Multivariate Autoregressive Model Based Heart Motion Prediction Approach for Beating Heart Surgery

Directory of Open Access Journals (Sweden)

Fan Liang

2013-02-01

Full Text Available A robotic tool can enable a surgeon to conduct off-pump coronary artery graft bypass surgery on a beating heart. The robotic tool actively alleviates the relative motion between the point of interest (POI on the heart surface and the surgical tool and allows the surgeon to operate as if the heart were stationary. Since the beating heart's motion is relatively high-band, with nonlinear and nonstationary characteristics, it is difficult to follow. Thus, precise beating heart motion prediction is necessary for the tracking control procedure during the surgery. In the research presented here, we first observe that Electrocardiography (ECG signal contains the causal phase information on heart motion and non-stationary heart rate dynamic variations. Then, we investigate the relationship between ECG signal and beating heart motion using Granger Causality Analysis, which describes the feasibility of the improved prediction of heart motion. Next, we propose a nonlinear time-varying multivariate vector autoregressive (MVAR model based adaptive prediction method. In this model, the significant correlation between ECG and heart motion enables the improvement of the prediction of sharp changes in heart motion and the approximation of the motion with sufficient detail. Dual Kalman Filters (DKF estimate the states and parameters of the model, respectively. Last, we evaluate the proposed algorithm through comparative experiments using the two sets of collected vivo data.

Outcome of patients undergoing open heart surgery at the Uganda ...

African Journals Online (AJOL)

An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative ...

Heart Motion Prediction in Robotic-Assisted Beating Heart Surgery: A Nonlinear Fast Adaptive Approach

Directory of Open Access Journals (Sweden)

Fan Liang

2013-01-01

Full Text Available Off-pump Coronary Artery Bypass Graft (CABG surgery outperforms traditional on-pump surgery because the assisted robotic tools can alleviate the relative motion between the beating heart and robotic tools. Therefore, it is possible for the surgeon to operate on the beating heart and thus lessens post surgery complications for the patients. Due to the highly irregular and non-stationary nature of heart motion, it is critical that the beating heart motion is predicted in the model-based track control procedures. It is technically preferable to model heart motion in a nonlinear way because the characteristic analysis of 3D heart motion data through Bi-spectral analysis and Fourier methods demonstrates the involved nonlinearity of heart motion. We propose an adaptive nonlinear heart motion model based on the Volterra Series in this paper. We also design a fast lattice structure to achieve computational-efficiency for real-time online predictions. We argue that the quadratic term of the Volterra Series can improve the prediction accuracy by covering sharp change points and including the motion with sufficient detail. The experiment results indicate that the adaptive nonlinear heart motion prediction algorithm outperforms the autoregressive (AR and the time-varying Fourier-series models in terms of the root mean square of the prediction error and the prediction error in extreme cases.

Early experience with open heart surgery in a pioneer private ...

African Journals Online (AJOL)

Introduction: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review ...

Prior oral conditions in patients undergoing heart valve surgery.

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Silvestre, Francisco-Javier; Gil-Raga, Irene; Martinez-Herrera, Mayte; Lauritano, Dorina; Silvestre-Rangil, Javier

2017-11-01

Patients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group. A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions. Significant differences in bacterial plaque index were observed between the two groups ( p <0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls ( p <0.01). Sixty percent of the patients with valve disease presented periodontitis. Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery. Key words: Valve disease, aortic, mitral, heart surgery, periodontitis.

[Surgery of grown up congenital heart disease. About 540 cases].

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Haddad, A; Bourezak, R; Aouiche, M; Ait Mohand, R; Hamzaoui, A; Bourezak, S E

2015-09-01

With advances in recent decades in the field of congenital heart disease both for imaging in medical therapy, a large number of heart disease is diagnosed before birth. Many of them benefit from surgery and reach adulthood, they do not require further action. Some of them develop later in their lives other problems requiring reoperation in adulthood. This sparked the birth of a subspecialty within the department of congenital heart disease: GUCH Unit "grown up congenital heart disease". In developing countries, little heart are detected in childhood, a minority of them are operated and very few reach adulthood or with minor heart disease or become advanced enough then inoperable. Only part may still take advantage of surgery at this age. The aim of our study is to describe the spectrum and characteristics of congenital heart disease in adulthood in Algiers a center of cardiovascular surgery. A retrospective descriptive study of patients aged 15 and above operated for congenital heart defects between 1995 and 2011. Five hundred and forty patients aged 15 to 76years (29±10 years), including 314 women and 226 men are operated congenital heart defects between 1995 and 2011. The left-right shunts represent two thirds of heart disease, represented mainly (50%) by the atrial septal defect. Barriers to the ejection of the left heart represent one forth of cases with a predominance of subvalvular aortic stenosis. We find the native heart whose survival is considered exceptional in adulthood in the absence of surgery, such as tetralogy of Fallot, aortopulmonary windows wide, double outlet right ventricle and atrioventricular canal that take advantage of always surgery. The results are encouraging with low perioperative mortality (2%). The approach of congenital heart disease in developing countries is different from that of developed countries. Efforts need to be made in early detection and monitoring of congenital heart disease and improve access to surgery centers

Preoperative atrial fibrillation and long-term survival after open heart surgery in a rural tertiary heart institute.

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O'Neal, Wesley T; Efird, Jimmy T; Davies, Stephen W; Choi, Yuk Ming; Anderson, Curtis A; Kindell, Linda C; O'Neal, Jason B; Ferguson, T Bruce; Chitwood, W Randolph; Kypson, Alan P

2013-01-01

Preoperative atrial fibrillation (AF) is associated with increased morbidity and mortality after open heart surgery. However, the impact of preoperative AF on long-term survival after open heart surgery has not been widely examined in rural populations. Patients from rural regions are less likely to receive treatment for cardiac conditions and to have adequate medical insurance coverage. To examine the influence of preoperative AF on long-term survival following open heart surgery in rural eastern North Carolina. Long-term survival was compared in patients with and without preoperative AF after coronary artery bypass grafting (CABG) and CABG plus valve (CABG + V) surgery between 2002 and 2011. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. The study population consisted of 5438 patients. A total of 263 (5%) patients had preoperative AF. Preoperative AF was an independent predictor of long-term survival (open heart surgery: adjusted HR = 1.6, 95% CI = 1.3-2.0; CABG: adjusted HR = 1.6, 95% CI = 1.3-2.1; CABG + V: adjusted HR = 1.6, 95% CI = 1.1-2.3). Preoperative AF is an important predictor of long-term survival after open heart surgery in this rural population. Copyright © 2013 Elsevier Inc. All rights reserved.

Single-institution effectiveness assessment of open-heart surgery in octogenarians

NARCIS (Netherlands)

de Mol, B. A.; Kallewaard, M.; Lewin, F.; van Gaalen, G. L.; van den Brink, R. B.

1997-01-01

To determine short- and long-term outcome of open-heart surgery in octogenarians. We reviewed the medical charts of 130 consecutive octogenarians undergoing open-heart surgery. Patients with significant comorbidity were excluded from the study. The effect of cardiac and operative risk factors on

Maximal conservation and minimal usage of blood products in open heart surgery.

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Newland, P E; Pastoriza-Pinol, J; McMillan, J; Smith, B F; Stirling, G R

1980-05-01

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.

[Immunological status of the pediatric patient who has undergone heart surgery].

Science.gov (United States)

Valenzuela Flores, A; Wakida, G; Limón Rojas, A; Obregón, C; Orihuela, O; Romero, C

1995-01-01

Communication of results a study the effect of open and closed-heart surgery in the immune system of infants and children. Data collected 24 hrs before anesthesia and surgery and five days after surgery. Operating room and pediatric intensive care of Hospital Central de Petróleos Mexicanos (PEMEX) in the South, Mexico City. Children undergoing surgery for correction of congenital heart disease (age 16 months to 14 years). A total of 16 patients. increased neutrophil counts with luymphopenia in both groups (p < 0.05), serum levels of the complement components C3 and C4 were higher after surgery, serum immunoglobulin IgG, IgA and IgM were higher after surgery, serum immunoglobulin IgG, IgA and IgM were decreased form preoperative levels (p < 0.01). Two patients had infection in the surgical wound. The effect of open and closed-heart surgery produced transitory immunodeficiency with recuperation of his immune systems and 5th day after surgery.

Genetic polymorphism in postoperative sepsis after open heart surgery in infants.

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Fakhri, Dicky; Djauzi, Samsuridjal; Murni, Tri Wahyu; Rachmat, Jusuf; Harahap, Alida Roswita; Rahayuningsih, Sri Endah; Mansyur, Muchtaruddin; Santoso, Anwar

2016-05-01

Sepsis is one of the complications following open heart surgery. Toll-like receptor 2 and toll-interacting protein polymorphism influence the immune response after open heart surgery. This study aimed to assess the genetic distribution of toll-like receptor 2 N199N and toll-interacting protein rs5743867 polymorphism in the development of postoperative sepsis. A prospective cohort study was conducted in 108 children open heart surgery with a Basic Aristotle score ≥6. Patients with an accompanying congenital anomaly, human immunodeficiency virus infection, or history of previous open heart surgery were excluded. The patients' nutritional status and genetic polymorphism were assessed prior to surgery. The results of genetic polymorphism were obtained through genotyping. Patients' ages on the day of surgery and cardiopulmonary bypass times were recorded. The diagnosis of sepsis was established according to Surviving Sepsis Campaign criteria. Postoperative sepsis was observed in 21% of patients. There were 92.6% patients with toll-like receptor 2 N199N polymorphism and 52.8% with toll-interacting protein rs5743867 polymorphism. Toll-like receptor 2 N199N polymorphism tends to increase the risk of sepsis (odds ratio = 1.974; 95% confidence interval: 0.23-16.92; p = 0.504), while toll-interacting protein rs5743867 polymorphism tends to decrease the risk of sepsis (odds ratio = 0.496; 95% confidence interval: 0.19-1.27; p = 0.139) in infants open heart surgery. © The Author(s) 2016.

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...

Analysis of maternal-fetal outcomes of valvular heart surgeries in

Directory of Open Access Journals (Sweden)

Alireza Yaghoubi

2010-03-01

Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

Open heart surgery after renal transplantation.

Science.gov (United States)

Yamamura, Mitsuhiro; Miyamoto, Yuji; Mitsuno, Masataka; Tanaka, Hiroe; Ryomoto, Masaaki; Fukui, Shinya; Tsujiya, Noriko; Kajiyama, Tetsuya; Nojima, Michio

2014-09-01

to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan. we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)). 5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45. careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Open heart surgery in Ilorin: case report and experience with the first ...

African Journals Online (AJOL)

Open heart surgery is uncommonly done in Nigeria and restricted to few centres despite the burden of congenital heart disease. We present our first experience with open heart surgery at the University of Ilorin Teaching Hospital. A 15 years old female adolescent presented with a 2 years history of easy fatigability, ...

OPEN HEART SURGERY UNDER HYPOTHERMIA

African Journals Online (AJOL)

pulmonary blood flow by operation under hypothermia; open heart surgery ... po ition with the right arm abducted and the left arm at the ideo The ... pulmonary valve stenosis is pre ent. Mobilization ... The anaesthetist must try and prevent shivering,. 2. HOURS .... The exploratory inci ion into the right atrial cavity is then clo ed ...

Cerebroprotective effect of piracetam in patients undergoing open heart surgery.

Science.gov (United States)

Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

2011-01-01

Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery. Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis. A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955). Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.

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; Kikkenborg Berg, Selina

2016-01-01

collected data over 18 months (April 2013-October 2014). We recruited nine patients undergoing heart valve surgery from a randomized trial, CopenHeartVR and conducted 27 individual narrative interviews at 2-3 weeks, 3-4 months and 8-9 months after surgery. FINDINGS: Following heart valve surgery...

Inflammatory response and cardioprotection during open-heart surgery: the importance of anaesthetics.

Science.gov (United States)

Suleiman, M-S; Zacharowski, K; Angelini, G D

2008-01-01

Open-heart surgery triggers an inflammatory response that is largely the result of surgical trauma, cardiopulmonary bypass, and organ reperfusion injury (e.g. heart). The heart sustains injury triggered by ischaemia and reperfusion and also as a result of the effects of systemic inflammatory mediators. In addition, the heart itself is a source of inflammatory mediators and reactive oxygen species that are likely to contribute to the impairment of cardiac pump function. Formulating strategies to protect the heart during open heart surgery by attenuating reperfusion injury and systemic inflammatory response is essential to reduce morbidity. Although many anaesthetic drugs have cardioprotective actions, the diversity of the proposed mechanisms for protection (e.g. attenuating Ca(2+) overload, anti-inflammatory and antioxidant effects, pre- and post-conditioning-like protection) may have contributed to the slow adoption of anaesthetics as cardioprotective agents during open heart surgery. Clinical trials have suggested at least some cardioprotective effects of volatile anaesthetics. Whether these benefits are relevant in terms of morbidity and mortality is unclear and needs further investigation. This review describes the main mediators of myocardial injury during open heart surgery, explores available evidence of anaesthetics induced cardioprotection and addresses the efforts made to translate bench work into clinical practice.

Virtual Surgery in Congenital Heart Disease

DEFF Research Database (Denmark)

Sørensen, Thomas Sangild; Mosegaard, Jesper; Kislinskiy, Stefan

2014-01-01

et al., Cardiol Young 13:451–460, 2003). In combination with the availability of virtual models of congenital heart disease (CHD), techniques for computer- based simulation of cardiac interventions have enabled early clinical exploration of the emerging concept of virtual surgery (Sorensen et al...... Teaching, diagnosing, and planning of therapy in patients with complex structural cardiovascular heart disease require profound understanding of the three-dimensional (3D) nature of cardiovascular structures in these patients. To obtain such understanding, modern imaging modalities provide high...

Comparison of early period results of blood use in open heart surgery.

Science.gov (United States)

Huseyin, Serhat; Yuksel, Volkan; Guclu, Orkut; Turan, Fatma Nesrin; Canbaz, Suat; Ege, Turan; Sunar, Hasan

2016-01-01

Various adverse effects of homologous blood transfusion detected particularly in open heart surgery, in which it is frequently used, lead researchers to study on autologous blood use and to evaluate the patient's blood better. Due to the complications of homologous blood transfusion, development of techniques that utilize less transfusion has become inevitable. We aimed to evaluate the effects of acute normovolemic hemodilution (ANH) in patients undergoing open heart surgery. In this study, 120 patients who underwent open heart surgery were included. Patients were grouped into three: Autologous transfusion group (Group 1), homologous transfusion group (Group 2), and those received autologous blood and homologous blood products (Group 3). Patient data regarding preoperative characteristics, biochemical parameters, drainage, extubation time, duration of stay at intensive care, atrial fibrillation (AF) development, and hospital stay were recorded. A statistically significant difference ( P open heart surgery.

Cardiac Rehabilitation After Heart Valve Surgery

DEFF Research Database (Denmark)

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

2017-01-01

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...... ((Equation is included in full-text article.)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...

Heart Surgery Waiting Time: Assessing the Effectiveness of an Action

OpenAIRE

Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

2015-01-01

Background: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient’s problems. Objectives: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for r...

Open-heart surgery and coronary artery bypass grafting in Western Africa.

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Edwin, Frank; Frimpong-Boateng, Kwabena

2011-01-01

We read with concern the paper of Budzee and colleagues in a recent issue of the Pan African Medical Journal. We wish to draw the attention of the authors and the readership of the journal to gross inaccuracies in the report. The first open-heart surgery in Nigeria is reported to have taken place on 1(st) February 1974 at the University of Nigeria Teaching Hospital (UNTH) in Enugu. Publications from the group in Abidjan indicate the performance of the first 300 cases of open-heart surgery by 1983, the figure increasing to 850 by 1987. Senegal reportedly began performing open-heart surgery in 1995 and is currently a reference point for open cardiac procedures for francophone West Africa. The Ghanaian open-heart experience began in 1964 when surface cooling was used to achieve hypothermia for the successful closure of an atrial septal defect. However, it was not until 1989 that Ghana's National Cardiothoracic Center (NCTC) was established. The NCTC performs regular open-cardiac procedures covering almost the entire spectrum of cardiothoracic procedures including video-assisted thoracoscopic surgery (VATS). The NCTC is equipped with modern cardiovascular/thoracic facilities and has been accredited by the West African College of Surgeons as a center of excellence for the training of cardiothoracic surgeons and has performed creditably in this regard. It is emphasized that open-heart surgery has been practiced in West Africa for decades and continues to be practiced with excellence matching international standards at Ghana's National Cardiothoracic Center.

Myocardial protection in heart surgery.

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Mentzer, Robert M

2011-01-01

One of the unmet clinical needs in heart surgery is the prevention of myocardial stunning and necrosis that occurs as a result of ischemia-reperfusion. Myocardial stunning, a frequent consequence after heart surgery, is characterized by a requirement for postoperative inotropic support despite a technically satisfactory heart operation. In high-risk patients with marginal cardiac reserve, stunning is a major cause of prolonged critical care and may be associated with as much as a 5-fold increase in mortality. In contrast, the frequency of myocardial necrosis (myocardial infarction [MI]) after cardiac surgery is less appreciated and its consequences are much more subtle. The consequences may not be apparent for months to years. While we now have a much better understanding of the molecular mechanisms underlying myocardial stunning and MI, we still have no effective way to prevent these complications, nor a consistently effective means to engage the well-studied endogenous mechanisms of cardioprotection. The failure to develop clinically effective interventions is multifactorial and can be attributed to reliance on findings obtained from subcellular and cellular studies, to drawing conclusions from preclinical large animal studies that have been conducted in a disease-free state, and to accepting less than robust surrogate markers of injury in phase II clinical trials. These factors also explain the disappointing failure to identify effective adjuvant therapy in the setting of percutaneous coronary revascularization for acute MI (AMI) and reperfusion injury. These issues have contributed to the disappointing outcomes of large and costly phase III trials, resulting in a lack of enthusiasm on the part of the pharmaceutical industry to engage in further drug development for this indication. The purpose of this review is to (1) define the scope of the clinical problem; (2) summarize the outcomes of selected phases II and III clinical trials; and (3) identify the gap that

Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

DEFF Research Database (Denmark)

Toft, P; Tønnesen, Else Kirstine; Zülow, I

1997-01-01

Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open-heart...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p open-heart as well as abdominal operations. Thus CPB...

Current status of cardiovascular surgery in Japan 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database. 2: Congenital heart surgery.

Science.gov (United States)

Hirata, Yasutaka; Hirahara, Norimichi; Murakami, Arata; Motomura, Noboru; Miyata, Hiroaki; Takamoto, Shinichi

2018-01-01

We analyzed the mortality and morbidity of congenital heart surgery in Japan using the Japan Cardiovascular Surgery Database (JCVSD). Data regarding congenital heart surgery performed between January 2013 and December 2014 were obtained from JCVSD. The 20 most frequent procedures were selected and the mortality rates and major morbidities were analyzed. The mortality rates of atrial septal defect repair and ventricular septal defect repair were less than 1%, and the mortality rates of tetralogy of Fallot repair, complete atrioventricular septal defect repair, bidirectional Glenn, and total cavopulmonary connection were less than 2%. The mortality rates of the Norwood procedure and total anomalous pulmonary venous connection repair were more than 10%. The rates of unplanned reoperation, pacemaker implantation, chylothorax, deep sternal infection, phrenic nerve injury, and neurological deficit were shown for each procedure. Using JCVSD, the national data for congenital heart surgery, including postoperative complications, were analyzed. Further improvements of the database and feedback for clinical practice are required.

Nursing Casuistry in Heart Surgery : Plastic Mitral Valve

OpenAIRE

Břízová, Pavla

2010-01-01

Topic of this thesis is " Mitral Valvuloplasty". The thesis has been divided into theoretical and practical parts. The theoretical part begins with the classification of heart diseases. Main topic of this thesis is mitral insufficiency - its etiology and pathogenesis, clinical picture, therapy, the possibility of prosthetic valves and post surgery complications. Theoretical part also contains information about the preoperative and post-operative care at cardiac surgery department. The practic...

Results of open heart surgery in Jehovah's Witness patients. Single centre experience.

Science.gov (United States)

Juraszek, Andrzej; Kołsut, Piotr; Szymański, Jarosław; Kuriata, Jarosław; Kuśmierski, Krzysztof; Sitkowska-Rysiak, Ewa; Jasińska, Małgorzata; Kuśmierczyk, Mariusz

2017-09-01

Evaluation the results in patients from the religious community of Jehovah's Witness (JW) undergoing open heart surgery at our institution. Between September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

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

DEFF Research Database (Denmark)

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

2017-01-01

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...... heart valve surgery. Design We conducted a cost-utility analysis based on a randomised controlled trial of 147 patients who had undergone heart valve surgery and were followed for 6 months. Methods Patients were randomised to cardiac rehabilitation consisting of 12 weeks of physical exercise training...

The assessment of neural injury following open heart surgery by physiological tremor analysis.

Science.gov (United States)

Németh, Adám; Hejjel, László; Ajtay, Zénó; Kellényi, Lóránd; Solymos, Andor; Bártfai, Imre; Kovács, Norbert; Lenkey, Zsófia; Cziráki, Attila; Szabados, Sándor

2013-02-21

The appearance of post-operative cognitive dysfunction as a result of open heart surgery has been proven by several studies. Focal and/or sporadic neuron damage emerging in the central nervous system may not only appear as cognitive dysfunction, but might strongly influence features of physiological tremor. We investigated 110 patients (age: 34-73 years; 76 male, 34 female; 51 coronary artery bypass grafting (CABG), 25 valve replacement, 25 combined open heart surgery, 9 off-pump CABG) before surgery and after open-heart surgery on the 3(rd) to 5(th) post-operative day. The assessment of the physiological tremor analysis was performed with our newly developed equipment based on the Analog Devices ADXL 320 JPC integrated accelerometer chip. Recordings were stored on a PC and spectral analysis was performed by fast Fourier transformation (FFT). We compared power integrals in the 1-4 Hz, 4-8 Hz and 8-12 Hz frequency ranges and these were statistically assessed by the Wilcoxon rank correlation test. We found significant changes in the power spectrum of physiological tremor. The spectrum in the 8-12 Hz range (neuronal oscillation) decreased and a shift was recognised to the lower spectrum (p open heart surgery.

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.

Early illness experiences related to unexpected heart surgery: A qualitative descriptive study.

Science.gov (United States)

Chang, Yu-Ling; Tsai, Yun-Fang

2017-09-01

Most studies on patients' experiences following emergency cardiac surgery focus on evaluation of patients after their discharge. Few studies have evaluated patients' experiences after being transferred from intensive care and before being discharged. This study aimed to describe patients' experiences in the early stages of recovery following emergency heart surgery. For this exploratory qualitative descriptive study, 13 patients were recruited from a medical centre in northern Taiwan. Participants had undergone emergency heart surgery and had resided in the cardiothoracic surgical ward for ≥6 days following transfer from the ICU; all expected to be discharged from the hospital within 3 days. Semi-structured, face-to-face interviews were conducted in private after the patients had been transferred to the cardiothoracic surgical wards. Audiotaped interviews were transcribed and analysed using content analysis. Data analysis identified four themes, which represented different recovery stages: sudden and serious symptoms, nightmares and vivid dreams, physical and emotional disturbances, and establishing a new life after emergency surgery. A fifth theme, support for a new lifestyle, occurred between the four stages. Participants experienced symptoms of physical and psychological stress during the early recovery stages following emergency heart surgery. A lack of understanding of the process of recovery increased these difficulties; participants wanted and needed multidisciplinary care and education. Emergency heart surgery does not allow healthcare professionals to inform patients of what to expect post-surgery. Our findings suggest that rather than waiting until discharge to offer disease information and treatment plans, multidisciplinary care should be initiated as soon as possible to facilitate recovery. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

3D force control for robotic-assisted beating heart surgery based on viscoelastic tissue model.

Science.gov (United States)

Liu, Chao; Moreira, Pedro; Zemiti, Nabil; Poignet, Philippe

2011-01-01

Current cardiac surgery faces the challenging problem of heart beating motion even with the help of mechanical stabilizer which makes delicate operation on the heart surface difficult. Motion compensation methods for robotic-assisted beating heart surgery have been proposed recently in literature, but research on force control for such kind of surgery has hardly been reported. Moreover, the viscoelasticity property of the interaction between organ tissue and robotic instrument further complicates the force control design which is much easier in other applications by assuming the interaction model to be elastic (industry, stiff object manipulation, etc.). In this work, we present a three-dimensional force control method for robotic-assisted beating heart surgery taking into consideration of the viscoelastic interaction property. Performance studies based on our D2M2 robot and 3D heart beating motion information obtained through Da Vinci™ system are provided.

Outcomes of Tracheostomy in Children Requiring Surgery for Congenital Heart Disease.

Science.gov (United States)

Ortmann, Laura A; Manimtim, Winston M; Lachica, Charisse I

2017-02-01

Outcomes after discharge in children requiring tracheostomy after cardiac surgery have not been fully described. A retrospective, single-center study was performed on all children tracheostomy and surgery for congenital heart disease from January 2002 to May 2015. Forty-six tracheostomies were placed after surgery and four before. Single-ventricle anatomy was present in 12 (33%) patients. Incidence of tracheostomy after heart surgery increased from 0.8% the first half of the study period to 2% the second half. Median time between cardiac surgery and tracheostomy was 58 days. The most common indication for tracheostomy was multifactorial (30%) followed by airway malacia (22%). Median length to follow-up for survivors was 3.9 years (range 0.4-11.8 years). Survival to hospital discharge was 72%, and intermediate survival was 48%. Survival in those with systemic to pulmonary artery shunts at the time of tracheostomy was 22% compared to 59% for those with biventricular anatomy. Heart failure and multiple indications for tracheostomy were associated with worse outcome. There was no difference in survival for those discharged with a ventilator compared to those that were not. The most common cause of death after discharge was tracheostomy tube dislodgement/obstruction, accounting for 5 of 11 that died. Survival with a tracheostomy after cardiac surgery is poor, and children with systemic to pulmonary artery shunts are at especially high risk of death.

Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass.

Science.gov (United States)

Meyborg, Matthias; Abdi-Tabari, Zila; Hoffmeier, Andreas; Engelbertz, Christiane; Lüders, Florian; Freisinger, Eva; Malyar, Nasser M; Martens, Sven; Reinecke, Holger

2016-05-01

In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Open-heart surgery using a centrifugal pump: a case of hereditary spherocytosis.

Science.gov (United States)

Matsuzaki, Yuichi; Tomioka, Hideyuki; Saso, Masaki; Azuma, Takashi; Saito, Satoshi; Aomi, Shigeyuki; Yamazaki, Kenji

2016-08-26

Hereditary spherocytosis is a genetic, frequently familial hemolytic blood disease characterized by varying degrees of hemolytic anemia, splenomegaly, and jaundice. There are few reports on adult open-heart surgery for patients with hereditary spherocytosis. We report a rare case of an adult open-heart surgery associated with hereditary spherocytosis. A 63-year-old man was admitted for congestive heart failure due to bicuspid aortic valve, aortic valve regurgitation, and sinus of subaortic aneurysm. The family history, the microscopic findings of the blood smear, and the characteristic osmotic fragility confirmed the diagnosis of hereditary spherocytosis. Furthermore, splenectomy had not been undertaken preoperatively. The patient underwent a successful operation by means of a centrifugal pump. Haptoglobin was used during the cardiopulmonary bypass, and a biological valve was selected to prevent hemolysis. No significant hemolysis occurred intraoperatively or postoperatively. There are no previous reports of patients with hereditary spherocytosis, and bicuspid aortic valve. We have successfully performed an adult open-heart surgery using a centrifugal pump in an adult patient suffering from hereditary spherocytosis and bicuspid aortic valve.

Early biomarkers of acute kidney failure after heart angiography or heart surgery in patients with acute coronary syndrome or acute heart failure.

Science.gov (United States)

Torregrosa, Isidro; Montoliu, Carmina; Urios, Amparo; Elmlili, Nisrin; Puchades, María Jesús; Solís, Miguel Angel; Sanjuán, Rafael; Blasco, Maria Luisa; Ramos, Carmen; Tomás, Patricia; Ribes, José; Carratalá, Arturo; Juan, Isabel; Miguel, Alfonso

2012-01-01

Acute kidney injury (AKI) is a common complication in cardiac surgery and coronary angiography, which worsens patients' prognosis. The diagnosis is based on the increase in serum creatinine, which is delayed. It is necessary to identify and validate new biomarkers that allow for early and effective interventions. To assess the sensitivity and specificity of neutrophil gelatinase-associated lipocalin in urine (uNGAL), interleukin-18 (IL-18) in urine and cystatin C in serum for the early detection of AKI in patients with acute coronary syndrome or heart failure, and who underwent cardiac surgery or catheterization. The study included 135 patients admitted to the intensive care unit for acute coronary syndrome or heart failure due to coronary or valvular pathology and who underwent coronary angiography or cardiac bypass surgery or valvular replacement. The biomarkers were determined 12 hours after surgery and serum creatinine was monitored during the next six days for the diagnosis of AKI. The area under the ROC curve (AUC) for NGAL was 0.983, and for cystatin C and IL-18 the AUCs were 0.869 and 0.727, respectively. At a cut-off of 31.9 ng/ml for uNGAL the sensitivity was 100% and the specificity was 91%. uNGAL is an early marker of AKI in patients with acute coronary syndrome or heart failure and undergoing cardiac surgery and coronary angiography, with a higher predictive value than cystatin C or IL-18.

Pomegranate Supplementation Protects against Memory Dysfunction after Heart Surgery: A Pilot Study

Directory of Open Access Journals (Sweden)

Susan A. Ropacki

2013-01-01

Full Text Available Memory dysfunction is a common complaint following heart surgery and may be related to a diffuse ischemic state induced by microemboli dislodged during the procedure. Ischemia can induce damage by a number of mechanisms, including oxidative stress. Because pomegranates contain a variety of polyphenols with antioxidant and other potentially beneficial effects, we tested whether supplementation with a pomegranate extract before and after heart surgery could protect against postoperative cognitive dysfunction. Patients undergoing elective coronary artery bypass graft and/or valve surgery were given either 2 g of pomegranate extract (in 2 POMx pills or placebo (pills containing no pomegranate ingredients per day from one week before surgery to 6 weeks after surgery. The patients were also administered a battery of neuropsychological tests to assess memory function at 1 week before surgery (baseline, 2 weeks after surgery, and 6 weeks after surgery. The placebo group had significant deficits in postsurgery memory retention, and the pomegranate treatment not only protected against this effect, but also actually improved memory retention performance for up to 6 weeks after surgery as compared to presurgery baseline performance.

Oxidative Stress after Surgery on the Immature Heart

Directory of Open Access Journals (Sweden)

Daniel Fudulu

2016-01-01

Full Text Available Paediatric heart surgery is associated with increased inflammation and the production of reactive oxygen species. Use of the extracorporeal cardiopulmonary bypass during correction of congenital heart defects generates reactive oxygen species by various mechanisms: haemolysis, neutrophil activation, ischaemia reperfusion injury, reoxygenation injury, or depletion of the endogenous antioxidants. The immature myocardium is more vulnerable to reactive oxygen species because of developmental differences compared to the adult heart but also because of associated congenital heart diseases that can deplete its antioxidant reserve. Oxidative stress can be manipulated by various interventions: exogenous antioxidants, use of steroids, cardioplegia, blood prime strategies, or miniaturisation of the cardiopulmonary bypass circuit. However, it is unclear if modulation of the redox pathways can alter clinical outcomes. Further studies powered to look at clinical outcomes are needed to define the role of oxidative stress in paediatric patients.

Predictors and Frequency of Conduction Disturbances After Open-Heart Surgery

Directory of Open Access Journals (Sweden)

Zahra Emkanjoo

2008-02-01

Full Text Available Introduction The risk of developing conduction disturbances after coronary bypass grafting (CABG or valvular surgery has been well established in previous studies, leading to permanent pacemaker implantation in about 2% to 3% of patients, and in 10% of patients undergoing repeat cardiac surgery.We sought to determine the incidence, features and predictors of conduction disorders in the immediate post-operative period of patients subjected to open-heart surgery, and the need for permanent pacemaker implantation.Material and Method We prospectively studied 374 consecutive patients who underwent open-heart surgery in our institution: coronary artery bypass (CABG (n=128, Mitral valve replacement(MVR(n=18, aortic valve replacement(AVR (n=21, MVR and AVR(n=56, repair of ventricular septal defect (VSD (n=51, repair of tetralogy of Fallot (TOF (n=57,CABG and valvular surgery (n=6, others (n=37.Results Among 374 patients included in our study (mean age 34.46±25.68; 146 males, 192 developed new conduction disorders: symptomatic sinus bradycardia in 8%, atrial fibrillation with slow ventricular response (AF in 4.5%, first-degree atrioventricular block (AVBin 6.4%, second-degree AVB in 0.3%, third-degree AVB in 7%, new right bundle branch block (RBBB in 33%, and new left bundle branch block (LBBB in 2.1%. In 5.6% patients, a permanent pacemaker was implanted, 47.6% of them underwent valvular surgery. In 44.1% of patients the conduction defects occurred in the first 48 hr. after surgery. In CABG group, 29.7% of patients developed new conduction disturbances; the most common of them was symptomatic sinus bradycardia. After valvular surgery 44.2% of patients developed conduction disturbances, of those the most common was atrial fibrillation with slow ventricular response . After VSD and TOF repair, the most common conduction disturbance was new RBBB. Perioperative myocardial infarction (MI occurred in 1.9% of patients. The occurrence conduction disturbance

Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery.

Science.gov (United States)

Salsano, Antonio; Giacobbe, Daniele Roberto; Sportelli, Elena; Olivieri, Guido Maria; Brega, Carlotta; Di Biase, Carlo; Coppo, Erika; Marchese, Anna; Del Bono, Valerio; Viscoli, Claudio; Santini, Francesco

2016-11-01

Patients undergoing major surgery are at increased risk of developing infections due to resistant organisms, including carbapenem-resistant Klebsiella pneumoniae (CR-Kp). In this study, we assessed risk factors for CR-Kp infections after open heart surgery in a teaching hospital in northern Italy. A retrospective study was conducted from January to December 2014. The primary outcome measure was postoperative CR-Kp infection, defined as a time-to-event end-point. The effect of potentially related variables was assessed by univariable and multivariable analyses. Secondary end-points were in-hospital mortality and 180-day postoperative mortality. Among 553 patients undergoing open heart surgery, 32 developed CR-Kp infections (6%). In the final multivariable model, CR-Kp colonization [hazard ratio (HR) 227.45, 95% confidence intervals (CI) 67.13-1225.20, P open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Effects of Inhalation of Lavender Essential Oil on Open-heart Surgery Pain.

Science.gov (United States)

Salamati, Armaiti; Mashouf, Soheyla; Sahbaei, Faezeh; Mojab, Faraz

2014-01-01

This study evaluated the effects of inhalation of lavender essential oil on the pain of open-heart surgery. The main complaint of patients after open-heart surgery is chest pain. Due to the side effects of opioids, it is important to use a non-invasive way to effectively relieve pain including aromatherapy with analgesics. This study was a clinical single-blind trial and was conducted on 40 patients who had open-heart surgery in the cardiac ICU of 2 Hospitals of Tehran University of Medical Sciences, 2012. Criteria included: full consciousness, spontaneous breathing ability and not using synthetic opioids within 2 hours before extubation. After extubation, the patients were asked to mark the intensity of their pain using the visual analogue scale. Then, a cotton swab which was impregnated with 2 drops of lavender essential oil 2% was placed in their oxygen mask, and they got breath for 10 minutes. 30 minutes after aromatherapy, they were asked to re-mark their pain intensity. The level of patient's pain before and after aroma therapy were compared. The pain mean level before and after inhaling lavender essential oil was 5.60 (SD = 2.262) and 4.98 (SD = 2.293), respectively (p-value>0.05). Therefore, there is no significant difference and the result of study proves that lavender essential oil inhalation has no effect on reducing the pain of open-heart surgery.

The effect of pleasant olfactory mental imagery on the incidence and extent of atelectasis in patients after open heart surgery.

Science.gov (United States)

Rezaei-Nodehi, Masoud; Shorofi, Seyed Afshin; Bagheri-Nesami, Masoumeh; Ghafari, Rahman; Yazdani-Charati, Jamshid; Darbeheshti, Manizheh

2018-02-01

Atelectasis is the most common pulmonary complication after open heart surgery. This study was intended to examine the effects of pleasant olfactory mental imagery on postoperative atelectasis in patients undergoing open heart surgery. This is a randomized controlled clinical trial. The sample consisted of 80 patients who were randomly assigned to either practice olfactory mental imagery (test group) or receive routine care (control group). A card with the image of roses was given to patients and they were asked to look at the image, visualize the scent of roses in the mind, and then sniff as much as possible, hold their breath for 2s and eventually exhale slowly through the nose. This procedure was consecutively repeated five times. After a fifteen-minute break, patients proceeded to practice olfactory mental imagery with other fruit images (banana, apple, and lemon). The test group executed the olfactory mental imagery for two hours in the morning and two hours in the afternoon on postoperative days 1 and 2. The control group received the routine ICU care. A questionnaire collected information on sociodemographic characteristics and clinical parameters. Chest radiographs were used to diagnose atelectasis, which were evaluated by the hospital radiologist. No statistically significant differences were observed between the two groups regarding sociodemographic, medical and surgical information. The incidence of atelectasis in the test group (40%, n=16) was significantly lower than in the control group (67.5%, n=27) on postoperative day 2 (p=0.02). Our findings suggest that olfactory mental imagery can improve respiratory function and reduce the risk of atelectasis in patients with cardiac surgery. Copyright © 2017 Elsevier Ltd. All rights reserved.

Atenolol Is Associated with Lower Day of Surgery Heart Rate as compared to Long and Short-acting Metoprolol

Science.gov (United States)

Schonberger, Robert B.; Brandt, Cynthia; Feinleib, Jessica; Dai, Feng; Burg, Matthew M.

2012-01-01

Objectives We analyzed the association between outpatient beta-blocker type and day-of-surgery heart rate in ambulatory surgical patients. We further investigated whether differences in day of surgery heart rate between atenolol and metoprolol could be explained by once-daily versus twice-daily dosing regimens. Design Retrospective observational study. Setting VA Hospital Participants Ambulatory surgical patients on chronic atenolol or metoprolol. Interventions None. Measurements and Main Results Using a propensity-score matched cohort, we compared day of surgery heart rates of patients prescribed atenolol versus metoprolol. We then differentiated between once-daily and twice-daily metoprolol formulations and compared day of surgery heart rates within a general linear model. Day of surgery heart rates in patients prescribed atenolol vs. any metoprolol formulation were slower by a mean of 5.1 beats/min (66.6 vs. 71.7; 95% CI of difference 1.9 to 8.3, p=0.002), a difference that was not observed in preoperative primary care visits. The general linear model demonstrated that patients prescribed atenolol (typically QD dosing) had a mean day of surgery heart rate 5.6 beats/min lower compared to patients prescribed once-daily metoprolol succinate (68.9 vs. 74.5; 95% CI of difference: −8.6 to −2.6, p<0.001) and 3.8 beats/minute lower compared to patients prescribed twice-daily metoprolol tartrate (68.9 vs. 72.7; 95% CI of difference: −6.1 to −1.6, p<0.001). Day of surgery heart rates were similar between different formulations of metoprolol (95% CI of difference: −1.0 to +4.6, p=0.22). Conclusions Atenolol is associated with lower day of surgery heart rate vs. metoprolol. The heart rate difference is specific to the day of surgery and is not explained by once-daily versus twice-daily dosing regimens. PMID:22889605

Multi-modality blood conservation strategy in open-heart surgery: an audit.

Science.gov (United States)

Reddy, Srikrishna Modugula; Talwar, Sachin; Velayoudam, Devgourou; Gharde, Parag; Mallick, Vishwas; Jha, Raju Kumar; Kumar, Lokender; Arkalgud, Sampath Kumar

2009-09-01

The objective of this study was to perform an audit of the use of homologous blood and blood products in patients undergoing open-heart surgery by a single surgical team that follows an in-house protocol for blood conservation. The hospital records of 310 consecutive patients (age >15 years) undergoing open-heart surgery over a period of 8 months were retrospectively reviewed to assess the comprehensive blood conservation protocol. Homologous blood and blood product usage during and after surgery, in the intensive care unit and up to hospital discharge was analyzed. Two hundred and fifty-six patients (82.6%) did not receive any blood or blood products. Only 54 patients (17.4%) received one or more units of allogenic transfusion either intraoperatively or postoperatively until discharge. Mean hemoglobin at discharge was 9.8 Grams% (8.9-12 Grams%). A standardized multidisciplinary approach to blood conservation in cardiac surgery decreases bleeding and transfusion requirements in a safe and cost effective manner.

Congenital heart surgery: what we do to our patients

African Journals Online (AJOL)

congenital heart surgery does not end at discharge at the door of the ... of obstructed right ventricular outflow, for example in tetralogy of. Fallot, or ... Patent ductus arteriosus (PDA). PDAs are commonly closed by transvascular catheter ...

Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history

DEFF Research Database (Denmark)

Park-Hansen, Jesper; Holme, Susanne J V; Irmukhamedov, Akhmadjon

2018-01-01

BACKGROUND: Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by l...

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire.

Science.gov (United States)

Yangni-Angate, Koffi Herve; Meneas, Christophe; Diby, Florent; Diomande, Manga; Adoubi, Anicet; Tanauh, Yves

2016-10-01

Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.

The World Society for Pediatric and Congenital Heart Surgery: its mission and history.

Science.gov (United States)

Tchervenkov, Christo I; Stellin, Giovanni; Kurosawa, Hiromi; Jacobs, Jeffrey P; Mavroudis, Constantine; Bernier, Pierre-Luc; Maruszewski, Bohdan; Kreutzer, Christian; Cicek, Sertac; Kinsley, Robin H; Nunn, Graham R; Jonas, Richard A

2009-01-01

The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) was established in 2006 to assemble pediatric and congenital heart surgeons from all continents and regions of the world and their colleagues from related specialties dealing with pediatric and congenital heart disease. Since its birth, it has held a highly successful inaugural scientific meeting in 2007 in Washington, DC, and a World Summit on Pediatric and Congenital Heart Surgery Services, Education, and Cardiac Care for Children and Adults with Congenital Heart Disease in 2008 in Montreal. It currently has 549 members from 71 countries and in a short period of time has become the largest organization in the world of pediatric and congenital heart surgeons. Its brief history already seems to be a guarantee of a promising future. Projects in the areas of research, training and education, patient care, and community service will allow the Society to reach its goals. By bringing together professionals from every region of the world, the WSPCHS should play a significant role in the improvement of care for children and adults with congenital heart disease around the world.

Prevalence and significance of gallium-67 uptake in the heart after open-heart surgery

International Nuclear Information System (INIS)

Huikuri, H.V.; Ikaeheimo, M.J.A.; Airaksinen, J.; Linnaluoto, M.M.; Heikkilae, J.T.; Takkunen, J.T.

1988-01-01

Radioactive gallium-67 (Ga-67) has been shown to accumulate within areas of pericardial inflammation. The present study estimated prospectively the prevalence and clinical significance of Ga-67 uptake in the heart in 62 patients 10 to 16 days after open-heart surgery. Of 62 patients studied, markedly diffuse Ga-67 uptake was detected in 21 (34%) and focal or mild diffuse uptake in 23 (37%). Results were negative in 18 (29%). Nine patients with a negative scan result (50%) had received corticosteroid therapy before imaging, whereas only 2 patients with a positive scan result (5%) were receiving steroids. The erythrocyte sedimentation rate and C-reactive protein level were both higher in patients with Ga-67 uptake compared with those with a negative scan result (p less than 0.01 in both). No other clinical, echocardiographic or electrocardiographic indicators of postpericardiotomy syndrome were related to Ga-67 uptake. No patient developed cardiac tamponade or constrictive pericarditis during the 12-week follow-up and the Ga-67 scan results did not predict the occlusion of coronary artery bypass grafts. Thus, pericardial inflammation manifested as Ga-67 uptake is a common finding after open-heart surgery and appears to be a benign condition

Effect of oxygen treatment on heart rate after abdominal surgery

DEFF Research Database (Denmark)

Rosenberg-Adamsen, S; Lie, C; Bernhard, A

1999-01-01

BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate....... METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial...... oxygen saturation rate increased significantly from 96% to 99% (P heart rate decreased significantly from 85 beats/min to 81 beats/min (P heart rate occurred...

Topical use of tranexamic acid in open heart surgery.

Science.gov (United States)

Chaudhary, Farid Ahmad; Pervaz, Zahid; Ilyas, Sana; Niaz, Muhammad Nabeel

2018-04-01

To determine the efficacy of topical pouring of tranexamic acid in reducing post-operative mediastinal bleeding, requirement for blood products and the rate of re-exploration for re-securing haemostasis or relief of pericardial tamponade after open heart surgery. The prospective, randomised, placebo-controlled, double-blind comparative study was conducted from March 2013 to September 2015 at Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social Security Institution, Lahore, and comprised patients scheduled for primary isolated elective or urgent open heart surgery. The subjects were divided into two equal groups. The hetranexamic acid group received cardiac bath with 2gm of tranexamic acid diluted in 50mlof normal saline, while the placebo group received cardiac bath without tranexamic acid. Before the closure of sternum, the solution was poured into pericardial cavity as cardiac bath while the chest tubes were temporarily clamped. Data was entered into a pre-designed proforma. Of the 100 subjects, there were 50(50%) in each of the two groups. There was no difference in surgical characteristics and perioperative complications in the groups (p>0.05). After 48 post-operative hours, total blood loss was significantly less in the tranexamic acid group compared to the placebo group (pacid group than the placebo group (pacid group was re-explored for excessive bleeding compared to 4(8%) in the placebo group. There was significant reduction in post-operative blood drainage, need of blood products and rate of re-exploration after topical use of tranexamic acid in open heart surgery.

Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

DEFF Research Database (Denmark)

Toft, P; Nielsen, C H; Tønnesen, E

1998-01-01

surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before...... to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play...

Relation of milrinone after surgery for congenital heart disease to significant postoperative tachyarrhythmias.

