Publications by authors named "Johan Heiberg"

48 Publications

Long-term neurodevelopmental effects of intraoperative blood pressure during surgical closure of a septal defect in infancy or early childhood.

Cardiol Young 2021 Apr 12:1-7. Epub 2021 Apr 12.

Department of Anesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark.

Background: Many children born with congenital heart defects are faced with cognitive deficits and psychological challenges later in life. The mechanisms behind are suggested to be multifactorial and are explained as an interplay between innate and modifiable risk factors. The aim was to assess whether there is a relationship between mean arterial pressure during surgery of a septal defect in infancy or early childhood and intelligence quotient scores in adulthood.

Methods: In a retrospective study, patients were included if they underwent surgical closure of a ventricular septal defect or an atrial septal defect in childhood between 1988 and 2002. Every patient completed an intelligence assessment upon inclusion, 14-27 years after surgery, using the Wechsler Adult Intelligence Scale Version IV.

Results: A total of 58 patients met the eligibility criteria and were included in the analyses. No statistically significant correlation was found between blood pressure during cardiopulmonary bypass and intelligence quotient scores in adulthood (r = 0.138; 95% CI-0.133-0.389). Although amongst patients with mean arterial pressure < 40 mmHg during cardiopulmonary bypass, intelligence quotient scores were significantly lower (91.4; 95% CI 86.9-95.9) compared to those with mean arterial pressure > 40 mmHg (99.8; 95% CI 94.7-104.9).

Conclusions: Mean arterial pressure during surgery of ventricular septal defects or atrial septal defects in childhood does not correlate linearly with intelligence quotient scores in adulthood. Although there may exist a specific cut-off value at which low blood pressure becomes harmful. Larger studies are warranted in order to confirm this, as it holds the potential of partly relieving CHD patients of their cognitive deficits.
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http://dx.doi.org/10.1017/S1047951121001414DOI Listing
April 2021

Abnormal Left-Hemispheric Sulcal Patterns in Adults With Simple Congenital Heart Defects Repaired in Childhood.

J Am Heart Assoc 2021 Apr 22;10(7):e018580. Epub 2021 Mar 22.

Department of Clinical Medicine Aarhus University Aarhus N Denmark.

Background Children operated on for a simple congenital heart defect (CHD) are at risk of neurodevelopmental abnormalities. Abnormal cortical development and folding have been observed in fetuses with CHD. We examined whether sulcal folding patterns in adults operated on for simple CHD in childhood differ from those of healthy controls, and whether such differences are associated with neuropsychological outcomes. Methods and Results Patients (mean age, 24.5 years) who underwent childhood surgery for isolated atrial septal defect (ASD; n=33) or ventricular septal defect (VSD; n=30) and healthy controls (n=37) were enrolled. Sulcal pattern similarity to healthy controls was determined using magnetic resonance imaging and looking at features of sulcal folds, their intersulcal relationships, and sulcal graph topology. The sulcal pattern similarity values were tested for associations with comprehensive neuropsychological scores. Patients with both ASD and VSD had decreased sulcal pattern similarity in the left hemisphere compared with controls. The differences were found in the left temporal lobe in the ASD group and in the whole left hemisphere in the VSD group (=0.033 and =0.039, respectively). The extent of abnormal left hemispheric sulcal pattern similarity was associated with worse neuropsychological scores (intelligence, executive function, and visuospatial abilities) in the VSD group, and special educational support in the ASD group. Conclusions Adults who underwent surgery for simple CHD in childhood display altered left hemisphere sulcal folding patterns, commensurate with neuropsychological scores for patients with VSD and special educational support for ASD. This may indicate that simple CHD affects early brain development. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03871881.
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http://dx.doi.org/10.1161/JAHA.120.018580DOI Listing
April 2021

Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome - a post-hoc analysis of the TTH48 trial.

Scand J Trauma Resusc Emerg Med 2021 Feb 19;29(1):37. Epub 2021 Feb 19.

Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

Background: Transthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s') from 24 h (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors.

Methods: We investigated the association between peak systolic velocity of the mitral plane (s') and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33 ± 1 °C for 24 h (h) (n = 47) vs. 48 h (n = 52) following OHCA (TTH48-trial). TTE was conducted at 24 h, 48 h, and 72 h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s'. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e', E/e' and tricuspid annular plane systolic excursion (TAPSE).

Results: Across all three scan time points s' was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7-1.4, p = 0.98), 48 h: 1.13 (95%CI: 0.9-1.4, p = 0.34), 72 h: 1.04 (95%CI: 0.8-1.4, p = 0.76)). LVEF, GLS, E/e', and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e' at 48 h following TTM was 5.74 cm/s (95%CI: 5.27-6.22) in patients with good outcome (CPC180 1-2) vs. 4.95 cm/s (95%CI: 4.37-5.54) in patients with poor outcome (CPC180 3-5) (p = 0.04).

Conclusions: s' assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA.

Trial Registration: NCT02066753 . Registered 14 February 2014 - Retrospectively registered.
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http://dx.doi.org/10.1186/s13049-021-00849-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893899PMC
February 2021

Left atrial mechanical contraction in discontinuation of anticoagulants after surgical ablation of atrial fibrillation: A response letter.

J Card Surg 2021 Mar 29;36(3):1173. Epub 2021 Jan 29.

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.

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http://dx.doi.org/10.1111/jocs.15379DOI Listing
March 2021

Biatrial ablation vs. Pulmonary vein isolation in atrial fibrillation patients undergoing cardiac surgery: a retrospective study.

Scand Cardiovasc J 2021 Apr 11;55(2):116-121. Epub 2020 Nov 11.

Department of Cardiothoracic and Vascular surgery, Aarhus University Hospital, Aarhus, Denmark.

