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Sample records for open heart surgery

  1. Open heart surgery

    Science.gov (United States)

    Heart surgery - open ... lung machine is used in most cases during open heart surgery. While the surgeon works on the ... with these procedures, the surgeon may have to open the chest to do the surgery.

  2. Infections in open heart surgery.

    Science.gov (United States)

    Baddour, L M; Kluge, R M

    1989-01-01

    More than 250,000 open heart surgical procedures are performed annually in the United States. The majority of these procedures are coronary artery bypass grafts (CABG) and valve replacements. In this forum our authors discuss the kinds of infections that occur in patients following open heart surgery, as well as the documented risk factors and microbiology of these infections. We also asked each author to outline the criteria used to diagnose post open heart surgery infections, and to address associated consequences and complications. Finally, we were interested in each author's definition of the infection control practitioner's role in the prevention of this particular subset of nosocomial infections.

  3. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies

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

    African Journals Online (AJOL)

    Training of the superspecialties abroad is largely limited to observation with little or no opportunity ... Results: A total of 124 patients underwent open heart surgery during the study period. ..... The experience at the Uganda heart institute shows.

  5. Upper gastrointestinal bleeding after open heart surgery

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    Aithoussa Mahdi

    2014-01-01

    Full Text Available Objective: The occurrence of digestive complications especially upper gastrointestinal bleeding (UGIB has increased after cardiac surgery. The aim of this study was to determine the incidence of UGIB and identify the independent risk factors. Materials and Methods: We retrospectively analyzed data of 1077 patients undergoing cardiopulmonary bypass (CPB from 1994 to 2012 The group of patients with UGIB (n1 = 20 was compared with the population group (n2 = 1057. Demographic characteristics, therapeutic management, endoscopic findings, and outcomes were analyzed. Through a regression analysis we identified independent risk factors of UGIB. Results: The mean age of the group n1 was 58.2 ± 12.4 years and 50.18 ± 13.5 years in the group n2 . UGIB occurred about 13 ± 5.5 days after cardiac surgery. Gastroduodenal ulcer was the most common etiology of hemorrhage (n = 13, 65%. Renal insufficiency, previous gastric ulcer, increased lactate concentration during CPB, prolonged mechanical ventilation, use of vasopressor drug and pulmonary infection was likely contributing factors in UGIB. Conclusion: UGIB following open cardiac surgery is most frequently secondary to gastroduodenal ulceration. Many determinant factors of bleeding are incriminated. Surgeons must be aware of these factors to avoid fatal complications.

  6. Spontaneous bleeding from liver after open heart surgery.

    Science.gov (United States)

    Mir, Najeeb H; Shah, Mian T; Obeid, Mahmoud Ali; Gallo, Ricardo; Aliter, Hashem

    2013-01-01

    Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Interference suppression for EEG recording during open heart surgery

    NARCIS (Netherlands)

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

    1979-01-01

    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

  8. 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.

  9. [Unexplained right-sided heart failure following open heart surgery: mind the pericardium].

    Science.gov (United States)

    Swinkels, B M; Braam, R L; Rensing, B J W M; Jaarsma, W; Defauw, J J A M; Plokker, H W M

    2008-08-30

    Three men, aged 67 years, 80 years and 53 years, respectively, developed signs and symptoms of progressive right-sided heart failure following open heart surgery. They were diagnosed with constrictive pericarditis based on echocardiography, cardiac magnetic resonance and cardiac catheterisation. Following pericardiectomy, two of the patients fully recovered, while one, the 80-year-old man, died during convalescence. When signs and symptoms of progressive right-sided heart failure develop after open heart surgery, a diagnosis of constrictive pericarditis should be considered. Constrictive pericarditis after open heart surgery may be caused by inflammation of the pericardium; an old, fibrotic haemopericardium, which may be diffuse or loculated; pericardial adhesions; or a combination of these entities. Diagnosing constrictive pericarditis is difficult and may take a long time. However, it is important to recognise this disorder early before it has progressed to an advanced stage. Pericardiectomy is the only effective therapy. When performed too late, survival is significantly reduced.

  10. Postoperative Adiponectin Levels in Pediatric Patients Undergoing Open Heart Surgery

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    A. Thaler

    2013-01-01

    Full Text Available Background. Adipose tissue is an important endocrine organ that secretes cytokines, including adiponectin, levels of which are negatively correlated with the severity of the inflammatory process. Aim. To assess the time course of adiponectin levels following open heart surgery with cardiopulmonary bypass and its correlation with early postoperative outcomes. Materials and Methods. Blood samples were obtained from 24 children undergoing cardiac surgery and analyzed for adiponectin, C-reactive protein, and other inflammatory markers. Results. Baseline adiponectin levels were negatively correlated with patients’ preoperative weight and age. Postoperative adiponectin levels decreased compared to baseline ( and correlated negatively with duration of cardiopulmonary bypass (, , length of stay in the pediatric intensive care unit (, , and the inotropic score (, . Adiponectin levels were positively correlated with sVCAM 1 levels; however, there was no correlation between adiponectin levels and sP selectin, tPA, MCP1, and sCD40. Conclusions. The inflammatory response after open heart surgery with cardiopulmonary bypass is associated with a reduction in adiponectin levels. Prolonged or more complicated surgery induced a more substantial inflammatory process characterized by a significant reduction in adiponectin levels over time and a delayed return to baseline levels.

  11. The effects of listening to preferred music on pain intensity after open heart surgery

    OpenAIRE

    Jafari, Hedayat; Zeydi, Amir Emami; Khani, Soghra; Esmaeili, Ravanbakhsh; Soleimani, Aria

    2012-01-01

    Background: Pain is a common phenomenon after surgery. Cardiac surgeries are no exception and patients generally experience acute pain after these surgeries. Inadequate pain management after cardiac surgery predisposes patients to many complications. Therefore, the aim of this study was to determine the effects of listening to preferred music on pain intensity after open heart surgery. Materials and Methods: This study was a randomized clinical trial (RCT) conducted in open heart intensive ca...

  12. Autotransfusion of shed mediastinal blood after open heart surgery

    Institute of Scientific and Technical Information of China (English)

    赵康丽; 许建屏; 胡盛寿; 吴清玉; 魏以桢; 刘迎龙

    2003-01-01

    Objective To determine the safety and effectiveness of autotransfusion of shed mediastinal blood after open heart surgery. Methods Sixty patients undergoing coronary artery bypass grafting (CABG) were selected randomly to receive either nonwashed shed mediastinal blood (Group 1, n=30) or banked blood (Group 2, n=30). Drainage and transfusion volume were determined after the operation. Hb, RBC, HCT and PLT were detected immediately before and after the operation, as well as 24 hours and 7 days after the operation. Data were analyzed using Fisher's exact test. A P0.05). In the two groups, no significant difference in the mean blood loss was observed during 24 hours after the operation (660±300 ml in Group 1 and 655±280 ml in Group 2, P>0.05). In Group 1, the mean volume autotransfused was 280±160 ml, and the patients required 360±80 ml banked blood compared with 660±120 ml in Group 2. In other words, the banked blood requirement in Group 1 was 40% lower. Conclusions Autotransfusion of shed mediastinal blood after an open heart operation is safe and effective.

  13. [Spontaneous epidural hematoma after open heart surgery: case report].

    Science.gov (United States)

    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M

    1999-11-01

    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

  14. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

    Directory of Open Access Journals (Sweden)

    Golamali Mollasadeghi

    2007-06-01

    Full Text Available Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg or sufentanil (5µ/kg plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg. Results: Ten patients had severe mitral valve disease (66.6%, three had aortic valve disease (20%, one had subvalvular aortic stenosis (6.7%, and the remaining one had left atrial myxoma (6.7%. There were five fetal deaths (33.3% and one maternal death (6.7%. Conclusion: It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited.

  15. Multi-organ protection during open heart surgery

    Institute of Scientific and Technical Information of China (English)

    万松; 严秉泉

    2001-01-01

    Purpose and Methods Open-heart surgery with the use of cardiopulmonary bypass (CPB) is associated with an inflammatory cascade which contributes to the development of postoperative complications including multiple organ failure. To provide an update on the subject, we briefly review the recent English-language literature. Results During CPB, various factors have been recognized to induce a complex inflammatory response. Based on an enhanced understanding of the underlying mechanisms, therapeutic strategies have been developed to reduce this inflammatory reaction and its subsequent damaging effects. Off-pump coronary artery bypass grafting may result in less inflammatory injury as compared with the conventional maneuver, which can in turn, diminish the incidence of cardiac, renal, or neurological dysfunction. It is also clear that improving the biocompatibility of CPB materials can lead to a better patient recovery. Inasmuch as the pathophysiology involved appears to be multifactorial, it is unlikely that a single intervention could achieve the desired goal. Both pharmacologic strategies, such as steroid pretreatment, and modification of mechanical devices, such as the use of heparin-coated CPB circuits, could have important clinical implications. The balance between pro- and anti-inflammatory responses may be crucial in limiting the extent of inflammatory injury. Conclusions To date, the concept of organ protection should no longer be limited to the individual organ. Instead, investigations must be extended to focus on a systemic level.

  16. Open-heart Surgery Complications Following Programmed Education and Nurses' Clinical Competence

    Directory of Open Access Journals (Sweden)

    Mahnaz Rakhshan

    2017-01-01

    Full Text Available Heart surgery can lead to certain complications that, if not diagnosed and treated on time, can be fatal. In view of the fact that nurses' clinical competence affects the quality of clinical judgment, the present study aimed to explore the effect of programmed education and nurses' clinical competence on complications following open-heart surgeries. The results of the present study showed that a closer attention to regular and programmed education and informing of open-heart surgery patients, especially before surgery and at the time of discharge, along with the clinical competence of nurses in ICUs, can reduce the incidence of post-surgery complications. Since the nurses' clinical competence greatly affects their clinical judgments and quality of care, paying greater attention to the nurses' education through systematic programs and increasing the clinical competence can lead to fewer post-heart-surgery complications; this, in turn, reduces the length of stay and the ensuing costs.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-02-01

    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.

  18. [The management of infectious mediastinitis after the open heart surgery].

    Science.gov (United States)

    Imada, T; Morishige, N; Nonaka, K; Yamanaka, J

    2000-03-01

    Between October of 1992 and September of 1998, we performed 604 open heart operations. Among them, 12 cases (1.9%) were complicated with postoperative infectious mediastinitis. Five patients (Group A) were treated by conservative therapy which consists of open drainage and intermittent closed irrigation with dilute povidone iodine solution. Seven patients (Group B) were treated surgically in addition to the above-mentioned conservative treatment. Among those patients, one patient developed fatal complication. We have realized that mental care of the patients was also very important when long term hospitalization was necessitated. The hyperbaric oxygen therapy seemed to be also effective for postoperative mediastinitis caused by MRSA.

  19. 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 surgery and eight with abdominal surgery were studied. The adhesion molecules CD11a/CD18 (LFA-1_, CD11c/CD18 and CD44 and the activation molecules CD25, CD69, CD71 and MHCII were measured, using monoclonal antibodies and flow cytometry. Lymphocytopenia was observed during CPB and for some hours after both...... 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

  20. Heart Surgery: MedlinePlus Health Topic

    Science.gov (United States)

    ... Is a Pediatric Heart Surgeon? (American Academy of Pediatrics) Also in Spanish Patient Handouts Aortic valve surgery - open (Medical Encyclopedia) ... Spanish Open heart surgery (Medical Encyclopedia) Also in Spanish ... heart surgery Pediatric heart surgery - discharge Sternal exploration or closure Related ...

  1. Delayed cardiac tamponade after open heart surgery - is supplemental CT imaging reasonable?

    Science.gov (United States)

    Floerchinger, Bernhard; Camboni, Daniele; Schopka, Simon; Kolat, Philipp; Hilker, Michael; Schmid, Christof

    2013-06-24

    Cardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade. Twenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored. In 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%. Diagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade.

  2. The effects of listening to preferred music on pain intensity after open heart surgery.

    Science.gov (United States)

    Jafari, Hedayat; Emami Zeydi, Amir; Khani, Soghra; Esmaeili, Ravanbakhsh; Soleimani, Aria

    2012-01-01

    Pain is a common phenomenon after surgery. Cardiac surgeries are no exception and patients generally experience acute pain after these surgeries. Inadequate pain management after cardiac surgery predisposes patients to many complications. Therefore, the aim of this study was to determine the effects of listening to preferred music on pain intensity after open heart surgery. This study was a randomized clinical trial (RCT) conducted in open heart intensive care unit (ICU) of a university hospital in Sari, Iran. A total of 60 patients who were scheduled to undergo open heart surgery were randomly allocated in two groups. Patients in the intervention group (n = 30) listened to their preferred music by headphones for 30 minutes, whereas those in the control group (n = 30) did not listen to music. Using a Numerical Rating Scale (NRS), pain intensity was measured among the patients before the intervention, and immediately, 30 minutes and one hour after the intervention. Data was analyzed by Chi-square test, student's t-test and repeated measures analysis of variance (ANOVA). Mean pain intensity in the intervention group before, immediately after, 30 minutes and one hour after the intervention were 5.8, 3.1, 2.5 and 2.4, respectively. Corresponding numbers in the control group were 4.7, 4.7, 4.8 and 4.9, respectively. Repeated measures ANOVA showed music to significantly reduce pain intensity (p = 0.0001). Music can be effective as a non-pharmacological, inexpensive, non-invasive and side effect free method for pain management after open heart surgery.

  3. Commencing open heart surgery in resource limited countries: lessons from the LASUTH experience.

    Science.gov (United States)

    Oludara, Mobolaji Adewale; Nwiloh, Jonathan; Fabamwo, Adetokunbo; Adebola, Phillip

    2014-01-01

    The challenge of commencing cardiac surgery in developing countries of Africa is onerous. We present a model from the experience of carrying out open cardiac surgical procedures at the Lagos State University Teaching Hospital (LASUTH) with three separate missions between 2004 and 2006. This paper details the challenges of starting open heart surgery in a resource limited environment. We propose that owing to the huge financial investment needed, government sponsorship as well as collaboration with overseas based and local non-governmental agencies may be required to jump start the process of open cardiac surgery. Local staff training opportunities are also provided by such missions and this can further be complemented by overseas exposure in areas of need for capacity building. In our centre, the initial investment has led to the recruitment of additional trained staff including 2 cardiothoracic surgeons. Further benefits of training of 2 perfusionists and a nurse has improved capacity in cardiac surgery service at our center.

  4. Effect of music on postoperative pain and physiologic parameters of patients after open heart surgery.

    Science.gov (United States)

    Özer, Nadiye; Karaman Özlü, Zeynep; Arslan, Sevban; Günes, Nezihat

    2013-03-01

    The aim of this study was to investigate the effect of listening to personal choice of music on self-report of pain intensity and the physiologic parameters in patients who have undergone open heart surgery. The study design was quasiexperimental. Patients were selected through convenience sampling in the Cardiovascular Surgery Intensive Care Unit at a university hospital. The study was conducted with a total of 87 patients who underwent open heart surgery: 44 in the music group, 43 in the control group, ages between 18 and 78 years. Through pretest-posttest design, postoperative first-day data were collected. First, physiologic parameters (blood pressure, heart rate, oxygen saturation, and respiratory rate) were recorded and a unidimensional verbal pain intensity scale applied to all participants. Later, the control group had a rest in their beds while the music group listened to their choice of music for 30 minutes. Physiologic data were then collected and the pain intensity scale applied once more. In the music group, there was a statistically significant increase in oxygen saturation (p = .001) and a lower pain score (p = .001) than in the control group. There was no difference between the groups in the other physiologic parameters. Results of this research provide evidence to support the use of music. Music might be a simple, safe, and effective method of reducing potentially harmful physiologic responses arising from pain in patients after open heart surgery. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

    Directory of Open Access Journals (Sweden)

    Tomar Akhlesh

    2003-01-01

    Full Text Available 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 difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I in which one unit of whole blood was withdrawn, and PRP group (Group II where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001 and required 38.5% less homologous blood and blood products (p<0.05, in the postoperative period. Haemoglobin levels on day zero (day of operation and day three were statistically not different between the two groups. We

  6. [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.

  7. Comparative study on cerebral injury after open heart surgery in patients with congenital and rheumatic heart disease

    Institute of Scientific and Technical Information of China (English)

    WANG Yong; XIAO Ying-bin; CHEN Lin; ZHONG Qian-jin; WANG Xue-feng

    2005-01-01

    Objective: To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease. Methods: Forty patients with congenital heart disease (CHD, CHD group, n=20) or rheumatic heart disease (RHD, RHD group, n=20) underwent on-pump (cardiopulmonary bypass, CPB) heart-beating open heart surgery. Blood samples before CPB, and 20 minutes, 1 hour, 24 hours and 7 days after CPB were collected, and the levels of neuron-specific enolase (NSE) and protein S-100b in the plasma were determined with enzyme-linked immunoadsorbent assay (ELISA), respectively. All the patients were examined with electroencephalogram (EEG) before and 1 week after operation. The changes of NSE, S-100b and EEG compared to verify the difference of postoperative cerebral injury between CHD cases and RHD cases. Results: The plasma level of S-100b increased significantly 20 minutes after CPB and was still higher than the preoperative level at 24 hours after operation in both groups (P<0.01). The plasma level of NSE increased more significantly in the CHD group than in the RHD group 20 minutes after CPB and it returned to the normal level 24 hours after CPB in the CHD group but remained at a high level in the RHD group (P<0.01). The levels of NSE and S-100b returned to the normal levels on the 7th day after CPB. Abnormal EEG was found in 75% of the patients in the CHD group and 60% in the RHD group. Conclusions: On-pump heart-beating open heart surgery can cause certain cerebral injury in the patients with CHD or RHD. The injury was more severe and recovered more quickly in the CHD group than in the RHD group.

  8. [Application of new chest holder in the median sternotomy for open heart surgery in adults].

    Science.gov (United States)

    Xu, C Y; Feng, D G; Wang, J X; Cheng, Z Y; Wang, F; Lin, B; Xie, Z L; Suo, L N; Du, P

    2016-09-13

    Objective: To explore the application of new chest holder in the median sternotomy for open heart surgery in adults. Methods: Two hundred adult patients in Henan Provincial People's Hospital from May 2013 to May 2015 were enrolled in the study and randomly divided into two groups. Experimental group included 100 cases who accepted the new type of chest holder in the open heart surgery. Control group were also composed of 100 cases whose sternums were fixed with the pure steel wire cerclage. Sternal closure time was recorded since the sternum closing. All subjects were followed up to obtain the chest incision healing, the incidence of sternal dehiscence, infection and secondary thoracotomy, and thus to estimated the effect of new chest holder. Results: All patients in the experimental group reached the effect of firm closed chest surgery. Sternal closure time of experimental group was much shorter than that of control group[(10±2) vs (21±4) min, Pholder in the median sternotomy for open heart surgery is more convenient with small surgical trauma. It can also effectively reduce the incidence of sternal instability, dehiscence, infection and secondary thoracotomy.

  9. 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 < 0.01). The magnitude of the shift was not significantly higher for females than for males (p < 0.157). We found no significant difference between the shift and the cross-clamp or perfusion time (p < 0.6450). The assessment of physiological tremor by means of our novel, feasible method may provide a deeper insight into the mechanism of central nervous system damage associated with open heart surgery.

  10. BASE DEFICIT IN IMMEDIATE POSTOPERATIVE PERIOD OF OPEN HEART SURGERY AND OUTCOME OF PATIENTS

    Directory of Open Access Journals (Sweden)

    F. Sabzi

    2007-07-01

    Full Text Available "nBase deficit is a non-respiratory indicator of acid base status. Aim of this study is to assess relationship between the base deficit value in immediate post operative period of CABG and valvular heart disease with cardiopulmonary and in hospital outcome of patient. A total of 136 consecutive with CABG and valvular heart disease scheduled in study. 20 variables were determined during the pre-intra-and postoperative period. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq. Secondly a logistic regression model was performed on the variables shown to have a statistically significant difference in univariate analysis with determination of the odd ratio. 3 variables had a statistically significant difference in univariate analysis and 2 of them high lighted by the linear logistic model. The value of base deficit measured during the immediate postoperative open-heart surgery is correlated with volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra aortic balloon pump after surgery.

  11. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... the type of defect, and the type of surgery that was done. Many children recover completely and lead normal, active lives.

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

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    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.

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

    Science.gov (United States)

    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 protocol group (P protocol significantly decreased the total antibiotic dose used in the perioperative period (P protocol group patients required this additional change in the antibiotic regimen (P protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

  14. 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.

  15. The Role of Acu-TENS in Hemodynamic Recovery after Open-Heart Surgery

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    Maggie C. S. Ng

    2011-01-01

    Full Text Available Increased heart rate (HR and reduced blood pressure (BP are common consequences of cardiac surgery. This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points (Acu-TENS on HR, BP, rate pressure product (RPP and nausea and vomiting score after open-heart surgery. After open heart surgery, 40 patients were randomly allocated to either an Acu-TENS group, which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1–5, or a Placebo-TENS group, which received identical electrode placement but with no electrical output from the TENS unit, despite an output indicator light appearing activated. HR, systolic and diastolic BPs (SBP and DBP were recorded and RPP computed. Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention. Daily HR, BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group. A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days, with all variables returning to preoperative values by Day 4 (P > .2. In the Placebo-TENS and Control groups the HR remained higher (P < .0001, BP lower (P < .05 and RPP higher (P = .01 than respective preoperative values at Day 4. The dose of Maxolon required was lowest in the Acu-TENS group (P = .038. We concluded that Acu-TENS facilitated an earlier return to preoperative BP, HR and RPP values in patients after acute heart surgery.

  16. The Effects of Open Heart Surgery (Coronary Bypass on Depression and Social Adjustment of Hospitalized Heart Patients

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    Farah Naderi

    2009-01-01

    Full Text Available Problem statement: Post treatment preparation is critical period, as patients may have difficulties with psychosocial adjustment, especially related to dissatisfaction with side effects of medicine taking therapy and a lack of socialization skills/social competence. Different psychological issues arise for patients depending upon where they are in the medical treatment process. Approach: The current research was processed with the intention of examining and presenting the effects of open heart surgery (coronary bypass on male and female hospitalized heart patients' depression and social adjustment in Tehran Shahid Modarress Hospital; regarding age, sex, employment and marital status The research sample particularized 118 patients (42 female and 76 male whom were selected by simple random sampling procedure. To obtain data, Beck Depression Inventory (BDI and Social Adjustment Scale Self-Report (SAS-SR were implemented a couple weeks before and after surgery procedure as pretest and post test with one group. The research design was quasi-experimental. Results: Results were considered significant at p value less than to equal to 0.0001 (p≤0.0001 and revealed that: Heart surgery decreased social adjustment but had no significant impact on heart inpatients' depression. Conclusion: After treatment, it was common for patients to exhibit behavior problems, depression, poor social adaptation and/or noncompliance with the medical regimen. The psychosocial adaptation of surgery procedure can be promoted through support and counseling by one or all members of the surgery team caring for the patients and their families. This process must start during the first visit to the treatment center.

  17. Music: an intervention for pain during chest tube removal after open heart surgery.

    Science.gov (United States)

    Broscious, S K

    1999-11-01

    Pain associated with chest tube removal is a major problem for patients who undergo open heart surgery. Because this pain is short-lived, timing the administration of pharmacological agents for pain relief is difficult and is therefore done inconsistently. To examine the effect of music as an intervention for pain relief during chest tube removal after open heart surgery. In an experimental design, 156 subjects (mean age, 66 years; 69% men) were randomly assigned to 1 of 3 groups: control, white noise, or music. All subjects preselected the type of music they preferred hearing. Ten minutes before the chest tube was removed, the patient's heart rate and blood pressure were measured, the patient rated pain intensity by using a numeric rating scale, and the prerecorded audiotape of music was begun. The patients rated their pain again immediately after chest tube removal and 15 minutes later. Physiological variables were assessed every 5 minutes until 15 minutes after the chest tubes were removed. Self-reported pain intensity, physiological responses, and narcotic intake after chest tube removal did not differ significantly among the 3 groups. Although the findings were not statistically significant, most subjects enjoyed listening to the music, and therefore the use of music as an adjuvant to other therapies may be an appropriate nursing intervention.

  18. Open Heart Surgery in a Newly Established Cardiovascular Department: The first 300 cases

    Directory of Open Access Journals (Sweden)

    Kemal Korkmaz

    2016-01-01

    Full Text Available Aim: Evaluation of the results of open heart surgery in a newly established cardiovascular clinic: Ankara Numune Education and Research Hospital. Material and Method: Between June 2012 and January 2014, 300 open heart surgeries were performed. Urgent operation was performed in 22 patients (7.3% because of ST-elevation myocardial infarction and in 1 patient because of left ventricular aneurysm rupture. Coronary artery bypass grafting was performed in 211 (70.3% patients. The other patients underwent various complex operations such as valve repair, Tirone-David procedure and repair of atrioventricular canal defect. Results: In 3 patients (1% hospital mortality was seen. Reoperation was performed in 8 patients (2.6% because of pericardial tamponade and in 9 patients (3% because of bleeding. Atrial fibrillation was developed in 28 patients (9.3% in the postoperative period and normal sinus rhythm was established with medical cardioversion. Intra-aortic balloon pump(IABP was used in 4 patients preoperatively and in 11 patients postoperatively, including 15 patients(%5. Discussion: In the current era, the patients who are consulted to cardiovascular surgery clinics become more chronic, high risk and patients with additional co-morbid diseases because of the developments in interventional cardiology. Our newly established center aims to be a nationally and internationally successful clinic which was proved by low mortality and morbidity rates with a team who follows the developments and constantly educate and trained.

  19. Genetic and clinical risk factors for fluid overload following open-heart surgery.

    Science.gov (United States)

    Enger, T B; Pleym, H; Stenseth, R; Wahba, A; Videm, V

    2014-05-01

    Post-operative fluid overload following cardiac surgery is associated with increased morbidity and mortality. We hypothesised that genetic variations and pre-operative clinical factors predispose some patients to post-operative fluid overload. Perioperative variables were collected prospectively for 1026 consecutive adults undergoing open-heart surgery at St. Olavs University Hospital, Norway from 2008-2010. Post-operative fluid overload was defined as a post-operative fluid balance/kg ≥ the 90th percentile of the study population. Genotyping was performed for 31 single-nucleotide polymorphisms related to inflammatory/vascular responses or previously associated with complications following open-heart surgery. Data were analysed using logistic regression modelling, and the findings were internally validated by bootstrapping (n = 100). Homozygous carriers of the common G allele of rs12917707 in the UMOD gene had a 2.2 times greater risk of post-operative fluid overload (P = 0.005) after adjustment for significant clinical variables (age, duration of cardiopulmonary bypass, and intraoperative red cell transfusion). A genetic risk score including 14 single-nucleotide polymorphisms was independently associated with post-operative fluid overload (P = 0.001). The number of risk alleles was linearly associated with the frequency of fluid overload (odds ratio per risk allele 1.153, 95 % confidence interval 1.056-1.258). Nagelkerke's R(2) increased with 7.5% to a total of 25% for the combined clinical and genetic model. Hemofiltration did not reduce the risk. A common variation in the UMOD gene previously shown to be related to renal function was associated with increased risk of post-operative fluid overload following cardiac surgery. Our findings support a genetic susceptibility to disturbed fluid handling following cardiac surgery. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  20. Open heart surgery in dialysis-dependent patients with end stage renal failure

    Directory of Open Access Journals (Sweden)

    Orkut Güçlü

    2013-09-01

    Full Text Available Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75% and nine women(25% totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76 years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3: 335-338Key words: Cardiac surgery, chronic renal failure, mortality

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

    Science.gov (United States)

    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.

  2. Profile of acute kidney injury after open heart surgeries in a tertiary care hospital.

    Science.gov (United States)

    Rather, Fayaz A; Najar, Saleem M; Malla, Hilal A; Ahangar, A G; Bhat, Hilal M; Wani, Imtiyaz A

    2015-11-01

    Our objective is to determine the incidence, etiology, risk factors and outcome of acute kidney injury (AKI) after open heart surgery. A prospective study was conducted on 62 patients who underwent open heart surgery and were followed-up for the development of AKI and to determine its incidence, etiology and outcome. Post-operative AKI was considered when the post-operative serum creatinine was >1.5 mg/dL or there was doubling of serum creatinine above the baseline (pre-operative) with a prior normal renal function. The incidence of AKI in the post-operative period in our study was 17.7%. The common etiological factors for AKI in our study were sepsis, hypotension, prolonged need for ventilator and inotropic support and drugs given in the post-operative period. The important risk factors for the development of AKI in the post-operative period were hypertension, diabetes mellitus, gout, prolonged total bypass time and prolonged aortic cross-clamp time. The overall mortality in our study subjects was 11.3% (seven of 62 died) and the mortality in the patients who developed post-operative AKI was 71.4%.

  3. Clinical evaluation of the centrifugal pump in open heart surgery: a comparative study of different pumps.

    Science.gov (United States)

    Takarabe, K; Yoshikai, M; Murayama, J; Hamada, M; Ito, T

    1997-07-01

    The centrifugal pump is now widely used in open heart surgery for its clinical benefits related to the blood elements and the coagulation system. The purpose of this study was to compare the clinical performances of and the outcomes offered by 4 types of centrifugal pumps. For each pump, we investigated the effects on the blood elements, coagulation system, complements, and immunoglobulins during open heart surgery. Four types of centrifugal pumps were used: the HPM-15 (Nikkiso Co.), the Capiox (Terumo Co.), the Lifestream (St. Jude Medical Co.), and the BP-80 (Medtronic, BioMedicus Co.). The platelet count, lactate dehydrogenase (LDH), antithrombin III (AT III), thrombin-antithrombin complex (TAT), complements (C3, C4, and CH50), and immunoglobulins (IgG, IgA, and IgM) were measured before and after cardiopulmonary bypass (CPB). The platelet count was decreased more significantly by the HPM-15 than by any of the other pumps. The other parameters showed no difference among the 4 pumps. In clinical use, each of the 4 types of centrifugal pumps was safe.

  4. Who Needs Heart Surgery?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. Who Needs Heart Surgery? Heart surgery is used to treat ... will work with you to decide whether you need heart surgery. A cardiologist specializes in diagnosing and ...

  5. Heart valve surgery

    Science.gov (United States)

    ... Tricuspid valve stenosis Risks The risks of having cardiac surgery include: Death Heart attack Heart failure Bleeding requiring ... and the A.D.A.M. Editorial team. Heart Surgery Read more Heart Valve Diseases Read more Latest ...

  6. RELEASE OF SERUM TROPONIN I AND ITS RELATIONSHIP TO MULTIFACTORS FOLLOWING OPEN HEART SURGERY IN CHILDREN

    Institute of Scientific and Technical Information of China (English)

    CAI Ji-ming; SHI Zhen-ying; ZHOU Yan-ping; CHEN Lin; SU Zhao-kang; YANG Yan-min

    2005-01-01

    Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A (TOF, n=31) and group B (VSD, n=26). Blood samples were drawn preoperatively, 5min(T0), 6h(T6), 12h(T12), 24h(T24), 48h(T48), 72h(T72) after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia (30℃~ 32℃), cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass (CPBT), cross-clamping time (CCT), clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 (P0.05). Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B.There was a positive correlation between peak CTnI and CPBT, CCT (r=0.51; P<0.01), myocardial operative injury after ventriculotomy and muscle resection (r=0.35, P<0.01). Also the peak CTnI value was correlated to the clinical score for cardiac function (r=-0.52; P<0.01). 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support.Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.

  7. Effect of music on postoperative pain in patients under open heart surgery.

    Science.gov (United States)

    Mirbagher Ajorpaz, Neda; Mohammadi, Abouzar; Najaran, Hamed; Khazaei, Shala

    2014-09-01

    Music, as a non-pharmacological and inexpensive nursing intervention, can be used easily as a complementary technique in reducing pain along with other methods. While some studies have demonstrated pain to decrease after music, others found music to be ineffective on pain. The aim of this study was to investigate the effect of music on postoperative pain in patients under open heart surgery. A quasi-experimental study was performed on 60 patients under open heart surgery referred to ICU of Shahid Beheshti hospital in Kashan city. Patients were randomly divided into two groups including experimental and control groups. Patients in music group listened to nonverbal music for 30 minutes after surgery by headphones. The control group did not receive any intervention other than routine care. Before and after intervention, pain intensity was measured and recorded by visual analog scale in two groups. Data was analyzed using Chi-Square and t-tests. Before intervention, the mean of pain intensity was 6.32 ± 0.21 and 6.10 ± 0.21 for experimental and control groups, respectively; and the difference was not significant (P = 0.21). After intervention, the mean of pain intensity was 3.11 ± 0.12 and 5.81 ± 0.38 for experimental and control groups, respectively; and the difference was significant (P = 0.04). Listening to the relaxant music can reduce postoperative pain. It is suggested that relaxant music be used as a complementary method in patients in order to reduce prospective pain.

  8. Beginnings of open-heart surgery in Gdansk - double role of the Pemco heart-lung machine and new facts about Dutch-Polish cooperation.

    Science.gov (United States)

    Paprocka-Lipińska, Anna

    2016-06-01

    The first open-heart surgery in Gdansk took place in 1975. It was possible thanks to the gift of a Pemco extracorporeal circulation machine from the Netherlands to the Surgery Institute of the Medical Academy of Gdansk. The article presents additional, unpublished informations which enable a new interpretation of the previously known facts.

  9. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  11. Prognostic Value of Serum B-Type Natriuretic Peptide in Early Mortality and Morbidity of Children with Congenital Heart Disease after Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Nozar Givtaj

    2009-06-01

    Full Text Available Background: Brain type natriuretic peptide (BNP is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery. Methods: We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children. Results: In total, 96 patients, comprising 40 (41.7% females and 56 (58.3% males with a mean age of 4.1 years (range: 1 month to 17 years, with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital (P value=0.004, congestive heart failure after surgery (P value<0.001 , patients' cyanosis (P value=0.045, duration of ICU stay (r=0.342, P value=0.004, and post-operative need for inotropic drugs (P value<0.001. Conclusion: The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children.

  12. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  13. Are there independent predisposing factors for postoperative infections following open heart surgery?

    Directory of Open Access Journals (Sweden)

    Lola Ioanna

    2011-11-01

    Full Text Available Abstract Background Nosocomial infections after cardiac surgery represent serious complications associated with substantial morbidity, mortality and economic burden. This study was undertaken to evaluate the frequency, characteristics, and risk factors of microbiologically documented nosocomial infections after cardiac surgery in a Cardio-Vascular Intensive Care Unit (CVICU. Methods All patients who underwent open heart surgery between May 2006 and March 2008 were enrolled in this prospective study. Pre-, intra- and postoperative variables were collected and examined as possible risk factors for development of nosocomial infections. The diagnosis of infection was always microbiologically confirmed. Results Infection occurred in 24 of 172 patients (13.95%. Out of 172 patients, 8 patients (4.65% had superficial wound infection at the sternotomy site, 5 patients (2.9% had central venous catheter infection, 4 patients (2.32% had pneumonia, 9 patients (5.23% had bacteremia, one patient (0.58% had mediastinitis, one (0.58% had harvest surgical site infection, one (0.58% had urinary tract infection, and another one patient (0.58% had other major infection. The mortality rate was 25% among the patients with infection and 3.48% among all patients who underwent cardiac surgery compared with 5.4% of patients who did not develop early postoperative infection after cardiac surgery. Culture results demonstrated equal frequencies of gram-positive cocci and gram-negative bacteria. A backward stepwise multivariable logistic regression model analysis identified diabetes mellitus (OR 5.92, CI 1.56 to 22.42, p = 0.009, duration of mechanical ventilation (OR 1.30, CI 1.005 to 1.69, p = 0.046, development of severe complications in the CICU (OR 18.66, CI 3.36 to 103.61, p = 0.001 and re-admission to the CVICU (OR 8.59, CI 2.02 to 36.45, p = 0.004 as independent risk factors associated with development of nosocomial infection after cardiac surgery. Conclusions We

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

    Science.gov (United States)

    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.

  15. Changes in activities performed in leisure time after open heart surgery.

    Science.gov (United States)

    Bunzel, B; Eckersberger, F

    1989-06-01

    To assess any changes made in the leisure activities performed after open heart surgery, 94 patients (48 with aortocoronary bypass operation, 46 with valve replacements) were asked exactly one year postoperatively whether activities, collected in a list of 21 items, had increased, decreased or remained equal since their operation. In spite of the fact that most leisure activities seemed to have remained unchanged, after operation patients seem to undertake activities quite contrary to their motivations for undergoing surgery in the first place: active participation (such as involvement in some kind of sport, going out to cinema, theatre, restaurants,...) decreases, whereas passive activities (such as watching sports on television, listening to music,...) increases significantly. Although 90% of the patients stated their physical, and 67% their emotional status, as being clearly improved compared to preoperative values, the experience of body limitations as well as of fear and anxiety seems to be so durable that the patients, now in good condition, become passive onlookers and cease to participate in social life.

  16. Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Fariborz Akbarzadeh

    2006-05-01

    Full Text Available Background: Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are candidates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease. Methods: We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.. Results: No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively... Conclusions: The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease.

  17. 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

    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...... 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...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...

  18. 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......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...

  19. Feto-maternal outcomes of urgent open-heart surgery during pregnancy.

    Science.gov (United States)

    Hosseini, Saeid; Kashfi, Fahimeh; Samiei, Niloufar; Khamoushi, Amirjamshid; Ghavidel, Alireza Alizadeh; Yazdanian, Forouzan; Mirmesdagh, Yalda; Mestres, Carlos A

    2015-03-01

    Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy. Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variables included incidence of low birth weight, prematurity, and fetal malformation. Patients were allocated to two groups: Group A (n = 9) included pregnant women with living neonates, while group B (n = 7) included pregnant women with an aborted fetus or dead neonate. All data were compared between the groups. There was no in-hospital maternal mortality. There were no significant differences between the two groups regarding age, gestational age, previous cardiac operation, type of surgery, duration of operation, perfusion pressure and core temperature during CPB. The CPB time was longer in group B (110.3 ± 57.1 min) than in group A (62 ± 15.7 min) (p = 0.028), as was the aortic cross-clamp time (54.3 ± 27.2 min and 38.7 ± 9.3 min in groups A and B, respectively) (p = 0.014). Group B patients received higher doses of inotropes perioperatively. No congenital abnormalities were identified in any of the living neonates. The durations of CPB and aortic cross-clamping may not affect maternal outcome, but shorter CPB and aortic

  20. Clinical application of disposable heparin sensors. Blood heparin measurements during open heart surgery.

    Science.gov (United States)

    Yun, J H; Lee, L M; Wahr, J A; Fu, B; Meyerhoff, M E; Yang, V C

    1995-01-01

    The authors previously reported the development of an ion selective electrode type heparin sensor consisting of a specially formulated polymer membrane doped with tridodecylmethylammonium chloride as the heparin complexing agent. They also demonstrated the feasibility of measuring blood heparin levels by protamine titration, using a disposable copper wire sensor coated with the heparin sensing membrane to probe the titration end point. In this article, the results of further titration studies conducted on 44 clinical whole blood specimens obtained from 8 patients undergoing open heart surgery were reviewed. Samples were taken from patients at four different stages during the bypass surgery: 1) before heparin administration; 2) immediately after heparin administration; 3) within 30 min to 3 hr after heparin administration; and 4) within 30 min after protamine administration. Heparin anticoagulant activity in these samples was monitored by the activated clotting time assay, whereas heparin concentrations were measured by protamine titration using either the Hepcon HMS Titrator (Medtronic HemoTec Inc., Englewood, CO) or the coated wire heparin sensor to determine titration end points. Results indicate that heparin levels determined by the sensor method were in good agreement with those determined by the Hepcon HMS Titrator. When the heparin concentrations estimated by the two methods show significant discrepancy (> 1.0 unit/ml), the sensor method seems to provide more precise values, as verified by an additional chromogenic heparin assay. The overall time required to complete the titration process and heparin measurement with a pre made heparin sensor was less than 3 min. Clinically, the heparin sensor could be used as a safeguard to precisely monitor heparin levels during surgical procedures. Alternatively, the sensor could be used to assess the accurate protamine dose required for full heparin reversal.

  1. Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Nasir Hussain

    2012-01-01

    Full Text Available Central venous catheters (CVC are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

  2. Clinical use of centrifugal pumps and the roller pump in open heart surgery: a comparative evaluation.

    Science.gov (United States)

    Yoshikai, M; Hamada, M; Takarabe, K; Okazaki, Y; Ito, T

    1996-06-01

    Centrifugal pumps have been used widely as the main pump in open heart surgery to reduce damage to blood elements and to reduce the activation of the coagulation system. The purpose of this study was the evaluation and comparison of the effects of two types of centrifugal pumps and of one type of roller pump on blood elements, the coagulation system, complements, and immunoglobulins. Two types of centrifugal pumps (Lifestream; St. Jude Medical, Chelmsford, Massachusetts; and BP-80: Medtronic, BioMedicus, Inc., Eden Prairie, Minnesota, U.S.A.) and one roller pump (Mera Co.) were used separately as the main pump for cardiopulmonary bypass (CPB) in 29 patients. Platelet counts, lactate dehydrogenase, antithrombin III, thrombin-antithrombin complex (TAT), complements (C3, C4, and CH50) and immunoglobulins G, A, and M values were measured before and after CPB and compared. Values, except those for TAT, showed no significant difference among the three groups. The TAT values increased less in each of the centrifugal pump groups than in the roller pump group. This finding suggests that thrombin synthesis might be suppressed by the use of a centrifugal pump.

  3. Role of Negative-Pressure Wound Therapy in Deep Sternal Wound Infection After Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Cemalettin Aydın

    2013-08-01

    Full Text Available Introduction: Mediastinitis is a devastating complication in open heart surgery. The most common treatments after debridement are rewiring with antibiotic irrigation. Vacuum assisted closure therapy is a recently introduced technique that promotes the healing of difficult wounds, including post-sternotomy mediastinitis.Patients and Methods: Forty one patients with deep sternal wound infection were divided into two groups based on the treatment method used. Twenty two patients with post-cardio to my deep sternal wound infection were treated primarily by vacuum assisted closure method (group A and 19 patients with deep sternal wound infection who received closed mediastinal irrigation were treated with antibiotics (group B between January 2006 and January 2010.Results: The two groups were compared. Three patients died during treatment in group B. The median healing time was significantly shorter in group A (mean, 13.5 ± 3.2 days compared to 18 days (mean, 21.2 ± 16.4 days in group B (p< 0.001. Deep sternal wound infection showed no recurrences after the vacuum treatment, while 7 (24% patients in group B suffered recurrences. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days (p= 0.001.Conclusion: A significantly shorter healing time was confirmed with vacuum assisted closure. Hospital stay remained significantly shorter in group A (35 vs. 46 days.

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

    Science.gov (United States)

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

    2016-01-01

    Background: 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. Materials and Methods: 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: 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 Aromatherapy with lavender is suggested to be considered as a nursing intervention in clinical settings. PMID:27563324

  5. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade.

    Science.gov (United States)

    Nandi, P; Leung, J S; Cheung, K L

    1976-01-01

    Between July 1968 and December 1975, 821 patients underwent open heart operations. In 596 cases the pericardium was left open and in 225 the pericardium was closed. Forty-one patients in the open pericardium group required reoperation and 23 of these had tamponade. Four patients in the closed pericardium group had reoperation but there was not a single case of tamponade. In most cases that required reoperation the bleeding was from extrapericardial sources. Absence of tamponade in the closed pericardium group can be explained by the fact that blood from extrapericardial sources of bleeding cannot collect round the heart because the pericardium is closed. Thus closure of pericardium helps to prevent tamponade. Reoperations some months or years after the original operation are technically easier and less hazardous if the pericardium has been closed because the closed pericardium prevents the heart from becoming adherent to the back of sternum and also because there are fewer adhesions in the pericardial cavity. PMID:795444

  6. 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...... and the control group regarding the expression of adhesion molecules or the oxidative burst activity. In the steroid group the fluid gain during extracorporeal circulation (ECC) was 683 ml (median) compared to 1488 ml in the control group. Steroids prevented hyperthermia in the postoperative period but did...... 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...

  7. Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

    OpenAIRE

    Fevzi Sarper Türker; Ayşe Doğan; Gonca Ozan; Kurtuluş Kıbar; Mine Erışır

    2016-01-01

    Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) w...

  8. 2004 survey of ECMO in the neonate after open heart surgery: circuitry and team roles.

    Science.gov (United States)

    Searles, Bruce; Gunst, Gordy; Terry, Bryan; Melchior, Richard; Darling, Edward

    2005-12-01

    Over the past 20 years, the bulk of the literature and texts published about extracorporeal membrane oxygenation (ECMO) has been written by physicians and nurses. The consensus of this body of printed information would suggest, among other things, that (1) despite significant advancements in extracorporeal technology, the standard ECMO circuit has remained fundamentally unchanged since originally described in 1982, and (2) perfusionists are nearly absent from the staffing algorithm at most centers. While these conclusions may be representative of the extracorporeal life support (ELSO) reporting centers, they may not be representative of the field as a whole. We hypothesized that the use of modern extracorporeal equipment and the involvement of perfusionists in ECMO patient care is largely underreported in previous studies. To study this hypothesis, we developed a standard survey instrument and queried perfusion teams from the hospitals listed on the American Society of Extra-Corporeal Technology Pediatric Registry. All centers were contacted by phone and were asked questions regarding their caseload, circuitry, and staffing algorithms. Data are reported as a percentage of respondents. ECMO is used as a method of mechanical support after neonatal open heart surgery in 94% of centers surveyed. For 60% of the centers, a silicone membrane oxygenator is used exclusively, whereas 40% of the centers have used a hollow fiber oxygenator (HFO), and of that group, 19% use a HFO routinely for neonatal post-cardiopulmonary bypass ECMO. Roller pumps are used exclusively at 65% of the centers, whereas centrifugal pumps are used routinely in 12%, and 23% have used both. Perfusionists are responsible for set-up/initiation (79%) and daily rounding/troubleshooting (71%), and provide around-the-clock bedside care (46%) at the surveyed centers. These data suggest that previously published ELSO-centric ECMO studies may significantly underestimate the contemporary application of modern

  9. Tissue perfusion in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components.

    Science.gov (United States)

    Chasovskyi, K; Fedevych, O; McMullan, D M; Mykychak, Y; Vorobiova, G; Zhovnir, V; Yemets, I

    2015-09-01

    This study evaluates the hemoglobin-oxygen relationship and tissue perfusion during cardiopulmonary bypass (CPB) in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components. We compared perioperative hematocrit (Hct), fetal hemoglobin (HbF), p(50)O(2), pH, pCO(2), serum lactate, duration of mechanical ventilation and intensive care unit (ICU) length of stay in neonates undergoing open-heart surgery using autologous umbilical cord blood (Group I, N=45) or donor blood components (Group II, N=65). The groups were similar with respect to diagnosis, weight, type of procedure, duration of CPB and duration of myocardial ischemia. Mean p(50)O(2) was significantly lower in Group I during CPB (19.7 vs. 22.3 mmHg, p=0.004) and at the end of CPB (20.1 vs. 22.8 mmHg, p=0.003). Median peak lactate during CPB was higher in Group I (4.8 vs. 2.2 mmol/l, pblood, tissue oxygen delivery appears to be preserved in neonates who undergo open-heart surgery using autologous umbilical cord blood. © The Author(s) 2014.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Endotracheal tube tip culture in post-operative respiratory infections in open heart surgery patients: a one year prospective study

    Directory of Open Access Journals (Sweden)

    Chandra Mouli HC

    2016-10-01

    Full Text Available Background: Respiratory tract infections are a common occurrence after open heart surgery, leading to prolonged hospital stay, morbidity and costing the hospital exchequer. This study was conducted to study the utility of postextubation endotracheal tube [ET] tip culture in providing an early-basis for starting evidence-based antibiotic therapy. Methods: We retrospectively reviewed the case records of 172 patients who had undergone heart surgery at our tertiary care teaching hospital for occurrence of post-operative infections from clinical and microbiological data. Results: Bacterial culture was positive in 67(39% patients. Endotracheal tube patients, grew organisms that were sensitive to empirical antibiotic therapy, in 39 (58% patients. In 28 (42% patients organisms resistant to empirical therapy were grown; only 14 of the 28 patients (50% were symptomatic. Staphylococcus was the most common organism isolated followed by Acinetobacter and Enterobacter. Pseudomonas aeruginosa isolates were sensitive to all the antibiotics tested. Resistance was high among Acinetobacter sp. All the Gram-negative bacteria were sensitive to tigecycline. Resistance for beta-lactam antibiotics ranged from 35%-66% with imipenem being the most effective antibiotic. Conclusion: Our observations provide useful information regarding the microbiology of respiratory infection occurring in post-operative patients who had undergone open-heart surgery. Post-extubation endotracheal tip culture appears to be a useful tool for reliable and accurate diagnosis and treatment of these infections.

