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Browsing by Author "Joseph, Mark"

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    A retrospective comparison of albumin versus mannitol priming fluid with relation to postoperative atrial fibrillation
    Binder, M. Scott; Wu, YingXing; Baker, Joseph W.; Rowe, Joseph F.; Wyatt, David A.; Choate, Cynthia; Poelzing, Steven; Joseph, Mark (Wiley, 2022-09-18)
    Background and aim of the study: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery which can result in increased mortality and increased healthcare costs. During Hurricane Maria (2017), a nationwide shortage of mannitol occurred, and our institution switched to the utilization of albumin as a priming fluid solution. We observed decreased rates of POAF during that time and began alternating albumin and mannitol priming fluid solutions. We hypothesized this observation may be from altered perinexal conduction from albumin utilization. Methods: A retrospective chart review of all patients from January 2020 through December 2020 who underwent cardiac surgery was performed, to determine if albumin was associated with reduced POAF rates. Two hundred and thirteen patients were identified and 4 were excluded. Two hundred and nine patients (110 albumin priming fluid and 99 mannitol priming fluid) were included in our final analysis. Results: Analysis was performed for all patients with POAF and in patients with new-onset AF (without a history of prior AF) after surgery. POAF rates showed no statistically significant difference between cohorts. For all patients, POAF occurred in 43% of the albumin subgroup and 47% of the mannitol subgroup (p = .53) and for patients with new-onset AF, POAF occurred in 35% of the albumin subgroup versus 42% of the mannitol subgroup (p = .36). Logistic regression revealed that age, ejection fraction and cardiopulmonary bypass time was associated with POAF, in our cohort. Conclusions: The use of albumin compared to mannitol as priming fluid solutions was not associated with statistically significant reductions in POAF rate, in our population.
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    Sex Differences in Cardiac Electrophysiology
    Depman, Madeline Jay (Virginia Tech, 2021-09-10)
    In recent years there has been more focus on investigating sex differences across all medical fields, including cardiology. There are sex differences in disease presentation, treatment and baseline function. These differences are critical to understand in order to properly treat both men and women. Even with an increased focus on this field, research has a male bias and there is more work to be done. Cardiac conduction is a highly synchronized process. Electrical signals are passed cell to cell through two mechanisms, ephaptic coupling and gap junctional coupling. These methods of electrical communication rely on gap junctions, sodium channels and the perinexus. When conduction is disrupted it causes arrhythmias. When investigating these three critical determinants of cardiac conduction in guinea pig hearts, we determined that there are sex differences in two of three investigated determinants. It appears that females are more susceptible to sodium channel modulation while males are more susceptible to gap junction modulation. Understanding these differences is critical to clinical care. It has been shown that females have higher mortality following cardiothoracic surgery and the reason for this is unknown. During cardiothoracic surgery the heart is arrested and maintained by a fluid, cardioplegia solution. Cardioplegia solutions contain components that are known to modulate conduction. We investigated the sex differences in cardiac electrophysiology with a focus on cardiac conduction and components of a common cardioplegia solution; we determined that there are electrophysiologic sex differences in response to both magnesium and mannitol. The sex substrates in three of the major determinants of conduction (sodium channels, gap junctions and perinexal width) and the differences in the effects of cardioplegia components on males and females may help to explain the higher mortality of females post cardiothoracic surgery.