Objectives: Surgical ablation is an established treatment for patients with atrial fibrillation undergoing cardiac surgery. This study aimed to compare postoperative rhythm outcomes and pacemaker implantation rates after biatrial ablation or pulmonary vein isolation (PVI) concomitantly with other cardiac surgery. In a retrospective study, we included patients who underwent biatrial ablation or PVI. Postoperative rhythm status was assessed by Holter monitoring. All data on outcomes and patient characteristics were collected retrospectively. In total 109 patients had a biatrial procedure whereas 337 had PVI performed. In patients with persistent/long-standing persistent atrial fibrillation, freedom from atrial fibrillation was more common after biatrial ablation than after PVI (63% and 45%, respectively;  = .039). Postoperative permanent pacemaker implantation was more common after biatrial ablation (12% and 6%, respectively;  = .039), compared to PVI. Age < 65 years (OR:2.0, 95% CI:1.1-3.6) was a predictor of freedom from atrial fibrillation in the biatrial group, whereas absence of left atrial dilatation (OR:1.8, 95% CI:1.1-3.2) and HAS-BLED score < 2 (OR:1.9, 95% CI:1.0-3.8) were significant predictors of freedom from atrial fibrillation in the PVI group. In patients with persistent/long-standing persistent atrial fibrillation, biatrial ablation is more effective than PVI in terms of obtaining freedom from postoperative atrial fibrillation. Although our groups were heterogenic in terms of concomitant surgery, our study also indicates that the risk of needing a permanent pacemaker is higher after biatrial ablation, compared to PVI. Therefore, our study highlights that the decision between biatrial ablation or PVI should be performed on an individual basis.
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http://dx.doi.org/10.1080/14017431.2020.1846775DOI Listing
April 2021

Discontinuation of anticoagulants after successful surgical ablation of atrial fibrillation.

J Card Surg 2020 Sep 27;35(9):2216-2223. Epub 2020 Jul 27.

Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.

Background: The decision of whether to continue oral anticoagulation therapy (OAT) after successful surgical ablation of atrial fibrillation is challenging, and current guidelines provide no specific recommendations on whether or not it is safe to terminate OAT. Therefore, the aim of this study was to assess long-term outcomes in patients who either did or did not, receive OAT after surgical ablation of atrial fibrillation.

Methods: In a prospective follow-up study, patients were included if surgical ablation of atrial fibrillation concomitantly with other cardiac surgery was done, between 2004 and 2018 at Aarhus University Hospital, Denmark. After 12 months, OAT was discontinued if: (a) sinus rhythm was documented by electrocardiogram, (b) atrial fibrillation was absent on 5-day Holter monitoring, (c) CHADS score ≤2, and (d) no other indications for OAT were present. Follow-up was ended in April 2019.

Results: A total of 560 patients underwent surgical ablation of which 436 patients reached the baseline at 12 months; 286 patients received OAT, and 150 had OAT discontinued. Survival analysis revealed no differences between the two groups (P = .723). Mean survival time in the group receiving OAT was 5.3 ± 3.3 years, compared to 5.1 ± 3.0 years in the group where OAT was discontinued (P = .784). There was no difference in major adverse cardiac and cerebrovascular events between the two groups (P = .846).

Conclusion: Discontinuation of OAT is safe in patients with a CHADS score ≤2 following successful surgical ablation and left atrial appendage occlusion. This conclusion needs to be confirmed in randomized trials.
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http://dx.doi.org/10.1111/jocs.14719DOI Listing
September 2020

Neuropsychological Status and Structural Brain Imaging in Adults With Simple Congenital Heart Defects Closed in Childhood.

J Am Heart Assoc 2020 06 19;9(11):e015843. Epub 2020 May 19.

Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Aarhus N Denmark.

Background Neurodevelopmental impairments are common in survivors of complex congenital heart defects (CHD). We report neuropsychological and brain imaging assessments in adults operated for isolated septal defects. Methods and Results Patients (mean age 25.6 yrs) who underwent childhood surgery for isolated atrial septal defect (n=34) or ventricular septal defect (n=32), and healthy matched peers (n=40), underwent a standard battery of neuropsychological tests and a 3.0T brain magnetic resonance imaging scan. Patient intelligence was affected with lower scores on Full-Scale intelligence quotient (<0.001), Verbal Comprehension (<0.001), Perceptual Reasoning (=0.007), and Working Memory (<0.001) compared with controls. Also, the CHD group had poorer visuospatial abilities (Immediate Recall, =0.033; Delayed Recall, =0.018), verbal memory (Trial 1, =0.015; Total Learning, <0.001; Delayed Recall, =0.007), executive function (Executive Composite Score, <0.001), and social recognition (Reading the Mind in the Eyes Test, =0.002) compared with controls. Self-reported levels of executive dysfunction, attention deficits and hyperactivity behavior, and social cognition dysfunction were higher in the CHD group compared with population means and controls. We found similar global and regional morphometric brain volumes and a similar frequency of brain magnetic resonance imaging abnormalities in the 2 groups. The CHD group had a high occurrence of psychiatric disease and a larger need for special teaching during school age. Conclusions Children operated for simple CHD demonstrate poorer neurodevelopmental outcomes in adulthood when compared with healthy controls and expected population means. REGISTRATION URL: https://www.clini​caltr​ials.gov. Unique identifier: NCT03871881.
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http://dx.doi.org/10.1161/JAHA.120.015843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428999PMC
June 2020

Disappearance of the shunt and lower cardiac index during exercise in small, unrepaired ventricular septal defects.

Cardiol Young 2020 Apr 25;30(4):526-532. Epub 2020 Mar 25.

Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blv. 99, DK-8200Aarhus N, Denmark.

Objectives: Clinical studies have revealed decreased exercise capacity in adults with small, unrepaired ventricular septal defects. Increasing shunt ratio and growing incompetence of the aortic and pulmonary valve with retrograde flow during exercise have been proposed as reasons for the previously found reduced exercise parameters. With MRI, haemodynamic shunt properties were measured during exercise in ventricular septal defects.

Methods: Patients with small, unrepaired ventricular septal defects and healthy peers were examined with MRI during exercise. Quantitative flow scans measured blood flow through ascending aorta and pulmonary artery. Scans were analysed post hoc where cardiac index, retrograde flows, and shunt ratio were determined.

