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Sample records for cardiac surgery descriptive

  1. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  2. Rhabdomyolysis following Cardiac Surgery: A Prospective, Descriptive, Single-Center Study

    PubMed Central

    Ewila, Hesham; Aboulnaga, Sameh; Tuli, Alejandro Kohn; Singh, Rajvir

    2016-01-01

    Purpose. Rhabdomyolysis (RML) following cardiac surgery and its relationship with acute kidney injury (AKI) require investigation. Patients and Methods. All patients undergoing cardiac surgery in our hospital were enrolled in this prospective study during a 1-year period. To investigate the occurrence of RML and its association with AKI, all patients in the study underwent serial assessment of serum creatine kinase (CK) and myoglobin levels. Serial renal function, prior statin treatment, and outcome variables were recorded. Results. In total, 201 patients were included in the study: 185 men and 16 women with a mean age of 52.0 ± 12.4 years. According to the presence of RML (CK of ≥2,500 U/L), the patients were divided into Group I (RML present in 17 patients) and Group II (RML absent in 184 patients). Seven patients in Group I had AKI (41%) where 34 patients in group II had AKI (18.4%), P = 0.025. We observed a significantly longer duration of ventilation, length of stay in the ICU, and hospitalization in Group I (P < 0.001 for all observations). Conclusions. An early elevation of serum CK above 2500 U/L postoperatively in high-risk cardiac surgery could be used to diagnose RML that may predict the concomitance of early AKI. PMID:27034948

  3. Cardiac surgery outcomes.

    PubMed

    Halpin, Linda S; Barnett, Scott D; Beachy, Jim

    2003-01-01

    Accrediting organizations and payers are demanding valid and reliable data that demonstrate the value of services. Federal agencies, healthcare industry groups, and healthcare watchdog groups are increasing the demand for public access to outcomes data. A new and growing outcomes dynamic is the information requested by prospective patients in an increasingly consumer-oriented business. Patients demand outcomes, and resources are developing to meet these demands. Physicians are increasingly confronted with requests for information about their mortality and morbidity rates, malpractice suits, and disciplinary actions received. For example, in Virginia, prospective patients have access to data provided by the nonprofit group Virginia Health Information. After numerous resolutions by the Virginia Senate since 1999, the prospective Virginia medical consumer now has access to several annual publications: Virginia Hospitals: A Consumer's Guide, 1999 Annual Report and Strategic Plan Update, and the 1999 Industry Report: Virginia Hospitals and Nursing Facilities. Consumers have access to cardiac outcomes data stratified by hospital, gender, and cardiac service line (cardiac surgery, noninvasive cardiology, and invasive cardiology). This is particularly relevant to IHI because Virginia Health Information specifically targets cardiac care. IHI has a sizable investment in cardiovascular outcomes and has found outcomes measurement and research are key to providing quality care. IHI's goal is to move from an outcomes management model to a disease management model. The hope is to incorporate all aspects of the patient's continuum of care, from preoperative and diagnostic services through cardiac interventions to postoperative rehabilitation. Furthermore, every step along the way will be supported with functional status and quality of life assessments. Although these goals are ambitious and expensive, the return on investment is high. PMID:14618772

  4. Leadership in cardiac surgery.

    PubMed

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

    2011-06-01

    Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. This cannot be achieved without dynamic leadership; however, our contention is that this is not enough. The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance. PMID:20884217

  5. [Cardiac surgery: within the revolution!].

    PubMed

    Raanani, Ehud

    2007-11-01

    Cardiac surgery is undergoing major changes. Until recently, coronary artery bypass grafting (CABG) constituted the majority of cardiac surgery cases that were performed. The sharp rise in percutaneous coronary interventions (PCI) mainly due to the development of drug eluting stents resulted in a drop in the worldwide number of CABG cases. The cardiac surgery community reacted by developing several new surgical procedures and techniques to better treat cardiac patients. Some of those procedures are demonstrated in this special issue of the Harefuah journal. Those procedures include better techniques to repair the aortic and mitral valves, minimally invasive techniques including video assisted methodology for valves and CABG surgery, surgery for congestive heart failure including new axial flow assist devices, surgery for the treatment of atrial fibrillation and more. The excellent results in cardiac surgery caused older and sicker patients to be referred to surgery. All these are creating a "revolution" in cardiac surgery. Those new technologies, surgical techniques and high risk patients require special financing. In order to complete the revolution and continue providing advanced "state of the art" cardiac surgery procedures for the patients, there is a need for special long term economic planning by the government and the Ministry of Health. PMID:18087831

  6. Pregnancy After Cardiac Surgery.

    PubMed

    Kanhere, Anjali Vivek; Kanhere, Vivek Madhav

    2016-02-01

    Heart disease is one of the common, indirect obstetric causes of maternal death. Management of these cases may challenge the entire team providing care to the mother and fetus. Advances in cardiac surgery has improved quality of life and level of functioning of cardiovascular system of patients with congenital or acquired heart disease. These diseases complicate 0.1-4 % pregnancies. Maternal complications in the form of thromboembolic, hemorrhagic episode and heart failure may occur. The fetus is in danger of effects of oral anticoagulation therapy and other medications given to the patient in order to support cardiovascular system, intrauterine growth restriction and danger of hypoxia. In recent era, we are facing more pregnant patients with previous history of surgical correction of congenital or rheumatic heart disease. In this review, we have attempted to draw a management protocol of such patients based on the available literature and various international guidelines. In pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labor. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Preconception counseling, evaluation and antenatal high-risk management protocol with the help of cardiologist and cardiac surgeon improves maternal and neonatal outcome. PMID:26924901

  7. [The third wave of cardiac surgery].

    PubMed

    Riera-Kinkel, Carlos

    2016-01-01

    A review of the history of cardiac surgery around the world is made divided into three stages, the first since the beginning of humanity until 300 years BC; the second moment shows how comes the platform that would give the anatomical and functional bases of the cardiovascular system. This historic moment includes: 1. the description and analysis of the function of blood and its components; 2. the description of the normal and abnormal Anatomy of the human heart and its vessels; 3. the anatomic and functional correlation: Foundation of the deductive thinking, and 4. the anatomic and functional integration with the clinic. Finally, the third wave, which is living today, is the stage of the technological explosion that begins with procedures as thoracoscopic surgery with the concept of reducing surgical trauma through minimum approach surgery. Also the use of robotics to solve some of the alterations in the CC, another is hybrid procedures and finally the use of fetal cardiac surgery. PMID:27428342

  8. [Hygienic handling in cardiac surgery].

    PubMed

    Shimasaki, T; Masaoka, T; Hirooka, S; Abe, H; Watanabe, T; Washio, M

    1993-04-01

    Some points regarding the hygienic handling in cardiac surgery are mentioned. The sternal infection or mediastinitis is still one of the most important complications after cardiac operation especially when ITA is used for CABG. After we paid much attention to these points, the postoperative sternal infection has decreased obviously. PMID:8468855

  9. Pulmonary Hypertension in Cardiac Surgery

    PubMed Central

    Denault, André; Deschamps, Alain; Tardif, Jean-Claude; Lambert, Jean; Perrault, Louis

    2010-01-01

    Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented. PMID:21286273

  10. [Cardiac evaluation before non-cardiac surgery].

    PubMed

    Menzenbach, Jan; Boehm, Olaf

    2016-07-01

    Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices. Application of diagnostic means, should be used adjusted to this risk estimation. Cardiac biomarkers are useful to discover risk of complications or mortality, that cannot be assessed by clinical signs. After preoperative optimization and perioperative cardiac protection, the observation of the postoperative period remains, to prohibit complications or even death. In consideration of limited resources of intensive care department, postoperative ward rounds beyond intensive care units are considered to be an appropriate instrument to avoid or recognize complications early to reduce postoperative mortality. PMID:27479258

  11. Massage therapy after cardiac surgery.

    PubMed

    Wang, Amy T; Sundt, Thoralf M; Cutshall, Susanne M; Bauer, Brent A

    2010-01-01

    Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. Mounting evidence demonstrates that such challenges can impair immune function and slow wound healing, in addition to causing suffering for the patient. Finding new approaches to mitigate these challenges is necessary if patients are to experience the full benefits of surgery. Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic. PMID:21167456

  12. When did cardiac surgery begin?

    PubMed

    Shumacker, H B

    1989-01-01

    Heart surgery is generally regarded as having begun on September 10, 1896 when Ludwig Rehn sutured a myocardial laceration successfully. There are valid reasons, however, to believe that cardiac surgery had its origin nearly a century earlier with the operative drainage of the pericardium by the little known Spanish surgeon, Francisco Romero, and highly regarded Baron Dominique Jean Larrey. This procedure entailed making a thoracic incision and opening and draining the pericardium. It must necessarily be considered a cardiac operation. The pericardium is part of the heart; its epicardium continues as the serosal layer of the fibrous pericardium; the pericardium is fused to the heart's base and great vessels; all books on heart surgery include pericardial operations. When Romero first operated is unknown, but it antedated 1814 when his work was presented in Paris; Larrey's operation was performed in 1810. These contributions are presented, and their priority with regard to the later initial efforts to suture myocardial laceration is reviewed briefly. PMID:2651455

  13. [Psychiatric effects of cardiac surgery].

    PubMed

    Imbert, D; Daubech, M J; Tignol, J; Bourgeois, M

    1976-11-01

    The authors report three cases of psychotic complications of cardiac surgery. A review is made from literature and an inventory of psychological and organic factors implicated in this pathology. These complications are still frequent (up to 50% for Braceland, and 70% for Rabiner and al.). For Blacher there is an almost universal "psychosis" in by-pass surgery and frequent "hidden psychosis" (they are ignored and denied both by the staff and the patient). They are caused by the emotional stress, intensive care unit syndrome, or personal vulnerability. The symbolism of the heart and the personality of the cardiac patient are also in cause. Neurologic accidents, hypoxy, embolisms, are now less frequent. The collaboration of a psychiatrist with the cardiologic staff is mandatory. With this collaboration not only psychiatric complications but also somatic morbidity and mortality would be reduced. PMID:1020860

  14. AKI Associated with Cardiac Surgery

    PubMed Central

    Thiele, Robert H.; Isbell, James M.

    2015-01-01

    Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%–6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short- and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician’s choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI. PMID:25376763

  15. Applications of Computational Modeling in Cardiac Surgery

    PubMed Central

    Lee, Lik Chuan; Genet, Martin; Dang, Alan B.; Ge, Liang; Guccione, Julius M.; Ratcliffe, Mark B.

    2014-01-01

    Although computational modeling is common in many areas of science and engineering, only recently have advances in experimental techniques and medical imaging allowed this tool to be applied in cardiac surgery. Despite its infancy in cardiac surgery, computational modeling has been useful in calculating the effects of clinical devices and surgical procedures. In this review, we present several examples that demonstrate the capabilities of computational cardiac modeling in cardiac surgery. Specifically, we demonstrate its ability to simulate surgery, predict myofiber stress and pump function, and quantify changes to regional myocardial material properties. In addition, issues that would need to be resolved in order for computational modeling to play a greater role in cardiac surgery are discussed. PMID:24708036

  16. Acute kidney injury after pediatric cardiac surgery

    PubMed Central

    Singh, Sarvesh Pal

    2016-01-01

    Acute kidney injury is a common complication after pediatric cardiac surgery. The definition, staging, risk factors, biomarkers and management of acute kidney injury in children is detailed in the following review article. PMID:27052074

  17. Subperiosteal Orbital Hemorrhage Complicating Cardiac Surgery

    SciTech Connect

    Peden, Marc C.; Bhatti, M. Tariq

    2004-09-15

    Subperiosteal orbital hemorrhage (SPOH) following cardiac surgery has not been previously reported. We present a patient who developed diplopia and right eye proptosis immediately after cardiac surgery for a mitral valve repair and coronary artery bypass graft. A computed tomography (CT) study demonstrated a right superior SPOH. The diplopia and proptosis resolved spontaneously within 4 weeks. Follow-up CT showed complete resolution of the SPOH.