  12. [Methicillin-cephem-resistant Staphylococcus aureus (MRSA) mediastinitis following open heart surgery].

    Science.gov (United States)

    Yanagisawa, H; Anzai, T; Iijima, T; Sakata, Y; Ishikawa, S; Obayashi, T; Otaki, A; Saito, A; Suzuki, M; Kamoshita, Y

    1991-11-01

    Mediastinitis following cardiac surgery occurs frequently in association with high mortality and morbidity. Patient was a 6-year-old boy suffering from Sotos syndrome with secundum type of ASD. He was operated upon to repair ASD. Following the surgery, he suffered from MRSA mediastinitis and osteomyelitis of the sternum. Routine method of closed irrigation after reopening of the sternal wound was ineffective. Patient recovered following aggressive debridement repeatedly, open drainage and topical irrigation with vancomycin. This appears to be a useful method to treat MRSA mediastinitis of the sternum.

  13. [First open heart surgery in hypothermia in Croatia performed in 1957].

    Science.gov (United States)

    Hromadko, Miroslav; Fatović-Ferencić, Stella

    2009-01-01

    In Zagreb, at the Surgical Department of University Hospital "Dr Ozren Novosel", today "Merkur" the first operation in hypothermia was performed on October 25th, 1957, on the patient with pulmonary valve stenosis. It allowed total circulatory interruption to do the operation in the open heart successfully, and this was the first such operation not only in Croatia but in the broader context of former Yugoslavia.

  14. Classification and discrimination of pediatric patients undergoing open heart surgery with and without methylprednisolone treatment by cytomics

    Science.gov (United States)

    Bocsi, Jozsef; Mittag, Anja; Pierzchalski, Arkadiusz; Osmancik, Pavel; Dähnert, Ingo; Tárnok, Attila

    2011-02-01

    Introduction: Methylprednisolone (MP) is frequently preoperatively administered in children undergoing open heart surgery. The aim of this medication is to inhibit overshooting immune responses. Earlier studies demonstrated cellular and humoral immunological changes in pediatric patients undergoing heart surgeries with and without MP administration. Here in a retrospective study we investigated the modulation of the cellular immune response by MP. The aim was to identify suitable parameters characterizing MP effects by cluster analysis. Methods: Blood samples were analysed from two aged matched groups with surgical correction of septum defects. Group without MP treatment consisted of 10 patients; MP was administered on 21 patients (median dose: 11mg/kg) before cardiopulmonary bypass (CPB). EDTA anticoagulated blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end (CPB2), 4h, 24h, 48h after surgery, at discharge and at out-patient followup (8.2; 3.3-12.2 month after surgery; median and IQR). Flow cytometry showed the biggest MP relevant changes at CPB2 and 4h postoperatively. They were used for clustering analysis. Classification was made by discriminant analysis and cluster analysis by means of Genes@work software. Results & conclusion: 146 parameters were obtained from analysis. Cross-validation revealed several parameters being able to discriminate between MP groups and to identify immune modulation. MP administration resulted in a delayed activation of monocytes, increased ratio of neutrophils, reduced T-lymphocytes counts. Cluster analysis demonstrated that classification of patients is possible based on the identified cytomics parameters. Further investigation of these parameters might help to understand the MP effects in pediatric open heart surgery.

  15. Types of Heart Surgery

    Science.gov (United States)

    ... from the NHLBI on Twitter. Types of Heart Surgery Coronary Artery Bypass Grafting Coronary artery bypass grafting ( ... TAHs) might be used to treat these patients. Surgery To Place Ventricular Assist Devices or Total Artificial ...

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Heart valve surgery - discharge

    Science.gov (United States)

    ... ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  18. Combination of balanced ultrafiltration with modified ultrafiltration attenu-ates pulmonary injury in patients undergoing open heart surgery

    Institute of Scientific and Technical Information of China (English)

    黄惠民; 姚廷俊; 王伟; 朱德明; 张蔚; 陈虹; 付维定

    2003-01-01

    Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB).Methods Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group, conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group, cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (Cstat), airway resistance (Raw), alveolar-arterial oxygen difference (A-a DO2), hematocrit (HCT), serum albumin (Alb), interleukin-6 (IL-6), endothelia-1 (ET-1) and thromboxane (TXB2) were measured. Results The pulmonary function was improved, HCT and serum albumin concentrations were increased, and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.Conclusions Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood, exclude harmful inflammatory mediators, and attenuate lung edema and inflammatory responsive pulmonary injury.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Mitral valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Mitral Valve Prolapse Browse the Encyclopedia A.D. ...

  1. Aortic valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otton CM, Bowow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  2. Efficacy and safety of modified Yale insulin infusion protocol in Japanese diabetic patients after open-heart surgery.

    Science.gov (United States)

    Tamaki, Motoyuki; Shimizu, Tomoaki; Kanazawa, Akio; Tamura, Yoshifumi; Hanzawa, Ayame; Ebato, Chie; Itou, Chiharu; Yasunari, Eisuke; Sanke, Haruna; Abe, Hiroko; Kawai, Junko; Okayama, Kaede; Matsumoto, Kazuhisa; Komiya, Koji; Kawaguchi, Minako; Inagaki, Noriko; Watanabe, Takahiro; Kanazawa, Yoshie; Hirose, Takahisa; Kawamori, Ryuzo; Watada, Hirotaka

    2008-09-01

    To our knowledge, there is currently no insulin infusion protocol for critically ill patients especially designed for Asian diabetics although many such protocols are used in Western countries. In this study, we modified the Yale insulin infusion protocol taking into consideration the characteristics of Japanese diabetics and hospital environment. We tested the modified protocol in 40 type 2 diabetic patients after elective open-heart surgery (MY group) comparing with 35 type 2 diabetic patients under empirical blood glucose control (EC group). Analyses of 1656 blood glucose measurements during insulin infusion revealed that percentage of samples that showed achievement of target blood glucose level (80-140 mg/dl) was higher under MY (78+/-15%, n=870) than EC (57+/-23%, n=786, p<0.0001). On the other hand, the percentage of samples in which blood glucose was less than 60 mg/dl was comparable in the two groups (MY: 0.5+/-5.9 per thousand, EC: 5.1+/-18.5 per thousand). None of the patients with hypoglycemia showed significant clinical adverse effects. In conclusion, our modified Yale insulin infusion protocol is effective and safe for tight blood glucose control in Japanese diabetic patients after open-heart surgery.

  3. Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran.

    Science.gov (United States)

    Davoudi, Alireza; Najafi, Narges; Alian, Shahriar; Tayebi, Atefe; Ahangarkani, Fatemeh; Rouhi, Samaneh; Heydari, Amirhosein

    2015-08-06

    Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens. The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014. In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used. Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR). We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and

  4. [Suppurative mediastinitis after open heart surgery: in comparison between infants-children and adults].

    Science.gov (United States)

    Fukasawa, M; Orita, H; Inui, K; Hirooka, S; Iijima, Y; Washio, M

    1993-02-01

    Among 361 consecutive patients who underwent open surgery from Jan. 1987 to Sept. 1991, risk factors and clinical courses were analyzed retrospectively in comparison between infants-children and adults. Seven mediastinitis (4.0%) occurred in 173 adult patients (20 to 75 y/o, mean: 54.4 y/o) and were not associated with age, sex, type of disease, and duration of operation or cardiopulmonary bypass. Postoperative mediastinitis significantly increased in the patients with low output syndrome (LOS) determined as use of IABP and/or assistant circulations (p MRSA in 10 and Staphylococcus epidermidis in one. In the seven of adult patients, two developed sepsis and four died with other organic failures or mediastinal bleeding. All five of infants healed after postoperative 33 to 145 days. The immature state of immune response might associate with postoperative mediastinitis in infants, whether LOS may be important in the immune suppression by surgical stress in adults, and the prognosis of mediastinitis might be effected by prolonged depression of postoperative cardiac function in adult patients.

  5. Less platelet damage in the curved vane centrifugal pump: a comparative study with the roller pump in open heart surgery.

    Science.gov (United States)

    Nishinaka, T; Nishida, H; Endo, M; Koyanagi, H

    1994-09-01

    The centrifugal pump with the curved vane (Lifestream Centrifugal Pump [LCP]) was applied to cardiopulmonary bypass (CPB) in 10 patients who underwent elective coronary artery bypass grafting. Serum hemoglobin levels, platelet counts, and serum beta-thromboglogulin (beta-TG) levels were measured during CPB. The results were compared with those for a comparative roller pump (RP) group (n = 10). There was no difference in CPB time between LCP (112 +/- 22 min) and RP (121 +/- 22 min) groups. Serum beta-TG levels (ng/ml) were lower in the LCP group than in the RP group (34 +/- 9 vs. 101 +/- 80, 5 min; 81 +/- 33 vs. 236 +/- 112, 30 min; 120 +/- 53 vs. 314 +/- 100, 60 min after initiation of CPB; p < 0.05). There were no significant differences in hemolysis and platelet depletion. The LCP showed excellent hemodynamic performance with less blood trauma in clinical application to open heart surgery.

  6. 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.

  7. Effect of applying cold gel pack on the pain associated with deep breathing and coughing after open heart surgery

    Science.gov (United States)

    Khalkhali, HamidReza; Tanha, Zahra Ebrahimi Rigi; Feizi, Aram; Ardabili, Shahyad Salehi

    2014-01-01

    Background: Coughing and deep breathing after sternotomy causes severe pain. This study was conducted to assess the effect of cold therapy on the pain in patients undergoing open heart surgery. Materials and Methods: In a randomized controlled trial (RCT) with crossover design, 50 eligible and consenting patients were recruited and randomly allocated to gel pack and non-gel pack groups on the first postoperative day. All patients performed four episodes of deep breathing and coughing (DB and C) every 2 h. Pain intesity was measured and compared at rest and after DB and C in both groups. At the end of the study, all patients were asked about their preferences for the cold gel pack application prior to DB and C. The study hypotheses were analyzed using repeated measures analysis of variance (RM-ANOVA). Results: Data analysis showed significant reduction in pain scores (P < 0.001) after cold gel application. Forty-five (90%) patients were inclined to reapply the gel pack in the future. Conclusion: Cold gel pack can reduce the pain associated with DB and C in cardiac surgery patients. PMID:25558248

  8. Nursing of extracorporeal circulation open - heart surgery patient%体外循环下心内直视手术患者的护理

    Institute of Scientific and Technical Information of China (English)

    秦爱华

    2011-01-01

    目的 探讨心脏直视手术患者的护理方法.方法 对96例心脏直视手术患者的围术期护理加以分析、归类和总结并进行随访.结果 本组96例心脏直视手术患者均存活,且随访均获得良好生活质量.结论 心内直视手术风险大,加强心理护理、术后各项监护的仔细观察及预防术后并发症是手术成功的关键.%Objective To investigate nursing of patients treated with open- heart surgery.Methods To analyze, classify, and summarize and carry on the revisit the perioperative care for 96 open- heart surgery patients.Results All 96 open - heart surgery patients survived and obtained good quality of life.Conclusion The risk of open- heart surgery is big.To strengthen psychological nursing, carefully observe of postoperative care and prevent the postoperative complications is key to successful operation.

  9. Heart Surgery Devices May Have Been Contaminated: CDC

    Science.gov (United States)

    ... 161469.html Heart Surgery Devices May Have Been Contaminated: CDC Patients who experience night sweats, fever, weight ... used during open heart surgery may have been contaminated with bacteria that puts patients at risk for ...

  10. Precautionary Measures for Successful Open Heart Surgery in G6PD Deficient Patient- A Case Report

    Science.gov (United States)

    2016-01-01

    Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis. The echocardiography report revealed severe mixed mitral lesion and moderate tricuspid regurgitation. On general examination she had mild pallor and icterus. We planned for a thorough investigation to prepare her for mitral valve replacement and tricuspid annuloplasty. These groups of patients are at high risk of haemolysis during perioperative period and need prolonged mechanical ventilation and hospital stay due to impaired oxygen carrying capacity and oxidative stress due to deficient free radical scavenging system. The patient underwent mechanical mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with precautionary measures to prevent the risk of haemolysis and associated complications. She had an uneventful recovery. PMID:28208930

  11. [The efficacy of function water (electrolyzed strong acid solution) on open heart surgery; postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus].

    Science.gov (United States)

    Ichihara, Toshihiko; Fujii, G; Eda, T; Sasaki, M; Ueda, Y

    2004-11-01

    Methicillin-resistant Staphylococcus aureus (MRSA) infection after cardiac surgery has recently increased. We compared the anti-inflammatory effect of an electrolyzed strong acid solution and a warm saline solution in patients with open heart surgery. These solutions were used for mediastinal irrigation before closing the sternum. Group A patients were irrigated by a warm saline solution, and group B patients were irrigated by an electrolyzed strong acid solution, administration of this water is safe, feasible, and easy for the prevention of MRSA infection. Postoperative infection was significantly decreased in the group B as compared in the group A. An electrolyzed strong acid solution may be effective on postoperative infection, particularly MRSA infection following open heart surgery.

  12. [Sudden onset of EDTA-dependent pseudothrombocytopenia in a patient scheduled for open heart surgery].

    Science.gov (United States)

    Satoh, Minako; Hirose, Yoshifumi; Gamo, Masahiro; Ohtsuka, Tatsuo; Yonezawa, Kouki; Tomioka, Toshiaki; Sakai, Keiko

    2003-04-01

    A 60-year-old woman scheduled for mitral and aortic valve replacement had sudden onset of thrombocytopenia without clinical symptoms. The platelet count was found to decrease after the sampling. Microscopic examinations confirmed platelet aggregations. Changing anticoagulant added to blood samples from EDTA to heparin resolved such platelet aggregations. This phenomenon was diagnosed as demonstrating EDTA-dependent pseudothrombocytopenia and the operation was performed as scheduled without platelet transfusion. Postoperative course was almost uneventful and the patient was discharged on 26th day after surgery. EDTA-dependent pseudothrombocytopenia must be ruled out when patients have thrombocytopenia without certain causes such as infections, drugs, or autoimmune diseases.

  13. The effect of combination of hemofilter, pre- and intraoperative methylprednisolone administration on systemic inflammatory response syndrome (SIRS post open heart surgery

    Directory of Open Access Journals (Sweden)

    . Supomo

    2017-02-01

    Full Text Available Systemic inflammatory response syndrome (SIRS occurs in almost all patients whom undergo open heart surgery causes the increase its morbidity and mortality. The effect of pre- and intraoperative methylprednisolone administration combined with hemofilter application in cardiopulmonary bypass machine in the reduction of SIRS incidence remains controversial. This study aimed to evaluate the effect pre- and intraoperative methylprednisolone administration combined with hemofilter on SIRS incidence after open heart surgery. This was an experimental study using prospective randomized open-blinded evaluation (PROBE design. Ninety-five patients from Dr. Sardjito General Hospital, Yogyakarta, and Dr. Cipto Mangunkusumo General Hospital, Jakarta, who had open heart surgery within the period of December 2011 to May 2012 were enrolled in this study. The patients were randomly allocated into two groups i.e. Group A (48 patients received pre-; intra-; and postoperative methylprednisolone (15; 5 and 5 mg/kg BW, respectively and hemofilter and Group B (47 patients just received intra- and postoperative methylprednisolone (15 and 5 mg/kg BW. The SIRS incidence was evaluated in 3; 24; 48 and 72 hours post surgery. This study showed that the SIRS incidence in Group B at 3 (OR= 0.12; 95%CI=0.03-0.39; p< 0.001 and 24 (OR= 0.38; 95%CI=0.14-0.996; p< 0.031 hours postoperative were significantly higher than that in Group A. In conclusion, pre- and intraoperative methylprednisolone administration combined hemofilter significantly decrease the SIRS incidence post open heart surgery.

  14. Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass.

    Science.gov (United States)

    Türker, Fevzi Sarper; Doğan, Ayşe; Ozan, Gonca; Kıbar, Kurtuluş; Erışır, Mine

    2016-01-01

    Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined. Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period. Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed.

  15. Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Fevzi Sarper Türker

    2016-01-01

    Full Text Available Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA and antioxidant indicators (GPx, GSH, CAT, and SOD were examined. Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period. Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed.

  16. Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Ozan, Gonca; Kıbar, Kurtuluş; Erışır, Mine

    2016-01-01

    Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined. Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period. Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed. PMID:28101295

  17. [Monitoring myocardial performance after open heart surgery by calculation of diastolic and systolic pressure time index (author's transl)].

    Science.gov (United States)

    Seybold-Epting, W; Fenchel, G; Stunkat, R; Seboldt, H; Hoffmeister, H E

    1978-10-01

    In order to determine the incidence of subendocardial ischemia after open heart surgery, subendocardial blood flow was monitored in 171 patients subjected to mitral and/or aortic valve replacement or coronary revascularization by on-line calculation of Diastolic (DPTI) and Systolic Pressure Time Index (TTI). Body hypothermia with an esophageal temperature of 25 degrees C and magnesium-aspartate-procaine cardioplegia were applied for myocardial protection. Ten patients developed low cardiac output state with two early deaths. In the two patients with fatal low cardiac output DPTI/TTI remained below 0.8. In the remaining 8 patients DPTI/TTI rose to 1.4 after a mean recovery time of 36 hours. In 161 patients (94%) no low cardiac output state evolved and DPTI/TTI rose to 1.3 within 60 min. after termination of cardiopulmonary bypass. Our results indicate that body hypothermia of 25 degrees C combined with magnesium-aspartate-procaine cardioplegia can reduce the incidence of subendocardial ischemia, but does not prevent this complication completely after anoxic times beyond 60-70 minutes.

  18. Influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    Shu-Tian Song; Ming Yang; Kun-Peng Li; Juan Xu; Chuan-Ming Bai; Ji-Wu Zhou

    2016-01-01

    Objective:To investigate and analyze the influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass.Methods:A total of 42 patients with open heart surgery with cardiopulmonary bypass during the period of June 2014 to January 2016 were randomly divided into the control group of 21 cases and the observation group of 21 cases. The control group was treated with routine postoperative treatment, and the observation group was treated with recombinant human brain natriuretic peptide on the basic treatment of control group, then the myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes of the two groups before the surgery and at 2 h, 12 h and 24 h after the surgery were respectively detected and compared.Results: There were no significant difference in myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes between two groups before the surgery (allP>0.05), while the myocardial enzymes and serum cardiac function indexes of the observation group at 2 h ,12 h and 24 h after the surgery were all significantly lower than those of control group, the oxygen metabolism indexes were significantly better than the levels of control group (allP<0.05).Conclusions:The recombinant human brain natriuretic peptide can effectively improve the myocardial enzymes, serum cardiac function indexes and oxygen metabolism state of patients with open heart surgery with cardiopulmonary bypass, and it has application value for the patients with the surgery is higher.

  19. Perioperative challenges in a patient of severe G6PD deficiency undergoing open heart surgery

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2012-01-01

    Full Text Available We describe a successful perioperative management of a case of 38-year-old male, presented with chronic jaundice with severe mitral stenosis and moderate tricuspid regurgitation; upon evaluation, he was found to have severe glucose-6-phosphate dehydrogenase (G6PD deficiency. Usually, patients deficient in G6PD exhibit increased hemolysis andtherefore increased need for blood transfusion after cardiac surgery as well as impaired oxygenation in the postoperative period leading to prolonged ventilation. On reperfusion after a period of ischemia, the antioxidant system recruits all of its components in an attempt to neutralize the overwhelming oxidative stress of free radicals, as the free radical scavenging system is deficient in these patients, the chances of free-radical-induced injury is more. Our patient underwent mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with necessary precautions to reduce the formation of free radicals. Treatment was targeted toward theprevention of free radical injuryin the G6PD-deficient patient. He had an uneventful intraoperative and postoperative course.

  20. The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome.

    LENUS (Irish Health Repository)

    Parissis, Haralabos

    2010-01-01

    BACKGROUND: The early and intermediate outcome of patients requiring intraaortic balloon pump (IABP) was studied in a cohort of 2697 adult cardiac surgical patients. METHODS: 136 patients requiring IABP (5.04%) support analysed over a 4 year period. Prospective data collection, obtained. RESULTS: The overall operative mortality was 35.3%. The "operation specific" mortality was higher on the Valve population.The mortality (%) as per time of balloon insertion was: Preoperative 18.2, Intraoperative 33.3, postoperative 58.3 (p < 0.05).The incremental risk factors for death were: Female gender (Odds Ratio (OR) = 3.87 with Confidence Intervals (CI) = 1.3-11.6), Smoking (OR = 4.88, CI = 1.23- 19.37), Preoperative Creatinine>120 (OR = 3.3, CI = 1.14-9.7), Cross Clamp time>80 min (OR = 4.16, CI = 1.73-9.98) and IABP insertion postoperatively (OR = 19.19, CI = 3.16-116.47).The incremental risk factors for the development of complications were: Poor EF (OR = 3.16, CI = 0.87-11.52), Euroscore >7 (OR = 2.99, CI = 1.14-7.88), history of PVD (OR = 4.99, CI = 1.32-18.86).The 5 years survival was 79.2% for the CABG population and 71.5% for the valve group. (Hazard ratio = 1.78, CI = 0.92-3.46). CONCLUSIONS: IABP represents a safe option of supporting the failing heart. The need for IABP especially in a high risk Valve population is associated with early unfavourable outcome, however the positive mid term results further justify its use.

  1. Application of combined ultrafiltration and vaccum-assisted venous drainage in extracorporeal circulation for open heart surgery in infants

    Directory of Open Access Journals (Sweden)

    Tao ZHANG

    2014-03-01

    (RBC transfusion was 0.5- 2.0(1.61±0.40U, postoperative mechanic ventilator support time was 6-74(34.1±16.6h, and the pericardial drainage volume within 24 hours was 70-410(115.6±75.8ml. One infant suffering from complete atrioventricular canal underwent atrial septal defect repair and mitral valvuloplasty died of respiratory and circulatory failure secondary to severe postoperative low cardiac output syndrome, and the other 71 infants recovered satisfactorily, the total death rate was 1.4%(1/72. Conclusions For low-body weight infants undergoing open heart surgery, application of combined ultrafiltration and VAVD in ECC could ensure satisfactory venous drainage and minimal priming solution volume, and provide enough perfusion flow, and maintain optimal internal environment and hematocrit. DOI: 10.11855/j.issn.0577-7402.2014.01.13

  2. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Bateman, T.M.; Czer, L.S.; Gray, R.J.; Kass, R.M.; Raymond, M.J.; Garcia, E.V.; Chaux, A.; Matloff, J.M.; Berman, D.S.

    1984-11-01

    Pericardial or mediastinal hemorrhage requiring reoperation occurs in 2% to 5% of patients, usually early (0 to 48 hours), after open-heart surgery. This hemorrhage may be occult, and resulting cardiac tamponade may easily be misinterpreted as ventricular dysfunction, common early postoperatively. In such cases, appropriate and timely intervention may not occur. Of 50 patients evaluated by technetium-99m red blood cell gated equilibrium radionuclide ventriculography (RNV) because of early postoperative cardiogenic shock of uncertain etiology, 17 had unique scintigraphic images suggestive of intrathoracic hemorrhage. Of these 17, 5 had a generalized halo of abnormal radioactivity surrounding small hyperdynamic right and left ventricles, 11 had localized regions of intense blood pool activity outside the cardiac chambers (two with compression of single chambers), and one demonstrated marked radionuclide activity in the right hemithorax (2000 ml of blood at reoperation). Twelve patients had exploratory reoperation for control of hemorrhage as a direct result of the scintigraphic findings, three were successfully treated with fresh frozen plasma and platelet infusions along with medical interventions to optimize cardiac performance, and two patients died in cardiogenic shock (presumed tamponade) without reoperation. In the 12 reoperated patients, all were confirmed to have active pericardial bleeding. Scintigraphic localization of abnormal blood pools within the pericardium corresponded to the sites at which active bleeding was witnessed at reoperation. The abnormal bleeding was etiologically related to the tamponade state, with marked improvement in hemodynamics after reoperation. Nine additional patients were reoperated for presumed tamponade after RNV revealed an exaggerated halo of photon deficiency surrounding the cardiac chambers.

  3. Bacteriological Profile of Patients Undergoing Open Heart Surgery and Evaluation of a Bacterial Filter using Protected Broncho-Alveolar Lavage.

    Science.gov (United States)

    Tempe, D K; Mehta, N; Mishra, B; Tondon, M S; Tomar, A S; Budharaja, P; Nigam, M

    1998-01-01

    Twenty seven patients undergoing elective open heart surgery were included in this prospective study. They were randomly divided into two groups. Group C (n = 12) constituted the control group in whom no breathing filter was used in the anaesthesia circuit in the operating room or in the ICU. Humidification of breathing gases was achieved with the help of conventional heated humidifier. In group F (n = 15), heat and moisture exahanging bacterial / viral filter was incorporated in the breathing circuit at the patient end between the catheter mount and Y connection of the breathing circuit. In both the groups, samples of throat swab, protected broncho-alveolar lavage with double catheter and Ryles tube aspirate were collected preoperatively (in the operation theatre) and postoperatively (in the Intensive Care Unit on day 1). All the samples were sent to the laboratory immediately after the collection for Gram staining and culture and sensitivity. Pathogenic organisms were isolated from a total of 9 patients (33%) preoperatively. Exogenous spread of the organisms to the lungs was considered to have occurred if new pathogenic organisms were isolated from the postoperative bronchoalveolar lavage and the simultaneous samples of the throat swab and Ryles tube did not contain the same organism. By this definition, the exogenous spread of the organisms occurred in one patient in group C and in no patient in group F (P = 0.46, Fishers test). The commonest organisms isolated were Staphylococcus aureus, Klebsiella sp. and Pseudomonas sp. We conclude that colonization of the pathogenic organisms is common (33%) in orophrynx and gastrointestinal tract in hospitalized patients. There was no difference in the exogenous spread of the organisms between the two groups. The unity of the filter, therefore, appears to be limited to prevent contamination of anaesthesia machines or ventilators as has been shown by earlier studies.

  4. Heart bypass surgery incision (image)

    Science.gov (United States)

    ... the left part of the chest between the ribs. This incision is much less traumatic than the traditional heart bypass surgery incision which separates the breast bone. Minimally invasive heart bypass surgery allows the patient less pain and a faster recovery.

  5. Pediatric Circulatory System of Guardianship After Open-heart Surgery%小儿心内直视手术后循环系统的监护

    Institute of Scientific and Technical Information of China (English)

    董云芳

    2015-01-01

    Objective To study the analysis of pediatric open-heart surgery treatment of posterior circulation system monitoring measures. Methods Selected 64 cases in January 2014 to December 2014 in our hospital during open-heart surgery treatment,after surgery to give close monitoring to the circulatory system. Results In 64 cases,63 cases recovered and discharged,only 1 cases was death because of the low cardiac. Conclusion Pediatric heart surgery treatment,strict monitoring circulation system is the key to ensure the operation curative effect,help children better in disease and rehabilitation.%目的:研究分析小儿心内直视手术治疗后循环系统的监护措施。方法选择2014年1月~2014年12月期间在我院进行心内直视手术治疗的64例患儿,在术后对循环系统给予严密监护。结果本组64例患儿中,63例患儿痊愈出院,仅1例患儿因为低心排而死亡。结论小儿心脏手术治疗后,严格监护循环系统是确保手术疗效的关键,有助于患儿疾病的好转及康复。

  6. Pulsatile flow and simple flow control method during weaning period in centrifugal pump: toward more expanded usage in open heart surgery.

    Science.gov (United States)

    Nishida, H; Koyanagi, H; Endo, M; Suzuki, S; Oshiyama, H; Nojiri, C; Fukasawa, H; Akutsu, T

    1994-09-01

    To expand the usage of the centrifugal pump (CP) in open heart surgery, we performed two studies. In the first, we evaluated pulsatile flow in the CP. In vitro pump performance of the Terumo Capiox pump (TCP) and the Sarns Delphin pump (SDP) and increase of free hemoglobin (mg/dl) after driving 6 h were investigated using bovine blood. A roller pump (RP) was used as a comparison. Equally effective pulsatile flow was obtained in both CPs. Hemolysis was less severe in TCP (120 mg/dl) than SDP (210 mg/dl) and RP (320 mg/dl). In the second study, we evaluated a simple flow control method. Flow rate was easily controlled with step-wise clamping of 3-pronged tubing (Triple-flow) without changing rotational speed, regardless of afterload. Fluctuation of flow was much less with this method than with the rotational speed change method. The use of pulsatile flow of TCP, with its minimum increase of hemolysis and the easier flow control method during the weaning process, may expand the usage of CP in open heart surgery.

  7. 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

    2016-10-24

    Simple and accurate expressions describing the PaO2-FiO2 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 PaO2-FiO2 data pairs were obtained from 25 non-smoking patients mechanically ventilated following open heart surgeries. One data pair was collected at each of FiO2 of 40, 60, 80, and 100% while maintaining same mechanical ventilation support settings. Similarly, another 100 hundred PaO2-FiO2 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 PaO2-FiO2 relationship in these patients was assessed by the regression and Bland-Altman analyses. Significant correlations were seen between the true and estimated FiO2 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 FiO2 values for non-smoking (3.1%) and smoking (4.1%) patients were observed. Also, significant correlations were seen between the true and estimated PaO2/FiO2 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 PaO2/FiO2 ratios for non-smoking (-18 mmHg) and smoking (-16 mmHg) patients were also observed. The new mathematical expression for the description of the PaO2-FiO2 relationship is valid and accurate in non-smoking and smoking patients who are receiving mechanical ventilation for post cardiac surgery.

  8. [Indications for surgery for valvular heart disease].

    Science.gov (United States)

    Halbach, Marcel; Wahlers, Thorsten; Baldus, Stephan; Rudolph, Volker

    2015-11-01

    Due to the demographic change, chronic valvular heart disease becomes increasingly important - especially age-related primary diseases of the aortic and mitral valve as well as secondary diseases of the mitral and tricuspid valve caused by other age-related cardiac disorders. Medical treatment is limited to symptom relief by use of diuretics. Specific drugs or drugs with a prognostic benefit are not available. Thus, valve repair or replacement are the key options for treatment of relevant valvular heart disease. While open heart surgery was the only approach for a long time, interventional, catheter-based therapies have evolved in the last decade. This article describes up-to-date recommendations on indications for surgery for the most prevalent valvular heart diseases in adults - aortic stenosis, and aortic, mitral and tricuspid regurgitation).

  9. Heart Surgery Terms

    Science.gov (United States)

    ... CABG) The surgical procedure to treat narrowing or " stenosis " of the coronary arteries is called coronary artery bypass, or CABG ( ... blood flow to the heart. Coronary artery disease Coronary artery disease is characterized by a narrowing or " stenosis " of the blood vessels to the heart resulting ...

  10. "Assessment of Skin Damage Appearance and Its Causes after Open Heart Surgery in Khatam-ol-Anbia Hospital during Second Half of the Year 1379"

    Directory of Open Access Journals (Sweden)

    M ADJALOOIAN

    2002-09-01

    Full Text Available To evaluate the quality of services in hospitals can rely on mortality rate and side effects rate. According to performed studies, side effects rate is a better indicator to evaluate the quality of hospital services, therefore decreasing of side effects is one of the main objectives in hospital management. A side effect of open-heart surgery is the skin damage. Some of Iranian patients who were operated on this kind of surgery have appeared some skin damages that medical articles haven’t pointed this matter. This study was performed to assess the appearance rate and also causes of skin damages to promote the services quality of Khatam-ol-Anbia Hospital in Tehran. During 6 months particulars of patients, who were operated on the open-heart surgery were considered. The data regarding the patients from their medical files and the data about skin damages rate from Nursing reports was collected. The skin damages were divided four groups on the basis of damage intensity: without damage; with skin redness; blustery; and intense phlogestic (inflamed. 102 patients (%28.2 somewhat suffered from skin damages. Among these 102 patients, 88 patients (%87.1 were affected with slight skin redness; 5 patients (%5 with intense skin redness; 5 patients (%5 with blister; and 3 cases with intense burn like damages. Generally, %1.4 of patients suffered from blister and %0.8 of cases from intense burn like damages; it means one case among every 50 patients needed special attention. In this study, the factors of weight, gender, diabetes, narcotics addiction, and function of one of the first aid of surgeon influenced the skin damage. It deserves to pay attention to the rate of patients’ losses and compensation amount, which must be, paid the patients by hospitals. It seems if the above mentioned matters are considered the importance of this study will be cleared more.

  11. Clinical analysis of 9 cases of complicated pneumomediastinum in infants with congenital heart disease after open heart surgery.%婴幼儿先心病术后并发纵膈气肿临床分析

    Institute of Scientific and Technical Information of China (English)

    仇杰; 费忠化; 刘宏生

    2012-01-01

    Objective To explore the common causes, diagnosis and treatment approaches in infants with congenital heart disease complicated pneumomediastinum after open heart surgery. Methods The diagnosis and treatment approaches of complicated pneumomediastinum of 9 infants with congenital heart disease after open-heart surgery from January 2011 to February 2012 in our hospital were retrospectively studied. Results 5 cases recovered in all patients, 3 cases treatment ineffective ( can' t maintain the circulation and abandoned treatment) , 1 case died due to the ineffective control of serious infection. Conclusions Congenital heart disease complicated pneumomediastinum in children after open heart surgery has great influences on heart-lung capability, and may complicated with mediastinal infection. Otherwise, because of it s variation in clinical manifestations, misdiagnosis and a high mortality rate were likely to happen. With an early diagnosis and treatment, the effect goes well.%目的 探讨婴幼儿先心病术后合并纵隔气肿的常见病因、诊断和治疗方法.方法回顾性分析作者于2011年1月至2012年2月收治的9例婴幼儿心内直视手术后并发纵隔气肿患儿临床资料.结果 本组患儿中5例痊愈,3例治疗效果欠佳,不能维持循环功能,家属放弃治疗,1例因严重感染未得到有效控制而死亡.结论 小儿先心病术后合并纵隔气肿,对心肺功能影响大,并可并发纵膈感染,临床表现多样,易发生误诊或漏诊,死亡率高,如能早期诊断,及时治疗,效果良好.

  12. The impact of gestational age on resource utilization after open heart surgery for congenital cardiac disease from birth to 1 year of age.

    Science.gov (United States)

    Bishop, Naomi B; Zhou, Theresa X; Chen, Jonathan M; Ward, Mary J; Carroll, Sheila J

    2013-03-01

    The impact of gestational age on perioperative morbidity was examined using a novel construct, the resource utilization index (RUI). The medical records of subjects from birth to 1 year of age entered into a pediatric cardiothoracic surgery database from a major academic medical center between 2007 and 2011 were reviewed. The hypothesis tested was that infants born at 37-38 weeks (early-term infants) experience greater resource utilization after open heart surgery than those born at 39 completed weeks and that this association can be observed until 1 year of age. The results support the premise that resource utilization increases linearly with declining gestational age among infants at 0-12 months who undergo cardiac surgery. Five of the six variables comprising the RUI showed statistically significant linear associations with gestational age in the predicted direction. Multivariate linear regression analysis showed that gestational age was a significant predictor of an increased RUI composite. Further investigation is needed to test the concept and to expand on these findings.

  13. The effect of foot reflexology on physiologic parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery: A clinical trial study.

    Science.gov (United States)

    Ebadi, Abbas; Kavei, Parastoo; Moradian, Seyyed Tayyeb; Saeid, Yaser

    2015-08-01

    The aim of this study was to investigate the efficacy of foot reflexology on physiological parameters and mechanical ventilation weaning time in patients undergoing open-heart surgery. This was a double blind three-group randomized controlled trial. Totally, 96 patients were recruited and randomly allocated to the experimental, placebo, and the control groups. Study groups respectively received foot reflexology, simple surface touching, and the routine care of the study setting. Physiological parameters (pulse rate, respiratory rate, systolic and diastolic blood pressures, mean arterial pressure, percutaneous oxygen saturation) and weaning time were measured. The study groups did not differ significantly in terms of physiological parameters (P value > 0.05). However, the length of weaning time in the experimental group was significantly shorter than the placebo and the control groups (P value reflexology in shortening the length of weaning time.

  14. Neuropsychomotor development before and after open-heart surgery in infants Desenvolvimento neuropsicomotor de lactentes antes e após cirurgia cardíaca

    Directory of Open Access Journals (Sweden)

    Taís Sica da Rocha

    2009-06-01

    Full Text Available There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%. The mean circulatory bypass time was 67 ± 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.As alterações neurológicas em lactentes com cardiopatia congênita podem agravar seu quadro clínico e levar a seqüelas permanentes. Foi realizada uma coorte prospectiva, com 20 lactentes, com idade média de 6,7 ± 4,2 meses, avaliando-se o perfil de desenvolvimento e o estado nutricional. Utilizou-se o exame neurológico e o teste de Denver II. Os testes foram aplicados 24h antes da cirurgia, na alta da unidade de terapia intensiva e 3 a 6 meses após. Os defeitos septais ocorreram em 11 casos (55%. O tempo médio de circulação extra-corpórea foi de 67ffl23,6 minutos. Quinze crianças tinham exame neurológico alterado e atraso no desenvolvimento neuropsicomotor antes da cirurgia, cuja normalização foi observada somente em seis após 6 meses .Quanto aos índices de Denver II, houve aumento em todos domínios, exceto o pessoal-social. O escore Z médio para peso antes da cirurgia foi -2,814 ± 1,98 e após -1,08 ± 1,47 (p<0.05, o qual foi realizado em média 5.2 ± 1.5 meses após a alta hospitalar. Melhora precoce tanto no desenvolvimento como no estado nutricional pôde ser observada neste grupo de lactentes ap

  15. Heart bypass surgery

    Science.gov (United States)

    ... help. Contact your provider if you have a cold, flu, fever, herpes breakout, or any other illness. Prepare your home so you can move around easily when you return from the hospital. The day before your surgery: Shower and shampoo well. You may be asked to ...

  16. What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery?

    Directory of Open Access Journals (Sweden)

    Seyed Jalil Mirhosseini

    2013-01-01

    Full Text Available Background: Atrial fibrillation (AF occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG AF in patients with severe left ventricle (LV dysfunction who underwent elective off-pump coronary artery bypass. Methods: This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU and hospital stay without postoperative AF were part of the control group. Results: The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (P value three days before surgery: 0.04; P value on surgical day: 0.01. Of the 54 male patients with postoperative AF (POAF, duration of AF was more in cases with elevated WBC count (12,000-14,000 than in those with lower elevated WBC count (10,000-12,000 ( P=0.025, but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count ( P=0.81. Conclusion: These findings show that three days

  17. Management of cardiopulmonary bypass for open heart surgery with beating heart%心脏跳动下心内直视手术的体外循环管理

    Institute of Scientific and Technical Information of China (English)

    杨宗英; 马瑞彦; 肖颖彬; 刘梅; 彭莉; 胡卫

    2011-01-01

    Objective To discuss the management melhods of cardiopulmonary bypass ( CPB) for palienls underwent open heart surgery with healing heart. Methods The CPB management melhods for 2 290 palienls underwenl open heart surgery with healing heart were summed-up. The left heart venling was established during the surgery and inlegraled sequelial de-airing procedure was conducted al the end of the surgery. The temperalure of nasopharynx was mainlained between 30 ~32 ℃, hemalocril was kept between 20% ~30% and the flow was controlled belween 2.4 ~3. 2 L·m-1· min-2 . Α-stat blood gas strategies were applied, meanwhile conventional ullrafilltration or modified ul-trafillralion was performed according to the condition. Results CPB went sucessful in all cases, the CPB time was 22 ~ 179 minules. Ventricular fibrillation was occurred in 256 cases and 181 cases experienced automatic recovery to healing. There were 22 cases died including 15 cases of complex congenital heart disease and 7 cases of severe valvular heart disease. No complication correlated wilh perfusion was oberved. Conclusion Open heart sugery wilh beating heart under mild hypothermia by cardiopulmonary bypass is safe and feasible, meanwhile it is easy for management and il can effectively prevenl ischemia reperfusion injury.%目的 探讨心脏跳动下心内直视手术中体外循环的管理方法.方法 总结分析2 290例心脏跳动下行心内直视手术的体外循环管理方法.术中均常规建立左心引流,术毕采用综合序贯排气技术.转流中鼻咽温维持在30~32 ℃,红细胞压积维持在20%~30%,流量控制在2.4~3.2 L·m-1·min-2,采用α稳态血气管理方法,术中酌情行常规超滤或改良超滤.结果 全组体外循环均顺利停机,转流时间22~179 min.术中室颤256例,其中181例自动复跳.全组死亡22例,其中复杂先天性心脏病15例,重症瓣膜病7例.全组无体外循环气栓并发症.结论 浅低温体外循环方法在心脏跳动

  18. 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...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...... burst of the granulocytes and monocytes decreased after declamping to 15% and 27% of initial values in vitro. Several hours after surgery, there was no significant difference between the two groups. These results can be explained by a granulocyte and monocyte refractory response developing subsequent...

  19. Cardioprotection of Shenfu Injection (参附注射液) against Myocardial Ischemia/Reperfusion Injury in Open Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    ZHENG Chuan-dong; MIN Su

    2008-01-01

    Objective: To investigate the protective effect of Shenfu Injection (参附注射液, SFI) against myocardium ischemia/reperfusion injury (IRI) in rnitral valve replacement (MVR) with cardiopulmonary bypass (CPB). Methods: Forty patients undergoing selective MVR were randomly assigned to the control group and trial Groups ⅠⅡ,Ⅲ, and Ⅳ according to the different administrations of SFI, 8 patients in each group. The changes of systolic blood pressure (SBP), mean blood pressure (MBP), diastolic blood pressure (DBP) in each group were monitored, respectively. The recovering percentage of spontaneous heart beat, the heart rate (HR) and cardiac rhythm as well as the abnormal duration of ECG-ST segment were recorded after the restoration of heart beat. The serum concentration of cardiac troponin Ⅰ (cTnl), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) were determined as well. Results: (1) The SBP, MBP and DBP values, the recovering rate of spontaneous heart beat, HR, ECG-ST, atrioventricular block and ventricular arrhythmia were significantly improved in group Ⅳ compared with any other groups. (2) Compared with the control group, the postoperative serum contents of cTnl and MDA were significantly decreased, but the activity of SOD was significantly increased in group Ⅳ. Conclusions: SFI had a certain protective effect against myocardium IRI. Moreover, better efficacy was seen with the administration of 1.5 mL/kg SFI into CPB priming fluid and pumping 1.5 mL/kg SFI via CPB as soon as the clamped aorta was unclamped.

  20. [Clinical experience of mechanical ventricular support with centrifugal pump for severe ventricular failure after open heart surgery].

    Science.gov (United States)

    Matsuwaka, R; Matsuda, H; Kaneko, M; Masai, T; Fudemoto, Y; Kobayashi, T; Imagawa, H; Miyamoto, K; Morisaki, H; Kawashima, Y

    1990-09-01

    Five adult patients (pts) with age 15-67 (mean 43) received mechanical circulatory support with centrifugal pump (Biomedicus, BP-80, Sarns centrifugal pump) for postcardiotomy profound shock. Three pts underwent left ventricular support (LVS) alone, and the other 2 required biventricular support (BVS). Duration of the LVS ranged from 33 to 240 hours (mean 126 hours) and the right ventricular support 92, 120 hrs. Pump flow rate was 1.1 to 2.5 (mean 1.9) L/min/m2. Sixteen pumps were used and the pump exchange was performed 9 times in five pts and an average perfusion time per pump was 57 hrs. Two of 3 pts with LVS alone survived and one died of multiorgan failure associated with right heart dysfunction. In two pts with BVS, one survived and the other died of persistent low cardiac output early after pump removal. As the complication during mechanical support, bleeding was seen in 3 pts and cerebral infarction in one. Although centrifugal pump has potential limitation in antithrombogenicity and durability, this device provides a simple and effective mechanical circulatory support.

  1. Vital Signs Changes in Post-Operative Corrective Surgery for Cyanotic and Noncyanotic Congenital Heart Diseases

    Directory of Open Access Journals (Sweden)

    H Amoozegar

    2008-07-01

    Full Text Available Background: Post open cardiac surgery is associated with rises in fever, blood pressure and heart rate. The objective of the present study was to determine the changes in temperature, blood pressure and heart rate in first week after open cardiac surgery of non-complicated cyanotic and noncyanotic congenital heart diseases.Patients and Methods: Temperature, blood pressure and heart rate were obtained from 100 patients with different congenital heart disease after open cardiac surgery. The patients divided in two groups, 40 cyanotic CHD and 60 noncyanotic CHD.Result: Half of patients had fever in first day after surgery. Cyanotic patients became afebrile earlier than noncyanotic group. Cyanotic patients had higher heart rate and lower blood pressure than noncyanotic group.Conclusion: The study suggests that post open heart surgery body temperature, blood pressure and heart rate are different in patients with cyanotic and non cyanotic congenital heart diseases.

  2. Direct oxymetric peripheral tissue perfusion monitoring during open heart surgery with the use of cardiopulmonary bypass: preliminary experience.

    Science.gov (United States)

    Lonsky, V; Svitek, V; Brzek, V; Kubicek, J; Volt, M; Horak, M; Mandak, J

    2011-11-01

    Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.

  3. Nurse and patient factors that influence nursing time in chest tube management early after open heart surgery: A descriptive, correlational study.

    Science.gov (United States)

    Cook, Myra; Idzior, Laura; Bena, James F; Albert, Nancy M

    2017-04-27

    Determine nurse characteristics and patient factors that affect nurses' time in managing chest tubes in the first 24-hours of critical-care stay. Prospective, descriptive. Cardiovascular critical-care nurses and post-operative heart surgery patients with chest tubes were enrolled from a single center in Ohio. Nurses completed case report forms about themselves, comfort and time in managing chest tubes, chest tube placement and management factors. Analysis included correlational and comparative statistics; Bonferroni corrections were applied, as appropriate. Of 29 nurses, 86.2% were very comfortable managing chest tubes and oozing/non-secure dressings, but only 41.4% were very comfortable managing clogged chest tubes. Of 364 patients, mean age was 63.1 (±12.3) years and 36% had previous heart surgery. Total minutes of chest tube management was higher with≥3 chest tubes, tube size cardiac surgeries (p≤0.002), heart failure (pNurse comfort with chest tube-related tasks affected time spent on chest tube management. Published by Elsevier Ltd.

  4. 小儿先天性心脏病心内直视手术的输血后肝炎%Post-transfusion Hepatitis in Children with Con genital Heart Disease After Open Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    朱德明; 陈玲; 苏肇伉

    1990-01-01

    作者报告采用前瞻性定群研究,对自1980年12月~1984年12月治疗的255例体外循环心内直视手术患儿进行随访,共发现6例输血后肝炎.本文对其分型、转归等进行了讨论,并就预防工作提出了建议.%Prospective cohort investigation of posttransfusion hepatitis(PTH)has been carried out in 255 cases who received open heart surgery and transfusion of bank blood perioperatively from Dec. 1980 to Dec. 1984.Patients'mean age was 6.29±2.6 years. 6 of 255 suffered from PTH in 1-5 menths after operation. The incidence of PTH was found to be 2.4%. These cases had symptoms and signs of hepatitis. All other factors influencing liver function impairment were ruled out. The incidence of PTH in this group was higher than that of nature hepatitis in the population of a local area of Shanghai City (P<0.05)and also higher than that of nature hepatitis in non-transfusion group(47 cases of ligation of patent ductus arteriosus, P<0.05)in the same period. All of PTH cases were cured by common supportive treatment.

