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Sample records for cardiac surgery evaluation

  1. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

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    Doerr, Fabian; Heldwein, Matthias B; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M; Wahlers, Thorsten; Hekmat, Khosro

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  2. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

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    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-02-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7{+-}10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6{+-}5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

  3. Cardiac Procedures and Surgeries

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    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiac Procedures and Surgeries Updated:Sep 16,2016 If you've had ... degree of coronary artery disease (CAD) you have. Cardiac Procedures and Surgeries Angioplasty Also known as Percutaneous Coronary Interventions [PCI], ...

  4. Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery

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    Fathala Ahmed

    2011-01-01

    Full Text Available The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG. Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1 the magnitude of the cardiac preoperative morbidity and mortality, (2 how to select a patient for further preoperative testing, (3 currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4 an approach to select the most appropriate noninvasive cardiac test, if needed.

  5. Patch in Cardiac Surgery

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    Alireza Alizadeh Ghavidel

    2014-06-01

    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  6. Port Access Cardiac Surgery.

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    Viganó, Mario; Minzioni, Gaetano; Spreafico, Patrizio; Rinaldi, Mauro; Pasquino, Stefano; Ceriana, Piero; Locatelli, Alessandro

    2000-10-01

    The port-access technique for cardiac surgery was recently developed at Stanford University in California as a less invasive method to perform some cardiac operations. The port-access system has been described in detail elsewhere. It is based on femoral arterial and venous access for cardiopulmonary bypass (CPB) and on the adoption of a specially designed triple-lumen catheter described originally by Peters, and subsequently modified and developed in the definitive configuration called the endoaortic clamp.

  7. Cardiac surgery 2015 reviewed.

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    Doenst, Torsten; Strüning, Constanze; Moschovas, Alexandros; Gonzalez-Lopez, David; Essa, Yasin; Kirov, Hristo; Diab, Mahmoud; Faerber, Gloria

    2016-10-01

    For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.

  8. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

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    Kelli Maria Souza Santos

    2014-09-01

    Full Text Available Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors at three different times: preoperatively (M1, the day of discharge (M2 and hospital discharge (M3. Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1, with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

  9. Leadership in cardiac surgery.

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    Rao, Christopher; Patel, Vanash; Ibrahim, Michael; Ahmed, Kamran; Wong, Kathie A; Darzi, Ara; von Segesser, Ludwig K; Athanasiou, Thanos

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance.

  10. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

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    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

  11. Robotic Applications in Cardiac Surgery

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    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  12. Transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound

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    Xin-Sheng Chen

    2016-01-01

    Objective:To analyze the transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound.Methods:A total of 80 patients undergoing laparoscopic surgery in our hospital were randomly divided into standard pneumoperitoneum pressure group (12-15 mmHg) and high pneumoperitoneum pressure group (>15 mmHg) (n=40), and the differences in the levels of coronary blood flow and cardiac function parameters under transesophageal echocardiography as well as the content of stress hormones and acute phase proteins in serum were compared between two groups of patients.Results: Coronary blood flow parameters D, Q, PDV, MDV and DAR levels of standard pneumoperitoneum pressure group were significantly higher than those of high pneumoperitoneum pressure group; cardiac function parameters COLVOT, LVEF and LVFAC levels were significantly higher than those of high pneumoperitoneum pressure group; stress hormones Cor, Ang-Ⅰ, Ang-Ⅱ, NE, Glucagon and C-peptide as well as acute phase proteins CRP, YKL-40 and HMGB1 content in serum were significantly lower than those of high pneumoperitoneum pressure group while the acute phase protein PA content was significantly higher than that of high pneumoperitoneum pressure group.Conclusions:Transesophageal echocardiography can timely detect the excessive pneumoperitoneum damage in laparoscopic surgery to the coronary blood flow and cardiac function in patients, and also prevent the occurrence of excessive operative wound.

  13. Evaluation of the Prevalence and Risk Factors of Delirium in Cardiac Surgery ICU

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    Kamran Shadvar

    2013-12-01

    Results: The prevalence of delirium in these patients was 23.5% (47 patients. The mean age of patients with delirium was more than other patients (P=0.001. The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB was higher than the patients without CPB (P=0.01. The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002. The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032. The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01. Conclusion: Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients.

  14. Thoracocentesis in cardiac surgery patients.

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    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders

    2015-01-01

    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

  15. Can cardiac surgery cause hypopituitarism?

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    Francis, Flverly; Burger, Ines; Poll, Eva Maria; Reineke, Andrea; Strasburger, Christian J; Dohmen, Guido; Gilsbach, Joachim M; Kreitschmann-Andermahr, Ilonka

    2012-03-01

    Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3-12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.

  16. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery

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    Paulo Sérgio da Silva

    2015-08-01

    Full Text Available Abstract Objective: To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. Methods: A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension and GII (with pulmonary hypertension. Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP 40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05. Results: The GI was composed of 21 patients and GII for 19. All patients (100% were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397. It required reintubation of 2 patients in GII (5% of the total, without statistically significant as compared to GI (P=0.488. Conclusion: In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery.

  17. Hemoglobin Drift after Cardiac Surgery

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    George, Timothy J.; Beaty, Claude A.; Kilic, Arman; Haggerty, Kara A.; Frank, Steven M.; Savage, William J.; Whitman, Glenn J.

    2013-01-01

    Introduction Recent literature suggests that a restrictive approach to red blood cell transfusions is associated with improved outcomes in cardiac surgery (CS) patients. Even in the absence of bleeding, intravascular fluid shifts cause hemoglobin levels to drift postoperatively, possibly confounding the decision to transfuse. We undertook this study to define the natural progression of hemoglobin levels in postoperative CS patients. Methods We included all CS patients from 10/10-03/11 who did not receive a postoperative transfusion. Primary stratification was by intraoperative transfusion status. Change in hemoglobin was evaluated relative to the initial postoperative hemoglobin. Maximal drift was defined as the maximum minus the minimum hemoglobin for a given hospitalization. Final drift was defined as the difference between initial and discharge hemoglobin. Results Our final cohort included 199 patients, 71(36%) received an intraoperative transfusion while 128(64%) did not. The average initial and final hemoglobin for all patients were 11.0±1.4g/dL and 9.9±1.3g/dL, respectively, an final drift of 1.1±1.4g/dL. The maximal drift was 1.8±1.1g/dL and was similar regardless of intraoperative transfusion status(p=0.9). Although all patients’ hemoglobin initially dropped, 79% of patients reached a nadir and experienced a mean recovery of 0.7±0.7g/dL by discharge. On multivariable analysis, increasing CPB time was significantly associated with total hemoglobin drift(Coefficient/hour: 0.3[0.1–0.5]g/dL, p=0.02). Conclusions In this first report of hemoglobin drift following CS, although all postoperative patients experienced downward hemoglobin drift, 79% of patients exhibited hemoglobin recovery prior to discharge. Physicians should consider the eventual upward hemoglobin drift prior to administering red cell transfusions. PMID:22609121

  18. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

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    Noyez, L.; Biemans, I.; Verkroost, M.W.; Swieten, H.A. van

    2013-01-01

    OBJECTIVE: This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. METHODS: Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Cor

  19. Minimally invasive cardiac surgery and transesophageal echocardiography

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    Ajay Kumar Jha

    2014-01-01

    Full Text Available Improved cosmetic appearance, reduced pain and duration of post-operative stay have intensified the popularity of minimally invasive cardiac surgery (MICS; however, the increased risk of stroke remains a concern. In conventional cardiac surgery, surgeons can visualize and feel the cardiac structures directly, which is not possible with MICS. Transesophageal echocardiography (TEE is essential during MICS in detecting problems that require immediate correction. Comprehensive evaluation of the cardiac structures and function helps in the confirmation of not only the definitive diagnosis, but also the success of surgical treatment. Venous and aortic cannulations are not under the direct vision of the surgeon and appropriate positioning of the cannulae is not possible during MICS without the aid of TEE. Intra-operative TEE helps in the navigation of the guide wire and correct placement of the cannulae and allows real-time assessment of valvular pathologies, ventricular filling, ventricular function, intracardiac air, weaning from cardiopulmonary bypass and adequacy of the surgical procedure. Early detection of perioperative complications by TEE potentially enhances the post-operative outcome of patients managed with MICS.

  20. Coagulopathy and hemostatic monitoring in cardiac surgery

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    Johansson, Pär I; Sølbeck, Sacha; Genet, Gustav;

    2012-01-01

    Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse...

  1. Preoperative respiratory physical therapy in cardiac surgery

    NARCIS (Netherlands)

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in

  2. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

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    Guerrero-Orriach, José Luis; Ariza-Villanueva, Daniel; Florez-Vela, Ana; Garrido-Sánchez, Lourdes; Moreno-Cortés, María Isabel; Galán-Ortega, Manuel; Ramírez-Fernández, Alicia; Alcaide Torres, Juan; Fernandez, Concepción Santiago; Navarro Arce, Isabel; Melero-Tejedor, José María; Rubio-Navarro, Manuel; Cruz-Mañas, José

    2016-01-01

    Purpose To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. Methods This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours. Conclusion Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery. PMID:27143905

  3. Endothelial dysfunction after non-cardiac surgery

    DEFF Research Database (Denmark)

    Søndergaard, E S; Fonnes, S; Gögenur, I

    2015-01-01

    with non-invasive measurements done both pre- and post-operatively and published in English. All types of non-cardiac surgery and both men and women of all ages were included. RESULTS: We found 1722 eligible studies in our search, and of these, five studies fulfilled our inclusion and exclusion criteria....... Endothelial function was disturbed in patients after non-cardiac surgery. Three studies found a significant decrease in the endothelial function immediately after surgery (2 and 24 h post-operatively). Two studies found that patients with previous endothelial dysfunction and scheduled for surgery (renal...... of post-operative myocardial damage....

  4. Anesthetic issues for robotic cardiac surgery

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    Wendy K Bernstein; Andrew Walker

    2015-01-01

    As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiolog...

  5. Corticosteroids in cardiac surgery: a continuing controversy

    NARCIS (Netherlands)

    Dieleman, J.M.

    2015-01-01

    Cardiac surgery leads to significant improvements in symptoms of cardiac disease and quality of life, but is still associated with a substantial risk of adverse events and postoperative disability. The perioperative systemic inflammatory response syndrome (SIRS) likely plays a role in the developmen

  6. ACUTE RENAL FAILURE AFTER CARDIAC SURGERY

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    N Safai

    2008-08-01

    Full Text Available "nAcute renal failure (ARF following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting (CABG or both, with or without cardiopulmonary bypass (CPB were included. Exclusion criteria were death within two days of operation (n= 8, incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria (on dipstick, type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF (P < 0.05. When both all variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF (Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004. Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF.

  7. Cardiac surgery for Kartagener syndrome.

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    Tkebuchava, T; von Segesser, L K; Niederhäuser, U; Bauersfeld, U; Turina, M

    1997-01-01

    Two patients (one girl, one boy) with Kartagener syndrome (situs inversus, bronchiectasis, sinusitis), despite pulmonary problems and associated congenital cardiac anomalies, were operated on at the ages of 4 years and 7 years, respectively. They had had previous palliative treatment at the age of 3 months and 1.3 years, respectively. Both postoperative periods after total correction were without significant complications. Long-term follow-up was available for 9 and 19 years, respectively, with no manifestations of heart insufficiency. Both patients are physically active, and neither requires cardiac medication. Patients with Kartagener syndrome and associated congenital cardiac anomalies can successfully undergo multiple cardiac operations with good long-term outcome.

  8. Recurrent late cardiac tamponade following cardiac surgery : a deceiving and potentially lethal complication

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    Harskamp, Ralf E.; Meuzelaar, Jacobus J.

    2010-01-01

    Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagno

  9. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

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    Ming Li

    2012-01-01

    Full Text Available Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

  10. Is there a future for neuroprotective agents in cardiac surgery?

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    van den Bergh, Walter M

    2010-01-01

    This article gives an overview of neuroprotective drugs that were recently tested in clinical trials in cardiac surgery. Also, recommendations are given for successful translational research and considerations for management during cardiac surgery.

  11. Fibrinogen Concentrate Therapy in Complex Cardiac Surgery

    NARCIS (Netherlands)

    Bilecen, Suleyman; Peelen, Linda M.; Kalkman, Cor J.; Spanjersberg, Alexander J.; Moons, Karel G. M.; Nierich, Arno P.

    2013-01-01

    Objectives: Fibrinogen concentrate increasingly is used to treat coagulopathic bleeding in cardiac surgery although its effectiveness and safety have not been shown. The authors conducted a cohort study to quantify the effects of fibrinogen concentrate on postoperative blood loss and transfusion and

  12. Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies

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    Felix Kur

    2009-05-01

    Full Text Available Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart11Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, GermanyAbstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.Keywords: aortic valve replacement, aorta, surgery, risk analysis

  13. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

    Science.gov (United States)

    Boitor, Mădălina; Martorella, Géraldine; Arbour, Caroline; Michaud, Cécile; Gélinas, Céline

    2015-06-01

    Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

  14. Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Eduesley Santana-Santos

    2016-01-01

    Full Text Available Background. Acute kidney injury (AKI is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD, are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n=23 and did not develop (n=35 AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG. Fifty-eight patients who survived (69.6±8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46±16 mL/min were followed up for 47.8±16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218, two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

  15. Hurricane Katrina: Impact on Cardiac Surgery Case Volume and Outcomes

    OpenAIRE

    Bakaeen, Faisal G.; Huh, Joseph; Chu, Danny; Coselli, Joseph S.; LeMaire, Scott A.; Mattox, Kenneth L.; Wall, Matthew J.; Wang, Xing Li; Shenaq, Salwa A.; Atluri, Prasad V.; Awad, Samir S.; Berger, David H.

    2008-01-01

    Hurricane Katrina produced a surge of patient referrals to our facility for cardiac surgery. We sought to determine the impact of this abrupt volume change on operative outcomes. Using our cardiac surgery database, which is part of the Department of Veterans Affairs' Continuous Improvement in Cardiac Surgery Program, we compared procedural outcomes for all cardiac operations that were performed in the year before the hurricane (Year A, 29 August 2004–28 August 2005) and the year after (Year B...

  16. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.

    1976-01-01

    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  17. Invasive hemodynamic monitoring in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Desanka Dragosavac

    1999-08-01

    Full Text Available OBJETIVE: To assess the hemodynamic profile of cardiac surgery patients with circulatory instability in the early postoperative period (POP. METHODS: Over a two-year period, 306 patients underwent cardiac surgery. Thirty had hemodynamic instability in the early POP and were monitored with the Swan-Ganz catheter. The following parameters were evaluated: cardiac index (CI, systemic and pulmonary vascular resistance, pulmonary shunt, central venous pressure (CVP, pulmonary capillary wedge pressure (PCWP, oxygen delivery and consumption, use of vasoactive drugs and of circulatory support. RESULTS: Twenty patients had low cardiac index (CI, and 10 had normal or high CI. Systemic vascular resistance was decreased in 11 patients. There was no correlation between oxygen delivery (DO2 and consumption (VO2, p=0.42, and no correlation between CVP and PCWP, p=0.065. Pulmonary vascular resistance was decreased in 15 patients and the pulmonary shunt was increased in 19. Two patients with CI < 2L/min/m² received circulatory support. CONCLUSION: Patients in the POP of cardiac surgery frequently have a mixed shock due to the systemic inflammatory response syndrome (SIRS. Therefore, invasive hemodynamic monitoring is useful in handling blood volume, choice of vasoactive drugs, and indication for circulatory support.

  18. [A tube retractor for cardiac surgery].

    Science.gov (United States)

    Ohkado, A; Shiikawa, A; Ishitoya, H; Murata, A

    2001-03-01

    A retractor exclusively used to retract the tubes in cardiac surgery which needs cardiopulmonary bypass was developed. The half-cylinder-shaped end, the lightly curved handle and the flat and triangular grip enable easy and effective grasp of the tubes. This new instrument facilitates operative procedures by effectively retracting the tubes which persistently obstruct the operative field, in such a case of placement of a retrograde cardioplegia tube via the right atrium.

  19. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

    Directory of Open Access Journals (Sweden)

    Guerrero-Orriach JL

    2016-04-01

    Full Text Available José Luis Guerrero-Orriach,1 Daniel Ariza-Villanueva,1 Ana Florez-Vela,1 Lourdes Garrido-Sánchez,2,3 María Isabel Moreno-Cortés,1 Manuel Galán-Ortega,1 Alicia Ramírez-Fernández,1 Juan Alcaide Torres,3 Concepción Santiago Fernandez,3 Isabel Navarro Arce,1 José María Melero-Tejedor,4 Manuel Rubio-Navarro,1 José Cruz-Mañas1 1Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain; 2CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain; 3Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA, University Hospital Virgen de la Victoria, Málaga, Spain; 4Department of Cardiovascular Surgery, University Hospital Virgen de la Victoria, Málaga, Spain Purpose: To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL and neuronal enolase. Methods: This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results: After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL, neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng

  20. Knowledge Management in Cardiac Surgery: The Second Tehran Heart Center Adult Cardiac Surgery Database Report

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    Kyomars Abbasi

    2015-10-01

    Full Text Available Background: The Adult Cardiac Surgery Databank (ACSD of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data.Methods: All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period.Results: There were 24959 procedures performed: 19663 (78.8% isolated coronary artery bypass grafting surgeries (CABGs; 1492 (6.0% isolated valve surgeries; 1437 (5.8% CABGs concomitant with other procedures; 832 (3.3% CABGs combined with valve surgeries; 722 (2.9% valve surgeries concomitant with other procedures; 545 (2.2% surgeries other than CABG or valve surgery; and 267 (1.1% CABGs concomitant with valve and other types of surgery. The overall mortality was 205 (1.04%, with the lowest mortality rate (0.47% in the isolated CABGs and the highest (4.49% in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males (1.90% vs. 0.74%, respectively.Conclusion: Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

  1. Preoperative physical therapy for elective cardiac surgery patients

    NARCIS (Netherlands)

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van

    2012-01-01

    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  2. Aspirin and clonidine in non-cardiac surgery

    DEFF Research Database (Denmark)

    Garg, Amit; Kurz, Andrea; Sessler, Daniel I;

    2014-01-01

    INTRODUCTION: Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce...... and preoperative chronic aspirin use. At the time of randomisation, a subpopulation agreed to a single measurement of serum creatinine between 3 and 12 months after surgery, and the authors will examine intervention effects on this outcome. ETHICS AND DISSEMINATION: The authors were competitively awarded a grant...

  3. Cardiac Rehabilitation After Heart Valve Surgery

    DEFF Research Database (Denmark)

    Pollmann, Agathe Gerwina Elena; Frederiksen, Marianne; Prescott, Eva

    2016-01-01

    PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart valve surgery is scarce, but nevertheless CR is recommended for this group of patients. Therefore, this study assessed the effect of CR on exercise capacity, cardiovascular risk factors, and long-term mortality and morbidity......·O2peak) or 6-minute walk test (6MWT). A composite endpoint of all-cause mortality and hospital admission due to myocardial infarction, stroke, heart failure, endocarditis, revascularization, or reoperation was used to assess the hazard ratio between CR attenders and nonattenders. Multivariable...

  4. Anesthetic issues for robotic cardiac surgery

    Directory of Open Access Journals (Sweden)

    Wendy K Bernstein

    2015-01-01

    Full Text Available As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE. This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.

  5. Application of robotics in congenital cardiac surgery.

    Science.gov (United States)

    Cannon, Jeremy W; Howe, Robert D; Dupont, Pierre E; Triedman, John K; Marx, Gerald R; del Nido, Pedro J

    2003-01-01

    Over the past 5 years, robotic systems that combine advanced endoscopic imaging with computer-enhanced instrument control have been used for both coronary revascularization and intracardiac procedures in adults. In addition, endoscope positioning systems and articulated instruments with a robotic wrist mechanism have further expanded the potential applications for robotics in cardiac surgery. In pediatric cardiac surgery, potential applications can be divided into simple scope manipulation versus the use of 3-dimensional imaging and a robotic wrist for dissection and reconstruction. A voice-controlled robotic arm for scope manipulation can facilitate current pediatric thoracoscopic procedures such as ligation of patent ductus arteriosus and division of vascular rings. By using an advanced imaging system along with a robotic wrist, more complex extracardiac and even intracardiac procedures can be performed in children. Examples include coarctation repair, septal defect repair, and mitral or tricuspid valvuloplasty. Furthermore, with adequate intracardiac imaging, a robot-assisted off-pump approach to intracardiac pathology is conceivable. New real-time 3-dimensional echocardiography now offers sufficient resolution to enable such procedures, while the addition of instrument tracking, haptic feedback, and novel tissue fixation devices can facilitate safe and reliable intracardiac repair without extracorporeal circulation.

  6. Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery

    DEFF Research Database (Denmark)

    Kowey, Peter R; Dorian, Paul; Mitchell, L Brent;

    2009-01-01

    Postoperative atrial arrhythmias are common and are associated with considerable morbidity. This study was designed to evaluate the efficacy and safety of vernakalant for the conversion of atrial fibrillation (AF) or atrial flutter (AFL) after cardiac surgery....

  7. Temporal changes in clot lysis and clot stability following tranexamic acid in cardiac surgery

    DEFF Research Database (Denmark)

    Tang, Mariann; Wierup, Per; Rea, Catherine J;

    2016-01-01

    Cardiac surgery induces a multifactorial coagulopathy. Regular use of tranexamic acid (TXA) is becoming standard of care. Clinical challenges include selecting optimal dosing regimen and balancing the benefit versus risk of additional dosing with antifibrinolytics. The objective was to evaluate...

  8. Clinical evaluation of the Spiral Pump® after improvements to the original project in patients submitted to cardiac surgeries with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Jarbas Jakson Dinkhuysen

    2014-09-01

    Full Text Available Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males, between 20 to 80 (67±14.4 years old weighing 53 to 102 (71.7±12.6 kg, mostly under myocardial revascularization surgery (34.6% and valvular surgery (32.8%. Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+, lactate desidrogenase (UI/L, fibrinogen level (mg/dL and platelet count (nº/mm3. Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application.

  9. Renal replacement therapy after cardiac surgery; renal function recovers

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Kandler, Kristian; Agerlin Windeløv, Nis

    2013-01-01

    To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy.......To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy....

  10. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  11. The application of European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for risk stratification in Indian patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

    Full Text Available Aims and Objectives: To validate European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for predicting mortality and STS risk-score for predicting morbidity in Indian patients after cardiac surgery. Materials and Methods: EuroSCORE II and STS risk-scores were obtained pre-operatively for 498 consecutive patients. The patients were followed for mortality and various morbidities. The calibration of the scoring systems was assessed using Hosmer-Lemeshow test. The discriminative capacity was estimated by area under receiver operating characteristic (ROC curves. Results: The mortality was 1.6%. For EuroSCORE II and STS risk-score C-statics of 5.43 and 6.11 were obtained indicating satisfactory model fit for both the scores. Area under ROC was 0.69 and 0.65 for EuroSCORE II and STS risk-score with P values of 0.068 and 0.15, respectively, indicating poor discriminatory power. Good fit and discrimination was obtained for renal failure, long-stay in hospital, prolonged ventilator support and deep sternal wound infection but the scores failed in predicting risk of reoperation and stroke. Mortality risk was correctly estimated in low ( 5% patients by both scoring systems. Conclusions: EuroSCORE II and STS risk-scores have satisfactory calibration power in Indian patients but their discriminatory power is poor. Mortality risk was over-estimated by both the scoring systems in high-risk patients. The present study highlights the need for forming a national database and formulating risk stratification tools to provide better quality care to cardiac surgical patients in India.

  12. Neuromuscular blockade in cardiac surgery: An update for clinicians

    Directory of Open Access Journals (Sweden)

    Hemmerling Thomas

    2008-01-01

    Full Text Available There have been great advancements in cardiac surgery over the last two decades; the widespread use of off-pump aortocoronary bypass surgery, minimally invasive cardiac surgery, and robotic surgery have also changed the face of cardiac anaesthesia. The concept of "Fast-track anaesthesia" demands the use of nondepolarising neuromuscular blocking drugs with short duration of action, combining the ability to provide (if necessary sufficiently profound neuromuscular blockade during surgery and immediate re-establishment of normal neuromuscular transmission at the end of surgery. Postoperative residual muscle paralysis is one of the major hurdles for immediate or early extubation after cardiac surgery. Nondepolarising neuromuscular blocking drugs for cardiac surgery should therefore be easy to titrate, of rapid onset and short duration of action with a pathway of elimination independent from hepatic or renal dysfunction, and should equally not affect haemodynamic stability. The difference between repetitive bolus application and continuous infusion is outlined in this review, with the pharmacodynamic and pharmacokinetic characteristics of vecuronium, pancuronium, rocuronium, and cisatracurium. Kinemyography and acceleromyography are the most important currently used neuromuscular monitoring methods. Whereas monitoring at the adductor pollicis muscle is appropriate at the end of surgery, monitoring of the corrugator supercilii muscle better reflects neuromuscular blockade at more central, profound muscles, such as the diaphragm, larynx, or thoraco-abdominal muscles. In conclusion, cisatracurium or rocuronium is recommended for neuromuscular blockade in modern cardiac surgery.

  13. The role of psychological support in cardiac surgery: initial experience

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2011-11-01

    Full Text Available The scientific literature has pointed out several predictors of negative outcome after surgery such as pain and depression, negatively affecting the postoperative outcome in cardiac surgery. From January 2009 until June 2010, 15 patients scheduled for cardiac surgery were enrolled. The patients were assessed by psychological evaluation either in the hospital stay either in the rehabilitation period with the aim of identifying their emotional condition (sentiments about the onset of the disease, support received from family and friends even by means of preformed tests for anxiety and depression (tests of Stay and Back. Thus, in our preliminary experience, the psychological evaluation failed to detect the occurrence of postoperative complications. Conversely, the psychological evaluation is very effective in detecting a poor emotional state and the psychological support decreases the degree of anxiety and depression with positive effects on postoperative outcome. In conclusion, a standardize test for anxiety and depression should be used for patients at hospital admission to detect who may benefits by psychological support.

  14. Sleep disturbances after non-cardiac surgery

    DEFF Research Database (Denmark)

    Rosenberg, Jacob

    2001-01-01

    After major non-cardiac surgery sleep pattern is usually disturbed with initial suppression of rapid eye movement sleep with a subsequent rebound during the first post-operative week. Deep sleep is also suppressed for several days after the operation and subjective sleep quality is impaired....... The sleep disturbances seem to be related to the magnitude of trauma and thereby to the surgical stress response and/or post-operative opioid administration. Post-operative sleep disturbances may contribute to the development of early post-operative fatigue, episodic hypoxaemia, haemodynamic instability...... and altered mental status, all with a potential negative effect on post-operative outcome. Minimizing surgical trauma and avoiding or minimizing use of opioids for pain relief may prevent or reduce post-operative sleep disturbances. Post-operative sleep pattern represents an important research field, since...

  15. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  16. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  17. Anesthesia Maintenance During Mini-Invasive Cardiac Valve Surgery

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky

    2013-01-01

    Full Text Available Based on own experience and published data the authors analyze the features and specific components of anesthesia maintenance during mini-invasive cardiac valve surgery. The following clinically relevant aspects of anesthesia and perioperative intensive care were identified: preoperative patient selection and surgical and anesthesia risk prediction; one-lung ventilation; peripheral connection of circulation and specific features of its performance; control of oxygen delivery in the bed of aortic arch branches; and echocardiographic monitoring. The main risks and probable complications due to these interventions, such as cerebral hypoxia, respiratory failure, pulmonary hypertension, etc., are described. The mechanisms of their development and the modes of prevention and treatment are shown. Key words: anesthesia in cardiac surgery, mini-invasive cardiac surgery, one-lung ventilation, anesthesia during cardiac valve surgery.

  18. Right ventricular dysfunction after cardiac surgery - diagnostic options

    DEFF Research Database (Denmark)

    Grønlykke, Lars; Ravn, Hanne Berg; Gustafsson, Finn;

    2017-01-01

    Right ventricular (RV) failure after cardiac surgery is associated with an ominous prognosis. The etiology of RV failure is multifaceted and the ability to recognize RV failure early is paramount in order to initiate timely treatment. The present review focuses on different diagnostic modalities......, reproducibility and comparability of the next generation of diagnostic modalities we propose to use simple, but obtainable echocardiographic measurements and ultimately the insertion of a pulmonary artery catheter (PAC) in order to diagnose RV failure after cardiac surgery....... for RV function and discusses the normal versus abnormal findings in RV monitoring after cardiac surgery and the limitations of the applicable diagnostic modalities. There are specific challenges in RV assessment after cardiac surgery due to a loss of longitudinal contraction and a concomitant gain...

  19. Organism Encumbrance of Cardiac Surgeon During Surgery

    Science.gov (United States)

    Karabdic, Ilirijana Haxhibeqiri; Veljovic, Fikret; Straus, Slavenka

    2016-01-01

    Introduction: Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. Material and Methods: There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position “1” and “2”. We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position “1” lasted 0.5 hours, and position “2” lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. Results: The analysis was done in three positions: “Operating position 1”, “Operating position 2 ‘, and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this

  20. Surgery for Primary Cardiac Tumors in Children Early and Late Results in a Multicenter European Congenital Heart Surgeons Association Study

    NARCIS (Netherlands)

    Padalino, Massimo A.; Vida, Vladimiro L.; Boccuzzo, Giovanna; Tonello, Marco; Sarris, George E.; Berggren, Hakan; Comas, Juan V.; Di Carlo, Duccio; Di Donato, Roberto M.; Ebels, Tjark; Hraska, Viktor; Jacobs, Jeffrey P.; Gaynor, J. William; Metras, Dominique; Pretre, Rene; Pozzi, Marco; Rubay, Jean; Sairanen, Heikki; Schreiber, Christian; Maruszewski, Bohdan; Basso, Cristina; Stellin, Giovanni

    2012-01-01

    Background-To evaluate indications and results of surgery for primary cardiac tumors in children. Methods and Results-Eighty-nine patients aged Conclusions-Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most freque

  1. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Kumamoto University, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto (Japan); Weissman, Gaby; Weigold, W. Guy [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Vembar, Mani [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States)

    2015-01-15

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality - graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality - was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. (orig.)

  2. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2015-01-01

    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  3. [Management of aortic stenosis in patients undergoing non-cardiac surgery].

    Science.gov (United States)

    Labbé, Vincent; Ederhy, Stéphane; Szymkiewicz, Olga; Cohen, Ariel

    2015-01-01

    There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.

  4. A low cost DICOM review station for cardiac surgery

    NARCIS (Netherlands)

    Gerritsen, MG; Dijk, WA; Waterbolk, TW; Mook, PH; van der Velde, W; van der Putten, N; Dassen, WRM; Baljon, MH; Murray, A; Swiryn, S

    1998-01-01

    A low-cost PC based DICOM multi modality review station for cardiac surgery has been developed for use during Minimally Invasive Coronary Surgery. This system is a Windows 95 networked PC for review of DICOM coronary catheterization, ultrasound and MRI cine's stored at a departmental image server. F

  5. Metabonomics of acute kidney injury in children after cardiac surgery.

    Science.gov (United States)

    Beger, Richard D; Holland, Ricky D; Sun, Jinchun; Schnackenberg, Laura K; Moore, Page C; Dent, Catherine L; Devarajan, Prasad; Portilla, Didier

    2008-06-01

    Acute kidney injury (AKI) is a major complication in children who undergo cardiopulmonary bypass surgery. We performed metabonomic analyses of urine samples obtained from 40 children that underwent cardiac surgery for correction of congenital cardiac defects. Serial urine samples were obtained from each patient prior to surgery and at 4 h and 12 h after surgery. AKI, defined as a 50% or greater rise in baseline level of serum creatinine, was noted in 21 children at 48-72 h after cardiac surgery. The principal component analysis of liquid chromatography/mass spectrometry (LC/MS) negative ionization data of the urine samples obtained 4 h and 12 h after surgery from patients who develop AKI clustered away from patients who did not develop AKI. The LC/MS peak with mass-to-charge ratio (m/z) 261.01 and retention time (tR) 4.92 min was further analyzed by tandem mass spectrometry (MS/MS) and identified as homovanillic acid sulfate (HVA-SO4), a dopamine metabolite. By MS single-reaction monitoring, the sensitivity was 0.90 and specificity was 0.95 for a cut-off value of 24 ng/microl for HVA-SO4 at 12 h after surgery. We concluded that urinary HVA-SO4 represents a novel, sensitive, and predictive early biomarker of AKI after pediatric cardiac surgery.

  6. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  7. Cardiac Complications after Non-cardiac Surgery: Perioperative Risk Prediction and Reduction Strategies

    NARCIS (Netherlands)

    E.J. Bakker (Erik Jan)

    2013-01-01

    markdownabstract__Abstract__ Introduction | 9 I More than 200 million people worldwide undergo non-cardiac surgery annually. It is estimated that 2-5 percent of these patients suffer a cardiac complication (i.e. myocardial infarction, congestive heart failure, arrhythmia), resulting in death in app

  8. Use of EuroSCORE as a predictor of morbidity after cardiac surgery

    OpenAIRE

    2014-01-01

    Objective To evaluate the use of the EuroSCORE as a predictor of postoperative morbidity after cardiac surgery. Methods We retrospectively analyzed the charts of 900 patients operated on and admitted to the intensive care unit postoperatively at the Royal Portuguese Hospital of Recife. We included all patients with complete medical records, excluding those who died during surgery, underwent transplantation or correction of congenital heart disease. We evaluated the development of respiratory ...

  9. [Minimally invasive cardiac surgery for aortic valve disease].

    Science.gov (United States)

    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  10. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Henning Bay Nielsen

    2014-03-01

    Full Text Available Near-infrared spectroscopy (NIRS is used to monitor regional cerebral oxygenation (rScO2 during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed i to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and ii to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparascopic surgery with the patient placed in anti-Tredelenburg’s position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic and abdominal surgery the occurrence of postoperative cognitive dysfunction might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of regional cerebral oxygenation. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

  11. Prolonged suction drainage prevents serous wound discharge after cardiac surgery.

    Science.gov (United States)

    Kockelbergh, R C; Harris, A M; John, R M; Bailey, J S; Firmin, R K

    1994-01-01

    A series of 180 patients was randomised to two groups after median sternotomy performed for cardiac surgery in order to evaluate the effect of suction drainage on serous wound discharge. In group A all wounds were drained using two conventional mediastinal drains, while in group B one suction drain and one conventional mediastinal drain were employed. Five patients developed serous wound discharge in group B compared with 14 in group A (chi 2, P < 0.02). There were no significant differences between the rates of major wound infection (group A, n = 1; group B, n = 1) or the incidence of postoperative pericardial effusion assessed by echocardiography (group A, n = 10; group B, n = 5).

  12. Medanta insulin protocols in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2014-01-01

    Full Text Available Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient′s estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.

  13. Prevalence of cardiac dysfunction and abnormalities in patients with adolescent idiopathic scoliosis requiring surgery.

    Science.gov (United States)

    Liu, Limin; Xiu, Peng; Li, Qian; Song, Yueming; Chen, Rigao; Zhou, Chunguang

    2010-12-01

    The prevalence of cardiac abnormalities in patients with adolescent idiopathic scoliosis in an Asian population has not been reported. A retrospective study was conducted to evaluate the incidence of cardiac abnormalities in these patients. From January 2007 to April 2009, echocardiography and pulmonary function tests were performed in 80 adolescent idiopathic scoliosis patients who required surgical intervention. A thorough analysis of cardiopulmonary functions and cardiac structures was performed. The risk factors, types of cardiac abnormalities, and associations between severity of scoliosis or pulmonary function and cardiac abnormalities were assessed. Cardiac abnormalities were detected by echocardiogram in 25 patients, including 14 with structural abnormalities and 11 with functional abnormalities. The most common functional abnormality was tricuspid regurgitation (9 of 80; 11.3%), whereas atrial septal defect was the most common structural abnormality (7 of 80). Altered hemodynamics occurred in 5 patients, including 3 with ventricular septal defect and 2 with mitral valve dysplasia. Abnormal electrocardiographic findings presented in only 9 of the 25 patients with cardiac abnormalities. No significant associations were found between severity of scoliosis or pulmonary function and cardiac abnormalities. A high incidence of cardiac abnormality exists in patients with adolescent idiopathic scoliosis in this region. Although most patients tolerated surgery, some patients were at risk of decompensation postoperatively. Electrocardiography is of limited value for detecting cardiac problems in patients with adolescent idiopathic scoliosis, we recommend echocardiography as a routine modality in the preoperative evaluation of patients with adolescent idiopathic scoliosis.

  14. [Minimally invasive direct cardiac surgery with the jakoscope retractor].

    Science.gov (United States)

    Galajda, Zoltán; Jakó, Géza; von Jakó, Ronald; Péterffy, Arpád

    2008-01-20

    The authors present a surgical retractor named jakoscope, useful in the field of abdominal, urological, vascular, thoracic and cardiac surgery procedures. This multifunctional device offers the possibility to utilize Minimally Invasive Direct Access Surgical Technology (MIDAST) in the above mentioned surgical specialties. In their department the authors use the jakoscope retractor for aortic valve replacement, off-pump coronary bypass operations and radiofrequency pulmonary vein ablation by mini-thoracotomy approach. In this report they published for the first time their experience with jakoscope device in the field of cardiac surgery. In these operations the device assured adequate minimally invasive direct access, without complications.

  15. The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery.

    Science.gov (United States)

    Hogan, Maurice; Klein, Andrew A; Richards, Toby

    2015-02-01

    Anaemia is common in patients with cardiac disease and also in those undergoing cardiac surgery. There is increasing evidence that preoperative anaemia is associated with increased patient morbidity and mortality following surgery. We performed a systematic literature review to assess the impact of anaemia and intravenous (IV) iron supplementation on outcomes in cardiac surgery. Sixteen studies examined preoperative anaemia in detail. One study examined the role of preoperative IV iron administration and a further three, the effect of postoperative iron supplementation on haemoglobin (Hb) levels and the need for transfusion. Preoperative anaemia was associated with higher mortality, more postoperative blood transfusions, longer intensive care unit (ICU) and total hospital stay and also a greater incidence of postoperative cardiovascular events. In the single study that examined preoperative IV iron in combination with erythropoietin treatment, there was decreased blood transfusion, shorter hospital stay and an increase in patient survival. However, this was a small retrospective cohort study, with the observation and treatment groups analysed over different time periods. Postoperative administration of IV iron therapy, either alone or in combination with erythropoietin, was not effective in raising Hb levels or reducing red cell concentrate transfusion. On the basis of currently available evidence, the effect of perioperative administration of IV iron to cardiac surgery patients, alone or in combination with erythropoietin, remains unproven. Well-designed and appropriately powered prospective randomized controlled trials are needed to evaluate perioperative iron supplementation in the context of cardiac surgery.

  16. Exercise-based cardiac rehabilitation after heart valve surgery

    DEFF Research Database (Denmark)

    Hansen, T B; Zwisler, Ann-Dorthe; Berg, S K

    2015-01-01

    BACKGROUND: Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR...... expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis....

  17. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Steinbrüchel, Daniel Andreas; Wanscher, Michael Jaeger;

    2014-01-01

    BACKGROUND: To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery. METHODS: Open-label, prospective....... 1, p = 0.31). 30-day mortality was 1 vs. 2, p = 0.54. CONCLUSIONS: In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed...

  18. Reoperation for bleeding in cardiac surgery

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik;

    2012-01-01

    At Odense University Hospital (OUH), 5-9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperati...

  19. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

    LENUS (Irish Health Repository)

    McKenny, M

    2011-05-01

    This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery.

  20. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Jan M.; Nathoe, Hendrik M.; Boasson, Marc P.; Kluin, Jolanda; Bunge, Jeroen J. H.; Nierich, Arno P.; Rosseel, Peter M.; Maaten, van der Joost; Hofland, Jan; Diephuis, Jan C.; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    Background. Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  1. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Stefan; Nathoe, HM; Boasson, Marc P; Kluin, Jolanda; Bunge, Jeroen J H; Nierich, Arno P; Rosseel, Peter M; van der Maaten, Joost M; Hofland, Jan; Diephuis, Jan C; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    BACKGROUND: Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  2. Great Expectations: Perceived Social Support in Couples Experiencing Cardiac Surgery.

    Science.gov (United States)

    Rankin, Sally H.; Monahan, Patricia

    1991-01-01

    Compared patient and spousal perceived support during the cardiac surgery recovery period and explored effects of social support on patient/spouse subjective mood states for 117 couples. Social support buffered the impact of caregiving burden on mood disturbance for caregiving spouses but did not significantly impact physical or mental health…

  3. Recent progress of pediatric cardiac surgery in China

    Institute of Scientific and Technical Information of China (English)

    WU Kai-hong; L(U) Xiao-dong; LIU Ying-long

    2006-01-01

    @@ Pediatric cardiac surgery in China has made great progress since the first successful open heart operation for correction of ventricular septal defect (VSD) with an artificial heart-lung machine in 1958.1 In recent years, the state has paid much attention to both the basic research and the primary,secondary and tertiary prevention of congenital heart disease.

  4. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  5. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  6. The state of robotic cardiac surgery in Europe

    Science.gov (United States)

    Navarra, Emiliano; Noirhomme, Philippe; Gutermann, Herbert

    2017-01-01

    Background In the past two decades, the introduction of robotic technology has facilitated minimally invasive cardiac surgery, allowing surgeons to operate endoscopically rather than through a median sternotomy. This approach has facilitated procedures for several structural heart conditions, including mitral valve repair, atrial septal defect closure and multivessel minimally invasive coronary artery bypass grafting. In this rapidly evolving field, we review the status of robotic cardiac surgery in Europe with a focus on mitral valve surgery and coronary revascularization. Methods Structured searches of MEDLINE, Embase, and Cochrane databases were performed from their dates of inception to June 2016. All original studies, except case-reports, were included in this qualitative review. Studies performed in Europe were presented quantitatively. Data provided from Intuitive Surgical Inc. are also presented. Results Fourteen papers on coronary surgery were included in the analysis and reported a mortality rate ranging between 0–1%, revision for bleeding between 2–7%, conversion to a larger incision between 2–15%, and patency rate between 92–98%. The number of procedures ranged between 23 and 170 per year. There were only a small number of published reports for robotic mitral valve surgery from European centers. Conclusions Coronary robotic surgery in Europe has been performed safely and effectively with very few perioperative complications in the last 15 years. On the other hand, mitral surgery has been developed later with increasing applications of this technology only in the last 5–6 years. PMID:28203535

  7. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert

    2016-01-01

    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  8. Changes in quality of life associated with surgical risk in elderly patients undergoing cardiac surgery.

    Science.gov (United States)

    Romero, Paola Severo; de Souza, Emiliane Nogueira; Rodrigues, Juliane; Moraes, Maria Antonieta

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk.

  9. Device-related atypical pressure ulcer after cardiac surgery.

    Science.gov (United States)

    Glasgow, D; Millen, I S; Nzewi, O C; Varadarajaran, B

    2014-08-01

    Medical devices must be closely monitored to prevent harm to patients. Pressure ulcers secondary to medical devices present a significant health burden in terms of length of stay in hospital and cost. Intensivists, anaesthetists and other professionals involved in managing critically ill patients following cardiac surgery need to be aware that pressure ulcers may develop in atypical sites and present at a later stage of the hospital stay. This case report highlights the important issue of device-related pressure ulcers in the cardiac surgical intensive care setting, particularly when the clinical status of the patient may preclude routine assessment and prophylaxis. An algorithm for preventing such pressure ulcers is suggested.

  10. [Multiplane transesophageal echocardiography for the monitoring of cardiac surgery].

    Science.gov (United States)

    Pepi, M; Barbier, P; Doria, E; Tamborini, G; Berti, M; Muratori, M; Guazzi, M; Maltagliati, A; Alimento, M; Celeste, F

    1994-08-01

    Multiplane transesophageal echocardiography (TEE) allows visualization of the heart and great vessels through an infinite number of imaging planes and improves the diagnostic capabilities of mono and biplane TEE. This study was undertaken to test whether MTEE is a useful intraoperative monitoring method during cardiac surgery. Intraoperative multiplane TEE was performed in 200 patients (mean age 56 +/- 19 years) as a part of the routine clinical care. We systematically acquired cardiac images from the gastric fundus (short and long axes of the ventricles), lower esophagus (four-chamber, two-chamber, and long axis), upper esophagus (13 views concerning the aorta, pulmonary artery, left and right atrium, systemic and pulmonary veins, coronary arteries, right ventricular outflow tract), and searched for complete views of the thoracic descending aorta. All views analyzed in the preoperative (immediately before cardiopulmonary bypass), intraoperative and postoperative phases evaluating: the angle between current and 0 degree at which each view was obtained; the success rate of each view; the usefulness of the different views in providing essential additional clinical information compared to 0 degrees and 90 degrees of the traditional biplane TEE. Most views of the heart and great vessels were visualized in oblique planes, and other views were significantly improved thanks to slight angle corrections. Multiplane TEE was particularly useful in the preoperative and postoperative phases of aortic dissection (11 cases), mitral valve repair (13 cases), left ventricular aneurysmectomy (9 cases), right atrial thrombosis (1 case), positioning of left ventricular hemopump (2 cases), mitral-aortic endocarditis (3 cases), bleeding from proximal suture of an aortic heterograft (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Acute gastrointestinal complications after cardiac surgery.

    Science.gov (United States)

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  12. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

    Directory of Open Access Journals (Sweden)

    Malik Madhur

    2010-01-01

    Full Text Available Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery were prospectively collected as per the EuroSCORE model. The model′s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73 and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6% was double that of predicted mortality (7.5%. The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

  13. Myocardial Ischemia Induces SDF-1α Release in Cardiac Surgery Patients.

    Science.gov (United States)

    Kim, Bong-Sung; Jacobs, Denise; Emontzpohl, Christoph; Goetzenich, Andreas; Soppert, Josefin; Jarchow, Mareike; Schindler, Lisa; Averdunk, Luisa; Kraemer, Sandra; Marx, Gernot; Bernhagen, Jürgen; Pallua, Norbert; Schlemmer, Heinz-Peter; Simons, David; Stoppe, Christian

    2016-06-01

    In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients' characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients.