Results: In total, 32 patients (26 ± 6 years) and 28 controls (27 ± 5 years) were included. The shunt ratio was 1.2 ± 0.2 at rest and decreased to 1.0 ± 0.2 at peak exercise, p < 0.01. Aortic cardiac index was lower at peak exercise in patients (7.5 ± 2 L/minute/m2) compared with controls (9.0±2L l/minute/m2), p<0.01. Aortic and pulmonary retrograde flow was larger in patients during exercise, p < 0.01. Positive correlation was demonstrated between aortic cardiac index at peak exercise and previously established exercise capacity for all patients (r = 0.5, p < 0.01).

Conclusions: Small, unrepaired ventricular septal defects revealed declining shunt ratio with increasing exercise and lower aortic cardiac index. Patients demonstrated larger retrograde flow both through the pulmonary artery and the aorta during exercise compared with controls. In conclusion, adults with unrepaired ventricular septal defects redistribute blood flow during exercise probably secondary to a more fixed pulmonary vascular resistance compared with age-matched peers.
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http://dx.doi.org/10.1017/S1047951120000505DOI Listing
April 2020

Cardiopulmonary dysfunction in adults with a small, unrepaired ventricular septal defect: A long-term follow-up.

Int J Cardiol 2020 05 27;306:168-174. Epub 2020 Feb 27.

Dept. of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark.

Background: There are increasing reports of cardiac and exercise dysfunction in adults with small, unrepaired ventricular septal defects (VSDs). The primary aim of this study was to evaluate pulmonary function in adults with unrepaired VSDs, and secondly to assess the effects of 900 μg salbutamol on lung function and exercise capacity.

Methods: Young adult patients with small, unrepaired VSDs and healthy age- and gender-matched controls were included in a double-blinded, randomised, cross-over study. Participants underwent static and dynamic spirometry, impulse oscillometry, multiple breath washout, diffusion capacity for carbon monoxide, and ergometer bicycle cardiopulmonary exercise test.

Results: We included 30 patients with VSD (age 27 ± 6 years) and 30 controls (age 27 ± 6 years). Patients tended to have lower FEV, 104 ± 11% of predicted, compared with healthy controls, 110 ± 14% (p = 0.069). Furthermore, the patient group had lower peak expiratory flow (PEF), 108 ± 20% predicted, compared with the control group, 118 ± 17% (p = 0.039), and showed tendencies towards lower forced vital capacity and increased airway resistance compared with controls. During exercise, the patients had lower oxygen uptake, 35 ± 8 ml/min/kg (vs 47 ± 7 ml/min/kg, p < 0.001), minute ventilation, 1.5 ± 0.5 l/min/kg (vs 2.1 ± 0.3 l/min/kg, p < 0.001) and breath rate, 48 ± 11 breaths/min (vs 55 ± 8 breaths/min, p = 0.008), than controls.

Conclusion: At rest, young adults with unrepaired VSDs are no different in pulmonary function from controls. However, when the cardiorespiratory system is stressed, VSD patients demonstrate significantly impaired minute ventilation and peak oxygen uptake, which may be early signs of parenchymal dysfunction and restrictive airway disease. These abnormalities were unaffected by the inhalation of salbutamol.
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http://dx.doi.org/10.1016/j.ijcard.2020.02.069DOI Listing
May 2020

Reduced biventricular contractility during exercise in adults with small, unrepaired ventricular septal defects: an echocardiographic study.

Eur J Cardiothorac Surg 2020 03;57(3):574-580

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.

Objectives: Small ventricular septal defects are often considered to be without long-term haemodynamic consequences and so the majority remains unrepaired. However, we recently showed reduced functional capacity and altered right ventricular morphology in adults with small, unrepaired ventricular septal defects. The underlying mechanisms behind these findings remain unclear, and so, biventricular contractility during exercise was evaluated.

Methods: Adults with small, unrepaired ventricular septal defects and healthy controls were examined with echocardiography during supine bicycle exercise with increasing workload. Tissue velocity Doppler was used for evaluating isovolumetric acceleration and systolic velocities during exercise.

Results: In total, 34 patients with ventricular septal defects, a median shunt- ratio of 1.2 (26 ± 6 years), and 28 healthy peers (27 ± 5 years) were included. Right ventricular isovolumetric acceleration was lower in patients as compared with controls at rest (97 ± 40 vs 158 ± 43 cm/s2, P = 0.01) and at peak heart rate (222 ± 115 vs 410 ± 120 cm/s2, P < 0.01). Peak systolic velocities were similar at rest, but differed with exercise (13 ± 3 vs 16 ± 3 cm/s, P = 0.02). Left ventricular isovolumetric acceleration was lower in patients as compared with controls throughout the test (P < 0.01). Septal isovolumetric acceleration was similar at rest, but reduced during increasing exercise as compared with controls (220 ± 108 vs 303 ± 119 cm/s2, P = 0.03). Left ventricular isovolumetric acceleration was negatively correlated with the shunt- ratio, and right ventricular and septal peak systolic velocities were positively correlated with lower functional capacity.

Conclusions: Altered biventricular contractility is present during exercise in adults with small, unrepaired ventricular septal defects. These results add to the growing number of studies showing that long-term outcome in unrepaired ventricular septal defects may not be benign.
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http://dx.doi.org/10.1093/ejcts/ezz278DOI Listing
March 2020

A randomized trial of desflurane or sevoflurane on postoperative quality of recovery after knee arthroscopy.

PLoS One 2019 5;14(8):e0220733. Epub 2019 Aug 5.

Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.

Background: Studies have described different recovery profiles of sevoflurane and desflurane typically early after surgery.

Methods: We conducted a randomized superiority trial to determine whether Overall Recovery 3 days after knee arthroscopy would be superior with desflurane. Adult participants undergoing knee arthroscopic surgery with general anesthesia were randomized to either desflurane or sevoflurane general anesthesia. Intraoperative and postoperative drugs and analgesics were administered at the discretion of the anesthesiologist. Postoperative quality of recovery was assessed using the "Postoperative Quality of Recovery Scale". The primary outcome was Overall Recovery 3 days after surgery and secondary outcomes were individual recovery domains at 15 minutes, 40 minutes, 1 day, 3 days, 1 month, and 3 months. Patients and researchers were blinded.