  5. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

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

  6. 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

    Directory of Open Access Journals (Sweden)

    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.

  7. 心内直视术后有创动脉血压监测护理%Nursing Experiences of Invasive Blood Pressure Monitoring for Patients Having Undergone Open-heart Surgery

    Institute of Scientific and Technical Information of China (English)

    程良平; 任燕; 张丽莉; 龚仁蓉

    2012-01-01

    Objective To summarize the nursing experiences of invasive blood pressure (IBP) monitoring for patients having undergone open-heart surgery. Methods We retrospectively analyzed the IBP monitoring processes for 634 patients who had undergone open-heart surgery from December 2009 to May 2010. Results In all the 634 cases, 3 had detached catheter, 2 had loose connection, 1 had detachment from the piezometer, and 2 had catheter obstruction. No complications like infection, hemorrhage, thrombosis or swelling of distal limb occurred. Conclusions, IBP monitoring is absolutely essential for hemodynamic monitoring after open-heart surgery. The focus of nursing is to keep the catheter clear, fixed, and prevent from infection, bleeding, thrombosis and swelling of distal limb.%目的 总结心内直视术后有创血压监测的护理经验.方法 回顾性分析2009年12月-2010年5月634例心内直视术后患者有创血压监测的护理过程.结果 除3例患者导管脱出,2例连接不紧密,1例与测压管脱开,2例导管堵塞外,其余均未发生感染、出血、栓塞及肢体远端肿胀等并发症.结论 有创血压监测是心内直视术后必不可少的监测方法,护理的重点是保持管道通畅、固定,预防感染、出血、栓塞及肢体远端肿胀.

  8. Concentration of serum sodium ion after extracorporeal circulation in open heart surgery.%体外循环心脏直视手术术后血清钠离子浓度的变化

    Institute of Scientific and Technical Information of China (English)

    苏泓洁; 孔令文; 向小勇; 赵兴吉; 都定元; 张为民; 谭远康; 卢仁福

    2011-01-01

    目的 分析体外循环心脏直视手术患者术后血清中钠离子的含量变化.方法 选取2008年8月至2010年8月在我院及重庆医科大学附属第一医院就诊行体外循环心脏直视手术的82例患者,检测这些患者术舌血清中钠离子浓度,并分析导致钠离子含量变化的原因.结果 术后有50例患者出现低钠血症(血清中钠离子的含量小于135 mmol/L,),低钠血症的发生率为61.1%(50/82),其中7例患者的低钠血症持续1~3 d,30例患者的低钠血症持续4~9 d,余13例患者的低钠血症的持续时间超过9 d.主动脉阻断时间与术后低钠血症的发生率正相关,术后多巴胺和硝普钠的给药时间与低钠血症的发生率负相关.结论 低钠血症的出现可能与手术创伤、手术对机体内分泌的刺激和体外循环有关.行体外循环心脏直视手术患者术后出现低钠血症的几率较高,纠正低钠血症有利于患者的术后恢复,临床上应注意纠正术后低钠血症.%Objective To detect the concentration of serum sodium ion after extracorporeal circulation in open heart surgery. Methods 82 patients who underwent extracorporeal circulation in open heart surgery from Aug,2008 to Aug, 2010, and the concentration of serum sodium ion after surgery was detected. Results 50 patients had hyponatremia after surgery, and the incidence of hyponatremia was 61.1% (50/82). 7 of 50 patients had hyponatremia less than 3 days; 30 of 50 patients had hyponatremia for 4 to 9 days; while the rest 13 patients had hyponatremia more than 9 days. The time length of aortic occlusion is positive correlated to hyponatremia, while the time length of dopamine and sodium nitroprusside using is negative correlated to hyponatremia. Conclusion Hyponatremia may be related to trauma of surgery, stimuli of hormonal system after surgery and extracorporeal circulation. The incidence of hyponatremia after extracorporeal circulation in open heart surgery is higher, and

  9. Clinical Analysis of Peripheral Nervous System Complications after Open-heart Surgery%心脏外科直视手术后周围神经系统并发症临床分析

    Institute of Scientific and Technical Information of China (English)

    龙艳丽; 高洪锋; 李师亮

    2011-01-01

    目的:探讨心脏外科直视手术后周围神经系统并发症的临床特征.方法:回顾性分析26例心脏外科直视手术后出现周围神经系统并发症患者的临床资料.结果:心脏外科直视手术后周围神经系统并发症发生率为1.412‰;以膈神经、喉返神经、桡神经、腓总神经损伤多见;保守治疗24例,手术治疗2例;预后较好24例,预后较差1例,死亡1例,死亡率为3.846%.结论:心脏外科直视手术后周围神经系统并发症临床并非少见,注重预防、早诊断、早治疗有助于降低发病率及改善预后.%Objective: To analyze the clinical characteristics of peripheral nervous system complications after open-heart surgery. Methods: The clinical data of 26 patients with peripheral nervous system complications after open-heart surgery were collected and retrospectively analyzed. Results: The incidence rate of the peripheral nervous system complications after openheart surgery was 1. 412%0. The phrenic nerves, recurrent laryngeal nerves, radial nerves, and common peroneal nerves were susceptible to injury. Twenty-four patients received conservative treatment and two received surgery. Twenty-four patients had a good prognosis, one had a poor prognosis, and one died. The mortality rate was 3. 846%. Conclusion: The peripheral nervous system complications after open-heart surgery are not rare. To pay more efforts to preventing the complications from happening and to making early diagnosis and treatment helps to decrease the incidence rate and to improve the prognosis.

  10. Congenital heart defect - corrective surgery

    Science.gov (United States)

    ... Hypoplastic left heart repair; Tetralogy of Fallot repair; Coarctation of the aorta repair; Atrial septal defect repair; ... done in the neonatal intensive care unit (NICU). Coarctation of the aorta repair: Coarctation of the aorta ...

  11. BREAST IMPLANT RUPTURE AS A COMPLICATION OF HEART SURGERY IN MEDIAN STERNOTOMY

    OpenAIRE

    G. Nisi; CAMPANA, M.; GRIMALDI, L; C. Brandi; R. Cuomo; C. D'Aniello

    2014-01-01

    The authors report a case of a woman who underwent heart surgery in median sternotomy after breast reconstruction using prosthesis in 1984. After this open heart surgery in 2008, she developed an injury at right breast implant with intra and extra capsular silicone gel spread out the prosthesis.

  12. Myocardial protection during heart surgery in China

    Institute of Scientific and Technical Information of China (English)

    Bingyang Ji; Jinping Liu

    2007-01-01

    @@ Myocardial protection (MP) is the key for cardiopulmonary bypass (CPB) heart surgery. MP during cardiac surgery (CS) aims to preserve myocardial function while providing a bloodless and motionless operating field. Strategies on how to attenuate or prevent post-ischemic myocardial dysfunction that occurs intra-operatively during CS have been discussed for more than half a century. In 1950, Bigelow et al1 first reported to decrease myocardial oxygen demand by means of hypothermia.

  13. Preparing Children for Heart Surgery

    Science.gov (United States)

    ... the medical team will monitor your child's heart rate and rhythm using a continuous electrocardiogram system called telemetry. You'll be able to play a bigger role in your child's care and will most likely be able to stay overnight in the room with your child. The doctor ...

  14. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... help. Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness. Prepare your home so you can move around easily when you return from the hospital. The day before your surgery: Shower and shampoo well. You may be asked to ...

  15. [Heart surgery in the aged patient].

    Science.gov (United States)

    Klinner, W; Bernheim, C; Laiacker, H

    1985-10-31

    107 patients at the age of 80 years or more were operated for coronary or valvular heart disease between 1978 and 1984. The indication for surgery was instable angina in coronary patients and intractable heart failure in such with valvular lesions. 9 coronary and 5 valvular patients died postoperatively, 7 were early postoperative deaths, mainly due to myocardial failure. The majority of cases could be improved for 1 to 2 stages according to NYHA-classification. In this group pulmonary complications were predominant. According to this observation heart operations can also be indicated in the older age patient group without very much more risk than in younger ones.

  16. Intensive Care in Children Following Open Heart Surgery%小儿体外循环心内直视手术后的监护体会

    Institute of Scientific and Technical Information of China (English)

    谷兴琳; 戴约; 钱龙宝; 夏建海; 任振; 张儒仿; 丁义林

    1989-01-01

    Fore Apr.1982 to 1987,open heart operations were performed on 300 children,all cases being menitored in ICU.The monitors included ECG,vital signs,blood gas analysis and so on.290 patients survived and 10 died.The authors considers that postoperative intensive care is one of the key menrsures for a successful operation.Discussed are also circulation.respiration.fluid supply and acid-base balances,and renal insufficiency.%我院近四年来共施行体外循环心内直视手术300例,术后均进行了监护,290例顺利康复(96.7%),10例死亡(3.3%).作者强调作好术后监护是手术成功的关键之一.本文着重对循环、呼吸、水与电解质平衡及肾功能不全等四个问题进行了讨论.

  17. 低出生体重儿及早产儿心脏手术的早期疗效分析%Early Outcome of Open Heart Surgery for Congenital Heart Diseases in Low Birth Weight Infants and Premature Infants

    Institute of Scientific and Technical Information of China (English)

    曾嵘; 庄建; 陈寄梅; 岑坚正; 丁以群; 王晟

    2012-01-01

    Objective To analyze the early outcomes of open heart surgery for congenital heart diseases in sixty low birth weight infants and premature infants. Methods Sixty low birth weight infants (body weight < 2 500 g) and premature infants with congenital heart diseases undergoing surgical repair from May 2003 to October 2011 were studied retrospectively in Guangdong Cardiovascular Institute. There were 43 male patients and 17 female patients with their mean gestational age of 33.5±4.1 weeks (ranging from 26 to 42 weeks) and mean age at operation of 24.9±12.5 d (ranging from 4 to 55 d). Among them there were 47 premature infants with their mean birth weight of 1 729.3±522.5 g (ranging from 640 to 2 500 g) and mean weight at operation of 1 953.2±463.6 g(ranging from 650 to 2 712 g). All the patients received preoperative treatment in newborn intensive care unit (NICU) and underwent surgical repair under general anesthesia, including 29 patients without cardiopulmonary bypass (CPB) and 31 patients with CPB . All surviving patients received postoperative monitoring and treatment in NICU, and their postoperative complications and in-hospital death were reported. Results A total of 13 patients died during hospitalization with a total in-hospital mortality of 21.7% (13/60), including 4 intra-operative deaths, 6 early deaths (within 72 h postoperatively) and 3 patients giving up postoperative treatment. CPB time was 121.0±74.7 min, aortic clamp time was 74.8±44. 7 min, and postoperative mechanical ventilation time was (136.9±138.1) h. Thirteen patients underwent delayed sternal closure. Eight patients underwent reexploation for postoperative bleeding. Ten patients had severe pneumonia, 2 patients had pulmonary hypertensive crisis, and 8 patients had low cardiac output syndrome. All the postoperative complications were resolved or improved after proper treatment. Follow-up was complete in 47 patients from 2 to 12 monthes. And all the patients were alive during follow

  18. Early extubation after congenital heart surgery

    Directory of Open Access Journals (Sweden)

    Mirza Halimić

    2014-12-01

    Full Text Available Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%, Down's syndrome 8.5 95%CI (1.6-43.15, failure to thrive 4.3 95%CI( 1-18. Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax and with odds ratio 35.1 95 %CI (4-286 and blood transfusion with odds ratio 4.6 95%CI (2-12. Blood transfusion (p=0.002 (Wald=9.2 95%CI (2-12, during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70% and extracorporeal circulation (ECC with cut-of 45.5 minutes (sensitivity 71% and specificity 65%.Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.

  19. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T

    2012-01-01

    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  20. Virtual Surgery in Congenital Heart Disease

    DEFF Research Database (Denmark)

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

    2014-01-01

     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...... 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...

  1. Virtual Surgery in Congenital Heart Disease

    DEFF Research Database (Denmark)

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

    2014-01-01

     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...... 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...

  2. 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...

  3. Computer-assisted LAD bypass grafting at the open heart

    Science.gov (United States)

    Hartung, Christine; Gnahm, Claudia; Friedl, Reinhard; Hoffmann, Martin; Dietmayer, Klaus

    2009-02-01

    Open heart bypass surgery is the standard treatment in advanced coronary heart diseases. For an effective revascularization procedure, optimal placement of the bypass is very important. To accelerate the intraoperative localization of the anastomosis site and to increase the precision of the procedure, a concept for computer assistance in open heart bypass surgery has been developed comprising the following steps: 1. Preprocedural planning: A patient-specific coronary map with information on vessel paths and wall plaque formations is extracted from a multi-slice computed tomography (MSCT). On this basis, the heart surgeon and the cardiac radiologist define the optimal anastomosis site prior to surgery. 2. Intraoperative navigation: During surgery, data are recorded at the beating heart using a stereo camera system. After registering the pre- and intraoperative data sets, preprocedural information can be transferred to the surgical site by overlaying the coronary map and the planned anastomosis site on the live video stream. With this visual guidance system, the surgeon can navigate to the planned anastomosis site. In this work, the proposed surgical assistance system has been validated for the left anterior descending coronary artery (LAD). The accuracy of the registration mechanism has been evaluated in retrospective on patient data sets and the effects of breathing motion were quantified. The promising results of the retrospective evaluation led to the in-vivo application of the computer assistance system during several bypass grafting procedures. Intraoperative navigation has been performed successfully and postoperative evaluation confirms that the bypass grafts were accurately positioned to the preoperatively planned anastomosis sites.

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

    Directory of Open Access Journals (Sweden)

    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

  5. Alterations after Open Heart Operations

    Directory of Open Access Journals (Sweden)

    Elena Z. Golukhova

    2011-01-01

    Full Text Available Cardiac surgery is commonly associated with brain ischemia. Few studies addressed brain electric activity changes after on-pump operations. Eyes closed EEG was performed in 22 patients (mean age: 45.2±11.2 before and two weeks after valve replacement. Spouses of patients were invited to participate as controls. Generalized increase of beta power most prominent in beta-1 band was an unambiguous pathological sign of postoperative cortex dysfunction, probably, manifesting due to gamma-activity slowing (“beta buzz” symptom. Generalized postoperative increase of delta-1 mean frequency along with increase of slow-wave activity in right posterior region may be hypothesized to be a consequence of intraoperative ischemia as well. At the same time, significant changes of alpha activity were observed in both patient and control groups, and, therefore, may be considered as physiological. Unexpectedly, controls showed prominent increase of electric activity in left temporal region whereas patients were deficient in left hemisphere activity in comparison with controls at postoperative followup. Further research is needed in order to determine the true neurological meaning of the EEG findings after on-pump operations.

  6. High readmission rate after heart valve surgery

    DEFF Research Database (Denmark)

    Sibilitz, K L; Berg, S K; Thygesen, Lau Caspar;

    2015-01-01

    of anxiety and depression were present in 13.6% and 13.8%, respectively (Hospital Anxiety and Depression Scale score ≥ 8). Twelve months following discharge, 483 persons (56%) were readmitted. Readmission was associated with lower self-reported health (SF-36 PCS: 46.5 vs. 43.9, and MCS 52.2 vs. 50.7). Higher...... after surgery (3.2 (1.2-8.9)) predicted mortality. CONCLUSIONS: 6-12 months after heart valve surgery the readmission rate is high and the self-reported health status is low. Readmission is associated with low self-reported health. Therefore, targeted follow-up strategies post-surgery are needed....

  7. Causes of hospital readmission after heart surgery

    Directory of Open Access Journals (Sweden)

    Bárbara Rodrigues Nunes Barreiros

    2016-12-01

    Full Text Available The objective was to identify readmission’s profile and causes of  heart surgery patients. A retrospective, descriptive study, through the revision of records from patients submitted to myocardial revascularization surgery or valvar prosthesis implantation with posterior readmission. Sixty-two patients composed the sample. The readmission rate was 5.9%. Surgical site infection was the main cause for readmission in 87.5% of patients submitted to myocardial revascularization surgery and in 12.5% of valvar implantation (p<0.001 and, it was associated with obesity (p=0.05 and dyslipidemia (p=0.007. To identify patients at risk of surgical site infection can minimize readmission rates and decrease care costs and, it deserves a special planning of multi-professional actions.

  8. Validation of open-surgery VR trainer

    NARCIS (Netherlands)

    Sanders, A.J.B.; Luursema, J.M.; Warntjes, P.; Mastboom, W.J.B.; Geelkerken, R.H.; Klaase, J.M.; Rödel, S.G.J.; ten Cate Hoedemaker, H.O.; Kommers, P.A.M.; Verwey, W.B.; Kunst, E.E.; Westwood, James D.

    2006-01-01

    VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. With the VREST - Virtual Lichtenstein Trainer, simulating the open surgery

  9. Validation of open-surgery VR trainer

    NARCIS (Netherlands)

    Sanders, A.J.B.; Luursema, J.-M.; Warntjes, P.; Mastboom, W.J.B.; Geelkerken, R.H.; Klaase, J.M.; Rodel, S.G.J.; Cate Hoedemaker, ten H.O.; Kommers, P.A.M.; Verwey, W.B.; Kunst, E.E.; Westwood, J.D.

    2006-01-01

    VREST (Virtual Reality Educational Surgical Tools) is developing a universal and autonomous simulation platform which can be used for training and assessment of medical students and for continuing education of physicians. With the VREST - Virtual Lichtenstein Trainer, simulating the open surgery pro

  10. Physical activity increases survival after heart valve surgery

    DEFF Research Database (Denmark)

    Lund, K.; Sibilitz, Kirstine Lærum; Kikkenborg berg, Selina;

    2016-01-01

    OBJECTIVES: Increased physical activity predicts survival and reduces risk of readmission in patients with coronary heart disease. However, few data show how physical activity is associated with survival and readmission after heart valve surgery. Objective were to assess the association between...... physical activity levels 6-12 months after heart valve surgery and (1) survival, (2) hospital readmission 18-24 months after surgery and (3) participation in exercise-based cardiac rehabilitation. METHODS: Prospective cohort study with registry data from The CopenHeart survey, The Danish National Patient...... of physical activity after heart valve surgery are positively associated with higher survival rates and participation in cardiac rehabilitation....

  11. Laparoscopic and open surgery for pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Mala Tom

    2001-08-01

    Full Text Available Abstract Backround Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report compares the outcome of laparoscopic and conventional (open resection for pheocromocytoma particular in regard to intraoperative hemodynamic stability and postoperative patient comfort. Methods Seven patients laparoscopically treated (1997–2000 and nine patients treated by open resection (1990–1996 at the National Hospital (Rikshospitalet, Oslo. Peroperative hemodynamic stability including need of vasoactive drugs was studied. Postoperative analgesic medication, complications and hospital stay were recorded. Results No laparoscopic resections were converted to open procedure. Patients laparoscopically treated had fewer hypertensive episodes (median 1 vs. 2 and less need of vasoactive drugs peroperatively than patients conventionally operated. There was no difference in operative time between the two groups (median 110 min vs. 125 min for adrenal pheochromocytoma and 235 vs. 210 min for paraganglioma. Postoperative need of analgesic medication (1 vs. 9 patients and hospital stay (median 3 vs. 6 days were significantly reduced in patients laparoscopically operated compared to patients treated by the open technique. Conclusion Surgery for pheochromocytoma can be performed laparoscopically with a safety comparable to open resection. However, improved hemodynamic stability peroperatively and less need of postoperative analgesics favour the laparoscopic approach. In experienced hands the laparoscopic technique is concluded to be the method of choice also for pheocromocytoma.

  12. The value of HFABP in the early detection of myocardial injury following open-heart surgery with cardiopulmonary bypass%体外循环心内直视术后早期检测HFABP的意义

    Institute of Scientific and Technical Information of China (English)

    姜友定; 徐建军; 王一明; 余娇; 晏浩; 李志勇; 熊佩文

    2008-01-01

    Objective To investigate the changes of the serum level of heart fatty acid binding protein (HFABP) during the perioporatien of open-heart surgery with cardiopulmenary bypass (CPB) and to clinical value in early detection of myocardial injury following open-heart surgery with CPB. Methods Eighteen patients following dato-selective open-heart surgery by CPB were enrolled at admission for the test. Blood samples were collected at 6 time points (T1 : at 8 PM the night before operation, I2: prior to CPB, 13:30min, T4 : 3h, T5: 12h, T6: 24h after aortic decalmping) and determined for serum levels of HFABP、CK-MB and cTnI. The changes of the serum levels of these three markers at different time points were analyzed and compared. Results Compared the serum level of all the markers from T2 to T6 with that at T1, the serum concentration of HFABP elevated obviously at T4, T5 and reached its peak at T4,and then decreased nearly to the normal level at T6; the level of CK-MB increased remarkably at T5、T6 and reached its peak at T5 end was still higher than that at T1 ; level of cTnI ascended clearly at T5 and reached to the peak at T6. There was significant difference of peak time point among these three markers: HFABP peaked much earlier than CK-MB and cTnI. The peak level of HF/ABP has a positive relationship with that of CK-MB, cTnI, and that of ACCT, but not with the dose of dopamine used after operation. Conclusion HFABP, a newly-known biomarker for the detection of myocardial injury following ischemia, is one of suitable biomarkers and superior to CK-MB and cTnI in the early detection of myocardial injury following opon-heart surgery with CPB.%目的 探讨体外循环(CPB)心内直视术围术期血清心型脂肪酸结合蛋白(heart fatty acid binding protein,HFABP)的变化规律和对术后心肌损伤早期检测的临床应用价值.方法 测定18例择期CPB下行心内直视手术的病人术前1 d(T1)、CPB前即刻(T2)、主动脉开放后30 min(T3)、3 h

  13. Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

    Directory of Open Access Journals (Sweden)

    Mohammad Abbasi Tashnizi

    2013-01-01

    Full Text Available Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG; but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

  14. LAPAROSCOPIC VS. OPEN SURGERY FOR CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Preetham

    2016-03-01

    Full Text Available INTRODUCTION Cholecystectomy in a layman language is the surgical removal of the bile duct. There is a plethora of pathologies of gall bladder in which the main mode of treatment is cholecystectomy. In an economy like India the Laparoscopic surgery may not be economic taking into consideration of the cost factor. The main aim of the study is to find out the pros and cons for each method used in cholecystectomy. The best way to operate is the laparoscopic. But the conventional open access surgery has to be used whenever the need arises. The cost effectiveness of the laparoscopic surgery has to be worked out for the better usage of the procedure

  15. Obesity Slows Recovery for Heart Surgery Patients: Study

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167721.html Obesity Slows Recovery for Heart Surgery Patients: Study They' ... Aug. 10 in The Annals of Thoracic Surgery . "Obesity is a growing problem for society that has ...

  16. Implante de marcapasso endocárdico transatrial concomitante a cirurgia com circulação extracorpórea Transatrial endocardial pacemaker implantation associated to open heart surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Roberto Costa

    1994-09-01

    ção. CONCLUSÕES: Os autores concluem que o implante de marcapasso endocárdico transatrial pode representar uma boa opção para se evitar o implante epicárdico ou dois procedimentos independentes quando a estimulação cardíaca permanente estiver associada a cirurgia cardíaca a céu aberto..BACKGROUND: Epimyocardial pacemaker leads has been progressively given-up due to poorer results in comparison to endocardial pacing. Transthoracic transatrial endocardial lead placement has been described to avoid epicardial pacing in special situations. Permanent pacing associated to open heart surgery is a special situation when epicardial leads have been implanted at the same procedure or endocardial leads have been inserted with an independent approach. OBJECTIVE: To propose transatrial endocardial pacemaker in cases of concomitance of permanent pacing and open heart surgery and to report our experience with this technique in 6 patients. MATERIAL AND METHODS: From July 83 to August 94, 6 patients, 5 to 64 years old, 4 male and 2 female, were submitted to open heart surgery for aortic valve replacement (4, Chaga's disease left ventricular aneurysm resection (1 and atrioseptoplasty and pulmonary valve comissurotomy (1 patient. At the same procedure, atrioventricular (5 or atrial (1 case pacemaker were implanted. The surgical technique consisted in stablishing cardiopulmonary bypass with two separated vena cava canulas and, under cardioplegic arrest, to correct the cardiac defect and to implant the leads through a rigth atriotomy, at the same procedure. AH the 6 patiens received atrial endocardial lead while only 4 patients were submitted to ventricular endocardial implantation. The pulse generators were implanted in the infra-clavicular region in the 4 male adults, in the submammary position in the woman and in the abdominal wall in the child. RESULTS: Intra-operative measurements showed excellent conditions for pacing and sensing. No peroperative complication occurred. After a 4 to

  17. Latitude of the study place and age of the patient are associated with incidence of mediastinitis and microbiology in open-heart surgery: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Abdelnoor M

    2016-06-01

    Full Text Available M Abdelnoor,1,2 Ø A Vengen,3 O Johansen,4 I Sandven,2 AM Abdelnoor5 1Centre for Clinical Heart Research, Department of Cardiology 2Oslo Centre for Biostatistics and Epidemiology, 3Department of Cardiovascular Surgery, 4Department of Cardiology, Oslo University Hospital, Oslo, Norway; 5Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon Objective: We aimed to summarize the pooled frequency of mediastinitis following open-heart surgery caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA, and Gram-negative bacteria. Design: This study was a systematic review and a meta-analysis of prospective and retrospective cohort studies. Materials and methods: We searched the literature, and a total of 97 cohort studies were identified. Random-effect model was used to synthesize the results. Heterogeneity between studies was examined by subgroup and meta-regression analyses, considering study and patient-level variables. Small-study effect was evaluated. Results: Substantial heterogeneity was present. The estimated incidence of mediastinitis evaluated from 97 studies was 1.58% (95% confidence intervals [CI] 1.42, 1.75 and that of Gram-positive bacteria, Gram-negative bacteria, and MRSA bacteria evaluated from 63 studies was 0.90% (95% CI 0.81, 1.21, 0.24% (95% CI 0.18, 0.32, and 0.08% (95% CI 0.05, 0.12, respectively. A meta-regression pinpointed negative association between the frequency of mediastinitis and latitude of study place and positive association between the frequency of mediastinitis and the age of the patient at operation. Multivariate meta-regression showed that prospective cohort design and age of the patients and latitude of study place together or in combination accounted for 17% of heterogeneity for end point frequency of mediastinitis, 16.3% for Gram-positive bacteria, 14.7% for Gram-negative bacteria, and 23.3% for MRSA bacteria

  18. [Clinical results of single-stage mobilization of pectoral muscle flaps and omental transposition for infected mediastinitis after open heart surgery].

    Science.gov (United States)

    Asakura, T; Aoki, K; Tadokoro, M; Nakagawa, T; Furuta, S

    1997-09-01

    The purpose of this study was to retrospectively evaluate the outcome of refractory infected mediastinitis managed primarily with mobilization of pectoral muscle flaps and omental transposition. From January 1992 to December 1995, infected mediastinitis occurred in 11 (2.5%) of 447 consecutive patients. All patients required sternal debridement. The wound was thoroughly irrigated with a solution of 0.5% povidone-iodine in physiological saline after debridement and then the defect was repaired. Reconstruction of the chest wall was attained using pectoral muscle flaps in seven patients and pectoral muscle flaps and omental transposition in four. Antibiotic therapy was provided for 6 weeks or more according to the regimen in North America. No hospital deaths occurred after surgery. Significant early complications occurred in four patients. The reasons for the prolonged hospitalization were a recurrent wound infection, prosthetic valve endocarditis and saphenous vein graft pseudoaneurysm formation caused by Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant Staphylococcus epidermidis (MRSE). Length of stay in ICU after surgical treatment was range 1 to 140 days (an average of 11 +/- 3 days in 9 patients without complications in ICU). Duration between surgical treatment and discharge was range 47 to 300 days (an average of 58 +/- 8 days in 7 patients without significant early complications). At the time of this report, the patients are doing well with no signs of recurrence of infection. The mean follow-up was 28.8 months (range 8 to 48 months). We conclude that single-stage mobilization of pectoral muscle flaps together with omental transposition is very usefull for managing refractory infected mediastinitis. But careful follow-up is needed after this procedure in case of MRSA-caused mediastinitis because of its tendency to recur.

  19. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    DEFF Research Database (Denmark)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A

    2013-01-01

    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  20. [Pulmonary hypertension in pediatric heart surgery].

    Science.gov (United States)

    Falcone, N

    2001-12-01

    Congenital heart disease can increase or decrease pulmonary blood flow, pulmonary vascular resistance (PVR) or pulmonary artery pressure (PAP). PAP is the product of PVR and pulmonary minute volume (Qp), such that pulmonary hypertension (PHT) may develop as a result of an increase in either PVR or Qp or both. Given that the pulmonary vascular bed is a low pressure system with high flow, any increase in resistance would generate PHT. The normal value of PVR is 2 Woods units (mm Hg/l/min). Increased PAP is due to hypoxic lesions of the endothelium, which release proteolytic enzymes that alter the balance of metabolites of arachidonic acid, regulators of pulmonary vasomotor tone. Hypoxia and acidosis cause intense pulmonary vasoconstriction (hypoxic vasoconstrictor reflex). An increase of PVR is due to a combination of vasoconstrictive processes and remodeling, with hypertrophy of the pulmonary artery. Structural lesions are related to hypertrophy of the endothelium, the transformation of fibroblasts to myocytes and the decrease of the alveolar/arteriolar ratio with the formation of new vessels.PHT may be primary or secondary to another disease. Primary PHT is a rare genetic disease. The most common secondary forms of PHT in pediatrics are due to persistence of neonatal anatomy (neonatal PHT), to heart diseases with left-right shunt (CIV, DAP, etc.), to diseases of the pulmonary parenchyma (interstitial viral infection, mucoviscidosis), and complications of heart surgery. All congenital heart diseases can lead to PHT if not treated promptly. Clinical signs of PHT are highly non-specific: dyspnea, fatigue, syncopes, exercise intolerance, precordialgia, cyanosis and edema. The best approaches to diagnosis and prognosis are echocardiography and cardiac catheterization with vasodilators. Anesthetics that do not alter PVR should be used in such patients, who are sensitive to changes in pulmonary ventilation, to changes in cardiac output and to anesthetics. The treatment of

  1. Exercise-based cardiac rehabilitation after heart valve surgery

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  2. Latitude of the study place and age of the patient are associated with incidence of mediastinitis and microbiology in open-heart surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Abdelnoor, M; Vengen, Ø A; Johansen, O; Sandven, I; Abdelnoor, A M

    2016-01-01

    We aimed to summarize the pooled frequency of mediastinitis following open-heart surgery caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative bacteria. This study was a systematic review and a meta-analysis of prospective and retrospective cohort studies. We searched the literature, and a total of 97 cohort studies were identified. Random-effect model was used to synthesize the results. Heterogeneity between studies was examined by subgroup and meta-regression analyses, considering study and patient-level variables. Small-study effect was evaluated. Substantial heterogeneity was present. The estimated incidence of mediastinitis evaluated from 97 studies was 1.58% (95% confidence intervals [CI] 1.42, 1.75) and that of Gram-positive bacteria, Gram-negative bacteria, and MRSA bacteria evaluated from 63 studies was 0.90% (95% CI 0.81, 1.21), 0.24% (95% CI 0.18, 0.32), and 0.08% (95% CI 0.05, 0.12), respectively. A meta-regression pinpointed negative association between the frequency of mediastinitis and latitude of study place and positive association between the frequency of mediastinitis and the age of the patient at operation. Multivariate meta-regression showed that prospective cohort design and age of the patients and latitude of study place together or in combination accounted for 17% of heterogeneity for end point frequency of mediastinitis, 16.3% for Gram-positive bacteria, 14.7% for Gram-negative bacteria, and 23.3% for MRSA bacteria. Evidence from this study suggests the importance of latitude of study place and advanced age as risk factors of mediastinitis. Latitude is a marker of thermally regulated bacterial virulence and other local surgical practice. There is concern of increasing risk of mediastinitis and of MRSA in elderly patients undergoing sternotomy.

  3. Open heart surgery at the LHC

    CERN Multimedia

    Anaïs Schaeffer

    2012-01-01

    On 17 January this year there was a race against time in the CMS cavern. In order to replace a faulty LHC component, members of the Vacuums, Surfaces and Coatings (VSC) Group, in collaboration with the CMS experiment team, had to extract and then reinsert a 2-m long section of vacuum chamber. And they had one hour to do it.   At the start of the LHC's winter technical stop, an X-ray was done to check the position of the RF fingers at Point 5. The X-ray at the top confirmed that the RF fingers (in the red circle) were not in the correct position, unlike on the lower picture. If the vacuum is insufficient, pressure mounts and the problems start. In the LHC the ideal pressure is around 10-10 mbar. Once this threshold is exceeded, the “noise”, which means the interference generated by the residual gas present in the machine, compromises physics measurements. In early summer 2011, a pressure a hundred times in excess of the ideal pressure was observed at the connec...

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

    Science.gov (United States)

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

    2010-01-01

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

  5. [Complicated acute apendicitis. Open versus laparoscopic surgery].

    Science.gov (United States)

    Gil Piedra, Francisco; Morales García, Dieter; Bernal Marco, José Manuel; Llorca Díaz, Javier; Marton Bedia, Paula; Naranjo Gómez, Angel

    2008-06-01

    Although laparoscopy has become the standard approach in other procedures, this technique is not generally accepted for acute appendicitis, especially if it is complicated due reports on the increase in intra-abdominal abscesses. The purpose of this study was to evaluate the morbidity in a group of patients diagnosed with complicated apendicitis (gangrenous or perforated) who had undergone open or laparoscopic appendectomy. We prospectively studied 107 patients who had undergone appendectomy for complicated appendicitis over a two year period. Mean operation time, mean hospital stay and morbidity, such as wound infection and intra-abdominal abscess were evaluated. In the group with gangrenous appendicitis morbidity was significantly lower in laparoscopic appendectomy group (p = 0.014). Wound infection was significantly higher in the open appendectomy group (p = 0.041), and there were no significant differences in intra-abdominal abscesses (p = 0.471). In the perforated appendicitis group overall morbidity (p = 0.046) and wound infection (p = 0.004) was significantly higher in the open appendectomy group. There were no significant differences in intra-abdominal abscesses (p = 0.612). These results suggest that laparoscopic appendectomy for complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over conventional surgery.

  6. Low Cost Simulator for Heart Surgery Training

    Directory of Open Access Journals (Sweden)

    Roberto Rocha e Silva

    Full Text Available Abstract Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

  7. 153例10公斤以下婴幼儿心脏直视手术的体外循环管理%Extracorporeal circulation of open heart surgery in infants with 153 cases weithed below 10kg management

    Institute of Scientific and Technical Information of China (English)

    孙卫红; 张曙东; 朱志成; 许日昊; 王天策; 柳克祥

    2012-01-01

    目的 总结10公斤以下婴幼儿心脏直视手术的体外循环管理.方法 2006年12月~2011年7月共对153例10公斤以下婴幼儿在体外循环下实施例心脏直视手术,男82例,女71例,年龄为5个月~5岁,平均(20.0±8.4)个月,其中5~12个月31例,13~24个月82例,25~36个月39例,37~60个月1例;体重4~10 kg,平均(8.9±1.3)kg.69例使用膜肺,84例使用西京87型(小号)鼓泡式氧合器;19例采用心脏不停跳下手术,其余均阻断升主动脉,灌注冷晶体心脏停搏液,浅或中低温高流量灌注.结果 体外循环时间为18~166(57.5) min,主动脉阻断时间为8~123(39) min,开放主动脉后148例患儿心脏自动复跳,自动复跳率为97%,辅助时间为4~60(16) min.术后患儿死亡3例,死亡率为2%,死亡原因2例为严重低心排,1例为突然心脏骤停,抢救无效临床死亡.结论 根据婴幼儿的体重、病情及手术操作难易程度选用膜肺或鼓泡肺,尽量减少预充晶体量,提高胶体预充量,采用高流量灌注,通过给予速尿、超滤、加入白蛋白提高胶体渗透压,排除体内多余水分及良好的心肌保护、肺保护、脑保护有利于患儿术后的恢复.%Objective To summarize the extracorporeal circulation (ECC) management in infants weighted below 10 kg with open heart surgery. Methods 153 cases weighted below 10 kg with open heart surgery from December 2006 to July 2011, Male 82 cases, female 71 cases, age 5 months - 5 years on average (20±8.4) months, 5-12 months 31 cases,13-24 months 82 cases, 25-36 months 39 cases, 37-60 months 1 case; weight was 4-10 kg, the average was (20±1.3) kg, 69 cases with membrane oxygenator, 84 cases with Xijing 87 (small) bubbling oxygenator; 19 patients with beating heart surgery, the rest were aortic cross clamp (ACC), infusion of cold crystalloid cardioplegia, mild or moderate low temperature and high flow in the perfusion. Results The mean ECC times were 18-166 (57.5) min, aortic cross-clamping times were 8

  8. Pediatric heart surgery in Ghana: three ethical questions.

    Science.gov (United States)

    Eyal, Nir

    2014-01-01

    When a group of doctors and nurses from Boston, Massachusetts, provided evaluation and heart surgery to children in Ghana, they encountered three rationing dilemmas: (1) What portion of surgery slots should they reserve for the simplest, most cost-effective surgeries? (2) How much time should be reserved for especially simple, nonsurgical interventions? (3) How much time should be reserved to training local staff to perform such surgeries? This article investigates these three dilemmas.

  9. [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.

  10. Mechanical bowel preparation in elective open colon surgery

    OpenAIRE

    Fa-Si-Oen, Patrick Regnier

    2006-01-01

    Mechanical bowel preparation is a long standing practice in elective open colon surgery dating from the 1970's. It has always been believed to reduce the rate of postoperative complications in the form of anastomotic leakage and wound infection. In this thesis we broadly and thoroughly examine the various aspects and the value of mechanical bowel preparation in elective open colon surgery. - Mechanical bowel preparation in elective open colon surgery does not reduce the rate of anastomotic le...

  11. Decreased risk of surgery for small bowel obstruction after laparoscopic colon cancer surgery compared with open surgery

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Erichsen, Rune; Scheike, Thomas

    2016-01-01

    . The HR for mortality after colonic resection was 2.54 (CI 1.91 to 3.38, P surgery as compared to those who did not. CONCLUSIONS: Laparoscopic surgery for colonic cancer was associated with a decreased risk of subsequent SBO surgery compared with open...... surgery. Further, subsequent SBO surgery was associated with increased mortality after colonic cancer resection.......BACKGROUND: The impact of surgical approach on the incidence of small bowel obstruction (SBO) is unclear. The aim of the current study was to analyze the long-term risk of surgery for SBO after open and laparoscopic surgery and to assess how subsequent SBO surgery impacts on mortality after colonic...

  12. [FIRST OPERATION ON OPEN HEART IN HYPOTHERMIA PERFORMED IN CROATIA IN 1957].

    Science.gov (United States)

    Hromadko, Miroslav; Fatović-Ferenčić, Stella

    2014-12-01

    On October 25, 1957, the first open heart surgery in hypothermia was performed in Zagreb, at the Department of Surgery, Dr. Ozren Novosel University Hospital (now Merkur University Hospital), in a female patient with pulmonary valve stenosis under the control of the eye and with interruption of venous circulation. It was the first such operation performed in hypothermia not only in Croatia, but probably in the territory of former Yugoslavia.

  13. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

    ... the left part of your chest between your ribs. This allowed your doctor to reach your heart. What to Expect at Home You may be ... ask your doctor Angina - when you have chest pain Antiplatelet drugs - P2Y12 inhibitors Aspirin and heart disease Being active after your heart attack Being ...

  14. The comparison of domestic and imported membrane oxygenators used during the open heart surgery%国产和进口膜式氧合器在心内直视手术中应用的比较

    Institute of Scientific and Technical Information of China (English)

    周蓉; 强毅; 李天成; 高百顺; 宋兵

    2012-01-01

    目的 通过比较国产和进口膜式氧合器在心内直视手术中的性能评价指标,为心脏手术中膜式氧合器的选择提供依据.方法 40例患者随机分为两组,每组20例,A组术中使用国产膜式氧合器,B组术中使用进口膜式氧合器,两组其他处理条件相同.两组均于体外循环(CPB)开始前(T1)、CPB 开始后30 min(T2)、CPB结束时(T3)、CPB结束后2 h (T4)、CPB结束后24 h (T5) 五个时点采静脉血,测定白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的水平;于T1和T3时点采静脉血及尿液,测定血、尿游离血红蛋白含量;同时测定两组患者T1、T2和T3动脉血pH值、氧分压(PaO2)、二氧化氮分压(PaCO2)、动脉血氧饱和度(SaO2)水平.结果 ①两组患者血清IL-6、TNF-α的水平均于CPB结束后明显升高(P0.05);② 两组患者术后血、尿游离血红蛋白含量均明显高于术前(P0.05);③ 两组pH值、PaCO2、SaO2比较差异无显著性(P>0.05),两组PaO2比较B组open heart surgery. Methods 40 patients were randomly divided into 2 groups: domestic membrane oxegenator group ( A group ) and imported membrane oxegenator group ( B Group ). The venous blood samples were taken by 5 time points: before car-diopulmonary bypass ( CPB ) ( T1 ), CPB 30 min ( T2 ), the ending of CPB ( T3 ), 2 h after CPB ( T4 ), and 24 h after CPB ( T5 ). The level of IL - 6, TNF - α, and the arterial blood gas were measured at these time points. The free hemoglobin of blood and urine samples taken by Tl and T3 were assessed also. Results The concentrations of IL - 6, TNF - α, and the free hemoglobin ( both blood and urine ) increased

  15. 中低温低流量体外循环在婴儿心内直视手术的临床研究%Clinical Studies of Mild & Moderate Hypothermic and Low-flow Extracorporeal Circulation on the Baby Open-heart Surgery

    Institute of Scientific and Technical Information of China (English)

    郑晓宇; 叶宁; 黄洪; 邬少君; 吴文绪; 蒋斌; 张迎春

    2013-01-01

    Objective:To investigate safety and feasibility of the application of mild & moderate hypothermic and low-flow extracorporeal circulation while undergoing open-heart surgery to the infants with congenital heart disease.Method:40 sick babies admitted to our department who undergoing open-heart surgery were randomly divided them into obsewation group and control group.The 20 sick babies in control group were applied mild hypothermia and high-flow perfusion technique for open-heart surgery,while the other 20 sick babies in observation group with moderate hypothermia and low-flow perfusion technique for open-heart surgery.Compared the postoperative brain function and the intraoperative blood gas of the two groups.Result:The moderate hypothermia and low-flow perfusion venous oxygen saturation was above 80% without hypoxia acidosis blood gas,and blood lactate didn't elevate.There is no significant difference (P> 0.05) on the lactate concentration of the artery blood and internal jugular vein blood of the observation group and the control group at each time.The postoperative recovery was good without significant cardiopubnonary bypass-related complications.Conclusion:The application of mild & moderate hypothermic and low-flow extracorporeal circulation while undergoing open-heart surgery to the infants not only can satisfy the need of oxygen supply of the brain tissue,but also reduce the destruction to the blood,keep the surgical area clear and help to reduce the adverse reactions led by long time high-flow perfusion.It provides new means to carry out clinical brain protection of infants with complex congenital heart surgery.%目的:探讨先天性心脏病婴儿进行心内直视手术时,应用中低温低流量体外循环的安全性和可行性.方法:40例因先天性心脏病行心内直视手术患儿,随机分为观察组(n=20):应用中度低温低流量的灌注技术;对照组(n=20):应用浅低温高流量的灌注技术.记录转机时间、手术时

  16. Extracorporeal total artificial heart as bailout surgery.

    Science.gov (United States)

    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.

  17. A STUDY OF CONVERSIONS OF LAPAROSOCOPIC SURGERIES INTO OPEN SURGERIES: A ANALYTICAL STUDY

    Directory of Open Access Journals (Sweden)

    Venkata Reddy

    2015-12-01

    Full Text Available INTRODUCTION: The aim of present study is to know the Conversions in Laparoscopic surgery to Open surgery in The patients of all the surgical units in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada over a period of 2 years from July 2013 to July 2015. The Objectives of present study is to compare the Conversion Rates of Laparoscopic Surgery to Open Surgery and the factors causing Conversion to Open Surgery in our institution. PATIENTS AND METHODS The protocol is approved by institution ethics committee and written informed consent was taken from each patient. Present clinical Study is an Analytical study conducted over period of 2 years from July 2013 to July 2015 in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. RESULTS Total number of 536 laparoscopic surgeries were attempted in elective operation theatres with 21 cases out of 536 cases were converted from laparoscopy to open surgery. Total conversion rate in present study is 4%. Most of conversions occurred in laparoscopic chelecystectomy 5.73% cases in comparison to laparoscopic appendectomy 2.26% and laparoscopic hernia repair with 0%. CONCLUSIONS Over all conversion rates of laparoscopic procedure into open surgery is low when compared to other international studies. Most common causes of conversion in present study is altered anatomy, adhesions and intra operative bleed. Conversion of laparoscopic surgery into open surgery resulted in decreased morbidity, complications and increase in duration of hospital stay

  18. Thoracic aorta coarctation in the adults: open surgery is still the gold standard.

    Science.gov (United States)

    Bozzani, Antonio; Arici, Vittorio; Ragni, Franco

    2013-04-01

    Aortic coarctation (CoA) is the fifth most common congenital heart defect, accounting for 6% to 8% of live births with congenital heart disease. Traditional treatment for CoA consists of open surgical repair, and the endovascular procedures have been proposed as an alternative treatment. We describe the case of a 50-year-old man presented to our department with mild lower limbs claudication and hypertension. The computed tomography scan diagnosed an aortic postductal coarctation, which we treated with aortoplasty with Dacron patch. The open surgery, in our opinion, is nowadays still preferable due to the time-stable and effective outcome.

  19. Shadowing: pediatric heart surgery in El Salvador.

    Science.gov (United States)

    Gardner, Caleb

    2012-01-01

    In September 2009, the year before the author began medical school, he accompanied a team of doctors, nurses, and technicians from the nonprofit organization Heart Care International (HCI) on a trip to El Salvador. Founded in 1994 by the heart surgeon Robert Michler, HCI strives to provide care to children with congenital heart disease in developing countries. In addition to El Salvador, HCI has worked in Guatemala and the Dominican Republic, leaving behind lasting local programs and always looking to the future for new opportunities.

  20. Inflammatory response in laparoscopic vs. open surgery for gastric cancer

    DEFF Research Database (Denmark)

    Okholm, Cecilie; Goetze, Jens Peter; Svendsen, Lars Bo

    2014-01-01

    lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer. METHODS: We conducted a literature search identifying relevant studies comparing......OBJECTIVE: Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may...... laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters. RESULTS: We identified seven studies that addressed the immunological status in patients...

  1. Heart Valve Surgery Recovery and Follow Up

    Science.gov (United States)

    ... you have any guidelines to follow concerning your heart rate or level of exertion. To improve overall cardiovascular health, follow a regular exercise program that includes moderate physical activity for 150 ...

  2. Predictors of healthcare associated infections in heart surgery

    Directory of Open Access Journals (Sweden)

    Érica Vieira de Andrade

    2013-12-01

    Full Text Available The objective of this study was to determine the incidence of patients with healthcare associated infections, the topographic location of those infections in the heart surgery postoperative period, and identify the risk factors associated with the occurrence of those infections. This retrospective study was performed with 460 heart surgery patients of a teaching hospital in Minas Gerais state. The data were collected from the hospital infection report forms and patients’ records. The incidence of patients with healthcare associated infections was 24.3% and respiratory tract infection had the highest rates (20.6%. Intubation time, permanence time of central venous catheter and indwelling urinary catheter were independent predictors. The findings point at the need to implement protocols for the care and maintenance of these invasive devices with the purpose of preventing and controlling healthcare associated infection in heart surgery. Descriptors: Cross Infection; Cardiac Surgical Procedures; Perioperative Nursing.

  3. 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.

