engleski

Assessment and treatment of impaired nutritional status in heart transplant and TAVI patients - short term and late surveillance

Assessment of nutritional status plays an important role before and after surgical treatment in order to assess the risk of malnutrition. At the end of 2015 we developed and implemented of nutritional care plan at the Department of Cardiac and Transpalnt Surgery for TAVI patients (transcatheter aortic valve implantation), for heart transplant patients and patients with mechanical circulatory support. The nutritional care plan consist of: assessing nutritional status, identify nutrition-related problems, planning and prioritizing nutrition intervention to meet these needs and evaluating the nutritional care outcomes. Methods: The study presents 20 patients (13 female and 50 male) Patients were divided into 3 group: heart transplant patients (age: 54±11, 5 ; BMI (body mass index)27, 5±3, 4 kg/m2 ; FFMI (fat free mass index) 15, 9±1, 41 kg/m2 ; serum albumin 32, 3±3, 13 g/L ; 25-OH D 18, 11±7, 43 nmol/L) ; patients with mechanical circulatory support (age: 64, 8±4, 87 ; BMI 26, 8±4, 04 kg/m2 ; serum albumin 31, 2±2, 9 g/L ; 25-OH D 11, 5 nmol/L) and TAVI patients (age: 82, 8±2, 31 ; BMI 24, 8±5, 74 kg/m2 ; FFMI 15, 8±2, 52 kg/m2: serum albumin 39, 6±6, 68 g/L ; 25-OH D 12, 7 nmol/L).Upon admission all patients underwent the following assessment: body composition was determined by bioelectric impedance ; nutritional status was assessed by MNA (Mini Nutritional Assessment) questionnaires ; handgrip strength of both hands examined with a dynamometer ; laboratory parameters serum albumin, serum total protein, total lymphocyte count, serum vitamin 25 -OH D, electrolytes and CRP. Results: According to BMI only 2 TAVI patients were underweight they have BMI less than 22 kg/m2. Other patients had normal or high BMI some of them are obese. According to MNA score 60% of the all analyzed patients could be described as being at risk of malnutrition, their score was less than 23. Seven patients lost more than 5% of fat free mass (LBM) and ten patients had a low FFMI. 75% of all patients had a hand-grip strength below 85 % of the standard values Laboratory values: serum albumin, lymfocyte count, serum vitamin 25-OH D in all patients were below standard values. After implementation nutritional care plan and nutrition support there was significant improvement in nutritional status of all analyzed patients. Conclusion: Nutritional support and intervention increases lean body mass, muscle strength and physical condition by stimulating muscle protein synthesis and improves postoperative outcome. After Nutrition intervention we can see improvement in LBM and all laboratory markers.

nutritional status ; cardiac surgery ; nutritional assessment ; malnutrition

nije evidentirano