.29, 6.88), P<0.001] weer independent influencing factors of postoperative delirium after cardiac surgery. ConclusionThe risk prediction models for postoperative delirium after cardiac surgery have good predictive performance, but there is a high overall risk of bias. In the future, large-sample, multicenter, high-quality prospective clinical studies should be conducted to construct the optimal risk prediction model for postoperative delirium in adults with cardiac surgery, aiming to identify and prevent the occurrence of postoperative delirium as early as possible.
Abstract: Objective To evaluate the protective effects of Ulinastatin on the peri-operative liver and renal function in patients undergoing cardiac surgery for tetralogy of Fallot (TO F). Methods Thirty-eight patients with TOF were divided into Ulinastatin group and control group according to admission sequence, 19 cases in each group.For Ulinastatin group, intravenous Ulinastatin was given with a dosage of 10 000U /kg at 1h before operation, 1h and 24 h after operation. For control group, no Ulinastatin was given. 10 ml fresh urine and 2 ml blood samples were collected before operation, and postoperative 1h, 10h, 24h, 48h and 72h, respect ively. The liver and renal functions were measured. Fluid intake, urine output, chest drainage, dosage of furosemide, durations of mechanical ventilation and intensive care unit ( ICU ) stay were recorded. Results Neither arrhythmia nor low cardiac output syndrome occurred for both groups. No peri-operative death. Compared with control group, dose of furosemide, period of mechanical ventilation were lower, while urine output was higher in Ulinastat in group; the aberrant climax value of urine pro tein and N-acetylglucosam inidase (NAG) were lower in Ulinastatin group (10h post-operat ively, urinem icroalbum in: 65. 2 ± 58. 3mg/L vs. 71. 8 ±58. 9mg/L ; urine transferrin: 5. 8 ± 3. 6mg/L vs. 7. 4 ± 5. 4mg/L ; urine immunoglobulin G: 26. 9±20. 3mg/L vs. 31. 3±23. 3mg/L ; 1h post-operat ively; urine NAG: 61. 4±81. 6U /L vs. 76.1±48. 5 U /L ; P lt; 0. 05) and maintained in shorter period (P lt; 0. 05) , it returned to baseline value at 48h and 72 h post-operatively. The value of alanine aminotransferase (ALT) significantly increased post-operatively at every time points in control group (P lt; 0. 01) , w hile no obvious change in Ulinastat in group (P gt; 0. 05). The increased value of aspartate aminotransferase (AST ) in Ulinastatin group was significantly lower than that in control group (10h post-operat ively: 144. 4±20. 8U /L vs. 202. 7±74. 1U /L ; P lt; 0. 01). The value of AST returned to baseline value at 48h and 72h post-operat ively. Conclusion U linastatin is an effect ive strategy for protecting peri-operat ive liver and renal function of the patients with tetralogy of Fallot and the clinical application of Ulinastatin is safe and effective.
Abstract: Objective To discuss whether priming solution with blood can reach a physiologic state after ultrafiltration and investigate the influence of this method on electrolytes, acidbase balance and cardiopulmonary function in patients in perioperative period. Methods Forty patients with congenital heart diseases treated in our hospital from February to June 2009 were enrolled in this study. The weight of these patients was less than 8 kg. They were randomly divided into two groups: the experimental group (n=20, 12 males and 8 females; age: 131.00±103.00 d; weight: 4.14±0.96 kg） and the control group (n=20, 11 males and 9 females; age: 127.00±88.00 d; weight: 4.38±1.05 kg). For patients in the experimental group, the priming solution was filtered with a blood ultrafilter in the cardiopulmonary bypass(CPB) circuit for twenty minutes, while the priming solution circulated in the CPB circuit without filtration for patients in the control group before operation. Data were obtained from the priming solution before and after ultrafiltration. Blood gas analysis was done and indexes like the electrolytes were detected during the operation. Fractional shorting (FS), ejection fraction (EF) and cardiac output (CO) were measured by echocardiography. Pulmonary function change was also observed. Results No death occurred in both groups. Mechanical ventilation time for the experimental group was significantly shorter than that of the control group (2.7±0.3 d vs. 4.1±0.4 d，Plt;0.05). After ultrafiltration for the experimental group, all indexes of the priming solution reached normal values: pH increased (from 6.89±0.22 to 7.40±0.57, P=0.001); base excess increased (from -16.12±0.98 mmol/L to +0.31±2.40 mmol/L, P=0.000); potassium concentration decreased (from 10.33±2.13 mmol/L to 4.27±0.93 mmol/L, P=0.000); interleukin8 (IL-8) decreased (from 78.40±6.10 pg/ml to 64.30±48.10 pg/ml, P=0.036); and bradykinin decreased (from 5 982±1 353 pg/ml to 531.00±35.00 pg/ml, P=0.031). The decrease of FS, EF and CO in the experimental group was smaller than that of the control group. Four hours after surgery, CO in the experimental group was significantly higher than that in the control group (2.77±0.95 L/min vs. 1.66±0.75 L/min, P=0.001). Twentyfour hours after surgery, EF in the experimental group was significantly higher than that in the control group (67.44%±6.89% vs. 61.17%±9.02%, P=0.003). Six hours after surgery, alveolararterial oxygen difference (A-aDO2) and respiratory index (RI) increased significantly (Plt;0.05) in both groups, and then started to drop to normal. Patients in the experimental group recovered gas exchange earlier than patients in the control group. Fortyeight hours after operation, A-aDO2 and RI in the experimental group were significantly lower than those in the control group (Plt;0.05). Conclusion Ultrafiltration of priming solution may confer an advantage in maintaining more physiological conditions, reducing inflammatory mediators, and improving cardiopulmonary function after operation, which is very important in performing cardiac surgery on the newborn and infants with complex congenital heart diseases.
Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.