Science.gov (United States)

Smith, Andrew H; Owen, Jill; Borgman, Kristie Y; Fish, Frank A; Kannankeril, Prince J

2011-12-01

Milrinone reduces the risk of low cardiac output syndrome for some pediatric patients after congenital heart surgery. Data from adults undergoing cardiac surgery suggest an association between milrinone and an increased risk of postoperative arrhythmias. We tested the hypothesis that milrinone is an independent risk factor for tachyarrhythmias after congenital heart surgery. Subjects undergoing congenital heart surgery at our institution were consecutively enrolled for 38 months, through September 2010. The data were prospectively collected, including a review of full-disclosure telemetry and the medical records. Within 38 months, 603 enrolled subjects underwent 724 operative procedures. The median age was 5.5 months (range 0.0 to 426), the median weight was 6.0 kg (range 0.7 to 108), and the cohort was 45% female. The overall arrhythmia incidence was 50%, most commonly monomorphic ventricular tachycardia (n = 85, 12%), junctional ectopic tachycardia (n = 69, 10%), accelerated junctional rhythm (n = 58, 8%), and atrial tachyarrhythmias (including atrial fibrillation, atrial flutter, and ectopic or chaotic atrial tachycardia, n = 58, 8%). Multivariate logistic regression analysis demonstrated that independent of age 3, and the use of epinephrine or dopamine, milrinone use on admission to the cardiac intensive care unit remained independently associated with an increase in the odds of postoperative tachyarrhythmia resulting in an intervention (odds ratio 2.8, 95% confidence interval 1.3 to 6.0, p = 0.007). In conclusion, milrinone use is an independent risk factor for clinically significant tachyarrhythmias in the early postoperative period after congenital heart surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

Relation of Milrinone Following Surgery for Congenital Heart Disease to Significant Postoperative Tachyarrhythmias

Science.gov (United States)

Smith, Andrew H.; Owen, Jill; Borgman, Kristie Y.; Fish, Frank A.; Kannankeril, Prince J.

2011-01-01

Milrinone reduces the risk of low cardiac output syndrome for some pediatric patients following congenital heart surgery. Data from adults undergoing cardiac surgery suggest an association between milrinone and increased risk for postoperative arrhythmias. We tested the hypothesis that milrinone is an independent risk factor for tachyarrhythmias following congenital heart surgery. Subjects undergoing congenital heart surgery at our institution were consecutively enrolled for 38 months, through September 2010. Data was prospectively collected, including review of full-disclosure telemetry and the medical record. Over 38 months, 603 enrolled subjects underwent 724 operative procedures. The median age was 5.5 months (0.0–426), weight was 6.0 kg (0.7–108), and the cohort was 45% female. Overall arrhythmia incidence was 50%, most commonly monomorphic ventricular tachycardia (n=85, 12%), junctional ectopic tachycardia (n=69, 10%), accelerated junctional rhythm (n=58, 8%), and atrial tachyarrhythmias (including atrial fibrillation, atrial flutter, and ectopic or chaotic atrial tachycardia, n=58, 8%). Multivariate logistic regression analysis demonstrated that independent of age less than 1 month, use of cardiopulmonary bypass, duration of cardiopulmonary bypass, RACHS-1 score greater than 3, and the use of epinephrine or dopamine, milrinone use on admission to the cardiac intensive care unit remained independently associated with an increase in the odds of postoperative tachyarrhythmia resulting in an intervention (OR 2.8 [95%CI 1.3–6.0], p=0.007). In conclusion, milrinone use is an independent risk factor for clinically significant tachyarrhythmias in the early postoperative period following congenital heart surgery. PMID:21890079

Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties Azul de metileno no tratamento da síndrome vasoplégica em cirurgia cardíaca: quinze anos de perguntas, respostas, dúvidas e certezas

Directory of Open Access Journals (Sweden)

Paulo Roberto Barbosa Evora

2009-09-01

Full Text Available OBJECTIVE: There is strong evidence that methylene blue (MB, an inhibitor of guanylate cyclase, is an excellent therapeutic option for vasoplegic syndrome (VS treatment in heart surgery. The aim of this article is to review the MB's therapeutic function in the vasoplegic syndrome treatment. METHODS: Fifteen years of literature review. RESULTS: 1 Heparin and ACE inhibitors are risk factors; 2 In the recommended doses it is safe (the lethal dose is 40 mg/kg; 3 The use of MB does not cause endothelial dysfunction; 4 The MB effect appears in cases of nitric oxide (NO up-regulation; 5 MB is not a vasoconstrictor, by blocking of the GMPc system it releases the AMPc system, facilitating the norepinephrine vasoconstrictor effect; 6 The most used dosage is 2 mg/kg as IV bolus followed by the same continuous infusion because plasmatic concentrations strongly decays in the first 40 minutes; 7 There is a possible "window of opportunity" for the MB's effectiveness. CONCLUSIONS: Although there are no definitive multicentric studies, the MB used to treat heart surgery VS, at the present time, is the best, safest and cheapest option, being a Brazilian contribution for the heart surgeryOBJETIVO: Existem fortes evidências de que o azul de metileno (AM, um inibidor da guanilato ciclase, é uma excelente opção terapêutica para o tratamento da síndrome vasoplégica (SV em cirurgia cardíaca. O objetivo deste artigo é rever o papel terapêutico do AM no tratamento da SV. MÉTODOS: Revisão da literatura em período de 15 anos. RESULTADOS: 1 A heparina e inibidores da ECA são fatores de risco; 2 Nas doses preconizadas é droga segura (a dose letal é de 40 mg/kg; 3 O AM não causa disfunção endotelial; 4 O efeito do AM só aparece em caso de supra-regulação de óxido nítrico (NO; 5 O AM não é um vasoconstritor, pelo bloqueio do sistema GMPc ele "libera" o sistema AMPc, facilitando o efeito vasoconstritor da noradrenalina; 6 A dosagem mais utilizada é 2

Contemporary cardiac surgery for adults with congenital heart disease.

Science.gov (United States)

Beurtheret, Sylvain; Tutarel, Oktay; Diller, Gerhard Paul; West, Cathy; Ntalarizou, Evangelia; Resseguier, Noémie; Papaioannou, Vasileios; Jabbour, Richard; Simpkin, Victoria; Bastin, Anthony J; Babu-Narayan, Sonya V; Bonello, Beatrice; Li, Wei; Sethia, Babulal; Uemura, Hideki; Gatzoulis, Michael A; Shore, Darryl

2017-08-01

Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery. This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified. Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline. Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Pericardial effusion and pericardial compartments after open heart surgery

International Nuclear Information System (INIS)

Duvernoy, O.; Larsson, S.G.; Persson, K.; Thuren, J.; Wikstroem, G.; Akademiska Sjukhuset, Uppsala; Akademiska Sjukhuset, Uppsala

1990-01-01

Thirty-three patients with pericardial effusion after open heart surgery were investigated with computed tomography (CT). Twelve of the 33 patients also underwent echocardiography prior to pericardiocentesis. The effusions were typed according to the results of the CT investigation. Because of postoperative adhesions, typical patterns of localized pericardial effusions were found in 16 patients. The localized compartments were seen on the right and left side of the heart and around the aorta and the pulmonary artery. CT was therefore shown to be of value for selecting the approach for drainage with catheter pericardiocentesis. (orig.)

Interference suppression for EEG recording during open heart surgery

NARCIS (Netherlands)

Weide, H. van der; Pronk, R.A.F.

A device for recording the EEG during open heart surgery is described. It differs from most standard equipment in two ways. First, the input circuit is completely floating from earth and will withstand 500 V DC. Second, radiofrequency (RF)_shielding and filtering permits continuous recording of the

Immediate extubation versus standard postoperative ventilation: Our experience in on pump open heart surgery

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Srikanta Gangopadhyay

2010-01-01

Full Text Available Elective postoperative ventilation in patients undergoing "on pump" open heart surgery has been a standard practice. Ultra fast-track extubation in the operating room is now an accepted technique for "off pump" coronary artery bypass grafting. We tried to incorporate these experiences in on pump open heart surgery and compare the haemodynamic and respiratory parameters in the immediate postoperative period, in patients on standard postoperative ventilation for 8-12 hours. After ethical committee′s approval and informed consent were obtained, 72 patients, between 28 and 45 years of age, undergoing on pump open heart surgery, were selected for our study. We followed same standard anaesthetic, cardiopulmonary bypass (CPB and cardioplegic protocol. Thirty-six patients (Group E were randomly allocated for immediate extubation following operation, after fulfillment of standard extubation criteria. Those who failed to meet these criteria were not extubated and were excluded from the study. The remaining 36 patients (Group V were electively ventilated and extubated after 8-12 hours. Standard monitoring for on pump open heart surgery, including bispectral index was done. The demographic data, surgical procedures, preoperative parameters, aortic cross clamp and cardiopulmonary bypass times were comparable in both the groups. Extubation was possible in more than 88% of cases (n=32 out of 36 cases in Group E and none required reintubation for respiratory insufficiency. Respiratory, haemodynamic parameters and postoperative complications were comparable in both the groups in the postoperative period. Therefore, we can safely conclude that immediate extubation in the operating room after on pump open heart surgery is an alternative acceptable method to avoid postoperative ventilation and its related complications in selected patients.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience.

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Akhtar, Raja Parvez; Abid, Abdul Rehman; Zafar, Hasnain; Gardezi, Syed Javed Raza; Waheed, Abdul; Khan, Jawad Sajid

2007-10-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. It was a cohort study. The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of non-cardiac surgical operation with minimal risk.

[Efficacy of Transdermal Patch of Bisoprolol for Paroxysmal Atrial Fibrillation after Open Heart Surgery].

Science.gov (United States)

Yamamoto, Kenji; Yamada, Tomoyuki; Hamuro, Mamoru; Kawatou, Masahide; Enomoto, Sakae

2017-11-01

2014 American Association for Thoracic Surgery (AATS) guidelines recommend beta blocker for prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. In recent years, transdermal patch of bisoprolol (TDPB) has become available in Japan. We examined the efficacy of TDPB for paroxysmal atrial fibrillation (PAF) after open heart surgery. Among 289 patients who had undergone open heart surgery in our hospital from December 2013 to April 2016, 48(16.6%)patients, for whom TDPB was used for PAF, were analyzed retrospectively. The summary of our PAF protocol:HR >80;a sheet of TDPB (4 mg) is pasted, HR≤60;TDPB is removed, HR >140 persisted;another sheet of TDPB is added. Eighteen of the 48 (37.5%) patients recovered sinus rhythm within 24 hours. Six patients( 12.5%), because of persistent tachycardia, shifted to continuous infusion of landiolol. Ten underwent electrical defibrillation during hospitalization. In 3 patients, TDPB was removed due to advanced bradycardia. TDPB could be used safely and feasibly for PAF after open heart surgery.

Modified nuss procedure in concurrent repair of pectus excavatum and open heart surgery.

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Sacco Casamassima, Maria Grazia; Wong, Ling Ling; Papandria, Dominic; Abdullah, Fizan; Vricella, Luca A; Cameron, Duke E; Colombani, Paul M

2013-03-01

Pectus excavatum (PE) can be associated with congenital and acquired cardiac disorders that also require surgical repair. The timing and specific surgical technique for repair of PE remains controversial. The present study reports the experience of combined repair of PE and open heart surgery at Johns Hopkins Hospital. A retrospective case review was conducted of all patients who presented for repair of PE deformity while undergoing concurrent open heart surgery from 1998 through 2011. A total of 9 patients met inclusion criteria. All patients had a connective tissue disorder. Repair of PE was performed by modified Nuss technique after completion of the cardiac procedure, performed through a median sternotomy. Open heart procedures were either aortic root replacement or mitral valvuloplasty. Eight patients had bar removal after an average period of 30.3 months. No PE recurrence, bar displacement, or upper sternal depression was reported in 7 patients. Postoperatively, 1 patient exhibited pectus carinatum after a separate spinal fusion surgery for scoliosis. One patient died of unrelated cardiac complications before bar removal. Simultaneous repair of PE and open heart surgery is safe and effective. We recommend that the decision to perform a single-stage versus a multistage procedure should be reserved until after the cardiac procedure has been completed. In such cases, the Nuss technique allows for correction of the pectus deformity with good long-term cosmetic and functional results. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Urinary apolipoprotein M as a biomarker of acute kidney injury in children undergoing heart surgery

DEFF Research Database (Denmark)

Svarrer, Eva Martha Madsen; Andersen, Henrik Ørbæk; Helvind, Morten

2016-01-01

AIM: To investigate whether apoM is excreted in urine of children undergoing heart surgery and the potential of apoM as early biomarker of acute kidney injury (AKI). MATERIALS & METHODS: Urine was collected in children undergoing heart surgery. ApoM was measured with ELISA. U-apoM was characterized.......018). Sensitivity was 0.71 and specificity was 0.68 at a cutoff level at 1.45 nmol/l. CONCLUSION: ApoM is excreted in the urine of children after cardiac surgery. Its potential as biomarker of AKI deserves exploration....

Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

DEFF Research Database (Denmark)

Toft, P; Tønnesen, Else Kirstine; Zülow, I

1997-01-01

Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p ... was associated with increased expression of the adhesion molecule CD11a/CD18 on lymphocytes, while the expression of activation molecules on lymphocytes was unchanged....

Preoperative Prevention of Heart Failure in Noncardiac Surgery

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V. V. Likhvantsev

2016-01-01

Full Text Available Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in noncardiac surgery. In this regard, developing the methods aimed to prevent and treatacute heart failure (AHF in the intraoperative period remain a challenging problem.Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in noncardiac surgery.Material and Methods. Design: Multicenter blind randomized placebocontrolled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30 day and annual mortality, the rate of acute myocardial infarction and stroke.Results. Levosimendan infusion at a rate of 0,05 μg/kg/min — 0,1 μg/kg/min to patients with low left ven tricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NTproBNP showed the best ratio of sensitivity/specificity in predicting 30day mortality in cumulative group: AUC=0,86 (90,77 to 0,93, P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index.Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05—0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged noncardiac surgery.

Non-cardiac surgery in patients with prosthetic heart valves: a 12 years experience

International Nuclear Information System (INIS)

Akhtar, R.P.; Khan, J.S.; Abid, A.R.; Gardezi, S.J.R.

2007-01-01

To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures. Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded. In this study, 507 consecutive patients with a mechanical heart valve replacement were followed-up. Forty two (8.28%) patients underwent non-cardiac surgical operations of which 24 (57.1%) were for abdominal and non-abdominal surgeries, 5 (20.8%) were emergency and 19 (79.2%) were planned. There were 18 (42.9%) caesarean sections for pregnancies. Among the 24 procedures, there were 7(29.1%) laparotomies, 7(29.1%) hernia repairs, 2 (8.3%) cholecystectomies, 2 (8.3%) hysterectomies, 1(4.1%) craniotomy, 1(4.1%) spinal surgery for neuroblastoma, 1(4.1%) ankle fracture and 1(4.1%) carbuncle. No untoward valve or anticoagulation related complication was seen during this period. Patients with mechanical valve prosthesis on life-long anticoagulation, if managed properly, can undergo any type of noncardiac surgical operation with minimal risk. (author)

[Nosocomial infections after cardiac surgery in infants and children with congenital heart disease].

Science.gov (United States)

Barriga, José; Cerda, Jaime; Abarca, Katia; Ferrés, Marcela; Fajuri, Paula; Riquelme, María; Carrillo, Diego; Clavería, Cristián

2014-02-01

Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. To determine risk factors for nosocomial infections in children after congenital heart surgery. A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

Early Extubation in the Operating Room after Congenital Open-Heart Surgery.

Science.gov (United States)

Fukunishi, Takuma; Oka, Norihiko; Yoshii, Takeshi; Kobayashi, Kensuke; Inoue, Nobuyuki; Horai, Tetsuya; Kitamura, Tadashi; Okamoto, Hirotsugu; Miyaji, Kagami

2018-01-27

Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

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Onakpoya, Uvie Ufuoma; Adenle, Adebisi David; Adenekan, Anthony Taiwo

2017-01-01

More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital. All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

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Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

2015-08-01

This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P open heart surgery.

Psychological interventions for acute pain after open heart surgery.

Science.gov (United States)

Ziehm, Susanne; Rosendahl, Jenny; Barth, Jürgen; Strauss, Bernhard M; Mehnert, Anja; Koranyi, Susan

2017-07-12

This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created

Risk of iron overload is decreased in beating heart coronary artery surgery compared to conventional bypass.

Science.gov (United States)

Mumby, S; Koh, T W; Pepper, J R; Gutteridge, J M

2001-11-29

Conventional cardiopulmonary bypass surgery (CCPB) increases the iron loading of plasma transferrin often to a state of plasma iron overload, with the presence of low molecular mass iron. Such iron is a potential risk factor for oxidative stress and microbial virulence. Here we assess 'off-pump' coronary artery surgery on the beating heart for changes in plasma iron chemistry. Seventeen patients undergoing cardiac surgery using the 'Octopus' myocardial wall stabilisation device were monitored at five time points for changes in plasma iron chemistry. This group was further divided into those (n=9) who had one- or two- (n=8) vessel grafts, and compared with eight patients undergoing conventional coronary artery surgery. Patients undergoing beating heart surgery had significantly lower levels of total plasma non-haem iron, and a decreased percentage saturation of their transferrin at all time points compared to conventional bypass patients. Plasma iron overload occurred in only one patient undergoing CCPB. Beating heart surgery appears to decrease red blood cell haemolysis, and tissue damage during the operative procedures and thereby significantly decreases the risk of plasma iron overload associated with conventional bypass.

Improvement in Creatinine Clearance after Open Heart Surgery in Infants as an Early Indicator of Surgical Success.

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Dagan, Amit; Dagan, Ovadia

2016-12-01

Early surgical correction of congenital heart malformations in neonates and small infants may be complicated by acute kidney injury (AKI), which is associated with higher morbidity and mortality rates, especially in patients who require dialysis. Glomerular filtration rate (GFR) is considered the best measurement of renal function which, in neonates and infants, is highly dependent on heart function. To determine whether measurements of creatinine clearance after open heart surgery in neonates and young infants can serve as an early indicator of surgical success or AKI. We conducted a prospective observational study in 19 neonates and small infants (body weight creatinine clearance and albumin excretion was performed before and during surgery and four times during 48 hours after surgery. Mean creatinine clearance was lowest during surgery (25.2 ± 4. ml/min/1.73 m2) and increased significantly in the first 16 hours post-surgery (45.7 ± 6.3 ml/min/1.73 m2). A similar pattern was noted for urine albumin which was highest during surgery (203 ± 31 µg/min) and lowest (93 ± 20 µg/min) 48 hours post-surgery. AKI occurred in four patients, and two patients even required dialysis. All six showed a decline in creatinine clearance and an increase in urine albumin between 8 and 16 hours post-surgery. In neonates and small infants undergoing open heart surgery, a significant improvement in creatinine clearance in the first 16 hours postoperatively is indicative of a good surgical outcome. This finding has important implications for the early evaluation and treatment of patients in the intensive care unit on the first day post-surgery.

Combined PCI and minimally invasive heart valve surgery for high-risk patients.

Science.gov (United States)

Umakanthan, Ramanan; Leacche, Marzia; Petracek, Michael R; Zhao, David X; Byrne, John G

2009-12-01

Combined coronary artery valvular heart disease is a major cause of morbidity and mortality in the adult patient population. The standard treatment for such disease has been open heart surgery in which coronary artery bypass grafting (CABG) is performed concurrently with valve surgery using a median sternotomy and cardiopulmonary bypass. With the increasing complexity of patients referred to surgery, some patients may prove to be poor surgical candidates for combined valve and CABG surgery. In certain selected patients who fall into this category, valve surgery and percutaneous coronary intervention (PCI) have been considered a feasible alternative. Conventionally, valve surgery is performed in the cardiac surgical operating room, whereas PCI is carried out in the cardiac catheterization laboratory. Separation of these two procedural suites has presented a logistic limitation because it impedes the concomitant performance of both procedures in one setting. Hence, PCI and valve surgery usually have been performed as a "two-stage" procedure in two different operative suites, with the procedures being separated by hours, days, or weeks. Technologic advancements have made possible the construction of a "hybrid" procedural suite that combines the facilities of a cardiac surgical operating room with those of a cardiac catheterization laboratory. This design has enabled the concept of "one-stage" or "one-stop" PCI and valve surgery, allowing both procedures to be performed in a hybrid suite in one setting, separated by minutes. The advantages of such a method could prove to be multifold by enabling a less invasive surgical approach and improving logistics, patient satisfaction, and outcomes in selected patients.

Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

Directory of Open Access Journals (Sweden)

Yadollah Jannati

2014-09-01

Full Text Available Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Methods: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression on SPSS software version 15. Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate.

Science.gov (United States)

Cheng-Ching, Esteban; John, Seby; Bain, Mark; Toth, Gabor; Masaryk, Thomas; Hui, Ferdinand; Hussain, Muhammad Shazam

2017-03-01

Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.

Towards robot-assisted anchor deployment in beating-heart mitral valve surgery.

Science.gov (United States)

Cheng, Lingbo; Sharifi, Mojtaba; Tavakoli, Mahdi

2018-06-01

Beating-heart intracardiac surgery promises significant benefits for patients compared with cardiopulmonary bypass based procedures. However, the fast motions of the heart introduce serious challenges for surgeons. In this work, a new impedance-controlled master-slave telerobotic system is developed to help perform anchor deployment for mitral valve annuloplasty under the guidance of live ultrasound images of the heart. The proposed bilateral teleoperation system can both reflect the non-oscillatory portion of slave-heart tissue interaction force on the surgeon's hand as haptic feedback and implement rapid compensation for the beating heart's motion. The surgical task involves performing anchor deployment on a simulated moving heart tissue to evaluate the effectiveness of the proposed strategy for safely interacting with a moving organ. The results obtained show that the telerobotic system increases the success rate of anchor deployment by 100% and reduces the excess force application rate by 70% compared with manual attempts. Copyright © 2018 John Wiley & Sons, Ltd.

Open-Heart surgery and cerebrovascular accident: retrospective study at King Khalid University Hospital

International Nuclear Information System (INIS)

Al-Satli, R.A.; Takrouri, Mohammad S.M.; Al-Daif, A.; Fouda, Mohamed N.; Maher, S.; Al-Khwsky, F.

2000-01-01

Stroke after coronary by-pass grafting (CABG) is often disabling. The incidence of ischemic stroke may approach 3% to 5%. Several risk factors have been identified including previous history of stroke, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation. Objective was to determine the incidence and risk factors of neurological deficit after open heart surgery. Retrospective study was done during the period 1992-1995 at the King Khalid University Hospital, Riyadh, Saudi Arabia. There were 350 patients who were subjected to (CABG), 10 patients (2.8%) found to suffer from cerebrovascular accidents (CVA) following open-heart surgery. In 8 patients, the complaint lasted more than 24 hours (stroke), while 2 patients developed transient ischemic attacks (TIA). Five factors were found to be associated with increased risk of post cardiac surgery CVA. These factors are postoperative atrial fibrillation, carotid bruit, past history of heart failure, past history of CVA and smoking. The authors concluded that it is necessary to start a prospective study to verify the area of improvement with regards to technique, selection of patients and mode of perfusion during cardiopulmonary bypass (CPB) Arabia. (author)

Re-exploration after open heart surgery at the madras medical mission, chennai, India.

Science.gov (United States)

Okonta, Ke; Rajan, S

2011-04-01

Re-explorations after open-heart surgery is a necessity in this Cardiac Center when a patient is obviously bleeding or shows features of cardiovascular instability. Timely intervention may reduce morbidity and mortality. This study aims to correlate the indications with the operative findings for re-explorations after open-heart surgeries as a way of justifying early surgical intervention. Between May2005 and April2011, 10,083 open-heart surgeries were performed in the Adult Cardiac Surgical Unit of the department of cardiac surgery, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India. The demographic data, the initial diagnoses, the types of surgery, the indications for re-exploration, the intraoperative findings, the timing, the estimated blood loss and treatment for the 362 patients who had reexploration were analysed using the Predictive Analysis Soft -ware(PASW)18. Out of the 10,083 patients who had cardiac operation within the period of study, three hundred and sixty two (3.6%) patients had re-exploration shortly after the operation. Males were 311(85.9%) while 51(14.1%) were female patients with mean age of 56.7+12.5years .The mean time interval between the primary surgery and the re-exploratory operation was 2.31+1.47hours and the mean chest tube drainage before re-exploration was 770.9+28.8ml. Coronary Artery Diseases (CAD) was the initial diagnosis 258 (71.3%) patients and Coronary Artery Bypass(CABG) operation was the initial surgery in 254(70.2%)patients, CABG and valve in 12(3.3%)patients, Valve surgery alone in 70(19.3%) patients, Bentall procedure(homograft aortic root replacement)in 13(3.6%) patients, others such as off-pump coronary artery bypass, Dor procedure(patch restoration of left ventricle by incising the aneurysm without excising it), pericardiectomy and thromboembelectomy in 13(3.6%). The indications for re-exploration were post operative haemorrhage in 283(78.2%) patients, Cardiac tamponade in 41(11.3%)patients

Alterations in plasma phosphorus, red cell 2,3-diphosphoglycerate and P50 following open heart surgery.

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Hasan, R A; Sarnaik, A P; Meert, K L; Dabbagh, S; Simpson, P; Makimi, M

1994-12-01

To evaluate changes in and the correlation between plasma phosphorus, red cell 2,3-diphosphoglycerate (DPG) and adenosine triphosphate (ATP), and P50 in children following heart surgery. Prospective, observational study with factorial design. A pediatric intensive care unit in a university hospital. Twenty children undergoing open heart surgery for congenital heart defects. None. Red cell 2,3-DPG and ATP, P50, plasma phosphorus, and arterial lactate were obtained before and at 1, 8, 16, 24, 48, and 72 hours after surgery. The amount of intravenous fluid and glucose administered, and age of blood utilized were documented. Variables were analyzed by repeated measure analysis of variance followed by paired t-tests. To investigate the relationship between variables at each time point, scatterplot matrices and correlation coefficients were obtained. There was a reduction in plasma phosphorus, red cell 2,3-DPG, and P50 and an increase in arterial lactate at 1, 8, 16, 24, 48, and 72 hours after surgery. Red cell 2,3-DPG correlated with P50 at 1, 8 and 16 hours. The decrease in the plasma phosphorus correlated with the amounts of intravenous fluid and glucose administered on the day of surgery and on the first and second postoperative days. The age of the blood utilized correlated with the decrease in red cell 2,3-DPG on the day of surgery. Reduction in red cell 2,3-DPG, P50, and plasma phosphorus occurs after open heart surgery in children. These changes can potentially contribute to impaired oxygen utilization in the postoperative period, when adequacy of tissue oxygenation is critical.

Brain volumes predict neurodevelopment in adolescents after surgery for congenital heart disease.

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von Rhein, Michael; Buchmann, Andreas; Hagmann, Cornelia; Huber, Reto; Klaver, Peter; Knirsch, Walter; Latal, Beatrice

2014-01-01

Patients with complex congenital heart disease are at risk for neurodevelopmental impairments. Evidence suggests that brain maturation can be delayed and pre- and postoperative brain injury may occur, and there is limited information on the long-term effect of congenital heart disease on brain development and function in adolescent patients. At a mean age of 13.8 years, 39 adolescent survivors of childhood cardiopulmonary bypass surgery with no structural brain lesions evident through conventional cerebral magnetic resonance imaging and 32 healthy control subjects underwent extensive neurodevelopmental assessment and cerebral magnetic resonance imaging. Cerebral scans were analysed quantitatively using surface-based and voxel-based morphometry. Compared with control subjects, patients had lower total brain (P = 0.003), white matter (P = 0.004) and cortical grey matter (P = 0.005) volumes, whereas cerebrospinal fluid volumes were not different. Regional brain volume reduction ranged from 5.3% (cortical grey matter) to 11% (corpus callosum). Adolescents with cyanotic heart disease showed more brain volume loss than those with acyanotic heart disease, particularly in the white matter, thalami, hippocampi and corpus callosum (all P-values Brain volume reduction correlated significantly with cognitive, motor and executive functions (grey matter: P < 0.05, white matter: P < 0.01). Our findings suggest that there are long-lasting cerebral changes in adolescent survivors of cardiopulmonary bypass surgery for congenital heart disease and that these changes are associated with functional outcome.

Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery

Science.gov (United States)

Boudoulas, Konstantinos Dean; Ravi, Yazhini; Garcia, Daniel; Saini, Uksha; Sofowora, Gbemiga G.; Gumina, Richard J.; Sai-Sudhakar, Chittoor B.

2013-01-01

Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery). Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions. PMID:24339838

Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study.

Science.gov (United States)

Park-Hansen, Jesper; Holme, Susanne J V; Irmukhamedov, Akhmadjon; Carranza, Christian L; Greve, Anders M; Al-Farra, Gina; Riis, Robert G C; Nilsson, Brian; Clausen, Johan S R; Nørskov, Anne S; Kruuse, Christina R; Rostrup, Egill; Dominguez, Helena

2018-05-23

Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1-0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1-1.0, p = 0.05). In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. LAACS study, clinicaltrials.gov NCT02378116 , March 4th 2015, retrospectively registered.

Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

Science.gov (United States)

Jenkins, Kathy J; Koch Kupiec, Jennifer; Owens, Pamela L; Romano, Patrick S; Geppert, Jeffrey J; Gauvreau, Kimberlee

2016-05-20

The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

[Case of neuroleptic malignant syndrome following open heart surgery for thoracic aortic aneurysm with parkinson's disease].

Science.gov (United States)

Shinoda, Maiko; Sakamoto, Mik; Shindo, Yuki; Ando, Yumi; Tateda, Takeshi

2013-12-01

An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.

Urine and serum microRNA-1 as novel biomarkers for myocardial injury in open-heart surgeries with cardiopulmonary bypass.

Science.gov (United States)

Zhou, Xian; Mao, Anqiong; Wang, Xiaobin; Duan, Xiaoxia; Yao, Yi; Zhang, Chunxiang

2013-01-01

MicroRNA-1 (miR-1) is a cardio-specific/enriched microRNA. Our recent studies have revealed that serum and urine miR-1 could be a novel sensitive biomarker for acute myocardial infarction. Open-heart surgeries with cardiopulmonary bypass (CPB) are often accompanied with surgery injury and CPB-associated injury on the hearts. However, the association of miR-1 and these intra-operative and post-operative cardiac injures is unknown. The objective of this study was to test the hypothesis that urine and serum miR-1 might be a novel biomarker for myocardial injuries in open-heart surgeries with CPB. Serum and urine miR-1 levels in 20 patients with elective mitral valve surgery were measured at pre-surgery, pre-CPB, 60 min post-CBP, and 24h post-CBP. Serum cardiac troponin-I (cTnI) was used as a positive control biomarker for cardiac injury. Compared with these in pre-operative and pre-CPB groups, the levels of miR-1 in serum and urine from patients after open-heart surgeries and CPB were significant increased at all observed time points. A similar pattern of serum cTnI levels and their strong positive correlation with miR-1 levels were identified in these patients. The results suggest that serum and urine miR-1 may be a novel sensitive biomarker for myocardial injury in open-heart surgeries with CPB.

MMPI Profile Predictors for Successful and Expired Open Heart Surgery Patients

Science.gov (United States)

Lair, Charles V.; King, Glen D.

1976-01-01

The present study was undertaken as a reanalysis of data collected and reported by Lair and Biddy to determine whether the personality dimensions of denial or anxiety, as measured by the MMPI, predict subsequent open heart surgery mortality differently by sex. (Author)

Coronary risk stratification of patients undergoing surgery for valvular heart disease

DEFF Research Database (Denmark)

Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia

2017-01-01

BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular ...

Dexmedetomidine Pharmacology in Neonates and Infants After Open Heart Surgery.

Science.gov (United States)

Su, Felice; Gastonguay, Marc R; Nicolson, Susan C; DiLiberto, MaryAnn; Ocampo-Pelland, Alanna; Zuppa, Athena F

2016-05-01

Dexmedetomidine is a highly selective α2-agonist with hypnotic, analgesic, and anxiolytic properties. Despite off-label administration, dexmedetomidine has found a niche in critically ill neonates and infants with congenital heart disease because of its minimal effects on respiratory function at sedative doses, facilitating early extubation and fast-track postoperative care. There are little pharmacokinetic data regarding newborns who have immature drug metabolizing capacity and who are at risk for reduced dexmedetomidine clearance and drug toxicity. The aim of this study was to determine the pharmacokinetics of dexmedetomidine in neonates and infants after open heart surgery. This study included 23 evaluable neonates (age, 1 day-1 month) and 36 evaluable infants (age, 1 month-24 months) after open heart surgery. Full-term neonates and infants requiring mechanical ventilation after open heart surgery received dexmedetomidine in a dose-escalation study. Dexmedetomidine was administered as a loading dose over 10 minutes followed by a continuous IV infusion up to 24 hours. Cohorts of 12 infants were enrolled sequentially to receive 0.35, 0.7, or 1 μg/kg dexmedetomidine followed by 0.25, 0.5, or 0.75 μg/kg/h dexmedetomidine, respectively. Cohorts of 9 neonates received 0.25, 0.35, or 0.5 μg/kg dexmedetomidine followed by 0.2, 0.3, or 0.4 μg/kg/h dexmedetomidine, respectively. Plasma dexmedetomidine concentrations were determined using a validated high-performance liquid chromatography-tandem mass spectrometry assay. A population nonlinear mixed effects modeling approach was used to characterize dexmedetomidine pharmacokinetics. Pharmacokinetic parameters of dexmedetomidine were estimated using a 2-compartment disposition model with weight allometrically scaled as a covariate on drug clearance, intercompartmental clearance, central and peripheral volume of distributions and age, total bypass time, and intracardiac shunting on clearance. Dexmedetomidine demonstrated

Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

Directory of Open Access Journals (Sweden)

Ramush Bejiqi

2017-11-01

CONCLUSION: Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties.

Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

Science.gov (United States)

Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

2017-08-01

Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

A red cell preservation strategy reduces postoperative transfusions in pediatric heart surgery patients.

Science.gov (United States)

Nathan, Meena; Tishler, Brielle; Gauvreau, Kimberlee; Matte, Gregory S; Howe, Robert J; Durham, Linda; Boyle, Sharon; Mathieu, Derek; Fynn-Thompson, Francis; DiNardo, James A; Ibla, Juan C

2018-03-25

Blood transfusion has well-documented adverse effects. As part of a blood conservation initiative at our center, we began routine use of cell saver for all congenital heart surgery performed on cardiopulmonary bypass since 2014. This study aimed to compare transfusion rates prior to, and in the first and second year after this initiative. We hypothesized that cell saver use would decrease transfusion requirements in second year after use of the cell saver compared to the pre cell saver group. Consecutive patients under 18 years undergoing congenital heart surgery on cardiopulmonary bypass were retrospectively analyzed as 3 one-year cohorts defined above. We excluded patients who required mechanical support or reoperation at index admission. Baseline characteristics, and use of blood intraoperatively and postoperatively were compared between groups. The 3 groups had similar baseline characteristics. Blood use was significantly lower in year 2 after cell saver initiation as compared to the pre cell saver group both intra- and postoperatively. The median difference in volume of intraoperative blood transfusion was lower by 138 mL/m 2 (-266, -10 mL/m 2 ) in year 2 when compared to the pre cell saver group. Similarly, the proportion of subjects requiring red blood cell transfusion postoperatively on day of surgery was lower by 10% (-15%, -6%). Standardized use of cell saver significantly decreased perioperative blood use in children undergoing cardiac surgery at our center. A risk-adjusted transfusion threshold for children undergoing heart surgery needs to be developed to further decrease exposure to blood products and associated costs. © 2018 John Wiley & Sons Ltd.

[Is psychoprophylaxis a valid approach for heart surgery in children?].

Science.gov (United States)

Pereira Ruschel, P; Pierini Cidade, D; Daudt, N S; Rossi Filho, R I

1995-10-01

To validate the hypothesys that a psycological preparation for children who will undergo cardiac surgery may improve the outcome. Sixty patients, with ages ranging between 3 and 10 years, submitted to heart surgery for treatment of congenital heart defects, were evaluated. They were divided in 2 groups: experimental and control. A questionnaire was designed for collecting data about psychological and clinical aspects of each patient. The following data was found to be of statistical significance: acceptance of peripheral vein puncture in the surgical group (chi 2 = 11.59, p < 0.05), calm awakening following general anesthesia (chi 2 = 9.64 p < 0.05), cooperation with the physiotherapy staff (chi 2 = 13.30, p < 0.05), coping with parents absence (chi 2 = 9.64, p < 0.05), acceptance of fluid restriction (chi 2 = 17.78, p < 0.05) and cooperation with removal of stitches and pacemaker electrodes (chi 2 = 19.20, p < 0.05). There was not statistical significance on demand of sedation, cooperation at removal of the orotracheal tube and during examination, necessity of reintubation and occurrence of clinical complications. However, the prepared group showed a slight tendency to have less postoperative complications (20%) than the control (27%). It was found that children who had adequated psychologic preparation prior to the correction of congenital heart defects had better psychological results with the imposed trauma.

Coronary risk stratification of patients undergoing surgery for valvular heart disease.

Science.gov (United States)

Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia; Heitmann, Merete; Pedersen, Frants; Schou, Morten; Mickley, Hans; Elming, Hanne; Steffensen, Rolf; Køber, Lars; Iversen, Kasper

2017-01-15

Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Decreasing warfarin sensitivity during the first three months after heart valve surgery : Implications for dosing

NARCIS (Netherlands)

Meijer, K.; Kim, Y. -K.; Schulman, S.

Introduction: Vitamin K antagonists are prescribed to prevent thromboembolic complications after heart valve surgery. In our experience, patients often show a progressive decrease in sensitivity to warfarin after surgery making it difficult to reach and maintain a therapeutic International

Lung Function before and Two Days after Open-Heart Surgery

Directory of Open Access Journals (Sweden)

Charlotte Urell

2012-01-01

Full Text Available Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n=107, 68 yrs, 80% male performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC (33±14% pred. than normal-weight patients (39±15% pred., (P=0.04. More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r=0.33, P=0.001; FEV1: r=0.35, P≤0.0001; IC: r=0.25, P=0.01. Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

Lung Function before and Two Days after Open-Heart Surgery.

Science.gov (United States)

Urell, Charlotte; Westerdahl, Elisabeth; Hedenström, Hans; Janson, Christer; Emtner, Margareta

2012-01-01

Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC) (33 ± 14% pred.) than normal-weight patients (39 ± 15% pred.), (P = 0.04). More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV(1): r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

Normothermic Versus Hypothermic Heart Surgery: Evaluation of Post-Operative Complications

Directory of Open Access Journals (Sweden)

H Akhlagh

2012-04-01

Full Text Available Introduction: The recently introduced technique of warm heart surgery may be a very effective method of myocardial protection. Although the systemic effects of hypothermic cardiopulmonary bypass are well known, the effects of warm heart surgery are not. Methods: In a prospective trial, 60 patients undergoing an elective coronary artery bypass grafting were randomly allocated to normothermic(30 patients and hypothermic(30 patients group and assessments regarding renal, respiratory and neurologic complications and bleeding volume was done. Resulst: Eighty percent of hypothermic group and 86% of normothermic group were males (p=0/36. Mean age was 56.4 and 56.1 years in hypothermic and normothermic groups, respectively. Groups had similar central temperature, shivering, nipride usage, intake and output, bleeding volume, neurologic complications and ICU staying(p>0/05 but inotrop usage and incidence of phrenic nerve palsy were higher in hypothermic group(p<0/05. Conclusion: Hypothermic procedure leads to a lower rate of respiratory complications, therefore we recommend replacing hypothermic procedure by normothermic one.

Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

DEFF Research Database (Denmark)

Toft, P; Tønnesen, Else Kirstine; Zülow, I

1997-01-01

Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open...

Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease.

Science.gov (United States)

Madsen, Nicolas L; Goldstein, Stuart L; Frøslev, Trine; Christiansen, Christian F; Olsen, Morten

2017-09-01

Cardiac surgery associated-acute kidney injury (CS-AKI) occurs in 30-50% of patients undergoing surgery for congenital heart disease. Here we determine if CS-AKI is associated with chronic kidney disease (CKD) in patients with congenital heart disease. Using Danish regional population-based registries, our cohort study included patients with congenital heart disease born between 1990-2010 with first cardiac surgery between 2005 and 2010 (under 15 years of age). Utilizing in- and out-patient laboratory serum creatinine data, we identified individuals fulfilling KDIGO stages of AKI within 5 days of cardiac surgery. A unique personal identifier enabled unambiguous data linkage and virtually complete follow-up. The cumulative incidences of CKD stages 2-5 according to presence of CS-AKI were computed utilizing serum creatinine values and Pottel's formula. Using Cox regression, the corresponding hazard ratios were computed, adjusting for sex, age at first cardiac surgery, calendar period of surgery, and congenital heart disease severity. Of 382 patients with congenital heart disease undergoing cardiac surgery, 127 experienced CS-AKI within 5 days of surgery. Median follow-up was 4.9 years. The five-year cumulative incidence of CKD for patients with CS-AKI was 12% (95% confidence interval 7%-20%), significantly higher than the 3% (1%-5%) for those without CS-AKI with a significant adjusted hazard ratio of 3.8 (1.4-10.4). Thus, CS-AKI in patients with congenital heart disease is common and is associated with an increased risk for CKD. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review

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Bauersfeld Urs

2009-01-01

Full Text Available Abstract Background Children with congenital heart defects (CHD requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA and health-related quality of life (QoL. Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population. Methods We included randomized controlled trials, case control, or cohort studies published between 1990–2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD. Results Twenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a A considerable proportion of children experienced psychological maladjustment according to their parents; (b studies on self-reported PA indicate a good outcome; (c the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d parental reports of psychological maladjustment were related to severity of CHD and developmental delay. Conclusion A significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.

Delayed Sternal Closure in Infant Heart Surgery-The Importance of Where and When: An Analysis of the STS Congenital Heart Surgery Database.

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Nelson-McMillan, Kristen; Hornik, Christoph P; He, Xia; Vricella, Luca A; Jacobs, Jeffrey P; Hill, Kevin D; Pasquali, Sara K; Alejo, Diane E; Cameron, Duke E; Jacobs, Marshall L

2016-11-01

Delayed sternal closure (DSC) is commonly used to optimize hemodynamic stability after neonatal and infant heart surgery. We hypothesized that duration of sternum left open (SLO) was associated with rate of infection complications, and that location of sternal closure may mitigate infection risk. Infants (age ≤365 days) undergoing index operations with cardiopulmonary bypass and DSC at STS Congenital Heart Surgery Database centers (from 2007 to 2013) with adequate data quality were included. Primary outcome was occurrence of infection complication, defined as one or more of the following: endocarditis, pneumonia, wound infection, wound dehiscence, sepsis, or mediastinitis. Multivariable regression models were fit to assess association of infection complication with: duration of SLO (days), location of DSC procedure (operating room versus elsewhere), and patient and procedural factors. Of 6,127 index operations with SLO at 100 centers, median age and weight were 8 days (IQR, 5-24) and 3.3 kg (IQR, 2.9-3.8); 66% of operations were STAT morbidity category 4 or 5. At least one infection complication occurred in 18.7%, compared with 6.6% among potentially eligible neonates and infants without SLO. Duration of SLO (median, 3 days; IQR, 2-5) was associated with an increased rate of infection complications (p < 0.001). Location of DSC procedure was operating room (16%), intensive care unit (67%), or other (17%). Location of DSC was not associated with rate of infection complications (p = 0.45). Rate of occurrence of infectious complications is high among infants with sternum left open following cardiac surgery. Longer duration of SLO is associated with increased infection complications. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

A dose-response study of dexmedetomidine administered as the primary sedative in infants following open heart surgery.

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Su, Felice; Nicolson, Susan C; Zuppa, Athena F

2013-06-01

To evaluate the dose-response relationship of dexmedetomidine in infants with congenital heart disease postoperative from open heart surgery. Prospective open-label dose-escalation pharmacokinetic-pharmacodynamic study. Tertiary pediatric cardiac ICU. Thirty-six evaluable infants, 1-24 months old, postoperative from open heart surgery requiring mechanical ventilation. Cohorts of 12 infants were enrolled sequentially to one of the three IV loading doses of dexmedetomidine (0.35, 0.7, and 1 mcg/kg) over 10 minutes followed by respective continuous infusions (0.25, 0.5, and 0.75 mcg/kg/hr) for up to 24 hours. Dexmedetomidine plasma concentrations were obtained at timed intervals during and following discontinuation of infusion. Pharmacodynamic variables evaluated included sedation scores, supplemental sedation and analgesia medication administration, time to tracheal extubation, respiratory function, and hemodynamic parameters. Infants achieved a deeper sedation measured by the University of Michigan Sedation Scale score (2.6 vs 1) despite requiring minimal supplemental sedation (0 unit doses/hr) and fewer analgesic medications (0.07 vs 0.15 unit doses/hr) while receiving dexmedetomidine compared with the 12-hour follow-up period. Thirty-one patients were successfully extubated while receiving the dexmedetomidine infusion. Only one patient remained intubated due to oversedation during the infusion. While receiving dexmedetomidine, there was a decrease in heart rate compared with baseline, 132 versus 161 bpm, but there was an increase in heart rate compared with postinfusion values, 132 versus 128 bpm. There was no statistically or clinically significant change in mean arterial blood pressure. Dexmedetomidine administration in infants following open heart surgery can provide improved sedation with reduction in supplemental medication requirements, leading to successful extubation while receiving a continuous infusion. The postoperative hemodynamic changes that occur in

Oral triiodothyronine normalizes triiodothyronine levels after surgery for pediatric congenital heart disease*.