  18. Mechanical Thrombectomy for Stroke After Cardiac Surgery.

    PubMed

    Madeira, Márcio; Martins, Catarina; Koukoulis, Giovanna; Marques, Marta; Reis, João; Abecassis, Miguel

    2016-08-01

    Stroke after cardiac surgery remains a devastating complication and its treatment options are limited. Systemic fibrinolysis is a relative contraindication, because it raises the risk of systemic hemorrhage. Endovascular therapy, mechanical thrombectomy, and intra-arterial fibrinolysis have emerged as safer options. We present three patients who developed strokes following cardiac surgery who underwent successful mechanical thrombectomy and review the literature on this subject. doi: 10.1111/jocs.12776 (J Card Surg 2016;31:517-520). PMID:27282492

  19. Ethical Issues in Cardiac Surgery

    PubMed Central

    Kavarana, Minoo N.; Sade, Robert M.

    2012-01-01

    While ethical behavior has always been part of cardiac surgical practice, ethical deliberation has only recently become an important component of cardiac surgical practice. Issues such as informed consent, conflict of interest, and professional self-regulation, among many others, have increasingly attracted the attention of cardiac surgeons. This review covers several broad topics of interest to cardiac surgeons and cardiologists, and treats several other topics more briefly. There is much uncertainty about what the future holds for cardiac surgical practice, research, and culture, and we discuss the background of ethical issues to serve as a platform for envisioning what is to come. PMID:22642634

  20. [EVOLUTION OF MINIMALLY INVASIVE CARDIAC SURGERY].

    PubMed

    Fujita, Tomoyuki; Kobayashi, Junjiro

    2016-03-01

    Minimally invasive surgery is an attractive choice for patients undergoing major cardiac surgery. We review the history of minimally invasive valve surgery in this article. Due to many innovations in surgical tools, cardiopulmonary bypass systems, visualization systems, and robotic systems as well as surgical techniques, minimally invasive cardiac surgery has become standard care for valve lesion repair. In particular, aortic cross-clamp techniques and methods for cardioplegia using the Chitwood clamp and root cannula or endoballoon catheter in combination with femoro-femoral bypass systems have made such procedures safer and more practical. On the other hand, robotically assisted surgery has not become standard due to the cost and slow learning curve. However, along with the development of robotics, this less-invasive technique may provide another choice for patients in the near future. PMID:27295770

  1. [Chronic surplus of Japanese cardiac surgeon--ideal nurse practitioner for cardiac surgery, cardiac surgeon's attitude toward the future].

    PubMed

    Ikegami, Hirohisa

    2014-03-01

    It is chronically surplus of doctors in the world of cardiac surgery. There are too many cardiac surgeons because cardiac surgery requires a large amount of manpower resources to provide adequate medical services. Many Japanese cardiac surgeons do not have enough opportunity to perform cardiac surgery operations, and many Japanese cardiac surgery residents do not have enough opportunity to learn cardiac surgery operations. There are physician assistants and nurse practitioners in the US. Because they provide a part of medical care to cardiac surgery patients, American cardiac surgeons can focus more energy on operative procedures. Introduction of cardiac surgery specialized nurse practitioner is essential to deliver a high quality medical service as well as to solve chronic problems that Japanese cardiac surgery has had for a long time. PMID:24749334

  2. Utility of cardiac troponins in patients with suspected cardiac trauma or after cardiac surgery.

    PubMed

    Adams, J E

    1997-12-01

    Detection of cardiac injury after blunt chest wall trauma or cardiac surgery is problematic. Previously available biomarkers have been hindered largely by limitations of specifity for myocardial damage. Both cardiac troponin I and T have been evaluated in these patient subgroups. While many questions remain unanswered, it appears that measurement of troponin proteins will facilitate patient care in these difficult situations. PMID:9439875

  3. Temporary epicardial pacing wire placement in totally endoscopic cardiac surgery.

    PubMed

    Yu, Tao; Zhang, Xiaoshen; Huang, Keli

    2016-07-01

    Temporary epicardial pacing wire placement is a common procedure in cardiac surgery. However, it is difficult to perform in totally endoscopic cardiac surgery. We describe a simple new technique to place temporary epicardial pacing wires quickly and safely. PMID:27130494

  4. Selective saccadic palsy after cardiac surgery.

    PubMed

    Kim, Eui-Jung; Oh, Sun-Young; Choi, Ha-Cheol; Shin, Byoung-Soo; Seo, Man-Wook; Choi, Jong-Bum

    2010-09-01

    We report a patient who showed a selective deficit of voluntary saccades and quick phases of nystagmus after cardiac surgery. Voluntary saccades in the horizontal plane were very slow, while vertical saccades, vestibular and optokinetic nystagmus, were absent. However, smooth pursuit, the vestibulo-ocular reflex, and the ability to hold steady eccentric gaze were preserved. PMID:20724946

  5. Fast-tracking in cardiac surgery.

    PubMed

    Aps, C

    Fast-tracking in cardiac surgery evolved as the pressure on bed space in intensive therapy units (ITU) grew and clinical management improved. It relies on achieving a patient condition that allows for earlier extubation and postoperative management in alternative facilities to the ITU. PMID:7582363

  6. Use of blood products in cardiac surgery.

    PubMed

    Renton, M C; McClelland, D B; Sinclair, C J

    1997-05-01

    The quantity of blood products used perioperatively during cardiac surgery is known to vary widely between institutions. This study looked at the amount of blood products used perioperatively in 74 consecutive elective cardiac operations in one institution. The results are compared with those from other European centres and a cost analysis carried out. On average 2.33 +/- 0.74 (95% confidence interval 1.93-2.77) units of red cell concentrate were transfused perioperatively per patient. Six (8%) patients received no blood products. In addition a number of preoperative factors were studied in an attempt to identify predictors of transfusion requirements. Age, preoperative haemoglobin, female sex and red cell mass were all found to have some predictive value. In the face of increasing demands on a limited supply of blood products we question the need for cross matching more than four units of red cell concentrate in elective cardiac surgery. PMID:9226702

  7. Cardiac Surgery-Associated Acute Kidney Injury

    PubMed Central

    Mao, Huijuan; Katz, Nevin; Ariyanon, Wassawon; Blanca-Martos, Lourdes; Adýbelli, Zelal; Giuliani, Anna; Danesi, Tommaso Hinna; Kim, Jeong Chul; Nayak, Akash; Neri, Mauro; Virzi, Grazia Maria; Brocca, Alessandra; Scalzotto, Elisa; Salvador, Loris; Ronco, Claudio

    2013-01-01

    Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy. PMID:24454314

  8. Cardiac surgery-associated acute kidney injury.

    PubMed

    Mao, Huijuan; Katz, Nevin; Ariyanon, Wassawon; Blanca-Martos, Lourdes; Adýbelli, Zelal; Giuliani, Anna; Danesi, Tommaso Hinna; Kim, Jeong Chul; Nayak, Akash; Neri, Mauro; Virzi, Grazia Maria; Brocca, Alessandra; Scalzotto, Elisa; Salvador, Loris; Ronco, Claudio

    2013-10-01

    Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy. PMID:24454314

  9. Acute Kidney Injury Subsequent to Cardiac Surgery.

    PubMed

    Kramer, Robert S; Herron, Crystal R; Groom, Robert C; Brown, Jeremiah R

    2015-03-01

    Acute kidney injury (AKI) after cardiac surgery is a common and underappreciated syndrome that is associated with poor shortand long-term outcomes. AKI after cardiac surgery may be epiphenomenon, a signal for adverse outcomes by virtue of other affected organ systems, and a consequence of multiple factors. Subtle increases in serum creatinine (SCr) postoperatively, once considered inconsequential, have been shown to reflect a kidney injury that likely occurred in the operating room during cardiopulmonary bypass (CPB) and more often in susceptible individuals. The postoperative elevation in SCr is a delayed signal reflecting the intraoperative injury. Preoperative checklists and the conduct of CPB represent opportunities for prevention of AKI. Newer definitions of AKI provide us with an opportunity to scrutinize perioperative processes of care and determine strategies to decrease the incidence of AKI subsequent to cardiac surgery. Recognizing and mitigating risk factors preoperatively and optimizing intraoperative practices may, in the aggregate, decrease the incidence of AKI. This review explores the pathophysiology of AKI and addresses the features of patients who are the most vulnerable to AKI. Preoperative strategies are discussed with particular attention to a readiness for surgery checklist. Intraoperative strategies include minimizing hemodilution and maximizing oxygen delivery with specific suggestions regarding fluid management and plasma preservation. PMID:26390675

  10. Acute Kidney Injury Subsequent to Cardiac Surgery

    PubMed Central

    Kramer, Robert S.; Herron, Crystal R.; Groom, Robert C.; Brown, Jeremiah R.

    2015-01-01

    Abstract: Acute kidney injury (AKI) after cardiac surgery is a common and underappreciated syndrome that is associated with poor short- and long-term outcomes. AKI after cardiac surgery may be epiphenomenon, a signal for adverse outcomes by virtue of other affected organ systems, and a consequence of multiple factors. Subtle increases in serum creatinine (SCr) postoperatively, once considered inconsequential, have been shown to reflect a kidney injury that likely occurred in the operating room during cardiopulmonary bypass (CPB) and more often in susceptible individuals. The postoperative elevation in SCr is a delayed signal reflecting the intraoperative injury. Preoperative checklists and the conduct of CPB represent opportunities for prevention of AKI. Newer definitions of AKI provide us with an opportunity to scrutinize perioperative processes of care and determine strategies to decrease the incidence of AKI subsequent to cardiac surgery. Recognizing and mitigating risk factors preoperatively and optimizing intraoperative practices may, in the aggregate, decrease the incidence of AKI. This review explores the pathophysiology of AKI and addresses the features of patients who are the most vulnerable to AKI. Preoperative strategies are discussed with particular attention to a readiness for surgery checklist. Intraoperative strategies include minimizing hemodilution and maximizing oxygen delivery with specific suggestions regarding fluid management and plasma preservation. PMID:26390675

  11. [Cardiac surgery in Jehovah's Witness].

    PubMed

    Furuse, A; Kotsuka, Y; Kawauchi, M; Tanaka, O; Hirata, K

    1998-02-01

    Clinical experiences of 35 cardiothoracic operations in Jehovah's Witness patients were presented with special reference to a method of taking informed consent for surgery. At first the surgeon explained the details of the proposed surgery including its risks and benefits. He should also express his confidence in accomplishing the operation without blood transfusion. Otherwise he should not dare to perform the operation. The surgeon asked the patient to talk about his or her religious belief in transfusion denial. Then the surgeon was allowed to talk about his professional duty and ethical belief in saving the patient at all costs. Finally, both the patient and the surgeon would sign the document of informed consent without fully determining whether or not the patient would undergo transfusion at an unexpected situation since the possibility of such unexpected necessity of blood transfusion was believed extremely low by both the surgeon and the patient. The trust of the patient in the technique of the surgeon was the key to this agreement. PMID:9492454

  12. Intensive Glycemic Control in Cardiac Surgery.

    PubMed

    Tsai, Lillian L; Jensen, Hanna A; Thourani, Vinod H

    2016-04-01

    Hyperglycemia has been found to be associated with increased morbidity and mortality in surgical patients, yet, the optimal glucose management strategy during the perioperative setting remains undetermined. While much has been published about hyperglycemia and cardiac surgery, most studies have used widely varying definitions of hyperglycemia, methods of insulin administration, and the timing of therapy. This has only allowed investigators to make general conclusions in this challenging clinical scenario. This review will introduce the basic pathophysiology of hyperglycemia in the cardiac surgery setting, describe the main clinical consequences of operative hyperglycemia, and take the reader through the published material of intensive and conservative glucose management. Overall, it seems that intensive control has modest benefits with adverse effects often outweighing these advantages. However, some studies have indicated differing results for certain patient subgroups, such as non-diabetics with acute operative hyperglycemia. Future studies should focus on distinguishing which patient populations, if any, would optimally benefit from intensive insulin therapy. PMID:26879308

  13. Brain Protection during Cardiac Surgery: Circa 2012

    PubMed Central

    Hammon, John W.