  4. The changes and clinical significance of heart fatty acid-binding protein concentrations in children patients after open heart surgery%儿童心脏直视术后心肌脂肪酸结合蛋白水平的变化及意义

    Institute of Scientific and Technical Information of China (English)

    王永连; 王忠民; 陈志军; 姚文健; 卢建国; 李汉臣

    2009-01-01

    Objective To observe the changes and clinical significance of plasma heart fatty acid-binding protein(H-FABP)in children after open heart surgery. Methods Forty patients with congenital heart disease(CHD) who had undergone cardiac operation with cardiopulmonary bypass(CPB) were selected in this study,and were randomly divided into two groups (each 20 cases): cold crystalloid cardioplegia perfusion group (Ⅰ group) and cold blood cardioplegia perfusion group(Ⅱ group). Blood samples were taken to check the plasma H-FABP concentration before CPB and different time after CPB. Plasma H-FABP concentration was estimated by enzyme-linked immunosorbent assay (ELISA). Results The difference of plasma concentration of H-FABP before operation was not obvious between Ⅰ group and Ⅱ group. The plas-ma concentration of H-FABP intraoperation and different time after operation was higher than that before anesthesia induction obviously in two groups, and Ⅰ group rose more significantly [(50.13±3.98) μg/L vs (39.27±4.22) μg/L, P0.05),体外循环结束即刻,1、4、12、24 hH-FABP水平较麻醉诱导前均有不同程度的升高(P<0.01),于体外循环结束后1 h达峰值(P<0.01),Ⅰ组升高比Ⅱ组更明显[(50.13±3.98)μg/L比(39.27±4.22)μg/L,P<0.01].结论 体外循环心脏术后H-FABP显著升高,峰值浓度出现早,可作为一项早期判断心肌损伤的敏感指标.与灌注晶体停搏液相比,含血停搏液有良好的心肌保护作用.

  5. Retained needles in laparoscopic surgery: open or observe?

    National Research Council Canada - National Science Library

    Ruscher, Kimberly A; Modeste, Kevin A; Staff, Ilene; Papasavas, Pavlos K; Tishler, Darren S

    2014-01-01

    ...) during laparoscopic surgery. A survey presented a relevant case and 18 multiple-choice and open-response questions about personal experience with and attitudes toward RFBs, clinical practices, and management...

  6. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    Science.gov (United States)

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran

    2013-01-01

    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  7. Sotalol for atrial tachycardias after surgery for congenital heart disease

    NARCIS (Netherlands)

    BeaufortKrol, GCM; BinkBoelkens, MTE

    1997-01-01

    Atrial tachycardias, in particular atrial flutter after surgery for congenital heart disease, is associated with a high mortality. Treatment with various antiarrhythmic drugs and/or antitachycardia pacemakers is not very successful. Sotalol, a Class III drug, has shown to be a promising drug in adul

  8. Chance of surgery in adult congenital heart disease

    NARCIS (Netherlands)

    Verheugt, Carianne L.; Uiterwaal, Cuno S. P. M.; Vaartjes, Ilonca; van der Velde, Enno T.; Zomer, A. C.; Meijboom, Folkert J.; Pieper, Petronella G.; Post, Marco C.; Vliegen, Hubert W.; Hazekamp, Mark G.; Grobbee, Diederick E.; Mulder, Barbara J. M.

    Background: Young patients with congenital heart disease reaching adulthood face mandatory transition to adult cardiology. Their new cardiologist needs to assess the chances of major future events such as surgery. Using a large national registry, we assessed if patient characteristics at the age of

  9. Effect of oxygen treatment on heart rate after abdominal surgery

    DEFF Research Database (Denmark)

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

    1999-01-01

    . 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...... supplementation were found between patients with or without an epidural catheter or between the postoperative day studied. CONCLUSION: Postoperative oxygen therapy increased arterial oxygen saturation and decreased heart rate after uncomplicated abdominal surgery in a consecutive unselected group of patients who......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...

  10. Recombinant factor VIIa (NovoSeven) as a hemostatic agent after surgery for congenital heart disease.

    Science.gov (United States)

    Razon, Yaron; Erez, Eldad; Vidne, Bernardo; Birk, Einat; Katz, Jacob; Tamari, Hanna; Dagan, Ovadia

    2005-03-01

    Postoperative bleeding and blood product requirements can be substantial in children undergoing open-heart surgery, and reexploration is required in 1% of cases. Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordisk, Denmark) is a hemostatic agent approved for the treatment of hemophilic patients with inhibitors to factor VIII or factor IX. It has also been used with success in other conditions. We present our experience with rFVIIa treatment for uncontrolled bleeding after open-heart surgery in five pediatric patients. The study group consisted of five patients after open-heart surgery with excessive blood loss. The patients were treated with rFVIIa after failure of conventional treatment to control the bleeding. Blood loss, blood product consumption, and coagulation test results were recorded before and after rFVIIa administration. In all cases, blood loss decreased considerably after rFVIIa administration (mean 7.8 ml x kg(-1) x h(-1)), almost eliminating the need for additional blood products, and the prolonged prothrombin time normalized. In two patients with thrombocytopathy, rFVIIa helped to discriminate surgical bleeding from bleeding caused by a defect in hemostasis. No side effects of rFVIIa treatment were noted. These cases support the impression that RFVIIa is efficient and safe in correcting hemostasis in children after cardiopulmonary bypass when other means fail. However, the data are still limited, and more extensive research is needed.

  11. Effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass%右美托咪定对心肺转流心内直视手术患儿血流动力学及应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    李晓松; 刘海涛; 任建军; 董振明

    2012-01-01

    Objective To evaluate the effects of dexmedetomidine infusion on hemodynamic and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass. Methods Thirty pediatric patients undergoing open heart surgery with cardiopulmonary bypass, ASA class D or 01, were randomly assigned to two groups: the group DEX (group D, n=15) and the group control (group C, n = 15). Patients In group D received an initial bolus dose of dexmedetomidine Cl. 0 礸/kg) over 10 minutes, immediately followed by a continuous infusion of 0. 5-1. 0 礸+kg -1穐-1 until the end of the operation. The same volume of normal saline was given in the control group. Hemodynamic parameters and concentrations of blood glucose, rartisol, norepinephrine and epinephrine were measured before injection(T0), 10 min and 15 min after administration Ti and T2), after incision (T3), after sternum saw (T4). after CPB(T6) and immediately after surgey(Ts). Results The values of HR, SBP. DBP and MAP decreased significantly at Ti-Ts in group D, and were significantly lower than those in group C, especially at T; (P<0. 05). In both groups, blood glucose,plasma cortisol, norepinephrine and epinephrine increased significantly at T4-T6. However, the values were lower in group D compared with those in group C(P <0.05). Conclusion Intraoperative dexmedetomidine infusion attenuated the hemodynamic and neuroendocrinal response to surgical trauma and cardiopulmonary bypass in pediatric patients undergoing corrective surgery for congenital heart disease%目的 观察右美托咪定连续输注对小儿先天性心脏病CPB心内直视手术期间的血流动力学及应激反应的影响.方法 CPB心内直视矫治手术患儿30例,ASAⅡ或Ⅲ级,随机均分为右美托咪定组(D组)和对照组(C组).D组接受初始剂量为1.0 μg/kg的右美托咪定(给药时间大于10 min),随后以0.5~1.0μg·kg-1·h-1的速度维持直至手术结束,C组则给予相

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

    Directory of Open Access Journals (Sweden)

    Kyomars Abbasi

    2015-10-01

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

  13. Prognosis of patients with carcinoid heart disease after valvular surgery.

    Science.gov (United States)

    Manoly, Imthiaz; McAnelly, Sarah-Louise; Sriskandarajah, Sanjeevan; McLaughlin, Kenneth Edward

    2014-08-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. We addressed the following question: in patients who are diagnosed with carcinoid heart disease (CHD), do valvular surgeries improve their prognosis? Fifty percent of the patients with clinically diagnosed carcinoid syndrome had cardiac involvement which was present either as valvular dysfunction or as cardiac metastases. These patients often require surgery due to their heightened risk of cardiac disease. Altogether 217 relevant papers were identified as a result of the below-mentioned search, of which 10 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Of the patients who were identified to have carcinoid heart disease in different studies, 193 patients had valve procedure, mainly replacements at tricuspid, mitral and aortic valve positions and either valvuloplasty or replacement at pulmonary valve. Tricuspid and pulmonary valves represented the majority of the excised valves among patients undergoing valvular surgery for CHD. The pathology of carcinoid valve was attributed to the presence of plaque, causing thickening and retraction. Pure regurgitation was the most common finding in all the valves except pulmonary valve which had both stenosis and insufficiency. Thirty-day mortality was 17% (range 1-63%) and long-term survivors were reported to be alive at an average of 58 months (28-80 months) after the valve surgery. The evidence demonstrates that surgical intervention can lead to improved prognosis and reduce the symptoms of heart failure. Postoperative mortality was mainly due to the carcinoid disease itself and not as a complication of the surgery. Therefore, surgery could be considered for symptomatic palliation in carefully selected individuals.

  14. 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.

  15. [Antibiotic prophylaxis with cephalosporins in heart surgery].

    Science.gov (United States)

    Reichart, B; Klinner, W; Adam, D

    1981-08-13

    60 minutes after i.v. injection tissue levels of 7 different cephalosporins were obtained using biological assay. The following concentrations were measured: cephalothn 1.4 micrograms/g; cepharin 4.7 micrograms/g; cephacetrile 11.2 micrograms/g; cephradine 15.4 micrograms/g; cefazedone 26.9 micrograms/g; cefamandole 40.3 micrograms/g, and finally cefoxitin 43 micrograms/g. The high tissue levels of cefamandole and cefoxitin are especially remarkable as i.v. doses of both antibiotics had been 50 mg/kg body weight ( doses of all other cephalosporins 100 mg/kg body weight). Except cephalothin, all cephalosporins tested were suitable for antibiotic prophylaxis in cardiac surgery.

  16. Incisional hernias after open versus laparoscopic surgery for colonic cancer

    DEFF Research Database (Denmark)

    Jensen, Kristian K.; Krarup, Peter-Martin; Scheike, Thomas;

    2016-01-01

    BACKGROUND: Laparoscopic surgery for colonic cancer decreases the incidence of postoperative complications and length of hospital stay as compared with open surgery, while the oncologic outcome remains equivalent. It is unknown whether the surgical approach impacts on the long-term rate of incisi......BACKGROUND: Laparoscopic surgery for colonic cancer decreases the incidence of postoperative complications and length of hospital stay as compared with open surgery, while the oncologic outcome remains equivalent. It is unknown whether the surgical approach impacts on the long-term rate...... of incisional hernia. Furthermore, risk factors for incisional hernia formation are not fully elucidated. The aim of this study was to evaluate the long-term effect of elective open versus laparoscopic surgery for colonic cancer on development of incisional hernia. METHODS: This nationwide cohort study included...... were performed. RESULTS: A total of 8489 patients were included, with a median follow-up of 8.8 (interquartile range 7.0-10.7) years. The incidence of incisional hernia was increased among patients operated on with open techniques compared with patients undergoing laparoscopic surgery (7.3 vs. 5.2 %, p...

  17. Comparison of endoscopic surgery and open surgery for gluteal muscle contracture.

    Science.gov (United States)

    Fu, Dehao; Yang, Shuhua; Xiao, Baojun; Wang, Hong; Meng, Chunqing

    2011-01-01

    To compare the clinical effects of endoscopic surgeries with traditional open surgeries in the treatment of gluteal muscle contracture and discuss their indications and value. In this retrospective study, 50 patients received traditional open surgeries and 52 received endoscopic surgeries. The 2 groups were compared in terms of surgery duration, incision lengths, postsurgical pain, complications, off-bed activity times, hospitalization duration, clinical outcome, and 1-year recurrence rates. The endoscopic surgery group was significantly superior to the open surgery group in regard to incision length, postsurgical pain, off-bed activity time, hospitalization duration, and patient cosmetic satisfaction. Differences were not statistically significant for the surgery duration, complications, clinical outcome, or the 1-year recurrence rate. All the endoscopic surgery group patients stated that they would choose endoscopic surgery again. The endoscopic release of gluteal muscle contracture is safe and reliable, with the advantages of less trauma and pain, shorter operative time, earlier rehabilitation, and return of functional activities. Its application, though, should be carefully controlled based on the indications. It is applicable to degree I and II patients, but may be used only very cautiously in degree III patients. Level III.

  18. Prevalence of peripheral nervous system complications after major heart surgery.

    Science.gov (United States)

    Gavazzi, Armando; de Rino, Francesca; Boveri, Maria Claudia; Picozzi, Anna; Franceschi, Massimo

    2016-02-01

    We evaluated 374 consecutive patients from May 2013 to April 2014 who underwent major cardiac surgery. Each patient had an interview and a neurological clinical examination during the rehabilitation period. Patients with possible peripheral nervous system (PNS) complications underwent further electrodiagnostic tests. Among 374 patients undergoing major heart surgery (coronary artery bypass grafting, valvular heart surgery, ascending aortic aneurysm repair) 23 (6.1 %) developed 34 new PNS complications. We found four brachial plexopathies; four carpal tunnel syndromes; five critical illness neuropathies; three worsening of pre-existing neuropathies; two involvement of X, one of IX and one of XII cranial nerves; three peroneal (at knee), one saphenous, two median (at Struthers ligament), six ulnar (at elbow) mononeuropathies; two meralgia parestheticas. Diabetes is a strong risk factor for PNS complications (p = 0.002); we could not find any other relationship of PNS complications with clinical conditions, demographic data (gender, age) or type of surgical intervention. The mononeuropathies of right arms can be related to ipsilateral vein cannulation; position of body and stretching from chest wall retraction may be the cause of mononeuropathies of left arms (more frequent); the use of saphenous vein and position of the limbs may be the cause of mononeuropathies of the legs; surgical and anesthetical procedures can injure cranial nerves; respiratory failure and infection during the first days after surgery can cause critical illness neuropathies. Careful preoperative assessment and intraoperative management may reduce the risk of long-term PNS complications after cardiac surgery.

  19. Academic proficiency in children after early congenital heart disease surgery.

    Science.gov (United States)

    Mulkey, Sarah B; Swearingen, Christopher J; Melguizo, Maria S; Reeves, Rachel N; Rowell, Jacob A; Gibson, Neal; Holland, Greg; Bhutta, Adnan T; Kaiser, Jeffrey R

    2014-02-01

    Children with early surgery for congenital heart disease (CHD) are known to have impaired neurodevelopment; their performance on school-age achievement tests and their need for special education remains largely unexplored. The study aimed to determine predictors of academic achievement at school age and placement in special education services among early CHD surgery survivors. Children with CHD surgery at codes. Predictors for achieving proficiency in literacy and mathematics and the receipt of special education were determined. Two hundred fifty-six children who attended Arkansas public schools and who had surgery as infants were included; 77.7 % had either school-age achievement-test scores or special-education codes of mental retardation or multiple disabilities. Scores on achievement tests for these children were 7-13 % lower than those of Arkansas students (p < 0.01). They had an eightfold increase in receipt of special education due to multiple disabilities [odds ratio (OR) 10.66, 95 % confidence interval (CI) 4.23-22.35] or mental retardation (OR 4.96, 95 % CI 2.6-8.64). Surgery after the neonatal period was associated with decreased literacy proficiency, and cardiopulmonary bypass during the first surgery was associated with decreased mathematics proficiency. Children who had early CHD surgery were less proficient on standardized school assessments, and many received special education. This is concerning because achievement-test scores at school age are "real-world" predictors of long-term outcomes.

  20. Effects of open and closed suction systems on the haemodynamic parameters in cardiac surgery patients.

    Science.gov (United States)

    Özden, Dilek; Görgülü, Refia S

    2015-05-01

    This study was carried out to determine the effects of open and closed suction systems on haemodynamic parameters of the patients who underwent open heart surgery. Nurses should work meticulously and carefully as many complications may develop if the method used to perform suctioning is not appropriate. The quasi-experimental study design was used. The study sample comprised 120 patients who underwent open heart surgery in the cardiovascular surgery intensive care unit of a state hospital in Turkey. Haemodynamic parameters were determined just before, right after, at the 5th and 15th minute after suctioning. The data were evaluated with the One-Way Analysis of Variance (ANOVA) for Repeated Measures, independent t-test and Bonferroni's test for further analysis (post hoc). The difference between heart rate (HR) and mean blood pressure, mean PaO2 and PaCO2 , SaO2 and pH values measured before, right after and at the 5th and 15th minute after suctioning was found to be significant in patients who underwent the open suctioning procedure. It was determined that the difference between mean PaO2 values was not significant and that SaO2 versus SpO2 values increased in patients who underwent the closed suctioning procedure. When the open and closed suction systems were compared, statistically significant difference was determined in terms of MAP, SpO2 . It was determined that HR, arterial blood pressure and arterial blood gases of the patients who underwent open heart surgery were negatively affected by the open suction system but did not increase significantly as soon as suctioning was over during the closed suctioning procedure. The data obtained indicate that closed system suctioning, compared with open system suctioning, can be used safely on this patient group. The closed suction system is recommended since it contributes to the enhancement of patient safety and the quality of nursing care. © 2014 The Authors. Nursing in Critical Care published by John Wiley & Sons

  1. [Late tamponade after heart surgery: a dreadful diagnostic pitfall].

    Science.gov (United States)

    Glock, Y F; Herreros, J; Tejeira, F J

    1983-05-01

    In a series of 250 consecutive open-heart operations, three cases of late cardiac tamponade were noted following the operation. This led the authors to review the literature pertaining to this complication. Ninety-nine cases were collected. The frequency of late tamponade associated with cardiac surgery was 0.62% and was fatal in 16.2% of those cases. The delay before the tamponade appeared varied from 3 days to 3 months (mean 14.5 +/- 7.8 days). The initial clinical picture is insidious and vague, and this constitutes the danger of late cardiac tamponade. The clinical signs are of the respiratory (dyspnea, chest pain), gastrointestinal (anorexia, vomiting) and central nervous (mental confusion, even coma) systems. Pallor with a drop in hematocrit in patients on anticoagulant therapy suggests occult bleeding. A definitive diagnosis depends on catheterization of the right side and on mono- and bidimensional echocardiography. The authors believe that computerized axial tomography represents an interesting noninvasive and reliable examination technique when it can be used during emergency treatment. Pericardial puncture, which is both a diagnostic and therapeutic technique, was useful in one third of the cases; it produced a false-negative result in 12%. The resulting differential diagnoses are pulmonary embolism, myocardial insufficiency and septic shock. Late cardiac tamponade may be produced by one of two mechanisms: hemopericardium due to overdosage of anticoagulants or an exacerbated form of the post-pericardiotomy syndrome. Emergency treatment is always necessary. Pericardiocentesis is a useful diagnostic aid and provides temporary stabilization preoperatively. A wide surgical approach is always indicated. The mortality in untreated patients is 100%. The frequency of immediate relapse or, occasionally, of delayed relapse is estimated to be 11%; relapse may be lethal.

  2. Technique of open laparoscopy for supramesocolic surgery in obese patients.

    Science.gov (United States)

    Deguines, Jean Baptiste; Qassemyar, Quentin; Dhahri, Abdennaceur; Brehant, Olivier; Fuks, David; Verhaeghe, Pierre; Regimbeau, Jean-Marc

    2010-08-01

    Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous. In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall. The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done. We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.

  3. Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

    National Research Council Canada - National Science Library

    Sibilitz, Kirstine Laerum; Berg, Selina Kikkenborg; Hansen, Tina Birgitte; Risom, Signe Stelling; Rasmussen, Trine Bernholdt; Hassager, Christian; Køber, Lars; Steinbrüchel, Daniel; Gluud, Christian; Winkel, Per; Thygesen, Lau Caspar; Hansen, Jane Lindschou; Schmid, Jean Paul; Conraads, Viviane; Brocki, Barbara Christina; Zwisler, Ann-Dorthe

    2013-01-01

    .... We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery...

  4. Tissue-engineered heart valve: future of cardiac surgery.

    Science.gov (United States)

    Rippel, Radoslaw A; Ghanbari, Hossein; Seifalian, Alexander M

    2012-07-01

    Heart valve disease is currently a growing problem, and demand for heart valve replacement is predicted to increase significantly in the future. Existing "gold standard" mechanical and biological prosthesis offers survival at a cost of significantly increased risks of complications. Mechanical valves may cause hemorrhage and thromboembolism, whereas biologic valves are prone to fibrosis, calcification, degeneration, and immunogenic complications. A literature search was performed to identify all relevant studies relating to tissue-engineered heart valve in life sciences using the PubMed and ISI Web of Knowledge databases. Tissue engineering is a new, emerging alternative, which is reviewed in this paper. To produce a fully functional heart valve using tissue engineering, an appropriate scaffold needs to be seeded using carefully selected cells and proliferated under conditions that resemble the environment of a natural human heart valve. Bioscaffold, synthetic materials, and preseeded composites are three common approaches of scaffold formation. All available evidence suggests that synthetic scaffolds are the most suitable material for valve scaffold formation. Different cell sources of stem cells were used with variable results. Mesenchymal stem cells, fibroblasts, myofibroblasts, and umbilical blood stem cells are used in vitro tissue engineering of heart valve. Alternatively scaffold may be implanted and then autoseeded in vivo by circulating endothelial progenitor cells or primitive circulating cells from patient's blood. For that purpose, synthetic heart valves were developed. Tissue engineering is currently the only technology in the field with the potential for the creation of tissues analogous to a native human heart valve, with longer sustainability, and fever side effects. Although there is still a long way to go, tissue-engineered heart valves have the capability to revolutionize cardiac surgery of the future.

  5. Logistic Regression Analysis of Risk Factors of Early Postoperative Cognitive Dysfunction in Patients after Open Heart Surgery%心内直视术后早期认知功能障碍危险因素的logistic回归分析

    Institute of Scientific and Technical Information of China (English)

    涂杰; 张炳东; 韦秋英; 李涛; 何芳

    2013-01-01

    目的 探讨心内直视术后早期认知功能障碍(POCD)的危险因素.方法 心内直视术后315例患者,分别在术前7 d和术后7 d采用中文版简易精神状态检查量表(MMSE)进行认知功能评价,按是否发生POCD,将患者分为POCD组和非POCD组.收集两组患者性别、年龄和体质指数等共26个相关因素,通过单因素分析和多因素logistic回归分析筛选心内直视术后发生早期POCD的独立危险因素.结果 315例患者中有301例完成本研究,其中发生POCD 138例(45.8%).单因素分析显示,年龄、受教育程度、吸烟、饮酒、高血压、冠心病、糖尿病、脑血管病、药物依赖、阿托品用量、体外循环时间、手术时间、术中低血压和术后疼痛在两组间差异有统计学意义(P均<0.05).多因素logistic回归分析显示:年龄、吸烟、饮酒、高血压、糖尿病、阿托品用量、体外循环时间和术中低血压是心内直视术后发生早期POCD的独立危险因素(P均<0.05),受教育程度是其保护因素.结论 POCD是心内直视术后常见的并发症.年龄、吸烟、饮酒、高血压、糖尿病、阿托品用量、体外循环时间和术中低血压是术后发生早期POCD的危险因素,受教育程度是其保护因素.%Objective To investigate the risk factors of early postoperative cognitive dysfunction( POCD ) in patients after open heart surgery. Methods A total of 315 patients undergoing open heart surgery were divided into POCD group and non-POCD group by the mini-mental state examination( MMSE ) 7 days before and after operation, respectively. The gender,age,body mass index and other 23 related factors were collected from both groups. The independent risk factors of early POCD after open heart surgery were determined by univariate and multivariate logistic regression analysis. Results Of 301 patients who completed the study ,138( 45.8% ) cases developed POCD. Univariate analysis showed that age,level of

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

    Directory of Open Access Journals (Sweden)

    Ghani A

    2010-01-01

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

  7. 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.

  8. Mechanical bowel preparation in elective open colon surgery

    NARCIS (Netherlands)

    Fa-Si-Oen, Patrick Regnier

    2006-01-01

    Mechanical bowel preparation is a long standing practice in elective open colon surgery dating from the 1970's. It has always been believed to reduce the rate of postoperative complications in the form of anastomotic leakage and wound infection. In this thesis we broadly and thoroughly examine the v

  9. Is open surgery for head and neck cancers truly declining?

    NARCIS (Netherlands)

    Hartl, D.M.; Brasnu, D.F.; Shah, J.P.; Hinni, M.L.; Takes, R.P.; Olsen, K.D.; Kowalski, L.P.; Rodrigo, J.P.; Strojan, P.; Wolf, G.T.; Rinaldo, A.; Suarez, C.; Mendenhall, W.M.; Paleri, V.; Forastiere, A.A.; Werner, J.A.; Ferlito, A.

    2013-01-01

    In the past two decades, major modifications in the way we treat head and neck cancers, due to advances in technology and medical oncology, have led to a decline in the use of open surgery as first-line treatment of cancers arising from several primary tumor sites. The incidence of tobacco- and alco

  10. Heart Motion Prediction Based on Adaptive Estimation Algorithms for Robotic Assisted Beating Heart Surgery

    Science.gov (United States)

    Tuna, E. Erdem; Franke, Timothy J.; Bebek, Özkan; Shiose, Akira; Fukamachi, Kiyotaka; Çavuşoğlu, M. Cenk

    2013-01-01

    Robotic assisted beating heart surgery aims to allow surgeons to operate on a beating heart without stabilizers as if the heart is stationary. The robot actively cancels heart motion by closely following a point of interest (POI) on the heart surface—a process called Active Relative Motion Canceling (ARMC). Due to the high bandwidth of the POI motion, it is necessary to supply the controller with an estimate of the immediate future of the POI motion over a prediction horizon in order to achieve sufficient tracking accuracy. In this paper, two least-square based prediction algorithms, using an adaptive filter to generate future position estimates, are implemented and studied. The first method assumes a linear system relation between the consecutive samples in the prediction horizon. On the contrary, the second method performs this parametrization independently for each point over the whole the horizon. The effects of predictor parameters and variations in heart rate on tracking performance are studied with constant and varying heart rate data. The predictors are evaluated using a 3 degrees of freedom test-bed and prerecorded in-vivo motion data. Then, the one-step prediction and tracking performances of the presented approaches are compared with an Extended Kalman Filter predictor. Finally, the essential features of the proposed prediction algorithms are summarized. PMID:23976889

  11. The application of sevoflurane inhalation during the whole range of cardiopulmonary bypass in open heart surgery%全程吸入七氟烷在体外循环手术中的应用研究

    Institute of Scientific and Technical Information of China (English)

    张晓华; 张利东; 程晓峰; 景华

    2012-01-01

    Objective This study aims to explore the feasibility and efficacy of sevoflurane inhalation via oxygenator during the whole range of cardiopulmonary bypass ( CPB ) on anesthesia maintenance. Methods 78 consecutive patients underwent routine heart valve replacement surgery were randomly divided into two groups, the sevoflurane group ( S group ) and propofol group ( P group ), with 39 patients in each group. In S group, the sevoflurane was inhaled via oxygenator once the CPB was stared, while in P group propofol was injected by means of target controlled infusion. The mean blood pressure and artery oxygen partial pressure were recorded during CPB. The serum level of troponin I was also recorded preoperatively and 8 and 24 hours post operation. Results There was no significant difference between the mean blood pressure, artery oxygen partial pressure and oxygen partial pressure in mixed venous blood in each group. The serum level of troponin I in S group was significantly lower than P group at 8 and 24 hours post operation ( P <0.01 ). Conclusion The sevoflurane inhalation via oxygenator during cardio pulmonary bypass is safe and feasible. Compared with propofol, sevoflurane is more effective on myocardial preservation.%目的 探讨体外循环转流期间经氧合器吸入七氟烷维持麻醉的可行性及优越性.方法 连续78例行心脏瓣膜置换术患者随机分为七氟烷组(S组)和丙泊酚组(P组),每组39例.S组体外循环开始后经氧合器吸入七氟烷,P组靶控输注丙泊酚,监测转流期间两组脑电双频谱指数(BIS)值、平均动脉压、动脉血氧分压并测定两组麻醉前、术后8小时、术后24小时血浆心肌肌钙蛋白I浓度.结果 转流期间两组BIS、平均动脉压、动脉血氧分压和混合静脉血氧分压差异无统计学意义;术后8小时、24小时血浆cTnI浓度S组明显低于P组(P<0.01).结论 体外循环转流期间经氧合器吸入七氟烷安全、可行;与丙泊酚相比,七

  12. [Changes in the cytokine network through escalating SIRS after heart surgery].

    Science.gov (United States)

    Sablotzki, A; Mann, V; Simm, A; Czeslick, E

    2001-09-01

    Changes in the Cytokine Network Through Escalating SIRS After Heart Surgery. Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). There is a lot of information about the immunologic alterations in patients undergoing cardiopulmonary bypass, but only little is known about the expression of cytokines in patients with severe SIRS or MODS following cardiovascular surgery. In the present study, we investigated the inflammatory response of patients with an escalating SIRS following open heart surgery. Plasma levels of cytokines (IL-1beta, IL-6, IL-8, IL-10, IL-12, IL-18, GM-CSF and TGF-beta) were measured at the first four postoperative days in 12 adult male patients with severe SIRS (SIRS-group), and 15 patients with uncomplicated course (control-group) following myocardial revascularization. All cytokines (except IL-1beta) were significantly elevated in SIRS-patients, the analysis of differences between the survivors and non-survivors within the SIRS-group showed dramatically elevated levels of IL-8 and IL-18 in non-survivors. From the results of our investigation we can conclude that monitoring of immunologic parameters, e.g. IL-8 and/or IL-18 may be helpful for the early detection and prognosis of high-risk patients with severe SIRS and MODS following cardiac surgery.

  13. Cardiac surgery is successful in heart transplant recipients.

    Science.gov (United States)

    Holmes, Timothy R; Jansz, Paul C; Spratt, Phillip; Macdonald, Peter S; Dhital, Kumud; Hayward, Christopher; Arndt, Grace T; Keogh, Anne; Hatzistergos, Joanna; Granger, Emily

    2014-08-01

    Improved survival of heart transplant (HTx) recipients and increased acceptance of higher risk donors allows development of late pathology. However, there are few data to guide surgical options. We evaluated short-term outcomes and mortality to guide pre-operative assessment, planning, and post-operative care. Single centre, retrospective review of 912 patients who underwent HTx from February 1984 - June 2012, identified 22 patients who underwent subsequent cardiac surgery. Data are presented as median (IQR). Indications for surgery were coronary allograft vasculopathy (CAV) (n=10), valvular disease (n=6), infection (n=3), ascending aortic aneurysm (n=1), and constrictive pericarditis (n=2). There was one intraoperative death (myocardial infarction). Hospital stay was 10 (8-21) days. Four patients (18%) returned to theatre for complications. After cardiac surgery, survival at one, five and 10 years was 91±6%, 79±10% and 59±15% with a follow-up of 4.6 (1.7-10.2) years. High pre-operative creatinine was a univariate risk factor for mortality, HR=1.028, (95%CI 1.00-1.056; p=0.05). A time dependent Cox proportional hazards model of the risk of cardiac surgery post-HTx showed no significant hazard; HR=0.87 (95%CI 0.37-2.00; p=0.74). Our experience shows cardiac surgery post-HTx is associated with low mortality, and confirms that cardiac surgery is appropriate for selected HTx recipients. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  14. Towards robotic heart surgery: introduction of autonomous procedures into an experimental surgical telemanipulator system.

    Science.gov (United States)

    Bauernschmitt, R; Schirmbeck, E U; Knoll, A; Mayer, H; Nagy, I; Wessel, N; Wildhirt, S M; Lange, R

    2005-09-01

    The introduction of telemanipulator systems into cardiac surgery enabled the heart surgeon to perform minimally invasive procedures with high precision and stereoscopic view. For further improvement and especially for inclusion of autonomous action sequences, implementation of force-feedback is necessary. The aim of our study was to provide a robotic scenario giving the surgeon an impression very similar to open procedures (high immersion) and to enable autonomous surgical knot tying with delicate suture material. In this experimental set-up the feasibility of autonomous surgical knot tying is demonstrated for the first time using stereoscopic view and force feedback. Copyright 2005 John Wiley & Sons, Ltd.

  15. Preoperative Prevention of Heart Failure in Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    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.

  16. An open source tool for heart rate variability spectral analysis.

    Science.gov (United States)

    Rodríguez-Liñares, L; Méndez, A J; Lado, M J; Olivieri, D N; Vila, X A; Gómez-Conde, I

    2011-07-01

    In this paper we describe a software package for developing heart rate variability analysis. This package, called RHRV, is a third party extension for the open source statistical environment R, and can be freely downloaded from the R-CRAN repository. We review the state of the art of software related to the analysis of heart rate variability (HRV). Based upon this review, we motivate the development of an open source software platform which can be used for developing new algorithms for studying HRV or for performing clinical experiments. In particular, we show how the RHRV package greatly simplifies and accelerates the work of the computer scientist or medical specialist in the HRV field. We illustrate the utility of our package with practical examples.

  17. Laparoscopic cholecystectomy causes less sleep disturbance than open abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Kiil, C

    2001-01-01

    was present 1 week after laparoscopy and 4 weeks after laparotomy. CONCLUSIONS: After laparotomy, total sleep time increased and there was a change in diurnal sleep distribution. These sleep alterations were less pronounced after laparoscopic cholecystectomy. Thus, sleep architecture was disturbed for ?4......BACKGROUND: The aim of this study was to examine subjective sleep quality before and after laparoscopic vs open abdominal surgery. METHODS: Twelve patients undergoing laparoscopic cholecystectomy and 15 patients undergoing laparotomy were evaluated with the aid of a sleep questionnaire from 4 days...... before until 4 weeks after surgery. RESULTS: Following laparoscopic surgery, total sleep time increased during the 1st week after the operation compared with preoperative values (p = 0.02), whereas sleep duration during weeks 2, 3, and 4 did not differ from the times reported preoperatively. Following...

  18. Arthroscopic Revision Surgery for Failure of Open Latarjet Technique.

    Science.gov (United States)

    Cuéllar, Adrián; Cuéllar, Ricardo; de Heredia, Pablo Beltrán

    2017-05-01

    To evaluate the efficacy in treating pain, limited range of motion, and continued instability of the Latarjet open technique via the use of arthroscopy. A retrospective review of patients who underwent arthroscopic capsule plication after failure of an open Latarjet technique was performed. Revision surgery was indicated in cases of recurrent instability and associated pain. Only patients with a glenoid defect Latarjet with a glenoid bone defect Latarjet procedures. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  19. Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

    Directory of Open Access Journals (Sweden)

    Mohamad Irani

    2016-01-01

    Full Text Available Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05, after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.

  20. 小儿体外循环深低温暂停循环心内直视手术脑电图监测%Monitoring of Electroencephalogram During Open Heart Surgery in Chlidren with Deep Hypothermia Limited Cardiopulmonary Bypass or Total Circuiatory Arrest

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 张志芳; 黄惠民; 张佩敏

    1989-01-01

    This papcr reports and discusses the changes of electroencephalograph (EEG) during and after open heart snrgery in children with deep hypothermia (18℃-20℃),limiteà cardiopulmonary bypass,total Circulatory arrest (TOA,37-75min) or with moderate hypothermia (25℃-28℃),standa rd cardiopulmonary bypass(SCB).The conclusions are:(1) The patient after open heart surgery with TCA or SCB has an anomalous course of EEG,and has more changes in TCA group,but such anomalies tend to return to the preoperative level in followup.(2) Hypothermia is safe,with EEG becoraing normal and no cerebral complications,if circulatory arrest time is less than 60min.(3) When the rectal temperature is <25℃ and the blood perfusion cooling is continuing,EEG would be highly a bnormal,when the rectal teroperature is lower down to 18-25℃ or during circulatory arrest,the EEG appears as a horizontal line.It is necessary to improve the measures so as to prevent the spasm of brain vessels while cooling is continuing.%本文通过脑电图(EEG)监测未了解小儿深低温皙停循环心内直视手术对患儿脑功能的影响.指出血流降温至肛温18~20℃,停循环时问限于60分钟以内,术后及随访中EEG均能恢复术前水平,临床上亦无明显神经系统并发症.证明此技术是安全可行的.本文亦显示了深低温停循环枝术的术中,术后EEG变化及恢复规律.

  1. Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery.

    Science.gov (United States)

    de Araujo Motta, Fabio; Dalla-Costa, Libera Maria; Dominguez Muro, Marisol; Lenzi, Andrea; Picharski, Gledson Luiz; Burger, Marion

    2016-11-01

    Candida species are the primary cause of invasive fungal infection in hospitalized children. There are few data on risk factors for postoperative candidemia in pediatric patients with congenital heart defects. This study aimed to identify risk factors for candidemia in patients with congenital heart defects who underwent cardiac surgery. This was a case-control study conducted in patients admitted to a pediatric cardiology intensive care unit from January 2006 to December 2013. Candidemia cases were matched with control patients without candidemia. Multivariate analyses were conducted to determine predictive probabilities for the incidence of candidemia at a risk higher than 10%. Thirty patients diagnosed with candidemia (incidence: 0.7 cases/1000 patient days) were matched with 75 controls. Risk factors independently associated with candidemia included Risk Adjustment for Congenital Heart Surgery (RACHS-1) category ≥3 [odds ratio (OR) = 3.165, 95% confidence interval: 1.377-8.467], use of acid suppression therapy (OR = 1.9, 95% confidence interval: 0.949-3.979) and thrombocytopenia (OR = 2.2, 95% confidence interval: 1.2-4.2). Predictive probabilities ranged from 11% (only in RACHS-1 category ≥3) to 58% (combined RACHS-1 ≥3, thrombocytopenia and acid suppression therapy use). The case fatality rate within 30 days after candidemia was 50%. This is the first report using the RACHS-1 category as a risk factor for invasive candidiasis in patients with congenital heart defects in the pediatric intensive care unit. Further studies must be conducted to validate the risk factors for candidemia in this pediatric population.

  2. [Epidemiology and prevention of anaphylactoid reactions in heart surgery patients].

    Science.gov (United States)

    Trekova, N A; Solovova, L E; Kuznetsov, R V; Asmangulian, E T

    2000-01-01

    A retrospective analysis of the incidence, severity, and causes of anaphylactoid reactions (AR) in 1504 cardiosurgical patients operated on at Research Center of Surgery in 1995-1999 showed that AR occurred in 109 (7.4%) patients: 60% during aortocoronary bypass operations, 27.2% during correction of acquired heart diseases, and 12.8% during correction of congenital heart diseases. Skin symptoms predominated in the structure of AR (59.7%); cardiovascular episodes ranked second (38.5%), and the incidence of pulmonary reactions was lowest (1.8%). The causes of AR during anesthesia and surgery were platelet-rich plasma and fresh-frozen plasma (35.3%), antibiotics (12.1%), protamine (12.1%), myorelaxants (9.9%), colloid plasma substitutes (8.8%), dioxidine (3.3%), heparin (2.2%), aprotinin (1.1%), diazepam (2.2%), and other agents (7.6%). A history of AR and repeated interventions are risk factors of AR. The protocol of AR prevention in cardiosurgical patients includes determination of risk factors, selection of the least hazardous agents, strict adherence to the rate of infusion of histamine-releasing drugs, minimum utilization of donor blood components (platelets and plasma), use of H1 and H2 blockers, corticosteroids (celestone) during premedication and operation. Such treatment helped decrease the severity and incidence of AR in cardiosurgical patients to 4.7%.

  3. 定时膨肺吸痰对心脏直视术后机械通气患者肺不张的影响%Effects of timing manual lung hyperinflation and suction on atelectasis in mechanically venti-lated patients undergoing open-heart surgery

    Institute of Scientific and Technical Information of China (English)

    秦丹; 汪大祝; 杨玉辉; 唐丽玲; 张大发

    2015-01-01

    Objective:To observe the effects of timing manual lung hyperinflation and suction on the atelectasis in mechanically ventilated patients under-going open-heart surgery.Methods:107 mechanically ventilated patients undergoing open-heart surgery were randomly assigned to experimental group(n=47) and control group(n=60).The patients in experimental group were treated with manual lung hyperinflation and suction once every 8 hours,those in control group,with conventional suction.Changes of the indicators were compared 30 min after the suction concerning PaO2 ,PaCO2 and SaO2 in the two groups,who received chest radiography or lung CT examination after one week of treatment for comparison of the incidence of atelectasis .Results:The pa-tients in the experimental group had significant improvement in hyoxemia and lower incidence of atelectasis after suctioning(P<0.05).Conclusion:Tim-ing manual lung hyperinflation and suction can improve the hyoxemia and reduce the incidence of atelectasis in mechanically ventilated patients undergoing open-heart surgery,suggesting that this management is worthy of wider clinical recommendation .%目的:初步探讨定时膨肺吸痰法对心脏直视手术后机械通气患者肺不张的影响。方法:将107例心脏直视手术后行呼吸机机械通气患者随机分为定时膨肺吸痰组(47例)和常规吸痰组(60例),定时膨肺吸痰组每8 h内用膨肺吸痰法吸痰1次,其余时间按常规吸痰法操作。比较两组患者吸痰后30 min PaO2、PaCO2、SaO2等血气指标的变化;治疗后1周常规行胸片或肺部CT检查,观察比较两组肺不张的发生率。结果:定时膨肺吸痰组患者吸痰后低氧血症较常规吸痰组明显改善( P<0.05),肺不张发生率显著低于常规吸痰组(P<0.05)。结论:定时膨肺吸痰能改善心脏直视术后机械通气患者的低氧血症,减少肺不张的发生率,值得临床推广。

  4. A Quadratic Nonlinear Prediction-Based Heart Motion Model Following Control Algorithm in Robotic-Assisted Beating Heart Surgery

    Directory of Open Access Journals (Sweden)

    Fan Liang

    2013-01-01

    Full Text Available Off‐pump coronary artery bypass graft surgery outperforms the traditional on‐pump surgery because the assisted robotic tools can cancel the relative motion between the beating heart and the robotic tools, which reduces post‐surgery complications for patients. The challenge for the robot assisted tool when tracking the beating heart is the abrupt change caused by the nonlinear nature of heart motion and high precision surgery requirements. A characteristic analysis of 3D heart motion data through bi‐spectral analysis demonstrates the quadratic nonlinearity in heart motion. Therefore, it is necessary to introduce nonlinear heart motion prediction into the motion tracking control procedures. In this paper, the heart motion tracking problem is transformed into a heart motion model following problem by including the adaptive heart motion model into the controller. Moreover, the model following algorithm with the nonlinear heart motion model embedded inside provides more accurate future reference by the quadratic term of sinusoid series, which could enhance the tracking accuracy of sharp change point and approximate the motion with sufficient detail. The experiment results indicate that the proposed algorithm outperforms the linear prediction‐based model following controller in terms of tracking accuracy (root mean square.

  5. [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.

  6. Critical appraisal of laparoscopic vs open rectal cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Winson Jianhong Tan; Min Hoe Chew; Angela Renayanti Dharmawan; Manraj Singh; Sanchalika Acharyya; Carol Tien Tau Loi; Choong Leong Tang

    2016-01-01

    AIM:To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection(LRR) and the impact of conversion in patients with rectal cancer.METHODS:An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection.Patients were compared in three groups:Open surgery(OP),laparoscopic surgery,and converted laparoscopic surgery.Short-term outcomes,long-term outcomes,and survival analysis were compared.RESULTS:Among 633 patients studied,200 patients had successful laparoscopic resections with a conversion rate of 11.1%(25 out of 225).Factors predictive of survival on univariate analysis include the laparoscopic approach(P = 0.016),together with factors such as age,ASA status,stage of disease,tumor grade,presence of perineural invasion and vascular emboli,circumferential resection margin < 2 mm,and postoperative adjuvant chemotherapy.The survival benefit of laparoscopic surgery was no longer significant on multivariateanalysis(P = 0.148).Neither 5-year overall survival(70.5% vs 61.8%,P = 0.217) nor 5-year cancer free survival(64.3% vs 66.6%,P = 0.854) were significantly different between the laparoscopic group and the converted group.CONCLUSION:LRR has equivalent long-term oncologic out c ome s w he n c ompare d t o OP.Laparos c opic conversion does not confer a worse prognosis.

  7. Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

    Directory of Open Access Journals (Sweden)

    Zahmacioglu Oguzhan

    2011-11-01

    Full Text Available Abstract Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services.

  8. Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

    Science.gov (United States)

    2011-01-01

    Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the analysis was "to be strong and resistive". We reached the conclusion that this condition was not a pathological build up but an attitude of coping, as it did not cause loss of functionality. The defensive psychological mechanisms used by these adolescents consisted of repression, compensation and reaction formation. We believe that this information is important to understand the real meaning of the manners displayed when these adolescents and their families pursue their daily lives, communicate and make relationships with their environment and especially professionals in the health services. PMID:22112589

  9. Fluid overload in infants following congenital heart surgery.

    Science.gov (United States)

    Hazle, Matthew A; Gajarski, Robert J; Yu, Sunkyung; Donohue, Janet; Blatt, Neal B

    2013-01-01

    To describe postoperative fluid overload patterns and correlate degree of fluid overload with intensive care morbidity and mortality in infants undergoing congenital heart surgery. Prospective, observational study. Fluid overload (%) was calculated by two methods: 1) (Total fluid in - Total fluid out)/(Preoperative weight) × 100; and 2) (Current weight - Preoperative weight)/(Preoperative weight) × 100. Composite poor outcome included: need for renal replacement therapy, upper quartile time to extubation or intensive care length of stay (> 6.5 and 9.9 days, respectively), or death ≤ 30 days after surgery. University hospital pediatric cardiac ICU. Forty-nine infants heart surgery with cardiopulmonary bypass during the period of July 2009 to July 2010. None. Patients had a median age of 53 days (21 neonates) and mean weight of 4.5 ± 1.3 kg. Forty-two patients (86%) developed acute kidney injury by meeting at least Acute Kidney Injury Network and Kidney Disease Improving Global Outcomes stage 1 criteria (serum creatinine rise of 50% or ≥ 0.3mg/dL). The patients with adverse outcomes (n = 17, 35%) were younger (7 [5 - 10] vs. 98 [33 - 150] days, p = 0.001), had lower preoperative weight (3.7 ± 0.7 vs. 4.9 ± 1.4 kg, p = 0.0002), higher postoperative mean peak serum creatinine (SCr) (0.9 ± 0.3 vs. 0.6 ± 0.3mg/dL, p = 0.005), and higher mean maximum fluid overload by both method 1 (12% ± 10% vs. 6% ± 4%, p = 0.03) and method 2 (24% ± 15% vs. 14% ± 8%, p = 0.02). Predictors of a poor outcome from multivariate analyses were cardiopulmonary bypass time, use of circulatory arrest, and increased vasoactive medication requirements postoperatively. Early postoperative fluid overload is associated with suboptimal outcomes in infants following cardiac surgery. Because the majority of patients developed kidney injury without needing renal replacement therapy, fluid overload may be an important risk factor for adverse outcomes with all degrees of acute kidney injury.

  10. 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

  11. The role of the nurse practitioner in congenital heart surgery.

    Science.gov (United States)

    O'Brien, Patricia

    2007-01-01

    Pediatric nurse practitioners are often members of the interdisciplinary team caring for children with congenital heart disease. The collaborative practice model, in which a physician-led team of physicians, nurse practitioners, and other clinicians work together to provide comprehensive, quality patient care, has had positive benefits for patients and their families, physicians, and nurses. The acute care pediatric nurse practitioner combines advanced training in assessment, diagnosis, and management of common pediatric health problems with advanced nursing expertise in patient education, counseling, and health promotion to meet the specialized needs of children with complex acute and chronic illnesses. This article focuses on the development and current practice of pediatric nurse practitioners in acute care settings and concludes with a discussion of the role of nurse practitioners on the postoperative cardiac surgery service at Children's Hospital, Boston.

  12. German Heart Surgery Report 2015: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

    Science.gov (United States)

    Beckmann, Andreas; Funkat, Anne-Katrin; Lewandowski, Jana; Frie, Michael; Ernst, Markus; Hekmat, Khosro; Schiller, Wolfgang; Gummert, Jan F; Welz, Armin

    2016-09-01

    On the basis of a long-standing voluntary registry, which was founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all heart, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during 2015 are analyzed. In 2015, a total of 103,967 heart surgery procedures (implantable cardioverter defibrillator, pacemaker, and extracardiac procedures without ECC excluded) were submitted to the database. Approximately 14.8% of the patients were at least 80 years old, resulting in an increase of 0.6% compared with the data of 2014. For 38,601 isolated coronary artery bypass grafting procedures (relationship on-/off-pump: 5:1), the unadjusted inhospital mortality was 2.7%. Concerning the 32,346 isolated heart valve procedures (including 10,606 catheter-based implantations) an unadjusted inhospital mortality of 4.4% was observed.This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, demonstrates advancements in heart medicine, and enables internal/external quality assurance for all participants. In addition, the registry demonstrates that the provision of heart surgery in Germany is appropriate and patients are treated nationwide in a round-the-clock service.