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Marwali, Eva M; Boom, Cindy E; Sakidjan, Indriwanto; Santoso, Anwar; Fakhri, Dicky; Kartini, Ay; Kekalih, Aria; Schwartz, Steven M; Haas, Nikolaus A

2013-09-01

This study was conducted to determine if oral triiodothyronine supplementation could prevent the decrease of serum triiodothyronine levels that commonly occurs after cardiopulmonary bypass for pediatric congenital heart surgery. Secondary objectives included identifying any significant adverse effects of oral triiodothyronine supplementation, including any effects on the thyroid/pituitary axis. Randomized, placebo-controlled, doubleblind clinical trial Operating room and ICU. Infants and children younger than 2 years of age undergoing congenital heart surgery using cardiopulmonary bypass (n = 43). Subjects were assigned to placebo (n = 15, group A) or one of two treatment groups: a low-dose group (group B, n = 14, 0.5 mcg/kg triiodothyronine orally every 24 hr for 3 d) or a high-dose group (group C, n = 14, 0.5 mcg/kg triiodothyronine orally every 12 hr for 3 d). Thyroid hormone, including total and free triiodothyronine levels at predetermined time points, potential side effects indicating hyperthyroidism, indicators of the thyroid-pituitary axis, and clinical endpoints. Oral triiodothyronine supplementation twice-daily maintained serum triiodothyronine levels within normal limits in group C, whereas serum levels progressively declined in groups A and B. A statistically significant difference in triiodothyronine levels between the treatment groups occurred between 18 and 36 hours post cross-clamp release, with the largest difference in serum levels between group C and group A noted at 36 hours post cross-clamp release (total triiodothyronine, 0.71 ± 0.15 [0.34-1.08] ng/mL [p triiodothyronine, 2.56 ± 0.49 [1.33-3.79] pg/mL [p triiodothyronine supplementation at a dose of 0.5 mcg/kg every 12 hours for 3 days can maintain total and free triiodothyronine levels within normal limits after open-heart surgery using cardiopulmonary bypass for congenital heart disease.

Application of the Transtheoretical Model to Exercise Behavior and Physical Activity in Patients after Open Heart Surgery.

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Huang, Hsin-Yi; Lin, Yu-Shan; Chuang, Yi-Cheng; Lin, Wei-Hsuan; Kuo, Li Ying; Chen, Jui Chun; Hsu, Ching Ling; Chen, Bo Yan; Tsai, Hui Yu; Cheng, Fei Hsin; Tsai, Mei-Wun

2015-05-01

To assess exercise behavior and physical activity levels after open heart surgery. This prospective cohort study included 130 patients (70.8% male, aged 61.0 ± 12.2 years, 53.8% coronary bypass grafting) who underwent open heart surgery. The exercise behavior and physical activity of these patients were assessed at the 3- and 6-month follow-up appointments. Additional interviews were also conducted to further assess exercise behavior. Physical activity duration and metabolic equivalents were calculated from self-reported questionnaire responses. Moreover, possible related demographic factors, clinical features, participation in cardiac rehabilitation programs, and physical activity levels were additionally evaluated. Six months after hospital discharge, most patients were in the action (39.2%) and maintenance (37.7%) stages. Other subjects were in the precontemplation (11.5%), contemplation (5.4%), and preparation (6.2%) stages. The average physical activity level was 332.6 ± 377.1 min/week and 1198.1 ± 1396.9 KJ/week. Subjects in the action and maintenance stages exercised an average of 399.4 ± 397.6 min/week, significantly longer than those in other stages (116.2 ± 176.2 min/week, p = 0.02). Subjects that participated in outpatient cardiac rehabilitation programs after discharge may have the better exercise habit. Gender had no significant effect on exercise behavior 6 months after hospital discharge. Most subjects following open heart surgery may maintain regular exercise behavior at 6 months after hospital discharge. Physical activity levels sufficient for cardiac health were achieved by subjects in the active and maintenance stages. Outpatient cardiac rehabilitation programs are valuable for encouraging exercise behavior after heart surgery. Exercise behavior; Open heart surgery; Physical activity; Transtheoretical model.

On-table Extubation after Open Heart Surgery in Children: An Experience from a Tertiary Care Hospital in a Developing Country.

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Hoda, Mehar; Haque, Anwarul; Aijaz, Fareena; Akhtar, Mohammad I; Rehmat, Amina; Amanullah, Muneer; Hasan, Babar S

2016-01-01

Recent advances in various disciplines of medicine have significantly changed the courses following cardiac surgery in children. On-table extubation (OTE) after open heart surgery in children is evolving. To assess the rate of postoperative complications in children extubated on table after open heart surgery. This is a retrospective, descriptive study. Operating room (OR) then admitted to the pediatric intensive care unit (PICU). All pediatric patients (between 0 and 18 years) undergoing open heart surgery between January 2011 and June 2013. On-table extubation. Rates of immediate postoperative complications, i.e., re-intubation, significant bleeding, low cardiac output syndrome, and arrhythmia in PICU, were assessed. Data are presented as frequencies and mean ± standard deviation. A total of 82 patients were included. Mean age at time of operation was 7.25 ± 6.6 years. Fifty-three percent (n = 44) were open heart surgery was feasible and safe in selected group of patients. There was no major complication observed in the PICU. © 2015 Wiley Periodicals, Inc.

Effect of Inhalation of Lavender Essential Oil on Vital Signs in Open Heart Surgery ICU.

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Salamati, Armaiti; Mashouf, Soheyla; Mojab, Faraz

2017-01-01

This study evaluated the effects of inhalation of Lavender essential oil on vital signs in open heart surgery ICU. The main complaint of patients after open-heart surgery is dysrhythmia, tachycardia, and hypertension due to stress and pain. Due to the side effects of chemical drugs, such as opioids, use of non-invasive methods such as aromatherapy for relieving stress and pain parallel to chemical agents could be an important way to decrease the dose and side effects of analgesics. In a multicenter, single-blind trial, 40 patients who had open-heart surgery were recruited. Inclusion criteria were full consciousness, lack of hemorrhage, heart rate >60 beats/min, systolic blood pressure > 100 mmHg, and diastolic blood pressure > 60 mmHg, not using beta blockers in the operating room or ICU, no history of addiction to opioids or use of analgesics in regular, spontaneous breathing ability and not receiving synthetic opioids within 2 h before extubation. Ten minutes after extubation, the patients› vital signs [including BP, HR, Central Venous Pressure (CVP), SPO2, and RR] were measured. Then, a cotton swab, which was impregnated with 2 drops of Lavender essential oil 2%, was placed in patients' oxygen mask and patients breathed for 10 min. Thirty minutes after aromatherapy, the vital signs were measured again. Main objective of this study was the change in vital sign before and after aromatherapy. Statistical significance was accepted for P 0.001), diastolic blood pressure (p = 0.001), and heart rate (p = 0.03) before and after the intervention using paired t-test. Although, the results did not show any significant difference in respiratory rate (p = 0.1), SpO2 (p = 0.5) and CVP (p = 0.2) before and after inhaling Lavender essential oil. Therefore, the aromatherapy could effectively reduce blood pressure and heart rate in patients admitted to the open heart surgery ICU and can be used as an independent nursing intervention in stabilizing mentioned vital signs. The

Prevalence and risk factors of mortality after surgery for congenital heart disease in Tabriz, Iran: A five year retrospective

International Nuclear Information System (INIS)

Sohrab, N.; Alireza, Y.; Ata, M.; Mahmoud, S.; Bahram, Q.; Azad, R.

2010-01-01

Objective: The mortality rate after surgeries for congenital heart disorders is the most important factor for determination of the quality of these operations. A study that evaluate the mortality rate of these surgeries has not been done till now in Iran. Therefore, the purpose of this study was to determine the prevalence and risk factors of mortality after surgery for correction of congenital heart disease. Methodology: In a retrospective study, 120 children who expired after cardiac surgery and also 150 children who survived after surgery were evaluated between 2005 and 2009. Personal and Social parameters and some risk factors were analyzed. Analysis of results was performed using SPSS version 14 and descriptive and inferential statistics. Results: It showed that 12.64% of children died after surgery. Important risk factors of death were age, weight, height, body surface, preoperative Blood Urea Nitrogen, preoperative Prothrombin Time, preoperative cyanosis and postoperative bleeding. Conclusion: The results of this study indicate that the death rate of children after heart surgery in cardiovascular center of Tabriz Medical University seems to be high. Because of the lack of studies in this field more trials are advised. (author)

Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

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Tavani, F.; Zimmerman, R.A. [Neuroradiology Dept., The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Clancy, R.R.; Licht, D.J. [Dept. of Neurology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Mahle, W.T. [Children' s Heart Hospital, Atlanta, GA (United States)

2003-04-01

We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

International Nuclear Information System (INIS)

Tavani, F.; Zimmerman, R.A.; Clancy, R.R.; Licht, D.J.; Mahle, W.T.

2003-01-01

We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

Nosocomial infections and antibiotic resistance pattern in open-heart surgery patients at Imam Ali Hospital in Kermanshah, Iran.

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Heydarpour, Fatemeh; Rahmani, Youssef; Heydarpour, Behzad; Asadmobini, Atefeh

2017-01-01

Background: Patients undergoing open heart surgery have a relatively high risk of acquiring nosocomial infections. The development of antibiotic-resistant infections is associated with prolonged hospital stays and mortalities. Objectives: The present study was conducted to investigate nosocomial infections and the antibiotic resistance pattern in bacteria causing these infections in open heart surgery patients at Imam Ali Hospital in Kermanshah in the west of Iran over a 4-year period from March 2011 to March 2014. Materials and methods: The present cross-sectional study was conducted on 135 cases of nosocomial infection among open heart surgery patients. The demographic characteristics and the risk factors of each case of infection were recorded. The antibiotic susceptibility test was carried out using the Minimum Inhibitory Concentration (MIC) method based on the Clinical and Laboratory Standards Institute (CLSI) protocol. The data collected were then analyzed in SPSS-16. Results: Out of the 6,000 patients who underwent open heart surgery during this 4-year period at the selected hospital, nosocomial infections developed in 135 patients (2.25%), 59.3% of whom were female and 40.7% male. Surgery site infection (SSI), pneumonia (PNEU), urinary tract infection (UTI) and blood stream infection (BSI) affected 52.6%, 37%, 9.6% and 0.8% of the cases, respectively. E.coli , Klebsiella spp. and S. aureus were the most common bacteria causing the nosocomial infections. E. coli was most frequently resistant to imipenem (23.3%) Klebsiella spp. to gentamicin (38.5%) S. aureus to co-trimoxazole (54.2%). Conclusion: SSI had a high prevalence in this study. Further studies should therefore be conducted to examine the risk factors associated with SSI in open heart surgery. Various studies have shown that antibiotic resistance patterns are different in different regions. Finding a definitive treatment therefore requires an antibiogram.

Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery

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Benedito Barbosa João

2014-01-01

Full Text Available Objective: Evaluate the ability of clonidine to reduce pulmonary arterial pressure in patients with pulmonary hypertension undergoing heart surgery, either by reducing the pressure values from the direct measurement of pulmonary arterial pressure or by reducing or eliminating the need for intraoperative dobutamine and nitroprusside. Method: Randomized, double-blind, placebo-controlled, comparative study conducted in 30 patients with pulmonary arterial hypertension type 2 undergoing cardiac surgery. Mean pulmonary arterial pressure and dosage of dobutamine and sodium nitroprusside were assessed four times: before intravenous administration of clonidine (2 μg/kg or placebo (T0, 30 min after tested treatment and before cardiopulmonary bypass (T1, immediately after CPB (T2, 10 min after protamine injection (T3. Results: There were no significant differences regarding mean pulmonary arterial pressure at any time of evaluation. There was no significant difference between groups regarding other variables, such as mean systemic arterial pressure, heart rate, total dose of dobutamine, total dose of sodium nitroprusside, and need for fentanyl. Conclusion: Data analysis from patients included in this study allows us to conclude that intravenous clonidine (2 μg/kg was not able to reduce the mean pulmonary arterial pressure in patients with pulmonary hypertension in group 2 (pulmonary venous hypertension, undergoing heart surgery, or reduce or eliminate the need for intraoperative administration of dobutamine and sodium nitroprusside. Keywords: Clonidine, Pulmonary hypertension, Heart surgery

Evaluating Quality of "Medical Tourism" For Heart Surgery: Measures That Matter.

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Schlosser, Michael; Lee, Felix

2017-02-01

There are some success stories. Lowe's pioneering flat-rate deal with the Cleveland Clinic for heart surgery has shown both cost savings and quality improvement. Other large employers, notably Walmart and PepsiCo, have followed suit, signing contracts with self-described, single-hospital "centers of excellence" for a handful of elective procedures.

Neuro-adaptive control in beating heart surgery based on the viscoelastic tissue model

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Setareh Rezakhani

2014-04-01

Full Text Available In this paper, the problem of 3D heart motion in beating heart surgery is resolved by proposing a parallel force-motion controller. Motion controller is designed based on neuro-adaptive approach to compensate 3D heart motion and deal with uncertainity in dynamic parameters, while an implicit force control is implemented by considering a viscoelastic tissue model. Stability analysis is proved through Lypanov’s stability theory and Barballet’s lemma. Simulation results, for D2M2 robot, which is done in nominal case and viscoelastic parameter mismatches demonstrate the robust performance of the controller.

A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases.

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Kono, Takanori; Tayama, Eiki; Hori, Hidetsugu; Ueda, Tomohiro; Yamaki, Yuta; Tanaka, Hiroyuki

2016-07-27

This study was conducted to evaluate the safety and efficacy of tolvaptan following open heart surgery.We retrospectively reviewed 109 patients who were administered tolvaptan following open heart surgery between August 2011 and July 2014. We divided the patients according to their urine output index (amount of urine output/body surface area) into tertiles as follows: T1 (low responders; n = 36), T2 (intermediate responders; n = 36), and T3 (high responders; n = 37). No fatal adverse events were observed following tolvaptan administration. The factors that showed a significant difference among the 3 groups were body surface area (BSA) and preoperative body weight. Body weight rapidly decreased and a greater increase in the serum sodium level was observed on day 1 in the T3 group than in the other 2 groups. No decrease in blood pressure and no significant differences in the occurrence of atrial fibrillation were observed among the 3 groups during tolvaptan administration.Tolvaptan can be safely and effectively administered to increase the urine output without adversely affecting the cardiovascular system or renal function following open heart surgery. However, careful attention is required regarding the possibility of a rapid increase in the serum sodium level so it is important to monitor changes in serum Na levels.

Linear and nonlinear characteristics of heart rate time series in obesity and during weight-reduction surgery

International Nuclear Information System (INIS)

Alam, I; Morgan, J; Baxter, J; Lewis, M J

2009-01-01

Obesity is associated with abnormal cardiac regulation by the autonomic nervous system (ANS), this being reversed by weight loss. Bariatric (weight-reduction) surgery can induce substantial long-term weight reductions. This study compares the acute influence on ANS control of two different types of bariatric surgery involving laparascopic and open procedures. To distinguish between the cardiac influences of surgery and obesity, we perform the same analysis for laparascopic surgery in non-obese patients. Eight morbidly obese and five non-obese patients underwent surgery. Obese patients received either laparoscopic procedures (group A: n = 5, BMI = 44.3 ± 2.7 kg m 2 ) or open procedures (group B: n = 3, BMI = 55.2 ± 4.5 kg m 2 ) and non-obese patients received a laparoscopic procedure (group C: n = 5, BMI = 30.8 ± 5.8 kg m −2 ). Holter ECG was recorded and heart rate variability (HRV) was quantified together with measures of complexity (sample entropy) and structure (Hurst coefficient, scaling coefficient) of the heart rate data. Multifractal characteristics of heart rate data, not previously reported for obese patients, are also quantified and interpreted. Mixed model ANOVA was used to assess the magnitudes of each quantified variable, with surgical group and perioperative time as main factors. HRV measures were influenced only during anaesthesia (LFn increase: p = 0.009; HFn decrease: p = 0.033) and did not discriminate between patient groups. Multifractality was the only characteristic of heart rate data that discriminated between patient groups, being significantly (p < 0.001) greater in non-obese (group C) compared with obese patients (groups A and B, who had similar multifractal properties). Multifractality was also enhanced during anaesthesia (p = 0.028) but did not differ for other stages. We conclude that obesity per se rather than response to surgery is the cause of reduced multifractality. Reduced multifractality in obesity might reflect a diminished

The efficacy of tolvaptan in the perioperative management of chronic kidney disease patients undergoing open-heart surgery.

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Yamada, Mitsutomo; Nishi, Hiroyuki; Sekiya, Naosumi; Horikawa, Kohei; Takahashi, Toshiki; Sawa, Yoshiki

2017-04-01

The perioperative management of chronic kidney disease (CKD) patients undergoing open-heart surgery is challenging. In this study, we evaluated the effects of tolvaptan in CKD patients after open-heart surgery. Between 2010 to 2015, 731 patients underwent open-heart surgery in our hospital. We consecutively selected 71 patients with stage IIIa-IV CKD and divided them into two groups. Those who received tolvaptan postoperatively were defined as the "Tolvaptan group" (n = 25) and those who did not were defined as the "Non-tolvaptan group" (n = 46). We compared the urine volume of postoperative days (POD) 1 and 2, the number of days to return to preoperative body weight (BW), and the change in the postoperative estimated glomerular filtration rate (eGFR). In the tolvaptan group, the urine volume was significantly larger (P = .04) and the duration to preoperative BW tended to be shorter. Overall, the postoperative change in the eGFR tended to be better in the tolvaptan group (P = .008). In particular, we found a significantly better trend in CKD stage IV (P = .04) patients and in the patients, whose cardiopulmonary bypass (CPB) time was longer than 120 min (P = .03). Tolvaptan can safely be used for CKD patients undergoing open-heart surgery and can provide a feasible urine volume without leading to a deterioration of their renal function.

Risk factors for nosocomial infections after cardiac surgery in newborns with congenital heart disease.

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García, Heladia; Cervantes-Luna, Beatriz; González-Cabello, Héctor; Miranda-Novales, Guadalupe

2017-11-23

Congenital heart diseases are among the most common congenital malformations. Approximately 50% of the patients with congenital heart disease undergo cardiac surgery. Nosocomial infections (NIs) are the main complications and an important cause of increased morbidity and mortality associated with congenital heart diseases. This study's objective was to identify the risk factors associated with the development of NIs after cardiac surgery in newborns with congenital heart disease. This was a nested case-control study that included 112 newborns, including 56 cases (with NI) and 56 controls (without NI). Variables analyzed included perinatal history, associated congenital malformations, Risk-Adjusted Congenital Heart Surgery (RACHS-1) score, perioperative and postoperative factors, transfusions, length of central venous catheter, nutritional support, and mechanical ventilation. Differences were calculated with the Mann-Whitney-U test, Pearson X 2 , or Fisher's exact test. A multivariate logistic regression was used to determine the independent risk factors. Sepsis was the most common NI (37.5%), and the main causative microorganisms were gram-positive cocci. The independent risk factors associated with NI were non-cardiac congenital malformations (OR 6.1, CI 95% 1.3-29.4), central venous catheter indwelling time > 14 days (OR 3.7, CI 95% 1.3-11.0), duration of mechanical ventilation > 7 days (OR 6.6, CI 95% 2.1-20.1), and ≥5 transfusions of blood products (OR 3.1, CI 95% 1.3-8.5). Mortality attributed to NI was 17.8%. Newborns with non-cardiac congenital malformations and with >7 days of mechanical ventilation were at higher risk for a postoperative NI. Efforts must focus on preventable infections, especially in bloodstream catheter-related infections, which account for 20.5% of all NIs. Copyright © 2017. Published by Elsevier B.V.

Gender Analysis in the Outcomes of a Lifestyle Intervention Among Patients Who Had an Open Heart Surgery.

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Kadda, Olga; Manginas, Athanasios; Stavridis, George; Balanos, Dimitris; Kotiou, Maria; Panagiotakos, Demosthenes B

2016-01-01

The aim of this study was to evaluate the gender-oriented differences in the outcomes of a lifestyle intervention trial (diet, smoking cessation, and exercise) among patients who had open heart surgery. A randomized, nonblind intervention study was performed on 500 patients who had open heart surgery. Immediately after hospital discharge, 250 patients were randomly allocated lifestyle intervention by receiving oral and written information in the form of a booklet with specific educational information for postoperative rehabilitation. The remaining 250 patients received the regular oral instructions. The applied lifestyle intervention proved to be beneficial only in men as far as quitting smoking (relative risk [RR]: 0.36, confidence interval [CI]: 0.16-0.80; P = .01) and returning to work (RR: 0.35, CI: 0.13-0.92; P = .03) are concerned. For both genders, no significant associations between dietary and physical activity recommendations were observed. Lifestyle nursing intervention immediately after open heart surgery had a beneficial effect on men 1 year after the surgery but not on women. Thus, there is a need for gender-specific studies among women. © The Author(s) 2015.

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 heart failure, this simple...

CARDIAC SURGERY FOR VALVULAR HEART DISEASE AT A REFERRAL HOSPITAL IN ETHIOPIA: A REVIEW OF CASES OPERATED IN THE LAST 30 YEARS.

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Guteta, Senbeta; Yadeta, Dejuma; Azazh, Aklilu; Mekonnen, Dufera

2016-04-01

Valvular heart disease has been a significant cause of heart disease worldwide. In Ethiopia, it particularly affects young individuals and constitutes the major cause of cardiovascular disease. Factors associated with choice of treatment for advanced valvular heart disease are variable. The objective of this study is to review surgery done for Ethiopian patients with valvular heart disease. We analyzed data on patients who had valve surgery and follow-up at the Tikur Anbessa Specialized Hospital cardiology unit. We collected data on sociodemographic characteristics, the pre-operative status of effected valves and co-morbidities, and assessed their associations with patient management options. A total of 157 valve surgeries were done from 1983 to 2013. Mean age at time of surgery was 26.7 years and females constituted 66% of the cases. Patients with rheumatic heart disease were younger, more likely to be female and have atrial fibrillation, but less likely to have impaired left ventricular systolic function when compared to patients with non-rheumatic heart disease. More than 75% of the surgical procedures done were mechanical valve replacement. Mechanical valves, compared with bioprosthetic valves, were more likely to be used in patients with rheumatic heart disease. The median age of those receiving mechanical valves, 24 (IQR 22-28) years, was lower than those receiving bioprosthetic valves, 31.5 (IQR 29.9-37.9) years. Mechanical valve replacement was significantly higher in those under the age of 20 years (Adjusted Odds Ratio 41.0, 95% CI: 3.0-557.2) and in those between 20 and 29 years of age (Adjusted Odds Ratio 14.3, 95% CI: 2.3-88.6). Valve surgery for valvular heart diseases has been more common performed for young and female patients. A great majority of the replacements done have been with mechanical valves. As many of the patients have been younger and female, the choice of valve surgery and the need for anticoagulation impacts subsequent management of

Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery

DEFF Research Database (Denmark)

Toft, P; Christiansen, K; Tønnesen, Else Kirstine

1997-01-01

on granulocytes and improve clinical outcome. Sixteen patients undergoing open heart surgery participated in the study. Eight were randomized to receive methylprednisolone (30 mg/kg intravenously) at the start of anaesthesia while eight patients served as a control group. The oxidative burst was measured flow...... not improve the weaning from the ventilator or reduce the stay in the intensive-care unit. In conclusion, treatment with steroids prevented hyperthermia following open heart surgery with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity...

Normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery (thermic-2): study protocol for a randomized controlled trial.

Science.gov (United States)

Baos, Sarah; Sheehan, Karen; Culliford, Lucy; Pike, Katie; Ellis, Lucy; Parry, Andrew J; Stoica, Serban; Ghorbel, Mohamed T; Caputo, Massimo; Rogers, Chris A

2015-05-25

During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body ("perfusion") while the heart is stopped. Typically the blood is cooled during this procedure ("hypothermia") and warmed to normal body temperature once the operation has been completed. The main rationale for "whole body cooling" is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body's metabolic rate and decreasing oxygen consumption. However, hypothermic perfusion also has disadvantages that can contribute toward an extended postoperative hospital stay. Research in adults and small randomized controlled trials in children suggest some benefits to keeping the blood at normal body temperature throughout surgery ("normothermia"). However, the two techniques have not been extensively compared in children. The Thermic-2 study will test the hypothesis that the whole body inflammatory response to the nonphysiological bypass and its detrimental effects on different organ functions may be attenuated by maintaining the body at 35°C-37°C (normothermic) rather than 28°C (hypothermic) during pediatric complex open heart surgery. This is a single-center, randomized controlled trial comparing the effectiveness and acceptability of normothermic versus hypothermic bypass in 141 children with congenital heart disease undergoing open heart surgery. Children having scheduled surgery to repair a heart defect not requiring deep hypothermic circulatory arrest represent the target study population. The co-primary clinical outcomes are duration of inotropic support, intubation time, and postoperative hospital stay. Secondary outcomes are in-hospital mortality and morbidity, blood loss and transfusion requirements, pre- and post-operative echocardiographic findings, routine blood gas and blood test results, renal function, cerebral function, regional oxygen saturation of blood in the cerebral cortex, assessment of

Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates.

Science.gov (United States)

Carmody, J Bryan; Seckeler, Michael D; Ballengee, Cortney R; Conaway, Mark; Jayakumar, K Anitha; Charlton, Jennifer R

2014-10-01

Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Using a linear change point model, a threshold renal volume of 17 cm³ was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm³ (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Pre-operative renal volume ≤17 cm³ is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.

Aid decision algorithms to estimate the risk in congenital heart surgery.

Science.gov (United States)

Ruiz-Fernández, Daniel; Monsalve Torra, Ana; Soriano-Payá, Antonio; Marín-Alonso, Oscar; Triana Palencia, Eddy

2016-04-01

In this paper, we have tested the suitability of using different artificial intelligence-based algorithms for decision support when classifying the risk of congenital heart surgery. In this sense, classification of those surgical risks provides enormous benefits as the a priori estimation of surgical outcomes depending on either the type of disease or the type of repair, and other elements that influence the final result. This preventive estimation may help to avoid future complications, or even death. We have evaluated four machine learning algorithms to achieve our objective: multilayer perceptron, self-organizing map, radial basis function networks and decision trees. The architectures implemented have the aim of classifying among three types of surgical risk: low complexity, medium complexity and high complexity. Accuracy outcomes achieved range between 80% and 99%, being the multilayer perceptron method the one that offered a higher hit ratio. According to the results, it is feasible to develop a clinical decision support system using the evaluated algorithms. Such system would help cardiology specialists, paediatricians and surgeons to forecast the level of risk related to a congenital heart disease surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Incidence and risk factors associated with nosocomial infection in pediatric heart surgery].

Science.gov (United States)

Duarte-Raya, Fidencia; Baeza-Zarco, Fabiola Janet

2016-01-01

Nosocomial infections are responsible for a high rate of morbidity and mortality in pediatric patients undergoing heart surgery. Our objective was to determine the incidence and associated risk factors to nosocomial infections in this group of patients. A descriptive, prospective, clinical study was conducted in a tertiary hospital for a year. We calculated the rate of incidence, accumulated incidence and devices used. Was Applied the EPIDAT 2004 version 3.1 program OPS for obtaining of Chi-square with Yates correction for p with a confidence of 95 %, alpha of 0.05 with a degree of freedom, we calculated odds ratio, besides of the identification of microorganisms, their sensitivity and resistance to antibiotics. We calculated rates of: 45 % the incidence, 80.6 % cumulative incidence, 7.4 % of mortality, 13.3 % of case-fatality rate of infected and 2.7 % non-infected. The 44.4 % with pneumonia, 74 % associated with mechanical ventilation, 100 % nasogastric tube. The most frequently isolated microorganisms are: Acinetobacter baumanni, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa with high resistance to antibiotics. Pediatric patients undergoing heart surgery have high risk of infection heart disease, cyanogen's have 5 times more risk. We observed a statistically significant association with infection using nasogastric probe and endotracheal tube, the risk increases to increased hospital stay. Infected patients have 4 times the risk of death.

Multimedia Exercise Training Program Improves Distance Walked, Heart Rate Recovery, and Self-efficacy in Cardiac Surgery Patients.

Science.gov (United States)

Wang, Li-Wei; Ou, Shu-Hua; Tsai, Chien-Sung; Chang, Yue-Cune; Kao, Chi-Wen

2016-01-01

Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated. The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery. For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach. Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P self-efficacy (P = .002) at hospital discharge. Furthermore, the intervention effects on 6MWT distance (P self-efficacy (P exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.

Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery

Directory of Open Access Journals (Sweden)

Rakhee Goyal

2013-01-01

Full Text Available The number of patients with uncorrected congenital cyanotic heart disease is less but at times some may present for non-cardiac surgery with a high anesthetic risk. Some of these may even be adults with compromised cardiopulmonary physiology posing greater challenges to the anesthesiologist. The authors have used a combination of dexmedetomidine and ketamine for anesthesia for non cardiac surgery in five patients with cyanotic heart disease and right to left shunt (3-Eisenmenger′s syndrome, 2-Tetralogy of Fallot. The sympathoinhibitory effects of dexmedetomidine were balanced with the cardiostimulatory effects of ketamine, thereby maintaining good cardiovascular stability. The analgesia was good and there was no postoperative agitation.This drug combination was effective and safe for patients with cyanotic heart disease for non cardiac surgeries.

Effect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery

DEFF Research Database (Denmark)

Toft, P; Christiansen, K; Tønnesen, Else Kirstine

1997-01-01

Following cardiac surgery with cardiopulmonary bypass (CPB), activated granulocytes may be involved with ischaemia/ reperfusion injury. The purpose of this study was to investigate whether steroids could reduce the oxidative burst activity of granulocytes, the expression of adhesion molecules...... on granulocytes and improve clinical outcome. Sixteen patients undergoing open heart surgery participated in the study. Eight were randomized to receive methylprednisolone (30 mg/kg intravenously) at the start of anaesthesia while eight patients served as a control group. The oxidative burst was measured flow...... not improve the weaning from the ventilator or reduce the stay in the intensive-care unit. In conclusion, treatment with steroids prevented hyperthermia following open heart surgery with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity...

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

Objective: The evidence for cardiac rehabilitation after valve surgery remains sparse. Current recommendations are therefore based on patients with ischaemic heart disease. The aim of this randomised clinical trial was to assess the effects of cardiac rehabilitation versus usual care after heart......-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......, with aortic (62%), mitral (36%) or tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared with control had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0...

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy.

Science.gov (United States)

Balachandran, Rakhi; Kappanayil, Mahesh; Sen, Amitabh Chanchal; Sudhakar, Abhish; Nair, Suresh G; Sunil, G S; Raj, R Benedict; Kumar, Raman Krishna

2015-01-01

The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy

Directory of Open Access Journals (Sweden)

Rakhi Balachandran

2015-01-01

Full Text Available Background: The International Quality Improvement Collaborative (IQIC for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3% females. The median age was 8 months (0.03-216 and the median weight was 6.1Kg (1-100. The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001, surgical site infection (11.1% to 2.4%, P < 0.001 and duration of ICU stay from 114(8-999 hours to 72 (18-999 hours (P < 0.001 The decline in mortality from (4.3% to 2.2% did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

OpenAIRE

Bejiqi, Ramush; Retkoceri, Ragip; Bejiqi, Hana; Maloku, Arlinda; Vuçiterna, Armend; Zeka, Naim; Gerguri, Abdurrahim; Bejiqi, Rinor

2017-01-01

BACKGROUND: A feeding disorder in infancy and during childhood is a complex condition involving different symptoms such as food refusal and faddiest, both leading to a decreased food intake. AIM: We aimed to assess the prevalence and predictor factors of feeding difficulties in children who underwent cardiac open heart surgery in neonatal period and infancy. We address selected nutritional and caloric requirements for children after cardiac surgery and explore nutritional interdependence ...

Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

International Nuclear Information System (INIS)

Akhtar, K.; Ahmed, W.

2008-01-01

To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. Over a period of 6 months, 1149 cases underwent 2-D echocardiography. It was a non-probability purposive sampling. This study showed 25% of all referrals had normal hearts. A male preponderance (38%) was observed from 1 year to 5 years age group. Nineteen percent of the cases were categorized as cyanotic CHD with the remaining as acyanotic variety. Tetralogy of Fallot (TOF) represented 10%, Ventricular Septal Defects (VSD) 24%, followed by Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD), which comprised 6.6% and 6.5% respectively. VSD was the most common association in patients with more complex CHD (10%) followed by PDA in 3% and ASD in 1.2% of the cases. Most of the cases were category 2 in the RACHS-1 scoring system. VSD and TOF formed the major groups of cases profiled. Most of the cases recommended for surgery for congenital heart disease belonged to the risk category 2 (28.1%) followed by the risk category 1 (12.7%) of the RACHS-1 scoring system. (author)

Long-Term Persistency of Abnormal Heart Rate Variability following Long NICU Stay and Surgery at Birth

Directory of Open Access Journals (Sweden)

Mélanie Morin

2014-01-01

Full Text Available Preterm birth is associated with painful procedures during the neonatal intensive care unit (NICU stay. Full-term newborns can also experience pain, following surgery. These procedures can have long-lasting consequences. It has been shown that children born preterm show pain responses and cardiac alterations. This study aimed to explore the heart rate reactivity to pain in 107 subjects born either preterm or full-term who were between 7 and 25 years old at testing. We also evaluated the effect of pain experienced at birth, as represented by a longer NICU stay, time under ventilation, and surgery at birth. Participants were asked to immerse their right forearm in 10°C water for 2 minutes. Electrocardiograms were recorded at baseline and during the immersion procedure. Full-term subjects showed a stable increase in heart rate throughout the procedure, whereas preterm ones showed a strong increase at the beginning, which decreased over time. Also, preterm and full-term subjects who experienced pain at birth showed higher resting heart rate, stronger sympathetic activity, and lower cardiac vagal activity. Our study demonstrated a long-term impact of a long NICU stay and surgery at birth on cardiac autonomic activity. This could lead to impaired reactions to pain or stress in later life.

A Comparison Between the Hemodynamic Effects of Cisatracurium and Atracurium in Patient with Low Function of Left Ventricle who are Candidate for Open Heart Surgery.

Science.gov (United States)

Ghorbanlo, Masoud; Mohaghegh, Mahmoud Reza; Yazdanian, Forozan; Mesbah, Mehrdad; Totonchi, Ziya

2016-07-27

The need for muscle relaxants in general anesthesia in different surgeries including cardiac surgeries, and the type of relaxant to be used considering its different hemodynamic effects on patients with heart disease can be of considerable importance. In this study, the hemodynamic effects of two muscle relaxants, Cisatracurium and Atracurium in patients whit low function of left ventricle who are candidate for open heart surgery have been considered. This study has been designed as a randomized prospective double-blind clinical trial. The target population included all adult patients with heart disease whose ejection fraction reported by echocardiography or cardiac catheterization was 35% or less before the surgery, and were candidate for open heart surgery in Shahid Rajaei Heart Center. Taking into account the inclusion and exclusion criteria, the patients were randomly placed in two groups of 30 people each. In the induction stage, all the patients received midazolam, etomidate, and one of the considered muscle relaxant, either 0.2 mg/kg of cisatracurium or 0.5mg/kg of Atracurium within one minute. In the maintenance stage of anesthesia, the patients were administered by infusion of midazolam, sufentanil and the same muscle relaxant used in the induction stage. The hemodynamic indexes were recorded and evaluated in different stages of anesthesia and surgery as well as prior to transfer to ICU. In regard with descriptive indexes (age and sex distributions, premedication with cardiac drugs, ejection fraction before surgery, basic disease) there was no statistically significant difference between the groups. The significant difference of hemodynamic indexes between the two groups of this study, and the need for hemodynamic stability in all stages of surgery for patients with low function of left ventricle who are candidate for open heart surgery, proves that administering Cisatracurium as the muscle relaxant is advantageous and better.

Planning of vessel grafts for reconstructive surgery in congenital heart diseases

Science.gov (United States)

Rietdorf, U.; Riesenkampff, E.; Schwarz, T.; Kuehne, T.; Meinzer, H.-P.; Wolf, I.

2010-02-01

The Fontan operation is a surgical treatment for patients with severe congenital heart diseases, where a biventricular correction of the heart can't be achieved. In these cases, a uni-ventricular system is established. During the last step of surgery a tunnel segment is placed to connect the inferior caval vein directly with the pulmonary artery, bypassing the right atrium and ventricle. Thus, the existing ventricle works for the body circulation, while the venous blood is passively directed to the pulmonary arteries. Fontan tunnels can be placed intra- and extracardially. The location, length and shape of the tunnel must be planned accurately. Furthermore, if the tunnel is placed extracardially, it must be positioned between other anatomical structures without constraining them. We developed a software system to support planning of the tunnel location, shape, and size, making pre-operative preparation of the tunnel material possible. The system allows for interactive placement and adjustment of the tunnel, affords a three-dimensional visualization of the virtual Fontan tunnel inside the thorax, and provides a quantification of the length, circumferences and diameters of the tunnel segments. The visualization and quantification can be used to plan and prepare the tunnel material for surgery in order to reduce the intra-operative time and to improve the fit of the tunnel patch.

Randomized controlled trials in children's heart surgery in the 21st century: a systematic review.

Science.gov (United States)

Drury, Nigel E; Patel, Akshay J; Oswald, Nicola K; Chong, Cher-Rin; Stickley, John; Barron, David J; Jones, Timothy J

2018-04-01

Randomized controlled trials are the gold standard for evaluating health care interventions, yet are uncommon in children's heart surgery. We conducted a systematic review of clinical trials in paediatric cardiac surgery to evaluate the scope and quality of the current international literature. We searched MEDLINE, CENTRAL and LILACS, and manually screened retrieved references and systematic reviews to identify all randomized controlled trials reporting the effect of any intervention on the conduct or outcomes of heart surgery in children published in any language since January 2000; secondary publications and those reporting inseparable adult data were excluded. Two reviewers independently screened studies for eligibility and extracted data; the Cochrane Risk of Bias tool was used to assess for potential biases. We identified 333 trials from 34 countries randomizing 23 902 children. Most were early phase (313, 94.0%), recruiting few patients (median 45, interquartile range 28-82), and only 11 (3.3%) directly evaluated a surgical intervention. One hundred and nine (32.7%) trials calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51 (15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring Committee. The overall risk of bias was low in 22 (6.6%), high in 69 (20.7%) and unclear in 242 (72.7%). The recent literature in children's heart surgery contains few late-phase clinical trials. Most trials did not conform to the accepted standards of reporting, and the overall risk of bias was low in few studies. There is a need for high-quality, multicentre clinical trials to provide a robust evidence base for contemporary paediatric cardiac surgical practice.

[Ministernotomy: a preliminary experience in heart valve surgery].

Science.gov (United States)

Kovarević, Pavle; Mihajlović, Bogoljub; Velicki, Lazar; Redzek, Aleksandar; Ivanović, Vladimir; Komazec, Nikola

2011-05-01

The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median stemotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median stemotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 +/- 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 +/- 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 +/- 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 +/- 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full stemotomy. Partial upper median sternotomy represents the optimal surgical method for the interventions on the

Left septal atrial tachycardia after open-heart surgery: relevance to surgical approach, anatomical and electrophysiological characteristics associated with catheter ablation, and procedural outcomes.

Science.gov (United States)

Adachi, Toru; Yoshida, Kentaro; Takeyasu, Noriyuki; Masuda, Keita; Sekiguchi, Yukio; Sato, Akira; Tada, Hiroshi; Nogami, Akihiko; Aonuma, Kazutaka

2015-02-01

Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery. This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th-75th percentile, 3.6-4.2 versus 2.3; 1.6-2.6 mm; P=0.006) and broader area of low voltage (open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT. © 2014 American Heart Association, Inc.

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.

Central nervous system infections in heart transplant recipients

NARCIS (Netherlands)

van de Beek, Diederik; Patel, Robin; Daly, Richard C.; McGregor, Christopher G. A.; Wijdicks, Eelco F. M.

2007-01-01

OBJECTIVE: To study central nervous system infections after heart transplantations. DESIGN: Retrospective cohort study. SETTING: Cardiac Transplant Program at Mayo Clinic, Rochester, Minnesota. Patients Three hundred fifteen consecutive patients who underwent heart transplantation from January 1988

Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

Directory of Open Access Journals (Sweden)

Fangxiang Zhang

2017-01-01

Full Text Available We attempted to investigate cardioprotection of electroacupuncture (EA for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6, Ximen (PC4, Shenting (GV24, and Baihui (GV20 acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123.

Preoperative neutrophil response as a predictive marker of clinical outcome following open heart surgery and the impact of leukocyte filtration.

LENUS (Irish Health Repository)

Soo, Alan W

2010-11-01

Open heart surgery is associated with a massive systemic inflammatory response. Neutrophils, are the main mediator of this response. We hypothesised that the degree of neutrophil activation and inflammatory response to open heart surgery varies individually and correlates with clinical outcome. The aim of this study was to determine if individual clinical outcome can be predicted preoperatively through assessment of in-vitro stimulated neutrophil responses. Following that, the effects of neutrophil depletion through leukocyte filters are examined.

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case-Referent Study.

Science.gov (United States)

Ljungberg, Johan; Johansson, Bengt; Engström, Karl Gunnar; Albertsson, Elin; Holmer, Paul; Norberg, Margareta; Bergdahl, Ingvar A; Söderberg, Stefan

2017-05-05

Risk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case-referent study using data from large, population-based surveys. A total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population-based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained. This is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The Effect of Progressive Muscle Relaxation Exercises After Endotracheal Extubation on Vital Signs and Anxiety Level in Open Heart Surgery Patients

Directory of Open Access Journals (Sweden)

Özlem İbrahimoğlu

2017-12-01

Full Text Available Objective: The purpose of this study was to examine the effects of the exercises of progressive muscle relaxation (PMR on vital signs and anxiety level after endotracheal extubation in open heart surgery. Materials and Methods: This study was carried out as quasi-experimental, pre-test, and post-test with a control group. The study recruited 30 experimental and 30 control group open heart surgery patients, who met the inclusion criteria, from a cardiac and vascular surgery clinic of a university hospital. PMR exercises, which were taught before the surgery, were implemented after the surgery in the intensive care unit simultaneously with endotracheal extubation. The vital signs of the patients were monitored for the first 30 min. The anxiety levels were measured after 30 min of extubation with state anxiety inventory. Results: The lower rates of heartbeat, breathing, arterial blood pressure, and anxiety were observed in the experimental group in all measurements (first 30 min after endotracheal extubation, and the differences were statistically significant in favor of the experimental group (p<0.05. Conclusion: The study showed that the relaxation exercises after endotracheal extubation in open heart surgery patients was effective in improving vital signs and reducing anxiety level.

The impact of the maternal-foetal environment on outcomes of surgery for congenital heart disease in neonates.

Science.gov (United States)

Gaynor, James William; Parry, Samuel; Moldenhauer, Julie S; Simmons, Rebecca A; Rychik, Jack; Ittenbach, Richard F; Russell, William W; Zullo, Erin; Ward, John Laurenson; Nicolson, Susan C; Spray, Thomas L; Johnson, Mark P

2018-02-13

Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes. The most common diagnoses were transposition of the great arteries (n = 47) and hypoplastic left heart syndrome (n = 43). Impaired MFE was present in 28 of 135 (21%) subjects, with small for gestational age present in 17 (61%) patients. The presence of an impaired MFE was similar for all diagnoses, except transposition of the great arteries (P MFE (14 vs 38 days, P MFE (11.7% vs 2.8%, P = 0.104). However, for the entire cohort, survival at 36 months was greater for those without an impaired MFE (96% vs 68%, P = 0.001). For patients with hypoplastic left heart syndrome, survival was also greater for those without an impaired MFE (90% vs 43%, P = 0.007). An impaired MFE is common in pregnancies in which the foetus has congenital heart disease. After cardiac surgery in neonates, the presence of an impaired MFE was associated with lower survival at 36 months of age for the entire cohort and for the subgroup with hypoplastic left heart syndrome. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Ventilation and cardiac related impedance changes in children undergoing corrective open heart surgery

International Nuclear Information System (INIS)

Schibler, Andreas; Pham, Trang M T; Moray, Amol A; Stocker, Christian

2013-01-01

Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance. (paper)

Ventilation and cardiac related impedance changes in children undergoing corrective open heart surgery.

Science.gov (United States)

Schibler, Andreas; Pham, Trang M T; Moray, Amol A; Stocker, Christian

2013-10-01

Electrical impedance tomography (EIT) can determine ventilation and perfusion relationship. Most of the data obtained so far originates from experimental settings and in healthy subjects. The aim of this study was to demonstrate that EIT measures the perioperative changes in pulmonary blood flow after repair of a ventricular septum defect in children with haemodynamic relevant septal defects undergoing open heart surgery. In a 19 bed intensive care unit in a tertiary children's hospital ventilation and cardiac related impedance changes were measured using EIT before and after surgery in 18 spontaneously breathing patients. The EIT signals were either filtered for ventilation (ΔZV) or for cardiac (ΔZQ) related impedance changes. Impedance signals were then normalized (normΔZV, normΔZQ) for calculation of the global and regional impedance related ventilation perfusion relationship (normΔZV/normΔZQ). We observed a trend towards increased normΔZV in all lung regions, a significantly decreased normΔZQ in the global and anterior, but not the posterior lung region. The normΔZV/normΔZQ was significantly increased in the global and anterior lung region. Our study qualitatively validates our previously published modified EIT filtration technique in the clinical setting of young children with significant left-to-right shunt undergoing corrective open heart surgery, where perioperative assessment of the ventilation perfusion relation is of high clinical relevance.

Gender differences in the utilisation of surgery for congenital heart disease in India.

Science.gov (United States)

Ramakrishnan, Sivasubramanian; Khera, Rohan; Jain, Snigdha; Saxena, Anita; Kailash, Suparna; Karthikeyan, Ganesan; Kothari, Shyam S; Juneja, Rajnish; Bhargava, Balram; Kalaivani, Mani; Mehta, Manju; Bahl, Vinay K; Airan, Balram

2011-12-01

Corrective surgery for congenital heart disease may be life-saving, but its utilisation depends upon several social and economic factors. Girls with cardiac defects may not receive equitable care in India, but this has not been systematically studied. In this prospective study, parents or guardians of 405 consecutive children aged up to 12 years (mean ± SD age 3.43 ± 3.44 years; 271 boys) who had been advised to undergo elective paediatric cardiac surgery were interviewed using a validated questionnaire. The status of the patients was reviewed after a year and the factors associated with non-compliance with treatment were analysed. In a qualitative sub-study the parents of 20 children who had not undergone surgery were interviewed. Qualitative data were analysed using an inductive analytical approach. Of the 405 patients studied, 44% (59/134) of girls had undergone surgery at 1 year compared with 70% (189/271) of boys (χ²=24.97; pmatrimonial prospects of girls and lack of social support emerged as the major factors responsible for delays in undergoing surgery. Female gender is an important determinant of non-compliance with paediatric cardiac surgery. Deep-seated social factors underlie this gender bias.