    2013-01-01

    Abstract: Brain injury during cardiac surgery can cause a potentially disabling syndrome consisting mainly of cognitive dysfunction but can manifest itself as symptoms and signs indistinguishable from frank stroke. The cause of the damage is mainly the result of emboli consisting of solid material such as clots or atherosclerotic plaque, fat, and/or gas. These emboli enter the cerebral circulation from the cardiopulmonary bypass machine, break off the aorta during manipulation, and enter the circulation from cardiac chambers. This damage can be prevented or at least minimized by avoiding aortic manipulation, filtering aortic inflow from the pump, preventing air from entering the pump plus careful deairing of the heart. Shed blood from the cardiotomy suction should be processed by a cell saver whenever possible. By doing these maneuvers, inflammation of the brain can be avoided. Long-term neurocognitive damage has been largely prevented in large series of patients having high-risk surgery, which makes these preventive measures worthwhile. PMID:23930381

  14. [Role of antithrombin iii in cardiac surgery].

    PubMed

    Muedra, V; Barettino, D; D'Ocón, P

    2013-11-01

    Coagulation of blood is of multidisciplinary interest. Cardiac surgery produces major changes in the delicate balance between pro-and anti-coagulant serum factors. The role of antithrombin iii has been analysed after finding evidence that associated decreased levels of protein activity to postoperative morbidity and mortality. Supplementing exogenous antithrombin is considered with the aim of optimising outcomes. Its intrinsic anticoagulant and anti-inflammatory properties have stimulated a growing interest, and suggests new lines of research. PMID:23228672

  15. [Cardiac output monitoring by impedance cardiography in cardiac surgery].

    PubMed

    Shimizu, H; Seki, S; Mizuguchi, A; Tsuchida, H; Watanabe, H; Namiki, A

    1990-04-01

    The cardiac output monitoring by impedance cardiography, NCCOM3, was evaluated in adult patients (n = 12) who were subjected to coronary artery bypass grafting. Values of cardiac output measured by impedance cardiography were compared to those by the thermodilution method. Changes of base impedance level used as an index of thoracic fluid volume were also investigated before and after cardiopulmonary bypass (CPB). Correlation coefficient (r) of the values obtained by thermodilution with impedance cardiography was 0.79 and the mean difference was 1.29 +/- 16.9 (SD)% during induction of anesthesia. During the operation, r was 0.83 and the mean difference was -14.6 +/- 18.7%. The measurement by impedance cardiography could be carried out through the operation except when electro-cautery was used. Base impedance level before CPB was significantly lower as compared with that after CPB. There was a negative correlation between the base impedance level and central venous pressure (CVP). No patients showed any signs suggesting lung edema and all the values of CVP, pulmonary artery pressure and blood gas analysis were within normal ranges. From the result of this study, it was concluded that cardiac output monitoring by impedance cardiography was useful in cardiac surgery, but further detailed examinations will be necessary on the relationship between the numerical values of base impedance and the clinical state of the patients. PMID:2362347

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

    PubMed Central

    Abbasi, Kyomars; Karimi, Abbasali; Abbasi, Seyed Hesameddin; Ahmadi, Seyed Hossein; Davoodi, Saeed; Babamahmoodi, Abdolreza; Movahedi, Namdar; Salehiomran, Abbas; Shirzad, Mahmood; Bina, Peyvand

    2012-01-01

    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. PMID:23304179

  17. Neurodevelopmental Outcomes After Cardiac Surgery in Infancy

    PubMed Central

    Stopp, Christian; Wypij, David; Andropoulos, Dean B.; Atallah, Joseph; Atz, Andrew M.; Beca, John; Donofrio, Mary T.; Duncan, Kim; Ghanayem, Nancy S.; Goldberg, Caren S.; Hövels-Gürich, Hedwig; Ichida, Fukiko; Jacobs, Jeffrey P.; Justo, Robert; Latal, Beatrice; Li, Jennifer S.; Mahle, William T.; McQuillen, Patrick S.; Menon, Shaji C.; Pemberton, Victoria L.; Pike, Nancy A.; Pizarro, Christian; Shekerdemian, Lara S.; Synnes, Anne; Williams, Ismee; Bellinger, David C.; Newburger, Jane W.

    2015-01-01

    BACKGROUND: Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD). METHODS: We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI). RESULTS: Among 1770 subjects from 22 institutions, assessed at age 14.5 ± 3.7 months, PDIs and MDIs (77.6 ± 18.8 and 88.2 ± 16.7, respectively) were lower than normative means (each P < .001). Later calendar year of birth was associated with an increased proportion of high-risk infants (complexity of CHD and prevalence of genetic/extracardiac anomalies). After adjustment for center and type of CHD, later year of birth was not significantly associated with better PDI or MDI. Risk factors for lower PDI were lower birth weight, white race, and presence of a genetic/extracardiac anomaly (all P ≤ .01). After adjustment for these factors, PDIs improved over time (0.39 points/year, 95% confidence interval 0.01 to 0.78; P = .045). Risk factors for lower MDI were lower birth weight, male gender, less maternal education, and presence of a genetic/extracardiac anomaly (all P < .001). After adjustment for these factors, MDIs improved over time (0.38 points/year, 95% confidence interval 0.05 to 0.71; P = .02). CONCLUSIONS: Early neurodevelopmental outcomes for survivors of cardiac surgery in infancy have improved modestly over time, but only after adjustment for innate patient risk factors. As more high-risk CHD infants undergo cardiac surgery and survive, a growing population will require significant societal resources. PMID:25917996

  18. Assessment of Electrosurgery Burns in Cardiac Surgery

    PubMed Central

    Jalali, Seyyed Mehdi; Moradi, Mohammad; Khalaj, Alireza; Pazouki, Alireza; Tamannaie, Zeinab; Ghanbari, Sajjad

    2015-01-01

    Background: Monopolar surgery is applied mostly in major operations, while bipolar is used in delicate ones. Attention must be paid in electrosurgery application to avoid electrical burns. Objectives: We aimed to assess factors associated with electrosurgery burns in cardiac surgery operating rooms. Patients and Methods: This was a case-control study in which two groups of 150 patients undergoing cardiac surgery in Imam Khomeini Hospital were recruited. Several factors like gender, age, operation duration, smoking, diseases, infection, atopia, , immunosuppressive drugs use, hepatic cirrhosis, and pulmonary diseases were compared between the two groups. Patients were observed for 24 hours for development of any burn related to the operation. Data was analyzed using SPSS v.11.5, by Chi square and T-test. Results: Patients in the two groups were similar except for two factors. DM and pulmonary diseases which showed significant differences (P = 0.005 and P = 0.002 respectively). Seventy-five patients from controls and 35 from the study group developed burns, which was significant (P ˂ 0.0001). Conclusions: None of the factors were significantly related to developing burns. The differences between the two groups highlights the importance of systems modifications to lessen the incidence of burns. PMID:26839854

  19. Nutrition support after neonatal cardiac surgery.

    PubMed

    Owens, Joyce L; Musa, Ndidiamaka

    2009-01-01

    Congenital heart disease is the most common birth defect in the United States, with an estimated frequency of approximately 12-14 of 1000 live births per year. Neonates with congenital heart disease often need palliative or corrective surgery requiring cardiopulmonary bypass during the first weeks of life. The neonate undergoing cardiopulmonary bypass surgery experiences a more profound metabolic response to stress than that seen in older children and adults undergoing surgery. However, compared with older children and adults, the neonate has less metabolic reserves and is extremely vulnerable to the negative metabolic impact induced by stress, which can lead to suboptimal wound healing and growth failure. There are complications associated with the metabolic derangements of neonatal surgery requiring cardiopulmonary bypass, including but not limited to acute renal failure, chylothorax, and neurological dysfunction. This article discusses the importance of nutrition and metabolic support for the neonate undergoing cardiopulmonary bypass and the immediate postoperative nutrition needs of such a patient. Also, this article uses a case study to examine the feeding methodology used at one particular institution after neonatal cardiac surgery. The purpose of the case study is to provide an illustration of the many factors and obstacles that clinicians often face in the provision and timing of nutrition support. PMID:19321898

  20. Perioperative Ventilatory Management in Cardiac Surgery

    PubMed Central

    Fischer, Marc-Olivier; Courteille, Benoît; Guinot, Pierre-Grégoire; Dupont, Hervé; Gérard, Jean-Louis; Hanouz, Jean-Luc; Lorne, Emmanuel

    2016-01-01

    Abstract Protective ventilation is associated with a lower incidence of pulmonary complications. However, there are few published data on routine pulmonary management in adult cardiac surgery. The present study's primary objective was to survey pulmonary management in this high-risk population, as practiced by anesthesiologists in France. All 460 registered France-based cardiac anesthesiologists were invited (by e-mail) to participate in an online survey in January–February 2015. The survey's questionnaire was designed to assess current practice in pre-, per-, and postoperative pulmonary management. In all, 198 anesthesiologists (43% of those invited) participated in the survey. Other than during the cardiopulmonary bypass (CPB) per se, 179 anesthesiologists (91% of respondees) [95% confidence interval (CI): 87–95] used a low-tidal-volume approach (6–8 mL/kg), whereas techniques based on positive end-expiratory pressure and recruitment maneuvers vary greatly from 1 anesthesiologist to another. During CPB, 104 (53%) [95% CI: 46–60] anesthesiologists withdrew mechanical ventilation (with disconnection, in some cases) and 97 (49%) [95% CI: 42–56] did not prescribe positive end-expiratory pressure. One hundred sixty-five (83%) [95% CI: 78–88] anesthesiologists stated that a written protocol for peroperative pulmonary management was not available. Twenty (10%) [95% CI: 6–14] and 11 (5%) [95% CI: 2–8] anesthesiologists stated that they did use protocols for ventilator use and recruitment maneuvers, respectively. The preoperative period (pulmonary examinations and prescription of additional assessments) and the postoperative period (extubation, and noninvasive ventilation) periods vary greatly from 1 anesthesiologist to another. The great majority of French cardiac anesthesiologists use a low tidal volume during cardiac surgery (other than during CPB per se). However, pulmonary management procedures varied markedly from 1 anesthesiologist to another

  1. Cardiac surgery, a right target for hyperoxia?

    PubMed

    Boisramé-Helms, Julie; Radermacher, Peter; Asfar, Pierre

    2016-01-01

    In perioperative cardiac surgery period, supra-physiological arterial oxygen partial pressures is common practice, although there is no clear evidence of any benefit. Smit et al. have shown that a "conservative" approach did not improve hemodynamics, decrease oxidative stress or myocardial tissue damage, but was not associated with major deleterious event either. Here, we outline major oxygen friend or foes properties, which may partly explain the study results, and place the clinical trial from Smit et al. in a global context. PMID:27306619

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

    PubMed

    Dziatkowiak, A J

    2006-04-01

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

  3. Anesthetic issues for robotic cardiac surgery

    PubMed Central

    Bernstein, Wendy K.; Walker, Andrew

    2015-01-01

    As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure. PMID:25566713

  4. Robotic cardiac valve surgery: transcending the technologic crevasse!

    PubMed

    Felger, J E; Nifong, L W; Chitwood, W R

    2001-03-01

    "The man with a new idea is a crank until the idea succeeds."--Mark Twain. With the profound public stress for minimally invasive surgery that guided General Surgery, Cardiothoracic Surgery has progressed with warranted enthusiasm. The explosion of technological advancements in optics, instrumentation and cardiopulmonary bypass has permitted minimally invasive cardiac procedures to be performed with safety, efficiency, and efficacy. In this chapter, we review the evolution of minimally invasive cardiac valve surgery. The articles of leading minimally invasive valve surgeons, both European and American, are reviewed. The indications for minimally invasive surgery are explained. Furthermore, the present day state of "robotic" mitral valve surgery is described. PMID:11224648

