Objective:To explore the clinical outcomes and recent follow-up results of the Modified Diamond Protocol in patients with low ejection fraction heart failure (HF) during the perioperative period of cardiac surgery.Methods:Retrospectively collected clinical data of 62 patients who underwent open heart surgery in the cardiac surgery department of Nanjing Drum Tower Hospital from August 2022 to January 2024, including 48 males and 14 females with mean age of (63.3±11.5)years old. All patients were diagnosed with low ejection fraction heart failure preoperatively, with left ventricular ejection fraction (LVEF) ≤0.35. Based on the indications of postoperative heart failure medication, 21 patients who received the Modified Diamond Protocol treatment were included in the Modified group, and 41 patients who received the standard treatment plan were included in the Control group. The baseline clinical characteristics and data of the two groups were compared. The left ventricular end-diastolic diameter (LVDd), pulmonary artery pressure (PH), LVEF, postoperative heart failure improvement, mortality, and readmission rates at preoperative, postoperative, and final discharge follow-up times of the two groups were analyzed.Results:There was no statistical difference in baseline data between the control group and the modified diamond regimen group ( P>0.05). There were no perioperative deaths in either group of patients. Compared to preoperative levels, there were significant decrease in PH, a significant reduction in LVDd, and significant increase in LVEF within each group ( P<0.05). Compared to control group, the Modified group demonstrated a greater reduction in PH (-17 mmHg vs. -12 mmHg, 1 mmHg=0.133 kPa), a greater reduction in LVDd (-0.59 mm vs. -0.57 mm), and a greater increase in LVEF (0.08 vs. 0.03), indicating an overall better improvement in cardiac function in the Modified group. However, there were no statistically significant differences between two groups ( P>0.05). All patients were followed up for 3-12 months. The overall mortality rate within 1 year was 12.9%(8/62). During the final follow-up for cardiac function, when comparing within each group, both groups showed a decrease in PH, a reduction in LVDd, and an increase in LVEF, all of which were improvements compared to preoperative levels, with statistically significant differences( P<0.05). Compared to control group, the Modified group showed a greater decrease in pulmonary hypertension (PH) (-17 mmHg vs. -12 mmHg), a greater reduction in LVDd(-0.58 mm vs. -0.57 mm), and a greater increase in left ventricular ejection fraction (LVEF) (0.06 vs. 0.07). The overall improvement in cardiac function was similar between the two groups, with no statistically significant differences( P>0.05). The readmission rate in the Modified group was significantly lower than in the Control group (9.5% vs. 36.6%, P=0.02), and the mortality rate was relatively lower (4.8% vs. 19.5%, P=0.11). Conclusion:The Modified Diamond Protocol is an effective approach to enhance postoperative cardiac function in patients with low ejection fraction undergoing cardiac surgery, contributing to early recovery and reduced readmission rates, but the long-term trend in mortality rates remain to be observed.

Objective To investigate the clinical manifestations,risk factors,treatment strategies and clinical prevention feasibility of diabetic ketoacidosis(DKA)after coronary artery bypass transplantation(CABG).Methods Clinical data of 9 patients with ketoacidosis after CABG surgery treated and treated by CICU in the Intensive Care Unit of Cardiac Surgery in Nanjing Gulou Hospital from January 2022 to January 2024 were retrospectively analyzed,and the diagnosis and treatment process and short-term postoperative follow-up were conducted to evaluate the causes of ketoacidosis in order to obtain clinical characteristics.To provide early warning information for follow-up diagnosis and treatment,and to evaluate the effect of perioperative corrective treatment strategy on the short-term prognosis of patients.Results The median duration of DKA in the 9 patients was 2.6 days after surgery,and the clinically suggestive symptoms were tachyarrhythmia(8/9),hypotension(4/9),polyuria(6/9),intractable hyperglycemia(3/9),and derangation(5/9).Analysis of concomitant manifestations or risk factors were mainly the perioperative use of sodium-glucose cotransporter 2 inhibitors(SGLT2i)(9/9),age＞60 years old.The main diagnosis was based on abnormal blood ketone and urine ketone.Blood gas analysis suggested metabolic acidosis,and BE showed serious negative performance.After early diagnosis,8 patients took the volumetric surplus strategy,and the average correction time was 5.6 days.One patient was slow to correct and eventually died from other types of severe complications.Conclusion Perioperative use of SGLT2-i drugs in CHD patients with heart failure and type 2 diabetes is a high risk factor for DKA.The strategy of early diagnosis and parallel capacity surplus is an important way to correct DKA.

