No abstract

TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.

Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA) can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02). Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

The anatomical location of adipose tissue might have direct implications for its functionality and risk of cardiovascular disease. Adipose tissue surrounding blood vessels may be thermogenically more active in specific areas of the body, releasing substances that regulate vascular metabolism. In humans, the phenotypic characteristics of adipose tissue surrounding the aorta and the cardiovascular disease risk that it might entail remain largely unknown. Here, we compared thermogenesis-related molecular features of human periaortic adipose tissue samples with those of subcutaneous adipose tissue, obtained by sternotomy from 42 patients undergoing cardiovascular surgery. To determine the expression of genes related to energy expenditure and the levels of some adipokines, histological examinations, quantitative PCR, and protein expression measurements in adipocyte precursor cells were performed. Periaortic adipocytes were smaller than those from subcutaneous tissue. Moreover, weight gain induced periaortic adipocyte hypertrophy (r = -0.91, p<0.01). Compared to subcutaneous tissue, adiponectin, FABP4, IL-4 and IL-6 was decreased in periaortic adipocytes, whereas FGF21, UCP-1, PGC-1a, CITED1, Omentin and TFAM (Mitochondrial protein) increased. Upon analyzing patients’ clinical conditions, it emerged that the levels of PGC-1a both in male (r = -0.48 p<0.04) and female (r = -0.61, p<0.05) and TFAM in male (r = -0.72, p<0.0008) and female (r = -0.86, p<0.002) decreased significantly with progressive weight gain. However, no differences were observed in patients with diabetes mellitus 2 or Hyperlipidemia. Adipocytes surrounding the ascending aorta present markers of major thermogenic activity than those in subcutaneous tissue. Nevertheless, this characteristic might change, due to unfavorable metabolic conditions such as obesity, which is a risk factor for cardiovascular disease.