  5. Postoperative cognitive dysfunction and neuroinflammation; Cardiac surgery and abdominal surgery are not the same.

    PubMed

    Hovens, Iris B; van Leeuwen, Barbara L; Mariani, Massimo A; Kraneveld, Aletta D; Schoemaker, Regien G

    2016-05-01

    Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. To gain insight in the mechanisms underlying the higher incidence of POCD after cardiac versus non-cardiac surgery, systemic and central inflammatory changes, alterations in intraneuronal pathways, and cognitive performance were studied after cardiac and abdominal surgery in rats. Male Wistar rats were subjected to ischemia reperfusion of the upper mesenteric artery (abdominal surgery) or the left coronary artery (cardiac surgery). Control rats remained naïve, received anesthesia only, or received thoracic sham surgery. Rats were subjected to affective and cognitive behavioral tests in postoperative week 2. Plasma concentrations of inflammatory factors, and markers for neuroinflammation (NGAL and microglial activity) and the BDNF pathway (BDNF, p38MAPK and DCX) were determined. Spatial memory was impaired after both abdominal and cardiac surgery, but only cardiac surgery impaired spatial learning and object recognition. While all surgical procedures elicited a pronounced acute systemic inflammatory response, NGAL and TNFα levels were particularly increased after abdominal surgery. Conversely, NGAL in plasma and the paraventricular nucleus of the hypothalamus and microglial activity in hippocampus and prefrontal cortex on postoperative day 14 were increased after cardiac, but not abdominal surgery. Both surgery types induced hippocampal alterations in BDNF signaling. These results suggest that POCD after cardiac surgery, compared to non-cardiac surgery, affects different cognitive domains and hence may be more extended rather than more severe. Moreover, while abdominal surgery effects seem limited to hippocampal brain regions, cardiac surgery seems associated with more wide spread alterations in the brain. PMID:26867718

  6. Peri-operative cardiac protection for non-cardiac surgery.

    PubMed

    Wong, S S C; Irwin, M G

    2016-01-01

    Cardiovascular complications are an important cause of morbidity and mortality after non-cardiac surgery. Pre-operative identification of high-risk individuals and appropriate peri-operative management can reduce cardiovascular risk. It is important to continue chronic beta-blocker and statin therapy. Statins are relatively safe and peri-operative initiation may be beneficial in high-risk patients and those scheduled for vascular surgery. The pre-operative introduction of beta-blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should only be considered in high-risk patients and the dose should be titrated to heart rate. Alpha-2 agonists may also contribute to hypotension. Aspirin continuation can increase the risk of major bleeding and offset the benefit of reduced myocardial risk. Contrary to the initial ENIGMA study, nitrous oxide does not seem to increase the risk of myocardial injury. Volatile anaesthetic agents and opioids have been shown to be cardioprotective in animal laboratory studies but these effects have, so far, not been conclusively reproduced clinically. PMID:26620144

  7. Quality assessment of cardiac surgery in Britain.

    PubMed

    Treasure, T; Bridgewater, B; Gallivan, S

    2009-10-01

    Data are available for every Cardiac Surgery unit in Britain and in 70 % are identifiable by surgeon. The data are linked to registration of deaths so survival for a range of operations, and associated patient or procedure related factors, can be evaluated. The choice of statistical triggers (outside 99.99 % confidence intervals) and the time frames of reported data (averaged over three years) (See P.285/353 of the report http://www.scts.org/documents/PDF/5thBlueBook2003.pdf) reduces its value as an early warning system but the rigour of data collecting systems and the level of scrutiny required probably ensure that poor performance will be detected. PMID:19834854

  8. Pharmacokinetics of paracetamol after cardiac surgery.

    PubMed Central

    Hopkins, C S; Underhill, S; Booker, P D

    1990-01-01

    Plasma concentration was measured after rectal and nasogastric administration of paracetamol 15 mg/kg to 28 febrile children aged between 9 days to 7 years who had undergone cardiac surgery. After equivalent doses, rectal administration in neonates and children on the first postoperative day was found to produce plasma concentrations below the therapeutic range with higher concentrations after nasogastric paracetamol on the second postoperative day. There was less variance in plasma paracetamol concentrations in neonates. Both plasma elimination half life and area under the plasma concentration time curve were significantly increased in neonates after suppository dosing compared with older children. There was no difference in antipyretic effect between the two routes of administration, but this was much lower than that previously reported in febrile children. PMID:2221970

  9. Renal insufficiency in neonates after cardiac surgery.

    PubMed

    Asfour, B; Bruker, B; Kehl, H G; Fründ, S; Scheld, H H

    1996-07-01

    Renal failure after cardiac surgery using cardiopulmonary bypass (CPB) is well understood for infants, children and adults. The perioperative risk factors after CPB for immature kidneys in newborns are not well known. This retrospective study investigates perioperative risk factors for renal insufficiency in neonates. I) Preoperative: Age; weight, performed angiography, amount of dye used in angiography, renal disease and creatinine. II) Intraoperative: Duration of operation, duration of MAP < 40 mmHg, use of deep hypothermia, in-out fluid balance, duration of CPB, duration of circulatory arrest and cross-clamp time. III) Postoperative: Creatinine, use of catecholamines, use of nitroglycerine (NG) or phosphodiesterase inhibitors (PDI) and additional antibiotics. From Jan. 1990 to Dec. 1994 50 neonates underwent cardiac surgery using CPB (n = 23 transposition of the great arteries; n = 4 pulmonary atresia; n = 6 critical pulmonary stenosis; n = 5 hypoplastic left heart syndrome; n = 3 Ebstein's anomaly; n = 2 interrupted arch with hypoplastic left ventricle; n = 2 single ventricle; n = 1 each: double outlet right ventricle, tricuspid atresia, critical aortic stenosis, rhabdo-myosarkoma, corrected transposition of the great arteries.) Thirty-one patients entered the study. Depending on the postoperative creatinine level two groups (group I: creatinine <1 mg/dl and group II: >1 mg/dl) were created. The diureses between the two groups did not differ. Comparing the patients of group I vs. group II, patients of group I were younger (mean age: 7.7 d. vs. 11.4 d), lighter (mean weight: 3260 g vs. 3430 g), less had angiography (44% vs. 77%), received more dye (mean amount: 14 ml vs. 7 ml), the duration of MAP < 40 mmHg while on CPB was longer (mean duration 3 min vs. 21 min), more patients were operated on using deep hypothermia (55% vs. 27%), the postoperative in-out-fluid balance was more positive (mean balance +413 ml vs. +221 ml), received postop. more frequently high

  10. Adjuvant Cardioprotection in Cardiac Surgery: Update

    PubMed Central

    Wagner, Robert; Piler, Pavel; Gabbasov, Zufar; Maruyama, Junko; Maruyama, Kazuo; Nicovsky, Jiri

    2014-01-01

    Cardiac surgery patients are now more risky in terms of age, comorbidities, and the need for complex procedures. It brings about reperfusion injury, which leads to dysfunction and/or loss of part of the myocardium. These groups of patients have a higher incidence of postoperative complications and mortality. One way of augmenting intraoperative myocardial protection is the phenomenon of myocardial conditioning, elicited with brief nonlethal episodes of ischaemia-reperfusion. In addition, drugs are being tested that mimic ischaemic conditioning. Such cardioprotective techniques are mainly focused on reperfusion injury, a complex response of the organism to the restoration of coronary blood flow in ischaemic tissue, which can lead to cell death. Extensive research over the last three decades has revealed the basic mechanisms of reperfusion injury and myocardial conditioning, suggesting its therapeutic potential. But despite the enormous efforts that have been expended in preclinical studies, almost all cardioprotective therapies have failed in the third phase of clinical trials. One reason is that evolutionary young cellular mechanisms of protection against oxygen handling are not very robust. Ischaemic conditioning, which is among these, is also limited by this. At present, the prevailing belief is that such options of treatment exist, but their full employment will not occur until subquestions and methodological issues with the transfer into clinical practice have been resolved. PMID:25215293

  11. Pharmacological Risk Factors for Delirium after Cardiac Surgery: A Review

    PubMed Central

    Tse, Lurdes; Schwarz, Stephan KW; Bowering, John B; Moore, Randell L; Burns, Kyle D; Richford, Carole M; Osborn, Jill A; Barr, Alasdair M

    2012-01-01

    Purpose: The objective of this review is to evaluate the literature on medications associated with delirium after cardiac surgery and potential prophylactic agents for preventing it. Source: Articles were searched in MEDLINE, Cumulative Index to Nursing and Allied Health, and EMBASE with the MeSH headings: delirium, cardiac surgical procedures, and risk factors, and the keywords: delirium, cardiac surgery, risk factors, and drugs. Principle inclusion criteria include having patient samples receiving cardiac procedures on cardiopulmonary bypass, and using DSM-IV-TR criteria or a standardized tool for the diagnosis of delirium. Principal Findings: Fifteen studies were reviewed. Two single drugs (intraoperative fentanyl and ketamine), and two classes of drugs (preoperative antipsychotics and postoperative inotropes) were identified in the literature as being independently associated with delirium after cardiac surgery. Another seven classes of drugs (preoperative antihypertensives, anticholinergics, antidepressants, benzodiazepines, opioids, and statins, and postoperative opioids) and three single drugs (intraoperative diazepam, and postoperative dexmedetomidine and rivastigmine) have mixed findings. One drug (risperidone) has been shown to prevent delirium when taken immediately upon awakening from cardiac surgery. None of these findings was replicated in the studies reviewed. Conclusion: These studies have shown that drugs taken perioperatively by cardiac surgery patients need to be considered in delirium risk management strategies. While medications with direct neurological actions are clearly important, this review has shown that specific cardiovascular drugs may also require attention. Future studies that are methodologically consistent are required to further validate these findings and improve their utility. PMID:23449337

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

    PubMed Central

    Mazzeffi, Michael; Johnson, Kyle; Paciullo, Christopher

    2015-01-01

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review. PMID:25849690

  13. Psychological depression and cardiac surgery: a comprehensive review.

    PubMed

    Tully, Phillip J

    2012-12-01

    The psychological and neurological impact of cardiac surgery has been of keen empirical interest for more than two decades although reports showing the prognostic influence of depression on adverse outcomes lag behind the evidence documented in heart failure, myocardial infarction, and unstable angina. The paucity of research to date is surprising considering that some pathophysiological mechanisms through which depression is hypothesized to affect coronary heart disease (e.g., platelet activation, the inflammatory system, dysrhythmias) are known to be substantially influenced by the use of cardiopulmonary bypass. As such, cardiac surgery may provide a suitable exemplar to better understand the psychiatric mechanisms of cardiopathogenesis. The extant literature is comprehensively reviewed with respect to the deleterious impact of depression on cardiac and neuropsychological morbidity and mortality. Research to date indicates that depression and major depressive episodes increase major cardiovascular morbidity risk after cardiac surgery. The association between depressive disorders and incident delirium is of particular relevance to cardiac surgery staff. Contemporary treatment intervention studies are also described along with suggestions for future cardiac surgery research. PMID:23441564

  14. Medanta insulin protocols in patients undergoing cardiac surgery

    PubMed Central

    Bansal, Beena; Mithal, Ambrish; Carvalho, Pravin; Mehta, Yatin; Trehan, Naresh

    2014-01-01

    Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification. PMID:25143899

  15. Paediatric cardiac surgery in a patient with cold agglutinins.

    PubMed

    Hasegawa, Tomomi; Oshima, Yoshihiro; Maruo, Ayako; Matsuhisa, Hironori

    2012-03-01

    Cold agglutinins (CAs) lead to organ thrombosis or haemolysis due to increased blood viscosity and red blood cell clumping when blood temperature drops below the thermal amplitude for haemagglutination. Although it is well known that CAs are particularly relevant to adult cardiac surgery with hypothermic cardiopulmonary bypass (CPB), paediatric cardiac surgery with congenital heart disease and with CAs has been reported very rarely. We present here a case of paediatric cardiac surgery to repair atrial septal defect with pulmonary stenosis in an 11-month old infant with a family history of CAs. She was detected to have a high titre of CAs preoperatively, and underwent an intracardiac repair with normothermic CPB using temporary electrical fibrillation for added safety. Her post-operative course was uneventful without any complications. PMID:22184466

  16. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    PubMed Central

    Li, Ming; Mazilu, Dumitru; Horvath, Keith A.