Results: 300 patients were randomized to sevoflurane or desflurane (age 51.7±14.1 vs. 47.3±13.5 years; duration of anesthesia 24.9±11.1 vs. 23.3±8.3 minutes). The proportion achieving baseline or better scores in all domains increased over the follow-up period in both groups but was not different at day 3 (sevoflurane 43% vs. desflurane 37%, p = 0.314). Similarly, rates of recovery increased over time in the five subdomains, with no differences between groups for physiological, p = 0.222; nociceptive, p = 0.391; emotive, p = 0.30; Activities-of-daily-living, p = 0.593; and cognitive recovery, p = 0.877.

Conclusion: No significant difference in the quality of recovery scale could be shown using sevoflurane or desflurane general anesthesia after knee arthroscopy in adult participants.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220733PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681958PMC
March 2020

Reply to the "Letter to the Editor" by Dr. Lin.

Int J Cardiol 2019 03;278:94

Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.

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http://dx.doi.org/10.1016/j.ijcard.2018.12.037DOI Listing
March 2019

Heart rate variability is impaired in adults after closure of ventricular septal defect in childhood: A novel finding associated with right bundle branch block.

Int J Cardiol 2019 Jan 25;274:88-92. Epub 2018 Jun 25.

Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Background: Ventricular septal defects (VSDs) generally have benign long-term prognoses, but recent studies have indicated increased pulmonary vascular resistance. A potential tool for monitoring pulmonary artery pressure is heart rate variability, and therefore, the aim of this study was to assess heart rate variability in adults with a surgically repaired or unrepaired VSD.

Methods: In a long-term, follow-up study, three groups were included; VSD-patients operated in early childhood, patients with an open VSD, and controls. For each patient, 24-hour Holter monitoring was performed and heart rate variability was assessed.

Results: In total, 30 participants with a surgically closed VSD, 30 participants with an unrepaired VSD, and 36 controls were included. In the closed VSD group, there was a higher proportion of participants, who had low sNN50 (p = 0.005) and low sNN6% (p = 0.017) than in the other two groups. Similar differences were found when sNN50 was divided into increases and decreases (p = 0.007 and p = 0.005, respectively) as well as sNN6% (p = 0.014 and p = 0.014, respectively). Lastly, there was a higher proportion of patients in the closed VSD group with low rMSSD than in the other two groups (p = 0.005). For the closed VSD group, the proportion of participants with low total sNN50 (p = 0.046) and low total sNN6% (p = 0.046) were higher among participants with a complete right bundle branch block (RBBB) than among participants with no or an incomplete RBBB.

Conclusions: Adults who had surgical VSD closure in early childhood had impaired heart rate variability and, particularly, participants with complete RBBB had lower heart rate variability.
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http://dx.doi.org/10.1016/j.ijcard.2018.06.097DOI Listing
January 2019

The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.

J Thorac Cardiovasc Surg 2018 11 5;156(5):1906-1915.e3. Epub 2018 Jun 5.

Departments of Cardiothoracic Surgery, Anaesthesia, and Intensive Care, St George's Hospital, London, United Kingdom. Electronic address:

Objective: To examine the influence of prolonged intensive care unit (ICU) stay on quality of life and recovery following cardiac surgery.

Methods: Quality of life was assessed using the Short Form 36 Health Survey (SF36). The Postoperative Quality of Recovery Scale was used to assess quality of recovery, disability, and cognition after ICU discharge over 12 months' follow-up. Prolonged ICU stay was defined as ≥3 postoperative days. Mortality and major adverse cardiac and cerebrovascular events were recorded up to 12 months.

Results: For quality of life, the physical component improved over time in both groups (P < .01 for both groups), as did the mental component (P < .01 for both groups). The long ICU group had lower physical and mental components over time (both P values < .01), but by 12 months the values were similar. The overall quality of recovery was lower for the long ICU group (P < .01). Likewise, we found higher rates of recovery in the normal ICU group than in the long ICU group in terms of emotive recovery (P < .01), activities of daily living (P < .01), and cognitive recovery (P = .03) but no differences in terms of physiologic (P = .91), nociceptive (P = .89), and satisfaction with anesthetic care (P = .91). Major adverse cardiac and cerebrovascular events (P < .01), 30-day mortality (P < .01), and length of ward stay (P < .01) were all higher with prolonged ICU stay.

Conclusions: Patients with prolonged ICU stay have lower quality of life scores; however, they achieve similar midterm quality of recovery, but with reduced survival, increased major adverse cardiac and cerebrovascular events, and longer hospital length of stay.
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http://dx.doi.org/10.1016/j.jtcvs.2018.05.076DOI Listing
November 2018

Exercise performance after salbutamol inhalation in non-asthmatic, non-athlete individuals: a randomised, controlled, cross-over trial.

BMJ Open Sport Exerc Med 2018 30;4(1):e000397. Epub 2018 Aug 30.

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.

Background: Asthma is a frequent diagnosis in competitive sports, and inhaled β-agonists are commonly used by athletes. Although inhaled β-agonists do not seem to improve performance in athletes, it has remained uncertain whether they can increase exercise performance in non-athletes.

Objective: To investigate the effect of inhaled β-agonists on exercise performance in healthy non-athlete individuals.

Methods: In a double-blinded, placebo-controlled, cross-over trial, healthy, non-asthmatic, non-athlete individuals were randomised to inhalation of either 900 µg of salbutamol or placebo. Cardiopulmonary exercise testing, dynamic spirometry and impulse oscillometry were performed. The primary outcome was the effect from salbutamol on peak oxygen uptake, whereas secondary outcomes were breathing reserve and ventilation efficiency, and workload, heart rate, breath rate and minute ventilation at peak exercise under influence of salbutamol.

