|Year : 2022 | Volume
| Issue : 2 | Page : 61-62
Preface to the second issue of Heart India 2022
Alok Kumar Singh
Department of Cardiology, Life Line Hospital, Varanasi, Uttar Pradesh, India
|Date of Submission||05-Aug-2022|
|Date of Acceptance||05-Aug-2022|
|Date of Web Publication||12-Aug-2022|
Dr. Alok Kumar Singh
Department of Cardiology, Life Line Hospital, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh AK. Preface to the second issue of Heart India 2022. Heart India 2022;10:61-2
In this issue of “Heart India,” we are publishing six original research articles, one case series, and one case report. Prediction of outcome immediately after complex cardiac surgery is always difficult, as both measurement of conventional hemodynamic parameters and risk scoring systems have shown to be insufficient. There are multiple studies in adult patients showing that lactate clearance is better for predicting mortality in postoperative patients,, but its association with postoperative outcomes has been not as vigorously investigated in pediatric patients undergoing cardiac surgery. In the first original research article, Patel et al. have studied the association of serum lactate clearance as a predictor of outcome in infants' postcardiac surgery, and they have concluded that poor lactate clearance and high lactate level were associated with high mortality. Serial lactate levels and decreasing trend of lactate clearance in the early postoperative period are good predictors of postoperative outcome in pediatric cardiac surgery.
The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is a cardiac risk for predicting mortality after cardiac surgery. It was launched in 1999 and revised in 2012 as EuroSCORE II. It has been widely used to predict operative mortality and as benchmark of results in hospitals. In the second original research article, Patel et al. have studied the early outcomes of off-pump coronary artery bypass in high-risk patients and the role of EuroSCORE II in predicting them. Authors of this study have concluded that severe renal failure needing dialysis, stroke, and deep sternal wound infection in the postoperative period carries high morbidity and mortality after opcabg-off pump coronary artery bypass grafting (OPCABG). There is no ideal risk prediction model for an individual patient, but multidisciplinary approach and individual patient factors determine the operative risk.
Elevated uric acid (UA) has been observed to be associated with several vascular diseases, such as hypertension, coronary artery disease (CAD), cerebrovascular disease, vascular dementia, preeclampsia, and chronic kidney disease. In the third original research article, Naim et al. have studied the association of serum uric acid and 1-year major adverse cardiovascular events in patients undergoing percutaneous coronary intervention (PCI). The authors of this study have concluded that elevated serum UA level in patients undergoing PCI was associated with angiographically more severe and multi-vessel CAD, higher frequency of major adverse cardiac events, congestive heart failure, and new-onset atrial fibrillation (AF), and higher mortality than those having normal UA levels.
Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction, with a reported incidence of 1%–3% in the prethrombolytic era and <0.5% with thrombolysis. In the fourth original research article, Kakkar and Desai have studied the postoperative outcomes in patients with postinfarction VSD. The authors of this study have concluded that postinfarction VSD still remains one of the most challenging conditions to treat surgically with considerable early mortality. AF is the most prevalent arrhythmia associated with mitral valve disease, resulting in significant morbidity and mortality. In the fifth original research article, Desai and Kakkar have studied the postoperative outcomes after pulmonary vein isolation for AF in mitral valve surgery, and they have concluded that pulmonary vein isolation is more useful in younger patients in comparison to older patients in patients undergoing mitral valve surgery.
Surgical management of diffuse CAD requires aggressive techniques for complete revascularization. In the sixth original research article, Gadkari et al. have studied the role of coronary endarterectomy (CE) for diffuse coronary disease undergoing coronary artery bypass grafting. The authors of this study have concluded that in patients with diffuse CAD, CE is a safe technique with comparable mortality and lesser complication rate if performed adequately. Despite perioperative difficulties, early outcomes are favorable for CE to the left anterior descending artery (LAD) artery grafted with the left internal thoracic artery. Single-vessel CE yielded a better result compared to multivessel CE.
The role of infection and inflammation in the pathogenesis of atherosclerotic disease is a controversial conundrum; high index of suspicion is required since the clinical features are very nonspecific. Diwaker et al. have reported three cases of reversible hypertension secondary to tubercular etiology. In the last article, Das et al. reported a case of chronic total occlusion (CTO) reanalyzing with the strategy of interesting combination of reversal of wire upgradation and miniature balloon technique. The present case report highlights the fact that the rule of thumb of wire upgradation during CTO revascularization always not lead to success, BUT sometime downgradation of the wire also can lead to successful revascularization. CTO revascularization although has some fixed strategy, sometimes, a permutation and combination even giving a fair try with wire down gradation can achieve success.
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