Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial Deformation Analysis and 3-Dimensional Echocardiography.

Right Ventricular (RV) output mostly derives from longitudinal shortening in normal hearts. However, following even uncomplicated cardiac surgery with preserved RV function a significant and sustained decrease in longitudinal contraction has been observed. How the RV compensates and sustains output in this setting remains unsettled. The aim of this study was to evaluate the RV contraction pattern by speckle tracking echocardiography to elucidate possible compensatory mechanisms mitigating the reduced RV longitudinal contraction after cardiac surgery. Thirty patients with normal preoperative ejection fraction and no valvulopathy underwent coronary artery bypass grafting (CABG) with the use of cardiopulmonary bypass (CPB). RV dedicated speckle tracking software measuring longitudinal and transverse displacement, as well as strain, was employed on transesophageal echocardiographic (TEE) images as part of the Right Ventricular Echocardiography in cardiac SurgEry (ReVERSE) study. Data was recorded at baseline (after anesthesia induction), immediately after CPB and upon chest closure. Tricuspid Annulus Plane Systolic Excursion (TAPSE) was reduced from 2.0 [1.6–2.5 cm] to 0.8 [0.6–11 mm] from baseline to after chest closure. RV longitudinal displacement was reduced from 6.1 [3.4–8.8 mm] to 2.9 [0.4–5.4 mm] at the same time-points. RV speckle tracking revealed concomitantly that transverse displacement of the free wall increased significantly from 1.2 [0–2.7 mm] at baseline to 5.4 [3.6–7.2 mm] after chest closure. RV speckle tracking strain did not change significantly. Increased transverse displacement likely compensates for reduction in RV longitudinal contraction following cardiac surgery and maintains cardiac output. The sustained output from the right ventricle was not related to an increased contractility.

Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE).

Perioperative Course of Three-Dimensional-Derived Right Ventricular Strain in Coronary Artery Bypass Surgery: A Prospective, Observational, Pilot Trial.

Right ventricular (RV) function is an important prognostic indicator. The acute effects of cardiac interventions or cardiac surgery on global and longitudinal RV function are not entirely understood. In this study, acute changes of RV function during mitral valve surgery (MVS), percutaneous mitral valve repair (PMVR) and off-pump coronary artery bypass surgery (OPCAB) were investigated employing 3D echocardiography. Twenty patients scheduled for MVS, 23 patients scheduled for PMVR and 25 patients scheduled for OPCAB were included retrospectively if patients had received 3D transesophageal echocardiography before and immediately after MVS, PMVR or OPCAB, respectively. RV global and longitudinal function was assessed using a 3D multiparameter set consisting of global right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), longitudinal contribution to RVEF (RVEFlong) and free wall longitudinal strain (FWLS). Longitudinal RV function was significantly depressed immediately after MVS, as reflected by all parameters (RVEFlong: 20 ± 5% vs. 13 ± 6%, p <  0.001, TAPSE: 13.1 ± 5.1 mm vs. 11.0 ± 3.5 mm, p = 0.04 and FWLS: −20.1 ± 7.1% vs. -15.4 ± 5.1%, p <  0.001, respectively). The global RVEF was slightly impaired, but the difference did not reach significance (37 ± 13% vs. 32 ± 9%, p = 0.15). In the PMVR group, both global and longitudinal RV function parameters were unaltered, whereas the OPCAB group showed a slight reduction of RVEFlong only (18 ± 7% vs. 14 ± 5%, p <  0.01). RVEFlong yielded moderate case-to-case but good overall reproducibility. TAPSE, FWLS and RVEFlong reflect the depression of longitudinal compared to global RV function initially after MVS. PMVR alone had no impact, while OPCAB had a slight impact on longitudinal RV function. The prognostic implications of these phenomena remain unclear and require further investigation.

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Acute changes of global and longitudinal right ventricular function: an exploratory analysis in patients undergoing open-chest mitral valve surgery, percutaneous mitral valve repair and off-pump coronary artery bypass grafting.

The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study.