Results: A total of 36 healthy subjects with a mean age of 26±5 years were included. Salbutamol had no effect on peak oxygen uptake compared with placebo, 46.8±1.3 mL/kg/min versus 46.6±1.2 mL/kg/min, p=0.64. Salbutamol had no effect on workload, p=0.20, heart rate, p=0.23, breath rate, p=0.10, or minute ventilation, p=0.26, at peak exercise compared with placebo. Salbutamol lowered oxygen uptake, p=0.04, and workload, p=0.04, at anaerobic threshold compared with placebo. Forced expiratory volume in 1 s, 116%±13% of predicted, and peak expiratory flow, 122%±16% of predicted, increased after inhalation of salbutamol compared with placebo; 109%±13% and 117%±17%, respectively, p<0.01. Breathing reserve was found to be higher, 22%±2%, after salbutamol inhalation than after placebo, 16%±2%, p<0.01.

Conclusion: Inhaled salbutamol did not improve peak oxygen uptake in healthy, non-asthmatic, non-athlete individuals compared with placebo.

Trial Registration Number: NCT02914652.
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http://dx.doi.org/10.1136/bmjsem-2018-000397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135409PMC
August 2018

Biventricular morphology in adults born with a ventricular septal defect.

Cardiol Young 2018 Dec 30;28(12):1379-1385. Epub 2018 Aug 30.

1Department of Cardiothoracic and Vascular Surgery,Aarhus University Hospital,Aarhus,Denmark.

Ventricular septal defects - large, surgically closed or small, untreated - have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups' right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.
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http://dx.doi.org/10.1017/S1047951118001361DOI Listing
December 2018

Surgical closure of a ventricular septal defect in early childhood leads to altered pulmonary function in adulthood: A long-term follow-up.

Int J Cardiol 2019 Jan 2;274:100-105. Epub 2018 Jul 2.

Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.

Background: The long-term outlook after surgical closure of ventricular septal defect (VSD) has traditionally been considered benign. However, there is an increasing awareness of not only late cardiac dysfunction, but also pulmonary abnormalities. The primary aim of this study was to describe pulmonary function in adults with a surgically repaired VSD, and secondarily to determine the effects of salbutamol on the potential abnormalities.

Methods: All patients (operated for a VSD in early childhood) and controls (age- and gender-matched) underwent static and dynamic spirometry, impulse oscillometry, multiple breath washout, diffusion capacity for carbon monoxide, and cardiopulmonary exercise testing. In a double-blinded, cross-over study, participants were randomized to inhalation of either 900 μg of salbutamol or placebo. The primary outcome was forced expiratory volume in 1 s.

Results: In total, 30 participants with a surgically closed VSD and 30 healthy controls were included. The VSD participants had a lower forced expiratory volume in 1 s (99 ± 13% vs. 111 ± 13%), p < 0.001, impaired forced vital capacity, (106 ± 12% vs. 118 ± 13%), p < 0.001, and lower peak expiratory flow, (95 ± 18% vs. 118 ± 19%), p < 0.001, than the control group. Also, the VSD group had a lower alveolar volume than the control group, (92 ± 10% vs. 101 ± 11%), p < 0.001, but there were no differences in the remaining pulmonary function parameters. Salbutamol reduced airway resistances in both groups, but exercise performance was not improved by salbutamol, however.

Conclusions: Adults who have undergone surgical closure of a VSD in early childhood have reduced pulmonary function compared with controls, which is unaffected by inhalation of salbutamol.
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http://dx.doi.org/10.1016/j.ijcard.2018.06.109DOI Listing
January 2019

Propofol Attenuates the Myocardial Protection Properties of Desflurane by Modulating Mitochondrial Permeability Transition.

Anesth Analg 2018 08;127(2):387-397

From the Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.

Background: Desflurane and propofol are cardioprotective, but relative efficacy is unclear. The aim was to compare myocardial protection of single, simultaneous, and serial administration of desflurane and propofol.

Methods: Sixty New Zealand White rabbits and 65 isolated Sprague Dawley rat hearts randomly received desflurane, propofol, simultaneous desflurane and propofol, or sequential desflurane then propofol. Rabbits were subdivided to receive either ischemia-reperfusion with temporary occlusion of the left anterior descending artery or a time-matched, nonischemic perfusion protocol, whereas rat hearts were perfused in a Langendorff model with global ischemia-reperfusion. End points were hemodynamic, functional recovery, and mitochondrial uptake of H-2-deoxy-D-glucose as an indicator of mitochondrial permeability transition.

Results: In rabbits, there were minimal increases in preload-recruitable stroke-work with propofol (P < .001), desflurane (P < .001), and desflurane-and-propofol (P < .001) groups, but no evidence of increases with pentobarbitone (P = .576) and desflurane-then-propofol (P = .374). In terms of end-diastolic pressure-volume relationship, there was no evidence of increase compared to nonischemic controls with desflurane-then-propofol (P = .364), a small but significant increase with desflurane (P < .001), and larger increases with pentobarbitone (P < .001), propofol (P < .001), and desflurane-and-propofol (P < .001).In rat hearts, there was no statistically significant difference in mitochondrial H-activity between propofol and desflurane-and-propofol (165 ± 51 × 10 vs 154 ± 51 × 10 g·mL·min/μmol; P = .998). Desflurane had lower uptake than propofol (65 ± 21 × 10 vs 165 ± 51 × 10 g·mL·min/μmol; P = .039), but there was no statistically significant difference between desflurane and desflurane-then-propofol (65 ± 21 × 10 vs 59 ± 11 × 10 g·mL·min/μmol; P = .999).

Conclusions: Propofol and desflurane are cardioprotective, but desflurane is more effective than propofol. The added benefit of desflurane is lost when used simultaneously with propofol.
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http://dx.doi.org/10.1213/ANE.0000000000003450DOI Listing
August 2018

Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging.

Clin Imaging 2017 Nov - Dec;46:102-107. Epub 2017 Jul 27.

MR Research Center, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Aarhus University Hospital, Denmark.

Purpose: The aim was to establish a method for performing dynamic exercise during magnetic resonance imaging (MRI) using a slowly increasing workload protocol.

Methods: An ergometer bicycle with a step-wise, exercise protocol was used. Real-time phase-contrast MRI images of the aorta were obtained at each exercise step.

Results: In total, 40 participants completed the exercise protocol to reach a mean maximum cardiac output of 13.7±3.7l/min and a heart rate of 150±16beats/min at the highest exercise level. Less than 1% of scans were discarded due to poor quality.