[Effect of dexmedetomidine and midazolam on respiration and circulation functions in patients undergoing open heart surgery under acupuncture-assisted general anesthesia].

Science.gov (United States)

Tang, Wei; Wang, Jian; Fu, Guo-Qiang; Yuan, Lan

2014-06-01

To evaluate the effect of Dexmedetomidine and Midazolam on respiratory and circulation in patients experiencing open heart surgery under acupuncture-assisted general anesthesia. Sixty patients undergoing open heart surgery (cardiac valve replacement surgery and aortic valve replacement surgery) were randomly and equally divided into Dexmedetomidine (D) and Midazolam (M) groups. Electroacupuncture (EA) was applied to bilateral Yunmen (LU 2), Zhongfu (LU1), Lieque (LU7) and Neiguan (PC6). For patients of group D, Dexmedetomidine (i.v., loading dose: 1 microg/kg, and succedent dose: 0.2-1 microg x kg(-1) x h(-1)) was given. For patients of group M, Midazolam (i.v., loading dose: 0.05 mg/kg, succedent dose: 0.01-0.03 mg x kg(-1) x h(-1)) was given. Arterial oxygen pressure (PaO2), arterial carbondioxide tension (PaCO2), O2 saturation (SPO2), mean arterial pressure (MAP), heart rate (HR), anesthetic effect, time of spontaneous breathing recovery, and time of resuscitation were recorded before operation (T0), immediately after skin incision (T1), immediately after sternotomy (T2), before suspension of cardiopulmonary bypass (CPB, T3), immediately after cardiac re-beating (T4), immediately after CPB cessation (T5), and at the end of surgery (T6). Before operation, no significant differences were found between the group D and M in the levels of PaO2, PaCO2 and SPO2 (P > 0.05). The PaO2 and SPO2 levels after skin incision, sternotomy, before suspension of CPB and at the end of surgery were significantly lower in group M than in group D (P heart re-beating,after CPB cessation and at the end of surgery in group M were considerably higher than those in group D (P 0.05). It suggested that the respiration and circulation states in group D were more smoothly than those in group M. There was no significant difference between the two groups in the time of resuscitation (P > 0.05). Dexmedetomidine is superior to Midazolam in analgesia, and improving respiration and circulation

Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial.

Science.gov (United States)

Soltani, Ghasem; Jahanbakhsh, Saeed; Tashnizi, Mohammad Abbasi; Fathi, Mehdi; Amini, Shahram; Zirak, Nahid; Sheybani, Shima

2017-10-01

Arrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized. This study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery. This randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test. A total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001). It seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes

Healthcare-associated prosthetic heart valve, aortic vascular graft, and disseminated Mycobacterium chimaera infections subsequent to open heart surgery.

Science.gov (United States)

Kohler, Philipp; Kuster, Stefan P; Bloemberg, Guido; Schulthess, Bettina; Frank, Michelle; Tanner, Felix C; Rössle, Matthias; Böni, Christian; Falk, Volkmar; Wilhelm, Markus J; Sommerstein, Rami; Achermann, Yvonne; Ten Oever, Jaap; Debast, Sylvia B; Wolfhagen, Maurice J H M; Brandon Bravo Bruinsma, George J; Vos, Margreet C; Bogers, Ad; Serr, Annerose; Beyersdorf, Friedhelm; Sax, Hugo; Böttger, Erik C; Weber, Rainer; van Ingen, Jakko; Wagner, Dirk; Hasse, Barbara

2015-10-21

We identified 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three European Hospitals. Infections originated from the heater-cooler unit of the heart-lung machine. Here we describe clinical aspects and treatment course of this novel clinical entity. Interdisciplinary care and follow-up of all patients was documented by the study team. Patients' characteristics, clinical manifestations, microbiological findings, and therapeutic measures including surgical reinterventions were reviewed and treatment outcomes are described. The 10 patients comprise a 1-year-old child and nine adults with a median age of 61 years (range 36-76 years). The median duration from cardiac surgery to diagnosis was 21 (range 5-40) months. All patients had prosthetic material-associated infections with either prosthetic valve endocarditis, aortic graft infection, myocarditis, or infection of the prosthetic material following banding of the pulmonary artery. Extracardiac manifestations preceded cardiovascular disease in some cases. Despite targeted antimicrobial therapy, M. chimaera infection required cardiosurgical reinterventions in eight patients. Six out of 10 patients experienced breakthrough infections, of which four were fatal. Three patients are in a post-treatment monitoring period. Healthcare-associated infections due to M. chimaera occurred in patients subsequent to cardiac surgery with extracorporeal circulation and implantation of prosthetic material. Infections became clinically apparent after a time lag of months to years. Mycobacterium chimaera infections are easily missed by routine bacterial diagnostics and outcome is poor despite long-term antimycobacterial therapy, probably because biofilm formation hinders eradication of pathogens. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis.

Science.gov (United States)

Juhl, Alexander Andersen; Hody, Sofie; Videbaek, Tina Senholt; Damsgaard, Tine Engberg; Nielsen, Per Hostrup

2017-04-20

The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.

67Ga imaging in the patients with infective endocarditis after surgery for congenital heart disease

International Nuclear Information System (INIS)

Kohata, Tohru; Ono, Yasuo; Kamiya, Tetsuro; Nishimura, Tsunehiko; Takamiya, Makoto; Yagihara, Toshikatsu

1991-01-01

67 Ga imaging was performed in sixteen patients (age: 8 m.-18 y.) who had persistent fever and positive acute phase reactants after surgery for congenital heart disease. Abnormal uptake of 67 Ga over the heart and the lungs was evaluated with a computer. Abnormal uptake of 67 Ga was observed in seven patients. Of them, three showed it in the area of peripheral pulmonary artery and the other four showed it in the area of artificial vessels for pulmonary artery reconstruction. In six patients with positive blood cultures, five showed abnormal uptake of 67 Ga and in ten patients with negative blood cultures, two showed it. Vegetation was detected with 2D-echocardiography in four patients and all of them showed abnormal uptake of 67 Ga, while in 12 patients without vegetation three showed it. In conclusion, 67 Ga imaging was useful to detect the foci of infective endocarditis or pulmonary embolism caused by the vegetation in infective endocarditis in the patients after surgery for congenital heart disease, especially in the peripheral pulmonary arteries and artificial vessels which could not be detected with 2D-echo. (author)

[Quality of service provided to heart surgery patients of the Unified Health System-SUS].

Science.gov (United States)

Borges, Juliana Bassalobre Carvalho; Carvalho, Sebastião Marcos Ribeiro de; Silva, Marcos Augusto de Moraes

2010-01-01

To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (Pquality of service with: gender, in empathy (P= 0.04) and age, in reliability (P = 0.02). There was no significant association between ECC and quality of service. Service quality was satisfactory. The patient demonstrated a high expectation to hospital medical service. Women present a higher perception of quality in empathy and younger people in reliability. The use of ECC is not related to service quality in this sample. The data obtained in this study suggest that the quality of this health service can be monitored through the periodical application of the SERVQUAL scale.

The Combined Impact of Postoperative Heart Failure and EuroSCORE on Long-Term Outcome after Surgery for Aortic Stenosis

NARCIS (Netherlands)

Hultkvist, Henrik; Vanky, Farkas; Svedjeholm, Rolf

2011-01-01

Background and aim of the study: Although the EuroSCORE was developed for predicting operative mortality after cardiac surgery, it has also been shown to predict long-term mortality. It has been reported that postoperative heart failure (PHF) in association with surgery, albeit comparatively benign

[The beginnings and the development of heart surgery in Debrecen; the consequence of Professor József Schnitzler's initiative].

Science.gov (United States)

Péterffy, Arpád

2009-10-04

In the early 1960s, cardiac surgery was founded in Debrecen in the department of thoracic surgery, on Professor József Schnitzler's initiative with the cooperation of the head surgeon Arpád Eisert from Nyíregyháza. During the first 5 years, between 1963-1968, 44 closed cardiac surgical procedures were performed (closure of patent ductus arteriosus, pulmonal and mitral stenosis, pericardectomy). The first open heart surgery was performed by Gábor Kovács visiting professor from Szeged in 1968, after the Pemco heart-lung machine, a donation by Béla Köteles and the Presbyterian Church in Cleveland had arrived. The cardiac surgical activity was led by Professor András Gömöry (1972-1983). During the first 20 years 310 open, 220 closed cardiac surgical, and 612 pacemaker operations were performed. After Professor Schnitzler's retirement in 1983, Arpád Péterffy was appointed the head of the entire department (general and cardio-thoracic surgery). In the last 25 years, 18,000 open, 1500 closed and 8500 pacemaker procedures altogether 32,000 were performed. In 2008 associate professor Tamás Szerafin became the head of the department of cardiac surgery.

Risk model of prolonged intensive care unit stay in Chinese patients undergoing heart valve surgery.

Science.gov (United States)

Wang, Chong; Zhang, Guan-xin; Zhang, Hao; Lu, Fang-lin; Li, Bai-ling; Xu, Ji-bin; Han, Lin; Xu, Zhi-yun

2012-11-01

The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in

Association of temporary complete AV block and junctional ectopic tachycardia after surgery for congenital heart disease

International Nuclear Information System (INIS)

Paech, Christian; Dähnert, Ingo; Kostelka, Martin; Mende, Meinhardt; Gebauer, Roman

2015-01-01

Junctional ectopic tachycardia (JET) is a postoperative complication with a mortality rate of up to 14% after surgery for congenital heart disease. This study evaluated the risk factors of JET and explored the association of postoperative temporary third degree atrioventricular (AV) block and the occurrence of JET. Data were collected retrospectively from 1158 patients who underwent surgery for congenital heart disease. The overall incidence of JET was 2.8%. Temporary third degree AV block occurred in 1.6% of cases. Permanent third degree AV block requiring pacemaker implantation occurred in 1% of cases. In all, 56% of patients with JET had temporary AV block (P < 0.001), whereas no case of postoperative JET was reported in patients with permanent AV block (P = 0.56). temporary third degree AV block did not suffer from JET. A correlation between temporary third degree AV block and postoperative JET could be observed. The risk factors identified for JET include younger age groups at the time of surgery, longer aortic cross clamping time and surgical procedures in proximity to the AV node

Randomized controlled trials in children’s heart surgery in the 21st century: a systematic review

Science.gov (United States)

Drury, Nigel E; Patel, Akshay J; Oswald, Nicola K; Chong, Cher-Rin; Stickley, John; Barron, David J; Jones, Timothy J

2018-01-01

Abstract OBJECTIVES Randomized controlled trials are the gold standard for evaluating health care interventions, yet are uncommon in children’s heart surgery. We conducted a systematic review of clinical trials in paediatric cardiac surgery to evaluate the scope and quality of the current international literature. METHODS We searched MEDLINE, CENTRAL and LILACS, and manually screened retrieved references and systematic reviews to identify all randomized controlled trials reporting the effect of any intervention on the conduct or outcomes of heart surgery in children published in any language since January 2000; secondary publications and those reporting inseparable adult data were excluded. Two reviewers independently screened studies for eligibility and extracted data; the Cochrane Risk of Bias tool was used to assess for potential biases. RESULTS We identified 333 trials from 34 countries randomizing 23 902 children. Most were early phase (313, 94.0%), recruiting few patients (median 45, interquartile range 28–82), and only 11 (3.3%) directly evaluated a surgical intervention. One hundred and nine (32.7%) trials calculated a sample size, 52 (15.6%) reported a CONSORT diagram, 51 (15.3%) were publicly registered and 25 (7.5%) had a Data Monitoring Committee. The overall risk of bias was low in 22 (6.6%), high in 69 (20.7%) and unclear in 242 (72.7%). CONCLUSIONS The recent literature in children’s heart surgery contains few late-phase clinical trials. Most trials did not conform to the accepted standards of reporting, and the overall risk of bias was low in few studies. There is a need for high-quality, multicentre clinical trials to provide a robust evidence base for contemporary paediatric cardiac surgical practice. PMID:29186478

Exercise-based cardiac rehabilitation for adults after Heart valve surgery (protocol)

DEFF Research Database (Denmark)

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

2013-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of exercise-based intervention programmes (exercise-based interventions alone or in combination with psycho-educational components), compared to no intervention, or treatment...... as usual, in adults who have had heart valve surgery. In this review we will focus on programmes that include an exercise-based intervention with, or without, another rehabilitation component (such as a psycho-educational component)....

Ministernotomy: A preliminary experience in heart valve surgery

Directory of Open Access Journals (Sweden)

Kovačević Pavle

2011-01-01

Full Text Available Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult. Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35% and 3 mitral valve replacements (17.65%. Mean age of the patients was 60.78 ± 12.99 years (64.71% males, 35.29% females. Mean extubation time was 12.53 ± 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ± 10.17 days (in 29.4% of the patients less than 8 days. Mean postoperative drainage was 547.06 ± 335.2 mL. Postoperative complications included: bleeding (5.88% and cerebrovascular insult (5.88%. One patient (5.88% required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents

Comparison of intraoperative volume and pressure-controlled ventilation modes in patients who undergo open heart surgery.

Science.gov (United States)

Hoşten, Tülay; Kuş, Alparslan; Gümüş, Esra; Yavuz, Şadan; İrkil, Serhat; Solak, Mine

2017-02-01

Respiratory problems occur more frequently in patients who undergo open heart surgery. Intraoperative and postoperative ventilation strategies can prevent these complications and reduce mortality. We hypothesized that PCV would have better effects on gas exchange, lung mechanics and hemodynamics compared to VCV in CABG surgery. Our primary outcome was to compare the PaO 2 /FiO 2 ratio. Patients were randomized into two groups, (VCV, PCV) consisting of 30 individuals each. Two patients were excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min fresh air gas flow was set at 3L/min in all patients. In the VCV group TV was set at 8 mL/kg of the predicted body weight. In the PCV group, peak inspiratory pressure was adjusted to the same tidal volume with the VCV group. PaO2/FiO2 was found to be higher with PCV at the end of the surgery. Time to extubation and ICU length of stay was shorter with PCV. Ppeak was similar in both groups. Pplateau was lower and Pmean was higher at the and of the surgery with PCV compared to VCV. The hemodynamic effects of both ventilation modes were found to be similar. PVC may be preferable to VCV in patients who undergo open heart surgery. However, it would be convenient if our findings are supported by similar studies.

Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

Science.gov (United States)

Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

2016-11-01

Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Open heart surgery with deep hypothermic cardiopulmonary bypass and more than 90 minutes of aortic cross clamp time in 10 small dogs

Directory of Open Access Journals (Sweden)

Kippei Mihara

2017-04-01

Full Text Available No previous reports have described cardiopulmonary bypass (CPB techniques involving long aortic cross clamp (ACC times in small-breed dogs. We previously described open heart surgery under deep hypothermic CPB in small and toy dogs with an approximate ACC time limit of 1 hour, given the low success rate beyond 90 minutes of ACC time. Herein, we describe improvements in cardiac anesthesia, CPB, and cardioplegia that led to a high success rate of open heart surgery with a long ACC time in small dogs. Ten small-breed dogs with severe mitral regurgitation were subjected to mitral valve plasty that necessitated cardiopulmonary bypass (CPB beyond 90 minutes of ACC time. In the present study, all dogs survived surgery; 7 survived to discharge. In other words, we achieved a high success rate of 70% with mitral valve plasty beyond 90 minutes of ACC time (mean, 105.1 minutes: range, 90-117 minutes. For small dogs, successful open heart surgery with a long ACC time may require cardiac balanced anesthesia, CPB with increased drainage and, importantly, thorough cardioplegia without hemodilution.

Relationship Between Cerebral Oxygenation and Hemodynamic and Oxygen Transport Parameters in Surgery for Acquired Heart Diseases

Directory of Open Access Journals (Sweden)

A. I. Lenkin

2012-01-01

Full Text Available Objective: to evaluate the relationship between cerebral oxygenation and hemodynamic and oxygen transport parameters in surgical correction of concomitant acquired heart diseases. Subjects and methods. Informed consent was received from 40 patients who required surgery because of concomitant (two or more acquired heart defects. During procedure, perioperative monitoring of oxygen transport and cerebral oxygenation was performed with the aid of PiCCO2 monitor (Pulsion Medical Systems, Germany and a Fore-Sight cerebral oximeter (CASMED, USA. Anesthesia was maintained with propofol and fen-tanyl, by monitoring the depth of anesthesia. Early postoperative intensive therapy was based on the protocol for early targeted correction of hemodynamic disorders. Oxygen transport and cerebral oxygenation parameters were estimated intraopera-tively and within 24 postoperative hours. A statistical analysis including evaluation of Spearman correlations was performed with the aid of SPSS 15.0. Results. During perfusion, there was a relationship between cerebral oximetry values and hemat-ocrit levels, and oxygen partial pressure in the venous blood. Furthermore, a negative correlation between cerebral oximetry values and blood lactate levels was found 30 minutes after initiation of extracorporeal circulation (EC. During the study, there was a positive correlation between cerebral oxygenation and values of cardiac index, central venous saturation, and oxygen delivery index. There was a negative relationship between cerebral oxygenation and extravascular lung water at the beginning of surgery and a correlation between cerebral oximetry values and oxygenation index by the end of the first 24 postoperative hours. Conclusion. The cerebral oxygenation values correlate -with the main determinants of oxygen transport during EC and after cardiac surgical procedures. Cerebral oximetry may be used in early targeted therapy for the surgical correction of acquired combined

Perioperative erythropoietin protects the CNS against ischemic lesions in patients after open heart surgery.

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Lakič, Nikola; Mrak, Miha; Šušteršič, Miha; Rakovec, Peter; Bunc, Matjaž

2016-12-01

The aim of this study was to establish erythropoietin as a protective factor against brain ischemia during open heart surgery. A total of 36 consecutive patients scheduled for revascularization heart surgery were included in the study. Of the patients 18 received 3 intravenous doses of recombinant human erythropoietin (rHuEpo, 24,000 IU) and 18 patients received a placebo. Magnetic resonance imaging (MRI) to detect new brain ischemic lesions was performed. Additionally, S100A, S100B, neuron-specific enolase A and B (NSE-A and B) and the concentration of antibodies against N‑methyl-D-aspartate receptors (NMDAR) to identify new neurological complications were determined. Patients who received rHuEpo showed no postoperative ischemic changes in the brain on MRI images. In the control group 5 (27.8 %) new ischemic lesions were found. The NMDAR antibody concentration, S100A, S100B and NSE showed no significant differences between the groups for new cerebral ischemia. High levels of lactate before and after external aortic compression (p = 0.022 and p = 0.048, respectively) and duration of operation could predict new ischemic lesions (p = 0.009). The addition of rHuEpo reduced the formation of lesions detectable by MRI in the brain and could be used clinically as neuroprotection in cardiac surgery.

Report of the Third Heart Surgery Forum Scientific Sessions: Zagreb, Croatia December 6-8, 2017: Conference Highlights.

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Firstenberg, Michael S; Nguyen, Tom C; Roberts, Harold; Levinson, Mark M; Rudez, Igo

2018-02-26

The Heart Surgery Forum is an online community dedicated to topics related to all aspects of cardiothoracic surgery. It consists of an informative website (www.hsforum.com), a traditional indexed journal both in print and online, and an email-based "list-serv" for discussion of surgical cases and techniques. The email list-serv, "OpenHeart-L" (The Forum) is composed of surgeons and allied specialties (perfusion, anesthesia, nursing). Dr. Mark Levinson (USA) started The Forum originally in 1995. He also served as the first Editor-in-Chief of the print journal for many years. Coinciding with the popularity of The Forum, and the desire by many members to meet in person, the First Heart Surgery Forum Conference (#1 HSF) was held in Savudrija, Istria, Croatia in 2010. The overwhelming success of this meeting, in terms of attendance and scientific content, resulted in #2 HSF being held in Split, Croatia in 2014. Recently, the #3 HSF meeting was held in Zagreb, Croatia on December 6-8th, 2017. This report highlights the scientific events of this meeting, and more importantly aims to inspire greater involvement by the international cardiothoracic community. Substantial increasing attendance was seen at each subsequent meeting, not only in terms of the number of participants and lectures, but also in the number of countries represented.

Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial.

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Kadda, Olga; Kotanidou, Anastasia; Manginas, Athanasios; Stavridis, George; Nanas, Serafim; Panagiotakos, Demosthenes B

2015-06-01

To evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery. Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease. Randomised, nonblind and lifestyle counselling intervention study with a one-year follow-up. A randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation. According to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs. A well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome. © 2015 John Wiley & Sons Ltd.

Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

DEFF Research Database (Denmark)

Toft, P; Nielsen, C H; Tønnesen, Else Kirstine

1998-01-01

Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... during cardiopulmonary bypass was observed. The percentage of CD11a-positive granulocytes increased from 30% pre-operatively to 75% following cardiopulmonary bypass, while CD44-positive granulocytes increased from 5% to 13%. Despite the extent of the changes, these were not significant. The oxidative...... to an increased per-operative oxidative burst activity, and the induction of adhesion molecules on granulocytes associated with the cardiopulmonary bypass and surgery. In conclusion, open-heart surgery with cardiopulmonary bypass was associated with a rapid and pronounced activation of leukocytes which may play...

sup 67 Ga imaging in the patients with infective endocarditis after surgery for congenital heart disease

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Kohata, Tohru; Ono, Yasuo; Kamiya, Tetsuro; Nishimura, Tsunehiko; Takamiya, Makoto; Yagihara, Toshikatsu [National Cardiovascular Center, Suita, Osaka (Japan)

1991-11-01

{sup 67}Ga imaging was performed in sixteen patients (age: 8 m.-18 y.) who had persistent fever and positive acute phase reactants after surgery for congenital heart disease. Abnormal uptake of {sup 67}Ga over the heart and the lungs was evaluated with a computer. Abnormal uptake of {sup 67}Ga was observed in seven patients. Of them, three showed it in the area of peripheral pulmonary artery and the other four showed it in the area of artificial vessels for pulmonary artery reconstruction. In six patients with positive blood cultures, five showed abnormal uptake of {sup 67}Ga and in ten patients with negative blood cultures, two showed it. Vegetation was detected with 2D-echocardiography in four patients and all of them showed abnormal uptake of {sup 67}Ga, while in 12 patients without vegetation three showed it. In conclusion, {sup 67}Ga imaging was useful to detect the foci of infective endocarditis or pulmonary embolism caused by the vegetation in infective endocarditis in the patients after surgery for congenital heart disease, especially in the peripheral pulmonary arteries and artificial vessels which could not be detected with 2D-echo. (author).

Heart transplantation in adults with congenital heart disease.

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Houyel, Lucile; To-Dumortier, Ngoc-Tram; Lepers, Yannick; Petit, Jérôme; Roussin, Régine; Ly, Mohamed; Lebret, Emmanuel; Fadel, Elie; Hörer, Jürgen; Hascoët, Sébastien

2017-05-01

With the advances in congenital cardiac surgery and postoperative care, an increasing number of children with complex congenital heart disease now reach adulthood. There are already more adults than children living with a congenital heart defect, including patients with complex congenital heart defects. Among these adults with congenital heart disease, a significant number will develop ventricular dysfunction over time. Heart failure accounts for 26-42% of deaths in adults with congenital heart defects. Heart transplantation, or heart-lung transplantation in Eisenmenger syndrome, then becomes the ultimate therapeutic possibility for these patients. This population is deemed to be at high risk of mortality after heart transplantation, although their long-term survival is similar to that of patients transplanted for other reasons. Indeed, heart transplantation in adults with congenital heart disease is often challenging, because of several potential problems: complex cardiac and vascular anatomy, multiple previous palliative and corrective surgeries, and effects on other organs (kidney, liver, lungs) of long-standing cardiac dysfunction or cyanosis, with frequent elevation of pulmonary vascular resistance. In this review, we focus on the specific problems relating to heart and heart-lung transplantation in this population, revisit the indications/contraindications, and update the long-term outcomes. Copyright © 2017. Published by Elsevier Masson SAS.

Outcomes of laparoscopic and open surgery in children with and without congenital heart disease.

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Chu, David I; Tan, Jonathan M; Mattei, Peter; Simpao, Allan F; Costarino, Andrew T; Shukla, Aseem R; Rossano, Joseph W; Tasian, Gregory E

2017-11-17

Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD. We performed a retrospective cohort study using the 2013-2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay. Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15-0.79]), inhospital mortality (OR 0.42 [0.22-0.81]) and 30-day morbidity (OR 0.61 [0.50-0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend=0.01) and in-hospital mortality (ptrend=0.05), but not for 30-day mortality (ptrend=0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children. Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD. Level III: Treatment Study. Copyright © 2017 Elsevier Inc. All rights reserved.

Pain and cardiorespiratory responses of children during physiotherapy after heart surgery.

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Araujo, Adriana Sanches Garcia; Klamt, Jyrson Guilherme; Vicente, Walter Villela de Andrade; Garcia, Luis Vicente

2014-01-01

The aim of the present study was to determine the occurrence of pain and changes in blood pressure, heart rate, respiratory rate, and arterial oxygen saturation associated with physiotherapy in children undergoing cardiac surgery. Eighteen extubated children were assessed for the presence of pain using the face, legs, activity, cry, consolability scale, and blood pressure, heart rate, respiratory rate and arterial oxygen saturation were simultaneously recorded. The physiological parameters were measured at the following time periods: immediately before physiotherapy, five and 10 minutes after the beginning of physiotherapy, and five minutes after its end. Pain was assessed immediately before physiotherapy, ten minutes after the beginning of physiotherapy and five minutes after its end. Pain and physiological changes were assessed by the Friedman test and the correlation between the physiological parameters and the pain scores was assessed by the Spearman test. Pain increased during physiotherapy and decreased significantly after it compared to pre-physiotherapy scores. Systolic blood pressure and heart rate increased significantly after 10 minutes of the beginning of physiotherapy. Arterial oxygen saturation tended to decrease during physiotherapy and to increase after it, although without significance. The correlation between pain scores and the physiological variables was significant only for systolic blood pressure and heart rate ten minutes after the beginning of physiotherapy. Manipulation after the beginning of physiotherapy seems to be accompanied by significant pain and by important associated cardiovascular changes. Apparent analgesia and improved respiratory function were observed after respiratory physiotherapy.

Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials.

Science.gov (United States)

Lu, Jun; Meng, Haoyu; Meng, Zhaoyi; Sun, Ying; Pribis, John P; Zhu, Chunyan; Li, Quan

2015-01-01

Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P open-heart surgery. Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.

Update to the study protocol, including statistical analysis plan for a randomized clinical trial comparing comprehensive cardiac rehabilitation after heart valve surgery with control

DEFF Research Database (Denmark)

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

2015-01-01

, either valve 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 hypothesize that a comprehensive cardiac rehabilitation program can improve physical capacity and self-assessed mental health...... and reduce hospitalization and healthcare costs after heart valve surgery. METHODS: This randomized clinical trial, CopenHeartVR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210...... patients 1:1 to an intervention or a control group, using central randomization, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise and a psycho-educational intervention comprising five consultations. The primary outcome is peak oxygen uptake...

Kosovo’s Experience for Children with Feeding Difficulties after Cardiac Surgery for Congenital Heart Defect

Science.gov (United States)

Bejiqi, Ramush; Retkoceri, Ragip; Bejiqi, Hana; Maloku, Arlinda; Vuçiterna, Armend; Zeka, Naim; Gerguri, Abdurrahim; Bejiqi, Rinor

2017-01-01

BACKGROUND: A feeding disorder in infancy and during childhood is a complex condition involving different symptoms such as food refusal and faddiest, both leading to a decreased food intake. AIM: We aimed to assess the prevalence and predictor factors of feeding difficulties in children who underwent cardiac open heart surgery in neonatal period and infancy. We address selected nutritional and caloric requirements for children after cardiac surgery and explore nutritional interdependence with other system functions. METHODS: This was a retrospective study in a tertiary referral hospital, and prior approval from the institutional ethics committee was obtained. Information for 78 children (42 male and 36 female) was taken from patients charts. Data were analysed with descriptive statistics and logistic regression. RESULTS: From a cohort of analysed children with feeding problems we have occurred in 23% of such cases. At the time of the study, refusal to eat or poor appetite was reported as a significant problem in 19 children and subnormal height and weight were recorded in 11 children. Early neonatal intervention and reoperation were identified as risk factors for latter feeding difficulties or inadequate intake. Children with feeding problems also tended to eat less than children without feeding problems. There was a trend towards more feeding problems in patients with chromosomal abnormalities or other associated anomalies. CONCLUSION: Feeding disorder is often and a frequent long-term sequel in children after neonatal or early infancy heart surgery. Patients with chromosomal and associated anomalies who underwent multiple cardiac surgeries are at risk of developing feeding difficulties. PMID:29362619

Topical Application of Tranexamic Acid Reduces Postoperative Bleeding in Open-Heart Surgery: Myth or Fact

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Shah, M. U. A.; Asghar, M. I.; Cahaudhri, M. S.; Janjua, A. M.; Iqbal, A.

2015-01-01

Objective: To determine the efficacy of topical application of Tranexamic acid in controlling postoperative bleeding in open-heart surgery. Study Design: Double blind randomized control trial. Place and Duration of Study: Departments of Cardiac Surgery and Intensive Care of Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan, from May to October 2011. Methodology: A total of 100 consecutive adult patients fulfilling the inclusion criteria undergoing elective on-pump cardiac surgeries were randomly divided in groups A and B. A study solution that contained 2.5 g of Tranexamic acid in 250 ml normal saline in group-A and equal amount of normal saline (placebo) in group-B was poured in the pericardial cavity over the mediastinal tissues before sternal closure. Postoperative bleeding was measured in both groups for 24 hours in the cardiac surgical ICU. Efficacy of Topical Tranexamic Acid / Placebo was measured in terms of mean postoperative bleeding in ml. Kindly again include these lines which seem to have been omitted in the final proof. Results: There was significant difference in the mean postoperative bleeding within 24 hours among the two groups 340.1 ± 112.4 ml in Tranexamic acid group vs. 665 ± 187.28 ml in placebo group (p < 0.001). Conclusion: Patients who did not have topical Tranexamic acid before chest closure had a significantly higher postoperative bleeding. Topical Tranexamic acid application is an effective and economical way for controlling non-surgical bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. (author)

Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran.

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Nashibi, Roohangiz; Mohammadi, Mohammad Javad; Alavi, Seyed Mohammad; Yousefi, Farid; Salmanzadeh, Shokrolah; Ahmadi, Fatemeh; Varnaseri, Mehran; Ramazani, Asghar; Moogahi, Sasan

2018-02-01

The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.

Routine aspiration of subglottic secretions after major heart surgery: impact on the incidence of ventilator-associated pneumonia.

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Pérez Granda, M J; Barrio, J M; Hortal, J; Muñoz, P; Rincón, C; Bouza, E

2013-12-01

Aspiration of subglottic secretions (ASS) is recommended in patients requiring mechanical ventilation for ≥48h. We assessed the impact of the introduction of ASS routinely in all patients after major heart surgery in an ecological study comparing ventilator-acquired pneumonia (VAP) incidence, days of mechanical ventilation, and cost of antimicrobial agents before and after the implementation of ASS. Before and after the intervention the results (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P = 0.04); cost of antimicrobials, €71,384 vs €63,446 (P = 0.002); and days of mechanical ventilation, 507.5 vs 377.5 (P = 0.009). From the moment of induction of anaesthesia all patients undergoing major heart surgery should routinely receive ASS. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Protective effects of recombinant human brain natriuretic peptide in perioperative period during open heart surgery.

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Xu, Yunbin; Li, Yong; Bao, Weiguo; Qiu, Shi

2018-03-01

The aim of the present study was to evaluate the protective effects and safety aspects of recombinant human brain natriuretic peptide (rhBNP) on cardiac functions of patients undergoing open-heart surgery during perioperative period. In total, 150 patients undergoing open heart surgery in the Second Hospital of Shandong Universty from August 2015 to July 2016 were randomly divided into control group and observation group each with 75 cases. Patients in control group were treated by routine rehabilitation while patients in the observation group were treated by both the routine rehabilitation and rhBNP. All the observations were made before operation, after operation and 7 days after operation. The changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) of patients, the left ventricular ejection fraction (LVEF), cardiac function [Cardiac output (CO), pulmonary capillary wedge pressure (PAWP) and central venous pressure (CVP)] of patients were measured. Further, respirator support time, ICU stay time, incidence of complications and vital signs (BP, HR, SaO2) of patients in the two groups were also compared. NT-proBNP levels of all patients improved after operation but it decreased in both groups after 7 days of operation. The decrease of NT-proBNP levels in observation group was significantly higher than that of control group. Whereas, LVEF, CO, PAWP and CVP of patients in both the groups increased after operation but effects were significantly higher in the observation group after 7 days of medication. Respirator support time and ICU stay time of patients in observation group were significantly shorter than those in control group, and the incidence of postoperative complications of patients in the observation group were significantly lower than the control group. Moreover, BP, HR and SaO2 of patients in observation group were significantly elevated in comparison to control group (Popen heart surgery, and is safe as well as reliable.

Heart Surgery Waiting Time: Assessing the Effectiveness of an Action.

Science.gov (United States)

Badakhshan, Abbas; Arab, Mohammad; Gholipour, Mahin; Behnampour, Naser; Saleki, Saeid

2015-08-01

Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient's problems. The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients' emotionally readiness.

Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results

Science.gov (United States)

Chernyavskiy, Alexander; Fomichev, Alexey; Minin, Stanislav; Nikitin, Nikita

2017-10-01

Background: The problem of incomplete myocardial revascularization for diffuse and distal lesions of the myocardium is still relevant. We assessed the clinical and instrumental long-term results of autologous bone marrow cell (BMC) implantation in laser channels in ischemic heart disease with diffuse and distal coronary disease. 35 coronary heart disease (CHD) patients with diffuse and distal coronary disease during coronary artery bypass grafting (CABG) underwent BMC implantation in laser channels. The control group consisted of 29 patients. All patients in this group underwent only CABG. Clinical and instrumental assessment of the method's effect was carried out at two weeks, six months, and six years after surgery. Indirect revascularization showed more significant decreasing of the functional class (FC) New York Heart Association (NYHA), myocardial perfusion and contractility improvement. Autologous BMC implantation in laser channels is an effective method of CHD surgical treatment if it is impossible to perform direct myocardial revascularization. The indirect revascularization effect is formed in the first six months after surgery and remains at the same level for six years.

Pain and cardiorespiratory responses of children during physiotherapy after heart surgery

Directory of Open Access Journals (Sweden)

Adriana Sanches Garcia Araujo

2014-04-01

Full Text Available Objective: The aim of the present study was to determine the occurrence of pain and changes in blood pressure, heart rate, respiratory rate, and arterial oxygen saturation associated with physiotherapy in children undergoing cardiac surgery. Methods: Eighteen extubated children were assessed for the presence of pain using the face, legs, activity, cry, consolability scale, and blood pressure, heart rate, respiratory rate and arterial oxygen saturation were simultaneously recorded. The physiological parameters were measured at the following time periods: immediately before physiotherapy, five and 10 minutes after the beginning of physiotherapy, and five minutes after its end. Pain was assessed immediately before physiotherapy, ten minutes after the beginning of physiotherapy and five minutes after its end. Pain and physiological changes were assessed by the Friedman test and the correlation between the physiological parameters and the pain scores was assessed by the Spearman test. Results: Pain increased during physiotherapy and decreased significantly after it compared to pre-physiotherapy scores. Systolic blood pressure and heart rate increased significantly after 10 minutes of the beginning of physiotherapy. Arterial oxygen saturation tended to decrease during physiotherapy and to increase after it, although without significance. The correlation between pain scores and the physiological variables was significant only for systolic blood pressure and heart rate ten minutes after the beginning of physiotherapy. Conclusion: Manipulation after the beginning of physiotherapy seems to be accompanied by significant pain and by important associated cardiovascular changes. Apparent analgesia and improved respiratory function were observed after respiratory physiotherapy.

Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial.

Science.gov (United States)

Amanullah, Muhammad M; Hamid, Mohammad; Hanif, Hashim M; Muzaffar, Marium; Siddiqui, Maria T; Adhi, Fatima; Ahmad, Khabir; Khan, Shahjahan; Hasan, Zahra

2016-03-01

Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes. We conducted a randomised controlled trial to evaluate the trends in the levels of immunomodulators and their effects on clinical parameters. To assess the effects of intravenous steroids on early post-operative inflammatory markers and clinical parameters in children undergoing open-heart surgery. A randomised controlled trial involving 152 patients, from one month up to 18 years of age, who underwent open-heart surgery for congenital heart disease from April 2010-2012 was carried out. Patients were randomised and administered either three scheduled intravenous pulse doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at four time intervals and serum levels of inflammatory cytokines - Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were measured. Clinical parameters were also assessed. Blood cytokine levels were compared between the dexamethasone (n=65) and placebo (n=64) groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively (p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively (p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis factor-alpha levels did not differ between the groups at any time intervals. The clinical parameters were similar in both the groups. Dexamethasone caused quantitative suppression of Interleukin-6 and increased Interleukin-10 activation, contributing to reduced immunopathology, but it did not translate into clinical benefit in the short term.

The cost of open heart surgery in Nigeria.

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Falase, Bode; Sanusi, Michael; Majekodunmi, Adetinuwe; Ajose, Ifeoluwa; Idowu, Ariyo; Oke, David

2013-01-01

Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.

The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery

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Mohsen Ziyaeifard

2016-01-01

Full Text Available Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF versus conventional ultrafiltration (CUF on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group and sole CUF was performed for other 23 patients (control group. In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU stay, and inotrope requirement were compared between the two groups. Results: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05 only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P = 0.004 and ICU stay (P = 0.007 between the two groups. Inotropes including milrinone (P = 0.04, epinephrine (P = 0.001, and dobutamine (P = 0.002 were used significantly less frequently for patients in the intervention than the control group. Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery.

Pericarditis - after heart attack

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... include: A previous heart attack Open heart surgery Chest trauma A heart attack that has affected the thickness of your heart muscle Symptoms Symptoms include: Anxiety Chest pain from the swollen pericardium rubbing on the ...

Prevalence and Risk Factors of Postoperative Delirium in Patients Undergoing Open Heart Surgery in Northwest of Iran

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Ahmadreza Jodati

2013-09-01

Full Text Available Introduction: Delirium as a relatively common complication following cardiac surgery remains a contributory factor in postoperative mortality and an obstacle to early discharge of patients.Methods: In the present study 329 patients who underwent open heart surgery between 1st January 2008 to 1st January 2009 in Shahid Madani Heart Center, Tabriz, Iran were enrolled.Results: Overall 4.9% of patients developed delirium after cardiac surgery. We found atrial fibrillation (P = 0.005, lung diseases (P = 0.04 and hypertension (P = 0.02 to be more common in patients who develop delirium postoperatively. Furthermore, the length of intensive care unit (ICU stay, cardiopulmonary bypass (CPB time, and ventilation period were also significantly increased. Also a statistically meaningful relationship between the female gender and development of delirium was also noted (P = 0.02. On the other hand no meaningful relationship was detected between diabetes, history of cerebral vascular diseases, peripheral vascular diseases, myocardial infarction, development of pneumonia following surgery, and laboratory levels of sodium, potassium, glucose, and complete blood cell count (CBC including white blood cells, red blood cells, platelets in the blood-hemoglobin and hematocrits. Also environmental factors like presence of other patients or companion with the patient, and objects like clock, window and calendar in the patient’s room did not affect prevention of delirium.Conclusion: Based on this and other investigations, it can be suggested to use MMPI test to recognize pathologic elements to prevented delirium after surgery and complementary treatment for coping with delirium.

Population Pharmacokinetic Model for Vancomycin Used in Open Heart Surgery: Model-Based Evaluation of Standard Dosing Regimens.

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Alqahtani, Saeed A; Alsultan, Abdullah S; Alqattan, Hussain M; Eldemerdash, Ahmed; Albacker, Turki B

2018-04-23

The purpose of this study was to investigate the population pharmacokinetics of vancomycin in patients undergoing open heart surgery. In this observational pharmacokinetic study, multiple blood samples were drawn over a 48-h period of intravenous vancomycin in patients who were undergoing open heart surgery. Blood samples were analysed using the Architect i4000SR Immunoassay Analyzer. Population pharmacokinetic models were developed using Monolix 4.4 software. Pharmacokinetic-pharmacodynamic (PK-PD) simulations were performed to explore the ability of different dosage regimens to achieve the pharmacodynamic targets. One-hundred and sixty-eight blood samples were analysed from 28 patients. The pharmacokinetics of vancomycin was best described by a two-compartment model with between-subject variability in CL, V of the central compartment, and V of the peripheral compartment. CL and central compartment V of vancomycin were related to CL CR , body weight, and albumin concentration. Dosing simulations showed that standard dosing regimens of 1 and 1.5 g failed to achieve the PK-PD target of AUC 0--24 /MIC > 400 for an MIC of 1 mg/L, while high weight-based dosing regimens were able to achieve the PK-PD target. In summary, administration of standard doses of 1 and 1.5 g of vancomycin two times daily provided inadequate antibiotic prophylaxis in patients undergoing open heart surgery. The same findings were obtained when 15 mg/kg and 20 mg/kg doses of vancomycin were administered. Achieving the PK-PD target required higher doses (25 mg/kg and 30 mg/kg) of vancomycin. Copyright © 2018 American Society for Microbiology.

Congenital heart disease

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Congenital heart disease (CHD) is a problem with the heart's structure and function that is present at birth. ... Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, ... Sabiston Textbook of Surgery: The Biological Basis of Modern ...

Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.

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Benotti, Peter N; Wood, G Craig; Carey, David J; Mehra, Vishal C; Mirshahi, Tooraj; Lent, Michelle R; Petrick, Anthony T; Still, Christopher; Gerhard, Glenn S; Hirsch, Annemarie G

2017-05-23

Obesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long-term cardiovascular events. A cohort of Roux-en-Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated-measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan-Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events ( P =0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42-0.82). Improvements of cardiovascular risk factors (eg, 10-year cardiovascular risk score, total cholesterol, high-density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery. Gastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure. © 2017 The Authors and Geisinger Clinic. Published on behalf of the American Heart Association, Inc., by Wiley.

Bariatric Surgery Is Gaining Ground as Treatment of Obesity After Heart Transplantation: Report of Two Cases.

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Tsamalaidze, Levan; Elli, Enrique F

2017-11-01

Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.

Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease.

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Shvartz, Vladimir A; Kiselev, Anton R; Karavaev, Anatoly S; Vulf, Kristina A; Borovkova, Ekaterina I; Prokhorov, Mikhail D; Petrosyan, Andrey D; Bockeria, Olga L

2018-01-01

Introduction: Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). Methods: The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. Results: We found no differences ( Р > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD ( P = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. Conclusion: The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).

Management of tricuspid valve regurgitation: Position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease.

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Antunes, Manuel J; Rodríguez-Palomares, José; Prendergast, Bernard; De Bonis, Michele; Rosenhek, Raphael; Al-Attar, Nawwar; Barili, Fabio; Casselman, Filip; Folliguet, Thierry; Iung, Bernard; Lancellotti, Patrizio; Muneretto, Claudio; Obadia, Jean-François; Pierard, Luc; Suwalski, Piotr; Zamorano, Pepe

2017-12-01

Tricuspid regurgitation (TR) is a very frequent manifestation of valvular heart disease. It may be due to the primary involvement of the valve or secondary to pulmonary hypertension or to the left-sided heart valve disease (most commonly rheumatic and involving the mitral valve). The pathophysiology of secondary TR is complex and is intrinsically connected to the anatomy and function of the right ventricle. A systematic multimodality approach to diagnosis and assessment (based not only on the severity of the TR but also on the assessment of annular size, RV function and degree of pulmonary hypertension) is, therefore, essential. Once considered non-important, treatment of secondary TR is currently viewed as an essential concomitant procedure at the time of mitral (and, less frequently, aortic valve) surgery. Although the indications for surgical management of severe TR are now generally accepted (Class I), controversy persists concerning the role of intervention for moderate TR. However, there is a trend for intervention in this setting, especially at the time of surgery for left-sided heart valve disease and/or in patients with significant tricuspid annular dilatation (Class IIa). Currently, surgery remains the best approach for the interventional treatment of TR. Percutaneous tricuspid valve intervention (both repair and replacement) is still in its infancy but may become a reliable option in future, especially for high-risk patients with isolated primary TR or with secondary TR related to advanced left-sided heart valve disease. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

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Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

2014-03-01

Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

Depression and reduced heart rate variability after cardiac surgery: the mediating role of emotion regulation.

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Patron, Elisabetta; Messerotti Benvenuti, Simone; Favretto, Giuseppe; Gasparotto, Renata; Palomba, Daniela

2014-02-01

Heart rate variability (HRV), as an index of autonomic nervous system (ANS) functioning, is reduced by depression after cardiac surgery, but the underlying mechanisms of this relationship are poorly understood. Poor emotion regulation as a core symptom of depression has also been associated with altered ANS functioning. The present study aimed to examine whether emotion dysregulation could be a mediator of the depression-reduced HRV relationship observed after cardiac surgery. Self-reported emotion regulation and four-minute HRV were measured in 25 depressed and 43 nondepressed patients after cardiac surgery. Mediation analysis was conducted to evaluate emotion regulation as a mediator of the depression-reduced HRV relationship. Compared to nondepressed patients, those with depression showed lower standard deviation of normal-to-normal (NN) intervals (pbehavior partially mediated the effect of depression on LF n.u. and HF n.u. Results confirmed previous findings showing that depression is associated with reduced HRV, especially a reduced vagal tone and a sympathovagal imbalance, after cardiac surgery. This study also provides preliminary evidence that increased trait levels of suppression of emotion-expressive behavior may mediate the depression-related sympathovagal imbalance after cardiac surgery. Copyright © 2013 Elsevier B.V. All rights reserved.