  14. Same day admission for elective cardiac surgery: how to improve outcome with satisfaction and decrease expenses.

    Science.gov (United States)

    Silvay, George; Goldberg, Andrew; Gutsche, Jacob T; T Augoustides, John G

    2016-06-01

    Admission on the day of surgery for elective cardiac and non-cardiac surgery has been established as a prevalent, critical practice. This approach realizes medical, logistical, psychological and fiscal benefits, and its success is predicated on an effective outpatient pre-operative evaluation. The establishment of a highly functional pre-operative clinic with a comprehensive set-up and efficient logistical pathways is invaluable. This notion has been expanded in recent years to include the entire peri-operative period and the concept of a 'peri-operative anesthesia/surgical home' is gaining popularity and support. Evaluating patients prior to admission for surgery, anesthesiologists can place themselves at the forefront of reducing unnecessary pre-operative hospital admissions, excess lab tests, unneeded consultations, and ultimately decrease the cancellations on the day of surgery. Furthermore, by taking a leadership role in the pre-operative clinic, anesthesiologists place themselves squarely at the forefront of the burgeoning movement for the peri-operative surgical home and continue to cement the indispensability of the anesthesiologist during the entire peri-operative course. The authors present this review as a follow-up describing the successful implementation of a pre-operative same-day cardiac surgery clinic and offer these experiences over the last 8 years as a guide to helping other anesthesiologists do the same.

  15. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome.

  16. Ibuprofen - a Safe Analgesic During Cardiac Surgery Recovery?

    DEFF Research Database (Denmark)

    Qazi, Saddiq Mohammad; Sindby, Eske Jesper; Nørgaard, Martin Agge

    2015-01-01

    , in a short term post-cardiac surgery setting. Particular attention was given to the rate of myocardial infarction, sternal healing, gastro-intestinal complications, renal failure and all-cause mortality. METHODS: This was a single-centre, open label parallel design randomised controlled study. Patients, who...... of sternal healing, postoperative myocardial infarction or gastrointestinal bleeding. The preoperative levels of creatinine were found to increase by 100% in nine patients (9.6%) in the ibuprofen group, resulting in an acute renal injury (in accordance with the RIFLE-criteria). Eight of these patients...... returned to normal renal function within 14 days. The levels of creatinine in patients in the oxycodone group were not found to increase to the same magnitude. CONCLUSION: The results of this study suggest that patients treated postoperatively, following cardiac surgery, are at no greater risk of harm...

  17. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    Maura Gabriela FELEA

    2014-11-01

    Full Text Available The elderly rehabilitation program after coronary artery bypass graft (CABG encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed by six minute walk perimeter and quality of life questionnaire. This article describes the extents of multiple dimensions facets of cardiac rehabilitation program, like effort capacity and psycho-social benefits, morbi-mortality and cost-effectiveness. Referral to cardiac rehabilitation for primary and secondary prevention programs remains low in developing countries. There is a need for a network intelligence schema in order to address patients’ needs and to improve health care professionals’ education.

  18. The peripheral cannulation technique in minimally invasive congenital cardiac surgery.

    Science.gov (United States)

    Vida, Vladimiro L; Tessari, Chiara; Putzu, Alessandro; Tiberio, Ivo; Guariento, Alvise; Gallo, Michele; Stellin, Giovanni

    2016-08-19

    Congenital minimally invasive cardiac surgery has gained wide acceptance thanks to its favorable outcomes. The introduction of peripheral cannulation for cardiopulmonary bypass further reduces surgical trauma by decreasing surgical access and allowing the spectrum of surgical access for the correction of simple congenital heart defects to be widened. Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels, proves to be a safe and effective tool in patients with body weight above 15 kg.

  19. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    OpenAIRE

    Maura Gabriela FELEA; Mitu, Florin; Maria M. LEON

    2014-01-01

    The elderly rehabilitation program after coronary artery bypass graft (CABG) encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed ...

  20. Topical thrombin preparations and their use in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Brianne L Dunn

    2009-10-01

    Full Text Available Brianne L Dunn1, Walter E Uber1, John S Ikonomidis21Department of Pharmacy Services and 2Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USAAbstract: Coagulopathic bleeding may lead to increased morbidity and mortality after cardiac surgery. Topical bovine thrombin has been used to promote hemostasis after surgical procedures for over 60 years and is used frequently as a topical hemostatic agent in cardiac surgery. Recently, use of bovine thrombin has been reported to be associated with increased risk for anaphylaxis, thrombosis, and immune-mediated coagulopathy thought secondary to the production of antifactor V and antithrombin antibodies. In patients who develop bovine thrombin-induced immune-mediated coagulopathy, clinical manifestations may range from asymptomatic alterations in coagulation tests to severe hemorrhage and death. Patients undergoing cardiac surgical procedures may be at increased risk for development of antibodies to bovine thrombin products and associated complications. This adverse immunologic profile has led to the development of alternative preparations including a human and a recombinant thrombin which have been shown to be equally efficacious to bovine thrombin and have reduced antigenicity. However, the potential benefit associated with reduced antigenicity is not truly known secondary to the lack of long-term experience with these products. Given the potentially higher margin of safety and less stringent storage concerns compared to human thrombin, recombinant thrombin may be the most reasonable approach in cardiac surgery.Keywords: bovine thrombin, human thrombin, recombinant thrombin, immune-mediated coagulopathy, topical hemostatic agents, thrombin 

  1. Rationale for implementation of warm cardiac surgery in pediatrics

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    Yves eDurandy

    2016-05-01

    Full Text Available Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing.In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results.We were convinced by the easiness, safety and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program.This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery.

  2. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    Science.gov (United States)

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  3. New Technologies for Surgery of the Congenital Cardiac Defect

    Directory of Open Access Journals (Sweden)

    David Kalfa

    2013-07-01

    Full Text Available The surgical repair of complex congenital heart defects frequently requires additional tissue in various forms, such as patches, conduits, and valves. These devices often require replacement over a patient’s lifetime because of degeneration, calcification, or lack of growth. The main new technologies in congenital cardiac surgery aim at, on the one hand, avoiding such reoperations and, on the other hand, improving long-term outcomes of devices used to repair or replace diseased structural malformations. These technologies are: 1 new patches: CorMatrix® patches made of decellularized porcine small intestinal submucosa extracellular matrix; 2 new devices: the Melody® valve (for percutaneous pulmonary valve implantation and tissue-engineered valved conduits (either decellularized scaffolds or polymeric scaffolds; and 3 new emerging fields, such as antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. These new technologies for structural malformation surgery are still in their infancy but certainly present great promise for the future. But the translation of these emerging technologies to routine health care and public health policy will also largely depend on economic considerations, value judgments, and political factors.

  4. Optimal technique for deep breathing exercises after cardiac surgery.

    Science.gov (United States)

    Westerdahl, E

    2015-06-01

    Cardiac surgery patients often develop a restrictive pulmonary impairment and gas exchange abnormalities in the early postoperative period. Chest physiotherapy is routinely prescribed in order to reduce or prevent these complications. Besides early mobilization, positioning and shoulder girdle exercises, various breathing exercises have been implemented as a major component of postoperative care. A variety of deep breathing maneuvres are recommended to the spontaneously breathing patient to reduce atelectasis and to improve lung function in the early postoperative period. Different breathing exercises are recommended in different parts of the world, and there is no consensus about the most effective breathing technique after cardiac surgery. Arbitrary instructions are given, and recommendations on performance and duration vary between hospitals. Deep breathing exercises are a major part of this therapy, but scientific evidence for the efficacy has been lacking until recently, and there is a lack of trials describing how postoperative breathing exercises actually should be performed. The purpose of this review is to provide a brief overview of postoperative breathing exercises for patients undergoing cardiac surgery via sternotomy, and to discuss and suggest an optimal technique for the performance of deep breathing exercises.

  5. Risk Factors for post-Cardiac Surgery Diaphragmatic Paralysis in Children with Congenital Heart Disease

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    Parvin Akbariasbagh

    2015-12-01

    Full Text Available Background: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics.Methods: This cross-sectional study, conducted in a 2-year period (2006–2008, included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated.Results: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months, 25 (5.5% infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery.  The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock–Taussig shunt surgery, respectively. Thirteen (52% of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients.Conclusion: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases.

  6. Cardiac surgery in nonagenarians: pushing the boundary one further decade.

    Science.gov (United States)

    Easo, Jerry; Hölzl, Philipp P F; Horst, Michael; Dikov, Valentin; Litmathe, Jens; Dapunt, Otto

    2011-01-01

    With increasing age of the general population, the necessity for cardiac surgery in the collective of patients aged 90 and older has been increasing. To aid in the choice of adequate therapy we investigated our experience for the group of nonagenarians undergoing surgical interventions. From 6/2000 to 9/2007, 17 patients aged 90 and older underwent open-heart surgery at our institution. We performed a retrospective data analysis including baseline preoperative clinical status, intra- and postoperative results and the long-term survival in the further postoperative course. We performed cardiac surgical procedures in 17 patients (male/female ratio 6/11), including isolated aortic valve replacement (n = 7), aortic root replacement (n = 2), isolated coronary bypass surgery (n = 4), combined coronary and valve surgery (n = 5), re-operative valve replacement (n = 1) and root replacement with arch repair (n = 1). Emergency procedures were performed in 11.8% (2/17). Mean age was 91.9 ± 1.2 years, ranging 90.1-94.2. Mean follow-up was 3.2 ± 2.2 years. The 30-day mortality was 17.6% (3/17), overall mortality at 42.9 follow-up patient years was 58.8% (10/17). We conclude that cardiac surgery procedures can be performed with therapeutic benefit for selected nonagenarians safely and with acceptable operative risk. After analysis our clinical experience we believe age alone not to be a contraindication for surgical intervention, consideration of the physiologic status of the patient reflects on the postoperative outcome. Survival of the patients investigated that survived the initial 30-day postoperative period was similar to the estimated survival of the equally aged general population in Germany.

  7. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

    NARCIS (Netherlands)

    Noordzij, P. G.; van Geffen, O.; Dijkstra, I. M.; Boerma, D.; Meinders, A. J.; Rettig, T. C D; Eefting, F. D.; van Loon, D.; van de Garde, E. M W; van Dongen, E. P A

    2015-01-01

    BACKGROUND: Postoperative non-cardiac complication rates are as high as 11-28% after high-risk abdominal procedures. Emerging evidence indicates that postoperative cardiac troponin T elevations are associated with adverse outcome in non-cardiac surgery. The aim of this study was to determine the rel

  8. Inhaled nitric oxide in cardiac surgery: Evidence or tradition?

    Science.gov (United States)

    Benedetto, Maria; Romano, Rosalba; Baca, Georgiana; Sarridou, Despoina; Fischer, Andreas; Simon, Andre; Marczin, Nandor

    2015-09-15

    Inhaled nitric oxide (iNO) therapy as a selective pulmonary vasodilator in cardiac surgery has been one of the most significant pharmacological advances in managing pulmonary hemodynamics and life threatening right ventricular dysfunction and failure. However, this remarkable story has experienced a roller-coaster ride with high hopes and nearly universal demonstration of physiological benefits but disappointing translation of these benefits to harder clinical outcomes. Most of our understanding on the iNO field in cardiac surgery stems from small observational or single centre randomised trials and even the very few multicentre trials fail to ascertain strong evidence base. As a consequence, there are only weak clinical practice guidelines on the field and only European expert opinion for the use of iNO in routine and more specialised cardiac surgery such as heart and lung transplantation and left ventricular assist device (LVAD) insertion. In this review the authors from a specialised cardiac centre in the UK with a very high volume of iNO usage provide detailed information on the early observations leading to the European expert recommendations and reflect on the nature and background of these recommendations. We also provide a summary of the progress in each of the cardiac subspecialties for the last decade and initial survey data on the views of senior anaesthetic and intensive care colleagues on these recommendations. We conclude that the combination of high price tag associated with iNO therapy and lack of substantial clinical evidence is not sustainable on the current field and we are risking loosing this promising therapy from our daily practice. Overcoming the status quo will not be easy as there is not much room for controlled trials in heart transplantation or in the current atmosphere of LVAD implantation. However, we call for international cooperation to conduct definite studies to determine the place of iNO therapy in lung transplantation and high

  9. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

    DEFF Research Database (Denmark)

    Nielsen, Henning B

    2014-01-01

    Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii...

  10. Economies of scale in cardiac surgery

    DEFF Research Database (Denmark)

    Lillrank, Paul; Chaudhuri, Atanu; Torkki, Paulus

    2015-01-01

    Objective: The objective of this paper is to investigate the impact of scale of surgical units on the productivity of patient processes. Methods: The context, intervention, mechanism, output (CIMO) model of Evaluation research is used. The scale–performance mechanisms are examined through resourc...

  11. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  12. EVALUATION OF NEONATAL CARDIAC MURMURS

    Directory of Open Access Journals (Sweden)

    Somaiah

    2014-09-01

    Full Text Available Cardiovascular malformations are the most common cause of congenital malformations, the diagnosis of which requires a close observation in the neonatal period. Early recognition of CHD is important in the neonatal period, as many of them may be fatal if undiagnosed and may require immediate intervention. The objectives of this study are to study the epidemiology of neonatal cardiac murmurs, to identify clinical characteristics which differentiate pathological murmur from functional murmurs and to assess the reliability of clinical evaluation in diagnosing CHD. Method of study included all neonates admitted to the NICU, postnatal ward, attending pediatric OPD or neonatal follow up clinic and were detected to have cardiac murmurs. It was a cross sectional study over a period of 16months. A clinical diagnosis was made based on history and clinical examination. Then Chest X-ray and ECG, Echocardiography was done in all neonates for confirmation of the diagnosis. These neonates were again examined daily till they were in hospital and during the follow-up visit at 6 weeks. The results of 70 neonates in this study conducted over a period of 24 months included the incidence of cardiac murmurs among intramural neonates which was 13.5 for 1000 live births. Most frequent symptom was fast breathing in 10(14.3% cases. VSD was the most common diagnosis clinically in 23 (33% babies. The most frequent Echo diagnosis was acyanotic complex congenital heart disease in 25(36% cases followed by 12(17% cases each of VSD and ASD respectively. Overall in our study 77.1% (54cases of the murmurs were diagnosed correctly and confirmed by Echocardiography The study concluded that it is possible to make clinical diagnosis in many cases of congenital heart diseases, the functional murmurs could be differentiated from those arising from structural heart disease and evaluation of the infants based only on murmurs, few congenital heart diseases can be missed.

  13. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

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    Leela K Lella

    Full Text Available The significance of right ventricular ejection fraction (RVEF, independent of left ventricular ejection fraction (LVEF, following isolated coronary artery bypass grafting (CABG and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR, independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25% and 61 patients had normal RVEF (mean 50% (p<0.001. Fifty-four patients had reduced LVEF (mean 30% and 55 patients had normal LVEF (mean 59% (p<0.001. Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05. Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03. Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.

  14. [Metabolic support of the ischemic heart during cardiac surgery].

    Science.gov (United States)

    Luna Ortiz, Pastor; Serrano Valdés, Xenia; Rojas Pérez, Eduardo; de Micheli, Alfredo

    2006-01-01

    We examine [IBM1] the basic principles and clinical results of the metabolic intervention with glucose-insulin-potassium (GIK) solutions in the field of cardiovascular surgery. On the basis of many international publications concerning this subject, and the experience obtained in the operating room of the Instituto Nacional de Cardiologia "Ignacio Chávez", we conclude that the metabolic support wit GIK is a powerful system that provides very useful energy to protect the myocardium during cardiac and non-cardiac surgery. The most recent publications indicate their effects in reducing low output syndromes, due to interventions on the coronary arteries, as well as producing a significant reduction of circulating fatty acids. These effects are produced also in the field of interventional cardiology, where GIK solutions protect the myocardium against damage due to impaired microcirculation. It is evident that these solutions must be utilized in higher concentrations that the initial ones, equal to those employed in laboratory animals. On the other side, it is worthy to remember that it has been always underlined that this treatment represents only a protection for the myocardium. Therefore, its association with other drugs or treatments favoring a good myocardial performance is not contraindicated--on the contrary, it yields better results. The present review presents pharmacological approaches, such as the use of glutamato, aspartate, piruvato, trimetazidina ranolazine and taurine to optimize cardiac energy metabolism, for the management of ischemic heart disease.

  15. Crystalloid-based cardioplegia for minimally invasive cardiac surgery.

    Science.gov (United States)

    Misfeld, Martin; Davierwala, Piroze

    2012-01-01

    With the ever-increasing popularity of minimally invasive (MI) cardiac surgery, procedures like aortic valve replacement, with or without concomitant aortic surgery, and mitral and tricuspid valve procedures are now routinely performed through a minimal-access partial upper sternotomy and right anterolateral small thoracotomy, respectively, in our institution. To have optimal visualization through a small incision, it is extremely important to reduce the number of instruments, retractors, and cannulae passing through the incision to a bare minimum and to avoid repeated manipulation of the operative field. Repeated use of blood cardioplegia to maintain myocardial protection can sometimes prevent the surgeon from executing the aforementioned measures. However, if adequate myocardial protection can be achieved and maintained by administering a single dose of crystalloid cardioplegia, it would help expedite the operation with greater ease. At our institution, myocardial protection during aortic valve surgery is achieved using either blood or crystalloid cardioplegia according to surgeon preference. However, crystalloid cardioplegia has become the standard myocardial protection strategy for performing MI mitral valve surgery. Our experience with crystalloid cardioplegia for MI mitral valve surgery is the focus of this article.

  16. Robotics in Cardiac Surgery: Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Bryan Bush

    2013-07-01

    Full Text Available Robotic cardiac operations evolved from minimally invasive operations and offer similar theoretical benefits, including less pain, shorter length of stay, improved cosmesis, and quicker return to preoperative level of functional activity. The additional benefits offered by robotic surgical systems include improved dexterity and degrees of freedom, tremor-free movements, ambidexterity, and the avoidance of the fulcrum effect that is intrinsic when using long-shaft endoscopic instruments. Also, optics and operative visualization are vastly improved compared with direct vision and traditional videoscopes. Robotic systems have been utilized successfully to perform complex mitral valve repairs, coronary revascularization, atrial fibrillation ablation, intracardiac tumor resections, atrial septal defect closures, and left ventricular lead implantation. The history and evolution of these procedures, as well as the present status and future directions of robotic cardiac surgery, are presented in this review.

  17. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.

  18. Immediate extubation in cardiac surgery: evaluation using electroencephalogram Extubação imediata em cirurgia cardíaca: avaliação pelo eletroencefalograma

    Directory of Open Access Journals (Sweden)

    Valdester Cavalcante Pinto Jr.

    2003-10-01

    Full Text Available BACKGROUND AND OBJECTIVES:The current techniques of anesthesia employed in cardiac surgery leading to immediate extubation depend on adequate analgesia and titration of anesthetic drugs. We sought to determine the best possible moment of extubation, using the bispectral index of the electroencephalogram. METHOD: Twelve ASA III patients were analyzed. Seven (58.4% were children (Group I, submitted to correction of congenital cardiac defects with ages ranging from 0 to 7 years. Five adults (Group II, with ages ranging from 30 to 75 years, underwent coronary artery bypass grafts. In Group I spinal anesthesia (L5-S1 using hyperbaric 0.5% bupivacaine (0.5mg/kg and morphine (5µg/kg was chosen. In Group II epidural anesthesia (T3-T4 with catheter placement plus ropivacaine (60mg and morphine (2mg were employed. For the induction of anesthesia fentanila (4µg/kg, muscle relaxant and propofol (to bring the bispectral index value down to 30 were utilized. General anesthesia was maintained with sevofluorane, maintaining the bispectral index value between 40 and 60. Extubation was programmed at a bispectral index value of 90. RESULTS: All patients were extubated up to one hour after the end of the surgical procedure, 91.6% of them in the operating room. All had the cognitive functions preserved without history of explicit memory or pain (adults and children who were able to speak, nor facial expression of pain (small children. Four (57% patients in Group I and one (20% in Group II had post-operative pruritus. Two patients (28% in Group II had emesis. CONCLUSIONS: The results suggest that the technique employed is safe and effective, as long as the criteria for its use are strictly observed.INTRODUÇÃO: As técnicas empregadas em cirurgia cardíaca visando a extubação imediata (EI dependem de analgesia adequada e titulação de drogas anestésicas. OBJETIVO: A finalidade deste estudo é analisar a EI, utilizando eletroencefalograma (índice bispectral

  19. Cardiac surgery for adults with mental retardation. Dilemmas in management.

    Science.gov (United States)

    Goldhaber, S Z; Reardon, F E; Goulart, D T; Rubin, I L

    1985-10-01

    In summary, cardiac surgery for adults with mental retardation raises a series of controversial legal, economic, ethical, medical, and nursing dilemmas. During the past 20 years, many improvements have taken place in the care of these patients. However, in the future, judicial and statutory mandates requiring high-quality medical care for persons with mental retardation may conflict increasingly with hospital cost-control legislation and thereby affect clinical decisions. For example, it is conceivable that elective repair of an ostium secundum atrial septal defect in an asymptomatic patient will expend the limited resources necessary to carry out emergency revascularization in a symptomatic patient with impending myocardial infarction. This issue becomes even more delicate when the asymptomatic patient is a mentally retarded ward of the state, and the symptomatic patient is a middle-aged man supporting a wife and several college-age children. There may be no easy solution to this problem, and it will provide the grist for many bioethicists. Fortunately, from a practical point of view, we do not currently have to choose between these patients to receive treatment. Our hope is that health care for mentally retarded patients will not be compromised. We believe that decisions about patient management should be based on enlightened clinical judgment rather than on preconceived notions about this population. In the quest for optimal health care delivery, the special needs of these patients should be considered when cardiac catheterization and possible cardiac surgery are contemplated. Although we have presented an approach to a patient with cardiac disease requiring cardiac surgery, we believe that this approach can be utilized for any retarded patient requiring acute medical care. Currently, because there has not been much training in this area, many physicians and nurses lack first-hand experience in caring for the mentally retarded. This inexperience may lead to

  20. Antipsychotic-Induced Neuroleptic Malignant Syndrome After Cardiac Surgery.

    Science.gov (United States)

    Moll, Vanessa; Ward, Ceressa T; Zivot, Joel B

    2016-07-01

    We report a case of neuroleptic malignant syndrome (NMS) in a postoperative cardiac surgery patient after the administration of typical and atypical antipsychotics for the treatment of delirium. On postoperative day 8, the patient's temperature peaked at 40.6°C. Agitation, rigidity, elevation in creatine kinase, and leukocytosis were associated findings. NMS was suspected on postoperative day 10. All antipsychotics were discontinued; dantrolene infusions and fluid therapy were initiated. After 2 days of NMS treatment, the patient's symptoms resolved. The temporal relationship between discontinuation of all antipsychotics, initiation of dantrolene, and clinical improvement supports the diagnosis of antipsychotic-induced NMS.

  1. Dexmedetomidine as an Anesthetic Adjuvant in Cardiac Surgery: a Cohort Study

    Science.gov (United States)

    Brandão, Paulo Gabriel Melo; Lobo, Francisco Ricardo; Ramin, Serginando Laudenir; Sakr, Yasser; Machado, Mauricio Nassau; Lobo, Suzana Margareth

    2016-01-01

    OBJECTIVE: α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery. METHODS: We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group). RESULTS: A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality. CONCLUSION: Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results. PMID:27737403

  2. Systematic traction techniques in minimal-access pediatric cardiac surgery.

    Science.gov (United States)

    Oiwa, Hiroshi; Ishida, Ryoichi; Sudo, Kenichi

    2004-11-01

    Minimal-access pediatric cardiac surgery is now common in the treatment of simple congenital heart defects. However, methods of securing a good, unobstructed view for surgery and the difficulties of working in a deep, narrow field jeopardize safety in surgical procedures, especially for less experienced surgeons have been described. Our systematic, step-by-step traction techniques on the skin, the pericardium, the right atrial appendage, the aortic root, both venae cavae, and the free wall of the right ventricular outflow, using a mechanical retractor and traction sutures, facilitate surgical field exposure and the achievement of safety. As described below, our procedures are simple, allow direct inspection, and assist those working toward technical mastery.

  3. Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery

    DEFF Research Database (Denmark)

    Hansen, Tina B; Berg, Selina K; Sibilitz, Kirstine L;

    2015-01-01

    BACKGROUND: As with ischaemic heart disease, cardiac rehabilitation (CR) is recommended for patients undergoing heart valve surgery; recommendations are based on limited evidence. The organization of CR programmes and factors associated with uptake among patients undergoing heart valve surgery have...

  4. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

    Full Text Available Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B. In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results — Thirty nine of males (65% and 21 females (35% with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7 and predicted peak flow indices (CI95%: 1.9 to 9.4 of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0 and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67 in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion — Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.

  5. Is levosimendan effective in paediatric heart failure and post-cardiac surgeries?

    Science.gov (United States)

    Angadi, Ullas; Westrope, Claire; Chowdhry, Mohammed F

    2013-10-01

    other vasoactive drugs were insufficient to maintain stable haemodynamics. A small sample size was indeed a limitation in all the above studies. Furthermore, it is best used as a rescue drug on a named-patient basis. A small sample size was indeed a limitation in all the above studies. Larger, well-designed trials are required to further evaluate the efficacy and feasibility of levosimendan in paediatric heart failure and post-cardiac surgeries.

  6. Anesthesia for major general surgery in neonates with complex cardiac defects.

    Science.gov (United States)

    Walker, Amy; Stokes, Monica; Moriarty, Anthony

    2009-02-01

    Centers with large cardiac workloads may be presented with neonates who need major general surgery before correction or palliation of a serious cardiac defect. This is still a rare situation with only three short case reports available in the medical literature (1-3). We have reviewed the anesthetic and analgesic regimens of 18 such neonates who presented to the Birmingham Children's Hospital in the 4-year period 2004-2007. These children require meticulous preoperative evaluation and although it might be anticipated that they would pose a serious challenge to anesthetists, in reality with thorough investigation, preparation, and careful management, they tolerate general anesthesia well. These children may be transferred to centers of specialist pediatric cardiac anesthesia to be benefited from experience obtained there.

  7. A Historic Case of Cardiac Surgery in Pregnancy

    Directory of Open Access Journals (Sweden)

    Said Benlamkaddem

    2016-01-01

    Full Text Available Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall’s procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion. Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature.

  8. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Rafael Badenes

    2015-01-01

    Full Text Available Postoperative pulmonary dysfunction (PPD is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC and mechanical ventilation (VM. Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD and pulmonary infections in surgical patients. In this way, the open lung approach (OLA, a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.

  9. Choreoathetosis after cardiac surgery with hypothermia and extracorporeal circulation.

    Science.gov (United States)

    Gherpelli, J L; Azeka, E; Riso, A; Atik, E; Ebaid, M; Barbero-Marcial, M

    1998-08-01

    Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.

  10. A Historic Case of Cardiac Surgery in Pregnancy

    Science.gov (United States)

    Labib, Smael; Harandou, Mustapha

    2016-01-01

    Background. Heart disease is the leading cause of nonobstetric mortality in pregnant women. Because of high risk, medical management represents the first line of treatment. However, when medical treatment fails, cardiac surgery becomes necessary. Case Presentation. A 27-year-old female who underwent successfully cardiac surgery three times within 3 years. At the first time, she had an aortic valve replacement at 25 weeks of gestation after an infectious endocarditis complicated with an ischemic stroke. At 39 weeks of gestation, she had delivered, vaginally, a healthy baby boy weighing 2800 g. In the second time, pregnant again at 30 weeks of gestation, she had a mitral valve replacement with an aortic prosthesis reinforcement after a paraprosthetic regurgitation and a mitral vegetation. A fetal death in utero had occurred; the extraction of the fetus by cesarean section with a tubal ligation was performed after stabilization of the mother. In the third time, she underwent successfully a mitral prosthesis replacement with Bentall's procedure after a mitral prosthesis disinsertion with an abscess of aortic annulus due to new episode of infectious endocarditis. Conclusion. Our patient has assembled almost all poor prognosis factors, which makes her a real historic case, probably never described in the literature. PMID:27803828

  11. Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Mahdi; Najafi; David; Faraoni

    2015-01-01

    Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of perioperative strategies that aims to detect and treat preoperative anemia,prevent excessive blood loss,and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions,several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications,dosage,and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects,some high-risk patients(e.g.,symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade,a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

  12. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  13. Outcome of children with Pentalogy of Cantrell following cardiac surgery.

    LENUS (Irish Health Repository)

    O'Gorman, Clodagh S

    2012-02-01

    Although single individual reports have documented outcomes in children with pentalogy of are few data available for postoperative outcome of this cohort of patients after cardiac surgery. The aim of this study was to retrospectively review the clinical details of patients with pentalogy of Cantrell managed at two centers. Two cardiac surgical institutions retrospectively studied all patients with pentalogy of Cantrell and significant congenital heart disease who underwent surgical intervention, excluding PDA ligation, between 1992 and 2004. Seven children with pentalogy of Cantrell underwent surgical intervention at a median age of 60 days (range, 1-11 months). Three patients had tetralogy of Fallot, two double outlet right ventricle, one patient had tricuspid atresia, and one patient a perimembranous ventricular septal defect. The mean duration of postoperative ventilation was 112.8 days (range, 4-335 days) but three patients required ventilation for more than 100 days. Patients who had a preoperative diaphragmatic plication required a longer duration of ventilation (mean = 186.5 days [range, 100-273 days] compared with mean = 132 days [range, 4-335 days]). Four patients survived, with three patients weaned from ventilation. Three patients had withdrawal of care following failure to wean from ventilation, following multisystem organ failure, and at the request of their parents. In conclusion, the postoperative care of children with pentalogy of Cantrell after cardiac surgery is often complicated by prolonged need for ventilatory support and multiple postoperative complications. Earlier surgical intervention does not necessarily reduce morbidity and mortality. These data may help in the counseling of parents prior to surgical intervention.

  14. Ischemic Colitis after Cardiac Surgery: Can We Foresee the Threat?

    Science.gov (United States)

    Arif, Rawa; Farag, Mina; Zaradzki, Marcin; Reissfelder, Christoph; Pianka, Frank; Bruckner, Thomas; Kremer, Jamila; Franz, Maximilian; Ruhparwar, Arjang; Szabo, Gabor; Beller, Carsten J.; Karck, Matthias; Kallenbach, Klaus; Weymann, Alexander

    2016-01-01

    Introduction Ischemic colitis (IC) remains a great threat after cardiac surgery with use of extracorporeal circulation. We aimed to identify predictive risk factors and influence of early catecholamine therapy for this disease. Methods We prospectively collected and analyzed data of 224 patients, who underwent laparotomy due to IC after initial cardiac surgery with use of extracorporeal circulation during 2002 and 2014. For further comparability 58 patients were identified, who underwent bypass surgery, aortic valve replacement or combination of both. Age ±5 years, sex, BMI ± 5, left ventricular function, peripheral arterial disease, diabetes and urgency status were used for match-pair analysis (1:1) to compare outcome and detect predictive risk factors. Highest catecholamine doses during 1 POD were compared for possible predictive potential. Results Patients’ baseline characteristics showed no significant differences. In-hospital mortality of the IC group with a mean age of 71 years (14% female) was significantly higher than the control group with a mean age of 70 (14% female) (67% vs. 16%, p<0.001). Despite significantly longer bypass time in the IC group (133 ± 68 vs. 101 ± 42, p = 0.003), cross-clamp time remained comparable (64 ± 33 vs. 56 ± 25 p = 0.150). The majority of the IC group suffered low-output syndrome (71% vs. 14%, p<0.001) leading to significant higher lactate values within first 24h after operation (55 ± 46 mg/dl vs. 31 ± 30 mg/dl, p = 0.002). Logistic regression revealed elevated lactate values to be significant predictor for colectomy during the postoperative course (HR 1.008, CI 95% 1.003–1.014, p = 0.003). However, Receiver Operating Characteristic Curve calculates a cut-off value for lactate of 22.5 mg/dl (sensitivity 73% and specificity 57%). Furthermore, multivariate analysis showed low-output syndrome (HR 4.301, CI 95% 2.108–8.776, p<0.001) and vasopressin therapy (HR 1.108, CI 95% 1.012–1.213, p = 0.027) significantly

  15. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

    NARCIS (Netherlands)

    M.D. Kertai (Miklos); J.J. Bax (Jeroen); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam); G.J. L' Italien; H. van Urk (Hero); D. Poldermans (Don); J.R.T.C. Roelandt (Jos); H. Boersma (Eric)

    2003-01-01

    textabstractOBJECTIVE: To evaluate the discriminatory value and compare the predictive performance of six non-invasive tests used for perioperative cardiac risk stratification in patients undergoing major vascular surgery. DESIGN: Meta-analysis of published reports. METHODS: Eight

  16. Effectiveness of massage therapy on post-operative outcomes among patients undergoing cardiac surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    C. Ramesh

    2015-09-01

    Full Text Available The incidence and prevalence of cardiovascular disease (CVD are increasing rapidly in developing countries. Most patients with CVD do not respond to medical treatment and have to undergo cardiac surgery. This highly stressful experience results in increased levels of anxiety for patients. The objective of this review was to evaluate the efficacy of massage therapy on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science and the Cochrane library databases for original research articles published between 2000 and 2015. Original articles that reported the efficacy of massage therapy in patients undergoing cardiac surgery were included. The Cochrane data extraction form was used to extract data. A total of 297 studies were identified in the literature search. However, only seven studies were eligible for analysis. Of the seven studies, six studies demonstrated the effects of massage therapy on improving post-operative outcomes of patients, while one study found no evidence of improvement. Although the methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that massage therapy can lead to positive postoperative outcomes. Evidence of the effectiveness of massage therapy in patients undergoing cardiac surgery remains inconclusive. Additional research is needed to provide a strong evidence base for the use of massage therapy to improve post-operative outcomes and recovery among cardiac surgery patients

  17. Factors which influence the cardiac surgeon's decision not to operate on patients referred for consideration of surgery

    Directory of Open Access Journals (Sweden)

    Sivaprakasam Rajesh

    2008-02-01

    Full Text Available Abstract Background The aim of this study was to document what proportion of patients referred for consideration of cardiac surgery are turned down, the reasons given for not operating and also to evaluate what happens to those patients who do not undergo surgery. Methods 382 elective patients referred for consideration of cardiac surgery to one of six consultant cardiac surgeons at Wythenshawe Hospital during a one year period from were included in the study. Data for those patients who underwent an operation were collected prospectively in a cardiac surgery database. The case notes of those patients who did not undergo an operation were reviewed to establish reasons given by surgeons for not operating. Patients were followed up to determine vital status at the end of the study period. Results 333 (87.2% patients underwent an operation and 49 (12.8% did not. 68% of patients turned down were thought to be too high-risk. 14% of patients did not fulfill symptomatic or prognostic criteria for surgery and in 8% of patients coronary artery surgery was thought ineffective due to poor distal vessels. 6% of patients declined an operation and 4% were thought to be more suitable for coronary angioplasty. Patients turned down for surgery had more renal dysfunction (p = 0.017, respiratory disease (p Conclusion 12.8% of patients referred for consideration of cardiac surgery did not undergo an operation. Two thirds of patients not accepted for surgery were thought too high risk. Those patients who did not undergo an operation had a significantly worse mortality.

  18. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

  19. Postoperative delirium and factors related in a cardiac surgery unit care

    Directory of Open Access Journals (Sweden)

    Julia de las Pozas Abril

    2011-07-01

    Full Text Available Objective: Describe the incidence of postoperative delirium and related risk factors associated with this complication in patients undergoing cardiac surgery. Method: Cohort study conducted for 3 months in a sample of 105 patients undergoing cardiac surgery in a hospital in Madrid. The emergence of delirium with scale ICDSC (Intensive Care Delirium Screening Checklist was measured during the first five days of postoperative and collected data on preoperative, intra-operative and post-operative factors to relate to the emergence of delirium. Results: 95 Patients studied, 15 of them developed delirium, which means an incidence of 15.7%. We found that there was a significant relationship between delirium appearance and age of the patients, the presence of atrial fibrillation, intubation orotraqueal time and the administration of adrenaline during the immediate post-operative management. The multivariable model showed the duration of orotraqueal intubation to be independently associated with delirium. Conclusions: The incidence of delirium found in this study as well as the identification of the time of orotraqueal intubation as independent risk factor supposes a new contribution to the knowledge of this postoperative complication and allow us to begin to evaluate its importance in the unit of cardiac surgery.

  20. Acute Mesenteric Ischemia after Cardiac Surgery: An Analysis of 52 Patients

    Directory of Open Access Journals (Sweden)

    Cuneyt Eris

    2013-01-01

    Full Text Available Objective. Acute mesenteric ischemia (AMI is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. Methods. From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. Results. The study included 6013 patients, of which 52 (0.86% patients suffered from AMI, 35 (67% of whom died. The control group (150 patients was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB. Preoperative parameters including age (, renal insufficiency (, peripheral vascular disease (, preoperative inotropic support (, poor left ventricular ejection fraction (, cardiogenic shock (, and preoperative intra-aortic balloon pump (IABP support ( revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (, dialysis (, inotropic support (, prolonged ventilator time (, and IABP support ( appeared significantly higher in the AMI group than the control group. Conclusions. Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

  1. The effect of preoperative intravenous paracetamol administration on postoperative fever in pediatrics cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mohammad-Hasan Abdollahi

    2014-01-01

    Full Text Available Background: Post-operative fever is a common complication of cardiac operations, which is known to be correlated with a greater degree of cognitive dysfunction 6 weeks after cardiac surgery. The aim of the present study was to examine efficacy and safety of single dose intravenous Paracetamol in treatment of post-operative fever in children undergoing cardiac surgery. Materials and Methods: In this randomised, double-blind, placebo-controlled clinical trial, 80 children, aged 1-12 years, presenting for open heart surgery were entered in the trial and randomly allocated into two groups: Placebo and Paracetamol. After induction of anaesthesia, 15 mg/kg intravenous Paracetamol solution was infused during 1 h in the Paracetamol group. Patients in placebo group received 15 mg/kg normal saline infusion during the same time. Since the end of operation until next 24 h in intensive care unit, axillary temperature of the two group patients was recorded in 4-h intervals. Any fever that occurred during this period had been treated with Paracetamol suppository (125 mg and the amount of antipyretic drug consumption for each patient had been recorded. In order to examine the safety of Paracetamol, patients were evaluated for drug complication at the same time. Results: Mean axillary temperature during first 24 h after operation was significantly lower in Paracetamol group compared with placebo group (P = 0.001. Overall fever incidence during 24 h after operation was higher in placebo group compared with Paracetamol group (P = 0.012. Of Paracetamol group patients, 42.5% compared with 15% of placebo group participants had no consumption of antipyretic agent (Paracetamol suppository during 24 h after operation (P = 0.001. Conclusion: This study suggests that single dose administration of intravenous Paracetamol before paediatric cardiac surgeries using cardiopulmonary bypass; reduce mean body temperature in the first 24 h after operation.

  2. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    OpenAIRE

    André Luiz Lisboa Cordeiro; Thiago Araújo de Melo; Daniela Neves; Julianne Luna; Mateus Souza Esquivel; André Raimundo França Guimarães; Daniel Lago Borges; Jefferson Petto

    2016-01-01

    Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled tri...

  3. High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated with Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

    DEFF Research Database (Denmark)

    Stenger, Michael; Fabrin, Anja; Schmidt, Henrik;

    2013-01-01

    The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.......The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome....

  4. Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Vladimir Pichugin

    2014-12-01

    Full Text Available Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP and the “beating heart” in combination with pulmonary artery perfusion (PAP and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients, the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients, the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients, the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level, oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and

  5. Role of prophylactic coronary revascularisation in improving cardiovascular outcomes during non-cardiac surgery: A narrative review.

    Science.gov (United States)

    Rahat, T; Nguyen, T; Latif, F

    2016-10-01

    Coronary revascularisation has been a topic of debate for over three decades in patients undergoing high-risk non-cardiac surgery. The paradigm shifted from routine coronary angiography toward stress test guided decision-making based on larger randomised trials. However, this paradigm is challenged by relatively newer data where routine coronary angiography and revascularisation is shown to improve perioperative cardiovascular outcomes. We review major studies performed over a long period including more contemporary data with regard to the 2014 American College of Cardiology/American Heart Association as well as 2014 European Society of Cardiology guideline on perioperative cardiovascular evaluation of patients undergoing non-cardiac surgery.

  6. Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

    Directory of Open Access Journals (Sweden)

    Satoshi Kurokawa

    2014-04-01

    Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.

  7. The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections: a retrospective study

    NARCIS (Netherlands)

    Vranken, N.P.; Weerwind, P.W.; Barenbrug, P.J.; Teerenstra, S.; Ganushchak, Y.M.; Maessen, J.G.

    2014-01-01

    OBJECTIVES: We aimed to investigate the association of patient characteristics and allogeneic blood transfusion products in development of post-cardiac surgery nosocomial infections. METHODS: This retrospective study was conducted in 7888 patients undergoing cardiac surgery with median sternotomy an

  8. Gene therapy during cardiac surgery: role of surgical technique to minimize collateral organ gene expression.

    Science.gov (United States)

    Katz, Michael G; Swain, JaBaris D; Fargnoli, Anthony S; Bridges, Charles R

    2010-12-01

    Effective gene therapy for heart failure has not yet been achieved clinically. The aim of this study is to quantitatively assess the cardiac isolation efficiency of the molecular cardiac surgery with recirculating delivery (MCARD™) and to evaluate its efficacy as a means to limit collateral organ gene expression. 10(14) genome copies (GC) of recombinant adeno-associated viral vector 6 encoding green fluorescent protein under control of the cytomegalovirus promoter was delivered to the nine arrested sheep hearts. Blood samples were assessed using real-time quantitative polymerase chain reaction (RT QPCR). Collateral organ gene expression was assessed at four-weeks using immunohistochemical staining. The blood vector GC concentration in the cardiac circuit during complete isolation trended from 9.59±0.73 to 9.05±0.65 (log GC/cm(3)), and no GC were detectable in the systemic circuit (P800-fold (P99% isolation efficiency. Conversely, incomplete isolation resulted in equalization of vector GC concentration in the circuits, leading to robust collateral organ gene expression. MCARD™ is an efficient, clinically translatable myocardial delivery platform for cardiac specific gene therapy. The cardiac surgical techniques utilized are critically important to limit collateral organ gene expression.

  9. Combined Application of Circulatory Assist Devices Following Cardiac Arrest in Patients after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    Huang Huanlei; Xiao Xuejun; Wu Ruobin; Ruixin; Cheng Anheng; Zhang Xiaohua; Luo Zhengxiang

    2006-01-01

    Objectives To evaluateretrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation (CPCR). Methods Assisted circulation devices,including emergency cardiopulmonary bypass (ECPB), intra-aortic balloon pump (IABP), and left ventricular assist device (LVAD), were applied to 16 adult patients who had cardiac arrest 82 min~56 h after open heart surgery and did not respond to 20 min or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB.Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3~49 months (mean =22 months). Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% (6/16) long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis,and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.

  10. Subject-specific models for image-guided cardiac surgery

    Science.gov (United States)

    Wierzbicki, Marcin; Moore, John; Drangova, Maria; Peters, Terry

    2008-10-01

    Three-dimensional visualization for planning and guidance is still not routinely available for minimally invasive cardiac surgery (MICS). This can be addressed by providing the surgeon with subject-specific geometric models derived from 3D preoperative images for planning of port locations or to rehearse the procedure. For guidance purposes, these models can also be registered to the subject using intraoperative images. In this paper, we present a method for extracting subject-specific heart geometry from preoperative MR images. The main obstacle we face is the low quality of clinical data in terms of resolution, signal-to-noise ratio, and presence of artefacts. Instead of using these images directly, we approach the problem in three steps: (1) generate a high quality template model, (2) register the template with the preoperative data, and (3) animate the result over the cardiac cycle. Validation of this approach showed that dynamic subject-specific models can be generated with a mean error of 3.6 ± 1.1 mm from low resolution target images (6 mm slices). Thus, the models are sufficiently accurate for MICS training and procedure planning. In terms of guidance, we also demonstrate how the resulting models may be adapted to the operating room using intraoperative ultrasound imaging.

  11. Identification of systems failures in successful paediatric cardiac surgery.

    Science.gov (United States)

    Catchpole, K R; Giddings, A E B; de Leval, M R; Peek, G J; Godden, P J; Utley, M; Gallivan, S; Hirst, G; Dale, T

    Patient safety will benefit from an approach to human error that examines systemic causes, rather than blames individuals. This study describes a direct observation methodology, based on a threat and error model, prospectively to identify types and sources of systems failures in paediatric cardiac surgery. Of substantive interest were the range, frequency and types of failures that could be identified and whether minor failures could accumulate to form more serious events, as has been the case in other industries. Check lists, notes and video recordings were employed to observe 24 successful operations. A total of 366 failures were recorded. Coordination and communication problems, equipment problems, a relaxed safety culture, patient-related problems and perfusion-related problems were most frequent, with a smaller number of skill, knowledge and decision-making failures. Longer and more risky operations were likely to generate a greater number of minor failures than shorter and lower risk operations, and in seven higher-risk cases frequently occurring minor failures accumulated to threaten the safety of the patient. Non-technical errors were more prevalent than technical errors and task threats were the most prevalent systemic source of error. Adverse events in surgery are likely to be associated with a number of recurring and prospectively identifiable errors. These may be co-incident and cumulative human errors predisposed by threats embedded in the system, rather than due to individual incompetence or negligence. Prospectively identifying and reducing these recurrent failures would lead to improved surgical standards and enhanced patient safety.

  12. Outlined history of the development of the world and Polish cardiac surgery.

    Science.gov (United States)

    Dziatkowiak, A J

    2006-04-01

    It was the dream of humanity to perform surgery on an open non-beating heart. Scientific and medical discoveries five thousand years ago in China, partially adopted by the Western civilization, laid, through ancient Egypt, Mesopotamia, Greece, Rome and, later on in the Renaissance, the foundations for the development of empirical medicine. The 19th and the 20th centuries shoved dynamic scientific and technical development in various fields including medicine and surgery whose importance grew with the necessity to help the patients wounded in the wars. A break-through event in the development of surgery was overcoming of pain and discovery of reasons of infections and the control thereof, and, in the case of cardiology and cardiac surgery, the discoveries in physiology of circulation and the diagnostics of cardiovascular system diseases. This review contains a brief description of medical science in the past centuries, emphasizing the most important discoveries. A focus has been placed on the contribution of general surgery and thoracic surgery to the development of Polish and World cardiac surgery. The I Congress of the Polish Surgeons was held in 1889 in the Austria occupied territory of Cracow, which celebrated its one hundredth anniversary. The main obstacles in the development of clinical cardiac surgery included intratracheal general anesthesia, antisepsis and aseptics, hypothermia, oxygenators, extracorporeal circulation, transfusions, blood clotting and thromboses and cardioplegia. The spectacular heart and aorta surgical operations performed for the first time in the world and in Poland as well as the names of cardiac surgeons employed by the important cardiac surgery centers in Poland have been mentioned. The Department of Heart, Vascular and Transplantology Surgery of Cracow, the role and the share of Fundacja Rozwoju Kardiochirurgii COR AEGRUM in Cracow (COR AEGRUM Foundation for the Development of Cardiac Surgery in Cracow) in the construction of the

  13. Preoperative Evaluation for Noncardiac Surgery.

    Science.gov (United States)

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  14. Blood glucose management in the patient undergoing cardiac surgery: A review

    Institute of Scientific and Technical Information of China (English)

    Pingle; Reddy; Brian; Duggar; John; Butterworth

    2014-01-01

    Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.

