Publications by authors named "Palesa Motshabi Chakane"

6 Publications

  • Page 1 of 1

Ultrasound Hepatic Vein Ratios Are Associated With the Development of Acute Kidney Injury After Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 Jul 28. Epub 2021 Jul 28.

Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa.

Objective: The authors investigated the use of hepatic venous and right-heart ultrasound parameters in predicting cardiac surgery-associated acute kidney injury (AKI).

Design: This was a prospective, contextual, descriptive two-center study. Blood tests,clinical and ultrasound data were obtained preoperatively, and postoperative day one, and day four. The hepatic vein, inferior vena cava, and right-heart Doppler ultrasound parameters were obtained and analyzed.

Setting: The sites of the study were Johannesburg, South Africa, and Aarhus, Denmark.

Participants: Adult patients who satisfied inclusion criteria, between August 2019 and January 2020, were included, with a total of 152 participants.

Interventions: None.

Measurements And Main Results: The median (interquartile range) age of patients was 68 (55-73) years, predominantly male, and the majority were hypertensive. Of 152 patients analyzed, 54 (35%) patients developed AKI. Among these, 37 (69%) were classified as Kidney Disease: Improving Global Outcomes (KDIGO) stage I, 11 (20%) as stage II, while six (11%) were stage III. Age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.00-1.10 p = 0.031), The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (AOR 1.43, 95% CI 1.14-1.80, p = 0.005], and preoperative serum creatinine (AOR 1.04, 95% CI 1.01-1.08, p = 0.013) were predictive of AKI. Those who developed AKI had experienced longer cardiopulmonary bypass (CPB) times (p < 0.001). Preoperatively, hepatic vein S-wave measurements were significantly higher in patients with AKI (p < 0.05). On postoperative day one (D1), the hepatic vein flow ratios of patients with AKI were significantly decreased, driven by low S waves and high D waves, and accompanied by significantly elevated central venous pressure (CVP) levels. CVP levels on D1 postoperatively were predictive of AKI (AOR 1.31, 95% CI 1.11-1.55, p = 0.001). Measurements of right ventricular (RV) base, tricuspid annular plane excursion (TAPSE), and inferior vena cava were not associated with the development of AKI (p > 0.05).

Conclusion: There was an association between the development of AKI and a decrease in hepatic flow ratios on D1, driven by low S-wave and high D-wave velocities. The presence of venous congestion was reflected by significantly elevated CVP values, which were independently associated with AKI on D1. RV base and TAPSE measurements were, however, not associated with AKI. These parameters may reflect perioperative circumstances, including prolonged CPB times and potential fluid management, which can be modified in this period.
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http://dx.doi.org/10.1053/j.jvca.2021.07.039DOI Listing
July 2021

Dengue and the heart.

Cardiovasc J Afr 2021 Jul 20;32:1-6. Epub 2021 Jul 20.

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Email:

Background: Peri-operative morbidity and mortality are increased in patients with rheumatic heart disease. Pre-operative risk stratification is imperative for optimisation and a better outcome.

Methods: This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxeke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled. The objectives of the study were to describe the demographic profile of the patients presenting for rheumatic mitral valve surgery, describe their peri-operative cardiovascular and echocardiographic parameters, and risk stratify according to their clinical and echocardiographic parameters. Demographic, echocardiographic and laboratory data as well as the cardiovascular examination were analysed. Descriptive statistics using proportions (percentages), means (standard deviations) or medians (interquartile ranges) were used where appropriate.