    2012-01-01

    Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models. PMID:23125924

  17. Emergency Pulmonary Embolectomy Using Minimally Invasive Cardiac Surgery.

    PubMed

    Kodani, Noriko; Ohashi, Takeki; Iida, Hiroshi; Kageyama, Souichirou; Furui, Masato; Uchino, Gaku

    2016-04-01

    A 78-year-old man who had undergone operation for acute type A aortic dissection presented with dyspnea and shock. Chest computed tomography revealed pulmonary embolism. Minimally invasive cardiac surgery was performed through a right fourth intercostal skin incision using cardiopulmonary bypass through the right femoral artery and vein. The right pulmonary artery below the superior vena cava was incised vertically, and the thrombus was extracted directly by balloon catheter. The patient was weaned off cardiopulmonary bypass uneventfully. The postoperative course was also uneventful. In redo cardiac surgery, pulmonary embolectomy through minimally invasive right thoracotomy can be easily performed, with quick recovery. PMID:27000575

  18. Factors affecting postoperative blood loss in children undergoing cardiac surgery.

    PubMed

    Faraoni, David; Van der Linden, Philippe

    2014-01-01

    We hypothesized that the influence of cyanotic disease on postoperative blood loss is closely related to age in children undergoing cardiac surgery. Here, we demonstrate that the presence of a cyanotic disease is associated with increased postoperative blood loss in children aged 1 to 6 months. Children with cyanotic disease and aged<1 month who received fresh frozen plasma during cardiopulmonary bypass had less postoperative blood loss and higher maximal clot firmness on FIBTEM than cyanotic children from all other groups. Additional studies are needed to define optimal pathophysiology-based management in children undergoing cardiac surgery. PMID:24512988

  19. Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

    PubMed Central

    Ramchandani, Mahesh; Al Jabbari, Odeaa; Abu Saleh, Walid K.; Ramlawi, Basel

    2016-01-01

    For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs—the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation. PMID:27127556

  20. Cutaneous microangiopathic thrombosis complicated by pyoderma gangrenosum in post-cardiac surgery heparin-induced thrombocytopaenia.

    PubMed

    Luthra, Suvitesh; Theodore, Sanjay; Liava'a, Matthew; Atkinson, Victoria; Tatoulis, James

    2009-08-01

    Thrombotic cutaneous gangrene is a rare complication of heparin-induced thrombocytopaenia after cardiac surgery. We report a case and discuss management issues with cardiopulmonary bypass for cardiac surgery in this condition. PMID:18375181

  1. Pleural effusions in children undergoing cardiac surgery

    PubMed Central

    Talwar, Sachin; Agarwala, Sandeep; Mittal, Chander Mohan; Choudhary, Shiv Kumar; Airan, Balram

    2010-01-01

    Persistent pleural effusions are a source of significant morbidity and mortality following surgery in congenital heart disease. In this review, we discuss the etiology, pathophysiology, and management of this common complication. PMID:20814477

  2. Associated with Health Care-Associated Infections in Cardiac Surgery

    PubMed Central

    Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod; Argenziano, Michael; Alexander, John; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.

    2014-01-01

    BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES To determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data, routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients, mean age of 64 ± 13 years, 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%) and C. Difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions, among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAI was on average nearly three times as much as readmissions not related to HAI. CONCLUSIONS Hospital cost, length of stay, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. PMID:25572505

  3. Role of radionuclide cardiac imaging in coronary artery bypass surgery

    SciTech Connect

    Iskandrian, A.S.; Heo, J.; Mostel, E.

    1987-01-01

    The main applications of cardiac nuclear imaging in coronary artery bypass surgery include: patient selection, prediction of improvement in resting LV function after revascularization, diagnosis of perioperative myocardial infarction, assessment of the results of revascularization, evaluation of new or recurrent symptoms, and in risk stratification. Proper understanding of which test to be used, when, and why may be important to optimize patient management.

  4. Early detection of acute kidney injury after pediatric cardiac surgery

    PubMed Central

    Jefferies, John Lynn; Devarajan, Prasad

    2016-01-01

    Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy. PMID:27429538

  5. Tapia's syndrome — a rare complication following cardiac surgery

    PubMed Central

    Nalladaru, Zubin; Wessels, Andre; DuPreez, Leon

    2012-01-01

    Tapia's syndrome is a rare complication following cardiac surgery. It includes the extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve and results in ipsilateral paralysis of the vocal cord and the tongue. It is usually a complication related to anaesthesia and positioning of the head of the patient during surgery. We describe this rare complication which occurred at our institute. A 49-year old man developed Tapia's syndrome after an uneventful coronary artery bypass surgery. He complained of dysphonia, hoarseness of voice and an inability to swallow soon after extubation. The syndrome resolved completely over the following weeks with no neurological deficit. PMID:22108947

  6. Impact of hepatic cirrhosis on outcome in adult cardiac surgery.

    PubMed

    Dimarakis, Ioannis; Grant, Stuart; Corless, Rebecca; Velissaris, Theodore; Prince, Martin; Bridgewater, Ben; Asimakopoulos, George

    2015-02-01

    Increasing prevalence of hepatic disease is likely to translate in a growing number of patients with significant hepatic disease requiring cardiac surgery. Available cardiac risk stratification models do not address the risk associated with hepatic disease. However, weighted mean mortality rates based on previous studies of cardiac surgery in patients with hepatic disease demonstrate operative mortality rates that range from 9.88% (standard deviation [SD] 9.69) for patients in Child-Turcotte-Pugh (CTP) class A cirrhosis to 69.23% (SD 28.55) for patients with CTP class C cirrhosis. This review comprehensively appraises the pathophysiology of hepatic disease, reported clinical outcomes and considerations for risk stratification. PMID:25291160

  7. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  8. Cardiovascular effects of hyperoxia during and after cardiac surgery.

    PubMed

    Spoelstra-de Man, A M E; Smit, B; Oudemans-van Straaten, H M; Smulders, Y M

    2015-11-01

    During and after cardiac surgery with cardiopulmonary bypass, high concentrations of oxygen are routinely administered, with the intention of preventing cellular hypoxia. We systematically reviewed the literature addressing the effects of arterial hyperoxia. Extensive evidence from pre-clinical experiments and clinical studies in other patient groups suggests predominant harm, caused by oxidative stress, vasoconstriction, perfusion heterogeneity and myocardial injury. Whether these alterations are temporary and benign, or actually affect clinical outcome, remains to be demonstrated. In nine clinical cardiac surgical studies in low-risk patients, higher oxygen targets tended to compromise cardiovascular function, but did not affect clinical outcome. No data about potential beneficial effects of hyperoxia, such as reduction of gas micro-emboli or post-cardiac surgery infections, were reported. Current evidence is insufficient to specify optimal oxygen targets. Nevertheless, the safety of supraphysiological oxygen suppletion is unproven. Randomised studies with a variety of oxygen targets and inclusion of high-risk patients are needed to identify optimal oxygen targets during and after cardiac surgery. PMID:26348878

  9. Ground zero: building a cardiac surgery program.

    PubMed

    Pedersen, A; Earley, M B; Fenner, D J; Postlewaite, C S; Scott, A D

    2001-01-01

    More and more community hospitals are opening cardiovascular surgery programs to provide a broader spectrum of services closer to home. This article leads the reader through one hospital's experience in opening a new heart center and highlights the philosophy, triaging of issues, and staff preparation needed to achieve successful patient outcomes. Our case study can serve as a guide for other hospitals as they take on the challenge of opening new programs. PMID:22076456

  10. Cardiac surgery and catheterization in patients with haemophilia.

    PubMed

    MacKinlay, N; Taper, J; Renisson, F; Rickard, K

    2000-03-01

    The present study summarizes the results of 12 cardiac surgical procedures performed in a carrier of Haemophilia B and in six patients with Haemophilia A at a single centre from 1979 to 1998. The median age of the patients at the time of intervention was 56 years ranging from 18 years to 73 years. The six patients with Haemophilia A ranged in severity from moderately to mildly affected. Three patients were hepatitis C antibody positive. No patients were HIV antibody or hepatitis B surface antigen positive. The cardiac procedures included cardiac catheterization (n=4), coronary artery bypass surgery (n=2), percutaneous transluminal coronary angioplasty (n=1), cardiac valve replacement (AVR n=1 and AVR/MVR n=2), and closure of an atrial septal defect and subsequent drainage of a pericardial effusion (n=1). No patients had demonstrable inhibitors at the time of surgery. Haemostasis was achieved with AHF in 10/11 procedures and high purity factor IX (Immunine) in one procedure. The initial procedures involved intermittent bolus factor therapy while more recently, AHF was administered by continuous intravenous infusion. All patients demonstrated excellent intra- and post-operative haemostasis. These results, although from a small and varied group of patients, demonstrate that cardiac surgical procedures can be performed safely in patients with Haemophilia. PMID:10781193

  11. Preoperative evaluation of the cardiac patient for noncardiac surgery.

    PubMed Central

    Fleisher, L. A.; Barash, P. G.

    1993-01-01

    Perioperative cardiac events continue to represent a significant cause of morbidity in patients undergoing noncardiac surgery. The evaluation of the high risk patient should begin with an assessment of the probability of coronary artery disease and exercise tolerance. Decisions to undergo further evaluation, including noninvasive testing, should be based upon the perioperative morbidity and mortality rate for the planned surgical procedure. In patients with significant coronary artery stenoses and a high probability of perioperative cardiac morbidity, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and preoperative optimization of hemodynamics in an intensive care unit have all been advocated as means of reducing risk. PMID:7825340

  12. A history of innovation: cardiac surgery in Minnesota.

    PubMed

    Aho, Johnathon M; Schaff, Matthew S; Thiels, Cornelius A; Darling, Robert A; Koerner, Mark N Price; Schaff, Hartzell V

    2015-01-01

    For centuries, the heart was believed to be an inoperable organ. Through the development of new technologies and techniques, the initial difficulties inherent with operating on a moving organ began to fade. But as surgeons in the last century pushed the boundaries of cardiac repair, new problems arose. To solve them, they enlisted the help of physiologists, residents and engineers. By taking a multidisciplinary approach, sharing information and ideas, and working collaboratively, University of Minnesota and Mayo Clinic investigators found themselves at the forefront of cardiac surgery. This article reviews Minnesota's contributions to the field. PMID:25665265

  13. Fibrinogen reduction and coagulation in cardiac surgery: an investigational study.

    PubMed

    Gielen, Chantal L I; Grimbergen, Jos; Klautz, Robert J M; Koopman, Jaap; Quax, Paul H A

    2015-09-01

    Fibrinogen as precursor of fibrin plays an essential role in clot formation. There are three main mechanisms associated with a reduction in fibrinogen concentration during cardiac surgery: hemodilution, consumption, and degradation. Moreover, early fibrinogen degradation products (FgDPs) can interfere with normal fibrin formation of intact fibrinogen. The aim of this study was to determine the relative contributions of hemodilution, consumption, and degradation to fibrinogen loss in cardiac surgery and to evaluate the effects fibrinogen degradation products on blood clot formation in vitro. First, fibrin and fibrinogen concentrations, their degradation products, hematocrit, and albumin concentrations were compared in 10 patients before and after isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Second, ex-vivo fibrinogen supplementation experiments were performed. Finally, the effects of purified FgDPs on clotting time and clot firmness were established in vitro in whole blood by ROTEM. Fibrinogen plasma concentration decreased 30% during surgery. This drop appears to be mainly caused by hemodilution, as both hematocrit and albumin levels decreased and no relevant increase in D-dimer levels and FgDPs was observed. Furthermore, the coagulation profile normalized after addition of purified fibrinogen. Early FgDPs demonstrated a significant impact on in-vitro whole blood clotting. Although early FgDPs have a pronounced effect on blood clot formation in vitro and therefore may induce or enhance in vivo coagulopathy, the drop of fibrinogen concentration seen after CABG surgery (using tranexamic acid) is primarily caused by hemodilution. PMID:26083991

  14. [Reoperative cardiac surgery after previous coronary artery bypass grafting].