  15. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  16. Aprotinin and hemostasis monitoring concerns during cardiac surgery.

    Science.gov (United States)

    Swartz, Michael F; Fink, Gregory W; Searles, Bruce

    2004-12-01

    Aprotinin (Trasylol) is a serine protease inhibitor, isolated from bovine lung that initially was marketed for the treatment of pancreatitis. In the mid 1980s, reports of its ability to decrease hemorrhaging after cardiopulmonary bypass surgery introduced the drug to the realm of cardiac surgery. Unfortunately, its introduction into this arena was followed by the publication of multiple studies and case reports that blamed aprotinin for poor outcomes in the form of early graft closure. More than 17 years have passed since the initial article describing the use of aprotinin during cardiopulmonary bypass, and with time there has been a significant increase in scientific knowledge and clinical experience. Interestingly, modern literature does not support the dogma that aprotinin is a procoagulant. Aprotinin increases the activated partial thromboplastin time (aPTT), as well as the kaolin- and celite-activated clotting time (ACT), regardless of heparin. Aprotinin, because of its ability to inhibit kallikrein, has been found to decrease thrombin antithrombin III complexes, fibrin-split products, fibrinopeptide 1+2, prothrombin fragments, and all markers of thrombin formation. Some authors have suggested that it may have a synergistic effect with heparin to ensure graft patency. Anticoagulation monitoring during the use of aprotinin also has been developed based on early studies. Aprotinin administration does influence the results of various ACT tests, and consequently different methods of testing anticoagulation have been developed. Researchers have demonstrated that the celite ACT is not "artificially" prolonged in the presence of heparin and aprotinin, rather the kaolin ACT is "artificially" shortened. This article will review the scientific literature with regard to aprotinin's anticoagulatory effects and review the current recommendations for hemostasis monitoring during the use of aprotinin.

  17. Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; GAO Chang-qing; WANG Gang; WANG Jia-li

    2012-01-01

    Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9%) and 62 male (48.1%) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3%) patients underwent mitral valve repair,27 (20.9%) mitral valve replacement,27 (20.9%) left atrial myxoma removal,and 14(10.9%) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100%),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100%),and aortic

  18. 新生儿先天性心脏病术后血液动力学的临床研究%Evaluation on the early hemodynamic changes after cardiac surgery for congenital heart diseases in neonates

    Institute of Scientific and Technical Information of China (English)

    仇黎生; 刘锦纷; 朱丽敏; 徐卓明

    2009-01-01

    Objective To accurately evaluate the early hemodynamic status of neonates who undergo complex neonatal cardiac surgery, through monitoring the cardiac index (CI), serum lactate (Lac), mixed venous oxygen saturation (SvO_2). Methods From January to November 2007, haemodynamic data of 80 patients who had open heart surgery for congenital heart disease were analyzed within 48 hours after operation. Of the 80 patients, 47 were neonates, their age ranged from 3 days to 29 days [mean (21.98±8.15) days]and weight ranged from 2. 6 kg to 4. 2 kg [mean (3.51±0.39) kg]. As the control group, 33 young infants at the age of 30 days to 180 days [mean (76. 36±24.79) days]with body weight ranged from 3. 1 kg to 6.0 kg [mean (4. 59±0. 59) kg]were also enrolled. The value of CI derived from pulse contour and was calculated by using the PiCCO system. Meanwhile, measurements of serum lactate level and SvO_2 were recorded. Serial measurements of the cardiac output were performed for the neonates.Results CI in survivors of neonates(2.01±0.35)L/(min·m~2)was lower than that of the infants(2.26±0.39)L/(min·m~2)after cardiac surgery(P<0.05)at 2h,6h postoperatively.However, urine output remained normal. The value of pulse pressure in neonates was less than that in young infants. Serum lactate level in neonates was significantly higher than that of young infants during cardiac surgical procedures (P<0.01) at 12 h postoperatively; the SvO_2 was more than 60% postoperatively in survived neonates, there was no significant difference (P0.05) in SvO_2 between neonates and young infants during preoperative and postoperative periods. There was a positive correlation between CI and SvO_2. Four neonates and 1 young infant died after surgical treatment, surgical mortality was 8.5% and 3.0%, respectively. The deaths of the neonates were related to the cardiocirculatory function decompensation, unrelieved severe acidosis preoperatively, and the transposition of great artery with coronary artery

  19. Feeding difficulties in neonates following cardiac surgery: determinants of prolonged feeding-tube use.

    Science.gov (United States)

    McKean, Elissa B; Kasparian, Nadine A; Batra, Shweta; Sholler, Gary F; Winlaw, David S; Dalby-Payne, Jacqueline

    2017-01-23

    Aim The aims of this study were to examine the prevalence and potential correlates of feeding difficulties in infants who underwent cardiac surgery in the neonatal period and to investigate resource utilisation by infants with feeding difficulties.

  20. Custodiol versus blood cardioplegia in pediatric cardiac surgery, two-center study

    Directory of Open Access Journals (Sweden)

    Ebtehal A. Qulisy

    2016-05-01

    Conclusions: Custodial cardioplegia is associated with less optimal myocardial protection and higher adverse outcomes compared to cold blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted.

  1. SvO2 Trigger in Transfusion Strategy After Cardiac Surgery

    Science.gov (United States)

    2016-05-18

    Undergoing Nonemergent Cardiac Surgery; Central Venous Catheter on the Superior Vena Cava (to Perform ScVO2 Measure); Anemia (Transfusion; Hemodynamic and Respiratory Stability; Bleeding Graded as Insignificant, Mild, Moderate of Universal Definition of Perioperative Bleeding

  2. Delirium in cardiac surgery : a study on risk-assessment and long-term consequenses

    NARCIS (Netherlands)

    Koster, Sandra

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or ea

  3. Cardiovascular disease and renal insufficiency:special considerations with cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Colin Lenihan; Donal Reddan

    2005-01-01

    Cardiovascular disease is an important cause of mortality in the chronic kidney disease (CKD) population. This review discusses cardiac surgery in the CKD population and considers ostoperative acute renal failure (ARF). CKD patients have worse outcomes following coronary artery bypass grafting (CABG) and cardiac valvular surgery than the general population. However,surgical revascularization is an effective treatment for coronary artery disease (CAD) in this population and may be associated with improved survival over percutaneous intervention (PCI) in advanced CKD. Cardiac surgery in the CKD population requires careful perioperative planning and management. Acute renal failure (ARF) is a serious complication following cardiac surgery, occurring in 1 to 8% of cases. Management of postoperative ARF is largely supportive and emphasis is placed on preoperative risk stratification and prevention.

  4. An operational research approach to identify cardiac surgery patients at risk of severe post-operative bleeding.

    Science.gov (United States)

    Reddy, Brian; Pagel, Christina; Vuylsteke, Alain; Gerrard, Caroline; Nashef, Sam; Utley, Martin

    2011-09-01

    Severe post-operative bleeding can lead to adverse outcomes for cardiac surgery patients and is a relatively common complication of cardiac surgery. One of the most effective drugs to prevent such bleeding, aprotinin, has been withdrawn from the market due to concerns over its safety. Alternative prophylactic drugs which can be given to patients to prevent bleeding can result in significant side effects and are expensive. For this reason it is difficult to make a clinical or economic case for administering these drugs to all cardiac surgery patients, and the prevailing view is that their use should be targeted at patients considered to be at relatively high risk of post-operative bleeding. However, there is currently no objective method for identifying such patients. Over the past 7 years, a team of clinicians and researchers at Papworth Hospital has collected data concerning post-operative blood loss for each cardiac surgery patient, totalling 11,592 consecutive records. They approached a team of operational researchers (MU, ACP, BR) with extensive experience of developing clinical risk models with the aim of devising a risk stratification scheme that could potentially be used to identify a cohort of higher risk patients. Such patients could be treated with the available prophylactic drugs or recruited to studies to evaluate new interventions. This paper is intended to describe the Operational Research process adopted in the development of this scheme. A concise description of the scheme and its clinical interpretation is published elsewhere.

  5. Prediction and Prevention of Acute Kidney Injury after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Su Rin Shin

    2016-01-01

    Full Text Available The incidence of acute kidney injury after cardiac surgery (CS-AKI ranges from 33% to 94% and is associated with a high incidence of morbidity and mortality. The etiology is suggested to be multifactorial and related to almost all aspects of perioperative management. Numerous studies have reported the risk factors and risk scores and novel biomarkers of AKI have been investigated to facilitate the subclinical diagnosis of AKI. Based on the known independent risk factors, many preventive interventions to reduce the risk of CS-AKI have been tested. However, any single preventive intervention did not show a definite and persistent benefit to reduce the incidence of CS-AKI. Goal-directed therapy has been considered to be a preventive strategy with a substantial level of efficacy. Many pharmacologic agents were tested for any benefit to treat or prevent CS-AKI but the results were conflicting and evidences are still lacking. The present review will summarize the current updated evidences about the risk factors and preventive strategies for CS-AKI.

  6. Using central venous catheter for suprapubic catheterization in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bilehjani E

    2017-01-01

    Full Text Available Eissa Bilehjani,1 Solmaz Fakhari2 1Department of Cardiovascular Anesthesia, Tabriz University of Medical Sciences, Madani Heart Hospital, 2Department of Anesthesiology, Tabriz University of Medical Sciences, Madani Heart Hospital, Tabriz, Iran Abstract: Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2–3 attempts. Keywords: suprapubic catheterization complication, urethral catheterization, central venous catheter, Seldinger’s technique, cardiac surgery

  7. Critical temperature ranges of hypothermia-induced platelet activation: possible implications for cooling patients in cardiac surgery.

    Science.gov (United States)

    Straub, Andreas; Breuer, Melanie; Wendel, Hans P; Peter, Karlheinz; Dietz, Klaus; Ziemer, Gerhard

    2007-04-01

    Cooling of the patient is routinely applied in cardiac surgery to protect organs against ischemia. Hypothermia induces activation of platelets, but the effects of temperatures such as used during cardiac surgery are not well described. To investigate this in an in-vitro study heparinized whole blood was incubated at different temperatures (37 degrees C, 34.5 degrees C, 32 degrees C, 29.5 degrees C, 27 degrees C, 24.5 degrees C, 22 degrees C, 19.5 degrees C and 17 degrees C). The effect of these temperatures on aggregation, P-selectin expression, GP IIb/IIIa activation and platelet microparticle (PMP) formation of unstimulated and ADP-stimulated platelets of 36 subjects was evaluated in flow cytometry. A four-parametric logistic model was fitted to depict the temperature effect on platelet parameters. Lower temperatures increased aggregates, P-selectin expression, and GP IIb/IIIa activation. The number of PMPs decreases with hypothermia. Additional experiments revealed a slight influence of heparin on platelet P-selectin expression but excluded an effect of this anticoagulant on the other evaluated parameters. Threshold temperatures, which mark 5% changes of platelet parameters compared to values at 37 degrees C, were calculated. On ADP-stimulated platelets the thresholds for P-selectin expression and GP IIb/IIa activation are 34.0 degrees C and 36.4 degrees C, respectively, and lie in the temperature range routinely applied in cardiac surgery. Hypothermia-induced platelet activation may develop in most patients undergoing cardiac surgery, possibly resulting in thromboembolic events, coagulation defects, and proinflammatory leukocyte bridging by P-selectin bearing platelets and PMPs. These findings suggest that pharmacological protection of platelets against hypothermia-induced damage may be beneficial during cardiac surgery.

  8. Two successful neonatal extracorporeal membrane oxygenation treatment for severe heart failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    TAN Lin-hua; DU Li-zhong; HE Xiao-jun; SUN Mei-yue; ZHANG Ze-wei; LIN Ru

    2009-01-01

    @@ Extracorporeal membrane oxygenation(ECMO)can play an important role by providing short-term circulatory support to enable myocardial recovery in patients with life-threatening heart failure.Currently,over 4000 children who received ECMO for cardiac support have been reported to the Extracorporeal Life Support Registry,with the majority of patients placed on ECMO following cardiac surgery.

  9. Clonidine as a First-Line Sedative Agent After Neonatal Cardiac Surgery: Retrospective Cohort Study

    NARCIS (Netherlands)

    Kleiber, N.; Wildt, S.N. de; Cortina, G.; Clifford, M.; Ducruet, T.; Tibboel, D.; Millar, J.

    2016-01-01

    OBJECTIVES: To determine the cardiovascular tolerance of clonidine used as a first-line sedative after cardiac surgery in small infants. DESIGN: Retrospective chart review. SETTING: A tertiary and quaternary referral cardiac PICU. PATIENTS: All infants younger than 2 months who received a clonidine

  10. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    Science.gov (United States)

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all ptamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, ptamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  11. Superior vena cava syndrome in a patient with previous cardiac surgery: what else should we suspect?

    Directory of Open Access Journals (Sweden)

    Dolou Paraskevi

    2010-06-01

    Full Text Available Abstract Background Although mediastinal tumors compressing or invading the superior vena cava represent the major causes of the superior vena cava syndrome, benign processes may also be involved in the pathogenesis of this medical emergency. One of the rarest benign causes is a pseudoaneurysm developing in patients previously having heart surgery. Case report We present the case of a large pseudoaneurysm of the ascending aorta, five years after primary surgery, with a significant compression of the right mediastinal venous system causing superior vena cava syndrome, detected at chest CT angiography. Perioperative findings showed two rush out points both coming from the distal aortic suture line which was performed five years ago. The patient underwent reoperation under circulatory arrest facilitating safe exploration and repair of the distal anastomotic leaks Conclusion Enhanced chest CT should be always undertaken in all patients with superior vena cava syndrome, especially in those previously having cardiac or aortic surgery to correctly evaluate the presence of a pseudoaneurysm. Mass effect to the superior vena cava makes necessary an open surgical treatment of the pseudoaneurysm so as to concurrently resolve the right mediastinal venous system's compression. Surgery should be performed in terms of safe approach to avoid exsanguination and cerebral malperfusion.

  12. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery

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    van der Merwe Juliana

    2011-03-01

    Full Text Available Abstract Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL, rates of postoperative atrial fibrillation (AF and length of stay (LOS in hospital. Methods Elective patients scheduled for coronary artery bypass graft and/or valve surgery at a public hospital in Melbourne, Australia were enrolled. Patients were randomized to receive either holistic therapy (HT or usual care (UC. HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery. A self-administered SF-36 questionnaire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF. Results The study population comprised 117 patients of whom 60 received HT and 57 received UC. Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient resources. HT, as delivered in this study, compared to UC did not result in significant changes in QOL, LOS or AF incidence. Conclusions Preoperative holistic therapy can be delivered in the hospital setting, although two weeks is insufficient to provide benefits beyond usual care on QOL, LOS or postoperative AF. Further research is now required to determine whether a similar program of longer duration, or targeted to high risk patients can provide measurable benefits. Trial registration This trial was conducted as part of a larger study and according to the principles contained in

  13. Does Parsonnet scoring model predict mortality following adult cardiac surgery in India?

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    Moningi Srilata

    2015-01-01

    Full Text Available Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG, valve surgery and combined procedures (CABG with valve surgery. The model calibration was performed using Hosmer-Lemeshow goodness of fit test and receiver operating characteristics (ROC analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients, 7.1% (34 patients for CABG, 4.3% (16 patients for valve surgery and 16.2% (6 patients for combined procedures. The Hosmer-Lemeshow statistic was <0.05 for the total data and also within the sub-groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62-0.77 and when tested separately, it was 0.73 (0.64-0.81 for CABG, 0.79 (0.63-0.92 for valve surgery (good discriminatory ability and only 0.55 (0.26-0.83 for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] - 1.7, preoperative intra-aortic balloon pump (OR - 10.7, combined procedures (OR - 5.1, dialysis dependency (OR - 23.4, and re-operation (OR - 9.4. Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined procedures.

  14. Evidence of Impaired Neurocognitive Functioning in School-Age Children Awaiting Cardiac Surgery

    Science.gov (United States)

    van der Rijken, Rachel; Hulstijn-Dirkmaat, Gerdine; Kraaimaat, Floris; Nabuurs-Kohrman, Lida; Daniels, Otto; Maassen, Ben

    2010-01-01

    Aim: Children with congenital heart disease (CHD) are at risk of developing neurocognitive problems. However, as these problems are usually identified after cardiac surgery, it is unclear whether they resulted from the surgery or whether they pre-existed and hence might be explained by complications and events associated with the heart disease…

  15. Sinus node function after cardiac surgery : is impairment specific for the maze procedure?

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Van Den Berg, MP; Grandjean, JG; Tieleman, RG; Smit, AJ; Huet, RCG; Van Der Maaten, JMAA; Volkers, CP; Ebels, T; Crijns, HJGM

    2004-01-01

    Background: Maze surgery is a final solution for intractable atrial fibrillation (AF), but an adverse effect on postoperative sinus node function has been reported. Whether this also applies to other types of cardiac surgery is unclear. Methods: We assessed postoperative rhythm by means of repeated

  16. Obstruction of endotracheal tube with relevant respiratory acidosis during pediatric cardiac surgery

    NARCIS (Netherlands)

    Morei, N.M.; Mungroop, H. E.; Michielon, Guido; Scheeren, Thomas

    2014-01-01

    We describe a case of pediatric cardiac surgery in a 21- days old baby, in whom a nasal endotracheal tube (ETT) was inserted. At the end of surgery both ventilatory pressures and end-tidal CO2 increased suggesting airway obstruction. Suctioning of the ETT lumen did not relieve the problem, only ETT

  17. Microbial air monitoring in the operating theatres of Salam Center for Cardiac Surgery in Khartoum (Sudan

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    Margherita Scapaticci

    2012-06-01

    Full Text Available The seriousness of postoperative infections and the increased susceptibility of patients undergoing cardiac surgery increase the demand for the operating theatre (OT asepsis to prevent bacterial infections. In fact, the organisms carried by the air reach the wound after having sedimented onto sterile field. The air represents a critical point for quality control of air filtration systems, for sanitization procedures and for the evolution of hygienic features of the OT environment.Aim of the study is to evaluate the prevalence of microorganisms found in the operating rooms (OR air monitoring in the Salam Center for Cardiac Surgery of Khartoum (Sudan between July 2008 and March 2009.The specimens were collected every month in two different times: “OR at rest” (after sanitization and “OR operational”, using sedimentation method (Fisher 1972. Results showed that each sample collected at rest had IMA (index of microbial air contamination < 5CFU/plt, whereas the bacterial growth was between 25 and 50 CFU/plt when the samples had been collected in the same places during operating activities.This indicate the effectiveness of sanitization procedures and confirm that people working in OT are an important source of bacteria causing postoperative infections. Coagulase negative Staphylococci, Gram negative bacillus and Staphylococcus aureus spp. were the predominant organisms isolated.

  18. Blood neutrophil bactericidal activity against methicillin-resistant and methicillin-sensitive Staphylococcus aureus during cardiac surgery.

    Science.gov (United States)

    Mekontso-Dessap, Armand; Honoré, Stéphanie; Kirsch, Matthias; Plonquet, Anne; Fernandez, Eric; Touqui, Lhousseine; Farcet, Jean-Pierre; Soussy, Claude-James; Loisance, Daniel; Delclaux, Christophe

    2005-08-01

    Whether methicillin-resistant Staphylococcus aureus (MRSA) constitutes per se an independent risk factor for morbidity and mortality after surgery as compared with methicillin-sensitive Staphylococcus aureus (MSSA) remains a subject of debate. The aim of this study was to assess whether innate defenses against MRSA and MSSA strains are similarly impaired after cardiac surgery. Both intracellular (isolated neutrophil functions) and extracellular (plasma) defenses of 12 patients undergoing scheduled cardiac surgery were evaluated preoperatively (day 0) and postoperatively (day 3) against two MSSA strains with a low level of catalase secretion and two MRSA strains with a high level of catalase secretion, inasmuch as SA killing by neutrophils relies on oxygen-dependent mechanisms. After surgery, an increase in plasma concentration of IL-10, an anti-inflammatory cytokine able to inhibit reactive oxygen species secretion and bactericidal activity of neutrophils, was evidenced. Despite the fact that univariate analysis suggested a specific impairment of neutrophil functions against MRSA strains, two-way repeated-measures ANOVA failed to demonstrate that the effect of S. aureus phenotype was significant. On the other hand, an increase in type-II secretory phospholipase A2 activity, a circulating enzyme involved in SA lysis, was evidenced and was associated with an enhancement of extracellular defenses (bactericidal activity of plasma) against MRSA. Overall, cardiac surgery and S. aureus phenotype had a significant effect on plasma bactericidal activity. Cardiac surgery was characterized by enhanced antibacterial defenses of plasma, whereas neutrophil killing properties were reduced. The overall effect of S. aureus phenotype on neutrophil functions did not seem significant.

  19. 直视微创二次心脏手术早中期疗效及安全性评估%Early evaluation of redo minimally invasive cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    许李力; 尤斌; 李平; 高峰; 陈长城; 徐屹; 刘硕; 李光

    2015-01-01

    目的:初步总结微创直视手术在二次心脏手术中临床应用的疗效及安全性。方法2012年6月—2015年2月在二次心脏手术中共完成微创直视手术21例。其中男10例,女11例;平均年龄(49 j.4±18.3)岁,平均体质量指数(BMI)(24.9±7.5)kg/m2。二次手术原因:二尖瓣机械瓣卡瓣或瓣周漏9例,主动脉瓣机械瓣卡瓣或瓣周漏2例,三尖瓣关闭不全7例,室间隔修补术后残余漏3例。手术均在股动静脉插管体外循环下完成。结果本组无1例转为传统胸正中切口开胸手术。手术时间(4.4±1.3)h,体外循环时间(108.0±80.6)min,其中心脏不停跳下完成手术16例,其余5例为主动脉阻断后手术,气管插管时间(24.7±12.3)h,ICU时间(27.0±10.8)h,手术后住院时间(7.3±3.1)d;术后第1天引流量784(314~2790)ml,无围术期死亡病例,亦无明显并发症发生。出院时心功能1级12例,2级6例,3级2例,4级1例。随访时间为(18.9±7.8)月,随访期间无术后死亡病例,亦无明显重大不良事件。结论微创直视手术在二次心脏手术中的近期手术效果良好,手术安全性高,适用于常见二次心脏手术;其创伤小,开胸简化,具有并发症和病死率低等特点。%Objective To summarize the clinical efficacy and safety of minimally invasive surgery in patients who were underwent the second cardiac surgery .Methods From 2012 June to 2015 February, in the second heart operation , 21 cases were completed the minimally invasive operation .There were 10 males, 11 females;the average age was (49.4 ±18.3) years old, the average body mass index (BMI) was (24.9 ±7.5) kg/m2.The second operation reasons were as follows:9 cases of mitral valve flap , 2 cases of aortic valve mechanical valve flap , 7 cases of tricuspid insufficient , 3 case of ventricular septal repair .All operations were

  20. Cardiac evaluation of liver transplant candidates

    Institute of Scientific and Technical Information of China (English)

    Mercedes Susan Mandell; JoAnn Lindenfeld; Mei-Yung Tsou; Michael Zimmerman

    2008-01-01

    Physicians previously thought that heart disease was rare in patients with end stage liver disease. However, recent evidence shows that the prevalence of ischemic heart disease and cardiomyopathy is increased in transplant candidates compared to most other surgical candidates. Investigators estimate that up to 26% of all liver transplant candidates have at least one critical coronary artery stenosis and that at least half of these patients will die perioperatively of cardiac complications. Cardiomyopathy also occurs in greater frequency. While all patients with advanced cardiac disease have defects in cardiac performance, a larger than expected number of patients have classical findings of dilated, restrictive and hypertropic cardiomyopathy. This may explain why up to 56% of patients suffer from hypoxemia due to pulmonary edema following transplant surgery. There is considerable controversy on how to screen transplant candidates for the presence of heart disease. Questions focus upon, which patients should be screened and what tests should be used. This review examines screening strategies for transplant candidates and details the prognostic value of common tests used to identify ischemic heart disease. We also review the physiological consequences of cardiomyopathy in transplant candidates and explore the specific syndrome of "cirrhotic cardiomyopathy".

  1. Evaluation of Anesthesia Management of Pediatric Cardiac Surgery with Cardiopulmonary Bypass on Piglets%小儿体外循环心脏手术麻醉管理方法在幼猪中的应用评价

    Institute of Scientific and Technical Information of China (English)

    王晓凑; 薛庆华; 晏馥霞; 李立环; 李守军; 胡盛寿

    2012-01-01

    Objective To evaluate the effectiveness and safety of anesthesia management of pediatric cardiac on piglets with low temperature and low flow eardiopulmonary bypass ( CPB). Methods Forty - two general - type piglets were utilized, with ketamine and atropine intramuscular injection as basal anaesthesia,fentanyl,pipecuronium bromide,midazolam were intravenously injected and sevoflurane was inhaled for anesthesia induction and maintenance. Mechanical ventilation was discontinued after full flow CPB,0.49 kPa pressure of adjustable pressure limiting valve was used to keep lungs slightly inflated. Airway secretions were suctioned regularly and manual ventilation was given to expand lungs once the circulation restarted, and then full mechanical ventilation was reinstated. Internal environment disorder was rectified according to the result of arterial blood gases analysis, and dopamine and dobutamine were intravenously injected by pump in order to maintain circulation steadiness, while arrhythmias was corrected according to their types. Haemodynamics, arterial blood gas analysis, breath parameters , duration of anesthesia, CPB and aorta arrest were monitored and recorded. Results One piglet died of heart arrest after CPB, while other 41 cases went through and completed the experiments. Durations of aortic cross clamp,CPB,and anesthesia maintain were (125 ±8) min, (184 ± 10) min, (335 ±17) min,separately. Conclusion Anesthesia management of pediatric cardiac surgery with CPB on piglets has preferable anesthesia effectiveness and safety.%目的 评价小儿心脏手术的麻醉管理技术应用于幼猪低温低流量体外循环(CPB)心脏手术的全麻效果及其安全性.方法 普通幼猪42只,基础麻醉采用氯胺酮加硫酸阿托品肌肉注射,麻醉诱导和维持采用芬太尼、哌库溴铵和咪达唑仑静脉注射,并辅助吸入七氟烷;CPB全流量后停止机械通气,给予可调压力限制阀0.49 kPa压力静态膨肺,主动脉开放后吸

  2. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e

    2010-01-01

    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  3. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

    OpenAIRE

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck,Guilherme Lobosco; Rocha, Alexandre Marins; Rosa,Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-01-01

    Background The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods A total of 211 patients referred for elective surgeries, without suspic...

  4. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

  5. Incidence and management of diaphragmatic palsy in patients after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Background: Diaphragm is the most important part of the respiratory system. Diaphragmatic palsy following cardiac surgery is not uncommon and can cause deterioration of pulmonary functions and attendant pulmonary complications. Objectives: Aim of this study was to observe the incidence of diaphragmatic palsy after off pump coronary artery bypass grafting (OPCAB as compared to conventional CABG and to assess the efficacy of chest physiotherapy on diaphragmatic palsy in post cardiac surgical patients. Design and Setting: An observational prospective interventional study done at a tertiary care cardiac centre. Patients: 2280 consecutive adult patients who underwent cardiac surgery from February 2005 to august 2005. Results: 30 patients out of 2280 (1.31% developed diaphragmatic palsy. Patients were divided based on the presence or absence of symptoms viz. breathlessness at rest or exertion or with the change of posture along with hypoxemia and / or hypercapnia. Group I included 14 patients who were symptomatic (CABG n=13, post valve surgery n=1, While Group II included 16 asymptomatic patients (CABG n=12, post valve surgery n=4, 9 patients (64% from Group I (n=14 and 4 patients (25% from group II showed complete recovery from diaphragmatic palsy as demonstrated ultrasonographically. Conclusion: The incidence of diaphragmatic palsy was remarkably less in our adult cardiac surgical patients because most of the cardiac surgeries were performed off pump and intensive chest physiotherapy beginning shortly after extubation helped in complete or near complete recovery of diaphragmatic palsy. Chest Physiotherapy led to marked improvement in functional outcome following post cardiac surgery diaphragmatic palsy. We also conclude that ultrasonography is a simple valuable bed-side tool for rapid diagnosis of diaphragmatic palsy

  6. Risk Factors for Postoperative Encephalopathies in Cardiac Surgery

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    A. N. Shepelyuk

    2012-01-01

    Full Text Available Objective: to reveal risk factors for postoperative neurological complications (PONC during surgery under extracorporeal circulation (EC. Subjects and methods. Five hundred and forty-eight patients were operated on under EC. Multimodality monitoring was performed in all the patients. Pre-, intra-, and postoperative data were analyzed. Results. Two patient groups were identified. These were 1 59 patients with PONC and 2 489 patients without PONC. The patients with PONC were older than those without PONC (61.95±1.15 and 59±0.4 years and had a smaller body surface area (1.87±0.02 and 1.97±0.01 m2; in the PONC group, there were more women (37.3±6.4 and 22.1±1.9%. In Group 1, comorbidity was a significantly more common indication for surgery (33.9±6.22 and 9.2±1.29%. In this group, cerebral oxygenation (CO was significantly lower (64±1.41 and 69.9±0.38%. In the preoperative period, there were group differences in hemoglobin (Hb, total protein, creatinine, and urea (135±2.03; 142±0.71 g/l, 73±0.93; 74.9±0.3 mmol/l, 104.7±3.3; 96.3±1.06 mmol/l, 7.5±0.4; 6.5±0.1 mmol/l, respectively. The PONC group more frequently exhibited more than 50% internal carotid artery (ICA stenosis (28.8±5.95; 15.3± 1.63%; р<0.05, dyscirculatory encephalopathies (DEP (38.9±6.4 and 19.4±1.8%; р<0.05, CO, Hb, hematocrit, and oxygen delivery were lower in Group 1 at all stages. In the preperfusion period, cardiac index was lower in Group 1 (2.3±0.1 and 2.5±0.03 l/min/m2; р<0.01. In the postper-fusion period, blood pressure was lower in Group 1 (72.3±1.4 and 76.4±0.47 mm Hg; р=0.007 and higher rate was higher (92.65±1.5 and 88.16±0.49 min-1; р=0.007. Lower PCO2a was noted in Group 1. In this group, the patients were given epinephrine more frequently (33.9±6.2 and 20.5±1.8%; р<0.05 and in larger dosages (0.02±0.001 and 0.01±0.003 ^g/kg/min; р<0.05. Conclusion. The preoperative risk factors of CONC is female gender, lower body surface area

  7. A common-source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery.

    Science.gov (United States)

    Boyce, J M; Potter-Bynoe, G; Opal, S M; Dziobek, L; Medeiros, A A

    1990-03-01

    A single strain of Staphylococcus epidermidis caused an outbreak of postoperative wound infections and endocarditis during a 6-month period. Infections caused by the epidemic strain developed more frequently in valve surgery patients than in those undergoing coronary artery bypass graft surgery (P = .03) and occurred only in patients operated on by surgeon A. None of 17 members of the cardiac surgery team carried the epidemic strain in their anterior nares, axillae, or inguinal folds. Hand cultures were performed on 8 surgical personnel, and only surgeon A carried the epidemic strain on his hands. Isolates from cardiac surgery patients, bypass pump blood cultures, and the hands of the implicated surgeon all had identical antimicrobial susceptibility patterns, plasmid profiles, and EcoRI restriction endonuclease digest patterns. In the 24 months after control measures were implemented, no infections caused by the epidemic strain occurred among open heart surgery patients. The findings suggest that the common-source outbreak of infections among cardiac surgery patients was due to carriage of a strain S. epidermidis on the hands of a cardiac surgeon.

  8. Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Mohindra R

    2002-01-01

    Full Text Available The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluation to understand the abnormal anatomy and physiology, and related anaesthetic implications. No anaesthetic agent is an absolute contraindication, although drugs beneficial for one lesion may be detrimental for another. Regional anaesthesia has also been safely used in children with congenital heart disease. However the anaesthesiologist must have a detailed understanding of the pathophysiology of the lesion and the pharmacology of drugs being used to be able to provide safe anaesthesia for children with congenital heart disease.

  9. A comparison of pain measures in newborn infants after cardiac surgery.

    Science.gov (United States)

    Franck, Linda S; Ridout, Deborah; Howard, Richard; Peters, Judy; Honour, John W

    2011-08-01

    Accurate pain assessment tools to evaluate pain in critically ill neonates in the postoperative period are lacking. Therefore, we compared a number of potentially useful indices of pain in critically ill neonates following cardiac surgery. Eighty-one full-term infants were studied during the first 48 postoperative hours and the following indices were measured: heart rate, mean arterial blood pressure, heart-rate variability, urinary and plasma cortisol, and 4 composite pain measurement scales: Children's and Infants' Postoperative Pain Scale (CHIPPS), CRIES, COMFORT, and Premature Infant Pain Profile (PIPP). Regression models were used to investigate relationships between individual pain indices or composite pain assessment scales with respect to procedural intensity and opioid dose and plasma levels. COMFORT score performed best, with a 27% difference in score between procedures causing tissue damage and those that did not (Ppain indices studied, the COMFORT score performed best, with both behavioural and physiological components providing significant contributions.

  10. [Important role of a nurse parctitioner-like specialized registered nurse in a cardiac surgery team].

    Science.gov (United States)

    Izutani, Hironori

    2012-11-01

    Team medical practice by physician, nurse, and other co-medical staffs has been performed and it provides numerous values to the patients. Japanese Ministry of Health, Labor and Welfare reported that a registered nurse was a key person of medicine. The importance of nurse's role expansion and involving medical cure by a registered nurse was emphasized in the report. Japanese nurse practitioner for a new profession is going to start in near future. In our institute, a specialized registered nurse has joined a cardiac surgery team. She plays an important role of assisting and consulting cardiac physicians for patient cure and care as a member of the surgery team. Cardiac surgery team including specialized registered nurse gives quality surgical results and patient satisfaction.

  11. The inflammatory response in cardiac surgery: an overview of the pathophysiology and clinical implications.

    Science.gov (United States)

    Corral-Velez, Vicente; Lopez-Delgado, Juan C; Betancur-Zambrano, Nelson L; Lopez-Suñe, Neus; Rojas-Lora, Mariel; Torrado, Herminia; Ballus, Josep

    2015-01-01

    During cardiac surgery different factors, such as the aortic clamp, the extracorporeal circulation and the surgical injury itself, produce complex inflammatory responses which can lead to varying degrees of ischemia-reperfusion injury and/or systemic inflammatory response. This may have clinical implications due to hemodynamic changes related with an enlarged vasodilatory response. Thus, maintaining adequate levels of blood pressure during and after cardiac surgery represents a challenge for physicians when inflammatory response appears. The use of noradrenaline to raise arterial pressure is the most current pharmacological approach in the operating room and ICU. However, it is not always effective and other drugs, such as methylene blue, have to be used among others in specific cases as rescue therapy. The aim of our research is to review briefly the pathophysiology and clinical implications in the treatment of the inflammatory response in cardiac surgery, together with the mechanisms involved in those treatments.

  12. Cardiac rehabilitation patient's perspectives on the recovery following heart valve surgery: a narrative analysis

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe Olsen; Berg, Selina Kikkenborg;

    2016-01-01

    AIMS: To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. BACKGROUND: Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging......, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. DESIGN: A qualitative study with serial interviews analysed using narrative methods. METHODS: We......, the participants expected to return to normality. The analysis identified four courses of recovery, with three non-linear complex pathways deviating from the classic restitution narrative: the frustrated struggle to resume normality, the challenged expectation of normality - being in a limbo and becoming a heart...

  13. Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Jagdish Menghraj Shahani

    2012-01-01

    Full Text Available The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.

  14. Increased incidence of acute kidney injury with aprotinin use during cardiac surgery detected with urinary NGAL

    DEFF Research Database (Denmark)

    Wagener, G.; Gubitosa, G.; Wang, S.;

    2008-01-01

    BACKGROUND: Use of aprotinin has been associated with acute kidney injury after cardiac surgery. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel, very sensitive marker for renal injury. Urinary NGAL may be able to detect renal injury caused by aprotinin. This study determined...... if the use of aprotinin is associated with an increased incidence of acute kidney injury and increased levels of urinary NGAL. METHODS: In this prospective, observational study 369 patients undergoing cardiac surgery were enrolled. 205 patients received aprotinin and 164 received epsilon amino-caproic acid...... intraoperatively. Urinary NGAL was measured before and immediately after cardiac surgery and 3, 18 and 24 h later. The association of aprotinin use with the incidence of acute kidney injury (increase of serum creatinine >0.5 mg/dl) and NGAL levels was determined using logistic and linear regression models. RESULTS...

  15. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery

    DEFF Research Database (Denmark)

    Sibilitz, Kirstine L.; Berg, Selina K.; Rasmussen, Trine B.

    2016-01-01

    -educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36. Results: 76% were men, mean age 62 years.......40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Conclusions: Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other...... valve surgery. Methods: The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho...

  16. Divine Love and Deep Connections: A Long-Term Followup of Patients Surviving Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Amy L. Ai

    2011-01-01

    Full Text Available We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental, optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery.

  17. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Alireza Abdollahi Moghaddam

    2016-03-01

    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  18. Catecholamine and volume therapy for cardiac surgery in Germany--results from a postal survey.

    Directory of Open Access Journals (Sweden)

    Christoph Sponholz

    Full Text Available Management of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.Between April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.51 (63% questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure, supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%, epinephrine (30% or phosphodiesterase inhibitors (8% were first choice. In case of hypotension following vasoplegia, norepinephrine (96% represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES being first choice (64%.Choice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in

  19. Magnetic Resonance Imaging Evaluation of Cardiac Masses

    Energy Technology Data Exchange (ETDEWEB)

    Braggion-Santos, Maria Fernanda, E-mail: ferbraggion@yahoo.com.br [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Hospital Universitário - Universidade de Heidelberg, Heidelberg (Germany); Koenigkam-Santos, Marcel [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Hospital Universitário - Universidade de Heidelberg, Heidelberg (Germany); Teixeira, Sara Reis [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Volpe, Gustavo Jardim [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Divisão de Cardiologia - Universidade Johns Hopkins, Baltimore (United States); Trad, Henrique Simão [Centro de Ciências das Imagens e Física Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Schmidt, André [Divisão de Cardiologia do Departamento de Clínica Médica - Hospital das Clínicas - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2013-09-15

    Cardiac tumors are extremely rare; however, when there is clinical suspicion, proper diagnostic evaluation is necessary to plan the most appropriate treatment. In this context, cardiovascular magnetic resonance imaging (CMRI) plays an important role, allowing a comprehensive characterization of such lesions. To review cases referred to a CMRI Department for investigation of cardiac and paracardiac masses. To describe the positive case series with a brief review of the literature for each type of lesion and the role of cardiovascular magnetic resonance imaging in evaluation. Between August 2008 and December 2011, all cases referred for CMRI with suspicion of tumor involving the heart were reviewed. Cases with positive histopathological diagnosis, clinical evolution or therapeutic response compatible with the clinical suspicion and imaging findings were selected. Among the 13 cases included in our study, eight (62%) had histopathological confirmation. We describe five benign tumors (myxomas, rhabdomyoma and fibromas), five malignancies (sarcoma, lymphoma, Richter syndrome involving the heart and metastatic disease) and three non-neoplastic lesions (pericardial cyst, intracardiac thrombus and infectious vegetation). CMRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, contributing to a more accurate diagnosis in a noninvasive manner and assisting in treatment planning, allowing safe clinical follow-up with good reproducibility.

  20. SODIUM BICARBONATE INFUSION: TO PREVENT CARDIAC SURGERY - ASSOCIATED ACUTE KIDNEY INJURY

    Directory of Open Access Journals (Sweden)

    Ramesh

    2015-02-01

    Full Text Available OBJECTIVES: The incidence of cardiac surgery – associated acute kidney injury is 50% of patients and is associated with increased mortality and morbidity. This study aimed to determine if perioperative urinary and plasma alkalization with sodium bicarbonate infusion re duces the incidence of cardiac surgery – associated acute kidney injury. SETTING AND DESIGN: This study is double blind randomized control trial conducted at U N Mehta Institute of Cardiology and Research Center , India. METHOD S AND RESULT: A total of 140 pat ients scheduled to undergo elective cardiac surgery , who were at increased risk of development of cardiac surgery – associated acute kidney injury using recognized risk factors. Patients were randomly allocated to receive either sodium bicarbonate (n = 70 o r sodium chloride (n = 70 infusion , commencing at the start of anesthesia , in a dose of 4 mmol/kg over 24 hour. The primary outcome measure was the number of patients with development of CSA - AKI , defined as an increase in creatinine greater than 25% from baseline to peak value within the first three postoperative days. Significant differences among the groups in both plasma and urinary pH were achieved 6 hours after commencement of the infusion , and these changes persisted for more than 24 hours. A total o f 7 out of 70(10% patients in the sodium bicarbonate group and 16 out of 70(22.85% patients in the sodium chloride group developed acute kidney injury within the first three postoperative days with p value of 0.06 which is statistically not significant . There were also no significant differences in ventilation hours , ICU or hospital length of stay , or mortality. CONCLUSIONS: Perioperative alkalization of blood and urine using an infusion of sodium bicarbonate did not result in a decrease in the incidence of acute kidney injury in patients undergoing cardiac surgery. KEYWORDS: Acute kidney injury; Cardiac surgery; Cardiopulmonary bypass; Creatinine

  1. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2016-01-01

    Full Text Available Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF. Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE during cardiac surgery under hypothermic cardiopulmonary bypass (CPB. Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP, cardiac output (CO, SMABF, superior mesenteric artery (SMA diameter, superior mesentric artery blood flow over cardiac output (SMA/CO ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P 0.05 between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

  2. Bilateral diaphragm paralysis after simultaneous cardiac surgery and Nuss procedure in the infant

    Directory of Open Access Journals (Sweden)

    Yuichi Tabata

    2015-01-01

    Full Text Available The case of a 15-month-old boy with bilateral diaphragm paralysis after simultaneous cardiac surgery for tetralogy of Fallot, and Nuss procedure for pectus excavatum, is presented. Extubated one day after his first operation, the boy suffered severe respiratory distress soon after, due to bilateral diaphragmatic paralysis. Diaphragm paralysis restricted abdominal respiration, while thoracic respiration was inhibited by metallic bar after the Nuss Procedure, which combined prevented extubation for 47 days. Thoracoplasty, such as the Nuss Procedure, should not be performed simultaneously with cardiac surgery because abdominal and thoracic respiration can be restricted in infants, causing prolonged, severe, post-surgical respiratory failure.

  3. Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Sevuk U

    2015-06-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Rojhat Altindag,2 Baris Yaylak,2 Mehmet Sahin Adiyaman,2 Nurettin Ay,3 Vahhac Alp,3 Unal Beyazit,3 1Department of Cardiovascular Surgery, 2Department of Cardiology, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Objective: Postpericardiotomy syndrome (PPS, which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery. Methods: A total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray. Results: PPS incidence was significantly lower in patients who received diclofenac (20% vs 43% (P<0.001. Patients given diclofenac had a significantly lower incidence of pericardial effusion (15% vs 30% (P=0.01. Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07. Logistic regression analysis demonstrated that diclofenac administration (odds

  4. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    WANG Yun; YUE Yun; SUN Yong-hai; WU An-shi; WU Qi-wei; ZHANG Yong-qian; FENG Chun-sheng

    2005-01-01

    Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the

  5. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.

    Science.gov (United States)

    Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir

    2016-06-01

    In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

  6. Acute mediastinitis: multidetector computed tomography findings following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Macedo, Clarissa Aguiar de [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Instituto do Coracao (InCor)]. E-mail: clarissaaguiarm@yahoo.com.br; Baena, Marcos Eduardo da Silva [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Ultrasonography; Uezumi, Kiyomi Kato [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Computed Tomography; Castro, Claudio Campi de [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Unit of Magnetic Resonance Imaging; Lucarelli, Claudio Luiz [Instituto do Coracao (InCor), Sao Paulo, SP (Brazil). Center of Diagnosis; Cerri, Giovanni Guido [Universidade de Sao Paulo (USP), SP (Brazil). School of Medicine. Dept. of Radiology

    2008-07-15

    Postoperative mediastinitis is defined as an infection of the organs and tissues in the mediastinal space, with an incidence ranging between 0.4% and 5% of cases. This disease severity varies from infection of superficial tissues in the chest wall to fulminant mediastinitis with sternal involvement. Diagnostic criterion for postoperative detection of acute mediastinitis at computed tomography is the presence of fluid collections and gas in the mediastinal space, which might or might not be associated with peristernal abnormalities such as edema of soft tissues, separation of sternal segments with marginal bone resorption, sclerosis and osteomyelitis. Other associated findings include lymphadenomegaly, pulmonary consolidation and pleural/ pericardial effusion. Some of these findings, such as mediastinal gas and small fluid collections can be typically found in the absence of infection, early in the period following thoracic surgery where the effectiveness of computed tomography is limited. After approximately two weeks, computed tomography achieves almost 100% sensitivity and specificity. Patients with clinical suspicion of mediastinitis should be submitted to computed tomography for investigating the presence of fluid collections to identify the extent and nature of the disease. Multidetector computed tomography allows 3D images reconstruction, contributing particularly to the evaluation of the sternum. (author)

  7. The role of three-dimensional visualization in robotics-assisted cardiac surgery

    Science.gov (United States)

    Currie, Maria; Trejos, Ana Luisa; Rayman, Reiza; Chu, Michael W. A.; Patel, Rajni; Peters, Terry; Kiaii, Bob

    2012-02-01

    Objectives: The purpose of this study was to determine the effect of three-dimensional (3D) versus two-dimensional (2D) visualization on the amount of force applied to mitral valve tissue during robotics-assisted mitral valve annuloplasty, and the time to perform the procedure in an ex vivo animal model. In addition, we examined whether these effects are consistent between novices and experts in robotics-assisted cardiac surgery. Methods: A cardiac surgery test-bed was constructed to measure forces applied by the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) during mitral valve annuloplasty. Both experts and novices completed roboticsassisted mitral valve annuloplasty with 2D and 3D visualization. Results: The mean time for both experts and novices to suture the mitral valve annulus and to tie sutures using 3D visualization was significantly less than that required to suture the mitral valve annulus and to tie sutures using 2D vision (p∠0.01). However, there was no significant difference in the maximum force applied by novices to the mitral valve during suturing (p = 0.3) and suture tying (p = 0.6) using either 2D or 3D visualization. Conclusion: This finding suggests that 3D visualization does not fully compensate for the absence of haptic feedback in robotics-assisted cardiac surgery. Keywords: Robotics-assisted surgery, visualization, cardiac surgery

  8. Impact of mild renal impairment on early postoperative mortality after open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Ghani A

    2010-01-01

    Full Text Available Preoperative severe renal impairment is included in the risk scores to predict out-come after open cardiac surgery. The purpose of this study was to assess the impact of pre-operative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collec-ted. Cases with preoperative creatinine clearance below 60 mL/min were excluded from the study. Data were retrospectively analyzed to find the impact of renal impairment on short-term outcome. Of the 500 cases studied, 47 had preoperative creatinine clearance between 89-60 mL/min. The overall mortality in the study cases was 6.8%. The mortality was 28.7% in those who developed postoperative ARF, 33.3% in those who required dialysis and 40.8% in those with preoperative mild renal impairment. Binary logistic regression analysis showed that female gender (P = 0.01, preoperative mild renal impairment (P = 0.007 as well as occurrence of multi organ failure (P < 0.001 were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.