Association Between Valvular Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Heart Failure

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Kiefer, Todd; Park, Lawrence; Tribouilloy, Christophe; Cortes, Claudia; Casillo, Roberta; Chu, Vivian; Delahaye, Francois; Durante-Mangoni, Emanuele; Edathodu, Jameela; Falces, Carlos; Logar, Mateja; Miró, José M.; Naber, Christophe; Tripodi, Marie Françoise; Murdoch, David R.; Moreillon, Philippe; Utili, Riccardo; Wang, Andrew

2016-01-01

Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described. Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome. Design, Setting, and Patients The International Collaboration on Endocarditis–Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006. Main Outcome Measures In-hospital and 1-year mortality. Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%–34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%–69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%–64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%–32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%–23.4%] vs 44.8% [95% CI, 40.4%–49.0%], respectively; Pendocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality. PMID:22110106

Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery.

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Mahle, William T; Nicolson, Susan C; Hollenbeck-Pringle, Danielle; Gaies, Michael G; Witte, Madolin K; Lee, Eva K; Goldsworthy, Michelle; Stark, Paul C; Burns, Kristin M; Scheurer, Mark A; Cooper, David S; Thiagarajan, Ravi; Sivarajan, V Ben; Colan, Steven D; Schamberger, Marcus S; Shekerdemian, Lara S

2016-10-01

To determine whether a collaborative learning strategy-derived clinical practice guideline can reduce the duration of endotracheal intubation following infant heart surgery. Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-clinical practice guideline implementation at the four sites participating in the collaborative (active sites) compared with data from five Pediatric Heart Network centers not participating in collaborative learning (control sites). Ten children's hospitals. Data were collected for infants following two-index operations: 1) repair of isolated coarctation of the aorta (birth to 365 d) and 2) repair of tetralogy of Fallot (29-365 d). There were 240 subjects eligible for the clinical practice guideline at active sites and 259 subjects at control sites. Development and application of early extubation clinical practice guideline. After clinical practice guideline implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p collaborative learning strategy designed clinical practice guideline significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation clinical practice guideline did not significantly change postoperative ICU length of stay.

Valvular Heart Disease.

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Mrsic, Zorana; Hopkins, Scott P; Antevil, Jared L; Mullenix, Philip S

2018-03-01

This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons. Published by Elsevier Inc.

RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow-Up.

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Meybohm, Patrick; Kohlhaas, Madeline; Stoppe, Christian; Gruenewald, Matthias; Renner, Jochen; Bein, Berthold; Albrecht, Martin; Cremer, Jochen; Coburn, Mark; Schaelte, Gereon; Boening, Andreas; Niemann, Bernd; Sander, Michael; Roesner, Jan; Kletzin, Frank; Mutlak, Haitham; Westphal, Sabine; Laufenberg-Feldmann, Rita; Ferner, Marion; Brandes, Ivo F; Bauer, Martin; Stehr, Sebastian N; Kortgen, Andreas; Wittmann, Maria; Baumgarten, Georg; Meyer-Treschan, Tanja; Kienbaum, Peter; Heringlake, Matthias; Schoen, Julika; Treskatsch, Sascha; Smul, Thorsten; Wolwender, Ewa; Schilling, Thomas; Fuernau, Georg; Bogatsch, Holger; Brosteanu, Oana; Hasenclever, Dirk; Zacharowski, Kai

2018-03-26

Remote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham-RIPC. In this follow-up paper, we present 1-year follow-up of the composite primary end point and its individual components (all-cause mortality, myocardial infarction, stroke and acute renal failure), in a sub-group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1-year composite primary end point (RIPC versus sham-RIPC 16.4% versus 16.9%) and its individual components (all-cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively. Similar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long-term outcome in cardiac surgery patients undergoing propofol anesthesia. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01067703. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Heart disease and depression

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... gov/ency/patientinstructions/000790.htm Heart disease and depression To use the sharing features on this page, ... a heart attack or heart surgery Signs of Depression It is pretty common to feel down or ...

An analysis of changes on plain chest films after open-heart surgery

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Choi, See Sung; Kim, Byung Chan; Won, Jong Jin [Wonkwang University College of Medicine, Seoul (Korea, Republic of)

1988-08-15

This retrospective study was performed to detect thoracic change on chest films after open-heart surgery. Authors reviewed total 160 cases who underbent median sternotomy from July 1984 to January 1988. The results were as follows: 1. Although all cases showed mediastinal widening by the mean 29.9% (SD 16.2), there was no case of reoperation due to excessive mediastinal hemorrhage. 2. Among 160 cases, 87 cases (54%) showed thoracic alterations after surgery. 3. Abnormal sternal findings were radiolucent vertical line in 15 cases (9%), sternal dehiscence in 4 cases (2%), sternal osteomyelitis in 4 cases (2%). 4. The types of pulmonary parenchymal lesions were 24 cases (15%) of atelectasis, 15 cases (9%) of pneumonia and 3 cases (2%) of pulmonary edema. 5. Pleural effusion was noted in 39 cases (24%). 6. Among the abnormal extra-alveolar air collections, there were pneumothorax in 10 cases (6%), pneumomediastinum and pneumopericardium in 29 cases (18%), and pneumoperitoneum in 5 cases (3%). 7. In 23 cases with phrenic nerve paralysis, the involved site was left in all and the associated pulmonary infiltration in left lower love was found in 82% (19/23). 8. 4 cases of cardiac tamponade developed 9 to 20 days after surgery ('late' form)

An analysis of changes on plain chest films after open-heart surgery

International Nuclear Information System (INIS)

Choi, See Sung; Kim, Byung Chan; Won, Jong Jin

1988-01-01

This retrospective study was performed to detect thoracic change on chest films after open-heart surgery. Authors reviewed total 160 cases who underbent median sternotomy from July 1984 to January 1988. The results were as follows: 1. Although all cases showed mediastinal widening by the mean 29.9% (SD 16.2), there was no case of reoperation due to excessive mediastinal hemorrhage. 2. Among 160 cases, 87 cases (54%) showed thoracic alterations after surgery. 3. Abnormal sternal findings were radiolucent vertical line in 15 cases (9%), sternal dehiscence in 4 cases (2%), sternal osteomyelitis in 4 cases (2%). 4. The types of pulmonary parenchymal lesions were 24 cases (15%) of atelectasis, 15 cases (9%) of pneumonia and 3 cases (2%) of pulmonary edema. 5. Pleural effusion was noted in 39 cases (24%). 6. Among the abnormal extra-alveolar air collections, there were pneumothorax in 10 cases (6%), pneumomediastinum and pneumopericardium in 29 cases (18%), and pneumoperitoneum in 5 cases (3%). 7. In 23 cases with phrenic nerve paralysis, the involved site was left in all and the associated pulmonary infiltration in left lower love was found in 82% (19/23). 8. 4 cases of cardiac tamponade developed 9 to 20 days after surgery ('late' form).

Levosimendan versus milrinone in neonates and infants after corrective open-heart surgery: a pilot study.

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Lechner, Evelyn; Hofer, Anna; Leitner-Peneder, Gabriele; Freynschlag, Roland; Mair, Rudolf; Weinzettel, Robert; Rehak, Peter; Gombotz, Hans

2012-09-01

Low cardiac output syndrome commonly complicates the postoperative course after open-heart surgery in children. To prevent low cardiac output syndrome, prophylactic administration of milrinone after cardiopulmonary bypass is commonly used in small children. The aim of this study was to compare the effect of prophylactically administered levosimendan and milrinone on cardiac index in neonates and infants after corrective open-heart surgery. Prospective, single-center, double-blind, randomized pilot study. Tertiary care center, postoperative pediatric cardiac intensive care unit. After written informed consent, 40 infants undergoing corrective open-heart surgery were included. At weaning from cardiopulmonary bypass, either a 24-hr infusion of 0.1 μg/kg/min levosimendan or of 0.5 μg/kg/min milrinone were administered. Cardiac output was evaluated at 2, 6, 9, 12, 18, 24, and 48 hrs after cardiopulmonary bypass using a transesophageal Doppler technique (Cardio-QP, Deltex Medical, Chichester, UK). Cardiac index was calculated from cardiac output and the patients' respective body surface area. Intention-to-treat data of 39 patients (19 in the levosimendan and 20 in the milrinone group) were analyzed using analysis of variance for repeated measurements for statistics. Analysis of variance revealed for both, cardiac index and cardiac output, similar results with no significant differences of the factors group and time. A significant interaction for cardiac output (p = .005) and cardiac index (p = .007) was found, which indicates different time courses of cardiac index in the two groups. Both drugs were well tolerated; no death or serious adverse event occurred. In our small study, postoperative cardiac index over time was similar in patients with prophylactically administered levosimendan and patients with prophylactically given milrinone. We observed an increase in cardiac output and cardiac index over time in the levosimendan group, whereas cardiac output and cardiac

Association between depression and heart rate variability in patients after cardiac surgery: a pilot study.

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Patron, Elisabetta; Messerotti Benvenuti, Simone; Favretto, Giuseppe; Valfrè, Carlo; Bonfà, Carlotta; Gasparotto, Renata; Palomba, Daniela

2012-07-01

Depression is a risk factor for cardiovascular diseases. Reduced heart rate variability (HRV), which reflects altered autonomic nervous system activity, has been suggested as one of the mechanisms linking depression to cardiovascular diseases. However, the relationship between depression and HRV has not yet been investigated in patients undergone cardiac surgery. Therefore, the main aim of this study was to examine whether postoperative depression could be related to reduced HRV. Eleven patients with depression and 22 patients without depression, who had undergone cardiac surgery, were enrolled postoperatively. In all patients, HRV was derived from a four-minute blood volume pulse recording at rest. Analyses of covariance and partial correlations, while controlling for anxiety, were used to examine the associations between postoperative depression and each HRV parameter. Compared to non-depressed patients, patients with depression showed significantly lower standard deviation of N-to-N intervals (SDNN) (p=.02), root mean square successive difference of N-to-N intervals (rMSSD) (p=.001), and high-frequency power (p=.002). Partial correlation analyses showed that depression was inversely related to SDNN (r=-.49, p=.005), rMSSD (r=-.58, p=.001), and high-frequency power (r=-.41, p=.02), whereas it was unrelated to other HRV parameters (p's>.09). The current findings extend the depression-reduced HRV relationship to the patients after cardiac surgery. Also, our study suggests that postoperative depression is more likely to be associated with reduced vagal modulation on the heart than with excessive sympathetic activity. Copyright © 2012 Elsevier Inc. All rights reserved.

Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

Directory of Open Access Journals (Sweden)

Youming Long

2014-01-01

Full Text Available Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9% patients were women. Fifteen (55.6% patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2, moyamoya disease (n = 1, and neuromyelitis optica (n = 1. We found positive associations between mRS (>3 and female gender (r = 0.873, P10 × 109/L (r = 0.722, P = 0.002, tumour size (r = 0.866, P0.05. Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

Effect of lavender essence inhalation on the level of anxiety and blood cortisol in candidates for open-heart surgery.

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Hosseini, SeyedAbedin; Heydari, Alemeh; Vakili, MohammadAli; Moghadam, Shahram; Tazyky, SadeghAli

2016-01-01

Surgery, as a treatment, is a stressful experience. The anxiety is more severe in open-heart surgery patients due to its risk and complications. The present study aimed to determine the effect of lavender essence on the levels of anxiety and blood cortisol in candidates for open-heart surgery. This was a single-blind clinical trial, a random allocation study with a control group conducted on 90 candidates for open-heart surgery in two groups of study and control. The study and control groups inhaled two drops of lavender and distilled water for 20 min, respectively. Spielberger questionnaire was filled by the patients. A 2 ml blood sample was taken to measure the cortisol level and patients' vital signs were recorded before and after intervention. Data were analyzed by chi-square in the form of mean, SD, and frequency distribution, independent t-test, paired t-test, and analysis of covariance (ANCOVA), with a significance level of P = 0.05 to modify the pre-test scores. Results showed a significant reduction in mean anxiety score from 56.73 (5.67) to 54.73 (5.42) after intervention in the study group, compared to the control group [1.11 (1.17)] (P < 0.001). There was also a higher difference in cortisol level in the study group compared to the control group [1.88 (0.56) vs. 0.42 (0.45)]. ANCOVA test showed that the 10.8% variance in anxiety score and 69.6% decrease in blood cortisol resulted from inhalation of lavender. Results showed the positive effect of lavender essence on anxiety and blood cortisol level among the patients. Aromatherapy with lavender is suggested to be considered as a nursing intervention in clinical settings.

A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery.

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Tabaja, Hussam; Hajar, Zeina; Kanj, Souha S

2017-10-01

Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.

Do neonatal mouse hearts regenerate following heart apex resection?

DEFF Research Database (Denmark)

Andersen, Ditte Caroline; Ganesalingam, Suganya; Jensen, Charlotte Harken

2014-01-01

The mammalian heart has generally been considered nonregenerative, but recent progress suggests that neonatal mouse hearts have a genuine capacity to regenerate following apex resection (AR). However, in this study, we performed AR or sham surgery on 400 neonatal mice from inbred and outbred...

Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital.

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Akhtar, Mohammad Irfan; Sharif, Hasanat; Hamid, Mohammad; Samad, Khalid; Khan, Fazal Hameed

2016-01-01

Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.

Mitral valve surgery - open

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... Taking warfarin (Coumadin) References Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... A.M. Editorial team. Heart Surgery Read more Heart Valve Diseases Read more Mitral Valve Prolapse Read more A. ...

Cardiac surgery in the parturient.

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Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

2009-03-01

Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

What Is a Pediatric Heart Surgeon?

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... Text Size Email Print Share What is a Pediatric Heart Surgeon? Page Content Article Body If your ... require heart surgery. What Kind of Training Do Pediatric Heart Surgeons Have? Pediatric heart surgeons are medical ...

Options for Heart Valve Replacement

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... Guide: Understanding Your Heart Valve Problem | Spanish Symptom Tracker | Spanish Pre-surgery Checklist | Spanish What Is Heart ... Cardiac Arrest: How Are They Different? 7 Warning Signs of a Heart Attack 8 Low Blood Pressure - ...

"Whoever increases his knowledge merely increases his heartache." Moral tensions in heart surgery patients' and their spouses' talk about information seeking. Discourse analysis, Social constructionism, Heart surgery, Information seeking

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Tuominen Kimmo

2004-01-01

Full Text Available The paper analyses accounts of information behaviour that are produced by 20 heart surgery patients and their spouses. It is shown that patients and their significant others have to act in a context in which health ideologies stressing self sufficiency and patient compliance play a strong role. Thus, the analysed accounts and narratives of information seeking reflect moral demands that ill persons and their significant others are facing in contemporary society. The author uses social constructionist discourse analysis to examine how the interviewees have to relate their descriptions of information practices to existing moral presuppositions on how rational individuals should behave.

MID TERM RESULTS AFTER OPEN HEART SURGERY IN HEMODIALYSIS PATIENTS AWAITING KIDNEY TRANSPLANT: DOES CARDIOVASCULAR SURGICAL INTERVENTION PRIOR TO TRANSPLANTATION PROLONG SURVIVAL?

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Ozbek, C; Sever, K; Demirhan, O; Mansuroglu, D; Kurtoglu, N; Ugurlucan, M; Sevmis, S; Karakayali, H

2015-12-01

The aim of this study was to compare the mid and long term postoperative outcomes between the hemodialysis-dependent patients awaiting kidney transplantat who underwent open heart surgery in our department during the last five years, and those who did not receive a renal transplant, to determine the predictors of mortality, and assess the possible contribution of post heart surgery kidney transplantation to survival. The patients were separated into two groups: those who underwent a transplantation after open heart surgery were included in the Tp+ group, and those who did not in the Tp- group Between June 2008 and December 2012, 127 dialysis dependent patients awaiting kidney transplant and who underwent open heart surgery were separated into two groups. Those who underwent transplantation after open heart surgery were determined as Tp+ (n=33), and those who did not as Tp- (n=94). Both groups were compared with respect to preoperative paramaters including age, sex, diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), obesity, smoking, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), left ventricle ejection fraction (EF), Euroscore; operative parameters including cross clamp time, perfusion time, number of grafts, use of internal mammary artery (IMA); postoperative parameters including revision, blood transfusion, ventilation time, use of inotropic agents, length of stay in the intensive care unit and hospital, and follow up findings. Problems encountered during follow up were recorded. Predictors of mortality were determined and the survival was calculated. Among the preoperative parameters, when compared with the Tp- group, the Tp+ group had significantly lower values in mean age, presence of DM, obesity, PVD, and Euroscore levels, and higher EF values. Assessment of postoperative values showed that blood transfusion requirement and length of hospital stay were significantly lower in the Tp+ group compared to the Tp

Efficacy of tranexamic acid as compared to aprotinin in open heart surgery in children

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Nagarajan Muthialu

2015-01-01

Full Text Available Background: Coagulopathy is a major issue in children undergoing high-risk pediatric cardiac surgery. Use of anti-fibrinolytics is well documented in adults, but recently there are questions raised about safety and effectiveness of their use on routine use. Tranexamic acid is a potent anti-fibrinolytic, but its role is not fully understood in children. This study aims to study the benefits tranexamic acid in controlling postoperative bleeding in pediatric cardiac surgical patients. Methods and Results: Fifty consecutive children who underwent cardiac surgery were randomized prospectively to receive either aprotinin (Group A; n = 24 or tranexamic acid (Group B; n = 26 from September 2009 to February 2010 were studied. Primary end points were early mortality, postoperative drainage, reoperation for bleeding and complications. Mean age and body weight was smaller in Group A (Age: 48.55 vs. 64.73 months; weight 10.75 vs. 14.80 kg respectively. Group A had more cyanotic heart disease than Group B (87.5% vs. 76.92%. Mean cardiopulmonary bypass time (144.33 vs. 84.34 min and aortic cross-clamp time (78.5 vs. 41.46 min were significantly higher in group A. While the blood and products usage was significantly higher in Group A, there was no difference in indexed postoperative drainage in first 4, 8 and 12 h and postoperative coagulation parameters. Mean C-reactive protein was less in Group A than B and renal dysfunction was seen more in Group A (25% vs. 7.6%. Mortality in Group A was 16.66% and 7.6% in Group B. Conclusion: Anti-fibrinolytics have a definitive role in high-risk children who undergo open-heart surgery. Tranexamic acid is as equally effective as aprotinin with no additional increase in morbidity or mortality. Ultramini Abstract: Coagulopathy has been a major issue in pediatric cardiac surgery, and anti-fibrinolytics have been used fairly regularly in various settings. This study aims to evaluate the efficacy of tranexamic acid as compared

[Heart surgery in Brazilian Indians].

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Gomes, W J; Carvalho, A C; Vieira Filho, J P; Souza, R B; Palma, J H; Maluf, M A; Branco, J N; Buffolo, E

1997-01-01

Our experience with surgical treatment of heart diseases in Indians living in the Amazon rain forest in primitive stages was reviewed. From 1988 to 1995, 18 patients underwent cardiovascular surgical procedures at the São Paulo Hospital of the Escola Paulista de Medicina. Seven patients had valvar disease, nine congenital heart defects, one submitral aneurysm and one arrhythmia. Thirteen Indians came from tribes of the Amazon rain forest area: three from the Xavante, two from Waiapi, two from Tucano, two from Macuxi, two from Mayoruna, and one of each tribe of Xikrin, Guajajara, Terena, Surui, Galibi, Cinta-Larga and Pataxó. We performed 22 operations, with two hospital deaths. Follow-up was possible in 87.5% of cases, with one late death. The majority of cases were due to congenital heart defects and in this series it was noted the absence of operations to treat coronary artery disease. The incidence of valve disease was higher in accultured or semi-accultured Indians. The surgical treatment of cardiovascular disease has made possible to the surviving indians to return to and be accepted by their fellow tribesmen.

Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

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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

Valvular Heart Disease in Heart Failure

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Giuseppe MC Rosano

2017-01-01

Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

The World Database for Pediatric and Congenital Heart Surgery: The Dawn of a New Era of Global Communication and Quality Improvement in Congenital Heart Disease.

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St Louis, James D; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Cervantes, Jorge; Tchervenkov, Christo I; Jacobs, Jeffery P; Sakamoto, Kisaburo; Stellin, Giovanni; Kirklin, James K

2017-09-01

The World Society for Pediatric and Congenital Heart Surgery was founded with the mission to "promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with an emphasis on excellence in teaching, research, and community service." Early on, the Society's members realized that a crucial step in meeting this goal was to establish a global database that would collect vital information, allowing cardiac surgical centers worldwide to benchmark their outcomes and improve the quality of congenital heart disease care. With tireless efforts from all corners of the globe and utilizing the vast experience and invaluable input of multiple international experts, such a platform of global information exchange was created: The World Database for Pediatric and Congenital Heart Disease went live on January 1, 2017. This database has been thoughtfully designed to produce meaningful performance and quality analyses of surgical outcomes extending beyond immediate hospital survival, allowing capture of important morbidities and mortalities for up to 1 year postoperatively. In order to advance the societal mission, this quality improvement program is available free of charge to WSPCHS members. In establishing the World Database, the Society has taken an essential step to further the process of global improvement in care for children with congenital heart disease.

Smoking and surgery

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Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

Outcome of cardiac surgery in patients with congenital heart disease in England between 1997 and 2015.

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Aleksander Kempny

Full Text Available The number of patients with congenital heart disease (CHD is increasing worldwide and most of them will require cardiac surgery, once or more, during their lifetime. The total volume of cardiac surgery in CHD patients at a national level and the associated mortality and predictors of death associated with surgery are not known. We aimed to investigate the surgical volume and associated mortality in CHD patients in England.Using a national hospital episode statistics database, we identified all CHD patients undergoing cardiac surgery in England between 1997 and 2015.We evaluated 57,293 patients (median age 11.9years, 46.7% being adult, 56.7% female. There was a linear increase in the number of operations performed per year from 1,717 in 1997 to 5,299 performed in 2014. The most common intervention at the last surgical event was an aortic valve procedure (9,276; 16.2%, followed by repair of atrial septal defect (9,154; 16.0%, ventricular septal defect (7,746; 13.5%, tetralogy of Fallot (3,523; 6.1% and atrioventricular septal defect (3,330; 5.8% repair. Associated mortality remained raised up to six months following cardiac surgery. Several parameters were predictive of post-operative mortality, including age, complexity of surgery, need for emergency surgery and socioeconomic status. The relationship of age with mortality was "U"-shaped, and mortality was highest amongst youngest children and adults above 60 years of age.The number of cardiac operations performed in CHD patients in England has been increasing, particularly in adults. Mortality remains raised up to 6-months after surgery and was highest amongst young children and seniors.

Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

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Kim JW

2016-04-01

Full Text Available Jong Wan Kim,1 Jeong Yeon Kim,1 Byung Mo Kang,2 Bong Hwa Lee,3 Byung Chun Kim,4 Jun Ho Park5 1Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, 2Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, 3Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, 4Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea Purpose: The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer.Patients and methods: We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery.Results: Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001, but the time to soft food intake (6.0 vs 6.6 days, P=0.036 and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018 were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001. The 5-year overall survival (90.8% vs 88.6%, P=0.540 and disease-free survival (86.1% vs 78.9%, P=0.201 rates were similar in both groups.Conclusion: The present study showed that laparoscopic surgery is associated

Association of β-Blocker Therapy With Risks of Adverse Cardiovascular Events and Deaths in Patients With Ischemic Heart Disease Undergoing Noncardiac Surgery

DEFF Research Database (Denmark)

Andersson, Charlotte; Mérie, Charlotte; Jørgensen, Mads Wissenberg

2014-01-01

IMPORTANCE: Clinical guidelines have been criticized for encouraging the use of β-blockers in noncardiac surgery despite weak evidence. Relevant clinical trials have been small and have not convincingly demonstrated an effect of β-blockers on hard end points (ie, perioperative myocardial infarction......, ischemic stroke, cardiovascular death, and all-cause death). OBJECTIVE: To assess the association of β-blocker treatment with major cardiovascular adverse events (MACE) and all-cause mortality in patients with ischemic heart disease undergoing noncardiac surgery. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE...... to calculate the 30-day risks of MACE (ischemic stroke, myocardial infarction, or cardiovascular death) and all-cause mortality associated with β-blocker therapy. MAIN OUTCOMES AND MEASURES: Thirty-day risk of MACE and all-cause mortality. RESULTS: Of 28,263 patients with ischemic heart disease undergoing...

Congenital heart defect corrective surgeries

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... make it bigger with a patch made of Gore-tex, a man-made (synthetic) material. Another way ... 434. Bhatt AB, Foster E, Kuehl K, et al; American Heart Association Council on Clinical Cardiology. Congenital ...

Long-Term Adjustment after Surviving Open Heart Surgery: The Effect of Using Prayer for Coping Replicated in a Prospective Design

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Ai, A. L.; Ladd, K. L.; Peterson, C.; Cook, C. A.; Shearer, M.; Koenig, H. G.

2010-01-01

Purpose: Despite the growing evidence for effects of religious factors on cardiac health in general populations, findings are not always consistent in sicker and older populations. We previously demonstrated that short-term negative outcomes (depression and anxiety) among older adults following open heart surgery are partially alleviated when…

A naïve Bayes classifier for planning transfusion requirements in heart surgery.

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Cevenini, Gabriele; Barbini, Emanuela; Massai, Maria R; Barbini, Paolo

2013-02-01

Transfusion of allogeneic blood products is a key issue in cardiac surgery. Although blood conservation and standard transfusion guidelines have been published by different medical groups, actual transfusion practices after cardiac surgery vary widely among institutions. Models can be a useful support for decision making and may reduce the total cost of care. The objective of this study was to propose and evaluate a procedure to develop a simple locally customized decision-support system. We analysed 3182 consecutive patients undergoing cardiac surgery at the University Hospital of Siena, Italy. Univariate statistical tests were performed to identify a set of preoperative and intraoperative variables as likely independent features for planning transfusion quantities. These features were utilized to design a naïve Bayes classifier. Model performance was evaluated using the leave-one-out cross-validation approach. All computations were done using spss and matlab code. The overall correct classification percentage was not particularly high if several classes of patients were to be identified. Model performance improved appreciably when the patient sample was divided into two classes (transfused and non-transfused patients). In this case the naïve Bayes model correctly classified about three quarters of patients with 71.2% sensitivity and 78.4% specificity, thus providing useful information for recognizing patients with transfusion requirements in the specific scenario considered. Although the classifier is customized to a particular setting and cannot be generalized to other scenarios, the simplicity of its development and the results obtained make it a promising approach for designing a simple model for different heart surgery centres needing a customized decision-support system for planning transfusion requirements in intensive care unit. © 2011 Blackwell Publishing Ltd.

NORMOTHERMIA FOR PEDIATRIC AND CONGENITAL HEART SURGERY: AN EXPANDED HORIZON

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Ahmad Mahir eShamsuddin

2015-04-01

Full Text Available Cardiopulmonary bypass (CPB in pediatric cardiac surgery is generally performed with hypothermia, flow reduction and hemodilution. From 10/2013 to 12/2014 55 patients, median age 6 years (range 2 months to 52 years, median weight 18.5kg (range 3.2 to 57 kg, underwent surgery with normothermic high flow CPB in a new unit.There were no early or late deaths. Fifty patients (90.9% were extubated within 3 hrs, 3 (5.5% within 24 hrs and 2 (3.6% within 48 hrs. Twentyfour patients (43.6% didn’t require inotropic support, 31 (56.4% received dopamine or dobutamine: 21 ≤5 mcg/kg/min, 8 5-10 mcg/kg/min, and 2 >10 mcg/kg/min. Two patients (6.5% required noradrenaline 0.05-0.1 mcg/kg/min.On arrival to ICU and after 3 and 6 hrs and 8:00 am the next morning, mean lactate levels were 1.9±09, 2.0±1.2, 1.6±0.8 and 1.4±0.7 mmol/L (0.6-5.2 mmol/L respectively. From arrival to ICU to 8:00 am the next morning mean urine output was 3.8±1.5 mL/kg/hr (0.7-7.6 mL/kg/hr, and mean chest drainage was 0.6±0.5 mL/kg/hr (0.1-2.3 mL/kg/hr. Mean ICU and hospital stay were 2.7±1.4 days (2-8 days and 7.2±2.2 days (4-15 days respectively. In conclusion, normothermic high flow CPB allows pediatric and congenital heart surgery with favorable outcomes even in a new unit. The immediate post-operative period is characterized by low requirement for inotropic and respiratory support, low lactate production, adequate urine output, minimal drainage from the chest drains, shorter ICU and hospital stay.

Cyanotic congenital heart disease and atherosclerosis

DEFF Research Database (Denmark)

Tarp, Julie Bjerre; Jensen, Annette Schophuus; Engstrøm, Thomas

2017-01-01

Improved treatment options in paediatric cardiology and congenital heart surgery have resulted in an ageing population of patients with cyanotic congenital heart disease (CCHD). The risk of acquired heart disease such as atherosclerosis increases with age.Previous studies have speculated whether...

Extracorporeal total artificial heart as bailout surgery.

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Perrodin, Stéphanie F; Muller, Olivier; Gronchi, Fabrizio; Liaudet, Lucas; Hullin, Roger; Kirsch, Matthias

2017-03-01

We report the use of a total extracorporeal heart for uncontrolled bleeding following a proximal left anterior descending artery perforation, using two centrifugal ventricular assist devices after heart explantation. The literature describing similar techniques and patient outcomes for this "bailout" technique are reviewed. © 2017 Wiley Periodicals, Inc.

Changes of the serum antibiotic levels during open heart surgery (ceftazidim, ciprofloxacin, clindamycin).

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Lonský, V; Dominik, J; Mand'ák, J; Pozlerová, E; Hejzlar, M; Lonská, V; Marsíková, M; Kubícek, J; Snítilová, M

2000-01-01

Wound, mediastinal and intracardiac infections are still very serious complications of open-heart surgery. The incidence of it is still in the range of 0.4%-5%. The aims of our study were to assess the adequacy of regimen using ceftazidim (CTZ), ciprofloxacin (CPF) and clindamycin (CLIN) as prophylactic antibiotics and to verify whether cardiopulmonary bypass (CPB) can modify the time of antibiotic serum concentrations. That is why the serum levels of them were measured during open heart procedures. The prospective study comprised 75 consequent coronary patients randomized in to three groups receiving 1 g of CTZ or 400 mg of CPF or 900 mg of CLIN i.v. with anesthesia induction. Routine coronary surgery with left internal mammary artery harvesting, moderate body hypothermic (30 degrees C) CPB with crystaloid cardioplegia was performed. Serum antibiotic levels were determined before application, with skin incision, prior CPB induction, after cardioplegia infusion, every 20 minutes of CPB, prior end of CPB, in time of chest closure. Conventional cylinder-plate microbiological assay was used for antibiotic level measurement. All serum antibiotic concentrations showed a sharp decrease immediately after starting CPB and lasted until CPB ended. After initiating of CPB after cardioplegia administration serum concentrations of CTZ (105 min after initial dose) decreased by, on average 55%, CPF (97 min) by 42% and CLIN (116 min) by 78%. CPB can modify the time course of antibiotic serum concentrations. The serum levels of CTZ at the end of the longest procedures were found to be below the MICs for some of the suspected pathogens. We recommend to use higher antibiotic doses for prophylaxis and to administer the second dose with protamin sulphate to obtain maximum concentration in newly formed blood clots.

Pilot study of association of catechol-O-methyl transferase rs4680 genotypes with acute kidney injury and tubular stress after open heart surgery.

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Albert, Christian; Kube, Johanna; Haase-Fielitz, Anja; Dittrich, Annemarie; Schanze, Denny; Zenker, Martin; Kuppe, Hermann; Hetzer, Roland; Bellomo, Rinaldo; Mertens, Peter R; Haase, Michael

2014-01-01

To assess the association of genetic variants of catecholamine-O-methyltransferase (COMT) genotypes with acute kidney injury (AKI) and tubular stress after open heart surgery. We genotyped 195 patients for the COMT-Val158Met polymorphism and measured creatinine, neutrophil gelatinase-associated lipocalin and midkine. We analyzed the association between such polymorphisms and these kidney-related variables. Nonsignificantly more COMT LL patients developed RIFLE-AKI compared with non-LL patients (p = 0.11). Compared with HL and HH patients, LL patients who developed AKI had lower increases in serum creatinine. COMT LL patients had less pronounced release of tubular stress biomarkers (neutrophil gelatinase-associated lipocalin: p = 0.045, midkine: p = 0.072). COMT genotype may associate with different patterns of renal functional changes and tubular stress biomarker release response after open heart surgery.

Circulating microparticles from patients with valvular heart disease and cardiac surgery inhibit endothelium-dependent vasodilation.

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Fu, Li; Hu, Xiao-Xia; Lin, Ze-Bang; Chang, Feng-Jun; Ou, Zhi-Jun; Wang, Zhi-Ping; Ou, Jing-Song

2015-09-01

Vascular function is very important for maintaining circulation after cardiac surgery. Circulating microparticles (MPs) generated in various diseases play important roles in causing inflammation, coagulation, and vascular injury. However, the impact of MPs generated from patients who have valvular heart disease (VHD), before and after cardiac surgery, on vascular function remains unknown. This study is designed to investigate the impact of such MPs on vasodilation. Microparticles were isolated from age-matched healthy subjects and patients who had VHD, before cardiac surgery, and at 12 hours and 72 hours afterward. The number of MPs was measured and compared. Effects evaluated were of the impact of MPs on: vasodilation of mice aorta; the phosphorylation and expression of Akt, endothelial nitric oxide synthase (eNOS), protein kinase C-βII (PKC-βII), and p70 ribosomal protein S6 kinase (p70S6K); expression of caveolin-1; the association of eNOS with heat shock protein 90 (HSP90); and generation of nitric oxide and superoxide anion of human umbilical vein endothelial cells. Compared with the healthy subjects, VHD patients had significantly higher levels of circulating MPs and those MPs before cardiac surgery can: impair endothelium-dependent vasodilation; inhibit phosphorylation of Akt and eNOS; increase activation of PKC-βII and p70S6K; enhance expression of caveolin-1; reduce the association of HSP90 with eNOS; decrease nitric oxide production, and increase superoxide anion generation. These deleterious effects were even stronger in postoperative MPs. Our data demonstrate that MPs generated from VHD patients before and after cardiac surgery contributed to endothelial dysfunction, by uncoupling and inhibiting eNOS. Circulating MPs are potential therapeutic targets for the maintenance of vascular function postoperatively. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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.

The Danish Heart Registry

DEFF Research Database (Denmark)

Özcan, Cengiz; Juel, Knud; Lassen, Jens Flensted

2016-01-01

AIM: The Danish Heart Registry (DHR) seeks to monitor nationwide activity and quality of invasive diagnostic and treatment strategies in patients with ischemic heart disease as well as valvular heart disease and to provide data for research. STUDY POPULATION: All adult (≥15 years) patients...... undergoing coronary angiography (CAG), percutaneous coronary intervention (PCI), coronary artery bypass grafting, and heart valve surgery performed across all Danish hospitals were included. MAIN VARIABLES: The DHR contains a subset of the data stored in the Eastern and Western Denmark Heart Registries (EDHR...

Infant temperament and parental stress in 3-month-old infants after surgery for complex congenital heart disease.

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Torowicz, Deborah; Irving, Sharon Y; Hanlon, Alexandra L; Sumpter, Danica F; Medoff-Cooper, Barbara

2010-04-01

This study aimed to identify and compare differences in temperament and maternal stress between infants with complex congenital heart disease and healthy controls at 3 months of age. Study sample was drawn from an existing longitudinal study examining growth in infants with congenital heart disease when compared with healthy controls. Infant temperament and parental stress were measured in 129 mother-infant dyads. Inclusion criteria for infants with congenital heart disease were > or = 36-week postmenstrual age, > or = 2500 g at birth, surgery in first 6 weeks of life, and no major congenital anomalies or genetic syndromes. The Early Infancy Temperament Questionnaire and Parent Stress Index were the assessment tools used. Infants with single ventricular (SV) physiology were more negative in mood (F = 7.14, p parenting an irritable infant with SV physiology put these mothers at risk for high levels of stress. Results suggest the need for predischarge anticipatory guidance for parents to better understand and respond to the behavioral style of their infants, in particular, infants with SV physiology.

School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy.

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Mulkey, Sarah B; Bai, Shasha; Luo, Chunqiao; Cleavenger, Jordyn E; Gibson, Neal; Holland, Greg; Mosley, Bridget S; Kaiser, Jeffrey R; Bhutta, Adnan T

2016-11-01

To evaluate test proficiency and the receipt of special education services in school-age children who had undergone surgery for congenital heart disease (CHD) at age Education longitudinal database containing achievement test scores in literacy and mathematics for grades 3-4 and special education codes. The primary negative outcome was not achieving grade-level proficiency on achievement tests. Logistic regression accounting for repeated measures was used to evaluate for associations between achieving proficiency and demographic data, maternal education, and clinical factors. A total of 362 of 458 (79%) children who underwent surgery for CHD were matched to the Arkansas Department of Education database, 285 of whom had grade 3 and/or 4 achievement tests scores. Fewer students with CHD achieved proficiency in literacy and mathematics (P education predicted proficiency in literacy (P special education services (26.9% vs 11.6%; P special education services than all state students. Results from this study support the need for neurodevelopmental evaluations as standard practice in children with CHD. Copyright © 2016 Elsevier Inc. All rights reserved.

Iatrogenic nerve injuries during shoulder surgery.

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Carofino, Bradley C; Brogan, David M; Kircher, Michelle F; Elhassan, Bassem T; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

2013-09-18

The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery. A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome. The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus. Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery.

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Kruse, Tamara; Wahl, Sharon; Guthrie, Patricia Finch; Sendelbach, Sue

2017-08-01

Traditionally chest tubes are set to -20 cm H 2 O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H 1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes. ©2017 American Association of Critical-Care Nurses.

Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectocardiography

International Nuclear Information System (INIS)

Lowenthal, I.S.; Parisi, A.F.; Tow, D.E.; Barsamian, E.M.; Sasahara, A.A.; McCaughan, D.; Clemson, H.C.

1977-01-01

In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery

Surgical Treatment of the Giant Leiyomyoma of the Esophagus After Fifteen Years

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Mehmet Bilgin

2015-11-01

Full Text Available Leiyomyomas are benign intramural tumors of esophagus which are rarely seen. Nearly half of the patients are asymptomatic because leiyomyomas grow slowly and intramural. Dysphagia and retrosternal pain are the most common symptoms.Osephagus leiyomyomas may appear as mediastinal mass in chest radiography and may be recognised by coincidence. It is known that they are solitary, round or oval, and their diameter may reach 15-17cm size. When it grows up to the giant diamaters, surgery is the choice of treatment. Because tumors covering distal part of esophagus and cardia are ulcerated and adhesive to mucosa resection, esophagogastric anasthomosis may be required. We are presenting the clinical and radiologic findings of this giant leiyoma case who did not accept surgical treatment fifteen years ago, and whose leiomyoma reached up to a big diamater.

Combined usage of inhaled and intravenous milrinone in pulmonary hypertension after heart valve surgery.

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Carev, Mladen; Bulat, Cristijan; Karanović, Nenad; Lojpur, Mihajlo; Jercić, Antonio; Nenadić, Denis; Marovih, Zlatko; Husedzinović, Ino; Letica, Dalibor

2010-09-01

Secondary pulmonary hypertension is a frequent condition after heart valve surgery. It may significantly complicate the perioperative management and increase patients' morbidity and mortality. The treatment has not been yet completely defined principally because of lack of the selectivity of drugs for the pulmonary vasculature. The usage of inhaled milrinone could be the possible therapeutic option. Inodilator milrinone is commonly used intravenously for patients with pulmonary hypertension and ventricular dysfunction in cardiac surgery. The decrease in systemic vascular resistance frequently necessitates concomitant use of norepinephrine. Pulmonary vasodilators might be more effective and also devoid of potentially dangerous systemic side effects if applied by inhalation, thus acting predominantly on pulmonary circulation. There are only few reports of inhaled milrinone usage in adult post cardiac surgical patients. We reported 2 patients with severe pulmonary hypertension after valve surgery. Because of desperate clinical situation, we decided to use the combination of inhaled and intravenous milrinone. Inhaled milrinone was delivered by means of pneumatic medication nebulizer dissolved with saline in final concentration of 0.5 mg/ml. The nebulizer was attached to the inspiratory limb of the ventilator circuit, just before the Y-piece. We obtained satisfactory reduction in mean pulmonary artery pressure in both patients, and they were successfully extubated and discharged. Although it is a very small sample of patients, we conclude that the combination of inhaled and intravenous milrinone could be an effective treatment of secondary pulmonary hypertension in high-risk cardiac valve surgery patient. The exact indications for inhaled milrinone usage, optimal concentrations for this route, and the beginning and duration of treatment are yet to be determined.

Physiological and performance adaptations to an in-season soccer camp in the heat: Associations with heart rate and heart rate variability

DEFF Research Database (Denmark)

Buchheit, M; Voss, S C; Nybo, Lars

2011-01-01

The aim of the present study was to examine the associations between adaptive responses to an in-season soccer training camp in the heat and changes in submaximal exercising heart rate (HRex, 5-min run at 9 ¿km/h), postexercise HR recovery (HRR) and HR variability (HRV). Fifteen well-trained but ......The aim of the present study was to examine the associations between adaptive responses to an in-season soccer training camp in the heat and changes in submaximal exercising heart rate (HRex, 5-min run at 9 ¿km/h), postexercise HR recovery (HRR) and HR variability (HRV). Fifteen well......-trained but non-heat-acclimatized male adult players performed a training week in Qatar (34.6¿±¿1.9°C wet bulb globe temperature). HRex, HRR, HRV (i.e. the standard deviation of instantaneous beat-to-beat R-R interval variability measured from Poincaré plots SD1, a vagal-related index), creatine kinase (CK...... at the beginning and at the end of the training week. Throughout the intervention, HRex and HRV showed decreasing (P¿...

EEG data during open heart surgery. Their automatic analysis related to anesthetic parameters and its use in peroperative monitoring of cerebral function

NARCIS (Netherlands)

Simons, A.J.R.; Pronk, R.A.F.

1982-01-01

It is generally agreed upon by experts that EEG monitoring of brain function during open heart surgery is of the utmost importance in preventing postoperative neurological and psychopathological consequences. Up to now, however, this monitoring has not been performed on a large scale: (1) it is a

Prediction of inspired oxygen fraction for targeted arterial oxygen tension following open heart surgery in non-smoking and smoking patients.

Science.gov (United States)

Bou-Khalil, Pierre; Zeineldine, Salah; Chatburn, Robert; Ayyoub, Chakib; Elkhatib, Farouk; Bou-Akl, Imad; El-Khatib, Mohamad

2017-10-01

Simple and accurate expressions describing the P a O 2 -F i O 2 relationship in mechanically ventilated patients are lacking. The current study aims to validate a novel mathematical expression for accurate prediction of the fraction of inspired oxygen that will result in a targeted arterial oxygen tension in non-smoking and smoking patients receiving mechanical ventilation following open heart surgeries. One hundred P a O 2 -F i O 2 data pairs were obtained from 25 non-smoking patients mechanically ventilated following open heart surgeries. One data pair was collected at each of F i O 2 of 40, 60, 80, and 100% while maintaining same mechanical ventilation support settings. Similarly, another 100 hundred P a O 2 -F i O 2 data pairs were obtained from 25 smoking patients mechanically ventilated following open heart surgeries. The utility of the new mathematical expression in accurately describing the P a O 2 -F i O 2 relationship in these patients was assessed by the regression and Bland-Altman analyses. Significant correlations were seen between the true and estimated F i O 2 values in non-smoking (r 2  = 0.9424; p < 0.05) and smoking (r 2  = 0.9466; p < 0.05) patients. Tight biases between the true and estimated F i O 2 values for non-smoking (3.1%) and smoking (4.1%) patients were observed. Also, significant correlations were seen between the true and estimated P a O 2 /F i O 2 ratios in non-smoking (r 2  = 0.9530; p < 0.05) and smoking (r 2  = 0.9675; p < 0.05) patients. Tight biases between the true and estimated P a O 2 /F i O 2 ratios for non-smoking (-18 mmHg) and smoking (-16 mmHg) patients were also observed. The new mathematical expression for the description of the P a O 2 -F i O 2 relationship is valid and accurate in non-smoking and smoking patients who are receiving mechanical ventilation for post cardiac surgery.

Comorbid Conditions in Neonates With Congenital Heart Disease.

Science.gov (United States)

Krishnamurthy, Ganga; Ratner, Veniamin; Bacha, Emile; Aspelund, Gudrun

2016-08-01

The objectives of this review are to discuss the pathophysiology, clinical impact and treatment of major noncardiac anomalies, and prematurity in infants with congenital heart disease. MEDLINE and PubMed. Mortality risk is significantly higher in patients with congenital heart disease and associated anomalies compared with those in whom the heart defect occurs in isolation. Although most noncardiac structural anomalies do not require surgery in the neonatal period, several require surgery for survival. Management of such infants poses multiple challenges. Premature infants with congenital heart disease face challenges imposed by their immature organ systems, which are susceptible to injury or altered function by congenital heart disease and abnormal circulatory physiology independent of congenital heart disease. For optimal outcomes in premature infants or in infants with multiple congenital anomalies, a collaborative interdisciplinary approach is necessary.

Winning Hearts and Minds: Inspiring Medical Students into Cardiothoracic Surgery Through Highly Interactive Workshops.

