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Computational fluid dynamics model utilizing proper orthogonal decomposition to assess coronary physiology and wall shear stress
No full textBackground: Percutaneous coronary intervention (PCI) to alleviate symptoms and improve outcomes in patients with symptomatic coronary artery disease. However, conventional assessments like coronary angiography may not fully capture the hemodynamic significance of coronary lesions. This study explores the utility of Proper Orthogonal Decomposition (POD) in elucidating coronary flow dynamics pre- and post-stent placement.
Objectives: Through the utilization of POD modes, we aim to analyze the intricate geometries of individual patients, extracting dominant POD modes both pre- and post-PCI. By engaging these modes, our objective is to discern changes in velocity patterns and wall shear stress, offering insight into the physiological outcomes of stent interventions in coronary arteries.
Methods: The POD method with QR-decomposition was employed to generate POD modes, decomposing the vector field of interest into spatial functions modulated by time coefficients. Patients with prior coronary artery bypass surgery, myocardial bridging, collateral arteries, or recent myocardial infarction within 48 h were excluded from the study.
Results: Results demonstrated improved hemodynamic parameters post-PCI, with significant enhancements in coronary flow reserve and reduced wall shear stress. POD analysis revealed that the first five modes effectively characterized flow features, highlighting stenosis, stent deployment, and branch dynamics.
Conclusion: This exploratory study demonstrates POD\u27s potential for real-time assessment of coronary lesion significance and post-intervention outcomes. Its efficiency in capturing key flow characteristics offers a promising tool for personalized decision-making in interventional cardiology, enhancing our understanding of coronary hemodynamics and optimizing treatment strategies.
Keywords: Coronary artery dynamics; Hemodynamic assessment
Current practices for cohort reporting and statistical adjustment in studies from the STS Adult Cardiac Surgery Database
No full textBackground: Current reporting and statistical adjustment practices of studies based on the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) have not been described.
Methods: A review identified all published studies based on STS ACSD data from January 2016 to March 2024. Data were extracted by two authors and independently checked by the senior author.
Results: A total of 134 studies were included. Forty-six (34.3%) were on coronary artery bypass grafting, 22 (16.4%) on mitral valve surgery, 16 (11.9%) on aortic surgery, 14 (10.4%) on surgical aortic valve replacement, 3 (2.2%) on tricuspid valve surgery, 18 (13.4%) on combined procedures, and 15 (11.2%) on other surgeries. Forty-nine (44.0%) studies used the Participant User File (PUF) program, with a significant increase over time (p trend = 0.005). Of the 1239 variables available in the STS ACSD (version 4.20.2), 136 (11.0%) (median 21 variables per study, interquartile range 16-25) were used to describe the baseline patient characteristics populations and 191 (15.4%) (median 22 variables per study, interquartile range 17 - 33) for statistical adjustment; 121 studies (90.3%) performed statical adjustment, with multivariable regression used in the majority (80, 66.1%). PUF manuscripts had significantly more junior first authors (20.3% vs. 1.3%, p=0.001) and were published in higher-impact journals (median impact factor 4.90 [IQR 3.70-9.15] vs. 3.90 [IQR 3.60-4.70]; p=0.002) compared to non-PUF manuscripts.
Conclusions: Our analysis provides data that may inform efforts to standardize reporting and analytic practices in studies based on the STS ACSD.
Keywords: STS National Database; cardiothoracic surgery; outcomes research; risk adjustment; variable selection
EACTS Expert Consensus Document on protected cardiac surgery: pre-emptive use of temporary mechanical circulatory support in adult cardiac surgery patients at high risk for perioperative low cardiac output syndrome
No full textPerioperative low cardiac output syndrome (LCOS) remains a significant complication in adult cardiac surgery, contributing to substantial morbidity, prolonged intensive care, and increased mortality. Its incidence is expected to rise further due to the evolving complexity of referred surgical patients, often characterised by advanced age, multiple comorbidities, challenging anatomy, and impaired haemodynamics. Despite advances in pharmacological and perioperative care, outcomes for high-risk patients have not shown significant improvement, prompting interest in temporary mechanical circulatory support (tMCS) as a proactive strategy. This Expert Consensus Document from the European Association for Cardio-Thoracic Surgery (EACTS) presents the first dedicated guidance on the pre-emptive use of tMCS in high-risk adult cardiac surgical patients. Developed by a multidisciplinary task force, it emphasises structured risk stratification, early initiation, and individualised device management informed by interdisciplinary Heart Team discussions. The document proposes clinical pathways for patient selection, defines criteria for tMCS initiation, and provides practical algorithms for various scenarios, including advanced heart failure, cardiogenic shock, and post-cardiotomy LCOS. It reviews the current evidence on available tMCS devices, such as intra-aortic balloon pumps, microaxial flow pumps, veno-arterial extracorporeal life support and hybrid strategies, and addresses perioperative care, ICU protocols, ethical considerations, as well as informed consent and support withdrawal. Despite promising results, substantial knowledge gaps remain, including long-term outcome data, device selection criteria, and cost-effectiveness analyses. This consensus aims to support clinical decision-making, standardise practice, and stimulate research to improve outcomes in a growing population of high-risk surgical patients.
Keywords: haemodynamic stabilisation; high-risk cardiac surgery; interdisciplinary Heart Team; low cardiac output syndrome; pre-emptive support; protected cardiac surgery; tMCS strategy; temporary mechanical circulatory support
Risk factors, outcomes, and early prediction of cardiac surgery-associated acute kidney injury: a post hoc subgroup analysis of the Epidemiology of Surgery Associated Acute Kidney Injury study
No full textBackground: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and important complication. The risk factors for CSA-AKI remain poorly described. We aimed to identify risk factors for CSA-AKI and develop a risk score for persistent CSA-AKI.