Objective To investigate the clinical manifestations,risk factors,treatment strategies and clinical prevention feasibility of diabetic ketoacidosis(DKA)after coronary artery bypass transplantation(CABG).Methods Clinical data of 9 patients with ketoacidosis after CABG surgery treated and treated by CICU in the Intensive Care Unit of Cardiac Surgery in Nanjing Gulou Hospital from January 2022 to January 2024 were retrospectively analyzed,and the diagnosis and treatment process and short-term postoperative follow-up were conducted to evaluate the causes of ketoacidosis in order to obtain clinical characteristics.To provide early warning information for follow-up diagnosis and treatment,and to evaluate the effect of perioperative corrective treatment strategy on the short-term prognosis of patients.Results The median duration of DKA in the 9 patients was 2.6 days after surgery,and the clinically suggestive symptoms were tachyarrhythmia(8/9),hypotension(4/9),polyuria(6/9),intractable hyperglycemia(3/9),and derangation(5/9).Analysis of concomitant manifestations or risk factors were mainly the perioperative use of sodium-glucose cotransporter 2 inhibitors(SGLT2i)(9/9),age＞60 years old.The main diagnosis was based on abnormal blood ketone and urine ketone.Blood gas analysis suggested metabolic acidosis,and BE showed serious negative performance.After early diagnosis,8 patients took the volumetric surplus strategy,and the average correction time was 5.6 days.One patient was slow to correct and eventually died from other types of severe complications.Conclusion Perioperative use of SGLT2-i drugs in CHD patients with heart failure and type 2 diabetes is a high risk factor for DKA.The strategy of early diagnosis and parallel capacity surplus is an important way to correct DKA.

Objective:To explore the clinical outcomes and recent follow-up results of the Modified Diamond Protocol in patients with low ejection fraction heart failure (HF) during the perioperative period of cardiac surgery.Methods:Retrospectively collected clinical data of 62 patients who underwent open heart surgery in the cardiac surgery department of Nanjing Drum Tower Hospital from August 2022 to January 2024, including 48 males and 14 females with mean age of (63.3±11.5)years old. All patients were diagnosed with low ejection fraction heart failure preoperatively, with left ventricular ejection fraction (LVEF) ≤0.35. Based on the indications of postoperative heart failure medication, 21 patients who received the Modified Diamond Protocol treatment were included in the Modified group, and 41 patients who received the standard treatment plan were included in the Control group. The baseline clinical characteristics and data of the two groups were compared. The left ventricular end-diastolic diameter (LVDd), pulmonary artery pressure (PH), LVEF, postoperative heart failure improvement, mortality, and readmission rates at preoperative, postoperative, and final discharge follow-up times of the two groups were analyzed.Results:There was no statistical difference in baseline data between the control group and the modified diamond regimen group ( P>0.05). There were no perioperative deaths in either group of patients. Compared to preoperative levels, there were significant decrease in PH, a significant reduction in LVDd, and significant increase in LVEF within each group ( P<0.05). Compared to control group, the Modified group demonstrated a greater reduction in PH (-17 mmHg vs. -12 mmHg, 1 mmHg=0.133 kPa), a greater reduction in LVDd (-0.59 mm vs. -0.57 mm), and a greater increase in LVEF (0.08 vs. 0.03), indicating an overall better improvement in cardiac function in the Modified group. However, there were no statistically significant differences between two groups ( P>0.05). All patients were followed up for 3-12 months. The overall mortality rate within 1 year was 12.9%(8/62). During the final follow-up for cardiac function, when comparing within each group, both groups showed a decrease in PH, a reduction in LVDd, and an increase in LVEF, all of which were improvements compared to preoperative levels, with statistically significant differences( P<0.05). Compared to control group, the Modified group showed a greater decrease in pulmonary hypertension (PH) (-17 mmHg vs. -12 mmHg), a greater reduction in LVDd(-0.58 mm vs. -0.57 mm), and a greater increase in left ventricular ejection fraction (LVEF) (0.06 vs. 0.07). The overall improvement in cardiac function was similar between the two groups, with no statistically significant differences( P>0.05). The readmission rate in the Modified group was significantly lower than in the Control group (9.5% vs. 36.6%, P=0.02), and the mortality rate was relatively lower (4.8% vs. 19.5%, P=0.11). Conclusion:The Modified Diamond Protocol is an effective approach to enhance postoperative cardiac function in patients with low ejection fraction undergoing cardiac surgery, contributing to early recovery and reduced readmission rates, but the long-term trend in mortality rates remain to be observed.