Science.gov (United States)

George, Joseph; Combellack, Tom; Lopez-Marco, Ana; Aslam, Umair; Ahmed, Yasir; Nanjaiah, Prakash; Youhana, Aprim; Kumar, Pankaj

The cardiothoracic surgical (CTS) specialty has witnessed a decline in the applicant pool. Early exposure, positive experiences, inspiring role models, and career insight are key in the decision-making process for specialty choice. Our objective was to assess the effect of high tutor:student ratio interactive CTS workshops in influencing the career choice of UK undergraduate medical students. Medical students attended a workshop comprising (1) guided dissection of fresh animal hearts, (2) surgical skills practice on models and fresh hearts, (3) operative videos (adult, congenital, transplant, and aortic) with interactive commentary, and (4) careers seminar. The tutor:student ratio was very high (between 3-1 and 5-1). A questionnaire was completed at the end of each workshop to assess its effect, including a 10-point Likert scale on the perceived attraction to CTS before and after the workshop. A total of 96 delegates attended 5 workshops in 3 UK medical schools. Response rate was 83% from 80 undergraduate students. In all, 58% were male (46/80). There was an equal proportion of sexes in the early years of medical school, but was significantly skewed toward male in the later years. There was a statistically significant increase of 2.1 (standard deviation [SD] = 1.5) in the Likert scores before (μ = 5.0, SD = 2.1) and after (μ = 7.1, SD = 1.9) (p = 0.001). This represents a 42% increase in the perceived attraction to the CTS specialty because of the workshops. Our workshops have a significant effect in stimulating undergraduate medical students toward a career in cardiothoracic surgery. We encourage national take-up of these easily organized daylong workshops to foster interest in the next generation of cardiothoracic surgeons. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Adverse cardiac events in children with Williams syndrome undergoing cardiovascular surgery: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

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Hornik, Christoph P; Collins, Ronnie Thomas; Jaquiss, Robert D B; Jacobs, Jeffrey P; Jacobs, Marshall L; Pasquali, Sara K; Wallace, Amelia S; Hill, Kevin D

2015-06-01

Patients with Williams syndrome (WS) undergoing cardiac surgery are at risk for major adverse cardiac events (MACE). Prevalence and risk factors for such events have not been well described. We sought to define frequency and risk of MACE in patients with WS using a multicenter clinical registry. We identified cardiac operations performed in patients with WS using the Society of Thoracic Surgeons Congenital Heart Surgery Database (2000-2012). Operations were divided into 4 groups: isolated supravalvular aortic stenosis, complex left ventricular outflow tract (LVOT), isolated right ventricular outflow tract (RVOT), and combined LVOT/RVOT procedures. The proportion of patients with MACE (in-hospital mortality, cardiac arrest, or postoperative mechanical circulatory support) was described and the association with preoperative factors was examined. Of 447 index operations (87 centers), median (interquartile range) age and weight at surgery were 2.4 years (0.6-7.4 years) and 10.6 kg (6.5-21.5 kg), respectively. Mortality occurred in 20 patients (5%). MACE occurred in 41 patients (9%), most commonly after combined LVOT/RVOT (18 out of 87; 21%) and complex LVOT (12 out of 131; 9%) procedures, but not after isolated RVOT procedures. Odds of MACE decreased with age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), weight (OR, 0.97; 95% CI, 0.93-0.99), but increased in the presence of any preoperative risk factor (OR, 2.08; 95% CI, 1.06-4.00), and in procedures involving coronary artery repair (OR, 5.37; 95% CI, 2.05-14.06). In this multicenter analysis, MACE occurred in 9% of patients with WS undergoing cardiac surgery. Demographic and operative characteristics were associated with risk. Further study is needed to elucidate mechanisms of MACE in this high-risk population. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery.

Science.gov (United States)

Abelha, Fernando José; Fernandes, Vera; Botelho, Miguela; Santos, Patricia; Santos, Alice; Machado, J C; Barros, Henrique

2012-02-01

BACKGROUND: A relationship between patients with a genetic predisposition to and those who develop postoperative delirium has not been yet determined. The aim of this study was to determine whether there is an association between apolipoprotein E epsilon 4 allele (APOE4) and delirium after major surgery. METHODS: Of 230 intensive care patients admitted to the post anesthesia care unit (PACU) over a period of 3 months, 173 were enrolled in the study. Patients' demographics and intra- and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist, and DNA was obtained at PACU admission to determine apolipoprotein E genotype. RESULTS: Fifteen percent of patients developed delirium after surgery. Twenty-four patients had one copy of APOE4. The presence of APOE4 was not associated with an increased risk of early postoperative delirium (4% vs. 17%; P = 0.088). The presence of APOE4 was not associated with differences in any studied variables. Multivariate analysis identified age [odds ratio (OR) 9.3, 95% confidence interval (CI) 2.0-43.0, P = 0.004 for age ≥65 years), congestive heart disease (OR 6.2, 95% CI 2.0-19.3, P = 0.002), and emergency surgery (OR 59.7, 95% CI 6.7-530.5, P < 0.001) as independent predictors for development of delirium. The Simplified Acute Physiology Score II (SAPS II) and The Acute Physiology and Chronic Health Evaluation II (APACHE II) were significantly higher in patients with delirium (P < 0.001 and 0.008, respectively). Hospital mortality rates of these patients was higher and they had a longer median PACU stay. CONCLUSIONS: Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery.

2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

Science.gov (United States)

Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

2014-03-01

This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status.

Science.gov (United States)

Yüksel, Volkan; Gorgulu, Yasemin; Cinar, Rugul Kose; Huseyin, Serhat; Sonmez, Mehmet Bulent; Canbaz, Suat

2016-01-01

The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1) and those diagnosed without acute coronary syndrome (Group 2). Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

Impact of Experiencing Acute Coronary Syndrome Prior to Open Heart Surgery on Psychiatric Status

Directory of Open Access Journals (Sweden)

Volkan Yüksel

Full Text Available Abstract Objective: The incidence of depression and anxiety is higher in patients with acute coronary syndrome. The aim of this study is to determine whether experiencing acute coronary syndrome prior to open heart surgery affects patients in terms of depression, hopelessness, anxiety, fear of death and quality of life. Methods: The study included 63 patients who underwent coronary bypass surgery between January 2015 and January 2016. The patients were divided into two groups: those diagnosed after acute coronary syndrome (Group 1 and those diagnosed without acute coronary syndrome (Group 2. Beck depression scale, Beck hopelessness scale, Templer death anxiety scale and death depression scale, State-Trait anxiety inventory and WHOQOL-Bref quality of life scale were applied. Results: There was no significant difference between the two groups in terms of the total score obtained from Beck depression scale, Beck hopelessness scale - future-related emotions, loss of motivation, future-related expectations subgroups, death anxiety scale, the death depression scale, State-Trait Anxiety Inventory - social and environmental subgroups. The mental quality of life sub-scores of group 2 were significantly higher. The patients in both groups were found to be depressed and hopeless about the future. Anxiety levels were found to be significantly higher in all of the patients in both groups. Conclusion: Acute coronary syndrome before coronary artery bypass surgery impairs more the quality of life in mental terms. But unexpectedly there are no differences in terms of depression, hopelessness, anxiety and fear of death.

[The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery].

Science.gov (United States)

Baysal, Ayse; Saşmazel, Ahmet; Yildirim, Ayse; Ozyaprak, Buket; Gundogus, Narin; Kocak, Tuncer

2014-01-01

In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension. In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72h, (2) intensive care unit stay >7days, and (3) mortality. The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n=35, n=16, respectively) showed significant differences in repeated measurement time points (p=0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5pgmL-1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r=0.67, p=0.0001). In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5pgmL-1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome. Copyright © 2013 Sociedade

The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery

Directory of Open Access Journals (Sweden)

Ayse Baysal

2014-09-01

Full Text Available Background and objectives: In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension. Methods: In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48 h after operation. The patients enrolled into the study were divided into two groups depending on: (1 Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2 Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1 duration of mechanical ventilation ≥72 h, (2 intensive care unit stay >7days, and (3 mortality. Results: The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n = 35, n = 16, respectively showed significant differences in repeated measurement time points (p = 0.0001. The preoperative brain natriuretic peptide cut-off value of 125.5 pg mL−1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r = 0.67, p = 0.0001. Conclusions: In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5 pg mL−1 are at risk of developing low cardiac

Validation of the Seattle Heart Failure Model (SHFM) in Heart Failure Population

International Nuclear Information System (INIS)

Hussain, S.; Kayani, A.M.; Munir, R.

2014-01-01

Objective: To determine the effectiveness of Seattle Heart Failure Model (SHFM) in a Pakistani systolic heart failure cohort in predicting mortality in this population. Study Design: Cohort study. Place and Duration of Study: The Armed Forces Institute of Cardiology - National Institute of Heart Diseases, Rawalpindi, from March 2011 to March 2012. Methodology: One hundred and eighteen patients with heart failure (HF) from the registry were followed for one year. Their 1-year mortality was calculated using the SHFM software on their enrollment into the registry. After 1-year predicted 1-year mortality was compared with the actual 1-year mortality of these patients. Results: The mean age was 41.6 +- 14.9 years (16 - 78 years). There were 73.7% males and 26.3% females. One hundred and fifteen patients were in NYHA class III or IV. Mean ejection fraction in these patients was 23 +- 9.3%. Mean brain natriuretic peptide levels were 1230 A+- 1214 pg/mL. Sensitivity of the model was 89.3% with 71.1% specificity, 49% positive predictive value and 95.5% negative predictive value. The accuracy of the model was 75.4%. In Roc analysis, AUC for the SHFM was 0.802 (p<0.001). conclusion: SHFM was found to be reliable in predicting one year mortality among patients with heart failure in the pakistan patients. (author)

Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

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Alessandro Varrica

2015-01-01

Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

Prolonged Activated Clotting Time after Protamine Administration Does Not Indicate Residual Heparinization after Cardiopulmonary Bypass in Pediatric Open Heart Surgery.

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Yamamoto, Tomohiro; Wolf, Hans-Gerd; Sinzobahamvya, Nicodème; Asfour, Boulos; Hraska, Victor; Schindler, Ehrenfried

2015-08-01

In open heart surgery, heparinization is commonly neutralized using an empirical heparin:protamine ratio ranging between 1:1 and 1:1.5. However, these ratios may result in protamine overdose that should be avoided for its negative side effects on the coagulation system. This study aimed to indicate the appropriate treatment for prolonged activated clotting time (ACT) after protamine administration following cardiopulmonary bypass (CPB) in pediatric open heart surgery by investigating the underlying reasons for it. Twenty-seven children (open heart surgery were included. Heparin was administered only before CPB (400 IU/kg) and in the pump priming volume for CPB (2,000 IU) and was neutralized by 1:1 protamine after CPB. The blood heparin concentration was measured using anti-Xa assay. ACT and blood concentrations of heparin, coagulation factors, thrombin-antithrombin complex, and prothrombin fragment 1 + 2 were assessed. A rotational thromboelastometry (ROTEM; Tem International GmbH, München, Bayern, Germany) was used to confirm the coagulation status and residual heparin after protamine administration. Anti-Xa assay showed that there is no residual heparin in the blood after 1:1 protamine administration. Nevertheless, ACT (128.89 ± 3.09 seconds before heparin administration) remained prolonged (177.14 ± 5.43 seconds at 10 minutes after protamine, 182.00 ± 5.90 seconds at 30 minutes after protamine). The blood concentrations of coagulation factors were significantly lower than those before heparin administration (p < 0.01). The low FIBTEM MCF of ROTEM (4.43 ± 0.32 mm) at 10 minutes after protamine indicated low fibrinogen concentration. Prolonged ACT after heparin neutralization by 1:1 protamine administration does not necessarily indicate residual heparin, but low blood concentrations of coagulation factors should be considered as a reason as well. Accordingly, supply of coagulation factors instead of additional protamine should be

Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study.

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Fonager, Kirsten; Lundbye-Christensen, Søren; Andreasen, Jan Jesper; Futtrup, Mikkel; Christensen, Anette Luther; Ahmad, Khalil; Nørgaard, Martin Agge

2014-01-01

Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce (RR = 0.74 (0.60-0.92)) whereas unemployment at the time of surgery had no impact on return to the workforce (RR = 0.96 (0.78-1.18)). Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit.

Relation between serum creatinine and postoperative results of open-heart surgery.

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Ezeldin, Tamer H

2013-10-01

To determine the impact of preoperative serum creatinine level in non-dialyzable patients on postoperative morbidity and mortality. This is a prospective study, where serum creatinine was used to give primary assessment on renal function status preoperatively. This study includes 1,033 patients, who underwent coronary artery bypass grafting, or valve(s) operations. The study took place at Al-Hada Military Hospital, Taif, Kingdom of Saudi between May 2008 and January 2012. Data were statistically analyzed using Chi square (x2) test and multivariable logistic regression, to evaluate the postoperative morbidity and mortality risks associated with low serum creatinine levels. Postoperative mortality increased with high serum creatinine level >1.8 mg/dL (pcreatinine level of more than 1.8 mg/dL was associated with increased risk of re-operation for bleeding, postoperative renal failure, prolonged ventilatory support, ICU stay, and total hospital stay. Perioperative serum creatinine is strongly related to post operative morbidity and mortality in open heart surgery. High serum creatinine in non-dialyzable patients can predict the increased morbidity and mortality after cardiac operations.

Changes in Near-Infrared Spectroscopy After Congenital Cyanotic Heart Surgery

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Judith Ju-Ming Wong

2018-04-01

Full Text Available BackgroundSince oxygen saturation from pulse oximetry (SpO2 and partial pressure of arterial oxygen (PaO2 are observed to improve immediately after surgical correction of cyanotic congenital heart disease (CHD, we postulate that cerebral (CrO2 and somatic (SrO2 oximetry also improves immediately post-correction. We aim to prospectively examine CrO2 and SrO2, before, during, and after surgical correction as well as on hospital discharge in children with cyanotic CHD to determine if and when these variables increase.MethodsThis is a prospective observational trial. Eligibility criteria included children below 18 years of age with cyanotic CHD who required any cardiac surgical procedure. CrO2 and SrO2 measurements were summarized at six time-points for comparison: (1 pre-cardiopulmonary bypass (CPB; (2 during CPB; (3 post-CPB; (4 Day 1 in the pediatric intensive care unit (PICU; (5 Day 2 PICU; and (6 discharge. Categorical and continuous variables are presented as counts (percentages and median (interquartile range, respectively.ResultsTwenty-one patients were analyzed. 15 (71.4% and 6 (28.6% patients underwent corrective and palliative surgeries, respectively. In the corrective surgery group, SpO2 increased immediately post-CPB compared to pre-CPB [99 (98, 100 vs. 86% (79, 90; p < 0.001] and remained in the normal range through to hospital discharge. Post-CPB CrO2 did not change from pre-CPB [72.8 (58.8, 79.0 vs. 72.1% (63.0, 78.3; p = 0.761] and even decreased on hospital discharge [60.5 (53.6, 62.9 vs. 72.1% (63.0, 78.3; p = 0.005]. Post-CPB SrO2 increased compared to pre-CPB [87.3 (77.2, 89.5 vs. 72.7% (65.6, 77.3; p = 0.001] but progressively decreased during PICU stay to a value lower than baseline at hospital discharge [66.9 (57.3, 76.9 vs. 72.7% (65.6, 77.3; p = 0.048].ConclusionCrO2 and SrO2 did not increase after corrective surgery of cyanotic CHD even up to hospital discharge. Future larger studies are required to

Intraoperative transesophageal echocardiography in congenital heart diseases surgery

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Ozores Suarez, Francisco Javier; Perez de Ordaz, Luis Bravo

2010-01-01

The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure

Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial

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Raquel Pei Chen Chan

2009-01-01

Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

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Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery.

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Bárta, Jiří; Brát, Radim

2017-08-17

The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery. The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up. Evaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP - 93.75%, Group LA - 86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP - 50%, Group LA - 47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm. Enhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to

Coronary artery surgery in a man with achondroplasia: a case report

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Daskalopoulos Marios E

2010-10-01

Full Text Available Abstract Introduction Achondroplasia is a musculoskeletal disorder associated with short stature. Despite an estimated prevalence of 1:25,000 in the general population, there is little literature concerning the diagnostic and treatment challenges faced by doctors dealing with a heart operation on a patient with this condition. Case presentation We present the case of a 41-year-old Caucasian man of Greek ethnicity with achondroplasia, who underwent bypass heart surgery. Conclusions The surgery was successful and did not present particular difficulties, showing that heart surgery can be safely performed on people with achondroplasia.

Nurses in post-operative heart surgery: professional competencies and organization strategies.

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Santos, Ana Paula Azevedo; Camelo, Silvia Helena Henriques; Santos, Fabiana Cristina Dos; Leal, Laura Andrian; Silva, Beatriz Regina da

2016-01-01

To analyze nurses' competencies with regard to their work in post-operative heart surgery and the strategies implemented to mobilize these competencies. This was an exploratory study with a qualitative approach and a methodological design of collective case study. It was carried out in three post-operative heart surgery units, consisting of 18 nurses. Direct observation and semi-structured interviews were employed to collect data. Data were construed through thematic analysis. nine competencies were found, as follows: theoretical-practical knowledge; high-complexity nursing care; nursing supervision; leadership in nursing; decision making; conflict management; personnel management; material and financial resources management; and on-job continued education. Organizational and individual strategies were employed to develop and improve competencies such as regular offerings of courses and lectures, in addition to the individual pursuit for knowledge and improvement. the study is expected to lead future nurses and training centers to evaluate the need for furthur training required to work in cardiac units, and also the need for implementing programs aimed at developing the competencies of these professionals. Analisar as competências dos enfermeiros para atuarem no pós-operatório de cirurgia cardíaca e estratégias implementadas para a mobilização dessas competências. Estudo exploratório, com abordagem qualitativa e desenho metodológico estudo de caso coletivo. Foi realizado em três unidades pós-operatórias de cirurgias cardíacas, com 18 enfermeiros. Na coleta de dados utilizou-se observação direta e entrevista semiestruturada. Para interpretação dos dados optou-se pela análise temática. Foram identificadas nove competências, sendo: conhecimento teórico-prático, cuidados de enfermagem de alta complexidade, supervisão e liderança em enfermagem, tomada de decisão, gerenciamento de conflitos, de recursos humanos, materiais, financeiros e educa

Platelet Rich Plasma and Knee Surgery

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Mikel Sánchez

2014-01-01

Full Text Available In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon’s goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

Performance of target-controlled infusion of propofol using two different pharmacokinetic models in open heart surgery - a randomised controlled study.

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Mathew, P J; Sailam, S; Sivasailam, R; Thingnum, S K S; Puri, G D

2016-01-01

We compared the performance of a propofol target-controlled infusion (TCI) using Marsh versus PGIMER models in patients undergoing open heart surgery, in terms of measured plasma levels of propofol and objective pharmacodynamic effect. Twenty-three, ASA II/III adult patients aged 18-65 years and scheduled for elective open heart surgery received Marsh or PGIMER (Postgraduate Institute of Medical Education and Research) pharmacokinetic models of TCI for the induction and maintenance of anaesthesia with propofol in a randomized, active-controlled, non-inferiority trial. The plasma levels of propofol were measured at specified time points before, during and after bypass. The performances of both the models were similar, as determined by the error (%) in maintaining the target plasma concentrations: MDPE of -5.0 (-12.0, 5.0) in the PGIMER group vs -6.4 (-7.7 to 0.5) in the Marsh group and MDAPE of 9.1 (5, 15) in the PGIMER group vs 8 (6.7, 10.1) in the Marsh group. These values indicate that both models over-predicted the plasma propofol concentration. The new pharmacokinetic model based on data from Indian patients is comparable in performance to the commercially available Marsh pharmacokinetic model. © The Author(s) 2015.

High resolution heart rate variability analysis in patients with angina pectoris during coronary artery bypass graft surgery

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Mironov, V. A.; Mironova, T. F.; Kuvatov, V. A.; Nokhrina, O. Yu.; Kuvatova, E. V.

2017-12-01

The purpose of the study is approbation of the capabilities of high-resolution rhythmocardiography (RCG) for the determination of the actual cardiovascular status of operated patients with angina pectoris during coronary artery bypass graft surgery (CABGS) for myocardial revascularization. The research was done by means of a KAP-RK-02-Mikor hardware-software complex with a monitor record and the time- and frequency-domain analyses of heart rate variability (HRV). Monitor records were made at each stage of CABGS in 123 patients. As a result, HRV manifested itself as a fairly adequate and promising method for the determination of the cardiovascular status during CABGS. In addition, the data of the HRV study during CABGS testify to the capability of RCG to determine the high risk of life-threatening cardioarrhythmias before and during operation, to different changes in sinoatrial heart node (SN) dysregulation, and contain the HRV symptoms of a high death risk before, during and after shunting. The loss of the peripheral autonomic sympathetic and parasympathetic control in SN in the form of the autonomic cardioneuropathy syndrome is a predictor of the complications related to CABGS. The obtained data on RCG monitoring of HRV recording are suggestive of wide prospects of the high-resolution RCG method to be used in cardiac surgery as a whole. The actual multivariant dysregulations of SN pacemaker activity testify to its adequacy to the pathophysiology of each period of the cardiac operation, according to the initial ischemic damages and localization of cardiosurgical manipulations during CABGS.

Changes in heart rate during third molar surgery

NARCIS (Netherlands)

Hollander, M. H. J.; Schortinghuis, J.; Vissink, A.

2016-01-01

Anxiety is an undesirable psychological phenomenon. Patients are usually anxious when subjected to third molar surgery, but the pattern of anxiety is unknown. The aim of this study was to assess the intensity and course of anxiety during third molar surgery. This study included 48 consecutive

Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study

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Kirsten Fonager

2014-01-01

Full Text Available Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce (RR=0.74 (0.60–0.92 whereas unemployment at the time of surgery had no impact on return to the workforce (RR=0.96 (0.78–1.18. Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit.

Follow-Up After Cardiac Surgery Should be Extended to at Least 120 Days When Benchmarking Cardiac Surgery Centers.

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Hansen, Laura S; Sloth, Erik; Hjortdal, Vibeke E; Jakobsen, Carl-Johan

2015-08-01

Short-term (30 days) mortality frequently is used as an outcome measure after cardiac surgery, although it has been proposed that the follow-up period should be extended to 120 days to allow for more accurate benchmarking. The authors aimed to evaluate whether mortality rates 120 days after surgery were comparable to general mortality and to compare causes of death between the cohort and the general population. A multicenter descriptive cohort study using prospectively entered registry data. University hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register as well as the Danish Register of Causes of Death. A weighted, age-matched general population consisting of all Danish patients who died within the study period was identified through the central authority on Danish statistics. A total of 11,988 patients (>15 years) who underwent cardiac-surgery at Aarhus, Aalborg and Odense University Hospitals from April 1, 2006 to December 31, 2012 were included. Coronary artery bypass grafting, valve surgery and combinations. Mortality after cardiac surgery matches with mortality in the general population after 140 days. Mortality curves run almost parallel from this point onwards, regardless of The European system for cardiac operative risk evaluation (EuroSCORE) and intervention. The causes of death in the cohort differed statistically significantly from the background population (pbenchmarking cardiac surgery centers. Regardless of preoperative heart function, heart failure was the consistent leading cause of death. Copyright © 2015 Elsevier Inc. All rights reserved.

Congenital Heart Disease and Impacts on Child Development

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Mariana Alievi Mari

2016-02-01

Full Text Available Abstract Objective: To evaluate the child development and evaluate a possible association with the commitment by biopsychosocial factors of children with and without congenital heart disease. Methods: Observational study of case-control with three groups: Group 1 - children with congenital heart disease without surgical correction; Group 2 - children with congenital heart disease who underwent surgery; and Group 3 - healthy children. Children were assessed by socio-demographic and clinical questionnaire and the Denver II Screening Test. Results: One hundred and twenty eight children were evaluated, 29 in Group 1, 43 in Group 2 and 56 in Group 3. Of the total, 51.56% are girls and ages ranged from two months to six years (median 24.5 months. Regarding the Denver II, the children with heart disease had more "suspicious" and "suspect/abnormal" ratings and in the group of healthy children 53.6% were considered with "normal" development (P≤0.0001. The biopsychosocial variables that were related to a possible developmental delay were gender (P=0.042, child's age (P=0.001 and income per capita (P=0.019. Conclusion: The results suggest that children with congenital heart disease are likely to have a developmental delay with significant difference between children who have undergone surgery and those awaiting surgery under clinical follow-up.

Heart Surgery: MedlinePlus Health Topic

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... Living With Related Issues Specifics See, Play and Learn Videos and Tutorials Research Clinical Trials Journal Articles Resources ... Also in Spanish Videos and Tutorials MedlinePlus: Surgery Videos ... strategy is better to reduce postoperative stroke... Article: Ferumoxtyol-enhanced MR ...

Morbidity in congenital heart surgery in a public hospital in Argentina.

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Althabe, María; Rodríguez R, Ricardo; Balestrini, María; Charroqui, Alberto; Krynski, Mariela; Lenz, Ana M; Montonati, Mercedes; Moreno, Guillermo; Pilan, María L; Magliola, Ricardo; García Delucis, Pablo

2018-02-01

To describe the complications associated with heart surgery, compare them to a reference population, and identify mortality risk factors. Retrospective and descriptive study. All patients who underwent surgery at Hospital Garrahan in the 2013-2015 period were included. Age, weight, procedure, mechanical ventilation, length of stay in days, morbidity, and course were recorded. Renal failure requiring dialysis, neurological deficit, permanent pacemaker, circulatory support, phrenic nerve or vocal cord palsy, reoperation, wound infection, chylothorax, and tracheotomy were considered morbidities. A descriptive, statistical analysis by risk category was done using the Society of Thoracic Surgeons (STS) morbidity score. 1536 patients, median age: 12 months (interquartile range [IQR] 25-75: 3-60), weight: 8 kg (IQR 25-75: 4.4 to 17.5), mortality: 5%. A total of 361 events were recorded in 183 patients. An unplanned reoperation was the most common event (7.2%); the rest occurred in < 3% of patients. Compared to patients without complications, patients who had events required more days on mechanical ventilation: 9.95 (IQR 25-75: 7.6512.24) versus 1.8 (IQR 2575: 1.46-2.14), p< 0.00001; a longer length of stay: 28.8 (IQR 25-75: 25.1-32.5) versus 8.5 (IQR 25-75: 7.9-9.2), p< 0.0001; and had a higher mortality: 19.6% versus 3.1% (RR: 4.58, 95% CI: 3.4 to 6.0), p< 0.0001. Circulatory support and renal failure were associated with a higher mortality. An unplanned reoperation was the most common event. Patients with complications required more days on mechanical ventilation and a longer length of stay and had a higher mortality. Circulatory support and renal failure were associated with a higher mortality. Sociedad Argentina de Pediatría

The changing epidemiology of congenital heart disease

NARCIS (Netherlands)

van der Bom, Teun; Zomer, A. Carla; Zwinderman, Aeilko H.; Meijboom, Folkert J.; Bouma, Berto J.; Mulder, Barbara J. M.

2011-01-01

Congenital heart disease is the most common congenital disorder in newborns. Advances in cardiovascular medicine and surgery have enabled most patients to reach adulthood. Unfortunately, prolonged survival has been achieved at a cost, as many patients suffer late complications, of which heart

Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial.

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Lagier, David; Nee, Laetitia; Guieu, Régis; Kerbaul, François; Fenouillet, Emmanuel; Roux, Nicolas; Giorgi, Roch; Theron, Alexis; Grisoli, Dominique; Gariboldi, Vlad; Collart, Frederic; Bruder, Nicolas; Velly, Lionel; Guidon, Catherine

2018-04-26

Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. A randomised controlled study. Single University Hospital. One hundred and ten patients scheduled for heart valve surgery with CPB. We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. ClinicalTrials.gov, no.: NCT01999829.

[A study of the process by which a school-age child adapted to body image changes following open-heart surgery].

Science.gov (United States)

Lin, Heng-Ching; Tsai, Jia-Ling

2006-10-01

This case report attempts to explore the adaptive process of body image changes in school-age children suffering from congenital ventricular septal defect (VSD) following open-heart surgery. After establishing trust relationship, we applied atraumatic care, projective communication techniques, interviews, behavioral observation, storytelling and play in our interaction with that child. We found the child experienced "body image disturbance" after open-heart surgery and underwent a four stage adaptive process as follows: (1) Impact (questioning, perception of punishment for wrongdoing, loss, anger); (2) Retreat (denial, anxiety, withdrawal, escaping social contact, inferiority); (3) Acknowledgment (cognitive change, active participation, future-oriented concerns); and (4) Reconstruction (positive self-image, reconstructing body image). Nursing intervention provided the case with more opportunities for sensory feedback and positive reinforcement and also assisted the patient to adopt a positive view of the situation and then to reconstruct and realize the meaning of such surgery. We reinforced the social supporting system to promote self-confidence, self-esteem, and self-value. The child finally accepted the wounds resulting from the operation as a symbol of "bravery"; a breakthrough likely to help in the child's re-entrance to school and normalization of life. Study findings both enhanced pediatric nurse understanding of the adaptive process involved in body image change and provided knowledge essential to designing flexible-option nursing interventions tailored to meet the demands of different adaptation stages. Obviously, such a caring model designed to meet the differing needs of different body image changes has the potential to benefit of body image integration greatly and can provide the pediatric nursing framework in the future.

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

variation. The overall uptake rate was 52%. Simultaneous CABG was associated with a higher probability of referral to CR (OR 2.02 (95%CI 1.12-3.65)); being unmarried (0.44 (0.27-0.72)) and having TAVI with a lower probability (0.26; 0.13-0.52). The referral pattern varied across administrative regions...... were linked to nationwide registries. We analysed the provision and content of programmes using descriptive statistics, and factors associated with referral and participation using logistic regression analysis. RESULTS: Coverage of CR programmes for these patients was high, with national programme......- and patient-level influenced uptake and included significant regional variation in referral pattern. Further research into the effect and organization of CR post heart valve surgery is needed....

Pulmonary artery perfusion versus no perfusion during cardiopulmonary bypass for open heart surgery in adults

DEFF Research Database (Denmark)

Buggeskov, Katrine B; Grønlykke, Lars; Risom, Emilie C

2018-01-01

BACKGROUND: Available evidence has been inconclusive on whether pulmonary artery perfusion during cardiopulmonary bypass (CPB) is associated with decreased or increased mortality, pulmonary events, and serious adverse events (SAEs) after open heart surgery. To our knowledge, no previous systematic...... handsearched retrieved study reports and scanned citations of included studies and relevant reviews to ensure that no relevant trials were missed. We searched for ongoing trials and unpublished trials in the World Health Organization International Clinical Trials Registry Platform (ICTRP) and at clinicaltrials......). We used GRADE principles to assess the quality of evidence. MAIN RESULTS: We included in this review four RCTs (210 participants) reporting relevant outcomes. Investigators randomly assigned participants to pulmonary artery perfusion with blood versus no perfusion during CPB. Only one trial included...

Acquired heart conditions in adults with congenital heart disease: a growing problem.

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Tutarel, Oktay

2014-09-01

The number of adults with congenital heart disease is increasing due to the great achievements in the field of paediatric cardiology, congenital heart surgery and intensive care medicine over the last decades. Mortality has shifted away from the infant and childhood period towards adulthood. As congenital heart disease patients get older, a high prevalence of cardiovascular risk factors is encountered similar to the general population. Consequently, the contribution of acquired morbidities, especially acquired heart conditions to patient outcome, is becoming increasingly important. Therefore, to continue the success story of the last decades in the treatment of congenital heart disease and to further improve the outcome of these patients, more attention has to be given to the prevention, detection and adequate therapy of acquired heart conditions. The aim of this review is to give an overview about acquired heart conditions that may be encountered in adults with congenital heart disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Health in adults with congenital heart disease

NARCIS (Netherlands)

Cuypers, Judith A. A. E.; Utens, Elisabeth M. W. J.; Roos-Hesselink, Jolien W.

2016-01-01

Since the introduction of cardiac surgery, the prospects for children born with a cardiac defect have improved spectacularly. Many reach adulthood and the population of adults with congenital heart disease is increasing and ageing. However, repair of congenital heart disease does not mean cure. Many

Alveolar recruitment manoeuvre is safe in children prone to pulmonary hypertensive crises following open heart surgery: a pilot study.

Science.gov (United States)

Amorim, Erica de Freitas; Guimaraes, Viviane Assuncao; Carmona, Fabio; Carlotti, Ana Paula de Carvalho Panzeri; Manso, Paulo Henrique; Ferreira, Cesar Augusto; Klamt, Jyrson Guilherme; Vicente, Walter Villela de Andrade

2014-05-01

To test the tolerance and safety of an alveolar recruitment manoeuvre performed in the immediate postoperative period of corrective open heart surgery in children with congenital heart disease associated with excessive pulmonary blood flow and pulmonary arterial hypertension due to left-to-right shunt. Ten infants aged 1-24 months with congenital heart disease associated with excessive pulmonary blood flow and pulmonary artery hypertension (mean pulmonary artery pressure ≥ 25 mmHg) were evaluated. The alveolar recruitment manoeuvre was performed in the operating theatre right after skin closure, and consisted of three successive stages of 30 s each, intercalated by a 1-min interval of baseline ventilation. Positive end-expiratory pressure was set to 10 cmH2O in the first stage and to 15 cmH2O in the two last ones, while the peak inspiratory pressure was kept at to 30 cmH2O in the first stage and at 35 cmH2O in the latter ones. Haemodynamic and respiratory variables were recorded. There was a slight but significant increase in mean pulmonary artery pressure from baseline to Stage 3 (P = 0.0009), as well as between Stages 1 and 2 (P = 0.0001), and 1 and 3 (P = 0.001), with no significant difference between Stages 2 and 3 (P = 0.06). Upon completion of the third stage, there were significant increases in arterial haemoglobin saturation as measured by pulse oximetry (P = 0.0009), arterial blood partial pressure of oxygen (P = 0.04), venous blood oxygen saturation of haemoglobin (P = 0.03) and arterial oxygen partial pressure over inspired oxygen fraction ratio (P = 0.04). A significant reduction in arterial blood partial pressure of carbon dioxide (P = 0.01) and in end tidal carbon dioxide also occurred (P = 0.009). The manoeuvre was well tolerated and besides a slight and transitory elevation in mean pulmonary artery, no other adverse haemodynamic or ventilatory effect was elicited. The alveolar recruitment manoeuvre seemed to be safe and well tolerated immediately

Evaluation of nutritional screening tools among patients scheduled for heart valve surgery.

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Lomivorotov, Vladimir V; Efremov, Sergey M; Boboshko, Vladimir A; Nikolaev, Dmitry A; Vedernikov, Pavel E; Shilova, Anna N; Lomivorotov, Vladimir N; Karaskov, Alexander M

2013-03-01

The study aim was to detect the most sensitive nutritional screening tool and to assess its prognostic value with regards to an adverse clinical course in patients with heart valve disease undergoing cardiopulmonary bypass (CPB). This prospective cohort study included 441 adult patients who were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002); Malnutrition Universal Screening Tool (MUST); Mini Nutritional Assessment (MNA); and Short Nutritional Assessment Questionnaire (SNAQ). Nutritional assessment was performed using a Subjective Global Assessment (SGA). In-hospital mortality, postoperative complications, and duration of hospital stay were each analyzed. With regards to the detection of malnutrition, the sensitivities of MUST, SNAQ, MNA and NRS-2002 were 100%, 92%, 84.6% and 43.6%, respectively. Malnutrition identified by MUST and MNA were associated with postoperative complications (OR 1.63, p = 0.033 and OR 1.6, p = 0.035) and prolonged hospitalization (OR 1.57, p = 0.048 and OR 1.7, p = 0.02). According to multivariate logistic regression analysis, along with well-known age and duration of CPB, malnutrition identified by MUST and MNA was associated with a risk of development of complications (OR 1.6, p = 0.049 and OR 1.6, p = 0.04, respectively). The sensitivities of SNAQ, MUST, NRS-2002 and MNA with regards to postoperative complications were 26.8%, 28.8%, 10%, and 31.6%, respectively. The MUST tool is preferable with regards to the detection of malnutrition. Both, MUST and MNA independently predicted postoperative complications. SNAQ and NRS-2002 proved insensitive with regards to the postoperative course among patients with heart valve disease who were scheduled for cardiothoracic surgery.

Pericardial effusion following cardiac surgery. A single-center experience.

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Nguyen, Hien Sinh; Nguyen, Hung Doan-Thai; Vu, Thang Duc

2018-01-01

Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m 2 , preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.

Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

OpenAIRE

Tomar Akhlesh; Tempe Deepak; Banerjee A; Hegde R; Cooper A; Khanna S

2003-01-01

Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and diff...

The Healthy Heart-Mind trial: melatonin for prevention of delirium following cardiac surgery: study protocol for a randomized controlled trial.

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Ford, Andrew H; Flicker, Leon; Passage, Jurgen; Wibrow, Bradley; Anstey, Matthew; Edwards, Mark; Almeida, Osvaldo P

2016-01-28

Delirium is a common occurrence in patients undergoing major cardiac surgery and is associated with a number of adverse consequences for the individual, their family and the health system. Current approaches to the prevention of delirium include identifying those at risk together with various non-pharmacological and pharmacological strategies, although the efficacy of these is often modest. Emerging evidence suggests that melatonin may be biologically implicated in the development of delirium and that melatonin supplementation may be beneficial in reducing the incidence of delirium in medical and surgical patients. We designed this trial to determine whether melatonin reduces the incidence of delirium following cardiac surgery compared with placebo. The Healthy Heart-Mind trial is a randomized, double-blind, placebo-controlled clinical trial of 3 mg melatonin or matching placebo administered on seven consecutive days for the prevention of delirium following cardiac surgery. We will recruit 210 adult participants, aged 50 and older, undergoing elective or semi-elective cardiac surgery with the primary outcome of interest for this study being the difference in the incidence of delirium between the groups within 7 days of surgery. Secondary outcomes of interest include the difference between groups in the severity and duration of delirious episodes, hospital length of stay and referrals to mental health services during admission. In addition, we will assess differences in depressive and anxiety symptoms, as well as cognitive performance, at discharge and 3 months after surgery. The results of this trial will clarify whether melatonin reduces the incidence of delirium following cardiac surgery. The trial is registered with the Australian Clinical Trials Registry, trial number ACTRN12615000819527 (10 August 2015).

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

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Ege Turan

2004-01-01

Full Text Available Abstract Background According to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting. Methods Electrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG and heart valve replacement with moderate hypothermic (mean 28°C cardiopulmonary bypass (CPB were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia. Results In all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement. No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms and amplitude (mV did not differ statistically before and after surgery in either group (p > 0.05. Conclusions Our results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery.

Heart Surgery Experience in Hitit University Faculty of Medicine Corum Research and Training Hospital: First Year Results

Directory of Open Access Journals (Sweden)

Adem Diken

2014-03-01

Full Text Available Aim: We aimed to assess the clinical outcomes of our department of cardiac surgery which was newly introduced in Hitit University Corum Education and Research Hospital. Material and Method: Between November 2012 and November 2013, a total of 110 open-heart surgeries were performed. Ten out of these (9.1% were emergency operations for acute ST elevation myocardial infarction Off-pump technique was used in 31 (29.2% patients and cardiopulmonary bypass was used in 75 (70.8%. A total of 106 patients received coronary artery bypass grafting, 1 received mitral reconstruction, 1 received Bentall procedure, 1 received tricuspid valve repair, 1 received mitral valve replacement, 1 received aortic valve replacement with aortic root enlargement and 1 received aortic supracoronary graft replacement. Results: Hospital mortality occurred in 1 (0.9% patient. Four patients (3.6% who were on dual antiaggregants underwent a revision for bleeding on the day of the operation. Morbidities occurred in 3 (2.7% patients. Atrial fibrillation occurred in 11 (10% patients and the normal sinus rhythm was achieved by amiodarone. Intraaortic balloon counterpulsation was used in 5 (4.5% patients. Discussion: The newly introduced cardiac surgery department of the Hitit University Corum Education and Research Hospital, which provides tertiary care to a wide rural community, serves with low morbidity and mortality.

Complications of nonbiliary laparoscopic gastrointestinal surgery : Radiologic findings and clinical courses

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Jung, Seon Ah; Lee, Sang Hoon; Won, Yong Sung; Park, Young Ha; Kim, Jun Gi [St. Vincent' s Hospital, College of Medicine, The Catholic University, Suwon (Korea, Republic of); Kim, Hyun [St. Mary' s Hospital, College of Medicine, The Catholic University, Taejon (Korea, Republic of)

2000-05-01

To evaluate the radiological findings and clinical course of the complications arising after nonbiliay laparoscopic gastrointestinal surgery (NLGS). We retrospectively reviewed the clinical records of 131 patients who underwent NLGS (83 cases involving colorectal surgery, 18 splenectomies, 14 appendectomies, ten adrenalectomies, three lumbar sympathectomies, two Duhamel's operation, and one peptic ulcer perforation repair) over a four-year period. Among these 131 patients, the findings of fifteen in whom postoperative complications were confirmed were analysed. The radiologic examinations these patients underwent included CT (n=3D8), barium enema and fistulography (n=3D4), ultrasonography (n=3D3), ascending venography of the lower legs (n=3D2), and penile Doppler sonography (n=3D1). We evaluated the radiologic findings and clinical courses of early (within 2 weeks) and late (after 2 weeks) postoperative complications. Sixteen cases of postoperative complications developed in fifteen patients ; in 14 (17%) after colorectal surgery and in one (6%) after splenectomy. Eleven of the sixteen cases (69%) involved early complications, consisting of an abscess in three, ischemic colitis in two, hemoperitoneum in one, perforation of the colon in one, pancreatitis in one, recto-vaginal fistula in one, deep vein thrombosis after colorectal surgery in one, and abscess after splenectomy in one. The remaining five cases (31%) involved late complications which developed after colorectal surgery, comprising anastomosic site stricture in two, abdominal wall (trocar site) metastasis in one, colo-cutaneous fistula in one, and impotence in one. Among the 16 cases involving postoperative complications, recto-vaginal fistula, colon perforation, and abdominal wall metastasis were treated by surgery, while the other thirteen cases were treated conservatively. Various postoperative complications develop after NLGS, with a higher rate of these being noted in cases involving colorectal

Complications of nonbiliary laparoscopic gastrointestinal surgery : Radiologic findings and clinical courses

International Nuclear Information System (INIS)

Jung, Seon Ah; Lee, Sang Hoon; Won, Yong Sung; Park, Young Ha; Kim, Jun Gi; Kim, Hyun

2000-01-01

To evaluate the radiological findings and clinical course of the complications arising after nonbiliay laparoscopic gastrointestinal surgery (NLGS). We retrospectively reviewed the clinical records of 131 patients who underwent NLGS (83 cases involving colorectal surgery, 18 splenectomies, 14 appendectomies, ten adrenalectomies, three lumbar sympathectomies, two Duhamel's operation, and one peptic ulcer perforation repair) over a four-year period. Among these 131 patients, the findings of fifteen in whom postoperative complications were confirmed were analysed. The radiologic examinations these patients underwent included CT (n=3D8), barium enema and fistulography (n=3D4), ultrasonography (n=3D3), ascending venography of the lower legs (n=3D2), and penile Doppler sonography (n=3D1). We evaluated the radiologic findings and clinical courses of early (within 2 weeks) and late (after 2 weeks) postoperative complications. Sixteen cases of postoperative complications developed in fifteen patients ; in 14 (17%) after colorectal surgery and in one (6%) after splenectomy. Eleven of the sixteen cases (69%) involved early complications, consisting of an abscess in three, ischemic colitis in two, hemoperitoneum in one, perforation of the colon in one, pancreatitis in one, recto-vaginal fistula in one, deep vein thrombosis after colorectal surgery in one, and abscess after splenectomy in one. The remaining five cases (31%) involved late complications which developed after colorectal surgery, comprising anastomosic site stricture in two, abdominal wall (trocar site) metastasis in one, colo-cutaneous fistula in one, and impotence in one. Among the 16 cases involving postoperative complications, recto-vaginal fistula, colon perforation, and abdominal wall metastasis were treated by surgery, while the other thirteen cases were treated conservatively. Various postoperative complications develop after NLGS, with a higher rate of these being noted in cases involving colorectal

Etiology of cardiogenic shock early after open-heart surgery: Assessment by Tc-99m RBC wall motion scintigraphy

International Nuclear Information System (INIS)

Bateman, T.; Gray, R.; Chaux, A.; Lee, M.; Matloff, J.; Raymond, M.; Berman, D.

1984-01-01

When life-threatening cardiogenic shock (CI 1.8 1/min/m/sup 2/, elevated right and left-side filling pressures) occurs early (0-48 hrs) after open-heart surgery, routine approaches frequently cannot distinguish between expected etiologies: (1) transient systolic failure of the LV, RV, or both, common early postoperatively (postop); (2) perioperative infarct of the LV or RV; (3) myocardial restriction due to active pericardial bleeding or to accumulated clots and fluid; (4) diminished LV reserve from aneurysmectomy; and (5) residual valvular regurgitation. Distinction is critical, because (1), (2), and (4) will be treated by optimizing preload and afterload; (3) with urgent (if active bleeding) or semi-urgent surgery; and (5) with repeat valvular surgery. In 22 pts with unexpected early postop cardiogenic shock, Tc-99m-RBC equilibrium radionuclide ventriculography revealed: global LV (3 pts) or RV (3 pts) dysfunction, new segmental LV dysfunction (2 pts), active bleeding (5 pts) and/or accumulated pericardial fluid ( 8 pts) with hyperdynamic LV and RV, and a small hyperdynamic LV without effusion (1 pt), providing a specific etiologic diagnosis in all cases. In the Cardiac Surgical ICU, therapeutic decisions frequently await and depend on the results of equilibrium radionuclide ventriculography, now routinely performed in postop pts with unexpected cardiogenic shock

Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.

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Hummel, Johanna; Rücker, Gerta; Stiller, Brigitte

2017-08-02

Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to

Aortic valve surgery - open

Science.gov (United States)

... gov/ency/article/007408.htm Aortic valve surgery - open To use the sharing features on this page, ... separates the heart and aorta. The aortic valve opens so blood can flow out. It then closes ...

Leaky valves : New operation improves the heart's pumping action

NARCIS (Netherlands)

Pistecky, P.; Havlik, P.; Van Kasteren, J.