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

    Science.gov (United States)

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

    2006-01-01

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

  14. Recommendations for the management of patients after heart valve surgery.

    Science.gov (United States)

    Butchart, Eric G; Gohlke-Bärwolf, Christa; Antunes, Manuel J; Tornos, Pilar; De Caterina, Raffaele; Cormier, Bertrand; Prendergast, Bernard; Iung, Bernard; Bjornstad, Hans; Leport, Catherine; Hall, Roger J C; Vahanian, Alec

    2005-11-01

    Approximately 50,000 valve replacement operations take place in Europe annually and almost as many valve repair procedures. Previous European guidelines on management of patients after valve surgery were last published in 1995 and were limited to recommendations about antithrombotic prophylaxis. American guidelines covering the broader topic of the investigation and treatment of patients with valve disease were published in 1998 but devoted relatively little space to post-surgical management. This document represents the consensus view of a committee drawn from three European Society of Cardiology (ESC) Working Groups (WG): the WG on Valvular Heart Disease, the WG on Thrombosis, and the WG on Rehabilitation and Exercise Physiology. In almost all areas of patient management after valve surgery, randomized trials and meta-analyses do not exist. Such randomized trials as do exist are very few in number, are narrowly focused with small numbers, have limited general applicability, and do not lend themselves to meta-analysis because of widely divergent methodologies and different patient characteristics. Recommendations are therefore almost entirely based on non-randomized studies and relevant basic science.

  15. Short-term prognostic value of perioperative coronary sinus-derived-serum cardiac troponin-I, creatine kinase-MB, lactate, pyruvate, and lactate-pyruvate ratio in adult patients undergoing open heart surgery

    Directory of Open Access Journals (Sweden)

    Ujjwal Kumar Chowdhury

    2016-01-01

    Full Text Available Objectives: To investigate the release pattern of different cardiac metabolites and biomarkers directly from the coronary sinus (CS and to establish the diagnostic discrimination limits of each marker protein and metabolites to evaluate perioperative myocardial injury in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB. Patients and Methods: Sixty-eight patients undergoing first mitral and/or aortic valve replacements with/without coronary artery bypass grafting and Bentall procedure under CPB and blood cardioplegic arrest were studied. All cardiac metabolites and biomarkers were measured in serial CS-derived blood samples at pre-CPB, immediate post aortic declamping, 10 minutes post-CPB and 12 hrs post-CPB. Results: Receiver operating characteristic curve analysis of cardiac biomarkers indicated lactate-pyruvate ratio as the superior diagnostic discriminator of myocardial injury with an optimal "cut-off" value >10.8 immediately after aortic declamping (AUC, 0.92; 95% CI: 0.85-0.98. Lactate was the second best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2mmol/l at immediately after aortic declamping (AUC, 0.89; 95% CI: 0.80-0.96. Cardiac troponin-I was the third best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >2.1ng/ml at immediately after aortic declamping (AUC, 0.88; 95% CI: 0.80-0.95. Creatine kinase-MB was the fourth best diagnostic discriminator of myocardial injury with an optimal "cut-off" value >58 log units/ml prior to decanulation (AUC, 0.85; 95% CI: 0.78-0.94. Conclusions: Measurable cardiac damage exists in all patients undergoing cardiac surgery under cardioplegic arrest. The degree of myocardial injury is more in patients with poor ventricular function and those requiring longer aortic clamp time. CS-derived lactate-pyruvate ratio, lactate, cTn-I served as superior diagnostic discriminators of peri-operative myocardial damage.

  16. Morphine versus Nalbuphine for Open Gynaecological Surgery: A Randomized Controlled Double Blinded Trial

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    Shiv Akshat

    2014-01-01

    Full Text Available Introduction. Pain is the commonest morbidity after open surgical procedures. The most effective treatment of postoperative pain is opioid therapy. Morphine, the commonly used opioid, is associated with many side effects including respiratory depression, sedation, postoperative nausea vomiting, and pruritus. Nalbuphine, on the other hand, is known to cause less respiratory depression. Thus this study was undertaken to compare the intraoperative and postoperative analgesic efficacy and side effect profile of the two drugs. Methodology. 60 patients undergoing open gynaecological surgery were randomized to receive either morphine (Group M or nalbuphine (Group N in the intraoperative and postoperative period. Intraoperative analgesic efficacy (measured by need for rescue analgesics, postoperative pain by visual analogue scale, and side effects like postoperative nausea, vomiting, sedation, respiratory depression, and pruritus were compared in both groups. Intraoperative and postoperative heart rate and blood pressure were also compared between the groups. Results. Need for intraoperative analgesia was significantly more in Group N (P=0.023. Postoperative VAS scores were significantly different between the groups at various time points; however, none of the patients required any rescue analgesia. The incidence of various side effects was not significantly different between the groups. The haemodynamic profile of patients was comparable between the groups in both intraoperative and postoperative period. Conclusion. Nalbuphine provides less effective intraoperative analgesia than morphine in patients undergoing open gynaecological surgery under general anaesthesia. Both drugs, however, provided similar postoperative analgesia and had similar haemodynamic and side effect profile.

  17. Heart valve surgery in China: past and present%中国心脏瓣膜外科的发展与现状

    Institute of Scientific and Technical Information of China (English)

    张宝仁

    2001-01-01

    @@ Heart valve surgery in China dates back to 4 to 5 decades ago. In 1954, the first closed mitral commissurotomy was successfully performed in a patient with mitral stenosis. In 1960, with the advent of transventricular dilator and by the route of left ventricle, the efficacy of mitral commissurotomy was improved. The procedure was rapidly adopted by many centers in this country[1]. In 1958, the first open heart surgery using cardiopulmonary bypass was performed in China. This was an epoch-making event, which opened up a new era in the field of cardiac surgery in China. Thereafter, in cities like Beijing and Shanghai, direct repairs of mitral lesions under CPB were made with good results. In 1965, the development of the first totally home-made ball valve prosthesis and its successful application in mitral valve replacement was another landmark in the history of heart valve surgery in China. In 1976, aortic valve replacement with glutaraldehyde-preserved bovine pericardial valve prosthesis was carried out successfully. The next year, the first porcine aortic valve prosthesis was produced and introduced to clinical use, which greatly accelerated the progress of heart valve surgery in China. During the last 2 decades, heart valve surgery and its techniques have been widely applied throughout China.

  18. Laparoendoscopic single-site retroperitoneoscopic adrenalectomy compared with conventional laparoscopy and open surgery

    Directory of Open Access Journals (Sweden)

    Szu-Han Chen

    2017-03-01

    Conclusion: The standard approach to adrenalectomy recently improved from open to laparoscopic surgery, transperitoneal to retroperitoneal access, and multiple ports to a single port. Here we found that laparoscopic surgery had better intra- and postoperative outcomes than open surgery. Furthermore, patients treated with LESS-RA required less postoperative recovery time and less analgesic use than those treated with CRA.

  19. Packing of renal fossa: Useful technique for intractable bleeding after open pyelolithotomy surgery

    Directory of Open Access Journals (Sweden)

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU is also described in trauma but not in controlling bleeding after open pyelolithotomy .This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications.

  20. NORMOTHERMIA FOR PEDIATRIC AND CONGENITAL HEART SURGERY: AN EXPANDED HORIZON

    Directory of Open Access Journals (Sweden)

    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.

  1. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.

    Science.gov (United States)

    Gersak, Borut; Sutlic, Zeljko

    2002-01-01

    the selected high risk patients or to minimize the deleterious effects of cardiopulmonary bypass (CPB) on the overall postoperative performance [Calafiore 1996, Tasdemir 1998]. Due to the fact, that the cardiac muscle should be protected at most during the cardiac arrest, retrograde blood cardioplegia was successfully introduced [Buckberg 1990], and more - the warm cardioplegia is being used recently [Kawasuji 1997]. The natural status of the human heart is the beating status, so it is reasonable to try to perform the operations on the beating heart. This has been done recently with the MID - CAB and OP - CAB (off-pump CABG) operations [Tasdemir 1998]. The retrograde warm blood cardioplegia has therefore led us to the premise, that with retrograde oxygenated blood perfusion it would be possible to achieve the operations on the beating heart even in the open heart surgery, such as aortic and/or mitral valve surgery. All will agree that the most damaging effect of the cardioplegia is the reperfusion injury [Allen 1997], and it is obvious that with the technique of retrograde continuous oxygenated blood perfusion this effect will be canceled. In this article, we would like to show the how-to technique for the operations on the beating heart in the case of operations on the aortic valve replacement (AVR) with mitral valve repair (MVR) or replacement MVR and with/without concomitant coronary artery bypass (CABG) surgery. The tricuspid valve repair (PTV) is normally done on the beating heart and there it is realized what problems or technical difficulties may arise during procedures on the mitral valve: the walls of the ventricles are not flattened and the exposure of the mitral valve is challenging task. Furthermore, the free walls of the ventricles with interventricular septum are in the state of the tonus, so every force applied to better expose the aortic or mitral valve is not acceptable

  2. Surgical Measures to Reduce Infection in Open Colorectal Surgery

    African Journals Online (AJOL)

    dell

    than 20% for emergency surgery and 5% for elective surgery for cancer; an ... 4% for colonic resection, and wound infection rates after surgery for colorectal cancer should be ..... obesity, jaundice etc) and post operative wound infection53.

  3. Quality of life after laparoscopic and open colorectal surgery: A systematic review

    Institute of Scientific and Technical Information of China (English)

    Sanne; AL; Bartels; Malaika; S; Vlug; Dirk; T; Ubbink; Willem; A; Bemelman

    2010-01-01

    This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) that compared laparoscopic with open colorectal surgery. Study selection, quality assessment and data extraction were carried out independently by two reviewers. Primary endpoint was quality of life after laparoscopic and open colorectal surgery, as assessed by validated questionnaires. The search...

  4. Impact of established skills in open surgery on the proficiency gain process for laparoscopic surgery.

    Science.gov (United States)

    Brown, Daniel C; Miskovic, Danilo; Tang, Benjie; Hanna, George B

    2010-06-01

    Laparoscopic training traditionally follows open surgical training. This study aimed to investigate the impact of experience in open surgery on the laparoscopic proficiency gain process. A survey form investigating the importance of open experience before the start of laparoscopic training was sent to surgical experts and trainees in the United Kingdom. A separate experimental study objectively assessed the effects of open experience on laparoscopic skill acquisition using a virtual reality simulator. In the study, 11 medical students with no prior surgical experience (group A) and 14 surgical trainees with open but no laparoscopic experience in (group B) performed 250 simulated laparoscopic cholecystectomies. Psychomotor skills were evaluated by motion analysis and video-based global rating scores. Before the first and after the fifth and tenth operation, knowledge of laparoscopic techniques was assessed by a written test and by self-reported confidence levels indicated on a questionnaire. The 80 experts and 282 trainees who responded to the survey believed prior open experience aids confidence levels, knowledge, and skills acquisition. In the simulation study, no intergroup difference was found for any parameter after the first procedure. Group B scored significantly higher in the laparoscopic knowledge test before training began (42.7% vs. 64.3%; p = 0.002), but no significant difference was found after five operations. The two groups did not differ significantly in terms of confidence. Group B had a significantly shorter total operation time only at the first operation (2,305.6 s vs. 1,884.6 s; p = 0.037). No significant intergroup difference in path length, number of movements, or video-based global rating scores was observed. Prior open experience does not aid the laparoscopic learning process, as demonstrated in a simulated setting. Given the wealth of evidence demonstrating translation of virtual skills to the operating theater, we propose that the safe and

  5. Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.

    Science.gov (United States)

    Racca, Vittorio; Bordoni, Bruno; Castiglioni, Paolo; Modica, Maddalena; Ferratini, Maurizio

    2017-07-01

    Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation. At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p OMT 1,781 ± 633 mL; p OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. [Association between fluid overload and acute renal injury after congenital heart disease surgery in infants].

    Science.gov (United States)

    Luo, De-Qiang; Chen, Zi-Li; Dai, Wei; Chen, Feng

    2017-04-01

    To study the association between fluid overload and acute kidney injury (AKI) after congenital heart disease surgery in infants. A retrospective analysis was performed on 88 infants aged less than 6 months who underwent a radical surgery for congenital heart disease. The treatment outcomes were compared between the infants with AKI after surgery and those without. The effect of cumulative fluid overload on treatment outcomes 2 days after surgery was analyzed. The risk factors for the development of AKI after surgery were assessed by logistic regression analysis. Compared with those without AKI after surgery, the patients with AKI had younger age, lower body weights, higher serum creatinine levels and higher vasoactive-inotropic score, as well as longer durations of intraoperative extracorporeal circulation and aortic occlusion (Pfluid overload 2 and 3 days after surgery (Pfluid overload and low cardiac output syndrome were major risk factors for the development of AKI after surgery. The children with cumulative fluid overload >5% at 2 days after surgery had a higher incidence rate of low cardiac output syndrome, a longer duration of mechanical ventilation, a longer length of stay in the ICU, a longer length of hospital stay, and a higher mortality rate (Pfluid overload after surgery for congenital heart disease tend to develop AKI, and fluid overload may be associated with poor outcomes after surgery.

  7. 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

    AIMS: To explore the structure and content of narratives about the recovery process among patients undergoing heart valve surgery participating in cardiac rehabilitation. BACKGROUND: Several studies with short-term follow-up have shown that recovering from cardiac surgery can be challenging......, but evidence on the long-term recovery process is very limited, especially following heart valve surgery. Furthermore, few studies have explored the recovery process among cardiac rehabilitation participants. DESIGN: A qualitative study with serial interviews analysed using narrative methods. METHODS: We...... patient. These deviating pathways were characterized by physical, existential and mental challenges even up to 9 months after surgery. CONCLUSION: The recovery processes of participants' in cardiac rehabilitation were often more complicated than anticipated. Patients undergoing heart valve surgery may...

  8. Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes.

    Science.gov (United States)

    Lewis, Matthew J; Ginns, Jonathan N; Ye, Siqin; Chai, Paul; Quaegebeur, Jan M; Bacha, Emile; Rosenbaum, Marlon S

    2016-02-01

    Many patients with adult congenital heart disease will require cardiac surgery during their lifetime, and some will have concomitant tricuspid regurgitation. However, the optimal management of significant tricuspid regurgitation at the time of cardiac surgery remains unclear. We assessed the determinants of adverse outcomes in patients with adult congenital heart disease and moderate or greater tricuspid regurgitation undergoing cardiac surgery for non-tricuspid regurgitation-related indications. All adult patients with congenital heart disease and greater than moderate tricuspid regurgitation who underwent cardiac surgery for non-tricuspid regurgitation-related indications were included in a retrospective study at the Schneeweiss Adult Congenital Heart Center. Cohorts were defined by the type of tricuspid valve intervention at the time of surgery. The primary end point of interest was a composite of death, heart transplantation, and reoperation on the tricuspid valve. A total of 107 patients met inclusion criteria, and 17 patients (17%) reached the primary end point. A total of 68 patients (64%) underwent tricuspid valve repair, 8 patients (7%) underwent tricuspid valve replacement, and 31 patients (29%) did not have a tricuspid valve intervention. By multivariate analysis, moderate or greater postoperative tricuspid regurgitation was associated with a hazard ratio of 6.12 (1.84-20.3) for the primary end point (P = .003). In addition, failure to perform a tricuspid valve intervention at the time of surgery was associated with an odds ratio of 4.17 (1.26-14.3) for moderate or greater postoperative tricuspid regurgitation (P = .02). Moderate or greater postoperative tricuspid regurgitation was associated with an increased risk of death, transplant, or reoperation in adult patients with congenital heart disease undergoing cardiac surgery for non-tricuspid regurgitation-related indications. Concomitant tricuspid valve intervention at the time of cardiac surgery should

  9. The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery.

    Science.gov (United States)

    Plerhoples, Timothy A; Hernandez-Boussard, Tina; Wren, Sherry M

    2012-03-01

    There is increasing interest in understanding the toll that operating takes on a surgeon's body. The effect of robotic surgery on surgeon discomfort has not been studied. We sought to document the discomfort of robotic surgery compared with open and laparoscopic surgery and to investigate the factors that affect the risk of physical symptoms. Nineteen-thousand eight-hundred and sixty-eight surgeons from all specialties trained in the use of robots were sent a 26-question online survey and 1,407 responded. One-thousand two-hundred and fifteen surgeons who practiced all three approaches were used in the analysis. Eight-hundred and seventy-one surgeons had physical discomfort or symptoms attributable to operating. Of those with symptoms, 55.4% attributed most of the symptoms to laparoscopic surgery, 36.3% to open surgery, and 8.3% to robotic surgery. A higher case load was predictive of increased symptoms for open and laparoscopic surgery, but not for robotic surgery. Robotic surgery was less likely than open or laparoscopic surgery to lead to neck, back, hip, knee, ankle, foot, and shoulder pain and less likely than laparoscopic surgery to lead to elbow and wrist pain. Robotic surgery was more likely than either open or laparoscopic surgery to lead to eye pain, and more likely than open surgery to lead to finger pain. Nearly a third (30.3%) of surgeons admit to giving consideration to their own discomfort when choosing an operative modality. Robotic surgery has promise in reducing the risk of physical discomfort for the operator. This is important as more surgeons consider their own health when choosing a surgical modality.

  10. Open surgery for chronic limb ischemia: a review.

    Science.gov (United States)

    Ricco, J B; Thanh Phong, L; Belmonte, R; Schneider, F; Valagier, A; Illuminati, G; Regnault De La Mothe, G

    2013-12-01

    This review considers the role of the different revascularization strategies in patients with chronic limb ischemia (CLI) and reveals that clinical evidence guiding therapeutic decision-making in CLI is poor and only careful basic recommendations can be made. For diffuse aortoiliac disease with occlusion of the aorta, aortobifemoral bypass remains the best option if the patient is fit for open surgery. Unilateral iliac occlusion should be treated by primary stenting, but an iliofemoral bypass may be the best option when the disease extends down to the common and deep femoral arteries. For infrainguinal revascularisation, bypass using the saphenous vein remains the best option for patients with occlusion of the superficial femoral artery >25 cm and for patients with multiple occlusions of the infrapopliteal arteries. In the absence of leg veins, arm veins should be used. Prosthetic grafts are the last option. Endovascular techniques are recommended in patients with short arterial lesions and limited life expectancy <2 years. Finally some patients with CLI are best treated by primary amputation. In conclusion, this review demonstrates that neither an endo- first nor a bypass-first attitude is appropriate in patients with CLI and suggests that these patients should be cared for by specialists in a multidisciplinary center in order to preserve their life and limbs, to conduct clinical trials and to control costs.

  11. Quality of life after laparoscopic and open colorectal surgery: A systematic review

    NARCIS (Netherlands)

    Bartels, S.A.; Vlug, M.S.; Ubbink, D.T.; Bemelman, W.A.

    2010-01-01

    This study was a systematic review of the available evidence on quality of life in patients after laparoscopic or open colorectal surgery. A systematic review was performed of all randomized clinical trials (RCTs) that compared laparoscopic with open colorectal surgery. Study selection, quality

  12. Incorporating robotics into an open-heart program.

    Science.gov (United States)

    Boehm, Dieter H; Arnold, Martin B; Detter, Christian; Reichenspurner, Hermann C

    2003-12-01

    The above described clinical series show that after a careful and thorough training program and stepwise introduction of surgical telemanipulation systems, application of telemanipulations is safe and shows acceptable results. Still, OR times are longer than for conventional procedures, and the operation is demanding, and expensive. The main shortcoming is that the procedure is only suitable for a highly selected patient population. However, despite all the clinical experience gathered in various centers, this technique is still evolving and in its beginning. There are some very promising developments that will improve the benefit of telemanipulators. For the first time, the separation of the surgeon from the surgical field facilitates training of surgeons on simulators. This might lead to a higher standard of surgical performance. Progress in sensor technology will make tactile-force feedback available, and new 3 D-visualization systems are designed to provide a better depth perception and higher resolution of the endoscopic image. Virtual stabilizing systems will enable robotic systems to operate on a virtual arrested heart without the need for CPB or mechanical stabilizers. These and other research topics summarized under the term augmented reality will enhance the natural senses and abilities of the surgeon. More and more, automatization will find its way into the OR. Preoperatively collected data about the patient's anatomy will be used to create safety margins, the robotic system will allow for the surgeon's movements, and instruments will be able to find their way to the surgical site without remote control. Because a stepwise approach has led to the clinical results that we and others have now achieved, it is the basis for further step-by-step development of the application of telemanipulation systems in coronary artery bypass grafting, and possibly other endoscopic procedures in cardiac surgery.

  13. 晶体停搏液与氧合血停搏液结合应用于重症心脏病手术心肌保护的临床观察%Clinical observation on the myocardial protective effect of a combination method of crystalloid and blood cardioplegic solution during open heart surgery

    Institute of Scientific and Technical Information of China (English)

    王国军; 游昕; 何绍明; 王敏

    2012-01-01

    time after aortic declamp was 5 ~700s, average time was ( 181 ± 159) s; there were 2 cases with electric shocks resuscitation (3% ) ; urine volume during cardiopulmonary bypass was 300 ~ 800ml, average was (422 ± 110) ml; ultrafiltrate content of conventional ultrafiltration and zero balancing ultrafiltration during cardiopulmonary bypass was (1 200 ~2 500) ml, average content was (1 600 ±420) ml; intraoperative bleeding was (300 ~ 1 550) ml, average was ( 630 ± 240 ) ml; intraoperative blood transfusions was ( 600 - 1 200 ) ml, average was ( 840 ± 230 ) ml. Patients discharged from hospital except 1 case died (1.5%) caused by syndrome de volume cardiaque bas. Conclusion The combination method of crystalloid and blood cardioplegic solution to perfuse the heart during open heart surgery under cardiopulmonary bypass is an effective method of myocardial protect.

  14. Development of pediatric and congenital heart surgery in latin america: accomplishments and remaining challenges.

    Science.gov (United States)

    Kreutzer, Christian; Capelli, Horacio; Sandoval, Nestor; Jatene, Marcelo; Kreutzer, Guillermo

    2011-04-01

    In the last 70 years, congenital heart surgery has dramatically evolved, and Latin America has completed this journey with unique regional features. Since the first ligation of a patent arterial duct by Enrique Finochietto in 1941 in Buenos Aires, the development of congenital heart surgery was deeply influenced by funding restrictions and scarcity of technology. However, the determined work of cardiovascular surgery pioneers as Hugo Filipozzi, Euriclides Zerbini, and Adib Jatene in Brazil; Helmut Jaeger in Chile; Hugo Baz and Clemente Robles in Mexico; Alberto Bejarano in Colombia; and Mario Brea and Fernando Tricerri in Argentina made cardiac surgery with cardiopulmonary bypass available by the late 1950s. In the following five decades new generations of cardiovascular surgeons received the legacy of these outstanding leaders and made several important contributions to the field in tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, single ventricle, truncus arteriosus, heart transplantation, and many others. Many centers in Latin America routinely perform congenital heart disease surgery with excellent results, covering the entire spectrum from the newborn to the adult congenital heart patient. The most important challenge that remains is to provide access to care to all children with congenital heart disease in Latin America, since currently only 42% of them receive surgical treatment.

  15. 体外膜氧合成功救治新生儿心脏术后严重低心排综合征一例%Extracorporeal membrane oxygenation treatment of a neonate with severe low cardiac output syndrome following open heart surgery

    Institute of Scientific and Technical Information of China (English)

    林茹; 谈林华; 张泽伟; 孙眉月; 杜立中

    2008-01-01

    目的 总结ECMO救治新生儿心脏术后严重低心排的成功经验.方法 2007年7月18日我们对一例患先天性大动脉转位(TGA)合并房间隔缺损(ASD)、动脉导管未闭(PDA)2.8 kg出生6 d的新生儿,进行了大动脉调转术(arteries switch)、ASD修补、PDA结扎术,畸形矫正后出现严重低心排综合征,低血压[<39/30 mm Hg(1 mm Hg=0.133 kPa)]、高乳酸血症(Lac 8.8 mmol/L)、高左房压(LAP>20 mm Hg)、血性痰、少尿[<1 ml/(kg·h)],由于转流时间较长(263 min)且难以脱离体外循环,常规治疗无效后接V-A ECMO进行心肺辅助.结果 经87h ECMO辅助后,左心功能明显恢复,患儿顺利脱离ECMO,ECMO第1天LVEF 20%,第2天34%,第3天43%;ECMO第1天CKMB 41 μ/L,第2天恢复正常.脱离ECMO后,在较高浓度血管活性药支持下[肾上腺素0.2 μg/(kg·min),多巴胺/多巴酚丁胺8 μg/(kg·min),米力农0.56 μg/(kg·min)],循环基本稳定.ECMO撤离后第4天,关闭胸部切口.ECMO撤离后第22天,撤离呼吸机,术后30 d撤离血管活性药.术后58 d康复出院.出院时心肺、肝肾功能正常,神志清醒,四肢肌张力和运动正常.整个病程中多次头颅超声检查均未发现脑出血、梗死等病灶.ECMO并发症:(1)肺出血;(2)伤口出血和心包填塞;(3)溶血;(4)高胆红素血症.结论 ECMO对抢救新生儿心脏术后严重心功能不全有良好的疗效.%Objective To summarize the experience of extracorporeal membrane oxygenation (ECMO)to rescue a neonate with severe low cardiac output syndrome following open heart surgery.Methods The patient was a male,2 d,2.8 kg,G3P2 full-term neonate with gestational age 40 weeks,born by Cesarean-section with Apgar score of 10 at 1 min.He was admitted due to severe dyspnea with oxygen desaturation and heart murmur on the second day after birth.Physical examination showed clear consciousness,cyanosis,dyspnea,RR 70 bpm and a grade Ⅱ/6 heart murmur.Bp was 56/45 mm Hg (1 mm Hg=0.133 kPa)and SpO2 around 65

  16. 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 patien

  17. 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

  18. Episodic arterial oxygen desaturation and heart rate variations following major abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Dirkes, W E; Kehlet, H

    1989-01-01

    In 20 patients undergoing elective major abdominal surgery, heart rate and arterial oxygen saturation were monitored continuously during the night 2 days before operation and during the first and second nights after operation (23:00 to 07:30). Mean heart rate increased by 16 beat min-1 (P less than...... arrhythmias on the morning of the third day after operation. In another patient the episodes of desaturation correlated with increases in heart rate. There was no correlation between administration of opioids and heart rate and saturation disturbances. The mechanism and clinical relevance of episodic...

  19. Instrument to assess educational programs for parents of children with congenital heart disease undergoing cardiac surgery.

    Science.gov (United States)

    Pino Armijo, Paola; Ramírez León, Muriel; Clavería Rodríguez, Cristian

    2017-10-01

    To design and validate an instrument to assess the relevance of educational programs for parents of children with congenital heart disease (CHD) undergoing cardiac surgery. In October 2011, an instrument was designed based on Kaufman's model and on the bibliography, and a survey was developed in the form of a checklist with 32 close-ended questions about received education and desired education, categorized into 5 items: educator, time, place, means, and content. The survey was reviewed by 4 academic professionals and 9 experts in the care of children with CHD, and the checklist was extended to include 42 close-ended questions and 5 open questions. The instrument was administered on the day before discharge to the parents of children with CHD undergoing cardiac surgery at the Department of Pediatrics between February and August 2013. The survey was self-administered by the first participants and administered by the investigator among the remaining participants. Fifty-five children met inclusion criteria; a total of 60 parents took part in the study. Agreement was observed between received education and desired education, which was statistically significant only in terms of education provided by a cardiologist (p= 0.000, K= 0.659) and in the hall (p= 0.000, K= 0.655). Statistically significant differences were observed between the 19 self-administered surveys and the 41 surveys administered by the investigator. Among the latter, a greater level of completion was observed for all items. A validated instrument was developed to assess the relevance of educational programs for parents of children with CHD undergoing cardiac surgery. This survey should be administered by a health care provider for a better understanding of information.

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

    Science.gov (United States)

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

    2015-01-01

    Background 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. Methods 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. Results 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

  1. 盐酸戊乙奎醚对心肺转流患者肠损伤和炎性因子的影响%Effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery

    Institute of Scientific and Technical Information of China (English)

    张丽丽; 孙莹杰; 张铁铮

    2011-01-01

    目的 探讨盐酸戊乙奎醚对心肺转流(CPB)患者肠损伤和炎性因子的影响.方法 40例ASA Ⅱ或Ⅲ级心瓣膜置换术患者,随机均分为盐酸戊乙奎醚组(P组)和对照组(C组),分别在CPB前10 min颈内静脉注射盐酸戊乙奎醚0.05 mg/kg或等容量生理盐水.分别于CPB前(T1)、主动脉开放10 min(T2)、停CPB即刻(T3)、术后2 h(T4)、6 h(T5)、18 h(T6)采取中心静脉血,应用ELISA法检测血清肠型脂肪酸结合蛋白(I-FABP)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)浓度.结果 与T1时比较,T2~T6时两组I-FABP、IL-6和IL-10浓度均显著升高(P<0.05).T2、T4、T5时P组I-FABP浓度显著低于C组,T4、T5时IL-6浓度亦显著低于C组(P<0.05).结论 盐酸戊乙奎醚0.05 mg/kg可减轻患者肠损伤和炎性因子的释放.%Objective To observe the effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery. Methods Forty patients undergoing heart valve replacement with cardiopulmonary bypass were randomly divided into two groups with 20 cases each: penehyclidine group(group P)and control group (group C) respectively. Patients in group P were injected PHC 0. 05 mg/kg before CPB 10 mins from the internal jugular vein, patients in group C were injected the same volume saline. Jugular vein blood was drawn at the following 6 time points: before CPB (T1), 10 min after aortic crossclamp release (T2), immediately at the end of CPB (T3), 2 h after operation(T4 ), 6 h after operation(T5 ), 18 h after operation(T6 ). The density of blood I-FABP was detected by enzyme-linked immunosorbent assay as well as cytokine levels (IL-6, IL-10). Results Comparing with T1 (beforeCPB), the concentration of blood I-FABP, IL-6 and IL-10 all increased significantly at T2 ,T3 ,T4 ,T5 ,T6 (P< 0. 05). In group P, the concentration of blood I-FABP was significantly lower atT2 ,T4 ,T5 than those in group C(P<0. 05). In group P, the

  2. Heart valve surgery in patients with homozygous sickle cell disease: A management strategy

    Directory of Open Access Journals (Sweden)

    El Mehdi Moutaouekkil

    2015-01-01

    Full Text Available Background: Patients with the homozygous sickle cell disease have increased perioperative mortality. Some indications like heart valve surgery, may justify an exchange blood transfusion to reduce the proportion of hemoglobin S (HbS and complications. Subjects and Methods: We report two female cases aged 20 and 27, of African origin with homozygous sickle cell anemia who underwent heart valve surgery to treat mitral valve regurgitation. This presentation describes the perioperative considerations including anesthesia and postoperative care. Results: A partial exchange blood transfusion decreased HbS levels from respectively, 90% and 84%, 9% to 27% and 34%, and simultaneously treated the anemia. Neither sickling crisis nor acidosis occurred in any patient, and no special postoperative complication occurred. Average hospital stay was 10 days. Currently, the two patients remain alive and free of cardiac symptoms. Discussion: Although the presence of sickle cell disorders is associated with increased risk of sickling and thus vaso-occlusive complications, they should not be taken as a contraindication for heart valve surgery. Nevertheless, monitoring of certain parameters such as venous, arterial oxygen content, pH, and body temperature is mandatory for a better outcome. Furthermore, preoperative exchange transfusion has a positive influence on the outcome of surgery and on the survival of patients undergoing heart valves surgery. Avoiding intraoperative hypoxia, hypothermia, and vaso-constrictive agents, minimizing HbS levels with preoperative exchange transfusion, and ensuring a stress-free environment with the judicious use of sedatives made surgery relatively safe in these cases.

  3. 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.

  4. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery.

    OpenAIRE

    Meybohm, Patrick; Bein, Berthold; Brosteanu, Oana; Cremer, Jochen; Gruenewald, Matthias; Stoppe, Christian; Coburn, Mark; Schaelte, Gereon; Böning, Andreas; Niemann, Bernd; Roesner, Jan; Kletzin, Frank; Strouhal, Ulrich; Reyher, Christian; Laufenberg-Feldmann, Rita

    2015-01-01

    BACKGROUND: Remote ischemic preconditioning (RIPC) is reported to reduce biomarkers of ischemic and reperfusion injury in patients undergoing cardiac surgery, but uncertainty about clinical outcomes remains. METHODS: We conducted a prospective, double-blind, multicenter, randomized, controlled trial involving adults who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass under total anesthesia with intravenous propofol. The trial compared upper-limb RIPC with a s...

  5. Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis.

    Science.gov (United States)

    Uccella, Stefano; Bonzini, Matteo; Palomba, Stefano; Fanfani, Francesco; Ceccaroni, Marcello; Seracchioli, Renato; Vizza, Enrico; Ferrero, Annamaria; Roviglione, Giovanni; Casadio, Paolo; Corrado, Giacomo; Scambia, Giovanni; Ghezzi, Fabio

    2016-01-01

    To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. Retrospective case-control study (Canadian Task Force classification II-1). Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. Laparoscopic or open surgical treatment for endometrial cancer. A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI obese women in the laparoscopic group. Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese

  6. Recognizing Advanced Heart Failure and Knowing Your Options

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Recognizing Advanced Heart Failure and Knowing Your Options Updated:Mar 25,2016 ... need in the future. Treatment Options for Advanced Heart Failure Major Interventions Open-heart surgery: For patients with ...

  7. 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.

  8. Treatment of pectus excavatum recurring after open surgery using Nuss procedure: A case report

    Directory of Open Access Journals (Sweden)

    Yucel Akkas

    2016-12-01

    Full Text Available We would like to report a 14-year-old male patient with pectus excavatum that recurred 10 years later after Ravitch surgery who was successfully operated using Nuss procedure. The patient underwent pectus excavatum surgery using Nuss procedure. The patient was discharged from the hospital at post-operative 5.day. The bar is planned to be removed in post-operative 3.year. In conclusion, surgery of pectus excavatum that recurred after open surgery is risky. Nuss procedure, which is a minimally-invasive technique, is a safe procedure that can be successfully applied in recurring cases due to short time of surgery and minimal blood loss.

  9. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tosun, Alptekin, E-mail: tosun_alptekin@yahoo.com [Giresun University Hospital, Department of Radiology (Turkey); Hancerliogullari, Kadir Oymen [Giresun University Hospital, Department of Pediatric Surgery (Turkey); Serifoglu, Ismail [Bulent Ecevit University Hospital, Department of Radiology (Turkey); Capan, Yavuz [Gaziantep Primer Hospital, Department of Surgery (Turkey); Ozkaya, Enis [Dr. Sami Ulus Maternity and Children' s Health Training and Research Hospital, Department of Obstetrics and Gynecology (Turkey)

    2015-03-15

    Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.

  10. Does Prior Laparoscopic and Open Surgery Experience Have Any Impact on Learning Curve in Transition to Robotic Surgery?

    Directory of Open Access Journals (Sweden)

    Cüneyt Adayener

    2016-12-01

    Full Text Available It has been 15 years since the Food And Drug Administration approved the Da Vinci® robotic surgery system. Robotic applications are being used extensively in urology, particularly in radical prostatectomy. Like all high-tech products, this system also has a high cost and a steep learning curve, therefore, preventing it from becoming widespread. There are various studies on the effect of open surgery or laparoscopy experience on the learning curve of robotic surgery. Analyzing these interactions well will provide valuable information on making the training period of robotic system more efficient.

  11. The role of primary plastic surgery in the management of open fractures.

    Science.gov (United States)

    Court-Brown, Charles M; Honeyman, Calum S; Clement, Nick D; Hamilton, Stuart A; McQueen, Margaret M

    2015-12-01

    A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/10(6)/year. The incidence in open upper and lower limb fractures was 5.3/10(6)/year and 22.7/10(6)/year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom.

  12. 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

    not been studied. This study investigated CR programmes for these patients and factors associated with referral and participation. DESIGN AND METHODS: We distributed two nationwide surveys: one to 37 hospitals and 98 municipalities and one to 742 consecutive patients undergoing heart valve surgery. Data...... 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....

  13. Open Mind, Open Heart: An Anthropological Study of the Therapeutics of Meditation Practice in the US.

    Science.gov (United States)

    Myers, Neely; Lewis, Sara; Dutton, Mary Ann

    2015-09-01

    Based on ethnographic fieldwork and interviews collected with meditation teachers and students in the United States, this article will argue that active training in meditation-based practices occasions the opportunity for people with traumatic stress to develop a stronger mind-body connection through heightened somatic awareness and a focus on the present moment that they find to be therapeutic. Three important themes related to healing through meditation for trauma emerged from the data and centered around the ways our interlocutors attempted to realign their sense of self, mind and body, after a traumatic experience. The themes helped explain why US women perceive meditation as therapeutic for trauma, namely that the practice of meditation enables one to focus on the lived present rather than traumatic memories, to accept pain and "open" one's heart, and to make use of silence instead of speech as a healing modality. As meditation practices increasingly enter global popular culture, promoted for postulated health benefits, the driving question of this research--how meditation may perpetuate human resilience for women who have experienced trauma based on their own perspectives of meditation practices--is a critical addition to the literature.

  14. EFFECTS OF ELECTROACUPUNCTURE ON PLASMA CATECHOLAMINE AND ANGIOTENSION Ⅱ IN OPEN HEART SURGICAL PATIENTS UNDERGOING CARDIOPULMONARY BYPASS

    Institute of Scientific and Technical Information of China (English)

    杨庆国; 杭燕南; 孙大金; 陈锡明; 王祥瑞; 许灿然; 姚建玲

    2001-01-01

    To study the effects of electroacupuncture on sympathetic adrenomedullary(SA) system and renin-an-giotensin-aldosterone (RAA) system in open heart surgical patients undergoing cardiopulmonary bypass (CPB), 30 patients with atrial septal defect were randomly divided into general anesthesia (GA) group, acupuncture anesthesia (AA) group and acupuncture with general anesthesia (AGA) group. Peripheral blood samples were taken before anesthesia and 30 min after CPB. The plasma concentrations of norepinephrine (NE), epinphrine (E) and angiotensin Ⅱ (AⅡ) were detected. Results: Plasma NE and E of post-CPB increased significantly in GA group and AA group, but decreased significantly in AGA group. Plasma A Ⅱ of post-CPB increased significantly in GA group, but no marked changes were found in AA group and AGA group. Conclusions: Acupuncture can improve the A Ⅱ response to cardiac surgery and CPB. AGA but not AA can inhibit the catecholamine (CA) response to cardiac surgery and CPB.

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

    Science.gov (United States)

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

    2016-01-01

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

  16. A randomized trial of laparoscopic versus open surgery for rectal cancer

    DEFF Research Database (Denmark)

    Bonjer, H Jaap; Deijen, Charlotte L; Abis, Gabor A;

    2015-01-01

    (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer. METHODS: In this international trial conducted in 30 hospitals, we randomly assigned patients with a solitary adenocarcinoma of the rectum within 15 cm of the anal verge, not invading adjacent tissues, and without...... of locoregional recurrence and disease-free and overall survival similar to those for open surgery. (Funded by Ethicon Endo-Surgery Europe and others; COLOR II ClinicalTrials.gov number, NCT00297791.)....

  17. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer

    NARCIS (Netherlands)

    Deijen, C.L. (Charlotte L.); Vasmel, J.E. (Jeanine E.); E.S.M. De Lange-De Klerk (E. S M); M.A. Cuesta (Miguel); P-P. Coene (Peter Paul); J.F. Lange (Johan); W.J.H.J. Meijerink (Jeroen); J.J. Jakimowicz; J. Jeekel (Hans); Kazemier, G. (Geert); Janssen, I.M.C. (Ignace M. C.); L. Påhlman (Lars); E. Haglind (Eva); H.J. Bonjer (H. Jaap); Hellberg, R.; Haglind, E.; Kurlberg, G.; P.G. Lindgren (P.); B. Lindholm (Bengt); L. Påhlman (Lars); C. Dahlberg (Caroline); M.S. Raab; B. Anderberg (Bo); Ewerth, S.; M. Janson (Martin); J.E. Åkerlund (J.); K. Smedh (K.); A. Montgomery; S. Skullman (Stefan); P.O. Nyström; A. Kald (A.); A. Wänström (A.); J. Dalén (Johan); I. Svedberg (I.); G. Edlund (G.); U. Kressner (U.); K. Öberg (Kjell); O. Lundberg (O.); G.E. Lindmark (G.); T. Heikkinen (T.); M. Morino (Mario); G. Giraudo (G.); Lacy, A.M.; S. Delgado (Salvadora); Macarulla Sanz, E.; Díez, J.M. (J. Medina); O. Schwandner (O.); T.H. Schiedeck (T.); Shekarriz, H.; Bloechle, C.; I. Baca (I.); Weiss, O.; S. Msika (Simon); G. Desvignes (G.); K.L. Campbell (K.); A. Cuschieri (A.); H.J. Bonjer (Jaap); W.R. Schouten (Ruud); G. Kazemier (Geert); J.F. Lange (Johan); E. van der Harst (Erwin); Coene, P.P.L.O.; P.W. Plaisier; M.J.O.E. Bertleff (Marietta); Cuesta, M.A.; W. van der Broek (W.); Meijerink, W.J.H.J.; J.J. Jakimowicz; G.A.P. Nieuwenhuijzen (Gerard); J.K. Maring (John); Kivit, J.; I.M.C. Janssen (Ignace); E.J. Spillenaar Bilgen (Ernst Jan); F.J. Berends (Frits)

    2016-01-01

    textabstractBackground: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch pa

  18. [Comparison of open versus laparoscopic surgeries for adrenal tumor: a meta-analysis].

    Science.gov (United States)

    Lin, Mao-Hu; Zhu, Xiao-Ying; Miao, Rui; He, Lei; Jia, Ning

    2016-11-20

    To systematically review the effectiveness and safety of open and laparoscopic surgeries for treatment of adrenal tumors. The online databases including CNKI, PUBMED, SinoMed, EBSCO, Springerlink, WanFang Data, and VIP were searched for clinical trials published from 1999 to 2016. A meta-analysis was performed using RevMan 5.2 software. A total of 2340 patients in 25 trials were included. The results of meta-analysis showed that laparoscopic surgery was better than open surgery in terms of intestinal function recovery time (OR=-0.96, 95%CI [-1.22, -0.70] P<0.000 01), hospitalization time (OR=-3.48, 95%CI [-4.13, -2.78], P<0.000 01), complications (OR=0.22, 95%CI [0.14, 0.35], P<0.0001), and volume of blood loss (OR=-104.77, 95%CI [-138.95, -70.60], P<0.000 01). There was no significant difference in the surgery cost between open and laparoscopic surgeries. Laparoscopic surgery is superior to open surgery for treatment of adrenal tumors for shorter intestinal function recovery time, surgery duration, and hospitalization time and less complications and blood loss.

  19. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer

    NARCIS (Netherlands)

    Deijen, C.L. (Charlotte L.); Vasmel, J.E. (Jeanine E.); E.S.M. De Lange-De Klerk (E. S M); M.A. Cuesta (Miguel); P-P. Coene (Peter Paul); J.F. Lange (Johan); W.J.H.J. Meijerink (Jeroen); J.J. Jakimowicz; J. Jeekel (Hans); Kazemier, G. (Geert); Janssen, I.M.C. (Ignace M. C.); L. Påhlman (Lars); E. Haglind (Eva); H.J. Bonjer (H. Jaap)

    2016-01-01

    markdownabstractBackground: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the

  20. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer

    NARCIS (Netherlands)

    Deijen, C.L.; Vasmel, J.E.; Lange-de Klerk, E.S. de; Cuesta, M.A.; Coene, P.L.O.; Lange, J.F.; Meijerink, W.J.H.J.; Jakimowicz, J.J.; Jeekel, J.; Kazemier, G.; Pahlman, L.; Haglind, E.; Bonjer, H.J.

    2017-01-01

    BACKGROUND: Laparoscopic surgery for colon cancer is associated with improved recovery and similar cancer outcomes at 3 and 5 years in comparison with open surgery. However, long-term survival rates have rarely been reported. Here, we present survival and recurrence rates of the Dutch patients

  1. Stem cells and heart: an open future or a mirage?

    Directory of Open Access Journals (Sweden)

    Pier Paolo Bassareo

    2016-01-01

    Full Text Available Stem cells (SC look like to be the possible solution to a number of human pathologies, including those involving the heart. In fact, some studies based on animal models suggest that SC can be used to repair the damaged cardiac tissue, such as in case of myocardial infarction. In fact it has been demonstrated that it would be possible to produce a quantity of SC sufficient to repair an animal heart having physiology and dimensions as the human heart.The aim of this short review is to examine the different subtypes of SC potentially involved in the heart repair (autologous and heterologous processes as well as the serious concerns that have still to be overcome before considering SC a sure therapy for the heart diseases: rejections, oncogenesis due to SC high proliferative activity, difficult in ruling their differentiation, massive SC death when introducing them in an ischemic environment, ethical problems when SC are derived from embryos. Proceedings of the 2nd International Course on Perinatal Pathology (part of the 11th International Workshop on Neonatology · October 26th-31st, 2015 · Cagliari (Italy · October 31st, 2015 · Stem cells: present and future Guest Editors: Gavino Faa, Vassilios Fanos, Antonio Giordano

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery

    Science.gov (United States)

    Sayed, Sajid A.; Katewa, Ashish; Srivastava, Vivek; Jana, Sujit; Patwardhan, Anil M.

    2014-01-01

    Background Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF. Methods Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography. Results The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05). Discussion In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function. PMID:25443604

  4. Effect of Vitamin K1 on Perioperative Blood Coagulation Factors During Open Heart Surgery in Children%维生素K1对小儿心内直视手术围术期凝血机制的影响

    Institute of Scientific and Technical Information of China (English)

    吕小东; 龙村; 姚亚丽; 姚忠喜

    2001-01-01

    目的 小儿心内直视手术中应用维生素K1(Vitamin K1, Vit K1),观察其对凝血因子的作用。 方法 30例心脏手术患者分为3组,A组:动脉导管未闭患者;B组:使用Vit K1治疗;C组:未使用Vit K1治疗。每组各10例。分别检测A组术前、术后,B组、C组术前24小时、麻醉后开胸前、鱼精蛋白中和后10分钟、术毕、术后6小时、1天、3天和5天的血浆凝血酶原时间(PT)、激活部分凝血活酶时间(APTT)、凝血酶时间(TT)、X因子活性、纤维蛋白原含量和红细胞压积。 结果 鱼精蛋白中和后10分钟血浆凝血酶原时间、激活部分凝血活酶时间、凝血酶时间最长,X因子活性、纤维蛋白原含量最低。与C组相比,B组术后24小时内血浆凝血酶原时间明显缩短,X因子活性明显升高。 结论 术前应用Vit K1可明显提高患者术后早期凝血因子水平,有利于减少术后出血的发生。%Objective To assess the effect of vitamin K1 (Vit K1) on blood coagulation factors during open heart operation in children. Methods Thirty patients undergoing cardiac operation were assigned to three groups:group A: patent ductus arteriosus patients(n=10); group B:patients with cardiopulmonary bypass(CPB) plus Vit K1 therapy(n=10); group C: patients with CPB, with no Vit K1 administered (n=10). Blood sample were obtained for the measurement of prothrombin time, activated partial thromboplastin time, thrombin time, factor X activity, plasma fibrinogen concentration and haematocrit. Results Prothrombin time, activated partial thromboplastin time, thrombin time are the longest, factor X activity and plasma fibrinogen concentration is the lowest on 10 minutes after injected protamine. Prothrombin time of group B was significantly shortening and factor X activity of it was increased than group C in 24 hours postoperation. Conclusion Activity of coagulation factors can be increased and maintained at a higher

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

    Directory of Open Access Journals (Sweden)

    Parvin Akbariasbagh

    2015-12-01

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

  6. Smith predictor-based robot control for ultrasound-guided teleoperated beating-heart surgery.

    Science.gov (United States)

    Bowthorpe, Meaghan; Tavakoli, Mahdi; Becher, Harald; Howe, Robert

    2014-01-01

    Performing surgery on fast-moving heart structures while the heart is freely beating is next to impossible. Nevertheless, the ability to do this would greatly benefit patients. By controlling a teleoperated robot to continuously follow the heart's motion, the heart can be made to appear stationary. The surgeon will then be able to operate on a seemingly stationary heart when in reality it is freely beating. The heart's motion is measured from ultrasound images and thus involves a non-negligible delay due to image acquisition and processing, estimated to be 150 ms that, if not compensated for, can cause the teleoperated robot's end-effector (i.e., the surgical tool) to collide with and puncture the heart. This research proposes the use of a Smith predictor to compensate for this time delay in calculating the reference position for the teleoperated robot. The results suggest that heart motion tracking is improved as the introduction of the Smith predictor significantly decreases the mean absolute error, which is the error in making the distance between the robot's end-effector and the heart follow the surgeon's motion, and the mean integrated square error.