    PubMed

    Hayashi, Yasunari; Ito, Toshiaki; Maekawa, Atsuo; Sawaki, Sadanari; Hoshino, Satoshi; Tokoro, Masayoshi; Yanagisawa, Junji

    2014-06-01

    Reoperative cardiac surgery after coronary artery bypass grafting( CABG) has been increasing. We reviewed 25 cases of reoperative cardiac surgery after CABG. Re-CABG was not included in this study. The patients consisted of 15 men and 10 women. The mean patient age was 74.4±6.3 years old. The reoperations were performed 6.3±5.1 years after CABG. They consisted of 7 aortic valve surgeries, 2 double valve surgeries, 12 mitral valve surgeries, and 4 total arch replacements. Resternotomy was performed in 20 cases, while right thoracotomy was performed in 5 cases. Internal thoracic artery( ITA)grafts had been used in 24 cases, and 22 of them were patent. Fifteen operations were performed under cardioplegic arrest with the patent ITA graft clamped from the left pleural space, while 5 operations were performed under perfused ventricular fibrillation with hypothermia. No differences were observed between the 2 groups in terms of cardiopulmonary bypass (CPB) time and peak creatine kinase MB (CK-MB). Operative mortality was 4% (1/25). To clamp left internal thoracic artery (LITA) graft from the left pleural space is easy and safe. In case clamping the patent graft is difficult, perfused ventricular fibrillation with hypothermia is a useful alternative. PMID:24917396

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

    PubMed

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

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. PMID:25829458

  16. Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and Perspectives.

    PubMed

    Katz, Michael G; Fargnoli, Anthony S; Kendle, Andrew P; Hajjar, Roger J; Bridges, Charles R

    2016-06-01

    The concept of gene therapy was introduced in the 1970s after the development of recombinant DNA technology. Despite the initial great expectations, this field experienced early setbacks. Recent years have seen a revival of clinical programs of gene therapy in different fields of medicine. There are many promising targets for genetic therapy as an adjunct to cardiac surgery. The first positive long-term results were published for adenoviral administration of vascular endothelial growth factor with coronary artery bypass grafting. In this review we analyze the past, present, and future of gene therapy in cardiac surgery. The articles discussed were collected through PubMed and from author experience. The clinical trials referenced were found through the Wiley clinical trial database (http://www.wiley.com/legacy/wileychi/genmed/clinical/) as well as the National Institutes of Health clinical trial database (Clinicaltrials.gov). PMID:26801060

  17. Prevention of Lung Injury in Cardiac Surgery: A Review

    PubMed Central

    Young, Robert W.

    2014-01-01

    Abstract: Inflammatory lung injury is an inevitable consequence of cardiac surgery with cardiopulmonary bypass. The lungs are particularly susceptible to the effects of the systemic inflammatory response to cardiopulmonary bypass. This insult is further exacerbated by a pulmonary ischemia–reperfusion injury after termination of bypass. Older patients and those with pre-existing lung disease will clearly be less tolerant of any lung injury and more likely to develop respiratory failure in the postoperative period. A requirement for prolonged ventilation has implications for morbidity, mortality, and cost of treatment. This review contains a summary of recent interventions and changes of practice that may reduce inflammatory lung injury after cardiac surgery. The review also focuses on a number of general aspects of perioperative management, which may exacerbate such injury, if performed poorly. PMID:25208430

  18. Ventricular assist devices and non-cardiac surgery.

    PubMed

    Roberts, S Michael; Hovord, David G; Kodavatiganti, Ramesh; Sathishkumar, Subramanian

    2015-01-01

    The use of ventricular assist devices has expanded significantly since their approval by the Food and Drug Administration in the United States in 1994. In addition to this, the prevalence of heart failure continues to increase. We aim to provide an overview of perioperative considerations and management of these patients for non-cardiac surgery. We performed a Medline search for the words "ventricular assist device," "Heartmate" and "HeartWare" to gain an overview of the literature surrounding these devices, and chose studies with relevance to the stated aims of this review. Patients with ventricular assist devices are presenting more frequently for surgery not related to their cardiac pathology. As the mechanically supported population grows, general anesthesiologists will be faced with managing these patients, possibly outside of the tertiary care setting. The unique challenges of this patient population can best be addressed by a thorough understanding of ventricular assist device physiology and a multidisciplinary approach to care. PMID:26685884

  19. Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and Perspectives

    PubMed Central

    Katz, Michael G.; Fargnoli, Anthony S.; Kendle, Andrew P.; Hajjar, Roger J.; Bridges, Charles R.

    2016-01-01

    The concept of gene therapy was introduced in the 1970s after the development of recombinant DNA technology. Despite the initial great expectations, this field experienced early setbacks. Recent years have seen a revival of clinical programs of gene therapy in different fields of medicine. There are many promising targets for genetic therapy as an adjunct to cardiac surgery. The first positive long-term results were published for adenoviral administration of vascular endothelial growth factor with coronary artery bypass grafting. In this review we analyze the past, present, and future of gene therapy in cardiac surgery. The articles discussed were collected through PubMed and from author experience. The clinical trials referenced were found through the Wiley clinical trial database (http://www.wiley.com/legacy/wileychi/genmed/clinical/) as well as the National Institutes of Health clinical trial database (Clinicaltrials.gov). PMID:26801060

  20. Rationale for Implementation of Warm Cardiac Surgery in Pediatrics.

    PubMed

    Durandy, Yves

    2016-01-01

    Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia-reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery. PMID:27200324

  1. Rationale for Implementation of Warm Cardiac Surgery in Pediatrics

    PubMed Central

    Durandy, Yves

    2016-01-01

    Cardiac surgery was developed thanks to the introduction of hypothermia and cardiopulmonary bypass in the early 1950s. The deep hypothermia protective effect has been essential to circulatory arrest complex cases repair. During the early times of open-heart surgery, a major concern was to decrease mortality and to improve short-term outcomes. Both mortality and morbidity dramatically decreased over a few decades. As a consequence, the drawbacks of deep hypothermia, with or without circulatory arrest, became more and more apparent. The limitation of hypothermia was particularly evident for the brain and regional perfusion was introduced as a response to this problem. Despite a gain in popularity, the results of regional perfusion were not fully convincing. In the 1990s, warm surgery was introduced in adults and proved to be safe and reliable. This option eliminates the deleterious effect of ischemia–reperfusion injuries through a continuous, systemic coronary perfusion with warm oxygenated blood. Intermittent warm blood cardioplegia was introduced later, with impressive results. We were convinced by the easiness, safety, and efficiency of warm surgery and shifted to warm pediatric surgery in a two-step program. This article outlines the limitations of hypothermic protection and the basic reasons that led us to implement pediatric warm surgery. After tens of thousands of cases performed across several centers, this reproducible technique proved a valuable alternative to hypothermic surgery. PMID:27200324

  2. Application of Mechanical Ventilation Weaning Predictors After Elective Cardiac Surgery

    PubMed Central

    Silva, Mayara Gabrielle Barbosa e; Borges, Daniel Lago; Costa, Marina de Albuquerque Gonçalves; Baldez, Thiago Eduardo Pereira; da Silva, Luan Nascimento; Oliveira, Rafaella Lima; Ferreira, Teresa de Fátima Ramos; Albuquerque, Renato Adams Matos

    2015-01-01

    OBJECTIVE To test several weaning predictors as determinants of successful extubation after elective cardiac surgery. METHODS The study was conducted at a tertiary hospital with 100 adult patients undergoing elective cardiac surgery from September to December 2014. We recorded demographic, clinical and surgical data, plus the following predictive indexes: static compliance (Cstat), tidal volume (Vt), respiratory rate (f), f/ Vt ratio, arterial partial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2), and the integrative weaning index (IWI). Extubation was considered successful when there was no need for reintubation within 48 hours. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were used to evaluate each index. RESULTS The majority of the patients were male (60%), with mean age of 55.4±14.9 years and low risk of death (62%), according to InsCor. All of the patients were successfully extubated. Tobin Index presented the highest SE (0.99) and LR+ (0.99), followed by IWI (SE=0.98; LR+ =0.98). Other scores, such as SP, NPV and LR-were nullified due to lack of extubation failure. CONCLUSION All of the weaning predictors tested in this sample of patients submitted to elective cardiac surgery showed high sensitivity, highlighting f/Vt and IWI. PMID:26934398

  3. Kinetics of Highly Sensitive Troponin T after Cardiac Surgery

    PubMed Central

    Omar, Amr S.; Sudarsanan, Suraj; Hanoura, Samy; Osman, Hany; Sivadasan, Praveen C.; Shouman, Yasser; Tuli, Alejandro Kohn; Singh, Rajvir; Al Khulaifi, Abdulaziz

    2015-01-01

    Perioperative myocardial infarction (PMI) confers a considerable risk in cardiac surgery settings; finding the ideal biomarker seems to be an ideal goal. Our aim was to assess the diagnostic accuracy of highly sensitive troponin T (hsTnT) in cardiac surgery settings and to define a diagnostic level for PMI diagnosis. This was a single-center prospective observational study analyzing data from all patients who underwent cardiac surgeries. The primary outcome was the diagnosis of PMI through a specific level. The secondary outcome measures were the lengths of mechanical ventilation (LOV), stay in the intensive care unit (LOSICU), and hospitalization. Based on the third universal definition of PMI, patients were divided into two groups: no PMI (Group I) and PMI (Group II). Data from 413 patients were analyzed. Nine patients fulfilled the diagnostic criteria of PMI, while 41 patients were identified with a 5-fold increase in their CK-MB (≥120 U/L). Using ROC analysis, a hsTnT level of 3,466 ng/L or above showed 90% sensitivity and 90% specificity for the diagnosis of PMI. Secondary outcome measures in patients with PMI were significantly prolonged. In conclusion, the hsTnT levels detected here paralleled those of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI. PMID:26539512

  4. New Technologies for Surgery of the Congenital Cardiac Defect

    PubMed Central

    Kalfa, David; Bacha, Emile

    2013-01-01

    The surgical repair of complex congenital heart defects frequently requires additional tissue in various forms, such as patches, conduits, and valves. These devices often require replacement over a patient’s lifetime because of degeneration, calcification, or lack of growth. The main new technologies in congenital cardiac surgery aim at, on the one hand, avoiding such reoperations and, on the other hand, improving long-term outcomes of devices used to repair or replace diseased structural malformations. These technologies are: 1) new patches: CorMatrix® patches made of decellularized porcine small intestinal submucosa extracellular matrix; 2) new devices: the Melody® valve (for percutaneous pulmonary valve implantation) and tissue-engineered valved conduits (either decellularized scaffolds or polymeric scaffolds); and 3) new emerging fields, such as antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. These new technologies for structural malformation surgery are still in their infancy but certainly present great promise for the future. But the translation of these emerging technologies to routine health care and public health policy will also largely depend on economic considerations, value judgments, and political factors. PMID:23908869

  5. Predictors of stroke in patients undergoing cardiac surgery

    PubMed Central

    dos Santos, Handerson Nunes; Magedanz, Ellen Hettwer; Guaragna, João Carlos Vieira da Costa; dos Santos, Natalia Nunes; Albuquerque, Luciano Cabral; Goldani, Marco Antonio; Petracco, João Batista; Bodanese, Luiz Carlos

