UVA Health research sheds light on several important questions in cardiothoracic surgery. We recap key results and clinical implications of this research presented in November 2023 at the Southern Thoracic Surgical Association’s (STSA) 70th Annual Meeting.
This research aligns with STSA’s aim to support members of the cardiothoracic surgery community in pursuing the best patient care, education, and scientific achievement. Here are some of the highlights of our presentations:
Can Hydrogen Gas After Ischemia Provide Neuroprotective Effects?
We tested whether inhaled hydrogen could provide a neuroprotective effect if given during an ischemic event like a heart attack.
In a cardiac arrest model, we measured protein markers that indicate tissue damage in the brains of adult pigs ventilated with hydrogen gas versus oxygen gas.
Results: We found that the inhaled hydrogen gas showed significant reductions in brain injury markers and oxidative stress.
Clinical Implications: This suggests that inhaled hydrogen could be used to develop new therapies for brain injuries, especially if administered during ischemic events.
Researchers: Andrew Young, Raymond Strobel, Hari Prasad Osuru, Evan Rotar, Irving Kron, Victor Laubach, Robert Thiele, Mark Roeser.
Can Preoperative Anemia Make Kidney Injury More Likely in Cardiac Surgery?
Anemia before surgery and red blood cell transfusions are both identified risk factors for kidney injury during heart surgery. In this study, we aimed to show the connection between preoperative anemia, blood transfusion, and acute kidney injury in heart surgery.
We analyzed a database of patients who underwent coronary artery bypass grafting surgery (CABG) between 2011 and 2022 and separated the patients into groups based on whether they were anemic or not. Also, to account for some preoperative and intra-operative differences, we matched them using a propensity score. We also performed a subgroup analysis of the anemic patients to see how getting blood during surgery versus after surgery affected them.
Results: Our findings showed that preoperative anemia is linked to more complications and deaths during heart surgery.
Clinical Implications: Treating anemia early and providing blood transfusions earlier for anemic patients could make outcomes better in heart surgery.
Researchers: Raza Ahmad, Raymond Strobel, Andrew Young, Alex Wisniewski, Anthony Norman, Ashley Zhang, Jared Beller, Nicholas Teman.
How Easily Can Socioeconomically Distressed Communities Access Heart & Lung Transplant Centers?
We know that a population’s socioeconomic status can raise the prevalence of chronic heart and lung conditions. Heart and lung transplants, although life-saving procedures that can help many patients with chronic heart and lung conditions, can only be offered at large facilities with the resources and capabilities to provide the complex care a transplant requires. In this study, we examined how difficult it may be for socioeconomically distressed communities to access facilities that offer heart and lung transplants.
We reviewed the United Network for Organ Sharing (UNOS) database for centers that performed heart or lung transplants in 2022 and referenced that with population centers and distances to the nearest facilities that offer heart and lung transplants.
Results: We found that over one-third of the U.S. population (38%) lives more than 1 hour away from a transplant center, and that the more socioeconomically distressed a population may be, the farther members of that population must travel to get to a transplant center.
Clinical Implications: Our findings highlight the need to recognize and mitigate geographical disparities in equitable access to heart and lung transplant services.
Researchers: Taylor Horgan, Ani Chandrabhatla, Adishesh Narahari, John Kern, Nicholas Teman, James Mehaffey, Christopher Scott, Leora Yarboro, Philip Carrott, Jr.
Does Distance Traveled Impact Aortic Dissection Outcomes?
In the event of an aortic dissection, traveling longer distances to receive care seems like it would negatively impact outcomes. But, the data examining this is limited. In this study, we examined the impact of distance traveled on the outcomes of acute type A aortic dissections (ATAAD).
We reviewed a regional collaborative database of patients who underwent ATAAD repair between 2011 and 2022. We sorted the patients into 4 groups based on distance traveled.
Results: Our review revealed that patients from socioeconomically distressed communities traveling farther distances for care had similar outcomes to those from more advantaged communities who traveled shorter distances for their care. Additionally, transferring patients did not negatively impact outcomes.
Clinical Implications: Our findings emphasize the importance of seeking repair at high-volume centers, as these are associated with lower mortality rates.
Researchers: Anthony Norman, Raymond Strobel, Andrew Young, Alex Wisniewski, Raza Ahmad, Michael Mazzeffi, Alan Speir, Mohammed Quader, Jard Beller, Leora Yarboro, John Kern, Kenan Yount, Nicholas Teman.
Can Postoperative Contact Isolation Negatively Impact Cardiac Surgery Patients?
Contact isolation following surgery can help reduce infections during recovery. However, some research has shown that contact isolation could inadvertently lead to worse outcomes by reducing patient-provider contact. In this study, we sought to uncover if contact isolation proved to be a factor in worse outcomes after cardiac surgery.
We conducted a comparative analysis of postoperative outcomes in nearly 9,000 cardiac surgery patients at UVA Health. We sorted the cases into patients in contact isolation and those without and also propensity matched them.
Results: Our findings showed that patients in contact isolation did have higher rates of mortality, readmission, and complications such as deep vein thrombosis and pulmonary embolism.
Clinical Implications: We propose that institutions more closely monitor these patients to ensure that contact isolation does not contribute to worse outcomes.
Researchers: Raza Ahmed, Andrew Young, Raymond Strobel, Alex Wisniewski, Anthony Norman, Leroa Yarboro, Kenan Yount, Nicholas Teman.
Insight on ChatGPT & More
We also presented abstracts about what kinds of studies cardiac researchers are conducting today (less basic and translational research) and whether ChatGPT is a good tool to help cardiothoracic surgery trainees in their clinical education (it’s not).
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