Methods: We performed a post hoc subgroup analysis restricted to patients who underwent cardiac surgery within the Epidemiology of Surgery Associated Acute Kidney Injury (EPIS-AKI) study. CSA-AKI was defined as AKI (according to the Kidney Disease: Improving Global Outcomes criteria) within 72 h after surgery. Persistent CSA-AKI was defined as CSA-AKI lasting \u3e48 h. We performed multivariable logistic regression analyses to identify risk factors for CSA-AKI and related outcomes.
Results: The original EPIS-AKI study included 3101 cardiac surgery patients. Of these, 802 (25.9%) developed CSA-AKI. On follow-up, 279 of the 802 patients (34.8%) developed persistent CSA-AKI. We identified independent risk factors for CSA-AKI, moderate/severe CSA-AKI, and persistent CSA-AKI. Patients with persistent CSA-AKI had a higher ICU and hospital mortality compared with patients with transient CSA-AKI. We developed a risk score for predicting persistent CSA-AKI with an area under the receiver operating characteristic curve of 0.79 (95% confidence interval, 0.7355-0.8457).
Conclusions: Overall, 25% of cardiac surgery patients developed CSA-AKI, and 33% of these patients experienced persistent CSA-AKI, which was associated with poor outcomes. We developed a risk score for predicting persistent CSA-AKI, the \u27EPIS CSA-AKI risk score\u27. Pending further external validation, the score might be used to identify patients who have a high risk for developing persistent CSA-AKI.
Keywords: acute kidney injury; cardiac surgery; cardiac surgery-associated acute kidney injury; persistent acute kidney injury; renal failure
In-Hospital Outcomes and Readmissions Following Transcatheter Mitral Valve Interventions in Octogenarians and Nonagenarians
No full textObjective: To compare in-hospital safety outcomes and readmissions following transcatheter mitral valve (MV) repair and replacement between octogenarians (80-89 years of age) and nonagenarians (≥90 years of age) vs younger patients (≤79 years of age).
Methods: We queried the Nationwide Readmissions Database (2016-2021) to identify patients 18 years of age and older who had been hospitalized for transcatheter MV repair or replacement. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included procedural complications, length of stay, total costs, and readmissions. In-hospital outcomes were compared using logistic regression model. Readmissions were compared using a Cox proportional hazards regression model.
Results: Among 60,809 patients hospitalized for transcatheter MV interventions (54,025 repairs and 6784 replacements), 22,951 (37.7%) were octogenarians, 3955 (6.5%) were nonagenarians, and 33,903 (55.8%) were ≤79 years of age. From 2016 through 2021, the volume of transcatheter MV repair and replacement increased in all age groups (all Ptrend\u3c .001). After adjustment for demographic and clinical factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality with repair (adjusted odds ratio [aOR], 1.32; 95% CI, 0.98 to 1.72 for octogenarians; aOR, 1.27; 95% CI, 0.87 to 1.85 for nonagenarians) and replacement (aOR, 1.34; 95% CI, 0.93 to 1.93 for octogenarians; aOR, 2.19; 95% CI, 0.96 to 4.96 for nonagenarians) compared with younger patients. Key procedural complications, length of stay, total costs, and 180-day all-cause and heart failure readmissions were also similar between octogenarians and nonagenarians vs younger patients.
Conclusion: Octogenarians and nonagenarians undergoing transcatheter MV interventions have similar in-hospital safety outcomes and readmissions compared with clinically similar younger patients
The Role of Bariatric Surgery in the Era of GLP-1 Receptor Agonists
No full textObesity continues to be a significant public health issue resulting in morbidity, premature mortality, and substantial costs to the healthcare system. Effective treatments for obesity and its associated co-morbidities exist. Bariatric surgery has been well studied and shown to be safe and effective. Glucagon-like peptide receptor agonists (GLP-1 RAs) are relatively newer but have also been shown to result in substantial weight loss. We reviewed the current literature on both bariatric surgery and GLP-1 RAs and will present the pros and cons of each as well as a discussion of the roles they play in treating obesity. Our goal was to provide a comprehensive reference that can be used by all providers treating obesity to have educated discussions about the current state of treatment options with their patients.
Keywords: Bariatric Surgery; GLP-1 Receptor Agonists; Obesity
Standardization of a Surgical Timeout Script to Improve Patient Safety in the Operating Room
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1024/thumbnail.jp
Keeping Patients Safe: A Visibility-Based Approach to Elopement Prevention
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1009/thumbnail.jp
Does Educating PCP Offices on the Presentation of Type 1 Diabetes in Children Decrease the Incidence of Diabetic Ketoacidosis at Diagnosis?
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1027/thumbnail.jp
Is low molecular weight polyethylene glycol used for decontamination of dermal phenol exposures?
No full textDermal phenol exposures have the capacity to cause extensive chemical burns and systemic toxicity. Decontamination with low molecular weight (300-400 MW) polyethylene glycol (LMW-PEG) is recommended, but it is unclear if LMW-PEG is readily accessible. Our aim was to identify dermal exposures of phenol that were reported to a regional poison center and describe the types of decontamination agents used. We performed a a retrospective study of phenol exposures reported to a single poison center from 2002-2025. Dermal decontamination was performed in 14/17 (82%) of cases, utilizing LMW-PEG in 0/14 (0%), water in 7/14 (50%), high molecular weight PEG (HMW-PEG) in 1/14 (7%), both water and HMW-PEG in 5/14 (36%), and water and isopropanol in 1/14 (7%). No systemic toxicity was reported. Our findings suggest alternative measures such as water or HMW-PEG are effective for decontamination of dermal phenol exposures.
Keywords: dermal decontamination; low molecular weight – polyethylene glycol; phenol; poison center