  9. Cardiac function in total anomalous pulmonary venous return before and after surgery.

    Science.gov (United States)

    Mathew, R; Thilenius, O G; Replogle, R L; Arcilla, R A

    1977-02-01

    Cardiac performance was evaluated in 12 infants with isolated total anomalous pulmonary venous return. Four had significant pulmonary venous obstruction and severe pulmonary hypertension (group A). Eight had no obvious venous obstruction, and the pulmonary pressures were lower (group B). In all subjects, right ventricular end-diastolic volume was increased (197% of predicted normal) and its ejection fraction was normal. Left ventricular volume was, generally speaking, still in the normal range (87% of predicted normal); however, its ejection fraction was reduced (0.57 vs normal of 0.73) and left ventricular output was low (3.08 L/min/m2 vs normal of 3.98). Left atrial volume was consistently small (53% of predicted normal) with an appendage of normal size. The infants in group A had smaller chamber volumes/m2 BSA than those in group B. Left atrial function was abnormal, characterized by reduced reservoir function and a greater role as "conduit" from right atrium to left ventricle. Left atrial size was not found to be critical in the surgical repair of TAPVR. Cardiac function is restored to normal following surgery.

  10. Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery

    DEFF Research Database (Denmark)

    Gu, Jiwei; Skals, Regitze Kuhr; Torp-Pedersen, Christian

    2017-01-01

    BACKGROUND: Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is assoc......BACKGROUND: Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC...... is associated with development of POAF. MATERIALS AND METHODS: Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University...

  11. Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients

    DEFF Research Database (Denmark)

    Jakobsen, Carl-Johan; Ryhammer, Pia Katarina; Jensen, Mariann Tang

    2012-01-01

    Numerous reports have emphasized the need for reduction in transfusions of allogeneic red blood cells (RBC) due to increased morbidity and mortality. Nevertheless, transfusion rates are still high in several cardiac surgery institutions. Reports on long-term survival after cardiac surgery and RBC...

  12. Pain after Cardiac Surgery: A Review of the Assessment and Management

    Directory of Open Access Journals (Sweden)

    Parizad Razieh

    2014-10-01

    Full Text Available Objective: Surgery is among the causes of acute pain. One of the major problems of patients after surgical procedures is postoperative pain. Annually, millions of people throughout the world undergo surgery and experience different intensities of postoperative pain. Due to physiological changes and given the stability of the heart and lung, the management and control of pain is rarely considered as a priority in the care of patients after cardiac surgery. Cardiac surgical patients experience pain due to the surgical incision and between the ribs nerve injury created during the course of the surgery, and irritation and inflammation of the pleura by catheters. Control and management of pain in intensive care units (ICU are the main tasks in nursing care. The purpose of this review study was the investigation, assessment, and management of pain in patients after cardiac surgery. Materials and Methods: In this study, the literature available on Magiran, Google Scholar, ScienceDirect, and PubMed were collected, and after reviewing, the relevant literature was studied. Results: Although pain is one of the major stressors in patients undergoing surgery, the measures taken for the treatment and care of these patients are associated with experiencing pain. In this regard, all the resources have emphasized the using of guidelines and tools to assess patients' pain. However, in cardiac surgery patients, sufficient attention is not paid to pain control. Patients reported poorly controlled pain and experiences of moderate to severe pain after surgery. Conclusion: Pain is a subjective experience, and in patients who cannot report their pain, it should be considered important. According to numerous studies, pain control is not performed in ICUs. Thus, efforts should be made for appropriate control and reduction of pain, use of valid methods to determine and control pain, and improvement of the quality of the programs.

  13. Anesthetic challenges in minimally invasive cardiac surgery: Are we moving in a right direction?

    Directory of Open Access Journals (Sweden)

    Vishwas Malik

    2016-01-01

    Full Text Available Continuously growing patient′s demand, technological innovation, and surgical expertise have led to the widespread popularity of minimally invasive cardiac surgery (MICS. Patient′s demand is being driven by less surgical trauma, reduced scarring, lesser pain, substantially lesser duration of hospital stay, and early return to normal activity. In addition, MICS decreases the incidence of postoperative respiratory dysfunction, chronic pain, chest instability, deep sternal wound infection, bleeding, and atrial fibrillation. Widespread media coverage, competition among surgeons and hospitals, and their associated brand values have further contributed in raising awareness among patients. In this process, surgeons and anesthesiologist have moved from the comfort of traditional wide incision surgeries to more challenging and intensively skilled MICS. A wide variety of cardiac lesions, techniques, and approaches coupled with a significant learning curve have made the anesthesiologist′s job a challenging one. Anesthesiologists facilitate in providing optimal surgical settings beginning with lung isolation, confirmation of diagnosis, cannula placement, and cardioplegia delivery. However, the concern remains and it mainly relates to patient safety, prolonged intraoperative duration, and reduced surgical exposure leading to suboptimal treatment. The risk of neurological complications, aortic injury, phrenic nerve palsy, and peripheral vascular thromboembolism can be reduced by proper preoperative evaluation and patient selection. Nevertheless, advancement in surgical instruments, perfusion practices, increasing use of transesophageal echocardiography, and accumulating experience of surgeons and anesthesiologist have somewhat helped in amelioration of these valid concerns. A patient-centric approach and clear communication between the surgeon, anesthesiologist, and perfusionist are vital for the success of MICS.

  14. The analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Dalia Abdelhamid Nasr

    2015-01-01

    Full Text Available Background: Median sternotomy, sternal spreading, and sternal wiring are the main causes of pain during the early recovery phase following cardiac surgery. Aim: This study was designed to evaluate the analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after parasternal block following cardiac surgery. Materials and Methods: The total of 40 patients (American Society of Anesthesiologist status II, III, 45-60 years old, undergoing coronary - artery bypass grafting were enrolled in this prospective, randomized, double-blind study. A presternal catheter was inserted with continuous infusion of 5 mL/h bupivacaine 0.25% (Group B or normal saline (Group C during the first 48 postoperative hrs. Primary outcomes were postoperative morphine requirements and pain scores, secondary outcomes were extubation time, postoperative respiratory parameters, incidence of wound infection, Intensive Care Unit (ICU and hospital stay duration, and bupivacaine level in blood. Statistical Methods: Student′s t-test was used to analyze the parametric data and Chi-square test for categorical variables. Results: During the postoperative 48 h, there was marked reduction in morphine requirements in Group B compared to Group C, (8.6 ± 0.94 mg vs. 18.83 ± 3.4 mg respectively, P = 0.2, lower postoperative pain scores, shorter extubation time (117 ± 10 min vs. 195 ± 19 min, respectively, P = 0.03, better respiratory parameters (PaO 2 /FiO 2, PaCO 2 and pH, with no incidence of wound infection, no differences in ICU or hospital stay duration. The plasma concentration of bupivacaine remained below the toxic threshold (at T24, 1.2 ug/ml ± 0.3 and T48 h 1.7 ± 0.3 ug/ml. Conclusion: Continuous presternal bupivacaine infusion has resulted in better postoperative analgesia, reduction in morphine requirements, shorter time to extubation, and better postoperative respiratory parameters than the control group.

  15. Population pharmacokinetics of remifentanil in infants and children undergoing cardiac surgery

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    Hammer Gregory B

    2009-07-01

    Full Text Available Abstract Background The aim of this study was to provide a model-based analysis of the pharmacokinetics of remifentanil in infants and children undergoing cardiac surgery with cardiopulmonary bypass (CPB. Methods We studied nine patients aged 0.5 to 4 years who received a continuous remifentanil infusion via a computer-controlled infusion pump during cardiac surgery with mildly hypothermic CPB were studied. Arterial blood samples taken prior to, during and after CPB were analyzed for remifentanil concentrations using a validated gas-chromatographic mass-spectrophotometric assay. We used population mixed-effects modeling to characterize remifentanil pharmacokinetics. The final model was evaluated by its predictive performance. Results The pharmacokinetics of remifentanil was described by a 1-compartment model with adjustments for CPB. Population mean parameter estimates were 1.41 L for volume of distribution (V and 0.244 L/min for clearance. V was increased during CPB and post-CPB to 2.41 times the pre-CPB value. The median prediction error and the median of individual median absolute prediction error were 2.44% and 21.6%, respectively. Conclusion Remifentanil dosage adjustments are required during and after CPB due to marked changes in the V of the drug. Simulations indicate that a targeted blood concentration of 14 ng/mL is achieved and maintained in 50% of typical patients by administration of an initial dose of 18 μg remifentanil followed by an infusion of 3.7 μg/min before, during and post-CPB, supplemented with a bolus dose of 25 μg given at the start of CPB.

  16. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Gluud, Christian;

    2006-01-01

    Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University...... anaesthesia and surgical centres and one coordinating centre. Participants 921 patients aged > 39 scheduled for major non-cardiac surgery. Interventions 100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days. Main outcome...... was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of 459...

  17. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

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    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  18. Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery

    OpenAIRE

    Hausenloy, DJ; Candilio, L.; Evans, R.; Ariti, C.; Jenkins, DP; Kolvekar, S.; Knight, R.; Laing, C; J. Nicholas; Pepper, J.; Robertson, S; Clayton, T.; Yellon, DM; ERICCA Trial Investigators; GOSS, A.

    2015-01-01

    BACKGROUND: Whether remote ischemic preconditioning (transient ischemia and reperfusion of the arm) can improve clinical outcomes in patients undergoing coronary-artery bypass graft (CABG) surgery is not known. We investigated this question in a randomized trial. / METHODS: We conducted a multicenter, sham-controlled trial involving adults at increased surgical risk who were undergoing on-pump CABG (with or without valve surgery) with blood cardioplegia. After anesthesia induction and before ...

  19. Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery

    OpenAIRE

    Fatina I Fadel; Abdel Rahman, Azza M.O.; Mohamed, Mohamed Farouk; Habib, Sonia A.; Ibrahim, Mona H.; Sleem, Zeinab S.; Bazaraa, Hafez M; Soliman, Mohamed M.A.

    2012-01-01

    Introduction Cardiopulmonary bypass (CPB) surgery is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) represents a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in pediatric cardiac surgery. Material and methods The study included forty children aged 2 to 78 months undergoing CPB. They were divided into group I: pat...

  20. Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden

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    Westerdahl Elisabeth

    2010-08-01

    Full Text Available Abstract Background Limited published data are available on how patients are mobilized and exercised during the postoperative hospital stay following cardiac surgery. The aim of this survey was to determine current practice of physiotherapy-supervised mobilization and exercise following cardiac surgery in Sweden. Methods A prospective survey was carried out among physiotherapists treating adult cardiac surgery patients. A total population sample was identified and postal questionnaires were sent to the 33 physiotherapists currently working at the departments of thoracic surgery in Sweden. In total, 29 physiotherapists (response rate 88% from eight hospitals completed the survey. Results The majority (90% of the physiotherapists offered preoperative information. The main rationale of physiotherapy treatment after cardiac surgery was to prevent and treat postoperative complications, improve pulmonary function and promote physical activity. In general, one to three treatment sessions were given by a physiotherapist on postoperative day 1 and one to two treatment sessions were given during postoperative days 2 and 3. During weekends, physiotherapy was given to a lesser degree (59% on Saturdays and 31% on Sundays to patients on postoperative day 1. No physiotherapy treatment was given in the evenings. The routine use of early mobilization and shoulder range of motion exercises was common during the first postoperative days, but the choice of exercises and duration of treatment varied. Patients were reminded to adhere to sternal precautions. There were great variations of instructions to the patients concerning weight bearing and exercises involving the sternotomy. All respondents considered physiotherapy necessary after cardiac surgery, but only half of them considered the physiotherapy treatment offered as optimal. Conclusions The results of this survey show that there are small variations in physiotherapy-supervised mobilization and exercise

  1. Urinary neutrophil gelatinase-associated lipocalin time course during cardiac surgery

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    Elena Bignami

    2015-01-01

    Full Text Available Background: NGAL is one of the most promising AKI biomarkers in cardiac surgery. However, the best timing to dose it and the reference values are still matter of discussion. Aim of the Study: We performed a uNGAL perioperative time course, to better understand its perioperative kinetics and its role in AKI diagnosis. Setting of the Study: San Raffaele University Hospital, cardiac surgery department. Material and Methods: We enrolled in this prospective observational study 19 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB. Based on preoperative characteristics, they were divided in low-risk and high-risk patients. uNGAL measurements were collected at pre-defined times before, during, and up to 24 hours after surgery. Statistical Analysis: Data were analysed by use of SAS 1999-2001 program or IBM SPSS Statistics. Results: In low-risk patients, uNGAL had the highest value immediately after general anesthesia induction (basal dosage: uNGAL: 12.20ng×ml -1 , IQR 14.00. It later decreased significantly (3.40 ng×ml -1 , IQR 4.80; P = 0.006 during CPB, and finally return to its original value 24 hours after surgery. In high-risk patients, uNGAL increased immediately after surgery; it had the highest value on ICU arrival (38,20 ng×ml -1 ; IQR 133,10 and remained high for several hours. A difference in uNGAL levels between the two groups was already observed at the end of surgery, but it became statistically significant on ICU arrival (P = 0.002. Conclusion: This study helps to better understand the different kinetics of this new biomarker in low-risk and high-risk cardiac patients.

  2. Major cardiac surgery induces an increase in sex steroids in prepubertal children.

    Science.gov (United States)

    Heckmann, Matthias; d'Uscio, Claudia H; de Laffolie, Jan; Neuhaeuser, Christoph; Bödeker, Rolf-Hasso; Thul, Josef; Schranz, Dietmar; Frey, Brigitte M

    2014-03-01

    While the neuroprotective benefits of estrogen and progesterone in critical illness are well established, the data regarding the effects of androgens are conflicting. Surgical repair of congenital heart disease is associated with significant morbidity and mortality, but there are scant data regarding the postoperative metabolism of sex steroids in this setting. The objective of this prospective observational study was to compare the postoperative sex steroid patterns in pediatric patients undergoing major cardiac surgery (MCS) versus those undergoing less intensive non-cardiac surgery. Urinary excretion rates of estrogen, progesterone, and androgen metabolites (μg/mmol creatinine/m(2) body surface area) were determined in 24-h urine samples before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled MCS and in 17 control children undergoing conventional non-cardiac surgery. Eight of the MCS patients had Down's syndrome. There were no significant differences in age, weight, or sex between the groups. Seven patients from the MCS group showed multi-organ dysfunction after surgery. Before surgery, the median concentrations of 17β-estradiol, pregnanediol, 5α-dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA) were (control/MCS) 0.1/0.1 (NS), 12.4/11.3 (NS), 4.7/4.4 (NS), and 2.9/1.1 (p=0.02). Postoperatively, the median delta 17β-estradiol, delta pregnanediol, delta DHT, and delta DHEA were (control/MCS) 0.2/6.4 (p=0.0002), -3.2/23.4 (p=0.013), -0.6/3.7 (p=0.0004), and 0.5/4.2 (p=0.004). Postoperative changes did not differ according to sex. We conclude that MCS, but not less intensive non-cardiac surgery, induced a distinct postoperative increase in sex steroid levels. These findings suggest that sex steroids have a role in postoperative metabolism following MCS in prepubertal children.

  3. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury

    NARCIS (Netherlands)

    Kiers, H.D.; Boogaard, M.H.W.A. van den; Schoenmakers, M.C.J.; Hoeven, J.G. van der; Swieten, H.A. van; Heemskerk, S.; Pickkers, P.

    2013-01-01

    BACKGROUND: Cardiac surgery-related acute kidney injury (CS-AKI) results in increased morbidity and mortality. Different models have been developed to identify patients at risk of CS-AKI. While models that predict dialysis and CS-AKI defined by the RIFLE criteria are available, their predictive powe

  4. Health outcomes with and without use of inotropic therapy in cardiac surgery

    DEFF Research Database (Denmark)

    Nielsen, Dorthe Viemose; Hansen, Malene Kærslund; Johnsen, Søren Paaske;

    2014-01-01

    BACKGROUND: Inotropes used to obtain short-term hemodynamic benefits in cardiac surgery may carry a risk of increased myocardial ischemia and adverse outcomes. This study investigated the association between intra- and postoperative use of inotropes and mortality and postoperative complications. ...

  5. Mallory-Weiss tear following cardiac surgery : transoesophageal echoprobe or nasogastric tube?

    NARCIS (Netherlands)

    De Vries, AJ; van der Maaten, JMAA; Laurens, RRP

    2000-01-01

    A case of fatal upper gastrointestinal bleeding from a Mallory-Weiss tear after transoesophageal echocardiography during cardiac surgery is reported. After the echocardiographic examination, which is considered a safe procedure, a nasogastric tube was inserted which immediately revealed bright red b

  6. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    Science.gov (United States)

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  7. Daptomycin as supportive treatment option in patients developing mediastinitis after open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Weis Florian

    2012-09-01

    Full Text Available Abstract Background Mediastinitis is a severe complication after cardiac surgery. While improvement of prophylaxis and of medical and surgical therapy has reduced its incidence, the treatment of mediastinitis continues to be a challenging problem. Within this study, we report the successful use of daptomycin as supportive therapy in patients developing mediastinitis after open cardiac surgery. Methods The records of 21 consecutive patients who developed mediastinitis after cardiac surgery were retrospectively reviewed. After diagnosis, all patients received surgical debridement and antibiotic therapy with daptomycin. All patients were followed up to death or discharge. Results Clinical improvement after combined surgical and antibiotic therapy with daptomycin was found in 90.5% of the patients. The median time until clinical improvement occurred was 5 [4/6] days. Daptomycin was well-tolerated and no major adverse events during therapy were observed observed. Conclusions This study provides new and helpful information regarding the beneficial use of daptomycin as supportive treatment option in patients developing mediastinitis after cardiac surgery.

  8. Comparison of Transcutaneous Electrical Nerve Stimulation and Parasternal Block for Postoperative Pain Management after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Nilgun Kavrut Ozturk

    2016-01-01

    Full Text Available Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229.

  9. Imaging of the distal ascending aorta using modified transesophageal echocardiography in cardiac surgery

    NARCIS (Netherlands)

    van Zaane, B.

    2009-01-01

    Epiaortic ultrasound scanning of the ascending aorta is a safe and useful method to detect atherosclerosis in patients undergoing cardiac surgery. The use of epiaortic ultrasound can lead to modifications of the surgical technique, which effectively reduces the post-operative incidence of stroke in

  10. Intraoperative High-Dose Dexamethasone and Severe AKI after Cardiac Surgery

    NARCIS (Netherlands)

    Jacob, Kirolos A.; Leaf, David E.; Dieleman, Jan M.; van Dijk, Diederik; Nierich, Arno P.; Rosseel, Peter M.; Maaten, van der Joost M.; Hofland, Jan; Diephuis, Jan C.; de Lange, Fellery; Boer, Christine; Kluin, Jolanda; Waikar, Sushrut S.

    2015-01-01

    Administration of prophylactic glucocorticoids has been suggested as a strategy to reduce postoperative AKI and other adverse events after cardiac surgery requiring cardiopulmonary bypass. In this post hoc analysis of a large placebo-controlled randomized trial of dexamethasone in 4465 adult patient

  11. Endotoxin release in cardiac surgery with cardiopulmonary bypass : pathophysiology and possible therapeutic strategies. An update

    NARCIS (Netherlands)

    Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim

    2011-01-01

    Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome

  12. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    André Luiz Lisboa Cordeiro

    Full Text Available Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54% males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073 and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031. Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

  13. SHEAR-INDUCED PATHWAY OF PLATELET-FUNCTION IN CARDIAC-SURGERY

    NARCIS (Netherlands)

    TABUCHI, N; TIGCHELAAR, [No Value; VANOEVEREN, W

    1995-01-01

    The contribution of platelet dysfunction to the impaired hemostasis after cardiac surgery remains to be established, because there is no sensitive method to assess platelet function. Measurement of the shear-induced pathway of platelet function, an important mechanism in inducing hemostasis, became

  14. Interdisciplinary preoperative patient education in cardiac surgery: effects of the implementation of an information protocol.

    NARCIS (Netherlands)

    Tromp, F.; Dulmen, S. van; Weert, J. van

    2004-01-01

    Background: In 1998, we carried out a study of interdisciplinary preoperative education in cardiac surgery given by nurses, physicians and health educators. Overlaps were found in gathering and providing information by physicians, nurses and health educators, and gaps were found in providing psychos

  15. Tools for precision enhancement in minimally invasive cardiac surgery: three dimensional visualization, computer enhancement and robotics.

    Science.gov (United States)

    Shennib, H

    1999-11-01

    This article is a current update of the rationale for development of new enabling technologies in minimally invasive cardiac surgery. Specifically the potential advantages of three dimensional visualization, computer enhancement technology and robotics in performance of totally endoscopic coronary artery bypass grafts will be addressed.

  16. Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Camila Takao Lopes

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify predictors of red blood cell transfusion (RBCT after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

  17. Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR)

    DEFF Research Database (Denmark)

    Sibilitz, Kirstine Laerum; Berg, Selina Kikkenborg; Hansen, Tina Birgitte

    2013-01-01

    replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce...

  18. Ibuprofen - a Safe Analgesic During Cardiac Surgery Recovery? A Randomized Controlled Trial?

    Directory of Open Access Journals (Sweden)

    Saddiq Mohammad Qazi

    2015-12-01

    Conclusion: The results of this study suggest that patients treated postoperatively, following cardiac surgery, are at no greater risk of harm if short term slow release ibuprofen combined with lansoprazole treatment is used when compared to an oxycodone based regimen. Renal function should, however, be closely monitored and in the event of any decrease in renal function ibuprofen must be discontinued.

  19. Mixed venous O2 saturation and fluid responsiveness after cardiac or major vascular surgery

    NARCIS (Netherlands)

    A.N. Kuiper (Arjan); R.J. Trof (R.); A.B.J. Groeneveld (Johan)

    2013-01-01

    textabstractBackground: It is unclear if and how SvO2 can serve as an indicator of fluid responsiveness in patients after cardiac or major vascular surgery.Methods: This was a substudy of a randomized single-blinded clinical trial reported earlier on critically ill patients with clinical hypovolemia

  20. Ex-vivo response to blood products and haemostatic agents after paediatric cardiac surgery

    DEFF Research Database (Denmark)

    Hvas, Anne-Mette; Andreasen, Jo B; Christiansen, Kirsten

    2013-01-01

    of fibrinogen concentrate, FFP or tranexamic acid improved clot stability significantly. Whole blood coagulation was significantly impaired after cardiac surgery in children. Ex-vivo studies showed a total reversal of the coagulopathy after addition of pooled platelets and significantly improved clot stability...

  1. Anesthesia for robotic cardiac surgery: An amalgam of technology and skill

    Directory of Open Access Journals (Sweden)

    Chauhan Sandeep

    2010-01-01

    Full Text Available The surgical procedures performed with robtic assitance and the scope for its future assistance is endless. To keep pace with the developing technologies in this field it is imperative for the cardiac anesthesiologists to have aworking knowledge of these systems, recognize potential complications and formulate an anesthetic plan to provide safe patient care. Challenges posed by the use of robotic systems include, long surgical times, problems with one lung anesthesia in presence of coronary artery disease, minimally invasive percutaneous cardiopulmonary bypass management and expertise in Trans-Esophageal Echocardiography. A long list of cardiac surgeries are performed with the use of robotic assistance, and the list is continuously growing as surgical innovation crosses new boundaries. Current research in robotic cardiac surgery like beating heart off pump intracardic repair, prototype epicardial crawling device, robotic fetal techniques etc. are in the stage of animal experimentation, but holds a lot of promise in future

  2. Peri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence.

    Science.gov (United States)

    Shi, William Y; Li, Sheila; Collins, Nicholas; Cottee, David B; Bastian, Bruce C; James, Allen N; Mejia, Ross

    2015-07-01

    Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.

  3. Cardiac safety in vascular access surgery and maintenance.

    Science.gov (United States)

    Malik, Jan; Kudlicka, Jaroslav; Tesar, Vladimir; Linhart, Ales

    2015-01-01

    More than 50% of all end-stage renal disease (ESRD) patients die from cardiovascular complications. Among them, heart failure and pulmonary hypertension play a major role, and published studies document significantly higher mortality rates in patients with these two states. Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred types of vascular access (VA). However, both AVF and AVG increase cardiac output and in turn could contribute to (the decompensation of) heart failure or pulmonary hypertension. No really safe access flow volume exists, and the ESRD patients' reactions to it vary considerably. We review the mechanisms involved in the cardiovascular consequences of increased cardiac output and available literary data. The link between access flow volume and increased mortality due to pulmonary hypertension or heart failure probably exists, but still has not been directly evidenced. Regular echocardiography is advisable especially in patients with symptoms or with high VA flow (>1,500 ml/min).

  4. History of cardiac surgery in Germany--in consideration of her relation to the German Cardiac Society.

    Science.gov (United States)

    Bircks, W

    2002-01-01

    As late as the end of World War II (1945), cardiac surgery did not play a clinical role worldwide. Successful cardiac operations were singular events often caused by unexpected circumstances. In contrast, the first successful suture of a cardiac stab wound by Ludwig Rehn (1896 in Frankfurt am Main) followed after experimental investigation of this topic in the laboratory. With a certain justification, this event can be mentioned as the beginning of clinical cardiac surgery. Operative procedures in patients with constrictive pericarditis followed, at that time, the ideas of Ludolf Brauer (precordial pericardiolysis) and were developed to perfection by Viktor Schmieden (subtotal pericardiectomy) during the 1920s. The first successful pulmonary embolectomy was performed in 1924 by Martin Kirschner; up to this date the sometimes used method of Friedrich Trendelenburg, already described in 1908, remained without success. The first successful operation of a ventricular aneurysm by Ferdinand Sauerbruch (1931) and the first successful closure of a patent duct (Botalli) by Emil Karl Frey (1938) occurred during operations undertaken under the circumstances of a preoperatively incorrect diagnosis. The results of the important experimental work of Ernst Jeger (monography 1913) and the first catheterization of the human heart by Werner Forssmann (1931) were not noticed by the surgical community at that time. In contrast to the time before World War II, in which German surgery was at the forefront, after the war there was a commanding need to approach the scientific and clinical level that meanwhile had been developed in the western countries, while there had been a standstill in Germany caused by its isolation since 1933 and the war since 1939. Surgeons in western Europe, the United States of America, and in Canada proved to be real friends. After one to two decades, the international clinical and scientific standard could be reached at some sites. A widespread clinical care

  5. Perioperative complications of cardiac surgery and postoperative care.

    Science.gov (United States)

    Nearman, Howard; Klick, John C; Eisenberg, Paul; Pesa, Nicholas

    2014-07-01

    The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion.

  6. Contaminated heparin and outcomes after cardiac surgery: a retrospective propensity-matched cohort study.

    Directory of Open Access Journals (Sweden)

    Heiko A Kaiser

    Full Text Available During 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU stay and heparin-induced thrombocytopenia following adult cardiac surgery.We conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years. Perioperative data were obtained from the institutional record of the Society of Thoracic Surgeons National Database, for which the data collection is prospective, standardized and performed by independent investigators. After matching, logistic regression was performed to evaluate the independent effect of CH on the composite adverse outcome (myocardial infarction, stroke, pneumonia, dialysis, cardiac arrest and on mortality. Cox regression was used to determine the association between CH and ICU length of stay. The 1∶5 matched groups included 220 patients potentially exposed to CH and 918 controls. There were more adverse outcomes in the exposed cohort (20.9% versus 12.0%; difference  =  8.9%; 95% CI 3.6% to 15.1%, P < 0.001 with an odds ratio for CH of 2.0 (95% CI, 1.4 to 3.0, P < 0.001. In the exposed group there was a non-significant increase in mortality (5.9% versus 3.5%, difference = 2.4%; 95% CI, -0.4 to 3.5%, P  =  0.1, the median ICU stay was longer by 14.1 hours (interquartile range -26.6 to 79.8, S = 3299, P = 0.0004 with an estimated hazard ratio for CH of 1.2 (95% CI, 1.0 to 1.4, P = 0.04. There was no difference in nadir platelet counts between cohorts.The results from this single center study suggest the possibility that contaminated heparin might have contributed to serious morbidity following cardiac surgery.

  7. Risk factors for transient dysfunction of gas exchange after cardiac surgery

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    Cristiane Delgado Alves Rodrigues

    2015-02-01

    Full Text Available Objective: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results: Fifteen patients had acute respiratory distress syndrome (2%, 199 (27.75% had mild transient dysfunction of gas exchange, 402 (56.1% had moderate transient dysfunction of gas exchange, and 39 (5.4% had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively. Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03. Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001. Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005, hemotherapy (P=0.0001, enteral nutrition (P=0.0012, or cardiac arrhythmia (P=0.0451. Conclusion: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and

  8. Cardiac surgery of premature and low birthweight newborns: is a change of fate possible?

    Science.gov (United States)

    Alkan-Bozkaya, Tijen; Türkoğlu, Halil; Akçevin, Atif; Paker, Tufan; Ozkan-Çerçi, Hilda; Dindar, Aygün; Ersoy, Cihangir; Bayer, Vedat; Aşkin, Demet; Undar, Akif

    2010-11-01

    Low birthweight (LBW) continues to be a high-risk factor in surgery for congenital heart disease. This risk is particularly very high in very low birthweight infants under 1500g and extremely LBW infants under 1000g. From January 2005 to December 2008, 33 consecutive LBW neonates underwent cardiac surgery in our clinic in keeping with the criteria for choice of surgery. Their weight range was between 800 and 1900g. Nine of them were under 1000g. Cardiopulmonary bypass (CPB) was used in 17 patients (39.5%) and pulsatile perfusion mode was applied to patients in the CPB group. The same surgical team operated to achieve palliation (8 patients, 24.2%) or full repair (25 patients, 75.8%). Median gestational age was 36 weeks with 12 (36.4%) premature babies (≤37 weeks). Median age at operation was 5 days. Pathologies were single ventricle (n=3), pulmonary atresia-ventricular septal defect (n=3), aortic coarctation (n=10), aorticopulmonary window and interrupted aortic arch combination (n=6), patent arterial duct (n=11), critical aortic stenosis (n=8), and tetralogy of Fallot with pulmonary atresia (n=2). One infant had VATER syndrome. Selective cerebral perfusion technique was used in complex arch pathologies for cerebral protection. Median follow-up was 14 months. There were four early postoperative deaths. None of the cases showed a need for early reoperation. The acceptable early- and midterm mortality rates in this group suggest that these operations can be successfully performed. There is a need for further multicenter studies to evaluate these high-risk groups.

  9. Predictors of Acute Renal Failure During Extracorporeal Membrane Oxygenation in Pediatric Patients After Cardiac Surgery.

    Science.gov (United States)

    Lv, Lin; Long, Cun; Liu, Jinping; Hei, Feilong; Ji, Bingyang; Yu, Kun; Hu, Qiang; Hu, Jinxiao; Yuan, Yuan; Gao, Guodong

    2016-05-01

    Acute renal failure (ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine (SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin (FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO (OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO (OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB (Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO (Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery.

  10. Exercise-based cardiac rehabilitation for adults after heart valve surgery

    DEFF Research Database (Denmark)

    Sibilitz, Kirstine Lærum; Berg, Selina Kikkenborg; Tang, Lars Hermann

    2016-01-01

    BACKGROUND: Exercise-based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise-based intervention programmes following heart valve surgery. OBJECTIVES: To assess the benefits and harms of exercise......-based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or without another intervention (such as a psycho-educational component). SEARCH METHODS: We searched...... handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled-trials.com, and The World Health Organization International Clinical Trials Registry Platform). SELECTION CRITERIA: We included randomised clinical trials that investigated exercise...

  11. Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Massimo Giordan; Loris Roncon; Emiliano Bedendo; Tranquillo Milan; Giorgio Rigatelli

    2006-01-01

    Background and objectives Peripheral vascular disease (PVD) is a major risk factor in candidates for cardiac surgery and can impact morbidity and mortality in the perioperative and follow-up period. Elderly patients with PVD may benefit from endovascular treatment prior to cardiac surgery. We sought to assess the common clinical settings requiring prophylactic endovascular treatment before coronary surgery in elderly patients, the results, and the mid-term impact on subsequent revascularization. Methods Between November 2002 and June 2006, 37 patients (25 males, mean age 79.9±8.3 years, mean serum creatinine 1.9±0.6 mg/dl) underwent endovascular repair of PVD before cardiac surgery. For each patient, diagnostic methods, indications for intervention, types of interventions, procedural success, and complications were recorded. Results Four clinical settings were identified: renal artery stenting prior to coronary surgery (7 patients), iliac artery angioplasty and stenting (10 patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting prior to utilization of ipsilateral arterial conduits bypass surgery (5patients), and carotid artery stenting before coronary surgery (15 patients). Technical success was achieved in all patients (100%);complications included brachial artery occlusion (1 patient), minor stroke (2 patients), contrast nephropathy (1 patient), and minor bleeding at the puncture site (3 patients). All patients underwent successful coronary or valvular surgery; no patients died in the perioperative period. After a mean follow-up of 26.6±3.1 months, all patients are alive and free from anginal symptoms or valvular dysfunction without clinical or Doppler ultrasonography evidence of restenosis of the implanted peripheral vascular stents. Conclusions It is not unusual for elderly patients who are candidates for cardiac surgery to require endovascular intervention for significant PVD prior to

  12. EVALUATION OF CARDIAC MURMURS IN NEONATES

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    Chakravathy

    2015-10-01

    Full Text Available BACKGROUND: Cardio vascular malformations are the most common congenital malformations. Early recognition of congenital heart disease is important in the neonatal period, as many of them may be fatal if undiagnosed. AIM : To study the epidemiology of neonatal cardiac murmurs. To identify clinical characteristics which differentiates pathological murmur from functional murmurs to assess the reliability of clinical evaluation in diagnosing congenital heart diseas e? METHODS : The study population included all neonates admitted in a Hospital in Visakhapatnam to the NICU, postnatal ward, attending pediatric OPD and were detected to have cardiac murmurs. It was a cross sectional study over a period of 16 months. A clinical diagnosis was made based on history and clinical examination. Then Chest X ray and ECG were done in symptomatic infants. Echo cardiography was done in all neonates for confirmation of diagnosis, the neonates were again examined daily till they were in hospital and during the follow up visit at 6 weeks. RESULTS : A total of 61 neonates were included and was conducted over a period of 16 months . T he incidence of cardiac murmurs among intramural neonates was 13.5 for 1000 live births. Most frequent symptom was fast breathing in 10[16.4%] cases. VSD was the most common diagnosis clinically in 19[31.47%] babies. The most frequent diagnosis was acyanotic complex congenital heart disease, Only intra mural neonates were considered for the incidence of murmurs and the incidence of cardiac murmurs among them babies was 13.5 for 1000 live in 23[37.7%] cases followed by 10[16.4%] cases each of VSD and ASD respectively. Overall in our study 73.77% [45 cases] of the murmurs were diagnosed correctly and confirmed by Echocardiography. INTERPRETATIONS & CONCLUSIONS: 1. It is possible to make clinical diagnosis in many cases of congenital heart diseases. 2. The functional murmurs could be differentiated from those arising from structural heart

  13. Evaluation of results in coronary surgery using EuroSCORE

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    Mihajlović Bogoljub

    2011-01-01

    Full Text Available Introduction. The European System for Cardiac Operative Risk Evaluation (EuroSCORE was developed in order to predict operative risk in cardiac surgery and to assess the quality of the cardio-surgical care. Introduction of the uniform terminology in result evaluation process leads to the significant improvement in measuring and evaluation of surgical treatment quality. Objective. The aim of the study was to evaluate our results in isolated coronary surgery using the EuroSCORE. Methods. The study was done respectively by analyzing predicted mortality according to the EuroSCORE model and observed operative risk in 4,675 coronary patients operated at our Clinic during the period 2001-2008. For statistical analyses, the Pearson, Chisquare and ANOVA tests were used. Results. The total postoperative mortality predicted by the EuroSCORE was 2.9±2.25, while the observed one was 2.2%. When the scoring system and observed results were compared over the years, a considerably lower observed mortality was found during the last 4 years. Overall average number of distal anastomoses was 2.62±0.84. During the period 2004-2008, the average number of coronary anastomoses increased over the years reaching the value of 2.77±0.88. The difference is at the level of statistical significance with the trend of further increase. Percentage of the patients with single or double graft myocardial revascularization decreases, while the number of the patients with triple or more bypasses increases. Conclusion. During the last years, the results in isolated coronary surgery have considerably improved. The EuroSCORE overestimates operative risk. In order to improve its predictive value, the model should be recalibrated.

  14. Four-Group Classification Based on Fibrinogen Level and Fibrin Polymerization Associated With Postoperative Bleeding in Cardiac Surgery.

    Science.gov (United States)

    Kawashima, Shingo; Suzuki, Yuji; Sato, Tsunehisa; Kikura, Mutsuhito; Katoh, Takasumi; Sato, Shigehito

    2016-10-01

    Fibrinogen and fibrin formation have a key role in perioperative hemostasis. The aim of this study is to examine the association of postoperative hemostasis with a combined evaluation of the fibrinogen level and fibrin polymerization in cardiac surgery. We retrospectively classified 215 consecutive cardiac surgery patients into 4 groups (Fuji-san classification) that were divided by fibrinogen level fibrinogen thromboelastometry value at 10 minutes with rotational thromboelastometry <6 mm (ie, low fibrin polymerization) at the warming of cardiopulmonary bypass. Four groups resulted; group I, the acceptable range (n = 85); group II, only hypofibrinogenemia (<150 mg/dL, ≥6 mm, n = 63); group III, hypofibrinogenemia and low fibrin polymerization (<150 mg/dL, <6 mm, n = 60); and group IV, only low fibrin polymerization (≥150 mg/dL, <6 mm, n = 7). The risk of chest tube drainage volume greater than 500 mL within the first 24 hours after surgery (with group I as the reference) was increased in group II (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.5-7.4; P < .01) and group III (OR, 8.5; 95% CI, 3.5-21.7; P < .01), and the risk greater than 1000 mL (with group I as the reference) was increased in group III (OR, 4.0; 95% CI, 1.1-17.3; P = .03) and group IV (OR, 23.1; 95% CI, 3.2-201.0; P < .01). Intraoperative blood transfusions were decreased by 24.5%, after stratifying the starting amount of fresh frozen plasma by the 4-group classification in the recent consecutive 65 (30.2%) patients (P < .01). The 4-group classification is associated with postoperative bleeding and may improve the quality of perioperative blood transfusion in cardiac surgery.

  15. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.

    Science.gov (United States)

    Kin, Hajime; Mukaida, Masayuki; Koizumi, Junichi; Kamada, Takeshi; Mitsunaga, Yoshino; Iwase, Tomoyuki; Ikai, Akio; Okabayashi, Hitoshi

    2016-03-01

    An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.

  16. Cardiac Dysrhythmias with General Anesthesia during Dental Surgery

    OpenAIRE

    Rodrigo, Chandra R.

    1988-01-01

    Dysrhythmias with general anesthesia during dental surgery have been frequently reported. The incidence appears higher in spontaneously breathing patients lightly anesthetized with halothane. Anxiety, sitting posture, hypoxia, Chinese race, and heart disease appear to aggravate the condition. Use of beta blockers or lidocaine prior to anesthesia, intravenous induction, controlled ventilation with muscle relaxants, and use of isoflurane or enflurane in spontaneously breathing patients appear t...

  17. Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; WANG Di-jia; LIU Shuang; JIA Ming; JIA Shi-jie

    2013-01-01

    Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8%,tracheotomy rate was 12.5%,VAP incidence was 0,and the in-hospital mortality was 18.8%,significantly lower than in the control group 80.9%,29.8%,17.0% and 38.3% respectively,P <0.05 or P <0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9

  18. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan-bo; WANG Xu; LI Shou-jun; YANG Ke-ming; SHENG Xiang-dong; YAN Jun

    2013-01-01

    Background Cardiac surgery for congenital heart disease covers a wide spectrum from simple to complex cardiac and extracardiac malformations.Innovations in pediatric cardiac surgery and perioperative care over the past decades have allowed surgical correction or at least palliation in almost all complex congenital heart defects in the first years of life.Diaphragmatic paralysis (DP) due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency,lung infections,prolonged hospital stay time and even death.Methods Between April 2001 and December 2010,among patients undergoing cardiac surgery for congenital heart disease,postoperative DP was diagnosed in 47/10 200 (0.46%) patients.Diaphragmatic placation was performed in 37/47 patients.DP was suspected in children who failed to wean from mechanical ventilation or in those with persistent respiratory distress when there is no cardiac cause.Decreased respiratory sounds in auscultation,paradoxical breathing during spontaneous ventilation and elevated hemidiaphragm on chest X-ray led us to use fluoroscopy,ultrasound and/or electromyogram (EMG).When chest X-rays did not have a diagnostic value in patients with persistent respiratory distress,bilateral DP was suspected and immediate fluoroscopy of EMG was performed for diagnosis.In all patients,diaphragmatic placation was performed using a thoracic approach,through the sixth or seventh intercostals space with lateral thoracotomy.Results A total of 47 patients (21 females and 26 males) with a median age of 7.21 months (range 0.27-71 months) were diagnosed DP after cardiac surgery.The incidence of DP was 0.46% after cardiac surgery.The paralysed hemidiaphragm was left side in 26/47 (55.3%),right side in 17/47 (36.2%) and bilateral in 4/47 (8.5%) cases.The assisted ventilation time after cardiac surgery was (450±216) (116-856) hours.The median time from cardiac surgery to surgical

  19. Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision.

    Science.gov (United States)

    Jones, Richard N; Rudolph, James L; Inouye, Sharon K; Yang, Frances M; Fong, Tamara G; Milberg, William P; Tommet, Douglas; Metzger, Eran D; Cupples, L Adrienne; Marcantonio, Edward R

    2010-12-01

    The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods. Factor analysis methods based on item response theory were used to evaluate the measure. Modified parallel analysis supported a single factor, and the battery formed an internally consistent set (coefficient alpha = .82). The developed measure provided a reliable, continuous measure (reliability > .90) across a broad range of performance (-1.5 SDs to +1.0 SDs) with minimal ceiling and floor effects.

  20. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Emília Nozawa

    2003-03-01

    Full Text Available OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23, airway resistance (p=0.21, and the dead space/tidal volume ratio (p=0.54. No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86, rapid and superficial respiration index (p=0.48, and carbon dioxide arterial pressure (p=0.86. Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

  1. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    Directory of Open Access Journals (Sweden)

    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  2. [SPCCTV and SPC Recommendations Related to the Waiting Times for Cardiac Surgery].

    Science.gov (United States)

    Neves, José Pedro; Pereira, Hélder; Sousa-Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José; Silva Cardoso, José

    2014-01-01

    Appointed jointly by the Portuguese Society for Cardiothoracic and Vascular Surgery (SPCCTV) and by the Portuguese Society of Cardiology (SPC), the Working Group related to the Waiting Times for Cardiac Surgery was created with the aim of developing practical recommendations about clinically acceptable waiting times for the three critical phases of the care of adults with a cardiac disease that require surgery or an intervention: cardiology appointments; diagnostic process and invasive therapy. Cardiac surgery has its own characteristics, not comparable to other surgical specialties and, therefore, it is important to reduce its maximum waiting times and, also, increase the efficacy of the systems which are responsible to monitor and trace the patient. The information given in this document was based, mostly, in available clinical information. The methodology used to establish the criteria was based on studies regarding disease's natural history, clinical studies that compared medical treatment with intervention, retrospective and prospective analysis of patients included on a waiting list, and experts or working groups' opinions. After this first step, marked by this publication, the SPCCTV and the SPC PSC should be considered as natural interlocutors about this matter and they are committed to decisively contribute to the definition of operational strategies through the adaption of the clinical evidence with reality and with the available resources.

  3. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

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    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  4. Outcomes of Cardiac Surgery in Patients With Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas).

    Science.gov (United States)

    Vargo, Patrick R; Schiltz, Nicholas K; Johnston, Douglas R; Smedira, Nicholas G; Moazami, Nader; Blackstone, Eugene H; Soltesz, Edward G

    2015-12-15

    A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes. In-hospital mortality rate was 7% for patients who underwent transplantation versus 4% for patients who did not undergo transplantation (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.16 to 2.38). Patients who underwent transplantation were at an increased risk for acute renal failure (OR 1.62, CI 1.36 to 1.94) and blood transfusions (OR 1.63, CI 1.36 to 1.95). Median length of stay was longer (10 vs 9 days), with greater median total charges ($111,362 vs $102,221; both p mortality after cardiac surgery. Renal protective strategies and bleeding control should be stressed to mitigate complications.

  5. Cardiac Defects and Results of Cardiac Surgery in 22q11.2 Deletion Syndrome

    Science.gov (United States)

    Carotti, Adriano; Digilio, Maria Cristina; Piacentini, Gerardo; Saffirio, Claudia; Di Donato, Roberto M.; Marino, Bruno

    2008-01-01

    Specific types and subtypes of cardiac defects have been described in children with 22q11.2 deletion syndrome as well as in other genetic syndromes. The conotruncal heart defects occurring in patients with 22q11.2 deletion syndrome include tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus, interrupted aortic…

  6. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge.

    Science.gov (United States)

    Nguyen, Nguyenvu; Pezzella, A Thomas

    2015-04-01

    A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas.