Results: A total of 102 patients were reviewed. Thirteen were excluded due to significant missing data. Of the 89 analysed, all had demographic data, 81 had cardiovascular clinical examination data, 82 had echocardiographic data and 52 had laboratory data. Forty-seven patients presented with mitral regurgitation (MR) and 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation who were classified under the MR group. In total, 45% (39 patients) had arrhythmias and 49% (42 patients) had congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary artery systolic pressure was 57 (20) mmHg and mean (SD) left atrial size was 53 (11) mm. Those with MS presented with mean (SD) mitral valve area of 0.9 (0.2) cm. Of the analysed MR patients, 51% presented with left ventricular ejection fraction < 60% and 55% with left ventricular end-systolic diameter > 40 mm. Among the analysed MS patients, 59% had mitral valve area < 1 cm. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology (ACC/AHA) guidelines for valvular heart disease due to missing vital information. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had asymptomatic severe MR (stage C) and 11 had symptomatic severe MR (stage D). One patient had progressive MS (stage B), eight had asymptomatic severe MS (stage C) and seven had symptomatic severe MS (stage D).

Conclusions: The majority of those who could be stratified presented in stages C and D of disease progression; however, they also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity.
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http://dx.doi.org/10.5830/CVJA-2021-024DOI Listing
July 2021

Factors associated with acute kidney injury and mortality during cardiac surgery.

Cardiovasc J Afr 2021 Feb 3;32:1-7. Epub 2021 Feb 3.

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Background: Cardiac surgery with cardiopulmonary bypass (CPB) is known to contribute towards the incidence of acute kidney injury (AKI) and peri-operative morbidity and mortality. There are several patient, anaesthetic and surgical factors that contribute to its occurrence. It is imperative to know the profile of a patient who is likely to develop this complication to mitigate for modifiable risks. This study aimed at describing a profile of AKI in an adult patient (over the age of 18 years) following cardiac surgery on CPB. Factors associated with the development of cardiac surgery-associated acute kidney injury (CSA-AKI) are described, as well as the relationship between CSA-AKI and in-hospital mortality.

Methods: This was a contextual, descriptive and retrospective single-centre study with data of 476 adult patients admitted post cardiac surgery between January 2016 and December 2017. Data were collected from Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa. All adult patients who presented for elective cardiac surgery (coronary artery bypass graft), valvular, aortic and other cardiac surgery on CPB were included. Peri-operative factors such as patient demographics, baseline renal function, co-morbid factors, length of CPB and aortic cross-clamp time, degree of hypothermia, use of assist devices, and post-operative serum creatinine (SCr) levels were collected. Incomplete essential peri-operative data and data for patients who presented on renal replacement therapy (RRT) already were excluded. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results: One hundred and thirty-five (28%) patients developed CSA-AKI and 20, 5 and 3% were in KDIGO 1, 2 and 3, respectively. Older age ( = 0.024), female gender ( = 0.015), higher serum creatinine level ( = 0.025), and lower estimated glomerular filtration rate (eGFR) ( = 0.025) were associated with the development of CSA-AKI, while a history of hypertension was predictive. Forty-six of the 476 patients died. Mortality rates were significantly higher in those with AKI compared to those without [28 (21%) vs 18 (5%), respectively ( = 0.001)]. The incidence was significantly worse in those with severe kidney injury, as evidenced by mortality rates of 44 versus 5% between KDIGO 3 and KDIGO 1 ( < 0.001). Pre-operative eGFR and CSA-AKI requiring RRT were significantly associated with mortality, while pre-operative eGFR was an independent predictor of mortality (hazard ratio 0.99, 95% confidence interval: 0.97-0.99, = 0.019).

Conclusions: A history of hypertension was predictive of the development of CSA-AKI, and pre-operative eGFR was an independent predictor of mortality in this cohort. Both factors are modifiable.
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http://dx.doi.org/10.5830/CVJA-2020-063DOI Listing
February 2021

Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa.

J Cardiothorac Surg 2021 Jan 7;16(1). Epub 2021 Jan 7.

Division of Cardiology, Department of Internal Medicine, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.

Background: The perioperative complications in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery have been reported predominantly from developed countries, with a paucity of data from sub-Saharan Africa. We aim to report on the clinical characteristics and perioperative complications in patients with obstructive coronary artery disease, managed with CABG surgery at a tertiary academic hospital in Johannesburg, South Africa.

