Interventional cardiology and cardiac surgery in India

Chaturvedi, Vivek; Talwar, Sachin; Airan, Balram; Bhargava, Balram

doi:10.1136/hrt.2007.133041

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…Although as the economy has developed, and cardiac surgery has become affordable for more patients, its complications are adding to the social economic burden in developing countries 35, 36. Considering the tremendous population in developing countries, this is worthy of concern.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Jiang

Teng

et al. 2016

JAHA

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BackgroundCardiac surgery–associated acute kidney injury (CSA‐AKI) is a common complication with a poor prognosis. In order to identify modifiable perioperative risk factors for AKI, which existing risk scores are insufficient to predict, a dynamic clinical risk score to allow clinicians to estimate the risk of CSA‐AKI from preoperative to early postoperative periods is needed.Methods and ResultsA total of 7233 cardiac surgery patients in our institution from January 2010 to April 2013 were enrolled prospectively and distributed into 2 cohorts. Among the derivation cohort, logistic regression was used to analyze CSA‐AKI risk factors preoperatively, on the day of ICU admittance and 24 hours after ICU admittance. Sex, age, valve surgery combined with coronary artery bypass grafting, preoperative NYHA score >2, previous cardiac surgery, preoperative kidney (without renal replacement therapy) disease, intraoperative cardiopulmonary bypass application, intraoperative erythrocyte transfusions, and postoperative low cardiac output syndrome were identified to be associated with CSA‐AKI. Among the other 1152 patients who served as a validation cohort, the point scoring of risk factor combinations led to area under receiver operator characteristics curves (AUROC) values for CSA‐AKI prediction of 0.74 (preoperative), 0.75 (on the day of ICU admission), and 0.82 (postoperative), and Hosmer–Lemeshow goodness‐of‐fit tests revealed a good agreement of expected and observed CSA‐AKI rates.ConclusionsThe first dynamic predictive score system, with Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition, was developed and predictive efficiency for CSA‐AKI was validated in cardiac surgery patients.

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Section: Discussionmentioning

confidence: 99%

Dynamic Predictive Scores for Cardiac Surgery–Associated Acute Kidney Injury

Jiang

Teng

et al. 2016

JAHA

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“…The median time from valve replacement was 24 months. Because Ϸ500 valve replacement procedures are performed annually at this center, 28 this translates to a 10% incidence of PVT. The latter estimate is consistent with a rate of 6.1% in the first 6 months after valve replacement reported in a retrospective study 1 and much higher than the 0.3 to 1.3 per 100 patient-years reported in developed countries.…”

Section: Burden Of Pvt In Developing Countriesmentioning

confidence: 99%

Accelerated Infusion of Streptokinase for the Treatment of Left-Sided Prosthetic Valve Thrombosis

et al. 2009

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Background— No large prospective studies have evaluated the efficacy of fibrinolytic therapy for left-sided prosthetic valve thrombosis, yet it remains the first line of treatment in developing countries. Methods and Results— We performed a randomized controlled trial comparing an accelerated infusion with the conventional infusion of streptokinase in 120 patients with a first episode of left-sided prosthetic valve thrombosis. The primary outcome measure was the occurrence of a complete clinical response, defined as objectively documented complete restoration of valve function in the absence of major complications. The secondary outcome was a composite of death, major bleeding, embolic stroke, or non–central nervous system systemic embolism. Patients were recruited over a 2.5-year period at a single center in India. Complete clinical response occurred in 38 (64.4%) of 59 patients with the accelerated infusion compared with 32 (53.3%) of 60 with the conventional infusion (hazard ratio 1.6, 95% confidence interval 0.9 to 2.5, P =0.055). There was no significant difference in the occurrence of the composite secondary outcome (hazard ratio 1.4, 95% confidence interval 0.5 to 3.5, P =0.50) or major bleeding (hazard ratio 2.2, 95% confidence interval 0.6 to 7.7, P =0.24) with the accelerated infusion. The success rate with fibrinolytic therapy was low overall (59%) and very low in patients in New York Heart Association functional class III/IV (24%). Conclusions— The large number of patients recruited from a single center underscores the massive burden of prosthetic valve thrombosis in developing countries. Fibrinolytic therapy with streptokinase is less efficacious than previously believed. The accelerated streptokinase infusion is not better than the standard infusion for left-sided prosthetic valve thrombosis. Developing countries urgently need more effective strategies to prevent and treat prosthetic valve thrombosis.

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“…4 Secondary treatments are often limited because of a paucity of skilled healthcare providers and, more important, the inability of the patient to afford costly medical procedures. 5 This great disparity in medical health care is clearly evident in the field of cardiac electrophysiology, specifically pacemaker implantation; this specialty is either severely underdeveloped or entirely nonexistent in many LMICs. 6 As a result, many individuals with symptomatic bradycardia experience a decreased quality of life and/or decreased life expectancy because of a lack of resources (personal correspondence, University of Philippines-Philippine General Hospital [UP-PGH], November 15, 2008).…”

Section: Health Of Body and Mind Is So Fundamental To The Good Life Tmentioning

confidence: 99%