Objective To investigate the role of clinical pharmacists in warfarin therapy. Methods A total of 134 patients underwent prosthetic heart valve replacement and had warfarin for life from March 2013 to October 2013 in Fujian Medical University Union Hospital. All patients were equally divided into two groups (an intervention and a non-intervention group) crosswise by sequence. There were 67 patients in each group. The anticoagulant effects of the two groups were compared. Results There was no statistical difference in the patients' demographic information between the two groups. However, the time for the patients to reach the target international normalized ratio(INR) values for the first time (7.1±3.3 dvs. 10.5±5.0 d,P=0.000) and time of INR in the therapy range (46.3%±18.8%vs.19.0%±16.2%,P=0.000) during their hospitalization, proportion of time of under anticoagulation (47.5%±19.5%vs. 71.2%±22.9%,P=0.000), proportion of time of anticoagulation overdose (5.3%±8.2%vs. 9.9%±16.7%,P=0.002) were significantly different. While there was no statistical difference in postoperative hospitalization time between the two groups (19.9±6.6 dvs. 18.1±7.0 d,P=0.137). There were 4 patients (6.0%) with minor hemorrhage and no severe complication was found in the intervention group. There were seven patients (10.4%) with mild hemorrhage, two patients with stroke, one patient with mild pulmonary embolism, and severe complication rate of 4.5% in the non-intervention group. Conclusion With clinical pharmacists involved in the whole anticoagulation therapy progress of patients after mechanical heart valve replacement, the time to achieve the therapeutic window for the first time is effectively shorten, and the time of the INR value controlled in therapeutic range is highly improved during hospitalization time. Moreover, the patients' risk of thrombosis and bleeding is eventually reduced.
Objective To develop and validate a nomogram prediction model for pulmonary infection in patients following cardiac valve replacement surgery, providing a reference for early screening of high-risk populations and implementing targeted preventive measures. Methods Clinical data of patients who underwent cardiac valve replacement surgery at the Second Affiliated Hospital of Anhui Medical University from January 2020 to October 2023 were collected. Patients were randomly assigned to a modeling group and a validation group in a 7 : 3 ratio. Based on the occurrence of pulmonary infection post-surgery, patients were divided into a pulmonary infection group and a non-pulmonary infection group. Risk factors for pulmonary infection after cardiac valve replacement were analyzed using least absolute shrinkage and selection operator (LASSO) regression and logistic regression to establish a risk prediction model, which was subsequently validated. Model evaluation was conducted using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Results A total of 689 patients were included, comprising 354 males and 335 females, with a mean age of (57.37±12.76) years. The incidence of pulmonary infection was 16.0% (110/689). Independent risk factors for pulmonary infection following cardiac valve replacement included emergency admission, smoking history, chronic obstructive pulmonary disease, duration of cardiopulmonary bypass, duration of tracheal intubation, and postoperative renal injury. The AUC for the modeling group was 0.911 [95%CI (0.877, 0.946) ], with a Hosmer-Lemeshow χ2-value of 6.577 (P=0.583) in the training group. The AUC value was 0.891 [95%CI (0.840, 0.941) ], with a Hosmer-Lemeshow χ2-value of 5.486（P=0.705）in the validation group. The model demonstrated good discrimination, calibration, and net benefit. Conclusion The established nomogram prediction model has significant predictive value and can be applied to risk assessment and individualized treatment for pulmonary infection in patients following cardiac valve replacement surgery.
A 23-year-old male patient was diagnosed with congenitally corrected transposition of the great arteries (ccTGA) at the age of 3 during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.