Conclusions: Dynamic, high intensity exercise is feasible during MRI.
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http://dx.doi.org/10.1016/j.clinimag.2017.07.010DOI Listing
May 2018

Corrigendum to "Small, unrepaired ventricular septal defects reveal poor exercise capacity compared with healthy peers: A prospective, cohort study" [Int. J. Cardiol. 227 (2017) 631-634].

Int J Cardiol 2017 11 19;247:54. Epub 2017 Jul 19.

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

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http://dx.doi.org/10.1016/j.ijcard.2017.07.018DOI Listing
November 2017

Quality of recovery after gastroscopy, colonoscopy, or both endoscopic procedures: an observational pilot study.

Minerva Anestesiol 2017 Nov 14;83(11):1161-1168. Epub 2017 Jun 14.

Department of Anesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia -

Background: Gastroscopy and colonoscopy are procedures with low complication rates and patients are usually discharged few hours after the procedures. Nevertheless, postoperative cognitive decline is a common condition, is often missed, and can potentially affect patients' ability to drive and undertake other daily living activities. The primary aim was to assess the incidence of failure to recover at Day 1 after either colonoscopy, gastroscopy, or both procedures combined.

Methods: In an observational pilot study, participants of 18 years or above undergoing endoscopy procedures, including colonoscopy (reference group), gastroscopy, or both, were included. Postoperative quality of recovery was measured over a 1-month period using the "Postoperative Quality of Recovery Scale" assessing recovery in five subdomains.

Results: In total, 102 participants were enrolled, comprised of 53 colonoscopy participants, 28 gastroscopy participants, and 21 "combined" participants. At Day 1, overall recovery in the colonoscopy group was 57%, compared to 45% in the gastroscopy group with an odds ratio of 1.6 (95% CI 0.5-4.9) and 40% in the "combined" group with an odds ratio of 2.0 (95% CI 0.6-6.9). Failure to recover was mainly due to failure in nociceptive and cognitive recovery at Day 1, which were 76% and 79% for colonoscopy participants, respectively, 61% and 84% for gastroscopy participants, compared with 63% and 60% for the "combined" group, respectively.

Conclusions: This study showed that incomplete recovery is common past discharge after gastroscopy, colonoscopy, or both procedures and the study demonstrated modest but clinically important differences in early quality of recovery between the procedures.
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http://dx.doi.org/10.23736/S0375-9393.17.11916-4DOI Listing
November 2017

Permanent chronotropic impairment after closure of atrial or ventricular septal defect.

Scand Cardiovasc J 2017 Oct 8;51(5):271-276. Epub 2017 Jun 8.

a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital , Aarhus , Denmark.

Objectives: Atrial and ventricular septal defects are commonly closed surgically with low rates of post-operative morbidity, and the long-term outcome has widely been described as benign. Nevertheless, there is an increasing understanding of late morbidity, and the possibility of postoperative chronotropic impairment is continuously questioned. Furthermore, potentially abnormal chronotropic responses may be associated with the recently demonstrated overrepresentation of late arrhythmias. We conducted this review to methodically describe the potential effects of surgical defect closure on the chronotropic response to exercise.

Methods: We performed a search protocol based on the 'Preferred Reporting Items for Systematic Reviews and Meta- Analyses' (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and crosschecked by a secondary reviewer.

Results: A search of electronic databases revealed 16 publications, which consistently reported an abnormal heart rate responses to exercise after surgical closure. In contrast, these and other studies convincingly showed normal chronotropic response in un-operated patients as well as after percutaneous closure. Potential mechanisms include disturbances in the sinoatrial or atrioventricular conduction system and denervation in the proximity of the aorta during the surgical procedure.

Discussion: ASD and VSD patients have abnormal heart rate responses to exercise after surgical closure, which indicates a need of change in the preoperative information given to these patients and their parents before surgical defect closure. Although there may not be any alternatives to surgery, patients should still be informed about potential long-term consequences, including the risk of chronotropic incompetence. Moreover, this review suggests that 'specialized', long-term follow up may be indicated.
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http://dx.doi.org/10.1080/14017431.2017.1337216DOI Listing
October 2017

Impaired cardiac output during exercise in adults operated for ventricular septal defect in childhood: a hitherto unrecognised pathophysiological response.

Cardiol Young 2017 Oct 25;27(8):1591-1598. Epub 2017 May 25.

1Department of Cardiothoracic & Vascular Surgery,Aarhus University Hospital,Aarhus,Denmark.

Background: Recent studies have demonstrated that surgical ventricular septal defect closure in childhood is associated with reduced functional capacity and disruption of the right ventricular force-frequency relationship during exercise. To further describe long-term cardiac function, we performed a non-invasive assessment of cardiac index during exercise in adults having undergone surgery for ventricular septal defect in early childhood.

Methods: A total of 20 patients (surgical age 2.1±1.4 years, age at examination 22.1±2.2 years) and 20 healthy, matched controls (23.4±2.1 years at examination) underwent continuous supine bicycle ergometry during MRI. Their blood flow was recorded in the ascending aorta and the pulmonary trunk at increasing exercise levels. Cardiac index, retrograde flow, and vessel diameters were determined by blinded, post hoc analyses.

Results: The patient group had normal cardiac index at rest (2.9±0.7 L/minute/m2), which was comparable with that of the controls (3.0±0.6 L/minute/m2); however, they had a lower increase in cardiac index during exercise (reaching 7.3±1.3 L/minute/m2 at submaximal exercise) compared with controls (8.2±1.2 L/minute/m2), p<0.05. Patients had a significantly higher ascending aorta retrograde flow than controls at rest and throughout exercise. In the pulmonary artery, the retrograde flow was minimal at rest in both groups, but increased significantly in patients during exercise compared with controls.

Conclusions: Young adults with a surgically closed ventricular septal defect have a reduced cardiac index during exercise compared with healthy, young adults. The impaired cardiac index appears to be related to an increasing retrograde flow in the pulmonary artery with progressive exertion.
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http://dx.doi.org/10.1017/S1047951117000877DOI Listing
October 2017

Impaired ventilatory efficiency after closure of atrial or ventricular septal defect.