  7. Use of nitric oxide in thoracic surgery for a high risk cardiac patient

    Directory of Open Access Journals (Sweden)

    Vishal Garg

    2014-01-01

    Full Text Available Nitric oxide (NO is a selective pulmonary vasodilator especially in the presence of pulmonary artery hypertension. With right ventricle (RV dysfunction, inhaled NO may increase RV ejection fraction and cardiac output. The main advantage of NO over intravenous therapy is its inability to decrease systemic pressure thereby maintaining the coronary perfusion pressure and the myocardial perfusion. In this case report, we discuss the use of NO in a routine thoracic surgery patient suffering with severe left ventricular dysfunction and a potential candidate for a very high cardiac risk.

  8. Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Jeremiah R. Brown

    2013-01-01

    Full Text Available Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient’s baseline inflammatory state measured by crude white blood cell (WBC counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4–16. Patients with elevated WBC count at baseline (10,000–12,000 and >12,000 mm3 had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%, P=0.037. Adjusted odds ratios were 1.42 (0.86, 2.34 for WBC counts 10,000–12,000 and 1.81 (1.03, 3.17 for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient’s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.

  9. Electrocardiographic R-wave changes during cardiac surgery.

    Science.gov (United States)

    Mark, J B; Chien, G L; Steinbrook, R A; Fenton, T

    1992-01-01

    The diagnostic accuracy of exercise electrocardiography has been improved by incorporation of R-wave gain factor to correct the measured ST-segment changes. If marked changes in R-wave amplitude occur in individual patients during cardiac operations, a similar gain factor correction may improve the intraoperative diagnosis of myocardial ischemia. This investigation was designed to determine the frequency and magnitude of intraoperative V5 R-wave amplitude changes during cardiac operations. Electrocardiograms were recorded from 83 patients while patients were awake, anesthetized (baseline), after placement of the Favaloro and Canadian sternal retractors, and at end-operation. Compared with baseline values, placement of the Canadian sternal retractor was associated with a reduction in V5 R-wave amplitude from 15 +/- 1 to 10 +/- 1 mm (mean +/- SEM), in V5 S-wave amplitude from 3.5 +/- 0.4 to 1.7 +/- 0.3 mm, and in absolute ST-segment deviation from 0.50 +/- 0.04 to 0.39 +/- 0.05 mm. Changes in V5 R-wave amplitude were correlated with changes in ST-segment deviation in patients with baseline ST-segment deviations greater than or equal to 0.5 mm (r = 0.55, P = 0.0004, n = 37). Changes associated with the Favaloro retractor and the respiratory cycle were less marked. However, the V5 R-wave amplitude was decreased from 15 +/- 1 to 9 +/- 1 mm at end-operation. In conclusion, sternal spreading with the Canadian retractor was associated with marked reductions in V5 R- and S-wave amplitudes and ST-segment deviations. Marked changes in V5 R-wave amplitude persisted after sternal closure.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Thiamine as an adjunctive therapy in cardiac surgery

    DEFF Research Database (Denmark)

    Wiuff Andersen, Lars; Holmberg, Mathias J; Berg, KM;

    2016-01-01

    BACKGROUND: Thiamine is a vitamin that is essential for adequate aerobic metabolism. The objective of this study was to determine if thiamine administration prior to coronary artery bypass grafting would decrease post-operative lactate levels as a measure of increased aerobic metabolism. METHODS......: We performed a randomized, double-blind, placebo-controlled trial of patients undergoing coronary artery bypass grafting. Patients were randomized to receive either intravenous thiamine (200 mg) or placebo both immediately before and again after the surgery. Our primary endpoint was post...

  11. Center of Cardiac Surgery Robotic Computerized Telemanipulation as Part of a Comprehensive Approach to Advanced Heart Care

    Science.gov (United States)

    2011-10-01

    Robotic OR Appendix E: Comparison Chart of daVinci Simulator Skill Sets and Training Exercise Activities 1 INTRODUCTION Robotic surgery recently...techniques in endoscopic cardiac bypass surgery is important not only for surgeons and surgical teams just beginning to perform robotic surgery , but also...Director, Robotic Surgery Scott Keith, PhD Faculty, Division of Biostatistics Rebecca O’Shea, MBA Senior Vice President for Clinical

  12. Evaluation of a novel integrated sensor system for synchronous measurement of cardiac vibrations and cardiac potentials.

    Science.gov (United States)

    Chuo, Yindar; Tavakolian, Kouhyar; Kaminska, Bozena

    2011-08-01

    The measurement of human body vibrations as a result of heart beating, simultaneously with cardiac potentials have been demonstrated in past studies to bring additional value to diagnostic cardiology through the detection of irregularities in the mechanical movement of the heart. The equipment currently available to the medical community is either large and bulky or difficult to synchronize. To address this problem, a novel integrated sensor system has been developed to record cardiac vibration and cardiac potential simultaneously and synchronously from a single compact site on the chest. The developed sensor system is lightweight, small in size, and suitable for mounting on active moving patients. The sensor is evaluated for its adequacy in measuring cardiac vibrations and potentials. In this evaluation, 45 independent signal recording are studied from 15 volunteers, and the morphology of the recorded signals are analyzed qualitatively (by visual inspection) and quantitatively (by computational methods) against larger devices used in established cardiac vibration studies (reference devices). It is found that the cardiac vibration signals acquired by the integrated sensor has 92.37% and 81.76% identically identifiable systolic and diastolic cardiac complexes, respectively, when compared to the cardiac vibration signals recorded simultaneously from the reference device. Further, the cardiac potential signals acquired by the integrated sensor show a high correlation coefficient of 0.8912 and a high estimated signal-to-noise-ratio of 22.00 dB when compared to the reference electrocardiograph (non-standard leads) acquired through a common clinical machine. The results suggest that the tiny, wearable, integrated sensor system that synchronously measures cardiac vibrations and cardiac potentials may be practical for use as an alternative or assistive cardiac diagnostic tool.

  13. Factors predisposing to wound infection in cardiac surgery. A prospective study of 517 patients.

    Science.gov (United States)

    Wilson, A P; Livesey, S A; Treasure, T; Grüneberg, R N; Sturridge, M F

    1987-01-01

    Postoperative wound infection can greatly prolong hospital stay after cardiac surgery, so the identification of predisposing factors may help in prevention or early institution of treatment. Transfer of organisms from the leg to the sternum during coronary artery surgery has been proposed as a major additional cause of sepsis. The definition of wound infection is not standardised and therefore makes comparison between centres difficult. In a prospective study of 517 patients, a wound scoring method (ASEPSIS) has been used to register all abnormal wounds to maximise the chances of identifying factors predisposing to infection. Abnormal healing was noted in 99 (19%) sternal wounds and 29 (8%) leg wounds. Obesity was the principal risk factor (P less than 0.005). Diabetes, reoperation, length of preoperative hospital stay, age, sex, or previous cardiac surgery had little effect on wound healing. The range of bacteria isolated from chest wounds after coronary artery surgery was similar to that after valvular surgery, but the rate of isolation was significantly greater. With careful attention to technique, leg wound infection rarely presented a clinical problem and did not appear to be a source of bacteria infecting the chest wound.

  14. Forced expiratory volume in one second predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery: a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    David A McAllister

    Full Text Available OBJECTIVE: An aging population and increasing use of percutaneous therapies have resulted in older patients with more co-morbidity being referred for cardiac surgery. Objective measurements of physiological reserve and severity of co-morbid disease are required to improve risk stratification. We hypothesised that FEV1 would predict mortality and length of stay following cardiac surgery. METHODS: We assessed clinical outcomes in 2,241 consecutive patients undergoing coronary artery bypass grafting and/or valve surgery from 2001 to 2007 in a regional cardiac centre. Generalized linear models of the association between FEV1 and length of hospital stay and mortality were adjusted for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, long-term use of bronchodilators or steroids for lung disease, and type and urgency of surgery. FEV1 was compared to an established risk prediction model, the EuroSCORE. RESULTS: Spirometry was performed in 2,082 patients (93% whose mean (SD age was 67 (10 years. Median hospital stay was 3 days longer in patients in the lowest compared to the highest quintile for FEV1, 1.35-fold higher (95% CI 1.20-1.52; p<0.001. The adjusted odds ratio for mortality was increased 2.11-fold (95% CI 1.45-3.08; p<0.001 per standard deviation decrement in FEV1 (800 ml. FEV1 improved discrimination of the EuroSCORE for mortality. Similar associations were found after excluding people with known pulmonary disease and/or airflow limitation on spirometry. CONCLUSIONS: Reduced FEV1 strongly predicted increased length of stay and in-hospital mortality following cardiac surgery. FEV1 is a widely available measure of physiological health that may improve risk stratification of complex patients undergoing cardiac surgery and should be evaluated for inclusion in new prediction tools.

  15. Prevention of cardiac complications in peripheral vascular surgery

    Energy Technology Data Exchange (ETDEWEB)

    Cutler, B.S.

    1986-04-01

    The prevalence of severe coronary artery disease in peripheral vascular patients exceeds 50 per cent. Complications of coronary artery disease are the most common causes of mortality following peripheral vascular operations. To reduce the incidence of cardiac complications, it is first necessary to identify patients at risk through screening tests. Screening methods in current use include risk factor analysis, exercise testing, routine coronary angiography, and dipyridamole thallium-201 scintigraphy. The risk factor approach has the advantage of being widely applicable since it makes use of historical, physical, and electrocardiographic findings that are already familiar to surgeons and anesthesiologists. It is also inexpensive. However, it may overlook the patient who has no symptoms of coronary artery disease, possibly as a result of the sedentary lifestyle imposed by complications of peripheral vascular disease. The electrocardiographically monitored stress test will identify the asymptomatic patient with occult coronary disease and is helpful in predicting operative risk. However, a meaningful test is dependent on the patient's ability to exercise--an activity that is frequently limited by claudication, amputation, or arthritis. Exercise testing also suffers from a lack of sensitivity and specificity when compared with coronary arteriography. Routine preoperative coronary angiography overcomes the exercise limitation of treadmill testing but is not widely applicable as a screening test for reasons of cost and inherent risk. Dipyridamole thallium-201 scanning, on the other hand, is safe and of relatively low cost and does not require exercise.

  16. Assessing quality in cardiac surgery: why this is necessary in the twenty-first century

    Science.gov (United States)

    Swain, J. A.; Hartz, R. S.

    2000-01-01

    The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application.

  17. Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Shah Ashish S

    2009-08-01

    Full Text Available Abstract We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.

  18. Novel biomarkers for cardiac surgery-associated acute kidney injury: a skeptical assessment of their role.

    Science.gov (United States)

    Sidebotham, David

    2012-12-01

    Cardiac surgery-associated acute kidney injury (AKI) is common and is associated with a high mortality rate. Traditional biomarkers of AKI (creatinine and urea) increase slowly in response to renal injury, are insensitive to mild degrees of AKI, and are influenced by nonrenal factors. There is considerable interest in novel biomarkers of AKI such as neutrophil gelatinase-associated lipocalin that increase rapidly after renal injury, detect mild degrees of AKI, and are less subject to nonrenal factors. It has been postulated that the early diagnosis of cardiac surgery-associated AKI using novel biomarkers will result in improved outcomes. However, there is little evidence that interventions started early in the course of evolving AKI enhance renal recovery. Until effective therapies are developed that significantly improve the outcome from AKI, there is little benefit from early diagnosis using novel biomarkers.

  19. Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Pradeep Bhaskar

    2015-01-01

    Full Text Available Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA. Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery.

  20. The World Congress of Paediatric Cardiology and Cardiac Surgery: "The Olympics of our profession".

    Science.gov (United States)

    Hugo-Hamman, Christopher; Jacobs, Jeffery Phillip

    2012-12-01

    The first World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr. Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children should really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses, and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada (2001, organised by Bill Williams and Lee Benson), Buenos Aires, Argentina (2005, organised by Horatio Capelli and Guillermo Kreutzer), and most recently Cairns, Australia (2009, organised by Jim Wilkinson). Having visited Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), and Australia (2009), and reflecting the "African Renaissance", the

  1. Conditioning techniques and ischemic reperfusion injury in relation to on-pump cardiac surgery

    DEFF Research Database (Denmark)

    Holmberg, Fredrik Eric Olof; Ottas, Konstantin Alex; Andreasen, Charlotte;

    2014-01-01

    OBJECTIVES: The objective was to investigate the potential protective effects of two conditioning methods, on myocardial ischemic and reperfusion injury in relation to cardiac surgery. DESIGN: Totally 68 patients were randomly assigned to either a control group (n = 23), a remote ischemic...... preconditioning (RIPC) group (n = 23) or a glucagon-like peptide-1 (GLP-1) analogue group (n = 22). The RIPC protocol consisted of three cycles of upper limb ischemia. The GLP-1 analogue protocol consisted of intravenous infusion with exenatide. The primary endpoint was postoperative cardiac enzyme release....... The other secondary endpoints were metabolic parameters related to myocardial ischemia, measured using microdialysis technique, as well as other operative- and postoperative data. RESULTS: Postoperative cardiac enzyme release indicated a possible beneficial effect of the interventions, but the difference...

  2. Successful use of levosimendan as a primary inotrope in pediatric cardiac surgery: An observational study in 110 patients

    Directory of Open Access Journals (Sweden)

    Reena Khantwal Joshi

    2016-01-01

    Conclusions: Levosimendan-based inotropic regime offers optimized cardiac output with a well-controlled heart rate and a low incidence of arrhythmias in patients undergoing all categories of congenital heart surgeries.

  3. Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP).

    Science.gov (United States)

    Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S; Menon, Mani; Trinh, Quoc-Dien

    2015-04-15

    The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication.

  4. The Solar Activity Effect on the Rate of Complications in Cardiac Surgery

    Science.gov (United States)

    Sheyner, Olga; Matusova, Elena; Fridman, Vladimir

    2010-05-01

    The essential effect of powerful solar flares on a rate of post voperation bleedings and tachyarrhythmias is revealed. The latter complication rate is found to increase in 1.5 times during the first 5-7- days after solar proton events and reach the maximum in the 2-4 days. The analysis of a flareless periods does not show such correlation. Thus, geoeffective solar flares are shown to be the additional risk factor for cardiac surgery.

  5. MEDIASTINAL HEMORRHAGE MANAGEMENT FOLLOWING CARDIAC SURGERY: IMPLEMENTATION OF THE PERIORATIVE NURSING DATA SET

    OpenAIRE

    Giakoumidakis, Konstantinos; Katzilieri,Christina

    2015-01-01

    ntroduction: Standardized nursing terminologies (SNT) provide a common language among nurses, contributing to standardized and evidence based nursing care plans Aim: The development of a standardized nursing care plan for the effective management of postoperative mediastinal hemorrhage of cardiac surgery patients Material and Method: The SNT Perioperative Nursing Data Set (PNDS), 3rd edition, was used for a care plan formation, which is consisted of a coding system of nursing diagnoses...

  6. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  7. Left-handed cardiac surgery: tips from set up to closure for trainees and their trainers.

    Science.gov (United States)

    Burdett, Clare; Dunning, Joel; Goodwin, Andrew; Theakston, Maureen; Kendall, Simon

    2016-09-01

    There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.

  8. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  9. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    Science.gov (United States)

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  10. Posttraumatic growth in patients who survived cardiac surgery: the predictive and mediating roles of faith-based factors.

    Science.gov (United States)

    Ai, Amy L; Hall, Daniel; Pargament, Kenneth; Tice, Terrence N

    2013-04-01

    Despite the growing knowledge of posttraumatic growth, only a few studies have examined personal growth in the context of cardiac health. Similarly, longitudinal research is lacking on the implications of religion/spirituality for patients with advanced cardiac diseases. This paper aims to explore the effect of preoperative religious coping on long-term postoperative personal growth and potential mediation in this effect. Analyses capitalized on a preoperative survey and medical indices from the Society of Thoracic Surgeons' National Database of patients undergoing cardiac surgery. Participants in the current follow-up study completed a mailed survey 30 months after surgery. Hierarchical regression analysis was performed to evaluate the extent to which preoperative use of religious coping predicted growth at follow-up, after controlling for key demographics, medical indices, mental health, and protective factors. Predictors of posttraumatic growth at follow-up were positive religious coping and a living status without a partner. Medical indices, optimistic expectations, social support, and other religious factors were unrelated to posttraumatic growth. Including religious factors diminished effects of gender, age, and race. Including perceived spiritual support completely eliminated the role of positive religious coping, indicating mediation. Preoperative positive religious coping may have a long-term effect on postoperative personal growth, explainable by higher spiritual connections as a part of significance-making. These results suggest that spirituality may play a favorable role in cardiac patients' posttraumatic growth after surviving a life-altering operation. The elimination of demographic effects may help explain previously mixed findings concerning the association between these factors and personal growth.

  11. For neonates undergoing cardiac surgery does thymectomy as opposed to thymic preservation have any adverse immunological consequences?

    Science.gov (United States)

    Afifi, Ahmed; Raja, Shahzad G; Pennington, Daniel J; Tsang, Victor T

    2010-09-01

    A best evidence topic in congenital cardiac surgery was written according to a structured protocol. The question addressed was whether neonatal thymectomy in patients undergoing cardiac surgery has any adverse immunological consequences. Altogether 164 papers were found using the reported search, of which nine papers represented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. The thymus is the major production site of T cells, whose stocks are built-up during foetal and early postnatal life. However, its function diminishes after the first years of life, and although thymic output is maintained into adulthood, the thymus mostly degenerates into fatty tissue in elderly adults. To date, there has been no general consensus with regard to the importance of this organ during childhood and adulthood. As a consequence, during cardiac surgery in neonates, partial or total thymectomy is routinely performed to enable better access to the heart and great vessels to correct congenital heart defects, suggesting that it may be dispensable during childhood and adulthood. Interestingly, current best available evidence from nine case-control studies suggests that neonatal thymectomy affects peripheral T-cell populations both in the short- as well as long-term and results in premature immunosenescence. However, the impact of these changes on the risk of infectious diseases or malignancy has not been thoroughly evaluated by any of these studies. Maintenance of a registry of patients undergoing neonatal thymectomy and further studies to assess the functional or clinical consequences of this practice would be valuable.

  12. Can a New Antiseptic Agent Reduce the Bacterial Colonization Rate of Central Venous Lines in Post- Cardiac Surgery Patients?

    Directory of Open Access Journals (Sweden)

    Fardin Yousefshahi

    2015-10-01

    Full Text Available Background: Central venous (CV catheters play an essential role in the management of critically ill patients in the Intensive Care Unit (ICU. CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil (an antiseptic agent composed of H2 O2 and silver and a control group.Methods: This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgeryICUs of a heart center. The participants were divided into interventional (113 patients and control (136 patients groups. Sanosil was added to the routine preparation procedure (Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion. After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts.Results: Catheter colonization occurred in 55 (22.1% patients: 26 (23% patients in the Sanosil group and 29 (21.3% in the control group; there was no significant statistical difference between the two groups (p value = 0.75, RR = 1.05, 95%CI:0.76-1.45. The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis:20 cases in the control group and 16 cases in the intervention group.Conclusion: Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization.

  13. An augmented reality platform for planning of minimally invasive cardiac surgeries

    Science.gov (United States)

    Chen, Elvis C. S.; Sarkar, Kripasindhu; Baxter, John S. H.; Moore, John; Wedlake, Chris; Peters, Terry M.

    2012-02-01

    One of the fundamental components in all Image Guided Surgery (IGS) applications is a method for presenting information to the surgeon in a simple, effective manner. This paper describes the first steps in our new Augmented Reality (AR) information delivery program. The system makes use of new "off the shelf" AR glasses that are both light-weight and unobtrusive, with adequate resolution for many IGS applications. Our first application is perioperative planning of minimally invasive robot-assisted cardiac surgery. In this procedure, a combination of tracking technologies and intraoperative ultrasound is used to map the migration of cardiac targets prior to selection of port locations for trocars that enter the chest. The AR glasses will then be used to present this heart migration data to the surgeon, overlaid onto the patients chest. The current paper describes the calibration process for the AR glasses, their integration into our IGS framework for minimally invasive robotic cardiac surgery, and preliminary validation of the system. Validation results indicate a mean 3D triangulation error of 2.9 +/- 3.3mm, 2D projection error of 2.1 +/- 2.1 pixels, and Normalized Stereo Calibration Error of 3.3.

  14. Perioperative neutrophil to lymphocyte ratio as a predictor of poor cardiac surgery patient outcomes

    Science.gov (United States)

    Giakoumidakis, Konstantinos; Fotos, Nikolaos V; Patelarou, Athina; Theologou, Stavros; Argiriou, Mihalis; Chatziefstratiou, Anastasia A; Katzilieri, Christina; Brokalaki, Hero

    2017-01-01

    Purpose The purpose of the present study was to investigate the association between the perioperative neutrophil to lymphocyte ratio (NLR) and cardiac surgery patient outcomes. Patients and methods A retrospective cohort study of 145 patients who underwent cardiac surgery in a tertiary hospital of Athens, Greece, from January to March 2015, was conducted. By using a structured short questionnaire, this study reviewed the electronic hospital database and the medical and nursing patient records for data collection purposes. The statistical significance was two-tailed, and p-values care unit (ICU) (p=0.002), and in-hospital (p=0.018), and likewise with delayed tracheal extubation (p≤0.001). Furthermore, patients with elevated NLR during the second postoperative day had significantly higher in-hospital mortality (p=0.018), increased incidence of pneumonia (p=0.022), higher probability of readmission to the ICU (p=0.002), prolonged ICU LOS (p≤0.001), and delayed tracheal extubation (p≤0.001). Conclusion Increased perioperative NLR seems to be associated with significantly higher mortality and morbidity in cardiac surgery patients. At the same time, NLR is a significant and inexpensive biomarker for the early identification of patients at high risk for complications. In addition, NLR levels could lead clinicians to perform measures for the optimal therapeutic patient approach. PMID:28243161

  15. Four-dimensional modeling of the heart for image guidance of minimally invasive cardiac surgeries

    Science.gov (United States)

    Wierzbicki, Marcin; Drangova, Maria; Guiraudon, Gerard; Peters, Terry

    2004-05-01

    Minimally invasive surgery of the beating heart can be associated with two major limitations: selecting port locations for optimal target coverage from x-rays and angiograms, and navigating instruments in a dynamic and confined 3D environment using only an endoscope. To supplement the current surgery planning and guidance strategies, we continue developing VCSP - a virtual reality, patient-specific, thoracic cavity model derived from 3D pre-procedural images. In this work, we apply elastic image registration to 4D cardiac images to model the dynamic heart. Our method is validated on two image modalities, and for different parts of the cardiac anatomy. In a helical CT dataset of an excised heart phantom, we found that the artificial motion of the epicardial surface can be extracted to within 0.93 +/- 0.33 mm. For an MR dataset of a human volunteer, the error for different heart structures such as the myocardium, right and left atria, right ventricle, aorta, vena cava, and pulmonary artery, ranged from 1.08 +/- 0.18 mm to 1.14 +/- 0.22 mm. These results indicate that our method of modeling the motion of the heart is not only easily adaptable but also sufficiently accurate to meet the requirements for reliable cardiac surgery training, planning, and guidance.

  16. Myocardial ischemic conditioning: Physiological aspects and clinical applications in cardiac surgery.

    Science.gov (United States)

    Bousselmi, Radhouane; Lebbi, Mohamed Anis; Ferjani, Mustapha

    2014-04-01

    Ischemia-reperfusion is a major determinant of myocardial impairment in patients undergoing cardiac surgery. The main goal of research in cardioprotection is to develop effective techniques to avoid ischemia-reperfusion lesions. Myocardial ischemic conditioning is a powerful endogenous cardioprotective phenomenon. First described in animals in 1986, myocardial ischemic conditioning consists of applying increased tolerance of the myocardium to sustained ischemia by exposing it to brief episodes of ischemia-reperfusion. Several studies have sought to demonstrate its effective cardioprotective action in humans and to understand its underlying mechanisms. Myocardial ischemic conditioning has two forms: ischemic preconditioning (IPC) when the conditioning stimulus is applied before the index ischemia and ischemic postconditioning when the conditioning stimulus is applied after it. The cardioprotective action of ischemic conditioning was reproduced by applying the ischemia-reperfusion stimulus to organs remote from the heart. This non-invasive manner of applying ischemic conditioning has led to its application in clinical settings. Clinical trials for the different forms of ischemic conditioning were mainly developed in cardiac surgery. Many studies suggest that this phenomenon can represent an interesting adjuvant to classical cardioprotection during on-pump cardiac surgery. Ischemic conditioning was also tested in interventional cardiology with interesting results. Finally, advances made in the understanding of mechanisms that underlie the cardioprotective action of ischemic conditioning have paved the way to a new form of myocardial conditioning which is pharmacological conditioning.

  17. Almanac 2012 adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology

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    Ben Bridgewater

    2013-03-01

    Full Text Available This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.

  18. Usefulness of 40-slice multidetector row computed tomography to detect coronary disease in patients prior to cardiac valve surgery

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    Pouleur, Anne-Catherine; Polain de Waroux, Jean-Benoit le; Kefer, Joelle; Pasquet, Agnes; Vanoverschelde, Jean-Louis; Gerber, Bernhard L. [Cliniques Universitaires St. Luc UCL, Cardiology Division, Woluwe St. Lambert (Belgium); Coche, Emmanuel [Cliniques Universitaires St. Luc UCL, Radiology Division, Woluwe St. Lambert (Belgium)

    2007-12-15

    Preoperative identification of significant coronary artery disease (CAD) in patients prior to valve surgery requires systematic invasive coronary angiography. The purpose of this current prospective study was to evaluate whether exclusion of CAD by multi-detector CT (MDCT) might potentially avoid systematic cardiac catheterization in these patients. Eighty-two patients (53 males, 62 {+-} 13 years) scheduled to undergo valve surgery underwent 40-slice MDCT before invasive quantitative coronary angiography (QCA). According to QCA, 15 patients had CAD (5 one-vessel, 6 two-vessel and 4 three-vessel disease). The remaining 67 patients had no CAD. On a per-vessel basis, MDCT correctly identified 27/29 (sensitivity 93%) vessels with and excluded 277/299 vessels (specificity 93%) without CAD. On a per-patient basis, MDCT correctly identified 14/15 patients with (sensitivity 93%) and 60/67 patients without CAD (specificity 90%). Positive and negative predictive values of MDCT were 67% and 98%. Performing invasive angiography only in patients with abnormal MDCT might have avoided QCA in 60/82 (73%). MDCT could be potentially useful in the preoperative evaluation of patients with valve disease. By selecting only those patients with coronary lesions to undergo invasive coronary angiography, it could avoid cardiac catheterization in a large number of patients without CAD. (orig.)

  19. Usefulness of 40-slice multidetector row computed tomography to detect coronary disease in patients prior to cardiac valve surgery.

    Science.gov (United States)

    Pouleur, Anne-Catherine; le Polain de Waroux, Jean-Benoît; Kefer, Joëlle; Pasquet, Agnès; Coche, Emmanuel; Vanoverschelde, Jean-Louis; Gerber, Bernhard L

    2007-12-01

    Preoperative identification of significant coronary artery disease (CAD) in patients prior to valve surgery requires systematic invasive coronary angiography. The purpose of this current prospective study was to evaluate whether exclusion of CAD by multi-detector CT (MDCT) might potentially avoid systematic cardiac catheterization in these patients. Eighty-two patients (53 males, 62 +/- 13 years) scheduled to undergo valve surgery underwent 40-slice MDCT before invasive quantitative coronary angiography (QCA). According to QCA, 15 patients had CAD (5 one-vessel, 6 two-vessel and 4 three-vessel disease). The remaining 67 patients had no CAD. On a per-vessel basis, MDCT correctly identified 27/29 (sensitivity 93%) vessels with and excluded 277/299 vessels (specificity 93%) without CAD. On a per-patient basis, MDCT correctly identified 14/15 patients with (sensitivity 93%) and 60/67 patients without CAD (specificity 90%). Positive and negative predictive values of MDCT were 67% and 98%. Performing invasive angiography only in patients with abnormal MDCT might have avoided QCA in 60/82 (73%). MDCT could be potentially useful in the preoperative evaluation of patients with valve disease. By selecting only those patients with coronary lesions to undergo invasive coronary angiography, it could avoid cardiac catheterization in a large number of patients without CAD.

  20. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    Science.gov (United States)

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  1. Incidence and risk factors of nosocomial infections after cardiac surgery in Georgian population with congenital heart diseases.

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    Lomtadze, M; Chkhaidze, M; Mgeladze, E; Metreveli, I; Tsintsadze, A

    2010-01-01

    Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The aim of the study was to determine the incidence, etiology and main risk factors of nosocomial infections (NI) following cardiac surgery in congenital heart diseases population. Retrospective case study was conducted. 387 patients with congenital heart disease (CHD), who underwent cardiac surgery from January 2007 to December 2008 were studied. The age of the most patients varied between 1 day to 15 years, 73 patients (18,8%) were older than 15 years. All 387 patients underwent cardiac surgery. The rate of NI was 16%. The most common infections were bloodstream infections (BSI) (7,75%) and respiratory tract infections (7%) respectively. The rate of NI was higher in patients under 1 year of age, after urgent surgery and urgent reoperation, long cardiopulmonary bypass (CPB) and aortic cross-clamp time, also in patients with prolonged mechanical ventilation, massive haemotransfusion, with open heart bone after surgery, reintubation, hospitalization in another hospital during last three month. It was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was blood stream infection. The main risk factors of NI in the same setting were age under 1 year, urgent surgery, urgent reoperation, long CPB and aortic cross-clamp time, long duration of mechanical ventilation, massive haemotransfusion, open heart bone after surgery, reintubation, hospitalization in another hospital during last three month.

  2. Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT Trial: a factorial trial evaluating the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery

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    Tang WH Wilson

    2010-06-01

    Full Text Available Abstract Background The perioperative period is characterized by an intense inflammatory response. Perioperative inflammation promotes postoperative morbidity and increases mortality. Blunting the inflammatory response to surgical trauma might thus improve perioperative outcomes. We are studying three interventions that potentially modulate perioperative inflammation: corticosteroids, tight glucose control, and light anesthesia. Methods/Design The DeLiT Trial is a factorial randomized single-center trial of dexamethasone vs placebo, intraoperative tight vs. conventional glucose control, and light vs deep anesthesia in patients undergoing major non-cardiac surgery. Anesthetic depth will be estimated with Bispectral Index (BIS monitoring (Aspect medical, Newton, MA. The primary outcome is a composite of major postoperative morbidity including myocardial infarction, stroke, sepsis, and 30-day mortality. C-reactive protein, a measure of the inflammatory response, will be evaluated as a secondary outcome. One-year all-cause mortality as well as post-operative delirium will be additional secondary outcomes. We will enroll up to 970 patients which will provide 90% power to detect a 40% reduction in the primary outcome, including interim analyses for efficacy and futility at 25%, 50% and 75% enrollment. Discussion The DeLiT trial started in February 2007. We expect to reach our second interim analysis point in 2010. This large randomized controlled trial will provide a reliable assessment of the effects of corticosteroids, glucose control, and depth-of-anesthesia on perioperative inflammation and morbidity from major non-cardiac surgery. The factorial design will enable us to simultaneously study the effects of the three interventions in the same population, both individually and in different combinations. Such a design is an economically efficient way to study the three interventions in one clinical trial vs three. Trial registration This trial is

  3. Patients submitted to cardiac surgery: sociodemographic characteristics, clinical epidemiological profile and complications

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    Priscila Rangel Dordetto

    2016-11-01

    Full Text Available Introduction: Mortality due to cardiovascular disease increases progressively with increasing blood pressure of 115/75 mmHg from. For treatments that require surgical procedures, it is noted that the techniques used in cardiac surgery are always advancing, using the new technology. Objectives: To conduct the characterization of patients undergoing cardiac surgery; identify the epidemiological profile and point the complications postoperatively. Method: This was a descriptive cross-sectional survey where the variables were extracted from medical records between April and June 2015. The data underwent descriptive statistical analysis and ethical recommendations were respected. Results: There was a predominance of males (56.0%, the Public Health System (SUS health insurance (85.0% of residents in the city of Sorocaba (62.0%, aged between 50 and 70 years (67.0 %, average of 58.7 (SD=10.5. Previous diseases such as systemic hypertension, type 2 diabetes, dyslipidemia stood out. The most frequently performed surgery was the Myocardial Revascularization (58.0%. Complications of the shock Hypovolemic and cardiogenic and Atrial Fibrillation appeared more often and the number of deaths was 20.0%. Conclusion: Given sociodemographic findings, the prevalent diseases, complications after surgery and frequency of deaths, they see against the literature findings, it is believed that could help to enhance the educational and assistance to prevention health and creating new strategies regarding adherence to treatment and control of cardiovascular disease.

  4. Ischemic stroke risk reduction following cardiac surgery by carotid compression

    Science.gov (United States)

    Isingoma, Paul

    Every year over 500,000 cardiovascular procedures requiring cardiopulmonary bypass (CPB) are performed in the United States. CPB is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. During CPB, an aortic cross-clamp is used to clamp the aorta and separate the systemic circulation from the outflow of the heart. Unfortunately, these procedures have been found to cause most cerebral emboli, which produce clinical, subclinical and silent neurologic injuries. Many clinical neurologic injuries occur in the postoperative period, with over 20% of the clinical strokes occurring during this period. In this study, we focus on visualizing the flow distribution in the aortic arch, the effect of carotid compression and the influence of compression time and MAP during CPB on reducing cerebral emboli. Experiments are performed with an aortic arch model in a mock cardiovascular system. Fluorescent particles are used to simulate emboli that are released into circulation immediately after carotid compression. The LVAD is used as the pump to produce flow in the system by gradually adjusting the speed to maintain desired clinical conditions. Aortic and proximal branches MAP of 65.0 +/- 5.0 mmHg (normal MAP) or 95.0 +/- 5.0 mmHg (high MAP), aortic flow of 4.0 +/- 0.5 L/min, and all branches flow (left and right carotids, and subclavian arteries) of 10% of the aortic flow. Flow distribution of particles is visualized using LaVision's DaVis imaging software and analyzed using imagej's particle analysis tool to track, count, and record particle properties from the aortic arch. Carotid compression for 10-20 seconds reduces the number of particles entering the carotid arteries by over 73% at normal MAP, and by over 85% at high MAP. A higher MAP resulted in fewer particles entering the branching vessels both at baseline and during occlusion conditions. A compression duration of

  5. Factors Influencing Neurodevelopment after Cardiac Surgery during Infancy

    Science.gov (United States)

    Hövels-Gürich, Hedwig Hubertine

    2016-01-01

    Short- and long-term neurodevelopmental (ND) disabilities with negative impact on psychosocial and academic performance, quality of life, and independence in adulthood are known to be the most common sequelae for surviving children after surgery for congenital heart disease (CHD). This article reviews influences and risk factors for ND impairment. For a long time, the search for independent risk factors was focused on the perioperative period and modalities of cardiopulmonary bypass (CPB). CPB operations to ensure intraoperative vital organ perfusion and oxygen supply with or without circulatory arrest or regional cerebral perfusion bear specific risks. Examples of such risks are embolization, deep hypothermia, flow rate, hemodilution, blood gas management, postoperative hyperthermia, systemic inflammatory response, and capillary leak syndrome. However, influences of these procedure-specific risk factors on ND outcome have not been found as strong as expected. Furthermore, modifications have not been found to support the effectiveness of the currently used neuroprotective strategies. Postoperative factors, such as need for extracorporal membrane oxygenation or assist device support and duration of hospital stay, significantly influence ND parameters. On the other hand, the so-called “innate,” less modifiable patient-specific risk factors have been found to exert significant influences on ND outcomes. Examples are type and severity of CHD, genetic or syndromic abnormalities, as well as prematurity and low birth weight. Structural and hemodynamic characteristics of different CHDs are assumed to result in impaired brain growth and delayed maturation with respect to the white matter. Beginning in the fetal period, this so-called “encephalopathy of CHD” is suggested a major innate risk factor for pre-, peri-, and postoperative additional hypoxic or ischemic brain injury and subsequent ND impairment. Furthermore, MRI studies on brain volume, structure, and

  6. Non-invasive Evaluation for Epilepsy Surgery

    Science.gov (United States)

    IWASAKI, Masaki; JIN, Kazutaka; NAKASATO, Nobukazu; TOMINAGA, Teiji

    2016-01-01

    Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient’s epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations. Essential components of non-invasive pre-surgical evaluation of epilepsy include detailed clinical history, long-term video-electroencephalography monitoring, epilepsy-protocol magnetic resonance imaging (MRI), and neuropsychological testing. However, a significant portion of drug-resistant epilepsy is associated with no or subtle MRI lesions or with ambiguous electro-clinical signs. Additional evaluations including fluoro-deoxy glucose positron emission tomography (FDG-PET), magnetoencephalography and ictal single photon emission computed tomography can play critical roles in planning surgery. FDG-PET should be registered on three-dimensional MRI for better detection of focal cortical dysplasia. All diagnostic tools are complementary to each other in defining the epileptogenic zone, so that it is always important to reassess the data based on other results to pick up or confirm subtle abnormalities. PMID:27627857

  7. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

    Science.gov (United States)

    Bauer, Brent A; Cutshall, Susanne M; Wentworth, Laura J; Engen, Deborah; Messner, Penny K; Wood, Christina M; Brekke, Karen M; Kelly, Ryan F; Sundt, Thoralf M

    2010-05-01

    Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

  8. Acute cardiac arrhythmias following surgery for congenital heart disease: mechanisms, diagnostic tools, and management.

    Science.gov (United States)

    Payne, Linda; Zeigler, Vicki L; Gillette, Paul C

    2011-06-01

    This article focuses on the management of those cardiac arrhythmias most commonly seen in the immediate postoperative period. They include ventricular tachycardia, ventricular fibrillation, atrial flutter, junctional ectopic tachycardia, bradycardia, and atrioventricular block. The mechanisms of cardiac arrhythmias are reviewed followed by a brief overview of the predominant acute arrhythmias, tools used for the diagnostic evaluation of these arrhythmias, management strategies, and, finally, nursing considerations.

  9. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

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    A. V. Rudakova

    2015-12-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  10. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

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    A. V. Rudakova

    2012-01-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  11. Impact of respiratory infection in the results of cardiac surgery in a tertiary hospital in Brazil

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    Isaac Newton Guimarães Andrade

    2015-09-01

    Full Text Available AbstractObjective:To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication.Methods:Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test.Results:The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00 Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001. The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001. The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively.Conclusion:The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay.

  12. The European System for Cardiac Operative Risk Evaluation (EuroSCORE is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study

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    Légaré Jean-Francois

    2009-07-01

    Full Text Available Abstract Background The European System for Cardiac Operative Risk Evaluation (EuroSCORE is a widely used risk assessment tool in patients with severe aortic stenosis to determine operability and to select patients for alternative therapies such as transcatheter aortic valve implantation. The objective of this study was to determine the accuracy of the EuroSCORE in predicting mortality following aortic valve replacement (AVR. Methods The logistic EuroSCORE was determined for all consecutive patients that underwent conventional AVR between 1995 and 2005 at our institution. Provincial Vital Statistics were used to determine all-cause mortality. The accuracy of the prognostic risk prediction provided by logistic EuroSCORE was assessed by comparing observed and expected operative mortality. Results During the study period, a total of 1,421 patients underwent AVR including 237 patients (16.7% that had a logistic EuroSCORE > 20. Among these patients, the mean predicted operative mortality was 38.7% (SD = 18.1. The actual mortality of these patients was significantly lower than that predicted by EuroSCORE (11.4% vs. 38.7%, observed/expected ratio 0.29, 95% CI 0.15–0.52, P 20 (log rank P = 0.0001, approximately 60% are alive at five years. Conclusion Actual operative mortality in patients undergoing AVR is significantly lower than that predicted by the logistic EuroSCORE. Additionally, medium-term survival following AVR is acceptable in high-risk patients with EuroSCORE > 20. More accurate risk prediction models are needed for risk-stratifying patients with severe aortic stenosis.

  13. Multidimensional evaluation of the elderly undergoing cardiac surgery Evaluación multidimensional de ancianos sometidos a cirugía cardíaca Avaliação multidimensional de idosos submetidos à cirurgia cardíaca

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    Marinez Kellermann Armendaris

    2012-01-01

    Full Text Available OBJECTIVE: Know the multidimensional aspects of the elderly undergoing cardiac surgery. METHODS: Descriptive epidemiological study conducted in the Cardiology Institute of the Distrito Federal-IC/DF. The instrument used for data collection contained the following variables: sociodemographic, clinical, assessment scores of cognitive function, emotional and functional capacity. Chi-square and Student's T tests were used for data analysis. RESULTS: Among the total population, 64% was female; illiterate elderly and with minimal training, combined, accounted for 80%. Dyslipidemia and systolic hypertension were the most prevalent chronic diseases. More than 50% of the elderly presented cognitive and emotional amendments, and functional dependency to some extent. CONCLUSION: These results point to the complexity of the elderly regarding their health condition, and also refer to the need for an integrated approach in health that reflects on improvements in the quality of life of the elderly.OBJETIVO: Conocer aspectos multidimensionales Del anciano sometido a cirugía cardiaca. MÉTODOS: Se trata de um estudio epidemiológico descriptivo, realizado en el Instituto de Cardiología del Distrito Federal-IC/DF. Para la recolección de los datos se utilizó un instrumento que contenía las variables: sociodemográficas, clínicas, escores de evaluación de la función cognitiva, capacidad funcional y emocional. Para el análisis de los datos se emplearon los tests del Chi-cuadrado y T de Student. RESULTADOS: De la población total, el 64% era del sexo femenino; Ancianos analfabetos y con formación mínima que, sumados, representaban el 80%.Dislipidemia, e Hipertensión arterial sistólica, fueron las enfermedades crónicas más prevalentes. Más del 50% de los ancianos presentaron alteraciones cognitivas y afectivas, y algún grado de dependencia funcional. CONCLUSIÓN: Esos resultados apuntan hacia la complejidad del anciano respecto a su condición de

  14. Correlation of Post-Operative Hypoalbuminemia with Outcome of Pediatric Cardiac Surgery

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    Mehdi Ghaderian

    2009-12-01

    Full Text Available Background: Hypoalbuminemia may be caused by liver disease, nephrotic syndrome, burns, protein-losing entropathy, malnutrition, and metabolic stress. Alterations in albumin in metabolic stress such as cardiac surgery have been previously investigated. We studied serum albumin concentration in children with congenital heart disease and also the association of hypoalbuminemia with mortality and morbidity after pediatric cardiac surgery.Methods: We measured serum albumin concentration prospectively in 300 children with congenital heart disease who underwent surgery between July and September 2008 in Shaheed Rajaee hospital. Serum albumin concentration was measured before and 48 hours after cardiac surgery and was subsequently compared between 2 groups: cyanotic and acyanotic and also with normal values.Results: Serum albumin concentration decreased on the second post-operative day in 70 (23.3% patients. There was a positive correlation between the post-surgical hypoalbuminemia and cyanotic heart disease. The cyanotic children had lower serum albumin concentration than the acyanotic ones (P value <0.001. There was a significant association between post-operative serum albumin concentration and acute renal failure (P value <0.001 and death (P value <0.001. Drop in serum albumin concentration was more prominent in the males than in the females (P value=0.038 and in the cyanotic patients than in the acyanotic ones (P value <0.001 as well as in those with acute renal failure (P value <0.001, pericardial effusion (P value=0.050, seizure (P value <0.001, and death (P value <0.001. Hypoalbuminemia was not associated with longer hospital (P value=0.142 or intensive care unit stay (P value=0.199 .Conclusion: Post-operative serum albumin concentration was lower in the cyanotic children and male patients in our study. In addition, the post-operative decrease in albumin was associated with an increased risk of pericardial effusion, renal failure, seizure, and

  15. Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study

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    Shio Priye

    2015-01-01

    Full Text Available Objectives: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. Settings and Design: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Interventions: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU and randomly divided into two groups. Group A (n = 32 received a 12 h infusion of normal saline and group B (n = 32 received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS pain ratings, Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU. Student′s t-test, Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups. Results: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001. Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group (P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively. Incidence of delirium was less in dexmedetomidine group (P = 0.086+. Hemodynamic parameters were statistically insignificant. Conclusions: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

  16. A genotype-specific, randomized controlled behavioral intervention to improve the neuroemotional outcome of cardiac surgery: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Hauer, D.; Kolassa, I.T.; Laubender, R.P.; Mansmann, U.; Hagl, C.; Roozendaal, B.; Quervain, D.J. de; Schelling, G.

    2013-01-01

    BACKGROUND: Cardiac surgery is one of the most commonly performed surgical procedures worldwide with >700,000 surgeries in 2006 in the US alone. Cardiac surgery results in a considerable exposure to physical and emotional stress; stress-related disorders such as depression or post-traumatic stres

  17. Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass

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    Claudia Gissi da Rocha Ferreira

    2014-12-01

    Full Text Available Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15 and a clonidine group (12, were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

  18. Nanofiber-reinforced biological conduit in cardiac surgery: preliminary report.

    Science.gov (United States)

    Guhathakurta, Soma; Galla, Satish; Ramesh, Balasundari; Venugopal, Jayarama Reddy; Ramakrishna, Seeram; Cherian, Kotturathu Mammen

    2011-06-01

    Several options are available for right ventricular outflow tract reconstruction, including commercially available bovine jugular vein and cryo-preserved homografts. Homograft non-availability and the problems of commercially available conduits led us to develop indigenously processed bovine jugular vein conduits with competent valves. They were made completely acellular and strengthened by non-conventional cross-linking without disturbing the extracellular matrix, which improved the luminal surface characteristics for hemocompatibility. Biocompatibility in vitro and in vivo, along with thermal stability, matrix stability, and mechanical strength have been evaluated. Sixty-nine patients received these conduits for right ventricular outflow tract reconstruction. Seven conduits dilated and 4 required replacement. To counteract dilatation, biodegradable polymeric nanofibers in various combinations and in isolation (collagen, polycaprolactone, polylactic acid) were characterized and used to reinforce the conduit circumferentially. Physical validation by mechanical testing, scanning electron microscopy, and in-vitro cytotoxicity was conducted. Thermal stability, spectroscopy studies of the polymer, and preclinical studies of the coated bovine jugular vein in animals are in progress. The feasibility studies have been completed, and the final polymer selection depends on evaluation of the functional superiority of the coated bovine jugular vein.