    2014-01-01

    Objective To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery. Methods A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05. Results The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001). Conclusion The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes. PMID:25140462

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

    PubMed

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

    2015-09-15

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

  7. Cardiac surgery in a fixed-reimbursement environment.

    PubMed

    Scully, H E

    1996-02-01

    Hospital and physician services in Canada are funded by public (government) sources. This article will describe the practice of cardiac surgery in this setting. Federal legislation has prescribed the principles of accessibility, universality, comprehensiveness, portability, and public administration for essential healthcare services in Canada. Provincial and territorial governments are responsible for the provision of services, receiving federal tax and cash transfers that supplement provincial/territorial funds for hospital, physician, and community health services. Hospitals negotiate annually for global budgets. Physicians work as independent contractors in hospitals (and communities) and are usually paid as specified by fee-for-service contracts negotiated at intervals with governments. Cardiac surgical services have been planned conjointly with government. Forty-two centers in Canada serve a population of 28 million. All but three of these centers are located in tertiary teaching hospitals; all but one do more than 200 pumps annually. The rate of cardiac operations is 80 per 100,000 population. In Ontario, the Provincial Adult Cardiac Care Network makes recommendations to governments about the distribution of the 7,600 pumps annually (population, 11 million), rationalizing waiting lists based on an urgency rating scale. Patients requiring emergent/urgent operations are well served. The average waiting time for an elective cardiac operation is 10.5 weeks. The waiting list mortality is less than 0.5%. The Provincial Adult Cardiac Care Network also determines the placement of new programs and participates in creating hospital funding formulas developed from a combination of resource and acuity intensity weighting. Most surgeons hold full-time academic appointments but are funded largely by practice income. Surgical fees average $2,000 (Canada) per case. Overhead, including malpractice insurance, is approximately 45%. All Canadian patients enjoy reasonably timely

  8. Predictors of early and late stroke following cardiac surgery

    PubMed Central

    Whitlock, Richard; Healey, Jeff S.; Connolly, Stuart J.; Wang, Julie; Danter, Matthew R.; Tu, Jack V.; Novick, Richard; Fremes, Stephen; Teoh, Kevin; Khera, Vikas; Yusuf, Salim

    2014-01-01

    Background: Much is known about the short-term risks of stroke following cardiac surgery. We examined the rate and predictors of long-term stroke in a cohort of patients who underwent cardiac surgery. Methods: We obtained linked data for patients who underwent cardiac surgery in the province of Ontario between 1996 and 2006. We analyzed the incidence of stroke and death up to 2 years postoperatively. Results: Of 108 711 patients, 1.8% (95% confidence interval [CI] 1.7%–1.9%) had a stroke perioperatively, and 3.6% (95% CI 3.5%–3.7%) had a stroke within the ensuing 2 years. The strongest predictors of both early and late stroke were advanced age (≥ 65 year; adjusted hazard ratio [HR] for all stroke 1.9, 95% CI 1.8–2.0), a history of stroke or transient ischemic attack (adjusted HR 2.1, 95% CI 1.9–2.3), peripheral vascular disease (adjusted HR 1.6, 95% CI 1.5–1.7), combined coronary bypass grafting and valve surgery (adjusted HR 1.7, 95% CI 1.5–1.8) and valve surgery alone (adjusted HR 1.4, 95% CI 1.2–1.5). Preoperative need for dialysis (adjusted odds ratio [OR] 2.1, 95% CI 1.6–2.8) and new-onset postoperative atrial fibrillation (adjusted OR 1.5, 95% CI 1.3–1.6) were predictors of only early stroke. A CHADS2 score of 2 or higher was associated with an increased risk of stroke or death compared with a score of 0 or 1 (19.9% v. 9.3% among patients with a history of atrial fibrillation, 16.8% v. 7.8% among those with new-onset postoperative atrial fibrillation and 14.8% v. 5.8% among those without this condition). Interpretation: Patients who had cardiac surgery were at highest risk of stroke in the early postoperative period and had continued risk over the ensuing 2 years, with similar risk factors over these periods. New-onset postoperative atrial fibrillation was a predictor of only early stroke. The CHADS2 score predicted stroke risk among patients with and without atrial fibrillation. PMID:25047983

  9. A composite outcome for neonatal cardiac surgery research

    PubMed Central

    Butts, Ryan J.; Scheurer, Mark A.; Zyblewski, Sinai C.; Wahlquist, Amy E.; Nietert, Paul J.; Bradley, Scott M.; Atz, Andrew M.; Graham, Eric M.

    2014-01-01

    Objective The objective of this study was to determine whether a composite outcome, derived of objective signs of inadequate cardiac output, would be associated with other important measures of outcomes and therefore be an appropriate end point for clinical trials in neonatal cardiac surgery. Methods Neonates (n = 76) undergoing cardiac operations requiring cardiopulmonary bypass were prospectively enrolled. Patients were defined to have met the composite outcome if they had any of the following events before hospital discharge: death, the use of mechanical circulatory support, cardiac arrest requiring chest compressions, hepatic injury (2 times the upper limit of normal for aspartate aminotransferase or alanine aminotransferase), renal injury (creatinine >1.5 mg/dL), or lactic acidosis (an increasing lactate >5 mmol/L in the postoperative period). Associations between the composite outcome and the duration of mechanical ventilation, intensive care unit stay, hospital stay, and total hospital charges were determined. Results The median age at the time of surgery was 7 days, and the median weight was 3.2 kg. The composite outcome was met in 39% of patients (30/76). Patients who met the composite outcome compared with those who did not had a longer duration of mechanical ventilation (4.9 vs 2.9 days, P<.01), intensive care unit stay (8.8 vs 5.7 days, P<.01), hospital stay (23 vs 12 days, P<.01), and increased hospital charges ($258,000 vs $170,000, P<.01). In linear regression analysis, controlling for surgical complexity, these differences remained significant (R2 = 0.29–0.42, P<.01). Conclusions The composite outcome is highly associated with important early operative outcomes and may serve as a useful end point for future clinical research in neonates undergoing cardiac operations. PMID:23587468

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

    PubMed Central

    Naguib, Aymen N.; Winch, Peter D.; Tobias, Joseph D.; Yeates, Keith O.; Miao, Yongjie; Galantowicz, Mark; Hoffman, Timothy M.

    2015-01-01

    Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5th edition). Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF) patients scored significantly higher than the low-dose fentanyl (LDF) + dexmedetomidine (DEX) (LDF + DEX) group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046). The bispectral index (BIS) value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011). For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ) score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027). Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental outcome. PMID

  11. Perfusionist strategies for blood conservation in pediatric cardiac surgery.

    PubMed

    Durandy, Yves

    2010-02-26

    There is increasing concern about the safety of homologous blood transfusion during cardiac surgery, and a restrictive transfusion practice is associated with improved outcome. Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants; however, considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children. These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuum-assisted venous drainage, microplegia, autologous blood predonation with or without infusion of recombinant (erythropoietin), cell salvaging, ultrafiltration and retrograde autologous priming. The three major techniques which are simple, safe, efficient, and cost-effective are: a prime volume as small as possible, cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration. Furthermore, these three techniques can be used for all the patients, including emergencies and small babies. In every pediatric surgical unit, a strategy to decrease or avoid blood bank transfusion must be implemented. A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-, peri-, and postoperative planning and management. PMID:21160681

  12. When blood runs cold: cold agglutinins and cardiac surgery.

    PubMed

    Findlater, Rhonda R; Schnell-Hoehn, Karen N

    2011-01-01

    Cold agglutinins are particular cold-reactive antibodies that react with red blood cells when the blood temperature drops below normal body temperature causing increased blood viscosity and red blood cell clumping. Most individuals with cold agglutinins are not aware of their presence, as these antibodies have little effect on daily living, often necessitating no treatment. However, when those with cold agglutinins are exposed to hypothermic situations or undergo procedures such as cardiopulmonary bypass with hypothermia during cardiac surgery, lethal complications of hemolysis, microvascular occlusion and organ failure can occur. By identifying those suspected of possessing cold agglutinins through a comprehensive nursing assessment and patient history, cold agglutinin screening can be performed prior to surgery to determine a diagnosis of cold agglutinin disease. With a confirmed diagnosis of cold agglutinin disease, the plan of care can be focused on measures to maintain the patient's blood temperature above the thermal amplitude throughout their hospitalization including the use of normothermic cardiopulmonary bypass with warm myocardial preservation techniques to prevent these fatal complications. Using a case report approach, the authors review the mechanism, clinical manifestations, detection and nursing management of a patient with cold agglutinins undergoing scheduled cardiac surgery. Cold agglutinin disease is rare. However, the risk to patients warrants an increased awareness of cold agglutinins and screening for those who are suspected of carrying these antibodies. PMID:21630629

  13. Risk assessment methods for cardiac surgery and intervention.

    PubMed

    Thalji, Nassir M; Suri, Rakesh M; Greason, Kevin L; Schaff, Hartzell V

    2014-12-01

    Surgical risk models estimate operative outcomes while controlling for heterogeneity in 'case mix' within and between institutions. In cardiac surgery, risk models are used for patient counselling, surgical decision-making, clinical research, quality assurance and improvement, and financial reimbursement. Importantly, risk models are only as good as the databases from which they are derived; physicians and investigators should, therefore, be aware of shortcomings of clinical and administrative databases used for modelling risk estimates. The most frequently modelled outcome in cardiac surgery is 30-day mortality. However, results of randomized trials to compare conventional surgery versus transcatheter aortic valve implantation (TAVI) indicate attrition of surgical patients at 2-4 months postoperatively, suggesting that 3-month survival or mortality might be an appropriate procedural end point worth modelling. Risk models are increasingly used to identify patients who might be better-suited for TAVI. However, the appropriateness of available statistical models in this application is controversial, particularly given the tendency of risk models to misestimate operative mortality in high-risk patient subsets. Incorporation of new risk factors (such as previous mediastinal radiation, liver failure, and frailty) in future surgical or interventional risk-prediction tools might enhance model performance, and thereby optimize patient selection for TAVI. PMID:25245832

  14. Cataract surgery without anaesthesia: two descriptions by Arthur Jacob.

    PubMed

    Haridas, R P

    2009-07-01

    Dr Arthur Jacob (1790-1874), of Dublin, Ireland, was one of the leading ophthalmologists of his time. He was the first to describe the membrane that contains the rods and cones in the eye (membrana Jacobi) and basal cell carcinoma (Jacob's ulcer). He made a curved needle for cataract surgery from a sewing needle (Jacob's needle). Two descriptions of cataract surgery without anaesthesia are presented. PMID:19705632

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

    PubMed Central

    Yang, Yang; Xiao, Feng; Wang, Jin; Song, Bo; Li, Xi-Hui; Li, Jian; He, Zhi-Song; Zhang, Huan; Yin, Ling

    2016-01-01

    Background To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery. Methods From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries. Results Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG), bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%]), pulmonary infection and hypoxemia (2, 3.1%), hemorrhage of upper digestive tract (1, 1.6%), incisional infection (3, 4.7%), subphrenic abscess (1, 1.6%), and postoperative acute renal failure and hemofiltration (3, 4.7%). Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%. Conclusion Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival. PMID:27486311

  16. Primary Endpoints of the Biventricular Pacing after Cardiac Surgery Trial

    PubMed Central

    Spotnitz, Henry M.; Cabreriza, Santos; Wang, Daniel Y.; Quinn, T. Alexander; Cheng, Bin; Bedrosian, Lauren; Aponte-Patel, Linda; Smith, Craig R.