Scand Cardiovasc J 2017 Aug 13;51(4):221-227. Epub 2017 May 13.

a Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital, Aarhus , Denmark.

Objectives: Atrial and ventricular septal defects are the most common congenital heart defects and the closing procedures share important similarities. Generally, the postoperative outcome is considered benign, but there is growing concern regarding late ventilatory function. Therefore, the aim of this review was to describe the ventilatory function in patients with open as well as percutaneously or surgically closed atrial and ventricular septal defects.

Methods: We performed a search protocol based on the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. A data collection form was specifically developed and data were extracted from the included studies by a primary reviewer and cross-checked by the secondary reviewer.

Results: We found an increasing evidence of late impairment in ventilatory efficiency, and despite that ventilatory function is commonly normal at rest, abnormalities were disclosed during exercise. There are indices that surgical closure plays an important role.

Discussion: Atrial septal defect and ventricular septal defect patients have persisting, long-term impairment in ventilatory efficiency during exercise. Although the pathogenesis behind this finding may be multifactorial, there are indices that the surgical procedure may play an important role. Nevertheless, the literature is this field is sparse, and additional studies are needed.
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http://dx.doi.org/10.1080/14017431.2017.1326623DOI Listing
August 2017

Effect of prolonged targeted temperature management on left ventricular myocardial function after out-of-hospital cardiac arrest - A randomised, controlled trial.

Resuscitation 2017 06 2;115:23-31. Epub 2017 Apr 2.

Research Center for Emergency Medicine, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.

Aim: To evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors.

Methods: A randomised, controlled trial comparing myocardial function after TTM at 33 ±1°C for 48h compared with 24h. A total of 105 OHCA patients were computer-randomised to 24h (n=50) or 48h (n=55) of TTM. Transthoracic echocardiography was performed after 24h, 48h and 72h. Echocardiographic parameters were evaluated by an investigator who was blinded to randomisation. The primary endpoint was peak systolic mitral annular velocity (Ś) measured as the difference in the period from 24h to 72h. The model was adjusted for age, primary rhythm and heart rate. The secondary outcomes were global peak longitudinal strain, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and the diastolic measures e' and E/e'.

Results: The mean difference of S' was significantly increased in the 48h group compared with the 24h group: -1.14cm/s (-1.83; -0.45), p=0.001. This difference was consistent after adjusting the data (p=0.008). However, there were no significant changes between the study groups with respect to the adjusted secondary outcomes of global peak longitudinal strain (p=0.07), LVEF (p=0.31), TAPSE (p=0.91), e' (p=0.26) and E/e' (p=0.18).

Conclusion: Prolonged TTM at 33°C of 48h compared with 24h in comatose OHCA survivors may improve the recovery of post-cardiac arrest left myocardial dysfunction demonstrated by the echocardiographic outcome, S'. ClinicalTrials.gov identifier: NCT02066753.
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http://dx.doi.org/10.1016/j.resuscitation.2017.03.021DOI Listing
June 2017

Does functional capacity depend on the size of the shunt? A prospective, cohort study of adults with small, unrepaired ventricular septal defects.

Eur J Cardiothorac Surg 2017 04;51(4):722-727

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus N, Denmark.

Objectives: Small ventricular septal defects (VSDs) are considered to have great prognoses and most remain unrepaired. However, we have recently demonstrated lower functional capacity in patients with small VSDs compared with healthy peers. Using magnetic resonance imaging scans, we determined whether the functional capacity was correlated to the size of the shunt.

Methods: We included patients with unrepaired VSDs and healthy adults between 18 and 40 years of age in a prospective, cohort study. Functional capacity was previously determined using an incremental bicycle test, establishing peak oxygen uptake. Magnetic resonance imaging scans were performed using a 1.5-tesla Philips scanner. With electrocardiographically triggered flow measurements, we calculated mean cardiac output from the pulmonary trunk and ascending aorta as well as vessel diameters.

Results: In total, 29 patients with unrepaired VSDs (26.5 ± 6 years) and 25 controls (26.9 ± 5 years) completed both studies. Previously measured peak oxygen uptake was nearly 20% lower in patients compared with controls (P = 0.002). All patients had shunt ratios below 1.5, with mean QpQs of 1.2 ± 0.1. When correlating shunt size to functional capacity, a negative correlation was found between the shunt ratio and peak oxygen uptake (r  = −0.44, P = 0.020). Compared with controls, patients had increased forward and retrograde flow in the pulmonary trunk but comparable flows in the ascending aorta. Pulmonary diameter was also increased in patients (30.3 ± 4 mm) compared with controls (28.2 ± 3 mm; P = 0.041), whereas aortic dimensions were comparable.

Conclusions: Our results demonstrate that, although small, unrepaired VSDs revealed reduced functional capacity that can be negatively correlated to the size of the shunt.
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http://dx.doi.org/10.1093/ejcts/ezw420DOI Listing
April 2017

A Pilot Assessment of 3 Point-of-Care Strategies for Diagnosis of Perioperative Lung Pathology.

Anesth Analg 2017 03;124(3):734-742

From the *Ballarat Health Services, Ballarat, Victoria, Australia; Departments of †Surgery and #Physiotherapy, University of Melbourne, Melbourne, Australia; Departments of ‡Anesthesia and Pain Management and **Surgery, Royal Melbourne Hospital, Melbourne, Australia; §St. Vincent's Hospital, Melbourne, Australia; ‖Department of Anesthesia and Pain Management, Monash Medical Centre, Victoria, Australia; and ¶Department of Medicine, Monash University, Melbourne, Australia.

Background: Lung ultrasonography is superior to clinical examination and chest X-ray (CXR) in diagnosis of acute respiratory pathology in the emergency and critical care setting and after cardiothoracic surgery in intensive care. Lung ultrasound may be useful before cardiothoracic surgery and after discharge from intensive care, but the proportion of significant respiratory pathology in this setting is unknown and may be too low to justify its routine use. The aim of this study was to determine the proportion of clinically significant respiratory pathology detectable with CXR, clinical examination, and lung ultrasound in patients on the ward before and after cardiothoracic surgery.