  19. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

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    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  20. Ultrasound-guided cannulation of the internal jugular vein in robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; WANG Gang; GAO Chang-qing

    2013-01-01

    Background Robotic assisted minimally invasive cardiac sugery is a new technique that uses small port sites and peripheral vessel cannulation for cardiopulmonary bypass (CPB) has been used.The right internal jugular vein (IJV)is commonly used for intraoperative venous access to the central circulation and identified with an external landmark.Previous studies have demonstrated the superiority of ultrasound guidance over external landmark technique in anaesthetic and intensive care settings.The aim of the present study was to delineate the utility of ultrasound-guided cannulation of the IJV during establishment of peripheral CPB in robotic cardiac surgery.Methods We prospectively studied 296 adult patients undergoing ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery at our institute from January 2007 to October 2012 (ultrasound group).The success rate,the first attempt success rate,access time and the complication rate of ultrasound-guided method were compared with the landmark-guided method used for 302 historical control patients (landmark group).Results In the ultrasound group,296 consecutive adult patients underwent ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery.In the landmark group,302 patients underwent right IJV cannulation using the landmark-guided technique.The success rate and the first attempt success rate in the ultrasound group were significantly higher than that in the landmark group (100% vs.88.1%,P <0.000 and 98.6% vs.38.4%,P <0.000).Average access time in the ultrasound group was shorter than that in the landmark group ((6.3±13.6) seconds;interquartile range (4-62) seconds vs.(44.5±129.5) seconds; interquartile range (5-986) seconds).The complication rate in the ultrasound group was significantly lower than that in the landmark group (0.3% vs.8.3%,P <0.000).Conclusion Compared with the landmark-guided approach

  1. Associations of hospital characteristics with nosocomial pneumonia after cardiac surgery can impact on standardized infection rates.

    Science.gov (United States)

    Sanagou, M; Leder, K; Cheng, A C; Pilcher, D; Reid, C M; Wolfe, R

    2016-04-01

    To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001-2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare.

  2. Influence of the sample anticoagulant on the measurements of impedance aggregometry in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Cristina Solomon

    2008-10-01

    Full Text Available Cristina Solomon1, Michael Winterhalter1, Isabel Gilde1, Ludwig Hoy2, Andreas Calatzis3, Niels Rahe-Meyer11Department of Anesthesiology, Hannover Medical School, Hannover, Germany; 2Institute for Biometry, Hannover Medical School, Hannover, Germany; 3Department Hemostasis Transfusion Medicine, University Hospital Munich, Munich, GermanyBackground: The standard method of assessment of platelet function is represented by light transmission aggregometry (LTA, performed in citrated platelet-rich plasma (PRP. With LTA, decrease and subsequent post-cardiopulmonary bypass (CPB recovery of platelet function have been reported during cardiac surgery. Multiple electrode aggregometry (MEA may be used as point-of-care method to monitor perioperative changes in platelet function. Since MEA assesses macroaggregation which is influenced by the plasmatic levels of unbound calcium, citrate may be inadequate as anticoagulant for MEA. We used citrate and heparin for MEA samples, to see with which anticoagulant the intraoperative decrease and postoperative recovery in platelet function previously described with other aggregometric methods in cardiac surgery may be observed with MEA.Methods: Blood was obtained from 60 patients undergoing routine cardiac surgery and the samples were collected in standard tubes containing unfractionated heparin (50 U/mL or trisodium citrate (3.2%. The samples were obtained before CPB, at 30 minutes on CPB, end of CPB and on the first postoperative day. MEA was performed using the Multiplate® analyzer. Collagen (COLtest, 100 μg/mL and TRAP-6 (thrombin receptor activating peptide, TRAPtest, 1mM/mL were used as aggregation agonists.Results: Platelet aggregometric response decreased significantly during CPB. Platelet aggregation assessed using TRAP-6 as agonist on heparinized blood significantly correlated with the duration of CPB (r = −0.41, p = 0.001, 2-tailed Pearson test. The aggregometric analysis performed on the first

  3. Raised plasma Robo4 and cardiac surgery-associated acute kidney injury.

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    Anne Burke-Gaffney

    Full Text Available OBJECTIVE: Endothelial dysfunction associated with systemic inflammation can contribute to organ injury/failure following cardiac surgery requiring cardiopulmonary bypass (CPB. Roundabout protein 4 (Robo4, an endothelial-expressed transmembrane receptor and regulator of cell activation, is an important inhibitor of endothelial hyper-permeability. We investigated the hypothesis that plasma levels of Robo4 are indicative of organ injury, in particular acute kidney injury (AKI, after cardiac surgery. METHODS: Patients (n = 32 undergoing elective cardiac surgery with CPB were enrolled, prospectively. Plasma Robo4 concentrations were measured pre-, 2 and 24 h post-operatively, using a commercially available ELISA. Plasma and endothelial markers of inflammation [interleukin (IL -6, -8, -10: von Willibrand factor (vWF and angiopoeitin-2 (Ang-2] and the AKI marker, neutrophil gelatinase-associated lipocalin (NGAL, were also measured by ELISA. RESULTS: Plasma Robo4 increased significantly (p<0.001 from pre-operative levels of 2515 ± 904 pg/ml to 4473 ± 1915 pg/ml, 2 h after surgery; and returned to basal levels (2682 ± 979 pg/ml by 24 h. Plasma cytokines, vWF and NGAL also increased 2 h post-operatively and remained elevated at 24 h. Ang-2 increased 24 h post-operatively, only. There was a positive, significant correlation (r = 0.385, p = 0.0298 between Robo-4 and IL-10, but not other cytokines, 2 h post-operatively. Whilst raised Robo4 did not correlate with indices of lung dysfunction or other biomarkers of endothelial activation; there was a positive, significant correlation between raised (2 h plasma NGAL and Robo4 (r = 0.4322, p = 0.0135. When patients were classed as AKI or non-AKI either using NGAL cut-off of 150 ng/ml, or the AKI Network (AKIN clinical classification; plasma Robo4 was significantly higher (p = 0.0073 and 0.003, respectively in AKI vs. non-AKI patients (NGAL cut-off: 5350 ± 2191 ng/ml, n = 16 vs. 3595 ± 1068 pg/ml, n = 16

  4. Current readings: long-term management of patients undergoing successful pediatric cardiac surgery.

    Science.gov (United States)

    DiBardino, Daniel J; Jacobs, Jeffrey P

    2014-01-01

    in all patients; and (3) concomitant procedures to treat associated lesions. The need for pulmonary valve replacement is increasing for many adults with congenital heart disease. In the past, chronic pulmonary regurgitation following repair of tetralogy of Fallot was considered benign. Current evidence demonstrates that chronic pulmonary regurgitation causes significant morbidity by producing right ventricular dilatation and dysfunction, exercise intolerance, arrhythmias, and sudden death. Multiple options exist for pulmonary valve replacement including several recent developments such as pulmonary valve replacement with a hand-sewn polytetrafluoroethylene bicuspid valve and percutaneous pulmonary valve replacement. Reoperative cardiac surgery is common in adults with congenital heart disease. Although a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, patients with the greatest number of previous surgeries appear to be a higher risk group. Multi-institutional data about adults with congenital heart disease from The Society of Thoracic Surgeons Congenital Heart Surgery Database can be used to estimate prognosis and council patients and their families. The six manuscripts reviewed in this article have been selected to give a flavor of the state of the art in the domain of caring for adults with congenital heart disease and to provide important information about the long term management of patients undergoing successful pediatric cardiac surgery.

  5. Intraoperative cardiac arrest during anesthesia:a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery in a US teaching hospital

    Institute of Scientific and Technical Information of China (English)

    AN Jian-xiong; Li-Ming Zhang; Erin A.Sullivan; GUO Qu-lian; John P.Williams

    2011-01-01

    Background Patient safety has been gained much more attention in recent years.The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center,USA.The main objectives of the study were to determine the incidence of intraoperative cardiac arrest,to identify possible causes of cardiac arrest and to explore amenable modifications.Methods With approval by the University of Pittsburgh Institutional Review Board,patients experienced cardiac arrest during surgery were retrieved from medical records,surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS),a hospital electronic searching system.Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH),USA.Results We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000).Fourteen patients (60.8%) died in the operating room,leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics.Immediate overall survival rate after arrest was 39% (9/23).Half of the patients (12/23) were emergency cases with 41% survival rate (5/12).One fourth of the arrests were trauma patients (6/23).Most arrest patients (87%,20/23) were American Society of Anesthesiologists Physical Status (ASA PS) Ⅳ and Ⅴ,while only three patients were ASA PS-Ⅰ,Ⅱ and Ⅲ,respectively.One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Conclusions Most intraoperative cardiac arrests were not due to anesthesia-related causes.Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

  6. Matrix Metalloproteinase-9 Production following Cardiopulmonary Bypass Was Not Associated with Pulmonary Dysfunction after Cardiac Surgery

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    Tso-Chou Lin

    2015-01-01

    Full Text Available Background. Cardiopulmonary bypass (CPB causes release of matrix metalloproteinase- (MMP- 9, contributing to pulmonary infiltration and dysfunction. The aims were to investigate MMP-9 production and associated perioperative variables and oxygenation following CPB. Methods. Thirty patients undergoing elective cardiac surgery were included. Arterial blood was sampled at 6 sequential points (before anesthesia induction, before CPB and at 2, 4, 6, and 24 h after beginning CPB for plasma MMP-9 concentrations by ELISA. The perioperative laboratory data and variables, including bypass time, PaO2/FiO2, and extubation time, were also recorded. Results. The plasma MMP-9 concentrations significantly elevated at 2–6 h after beginning CPB (P<0.001 and returned to the preanesthesia level at 24 h (P=0.23, with predominant neutrophil counts after surgery (P<0.001. The plasma MMP-9 levels at 4 and 6 h were not correlated with prolonged CPB time and displayed no association with postoperative PaO2/FiO2, regardless of reduced ratio from preoperative 342.9±81.2 to postoperative 207.3±121.3 mmHg (P<0.001. Conclusion. Elective cardiac surgery with CPB induced short-term elevation of plasma MMP-9 concentrations within 24 hours, however, without significant correlation with CPB time and postoperative pulmonary dysfunction, despite predominantly increased neutrophils and reduced oxygenation.

  7. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

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    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  8. A trial of nebulised heparin to limit lung injury following cardiac surgery.

    Science.gov (United States)

    Dixon, B; Smith, R; Santamaria, J D; Orford, N R; Wakefield, B J; Ives, K; McKenzie, R; Zhang, B; Yap, C H

    2016-01-01

    Cardiac surgery with cardiopulmonary bypass triggers an acute inflammatory response in the lungs. This response gives rise to fibrin deposition in the microvasculature and alveoli of the lungs. Fibrin deposition in the microvasculature increases alveolar dead space, while fibrin deposition in alveoli causes shunting. We investigated whether prophylactic nebulised heparin could limit this form of lung injury. We undertook a single-centre double-blind randomised trial. Forty patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomised to prophylactic nebulised heparin (50,000 U) or placebo. The primary endpoint was the change in arterial oxygen levels over the operative period. Secondary endpoints included end-tidal CO₂, the alveolar dead space fraction and bleeding complications. We found nebulised heparin did not improve arterial oxygen levels. Nebulised heparin was, however, associated with a lower alveolar dead space fraction (P heparin was not associated with bleeding complications. In conclusion, prophylactic nebulised heparin did not improve oxygenation, but was associated with evidence of better alveolar perfusion and CO₂elimination at the end of surgery.

  9. An Investigation of Safety and Efficacy of Intravenous Paracetamol in Pain Management Following Cardiac Surgery

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    Ehsan Mahdavi

    2015-09-01

    Full Text Available Introduction: Optimum pain management immediately after surgeries can lower the possibility of pain syndrome and its following consequences. Opioids are amongst the analgesics used for postoperative pain control; however, their application can bring about several adverse effects. In this study, all the published articles regarding efficacy of Paracetamol   in post-cardiac surgery pain management were systematically reviewed. Materials and Methods: Pubmed and Scopus were searched for relevant articles. The employed search strategy was as follows: (Paracetamol   OR Acetaminophen OR Propacetamol AND (pain OR analgesia AND coronary. All the English-language articles (with no time restriction, investigating the effectiveness of Acetaminophen in comparison with other analgesics or placebo, were included in the study. All the articles examining the efficacy of Paracetamol   in combination with other analgesics were excluded from the search results. Results: On the whole, our electronic search retrieved 192 articles from PubMed and 365 articles from Scopus. After screening the titles, abstracts, and full texts of the search results, only 5 English-language articles met our inclusion criteria. Conclusion: Although Paracetamol   demonstrated considerable efficacy in minimizing application of post-operative opioids, its strength in soothing post-operative pain is not significantly different from opioids. Further, conducting randomized-controlled-trials with large sample size are necessary to accurately reveal the efficacy of Paracetamol   in curtailing application of opioids in post cardiac surgeries.

  10. Management of patients with prosthetic heart valves during non-cardiac surgery.

    Science.gov (United States)

    Prendergast, Bernard D

    2004-01-01

    Non-cardiac surgery in patients with prosthetic heart valves poses the particular hazards of infective endocarditis, increased bleeding risk and the possibility of acute/subacute valve thrombosis or systemic thromboembolism associated with interrupted anticoagulation. Management is complicated by the absence of randomised trials examining peri-operative anticoagulation management. Thromboembolic risk increases substantially when oral anticoagulation is discontinued and valve thrombosis may be inapparent for 1-2 months. This delayed diagnosis makes it difficult to identify the inciting event, either clinically or in experimental trials. Furthermore, the absence of early post-operative events may falsely suggest that peri-operative anticoagulation was safe and adequate. The approach to management therefore remains controversial. Seamless oral anticoagulation is preferred whenever possible and this is safe for a range of minor procedures, including cardiac catheterisation, dental and ophthalmic surgery. Major surgical procedures require withdrawal of oral anticoagulation before surgery to lower the international normalised ratio (INR) to anticoagulation with unfractionated heparin which should be started when the INR is patients and anticoagulation is then resumed post-operatively, though therapeutic levels are not achieved for several days. The determination of which patients require prolonged overlap of heparin and oral anticoagulants is difficult. Clinical judgement is required but these regimes are strongly recommended for those at highest risk of thromboembolism. With strict adherence to these guidelines, the incidence of major complications is low.

  11. Association of blood products administration during cardiopulmonary bypass and excessive post-operative bleeding in pediatric cardiac surgery.

    Science.gov (United States)

    Agarwal, Hemant S; Barrett, Sarah S; Barry, Kristen; Xu, Meng; Saville, Benjamin R; Donahue, Brian S; Harris, Zena L; Bichell, David P

    2015-03-01

    Our objectives were to study risk factors and post-operative outcomes associated with excessive post-operative bleeding in pediatric cardiac surgeries performed using cardiopulmonary bypass (CPB) support. A retrospective observational study was undertaken, and all consecutive pediatric heart surgeries over 1 year period were studied. Excessive post-operative bleeding was defined as 10 ml/kg/h of chest tube output for 1 h or 5 ml/kg/h for three consecutive hours in the first 12 h of pediatric cardiac intensive care unit (PCICU) stay. Risk factors including demographics, complexity of cardiac defect, CPB parameters, hematological studies, and post-operative morbidity and mortality were evaluated for excessive bleeding. 253 patients were studied, and 107 (42 %) met the criteria for excessive bleeding. Bayesian model averaging revealed that greater volume of blood products transfusion during CPB was significantly associated with excessive bleeding. Multiple logistic regression analysis of blood products transfusion revealed that increased volume of packed red blood cells (PRBCs) administration for CPB prime and during CPB was significantly associated with excessive bleeding (p = 0.028 and p = 0.0012, respectively). Proportional odds logistic regression revealed that excessive bleeding was associated with greater time to achieve negative fluid balance, prolonged mechanical ventilation, and duration of PCICU stay (p < 0.001) after adjusting for multiple parameters. A greater volume of blood products administration, especially PRBCs transfusion for CPB prime, and during the CPB period is associated with excessive post-operative bleeding. Excessive bleeding is associated with worse post-operative outcomes.

  12. Lifestyle and the importance of health education in the cardiac rehabilitation after myocardial revascularization surgery - doi:10.5020/18061230.2007.p213

    Directory of Open Access Journals (Sweden)

    Denise Gonçaleves Moura Pinheiro

    2012-01-01

    Full Text Available In the treatment of ischemic cardiopathy, the prevention has a main role and the modifications in the lifestyle are indispensable for the good prognosis of the disease. The goal of the study was to describe the lifestyle regarding the prevalence of cardiovascular risk factors, such as smoking, alcohol consumption, dietary habits and sedentary behaviors before myocardial revascularization surgery and during the period of cardiac rehabilitation in a private institution that did not comprise structured health education activities. This was a retrospective, observational study, with a qualitative approach, held with 50 patients submitted to cardiac rehabilitation (36 men and 14 women; age 61±12.74 years. The data were collected from clinical records of the pre-cardiac rehabilitation evaluation which consisted of clinical data and information referring to the patients’ lifestyle. Amongst the most prevalent co-morbidities in the sample, there were: the hypertension (n=24; 48%, the diabetes mellitus (n=18; 36% and dyslipidemias (n=17; 34%. A high rate of smoke cessation (100% and 58% of sedentary behaviors (n=29 was observed after the cardiac surgery. This same number (n=29; 58% referred to have adhered to changes in dietary habits after the myocardial acute infarct. There was also an increase in the prevalence of alcohol consumption (n=21; 42% after myocardial revascularization. We conclude with this research that a cardiac rehabilitation program should provide to their patients, health education actions, for a necessary and real change in lifestyle habits, with the presence of a multidisciplinary team.

  13. Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery.

    Science.gov (United States)

    Brown, Z E; Görges, M; Cooke, E; Malherbe, S; Dumont, G A; Ansermino, J M

    2013-07-01

    In this prospective observational study we investigated the changes in cardiac index and mean arterial pressure in children when positioned prone for scoliosis correction surgery. Thirty children (ASA 1-2, aged 13-18 years) undergoing primary, idiopathic scoliosis repair were recruited. The cardiac index and mean arterial blood pressure (median (IQR [range])) were 2.7 (2.3-3.1 [1.4-3.7]) l.min(-1).m(-2) and 73 (66-80 [54-91]) mmHg, respectively, at baseline; 2.9 (2.5-3.2 [1.7-4.4]) l.min(-1).m(-2) and 73 (63-81 [51-96]) mmHg following a 5-ml.kg(-1) fluid bolus; and 2.5 (2.2-2.7 [1.4-4.8]) l.min(-1).m(-2) and 69 (62-73 [46-85]) mmHg immediately after turning prone. Turning prone resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7 l.min(-1).m(-2), p=0.001), or 18.5%, with a large degree of inter-subject variability (+10.3% to -40.9%). The changes in mean arterial blood pressure were not significant. Strategies to predict, prevent and treat decreases in cardiac index need to be developed.

  14. Predicting new-onset of postoperative atrial fibrillation in patients undergoing cardiac surgery using semi-automatic reading of perioperative electrocardiograms

    DEFF Research Database (Denmark)

    Gu, Jiwei; Graff, Claus; Melgaard, Jacob;

    2015-01-01

    P10 Predicting new-onset of postoperative atrial fibrillation in patients undergoingcardiac surgery using semi-automatic reading of perioperative electrocardiograms. Jiwei Gu, Claus Graff, Jacob Melgaard, Søren Lundbye-Christensen, Erik Berg Schmidt, Christian Torp-Pedersen, Kristinn Thorsteinsson......, Jan Jesper Andreasen. Aalborg, DenmarkBackground: Postoperative new onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. The aim of this study was to evaluate if semi-automatic readings of perioperative electrocardiograms (ECGs) is of any value in predicting POAF after...

  15. Intraoperative maintenance of normoglycemia with insulin and glucose preserves verbal learning after cardiac surgery.

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    Thomas Schricker

    Full Text Available OBJECTIVE: The hyperglycemic response to surgery may be a risk factor for cognitive dysfunction. We hypothesize that strict maintenance of normoglycemia during cardiac surgery preserves postoperative cognitive function. METHODS: As part of a larger randomized, single-blind, interventional efficacy study on the effects of hyperinsulinemic glucose control in cardiac surgery (NCT00524472, consenting patients were randomly assigned to receive combined administration of insulin and glucose, titrated to preserve normoglycemia (3.5-6.1 mmol L(-1; experimental group, or standard metabolic care (blood glucose 3.5-10 mmol L(-1; control group, during open heart surgery. The patients' cognitive function was assessed during three home visits, approximately two weeks before the operation, and two months and seven months after surgery. The following tests were performed: Rey Auditory Verbal Learning Task (RAVLT for verbal learning and memory, Digit Span Task (working memory, Trail Making A & B (visuomotor tracking and attention, and the Word Pair Task (implicit memory. Questionnaires measuring specific traits known to affect cognitive performance, such as self-esteem, depression, chronic stress and social support, were also administered. The primary outcome was to assess the effect of hyperinsulinemic-normoglycemic clamp therapy versus standard therapy on specific cognitive parameters in patients receiving normoglycemic clamp, or standard metabolic care. RESULTS: Twenty-six patients completed the study with 14 patients in the normoglycemia and 12 patients in the control group. Multiple analysis of covariance (MANCOVA for the RAVLT showed a significant effect for the interaction of group by visit (F = 4.07, p = 0.035, and group by visit by recall (F = 2.21, p = 0.04. The differences occurred at the second and third visit. MANCOVA for the digit span task, trail making and word pair association test showed no significant effect. CONCLUSIONS

  16. Cardiac anesthesia and surgery in geriatric patients: epidemiology, current surgical outcomes, and future directions.

    Science.gov (United States)

    Castillo, J G; Silvay, G; Chikwe, J

    2009-01-01

    The mean life expectancy of the population of the United States is projected to increase from 78.3 years at present to over 81 years in 2025, with a concomitant increase in the percentage of the population over the age of 75 years. Elderly patients are more likely to present with valvular and coronary artery disease than younger patients, and as better perioperative management contributes to improving post-operative outcomes and lower referral thresholds, very elderly patients form an increasingly large proportion of the cardiac surgical population. This article summarizes the impact of age-related pathophysiologic changes on patients' response to cardiac surgery and anesthesia, outlines useful perioperative strategies in this age group, and reviews the literature on outcomes after valvular and coronary in elderly patients.

  17. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...

  18. A systematic review of economic evaluations of cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Wong Wai

    2012-08-01

    Full Text Available Abstract Background Cardiac rehabilitation (CR, a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI, revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF. This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1 supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2 home-based CR was no different from centre-based CR; (3 no difference existed

  19. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox?

    Directory of Open Access Journals (Sweden)

    Marco Ranucci

    Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.

  20. Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

    Science.gov (United States)

    Kim, Eunhee; Park, Jung Bo; Kim, Youngwon; Yang, Ji-Hyuk; Jun, Tae-Gook; Kim, Chung Su

    2016-01-01

    required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery. PMID:27832187

  1. Cirurgia cardíaca na gravidez Cardiac surgery during pregnancy

    Directory of Open Access Journals (Sweden)

    Antoninho Sanfins Arnoni

    1986-08-01

    Full Text Available No Instituto Dante Pazzanese de Cardiologia, vem sendo realizado, desde 1975, um trabalho conjunto reunindo obstetras, pediatras, cardiologistas, anestesistas e cirurgiões cardiovasculares, com o intuito de melhorar os resultados da cirurgia cardíaca realizada em pacientes grávidas. Para isto, organizamos um protocolo, que inclui desde o pré-operatório até o nascimento da criança, passando por estudos ecocardiográficos, ultrassonográficos e por monitorização fetal durante a cirurgia. Vinte e seis pacientes foram operadas durante a gravidez, sendo 6 delas em 1985, após o início do estudo. Os resultados, tanto do lado materno como do fetal, são bons, não ocorrendo nenhum óbito materno nesta série e com as crianças nascendo bem e sem malformações e com crescimento e desenvolvimento normais, até o 6º mês de vida extra-uterina.At the Instituto Dante Pazzanese de Cardiologia, a team project has been carried out since 1975, including obstetricians, pediatricians, cardiologists, anesthesiologists and cardiovascular surgeons aim at getting better results of cardiac surgery in pregnant women. For this purpose, the group developed a protocol that goes from the preoperative period to the delivery of the baby, with ecocardiographic and ultrasonic studies and fetal monitoring during the cardiac surgery of the mother. Twenty six patients were submited to cardiac surgery during pregnancy, and six patients after beginning the study, in 1985. The maternal and fetal results were good, without maternal death and the children were born without malformations and having had normal development until the sixth month of life.

  2. Meta-analysis for outcomes of acute kidney injury after cardiac surgery

    Science.gov (United States)

    Shi, Qiankun; Hong, Liang; Mu, Xinwei; Zhang, Cui; Chen, Xin

    2016-01-01

    Abstract This study aimed to investigate the outcomes of acute kidney injury (AKI) after cardiac surgery by the meta-analysis. Electronic databases PubMed and Embase were searched for relative studies from December 2008 to June 2015. For eligible studies, the R software was conducted to meta-analyze outcomes of AKI patients (AKI group) and none-AKI patients after cardiac surgery (NO AKI group). The chi-square-based Q test and I2 statistic were used for heterogeneity analysis. P  50% revealed significant heterogeneity among studies, and then a random effects model was used; otherwise a fixed effect model was performed. Egger's test was performed for publication bias assessment. Subgroup analysis was performed by stratifying AKI definitions and study type. Totally 17 studies with 9656 subjects (2331 in the AKI group and 7325 in the NO AKI group) were enrolled. Significantly higher renal replacement therapy (RRT) (OR=23.67, 95%CI: 12.58–44.55), mortality (OR = 6.27, 95%CI: 3.58–11.00), serum creatinine (SMD = 1.42, 95%CI: 1.01–1.83), and hospital length of stay (LOS) (SMD = 0.45, 95%CI: 0.02–0.88) were shown in the AKI group compared with patients in the NO AKI group. Subgroup analysis showed that results of only 3 subgroups were reversed indicating that the definition of AKI did not affect its outcomes. Publication bias was only found among studies involving mortality and serum creatinine, but the 2 outcomes were not reversed after correction. This meta-analysis confirmed the worse outcomes of AKI in patients after cardiac surgery, including higher RRT rates, mortality, and longer hospital LOS than those of NO AKI patients. PMID:27930561

  3. Evaluation of malnutrition in orthopaedic surgery.

    Science.gov (United States)

    Cross, Michael Brian; Yi, Paul Hyunsoo; Thomas, Charlotte F; Garcia, Jane; Della Valle, Craig J

    2014-03-01

    Malnutrition can increase the risk of surgical site infection in both elective spine surgery and total joint arthroplasty. Obesity and diabetes are common comorbid conditions in patients who are malnourished. Despite the relatively high incidence of nutritional disorders among patients undergoing elective orthopaedic surgery, the evaluation and management of malnutrition is not generally well understood by practicing orthopaedic surgeons. Serologic parameters such as total lymphocyte count, albumin level, prealbumin level, and transferrin level have all been used as markers for nutrition status. In addition, anthropometric measurements, such as calf and arm muscle circumference or triceps skinfold, and standardized scoring systems, such as the Rainey-MacDonald nutritional index, the Mini Nutritional Assessment, and institution-specific nutritional scoring tools, are useful to define malnutrition. Preoperative nutrition assessment and optimization of nutritional parameters, including tight glucose control, normalization of serum albumin, and safe weight loss, may reduce the risk of perioperative complications, including infection.

  4. Evaluating Right Ventricle Function in Patients Undergoing Cardiac Surgery by Two-dimensional Speckle Tracking Imaging%二维斑点追踪技术定量评价心脏手术患者的右心室功能

    Institute of Scientific and Technical Information of China (English)

    黄国倩; 储祥麟; 黄杰春; 庞烈文; 王宜青

    2012-01-01

    Objective Right ventricular (RV) function is an independent prognosis predictor in patients undergoing cardiac surgery. The objective of this study is to evaluate the feasibility of quantifying RV function by Two-dimensional speckle tracking imaging (2D-STI); and to assess the influence of LV function and the cardiac surgery on RV function. Methods 2D-ST1 was performed in 61 patients who undergone cardiac surgery and 25 healthy subjects (Control group). The imaging was analyzed offline with Qlad 6. 0 TMQA to determine the longitudinal RV peak systolic strain (e) and the peak systolic velocity (S) of the 3 segments of RV free wall. The RV functional parameters were compared between patients with preserved LVEF (LVEF>50%) and with decreased LVEF (LVEF<50%), Meanwhile, the postoperative change of RV function was monitored 1 week, 3 months and six months after the surgery, and was compared with the pre-operative data. Results Patients with decreased LVEF had lower RV systolic peak strain and velocity, as compared both with preserved LVEF group (P<0.05) and with control group (P< 0. 05). There were no differences of RV functional parameters between the patients with preserved LVEF and the controls. Both in CPB group (n=33) and in OP group (n=28), RV systolic peak strain and velocity were decreased significantly 1 week after surgery as compared with those preoperative; and then recovered 3 and 6 months after surgery, with no difference when comparing with preoperative data and with those of control group. Conclusions 2D-ST1 could be a promising technique to quantify and monitor RV function noninvasively. The longitudinal systolic peak strain of free wall would be used as RV functional parameters. Patients with abnormal LVEF had damaged RV deformation and motion function. No matter under which pattern of circulation, cardiac surgery could do harm to RV function transiently; the reversible injury would be recovered in about 3 months after the surgery.%目的 右心室功

  5. Mechanical support availability in pediatric cardiac surgery: program size should not matter.

    Science.gov (United States)

    da Cruz, Eduardo M; Beghetti, Maurice; Kalangos, Afksendyios; Berner, Michel; Sierra, Jorge; Aggoun, Yacine; Tissot, Cécile; Pellegrini, Michel; Saudan, Sonja; Habre, Walid; Rimensberger, Peter C

    2008-09-26

    Intractable heart failure may require Extracorporeal Life Support (ECLS) techniques for rescue therapy. Nevertheless, in many small to middle-sized centers in Europe, this valuable resource is not available. In our University pediatric intensive care unit 0.9% of 1360 open-heart surgical patients required mechanical assistance over the latest 9 years with a survival rate of 69.2% and low residual morbidity. This favorable overall outcome suggests that regardless of the program size, it is possible to ensure the availability of efficient mechanical assistance that appears to be fundamental in a center performing surgery for complex congenital or acquired cardiac diseases.

  6. Cardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome

    OpenAIRE

    2015-01-01

    Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CSAKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0-17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output

  7. Catheter-Based Educational Experiences: A Canadian Survey of Current Residents and Recent Graduates in Cardiac Surgery.

    Science.gov (United States)

    Juanda, Nadzir; Chan, Vincent; Chan, Ryan; Rubens, Fraser D

    2016-03-01

    The past decade has witnessed significant developments in the use of catheter-based therapies in cardiovascular medicine. We sought to assess the educational opportunities for cardiac surgery trainees to determine their readiness for participation in these strategies. A web-based survey was distributed to current residents, recent graduates, and program directors in Canadian cardiac surgery residency programs from 2008-2013. The survey was distributed to 110 residents and graduates. Forty-five percent completed the survey. Thirty-five percent expressed that they experienced resistance organizing their rotations because they had to compete with non-cardiac surgery colleagues, and 6 were denied local cardiac catheterization rotations. By the end of the rotation, 56% were comfortable performing a diagnostic cardiac catheterization independently. Exposure to being the operator performing diagnostic catheterization was significantly associated with the positive perception of being able to perform a diagnostic catheterization independently (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.33-19.81; P = 0.017). Eighty-eight percent of respondents expressed the need for more exposure in catheter-based rotations. Seven of 11 program directors completed the survey. All believed such rotations should be mandatory and foresaw a bigger role for hybrid catheter-based/cardiac surgery procedures in the future. Trainees and program directors perceive that increased exposure to catheter-based therapies is important to career development as a cardiac surgeon. This survey will contribute to the development of a cardiac surgery training curriculum as we foresee more hybrid and team procedures.

  8. Protection of Coronary Endothelial Function during Cardiac Surgery: Potential of Targeting Endothelial Ion Channels in Cardioprotection

    Directory of Open Access Journals (Sweden)

    Qin Yang

    2014-01-01

    Full Text Available Vascular endothelium plays a critical role in the control of blood flow by producing vasoactive factors to regulate vascular tone. Ion channels, in particular, K+ channels and Ca2+-permeable channels in endothelial cells, are essential to the production and function of endothelium-derived vasoactive factors. Impairment of coronary endothelial function occurs in open heart surgery that may result in reduction of coronary blood flow and thus in an inadequate myocardial perfusion. Hyperkalemic exposure and concurrent ischemia-reperfusion during cardioplegic intervention compromise NO and EDHF-mediated function and the impairment involves alterations of K+ channels, that is, KATP and KCa, and Ca2+-permeable TRP channels in endothelial cells. Pharmacological modulation of these channels during ischemia-reperfusion and hyperkalemic exposure show promising results on the preservation of NO and EDHF-mediated endothelial function, which suggests the potential of targeting endothelial K+ and TRP channels for myocardial protection during cardiac surgery.

  9. [Anesthetic management of an infant with a single ventricle (asplenia syndrome) for non-cardiac surgery].

    Science.gov (United States)

    Uchida, K; Ando, T; Okuda, C

    1992-11-01

    Ketamine and fentanyl were used for surgery of esophageal hiatus hernia in a 9 month old boy with single ventricle (asplenia syndrome). The patient was orally premedicated with diazepam 2.5 mg, and intravenously with atropine 0.04 mg. General anesthesia was induced with ketamine-fentanyl-pancuronium-100% oxygen, and maintained with fentanyl-pancuronium-100% oxygen. The total dose of ketamine or fentanyl was 0.8 mg.kg-1 or 15 micrograms.kg-1, respectively. Systolic blood pressure and heart rate of the patient were stable during ketamine-fentanyl anesthesia. Arterial oxygen saturation measured by pulse oximetry was over 90% and arterial oxygen tension was above 60 mmHg during the operation. Ketamine-fentanyl anesthesia might be useful for non-cardiac surgery of a child with cyanotic congenital heart disease.

  10. Hyperthemia after cardiac surgery due to ascariasis in a child: report of a case.

    Science.gov (United States)

    Maekawa, Yoshiyuki; Sakamoto, Takahiko; Umezu, Kentaroh; Ohashi, Noburoh; Harada, Yorikazu; Matsui, Hikoroh

    2012-07-01

    Ascaris lumbricoides is the most common parasite affecting humans, especially in countries and regions with lower socio-economic conditions. A 2-year-old female child underwent right pulmonary angioplasty using cardiopulmonary bypass. Serious hyperthermia continued after surgery, and, therefore, a re-exploration of the mediastinum was performed because mediastinitis was suspected. No evidence of wound infection was revealed. Ascaris lumbricoides was subsequently isolated from her stool. The patient had no further hyperthermia throughout her hospitalization and was discharged uneventfully on post-operative day 12. The probable origin of the fever was an A. lumbricoides infection and ascariasis may cause the occurrence of serious hyperthermia during the perioperative period. Ascaris lumbricoides infection may, therefore, cause high-grade fever after cardiac surgery.

  11. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease - the perspective of cardiac surgery

    NARCIS (Netherlands)

    Jacobs, Marshall Lewis; Jacobs, Jeffrey Phillip; Franklin, Rodney C. G.; Mavroudis, Constantine; Lacour-Gayet, Francois; Tchervenkov, Christo I.; Walters, Hal; Bacha, Emile A.; Clarke, David Robinson; Gaynor, J. William; Spray, Thomas L.; Stellin, Giovanni; Ebels, Tjark; Maruszewski, Bohdan; Tobota, Zdzislaw; Kurosawa, Hiromi; Elliott, Martin

    2008-01-01

    This review includes a brief discussion, from the perspective of cardiac surgeons, of the rationale for creation and maintenance of multi-institutional databases of outcomes of congenital heart Surgery, together with a history of the evolution of such databases, a description of the current state of

  12. Late Post-Conditioning with Sevoflurane after Cardiac Surgery--Are Surrogate Markers Associated with Clinical Outcome?

    Directory of Open Access Journals (Sweden)

    John M Bonvini

    Full Text Available In a recent randomized controlled trial our group has demonstrated in 102 patients that late post-conditioning with sevoflurane performed in the intensive care unit after surgery involving extracorporeal circulation reduced damage to cardiomyocytes exposed to ischemia reperfusion injury. On the first post-operative day the sevoflurane patients presented with lower troponin T values when compared with those undergoing propofol sedation. In order to assess possible clinical relevant long-term implications in patients enrolled in this study, we performed the current retrospective analysis focusing on cardiac and non-cardiac events during the first 6 months after surgery.All patients who had successfully completed the late post-conditioning trial were included into this follow-up. Our primary and secondary endpoints were the proportion of patients experiencing cardiac and non-cardiac events, respectively. Additionally, we were interested in assessing therapeutic interventions such as initiation or change of drug therapy, interventional treatment or surgery.Of 102 patients analyzed in the primary study 94 could be included in this follow-up. In the sevoflurane group (with 41 patients 16 (39% experienced one or several cardiac events within 6 months after cardiac surgery, in the propofol group (with 53 patients 19 (36%, p=0.75. Four patients (9% with sevoflurane vs. 7 (13% with propofol sedation had non-cardiac events (p=0.61. While a similar percentage of patients suffered from cardiac and/or non-cardiac events, only 12 patients in the sevoflurane group compared to 20 propofol patients needed a therapeutic intervention (OR: 0.24, 95% CI: 0.04-1.43, p=0.12. A similar result was found for hospital admissions: 2 patients in the sevoflurane group had to be re-admitted to the hospital compared to 8 in the propofol group (OR 0.23, 95% CI: 0.04-1.29, p=0.10.Sevoflurane does not seem to provide protection with regard to the occurrence of cardiac and non-cardiac

  13. Centrifugal pump and roller pump in adult cardiac surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Saczkowski, Richard; Maklin, Michelle; Mesana, Thierry; Boodhwani, Munir; Ruel, Marc

    2012-08-01

    Centrifugal pump (CP) and roller pump (RP) designs are the dominant main arterial pumps used in cardiopulmonary bypass (CPB). Trials reporting clinical outcome measures comparing CP and RP are controversial. Therefore, a meta-analysis was undertaken to evaluate clinical variables from randomized controlled trials (RCTs). Keyword searches were performed on Medline (1966-2011), EmBase (1980-2011), and CINAHL (1981-2011) for studies comparing RP and CP as the main arterial pump in adult CPB. Pooled fixed-effects estimates for dichotomous and continuous data were calculated as an odds ratio and weighted-mean difference, respectively. The P value was utilized to assess statistical significance (P pump-related malfunction or mishap. The meta-analysis of RCTs comparing CP and RP in adult cardiac surgery suggests no significant difference for hematological variables, postoperative blood loss, transfusions, neurological outcomes, or mortality.

  14. Two large preoperative doses of erythropoietin do not reduce the systemic inflammatory response to cardiac surgery

    DEFF Research Database (Denmark)

    Poulsen, Troels Dirch; Andersen, Lars Willy; Steinbrüchel, Daniel

    2009-01-01

    OBJECTIVES: Cardiac surgery and cardiopulmonary bypass (CPB) induce an inflammatory reaction that may lead to tissue injury. Experimental studies suggest that recombinant human erythropoietin (EPO) independent of its erythropoietic effect may be used clinically as an anti-inflammatory drug. This ...... of inflammatory cytokines. In contrast, EPO may augment the TNF-alpha and NT-proBNP response. Although the long-term clinical impact remains unknown, the findings do not support use of EPO as an anti-inflammatory drug in patients undergoing cardiac surgery........ This study tested the hypothesis that 2 large doses of EPO administered shortly before CPB ameliorate the systemic inflammatory response to CPB. DESIGN AND SETTING: A prospective, double-blind, placebo-controlled and randomized study at a single tertiary care hospital. PARTICIPANTS: Patients scheduled...... concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-1beta receptor antagonist, IL-6, IL-10, and N-terminal probrain natriuretic peptide (NT-proBNP). Compared with placebo, EPO at day 3 after CPB augmented the TNF-alpha response (p

  15. A Meta-Analysis of Renal Function After Adult Cardiac Surgery With Pulsatile Perfusion.

    Science.gov (United States)

    Nam, Myung Ji; Lim, Choon Hak; Kim, Hyun-Jung; Kim, Yong Hwi; Choi, Hyuk; Son, Ho Sung; Lim, Hae Ja; Sun, Kyung

    2015-09-01

    The aim of this meta-analysis was to determine whether pulsatile perfusion during cardiac surgery has a lesser effect on renal dysfunction than nonpulsatile perfusion after cardiac surgery in randomized controlled trials. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were used to identify available articles published before April 25, 2014. Meta-analysis was conducted to determine the effects of pulsatile perfusion on postoperative renal functions, as determined by creatinine clearance (CrCl), serum creatinine (Cr), urinary neutrophil gelatinase-associated lipocalin (NGAL), and the incidences of acute renal insufficiency (ARI) and acute renal failure (ARF). Nine studies involving 674 patients that received pulsatile perfusion and 698 patients that received nonpulsatile perfusion during cardiopulmonary bypass (CPB) were considered in the meta-analysis. Stratified analysis was performed according to effective pulsatility or unclear pulsatility of the pulsatile perfusion method in the presence of heterogeneity. NGAL levels were not significantly different between the pulsatile and nonpulsatile groups. However, patients in the pulsatile group had a significantly higher CrCl and lower Cr levels when the analysis was restricted to studies on effective pulsatile flow (P < 0.00001, respectively). The incidence of ARI was significantly lower in the pulsatile group (P < 0.00001), but incidences of ARF were similar. In conclusion, the meta-analysis suggests that the use of pulsatile flow during CPB results in better postoperative renal function.

  16. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury.

    Science.gov (United States)

    Gambardella, Ivancarmine; Gaudino, Mario; Ronco, Claudio; Lau, Christopher; Ivascu, Natalia; Girardi, Leonard N

    2016-11-01

    Acute kidney injury (AKI) in cardiac surgery has traditionally been linked to reduced arterial perfusion. There is ongoing evidence that central venous pressure (CVP) has a pivotal role in precipitating acute renal dysfunction in cardiac medical and surgical settings. We can regard this AKI driven by systemic venous hypertension as 'kidney congestive failure'. In the cardiac surgery population as a whole, when the CVP value reaches the threshold of 14 mmHg in postoperative period, the risk of AKI increases 2-fold with an odds ratio (OR) of 1.99, 95% confidence interval (95% CI) of 1.16-3.40. In cardiac surgery subsets where venous hypertension is a hallmark feature, the incidence of AKI is higher (tricuspid disease 30%, carcinoid valve disease 22%). Even in the non-chronically congested coronary artery bypass population, CVP measured 6 h postoperatively showed significant association to renal failure: risk-adjusted OR for AKI was 5.5 (95% CI 1.93-15.5; P = 0.001) with every 5 mmHg rise in CVP for patients with CVP <9 mmHg; for CVP increments of 5 mmHg above the threshold of 9 mmHg, the risk-adjusted OR for AKI was 1.3 (95% CI 1.01-1.65; P = 0.045). This and other clinical evidence are discussed along with the underlying pathophysiological mechanisms, involving the supremacy of volume receptors in regulating the autonomic output in hypervolaemia, and the regional effect of venous congestion on the nephron. The effect of CVP on renal function was found to be modulated by ventricular function class, aetiology and acuity of venous congestion. Evidence suggests that acute increases of CVP should be actively treated to avoid a deterioration of the renal function, particularly in patients with poor ventricular fraction. Besides, the practice of treating right heart failure with fluid loading should be avoided in favour of other ways to optimize haemodynamics in this setting, because of the detrimental effects on the kidney function.

  17. Accuracy of Cardiac Output by Nine Different Pulse Contour Algorithms in Cardiac Surgery Patients: A Comparison with Transpulmonary Thermodilution

    Science.gov (United States)

    Bein, Berthold; Gruenewald, Matthias; Masing, Sarah; Huenges, Katharina; Haneya, Assad; Steinfath, Markus; Renner, Jochen

    2016-01-01

    Objective. Today, there exist several different pulse contour algorithms for calculation of cardiac output (CO). The aim of the present study was to compare the accuracy of nine different pulse contour algorithms with transpulmonary thermodilution before and after cardiopulmonary bypass (CPB). Methods. Thirty patients scheduled for elective coronary surgery were studied before and after CPB. A passive leg raising maneuver was also performed. Measurements included CO obtained by transpulmonary thermodilution (COTPTD) and by nine pulse contour algorithms (COX1–9). Calibration of pulse contour algorithms was performed by esophageal Doppler ultrasound after induction of anesthesia and 15 min after CPB. Correlations, Bland-Altman analysis, four-quadrant, and polar analysis were also calculated. Results. There was only a poor correlation between COTPTD and COX1–9 during passive leg raising and in the period before and after CPB. Percentage error exceeded the required 30% limit. Four-quadrant and polar analysis revealed poor trending ability for most algorithms before and after CPB. The Liljestrand-Zander algorithm revealed the best reliability. Conclusions. Estimation of CO by nine different pulse contour algorithms revealed poor accuracy compared with transpulmonary thermodilution. Furthermore, the less-invasive algorithms showed an insufficient capability for trending hemodynamic changes before and after CPB. The Liljestrand-Zander algorithm demonstrated the highest reliability. This trial is registered with NCT02438228 (ClinicalTrials.gov).

  18. Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management.

    Science.gov (United States)

    Andersen, Lars W

    2017-03-08

    Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations. This review ends with an assessment of the limited literature on this subject.

  19. A relative value method for measuring and evaluating cardiac reserve

    Directory of Open Access Journals (Sweden)

    Sun Xiaobo

    2002-12-01

    Full Text Available Abstract Background Although a very close relationship between the amplitude of the first heart sound (S1 and the cardiac contractility have been proven by previous studies, the absolute value of S1 can not be applied for evaluating cardiac contractility. However, we were able to devise some indicators with relative values for evaluating cardiac function. Methods Tests were carried out on a varied group of volunteers. Four indicators were devised: (1 the increase of the amplitude of the first heart sound after accomplishing different exercise workloads, with respect to the amplitude of the first heart sound (S1recorded at rest was defined as cardiac contractility change trend (CCCT. When the subjects completed the entire designed exercise workload (7000 J, the resulting CCCT was defined as CCCT(1; when only 1/4 of the designed exercise workload was completed, the result was defined as CCCT(1/4. (2 The ratio of S1 amplitude to S2 amplitude (S1/S2. (3 The ratio of S1 amplitude at tricuspid valve auscultation area to that at mitral auscultation area T1/M1 (4 the ratio of diastolic to systolic duration (D/S. Data were expressed as mean ± SD. Results CCCT(1/4 was 6.36 ± 3.01 (n = 67, CCCT(1 was 10.36 ± 4.2 (n = 33, S1/S2 was1.89 ± 0.94 (n = 140, T1/M1 was 1.44 ± 0.99 (n = 144, and D/S was 1.68 ± 0.27 (n = 172. Conclusions Using indicators CCCT(1/4 and CCCT(1 may be beneficial for evaluating cardiac contractility and cardiac reserve mobilization level, S1/S2 for considering the factor for hypotension, T1/M1 for evaluating the right heart load, and D/S for evaluating diastolic cardiac blood perfusion time.