  7. An empowerment health education program for children undergoing surgery for congenital heart diseases.

    Science.gov (United States)

    Ni, Zhihong; Chao, Yannfen; Xue, Xiaoling

    2016-09-01

    Since the surgery for congenital heart disease (CHD) is considered highly risky, appropriate postoperative care is crucial. After the surgery, children are often discharged with unhealed wounds, incomplete recovery, and continuing pain. Health education programs based on empowerment education model can assist clients to develop skills in self-management. This study aimed to evaluate the effectiveness of an empowerment health education program for improving caregiving knowledge, caring behaviors, and self-efficacy of parents caring for children after corrective surgery for CHD. This prospective clinical trial enrolled pediatric patients undergoing surgical correction for CHD. Patients were divided into two groups: the control group (n = 42), which received the standard education program, and the intervention group (n = 44), which participated in the empowerment theory-based education program. We collected data on left ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2); New York Heart Association classification of the patients; and the parents' caregiving knowledge, caring behaviors, and self-efficacy before surgery and one month and three months after surgery. At one month and three months after surgery, the intervention group scored higher than the control group in caregiving knowledge, caring behavior, and self-efficacy. By the third month after surgery, the intervention group had significantly higher values of LVEF and SpO2 than the control group. © The Author(s) 2015.

  8. Laparoscopic versus open surgery for adnexal tumor in pregnant women

    Directory of Open Access Journals (Sweden)

    Yu-Jin Koo

    2013-05-01

    Conclusion: Adnexal surgery during pregnancy could be performed in safety for both mother and fetus. The laparoscopic approach particularly offered more benefit than laparotomy in terms of surgical outcome and was shown to be as safe as laparotomy regarding obstetric complications such as miscarriage and preterm labor.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    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 ...

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

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

    Science.gov (United States)

    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.

  12. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease.

    Science.gov (United States)

    Piggott, Kurt D; Soni, Meshal; Decampli, William M; Ramirez, Jorge A; Holbein, Dianna; Fakioglu, Harun; Blanco, Carlos J; Pourmoghadam, Kamal K

    2015-07-01

    Acute kidney injury (AKI) and fluid overload have been shown to increase morbidity and mortality. The reported incidence of AKI in pediatric patients following surgery for congenital heart disease is between 15% and 59%. Limited data exist looking at risk factors and outcomes of AKI or fluid overload in neonates undergoing surgery for congenital heart disease. Neonates aged 6 to 29 days who underwent surgery for congenital heart disease and who were without preoperative kidney disease were included in the study. The AKI was determined utilizing the Acute Kidney Injury Network criteria. Ninety-five neonates were included in the study. The incidence of neonatal AKI was 45% (n = 43), of which 86% had stage 1 AKI. Risk factors for AKI included cardiopulmonary bypass time, selective cerebral perfusion, preoperative aminoglycoside use, small kidneys by renal ultrasound, and risk adjustment for congenital heart surgery category. There were eight mortalities (five from stage 1 AKI group, three from stage 2, and zero from stage 3). Fluid overload and AKI both increased hospital length of stay and postoperative ventilator days. To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound. © The Author(s) 2015.

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

    Science.gov (United States)

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

    2004-05-01

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

  14. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  15. Open aortic surgery after thoracic endovascular aortic repair.

    Science.gov (United States)

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

  16. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

    Directory of Open Access Journals (Sweden)

    Su Zhang

    2016-11-01

    Full Text Available Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120, urine abnormality (30/120 and fever (27/120. Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01. Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant

  17. Patents and heart valve surgery - II: tissue valves.

    Science.gov (United States)

    Cheema, Faisal H; Kossar, Alexander P; Rehman, Atiq; Younas, Fahad; Polvani, Gianluca

    2013-08-01

    Valvular heart disease affects millions of Americans yearly and currently requires surgical intervention to repair or replace the defective valves. Through a close-knit collaboration between physicians, scientists and biomedical engineers, a vast degree of research and development has been aimed towards the optimization of prosthetic heart valves. Although various methods have made fantastic strides in producing durable prostheses, the therapeutic efficacy of prosthetic valves is inherently limited by a dependency upon lifelong anticoagulant regimens for recipients - a difficult challenge for many in clinical setting. Thus, biological tissue valves have been developed to circumvent vascular and immunemediated complications by incorporating biological materials to mimic native valves while still maintaining a necessary level of structural integrity. Over the past decade, a multitude of patents pertaining to the refinement of designs as well as the advancement in methodologies and technologies associated with biological tissue valves have been issued. This review seeks to chronicle and characterize such patents in an effort to track the past, present, and future progress as well as project the trajectory of tissue valves in the years to come.

  18. Effect of gastrodin on CBF/CMRO2 in patients undergoing open-heart surgery with cardiopulmonary bypass%体外循环心脏直视手术期间天麻素对患者脑血流量/脑氧耗比值的影响

    Institute of Scientific and Technical Information of China (English)

    汤和青; 林雷; 侯俊; 方为; 陈春; 柯齐斌

    2012-01-01

    Objective To observe the effect of Gastrodin on CBF/CMRO2 in patients undergoing open-heart surgery with cardiopulmonary bypass(CPB). To discuss the effect and the mechanism of Gastrodin on cerebral injury undergoing CPB. Methods 30 patients ( ASA physical status II to M ) undergoing replacement of mitral valve were randomly divided into control group ( n = 15 ) and experimental group ( n = 15 ). The gastrodin ( 600mg) was administered in the same time that patient was undergoing routine anaesthesia in experimental group. Saline was administered in the control group. Blood was collected from radial artery and jugular bulb venous for blood gas analysis and blood lactic acid, measure and calculate the jugular bulb oxygen saturation( Sj-vO 2) , arterial oxygen content ( CaO 2) , cerebral oxygen extraction rate ( CERO 2 ) before CPB ( Tl ) , the nose temperature drop to constant temperature regularly to 28 °C ( T2), and 20 minute after heart beating ( T3 ). Results Two groups all stepped up at T2 compared with Tl .stepped down at T3 compared with T2. By group comparison, CBF/ CMRO2 of experimental group was significantly higher than that of another group at T2(P <0.05). Conclusion Undergoing CPB,Gastrodin could reduce cerebral oxygen consumption, would help to improve brain oxygen supply and demand balance, improve cerebral oxygen metabolism, reduce brain lactate production.%目的 观察体外循环心脏直视手术期间天麻素对患者脑血流量/脑氧耗的影响,并探讨其在体外循环心脏直视术期间的脑保护作用.方法选择择期在中低温心脏停跳CPB下二尖瓣置换的患者30例,随机分为试验组和对照组,每组各15例.两组患者采用统一的麻醉方案和体外循环方法,试验组在CPB前静脉滴注天麻素注射液(600mg),对照组静脉滴注生理盐水.分别于麻醉后CPB开始前鼻咽温为36℃时(T1)、CPB降温至28℃升主动脉阻断20min时(T2)、心脏复跳20min鼻咽温为36℃时(T3)采集桡

  19. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    Full Text Available Anne Helene Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Torbjørn Wisløff,5,6 Jon O Sundhagen,2 Syed SH Kazmi2 1Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Kalnes, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Department of Health Management and Health Economics, University of Oslo, 6Norwegian Institute of Public Health, Oslo, Norway Objectives: Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients’ health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs and costs after totally laparoscopic and open aortobifemoral bypass. Patients and methods: This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25 or open surgical procedure (n=25. One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay. Results: We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0

  20. Large orthotopic reservoir stone burden: Role of open surgery

    Directory of Open Access Journals (Sweden)

    Madbouly Khaled

    2010-01-01

    Full Text Available Purpose: To present our experience in open poucholithotomy as a primary management of large orthotopic reservoir stone burden and discuss different management options. Materials and Methods: Records of men underwent radical cystectomy and orthotopic urinary diversion were retrospectively reviewed as regards pouch stone formation. Patients with large reservoir stone burden managed by open poucholithotomy were further selected. Results: Large reservoir stone burden was encountered in 12 post radical cystectomy men. All underwent open poucholithotomy as a primary management of their reservoir stones. Median age at cystectomy was 46 (range: 32-55 years with a median total follow up period of 214.15 (range: 147-257 months and a median interval to stone detection of 99 (range: 63-132 months. The median stone burden was 5260 (range: 3179-20410 mm 2 . All patients were continent during the day while 5 showed nocturnal enuresis; 2 of them became continent after removal of the stones. Post poucholithotomy, all patients had sterile urine cultures except one who showed occasional colonization. None of the 12 patients showed stone recurrence after poucholithotomy. Two patients underwent revision of a dessuscepted nipple valve in association with stone removal. Conclusions: Open poucholithotomy for large reservoir stone burden is a feasible and safe option. It saves the reservoir mesentery and adjacent bowel. It allows complete removal of the stone(s leaving no residual fragments. Furthermore, it permits correction of concomitant reservoir abnormalities.

  1. Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

    Directory of Open Access Journals (Sweden)

    C. G. Ker

    2011-01-01

    Full Text Available In this study, we try to compare the benefit of laparoscopic versus open operative procedures. Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR and another 208 patients went for open liver resection (OR for hepatocellular carcinoma (HCC. Patients' selection for open or laparoscopic approach was not randomized. Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (=.016. The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9% and 106 patients (50.9% for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

  2. 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.

  3. 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

    : the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS (Bireme); and Conference Proceedings Citation Index-S (CPCI-S) on Web of Science (Thomson Reuters) on 23 March 2015. We...... 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......-based interventions compared with no exercise intervention control. The trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and received either heart valve replacement, or heart valve repair. DATA COLLECTION AND ANALYSIS: Two...

  4. Efficacy of non-penetrating trabecular surgery for open angle glaucoma:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    程金伟; 马晓晔; 魏锐

    2004-01-01

    Background Non-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma.Methods The published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis.Results A total of 37 articles were included in the meta-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7% (95% CI: 58.5%-81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0%-71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8%-85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6%-86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI: 61.4%-74.3%).Conclusions Non-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.

  5. Revision open Bankart surgery after arthroscopic repair for traumatic anterior shoulder instability.

    Science.gov (United States)

    Cho, Nam Su; Yi, Jin Woong; Lee, Bong Gun; Rhee, Yong Girl

    2009-11-01

    Only a few studies have provided homogeneous analysis of open revision surgery after a failed arthroscopic Bankart procedure. Open Bankart revision surgery will be effective in a failed arthroscopic anterior stabilization but inevitably results in a loss of range of motion, especially external rotation. Case series; Level of evidence, 4. Twenty-six shoulders that went through traditional open Bankart repair as revision surgery after a failed arthroscopic Bankart procedure for traumatic anterior shoulder instability were enrolled for this study. The mean patient age at the time of revision surgery was 24 years (range, 16-38 years), and the mean duration of follow-up was 42 months (range, 25-97 months). The preoperative mean range of motion was 173 degrees in forward flexion and 65 degrees in external rotation at the side. After revision surgery, the ranges measured 164 degrees and 55 degrees, respectively (P = .024 and .012, respectively). At the last follow-up, the mean Rowe score was 81 points, with 88.5% of the patients reporting good or excellent results. After revision surgery, redislocation developed in 3 shoulders (11.5%), all of which had an engaging Hill-Sachs lesion and associated hyperlaxity (2+ or greater laxity on the sulcus sign). Open revision Bankart surgery for a failed arthroscopic Bankart repair can provide a satisfactory outcome, including a low recurrence rate and reliable functional return. In open revision Bankart surgery after failed stabilization for traumatic anterior shoulder instability, the surgeon should keep in mind the possibility of a postoperative loss of range of motion and a thorough examination for not only a Bankart lesion but also other associated lesions, including a bone defect or hyperlaxity, to lower the risk of redislocation.

  6. Effects of tolvaptan in the early postoperative stage after heart valve surgery: results of the STAR (Study of Tolvaptan for fluid retention AfteR valve surgery) trial.

    Science.gov (United States)

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Kawamura, Masashi; Yoshioka, Daisuke; Saito, Tetsuya; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

    2015-12-01

    The purpose of this study was to assess the efficacy of tolvaptan, a vasopressin V2 receptor antagonist, for the management of postoperative surgical fluid retention after heart valve surgery. This was a prospective observational study of 64 patients with heart valve disease who underwent valve surgery between 2013 and 2014. Those in the tolvaptan group received tolvaptan in addition to conventional diuretic therapy. The results were compared to the results of 55 patients who underwent heart valve surgery between 2007 and 2010 and received conventional postoperative diuretics alone. The time to return to the preoperative BW was significantly shorter in the patients who received tolvaptan (6.1 ± 3.8 vs. 8.7 ± 6.7 days, p fluid retention during the early postoperative stage in cardiac surgery patients, without increased renal failure or abnormal electrolyte levels. This new type of diuretic therapy may be a suitable option for postoperative fluid management in patients undergoing cardiac surgery.

  7. Cause Analysis of Open Surgery Used After Percutaneous Vertebroplasty and Kyphoplasty

    Science.gov (United States)

    Xu, Zhengwei; Hao, Dingjun; Liu, Tuanjiang; He, Baorong; Guo, Hua; He, Limin

    2016-01-01

    Background The aim of this study was to analyze reasons why open surgery was done after percutaneous vertebroplasty and kyphoplasty. Material/Methods Patients (587 vertebral bodies) treated with percutaneous vertebroplasty or kyphoplasty in the Xi’an Honghui Hospital of Shanxi Province from January 2008 to January 2012 were retrospectively analyzed and 13 patients were enrolled in the study. These 13 patients had serious adverse events after percutaneous vertebroplasty or kyphoplasty. Their average age was 64.5 years old. Nine patients had spinal cord injury and 4 had nerve root injury. All the patients underwent open surgery within 4–12 h after definitive diagnosis. Results All 13 cases were followed up (average time 14.1 months, range 3–47 months). Reasons for open surgery included cement extravasation (6 cases, 46.2%), puncture mistake (3 cases, 23.1%), and false selection of indications (4 cases, 30.8%). At last follow-up, skin feeling was better than that before open surgery in 4 cases with nerve root injury, and muscle strength recovered to grade 5 (3 cases) and grade 4 (1 case). In 9 cases with spinal cord injury, 7 patients improved and 2 remained at the same ASIA level. Conclusions The main reasons for open surgery after percutaneous vertebroplasty and kyphoplasty were cement extravasation (the most common reason), puncture mistake, and false selection of indications. PMID:27444135

  8. Healthcare providers' caring: Nothing is too small for parents and children hospitalized for heart surgery.

    Science.gov (United States)

    Wei, Holly; Roscigno, Cecelia I; Swanson, Kristen M

    Parents of children with congenial heart disease (CHD) face frequent healthcare encounters due to their child's care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents' perceptions of healthcare providers' actions when their child undergoes heart surgery. To describe parents' perceptions of healthcare providers' actions when their child is diagnosed with CHD and undergoes heart surgery. This is a qualitative study with in-depth interviews. Parents of children with CHD were interviewed twice after surgery. We analyzed data using directed content analysis guided by Swanson Caring Theory. Findings of the study indicate that parents perceive caring when providers seek to understand them (knowing); accompany them physically and emotionally (being with); help them (doing for); support them to be the best parents they can be (enabling); and trust them to care for their child (maintaining belief). Healthcare providers play an irreplaceable role in alleviating parents' emotional toll when their child undergoes cardiac surgery. Providers' caring is an integral component in healthcare. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The impact of human rhinovirus infection in pediatric patients undergoing heart surgery.

    Science.gov (United States)

    Delgado-Corcoran, Claudia; Witte, Madolin K; Ampofo, Krow; Castillo, Ramon; Bodily, Stephanie; Bratton, Susan L

    2014-12-01

    Human rhinovirus (HRV), the most common cause of upper respiratory infection in children, can present as bronchiolitis, pneumonia, or asthma exacerbations. The impact of HRV in infants and toddlers with congenital heart disease is poorly defined. A case-control study was performed to compare the clinical course for 19 young children with respiratory symptoms who tested positive for rhinovirus after heart surgery with that of 56 matched control subjects. The control subjects were matched by surgical repair, age, weight, and time of the year. Patients with known HRVs before surgery and control subjects with respiratory symptoms or positive test results for viruses were excluded from the study. Human rhinovirus infection was associated with more than a tenfold increase in the odds of noninvasive ventilation after extubation (odds ratio [OR] 11.45; 95 % confidence interval [CI] 3.97-38.67), a 12-fold increase in the probability of extubation failure (OR 12.84; 95 % CI 2.93-56.29), and increased use of pulmonary medications including bronchodilator and nitric oxide (p rhinovirus increases resource use and prolongs postoperative recovery after pediatric heart surgery. Surgery timing should be delayed for patients with rhinovirus if possible.

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

    Science.gov (United States)

    Tsamalaidze, Levan; Elli, Enrique F

    2017-08-22

    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.

  11. [Post-operative management for 86 cases of heart valve replacement surgery patients undergoing transcutaneous electrical acupoint stimulation combined with general anesthesia].

    Science.gov (United States)

    Zhou, Wen-Xiong; Xu, Jian-Jun; Wu, Yao-Yao; Chi, Hao; Chen, Tong-Yu; Ge, Wen; Zhou, Jia

    2014-02-01

    To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia. From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass (heart valve replacement surgery without intubation) were recruited in the present summary. Post-operative managements in the Intensive Care Unit (ICU) were administrated with strict hemodynamic monitoring for volume infusion, routine administration of vasoactive drugs (including dopamine and nitroglycerin), oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. All the 86 patients under TEAS + general anesthesia and cardiopulmonary bypass and without intubation experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases (9.30%), the average stay duration in ICU was (28.6 +/- 6.2) hours, and the average draining volume of the interpleural space was (291 +/- 73)mL. The cardia insufficiency was found in 5 cases (5.81%), hypoxia occurred in 8 cases (9.30%), nausea in 8 cases (9.30%), vomiting 5 cases (5.81%) and post-operative gastrointestinal distension 13 cases (15.12%), mild renal insufficiency 3 cases (3.49%), fever (> 38.5 degrees C) 1 case(1. 16%) and severe post-operative pain 7 cases (8.14%). TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary bypass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

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

    Science.gov (United States)

    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.

  13. A simple clinical model for planning transfusion quantities in heart surgery

    Directory of Open Access Journals (Sweden)

    Biagioli Bonizella

    2011-06-01

    Full Text Available Abstract Background Patients undergoing heart surgery continue to be the largest demand on blood transfusions. The need for transfusion is based on the risk of complications due to poor cell oxygenation, however large transfusions are associated with increased morbidity and risk of mortality in heart surgery patients. The aim of this study was to identify preoperative and intraoperative risk factors for transfusion and create a reliable model for planning transfusion quantities in heart surgery procedures. Methods We performed an observational study on 3315 consecutive patients who underwent cardiac surgery between January 2000 and December 2007. To estimate the number of packs of red blood cells (PRBC transfused during heart surgery, we developed a multivariate regression model with discrete coefficients by selecting dummy variables as regressors in a stepwise manner. Model performance was assessed statistically by splitting cases into training and testing sets of the same size, and clinically by investigating the clinical course details of about one quarter of the patients in whom the difference between model estimates and actual number of PRBC transfused was higher than the root mean squared error. Results Ten preoperative and intraoperative dichotomous variables were entered in the model. Approximating the regression coefficients to the nearest half unit, each dummy regressor equal to one gave a number of half PRBC. The model assigned 4 units for kidney failure requiring preoperative dialysis, 2.5 units for cardiogenic shock, 2 units for minimum hematocrit at cardiopulmonary bypass less than or equal to 20%, 1.5 units for emergency operation, 1 unit for preoperative hematocrit less than or equal to 40%, cardiopulmonary bypass time greater than 130 minutes and type of surgery different from isolated artery bypass grafting, and 0.5 units for urgent operation, age over 70 years and systemic arterial hypertension. Conclusions The regression

  14. [The incidence of wound healing disorders in heart surgery].

    Science.gov (United States)

    Fritzsche, D; Krakor, R; Widera, R; Lindenau, K F

    1992-01-01

    In a five-year retrospective study we investigated the wound infection rate after median sternotomy in 2805 adult patients on whom elective surgery had been performed with extracorporeal circulation. On the basis of 14,700 apparently relevant data from 101 patients with wound healing disturbances at the sternotomy site, both the significance of predisposing risk profiles and the prevalence of nosocomial pathogens were evaluated. The control group was formed by 100 patients selected at random. The results were checked for statistical significance using the X2 test for alternative characters; the significance level was set at alpha = 5%. The infection rate observed in our group was 3.6%, which was assigned to 5 internally defined degrees of severity. Cases of healing by second intention were caused to 93% by coagulase-negative staphylococci and staphylococcus aureus. Factors leading to a decrease in oxygenation of the wound area (low-output syndrome, rethoracotomy), diabetes, obesity and the duration of wound drainage were accompanied by a significantly more frequent occurrence of wound healing disturbances. On the other hand, perfusion-technical parameters, operation duration, revascularisation techniques (IMA/ACVB), pulmonary conditioned hypoxemias and the end-of-year desinfection usual in our clinic had no influence on wound healing. Seasonal fluctuation of the epidermal microclimate appear to be responsible for the prevalence and virulence of the pathogen strains in the clinic environment. The preventive measures used in cardiosurgical clinics do not yet represent a fully developed prophylaxis against exposure to nosocomial pathogens.

  15. Comparison of Laparoscopic Adrenalectomy with Open Surgery for Adrenal Tumors

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    Hsun-Shuan Wang

    2009-08-01

    Full Text Available The role of laparoscopy in the management of adrenal tumors is well established. However, there are very few head-to-head comparisons between laparoscopic and open methods at the same institution. We retrospectively evaluated the operative and postoperative parameters of laparoscopic adrenalectomy for adrenal tumors and compared the results with those of traditional open adrenalectomy. Eighty-eight patients with adrenal tumors underwent adrenalectomy between January 1997 and October 2008 at our institute. Clinical data were retrospectively collected after assigning the patients into Group I (n = 51, who underwent the laparoscopic method, and Group II (n = 37, who underwent the traditional open method, by reviewing the patients' charts and related data. Patients in Group I experienced significantly less blood loss (88.6 ± 93.0 mL vs. 321.4 ± 265.4mL, p < 0.01, shorter hospital stay (6.7 ± 4.3 days vs. 11.3 ± 5.4 days, p < 0.01 and earlier oral intake (1.5 ± 0.6 daysvs. 2.2 ± 0.8 days, p < 0.01 postoperatively. In Group I, eight patients had adrenal tumors larger than 6 cm and no statistically significant differences were found compared with the other patients in Group I. Two patients in Group I had malignancies and no local or port site recurrence was found at regular follow-up. There was no mortality in either group. Laparoscopic adrenalectomy is a safe, effective and minimally invasive approach with the advantages of better cosmesis, less blood loss, shorter hospital stay and more rapid recovery. We recommend that laparoscopic adrenalectomy is considered as the gold standard procedure for adrenal tumors, irrespective of whether the tumor is benign or malignant.

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

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    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.

  17. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients.

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    Zhang, Su; Luo, You; Wang, Cheng; Xiong, Hu; Fu, Sheng-Jun; Yang, Li

    2016-01-01

    Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.

  18. 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...

  19. Thoracic aorta aneurysm open repair in heart transplant recipient; the anesthesiologist′s perspective

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    Fabrizio Monaco

    2016-01-01

    Full Text Available Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54-year-old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair.

  20. ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery.

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    Racca, V; Di Rienzo, M; Mazzini, P; Ripamonti, V; Gasti, G; Spezzaferri, R; Modica, M; Ferratini, M

    2015-08-01

    Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. Observational study. In-patients cardiac Rehabilitation Unit in Milan. Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years). We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (PICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. The ICF-based data provided functional information that was consistent with the patients' clinical course. The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.

  1. Echocardiographic guidance and monitoring of left atrial appendage closure with AtriClip during open-chest cardiac surgery.

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    Contri, Rachele; Clivio, Sara; Torre, Tiziano; Cassina, Tiziano

    2017-09-12

    Left atrial appendage (LAA) closure prevents thromboembolic risk and avoids lifelong anticoagulation due to atrial fibrillation (AF). Nowadays, AtriClip, a modern epicardial device approved in June 2010, allows external and safe closure of LAA in patients undergoing cardiac surgery during other open-chest cardiac surgical procedures. Such a surgical approach and its epicardial deployment differentiates LAA closure with AtriClip from percutaneous closure techniques such as Watchman (Boston Scientific, Marlborough, MA, USA), Lariat (SentreHEART Inc., Redwood City, CA, USA), and Amplatzer Amulet (St. Jude Medical, St. Paul, MN, USA) device procedures. AtriClip positioning must consider perioperative transesophageal echocardiography (TEE) to confirm LAA anatomical features, to explore the links with neighboring structures, and finally to assess its successful closure. We report a sequence of images to document the role of intraoperative TEE during an elective aortic valve replacement and LAA external closure with AtriClip. © 2017, Wiley Periodicals, Inc.

  2. A RETROSPECTIVE CLINICAL STUDY OF LAPAROSCOPIC AND OPEN SURGERY FOR CHOLECYSTECTOMY PROCEDURE

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    Konduru Siva Prasada Raju

    2017-03-01

    Full Text Available BACKGROUND The gall stone is one of the commonest ailments for which the hospital doors are knocked in India. Recent statistics suggest that about 15 to 30 percent of women in the fourth and fifth decade of life commonly suffer from this. The gall bladder should not be removed just considering the fact that the stones are there but the stones are formed in it and one major problem is its recurrence. Recent non – operative procedures like shock wave therapy and drugs are non - promising. Minimal access surgery is now the trend in any kind of surgery and cholecystectomy is no exception. Initially there was a huge benefit seen but now more and more complications are reported. In this study an effort has been put to understand the complications involved in both the Laparoscopic and Open type of surgery. This study is intended to help the practicing surgeon to anticipate the commonly involved complications in both the type of surgeries and also to help them understand the pros and cons of each type especially in resource challenged settings. MATERIALS AND METHODS This study was done in the Department of General Surgery in RIMS Medical College at Ongole. This study was done from January 2014 to December 2016. A sample size of 131 patients was selected and the retrospective analysis was done. RESULTS The mean age of the population in the sample size was 44.18 years and the range of the patients included from 10 years to 81 years. There were thirty seven males and ninety four females in the total study population. Female preponderance was seen which was statistically significant. Open surgery is the method of choice in an emergencyod of choice in case of emergency.All twenty three patients who underwent open surgery had significant post operative pain complained of post - operative pain requiring analgesic intervention. Only two patients complained of post – operative pain in case of laparoscopic procedure and none of them needed analgesics. Other

  3. 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.)

  4. The Influence of Fluid Overload on the Length of Mechanical Ventilation in Pediatric Congenital Heart Surgery.

    Science.gov (United States)

    Sampaio, Tatiana Z A L; O'Hearn, Katie; Reddy, Deepti; Menon, Kusum

    2015-12-01

    Fluid overload and prolonged mechanical ventilation lead to worse outcomes in critically ill children. However, the association between these variables in children following congenital heart surgery is unknown. The objectives of this study were to describe the association between fluid overload and duration of mechanical ventilation, oxygen requirement and radiologic findings of pulmonary and chest wall edema. This study is a retrospective chart review of patients who underwent congenital heart surgery between June 2010 and December 2013. Univariate and multivariate associations between maximum cumulative fluid balance and length of mechanical ventilation and OI were tested using the Spearman correlation test and multiple linear regression models, respectively. There were 85 eligible patients. Maximum cumulative fluid balance was associated with duration of mechanical ventilation (adjusted analysis beta coefficient = 0.53, CI 0.38-0.66, P Fluid overload is associated with prolonged duration of mechanical ventilation and PICU length of stay after congenital heart surgery. Fluid overload was also associated with physiological markers of respiratory restriction. A randomized controlled trial of a restrictive versus liberal fluid replacement strategy is necessary in this patient population, but in the meantime, accumulating observational evidence suggests that cautious use of fluid in the postoperative care may be warranted.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  6. Blood Pressure and Heart Rate Alterations through Music in Patients Undergoing Cataract Surgery in Greece

    Science.gov (United States)

    Merakou, Kyriakoula; Varouxi, Georgia; Barbouni, Anastasia; Antoniadou, Eleni; Karageorgos, Georgios; Theodoridis, Dimitrios; Koutsouri, Aristea; Kourea-Kremastinou, Jenny

    2015-01-01

    INTRODUCTION Music has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate. METHODS Two hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures. RESULTS According to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group (P blood pressure at both time recordings was recorded (P music influenced patients’ preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery. PMID:26106264

  7. Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery (combined surgery) from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identify risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent (50 %)were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age,weight, and preoperative hospital stay (days) were not found to be associated with prolonged mechanical ventilation. It was concluded that, for age and weight, this might be due to the lower number of old age patients (70 years and above) included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

  8. [Results of the treatment of open heart injuries at a central regional hospital].

    Science.gov (United States)

    Segida, V F; Efremov, N I; Chernov, A I

    1994-09-01

    In a period of 10 years seven patients with open injury to the heart were treated. Their ages ranged from 17 to 39 years. One patient had a gunshot injury, in six the injury was inflicted with a knife. In three patients the injuries were combined (concurrent injury to the lung in 2 and to the diaphragm in one) and in four isolated. Perforating injury of both ventricles and damage of the interventricular septum were found in one case. All patients underwent emergency closure of the heart wounds with an atraumatic synthetic thread and drainage of the pleural cavity. Complications developed in the postoperative period in six patients: suppuration of the operative wound in one and pericarditis in five. One patient died. Analysis of the obtained data testifies to the expediency of two-stage treatment with rehabilitation in cardiological departments. This shortens the period of rehabilitation of patients with open injuries to the heart treated in a central regional hospital.

  9. Extent, risk factors, and outcome of fluid overload after pediatric heart surgery*.

    Science.gov (United States)

    Seguin, Jade; Albright, Benjamin; Vertullo, Laura; Lai, Pamela; Dancea, Adrian; Bernier, Pierre-Luc; Tchervenkov, Christo I; Calaritis, Christos; Drullinsky, David; Gottesman, Ronald; Zappitelli, Michael

    2014-12-01

    Fluid overload is associated with poor PICU outcomes in different populations. Little is known about fluid overload in children undergoing cardiac surgery. We described fluid overload after cardiac surgery, identified risk factors of worse fluid overload and also determined if fluid overload predicts longer length of PICU stay, prolonged mechanical ventilation (length of ventilation) and worse lung function as estimated by the oxygenation index. Retrospective cohort study. Montreal Children's Hospital PICU, Montreal, Canada. Patients 18 years or younger undergoing cardiac surgery (2005-2007). None. Cumulative fluid overload % was calculated as [(total fluid in - out in L)/admission weight (kg) × 100] and expressed as PICU peak cumulative fluid overload % throughout admission and PICU day 2 cumulative fluid overload %. Primary outcomes were length of stay and length of ventilation. The secondary outcome was oxygenation index. Fluid overload risk factors were evaluated using stepwise linear regression. Fluid overload-outcome relations were evaluated using stepwise Cox regression (length of stay, length of ventilation) and generalized estimating equations (daily PICU cumulative fluid overload % and oxygenation index repeated measures). There were 193 eligible surgeries. Peak cumulative fluid overload % was 7.4% ± 11.2%. Fluid overload peaked on PICU day 2. Lack of past cardiac surgery (p = 0.04), cyanotic heart disease (p = 0.03), and early postoperative fluids (p = 0.0001) was independently associated with higher day 2 fluid overload %. Day 2 fluid overload % predicted longer length of stay (adjusted hazard ratio, 0.95; 95% CI, 0.92-0.99; p = 0.009) and length of ventilation (adjusted hazard ratio, 0.97; 95% CI, 0.94-0.99; p = 0.03). In patients without cyanotic heart disease, worse daily fluid overload % predicted worse daily oxygenation index. Fluid overload occurs early after cardiac surgery and is associated with prolonged PICU length of stay and ventilation

  10. Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs.

    Science.gov (United States)

    Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir

    2014-01-01

    Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE.

  11. Treatment of open hand injuries: does timing of surgery matter? A single-centre prospective analysis.

    Science.gov (United States)

    Juon, Bettina H; Iseli, Michelle; Kreutziger, Janett; Constantinescu, Mihai A; Vögelin, Esther

    2014-10-01

    The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.

  12. Effect of myocardial protection during beating heart surgery with right sub-axiliary approach

    Institute of Scientific and Technical Information of China (English)

    MA Jie; LI Xin-hua; YAN Zi-xing; LIU Ai-jun; ZHANG Wen-kai; YANG Li-na

    2009-01-01

    Background Cardiac troponin-I (cTnl) is one of the three regulatory subunits of the cardiac troponin which has the high sensibility and specificity of responding to myocardial injury. Studies have demonstrated that cTnl is released into the blood stream within hours following acute myocardial reperfusion injury. The clinical utility of cTnl for the assessment of myocardial damage is that it is more specific than creatine kinase MB (CKMB). This study investigated cTnl as a sensitive marker of myocardial reperfusion injury and its clinical value on beating heart surgery with right sub-axiliary incision. Methods From December 2002 threugh December 2004,100 patients with atrial septal defect (ASD), ventricular septal defect (VSD), atrial septal defect and ventricular septal defect (ASD+VSD), and tetralogy of Fallot were randomly divided into two groups: the treatment group (n=50) was operated on with a beating heart under extracorporeal circulation (ECC), and the control group (n=50) on an conventional arresting heart under ECC. The two groups both used a right sub-axillary incision. Blood samples from a central venous catheter (CVC) were collected before, at the end of aortic clamping, immediately after discontinue cardiopulmonary bypass (CPB), 3, 6, 24, and 48 hours after operation. The Abbott Axsym system with hol-automation fluorescent immunity analyzer was used for the quantitative determination of cTnl. cTnl was detected to investigate the effect of myocardial ischemia reperfusion injury and the clinical value of beating heart surgery with right sub-axillary incision. Results There were no significant differences between the two groups before operation. At the end of aortic clamping and thereafter, cTnl significantly increased in both groups, and reached the peak point at 6 hours after operation. At all the tested points, cTnl was significantly higher in the control group than the beating heart group (P <0.05), especially at 6 hours post operation (P <0.01). The

  13. 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

  14. Children with heart disease: Risk stratification for non-cardiac surgery.

    Science.gov (United States)

    Saettele, Angela K; Christensen, Jacob L; Chilson, Kelly L; Murray, David J

    2016-12-01

    Children with congenital or acquired heart disease have an increased risk of anesthesia related morbidity and mortality. The child's anesthetic risk is related to the severity of their underlying cardiac disease, associated comorbidities, and surgical procedure. The goal of this project was to determine the ease of use of a preoperative risk stratification tool for assigning pediatric cardiac staff and to determine the relative frequency that children with low, moderate, and high risk cardiac disease present for non-cardiac surgery at a tertiary pediatric hospital. A risk-stratification tool was prospectively applied to children with congenital heart disease who presented for non-cardiac surgery. Perioperative. We identified a subset of 100 children with congenital heart disease out of 2200 children who required general anesthesia for surgical or radiological procedures over a 6 week period. A risk stratification tool was utilized to place the patient into low, moderate, or high risk categories to help predict anticipated anesthetic risk. Each grouping specified assignment of staff caring for the patient, clarified preoperative expectations for cardiac assessment, and determined if patient care could be performed at our freestanding ambulatory surgical center. Electronic perioperative records were reviewed to obtain demographic information, the underlying heart disease, prior cardiac surgery, associated conditions, anesthetic management, complications, and provider type. Approximately 4.5% of children presented with cardiac disease over a 6 week period. In 100 consecutive children with cardiac disease, 23 of the children were classified as low risk, 66 patients were classified as moderate risk, and 11 of the patients were classified as high risk. Pediatric cardiac anesthesiologists provided care to all high risk patients. There were no serious adverse events. We found this risk stratification method an effective method to differentiate children into low, moderate

  15. Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals.

    Science.gov (United States)

    Chambers, John; Kabir, Saleha; Cajeat, Eric

    2014-02-01

    Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Retrospective database analysis in a teaching hospital open access echocardiography service. Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.

  16. Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study.

    Science.gov (United States)

    Kilkenny, Jessica; Larson, Dennis J; MacCormick, Mathew; Brown, Stephen H M; Singh, Ameet

    2017-08-01

    To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. Pilot study. Veterinary students (n = 10) from years 1 to 4. Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer. © 2017 The American College of Veterinary Surgeons.

  17. Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery: a prospective randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Hong-li; L(U) Fei-zhou; JIANG Jian-yuan; MA Xin; XIA Xin-lei; WANG Li-xun

    2011-01-01

    Background In recent years,a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy,but some dispute remains regarding the advantages over open surgery.This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors,postoperative back muscle function,and 24-month postoperative follow-up results.Methods From September 2006 to June 2008,patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study.Patients were randomized to undergo either minimally invasive surgery (MIS,transforaminal lumbar interbody fusion via MAST Quadrant retractor,41 cases) or open surgery (improved transforaminal lumbar interbody fusion,38 cases).Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group,and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P <0.05 for all).MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P <0.01).Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P <0.01).The Oswestry disability index and visual analog scale scores were better at 3,6,12 and 24 months postoperatively than preoperatively in both groups.Both groups of patients met the imaging convergence criteria at the last follow-up.Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery,which is conducive to early functional recovery.In the short term,MIS is superior to open surgery,but in the long term there is no significant difference between the two procedures.

  18. Iloprost for children with pulmonary hypertension after surgery to correct congenital heart disease.

    Science.gov (United States)

    Xu, Zhuoming; Zhu, Limin; Liu, Xinrong; Gong, Xiaolei; Gattrell, William; Liu, Jinfen

    2015-06-01

    Congenital heart disease (CHD) can cause pulmonary hypertension (PH) in children, and surgery to correct CHD may be complicated by postoperative pulmonary hypertensive crises (PHC). Clinical data regarding the use of inhaled iloprost to treat children with PH are scarce. Our aim was to determine the efficacy and safety of iloprost in children with PH following surgery to correct CHD. This was a randomized, placebo-controlled study of 22 children (median age 7 months) undergoing surgery to achieve biventricular repair. The combined clinical endpoint was a decrease of more than 20% in the ratio of systolic pulmonary arterial pressure to systolic arterial pressure or pulmonary resistance to systemic resistance, with no PHC or death. Patients were randomized to receive low-dose iloprost (30 ng/kg/min), high-dose iloprost (50 ng/kg/min), or placebo, for 10 min every 2 hr in the first 48 hr after surgery. PHC were experienced by two patients who received placebo and one patient treated with high-dose iloprost. The combined clinical endpoint was reached by six patients administered low-dose iloprost (P = 0.005) and four administered high-dose iloprost (P = 0.077), compared with none in the placebo group. Patients treated with iloprost showed a significant reduction from baseline in mean pulmonary vascular resistance index (-2.2 Wood units, P iloprost to treat children with PH following surgery to correct CHD. © 2014 Wiley Periodicals, Inc.

  19. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

    Directory of Open Access Journals (Sweden)

    Ahmet Baris-Durukan

    2015-10-01

    Full Text Available Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous

  20. Clinically silent preoperative brain injuries do not worsen with surgery in neonates with congenital heart disease.

    Science.gov (United States)

    Block, A J; McQuillen, P S; Chau, V; Glass, H; Poskitt, K J; Barkovich, A J; Esch, M; Soulikias, W; Azakie, A; Campbell, A; Miller, S P

    2010-09-01

    Preoperative brain injury, particularly stroke and white matter injury, is common in neonates with congenital heart disease. The objective of this study was to determine the risk of hemorrhage or extension of preoperative brain injury with cardiac surgery. This dual-center prospective cohort study recruited 92 term neonates, 62 with transposition of the great arteries and 30 with single ventricle physiology, from 2 tertiary referral centers. Neonates underwent brain magnetic resonance imaging scans before and after cardiac surgery. Brain injury was identified in 40 (43%) neonates on the preoperative magnetic resonance imaging scan (median 5 days after birth): stroke in 23, white matter injury in 21, and intraventricular hemorrhage in 7. None of the brain lesions presented clinically with overt signs or seizures. Preoperative brain injury was associated with balloon atrial septostomy (P = .003) and lowest arterial oxygen saturation (P = .007); in a multivariable model, only the effect of balloon atrial septostomy remained significant when adjusting for lowest arterial oxygen saturation. On postoperative magnetic resonance imaging in 78 neonates (median 21 days after birth), none of the preoperative lesions showed evidence of extension or hemorrhagic transformation (0/40 [95% confidence interval: 0%-7%]). The presence of preoperative brain injury was not a significant risk factor for acquiring new injury on postoperative magnetic resonance imaging (P = .8). Clinically silent brain injuries identified preoperatively in neonates with congenital heart disease, including stroke, have a low risk of progression with surgery and cardiopulmonary bypass and should therefore not delay clinically indicated cardiac surgery. In this multicenter cohort, balloon atrial septostomy remains an important risk factor for preoperative brain injury, particularly stroke. 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Effects of implant surgery on blood pressure and heart rate during sedation with propofol and midazolam.

    Science.gov (United States)

    Ueno, Daisuke; Sato, Junichi; Nejima, Jun; Maruyama, Keisuke; Kobayashi, Mariko; Iketani, Toshikazu; Sekiguchi, Rei; Kawahara, Hiroshi

    2012-01-01

    Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam. Medical records of 252 patients who underwent implant surgery were retrospectively analyzed. Patients were classified into four groups according to their age (in years) and hypertension status: A=≤64, no hypertension; B=≥65, no hypertension; C=≤64, hypertension; or D=≥65, hypertension. Hypertensive patients were further characterized by their antihypertensive medications: E=calcium channel blockers (CCBs), F=angiotensin II receptor blockers (ARBs), G=CCBs+ARBs, or H=no medication. IV sedation was administered in two stages. After midazolam injection to prevent angialgia, propofol was infused at the rate of 4 mg/kg/h, followed by a dose reduction. Systolic and diastolic BP and heart rate were recorded before, during, and after surgery. Systolic BP increased significantly after patients were draped in groups A, C, and D, with group D showing the most pronounced increase. Sedatives decreased BP in all groups. Diastolic BP in group F decreased significantly compared to group H after induction and before infiltration of local anesthetic. After infiltration, systolic BP decreased more significantly in group G than in group H. Intraoperative hypotension was observed in 25% of patients. The incidence of intraoperative hypertension in group D was markedly higher than in group A (23% vs 4%). IV sedation using midazolam and propofol reduces hypertensive risks during implant surgery. Nevertheless, care must be taken, especially in older hypertensive patients and in hypertensive patients on ARBs or ARBs+CCBs.

  2. Anesthetic management of a patient with prosthetic heart valve for non-cardiac surgery: A case report.

    Science.gov (United States)

    Umesh, Goneppanavar; Verma, Swati; Jasvinder, Kaur

    2008-09-30

    Patients with prosthetic heart valves are a challenge to any anesthesiologist due to the risk of infective endocarditis, bleeding and thrombosis. We present anesthetic management of a 58-year-old Indian lady with a prosthetic (mechanical) heart valve who underwent hemireplacement arthroplasty. Patients with prosthetic heart valves, especially those with the mechanical valves are prone for thrombosis and resultant complications if anticoagulation is not maintained properly. However, when they are scheduled for major surgery, they can be best managed by normalising the coagulation profile immediately prior to surgery and restarting the anticoagulation as early as possible.

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

    Energy Technology Data Exchange (ETDEWEB)

    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).

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

    Science.gov (United States)

    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 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.

  5. A Nurse Practitioner Clinic: A Novel Approach to Supporting Patients Following Heart Valve Surgery.

    Science.gov (United States)

    McLachlan, Andrew; Sutton, Tim; Ding, Patricia; Kerr, Andrew

    2015-11-01

    Valvular heart disease is an important healthcare issue and its impacts are increasing. Following valve surgery, traditional models of care involve medical personnel, however, significant gaps in guideline adherence and delays in follow-up have been reported. Internationally, there is increasing evidence that specialist nurses can function in a variety of clinical settings and improve patient management. In 2009, a nurse practitioner clinic to support patients following valve surgery was established. We used a retrospective clinical audit and clinical review with descriptive statistics to describe the development of the clinic and to provide guidance for other services for model of care development. Over four years, 462 patients have been reviewed at least once, with over half having multiple assessments, 37% had rheumatic heart disease. These patients were 20 years younger and more likely to be women, non-European, current smokers and have atrial fibrillation. All patients received a focussed lifestyle, rheumatic, thromboembolic and endocarditis risk and symptom review with tailored support, advice and referral where appropriate. Four percent were referred back to a cardiologist for early evidence of valve dysfunction and a further 1.5% required urgent admission for unstable symptoms. The nurse practitioner clinic offers a systematic approach to promoting guideline adherence post valvular surgery. Important clinical symptoms and differences in health needs were identified and were actioned appropriately. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  6. Heart Rate Variability in Nonlinear Rats with Different Orientation and Exploratory Activity in the Open Field.

    Science.gov (United States)

    Kur'yanova, E V; Teplyi, D L; Zhukova, Yu D; Zhukovina, N V

    2015-12-01

    The basic behavioral activity of nonlinear rats was evaluated from the sum of crossed peripheral and central squares and peripheral and central rearing postures in the open fi eld test. This index was low (30 episodes). Male rats with high score of orientation and exploratory activity were characterized by higher indexes of total heart rate variability than rats with low or intermediate activity. Specimens with a greater contribution of VLF waves into the total power spectrum of heart rate variability were shown to dominate among the rats with high behavioral activity. Our results are consistent with the notions of a suprasegmental nature of VLF waves.

  7. Wave emission from heterogeneities opens a way to controlling chaos in the heart.

    Science.gov (United States)

    Pumir, A; Nikolski, V; Hörning, M; Isomura, A; Agladze, K; Yoshikawa, K; Gilmour, R; Bodenschatz, E; Krinsky, V

    2007-11-16

    The effectiveness of chaos control in large systems increases with the number of control sites. We find that electric field induced wave emission from heterogeneities (WEH) in the heart gives a unique opportunity to have as many control sites as needed. The number of pacing sites grows with the amplitude of the electric field. We demonstrate that WEH has important advantages over methods used in clinics, and opens a new way to manipulate vortices in experiments, and potentially to radically improve the clinical methods of chaos control in the heart.

  8. Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.

    Science.gov (United States)

    Sarman, Hakan; Muezzinoglu, Umit Sefa; Memisoglu, Kaya; Aydin, Adem; Atmaca, Halil; Baran, Tuncay; Odabas Ozgur, Bahar; Ozgur, Turgay; Kantar, Cengizhan

    2016-01-01

    The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes

  9. Cataract surgery during active methicillin-resistant Staphylococcus aureus infection

    National Research Council Canada - National Science Library

    Mansour, Ahmad M; Salti, Haytham I

    2014-01-01

    ...) wounds of the forehead and sternum following craniotomy or open heart surgery. Both had debilitating cataracts and were told by the infectious diseases team that cataract surgery is very risky...