Methods: We retrospectively reviewed data from adult patients who underwent CABG surgery during a 17-year period (January 2000 - December 2017). Data was collected from the cardiothoracic surgery department's pre- and postoperative reports, the cardiology department's medical records, and anaesthesiology's intra-operative reports. We collected demographic, biochemical, clinical, surgical, echocardiographic, and angiographic data. Outcomes data collected included perioperative complications and mortality.

Results: We analysed 1218 consecutive patient records. The study cohort consisted of 951 (78.1%) males, and the mean age was 60.1 ± 10.1 years. During the study period, 137 (11.2%) patients demised with cardiac and sepsis-related causes of death accounting for 49.6 and 37.2%, respectively. Other perioperative complications included excessive bleeding in 222 (18.2%), prolonged ventilation (exceeding 48 h) in 139 (11.4%), and sternal sepsis in 125 (10.3%). On univariate logistic regression analysis, advanced age, a lower left ventricular ejection fraction, smoking, increased cardiopulmonary bypass (CPB) time, and a higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II were all significantly associated with mortality. The EuroSCORE II [OR: 0.15 95%CI: 0.09-0.22; p = 0.000], and prolonged CPB time [OR: 0.01 CI: 0.00-0.02; p = 0.000] were independent predictors of in-hospital all-cause mortality.

Conclusions: In our study, the crude perioperative mortality rate was 11.2%. Our mortality rate was significantly higher than the mortality rates reported in other developed and developing countries. To better understand the factors driving this high mortality rate, a prospective outcomes registry has been initiated, and this promises to inform on our contemporary mortality and morbidity outcomes.
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http://dx.doi.org/10.1186/s13019-020-01385-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792285PMC
January 2021

Cardiac surgery-associated acute kidney injury: pathophysiology and diagnostic modalities and management.

Cardiovasc J Afr 2020 Jul/Aug;31(4):205-212. Epub 2020 Jun 12.

Department of Anaesthesiology, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.

Acute kidney injury is a disease spectrum that can present with from mild renal dysfunction to complete renal failure that would require renal replacement therapy. Cardiac surgery-associated acute kidney injury is a complication that carries a grave disease burden. Risk factors are identified as being either modifiable or non-modifiable. This literature review aims to define the pathophysiology of cardiac surgery-associated acute kidney injury, the current definition and classification of acute kidney injury and the available diagnostic modalities, especially the use of biomarkers.
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http://dx.doi.org/10.5830/CVJA-2019-069DOI Listing
November 2020

Audit of transfusion of blood products in paediatric congenital heart surgery on cardiopulmonary bypass.

Cardiovasc J Afr 2018 Nov/Dec 23;29(6):381-386. Epub 2018 Nov 6.

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Email:

Background: Cardiac surgery is associated with peri-operative bleeding, which may result in the need for blood transfusion, particularly in paediatric congenital cardiac surgery on cardiopulmonary bypass (CPB). There is a necessity for regular auditing in order to improve practices.

Methods: Retrospective, contextual, descriptive data of 105 patients were collected for the period January to December 2014.

Results: The median age of patients was four (1-6) years, weight was 13 (8.4-20) kg, and mean lowest CPB haemoglobin level was 8.3 (1.5) g/dl. There was a statistically significant difference in median red packed cell (RPC), platelet and cryoprecipitate units per patient transfused across four RACHS (risk-adjusted classification for congenital heart surgery) categories ( = 0.03, = 0.0013, = 0.0001, respectively). There was a statistically significant correlation between transfused fresh frozen plasma units with CPB time ( = 0.2634, = 0.0199) and RPC units ( = -0.4654, < 0.001).

Conclusions: Although no standardised transfusion guidelines were available, overall transfusion of blood products was comparable to reported practices.
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http://dx.doi.org/10.5830/CVJA-2018-048DOI Listing
December 2019
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