2003-01-01

The action of any pump will start to decline when the valves no longer close properly. The same goes for the heart, the pump that maintains the circulation in our vascular system. Consequently, a major field of focus of open heart surgery is the repair or replacement of heart valves. Petr Havl a

Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome

Science.gov (United States)

Tran, Ngoc Hieu; Tantidhnazet, Syrina; Raocharernporn, Somchart; Kiattavornchareon, Sirichai; Pairuchvej, Verasak; Wongsirichat, Natthamet

2018-01-01

Background The benefit of computer-assisted planning in orthognathic surgery (OGS) has been extensively documented over the last decade. This study aimed to evaluate the accuracy of three-dimensional (3D) virtual planning in surgery-first OGS. Methods Fifteen patients with skeletal class III malocclusion who underwent bimaxillary OGS with surgery-first approach were included. A composite skull model was reconstructed using data from cone-beam computed tomography and stereolithography from a scanned dental cast. Surgical procedures were simulated using Simplant O&O software, and the virtual plan was transferred to the operation room using 3D-printed splints. Differences of the 3D measurements between the virtual plan and postoperative results were evaluated, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method. Results The virtual planning was successfully transferred to surgery. The overall mean linear difference was 0.88 mm (0.79 mm for the maxilla and 1 mm for the mandible), and the overall mean angular difference was 1.16°. The RMSD ranged from 0.86 to 1.46 mm and 1.27° to 1.45°, within the acceptable clinical criteria. Conclusion In this study, virtual surgical planning and 3D-printed surgical splints facilitated the diagnosis and treatment planning, and offered an accurate outcome in surgery-first OGS. PMID:29581806

Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome.

Science.gov (United States)

Tran, Ngoc Hieu; Tantidhnazet, Syrina; Raocharernporn, Somchart; Kiattavornchareon, Sirichai; Pairuchvej, Verasak; Wongsirichat, Natthamet

2018-05-01

The benefit of computer-assisted planning in orthognathic surgery (OGS) has been extensively documented over the last decade. This study aimed to evaluate the accuracy of three-dimensional (3D) virtual planning in surgery-first OGS. Fifteen patients with skeletal class III malocclusion who underwent bimaxillary OGS with surgery-first approach were included. A composite skull model was reconstructed using data from cone-beam computed tomography and stereolithography from a scanned dental cast. Surgical procedures were simulated using Simplant O&O software, and the virtual plan was transferred to the operation room using 3D-printed splints. Differences of the 3D measurements between the virtual plan and postoperative results were evaluated, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method. The virtual planning was successfully transferred to surgery. The overall mean linear difference was 0.88 mm (0.79 mm for the maxilla and 1 mm for the mandible), and the overall mean angular difference was 1.16°. The RMSD ranged from 0.86 to 1.46 mm and 1.27° to 1.45°, within the acceptable clinical criteria. In this study, virtual surgical planning and 3D-printed surgical splints facilitated the diagnosis and treatment planning, and offered an accurate outcome in surgery-first OGS.

The association between the transfusion of small volumes of leucocyte-depleted red blood cells and outcomes in patients undergoing open-heart valve surgery.

Science.gov (United States)

Zittermann, Armin; Koster, Andreas; Faraoni, David; Börgermann, Jochen; Schirmer, Uwe; Gummert, Jan F

2017-02-01

The relationship between the transfusion of red blood cell (RBC) units and outcomes in patients undergoing cardiac surgery is the subject of intense debates. In this study, we investigated the relationship between the transfusion of 1-2 leucocyte-depleted (LD) RBC units and outcomes in patients undergoing open-heart valve surgery. The investigation encompassed consecutive patients undergoing open-heart valve surgery at our institution between July 2009 and March 2015 who received no (RBC- group) or 1-2 units of LD RBC (RBC+ group). End-points were 30-day mortality (primary), the incidence of in-hospital major organ dysfunctions and 1-year mortality (secondary). Propensity score (PS)-adjusted statistical analysis was used to assess the effect of RBC transfusion on end-points. Thirty-day mortality rate was 0.2% (3/1485) in the RBC- group and 0.4% (6/1672) in the RBC+ group, with a PS-adjusted odds ratio (OR) for 30-day mortality of 1.00 (95% CI: 0.21-4.83;P = 0.99). The two groups showed no significant differences in PS-adjusted ORs for major complications, such as stroke, low cardiac output syndrome, thoracic wound infection and prolonged mechanical ventilation (>24 h). The PS-adjusted ORs for prolonged intensive care unit stay (>48 h) were, however, significantly higher in the RBC+ group (OR = 1.34 [95%CI: 1.04-1.72; P = 0.02]) than in the RBC- group. One-year mortality was comparable between groups (PS-adjusted hazard ratio for the RBC+ group: 0.85 [95% CI: 0.42-1.72; P = 0.65]). Our data do not provide evidence that in patients undergoing valve surgery with cardiopulmonary bypass, transfusion of 1-2 units of LD RBC increases operative mortality, the incidence of postoperative complications or 1-year mortality. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Preoperative warfarin reversal for early hip fracture surgery.

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Moores, Thomas Steven; Beaven, Alastair; Cattell, Andrew Edwin; Baker, Charles; Roberts, Philip John

2015-04-01

To evaluate our hospital protocol of low-dose vitamin K titration for preoperative warfarin reversal for early hip fracture surgery. Records of 16 men and 33 women aged 63 to 93 (mean, 81) years who were taking warfarin for atrial fibrillation (n=40), venous thromboembolism (n=9), cerebrovascular accident (n=3), and prosthetic heart valve (n=3) and underwent surgery for hip fractures were reviewed. The 3 patients with a prosthetic heart valve were deemed high risk for thromboembolism and the remainder low-risk. The international normalised ratio (INR) of patients was checked on admission and 6 hours after administration of vitamin K; an INR of fracture surgery within 36 to 48 hours of admission improves morbidity and mortality.

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…

The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

International Nuclear Information System (INIS)

Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

1989-01-01

The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

Cardioscopic tricuspid valve repair in a beating ovine heart.

Science.gov (United States)

Umakanthan, Ramanan; Ghanta, Ravi K; Rangaraj, Aravind T; Lee, Lawrence S; Laurence, Rita G; Fox, John A; Mihaljevic, Tomislav; Bolman, Ralph M; Cohn, Lawrence H; Chen, Frederick Y

2009-04-01

Open heart surgery is commonly associated with cardiopulmonary bypass and cardioplegic arrest. The attendant risks of cardiopulmonary bypass may be prohibitive in high-risk patients. We present a novel endoscopic technique of performing tricuspid valve repair without cardiopulmonary bypass in a beating ovine heart. Six sheep underwent sternotomy and creation of a right heart shunt to eliminate right atrial and right ventricular blood for clear visualization. The superior vena cava, inferior vena cava, pulmonary artery, and coronary sinus were cannulated, and the blood flow from these vessels was shunted into the pulmonary artery via a roller pump. The posterior leaflet of the tricuspid valve was partially excised to create tricuspid regurgitation, which was confirmed by Doppler echocardiography. A 7.0-mm fiberoptic videoscope was inserted into the right atrium to visualize the tricuspid valve. Under cardioscopic vision, an endoscopic needle driver was inserted into the right atrium, and a concentric stitch was placed along the posterior annulus to bicuspidize the tricuspid valve. Doppler echocardiography confirmed reduction of tricuspid regurgitation. All animals successfully underwent and tolerated the surgical procedure. The right heart shunt generated a bloodless field, facilitating cardioscopic tricuspid valve visualization. The endoscopic stitch resulted in annular plication and functional tricuspid valve bicuspidization, significantly reducing the degree of tricuspid regurgitation. Cardioscopy enables less invasive, beating-heart tricuspid valve surgery in an ovine model. This technique may be useful in performing right heart surgery without cardiopulmonary bypass in high-risk patients.

Radioisotope heart examination during exercise to diagnose ischemic heart disease

International Nuclear Information System (INIS)

Farsky, S.

1986-01-01

The radioisotope exercise test is discussed and its benefits characterized for the diagnosis of ischemic heart disease, namely the use of 99m Tc in scintiscanning heart ventricles and of 201 Tl in scintiscanning myocardial perfusion. The exercise ventricular function and perfusion scintigraphies are compared with the common exercise ECG examination, and their superior sensitivity and specificity emphasized. Considering the constraints of scintigraphic imaging, indications are outlined for patients including those with suspect serious ischemic heart disease in whom the exercise ECG test has been negative or inconclusive, patients with the so-called nondiagnostic ECG, patients with atypical symptoms, and healthy individuals for whom the exercise ECG test indicated with respect to their occupation has been positive. Both radionuclide imaging techniques are complementary and are shown to be valuable not only in improving the diagnosis of ischemic heart disease but also in identifying the high-risk patients in whom cardiac surgery is to be considered. (L.O.)

Left atrial leiomyosarcoma as cause of heart failure

International Nuclear Information System (INIS)

Valdes Martin, Alexander

2012-01-01

The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

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Parnell, Aimee S; Shults, Justine; Gaynor, J William; Leonard, Mary B; Dai, Dingwei; Feudtner, Chris

2014-02-01

Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (pDRG (pDRG experienced a significantly increased mortality (pDRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Results of beating heart mitral valve surgery via the trans-septal approach Resultados da abordagem transeptal para a valva mitral com coração batendo

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Tomas A Salerno

2009-03-01

Full Text Available OBJECTIVE: Mitral valve surgery can be performed through the trans-atrial or the trans-septal approach. Although the trans-atrial is the preferred method, the trans-septal approach has also been used recently and has a particular value in beating-heart mitral valve surgery. Herein we report our experience with beating-heart mitral valve surgery via trans-septal approach, and discuss its advantages and pitfalls. METHODS: Between 2000 and 2007, 214 consecutive patients were operated upon utilizing beating heart technique for mitral valve surgery. The operation was performed via transseptal approach with the aorta unclamped, the heart beating, with normal electrocardiogram and in sinus rhythm. RESULTS: Mean age was 56.03 ± 13.93 years (range: 19-86 years; median: 56 years. There were 131 (61.2% males and 83 (38.8% females. Of the prostheses used, 108 (50.5% were biological, and 39 (18.2% were mechanical. Mitral repairs were performed in 67 (31.3% patients. Mean hospital stay was 17.4 ± 20.0 days (range: 3-135 days; median: 11 days. Intra-aortic balloon pump (IABP utilization was required in 12 (5.6% of 214 patients. One-month mortality was 7.4%, and re-operation for bleeding was needed in 15 (7% patients. CONCLUSIONS: Beating-heart mitral valve surgery is an option for myocardial protection in patients undergoing mitral valve surgery. This technique is facilitated by the trans-septal approach due to reduced aortic insufficiency and improved visualization of the mitral apparatus.OBJETIVO: A cirurgia da valva mitral pode ser feita via transatrial ou transeptal. Embora a transatrial seja a preferida, a via transeptal tem sido utilizada mais recentemente e tido um grande valor nas operações com o coração batendo. Mostramos a nossa experiência na cirurgia da valva mitral via transeptal com coração batendo e discutimos seus benefícios e problemas. MÉTODOS: Entre 2000 e 2007, 214 pacientes consecutivos foram operados com o coração batendo. A

No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

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Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

2017-06-01

The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography.

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Lorenzo, Natalia; Mendez, Irene; Taibo, Mikel; Martinis, Gianfranco; Badia, Sara; Reyes, Guillermo; Aguilar, Rio

2018-03-19

Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation valvular heart disease surgery.

Comparison between intravenous boluses versus infusion of tranexamic acid (TXA) to reduce bleeding in paediatric cyanotic congenital heart disease (CHD) surgeries

International Nuclear Information System (INIS)

Junejo, F.; Irfan, M.; Akhtar, M.I.; Hamid, M.; Ahmed, S.S.

2018-01-01

To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid (TXA) to reduce postoperative bleeding in cyanotic congenital heart disease surgeries. Study Design:Single-blinded randomised clinical trial. Place and Duration of Study:Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017. Methodology:Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass (CPB), were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg after induction, after going to bypass and after protamine reversal. Data was collected through predesigned proforma. There were two primary outcomes: postoperative bleeding in the first 24 hours, and chest closure time. Results:Postoperative bleeding was 13.94 (10.27-20.18) ml/kg in the first 24 hours in infusion group and 15.05 (9.04-23.50) ml/kg in the bolus group. Chest closure time was 38.5 (25-45) in infusion group and 30 (20-46.25) minutes in the bolus group. There was no statistically significant and clinical difference between both groups regarding postoperative bleeding in the first 24 hours and chest closure time. Conclusion:These infusion and bolus groups had comparable postoperative bleeding and chest closure time. (author)

Randomized comparative study of intravenous infusion of three different fixed doses of milrinone in pediatric patients with pulmonary hypertension undergoing open heart surgery.

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Barnwal, Neeraj Kumar; Umbarkar, Sanjeeta Rajendra; Sarkar, Manjula Sudeep; Dias, Raylene J

2017-01-01

Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. Patients were randomized into three groups. All patients received fixed bolus dose of milrinone 50 μg/kg on pump during rewarming. Following this, patients in low-dose group received infusion of milrinone at the rate of 0.375 μg/kg/min, medium-dose group received 0.5 μg/kg/min, and high-dose group received 0.75 μg/kg/min over 24 h. Heart rate, mean arterial pressure (MAP), mean airway pressure (MaP), oxygenation index (OI), and central venous pressure (CVP) were compared at baseline and 24 h postoperatively. Dose of inotropic requirement, duration of ventilatory support and Intensive Care Unit (ICU) stay were noted. MAP, MaP, OI, and CVP were comparable in all three groups postoperatively. All patients in the low-dose group required low inotropic support while 70% of patients in the high-dose group needed high inotropic support to manage episodes of hypotension (P = 0.000). Duration of ventilatory support and ICU stay in all three groups was comparable (P = 0.412, P = 0.165). Low-dose infusions while having a clinical impact were more beneficial in avoiding adverse events and decreasing inotropic requirement without affecting duration of ventilatory support and duration of ICU stay.

Carcinoid heart disease.

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Hassan, Saamir A; Banchs, Jose; Iliescu, Cezar; Dasari, Arvind; Lopez-Mattei, Juan; Yusuf, Syed Wamique

2017-10-01

Rare neuroendocrine tumours (NETs) that most commonly arise in the gastrointestinal tract can lead to carcinoid syndrome and carcinoid heart disease. Patients with carcinoid syndrome present with vasomotor changes, hypermotility of the gastrointestinal system, hypotension and bronchospasm. Medical therapy for carcinoid syndrome, typically with somatostatin analogues, can help control symptoms, inhibit tumour progression and prolong survival. Carcinoid heart disease occurs in more than 50% of these patients and is the initial presentation of carcinoid syndrome in up to 20% of patients. Carcinoid heart disease has characteristic findings of plaque-like deposits composed of smooth muscle cells, myofibroblasts, extracellular matrix and an overlying endothelial layer which can lead to valve dysfunction. Valvular dysfunction can lead to oedema, ascites and right-sided heart failure. Medical therapy of carcinoid heart disease is limited to symptom control and palliation. Valve surgery for carcinoid heart disease should be considered for symptomatic patients with controlled metastatic carcinoid syndrome. A multidisciplinary approach is needed to guide optimal management. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The History of Heart Surgery at The Johns Hopkins Hospital.

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Patel, Nishant D; Alejo, Diane E; Cameron, Duke E

2015-01-01

Johns Hopkins has made many lasting contributions to cardiac surgery, including the discovery of heparin and the Blalock-Taussig Shunt, which represents the dawn of modern cardiac surgery. Equally important, Johns Hopkins has trained some of the world's leaders in academic cardiac surgery, and is committed to training the future leaders in our specialty. Copyright © 2015. Published by Elsevier Inc.

Evaluation of adenohypophyseal reserve in patients carrier of hypophyseal adenoma treated by trans-sphenoidal surgery

International Nuclear Information System (INIS)

Drubscky, A.T.

1980-01-01

Fifteen patients carrier hypophyseal adenomas, with ages varying between 16 to 53 years were studied. The patients presented sella changes to the conventional plane radiographies and were submited a surgery treatment, with acess to hypophysis by the trans-sphenoidal way. (author)

Hypoxia and the heart of poikilotherms

Czech Academy of Sciences Publication Activity Database

Ošťádal, Bohuslav

2014-01-01

Roč. 1, č. 1 (2014), s. 28-32 Institutional support: RVO:67985823 Keywords : blood supply heart * poikilotherms * tolerance to hypoxia Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

Hemolysis During Open-Heart Surgery With Vacuum-Assisted Venous Drainage at Different Negative Pressures in Pediatric Patients Weighing Less Than 10 kilograms.

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Kwak, Jae Gun; Lee, Jinkwon; Park, Minkyoung; Seo, Yu-Jin; Lee, Chang-Ha

2017-03-01

This study examined the degree of hemolysis during vacuum-assisted venous drainage at different negative pressures to identify an adequate negative pressure that provides effective venous drainage without significant hemolysis in open-heart surgery in children weighing less than 10 kg. Patients weighing less than 10 kg who underwent surgery for ventricular septal defect or atrial septal defect from 2011 to 2014 were enrolled. We used one of four negative pressures (20, 30, 40, or 60 mm Hg) for each patient. We measured haptoglobin, plasma hemoglobin, aspartate aminotransferase, and lactate dehydrogenase levels in the patients' blood three times perioperatively and determined the potential correlation between the change in each parameter with the level of negative pressure. Forty-six patients were enrolled in this study (mean age: 7.1 ± 7.0 months, mean body weight: 6.1 ± 1.8 kg). There were no significant differences according to the degree of negative pressure with respect to patient age, body weight, cardiopulmonary bypass (CPB) time, aorta cross-clamping time, blood flow during CPB, or lowest body temperature. All parameters that we measured reflected progression of hemolysis during CPB; however, the degree of change in the parameters did not correlate with negative pressure. In pediatric patients weighing less than 10 kg, the change in the degree of hemolysis did not differ with the amount of negative pressure. We may apply negative pressures up to 60 mm Hg without increasing the risk of hemolysis, with almost same the level of hemolysis using negative pressures of 20, 30, and 40 mm Hg for effective venous drainage and an ideal operative field during open-heart surgery.

[Sex differences in congenital heart disease].

Science.gov (United States)

Aubry, P; Demian, H

2016-12-01

Gender influences the clinical presentation and the management of some acquired cardiovascular diseases, such as coronary artery disease, resulting in different outcomes. Differences between women and men are also noticed in congenital heart disease. They are mainly related to the prevalence and severity of some congenital heart defects at birth, and in adulthood to the prognosis, incidence of Eisenmenger syndrome and risks of pregnancy. The role of gender on the risk of operative mortality of congenital heart surgery remains debated. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[The role of antiarrhythmic surgery in 2004].

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Guiraudon, G M

2004-11-01

In 2004, surgery for cardiac arrhythmias addresses essentially atrial fibrillation. Surgery is only a rare alternative for other cardiac arrhythmias in center that still have the surgical skill. Surgery for atrial fibrillation has the definite advantage of concomitant exclusion of the left atrial appendage which is the predominant site of intra-atrial thrombi with the associated risk of severe thrombo-embolic events. Our experience with surgery for lone atrial fibrillation, using the Corridor III operation, shows that surgery is associated with high efficacy and long term control of arrhythmia when the surgical technique is well performed. Failures were associated with incomplete line of block or exclusion. This experience shows the necessity of postoperative EP testing. Initially performed using open heart technique, surger for atrial fibrillation is now performed using mini-invasive technique. Indications for surgery for lone atrial fibrillation will decreased while other strategies are developing. To remain competitive surgery must have high efficacy and use mini-invasive techniques. i.e.: closed off pump beating heart via port access. Surgery for atrial fibrillation concomitant with other cardiac surgical repairs yields remarkable results, without increased surgical risk. Their indications go beyond mitral valve pathology. Future developments imply the following conditions: atrial surgery must not increase morbidity, and its cost-effectiveness must be documented. Combined surgery must be testable and tested to gain valid pathophysiological data to improve surgical rationales. Its impact in terms of survival, prevention of thrombo-embolic events and quality of life will be documented by clinical trials.

Cirurgia cardíaca em uma sociedade multiétnica: a experiência do Caribbean Heart Care Cardiac surgery in a multi-ethnic low volume service: the Caribbean Heart Care Experience

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Jose Burgos-Irazabal

2005-09-01

vary significantly amongst these races. We report the surgical experience (adult and paediatric of a low volume multiethnic population service based on Trinidad and Tobago. METHODS: The Adult Heart Surgery program started in November 1993. The data on a total of 878 cases (629 male, median age 67, range 18-88 years old is reported. Of these 39.4% were diabetics and 46.5% hypertensive. The procedures performed include coronary artery bypass grafting, valve repair and replacement, and major aortic surgery including emergency dissection. The paediatric heart surgery program started in Sept 1998 and a total of 279 operations have been performed (Age range, 2 weeks to 21 years RESULTS: Adult - Overall mortality was 3.8%. The majority of procedures were CABG (82.3% with an overall mortality of 2.8% (0% in 2004. Off pump CABG accounts for 43% of the total procedures (71.2% in 2004. Aortic valve surgery was carried out in 49 patients and mitral valve replacement/ repair in 96 either with or without CABG. Paediatric - The majority of the procedures were VSD 111, ASD 57, TOF 23, and 88 others (including A-V canal, BT shunt, aorta coarctation with an overall mortality of 1.5%. CONCLUSION: Heart surgery in a multiethnic low volume service can be performed with excellent results comparable to international standards for adults and paediatrics.

Valvular heart disease and anaesthesia.

Science.gov (United States)

Paul, Abhijit; Das, Sucharita

2017-09-01

Valvular heart disease presents as mixed spectrum lesion in healthcare settings in the third-world and developing countries. Rheumatic heart disease still forms the bulk of the aetiopathology of valve lesions. Mitral and aortic valve lesions top the list of valvular pathology. A thorough understanding of the pathophysiology of valvular heart disease is essential while planning anaesthesia and perioperative care for such patients. Meticulous use of optimal fluids, close monitoring of the changing haemodynamics and avoidance of situations that can cause major reduction of cardiac output and fluid shifts are mandatory to achieve good clinical outcome. We searched MEDLINE using combinations of the following: anaesthesia, aortic, mitral, regurgitation, stenosis and valvular heart disease. We also hand searched textbooks and articles on valvular heart disease and anaesthesia. This article mainly focuses on the understanding the pathophysiology of valvular heart disease in patients presenting for non-cardiac surgeries in secondary and tertiary care setting.

Chances of employment in women and men after surgery of congenital heart disease: comparisons between patients and the general population.

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Geyer, Siegfried; Norozi, Kambiz; Buchhorn, Reiner; Wessel, Armin

2009-01-01

It was examined whether women and men (17-45 years) with operated congenital heart disease differ with respect to chances of employment. Patients were compared with the general population. Patients (n = 314) were classified by type of surgery (curative, reparative, palliative) as indicator of initial severity of disease. The second classification was performed according to a system proposed by the New York Heart Association in order to take reported impairments into account. Controls (n = 1165) consisted of a 10% random sample drawn from the German Socio-Economic Panel. Chances of full-time employment decreased as disease severity increased. Chances of part-time and minor employment were higher in patients than among controls. These general effects were because of male patients, while the employment patterns of women did not differ from the control group. Independent of patient status, women were more likely to have lower rates of full-time employment, and the rates of part-time and minor employment were higher. Long-term adaptation to impairments as a result of congenital heart disease differs between women and men with respect to employment status. While female patients do not differ from the general population, males may lower their engagement in paid work.

Health in adults with congenital heart disease.

Science.gov (United States)

Cuypers, Judith A A E; Utens, Elisabeth M W J; Roos-Hesselink, Jolien W

2016-09-01

Since the introduction of cardiac surgery, the prospects for children born with a cardiac defect have improved spectacularly. Many reach adulthood and the population of adults with congenital heart disease is increasing and ageing. However, repair of congenital heart disease does not mean cure. Many adults with congenital heart disease encounter late complications. Late morbidity can be related to the congenital heart defect itself, but may also be the consequence of the surgical or medical treatment or longstanding alterations in hemodynamics, neurodevelopment and psychosocial development. This narrative review describes the cardiac and non-cardiac long-term morbidity in the adult population with congenital heart disease. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Introduction to the 2015 Supplement to Cardiology in the Young: Proceedings of the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute.

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Jacobs, Jeffrey P

2015-08-01

In the United States of America alone, ~14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on 4 and 5 February, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the Johns Hopkins All Children's Heart Institute International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". Information about George R. Daicoff, MD, and Ed and Sarainne Andrews is provided in this introductory manuscript to the 2015 Supplement to Cardiology in the Young entitled: "Proceedings of the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute". Dr Daicoff founded the All Children's Hospital Pediatric Heart Surgery programme and directed this programme for over two decades. Sarainne Andrews made her generous bequest to All Children's Hospital in honour of her husband Ed and his friendship with Dr Daicoff in order to support cardiovascular surgery research efforts.

The efficacy of preventive parasternal single injection of bupivacaine on intubation time, blood gas parameters, narcotic requirement, and pain relief after open heart surgery: A randomized clinical trial study

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Mahmoud Saeidi

2011-01-01

Full Text Available Background: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. Methods: : In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS device. Results: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO 2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Conclusions: Patients′ pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.

Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

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Bo Kyung Jin

2013-03-01

Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

Open Heart Surgery Does Not Increase the Incidence of Ipsilateral Ischemic Stroke in Patients with Asymptomatic Severe Carotid Stenosis.

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Castaldo, John E; Yacoub, Hussam A; Li, Yuebing; Kincaid, Hope; Jenny, Donna

2017-10-01

We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients. Our aim was to assess whether the practice change led to a greater incidence of stroke. A total of 7350 consecutive patients undergoing OHS during the specified time period were screened. Of these, 3030 had OHS between 2007 and 2011 but none were combined with carotid artery surgery (new cohort). The remaining 4320 had OHS before 2007 and 44 had combined procedures (old cohort). Of patients undergoing OHS during the 10-year period of observation, 230 had severe (>80%) carotid stenosis. In the old cohort (before 2007), carotid stenosis was associated with perioperative stroke in 2.5% of cases. None of the 113 patients having cardiac procedures after 2007 received combined carotid artery surgery; only 1 of these patients harboring severe carotid stenosis had an ischemic stroke (.9%) during the perioperative period. The difference in stroke incidence between the 2 cohorts was statistically significant (P = .002). The incidence of stroke in patients with severe carotid artery stenosis undergoing OHS was lower after combined surgery was discontinued. Combined carotid and OHS itself seems to be an important risk factor for stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Fifteen: Combining Magic Squares and Tic-Tac-Toe

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Yeo, Joseph B. W.

2012-01-01

Most students love to play games. Ernest (1986) believed that games could be used to teach mathematics effectively in four areas: motivation, concept development, reinforcement of skills, and practice of problem-solving strategies. Fifteen is an interesting and thought-provoking game that helps students learn mathematics at the same time. Playing…

Randomized comparative study of intravenous infusion of three different fixed doses of milrinone in pediatric patients with pulmonary hypertension undergoing open heart surgery

Directory of Open Access Journals (Sweden)

Neeraj Kumar Barnwal

2017-01-01

Full Text Available Background: Pulmonary hypertension secondary to congenital heart disease is a common problem in pediatric patients presenting for open heart surgery. Milrinone has been shown to reduce pulmonary vascular resistance and pulmonary artery pressure in pediatric patients and neonates postcardiac surgery. We aimed to evaluate the postoperative outcome in such patients with three different fixed maintenance doses of milrinone. Methodology: Patients were randomized into three groups. All patients received fixed bolus dose of milrinone 50 μg/kg on pump during rewarming. Following this, patients in low-dose group received infusion of milrinone at the rate of 0.375 μg/kg/min, medium-dose group received 0.5 μg/kg/min, and high-dose group received 0.75 μg/kg/min over 24 h. Heart rate, mean arterial pressure (MAP, mean airway pressure (MaP, oxygenation index (OI, and central venous pressure (CVP were compared at baseline and 24 h postoperatively. Dose of inotropic requirement, duration of ventilatory support and Intensive Care Unit (ICU stay were noted. Results: MAP, MaP, OI, and CVP were comparable in all three groups postoperatively. All patients in the low-dose group required low inotropic support while 70% of patients in the high-dose group needed high inotropic support to manage episodes of hypotension (P = 0.000. Duration of ventilatory support and ICU stay in all three groups was comparable (P = 0.412, P = 0.165. Conclusion: Low-dose infusions while having a clinical impact were more beneficial in avoiding adverse events and decreasing inotropic requirement without affecting duration of ventilatory support and duration of ICU stay.

Minimally invasive surgical treatment of valvular heart disease.

Science.gov (United States)

Goldstone, Andrew B; Joseph Woo, Y

2014-01-01

Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease. Copyright © 2014 Elsevier Inc. All rights reserved.

[Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia].

Science.gov (United States)

Moreno, Sandra; Parra, Beatriz; Botero, Javier E; Moreno, Freddy; Vásquez, Daniel; Fernández, Hugo; Alba, Sandra; Gallego, Sara; Castillo, Gilberto; Contreras, Adolfo

2017-12-01

Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

DMPD: NF-kappaB activation by reactive oxygen species: fifteen years later. [Dynamic Macrophage Pathway CSML Database

Lifescience Database Archive (English)

Full Text Available 16723122 NF-kappaB activation by reactive oxygen species: fifteen years later. Gloi...svg) (.html) (.csml) Show NF-kappaB activation by reactive oxygen species: fifteen years later. PubmedID 167...23122 Title NF-kappaB activation by reactive oxygen species: fifteen years later.

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...

Successful heart transplant after 1374 days living with a total artificial heart.

Science.gov (United States)

Gerosa, Gino; Gallo, Michele; Bottio, Tomaso; Tarzia, Vincenzo

2016-04-01

The CardioWest Total Artificial Heart (CW-TAH) has been approved as a temporary device for bridge to cardiac transplantation and is under investigation for destination therapy by US Food and Drug Administration (FDA). We herein report the longest worldwide survival out of hospital (1374 days) of a patient supported with Cardio West Total Artificial Heart (CW-TAH). This experience is intended as a proof of concept of using CW-TAH as the destination therapy in patients with biventricular failure. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Surgery of congestive heart failure - the role of computed tomography in the pre- and postsurgical diagnostic evaluation

International Nuclear Information System (INIS)

Lembcke, A.; Kivelitz, D.E.; Rogalla, P.; Dewey, M.; Klessen, C.; Hamm, B.; Enzweiler, C.N.H.; Dohmen, P.M.; Konertz, W.F.; Wiese, T.H.

2005-01-01

The treatment of advanced, drug resistant congestive heart failure gains in importance in the field of cardiac surgery. Cardiac imaging for preoperative assessment and follow-up focuses on the determination of ventricular volumes and function as well as on the detection of postoperative complications. Computed tomography (CT) is highly accurate irrespective of the individual patient's anatomic situation, has a low examiner dependence and short examination time, does not require an arterial vascular access and can be performed in patients with metal implants. CT is the modality of choice in the follow-up of heart transplants to detect extracardiac and cardiac complications including coronary calcifications as an early sign of transplant vasculopathy. In addition, CT visualizes the elements of mechanical assist devices and can identify their possible local cardiac and mediastinal complications CT can detect fibrolipomatous involution of the mobilized muscle flap in dynamic cardiomyoplasty and can depict fibrous reactions along the epicardial mesh implant in passive cardiac containment. Further indications include assessment of typical local postoperative complications, such as intrathoracic infection and mediastinal bleeding, intracardiac thrombus formation or pericardial effusion. CT is routinely used for evaluating bypass patency but is limited in assessing associated valve defects since it does not visualize flow. (orig.)

Beta-blocker withdrawal among patients presenting for surgery from home

Science.gov (United States)

Schonberger, Robert B.; Lukens, Carrie L.; Turkoglu, O. Dicle; Feinleib, Jessica L.; Haspel, Kenneth L.; Burg, Matthew M.

2012-01-01

Structured Abstract Objective This study sought to measure the incidence of perioperative beta-blocker non-compliance by patients who were prescribed chronic beta blocker therapy and presented for surgery from home. The effect of patient non-compliance on day of surgery presenting heart rate was also examined. Design Prospective observational study with outcome data obtained from review of the medical record. Setting The preoperative clinic and operating rooms of a Veterans Administration hospital. Participants Patients on chronic beta blocker therapy who presented from home for surgery. Interventions None. Measurements and Main Results Demographic and comorbidity data as well as data on self-reported compliance to beta-blocker therapy, initial day of surgery vital signs, and recent ambulatory vital signs were collected. Ten out of fifty subjects (20%; 95% CI = 9-31%) reported not taking their day of surgery beta-blocker. These self-reported non-adherers demonstrated a higher presenting heart rate on the day of surgery vs. adherent subjects (median of 78 beats per minute vs. 65 beats per minute, p=0.02 by Wilcoxon Rank-Sum Test). The difference-in-difference between baseline primary care and day of surgery heart rate was also statistically significant between compliant and non-compliant subjects (-7 beats per minute vs. +12.5 beats per minute, p<0.00001). Conclusions Patient self-report and physiologic data documented failure to take beta-blockers and possible beta-blocker withdrawal in 20% of patients who presented for surgery from home. If these findings are confirmed in larger studies, improved patient understanding of and compliance with medication instructions during preoperative visits should be a focus of future quality improvement initiatives. PMID:22418043

Routine intraoperative transesophageal echocardiography for pediatric open heart surgery: Is it justifiable?

International Nuclear Information System (INIS)

Elgamal, Mohamed-Adel F.; Najm, Hani K.; Abid-Allah, M.; Omran, Ahmad S.

2007-01-01

The routine use of intraoperative transesophageal echocardiography (IO TEE) in children is still debatable. The aim of this study was to determine the safety, benefit and the possible risk of the routine use of IO TEE. It was performed in all children under the age of 14 years with a complex congenital heart defects undergoing open heart surgery, from July 2001 to December 2002. Simple lesions such as secundum atrial septal defects or simple perimembraneous ventricular septal defects (VSD) and neonates less than 2.7 kg were excluded. All children underwent a pre-repair and post-repair complete IO TEE study. There were 112 children, 65 males and 47 females. Ages ranged from 4 days to 156 month, a median of 9 months. A full study was not done in three neonates (3%) because the probe could not be inserted in one, and because of airway compression resulting in desaturation in another two. A pre-repair study confirmed the preoperative transthoracic echocardiographic findings in 105 children (95%). Diagnostic discrepancy or unexpected lesions not reported preoperative were found in six children (5%). Of the 109 children who had full post-repair studies, 67 (60%) showed optimum repair with no residual lesions and 26 (23%) showed trivial or mild residual lesions accepted by the team. Going back on pump to fix moderate or severe residual lesions occurred in 16 (14%) children. In all of these children, the decision for going back on pump was prompted by the IO TEE examination alone. Mild complications occurred in two children (2%). Based on our results, we recommend the routine use of IO TEE. It is safe, has a low complication rate, adds additional information and has a high impact on the diagnosis of residual lesions required in the operating room. However, careful monitoring of the ventilation and airway pressure, particularly during probe insertion and manipulation in small children, is very essential. (author)

Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery: a multicenter double-blinded randomized controlled trial.

Directory of Open Access Journals (Sweden)

Michael Haase

Full Text Available Preliminary evidence suggests a nephroprotective effect of urinary alkalinization in patients at risk of acute kidney injury. In this study, we tested whether prophylactic bicarbonate-based infusion reduces the incidence of acute kidney injury and tubular damage in patients undergoing open heart surgery.In a multicenter, double-blinded (patients, clinical and research personnel, randomized controlled trial we enrolled 350 adult patients undergoing open heart surgery with the use of cardiopulmonary bypass. At induction of anesthesia, patients received either 24 hours of intravenous infusion of sodium bicarbonate (5.1 mmol/kg or sodium chloride (5.1 mmol/kg. The primary endpoint was the proportion of patients developing acute kidney injury. Secondary endpoints included the magnitude of acute tubular damage as measured by urinary neutrophil gelatinase-associated lipocalin (NGAL, initiation of acute renal replacement therapy, and mortality. The study was stopped early under recommendation of the Data Safety and Monitoring Committee because interim analysis suggested likely lack of efficacy and possible harm. Groups were non-significantly different at baseline except that a greater proportion of patients in the sodium bicarbonate group (66/174 [38%] presented with preoperative chronic kidney disease compared to control (44/176 [25%]; p = 0.009. Sodium bicarbonate increased urinary pH (from 6.0 to 7.5, p<0.001. More patients receiving bicarbonate (83/174 [47.7%] developed acute kidney injury compared with control patients (64/176 [36.4%], odds ratio [OR] 1.60 [95% CI 1.04-2.45]; unadjusted p = 0.032. After multivariable adjustment, a non-significant unfavorable group difference affecting patients receiving sodium bicarbonate was found for the primary endpoint (OR 1.45 [0.90-2.33], p = 0.120]. A greater postoperative increase in urinary NGAL in patients receiving bicarbonate infusion was observed compared to control patients (p = 0

Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department - Cluj-Napoca Heart Institute.

Science.gov (United States)

Molnar, Adrian; Muresan, Ioan; Trifan, Catalin; Pop, Dana; Sacui, Diana

2015-01-01

The introduction of Duke's criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon. We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit. The patients' age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases - 21%), Staphylococcus Spp. (15 cases - 15%), and Enterococcus Spp. (9 cases - 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases - 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases - 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases - 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve - mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological examination of valve pieces excised during surgery was

Indications and contraindications for surgery in esophageal cancer

International Nuclear Information System (INIS)

Carriquiry, G.

2004-01-01

In this story we will present the main problems that we have as a surgeons at the moment to decide the indication for surgery in patients with esophageal cancer. Undoubtedly, the patient that will be submitted to surgery must have strict criteria in order to obtain good results. The patient must be compensated from respiratory, cardiovascular, hepatic and renal point of view with a (IMC) above 20, with Karnofsky index above 80% (wanders well), that declares the acceptance of surgery as well as the conserved appetite. After deciding the surgery according to the general conditions, should be discuss the type of procedure, based primarily on tumor topography, because there are different results both morbidity and long-term survival. The indications for resection or palliative surgery depend on the tumor stage. The indications for resection surgery with conventional or eventual extended lymphadenectomy require a patient in good condition, good experience the surgical team and a good hospital support. In tumor stage I the indication is a supposedly curative surgery. The tumor stages II b, III and IV are the heritage of palliative surgery, with or without tumor resection. The age is not an absolute contraindication for surgery, but the hypertension, liver cirrhosis, respiratory diseases with severe functional impact, ischemic heart disease, dilated heart with lowered LVEF, severe psychological disorders and the loss of appetite are contraindication. The morbidity and mortality has declined markedly due to technological advances and specialization of surgical groups, so that surgery is still the best treatment for selected patients

Anesthesia for off-pump coronary artery bypass surgery

Directory of Open Access Journals (Sweden)

Thomas M Hemmerling

2013-01-01

Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

Heart Transplant in Patients with Predominantly Rheumatic Valvular Heart Disease.

Science.gov (United States)

Rosa, Vitor E E; Lopes, Antonio S S A; Accorsi, Tarso A D; Fernandes, Joao Ricardo C; Spina, Guilherme S; Sampaio, Roney O; Bacal, Fernando; Tarasoutchi, Flavio

2015-09-01

International records indicate that only 2.6% of patients with heart transplants have valvular heart disease. The study aim was to evaluate the epidemiological and clinical profile of patients with valvular heart disease undergoing heart transplantation. Between 1985 and 2013, a total of 569 heart transplants was performed at the authors' institution. Twenty patients (13 men, seven women; mean age 39.5 +/- 15.2 years) underwent heart transplant due to structural (primary) valvular disease. Analyses were made of the patients' clinical profile, laboratory data, echocardiographic and histopathological data, and mortality and rejection. Of the patients, 18 (90%) had a rheumatic etiology, with 85% having undergone previous valve surgery (45% had one or more operations), and 95% with a normal functioning valve prosthesis at the time of transplantation. Atrial fibrillation was present in seven patients (35%), while nine (45%) were in NYHA functional class IV and eight (40%) in class III. The indication for cardiac transplantation was refractory heart failure in seven patients (35%) and persistent NYHA class III/IV in ten (50%). The mean left ventricular ejection fraction (LVEF) was 26.6 +/- 7.9%. The one-year mortality was 20%. Histological examination of the recipients' hearts showed five (27.7%) to have reactivated rheumatic myocarditis without prior diagnosis at the time of transplantation. Univariate analysis showed that age, gender, LVEF, rheumatic activity and rejection were not associated with mortality at one year. Among the present patient cohort, rheumatic heart disease was the leading cause of heart transplantation, and a significant proportion of these patients had reactivated myocarditis diagnosed in the histological analyses. Thus, it appears valid to investigate the existence of rheumatic activity, especially in valvular cardiomyopathy with severe systolic dysfunction before transplantation.

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes.

Science.gov (United States)

Seifi, Sohila; Khatony, Alireza; Moradi, Gholamreza; Abdi, Alireza; Najafi, Farid

2018-01-01

Heart surgery patients are more at risk of poor peripheral perfusion, and peripheral capillary oxygen saturation (SpO2) measurement is regular care for continuous analysis of blood oxygen saturation in these patients. With regard to controversial studies on accuracy of the current pulse oximetry probes and lack of data related to patients undergoing heart surgery, the present study was conducted to determine accuracy of pulse oximetry probes of finger, toe, forehead and earlobe in detection of oxygen saturation in patients admitted to intensive care units for coronary artery bypass surgery. In this clinical trial, 67 patients were recruited based on convenience sampling method among those admitted to intensive care units for coronary artery bypass surgery. The SpO2 value was measured using finger, toe, forehead and earlobe probes and then compared with the standard value of arterial oxygen saturation (SaO2). Data were entered into STATA-11 software and analyzed using descriptive, inferential and Bland-Altman statistical analyses. Highest and lowest correlational mean values of SpO2 and SaO2 were related to finger and earlobe probes, respectively. The highest and lowest agreement of SpO2 and SaO2 were related to forehead and earlobe probes. The SpO2 of earlobe probes due to lesser mean difference, more limited confidence level and higher agreement ration with SaO2 resulted by arterial blood gas (ABG) analysis had higher accuracy. Thus, it is suggested to use earlobe probes in patients admitted to the intensive care unit for coronary artery bypass surgery. Registration of this trial protocol has been approved in Iranian Registry of Clinical Trials at 2018-03-19 with reference IRCT20100913004736N22. "Retrospectively registered."

Clinical utility of carotid duplex ultrasound prior to cardiac surgery.

Science.gov (United States)

Lin, Judith C; Kabbani, Loay S; Peterson, Edward L; Masabni, Khalil; Morgan, Jeffrey A; Brooks, Sara; Wertella, Kathleen P; Paone, Gaetano

2016-03-01

Clinical utility and cost-effectiveness of carotid duplex examination prior to cardiac surgery have been questioned by the multidisciplinary committee creating the 2012 Appropriate Use Criteria for Peripheral Vascular Laboratory Testing. We report the clinical outcomes and postoperative neurologic symptoms in patients who underwent carotid duplex ultrasound prior to open heart surgery at a tertiary institution. Using the combined databases from our clinical vascular laboratory and the Society of Thoracic Surgery, a retrospective analysis of all patients who underwent carotid duplex ultrasound within 13 months prior to open heart surgery from March 2005 to March 2013 was performed. The outcomes between those who underwent carotid duplex scanning (group A) and those who did not (group B) were compared. Among 3233 patients in the cohort who underwent cardiac surgery, 515 (15.9%) patients underwent a carotid duplex ultrasound preoperatively, and 2718 patients did not (84.1%). Among the patients who underwent carotid screening vs no screening, there was no statistically significant difference in the risk factors of cerebrovascular disease (10.9% vs 12.7%; P = .26), prior stroke (8.2% vs 7.2%; P = .41), and prior transient ischemic attack (2.9% vs 3.3%; P = .24). For those undergoing isolated coronary artery bypass grafting (CABG), 306 (17.8%) of 1723 patients underwent preoperative carotid duplex ultrasound. Among patients who had carotid screening prior to CABG, the incidence of carotid disease was low: 249 (81.4%) had minimal or mild stenosis (duplex scanning and those who did not. Primary outcomes of patients who underwent open heart surgery also showed no difference in the perioperative mortality (5.1% vs 6.9%; P = .14) and stroke (2.6% vs 2.4%; P = .85) between patients undergoing preoperative duplex scanning and those who did not. Operative intervention of severe carotid stenosis prior to isolated CABG occurred in 2 of the 17 patients (11.8%) identified who

Intellectual functioning in children with congenital heart defects treated with surgery or by catheter interventions

Directory of Open Access Journals (Sweden)

Carmen Ryberg

2016-11-01

Full Text Available Background: Studies suggest that children with congenital heart defects (CHD are at risk for adverse intellectual functioning. However, factors related to lower intellectual functioning in this group are largely unknown. This study describes intellectual functioning in children with CHD in relation to severity of the heart defect, the child´s age and the socioeconomic status of the family (SES.Methods: 228 children treated with surgery or by catheter technique were tested using the Wechsler intelligence scales to determine Full Scale IQ (FSIQ. FSIQ was then analyzed in relation to age (3- 5- , 9-, and 15-year-olds, severity of the diagnosis (mild, moderate, and severe, and SES (low, medium, and high. The median age was 70 months (5.8 years with a range of 162 months (30 months (2.5 years to 192 months (16.0 years. Results: The total mean score on FSIQ was 100.8 (SD = 14.5. Children with severe CHD had significantly lower FSIQ than children with mild and moderate CHD, and 9- and 15-year-olds had significantly lower FSIQ compared to the 3-year-olds. Children from families with low SES had significantly lower FSIQ than children from medium SES and high SES families. No interaction between severity of diagnosis, age, and SES was found for FSIQ.Conclusions: 83% of the children with CHD performed at or above average with respect to FSIQ. SES and severity of diagnosis had significant main effects on FSIQ. These factors should be considered when planning interventions and follow-up programs for children with CHD.

Congenital heart defects and extracardiac malformations.

Science.gov (United States)

Rosa, Rosana Cardoso M; Rosa, Rafael Fabiano M; Zen, Paulo Ricardo G; Paskulin, Giorgio Adriano

2013-06-01

To review the association between congenital heart defects and extracardiac malformations. Scientific articles were searched in the Medline, Lilacs, and SciELO databases, using the descriptors "congenital heart disease," "congenital heart defects," "congenital cardiac malformations," "extracardiac defects," and "extracardiac malformations." All case series that specifically explored the association between congenital heart defects and extracardiac malformations were included. Congenital heart diseases are responsible for about 40% of birth defects, being one of the most common and severe malformations. Extracardiac malformations are observed in 7 to 50% of the patients with congenital heart disease, bringing a greater risk of comorbidity and mortality and increasing the risks related to heart surgery. Different studies have attempted to assess the presence of extracardiac abnormalities in patients with congenital heart disease. Among the changes described, those of the urinary tract are more often reported. However, no study has evaluated all patients in the same way. Extracardiac abnormalities are frequent among patients with congenital heart disease, and patients with these alterations may present an increased risk of morbimortality. Therefore, some authors have been discussing the importance and cost-effectiveness of screening these children for other malformations by complementary exams.

