Tag Archives: cardiac surgery

Echocardiographic factors associated with prolonged duration of inotrope therapy and ICU length of stay in a retrospective study of cardiac surgery patients

Kelly Tankard1, William Vasquez McTeigue2, Matthew Smith2, Ariel Mueller2, Timothy Houle2, Eriberto Michel2, Judy Hung2, Adam Dalia2, Jerome Crowley2, Kenneth Shelton2

1 Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
2 Department of Anesthesiology, Massachusetts General Hospital, Boston, USA

DOI: 10.2478/jccm-2026-0032

Introduction: Post-operative heart failure following cardiac surgery carries risk and can impact patient outcomes. Preoperative echocardiography can be useful for stratifying risk. Although there has been a historical focus on left ventricular ejection fraction (LVEF), the importance of left ventricular (LV) size, as measured by left ventricle end-diastolic diameter (LVEDD), may be an underappreciated echocardiographic factor which can help predict risk in patients undergoing cardiac surgery.
Aim of the study: To investigate the association between LVEF and LVEDD with inotrope use, inotrope duration, and intensive care unit (ICU) length of stay (LOS) in patients undergoing cardiac surgery.
Materials and methods: Retrospective cohort study including 2,965 adult patients undergoing non-emergent cardiac surgery at a single academic institution between February 2017 and October 2021. Primary outcomes were the use of inotropes and duration of inotrope therapy. The secondary outcome was ICU LOS.
Results: In adjusted analyses, a one standard deviation increase in LVEF was associated with decreased odds of inotrope initiation (OR 0.45, 95% CI: 0.41 to 0.50; P < 0.001), while a one standard deviation increase in LVEDD was associated with increased odds of receiving inotropes (OR 1.18, 95% CI: 1.07 to 1.31; P = 0.001). Among those receiving inotropes, a one standard deviation increase in LVEF was associated with a 25% decrease in inotrope hours in adjusted analyses (0.75, 95% CI: 0.68 to 0.82; P < 0.001). An interaction was observed such that LVEDD modified the association between LVEF and ICU LOS (0.98, 95% CI: 0.95 to 0.99; P = 0.03).
Conclusions: Preoperative LVEDD, particularly when combined with LVEF, can predict risk after cardiac surgery.

Keywords: , , , ,
Full text: PDF

Right Heart Failure as an Atypical Presentation of Chronic Type A Aortic Dissection – Multimodality Imaging for Accurate Diagnosis and Treatment. A case report and mini-review of literature

Ioan Tilea1,2, Robert Adrian Dumbrava1,2, Alexandra Mihaela Ratiu1,3, Marius Mihai Harpa1,4, Cosmin Marian Banceu1,4, Dorina Nastasia Petra1,2, Horatiu Suciu1,4

1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Department of Internal Medicine II – Cardiology II, Emergency Clinical County Hospital, Targu Mures, Romania
3 Department of Radiology and Medical Imaging, Emergency Clinical County Hospital, Targu Mures, Romania
4 Cardiac Surgery Clinic, The Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania

DOI: 10.2478/jccm-2022-0016

Background: An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment.
Case presentation: A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were successfully performed. The patient was discharged in good condition with appropriate pharmacological treatment, guideline-directed; no imagistic signs of acute post-surgery complications were ascertained.
Conclusion: This paper highlights the importance of recognizing and providing a timely clinical and imagistic diagnosis of this very rare, potentially avoidable cause of right heart failure in patients with previous cardiac surgery.

Keywords: , , , ,
Full text: PDF