  20. Genetic Polymorphisms in Endothelin-1 as Predictors for Long-Term Survival and the Cardiac Index in Patients Undergoing On-Pump Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Ashham Mansur

    Full Text Available Genetic variants within the endothelin-1 gene (EDN1 have been associated with several cardiovascular diseases and may act as genetic prognostic markers. Here, we explored the overall relevance of EDN1 polymorphisms for long-term survival in patients undergoing on-pump cardiac surgery. A prospectively collected cohort of 455 Caucasian patients who underwent cardiac surgery with cardiopulmonary bypass was followed up for 5 years. The obtained genotypes and inferred haplotypes were analyzed for their associations with the five-year mortality rate (primary endpoint. The EDN1 T-1370G and K198N genotype distributions did not deviate from Hardy-Weinberg equilibrium and the major allele frequencies were 83% and 77%, respectively. The cardiovascular risk factors were equally distributed in terms of the different genotypes and haplotypes associated with the two polymorphisms. The five-year mortality rate did not differ among the different EDN1 T-1370G and K198N genotypes and haplotypes. Haplotype analysis revealed that carriers of the G-T (compound EDN1 T-1370G G/K198N T haplotype had a higher cardiac index than did non-carriers (p = 0.0008; however, this difference did not reach significance after adjusting for multiple testing. The results indicate that common variations in EDN1 do not act as prognostic markers for long-term survival in patients undergoing on-pump cardiac surgery.

  1. Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler – a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Sanders Stephen P

    2006-12-01

    Full Text Available Abstract Background Transcranial Doppler Ultrasound (TCD is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV. This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB. Methodology We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring". Discussion Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption. Conclusion In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.

  2. Effect of thoracic epidural anesthesia on oxygen delivery and utilization in cardiac surgical patients scheduled to undergo off-pump coronary artery bypass surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

    Full Text Available To evaluate the effect of thoracic epidural anesthesia (TEA on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.

  3. Influence of age on perioperative major adverse cardiovascular events and mortality risks in elective non-cardiac surgery

    DEFF Research Database (Denmark)

    Hansen, Peter Wæde; Gislason, Gunnar H.; Jørgensen, Mads Emil;

    2016-01-01

    -cause mortality were analyzed by multivariable logistic regression models (adjusted for comorbidities, revised cardiac risk index, cardiovascular pharmacotherapy, body mass index, and surgery type). RESULTS: A total of 386,818 procedures on 302,459 patients were included; mean age was 54.8years (min-max 20......BACKGROUND AND AIMS: Advanced age increases the risk of perioperative cardiovascular complications and may pose reluctance to subject elderly patients to surgery. We examined the impact of high age on perioperative major adverse cardiovascular events (MACE) and mortality in a nationwide cohort...... of patients undergoing elective surgery. METHODS: All Danish patients aged ≥20years undergoing non-cardiac, elective surgery in 2005-2011 were identified from nationwide administrative registers. Risks of 30-day MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, or cardiovascular death) and all...

  4. The impact of cardiac surgery in native valve infective endocarditis: Can euroSCORE guide patient selection?

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus V; Bruun, Louise E; Lund, Jens;

    2010-01-01

    of this study was to investigate the outcome of surgical treatment and to validate the ability of euroSCORE to predict operative mortality in NVE patients. METHODS: Prospective cohort study including 323 consecutive NVE patients. Patients were divided into 3 groups based on treatment strategy and indication....../contraindication for surgery. The additive and logistic euroSCORE was calculated and the observed and predicted mortality was compared. RESULTS: Cardiac surgery was associated with a good prognosis, in-hospital and after 12months, compared to conservative treatment. After adjustment for confounders surgery was associated...... with a survival benefit (hazard ratio (HR) 0.45, 95% CI: 0.27-0.76%; p=0.003). When propensity score was used in regression adjustment, cardiac surgery was still associated with a better outcome after 12months (HR 0.41, 95% CI: 0.25-0.68; p...

  5. Evaluation of respiratory and cardiac motion correction schemes in dual gated PET/CT cardiac imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lamare, F., E-mail: frederic.lamare@chu-bordeaux.fr; Fernandez, P. [Univ. Bordeaux, INCIA, UMR 5287, F-33400 Talence (France); CNRS, INCIA, UMR 5287, F-33400 Talence (France); Service de Médecine Nucléaire, Hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux (France); Le Maitre, A.; Visvikis, D. [INSERM, UMR1101, LaTIM, Université de Bretagne Occidentale, 29609 Brest (France); Dawood, M.; Schäfers, K. P. [European Institute for Molecular Imaging, University of Münster, Mendelstr. 11, 48149 Münster (Germany); Rimoldi, O. E. [Vita-Salute University and Scientific Institute San Raffaele, Milan, Italy and CNR Istituto di Bioimmagini e Fisiologia Molecolare, Milan (Italy)

    2014-07-15

    Purpose: Cardiac imaging suffers from both respiratory and cardiac motion. One of the proposed solutions involves double gated acquisitions. Although such an approach may lead to both respiratory and cardiac motion compensation there are issues associated with (a) the combination of data from cardiac and respiratory motion bins, and (b) poor statistical quality images as a result of using only part of the acquired data. The main objective of this work was to evaluate different schemes of combining binned data in order to identify the best strategy to reconstruct motion free cardiac images from dual gated positron emission tomography (PET) acquisitions. Methods: A digital phantom study as well as seven human studies were used in this evaluation. PET data were acquired in list mode (LM). A real-time position management system and an electrocardiogram device were used to provide the respiratory and cardiac motion triggers registered within the LM file. Acquired data were subsequently binned considering four and six cardiac gates, or the diastole only in combination with eight respiratory amplitude gates. PET images were corrected for attenuation, but no randoms nor scatter corrections were included. Reconstructed images from each of the bins considered above were subsequently used in combination with an affine or an elastic registration algorithm to derive transformation parameters allowing the combination of all acquired data in a particular position in the cardiac and respiratory cycles. Images were assessed in terms of signal-to-noise ratio (SNR), contrast, image profile, coefficient-of-variation (COV), and relative difference of the recovered activity concentration. Results: Regardless of the considered motion compensation strategy, the nonrigid motion model performed better than the affine model, leading to higher SNR and contrast combined with a lower COV. Nevertheless, when compensating for respiration only, no statistically significant differences were

  6. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    Science.gov (United States)

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  7. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery.

    Science.gov (United States)

    Gu, Y John; van Oeveren, Willem; Mungroop, Hubert E; Epema, Anne H; den Hamer, Inez J; Keizer, Jorrit J; Leuvenink, Ron P; Mariani, Massimo A; Rakhorst, Gerhard

    2011-02-01

    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

  8. Evaluation of cardiac ischaemia in cardiac asymptomatic newly diagnosed untreated patients with primary hypothyroidism

    NARCIS (Netherlands)

    Roos, A; Zoet-Nugteren, SK; Berghout, A

    2005-01-01

    Background: Hypothyroidism is regarded as a risk factor for coronary artery disease. Possible factors involved in this association are hyperlipidaemia and hypertension, both occurring with increased frequency in hypothyroid patients. The aim of our study was to evaluate signs/symptoms of cardiac isc

  9. Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Usha Kiran

    2009-01-01

    Full Text Available Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implanta-tion and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i In a surgical patient with a history of percu-taneous coronary intervention (PCI and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii Consider all patents with a recent stent implan-tation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision.

  10. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Wei WANG

    2011-06-01

    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  11. Intrathecal morphine plus general anesthesia in cardiac surgery: effects on pulmonary function, postoperative analgesia, and plasma morphine concentration

    Directory of Open Access Journals (Sweden)

    Luciana Moraes dos Santos

    2009-04-01

    Full Text Available OBJECTIVES: To evaluate the effects of intrathecal morphine on pulmonary function, analgesia, and morphine plasma concentrations after cardiac surgery. INTRODUCTION: Lung dysfunction increases morbidity and mortality after cardiac surgery. Regional analgesia may improve pulmonary outcomes by reducing pain, but the occurrence of this benefit remains controversial. METHODS: Forty-two patients were randomized for general anesthesia (control group n=22 or 400 µg of intrathecal morphine followed by general anesthesia (morphine group n=20. Postoperative analgesia was accomplished with an intravenous, patient-controlled morphine pump. Blood gas measurements, forced vital capacity (FVC, forced expiratory volume (FEV, and FVC/FEV ratio were obtained preoperatively, as well as on the first and second postoperative days. Pain at rest, profound inspiration, amount of coughing, morphine solicitation, consumption, and plasma morphine concentration were evaluated for 36 hours postoperatively. Statistical analyses were performed using the repeated measures ANOVA or Mann-Whiney tests (*p<0.05. RESULTS: Both groups experienced reduced FVC postoperatively (3.24 L to 1.38 L in control group; 2.72 L to 1.18 L in morphine group, with no significant decreases observed between groups. The two groups also exhibited similar results for FEV1 (p=0.085, FEV1/FVC (p=0.68 and PaO2/FiO2 ratio (p=0.08. The morphine group reported less pain intensity (evaluated using a visual numeric scale, especially when coughing (18 hours postoperatively: control group= 4.73 and morphine group= 1.80, p=0.001. Cumulative morphine consumption was reduced after 18 hours in the morphine group (control group= 20.14 and morphine group= 14.20 mg, p=0.037. The plasma morphine concentration was also reduced in the morphine group 24 hours after surgery (control group= 15.87 ng.mL-1 and morphine group= 4.08 ng.mL-1, p=0.029. CONCLUSIONS: Intrathecal morphine administration did not significantly alter

  12. EVALUATION OF SURGERY IN SIMPLE OVARIAN CYSTS

    Institute of Scientific and Technical Information of China (English)

    丁晓曼; 冷金花; 郎景和; 李华军

    2003-01-01

    Objective. To evaluate the surgery in simple ovarian cysts.Methods. From Jan. 1994 to Dec. 1999, 221 women with simple ovarian cysts were admitted into ourhospital. The diameter of cysts was <5 cm in 76 cases, and was≥5 cm in 145 cases ultrasonically.One hundred and eighty-four patients underwent laparosocopy, and thirty-seven underwent laparotomy.Results. Histological findings showed no malignancy in this series. Simple cysts, paraovarian cystsand corpus luteum were found histologically in 90.8% of cases with cysts <5 cm, and 60% of those withcysts >7 cm respectively, their difference was significant (X2=-37.13, P<0.001). The simple cysts, paraovar-ian cysts and corpus luteum cysts were found in 81.5% of postmenopausal women and 84.0% of pre-menopausal women. Conclusion. Patients with cysts >7 cm are indicated for surgical procedures, while a period of fol-lowup is acceptable for patients with cysts <7 cm, and surgery is advisable if the cyst is persistent dur-ing followup. Postmenopausal women with cysts should have operations.

  13. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    Directory of Open Access Journals (Sweden)

    Garcia-Fernandez Nuria

    2009-09-01

    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  14. Imaging evaluation of post pancreatic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Scialpi, Michele [Department of Radiology, ' Santissima Annunziata' Hospital, Via Bruno 1, I-74100 Taranto (Italy)]. E-mail: michelescialpi@libero.it; Scaglione, Mariano [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Volterrani, Luca [Institute of Radiology, University of Siena, I-53100 Siena (Italy); Lupattelli, Luciano [Institute of Radiology, University of Perugia, I-06122 Perugia (Italy); Ragozzino, Alfonso [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Romano, Stefania [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Rotondo, Antonio [Section of Radiology, Department ' Magrassi-Lanzara' , Second University, I-80138 Naples (Italy)

    2005-03-01

    The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease.

  15. Size distribution of air bubbles entering the brain during cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Emma M L Chung

    Full Text Available Thousands of air bubbles enter the cerebral circulation during cardiac surgery, but whether high numbers of bubbles explain post-operative cognitive decline is currently controversial. This study estimates the size distribution of air bubbles and volume of air entering the cerebral arteries intra-operatively based on analysis of transcranial Doppler ultrasound data.Transcranial Doppler ultrasound recordings from ten patients undergoing heart surgery were analysed for the presence of embolic signals. The backscattered intensity of each embolic signal was modelled based on ultrasound scattering theory to provide an estimate of bubble diameter. The impact of showers of bubbles on cerebral blood-flow was then investigated using patient-specific Monte-Carlo simulations to model the accumulation and clearance of bubbles within a model vasculature.Analysis of Doppler ultrasound recordings revealed a minimum of 371 and maximum of 6476 bubbles entering the middle cerebral artery territories during surgery. This was estimated to correspond to a total volume of air ranging between 0.003 and 0.12 mL. Based on analysis of a total of 18667 embolic signals, the median diameter of bubbles entering the cerebral arteries was 33 μm (IQR: 18 to 69 μm. Although bubble diameters ranged from ~5 μm to 3.5 mm, the majority (85% were less than 100 μm. Numerous small bubbles detected during cardiopulmonary bypass were estimated by Monte-Carlo simulation to be benign. However, during weaning from bypass, showers containing large macro-bubbles were observed, which were estimated to transiently affect up to 2.2% of arterioles.Detailed analysis of Doppler ultrasound data can be used to provide an estimate of bubble diameter, total volume of air, and the likely impact of embolic showers on cerebral blood flow. Although bubbles are alarmingly numerous during surgery, our simulations suggest that the majority of bubbles are too small to be harmful.

  16. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine

    2011-06-15

    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  17. Preoperative Preparation for Cardiac Surgery Facilitates Recovery, Reduces Psychological Distress, and Reduces the Incidence of Acute Postoperative Hypertension.

    Science.gov (United States)

    Anderson, Erling A.

    1987-01-01

    Cardiac surgery patients were assigned to information-only, information-plus-coping, or control preoperative preparation groups. Preoperatively, both experimental groups were significantly less anxious than were controls. Both experimental groups increased patients' belief in control over recovery. Postoperatively, experimental patients were less…

  18. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece

    Directory of Open Access Journals (Sweden)

    Konstantinos Giakoumidakis

    2014-01-01

    Conclusions: One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation.

  19. An Obesity Paradox of Asian Body Mass Index after Cardiac Surgery: Arterial Oxygenations in Duration of Mechanic Ventilation

    Directory of Open Access Journals (Sweden)

    Chiu-Hsia Chang

    2013-01-01

    Full Text Available Background. Numerous studies have documented an obesity paradox that overweight of Caucasian patients has better prognosis after cardiac surgery. This study is to examine Asian patients’ BMI to see whether an obesity paradox exists in DMV after cardiac surgery. Methods. A retrospective study consisted of 428 patients after cardiac surgery from January 2006 to December 2010 in the medical center of Taiwan. The Asian BMI was divided into 3 groups: under-normal weight patients (; , overweight patients (BMI 24 to <27; , and obese patients (; . Multivariable analysis and paired were used to compare all variables. Results. Overweight patients were significantly associated with the shortest DMV. Under-normal weight patients had significantly better oxygenations of AaDO2 and P/F ratio in the DMV; however, they correlated with the longest DMV, older age, more female, lower LVSV, higher BUN, more dialysis-dependent, and poorer outcomes, namely, 1-year mortality, HAP, reintubation, tracheotomy, and LOS. Conclusions. Asian overweight patients after cardiac surgery have better prognosis. Under-normal weight patients have higher risk factors, longer DMV, and poorer outcomes; even though they have better arterial oxygenations, they seem to need better arterial oxygenations for successful weaning ventilator.

  20. [Anesthesia management of geriatric patients with arterial pressure-based cardiac output monitoring FloTrac sensor for emergency surgery].

    Science.gov (United States)

    Yamamoto, Shunsuke; Goto, Koji; Yasuda, Norihisa; Kusaka, Junya; Hidaka, Seigo; Miyakawa, Hiroshi; Noguchi, Takayuki

    2009-06-01

    In cases of emergency surgery for geriatric patients, immediate anesthesia induction and careful intraoperative management is necessary without sufficient preoperative information. We report anesthesia management of a 96-year and a 90-year old patients with FloTrac sensor which is an arterial pressure-based cardiac output monitoring device and is able to manage critical patients effectively and safely during anesthesia.

  1. Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

    NARCIS (Netherlands)

    L.M.W. van Venrooij; P.A.M. van Leeuwen; R. de Vos; M.M.M.J. Borgmeijer-Hoelen; B.A.J.M. de Mol

    2009-01-01

    Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospe

  2. The effect of preoperative renal dysfunction with or without dialysis on early postoperative outcome following cardiac surgery.

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2011-01-01

    Although previous studies have shown increased mortality in renal dysfunction patients undergoing cardiac surgery, there is lack of data on the pattern of postoperative complications that occur in such patients and their distribution among dialysis and non-dialysis dependent renal dysfunction.

  3. Soluble receptor for advanced glycation end products as an indicator of pulmonary vascular injury after cardiac surgery

    NARCIS (Netherlands)

    S. Tuinman (Sietske); A.D. Cornet (Alexander); M.T. Kuipers (Maria); A.P.J. Vlaar (Alexander); M.J. Schultz (Marcus); A. Beishuizen (Auke); A.B.J. Groeneveld (Johan); N.P. Juffermans (Nicole)

    2013-01-01

    textabstractBackground: Cardiac surgery is frequently complicated by an acute vascular lung injury and this may be mediated, at least in part, by the (soluble) receptor for advanced glycation end products (sRAGE).Methods: In two university hospital intensive care units, circulating sRAGE was measure

  4. Outcome Management in Cardiac Surgery Using the Society of Thoracic Surgeons National Database.

    Science.gov (United States)

    Halpin, Linda S; Gallardo, Bret E; Speir, Alan M; Ad, Niv

    2016-09-01

    Health care reform has helped streamline patient care and reimbursement by encouraging providers to provide the best outcome for the best value. Institutions with cardiac surgery programs need a methodology to monitor and improve outcomes linked to reimbursement. The Society of Thoracic Surgeons National Database (STSND) is a tool for monitoring outcomes and improving care. This article identifies the purpose, goals, and reporting system of the STSND and ways these data can be used for benchmarking, linking outcomes to the effectiveness of treatment, and identifying factors associated with mortality and complications. We explain the methodology used at Inova Heart and Vascular Institute, Falls Church, Virginia, to perform outcome management by using the STSND and address our performance-improvement cycle through discussion of data collection, analysis, and outcome reporting. We focus on the revision of clinical practice and offer examples of how patient outcomes have been improved using this methodology.

  5. Spiral CT of Non-Graft Post Cardiac Surgery Complications: A Pictorial Essay

    Directory of Open Access Journals (Sweden)

    S. Shirani

    2010-06-01

    Full Text Available Spiral CT is a rapidly growing method for noninvasive visualization of post-operative complications, including post-operative complications in CABG (coronary artery bypass graft. In the recent years, several different, yet more efficient types have been introduced with progressive improvement in the diagnostic accuracy in the detection of post-operative complications. The introduction of 64-slice technology, which allows high resolution as well as reconstructed images, has resulted in further progress in the diagnostic process. This kind of diagnostic equipment will spread rapidly in the world. Although studies with large numbers of patients regarding spiral CT as a routine diagnostic method have not been reported, there is great need for it all over the world. In this article, we intend to review the spiral CT findings of non-graft complications in patients after cardiac surgery.

  6. Minimally invasive cardiac surgery in the adult: surgical instruments, equipment, and techniques.

    Science.gov (United States)

    Kitamura, M; Uwabe, K; Hirota, J; Kawai, A; Endo, M; Koyanagi, H

    1998-09-01

    To clarify the special instruments and equipment used for minimally invasive cardiac surgery (MICS), we examined the initial experiences with MICS operations with ministernotomy or minithoracotomy at our institution. Fifty adult patients with congenital, valvular, and/or ischemic heart diseases underwent MICS operations, and all surgical procedures were completed without conversion to full sternotomy. The length of the skin incision was about 10 cm or less in all patients. Postoperative recovery was favorable, and the majority of the patients were discharged from the hospital around the end of the second postoperative week. In this series of patients, an oscillating bone saw, lifting type retractor, 2 blade spreader, cannula with a balloon, and right-angled aortic clamp among other items, were very useful for successfully performing various operations with MICS approaches and techniques. The associated results suggest that MICS with ministernotomy or minithoracotomy was feasible using special instruments and equipment and could be encouraged for adult patients with various cardiovascular diseases.

  7. Rerouting surgery of cardiac type total anomalous pulmonary venous return in a premature newborn with very low birth weight.

    Science.gov (United States)

    Wu, En-Ting; Huang, Shu-Chien; Wu, Mei-Hwan; Wang, Jou-Kou; Chang, Chung-I

    2007-02-01

    Intracardiac repair for complex congenital heart defects in premature neonates with very low birth weight (VLBW) is still a challenge to pediatric cardiac surgeons. We report the successful rerouting of cardiac type total anomalous pulmonary venous return (TAPVR) in a premature newborn (36th gestational week) with VLBW (1250 g). She had severe hypoxemia and low cardiac output despite medical treatment. Rerouting surgery of TAPVR was performed under deep hypothermia circulatory arrest at the age of 20 days. The sternum was left open and approximated 2 days later. Follow-up echocardiography showed good ventricular function without pulmonary venous obstruction. The endotracheal tube was removed 7 days postoperatively. She was then discharged without complication. In conclusion, with improved cardiopulmonary bypass technique and perioperative care, open heart surgery can be performed in premature newborns with VLBW.

  8. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A;

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P failure, this simple...

  9. Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hui-Shan Wang

    Full Text Available BACKGROUND: Postoperative atrial fibrillation (POAF remains the most common complication after cardiac surgery. Current guidelines recommend β-blockers to prevent POAF. Carvedilol is a non-selective β-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF. OBJECTIVE: To investigate the efficacy of carvedilol in preventing POAF. METHODS: PubMed from the inception to September 2013 was searched for studies assessing the effect of carvedilol on POAF occurrence. Pooled relative risk (RR with 95% confidence interval (CI was calculated using random- or fixed-effect models when appropriate. Six comparative trials (three randomized controlled trials and three nonrandomized controlled trials including 765 participants met the inclusion criteria. RESULTS: Carvedilol was associated with a significant reduction in POAF (relative risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64, p<0.001. Subgroup analyses yielded similar results. In a subgroup analysis, carvedilol appeared to be superior to metoprolol for the prevention of POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001. No evidence of heterogeneity was observed. CONCLUSIONS: In conclusion, carvedilol may effectively reduce the incidence of POAF in patients undergoing cardiac surgery. It appeared to be superior to metoprolol. A large-scale, well-designed randomized controlled trial is needed to conclusively answer the question regarding the utility of carvedilol in the prevention of POAF.

  10. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  11. Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery.

    Science.gov (United States)

    Dornseifer, Ulf; Kleeberger, Charlotte; Ehrl, Denis; Herter, Frank; Ninkovic, Milomir; Iesalnieks, Igors

    2016-09-01

    Background Sternal defects following deep wound infections are predominantly reconstructed using local and regional flaps. The lack of appropriate recipient vessels after cardiac surgery may explain the minor role of free flaps. To date, arteriovenous loops have been the leading solution to enable microsurgical closure of these defects. However, the related surgical effort and the risk of flap failure are increased. We reviewed our experiences with the right gastroepiploic vessels as alternative recipient vessels for free flap reconstructions. Methods Between September 2010 and July 2015, 12 patients suffering deep wound infection after cardiac surgery underwent sternal reconstruction with free flaps anastomosed to the right gastroepiploic vessels. Gracilis flaps (n = 8) and anterolateral thigh perforator flaps (n = 4) were used for sternal reconstruction. Recipient vessels were harvested by laparoscopic dissection in five patients. Half of the free flaps were variably combined with omental flow-through flaps. Results Healing of all flaps was uneventful with no partial or total flap loss. Simultaneous interdisciplinary harvesting of recipient vessels by laparoscopy significantly shortened mean operative time from 313 to 216 minutes (p = 0.018). One incisional hernia was observed in the laparotomy group. Revision of a gracilis donor site was necessary in another patient due to postoperative bleeding. No recurrent sternal infection occurred during a mean follow-up of 20 months (range, 3-59 months). Conclusions The concept of gastroepiploic recipient vessels allows reliable free flap reconstructions of sternal defects in such high-risk patients without the need for arteriovenous loops.

  12. Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Marc Licker

    2012-01-01

    Full Text Available A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

  13. Intrathoracic migration of a breast implant after minimally invasive cardiac surgery.

    Science.gov (United States)

    Songcharoen, Somjade Jay; McClure, Michael; Aru, Roberto G; Songcharoen, Somprasong

    2015-03-01

    The aging population, in combination with the popularity of breast augmentation with implants, presents surgeons with a growing number of cases involving women undergoing minimally invasive cardiac surgery (MICS) who have breast implants. We present an unusual complication involving the delayed migration of a subpectoral implant into the chest cavity through an iatrogenic defect after a minimally invasive mitral valve repair. This chest wall defect was ultimately repaired with a latissimus dorsi flap. Although MICS has been described in women with breast implants, the documented experience remains limited. Most authors classically recommend explantation of the prosthesis to provide access to the chest wall; however, some have later suggested preserving the implant capsule in situ while performing the cardiac procedure with gentle retraction. From our literature review and experience, we recommend that the posterior capsule should remain intact. If this is not possible, then the chest wall closure should be reinforced with either mesh, soft tissue, or both. Soft tissue options include the conversion from a subpectoral to a subglandular position to use the pectoralis major, or a latissimus dorsi muscle flap. With the increasing number of these cases along with the complexities of minimally invasive procedures, close communication and planning should be undertaken between both cardiothoracic and plastic surgeons when taking care of these patients. Above all, when faced with postoperative complications after MICS, the plastic surgeon must maintain a high index of clinical suspicion and consider the possibility of intrathoracic migration of an implant so that proper workup and planning may be initiated.

  14. Weight-for-age standard score - distribution and effect on in-hospital mortality: A retrospective analysis in pediatric cardiac surgery

    OpenAIRE

    Antony George; Pushpa Jagannath; Joshi, Shreedhar S.; A M Jagadeesh

    2015-01-01

    Objective: To study the distribution of weight for age standard score (Z score) in pediatric cardiac surgery and its effect on in-hospital mortality. Introduction: WHO recommends Standard Score (Z score) to quantify and describe anthropometric data. The distribution of weight for age Z score and its effect on mortality in congenital heart surgery has not been studied. Methods: All patients of younger than 5 years who underwent cardiac surgery from July 2007 to June 2013, under single surgical...

  15. [Basic standards for a department of cardiac surgery. Quality requirements for the care of cardiac patients in connection with operations on the heart, the heart vessels and thoracic organ transplantation].

    Science.gov (United States)

    Beckmann, Andreas; Beyersdorf, F; Diegeler, A; Mohr, F W; Welz, A; Rein, J-G; Cremer, J

    2013-12-01

    Current evolutions and substantial amendments of the German health care system in combination with distinguished progress in cardiac surgery over the past years require both a reflection of principles in patient-centered care and an update of basic standard requirements for a department of cardiac surgery in Germany. In due consideration of the data from the voluntary registry of the German Society for Thoracic and Cardiovascular Surgery, this article accurately defines core requirements for a cardiac surgical department (cardiac surgery on-site), subdivided into facilities, staff and processes. If based on these standards, one may anticipate that cardiac surgical care is performed under appropriate conditions leading to an intrinsic benefit for patients.

  16. Heart Surgery Terms

    Science.gov (United States)

    ... Patients Choosing Wisely® Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

  17. Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

    Directory of Open Access Journals (Sweden)

    Knapik Piotr

    2011-11-01

    Full Text Available Abstract Background Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management. Methods We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192. The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort. Results Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p Conclusions Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.

  18. Retained Blood Syndrome After Cardiac Surgery: A New Look at an Old Problem.

    Science.gov (United States)

    Boyle, Edward M; Gillinov, A Marc; Cohn, William E; Ley, S Jill; Fischlein, Theodor; Perrault, Louis P

    2015-01-01

    Retained blood occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. As a result, a spectrum of mechanical and inflammatory complications can ensue in the acute, subacute, and chronic setting. The objectives of this review were to define the clinical syndrome associated with retained blood over the spectrum of recovery and to review existing literature regarding how this may lead to complications and contributes to poor outcomes. To better understand and prevent this constellation of clinical complications, a literature review was conducted, which led us to create a new label that better defines the clinical entity we have titled retained blood syndrome. Analysis of published reports revealed that 13.8% to 22.7% of cardiac surgical patients develop one or more components of retained blood syndrome. This can present in the acute, subacute, or chronic setting, with different pathophysiologic mechanisms active at different times. The development of retained blood syndrome has been linked to other clinical outcomes, including the development of postoperative atrial fibrillation and infection and the need for hospital readmission. Grouping multiple objectively measurable and potentially preventable postoperative complications that share a common etiology of retained blood over the continuum of recovery demonstrates a high prevalence of retained blood syndrome. This suggests the need to develop, implement, and test clinical strategies to enhance surgical drainage and reduce postoperative complications in patients undergoing cardiothoracic surgery.

  19. Evaluation of myocardial viability with cardiac PET before and after CABG and the study of hibernating myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Masahiro; Sakamoto, Shigeru [Kanazawa Medical Univ., Uchinada, Ishikawa (Japan); Seki, Hiroyasu

    1997-09-01

    This study included 28 patients in whom graft patency after coronary artery bypass graft (CABG) was confirmed by coronary angiography. Diagnosis included angina pectoris following myocardial infarction and severe angina pectoris accompanied by stenosis at the left main trunk region or lesion involving multiple branches. As a rule, cardiac PET ({sup 13}NH{sub 3}, {sup 18}FDG) was performed in fasted patients before and 1 to 2 months after surgery. Myocardial blood flow and glucose metabolism in the bypass site were mainly investigated. Furthermore, {sup 201}Tl-SPECT was concurrently performed. The effect of CABG was examined by the two procedures, and redistribution was compared between PET and {sup 201}Tl-SPECT. Preoperative PET with {sup 13}NH{sub 3} revealed reduced blood flow in the ischemic site in all patients. However, preoperative {sup 201}Tl-SPECT showed redistribution in 16 (57.1%) of 28 patients, while there was no redistribution in 12 patients (42.9%). In 10 (83.3%) of 12 patients evaluated as having no myocardial viability on {sup 201}Tl-SPECT, PET showed accumulation of {sup 18}FDG. However, in 21 (75%) of 28 patients, accumulation of {sup 18}FDG was reduced postoperatively, suggesting improvement of aerobic metabolism in cardiac muscle. These patients also showed improvement in regional wall motion. The energy source of cardiac muscle consists mainly of free fatty acid and glucose. Fasting healthy cardiac muscle depends on fatty acid for approximately 60% of its energy source. However, ischemic cardiac muscle depends on the glycolytic system, utilizing glucose. Progression of ischemia causes myocardial necrosis without metabolism. Therefore, ischemic cardiac muscle can be differentiated from infarcted cardiac muscle by cardiac PET. We evaluated myocardial viability before and after CABG for ischemic heart disease, and confirmed that cardiac PET is more useful than standard myocardial scan with {sup 201}Tl for evaluating myocardial viability. (K.H.)

  20. Evaluation of cardiac tumors with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Luna, Antonio [Clinica Las Nieves, MR Unit, Jaen (Spain); Ribes, Ramon [Reina Sofia Hospital, MR Unit, Radiology Department, Cordoba (Spain); Caro, Pilar [MR Unit, Dadisa, Cadiz (Spain); Vida, Jose [San Juan De Dios Hospital, MR Unit, Resalta, Cordoba (Spain); Erasmus, Jeremy J. [University of Texas, Department of Radiology, Houston, TX (United States)

    2005-07-01

    Primary cardiac neoplasms are rare, and are more commonly benign than malignant. However, metastases are by far the most common cardiac neoplasms. MRI allows evaluation of myocardial infiltration, pericardial involvement and/or extracardiac extension. MRI overcomes the usual limitations of echocardiography and assesses more accurately changes in cardiac function. Specific tumoral characterization is only possible in cases of myxoma, lipoma, fibroma and hemangioma. Suggestive features of malignancy are right side location, extracardiac extension, inhomogeneity in signal intensity of the tumor and pericardial effusion. The use of intravenous contrast material improves tumor characterization and depiction of tumor borders. MRI also allows differentiation of tumor from other nontumoral masses such as intracavitary tumors or fibromuscular elements of the posterior wall of the right atrium. (orig.)

  1. Evaluation of Cardiac Toxicity Biomarkers in Rats from Different Laboratories.

    Science.gov (United States)

    Kim, Kyuri; Chini, Naseem; Fairchild, David G; Engle, Steven K; Reagan, William J; Summers, Sandra D; Mirsalis, Jon C

    2016-12-01

    There is a great need for improved diagnostic and prognostic accuracy of potential cardiac toxicity in drug development. This study reports the evaluation of several commercially available biomarker kits by 3 institutions (SRI, Eli Lilly, and Pfizer) for the discrimination between myocardial degeneration/necrosis and cardiac hypertrophy as well as the assessment of the interlaboratory and interplatform variation in results. Serum concentrations of natriuretic peptides (N-terminal pro-atrial natriuretic peptide [NT-proANP] and N-terminal pro-brain natriuretic peptide [NT-proBNP]), cardiac and skeletal troponins (cTnI, cTnT, and sTnI), myosin light chain 3 (Myl3), and fatty acid binding protein 3 (FABP3) were assessed in rats treated with minoxidil (MNX) and isoproterenol (ISO). MNX caused increased heart-to-body weight ratios and prominent elevations in NT-proANP and NT-proBNP concentrations detected at 24-hr postdose without elevation in troponins, Myl3, or FABP3 and with no abnormal histopathological findings. ISO caused ventricular leukocyte infiltration, myocyte fibrosis, and necrosis with increased concentrations of the natriuretic peptides, cardiac troponins, and Myl3. These results reinforce the advantages of a multimarker strategy in elucidating the underlying cause of cardiac insult and detecting myocardial tissue damage at 24-hr posttreatment. The interlaboratory and interplatform comparison analyses also showed that the data obtained from different laboratories and platforms are highly correlated and reproducible, making these biomarkers widely applicable in preclinical studies.

  2. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    Science.gov (United States)

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  3. Incidence of inferior vena cava thrombosis detected by transthoracic echocardiography in the immediate postoperative period after adult cardiac and general surgery.

    Science.gov (United States)

    Saranteas, T; Kostopanagiotou, G; Tzoufi, M; Drachtidi, K; Knox, G M; Panou, F

    2013-11-01

    Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. Of the 395 cardiac surgical patients studied, the IVC was successfully visualised using the subcostal view in 315 patients (79.8%) and eight of these patients (2.5%) had a partially obstructive thrombosis in the IVC. In 250 out of 289 (85%) general surgical patients, the IVC was also clearly visualised, but only one patient (0.4%) had an IVC thrombosis (2.5 vs 0.4%, P cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.

  4. Postoperative neurocognitive dysfunction in patients undergoing cardiac surgery after remote ischemic preconditioning: a double-blind randomized controlled pilot study.

    Directory of Open Access Journals (Sweden)

    Patrick Meybohm

    Full Text Available BACKGROUND: Remote ischemic preconditioning (RIPC has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD in patients undergoing complex cardiac surgery. METHODS: We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5-7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion or if the combined Z score was 1.96 or greater (Z score criterion. RESULTS: According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5-7 days after surgery (p = 0.753. The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30 compared to the RIPC group (1.14±4.02; p = 0.228. Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19-1.94 µg/L vs. 0.48 (0.07-1.84 µg/L] and 24 hours after surgery [0.36 (0.14-1.89 µg/L vs. 0.26 (0.07-0.90 µg/L]. CONCLUSIONS: We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT00877305.

  5. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

    Science.gov (United States)

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck, Guilherme Lobosco; Rocha, Alexandre Marins; Rosa, Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-01-01

    Background The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Results Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). Conclusion There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. PMID:27982268

  6. A reduction of prothrombin conversion by cardiac surgery with cardiopulmonary bypass shifts the haemostatic balance towards bleeding.

    Science.gov (United States)

    Kremers, Romy M W; Bosch, Yvonne P J; Bloemen, Saartje; de Laat, Bas; Weerwind, Patrick W; Mochtar, Bas; Maessen, Jos G; Wagenvoord, Rob J; Al Dieri, Raed; Hemker, H Coenraad

    2016-08-30

    Cardiac surgery with cardiopulmonary bypass (CPB) is associated with blood loss and post-surgery thrombotic complications. The process of thrombin generation is disturbed during surgery with CPB because of haemodilution, coagulation factor consumption and heparin administration. We aimed to investigate the changes in thrombin generation during cardiac surgery and its underlying pro- and anticoagulant processes, and to explore the clinical consequences of these changes using in silico experimentation. Plasma was obtained from 29 patients undergoing surgery with CPB before heparinisation, after heparinisation, after haemodilution, and after protamine administration. Thrombin generation was measured and prothrombin conversion and thrombin inactivation were quantified. In silico experimentation was used to investigate the reaction of patients to the administration of procoagulant factors and/or anticoagulant factors. Surgery with CPB causes significant coagulation factor consumption and a reduction of thrombin generation. The total amount of prothrombin converted and the rate of prothrombin conversion decreased during surgery. As the surgery progressed, the relative contribution of α2-macroglobulin-dependent thrombin inhibition increased, at the expense of antithrombin-dependent inhibition. In silico restoration of post-surgical prothrombin conversion to pre-surgical levels increased thrombin generation excessively, whereas co-administration of antithrombin resulted in the normalisation of post-surgical thrombin generation. Thrombin generation is reduced during surgery with cardiopulmonary bypass because of a balance shift between prothrombin conversion and thrombin inactivation. According to in silico predictions of thrombin generation, this new balance increases the risk of thrombotic complications with prothrombin complex concentrate administration, but not if antithrombin is co-administered.

  7. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil;

    2015-01-01

    BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship......%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups. CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1...

  8. Usefulness of case reports to improve medical knowledge regarding trigemino-cardiac reflex in skull base surgery

    Directory of Open Access Journals (Sweden)

    Sadr-Eshkevari Pooan

    2011-04-01

    Full Text Available Abstract We describe the discovery of the trigemino-cardiac reflex by Schaller in 1999 and the continued improvement of the knowledge about the trigemino-cardiac reflex involved in neurosurgery, especially in skull base surgery, during the past several years. The achieved medical progress could be gained only by the practical experience described by different case reports and later case series that have been published in several principal scientific journals. Additionally, we explain the scientific as well as clinical importance of the communication of the case reports on TCR. Special reference has been given to the validity of the case reports for new phenomena in clinical medicine.

  9. Usefulness of case reports to improve medical knowledge regarding trigemino-cardiac reflex in skull base surgery.

    Science.gov (United States)

    Sandu, Nora; Sadr-Eshkevari, Pooan; Schaller, Bernhard J

    2011-04-15

    We describe the discovery of the trigemino-cardiac reflex by Schaller in 1999 and the continued improvement of the knowledge about the trigemino-cardiac reflex involved in neurosurgery, especially in skull base surgery, during the past several years. The achieved medical progress could be gained only by the practical experience described by different case reports and later case series that have been published in several principal scientific journals. Additionally, we explain the scientific as well as clinical importance of the communication of the case reports on TCR. Special reference has been given to the validity of the case reports for new phenomena in clinical medicine.

  10. Pharmaceutical Care for the Patient after Cardiac Surgery%心脏术后患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    陈岷; 童荣生; 黄晓波

    2011-01-01

    目的:临床药师参与临床药物治疗,对患者进行药学监护.方法:以一位心脏术后患者为例,临床药师参与药物治疗方案的制订,分析患者所用相关药物,跟踪其治疗效果及不良反应,对药物治疗过程进行综合评估.结果:患者的各项指标趋于正常.结论:临床药师的参与使药物治疗更趋合理,在达到治疗目标的同时,可减少药物的不良反应,有利于提高临床的药物治疗水平.%Objective: Clinical pharmacists involved in clinical drug therapy and pharmaceutical care for patients and cooperated with clinicians in order to promote rational drug use in clinics. Method: Clinical pharmacists involved in therapeutic scheme making, medication analysis and evaluation,such as anticoagulant drugs,antibiotics,cardiac drugs,and diuretics,etc. Used in the patient after cardiac surgery,and made a comprehensive drug treatment assessment including effectiveness and adverse reactions in whole therapy process. Result: All the indices of the patient trended toward normal. Conclusion: The participation of clinical pharmacists in clinical treatment team and clinical practice can make drug treatment more rational with therapeutic goal reached and adverse drug reactions reduced to improve the level of clinical drug treatment.

  11. Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica Thrombocytopenia in cardiac surgery: diagnostic and prognostic importance

    Directory of Open Access Journals (Sweden)

    Ederlon Rezende

    2011-03-01

    Full Text Available OBJETIVO: Pacientes submetidos à cirurgia cardíaca estão mais propensos a desenvolver plaquetopenia. A trombocitopenia induzida por heparina acomete cerca de 5% dos pacientes. O objetivo foi avaliar a importância clínica da trombocitopenia grave em pacientes no pós-operatório de cirurgia cardíaca. MÉTODOS: Estudo prospectivo observacional que incluiu os pacientes de cirurgia cardíaca com plaquetas 6. A mortalidade na Unidade de Terapia Intensiva (UTI e hospitalar, o tempo de internação, os escores de gravidade e a incidência de tromboses foram comparados em pacientes com escore e" 6 (grupo 1 e 6, em pacientes no pós-operatório de cirurgia cardíaca, está associado a maior incidência de trombose, assim como o maior escore está relacionado à elevada mortalidade hospitalar.OBJECTIVE: Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients. METHODS: It was included cardiac surgical patients with platelets 6 (group 1 and 6, in postoperative cardiac surgical patients, it is associated to higher incidence of thrombosis as well as the greater score is related to higher hospital mortality rate.

  12. Retinal evaluation and treatment after refractive corneal surgery.

    Science.gov (United States)

    Swinger, C A; Kraushar, M F

    1985-08-01

    Refractive corneal surgery (a collective term used to describe a variety of surgical procedures that alter the refractive status of the eye through the surgical modification of corneal curvature) shows promise for use in situations where current methods of optical correction do not meet the patient's needs. This article reviews our experiences with the retinal evaluation of patients who have undergone corneal refractive surgery and offers recommendations for the treatment of retinal pathology after such surgery.

  13. Impact of thoracic surgery on cardiac morphology and function in small animal models of heart disease: a cardiac MRI study in rats.

    Directory of Open Access Journals (Sweden)

    Peter Nordbeck

    Full Text Available BACKGROUND: Surgical procedures in small animal models of heart disease might evoke alterations in cardiac morphology and function. The aim of this study was to reveal and quantify such potential artificial early or long term effects in vivo, which might account for a significant bias in basic cardiovascular research, and, therefore, could potentially question the meaning of respective studies. METHODS: Female Wistar rats (n = 6 per group were matched for weight and assorted for sham left coronary artery ligation or control. Cardiac morphology and function was then investigated in vivo by cine magnetic resonance imaging at 7 Tesla 1 and 8 weeks after the surgical procedure. The time course of metabolic and inflammatory blood parameters was determined in addition. RESULTS: Compared to healthy controls, rats after sham surgery showed a lower body weight both 1 week (267.5±10.6 vs. 317.0±11.3 g, n<0.05 and 8 weeks (317.0±21.1 vs. 358.7±22.4 g, n<0.05 after the intervention. Left and right ventricular morphology and function were not different in absolute measures in both groups 1 week after surgery. However, there was a confined difference in several cardiac parameters normalized to the body weight (bw, such as myocardial mass (2.19±0.30/0.83±0.13 vs. 1.85±0.22/0.70±0.07 mg left/right per g bw, p<0.05, or enddiastolic ventricular volume (1.31±0.36/1.21±0.31 vs. 1.14±0.20/1.07±0.17 µl left/right per g bw, p<0.05. Vice versa, after 8 weeks, cardiac masses, volumes, and output showed a trend for lower values in sham operated rats compared to controls in absolute measures (782.2±57.2/260.2±33.2 vs. 805.9±84.8/310.4±48.5 mg, p<0.05 for left/right ventricular mass, but not normalized to body weight. Matching these findings, blood testing revealed only minor inflammatory but prolonged metabolic changes after surgery not related to cardiac disease. CONCLUSION: Cardio-thoracic surgical procedures in experimental myocardial infarction

  14. Cirurgia cardíaca no idoso Cardiac surgery in elderly patients

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    Danton R. da Rocha LOURES

    2000-03-01

    Full Text Available Com o aumento da expectativa de vida da população brasileira cresce o número de pessoas com idade superior a 70 anos que necessitam de operação cardíaca. CASUÍSTICA E MÉTODOS: Foram avaliados, retrospectivamente, 75 pacientes com idade 3 a 70 anos submetidos a operação cardíaca no HC-UFPR, entre 1995 e 1999, com objetivo de analisarmos os resultados imediatos e tardios. A idade variou de 70 a 88 anos, sendo 34 (46,7% do sexo feminino e 41 (53,3% do masculino. Os principais sintomas foram angina (81,3%, dispnéia (42,6% e síncope (16%. Os pacientes encontravam-se em classe I (57,3%, classe II (17,3%, classe III (18,6% e classe IV (6,6% da NYHA, 61,3% eram hipertensos, 48% tabagistas, 28% diabéticos e 9,3% haviam sido submetidos a operação cardíaca prévia. Foram realizadas 50 (66,6% revascularizações do miocárdio, 9 (12% trocas de valva aórtica, 5 (6,6% operações de aorta, 4 (5,2% trocas valvares + revascularização miocárdica e outros procedimentos (7%. As principais complicações pós-operatórias foram cardiovasculares: arritmias ventriculares (22,6%, arritmias supraventriculares (21,3%, baixo débito cardíaco (16%; infecciosas (16% e pulmonares (9,3%. O tempo médio de permanência na UTI foi de 5 dias. RESULTADOS: A mortalidade hospitalar foi de 13,3% e houve 5 óbitos tardios. Dos sobreviventes, 78,4% compareceram para seguimento ambulatorial. O tempo médio de seguimento foi de 20,7 meses e a sobrevida foi de 92%; um dos óbitos tardios foi de origem cardiovascular. CONCLUSÃO: Apesar de serem pacientes de maior complexidade clínica pela maior incidência de doenças crônicas e acometimento de outros órgãos, os avanços na cirurgia cardíaca e terapia intensiva tornaram possível a intervenção com baixa morbi-mortalidade.BACKGROUND: Because of the increase in the life expectancy of the Brazilian population, elderly patients are being increasingly referred to cardiac surgery. MATERIAL AND METHODS: Seventy

  15. Clinical Factors Associated with Dose of Loop Diuretics After Pediatric Cardiac Surgery: Post Hoc Analysis.

    Science.gov (United States)

    Haiberger, Roberta; Favia, Isabella; Romagnoli, Stefano; Cogo, Paola; Ricci, Zaccaria

    2016-06-01

    A post hoc analysis of a randomized controlled trial comparing the clinical effects of furosemide and ethacrynic acid was conducted. Infants undergoing cardiac surgery with cardiopulmonary bypass were included in order to explore which clinical factors are associated with diuretic dose in infants with congenital heart disease. Overall, 67 patients with median (interquartile range) age of 48 (13-139) days were enrolled. Median diuretic dose was 0.34 (0.25-0.4) mg/kg/h at the end of postoperative day (POD) 0 and it significantly decreased (p = 0.04) over the following PODs; during this period, the ratio between urine output and diuretic dose increased significantly (p = 0.04). Age (r -0.26, p = 0.02), weight (r -0.28, p = 0.01), cross-clamp time (r 0.27, p = 0.03), administration of ethacrynic acid (OR 0.01, p = 0.03), and, at the end of POD0, creatinine levels (r 0.3, p = 0.009), renal near-infrared spectroscopy saturation (-0.44, p = 0.008), whole-blood neutrophil gelatinase-associated lipocalin levels (r 0.30, p = 0.01), pH (r -0.26, p = 0.02), urinary volume (r -0.2755, p = 0.03), and fluid balance (r 0.2577, p = 0.0266) showed a significant association with diuretic dose. At multivariable logistic regression cross-clamp time (OR 1.007, p = 0.04), use of ethacrynic acid (OR 0.2, p = 0.01) and blood pH at the end of POD0 (OR 0.0001, p = 0.03) was independently associated with diuretic dose. Early resistance to loop diuretics continuous infusion is evident in post-cardiac surgery infants: Higher doses are administered to patients with lower urinary output. Independently associated variables with diuretic dose in our population appeared to be cross-clamping time, the administration of ethacrynic acid, and blood pH.