Cardiac surgery induces geometrical and functional changes, which are not clearly explained. Objective: to investigate the physiopathology of the heart after cardiac surgery using advanced techniques of echocardiography. Thirty patients undergoing cardiac surgery had echocardiographic study prior and after surgery. Left and right ventricular (RV) longitudinal displacement and strain were studied with speckle-tracking. Using longitudinal displacement, we defined a static longitudinal reference-point (sLRP) to which the other segments moved during systole. Transversal displacement and global function were determined by conventional-echo. Left and RV segments showed systolic longitudinal displacement towards the apex, which was the sLRP before surgery; and towards the medium segment of lateral RV-wall one week after surgery. The displacement of basal RV segment towards this sLRP was smaller, causing decreased TAPSE. Apical segments showed an inverse displacement towards the new sLRP, and septum displacement was decreased or inverted towards the lateral RV-wall, causing paradoxus septal motion. RV-wall longitudinal strain was reduced (− 23.1 ± 8.6 vs. − 14.6 ± 5.3;p < 0.001), RV transversal fractional shortening was increased (36.5 ± 10.5 vs. 41.7 ± 13; p = 0.011), and the RV fractional area change was unchanged (46.7 ± 9.5 vs. 47.8 ± 11.7; p = 0.625). The medium segment of RV lateral wall, in contact with sternotomy, remains static after surgery and acts as a new sLRP towards which the rest of segments move, explaining the reduction of TAPSE and paradoxus septal motion. The longitudinal strain of the lateral RV-wall gets impaired, but an increase of transversal motion maintains global RV function.

Geometrical and functional cardiac changes after cardiac surgery: a phisiopatological explanation based on speckle tracking

Introduction: Influenza vaccination campaigns have difficulty in reaching the 75% uptake in healthcare workers (HCWs) that public health organizations target. This study runs a campaign across 42 primary care centers (PCCs) where for every HCW vaccinated against influenza, a polio vaccine is donated through UNICEF for children in developing nations. It also analyses the efficacy and cost of the campaign. Method: This observational prospective non-randomized cohort study was conducted across 262 PCCs and 15.812 HCWs. A total of 42 PCCs were delivered the full campaign, 114 were used as the control group, and 106 were excluded. The vaccine uptake in HCWs within each of those PCCs was registered. The cost analysis assumes that campaign costs remain stable year to year, and the only added cost would be the polio vaccines (0.59€). Results: We found statistically significant differences between both groups. A total of 1423 (59.02%) HCWs got vaccinated in the intervention group and 3768 (55.76%) in the control group OR 1.14, CI 95% (1.04–1.26). In this scenario, each additional HCW vaccinated in the intervention group costs 10.67€. Assuming all 262 PCCs had joined the campaign and reached 59.02% uptake, the cost of running this incentive would have been 5506€. The potential cost of increasing uptake in HCWs by 1% across all PCC (n = 8816) would be 1683€, and across all healthcare providers, 8862€ (n = 83.226). Conclusions: This study reveals that influenza vaccination uptake can be innovative by including solidary incentives and be successful in increasing uptake in HCWs. The cost of running a campaign such as this one is low.

https://www.mdpi.com/2076-393X/11/3/557/pdf?version=1677563094

Increasing Influenza Vaccination in Primary Healthcare Workers Using Solidary Incentives: Analysis of Efficacy and Costs

Background: Reaching the public health organizations targets of influenza vaccination in at-risk patient groups remains a challenge worldwide. Recognizing the relationship between the healthcare system characteristics and the economic environment of the population with vaccination uptake can be of great importance to improve. Methods: Several characteristics were correlated in this retrospective ecological study with data from 6.8 million citizens, 15,812 healthcare workers across 258 primary care health centers, and average income by area of the care center in Spain. Results: No correlation between HCW vaccination status and patient vaccination was found. A weak negative significant correlation between the size of the population the care center covers and their vaccination status did exist (6 mo.–59 yr., r = 0.19, p = 0.002; 60–64 yr., r = 0.23, p < 0.001; ≥65 yr., r = 0.23, p ≥ 0.001). The primary care centers with fewer HCWs had better uptake in the at-risk groups in the age groups of 60–64 yr. (r = 0.20, p = 0.002) and ≥65 (r = 0.023, p ≥ 0.001). A negative correlation was found regarding workload in the 6 mo.–59 yr. age group (r = 0.18, p = 0.004), which showed the at-risk groups that lived in the most economically deprived areas were more likely to be vaccinated. Conclusions: This study reveals that the confounding variables that determine influenza vaccination in a population and in HCWs are complex. Future influenza campaigns should address these especially considering the possibility of combining influenza and SARS-CoV-2 vaccines each year.

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Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates

Alberto García Lledó

Papers

Geometrical and functional cardiac changes after cardiac surgery: a phisiopatological explanation based on speckle tracking

Increasing Influenza Vaccination in Primary Healthcare Workers Using Solidary Incentives: Analysis of Efficacy and Costs

Effect of Primary Care Center Characteristics, Healthcare Worker Vaccination Status and Patient Economic Setting on Patient Influenza Vaccination Coverage Rates