  10. [Cardiopulmonary stress testing in children who have had congenital heart disease surgery. Physical exercise recommendations during school hours].

    Science.gov (United States)

    Serra-Grima, Ricard; Doñate, Maite; Borrás, Xavier; Rissech, Miquel; Puig, Teresa; Albert, Dimpna C; Bartrons, Joaquim; Gran, Ferran; Manso, Begoña; Ferrer, Queralt; Girona, Josep; Casaldáliga, Jaume; Subirana, Maite

    2011-09-01

    To analyze and discover if stress testing with exhaled gases in children who have had congenital heart surgery is useful so we could make physical exercise recommendations according to heart disease, type of surgery performed, present hemodynamic state and level of exercise practiced. Prospective study of 108 children, who performed stress testing with exhaled gases, electrocardiogram monitoring and blood pressure. A questionnaire was used to obtain variables concerning heart disease, surgery, present functional condition and level of exercise practiced. Exercise recommendations were given after stress testing, and after a year 35 patients answered a questionnaire. There were significant differences between lesion severity and heart rate at rest and during effort, systolic pressure at rest and during effort, oxygen uptake, oxygen pulse, carbon dioxide production and test duration. A relationship was observed between level of weekly exercise and greater oxygen uptake and test duration, but this was not observed with the underlying heart disease. We observed that best performance occurred with fast repairing for 59 children with cyanotic heart disease. Increased exercise level was recommended for 48 children. The cardiopulmonary function study allows us to examine the physical performance of children who have had congenital heart surgery and provides us with important data so that we can recommend better physical exercise planning. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  11. Long-Term Oncologic Outcomes of Laparoscopic versus Open Surgery for Middle and Lower Rectal Cancer.

    Directory of Open Access Journals (Sweden)

    Shaotang Li

    Full Text Available Laparoscopic surgery for middle and lower rectal cancer remain controversial because anatomical and complex surgical procedures specifically influence oncologic outcomes. This study analyzes the long-term outcomes of laparoscopic versus open surgery for middle and lower rectal cancer.Patients (laparoscopic: n = 129, open: n = 152 who underwent curative resection for middle and lower rectal cancer from 2003 to 2008 participated in the study. The same surgical team performed all operations. The mean follow up time of all patients was 74.3 months.No statistical difference in local recurrence rate (7.8% vs. 7.2%; log-rank = 0.024; P = 0.876 and distant recurrence rate (20.9% vs.16.4%; log-rank = 0.699; P = 0.403 between laparoscopic and open groups were observed within 5 years. The 5-year overall survival rates of the laparoscopic and open groups were 72.9% and 75.7%, respectively; no significant statistical difference was observed between them (log-rank = 0.163; P = 0.686. The 5-year survival rates between groups were not different between stages: Stage I (92.6% vs. 86.7%; log-rank = 0.533; P = 0.465; stage II (75.8% vs. 80.5%; log-rank = 0.212; P = 0.645; and Stage III (63.8% vs. 69.1%, log-rank = 0272;P = 0.602. However, significant statistical difference amongst different stages were observed (log-rank = 1.802; P = 0.003.Laparoscopic and open surgery for middle and lower rectal cancer offer equivalent long-term oncologic outcomes. Laparoscopic surgery is feasible in these patients.

  12. Morbidity After Cardiac Surgery in Patients With Adult Congenital Heart Disease in Comparison With Acquired Disease.

    Science.gov (United States)

    Karangelis, Dimos; Mazine, Amine; Narsupalli, Sreekanth; Mendis, Shamarli; Veldtman, Gruschen; Nikolaidis, Nicolas

    2017-06-28

    Due to the advancements in congenital cardiac surgery and interventional cardiology in the last five decades, more than 85% of congenital heart patients now survive to adulthood. This retrospective study included 135 Adult Congenital Heart Disease (ACHD) patients, who had cardiac surgery at Southampton General Hospital over three consecutive years. We also included 42 patients with a structurally normal heart who had cardiac surgery for acquired cardiac conditions as a control group. Preoperative, intraoperative and postoperative data were analysed in both groups to identify risk factors for morbidity and mortality. In the ACHD group, in hospital mortality was 0.7%. In the control group no deaths were observed. Fifty-eight per cent of the ACHD patients had significantly higher perioperative morbidity with arrhythmias (26%), bleeding (3%), prolonged ventilation (11.3%) and renal replacement therapy 1.5%. In the non ACHD control group 32% (p=0.003) developed perioperative complications with arrhythmias (9.8%), bleeding (2.5%), prolonged ventilation (4.3%) and renal replacement therapy (2.5%). In ACHD patients total in-hospital stay was longer in patients with longer cardiopulmonary bypass (CPB) time (p=0.005), aortic cross clamp time (p=0.013) and higher preoperative alkaline phosphatase level (p=0.005). Early postoperative complications were higher in ACHD patients with longer cardiopulmonary bypass time (p=0.04) and presence of pulmonary artery hypertension (p=0.012). Even though the preoperative and operative characteristics are similar to both groups, the morbidity is more in ACHD group. Longer CBP time, aortic cross clamp time and presence of pulmonary hypertension are risk factors for higher morbidity in this group. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  13. Nutrition Support for Children Undergoing Congenital Heart Surgeries: A Narrative Review.

    Science.gov (United States)

    Wong, Judith J M; Cheifetz, Ira M; Ong, Chengsi; Nakao, Masakazu; Lee, Jan Hau

    2015-07-01

    Energy imbalance in infants and children with congenital heart disease (CHD) is common and influenced by age, underlying cardiac diagnoses, and presence or absence of congestive heart failure. During the surgical hospitalization period, these children are prone to nutritional deterioration due to stress of surgery, anesthetic/perfusion techniques, and postoperative care. Poor nutrition is associated with increased perioperative morbidity and mortality. This review aims to examine various aspects of nutrition in critically ill children with CHD, including (1) energy expenditure, (2) perioperative factors that contribute to energy metabolism, (3) bedside practices that are potentially able to optimize nutrient delivery, and (4) medium- to long-term impact of energy balance on clinical outcomes. We propose a nutrition algorithm to optimize nutrition of these children in the perioperative period where improvements in nutrition status will likely impact surgical outcomes.

  14. 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.

  15. Prevalence of antibodies to hepatitis C virus after blood transfusion in heart surgery.

    OpenAIRE

    Barcena, R.; A. Gonzalez; Martin-de-Argila, C.; Ulibarrena, C.; J. Graus; Grande, L. A.

    1994-01-01

    We studied the frequency and time of appearance of antibodies to the hepatitis C virus (HCV) retrospectively in the sera of 127 patients who underwent heart surgery between 1983 and 1986. They received blood from volunteer donors hepatitis B surface antigen (HBsAg) negative with normal serum alanine-aminotransferase levels. A prospective follow-up was carried out every 15 days for at least 6 months from the moment of the transfusion. Of the ten patients who developed biochemical criteria of p...

  16. 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)....

  17. Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan.

    Science.gov (United States)

    Khan, Amina; Abdullah, Ahmed; Ahmad, Huzaifa; Rizvi, Arjumand; Batool, Sehrish; Jenkins, Kathy J; Gauvreau, Kimberlee; Amanullah, Muneer; Haq, Anwar; Aslam, Nadeem; Minai, Fauzia; Hasan, Babar

    2017-04-13

    The International Quality Improvement Collaborative (IQIC) was formed to reduce mortality and morbidity from congenital heart disease (CHD) surgeries in low/middle-income countries. We conducted this study to compare the postoperative outcomes of CHD surgeries at a centre in Pakistan before and after joining IQIC. The IQIC provides guidelines targeting key drivers responsible for morbidity and mortality in postoperativepatients with CHD. We focused primarily on nurse empowerment and improving the infection control strategies at our centre. Patients with CHD who underwent surgery at this site during the period 2011-2012 (pre-IQIC) were comparedwith those getting surgery in 2013-2014 (post-IQIC). Morbidity (major infections), mortality and factors associated with them were assessed. There was a significant decrease in surgical site infections and bacterial sepsis in the post-IQIC versus pre-IQIC period (1% vs 30%, p=0.0001, respectively). A statistically insignificant decrease in the mortality rate was also noted in post-IQIC versus pre-IQIC period (6% vs 9%, p=0.17, respectively). Durations of ventilation and intensive care unit (ICU) and hospital stay were significantly reduced in the post-IQIC period. Age Surgery score >3, major chromosomal anomalies, perfusion-related event, longer ventilation and ICU/hospital stay durations were associated with greater odds of morbidity and mortality. Enrolling in the IQIC programme was associated with an improvement in the postsurgical outcomes of the CHD surgeries at our centre. © 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.

  18. Effect of Desmopressin on Platelet Aggregation and Blood Loss in Patients Undergoing Valvular Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    Lei Jin; Hong-Wen Ji

    2015-01-01

    Background:Blood loss after cardiac surgery can be caused by impaired platelet (PLT) function after cardiopulmonary bypass.Desmopressin or 1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of vasopressin.DDAVP can increase the level of von Willebrand factor and coagulation factor Ⅷ,thus it may enhance PLT function and improve coagulation.In this study,we assessed the effects of DDAVP on PLT aggregation and blood loss in patients undergoing cardiac surgery.Methods:A total of 102 patients undergoing valvular heart surgery (from October 2010 to June 2011) were divided into DDAVP group (n =52) and control group (n =50).A dose of DDAVP (0.3 μtg/kg) was administered to the patients intravenously when they were being re-warmed.At the same time,an equal volume of saline was given to the patients in the control group.PLT aggregation rate was measured with the AggRAM four-way PLT aggregation measurement instrument.The blood loss and transfusion,hemoglobin levels,PLT counts,and urine outputs at different time were recorded and compared.Results:The postoperative blood loss in the first 6 h was significantly reduced in DDAVP group (202 ± 119 ml vs.258 ± 143 ml,P =0.023).The incidence of fresh frozen plasma (FFP) transfusion was decreased postoperatively in DDAVP group (3.8% vs.12%,P =0.015).There was no significant difference in the PLT aggregation,urine volumes,red blood cell transfusions and blood loss after 24 h between two groups.Conclusions:A single dose of DDAVP can reduce the first 6 h blood loss and FFP transfusion postoperatively in patients undergoing valvular heart surgery,but has no effect on PLT aggregation.

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

    Science.gov (United States)

    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

  20. Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

    Directory of Open Access Journals (Sweden)

    Eva M. Marwali

    2016-06-01

    Full Text Available Background Most children undergoing cardiac surgery forcongenital heart disease (CHD in developing countries aremalnourished. Malnutrition is known as a co-morbidity factorthat might predict and influence outcomes after surgery.Objectives To evaluate the effect of malnutrition and otherassociated risk factors on post-operative outcomes in childrenwith CHDs underwent cardiac surgery.Methods We conducted a retrospective cohort study in a singlecenter tertiary pediatric cardiac intensive care unit (PCICUin Indonesia. Our cohort included all children between 5 and36 months of age undergoing congenital heart surgery withcardiopulmonary bypass from November 2011 until February2014. Outcomes measured were the length of intubation and thelength of ICU stay. Variables for potential influence investigatedwere the nutritional status, age, gender, type of cardiac anomaly(acyanotic vs. cyanotic, Aristotle score, cardiopulmonary bypasstime, aortic cross-clamp time, and Pediatric Risk of Mortality(PRISM III score.Results Out of 249 patients included, 147 (59% showedmalnourishment on admission. Malnourished patients weresignificantly younger in age, presented with an acyanotic heartdefects, and had higher PRISM III score. Additionally, they alsohad a longer mechanical ventilation time and ICU stay thanthose with a normal nutritional status. After adjusting for variousvariables using a multiple logistic regression model it could bedemonstrated that a higher Z-score for weight to age was asignificant protective factor for the intubation time of more than29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P =0.012. Non-malnourished patients had a 49% significantly higherchance for extubation with a hazard ratio of 1.49 (95% CI 1.12to 1.99, P= 0.007.Conclusion Malnourishment is clearly associated in a linearfashion with longer mechanical ventilation and ICU stay. As one ofsignificant and potentially treatable co-morbidity factors, preventionof malnourishment

  1. Systemic inflammatory response syndrome after pediatric congenital heart surgery: Incidence, risk factors, and clinical outcome.

    Science.gov (United States)

    Boehne, Martin; Sasse, Michael; Karch, André; Dziuba, Friederike; Horke, Alexander; Kaussen, Torsten; Mikolajczyk, Rafael; Beerbaum, Philipp; Jack, Thomas

    2017-02-01

    Systemic inflammatory response syndrome (SIRS) is frequent after cardiac surgery, but data on its incidence and perioperative risk factors are scarce for children with congenital heart disease. SIRS incidence within 72 hours following cardiac surgery was evaluated in a secondary analysis of children enrolled to a treatment-free control group of a randomized controlled trial. Intraoperative parameters were investigated for their association with SIRS using multivariable fractional polynomial logistic regression models. Effects of SIRS on various organ functions and length of stay were evaluated using time-varying Cox regression models. In 116 children after cardiac surgery (median age [range]: 7.4 month [1 day-16.2 years]) SIRS occurred in n = 39/102 with and n = 1/14 without cardiopulmonary bypass (CPB). Duration of CPB (hazard ratio [HR]: 2.28 per hour; 95% confidence interval [CI] 1.17; 4.42) and amount of fresh frozen plasma (HR: 1.23 per 10 mL/kg; 95%CI 1.06; 1.42) were identified as predictors for SIRS; neonates seemed to be less susceptible for SIRS development (HR: 0.86; 95%CI 0.79; 0.95). SIRS was associated with organ dysfunction (HR: 2.69; 95%CI 1.41; 5.12) and extended stay in the pediatric intensive care unit (PICU) (median: 168 vs. 96 hours; p = 0.007). SIRS is a frequent complication after pediatric congenital heart surgery; it affects nearly one third of children and prolongs PICU stay significantly. Duration of CPB and amount of fresh frozen plasma were identified as important risk factors. Neonates seem to be less susceptible to SIRS development. © 2016 Wiley Periodicals, Inc.

  2. Does malnutrition influence outcome in children undergoing congenital heart surgery in a developing country?

    Directory of Open Access Journals (Sweden)

    Eva M. Marwali

    2015-03-01

    Full Text Available Background Most children undergoing cardiac surgery for congenital heart disease (CHD in developing countries are malnourished. Malnutrition is known as a co-morbidity factor that might predict and influence outcomes after surgery. Objectives To evaluate the effect of malnutrition and other associated risk factors on post-operative outcomes in children with CHDs underwent cardiac surgery. Methods We conducted a retrospective cohort study in a single center tertiary pediatric cardiac intensive care unit (PCICU in Indonesia. Our cohort included all children between 5 and 36 months of age undergoing congenital heart surgery with cardiopulmonary bypass from November 2011 until February 2014. Outcomes measured were the length of intubation and the length of ICU stay. Variables for potential influence investigated were the nutritional status, age, gender, type of cardiac anomaly (acyanotic vs. cyanotic, Aristotle score, cardiopulmonary bypass time, aortic cross-clamp time, and Pediatric Risk of Mortality (PRISM III score. Results Out of 249 patients included, 147 (59% showed malnourishment on admission. Malnourished patients were significantly younger in age, presented with an acyanotic heart defects, and had higher PRISM III score. Additionally, they also had a longer mechanical ventilation time and ICU stay than those with a normal nutritional status. After adjusting for various variables using a multiple logistic regression model it could be demonstrated that a higher Z-score for weight to age was a significant protective factor for the intubation time of more than 29 hours with an odds ratio of 0.66 (95% CI 0.48 to 0.92, P = 0.012. Non-malnourished patients had a 49% significantly higher chance for extubation with a hazard ratio of 1.49 (95% CI 1.12 to 1.99, P= 0.007. Conclusion Malnourishment is clearly associated in a linear fashion with longer mechanical ventilation and ICU stay. As one of significant and potentially treatable co

  3. Technique of last resort: characteristics of patients undergoing open surgery in the laparoscopic era.

    Science.gov (United States)

    Guend, Hamza; Lee, David Y; Myers, Elizabeth A; Gandhi, Nipa D; Cekic, Vesna; Whelan, Richard L

    2015-09-01

    The utilization rates for minimally invasive colorectal resection techniques (MICR) continue to increase. In some centers MICR methods are the preferred approach, however, open methods continue to be utilized for select patients. In this study, the profile and short-term outcomes of open colorectal resection (CR) and MICR patients are determined and compared. A retrospective review of patients who underwent elective CR over 11 years at two institutions was performed. The MICR group contained both laparoscopic-assisted and hand-assisted cases. The past medical and surgical histories, indications, operations performed, and short-term outcomes were assessed. The Charlson co-morbidity index (CMI) was used to assess risk. During the study period 1080 patients underwent CR (Open, 141; MICR, 939). As judged by the CMI, there were more high-risk patients (score ≥2) in the Open group (34.38%) versus MICR (22.11%) p = 0.0029. Significantly more open patients had prior abdominal surgery and specifically CRs (Open, 15.60% vs. MICR, 2.13%, p MICR 6.8%, p MICR is the procedure of choice, patients selected for Open CR are higher risk and more complex as judged by the CMI and past operative history. Not surprisingly, this translates into a longer length of stay, higher rates of transfusion, diversion, and complications. This disparity in patients undergoing CRs makes direct comparison of MICR and Open resection outcomes not reasonable.

  4. Comparison of Oncologic Short Term Results of Laparoscopic Versus Open Surgery of Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Solati

    2015-06-01

    Full Text Available Background Today, with improvements in laparoscopy technique, surgery of rectal cancer is performed by laparoscopy. Objectives This study was performed to evaluate oncologic results of open versus laparoscopic surgery of rectal cancer in terms of resection margins, removal of lymph nodes and recurrence rate. Patients and Methods This descriptive-analytic study was performed on 88 patients with middle and lower rectal cancer in the two equivalent groups of laparoscopic and open surgery in Mashhad Ghaem and Omid hospitals during 2011 - 2013. Information including age, sex, number of removed and involved lymph nodes, proximal, distal, and radial margins, tumor stage and location, recurrence and disease-free survival collected in the questionnaire and analyzed using descriptive statistics and frequency distribution tables and t-test. Results Both groups of open and laparoscopic surgery had similar characteristics of age, sex, recurrence and disease-free survival, tumor margins and one-year mortality. The number of removed and involved lymph nodes was higher in the laparoscopic group (5.16 vs. 3.55, respectively, with P < 0.050, and 1.74 vs. 0.59 with P = 0.023, but the ratio of involved lymph nodes to the total number of removed lymph nodes was not different between the two groups (LNR (P = 0.071. Tumor stage was higher in the laparoscopic group and most were in stages II and III (P < 0.001. Conclusions Laparoscopic surgery is an effective technique for safe margin and removing lymph nodes in rectal cancer.

  5. The Image-Guided Surgery ToolKit IGSTK: an open source C++ software toolkit

    Science.gov (United States)

    Cheng, Peng; Ibanez, Luis; Gobbi, David; Gary, Kevin; Aylward, Stephen; Jomier, Julien; Enquobahrie, Andinet; Zhang, Hui; Kim, Hee-su; Blake, M. Brian; Cleary, Kevin

    2007-03-01

    The Image-Guided Surgery Toolkit (IGSTK) is an open source C++ software library that provides the basic components needed to develop image-guided surgery applications. The focus of the toolkit is on robustness using a state machine architecture. This paper presents an overview of the project based on a recent book which can be downloaded from igstk.org. The paper includes an introduction to open source projects, a discussion of our software development process and the best practices that were developed, and an overview of requirements. The paper also presents the architecture framework and main components. This presentation is followed by a discussion of the state machine model that was incorporated and the associated rationale. The paper concludes with an example application.

  6. Effective median sternotomy closure in high-risk open heart patients.

    Science.gov (United States)

    Bek, Eugene L; Yun, Kwok L; Kochamba, Gary S; Pfeffer, Thomas A

    2010-04-01

    We describe a novel surgical technique with a median sternotomy closure in high-risk open heart patients. In contrast to conventional sternal closure, in which sternal wires are passed through the intercostal space, the novel technique in sternal closure passes sternal wires transcostally or through costo-chondral joints. Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Towards open-source, low-cost haptics for surgery simulation.

    Science.gov (United States)

    Suwelack, Stefan; Sander, Christian; Schill, Julian; Serf, Manuel; Danz, Marcel; Asfour, Tamim; Burger, Wolfgang; Dillmann, Rüdiger; Speidel, Stefanie

    2014-01-01

    In minimally invasive surgery (MIS), virtual reality (VR) training systems have become a promising education tool. However, the adoption of these systems in research and clinical settings is still limited by the high costs of dedicated haptics hardware for MIS. In this paper, we present ongoing research towards an open-source, low-cost haptic interface for MIS simulation. We demonstrate the basic mechanical design of the device, the sensor setup as well as its software integration.

  8. Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Krog AH

    2016-09-01

    Full Text Available Anne H Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Irene Sandven,5 Per M Thorsby,1,6 Jørgen J Jørgensen,1,2 Jon O Sundhagen,2 Syed SS Kazmi2 1Institute of Clinical Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Fredrikstad, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Oslo Center for Biostatistics and Epidemiology (OCBE, 6Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway Purpose: Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.Patients and methods: This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial. Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14 or an open surgical procedure (n=16. The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6, IL-8, and C-reactive protein (CRP at six different time points.Results: The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC, and after adjusting for the confounding effect of coronary heart disease (P=0.010. The differences in serum levels of IL-8 and CRP did not reach statistical significance.Conclusion: In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass

  9. Voice analysis before and after vocal rehabilitation in patients following open surgery on vocal cords

    Directory of Open Access Journals (Sweden)

    Bunijevac Mila

    2016-01-01

    Full Text Available Background/Aim. The major role of larynx in speech, respiration and swallowing makes carcinomas of this region and their treatment very influential for patients’ life quality. The aim of this study was to assess the importance of voice therapy in patients after open surgery on vocal cords. Methods. This study included 21 male patients and the control group of 19 subjects. The vowel (A was recorded and analyzed for each examinee. All the patients were recorded twice: firstly, when they contacted the clinic and secondly, after a three-month vocal therapy, which was held twice per week on an outpatient basis. The voice analysis was carried out in the Ear, Nose and Throat (ENT Clinic, Clinical Hospital Center “Zvezdara” in Belgrade. Results. The values of the acoustic parameters in the patients submitted to open surgery on the vocal cords before vocal rehabilitation and the control group subjects were significantly different in all specified parameters. These results suggest that the voice of the patients was damaged before vocal rehabilitation. The results of the acoustic parameters of the vowel (A before and after vocal rehabilitation of the patients with open surgery on vocal cords were statistically significantly different. Among the parameters - Jitter (%, Shimmer (% - the observed difference was highly statistically significant (p 0.05 . Conclusion. There was a significant improvement of the acoustic parameters of the vowel (A in the study subjects three months following vocal therapy. Only one out of five representative parameters showed no significant improvement.

  10. Significance of epicardial fat in the diagnosis of coronary atherosclerosis before heart valve surgery

    Directory of Open Access Journals (Sweden)

    Joanna de Zayas Galguera

    2016-01-01

    Full Text Available Introduction: Epicardial fat has been shown to be related not only with clinical atherosclerosis, but also with subclinical atherosclerosis.Objective: To determine the significance of epicardial fat in the diagnosis of coronary atherosclerosis in patients with valvular heart disease.Method: The study included 62 patients scheduled for valve replacement surgery who had previously undergone invasive coronary angiography. Before surgery, epicardial fat measurement was performed by echocardiogram. Sensitivity, specificity, and positive and negative predictive values were determined, as well as the validity index and likelihood ratios for positive and negative tests.Results: 88.7% of patients with heart valve disease had no lesions in the coronary arteries. The most relevant parameters obtained from the measurement of epicardial fat were 78% sensitivity and 93% negative predictive value, and a ratio of positive and negative likelihood of 2.23 and 0.34 respectively.Conclusions: The group of patients with significant coronary lesions showed higher levels of epicardial fat than the group without coronary lesions. It confirms the diagnostic validity of this test for the detection of coronary atherosclerosis in the study patients.

  11. 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.

  12. 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.

  13. Comparison of the Performance of the Warfarin Pharmacogenetics Algorithms in Patients with Surgery of Heart Valve Replacement and Heart Valvuloplasty.

    Science.gov (United States)

    Xu, Hang; Su, Shi; Tang, Wuji; Wei, Meng; Wang, Tao; Wang, Dongjin; Ge, Weihong

    2015-09-01

    A large number of warfarin pharmacogenetics algorithms have been published. Our research was aimed to evaluate the performance of the selected pharmacogenetic algorithms in patients with surgery of heart valve replacement and heart valvuloplasty during the phase of initial and stable anticoagulation treatment. 10 pharmacogenetic algorithms were selected by searching PubMed. We compared the performance of the selected algorithms in a cohort of 193 patients during the phase of initial and stable anticoagulation therapy. Predicted dose was compared to therapeutic dose by using a predicted dose percentage that falls within 20% threshold of the actual dose (percentage within 20%) and mean absolute error (MAE). The average warfarin dose for patients was 3.05±1.23mg/day for initial treatment and 3.45±1.18mg/day for stable treatment. The percentages of the predicted dose within 20% of the therapeutic dose were 44.0±8.8% and 44.6±9.7% for the initial and stable phases, respectively. The MAEs of the selected algorithms were 0.85±0.18mg/day and 0.93±0.19mg/day, respectively. All algorithms had better performance in the ideal group than in the low dose and high dose groups. The only exception is the Wadelius et al. algorithm, which had better performance in the high dose group. The algorithms had similar performance except for the Wadelius et al. and Miao et al. algorithms, which had poor accuracy in our study cohort. The Gage et al. algorithm had better performance in both phases of initial and stable treatment. Algorithms had relatively higher accuracy in the >50years group of patients on the stable phase. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. No extensive experience in open procedures is needed to learn lobectomy by video-assisted thoracic surgery

    DEFF Research Database (Denmark)

    Konge, Lars; Petersen, René Horsleben; Hansen, Henrik Jessen;

    2012-01-01

    Lobectomies done by video-assisted thoracic surgery (VATS) result in fewer complications and less pain and save total costs compared with the traditional approach. However, the majority of procedures are still performed via open thoracotomies, because VATS lobectomy is considered difficult to learn......, requiring experience in open surgery, and causing complications in the initial phase of the learning curve. The aim of this study was to describe a training model appreciating patient safety during training and to explore the initial learning curve for a trainee rather inexperienced in open surgery....

  15. Oncologic Safety of Robot Thyroid Surgery for Papillary Thyroid Carcinoma: A Comparative Study of Robot versus Open Thyroid Surgery Using Inverse Probability of Treatment Weighting.

    Science.gov (United States)

    Sung, Tae-Yon; Yoon, Jong Ho; Han, Minkyu; Lee, Yi Ho; Lee, Yu-Mi; Song, Dong Eun; Chung, Ki-Wook; Kim, Won Bae; Shong, Young Kee; Hong, Suck Joon

    2016-01-01

    The aim of this study was to evaluate the oncologic safety of robot thyroid surgery compared to open thyroid surgery for papillary thyroid carcinoma (PTC). We enrolled 722 patients with PTC who underwent a total thyroidectomy with central compartment node dissection (CCND) from January 2009 to December 2010. These patients were classified into open thyroid surgery (n = 610) or robot thyroid surgery (n = 112) groups. We verified the impact of robot thyroid surgery on clinical recurrence and ablation/control-stimulated thyroglobulin (sTg) levels predictive of non-recurrence using weighted logistic regression models with inverse probability of treatment weighting (IPTW). Age, sex, thyroid weight, extent of CCND, and TNM were significantly different between the two groups (p robot groups (1.5% vs. 2.7%; p = 0.608). The proportion of patients with ablation sTg 0.05). Logistic regression with IPTW using the propensity scores estimated by adjusting all of the parameters demonstrated that robot thyroid surgery did not influence the clinical recurrence (OR; 0.784, 95% CI; 0.150-3.403, p = 0.750), ablation sTg (OR; 0.950, 95% CI; 0.361-2.399, p = 0.914), and control sTg levels (OR; 0.498, 95% CI; 0.190-1.189, p = 0.130). Robot thyroid surgery is comparable to open thyroid surgery with regard to oncologic safety in PTC patients.

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

    Science.gov (United States)

    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.

  17. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Research.

    Science.gov (United States)

    Jacobs, Marshall L; Jacobs, Jeffrey P; Pasquali, Sara K; Hill, Kevin D; Hornik, Christoph; O'Brien, Sean M; Shahian, David M; Habib, Robert H; Edwards, Fred H

    2016-09-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. With more than 400,000 total operations from nearly all centers performing pediatric and congenital heart operations in North America, the STS CHSD is an unparalleled platform for clinical investigation, outcomes research, and quality improvement activities in this subspecialty. In 2015, several major original publications reported analyses of data in the CHSD pertaining to specific diagnostic and procedural groups, age-defined cohorts, or the entire population of patients in the database. Additional publications reported the most recent development, evaluation, and application of metrics for quality measurement and reporting of pediatric and congenital heart operation outcomes. This use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation and the available wealth of data in it continue to grow. This article reviews outcomes research and quality improvement articles published in 2015 based on STS CHSD data.

  18. Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology

    Institute of Scientific and Technical Information of China (English)

    Jin-Fu Tu; Xiu-Fang Huang; Ru-Ying Hu; He-Yi You; Xiao-Feng Zheng; Fei-Zhao Jiang

    2011-01-01

    AIM:To investigate the feasibility and therapeutic effect of laparoscopic surgery for pyogenic liver abscess (PLA) with biliary pathology.METHODS:From January 2004 to October 2010,31 patients with PLA combined with biliary pathology meeting entry criteria received surgical management in our hospital.Of the 31 patients,13 underwent laparoscopic surgery (LS group) and 18 underwent open surgery (OS group).Clinical data including operation time,intraoperative blood loss,postoperative complication rate,length of postoperative hospital stay,and abscess recurrence rate were retrospectively analyzed and compared between the two groups.RESULTS:All patients received systemic antibiotic therapy.Four patients underwent ultrasound-guided percutaneous catheter drainage before operation.Postoperative complications occurred in 5 patients (16.1%,5/31) including 2 in the LS group and 3 in the OS group.One patient had retained calculus in the common bile duct and another had liver abscess recurrence in the OS group.No retained calculus and liver abscessrecurrence occurred in the LS group.In the two groups,there was no mortality during the perioperative period.There were no significant differences in operation time,intraoperative blood loss and transfusion,postoperative complication rate and abscess recurrence rate between the two groups.Oral intake was earlier (1.9 ± 0.4 d vs 3.1 ± 0.7 d,P < 0.05) and length of postoperative hospital stay was shorter (11.3 ± 2.9 d vs 14.5 ± 3.7 d,P < 0.05) in the LS group than in the OS group.CONCLUSION:Laparoscopic surgery for simultaneous treatment of PLA and biliary pathology is feasible in selected patients and the therapeutic effect is similar to that of open surgery.

  19. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation.

    Science.gov (United States)

    Chen, Huan-Chieh; Lee, Chih-Hsun; Wei, Li; Lui, Tai-Ngar; Lin, Tien-Jen

    2015-01-01

    Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group (P < 0.0001). Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and -0.56 in the open lumbar surgery group (P < 0.0001). Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

  20. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Surgery for Adjacent Segment Degeneration and Recurrent Disc Herniation

    Directory of Open Access Journals (Sweden)

    Huan-Chieh Chen

    2015-01-01

    Full Text Available Objective. The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD and open lumbar surgery for patients with adjacent segment degeneration (ASD and recurrence of disc herniation. Methods. From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients or repeated open lumbar surgery (25 patients, due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results. Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery group P<0.0001. Hospital stay and mean operating time were shorter significantly in the PELD group as compared to the open lumbar surgery group P<0.0001. Immediate postoperative pain improvement in VAS was 3.5 in the PELD group and −0.56 in the open lumbar surgery group P<0.0001. Conclusion. For ASD and recurrent lumbar disc herniation, PELD had more advantages over open lumbar surgery in terms of reduced blood loss, shorter hospital stay, operating time, fewer complications, and less postoperative discomfort.

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

    Science.gov (United States)

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

    2013-10-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'do children with heart failure post-cardiac surgery undergoing treatment with levosimendan have an acceptable haemodynamic improvement?' The use of levosimendan as a vasoactive drug is an accepted intervention for patients with altered haemodynamics post-cardiac surgeries. However, the role of levosimendan and its efficacy have been debated. Eleven relevant papers were identified, which represented the best evidence to answer the question. The author, journal, date, country of publication and relevant outcomes are tabulated. The 11 studies comprised 3 randomized trials, 2 of which compared levosimendan and milrinone. A single-centre randomized study that included 40 infants showed that cardiac output (CO) and cardiac index (CI) increased overtime in the levosimendan group compared with the milrinone group. The significant interaction for CO (P = 0.005) and CI (P = 0.007) indicated different time courses in the two groups. A similar, European randomized study undertaken on neonates (n = 63) showed better lactate levels [P = 0.015 (intensive care admission); P = 0.048 (after 6 h) with low inotropic scores in the levosimendan group. Although the length of mechanical ventilation and mortality were less, this was statistically insignificant. A retrospective cohort analysis (n = 13) in children reported a reduced use of dobutamine and improvement in the ejection fraction from 29.8 to 40.5% (P = 0.015) with the use of levosimendan. In a questionnaire-based study from Finland, 61.1% of respondents felt that it had saved the lives of some children when the other treatments had failed. No study reported any adverse effect attributable to use of levosimendan. In conclusion, the above studies were in favour of levosimendan as a safe and feasible drug providing potential clinical benefit in low cardiac output syndrome (LCOS) and post-cardiac surgeries when

  2. Nineteen Years of Adult Congenital Heart Surgery in a Single Center

    DEFF Research Database (Denmark)

    Perinpanayagam, Madurra; Larsen, Signe H; Emmertsen, Kristian

    2017-01-01

    who underwent cardiac surgery at Aarhus University Hospital, Denmark, from 1994 to 2012 were included in the study. Diagnoses, surgical procedures, postoperative complications, and survival were identified in hospital databases, medical records, and the Danish Civil Registration System. RESULTS: Four...... hundred seventy-four surgeries were performed in 445 adults (50% men). The median age was 39 years (range 18-83). Thirty-nine percent had previous surgical or catheter-based interventions. Thirty-day and in-hospital mortality were 1.1%. Postoperative complications occurred in 50% of cases, most were minor...... interval (CI): 1.5-3.7), New York Heart Association functional class III and IV compared to class I (OR = 2.2; 95% CI: 1.3-3.7) and age at surgery (OR = 1.03, 95% CI: 1.01-1.04), as risk factors for adverse events. Survival during a median follow-up of 7.8 years (range 0 days-21.4 years) was 85% (95% CI...

  3. Incidence and Etiology of Chylothorax after Congenital Heart Surgery in Children

    Directory of Open Access Journals (Sweden)

    Parvin Akbari-Asbagh

    2015-10-01

    Full Text Available Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax.Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period, a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous.Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax;3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and  2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001.Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax.

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

    Science.gov (United States)

    Prendergast, Bernard D

    2004-01-01

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

  5. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

    Science.gov (United States)

    Melkonian, Ernesto; Heine, Claudio; Contreras, David; Rodriguez, Marcelo; Opazo, Patricio; Silva, Andres; Robles, Ignacio; Rebolledo, Rolando

    2017-01-01

    BACKGROUND: The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. PATIENTS AND METHODS: The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. RESULTS: Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44). CONCLUSIONS: The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay. PMID:27251820

  6. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

    Directory of Open Access Journals (Sweden)

    Ernesto Melkonian

    2017-01-01

    Full Text Available Background: The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. Patients and Methods: The review of an institutional review board (IRB-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. Results: Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25. The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95, and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24 in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3% were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44. Conclusions: The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.

  7. Changes in the distance between carina and orotracheal tube during open or videolaparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Giovani de Figueiredo Locks

    2015-10-01

    Full Text Available ABSTRACTOBJECTIVE: To examine whether there are changes in the distance between the orotracheal tube and carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty.METHODS: 60 patients undergoing bariatric surgery by two techniques: open (G1 or videolaparoscopic (G2 gastroplasty were studied. After tracheal intubation, adequate ventilation of both hemitoraxes was confirmed by lung auscultation. The distance orotracheal tube-carina was estimated with the use of a fiber bronchoscope before and after installation of orthostatic retractors in G1 or before and after insufflation of pneumoperitoneum in patients in G2.RESULTS: G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubation were detected in either group. The mean orotracheal tube-carina distance variation was estimated in -0.03 cm (95% CI 0.06 to -0.13 in the group of patients undergoing open gastroplasty and in -0.42 cm (95% CI -0.56 to -1.4 in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5 cm to -1.6 cm in patients undergoing open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery.CONCLUSIONS: There was no significant change in orotracheal tube-CA distance after placement of orthostatic retractors in patients undergoing open gastroplasty. There was a reduction in orotracheal tube-CA distance after insufflation of pneumoperitoneum in patients undergoing videolaparoscopic gastroplasty. We recommend attention to lung auscultation and to signals of ventilation monitoring and reevaluation of orotracheal tube placement after peritoneal insufflation.

  8. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery.

    Science.gov (United States)

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-09-01

    Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P cardiac risk. These HR associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. FACTORS AFFECTING CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN SURGERY IN A TERTIARY HOSPITAL IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2016-01-01

    Full Text Available BACKGROUND Laparoscopic Cholecystectomy (LC is most commonly performed hepatobiliary minimally access surgery worldwide. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstone diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed and for whom conversion to open surgery is required. The NIH postulated that the outcome of LCs would be greatly influenced by surgeon-specific factors such as training, experience, skill and judgment.(1 In addition numerous patient and disease-related factors, such as male gender, obesity, old age (>65, prior abdominal surgery, acute cholecystitis, choledocholithiasis and anomalous anatomy have been reported as significant risk factors for conversion to the open procedure.(2-5 Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should not enter the Operating Room with idea of opening the abdomen in difficult case as failure or insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before and during surgery using the clinical and ultrasonographic criteria in our setup. MATERIALS AND METHODS A prospective study was performed in SRM Medical College and Hospital of all patients who underwent LC during (May 2013 to October 2015 was performed. The LCs were performed by 12 trained certified surgeons. The decision to convert to open was made by the individual surgeon and the reason for conversion was extracted from the patient’s medical record (operative report prospectively. The inclusion and exclusion criteria defined. All operations were performed with the patient under general anesthesia with endotracheal intubation

  10. Results of the open surgery after endoscopic basketimpaction during ERCP procedure

    Institute of Scientific and Technical Information of China (English)

    Sezgin Yilmaz; Ogun Ersen; Taner Ozkececi; Kadir S Turel; Serdar Kokulu; Emre Kacar; Murat Akici; Murat Cilekar; Ozgur Kavak; Yuksel Arikan

    2015-01-01

    AIM: To report the results of open surgery for patientswith basket impaction during endoscopic retrogradecholangiopancreatography (ERCP) procedure.METHODS: Basket impaction of either classicalDormia basket or mechanical lithotripter basket with anentrapped stone occurred in six patients. These patientswere immediately operated for removal of stone(s) andimpacted basket. The postoperative course, length ofhospital stay, diameter of the stone, complication andthe surgical procedure of the patients were reportedretrospectively.RESULTS: Six patients (M/F, 0/6) were operateddue to impacted basket during ERCP procedure. Themean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediatelyafter the failed ERCP procedure by making a right Yilmaz S et al . Surgery for basket impaction during ERCP subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

  11. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks

    Directory of Open Access Journals (Sweden)

    Shalchi Rosita

    2009-08-01

    Full Text Available Abstract Background The intent of this study was to predict conversion of laparoscopic cholecystectomy (LC to open surgery employing artificial neural networks (ANN. Methods The retrospective data of 793 patients who underwent LC in a teaching university hospital from 1997 to 2004 was collected. We employed linear discrimination analysis and ANN models to examine the predictability of the conversion. The models were validated using prospective data of 100 patients who underwent LC at the same hospital. Results The overall conversion rate was 9%. Conversion correlated with experience of surgeons, emergency LC, previous abdominal surgery, fever, leukocytosis, elevated bilirubin and alkaline phosphatase levels, and ultrasonographic detection of common bile duct stones. In the validation group, discriminant analysis formula diagnosed the conversion in 5 cases out of 9 (sensitivity: 56%; specificity: 82%; the ANN model diagnosed 6 cases (sensitivity: 67%; specificity: 99%. Conclusion The conversion of LC to open surgery is effectively predictable based on the preoperative health characteristics of patients using ANN.

  12. The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial.

    LENUS (Irish Health Repository)

    Neary, Peter M

    2012-01-01

    Thyroid drains following thyroid surgery are routinely used despite minimal supportive evidence. Our aim in this study is to determine the impact of routine open drainage of the thyroid bed postoperatively on ultrasound-determined fluid accumulation at 24 hours.

  13. Pulse-pressure variation predicts fluid responsiveness during heart displacement for off-pump coronary artery bypass surgery.

    Science.gov (United States)

    Lee, Jong-Hwan; Jeon, Yunseok; Bahk, Jae-Hyon; Gil, Nam-Su; Kim, Ki-Bong; Hong, Deok Man; Kim, Hyun Joo

    2011-12-01

    The aim of this study was to evaluate the ability of pulse-pressure variation to predict fluid responsiveness during heart displacement for off-pump coronary artery bypass surgery using receiver operating characteristic analysis. A prospective study. A clinical study in a single cardiac anesthesia institution. Thirty-five patients undergoing elective off-pump coronary artery bypass surgery. Central venous pressure, pulmonary arterial occlusion pressure, pulse-pressure variation, and cardiac index were measured 5 minutes after revascularization of the left anterior descending coronary artery and before heart displacement. Immediately after heart displacement for revascularization of the left circumflex artery, and 10 minutes after fluid loading with hydroxyethyl starch 6% (10 mL/kg) during heart displacement, the measurements were repeated. Patients whose cardiac indices increased by ≥15% from fluid loading were defined as responders. After heart displacement, only pulse-pressure variation showed significant difference between the responders and nonresponders (13.48 ± 6.42 v 7.33 ± 3.81, respectively; p fluid responsiveness (area under the curve = 0.839, p = 0.0001). Pulse-pressure variation >7.69% identified the responders, with a sensitivity of 86% and a specificity of 83%. Pulse-pressure variation successfully predicted fluid responsiveness and would be useful in guiding fluid management during heart displacement for off-pump coronary artery bypass surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Clinical safety and outcomes of laparoscopic surgery versus open surgery for palliative resection of primary tumors in patients with stage IV colorectal cancer: a meta-analysis.

    Science.gov (United States)

    Zhou, Min-Wei; Gu, Xiao-Dong; Xiang, Jian-Bin; Chen, Zong-You

    2016-05-01

    This study was performed to compare the clinical safety and outcomes of laparoscopic versus open surgery for primary tumors in patients with stage IV colorectal cancer. Pertinent studies were selected from the MEDLINE, EMBASE, and Cochrane Library databases; references from published articles; and reviews. Both prospective and retrospective studies were included for the meta-analysis. Clinical outcomes included safety, complications, mortality, and survival. Six trials involving 1802 patients were included. The operative time was longer for laparoscopic than for open surgery (mean difference (MD) = 44.20, 95 % confidence interval (CI) 17.31-71.09, Z = 3.22, P = 0.001). Laparoscopic surgery was also associated with fewer postoperative complications (odds ratio 0.53, 95 % CI 0.37-0.78, Z = 3.29, P = 0.001) and less operative blood loss (MD = -65.40, 95 % CI -102.37 to -28.42, Z = 3.47, P = 0.0005). Median survival ranged from 11.4 to 30.1 months. The total hospital stay was 1.68 days shorter for laparoscopic than for open surgery (95 % CI -1.83 to -1.53, Z = 21.64, P < 0.00001). Laparoscopic surgery for palliative resection of stage IV colorectal cancer is associated with better perioperative outcomes than open surgery.

  15. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

    OpenAIRE

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2016-01-01

    Background Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italia...

  16. Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-xiao; XU Jian-ping; GE Yi-peng; WEI Yu; YANG Yan; LIU Feng; SHI Yi

    2011-01-01

    Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation (FuwaiSCORE), the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery (the STS model), the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the initial Parsonnet's score (the Parsonnet model) in predicting prolonged intensive care unit (ICU) stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow (H-L) goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic (ROC) curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P>0.1. The area under ROC curve of the FuwaiSCORE was 0.81 (95%C/0.78-0.84). Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.

  17. Quality of life can both influence and be an outcome of general health perceptions after heart surgery

    Directory of Open Access Journals (Sweden)

    Veenstra Marijke

    2007-05-01

    Full Text Available Abstract Background Our aim was to investigate the existence of a reciprocal relationship between patients' assessment of quality of life and their appraisal of health. If present, this relationship will interfere with the interpretation of heart surgery's effect on overall quality of life. Methods Path analysis was used to investigate reciprocal causal relationships between general health perceptions and overall quality of life before and after heart surgery. Longitudinal data from a study of coronary artery bypass surgery were used to model lagged, cross-lagged, and simultaneous paths over four time-points of assessment from before surgery to one year afterwards. The conceptual framework for the analysis was the Wilson and Cleary causal pathway model. General health perceptions were measured with the Short Form 36. Overall quality of life was measured with i a single question regarding life satisfaction and ii the multi-item Quality of Life Survey. Results Acceptable model fit was obtained for reciprocal causation between general health perceptions and overall quality of life. Regression coefficients changed over different phases of rehabilitation. Serial correlation accounted for much of the variance within variables over time. Conclusion The present analysis demonstrates that unidirectional models of causality are inadequate to explain the effect of heart surgery on overall quality of life. Overall quality of life can causally influence as well as be an outcome of health status after coronary artery bypass surgery.

  18. Percutaneous nephrolithotomy with one-shot dilation method: Is it safe in patients who had open surgery before?

    Science.gov (United States)

    Süelözgen, Tufan; Isoglu, Cemal Selcuk; Turk, Hakan; Yoldas, Mehmet; Karabicak, Mustafa; Ergani, Batuhan; Boyacioglu, Hayal; Ilbey, Yusuf Ozlem; Zorlu, Ferruh

    2016-01-01

    Introduction: This study aimed to evaluate whether one-shot dilatation technique is as safe in patients with a history of open-stone surgery as it is in patients without previous open-stone surgery. Methods: Between January 2007 and February 2015, 82 patients who underwent percutaneous nephrolithotomy (PNL) surgery with one-shot dilation technique who previously had open-stone surgery were retrospectively reviewed and evaluated (Group 1). Another 82 patients were selected randomly among patients who had PNL with one-shot dilation technique, but with no history of open renal surgery (Group 2). Age, gender, type of kidney stone, duration of surgery, radiation exposure time, and whether or not there was any bleeding requiring perioperative and postoperative transfusion were noted for each patient. Results: The stone-free rates, operation and fluoroscopy time, and peroperative and postoperative complication rates were similar in both groups (p>0.05). Conclusions: Our experience indicated that PNL with one-shot dilation technique is a reliable method in patients with a history of open-stone surgery. PMID:27217866

  19. Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions.

    Directory of Open Access Journals (Sweden)

    Gilad Horowitz

    Full Text Available OBJECTIVE: To compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic medical center. PATIENTS: Sixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011. INTERVENTIONS: Open excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59% or frontal cranialization (n = 28, 41%. MAIN OUTCOME MEASURES: The prevalence of post-surgical complications and secondary mucocele formation were compiled. RESULTS: Pathologies included osteoma (n = 34, 49%, mucocele (n = 27, 39%, fibrous dysplasia (n = 6, 9%, and encephalocele (n = 2, 3%. Complications included skin infections (n = 6, postoperative cutaneous fistula (n = 1, telecanthus (n = 4, diplopia (n = 3, nasal deformity (n = 2 and epiphora (n = 1. None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (P<0.0001. CONCLUSION: Cranialization of the frontal sinus appears to be a good option for prevention of secondary mucocele development after open excision of benign frontal sinus lesions.