  16. Cardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome.

    Science.gov (United States)

    Ekure, Ekanem Nsikak; Esezobor, Christopher Imokhuede; Sridhar, Anuradha; Vasudevan, Jyothi; Subramanyan, Rajhavan; Cherian, Kotturathu Mammen

    2015-01-01

    Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CSAKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0-17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output CS. The study included 323 children with a median age of one year (0.04-17), of whom 22 (6.8%) were neonates and 18.3% had a single ventricle. About 60% of the children had Risk Adjusted Congenital Heart Surgery-I category 1 or 2 interventions. CS-AKI occurred in 39 children (12.1%). Factors associated with CS-AKI were sepsis and intraand post-operative hypotension. In-hospital mortality was six-fold higher in children who developed CS-AKI. CS-AKI was associated with two to three days more of mechanical ventilation and Intensive care unit stay. CS-AKI occurs in children in developing countries, but at a lower frequency mainly due to the predominance of post-neonatal children undergoing less-complex CSs. CS-AKI was associated with higher in-hospital mortality and increased utilization of hospital services. Factors associated with CS-AKI included intraand post-operative hypotension and sepsis.

  17. CVC related infections reported from Salam Center for Cardiac Surgery of Khartoum

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    Margherita Scapaticci

    2010-06-01

    Full Text Available Introduction: Central venous catheter (CVC plays an essential part in clinical management of patients admitted in Intensive Care Unit (ICU, even though catheterization is an invasive procedure that may facilitate bacterial migration from the skin surrounding the catheter insertion site to the catheter tip, representing a risk factor for the arise of bacteraemia and sepsis. Aim of our study was to assess the prevalence of micro-organisms found as responsibles of CVC-related infections and check their correspondence with those found in blood cultures collected from the same patients. Methods: The study was conduced from April 2008 to March 2009. In this period were analysed 29 CVC samples sent from ICU to the laboratory of the Salam Center for Cardiac Surgery of Khartoum (Sudan. CVC was removed after pericatheter skin disinfection and its tip was cut, put in a sterile container and finally sent to the laboratory, where it was immersed in Brain Heart Infusion (BHI and incubated at 37°C.A first culture of the sample on Blood Agar plate was done after an incubation period of 1 hour, the second one after 24 hours. In case of bacterial growth were practiced identification and sensitivity test of the isolated bacteria. Results: Of the 29 analysed samples 38% showed bacterial growth of which 27% caused by gram positive and 73% by gram negative bacteria. The identification tests showed also that among gram positive-related infection predominated those caused by Methicillin-Resistent Staphylococcus aureus (MRSA (67%, while among the gram negative infections predominated those caused by Pseudomonas spp (57%, followed by Enterobacter spp and Serratia spp. Conclusion: All the above mentioned infections were confirmed by examination of blood cultures collected simultaneously from the same patients. Furthermore the study showed that 73% of infections affected post-operative patients rather than those waiting for surgery.

  18. Calpain Activity and Toll-Like Receptor 4 Expression in Platelet Regulate Haemostatic Situation in Patients Undergoing Cardiac Surgery and Coagulation in Mice

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    Jui-Chi Tsai

    2014-01-01

    Full Text Available Human platelets express Toll-like receptors (TLR 4. However, the mechanism by which TLR4 directly affects platelet aggregation and blood coagulation remains to be explored. Therefore, in this study, we evaluated the platelet TLR4 expression in patients who underwent CABG surgery; we explored the correlation between platelet TLR4 expression and the early outcomes in hospital of patients. Additionally, C57BL/6 and C57BL/6-TlrLPS−/− mice were used to explore the roles of platelet TLR4 in coagulation by platelet aggregometry and rotation thromboelastometry. In conclusion, our results highlight the important roles of TLR4 in blood coagulation and platelet function. Of clinical relevance, we also explored novel roles for platelet TLR4 that are associated with early outcomes in cardiac surgery.

  19. Quantitative image quality evaluation for cardiac CT reconstructions

    Science.gov (United States)

    Tseng, Hsin-Wu; Fan, Jiahua; Kupinski, Matthew A.; Balhorn, William; Okerlund, Darin R.

    2016-03-01

    Maintaining image quality in the presence of motion is always desirable and challenging in clinical Cardiac CT imaging. Different image-reconstruction algorithms are available on current commercial CT systems that attempt to achieve this goal. It is widely accepted that image-quality assessment should be task-based and involve specific tasks, observers, and associated figures of merits. In this work, we developed an observer model that performed the task of estimating the percentage of plaque in a vessel from CT images. We compared task performance of Cardiac CT image data reconstructed using a conventional FBP reconstruction algorithm and the SnapShot Freeze (SSF) algorithm, each at default and optimal reconstruction cardiac phases. The purpose of this work is to design an approach for quantitative image-quality evaluation of temporal resolution for Cardiac CT systems. To simulate heart motion, a moving coronary type phantom synchronized with an ECG signal was used. Three different percentage plaques embedded in a 3 mm vessel phantom were imaged multiple times under motion free, 60 bpm, and 80 bpm heart rates. Static (motion free) images of this phantom were taken as reference images for image template generation. Independent ROIs from the 60 bpm and 80 bpm images were generated by vessel tracking. The observer performed estimation tasks using these ROIs. Ensemble mean square error (EMSE) was used as the figure of merit. Results suggest that the quality of SSF images is superior to the quality of FBP images in higher heart-rate scans.

  20. Comparison of Ice Packs Application and Relaxation Therapy in Pain Reduction during Chest Tube Removal Following Cardiac Surgery

    OpenAIRE

    2014-01-01

    Background: Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit. Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery. Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that i...

  1. Comparative Evaluation of Handheld Robot-Aided Intraocular Laser Surgery

    Science.gov (United States)

    Yang, Sungwook; MacLachlan, Robert A.; Martel, Joseph N.; Lobes, Louis A.; Riviere, Cameron N.

    2015-01-01

    This paper presents robot-aided intraocular laser surgery using a handheld robot known as Micron. The micromanipulator incorporated in Micron enables visual servoing of a laser probe, while maintaining a constant distance of the tool tip from the retinal surface. The comparative study was conducted with various control methods for evaluation of robot-aided intraocular laser surgery. PMID:27019653

  2. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate - A randomized controlled trial

    NARCIS (Netherlands)

    P. Segers; R.G.H. Speekenbrink; D.T. Ubbink; M.L. van Ogtrop; B.A. de Mol

    2006-01-01

    Context Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections. Objective To determine the efficacy of perioperative decontamination of the

  3. Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Deepanwita Das

    2016-01-01

    Full Text Available Introduction: Etomidate is usually preferred in the induction of cardiac compromised patients due to its relative cardiovascular stability. However, the use of this drug has been limited as etomidate induces suppression of cortisol biosynthesis as a result of blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazole radical of etomidate. This study was carried out to observe the effect of Vitamin C on adrenal suppression after etomidate induction in patients undergoing cardiac surgery. Materials and Methods: A total of 78 patients were randomly distributed into two groups. Group-I received oral Vitamin C (500 mg twice daily and Group-II received antacid tablet as placebo twice daily instead of Vitamin C for 7 consecutive days prior to surgery till morning of surgery. Patients of both the groups induced with etomidate (0.1-0.3 mg/kg. Blood cortisol was estimated at different points of time till 24 th postinduction hour/blood lactate, glucose, hemodynamic parameters, and perioperative outcomes were assessed. Results: Data of seventy patients (n = 35 in each group were finally analyzed. Cortisol level is statistically significantly higher in Group-I (69.51 ± 7.65 as compared to Group-II (27.74 ± 4.72 (P < 0.05 in the 1 st postinduction hour. In Group-II, cortisol was consistently lower for 1 st 24 postinduction hour. Total adrenaline requirement was statistically significantly high in Group-II. Time of extubation, length of Intensive Care Unit stay arrhythmia was similar in both the groups. Conclusion: Vitamin C effectively inhibits etomidate-induced adrenal suppression in cardiac patients, thereby etomidate can be used as a safe alternative for induction in cardiac surgery under cardiopulmonary bypass when pretreated with Vitamin C.

  4. Pulmonary perfusion with oxygenated blood or custodiol HTK solution during cardiac surgery for postoperative pulmonary function in COPD patients

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Wetterslev, Jørn; Secher, Niels H;

    2013-01-01

    Five to thirty percent of patients undergoing cardiac surgery present with chronic obstructive pulmonary disease (COPD) and have a 2- to 10-fold higher 30-day mortality risk. Cardiopulmonary bypass (CPB) creates a whole body systemic inflammatory response syndrome (SIRS) that could impair pulmona...... function. Impaired pulmonary function can, however, be attenuated by pulmonary perfusion with oxygenated blood or custodiol HTK (histidine-tryptophan-ketoglutarate) solution....

  5. Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year Experience

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    Vaislic Claude D

    2012-09-01

    Full Text Available Abstract Background Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients. Methods Data on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B. Results In group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation. Conclusions Cardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors.

  6. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

    Directory of Open Access Journals (Sweden)

    Kambiz Alizadeh

    2014-02-01

    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  7. Post-mortem computed tomography (PMCT and PMCT-angiography after cardiac surgery. Possibilities and limits

    Directory of Open Access Journals (Sweden)

    Beatrice Vogel

    2014-10-01

    Full Text Available Background: PMCT is a well-known tool of the forensic pathologist. It is employed worldwide. PMCT-angiography offers additional insights. This paper intends to demonstrate possibilities of both methods after cardiac surgery. Material and Methods: Exemplary cases with typical findings were selected from our own collection. PMCT was performed as whole body CT (1mm slice, pitch 1.5, 130kV, 180-130mAs, 16 slice MDCT. In PMCT-angiography, contrast material (1.2 litres is injected into the arteries (arterial phase, also documented with a whole body CT. Thereafter, contrast material is injected into the veins (venous phase, also documented with a whole body CT. The final CT is obtained after circulation has been provoked with a special pump (circulatory phase. Results: PMCT visualised pseudoarthrosis and fractures of the sternum, implanted valves (TAVI encroaching the ostia of the coronary arteries, bleeding and pericardial tamponade. PMCT-angiography showed the sources of the bleeding, vascular stenosis and obstruction and modified vascular supply. With respect to the postoperative care, malposition of tubes, drainages and complication of punctures could be seen. Conclusion: PMCT and PMCT-angiography can visualise complications and the cause of death. Such knowledge may allow for prevention of suffering and death. It may also aid in improving valve design and implantation procedures.

  8. Cold intermittent cardioplegia reduces the acidosis during prolonged cardiac surgery with cardiopulmonary bypass.

    Science.gov (United States)

    Nollo, Giandomenico; Ferrari, Paolo; Graffigna, Angelo C

    2011-01-01

    The effect on acid-base balance efficacy of intermittent warm and cold blood cardioplegia (IWBC, ICBC) was assessed in 44 patients who underwent cardiac surgery with prolonged aortic cross clamping. With this purpose a customized multi sensor probe was inserted in the coronary sinus, and pH, PO(2), PCO(2) and temperature were continuously measured at 1 Hz sampling rate. The mean cross-clamping time was of 76 ± 26 min on 19 IWBC cases and of 80 ± 24 min on 14 ICBC cases. With IWBC perfusion, at the end of every ischemic period, the lowest pH and PO(2) progressively decreased and the maximal PCO(2) increased. During ICBC the minimum of pH and PO(2) and maximum of PCO2 at the end of different ischemic period during time were constant, also during long cross-clamping time. With IWBC, myocardial ischemia seemed not completely reversed by standardized reperfusions, as reflected by steady deterioration of PCO(2) and pH after each reperfusion.

  9. Extra corporeal membrane oxygenation after pediatric cardiac surgery: A 10 year experience

    Directory of Open Access Journals (Sweden)

    Chauhan Sandeep

    2011-01-01

    Full Text Available Indications for extra corporeal membrane oxygenation (ECMO after pediatric cardiac surgery have been increasing despite the absence of encouraging survival statistics. Modification of ECMO circuit led to the development of integrated ECMO cardiopulmonary bypass (CPB circuit at the author′s institute, for children undergoing repair of transposition of great arteries among other congenital heart diseases (CHD. In this report, they analyzed the outcome of children with CHD, undergoing surgical repair and administered ECMO support in the last 10 years. The outcome was analyzed with reference to the timing of intervention, use of integrated ECMO-CPB circuit, indication for ECMO support, duration of ECMO run and the underlying CHD. The results reveal a significantly improved survival rate with the use of integrated ECMO-CPB circuit and early time of intervention rather than using ECMO as a last resort in the management. The patients with reactive pulmonary artery hypertension respond favorably to ECMO support. In all scenarios, early intervention is the key to survival.

  10. Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients.

    Science.gov (United States)

    Kramer, Philip A; Chacko, Balu K; George, David J; Zhi, Degui; Wei, Chih-Cheng; Dell'Italia, Louis J; Melby, Spencer J; George, James F; Darley-Usmar, Victor M

    2015-07-01

    Monitoring the bioenergetics of leucocytes is now emerging as an important approach in translational research to detect mitochondrial dysfunction in blood or other patient samples. Using the mitochondrial stress test, which involves the sequential addition of mitochondrial inhibitors to adherent leucocytes, we have calculated a single value, the Bioenergetic Health Index (BHI), which represents the mitochondrial function in cells isolated from patients. In the present report, we assess the BHI of monocytes isolated from the post-operative blood and post-operative pericardial fluid (PO-PCF) from patients undergoing cardiac surgery. Analysis of the bioenergetics of monocytes isolated from patients' PO-PCF revealed a profound decrease in mitochondrial function compared with monocytes isolated from their blood or from healthy controls. Further, patient blood monocytes showed no significant difference in the individual energetic parameters from the mitochondrial stress test but, when integrated into the BHI evaluation, there was a significant decrease in BHI compared with healthy control monocytes. These data support the utility of BHI measurements in integrating the individual parameters from the mitochondrial stress test into a single value. Supporting our previous finding that the PO-PCF is pro-oxidant, we found that exposure of rat cardiomyocytes to PO-PCF caused a significant loss of mitochondrial membrane potential and increased reactive oxygen species (ROS). These findings support the hypothesis that integrated measures of bioenergetic health could have prognostic and diagnostic value in translational bioenergetics.

  11. COMPARISON OF TWO ANALGESIA TECHNIQUES FOR PAIN MANAGEMENT DURING CHEST TUBE REMOVAL AFTER CARDIAC SURGERY

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    Gaurav

    2015-10-01

    Full Text Available BACKGROUND: This study aims to compare of two analgesia techniques for pain management during chest tube removal (CTR after cardiac surgery. Two groups were compared in terms of pain, sedation levels, and hemodynamic response removal of chest tube. METHODS: The study was designed as a prospective, randomized, double - blinded study. Forty patients who underwent coronary artery bypass graft (CABG surgery were enrolled. In postoperative period intravenous fentanyl 1μg/kg was given five minutes prior to chest tube removal (CTR. Each patient was explained about CTR procedure and VAS scoring charts. The patients were randomized into two groups as study group ( G roup S and control group ( G roup C. All patients received either adrenaline free xylocaine 2% infiltration ( G roup S, 6 ml around each of three chest tube (2 mediastinal + 1 pleural or normal saline 0.9% ( G roup C in double blind manner. Severity of pa in was recorded by asking Visual analogue scale (VAS from the patients. Faces rating scale (FRS, Behavioral rating scale (BRS and Ramsay sedation score (RSS along with hemodynamic data were also recorded, blinding to group at four time intervals; at baseline (T base , 2min ( T2m, 5 min (T5m 10 min (T10mand 20 min (T 20m. after CTR. RESULTS : The demographic characteristics of the patients in both groups were similar. Before chest tubes removal (CTR, all the scores of pain intensity (VAS, pain distress (FRS, BRS and sedation levels (RSS were comparable, but they differ significantly at T2, T5, and T10. However, these scores were comparable at T20. Patients remained alert and comfortable after 20 CTR regardless of which group they were assigned . CONCLUSION : Intravenous fentanyl 1μg/kg along with local infiltration of 2% xylocaine can substa ntially reduce pain and better regime than Intravenous fentanyl 1μg/kg alone during chest tube removal in post - coronary artery bypass graft surgery patients. Both techniques are equally safe in terms

  12. Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass

    Science.gov (United States)

    Tsakiridis, Kosmas; Vretzkakis, Giorgos; Mikroulis, Dimitris; Mpakas, Andreas; Kesisis, Georgios; Arikas, Stamatis; Kolettas, Alexandros; Moschos, Giorgios; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Tsiouda, Theodora; Siminelakis, Stavros; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Background The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. Materials and methods Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline. Results Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung’s inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical

  13. Renal Doppler Resistive Index as a Marker of Oxygen Supply and Demand Mismatch in Postoperative Cardiac Surgery Patients

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    Francesco Corradi

    2015-01-01

    Full Text Available Background and Objective. Renal Doppler resistive index (RDRI is a noninvasive index considered to reflect renal vascular perfusion. The aim of this study was to identify the independent hemodynamic determinants of RDRI in mechanically ventilated patients after cardiac surgery. Methods. RDRI was determined in 61 patients by color and pulse Doppler ultrasonography of the interlobar renal arteries. Intermittent thermodilution cardiac output measurements were obtained and blood samples taken from the tip of pulmonary artery catheter to measure hemodynamics and mixed venous oxygen saturation (SvO2. Results. By univariate analysis, RDRI was significantly correlated with SvO2, oxygen extraction ratio, left ventricular stroke work index, and cardiac index, but not heart rate, central venous pressure, mean artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, oxygen delivery index, oxygen consumption index, arterial lactate concentration, and age. However, by multivariate analysis RDRI was significantly correlated with SvO2 only. Conclusions. The present data suggests that, in mechanically ventilated patients after cardiac surgery, RDRI increases proportionally to the decrease in SvO2, thus reflecting an early vascular response to tissue hypoxia.

  14. Evaluation of dose to cardiac structures during breast irradiation

    DEFF Research Database (Denmark)

    Aznar, M C; Korreman, S-S; Pedersen, A N;

    2011-01-01

    delivered to the heart and the LAD in respiration-adapted radiotherapy of patients with left-sided breast cancer. METHODS: 24 patients referred for adjuvant radiotherapy after breast-conserving surgery for left-sided lymph node positive breast cancer were evaluated. The whole heart, the arch of the LAD...

  15. 心外科老年患者术后疼痛管理实践%Practice of Pain Management on Elderly Patients after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    胡海红

    2016-01-01

    Through the observation of 260 cases of elderly cardiac patients with postoperative pain after cardiac surgery, attention was paid to pain education to the elderly. Conducting objective assessment on pain, taking pain relief measures in time, assessing pain treatment effect, observing side effects of drugs and giving the corresponding treatment could achieve more efficient control o postoperative pain, which is key to ensure the success of surgery.

  16. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

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    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  17. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2014-07-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  18. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

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    Felix R Montes

    2012-01-01

    Full Text Available Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02. Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

  19. Glycine does not add to the beneficial effects of perioperative oral immune-enhancing nutrition supplements in high-risk cardiac surgery patients.

    NARCIS (Netherlands)

    Tepaske, R.; Velthuis, H. te; Straaten, H.M. van der; Bossuyt, P.M.; Schultz, M.J.; Eijsman, L.; Vroom, M.

    2007-01-01

    BACKGROUND: Elderly patients and patients with a poor cardiac function have increased morbidity rates when undergoing cardiac surgery. The aim of this study was to determine whether addition of glycine to a standard preoperative oral immune-enhancing nutrition supplement (OIENS) improves outcome. Gl

  20. Incidence and Progression of Cardiac Surgery-associated Acute Kidney Injury and its Relationship with Bypass and Cross Clamp Time

    Science.gov (United States)

    Karim, Habib Md Reazaul; Yunus, Mohd; Saikia, Manuj Kumar; Kalita, Jyoti Prasad; Mandal, Mrinal

    2017-01-01

    Introduction: Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times. Materials and Methods: Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software. Results: One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2nd POD. Serum creatinine followed a falling trend 3rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05). Conclusion: CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1st POD or increasing trend of serum creatinine beyond 3rd POD should alert for early intervention. PMID:28074790

  1. The influence of body mass index on outcomes in patients undergoing cardiac surgery: does the obesity paradox really exist?

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    Juan Carlos Lopez-Delgado

    Full Text Available Obesity influences risk stratification in cardiac surgery in everyday practice. However, some studies have reported better outcomes in patients with a high body mass index (BMI: this is known as the obesity paradox. The aim of this study was to quantify the effect of diverse degrees of high BMI on clinical outcomes after cardiac surgery, and to assess the existence of an obesity paradox in our patients.A total of 2,499 consecutive patients requiring all types of cardiac surgery with cardiopulmonary bypass between January 2004 and February 2009 were prospectively studied at our institution. Patients were divided into four groups based on BMI: normal weight (18.5-24.9 kg∙m-2; n = 523; 21.4%, overweight (25-29.9 kg∙m-2; n = 1150; 47%, obese (≥ 30-≤ 34.9 kg∙m-2; n = 624; 25.5% and morbidly obese (≥ 35kg∙m-2; n = 152; 6.2%. Follow-up was performed in 2,379 patients during the first year.After adjusting for confounding factors, patients with higher BMI presented worse oxygenation and better nutritional status, reflected by lower PaO2/FiO2 at 24h and higher albumin levels 48 h after admission respectively. Obese patients showed a higher risk for Perioperative Myocardial Infarction (OR: 1.768; 95% CI: 1.035-3.022; p = 0.037 and septicaemia (OR: 1.489; 95% CI: 1.282-1.997; p = 0.005. In-hospital mortality was 4.8% (n = 118 and 1-year mortality was 10.1% (n = 252. No differences were found regarding in-hospital mortality between BMI groups. The overweight group showed better 1-year survival than normal weight patients (91.2% vs. 87.6%; Log Rank: p = 0.029. HR: 1.496; 95% CI: 1.062-2.108; p = 0.021.In our population, obesity increases Perioperative Myocardial Infarction and septicaemia after cardiac surgery, but does not influence in-hospital mortality. Although we found better 1-year survival in overweight patients, our results do not support any protective effect of obesity in patients undergoing cardiac surgery.

  2. Dose dependent effect of statins on postoperative atrial fibrillation after cardiac surgery among patients treated with beta blockers

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    Kelly Rosemary F

    2009-11-01

    Full Text Available Abstract Background Previous studies on the effects of Statins in preventing atrial fibrillation (AF after cardiac surgery have shown conflicting results. Whether statins prevent AF in patients treated with postoperative beta blockers and whether the statin-effect is dose related are unknown. Methods We retrospectively studied 1936 consecutive patients who underwent coronary artery bypass graft (CABG (n = 1493 or valve surgery (n = 443 at the Minneapolis Veterans Affairs Medical Center. All patients were in sinus rhythm before the surgery. Postoperative beta blockers were administered routinely (92% within 24 hours postoperatively. Results Mean age was 66+10 years and 68% of the patients were taking Statins. Postoperative AF occurred in 588 (30% patients and led to longer length of stay in the intensive care unit versus those without AF (5.1+7.6 days versus 2.5+2.3 days, p 20 mg daily had a 36% reduction in the risk of postoperative AF (OR 0.64, 95% CI 0.43 to 0.6; p = 0.03 in comparison to those taking lower dosages. Conclusion Among cardiac surgery patients treated with postoperative beta blockers Statin treatment reduces the incidence of postoperative AF when used at higher dosages

  3. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system.

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Goepfert, M; Gogarten, W; Grosse, J; Heller, A R; Heringlake, M; Kastrup, M; Kroener, A; Loer, S A; Marggraf, G; Markewitz, A; Reuter, D; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2010-06-15

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical

  4. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

    Directory of Open Access Journals (Sweden)

    Schmitt, D. V.

    2010-01-01

    Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the

  5. Paediatric and congenital cardiac surgery in emerging economies: surgical 'safari' versus educational programmes.

    Science.gov (United States)

    Corno, Antonio F

    2016-07-01

    To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the

  6. Coronary Artery-Bypass-Graft Surgery Increases the Plasma Concentration of Exosomes Carrying a Cargo of Cardiac MicroRNAs: An Example of Exosome Trafficking Out of the Human Heart with Potential for Cardiac Biomarker Discovery.

    Directory of Open Access Journals (Sweden)

    Costanza Emanueli

    Full Text Available Exosome nanoparticles carry a composite cargo, including microRNAs (miRs. Cultured cardiovascular cells release miR-containing exosomes. The exosomal trafficking of miRNAs from the heart is largely unexplored. Working on clinical samples from coronary-artery by-pass graft (CABG surgery, we investigated if: 1 exosomes containing cardiac miRs and hence putatively released by cardiac cells increase in the circulation after surgery; 2 circulating exosomes and exosomal cardiac miRs correlate with cardiac troponin (cTn, the current "gold standard" surrogate biomarker of myocardial damage.The concentration of exosome-sized nanoparticles was determined in serial plasma samples. Cardiac-expressed (miR-1, miR-24, miR-133a/b, miR-208a/b, miR-210, non-cardiovascular (miR-122 and quality control miRs were measured in whole plasma and in plasma exosomes. Linear regression analyses were employed to establish the extent to which the circulating individual miRs, exosomes and exosomal cardiac miR correlated with cTn-I. Cardiac-expressed miRs and the nanoparticle number increased in the plasma on completion of surgery for up to 48 hours. The exosomal concentration of cardiac miRs also increased after CABG. Cardiac miRs in the whole plasma did not correlate significantly with cTn-I. By contrast cTn-I was positively correlated with the plasma exosome level and the exosomal cardiac miRs.The plasma concentrations of exosomes and their cargo of cardiac miRs increased in patients undergoing CABG and were positively correlated with hs-cTnI. These data provide evidence that CABG induces the trafficking of exosomes from the heart to the peripheral circulation. Future studies are necessary to investigate the potential of circulating exosomes as clinical biomarkers in cardiac patients.

  7. Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

    Science.gov (United States)

    Gandhi, Hemang; Mishra, Amit; Thosani, Rajesh; Acharya, Himanshu; Shah, Ritesh; Surti, Jigar; Sarvaia, Alpesh

    2017-01-01

    Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation. PMID:28163425

  8. The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

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    Novikov Ilia

    2011-10-01

    Full Text Available Abstract Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. Methods/Design A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed. Discussion We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. Trial

  9. Microfiltration platform for continuous blood plasma protein extraction from whole blood during cardiac surgery.

    Science.gov (United States)

    Aran, Kiana; Fok, Alex; Sasso, Lawrence A; Kamdar, Neal; Guan, Yulong; Sun, Qi; Ündar, Akif; Zahn, Jeffrey D

    2011-09-07

    This report describes the design, fabrication, and testing of a cross-flow filtration microdevice, for the continuous extraction of blood plasma from a circulating whole blood sample in a clinically relevant environment to assist in continuous monitoring of a patient's inflammatory response during cardiac surgeries involving cardiopulmonary bypass (CPB) procedures (about 400,000 adult and 20,000 pediatric patients in the United States per year). The microfiltration system consists of a two-compartment mass exchanger with two aligned sets of PDMS microchannels, separated by a porous polycarbonate (PCTE) membrane. Using this microdevice, blood plasma has been continuously separated from blood cells in a real-time manner with no evidence of bio-fouling or cell lysis. The technology is designed to continuously extract plasma containing diagnostic plasma proteins such as complements and cytokines using a significantly smaller blood volume as compared to traditional blood collection techniques. The microfiltration device has been tested using a simulated CPB circulation loop primed with donor human blood, in a manner identical to a clinical surgical setup, to collect plasma fractions in order to study the effects of CPB system components and circulation on immune activation during extracorporeal circulatory support. The microdevice, with 200 nm membrane pore size, was connected to a simulated CPB circuit, and was able to continuously extract ~15% pure plasma volume (100% cell-free) with high sampling frequencies which could be analyzed directly following collection with no need to further centrifuge or modify the fraction. Less than 2.5 ml total plasma volume was collected over a 4 h sampling period (less than one Vacutainer blood collection tube volume). The results tracked cytokine concentrations collected from both the reservoir and filtrate samples which were comparable to those from direct blood draws, indicating very high protein recovery of the microdevice

  10. Radiographic evaluation of cardiac silhouette in healthy Maine Coon cats

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    Caio Sabino de Oliveira

    2014-09-01

    Full Text Available Determining the size of the heart is important for evaluating cardiac patients, because the increase of the cardiac silhouette in the chest radiography can be indicative of heart disease. The vertebral heart size (VHS method is useful because it allows objective assessment of the limits of cardiac silhouette, and can help assess cardiomegaly and document changes in heart size in response to treatment or disease progression. The aim of this study was to compare VHS values of Maine Coon cats (MCC with values cited in the literature (7.5 ± 0.3 vertebrae obtained in non Maine Coon cats (NMCC. Sixty three MCC underwent the physical examination, electrocardiography, echocardiography, laboratory tests (blood count, biochemistry, including liver and kidney function, and total T4, as well as measurement of blood pressure. Faced with normal results, the cats were positioned in right lateral decubitus (right laterallateral projection, to perform chest radiography. The radiographic examinations were performed using the Fuji computed radiography system. The values of VHS found in the animals of this study were 7.61 ± 0.34 vertebrae with a minimum of 6.9 and of maximum 8.5 vertebrae. Statistical analysis performed by Student’s t test identified a significant difference between the values obtained in this study with those in the literature (p = 0.03 for non Maine Coon cats. The highest values of VHS obtained in MCC may be associated with the size of this giant breed.

  11. Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    S. de Hoogd (Sjoerd); S.J.G.M. Ahlers (Sabine); E.H.P.A. van Dongen (Eric); D. Tibboel (Dick); A. Dahan (Albert); C.A.J. Knibbe (Catherijne)

    2014-01-01

    textabstractBackground: Chronic thoracic pain after cardiac surgery is prevalent (11 to 56%) and may affect patients' physical and mental health status. Despite its favorable pharmacokinetic and pharmacodynamic properties, high doses of remifentanil administered during surgery are reported to cause

  12. Mediastinite em cirurgia cardíaca: análise dos fatores de risco e avaliação do tratamento utilizando irrigação contínua com solução de PVPI a 1% Mediastinitis in cardiac surgery: evaluation of risk factors and treatment with continuous irrigation with PVPI 1% solution

    Directory of Open Access Journals (Sweden)

    Luiz Cláudio Moreira Lima

    1996-09-01

    Full Text Available Com o objetivo de avaliar a eficácia do tratamento da mediastinite com irrigação contínua com solução de polivinilpirrolidona-iodo (PVPI a 1 %, associada a antibioticoterapia e analisar os fatores de risco desta grave infecção, foram estudados, retrospectivamente, 1113 pacientes submetidos a cirurgia para correção de lesões cardíacas, entre janeiro de 1993 e abril de 1995, no Instituto do Coração do Hospital Madre Teresa, Belo Horizonte, Minas Gerais. Onze fatores de risco para mediastinite foram analisados (idade, sexo, peso, diabetes, hipertensão arterial sistêmica, tabagismo, transfusão sangüínea, tempo de circulação extracorpórea, utilização de enxerto de artéria torácica interna, drenagem pleural e tempo de internação preoperatorio. A análise estatística demonstrou serem fatores de risco: peso (p=0,0001, utilização de enxerto de artéria torácica interna (p=0,001, drenagem de pleura (p=0,001 e tempo de internação pré-operatório (p=0,01. Dezoito (1,6% pacientes desenvolveram mediastinite no pós-operatório e foram submetidos a tratamento por aesbridamento cirúrgico, ressutura de esterno e instalação de irrigação contínua com solução de PVPI a 1 %, por um período médio de 8 dias. A média de internação hospitalar foi de 37 dias neste grupo de pacientes. O germe predominante foi o S. Aureus (72%. A mortalidade foi de 27% (5 pacientes, devido a infecção fora de controle. Os autores consideram que a facilidade de emprego e manejo da irrigação contínua com solução de PVPI a 1 %, associada a baixa taxa de mortalidade, demonstrou ser um método eficaz no tratamento desta grave complicação pós-operatória.In order to evaluate the efficacy of mediastinitis treatment with continuous wound irrigation with PVP11 % solution, plus antibyotics and surgical treatment, and to analise the risk factors of this serious infection, we retrospectively studied 1113 patients submited to cardiac surgery

  13. Antioxidant therapy reduces oxidative and inflammatory tissue damage in patients subjected to cardiac surgery with extracorporeal circulation.

    Science.gov (United States)

    Castillo, Rodrigo; Rodrigo, Ramón; Perez, Felipe; Cereceda, Mauricio; Asenjo, René; Zamorano, Jaime; Navarrete, Roberto; Villalabeitia, Eli; Sanz, Juan; Baeza, Cristián; Aguayo, Rubén

    2011-04-01

    Ischaemia reperfusion injury is a pathophysiological event that occurs after cardiac surgery with extracorporeal circulation. This clinical event has been associated with the induction of oxidative and inflammatory damage in atrial tissue. Here, we tested whether combined omega 3 polyunsaturated fatty acids (n-3 PUFA)-antioxidant vitamin protocol therapy reduces oxidative and inflammatory cardiac tissue damage. This trial assigned 95 either-sex patients to supplementation with n-3 PUFA (2 g/day), or matching placebo groups, 7 days before on-pump surgery. Antioxidant vitamins C (1 g/day) and E (400 IU/day) or placebo were added from 2 days before surgery until discharge. Blood and atrial tissue samples were obtained during the intervention. Reduced/oxidized glutathione (GSH/GSSG) ratio, malondialdehyde (MDA) and protein carbonylation were determined in atrial tissue. Leucocyte count and high-sensitivity C-reactive protein (hs-CRP) in blood plus nuclear factor (NF)-κappaB activation in atrial tissue served for inflammation assessment. Lipid peroxidation and protein carbonylation were 27.5 and 24% lower in supplemented patients (p < 0.01). GSH/GSSG ratio was 38.1% higher in supplemented patients compared with placebo (p < 0.01). Leucocyte count and serum hs-CRP levels were markedly lower throughout the protocol in supplemented patients (p < 0.01). Atrial tissue NF-κB DNA activation in supplemented patients was 22.5% lower than that in placebo patients (p < 0.05). The combined n-3 PUFA-antioxidant vitamin protocol therapy here proposed reduced the oxidative stress and inflammation biomarkers, in patients undergoing on-pump cardiac surgery.

  14. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

    Science.gov (United States)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2014-03-01

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial

  15. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients.

    Science.gov (United States)

    Sogg, Stephanie; Lauretti, Jennifer; West-Smith, Lisa

    2016-05-01

    Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and co-morbidity improvement and or resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariatric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral healthcare of the bariatric patient to the entire span of the surgical and postsurgical process.

  16. Postoperative Neurocognitive Dysfunction in Patients Undergoing Cardiac Surgery after Remote Ischemic Preconditioning: A Double-Blind Randomized Controlled Pilot Study

    Science.gov (United States)

    Meybohm, Patrick; Renner, Jochen; Broch, Ole; Caliebe, Dorothee; Albrecht, Martin; Cremer, Jochen; Haake, Nils; Scholz, Jens; Zacharowski, Kai; Bein, Berthold

    2013-01-01

    Background Remote ischemic preconditioning (RIPC) has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD) in patients undergoing complex cardiac surgery. Methods We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5–7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion) or if the combined Z score was 1.96 or greater (Z score criterion). Results According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5–7 days after surgery (p = 0.753). The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30) compared to the RIPC group (1.14±4.02; p = 0.228). Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19–1.94) µg/L vs. 0.48 (0.07–1.84) µg/L] and 24 hours after surgery [0.36 (0.14–1.89) µg/L vs. 0.26 (0.07–0.90) µg/L]. Conclusions We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed. Trial Registration ClinicalTrials.gov NCT00877305 PMID:23741380

  17. Initial evaluation of the "Trauma surgery course"

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    Tugnoli Gregorio

    2006-03-01

    Full Text Available Abstract Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course, developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.

  18. Living Within Limits: Unpleasant Experiences From the Perspective of Patients After Cardiac Surgery, a Content Analysis Study

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    Pourghane

    2014-07-01

    Full Text Available Background Cardio vascular diseases (CVDs are the main cause of death around the world and coronary artery bypass grafting (CABG has proven to be the most effective treatment for ischemic coronary heart diseases when other treatments are ineffective. Despite the perceived improvement in the health of patients undergoing CABG, there are problems that result from operations after they are discharged from hospital. Provision of information is an integral part of most psychological interventions. Having a clearer understanding of patients’ experiences will be helpful to healthcare workers with respect to patients’ care and education planning. Caring science places more attention on the patient's everyday life from his/her perspective. Most of the studies conducted in Iran used a quantitative method or measured care needs according to pre-defined criteria. Objectives The aim of this study was to explore the lived experiences of patients who have undergone cardiac surgery, in order to obtain a deeper understanding of what they experienced and what those who provide care for these patients experienced. Patients and Methods A qualitative design, using a content analysis approach, was adapted to collect the data and analyze the experiences of 18 patients after cardiac surgery through a purposive sampling strategy. After the selection of the participants, semi structured interviews were held in order to collect the data. Scientific accuracy, and rigor of the data and research ethics were respected. Results The data analysis revealed three main themes and 11 subthemes, categorized as conceptual and abstract, based on their nature: concern of going out therapeutic framework (Fear of the recurrence of heart attack, Fear of performing more activities than permitted, Fear of taking journeys, Fear of mass communication/Tired of living within the confines of the therapeutic framework (Need to take various medications, Dietary restrictions, Limitations in

  19. Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

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    Edward Gologorsky

    2010-01-01

    Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  20. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  1. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

    Science.gov (United States)

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C

    2016-08-01

    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.

  2. Cardiac evaluation in pediatric patients waiting for liver transplantation

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    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  3. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; QI Dan-ni; GU Cheng-xiong

    2010-01-01

    @@ Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft (CVBG), may be the proper therapeutic selection.1 The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old. However, few clinical trials and long-term outcome data have been presented. The use of venous arterialization has not been widely used. We report the use of a sequential saphenous vein graft from the aorta to middle cardiac vein in a patient with diffuse lesions in right coronary artery during off-pump coronary artery bypass surgery (OPCAB).

  4. An evaluation of the efficacy of‘2D speckle tracking’ in diagnosing the right ventricular function after cardiac surgery%二维斑点追踪技术定量评价心脏手术患者的右心室功能

    Institute of Scientific and Technical Information of China (English)

    曾小青; 黄继光

    2014-01-01

    Objective To understand the value of two-dimensional speckle tracking ( 2D-STI ) as a technology for determining the right ventricular function of patients having undergone cardiac surgery.Method 46 cases of cardiac surgery were first divided into two groups, one having abnormal LVEF ( LVEF 0.05) .One week later, longitudinal peak systolic peak velocity of the right ventricular free wall three segments observed in the OP group as compared with that of the CPB group was significantly lower than before surgery (P 0.05).Conclusion (2D-STI) can serve as an efficient technology for determining ventricular function of patients after cardiac surgery.It can help to make well informed judgment of the severity of illness, prognosis, and surgical strategy.%目的:探讨二维斑点追踪技术(2D-STI)对心脏手术患者右心室功能的诊断价值。方法将46例心脏手术患者分为左心室射血分数( LVEF)异常组( LVEF<50%)和LVEF正常组( LVEF≥50%),根据手术方法进一步分为非体外循环组( OP组,21例)和体外循环组( CPB组,25例),另选取健康对照组30例,在术前1周内行超声心动图检查,采用QLAB 6.0 TMQA软件对右心室心内膜轮廓进行斑点追踪,并自动计算出右心室游离壁基底段、中间段及心尖段收缩期纵向峰值应变(ε)及峰值运动速度( S)作为右心室功能的评价指标,术后1周、1个月进行随访评价。结果术前LVEF异常组右心室功能右心室游离壁3个节段纵向收缩期峰值及峰值速度均较LVEF正常组明显下降,差异有统计学意义(P<0.05),而LVEF正常组与对照组组比较差异无统计学意义(P>0.05)。术后1周时,OP组与CPB组右心室游离壁3个节段纵向收缩期峰值及峰值速度均较术前明显降低,差异有统计学意义( P<0.05),术后1个月时均有明显恢复,与术前及对照组比较,差异无统计学意义(P>0

  5. Recent application of minimally invasive robotic cardiac surgery%机器人微创心脏手术的应用现状

    Institute of Scientific and Technical Information of China (English)

    杨明; 高长青

    2011-01-01

    The minimally invasive approach is the direction of cardiac surgery.With the development of telemanipulation and computer technology,the minimally robotic surgery has become reality.As the one of the most minimally invasive cardiac surgery,the robotic surgical system provides cardiac surgeons with less invasive manner and dexterity manipulation.Robotic cardiac surgery is an evolutionary process and has resulted in a substantial increased attention to surgeons and patients.This review is to introduce the recent clinical application of robotic technology in cardiac surgery.%微创是心脏外科的发展方向之一.随着自动机械和计算机技术的进步,机器人微创外科手术已成为现实.机器人微创心脏手术具有创伤小、操作精细等优点,是微创心脏外科的前沿技术之一.作为一种革新的手术方式,机器人辅助下微创心脏手术得到了极大的关注,本文就机器人心脏手术的临床应用及手术效果作一综述.

  6. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice

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    Sanne E. Hoeks

    2010-07-01

    Full Text Available Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.

  7. Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial

    Science.gov (United States)

    Nie, Xiao-Lu; Zhang, Yan; Li, Xue-Ying; Li, Li-Huan; Ma, Daqing

    2017-01-01

    Background Delirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery. Methods This randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Eligible patients were randomized into two groups. Dexmedetomidine (DEX) was administered during anesthesia and early postoperative period for patients in the DEX group, whereas normal saline was administered in the same rate for the same duration for patients in the control (CTRL) group. The primary endpoint was the incidence of delirium during the first five days after surgery. Secondary endpoints included the cognitive function assessed on postoperative days 6 and 30, the overall incidence of non-delirium complications within 30 days after surgery, and the all-cause 30-day mortality. Results Two hundred eighty-five patients were enrolled and randomized. Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar between the two groups; however, the incidence of pulmonary complications was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of early extubation was significantly increased (OR 3.32, 95% CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the required treatment for postoperative hypotension (84.5% [120/142] in the DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003). Conclusions Dexmedetomidine administered during anesthesia and early postoperative period

  8. Evaluation of postoperative cardiac function in severe ischemic heart disease associated with decreased ejection fraction

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    Natsuaki, Masafumi; Itoh, Tsuyoshi; Norita, Hiroaki; Naitoh, Kouzou; Suda, Hisao [Saga Medical School (Japan)

    1997-09-01

    This clinical study was performed to clarify the postoperative cardiac functions after coronary artery bypass graft surgery in the cases associated with decreased left ventricular ejection fraction (EF) or increased end-diastolic volume index (EDVI). The patients were divided into two groups by preoperative EF. The EF of Group I ranged from 31 to 39% in 42 cases, and the EF of Group II was below 30% in 27 cases. Several parameters of cardiac function such as EF, peak ejection rate (PER), peak filling rate (PFR) or early diastolic peak filling rate were evaluated with radionuclide ventriculography. Postoperative mean values of these parameters significantly improved in both Group I and Group II compared to preoperative values. Although these parameters and left ventricular wall motion did not improve in the 7 cases with an EDVI over 140 ml/m{sup 2} in Group II, the clinical results of these 7 cases were good during the follow-up period except one case which preoperatively had frequent ventricular arrythmia. The clinical condition improved remarkably in the 3 patients who had preoperative angina pectoris among these 7 cases. Surgical indications must be carefully determined in cases with increased EDVI and frequent ventricular arrythmia. (author)

  9. Asystole due to trigemino-cardiac reflex: a rare complication of trans-sphenoidal surgery for pituitary adenoma.

    Science.gov (United States)

    Seker, Askin; Toktas, Zafer Orkun; Peker, Selcuk; Batirel, Halit Abbas; Necmettin Pamir, M

    2009-02-01

    The trigemino-cardiac reflex (TCR) is a well-known reflexive response in which bradycardia, hypotension, and gastric hypermotility are induced by stimulation of a peripheral or central portion of the trigeminal nerve. This reflex occurs during craniofacial surgery and other operations on or near the cerebellopontine angle, petrosal sinus, orbit and trigeminal ganglion. TCR is a well-known, although not well documented, phenomenon commonly observed during trans-sphenoidal surgery for resection of pituitary adenomas. We report a case in which asystole occurred during trans-sphenoidal surgery on a pituitary adenoma that was infiltrating the right cavernous sinus. When the anesthesiologist reported asystole, the team stopped manipulation and administered intravenous atropine. Intra-operative MRI showed a small tumour remnant in the right cavernous sinus. The operation was terminated but subsequent radiosurgery was planned for the residual tumor. Although TCR is rare and usually self-limiting, this case led us to change our treatment strategy. Surgeons who perform trans-sphenoidal surgery should be aware of this potential problem. Invasive pituitary adenomas should be removed gently and the risk of triggering TCR should be kept in mind.

  10. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery.

    Science.gov (United States)

    Carmona, M J C; Malbouisson, L M S; Pereira, V A; Bertoline, M A; Omosako, C E K; Le Bihan, K B; Auler Jr, J O C; Santos, S R C J

    2005-05-01

    The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 +/- 8 years, mean weight 75.4 +/- 11.9 kg and mean body surface area 1.83 +/- 0.19 m(2)), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an inc