Methods: In this prospective observational study, patients undergoing elective cardiothoracic surgery who received a CXR as part of standard care preoperatively or after discharge from the intensive care unit received a standardized clinical assessment and then a lung ultrasound examination within 24 hours of the CXR by 2 clinicians. The incidence of collapse/atelectasis, consolidation, alveolar-interstitial syndrome, pleural effusion, and pneumothorax were compared between clinical examination, CXR, and lung ultrasound (reference method) based on predefined diagnostic criteria in 3 zones of each lung.

Results: In 78 participants included, presence of any pathology was detected in 56% of the cohort by lung ultrasound; 24% preoperatively and 94% postoperatively. With lung ultrasound as a reference, the sensitivity of the 5 different pathologies ranged from 7% to 69% (CXR), 7% to 76% (clinical examination), and 14% to 94% (combined); the specificity of the 5 different pathologies ranged from 91% to 98% (CXR), from 90% to 99% (clinical examination), and from 82% to 97% (combined). For clinical examination and lung ultrasound, intraobserver agreements beyond chance ranged from 0.28 to 0.70 and from 0.84 to 0.97, respectively. The agreements beyond chance of pathologic diagnoses between modalities ranged from 0.11 to 0.64 (CXR and lung ultrasound), from 0.08 to 0.7 (CXR and lung ultrasound), and from 0 to 0.58 (clinical examination and CXR).

Conclusions: Clinically important respiratory pathology is detectable by lung ultrasound in a substantial number of noncritically ill, pre or postoperative cardiothoracic surgery participants with high estimate of interobserver agreement beyond that expected by chance, and we showed clinically significant diagnoses may be missed by the contemporary practice of clinical examination and CXR.
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http://dx.doi.org/10.1213/ANE.0000000000001726DOI Listing
March 2017

Small, unrepaired ventricular septal defects reveal poor exercise capacity compared with healthy peers: A prospective, cohort study.

Int J Cardiol 2017 Jan 29;227:631-634. Epub 2016 Oct 29.

Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Background: Small ventricular septal defects (VSDs) are considered to be without hemodynamic influence and most remain unrepaired. However, studies recently described late cardiac adverse consequences that could potentially affect functional capacity. Yet, this has never been assessed in adulthood. Therefore, the aim was to determine peak exercise capacity in adults with small VSDs compared with healthy, matched controls.

Methods: In a prospective, cohort study we included patients with unrepaired VSDs and healthy controls, (age 18 to 40years). Functional capacity was determined through incremental bicycle tests and gas exchange was measured breath-by-breath with Jaeger MasterScreen CPX®. Primary endpoint was peak oxygen uptake, while secondary endpoints were anaerobic threshold and health-related quality-of-life.

Results: In total, 34 VSD patients (age 26.5±6years) and 28 controls (age 26.9±5years) were included. There were no differences between groups in demographic characteristics or habitual exercise levels. At peak exercise, patients reached lower peak oxygen uptake, 36.2±9ml/kg/min, compared with controls, 43.8±6ml/kg/min (p=0.002) along with lower maximal workload; patients 3.2±1 watt/kg and controls 3.8±1 watt/kg (p=0.001). Aerobic capacity was also poorer in patients, 24.5±8ml/kg/min compared with controls, 31.2±7ml/kg/min (p=0.005). Lastly, patients had lower health-related quality-of-life in terms of physical (p=0.017) and social functioning (p=0.003) compared with controls. In the patient group physical functioning was directly correlated to the impaired peak oxygen uptake (r=0.473, p=0.005).

Conclusion: We demonstrated reduced subjective and objective functional capacity in small, unrepaired VSDs compared with controls. Furthermore, a correlation was seen between the impaired peak exercise capacity and lower self-estimated physical health.
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http://dx.doi.org/10.1016/j.ijcard.2016.10.086DOI Listing
January 2017

Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients.

Scand Cardiovasc J 2017 Apr 24;51(2):99-105. Epub 2016 Nov 24.

b Department of Cardiothoracic & Vascular Surgery , Aarhus University Hospital & Centre of Research in Rehabilitation (CORIR) , Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.

Objectives: Surgically treated type-A aortic dissection patients are often restricted from physical exercise due to a lack of knowledge about the blood pressure increase. Our aims were to evaluate the hemodynamic responses during exercise, and to assess changes in peak oxygen uptake, maximal workload, and quality-of-life after completion of an exercise-based cardiac rehabilitation program.

Design: Three subgroups were retrospectively identified based on their different eligibility criteria. Group I (n = 10) had performed an exercise-based cardiac rehabilitation program including exercise tests. Group II (n = 9) had followed the program without the tests. Group III (n = 10) had neither been rehabilitated nor tested. For evaluation of hemodynamic parameters, we included a group of surgically treated patients with aortic valve stenosis, group IV (n = 32). Questionnaires were obtained to measure quality-of-life.

Results: At baseline the group I and IV mean systolic blood pressure changed from 143 ± 16 mmHg and 150 ± 16 mmHg to 200 ± 32 mmHg and 213 ± 27 mmHg, respectively. The group I mean peak oxygen uptake changed from 23.5 ± 7.9 ml/min/kg before rehabilitation to 28.6 ± 8.4 ml/min/kg, p = .001, after rehabilitation. The mean maximal workload changed from 143 ± 80 W before rehabilitation to 178 ± 97 W, p = .003, after rehabilitation. At follow-up, the groups I-III physical quality-of-life score was 45.1 ± 15.0, 40.0 ± 9.0, and 30.0 ± 11.3, p < .025, respectively, and the mental quality-of-life score was 51.1 ± 6, 41.7 ± 6.7, and 32.5 ± 13.3, p < .001, respectively.

Conclusions: Our results suggest that type-A aortic dissection patients have hemodynamic responses to exercise that are comparable to other cardiovascular patients. Moreover, we found significant increases in peak oxygen uptake, maximal workload, and quality-of-life after ended ECR.
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http://dx.doi.org/10.1080/14017431.2016.1257149DOI Listing
April 2017