  20. Open Access Publishing: A Study of Current Practice in Oral and Maxillofacial Surgery Research.

    Science.gov (United States)

    Tahim, Arpan; Bansal, Hitesh; Goodson, Alexander M C; Payne, Karl F B; Sabharwal, Sanjeeve

    2016-12-01

    Open access (OA) publication has become an increasingly common route for dissemination of scientific research findings. However, it remains a contentious issue with continued debate as to its impact on the peer-review process and a potential change in the quality of subsequent evidence published. There is little research that looks into OA in oral and maxillofacial surgery. We investigated the OA policy in the 30 relevant journals listed in the Institute for Scientific Information Web of Knowledge journal citation report, comparing bibliometric data and quality of evidence produced in journals offering OA and those with subscription-only policies. 3474 articles were graded for evidence level and the results correlated to journal OA status. 76.7 % of journals offered authors OA services. There was no difference between impact factor, self-citation rate, total citations or quality of evidence between OA and subscription journals. These findings should send clear messages to both clinicians and researchers and should re- assure readers that scientific findings that are disseminated in open access form do not differ in quality to those in subscription-only format. It should reinforce that open access formats are a credible way to display research findings in oral and maxillofacial surgery.

  1. Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions.

    Science.gov (United States)

    Horowitz, Gilad; Amit, Moran; Ben-Ari, Oded; Gil, Ziv; Abergel, Abraham; Margalit, Nevo; Cavel, Oren; Wasserzug, Oshri; Fliss, Dan M

    2013-01-01

    To compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus. Retrospective case series. Tertiary academic medical center. Sixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011. Open excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59%) or frontal cranialization (n = 28, 41%). The prevalence of post-surgical complications and secondary mucocele formation were compiled. Pathologies included osteoma (n = 34, 49%), mucocele (n = 27, 39%), fibrous dysplasia (n = 6, 9%), and encephalocele (n = 2, 3%). Complications included skin infections (n = 6), postoperative cutaneous fistula (n = 1), telecanthus (n = 4), diplopia (n = 3), nasal deformity (n = 2) and epiphora (n = 1). None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (Pmucocele development after open excision of benign frontal sinus lesions.

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

    Directory of Open Access Journals (Sweden)

    Vladimir Pichugin

    2014-12-01

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

  3. Ventriculoperitoneal Shunting Surgery with Open Distal Shunt Catheter Placement in the Treatment of Hydrocephalus.

    Science.gov (United States)

    Zhang, Yang; Zhu, Xiaobo; Zhao, Jinchuan; Hou, Kun; Gao, Xianfeng; Sun, Yang; Wang, Wei; Zhang, Xiaona

    2015-11-01

    Ventriculoperitoneal shunting (VPS) is a major therapy for hydrocephalus, but has a significant risk of device malfunctioning. In this study, we explored a novel distal shunt catheter placement method in VPS for the treatment of hydrocephalus. Five patients with different etiologies of hydrocephalus underwent VPS with open distant shunt catheter attached outside. We analyzed different variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique, postoperative complications) and occurrence of shunt failure and infection. All hydrocephalus patients who received the distal shunt catheter placed outside can undergo regular VPS again after the condition improves. The modified VPS in the treatment of hydrocephalus with the distal shunt catheter placed outside could potentially reduce the necessity of repeat surgery for addressing the complications caused by catheter obstruction and infections, reduce the chance of adhesions, and would be of benefit to those patients who need future revisions.

  4. Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome.

    Science.gov (United States)

    Kawahito, Koji; Aizawa, Kei; Oki, Shinichi; Saito, Tsutomu; Misawa, Yoshio

    2016-06-01

    Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index 3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.

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

    Science.gov (United States)

    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.

  6. Heart rate variability and cardio-respiratory coupling during sleep in patients prior to bariatric surgery.

    Science.gov (United States)

    Trimer, R; Cabiddu, R; Mendes, R G; Costa, F S M; Oliveira, A D; Borghi-Silva, A; Bianchi, A M

    2014-03-01

    Obesity is associated with increased cardiac risk of morbidly and mortality and for the development and progression of obstructive sleep apnea (OSA). Severity of obesity negatively affects the heart rate variability (HRV) in patients with indication for bariatric surgery (BS). The purpose of this study is to determine if the severity of obesity alters the autonomic cardiac regulation and the cardio-respiratory coupling during sleep using spectral analysis of HRV and respiration variability signals (RS) in patients prior to BS. Twenty-nine consecutive preoperative BS and ten subjects (controls) underwent polysomnography. The spectral and cross-spectral parameters of the HRV and RS were computed during different sleep stages (SS). Spectral analysis of the HRV and RV indicated lower respiration regularity during sleep and a lower HRV in obese patients (OP) during all SS when compared with controls (p sleep and higher HF power (p sleep, and these alterations are related with severity of obesity and OSA parameters.

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

    Science.gov (United States)

    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.

  8. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

    Directory of Open Access Journals (Sweden)

    Manu Raj

    Full Text Available The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014 in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.The median age was 8.2 months (IQR: 3.0- 36.0 months. Most families belonged to upper middle (43.0% and lower middle (35.7% socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139 [I$ 11989 (IQR: 9696-15804], which was 0.93 (IQR: 0.52-1.49 times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50 and job-days was 15 (IQR: 11-24. Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  9. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

    Science.gov (United States)

    Raj, Manu; Paul, Mary; Sudhakar, Abish; Varghese, Anu Alphonse; Haridas, Aareesh Chittulliparamb; Kabali, Conrad; Kumar, Raman Krishna

    2015-01-01

    The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective. Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule. The median age was 8.2 months (IQR: 3.0- 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139) [I$ 11989 (IQR: 9696-15804)], which was 0.93 (IQR: 0.52-1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50) and job-days was 15 (IQR: 11-24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery. Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  10. 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.

  11. Gallbladder removal - open

    Science.gov (United States)

    Cholecystectomy - open; Surgery - gallbladder - open ... a medical instrument called a laparoscope ( laparoscopic cholecystectomy ). Open gallbladder surgery is used when laparoscopic surgery cannot ...

  12. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.

    Science.gov (United States)

    Niitsu, Hiroaki; Hinoi, Takao; Kawaguchi, Yasuo; Ohdan, Hideki; Hasegawa, Hirotoshi; Suzuka, Ichio; Fukunaga, Yosuke; Yamaguchi, Takashi; Endo, Shungo; Tagami, Soichi; Idani, Hitoshi; Ichihara, Takao; Watanabe, Kazuteru; Watanabe, Masahiko

    2016-01-01

    It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.

  13. Effect of heart rate on the hemodynamics of bileaflet mechanical heart valves' prostheses (St. Jude Medical) in the aortic position and in the opening phase: A computational study.

    Science.gov (United States)

    Jahandardoost, Mehdi; Fradet, Guy; Mohammadi, Hadi

    2016-03-01

    To date, to the best of the authors' knowledge, in almost all of the studies performed around the hemodynamics of bileaflet mechanical heart valves, a heart rate of 70-72 beats/min has been considered. In fact, the heart rate of ~72 beats/min does not represent the entire normal physiological conditions under which the aortic or prosthetic valves function. The heart rates of 120 or 50 beats/min may lead to hemodynamic complications, such as plaque formation and/or thromboembolism in patients. In this study, the hemodynamic performance of the bileaflet mechanical heart valves in a wide range of normal and physiological heart rates, that is, 60-150 beats/min, was studied in the opening phase. The model considered in this study was a St. Jude Medical bileaflet mechanical heart valve with the inner diameter of 27 mm in the aortic position. The hemodynamics of the native valve and the St. Jude Medical valve were studied in a variety of heart rates in the opening phase and the results were carefully compared. The results indicate that peak values of the velocity profile downstream of the valve increase as heart rate increases, as well as the location of the maximum velocity changes with heart rate in the St. Jude Medical valve model. Also, the maximum values of shear stress and wall shear stresses downstream of the valve are proportional to heart rate in both models. Interestingly, the maximum shear stress and wall shear stress values in both models are in the same range when heart rate is valve model when heart rate is >90 beats/min (up to ~40% growth compared to that of the native valve). The findings of this study may be of importance in the hemodynamic performance of bileaflet mechanical heart valves. They may also play an important role in design improvement of conventional prosthetic heart valves and the design of the next generation of prosthetic valves, such as percutaneous valves.

  14. Laparoscopic vs. open surgery for T4 colon cancer: A propensity score analysis.

    Science.gov (United States)

    de'Angelis, Nicola; Vitali, Giulio Cesare; Brunetti, Francesco; Wassmer, Charles-Henri; Gagniere, Charlotte; Puppa, Giacomo; Tournigand, Christophe; Ris, Frédéric

    2016-11-01

    The study aimed to compare, using propensity score matching (PSM) analyses, the short- and long-term results of laparoscopic colectomy (LC) versus open colectomy (OC) in a bicentric cohort of patients with T4 colon cancer. This is a retrospective PSM analysis of consecutive patients undergoing elective LC or OC for pT4 colon cancer (TNM stage II/III) between 2005 and 2014. Overall, 237 patients were selected. After PSM, 106 LC-and 106 OC-matched patients were compared. LC was associated with longer operative time and lower blood loss than OC (220 vs. 190 min, p colon cancer similar to open surgery and can be considered a safe and feasible alternative approach that confers the advantage of a faster recovery.

  15. Evaluation of the left ventricular reserve by dynamic exercise echocardiography after surgery for valvular heart diseases.

    Directory of Open Access Journals (Sweden)

    Sano,shunji

    1989-08-01

    Full Text Available Dynamic ergometer exercise in a supine position was applied to 64 patients more than 1 year after valvular heart surgery, and the left ventricular reserve was evaluated echocardiographically. The left ventricular reserve declined in the mitral stenosis-mitral valve replacement group, while it was better maintained in the mitral stenosis-mitral commissurotomy, aortic regurgitation and aortic stenosis groups. The patients were divided into 3 groups depending on whether the percentage increase during exercise of stroke index, an index of left ventricular pump function, increased, unchanged, or decreased. The percentage increase of mean velocity of circumferential fibre shortening (y and that of left ventricular end-diastolic diameter (x during exercise were plotted for each group. The increased group was isolated from the unchanged group by the line of y = -5.02x + 30.1; the unchanged group was isolated from the decreased group by that of y = -5.68x-10.0, and the increased and unchanged groups were clearly isolated from the decreased group by that of y = -6.86x-4.76. We conclude that dynamic ergometer exercise echocardiography is useful for evaluating the left ventricular reserve of postoperative patients with valvular heart disease. It was also thought that the subclinical state of cardiac failure can be effectively detected by the present method.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    -educational consultations (intervention) versus usual care without structured physical exercise or psycho-educational consultations (control). Primary outcome was physical capacity measured by VO2 peak and secondary outcome was self-reported mental health measured by Short Form-36. Results: 76% were men, mean age 62 years.......40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Conclusions: Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other......, 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...

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

    Science.gov (United States)

    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.

  18. Current Surgical Outcomes of Congenital Heart Surgery for Patients With Down Syndrome in Japan.

    Science.gov (United States)

    Hoashi, Takaya; Hirahara, Norimichi; Murakami, Arata; Hirata, Yasutaka; Ichikawa, Hajime; Kobayashi, Junjiro; Takamoto, Shinichi

    2017-09-12

    Current surgical outcomes of congenital heart surgery for patients with Down syndrome are unclear.Methods and Results:Of 29,087 operations between 2008 and 2012 registered in the Japan Congenital Cardiovascular Surgery Database (JCCVSD), 2,651 were carried out for patients with Down syndrome (9%). Of those, 5 major biventricular repair procedures [ventricular septal defect repair (n=752), atrioventricular septal defect repair (n=452), patent ductus arteriosus closure (n=184), atrial septal defect repair (n=167), tetralogy of Fallot (TOF) repair (n=108)], as well as 2 major single ventricular palliations [bidirectional Glenn (n=21) and Fontan operation (n=25)] were selected and their outcomes were compared. The 90-day and in-hospital mortality rates for all 5 major biventricular repair procedures and bidirectional Glenn were similarly low in patients with Down syndrome compared with patients without Down syndrome. On the other hand, mortality after Fontan operation in patients with Down syndrome was significantly higher than in patients without Down syndrome (42/1,558=2.7% vs. 3/25=12.0%, P=0.005). Although intensive management of pulmonary hypertension is essential, analysis of the JCCVSD revealed favorable early prognostic outcomes after 5 major biventricular procedures and bidirectional Glenn in patients with Down syndrome. Indication of the Fontan operation for patients with Down syndrome should be carefully decided.

  19. [Outcomes of home monitoring after palliative cardiac surgery in infants with congenital heart disease].

    Science.gov (United States)

    Kim, Sang Wha; Uhm, Ju Yeon; Im, Yu Mi; Yun, Tae Jin; Park, Jeong Jun; Park, Chun Soo

    2014-04-01

    Common conditions, such as dehydration or respiratory infection can aggravate hypoxia and are associated with interstage mortality in infants who have undergone palliative surgery for congenital heart diseases. This study was done to evaluate the efficacy of a home monitoring program (HMP) in decreasing infant mortality. Since its inception in May 2010, all infants who have undergone palliative surgery have been enrolled in HMP. This study was a prospective observational study and infant outcomes during HMP were compared with those of previous comparison groups. Parents were trained to measure oxygen saturation, body weight and feeding volume and to contact the hospital through the hotline for emergency situations. Telephone counseling was conducted by clinical nurse specialists every week post discharge. Forty-one infants were enrolled in HMP. Nine hundred telephone counseling sessions were conducted. Seventy-three infants required telephone triage with the most common conditions being gastrointestinal (50.7%) and respiratory symptoms (32.9%). With HMP intervention, interstage mortality decreased from 18.6% (8/43) to 9.8% (4/41) (χ²=1.15, p=.283). Results indicate that active measures and treatments using the HMP decrease mortality rates, however further investigation is required to identify various factors that contribute to hemodynamic complications during the interstage period.

  20. National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

    Science.gov (United States)

    Carson, Jeffrey S; Smith, Lynette; Are, Madhuri; Edney, James; Azarow, Kenneth; Mercer, David W; Thompson, Jon S; Are, Chandrakanth

    2011-12-01

    The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P pediatric surgery (P surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Visser, J.J.; Williams, M.A.; Kievit, J.; Bosch, J.L.; Hunink, M.G.M.; Teijink, J.A.; Verhoeven, E.L.; Smet, A.A. de; Geelkerken, R.H.; Steyerberg, E.W.; Sambeek, M.R. van

    2009-01-01

    OBJECTIVE: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surg

  2. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial

    DEFF Research Database (Denmark)

    Andersson, J; Angenete, E; Gellerstedt, M

    2013-01-01

    Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12¿months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial....

  3. MODIFIED SCANDINAVIAN TECHNIQUE – AN OPEN ACCESS TECHNIQUE FOR PRIMARY TROCAR IN LAPAROSCOPIC SURGERY

    Directory of Open Access Journals (Sweden)

    Dhamotharan

    2016-03-01

    Full Text Available BACKGROUND This study derives the advantages of Modified Scandinavian technique over the other techniques in laparoscopy. METHODOLOGY This is a prospective study involving 50 patients presenting with acute or chronic abdominal conditions who underwent laproscopic surgeries with Modified Scandinavian technique at Government Rajaji Hospital,Madurai between September 2013- 2015. Fifty cases with acute or chronic abdominal conditions like calculous cholecystitis, cholelithiasis, acute or subacute or chronic appendicitis, carcinoma rectum, etc without comorbidities were selected and studied in detail. A structured profoma was used to collect relevant information for each induvidual patient selected. RESULTS Out of 50 patients, none of them had intraoperative complications like bowel injury, vascular injury, preperitoneal insufflation or gas embolism. Only one patient had minor wound infection. 38 patients were followed up. No patient had any sequelae of incisional hernia or other complications. CONCLUSION According to this study, Modified Scandinavian open access technique is the safest technique for all patients particularly for thin individuals, suspected TB and patients with previous abdominal surgery. It is fast and easy to perform when compared with Hasson open technique. 1

  4. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery.

    Science.gov (United States)

    Haigentz, Missak; Silver, Carl E; Corry, June; Genden, Eric M; Takes, Robert P; Rinaldo, Alessandra; Ferlito, Alfio

    2009-12-01

    The widespread availability of novel primary treatment approaches against oropharyngeal cancers has provided several potentially curative surgical and nonsurgical treatment options for patients, generating both hope and controversy. As treatment is usually curative in intent, management considerations must include consideration of primary tumor and nodal disease control as well as long-term toxicities and functional outcomes. Anatomical and functional organ preservation (speech and deglutition) remains of paramount importance to patients with oropharyngeal cancer and the physicians involved in their care, accounting for the growing popularity of chemoradiotherapy and transoral surgical techniques for this indication. These novel approaches have greatly diminished the role of open surgery as initial therapy for oropharyngeal cancers. Open surgery which is often reserved for salvage on relapse, may still be an appropriate therapy for certain early stage primary lesions. The growing treatment armamentarium requires careful consideration for optimal individualized care. The identification of oncogenic human papillomavirus as a predictive and prognostic marker in patients with oropharyngeal cancer has great potential to further optimize the choice of treatment. In this review, novel primary therapies against oropharyngeal squamous cell carcinoma are presented in the context of anatomical, quality of life, and emerging biological considerations.

  5. Alterations in antioxidant and oxidant status of children after on-pump surgery for cyanotic and acyanotic congenital heart diseases.

    Science.gov (United States)

    Altin, Firat H; Yildirim, Hayriye A; Tanidir, Ibrahim C; Yildiz, Okan; Kahraman, Meliha Z; Ozturk, Erkut; Celebi, Sinem B; Kyaruzi, Mugisha; Bakir, İhsan

    2017-03-01

    Oxidative stress refers to an imbalance between reactive oxidative species and antioxidants. In this case-controlled, prospective, observational study, we investigated the total oxidant status, total antioxidant status, oxidative stress index, and albumin and C-reactive protein levels of children with cyanotic and acyanotic congenital heart diseases who had undergone on-pump cardiac surgery. The study groups consisted of 60 patients with congenital heart disease, who were operated under cardiopulmonary bypass, and a control group of 30 healthy individuals. The patients were classified into two groups. Among them, one was a patient group that consisted of 30 patients with acyanotic congenital heart disease and the other group consisted of 30 patients with cyanotic congenital heart disease. In the patient groups, blood samples were collected before surgery and at one and 24 hours following surgery. In control groups, blood samples were collected once during hospital admission. No statistically significant differences were found between the groups in terms of baseline total oxidant status, total antioxidant status, and oxidative stress index values. Regarding the postoperative first-hour and 24-hour total oxidant status and total antioxidant status levels as well as oxidative stress index values, there were no significant differences between the groups, except for an increase in total antioxidant status levels (p=0.002) 24 hours after surgery in cyanotic patients. There was no difference between oxidative stress status of cyanotic and acyanotic congenital heart disease patients and healthy individuals. Oxidative stress status of cyanotic and acyanotic patients does not change after cardiac surgery under cardiopulmonary bypass.

  6. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial.

    Science.gov (United States)

    Sibilitz, Kirstine L; Berg, Selina K; Rasmussen, Trine B; Risom, Signe Stelling; Thygesen, Lau C; Tang, Lars; Hansen, Tina B; Johansen, Pernille Palm; Gluud, Christian; Lindschou, Jane; Schmid, Jean Paul; Hassager, Christian; Køber, Lars; Taylor, Rod S; Zwisler, Ann-Dorthe

    2016-12-15

    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 valve surgery. The trial was an investigator-initiated, randomised superiority trial (The CopenHeartVR trial, VR; valve replacement or repair). We randomised 147 patients after heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting of physical exercise and monthly psycho-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. 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=0.40) or the exploratory physical and mental outcomes. Cardiac rehabilitation increased the occurrence of self-reported non-serious adverse events (11/72 vs 3/75, p=0.02). Cardiac rehabilitation after heart valve surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. Further research is needed to justify cardiac rehabilitation in this patient group. NCT01558765, Results. 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/.

  7. The influence of country of origin on engagement in self-care behaviours following heart surgery: a descriptive correlational study.

    Science.gov (United States)

    Fredericks, Suzanne

    2012-08-01

    The aim of this study was to determine whether an individual's country of origin influenced performance of self-care behaviours after heart surgery. Patients are required to perform self-care behaviours following cardiovascular surgery. Usual care encompasses a patient education initiative that addresses self-care behaviour performance. Within Canada, current heart surgery patient education efforts have been designed and evaluated using homogenous samples that self-identify their country of origin as England, Ireland or Scotland. However, approximately 42·6% of Canadian cardiovascular surgical patients self-identify their country of origin as India or China. Thus, current cardiovascular surgery patient education initiatives may not be applicable to all patients undergoing heart surgery, which may result in decreased patient outcomes such as performance of self-care behaviours. This descriptive study. A convenience sample of 90 patients who underwent heart surgery at one of two university-affiliated teaching hospitals, representing individuals of diverse backgrounds. Point-biserial correlational analysis was conducted to determine the relationship between country of origin and performance of self-care behaviours. Findings indicate individuals who self-identified their country of origin as England or Ireland were associated with a higher score on the number of self-care behaviours performed (p study provides preliminary evidence to suggest country of origin influences the amount of self-care behaviours individuals will perform. Patient education initiatives should incorporate the values, beliefs, attitudes and customs reflective of an individual's country of origin to enhance the likelihood of producing desired outcomes. © 2012 Blackwell Publishing Ltd.

  8. Factors Influencing Selection of Vaginal, Open Abdominal, or Robotic Surgery to Treat Apical Vaginal Vault Prolapse

    Science.gov (United States)

    Anand, Mallika; Weaver, Amy L.; Fruth, Kristin M.; Gebhart, John B.

    2016-01-01

    Objectives To determine factors influencing selection of Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), or robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. Methods We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery between January 1, 2000, and June 30, 2012, at our institution. Baseline characteristics and explicit selection factors were abstracted from the electronic medical records. Factors were compared between groups using χ2 tests for categorical variables, ANOVA for continuous variables, and Kruskal-Wallis tests for ordinal variables. Results Among the 512 patients identified who met inclusion criteria, the MMC group (n=174) had more patients who were older, American Society of Anesthesiologists class 3+ or greater, had anterior vaginal prolapse grade 3+, desired to avoid abdominal surgery, and did not desire a functional vagina. Patients in the ASC (n=237) and RSC (n=101) groups had more failed prolapse surgeries, suspected abdominopelvic pathologic processes, and chronic pain. Advanced prolapse was more frequently cited as an explicit selection factor for ASC than for either MMC or RSC. Conclusions The most common factors that influenced the type of apical vaginal vault prolapse surgery overlapped with characteristics that differed at baseline. In general, MMC was chosen for advanced anterior vaginal prolapse and baseline characteristics that increased surgical risks, ASC for advanced apical prolapse, and ASC or RSC for recurrent prolapse, suspected abdominal pathology, and patients with chronic pain or lifestyles including heavy lifting. Thus, efforts should be made to attempt to control for selection bias when comparing these procedures. PMID:26945273

  9. Does ICU structure impact patient outcomes after congenital heart surgery? A critical appraisal of "care models and associated outcomes in congenital heart surgery" by Burstein et al (Pediatrics 2011; 127: e1482-e1489).

    Science.gov (United States)

    Hilvers, Pamela S; Thammasitboon, Satid

    2014-01-01

    To review the findings and discuss the implications of different ICU care models on morbidity and mortality in pediatric patients after congenital heart surgery. The electronic PubMed database was used to perform the clinical query, as well as to search for additional pertinent literature. The article by Burstein DS et al "Care Models and Associated Outcomes in Congenital Heart Surgery. Pediatrics 2011; 15:77-81" was selected for critical appraisal and literature review. The authors evaluated in-hospital mortality, postoperative length of stay, and postoperative complications in pediatric patients after congenital heart surgery and compared the odds of these outcomes by model of care received (cardiac ICU or mixed ICU). The data for the study was extracted from the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) database. Overall, the cardiac ICU group represented hospitals with higher surgical volumes and included more patients with high-risk defects. After multivariate analysis, the adjusted in-hospital mortality was not associated with the care model (cardiac ICU vs. ICU). The only significant finding was a lower morality in the STS-EACTS risk category 3 (odds ratio, 0.47 [95% CI, 0.25-0.86]). There were no significant differences between groups for adjusted postoperative length of stay or postoperative complications. This paper suggests that the composition of the ICU is not a critical factor in determining outcomes after congenital heart surgery. Other factors, such as expertise of the nurses, physicians, and surgeons, as well as technical performance, should be considered.

  10. Prothrombotic SERPINC1 gene polymorphism may affect heparin sensitivity among different ethnicities of Chinese patients receiving heart surgery.

    Science.gov (United States)

    Wang, Jiang; Ma, Hai-Ping; Ti, Ai Lai Ti Ta Lai; Zhang, Yong-Qiang; Zheng, Hong

    2015-11-01

    The purpose of this study was to investigate a possible correlation between single-nucleotide polymorphisms (SNPs) of the antithrombin (gene, SERPINC1, and perioperative sensitivity to heparin in patients receiving heart surgery. The SERPINC1 genotype and allele frequency, coagulation parameters 24 hours before and after surgery, and clinical findings were compared among 3 ethnic groups, Han, Uighur, and Kazakh, patientswho received heart surgery. In Han patients, longer coagulation time as well as higher heparin and protamine dosage was observed. SERPINC1 gene sequencing identified 2 mutations in exon 5, g.981A>G (rs5877) and g.1011A>G (rs5878). The minor allele frequency of allele (A>G) for rs5877 and rs5878 was higher in the Han patients and was significantly different among the ethnic groups (P = .004 and P = .006, respectively). The increased SERPINC1 SNP frequency among Han patients receiving heart surgery might contribute to the differences in their perioperative sensitivity to heparin.

  11. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.

    Science.gov (United States)

    2015-06-13

    The benefit of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the effect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18-75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590. Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassified the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; pcoronary heart disease increased (1·09, 1·02-1·17; p=0·0172), the certainty increased (1·79, 1·62-1·96; pcoronary heart disease. This changed planned investigations (15% vs 1%; pcoronary heart disease, CTCA clarifies the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funded the trial

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

    Science.gov (United States)

    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

  13. 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.

  14. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

    Science.gov (United States)

    Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

    2016-12-01

    OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy

  15. Outcome of noncardiac surgery in children with congenital heart disease performed outside a cardiac center.

    Science.gov (United States)

    Ng, Shermayne M; Jin, Xi; Yates, Robert; Kelsall, Anthony W R

    2016-02-01

    The objective of this study was to review the outcome of children with congenital heart disease (CHD) undergoing noncardiac surgery requiring general anesthesia (GA) in a tertiary pediatric center between January 2010 and December 2012. A retrospective case note review of children <16years of age with confirmed CHD undergoing a surgical or interventional procedure requiring GA was performed. Patients were categorized into three risk groups according to White and Peyton's anesthetic risk classification of children with CHD undergoing noncardiac surgery [Critical Care and Pain 2012;12:17-22]. 117 children with CHD were identified with a total of 240 procedures conducted. 36 procedures were conducted in the high-risk group, 135 in the intermediate-risk group, and 69 in the low-risk group. 40% of these were major operations such as small bowel and colonic procedures. Overall mortality rate at 7days and 30days was 0% and 0.4%, respectively, with a 1% mortality rate in minor procedures and 0% mortality rate in major procedures. There were no unexpected deaths. 17% of procedures resulted in complications. A higher rate of complications was recorded in emergency procedures. 17% of these procedures required admission to the intensive care unit, with the highest admissions rate in the high-risk group. The median duration of hospital stay for the whole cohort was 1day (range of 0-71days). Our study shows that procedures requiring GA can be safely conducted on children from any of the three risk groups in a nonspecialist cardiac center provided that there is close liaison and careful planning between the different specialties. Copyright © 2016. Published by Elsevier Inc.

  16. Clinical significance of serum cortisol levels following surgery for congenital heart disease.

    Science.gov (United States)

    Teagarden, Alicia M; Mastropietro, Christopher W

    2017-03-01

    Use of hydrocortisone to treat refractory haemodynamic instability in patients recovering from surgery for congenital heart disease is common practice at many centres. We aimed to determine whether there is a relationship between total serum cortisol concentrations and haemodynamic response to this therapy. Material and methods We retrospectively reviewed patients cortisol measurements contemporaneous with its administration. Favourable responders were defined as patients in whom, at 24 hours after hydrocortisone initiation, either (1) systolic blood pressure was increased or unchanged and vasoactive-inotrope score was decreased or (2) systolic blood pressure increased by ⩾10% of baseline and vasoactive-inotrope score was unchanged. Variables were compared using t-tests or Mann-Whitney U tests as appropriate. In total, 24 patients were reviewed, with a median age of 1.4 months and range of 0.1-232 months. Among them, 14 (58%) patients responded favourably to hydrocortisone. At 24 hours, the median change in vasoactive-inotrope score was -18% in favourable responders and +31% in those who did not respond favourably, p=0.001. The mean pre-hydrocortisone total serum cortisol in favourable responders was 17.4±10.9 µg/dl compared with 46.1±44.7 µg/dl in those who did not respond favourably, p=0.03. Total serum cortisol obtained before initiation of hydrocortisone was significantly lower in patients who responded favourably to this therapy. Total serum cortisol may therefore be helpful in identifying children recovering from cardiac surgery who may or may not haemodynamically improve with hydrocortisone.

  17. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II)

    DEFF Research Database (Denmark)

    Andersson, J; Abis, G; Gellerstedt, M

    2014-01-01

    BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer. METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed...... the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual functioning...... radiotherapy, did not change these results. CONCLUSION: Sexual dysfunction is common in patients with rectal cancer, and treatment (including surgery) increases the proportion of patients affected. A laparoscopic approach does not change this. REGISTRATION NUMBER: NCT0029779 (http://www.clinicaltrials.gov)....

  18. Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized controlled trial.

    Science.gov (United States)

    Choi, Yong Seon; Shim, Jae Kwang; Kim, Jong Chan; Kang, Kyu-Sik; Seo, Yong Han; Ahn, Ki-Ryang; Kwak, Young Lan

    2011-07-01

    Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  19. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

    DEFF Research Database (Denmark)

    Joshi, G P; Rawal, N; Kehlet, H

    2012-01-01

    and increased time to home-readiness compared with regional anaesthesia. CONCLUSION: Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion......, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure...... that the recommendations had clinical validity. RESULTS: Of the 334 randomized studies identified, 79 were included. Quantitative analysis suggested that regional anaesthesia was superior to general anaesthesia for reducing postoperative pain. Spinal anaesthesia was associated with a higher incidence of urinary retention...

  20. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer

    DEFF Research Database (Denmark)

    Falcoz, Pierre-Emmanuel; Puyraveau, Marc; Thomas, Pascal-Alexandre

    2016-01-01

    OBJECTIVES: Video-assisted thoracoscopic anatomical resections are increasingly used in Europe to manage primary lung cancer. The purpose of this study was to compare the outcome following thoracoscopic versus open lobectomy in case-matched groups of patients from the European Society of Thoracic...... Surgeon (ESTS) database. METHODS: All patients having lobectomy as the primary procedure via thoracoscopy [video-assisted thoracoscopic surgery (VATS)-L)] or thoracotomy (TH-L) were identified in the ESTS database (January 2007 to December 2013). A propensity score was constructed using several patients......' baseline characteristics. The matching using the propensity score was responsible for the minimization of selection bias. A propensity score-matched analysis was performed to compare the incidence of postoperative major complications (according to the ESTS database definitions) and mortality at hospital...

  1. Visual outcome after emergency surgery for open globe eye injury in Japan.

    Science.gov (United States)

    Toride, Ai; Toshida, Hiroshi; Matsui, Asaki; Matsuzaki, Yusuke; Honda, Rio; Ohta, Toshihiko; Murakami, Akira

    2016-01-01

    Most patients with open globe eye injury are brought to hospital as emergency patients and usually require admission for emergency surgery. We analyzed the visual outcome in patients with open globe eye injury at our hospital over a 4-year period. This study reviewed 40 eyes of 40 patients with open globe eye injury who were presented to Juntendo University Shizuoka Hospital and required emergency surgery during the 4 years from January 2010 to December 2014. Retrospective evaluation of the visual outcome was performed using data from the medical records, including assessment of the influence of sex, side of the eye injury, cause of injury, and site/severity of injury. The mean age (SD) at the time of the injury was 58.9 years (±25.1 years). There were 28 males (70.0%) and 12 females (30.0%). Statistically significant improvement in visual acuity after treatment was noted in the males (P=0.0015, Wilcoxon test), but not in the females. Twenty-five patients had injury to the right eye (62.5%) and 15 had injury to the left eye (37.5%). A significant improvement in visual acuity was achieved after treatment of injury to the right eye (P=0.021), but not the left eye (P=0.109). The most frequent cause of injury was an accident (15 eyes; 37.5%). The second most frequent cause was work-related injury (14 eyes; 35.0%), which only occurred in males, and the third cause was accident due to negligence (eleven eyes; 27.5%). Two patients developed sympathetic ophthalmia and one patient developed postoperative endophthalmitis. The majority of patients with open globe eye injury were male workers in Japan. The visual outcome of work-related injury was better than that of injury due to other causes. The visual outcome was also better if the right eye was injured compared with the left eye. Patients with injuries due to negligence were older than the other groups, and this finding might be characteristic of an aging society.

  2. Visual outcome after emergency surgery for open globe eye injury in Japan

    Science.gov (United States)

    Toride, Ai; Toshida, Hiroshi; Matsui, Asaki; Matsuzaki, Yusuke; Honda, Rio; Ohta, Toshihiko; Murakami, Akira

    2016-01-01

    Background Most patients with open globe eye injury are brought to hospital as emergency patients and usually require admission for emergency surgery. We analyzed the visual outcome in patients with open globe eye injury at our hospital over a 4-year period. Patients and methods This study reviewed 40 eyes of 40 patients with open globe eye injury who were presented to Juntendo University Shizuoka Hospital and required emergency surgery during the 4 years from January 2010 to December 2014. Retrospective evaluation of the visual outcome was performed using data from the medical records, including assessment of the influence of sex, side of the eye injury, cause of injury, and site/severity of injury. Results The mean age (SD) at the time of the injury was 58.9 years (±25.1 years). There were 28 males (70.0%) and 12 females (30.0%). Statistically significant improvement in visual acuity after treatment was noted in the males (P=0.0015, Wilcoxon test), but not in the females. Twenty-five patients had injury to the right eye (62.5%) and 15 had injury to the left eye (37.5%). A significant improvement in visual acuity was achieved after treatment of injury to the right eye (P=0.021), but not the left eye (P=0.109). The most frequent cause of injury was an accident (15 eyes; 37.5%). The second most frequent cause was work-related injury (14 eyes; 35.0%), which only occurred in males, and the third cause was accident due to negligence (eleven eyes; 27.5%). Two patients developed sympathetic ophthalmia and one patient developed postoperative endophthalmitis. Conclusion The majority of patients with open globe eye injury were male workers in Japan. The visual outcome of work-related injury was better than that of injury due to other causes. The visual outcome was also better if the right eye was injured compared with the left eye. Patients with injuries due to negligence were older than the other groups, and this finding might be characteristic of an aging society. PMID

  3. Occult rib fractures and brachial plexus injury following median sternotomy for open-heart operations.

    Science.gov (United States)

    Baisden, C E; Greenwald, L V; Symbas, P N

    1984-09-01

    The incidence and the sites of rib fractures during open-heart operations through a median sternotomy incision were studied in 36 consecutive patients divided into two groups. In Group 1 (24 patients), a conventional Ankeney retractor was used to expose the heart, and in Group 2 (12 patients), a similar retractor was used but with its uppermost pair of blades removed. Thorough physical examinations and preoperative and postoperative chest roentgenograms were obtained, and postoperative bone scans were done in all patients. No rib fractures were detected on the routine chest roentgenograms in patients in either group. Bone scans, however, showed 44 rib fractures (15 of the first rib, 13 of the second rib, 4 of the third rib, 6 of the fourth rib, 3 of the fifth rib, and 3 of the sixth rib) in 16 patients in Group 1. Six patients in Group 2 had 9 rib fractures (2 of the first rib, 4 of the second rib, and 1 each of the third, fifth, and sixth ribs). None of the patients in Group 2 had brachial plexus injury and neither of the first rib fractures in this group were located posteriorly, whereas 3 patients in Group 1 had both brachial plexus injury and posterior first rib fractures.

  4. A portable image overlay projection device for computer-aided open liver surgery.

    Science.gov (United States)

    Gavaghan, Kate A; Peterhans, Matthias; Oliveira-Santos, Thiago; Weber, Stefan

    2011-06-01

    Image overlay projection is a form of augmented reality that allows surgeons to view underlying anatomical structures directly on the patient surface. It improves intuitiveness of computer-aided surgery by removing the need for sight diversion between the patient and a display screen and has been reported to assist in 3-D understanding of anatomical structures and the identification of target and critical structures. Challenges in the development of image overlay technologies for surgery remain in the projection setup. Calibration, patient registration, view direction, and projection obstruction remain unsolved limitations to image overlay techniques. In this paper, we propose a novel, portable, and handheld-navigated image overlay device based on miniature laser projection technology that allows images of 3-D patient-specific models to be projected directly onto the organ surface intraoperatively without the need for intrusive hardware around the surgical site. The device can be integrated into a navigation system, thereby exploiting existing patient registration and model generation solutions. The position of the device is tracked by the navigation system's position sensor and used to project geometrically correct images from any position within the workspace of the navigation system. The projector was calibrated using modified camera calibration techniques and images for projection are rendered using a virtual camera defined by the projectors extrinsic parameters. Verification of the device's projection accuracy concluded a mean projection error of 1.3 mm. Visibility testing of the projection performed on pig liver tissue found the device suitable for the display of anatomical structures on the organ surface. The feasibility of use within the surgical workflow was assessed during open liver surgery. We show that the device could be quickly and unobtrusively deployed within the sterile environment.

  5. Relationships betveen pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

    Institute of Scientific and Technical Information of China (English)

    CHANG Ling-hua; MA Tso-chiang; TSAY Shiow-luan; JONG Gwo-ping

    2012-01-01

    Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6% of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients,and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p <0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

  6. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.

    Science.gov (United States)

    Hortal, Javier; Muñoz, Patricia; Cuerpo, Gregorio; Litvan, Hector; Rosseel, Peter M; Bouza, Emilio

    2009-01-01

    Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high

  7. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery

    Institute of Scientific and Technical Information of China (English)

    Kai Luo; Jie-Shou Li; Ling-Tang Li; Kei-Hui Wang; Jing-Mei Shun

    2003-01-01

    AIM: To determine the least invasive surgical procedure by comparing the levels of operative stress hormones, responsereactive protein (CRP) and rest energy expenditure (REE)after laparoscopic (LC) and open cholecystectomy (OC).METHODS: Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (14) and OC (12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were determined.RESULTS: In the third postoperative day, the insulin levels were lower compared to that before operation (P<0.05).Tn the first postoperative day, the levels of somatotropin and cortisol were higher in OC than those in LC. After operation the parameters of somatotropin, CRP and cortisol increased, compared to those in the preoperative period in the all patients (P<0.05). In the all-postoperative days,the CRP level was higher in OC than that in LC (7.46±0.02;7.38±0.01, P<0.05). After operation the REE level all increased in OC and LC (P<0.05). In the all-postoperative days, the REE level was higher in OC than that in LC (1438.5±A18.5;1222.3±L80.8, P<0.05).CONCLUSION: LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These advantages are beneficial to the restoration of stress hormones, the nitrogen balance, and the energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of the penumoperitonium it uses during surgery.

  8. Oncologic Results of Retroperitoneoscopic Versus Open Surgery for T2 Upper Tract Urothelial Carcinoma.

    Science.gov (United States)

    Shan, Hongli; Wang, Xiaoqing; Sun, Qingnian; Chen, Qihui; Xu, Bo; Hao, Yuanyuan; Xu, Wei

    2015-12-01

    The present study was designed to compare oncologic outcomes of T2 upper tract urothelial carcinoma patients treated with retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). T2 upper tract urothelial carcinoma patients were treated with RNU (n = 110) or ONU (n = 118) and followed-up for > 5 years. Demographic and clinical data, including preoperative indexes, intraoperative indexes, and oncological outcomes, were retrospectively compared to determine the efficacy of the 2 procedures. The RNU and ONU groups were statistically similar in age, sex, tumor location, and tumor pathologic grade. The original surgery time required for RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 43.2 months; range, 6-72 months) revealed that the estimated 5-year overall survival rate and the estimated 5-year disease-specific survival rate after RNU was slightly worse than after ONU (66.0% vs. 67.1%, and 80.8% vs. 83.8%, respectively), and the estimated 5-year recurrence-free survival rate and the estimated 5-year intravesical recurrence-free survival rates were slightly better than ONU (79.5% vs. 77.9%, and 68.3% vs. 65.6%, respectively). However, none of these differences were statistically significant. The open surgery strategy and the RNU strategy are equally effective for treating T2 upper tract urothelial carcinoma. However, the RNU procedure is safer, less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta-analysis on clinical efficacy.

    Science.gov (United States)

    Zhao, Jun-Kang; Chen, Nan-Zheng; Zheng, Jian-Bao; He, Sai; Sun, Xue-Jun

    2014-11-01

    Colorectal cancer is one of the main malignant tumors threatening human health. Surgery plays a pivotal role in treating colorectal cancer. The present study aimed to compare the clinical effect in patients with rectal cancer undergoing laparoscopic versus open surgery by meta-analysis of the randomized controlled trials (RCTs) published in the past 20 years. The data showed that 14 RCTs comparing laparoscopic surgery with conventional open surgery for rectal cancer matched the selection criteria and reported on 2,114 subjects, of whom 1,111 underwent laparoscopic surgery and 1,003 underwent open surgery for rectal cancer. Blood loss (PCRM) (P=0.86), regional recurrence ((P=0.08), port site or wound metastasis (P=0.67), distant metastasis (P=0.12), 3-year overall survival (OS) (P=0.42), 3-year disease-free survival (DFS) (P=0.44), 5-year OS (P=0.60) and 5-year DFS (P=0.70). Therefore, laparoscopy for the treatment of patients with rectal cancer has the advantage of recovery and the same complications and prognosis as laparotomy, which indicates that laparoscopy may provide a potential survival benefit for patients with rectal cancer.

  10. Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery.

    Science.gov (United States)

    Guerra, Francesco; Giuliani, Giuseppe; Iacobone, Martina; Bianchi, Paolo Pietro; Coratti, Andrea

    2017-04-04

    Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery. PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3. A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13). Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.

  11. Prevalence of antibodies to hepatitis C virus after blood transfusion in heart surgery.

    Science.gov (United States)

    Barcena, R; Gonzalez, A; Martin-de-Argila, C; Ulibarrena, C; Graus, J; Grande, L A

    1994-08-01

    We studied the frequency and time of appearance of antibodies to the hepatitis C virus (HCV) retrospectively in the sera of 127 patients who underwent heart surgery between 1983 and 1986. They received blood from volunteer donors hepatitis B surface antigen (HBsAg) negative with normal serum alanine-aminotransferase levels. A prospective follow-up was carried out every 15 days for at least 6 months from the moment of the transfusion. Of the ten patients who developed biochemical criteria of post-transfusional non-A non-B hepatitis, six seroconverted to anti-HCV (60%). Of the other 117, two were already positive before transfusion (1.51%), one patient showed antibodies only in the first post-transfusional serum (passive transfer), and another two patients with no evidence of post-transfusional hepatitis developed HCV antibodies on the 90th day, remaining indefinitely (afterwards seroconversion without hepatitis); both patients' earlier sera were anti-HCV negative. Four (40%) of the ten patients with post-transfusional hepatitis did not develop any serum markers to known hepatotropic agents. Although these findings do not exclude a viral infection by these viruses, they are consistent with the involvement of an unidentified non-A, non-B, non-C agent.

  12. Objectifying Acupuncture Effects by Lung Function and Numeric Rating Scale in Patients Undergoing Heart Surgery

    Directory of Open Access Journals (Sweden)

    Anna Maimer

    2013-01-01

    Full Text Available Rationale. Poststernotomy pain and impaired breathing are common clinical problems in early postoperative care following heart surgery. Insufficiently treated pain increases the risk of pulmonary complications. High-dose opioids are used for pain management, but they may cause side effects such as respiratory depression. Study Design. We performed a prospective, randomized, controlled, observer-blinded, three-armed clinical trial with 100 patients. Group 1 (n=33 and Group 2 (n=34 received one 20 min session of standardized acupuncture treatment with two different sets of acupoints. Group 3 (n=33 served as standard analgesia control without additional intervention. Results. Primary endpoint analysis revealed a statistically significant analgesic effect for both acupuncture treatments. Group 1 showed a mean percentile pain reduction (PPR of 18% (SD 19, P<0.001. Group 2 yielded a mean PPR of 71% (SD 13, P<0.001. In Group 1, acupuncture resulted in a mean forced vital capacity (FVC increase of 30 cm3 (SD 73 without statistical significance (P=0.303. In Group 2, posttreatment FVC showed a significant increase of 306 cm3 (SD 215, P<0.001. Conclusion. Acupuncture revealed specific analgesic effects after sternotomy. Objective measurement of poststernotomy pain via lung function test was possible.

  13. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Philip Rothman, Josephine; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2016-01-01

    BACKGROUND: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystecto...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  14. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A;

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P failure, this simple...

  15. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A; Søndergaard, Kathrine Bach; Pallisgaard, Jannik; Smith, J Gustav; Vasan, Ramachandran S; Larson, Martin G; Jensen, Per Føge; Køber, Lars; Torp-Pedersen, Christian

    2014-12-01

    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. 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 surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65 years (2), age 66-75 years (4), age 76-85 years (5), or age >85 years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from 50% for a score ≥20. Internal validation 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 < 0.05 performed only slightly better, c-statistic = 0.81, but was limited in use by its complexity. For patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology.

  16. Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery.

    Science.gov (United States)

    Bartel, Thomas; Rivard, Andrew; Jimenez, Alejandro; Mestres, Carlos A; Müller, Silvana

    2017-02-16

    Advanced percutaneous and surgical procedures in structural and congenital heart disease require precise pre-procedural planning and continuous quality control. Although current imaging modalities and post-processing software assists with peri-procedural guidance, their capabilities for spatial conceptualization remain limited in two- and three-dimensional representations. In contrast, 3D printing offers not only improved visualization for procedural planning, but provides substantial information on the accuracy of surgical reconstruction and device implantations. Peri-procedural 3D printing has the potential to set standards of quality assurance and individualized healthcare in cardiovascular medicine and surgery. Nowadays, a variety of clinical applications are available showing how accurate 3D computer reformatting and physical 3D printouts of native anatomy, embedded pathology, and implants are and how they may assist in the development of innovative therapies. Accurate imaging of pathology including target region for intervention, its anatomic features and spatial relation to the surrounding structures is critical for selecting optimal approach and evaluation of procedural results. This review describes clinical applications of 3D printing, outlines current limitations, and highlights future implications for quality control, advanced medical education and training.

  17. Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1 method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS mortality score

    Directory of Open Access Journals (Sweden)

    Paulo Ernando Ferraz Cavalcanti

    2015-04-01

    Full Text Available AbstractObjective:To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score fit to our center and determine the best method of discriminating hospital mortality.Methods:Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed.Results:360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1 - 1.3%, (2 - 11.4%, (3-27.3%, (4 - 50 %, (P<0.001; Aristotle basic score (1 - 1.1%, (2 - 12.2%, (3 - 34%, (4 - 64.7%, (P<0.001; and STS-EACTS mortality score (1 - 5.5 %, (2 - 13.6%, (3 - 18.7%, (4 - 35.8%, (P<0.001. The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766.Conclusion:The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality.

  18. 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.

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

    Science.gov (United States)

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

    2016-06-01

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

  20. Mitral valve surgery in a patient with dextrocardia and 180° counter-clockwise rotated heart due to congenital agenesis of the right lung.

    Science.gov (United States)

    Atsumi, Yosuke; Tokunaga, Shigehiko; Yasuda, Shota; Fushimi, Kenichi; Masuda, Munetaka

    2013-11-01

    We report a case of severe mitral regurgitation (MR) with dextrocardia and 180° counterclockwise rotated situs solitus heart. We describe the technique for mitral valve surgery in a patient with dextrocardia and agenesis of the right lung.

  1. 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 surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.

  2. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review

    Science.gov (United States)

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01