[Atrial fibrillation concomitant with valvular heart disease].

Science.gov (United States)

Ishii, Yosuke

2013-01-01

Patients with valvular heart disease frequently have atrial fibrillation(AF) due to elevated pressure and dilatation of the left and right atria and pulmonary veins. Guidelines for valvular heart disease and AF recommend that surgical treatment for the valvular heart disease should be performed concomitantly with AF surgery. The Full-Maze procedure has evolved into the gold standard of treatment for medically refractory AF. In addition to the pulmonary vein isolation, the right and left atrial incisions of the Full-Maze procedure are designed to block potential macroreentrant pathways. According to the mechanisms of AF with valvular heart disease, the Full-Maze procedure is more effective for the patients than the pulmonary vein isolation alone.

[ESC guidelines on the management of valvular heart disease. What has changed and what is new?].

Science.gov (United States)

Mangner, N; Schuler, G

2013-12-01

In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least

Dysphagia in infants after open heart procedures.

Science.gov (United States)

Yi, Sook-Hee; Kim, Sang-Jun; Huh, June; Jun, Tae-Gook; Cheon, Hee Jung; Kwon, Jeong-Yi

2013-06-01

The aims of this study were to evaluate the prevalence and the clinical predictors of dysphagia and to determine the characteristics of videofluoroscopic swallowing study findings in infants after open heart procedures. This study is a retrospective review of 146 infants who underwent open heart surgery. The infants with dysphagia were compared with those without dysphagia. The videofluoroscopic swallowing study findings of the infants with dysphagia were also evaluated. Of the 146 infants who underwent open heart surgery, 35 (24.0%) had dysphagia symptoms. The infants with dysphagia had lower body weight at operation, more malformation syndromes, longer operation times, and more complex operations than did the infants without dysphagia. In addition, the infants with dysphagia required more time to achieve full oral feeding and had longer hospital stays. Thirty-three infants underwent videofluoroscopic swallowing study: 32 (97.0%) exhibited at least one abnormal finding among the videofluoroscopic swallowing study parameters and 21 (63.6%) exhibited tracheal aspiration. Given the high rate of aspiration in the infants who underwent open heart procedures, monitoring and prompt recognition of the signs and the risk factors of dysphagia may substantially improve infant care with oral feeding and reduce the duration of hospital stays.

Cardiovascular magnetic resonance in congenital heart disease

International Nuclear Information System (INIS)

Cazacu, A.; Ciubotaru, A.

2010-01-01

The increasing prevalence of congenital heart disease can be attributed to major improvements in diagnosis and treatment. Cardiovascular magnetic resonance imaging plays an important role in the clinical management strategy of patients with congenital heart disease. The development of new cardiovascular magnetic resonance (CMR) techniques allows comprehensive assessment of complex cardiac anatomy and function and provides information about the long-term residual post-operative lesions and complications of surgery. It overcomes many of the limitations of echocardiography and cardiac catheterization. This review evaluates the role of cardiovascular magnetic resonance imaging modality in the management of subject with congenital heart disease (CHD). (authors)

Difficult cases in heart failure: the challenge of neurocognitive dysfunction in severe heart failure.

Science.gov (United States)

Sangha, Sumadeep S; Uber, Patricia A; Park, Myung H; Scott, Robert L; Mehra, Mandeep R

2002-01-01

Often ignored, neurocognitive dysfunction in chronic heart failure represents a daunting morbidity progressing to loss of self-reliance. Although the precise mechanisms arbitrating the development of this disorder remain elusive, microembolization and cerebral hypoperfusion are implicated. Other causes of cognitive decline may include prior cardiac surgery, chronic hypertension, sleep disordered breathing, hyperhomocysteinemia, dementia of aging, and more traditional causes such as Alzheimer's disease. The discovery of neurocognitive defects in heart failure must prompt a well-constructed diagnostic evaluation to search for the underlying causes since this process may be at least partially reversible in many cases. Copyright 2002 CHF, Inc

Surgical outcomes in native valve infectious endocarditis: the experience of the Cardiovascular Surgery Department – Cluj-Napoca Heart Institute

Science.gov (United States)

MOLNAR, ADRIAN; MURESAN, IOAN; TRIFAN, CATALIN; POP, DANA; SACUI, DIANA

2015-01-01

Background and aims The introduction of Duke’s criteria and the improvement of imaging methods has lead to an earlier and a more accurate diagnosis of infectious endocarditis (IE). The options for the best therapeutic approach and the timing of surgery are still a matter of debate and require a close colaboration between the cardiologist, the infectionist and the cardiac surgeon. Methods We undertook a retrospective, descriptive study, spanning over a period of five years (from January 1st, 2007 to December 31st, 2012), on 100 patients who underwent surgery for native valve infectious endocarditis in our unit. Results The patients’ age varied between 13 and 77 years (with a mean of 54 years), of which 85 were males (85%). The main microorganisms responsible for IE were: Streptococcus Spp. (21 cases – 21%), Staphylococcus Spp. (15 cases – 15%), and Enterococcus Spp. (9 cases – 9%). The potential source of infection was identified in 26 patients (26%), with most cases being in the dental area (16 cases – 16%). The lesions caused by IE were situated in the left heart in 96 patients (96%), mostly on the aortic valve (50 cases – 50%). In most cases (82%) we found preexisting endocardial lesions which predisposed to the development of IE, most of them being degenerative valvular lesions (38 cases – 38%). We performed the following surgical procedures: surgery on a single valve - aortic valve replacement (40 cases), mitral valve replacement (19 cases), mitral valve repair (1 case), surgery on more than one valve – mitral and aortic valve replacement (20 cases), aortic and tricuspid valve replacement (1 case), aortic valve replacement with a mechanical valve associated with mitral valve repair (5 cases), aortic valve replacement with a biological valve associated with mitral valve repair (2 cases), and mitral valve replacement with a mechanical valve combined with De Vega procedure on the tricuspid valve (1 case). In 5 patients (5%) the bacteriological

Heart transplantation for adults with congenital heart disease: current status and future prospects.

Science.gov (United States)

Matsuda, Hikaru; Ichikawa, Hajime; Ueno, Takayoshi; Sawa, Yoshiki

2017-06-01

Increased survival rates after corrective or palliative surgery for complex congenital heart disease (CHD) in infancy and childhood are now being coupled with increased numbers of patients who survive to adulthood with various residual lesions or sequelae. These patients are likely to deteriorate in cardiac function or end-organ function, eventually requiring lifesaving treatment including heart transplantation. Although early and late outcomes of heart transplantation have been improving for adult survivors of CHD, outcomes and pretransplant management could still be improved. Survivors of Fontan procedures are a vulnerable cohort, particularly when single ventricle physiology fails, mostly with protein-losing enteropathy and hepatic dysfunction. Therefore, we reviewed single-institution and larger database analyses of adults who underwent heart transplantation for CHD, to enable risk stratification by identifying the indications and outcomes. As the results, despite relatively high early mortality, long-term results were encouraging after heart transplantation. However, further investigations are needed to improve the indication criteria for complex CHD, especially for failed Fontan. In addition, the current system of status criteria and donor heart allocation system in heart transplantation should be arranged as suitable for adults with complex CHD. Furthermore, there is a strong need to develop ventricular assist devices as a bridge to transplantation or destination therapy, especially where right-sided circulatory support is needed.

Exercise stress echocardiography in patients with valvular heart disease.

Science.gov (United States)

Sharma, Vishal; Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J

2015-09-01

Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved 60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD.

Face and Construct Validity of the SimSurgery SEP VR Simulator for Salpingectomy in Case of Ectopic Pregnancy

NARCIS (Netherlands)

Hessel, M.; Buzink, S.N.; Schoot, B.C.; Jakimowicz, J.J.

2012-01-01

Objective: To secure patient safety, skills needed for laparoscopy are preferably obtained in a non-patient setting. Therefore, we assessed face and construct validity of performance of a salpingectomy in case of ectopic pregnancy on the SimSurgery SEP VR simulator. Materials and Methods: Fifteen

[Distance covered in walking test after heart surgery in patients over 70 years of age: outcome indicator for the assessment of quality of care in intensive rehabilitation].

Science.gov (United States)

De Feo, Stefania; Mazza, Antonio; Camera, Federica; Maestri, Antonella; Opasich, Cristina; Tramarin, Roberto

2003-06-01

For quality-of-care assessment of rehabilitation programs after cardiac surgery, measures of functional recovery have been proposed as outcome indicators. Aim of this study was to evaluate the feasibility, the safety and the informative content of the 6-min walking test (6 WT) performed in elderly patients soon after admission in an intensive rehabilitation program after cardiac surgery. Population consists of 115 consecutive over-70 patients admitted to an in-hospital rehabilitation program after cardiac surgery. Within 7 days of admission, in 107 patients (93%) clinical conditions allowed the execution of a 6 WT, on ECG telemetry monitoring. Resting and exertional heart rate, score of fatigue (Borg Scale 1 divided by 20), symptoms, ECG alterations and arrhythmias were recorded. Other considered variables were: comorbidity (Charlson index), length of stay and complications occurring during the whole surgical and rehabilitation in-hospitalisation stay, disability (nursing needs: Maslow and nursing chart), functional status at discharge, left ventricular ejection fraction, number of exercise treatment sessions, self-perceived health-status at admission and at discharge (EuroQoL questionnaire). The mean walked distance was 194 +/- 93 m. No complication neither ECG alteration occurred during the 6 WT; only isolated premature ventricular beats were recorded in 26 pts. Heart rate increased from 86 +/- 13 at rest to 95 +/- 17 bpm at the end of the 6 WT (p needs, self-perceived health-status and functional capacity at discharge differed between patients who performed the 6 WT within 4 days compared with those who did it later, and between patients who walked < or = 120 m (lower quartile) compared with those who walked more. In elderly patients after cardiac surgery the 6 WT performed within the first week of admission in rehabilitation unit is feasible and safe. Simple cut-offs like timing of the 6 WT and walking performance identify more severe patients with lower

Magnetic resonance imaging of valvular heart disease

DEFF Research Database (Denmark)

Søndergaard, Lise; Ståhlberg, F; Thomsen, C

1999-01-01

The optimum management of patients with valvular heart diseases requires accurate and reproducible assessment of the valvular lesion and its hemodynamic consequences. Magnetic resonance imaging (MRI) techniques, such as volume measurements, signal-void phenomena, and velocity mapping, can be used...... in an integrated approach to gain qualitative and quantitative information on valvular heart disease as well as ventricular dimensions and functions. Thus, MRI may be advantageous to the established diagnostic tools in assessing the severity of valvular heart disease as well as monitoring the lesion and predicting...... the optimal timing for valvular surgery. This paper reviews the validation of these MRI techniques in assessing valvular heart disease and discusses some typical pitfalls of the techniques, including suggestions for solutions.J. Magn. Reson. Imaging 1999;10:627-638....

Radiation-induced valvular heart disease.

Science.gov (United States)

Gujral, Dorothy M; Lloyd, Guy; Bhattacharyya, Sanjeev

2016-02-15

Radiation to the mediastinum is a key component of treatment with curative intent for a range of cancers including Hodgkin's lymphoma and breast cancer. Exposure to radiation is associated with a risk of radiation-induced heart valve damage characterised by valve fibrosis and calcification. There is a latent interval of 10-20 years between radiation exposure and development of clinically significant heart valve disease. Risk is related to radiation dose received, interval from exposure and use of concomitant chemotherapy. Long-term outlook and the risk of valve surgery are related to the effects of radiation on mediastinal structures including pulmonary fibrosis and pericardial constriction. Dose prediction models to predict the risk of heart valve disease in the future and newer radiation techniques to reduce the radiation dose to the heart are being developed. Surveillance strategies for this cohort of cancer survivors at risk of developing significant heart valve complications are required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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....

Echocardiographic evaluation of simple versus complex congenital heart disease in a tertiary care Paediatrics Hospital

Directory of Open Access Journals (Sweden)

Uttam Kumar Sarkar

2017-10-01

Full Text Available Background & Objectives:Congenital heart diseases are treatable either by catheter based intervention or open heart surgery according to their quality. In our study we aim to analyze congenital heart disease echocardiographically into simple versus complex heart disease at a tertiary care centre with a public health planning and policy making perspective.Materials & Methods:This hospital based study was done on 1010 patients, both from in-patient and out-patient, who were clinically suspected to have heart disease from January 2015 to September 2016 at Dr.B.C.Roy P.G.I.P.S. Kolkata and echocardiographically categorized.Results:A VSD was the commonest acyanotic heart disease (17. 08%.Tetralogy of Fallot (TOF was commonest complex cyanotic heart disease (10.64%, VSD +ASD was the commonest combined lesion (8.12%. Simple heart lesions (63.1% were commoner than complex (36.9% congenital heart diseases.Conclusion:Health policy makers should give due care to manage Congenital Heart Disease either catheter based or surgically keeping in mind about 63.1% of the lesions are simple cardiac lesions and 36.9% lesions are complex cardiac lesion where complex surgery is required. 

The Burden of Clostridium difficile after Cervical Spine Surgery.

Science.gov (United States)

Guzman, Javier Z; Skovrlj, Branko; Rothenberg, Edward S; Lu, Young; McAnany, Steven; Cho, Samuel K; Hecht, Andrew C; Qureshi, Sheeraz A

2016-06-01

Study Design Retrospective database analysis. Objective The purpose of this study is to investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after cervical spine surgery. Methods A total of 1,602,130 cervical spine surgeries from the Nationwide Inpatient Sample database from 2002 to 2011 were included. Patients were included for study based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for cervical spine surgery for degenerative spine diagnoses. Baseline patient characteristics were determined. Multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. Results Incidence of C. difficile infection in postoperative cervical spine surgery hospitalizations is 0.08%, significantly increased since 2002 (p difficile infection were significantly increased in patients with comorbidities such as congestive heart failure, renal failure, and perivascular disease. Circumferential cervical fusion (odds ratio [OR] = 2.93, p difficile infection after degenerative cervical spine surgery. C. difficile infection after cervical spine surgery results in extended length of stay (p costs (p difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p difficile to be a significant predictor of inpatient mortality (OR = 3.99, p difficile increases the risk of in-hospital mortality and costs approximately $6,830,695 per year to manage in patients undergoing elective cervical spine surgery. Patients with comorbidities such as renal failure or congestive heart failure have increased probability of developing infection after surgery. Accepted antibiotic guidelines in this population must be followed to decrease the risk of developing postoperative C. difficile colitis.

Patterns of Transition Experience for Parents Going Home from Hospital with their Infant after First Stage Surgery for Complex Congenital Heart Disease.

Science.gov (United States)

Gaskin, Kerry L

2017-12-04

The purpose of this study was to explore parents' experiences of one specific timepoint in their infant's journey: the transition from hospital to home, following the first stage of their infant's cardiac surgery for complex congenital heart disease. A prospective longitudinal mixed methods study, underpinned with Middle Range Transition Theory (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). Face to face and telephone interviews were conducted and self-report forms completed by parents at four-time points: before discharge (T0), 2weeks after discharge (T1), 8weeks after discharge (T2) and after stage two surgery (T3). Interviews were transcribed verbatim before inductive thematic analysis. Parents were recruited over a 15-month period from 2013 to 2015. Twelve mothers and 4 fathers took part. The infants had functionally univentricular heart (left n=10, right n=1) and a systemic shunt dependent lesion, tetralogy of Fallot (n=1). Dynamic constructivist and constructionist social processes occurred for all parents, involving physical, physiological, psychological and cognitive elements within four 'patterns of experience', two of which 'safety and security' and 'love and support' are presented in this paper. Parental support is essential; parents need to be engaged in discharge planning process and given the opportunity to express their needs to ensure that discharge care is truly patient and family centered. Transition from hospital to home was complex and multi-faceted, with unanticipated physical and emotional transitions superimposed upon those that were expected. Copyright © 2017 Elsevier Inc. All rights reserved.

Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease.

Science.gov (United States)

Burkhardt, Barbara E U; Rücker, Gerta; Stiller, Brigitte

2015-03-25

Children with congenital heart disease often undergo heart surgery at a young age. They are at risk for postoperative low cardiac output syndrome (LCOS) or death. Milrinone may be used to provide inotropic and vasodilatory support during the immediate postoperative period. This review examines the effectiveness of prophylactic postoperative use of milrinone to prevent LCOS or death in children having undergone surgery for congenital heart disease. Electronic and manual literature searches were performed to identify randomised controlled trials. We searched CENTRAL, MEDLINE, EMBASE and Web of Science in February 2014 and conducted a top-up search in September 2014 as well as clinical trial registries and reference lists of published studies. We did not apply any language restrictions. Only randomised controlled trials were selected for analysis. We considered studies with newborn infants, infants, toddlers, and children up to 12 years of age. Two review authors independently extracted data according to a pre-defined protocol. We obtained additional information from all study authors. Three of the five included studies compared milrinone versus levosimendan, one study compared milrinone with placebo, and one compared milrinone verus dobutamine, with 101, 242, and 50 participants, respectively. Three trials were at low risk of bias while two were at higher risk of bias. The number and definitions of outcomes were non-uniform as well. In one study comparing two doses of milrinone and placebo, there was some evidence in an overall comparison of milrinone versus placebo that milrinone lowered risk for LCOS (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.28 to 0.96; 227 participants). The results from two small studies do not provide enough information to determine whether milrinone increases the risk of LCOS when compared to levosimendan (RR 1.22, 95% CI 0.32 to 4.65; 59 participants). Mortality rates in the studies were low, and there was insufficient evidence to

History of cardiac trauma surgery

African Journals Online (AJOL)

the bladder, of the brain, of the heart, of the diaphragm, of ... 'In the left side of the chest, the pericardium and the left lung ... Farina of Rome sutured the right ventricle in a 30-year-old .... 10% versus 26% in those who had surgery later. Beall et ...

Malignant Tumors Of The Heart

International Nuclear Information System (INIS)

Dubrava, J.

2007-01-01

Autoptic prevalence of the heart tumors is 0,01 – 0,3 %. 12 – 25 % of them are malignant tumors and 75 – 88 % are benign. Malignancies are more frequently found in the right heart. Metastatic tumors occur 20 – 40-times more frequently than primary neoplasms. Even 94 % of primary malignant tumors are sarcomas. Most frequent of them are angio sarcomas. Heart metastases are only found in extensive dissemination. Highest prevalence of heart metastases is observed in melanoma, followed by malignant germ cell tumors, leukemia, lymphoma, lung cancer. The clinical presentation is due to the combination of heart failure, embolism, arrhythmias, pericardial effusion or tamponade. The symptoms depend on anatomical localization and the tumor size but not on the histological type. Prognosis of the heart malignancies is poor. Untreated patients die within several weeks to 2 years after the diagnosis was determined. Whenever possible the heart tumor should be resected, despite the surgery is usually neither definite nor sufficiently effective therapy. The patients with completely resectable sarcomas have better prognosis (median of survival 12 – 24 months) than the patients with incomplete resection (3 – 10 months). Complete excision is possible in only less than half of the patients. In some patients chemotherapy, radiotherapy, heart transplantation or combination of them prolonged the survival up to 2 years. Despite of this treatment median of the survival is only 1 year. (author)

A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

Science.gov (United States)

Kim, Won-Gon

2016-08-01

A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book.

Role of hepatic resection for patients with carcinoid heart disease

DEFF Research Database (Denmark)

Bernheim, A.M.; Connolly, H.M.; Rubin, J.

2008-01-01

OBJECTIVE: To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005...... nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery Udgivelsesdato: 2008/2...

Cardiovascular magnetic resonance in adults with previous cardiovascular surgery.

Science.gov (United States)

von Knobelsdorff-Brenkenhoff, Florian; Trauzeddel, Ralf Felix; Schulz-Menger, Jeanette

2014-03-01

Cardiovascular magnetic resonance (CMR) is a versatile non-invasive imaging modality that serves a broad spectrum of indications in clinical cardiology and has proven evidence. Most of the numerous applications are appropriate in patients with previous cardiovascular surgery in the same manner as in non-surgical subjects. However, some specifics have to be considered. This review article is intended to provide information about the application of CMR in adults with previous cardiovascular surgery. In particular, the two main scenarios, i.e. following coronary artery bypass surgery and following heart valve surgery, are highlighted. Furthermore, several pictorial descriptions of other potential indications for CMR after cardiovascular surgery are given.

Surgical results of reoperative tricuspid surgery: analysis from the Japan Cardiovascular Surgery Database†.

Science.gov (United States)

Umehara, Nobuhiro; Miyata, Hiroaki; Motomura, Noboru; Saito, Satoshi; Yamazaki, Kenji

2014-07-01

Tricuspid valve insufficiency (TI) following cardiovascular surgery causes right-side heart failure and hepatic failure, which affect patient prognosis. Moreover, the benefits of reoperation for severe tricuspid insufficiency remain unclear. We investigated the surgical outcomes of reoperation in TI. From the Japan Cardiovascular Surgery Database (JACVSD), we extracted cases who underwent surgery for TI following cardiac surgery between January 2006 and December 2011. We analysed the surgical outcomes, specifically comparing tricuspid valve replacement (TVR) and tricuspid valve plasty (TVP). Of the 167 722 surgical JACVSD registered cases, reoperative TI surgery occurred in 1771 cases, with 193 TVR cases and 1578 TVP cases. The age and sex distribution was 684 males and 1087 females, with an average age of 66.5 ± 10.8 years. The overall hospital mortality was 6.8% and was significantly higher in the TVR group than in the TVP group (14.5 vs 5.8%, respectively; P tricuspid surgery were unsatisfactory. Although TVR is a last resort for non-repairable tricuspid lesions, it carries a significant risk of surgical mortality. Improving the patient's preoperative status and opting for TVP over TVR is necessary to improve the results of reoperative tricuspid surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Robotics in pediatric surgery: perspectives for imaging

Energy Technology Data Exchange (ETDEWEB)

Kant, Adrien J.; Klein, Michael D. [Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children' s Research Center of Michigan, Detroit, MI 48201 (United States); Langenburg, Scott E. [Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children' s Research Center of Michigan, Detroit, MI 48201 (United States); Department of Pediatric Surgery, Children' s Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201 (United States)

2004-06-01

Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance. (orig.)

Robotics in pediatric surgery: perspectives for imaging

International Nuclear Information System (INIS)

Kant, Adrien J.; Klein, Michael D.; Langenburg, Scott E.

2004-01-01

Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance. (orig.)

Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

Energy Technology Data Exchange (ETDEWEB)

Tanis, Wilco [Haga Teaching Hospital, Department of Cardiology, The Hague (Netherlands); Haga Teaching Hospital, The Hague (Netherlands); Sucha, Dominika; Habets, Jesse [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Laufer, Ward; Chamuleau, Steven [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Herwerden, Lex.A. van [University Medical Center Utrecht, Department of Cardiothoracic Surgery, Utrecht (Netherlands); Symersky, Petr [Vrije Universiteit, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Budde, Ricardo P.J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands)

2015-06-01

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. (orig.)

Multidetector-row computed tomography for prosthetic heart valve dysfunction: is concomitant non-invasive coronary angiography possible before redo-surgery?

International Nuclear Information System (INIS)

Tanis, Wilco; Sucha, Dominika; Habets, Jesse; Laufer, Ward; Chamuleau, Steven; Herwerden, Lex.A. van; Symersky, Petr; Budde, Ricardo P.J.

2015-01-01

Retrospective ECG-gated multidetector-row computed tomography (MDCT) is increasingly used for the assessment of prosthetic heart valve (PHV) dysfunction, but is also hampered by PHV-related artefacts/cardiac arrhythmias. Furthermore, it is performed without nitroglycerine or heart rate correction. The purpose was to determine whether MDCT performed before potential redo-PHV surgery is feasible for concomitant coronary artery stenosis assessment and can replace invasive coronary angiography (CAG). PHV patients with CAG and MDCT were identified. Based on medical history, two groups were created: (I) patients with no known coronary artery disease (CAD), (II) patients with known CAD. All images were scored for the presence of significant (>50 %) stenosis. CAG was the reference test. Fifty-one patients were included. In group I (n = 38), MDCT accurately ruled out significant stenosis in 19/38 (50 %) patients, but could not replace CAG in the remaining 19/38 (50 %) patients due to non-diagnostic image quality (n = 16) or significant stenosis (n = 3) detection. In group II (n = 13), MDCT correctly found no patients without significant stenosis, requiring CAG imaging in all. MDCT assessed patency in 16/19 (84 %) grafts and detected a hostile anatomy in two. MDCT performed for PHV dysfunction assessment can replace CAG (100 % accurate) in approximately half of patients without previously known CAD. (orig.)

A dedicated lab for interventional cardiology and hybrid surgery

Energy Technology Data Exchange (ETDEWEB)

Berger, F. [KinderSpital Zurich (Switzerland). Department of Congenital Heart Disease/Pediatric Cardiology

2004-07-01

Pediatric interventionalists and surgeons treating congenital heart defects at the KinderSpital children's hospital in Zurich, Switzerland, use a ''hybrid'' approach to minimize the incidence and extent of open-heart surgery. The hybrid approach combines catheterization and surgical techniques in a single procedure, performed in the same lab. The combined cardiac cath lab/surgery suite is equipped with a Philips Integris Allura BH5000 9''/9'' biplane system, designed to meet all the requirements for pediatric applications, including the need to keep the quantity of contrast agent and the radiation dose to the minimum. Wherever possible, diagnostic X-ray examinations are supplemented by MR and Ultrasound. (orig.)

Anticoagulation in adults with congenital heart disease

DEFF Research Database (Denmark)

Jensen, A S; Idorn, L; Nørager, B

2015-01-01

Adults with congenital heart disease are a growing population. One of the major challenges in the care of these patients is to prevent thromboembolic episodes. Despite relative young age and no typical cardiovascular risk factors, this cohort has a high prevalence of thrombotic events....... Furthermore, there is a lack of scientific evidence regarding how to prevent thromboembolic events with anticoagulation in adults with congenital heart disease. The aim of this paper is to review the current literature pertaining to anticoagulation in adults with congenital heart disease and hence enable....... It is difficult to use treatment algorithms from the general adult population with acquired heart disease in this heterogeneous population due to special conditions such as myocardial scarring after previous surgery, atypical atrial flutter, prothrombotic conditions and the presence of interatrial shunts...

CUDA-based real time surgery simulation.

Science.gov (United States)

Liu, Youquan; De, Suvranu

2008-01-01

In this paper we present a general software platform that enables real time surgery simulation on the newly available compute unified device architecture (CUDA)from NVIDIA. CUDA-enabled GPUs harness the power of 128 processors which allow data parallel computations. Compared to the previous GPGPU, it is significantly more flexible with a C language interface. We report implementation of both collision detection and consequent deformation computation algorithms. Our test results indicate that the CUDA enables a twenty times speedup for collision detection and about fifteen times speedup for deformation computation on an Intel Core 2 Quad 2.66 GHz machine with GeForce 8800 GTX.

Explaining the Decline in Coronary Heart Disease Mortality in the Czech Republic between 1985 and 2007

Czech Academy of Sciences Publication Activity Database

Bruthans, J.; Cifková, R.; Lánská, V.; O'Flaherty, M.; Critchley, J.A.; Holub, J.; Janský, P.; Zvárová, Jana; Capewell, S.

2014-01-01

Roč. 21, č. 7 (2014), s. 829-839 ISSN 2047-4873 Institutional support: RVO:67985807 Keywords : coronary heart disease * Czech MONICA and Czech post-MONICA * coronary heart disease management * coronary heart disease mortality * coronary heart disease risk factors Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery Impact factor: 3.319, year: 2014

MR imaging of congenital heart disease

International Nuclear Information System (INIS)

Kersting-Sommerhoff, B.A.; Diethelm, L.; Teitel, D.F.; Sommerhoff, C.P.; Higgins, C.B.

1988-01-01

Sensitivity and specificity of MR imaging for the evaluation of congenital heart disease was assessed in 51 patients (31 male and 20 female, aged 3-69 years), with a total of 115 congenital heart lesions. The true diagnosis was established by angiocardiography, catheterization, or surgery. Sensitivity at a specificity level of 90% was determined by means of receiver operating characteristic curves for great vessel relationships (100%), thoracic aorta anomalies (94%), atrial (91%) and ventricular (100%) septal defects, visceroatrial situs (100%), loop (100%), right ventricular outflow obstructions (95%), aortic valve (52%), mitral valve (62%), and tricuspid valve (76%). Spin-echo MR imaging is a reliable method for the noninvasive evaluation of congenital heart disease but is limited in the assessment of some valvular anomalies

Surgical pathology of excised heart valves in a referral hospital in iran

International Nuclear Information System (INIS)

Yaghoubi, A.R.; Raeesi, K.

2007-01-01

Assessment of surgical pathology of excised heart valves in a referral hospital in Iran in a five years period. This retrospective descriptive study was done from 2002 to 2005 in Rajaie heart center in Tehran, Iran. Surgery and pathology records of patients who underwent valve replacement or repair surgery were reviewed. Of 1563 patients 738 (47.2%) underwent mitral, 565 (36.1%) aortic, and 215 (14%) multivalve operation. Most common pathology of mitral valve was rheumatic (68%), while degenerative calcific pathology was dominant in aortic valve (52%). Rheumatic involvement was 46%, and degenerative pathology was common in tricuspid and pulmonary valves (50% and 67%, respectively). Time trend analysis shows no significant variation in excised valves pathology or pattern from 2002 to 2005 (p=0.112). Rheumatic pathology in excised heart valves is still common in this referral heart center in Iran, and no obvious change in this pattern was found during a 5 years period. (author)

Obesity-related cardiorenal disease: the benefits of bariatric surgery.

Science.gov (United States)

Fenske, Wiebke; Athanasiou, Thanos; Harling, Leanne; Drechsler, Christiane; Darzi, Ara; Ashrafian, Hutan

2013-09-01

The inexorable increase in the prevalence of obesity is a global health concern, which will result in a concomitant escalation in health-care costs. Obesity-related metabolic syndrome affects approximately 25% of adults and is associated with cardiovascular and renal disease. The heart and kidneys are physiologically interdependent, and the pathological effects of obesity can lead to cardiorenal syndrome and, ultimately, kidney and heart failure. Weight loss can prevent or ameliorate obesity-related cardiorenal syndrome, but long-term maintenance of a healthy weight has been difficult to achieve through lifestyle changes or pharmacotherapy. Bariatric surgery offers both sustained weight loss and favourable metabolic changes, including dramatic improvements in glycaemic control and symptoms of type 2 diabetes mellitus. Procedures such as Roux-en-Y gastric bypass offer immediate multisystemic benefits, including bile flow alteration, reduced gastric size, anatomical gut rearrangement and altered flow of nutrients, vagal manipulation and enteric hormone modulation. In patients with cardiorenal syndrome, bariatric surgery also offers renoprotection and cardioprotection, and attenuates both kidney and heart failure by improving organ perfusion and reversing metabolic dysfunction. However, further research is required to understand how bariatric surgery acts on the cardiorenal axis, and its pioneering role in novel treatments and interventions for cardiorenal disease.

Inter-observer variation in delineation of the heart and left anterior descending coronary artery in radiotherapy for breast cancer: a multi-centre study from Denmark and the UK

DEFF Research Database (Denmark)

Lorenzen, Ebbe L; Taylor, Carolyn W; Maraldo, Maja

2013-01-01

BACKGROUND AND PURPOSE: To determine the extent of inter-observer variation in delineation of the heart and left anterior descending coronary artery (LADCA) and its impact on estimated doses. METHODS AND MATERIALS: Nine observers from five centres delineated the heart and LADCA on fifteen patient...... guidelines were used. In contrast, for the LADCA there was substantial variation in the estimated dose, which was not reduced with guidelines....

Heart Rate and Increased Intravascular Volume

Czech Academy of Sciences Publication Activity Database

Souček, M.; Kára, T.; Jurák, Pavel; Halámek, Josef; Špinarová, L.; Meluzín, J.; Toman, J.; Řiháček, I.; Šumbera, J.; Fráňa, P.

2003-01-01

Roč. 52, - (2003), s. 137 - 140 ISSN 0862-8408 R&D Projects: GA ČR GA102/02/1339 Institutional research plan: CEZ:AV0Z2065902 Keywords : kidneys * heart rate * atrial mechanisms Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.939, year: 2003

Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery.

Science.gov (United States)

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

2015-11-01

Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Nonpharmacologic control of postoperative supraventricular arrhythmias using AV nodal fat pad stimulation in a young animal open heart surgical model.

Science.gov (United States)

Moak, Jeffrey P; Mercader, Marco A; He, Dingchao; Trachiotis, Gregory; Langert, Joshua; Blicharz, Andy; Montaque, Erin; Li, Xiyan; Cheng, Yao I; McCarter, Robert; Bornzin, Gene A; Martin, Gerard R; Jonas, Richard A

2013-06-01

Supraventricular arrhythmias (junctional ectopic tachycardia [JET] and atrial tachyarrhythmias) frequently complicate recovery from open heart surgery in children and can be difficult to manage. Medical treatment of JET can result in significant morbidity. Our goal was to develop a nonpharmacological approach using autonomic stimulation of selective fat pad (FP) regions of the heart in a young canine model of open heart surgery to control 2 common postoperative supraventricular arrhythmias. Eight mongrel dogs, varying in age from 5 to 8 months and weighting 22±4 kg, underwent open heart surgery replicating a nontransannular approach to tetralogy of Fallot repair. Neural stimulation of the right inferior FP was used to control the ventricular response to supraventricular arrhythmias. Right inferior FP stimulation decreased baseline AV nodal conduction without altering sinus cycle length. AV node Wenckebach cycle length prolonged from 270±33 to 352±89 ms, P=0.02. Atrial fibrillation occurred in 7 animals, simulating a rapid atrial tachyarrhythmias. FP stimulation slowed the ventricular response rate from 166±58 to 63±29 beats per minute, Popen heart surgery model. FP stimulation may be a useful new technique for managing children with JET and atrial tachyarrhythmias.

Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery.

Directory of Open Access Journals (Sweden)

Huiqi Jiang

Full Text Available The primary aim was to investigate the role of underlying heart disease on preoperative NT-proBNP levels in patients admitted for adult cardiac surgery, after adjusting for the known confounders age, gender, obesity and renal function. The second aim was to investigate the predictive value of preoperative NT-proBNP with regard to severe postoperative heart failure (SPHF and postoperative mortality.A retrospective cohort study based on preoperative NT-proBNP measurements in an unselected cohort including all patients undergoing first time surgery for coronary artery disease (CAD; n = 2226, aortic stenosis (AS; n = 406 or mitral regurgitation (MR; n = 346 from April 2010 to August 2016 in the southeast region of Sweden (n = 2978. Concomitant procedures were not included, with the exception of Maze or tricuspid valve procedures.Preoperative NT-proBNP was 1.67 times (p<0.0001 and 1.41 times (p<0.0001 higher in patients with AS or MR respectively, than in patients with CAD after adjusting for confounders. NT-proBNP demonstrated significant discrimination with regard to SPHF in CAD (AUC = 0.79, 95%CI 0.73-0.85, p<0.0001, MR (AUC = 0.80, 95%CI 0.72-0.87, p<0.0001 and AS (AUC = 0.66, 95%CI 0.51-0.81, p = 0.047. In CAD patients NT-proBNP demonstrated significant discrimination with regard to postoperative 30-day or in-hospital mortality (AUC = 0.78; 95%CI 0.71-0.85, p<0.0001. The number of deaths was too few in the AS and MR group to permit analysis. Elevated NT-proBNP emerged as an independent risk factor for SPHF, and postoperative mortality in CAD.Patients with AS or MR have higher preoperative NT-proBNP than CAD patients even after adjusting for confounders. The predictive value of NT-proBNP with regard to SPHF was confirmed in CAD and MR patients but was less convincing in AS patients.

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

NARCIS (Netherlands)

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,

Patient-specific pediatric silicone heart valve models based on 3D ultrasound

Science.gov (United States)

Ilina, Anna; Lasso, Andras; Jolley, Matthew A.; Wohler, Brittany; Nguyen, Alex; Scanlan, Adam; Baum, Zachary; McGowan, Frank; Fichtinger, Gabor

2017-03-01

PURPOSE: Patient-specific heart and valve models have shown promise as training and planning tools for heart surgery, but physically realistic valve models remain elusive. Available proprietary, simulation-focused heart valve models are generic adult mitral valves and do not allow for patient-specific modeling as may be needed for rare diseases such as congenitally abnormal valves. We propose creating silicone valve models from a 3D-printed plastic mold as a solution that can be adapted to any individual patient and heart valve at a fraction of the cost of direct 3D-printing using soft materials. METHODS: Leaflets of a pediatric mitral valve, a tricuspid valve in a patient with hypoplastic left heart syndrome, and a complete atrioventricular canal valve were segmented from ultrasound images. A custom software was developed to automatically generate molds for each valve based on the segmentation. These molds were 3D-printed and used to make silicone valve models. The models were designed with cylindrical rims of different sizes surrounding the leaflets, to show the outline of the valve and add rigidity. Pediatric cardiac surgeons practiced suturing on the models and evaluated them for use as surgical planning and training tools. RESULTS: Five out of six surgeons reported that the valve models would be very useful as training tools for cardiac surgery. In this first iteration of valve models, leaflets were felt to be unrealistically thick or stiff compared to real pediatric leaflets. A thin tube rim was preferred for valve flexibility. CONCLUSION: The valve models were well received and considered to be valuable and accessible tools for heart valve surgery training. Further improvements will be made based on surgeons' feedback.

Exercises in anatomy: the normal heart.

Science.gov (United States)

Anderson, Robert H; Sarwark, Anne; Spicer, Diane E; Backer, Carl L

2014-01-01

In the first of our exercises in anatomy, created for the Multimedia Manual of the European Association of Cardiothoracic Surgery, we emphasized that thorough knowledge of intracardiac anatomy was an essential part of the training for all budding cardiac surgeons, explaining how we had used the archive of congenitally malformed hearts maintained at Lurie Children's Hospital in Chicago to prepare a series of videoclips, demonstrating the salient features of tetralogy of Fallot. In this series of videoclips, we extend our analysis of the normal heart, since for our initial exercise we had concentrated exclusively on the structure of the right ventricular outflow tract. We begin our overview of normal anatomy by emphasizing the need, in the current era, to describe the heart in attitudinally appropriate fashion. Increasingly, clinicians are demonstrating the features of the heart as it is located within the body. It is no longer satisfactory, therefore, to describe these components in a 'Valentine' fashion, as continues to be the case in most textbooks of normal or cardiac anatomy. We then emphasize the importance of the so-called morphological method, which states that structures within the heart should be defined on the basis of their own intrinsic morphology, and not according to other parts, which are themselves variable. We continue by using this concept to show how it is the appendages that serve to distinguish between the atrial chambers, while the apical trabecular components provide the features to distinguish the ventricles. We then return to the cardiac chambers, emphasizing features of surgical significance, in particular the locations of the cardiac conduction tissues. We proceed by examining the cardiac valves, and conclude by providing a detailed analysis of the septal structures. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Resurgery for recurrent heart valve diseases

Directory of Open Access Journals (Sweden)

Chong-lei REN

2017-02-01

Full Text Available Objective　To summarize the experience with resurgery for recurrent valvular heart diseases. Methods　From June 2004 to June 2015, 28 patients (15 males and 13 females with ages ranging from 44 to 67 years (55.6±6.5 years with recurrent heart valve disease underwent resurgery. The reasons for resurgery included perivalvular leakage (7 cases, bioprosthetic valve decline (6 cases in mitral valve and 3 in tricuspid valve, mechanical prostheses dysfunction (2cases, infective endocarditis after valve replacement (2 cases, restenosis of repaired native valve (1 case, and severe tricuspid insufficiency after left-side valve surgery (7 cases. Resurgery included mitral valve replacement in 18 patients and tricuspid valve replacement in 10. All the patients underwent third or fourth or even fifth cardiac surgery for valve replacement. Results　There were 2 hospital deaths with a mortality of 7.1% (2/28. The main causes of early-stage deaths were low cardiac output syndrome. The main postoperative complications were respiratory failure in 3, low cardiac output syndrome in 2, reexploration for bleeding in 2 and serious infectious shock in 1. All the patients were found with the great improvement in heart function and the re-implanted prostheses worked well during follow-up. Conclusions　Although resurgery for recurrent heart valve disease poses a continuing challenge to cardiac surgeon, it could be performed with the satisfactory results. The keys to a successful cardiac resurgery include appropriate operational timing, refined surgical technique and reasonable perioperative managements. DOI: 10.11855/j.issn.0577-7402.2017.01.11

Acute postoperative digitalization of patients with arteriosclerotic heart disease after major surgery. A randomized haemodynamic study and proposal for therapy.

Science.gov (United States)

Bille-Brahe, N E; Engell, H C; Sørensen, M B

1980-12-01

Twenty patients with impaired left ventricular function during exercise, who underwent major vascular surgery for arteriosclerotic disease, were randomly digitalized in the immediate postoperative period. All patients had a smooth postoperative course. Haemodynamic measurements showed improved left ventricular function in those who received digitalis, since 60 min after full digitalization the digitalized patients had a highly significant decrease in pulmonary capillary wedge pressure (PCWP) with unchanged stroke volume index (SVI) and left ventricular stroke work index (LVSWI). The same improvement in cardiac function was present the next morning. The present study provides haemodynamic data in support of clinical studies showing a beneficial effect of prophylactic digitalization in surgical patients with clinical signs of arteriosclerotic heart disease, though not in overt failure.

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

NARCIS (Netherlands)

Harskamp, Ralf E.; Meuzelaar, Jacobus J.

2010-01-01

Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery. We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagnosis was delayed because of

Anesthetic management of a 2-day-old with complete congenital heart block

Directory of Open Access Journals (Sweden)

Puneet Khanna

2014-01-01

Full Text Available Maternal connective tissue disorders such as Systemic Lupus Erythematosus (most common, Sjogren′s syndrome, mixed connective tissue disorders may lead to the rare condition of complete congenital heart block in the neonate. Rare fetal syndromes such as myocarditis, 18p syndrome, mucopolysaccharidoses and mitochondrial diseases are other causes. The mortality rate of this condition is inversely propotional to the age of presentation being 6 % in the neonatal age group. As the cardiac output in the neonate is heart rate dependent, it is crucial to maintain the heart rate in these patients. Pharamacological interventions with dopamine, isoprenaline, epinephrine and atropine are known for their variable response. Although permanent pacing is the most reliable mode of management, the access to it is often not readily available, especially in the developing countries. In such cases temporary pacing methods become lifesaving. Of all the modalities of temporary pacing (transcutaneous, transesophageal and transvenous transcutaneous pacing is the most readily available and immediate mode. In this case report we present a two day old neonate with isolated complete congenital heart block and a resting heart rate of 50-55/min in immediate need of palliative surgery for trachea-esophageal fistula (TEF. With pharmacological intervention the heart rate could only be raised to 75-80/min. The surgery was successfully carried out using transcutaneous pacing to maintain a heart rate of 100/min.

Does the Attention Deficit Hyperactivity Disorder interfere with bariatric surgery results?

Directory of Open Access Journals (Sweden)

Doglas Gobbi Marchesi

Full Text Available ABSTRACT Objective: to analyze possible negative effects of Attention Deficit Hyperactivity Disorder (ADHD on the success of bariatric surgery. Methods: we evaluated forty patients undergoing bariatric surgery and with regular post-operative follow-up of at least one year. To all, we applied the questionnaire advocated in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV of the American Psychiatric Association for ADHD, as well as analyzed their postoperative data. Results: fifteen (38% patients presented a positive questionnaire for ADHD. Patients with ADHD presented higher BMI than patients without the disorder (45.8 vs. 40.9 kg/m2, p=0.017, and the difference remained in all postoperative stages. There was no statistically significant difference in surgery success (33.3% x 66.7%, p=0.505 or in BMI reduction (30.71% x 31.88%, p=0.671 one year after the procedure. Conclusion: ADHD patients have a higher BMI. However, the presence of ADHD does not influence the success of bariatric surgery and the reduction of BMI.

[Valvular heart disease: preoperative assessment and postoperative care].

Science.gov (United States)

Nägele, Reto; Kaufmann, Beat A

2013-10-30

Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

The evaluation of mitral heart disease by angiocardiography

International Nuclear Information System (INIS)

Lee, Yong Chul

1980-01-01

Left ventriculography with RAO projection gives many information about the states of mitral apparatus and of left ventricular function. The knowledge about these are very important to determination of performance, time and method of cardiac surgery in mitral valvular heart diseases. 20 patients of mitral valvular heart disease were studied with left ventriculographies in RAO projection which were taken before open heart surgery at department of radiology, National Medical Center during 1976 to June 1980, Comparing with operative findings and pathologic specimens. The results are as follows; 1. Poor motilities and irregularities of mitral valves which were visible above the fulcrum, and irregularities and severe retraction of the fornix during left ventricular systolic phases on left ventriculographies were compatible to the stage III by Sellers' classification of mitral valvular stenosis on operative findings. Mild degree of irregularities and restriction with smooth fornix suggested the stage I. The findings between these two, the stage II. 2. MI group showed left ventricular dilation without hypertrophy, MS group, no significant effect on LV, Ao group, enlargement with hypertrophy. 3. In Ms and MI groups, ejection fraction were relatively well preserved until grade I-II of NYHA Classification. But grade III-IV revealed decreased ejection fraction. E. F. was below 0.55 in 86% of grade III-IV. In Ao group, grade IV showed well preservation of E. F. 4. The pattern of left ventricular contraction demonstrated hypokinetic synesis or asynesis in 44.4% of grade IV, but was normal in all cases below grade III. Hyperkinetic synesis was visible in all Ao group. 5. Left ventriculography is essential to evaluation of mitral valve apparatus and LV function in mitral heart diseases before cardiac surgery