    2013-01-01

    Background To determine whether optimized biventricular pacing increases cardiac index in patients at risk of left ventricular dysfunction after cardiopulmonary bypass. Procedures included coronary artery bypass, aortic or mitral surgery and combinations. This trial was approved by the Columbia University Institutional Review Board and was conducted under an Investigational Device Exemption. Methods Screening of 6,346 patients yielded 47 endpoints. With informed consent, 61 patients were randomized to pacing or control groups. Atrioventricular and interventricular delays were optimized one (Phase I), two (Phase II), and 12–24 hours (Phase III) after bypass in all patients. Cardiac index was measured by thermal dilution in triplicate. Two-sample t-test assessed differences between groups and subgroups. Results Cardiac index was 12% higher (2.83±0.16 (S.E.M.) vs. 2.52±0.13 liters/minute/square meter) in the paced group, less than predicted and not statistically significant (p=0.14). However, when aortic and aortic/mitral surgery groups were combined, cardiac index increased 29% in the paced group (2.90±0.19, n=14) vs. controls (2.24±0.15, n=11) (p=0.0138). Using a linear mixed effects model, t-test revealed that mean arterial pressure increased with pacing vs. no pacing at all optimization points (Phase I 79.2±1.7 vs. 74.5±1.6 mmHg, p=0.008, Phase II 75.9±1.5 vs. 73.6±1.8, p=0.006, Phase III 81.9±2.8 vs. 79.5±2.7, p=0.002) Conclusions Cardiac index did not increase significantly overall but increased 29% after aortic valve surgery. Mean arterial pressure increased with pacing at three time points. Additional studies are needed to distinguish rate from resynchronization effects, emphasize atrioventricular delay optimization, and examine clinical benefits of temporary postoperative pacing. PMID:23866800

  17. Outlier Payments For Cardiac Surgery And Hospital Quality

    PubMed Central

    Baser, Onur; Fan, Zhahoui; Dimick, Justin B.; Staiger, Douglas O.; Birkmeyer, John D.

    2010-01-01

    In 2002, several hospitals in the Tenet system were accused of overbilling Medicare for cardiac surgery. This led to increased scrutiny of so-called outlier payments, which are used to compensate hospitals when actual costs far exceed those anticipated under prospective payment. Since then, the overall proportion of coronary artery bypass graft (CABG) procedures associated with outlier payments has fallen from 13 percent in 2000–02 to 8 percent in 2003–06. Still, there is variation across U.S. hospitals, with some hospitals experiencing much higher rates. These findings imply that there is potential for quality improvement to reduce costs while improving morbidity and mortality. PMID:19597215

  18. Fetal monitoring during maternal cardiac surgery with cardiopulmonary bypass.

    PubMed Central

    Koh, K. S.; Friesen, R. M.; Livingstone, R. A.; Peddle, L. J.

    1975-01-01

    Fetal cardiac activity was monitored with an external ultrasound transducer in two patients with clinical class III heart disease due to severe mitral stenosis complicated by pulmonary hypertension, undergoing open heart surgery with cardiopulmonary bypass in the 2nd trimester of pregnancy. Fetal distress was detected in one patient, who had mitral valvuloplasty, and was corrected by increasing the rate of blood flow, and the other patient had a mitral valve replacement but no fetal distress was noted. The postoperative course of both mothers and fetuses was uneventful. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:1125921

  19. Antiphospholipid syndrome and perioperative hemostatic management of cardiac valvular surgery.

    PubMed

    Hogan, W J; McBane, R D; Santrach, P J; Plumhoff, E A; Oliver, W C; Schaff, H V; Rodeheffer, R J; Edwards, W D; Duffy, J; Nichols, W L

    2000-09-01

    Hemostatic aspects of antiphospholipid syndrome (APS) present unique challenges to clinicians and laboratory personnel alike, particularly in the perioperative period. These challenges are especially evident in patients requiring cardiac valve replacement surgery. However, the literature outlining the optimal approach in such patients is limited. We present the case of a 25-year-old woman with severe aortic regurgitation as a result of APS with particular reference to the precautions necessary during perioperative care. Particularly important are the prevention of thrombotic or hemorrhagic complications, management of associated thrombocytopenia, and laboratory methods of perioperative anticoagulation monitoring in the setting of prolonged clotting times. PMID:10994834

  20. Pulmonary artery catheter entrapment in cardiac surgery: a simple percutaneous solution.

    PubMed

    Divakaran, Vijay; Caldera, Angel; Stephens, Jack; Gonzalez, Rafael

    2015-10-01

    Pulmonary artery catheter entrapment is a reported complication after cardiac surgery from inadvertent suturing of the catheter to the vena-caval wall during surgery. This article reports a simple percutaneous technique to retrieve the trapped catheter. PMID:25547257

  1. Cardiac Dysrhythmias with General Anesthesia during Dental Surgery

    PubMed Central

    Rodrigo, Chandra R.

    1988-01-01

    Dysrhythmias with general anesthesia during dental surgery have been frequently reported. The incidence appears higher in spontaneously breathing patients lightly anesthetized with halothane. Anxiety, sitting posture, hypoxia, Chinese race, and heart disease appear to aggravate the condition. Use of beta blockers or lidocaine prior to anesthesia, intravenous induction, controlled ventilation with muscle relaxants, and use of isoflurane or enflurane in spontaneously breathing patients appear to decrease the incidence. It is stressed that continuous cardiac monitoring should be done in patients undergoing dental surgery under anesthesia in order to detect diagnose and treat any dysrhythmia. The great majority of dysrhythmias disappear either spontaneously or when the stimulus is stopped. In some cases there may be an obvious cause that should be immediately corrected. The need for drug intervention is rare and must be used with great care when used. PMID:3046439

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

    PubMed Central

    Goldsmith, Yulia; Chan, Jacqueline; Iskandir, Marina; Gulkarov, Iosif; Tortolani, Anthony; Brener, Sorin J.; Sacchi, Terrence J.; Heitner, John F.

    2015-01-01

    Background The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery. Methods From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months. Findings Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization. Conclusion Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures. PMID:26197273

  3. A spectral approach for the quantitative description of cardiac collagen network from nonlinear optical imaging.

    PubMed

    Masè, Michela; Cristoforetti, Alessandro; Avogaro, Laura; Tessarolo, Francesco; Piccoli, Federico; Caola, Iole; Pederzolli, Carlo; Graffigna, Angelo; Ravelli, Flavia

    2015-08-01

    The assessment of collagen structure in cardiac pathology, such as atrial fibrillation (AF), is essential for a complete understanding of the disease. This paper introduces a novel methodology for the quantitative description of collagen network properties, based on the combination of nonlinear optical microscopy with a spectral approach of image processing and analysis. Second-harmonic generation (SHG) microscopy was applied to atrial tissue samples from cardiac surgery patients, providing label-free, selective visualization of the collagen structure. The spectral analysis framework, based on 2D-FFT, was applied to the SHG images, yielding a multiparametric description of collagen fiber orientation (angle and anisotropy indexes) and texture scale (dominant wavelength and peak dispersion indexes). The proof-of-concept application of the methodology showed the capability of our approach to detect and quantify differences in the structural properties of the collagen network in AF versus sinus rhythm patients. These results suggest the potential of our approach in the assessment of collagen properties in cardiac pathologies related to a fibrotic structural component. PMID:26737722

  4. Sonolysis in Prevention of Brain Infarction During Cardiac Surgery (SONORESCUE)

    PubMed Central

    Školoudík, David; Hurtíková, Eva; Brát, Radim; Herzig, Roman

    2016-01-01

    Abstract Here, we examined whether intraoperative sonolysis can alter the risk of new ischemic lesions in the insonated brain artery territory during coronary artery bypass grafting (CABG) or valve surgery. Silent brain ischemic lesions could be detected in as many as two-thirds of patients after CABG or valve surgery. Patients indicated for CABG or valve surgery were allocated randomly to sonolysis (60 patients, 37 males; mean age, 65.3 years) of the right middle cerebral artery (MCA) during cardiac surgery and control group (60 patients, 37 males; mean age, 65.3 years). Neurologic examination, cognitive function tests, and brain magnetic resonance imaging (MRI) were conducted before intervention as well as 24 to 72 hours and 30 days after surgery. New ischemic lesions on control diffusion-weighted MRI in the insonated MCA territory ≥0.5 mL were significantly less frequent in the sonolysis group than in the control group (13.3% vs 26.7%, P = 0.109). The sonolysis group exhibited significantly reduced median volume of new brain ischemic lesions (P = 0.026). Stenosis of the internal carotid artery ≥50% and smoking were independent predictors of new brain ischemic lesions ≥0.5 mL (odds ratio = 5.685 [1.272–25.409], P = 0.023 and 4.698 [1.092–20.208], P = 0.038, respectively). Stroke or transient ischemic attack occurred only in 2 control patients (P = 0.496). No significant differences were found in scores for postintervention cognitive tests (P > 0.05). This study provides class-II evidence that sonolysis during CABG or valve surgery reduces the risk of larger, new ischemic lesions in the brain. www.clinicaltrials.gov (NCT01591018). PMID:27196464

  5. Virtual Reality for Pain Management in Cardiac Surgery

    PubMed Central

    Mosso-Vázquez, José Luis; Gao, Kenneth; Wiederhold, Brenda K.

    2014-01-01

    Abstract Surgical anxiety creates psychological and physiological stress, causes complications in surgical procedures, and prolongs recovery. Relaxation of patients in postoperative intensive care units can moderate patient vital signs and reduce discomfort. This experiment explores the use of virtual reality (VR) cybertherapy to reduce postoperative distress in patients that have recently undergone cardiac surgery. Sixty-seven patients were monitored at IMSS La Raza National Medical Center within 24 hours of cardiac surgery. Patients navigated through a 30 minute VR simulation designed for pain management. Results were analyzed through comparison of pre- and postoperative vital signs and Likert scale survey data. A connection was found in several physiological factors with subjective responses from the Likert scale survey. Heavy positive correlation existed between breathing rate and Likert ratings, and a moderate correlation was found between mean arterial pressure and Likert ratings and heart rate and Likert ratings, all of which indicated lower pain and stress within patients. Further study of these factors resulted in the categorization of patients based upon their vital signs and subjective response, providing a context for the effectiveness of the therapy to specific groups of patients. PMID:24892200

  6. Risk factors for perioperative ischemic stroke in cardiac surgery

    PubMed Central

    da Costa, Mário Augusto Cray; Gauer, Maria Fernanda; Gomes, Ricardo Zaneti; Schafranski, Marcelo Derbli

    2015-01-01

    Objective The purpose of this study was to evaluate the risk factors for ischemic stroke in patients undergoing cardiac surgery. Methods From January 2010 to December 2012, 519 consecutive patients undergoing cardiac surgery were analyzed prospectively. The sample was divided into two groups: patients with stroke per and postoperative were allocated in Group GS (n=22) and the other patients in the group CCONTROL (n=497). The following variables were compared between the groups: gender, age, carotid stenosis ≥ 70%, diabetes on insulin, chronic obstructive pulmonary disease, peripheral arteriopathy, unstable angina, kidney function, left ventricular function, acute myocardial infarction, pulmonary arterial hypertension, use of cardiopulmonary bypass. Ischemic stroke was defined as symptoms lasting over 24 hours associated with changes in brain computed tomography scan. The variables were compared using Fisher’s exact test, Chi square, Student’s t-test and logistic regression. Results Stroke occurred in 4.2% of patients and the risk factors statistically significant were: carotid stenosis of 70% or more (P=0.03; OR 5.07; IC 95%: 1.35 to 19.02), diabetes on insulin (P=0.04; OR 2.61; IC 95%: 1.10 to 6.21) and peripheral arteriopathy (P=0.03; OR 2.61; 95% CI: 1.08 to 6.28). Conclusion Risk factors for ischemic stroke were carotid stenosis of 70% or more, diabetes on insulin and peripheral arteriopathy. PMID:26313728

  7. Obesity and Oxidative Stress Predict AKI after Cardiac Surgery

    PubMed Central

    Pretorius, Mias; Schildcrout, Jonathan S.; Mercaldo, Nathaniel D.; Byrne, John G.; Ikizler, T. Alp; Brown, Nancy J.

    2012-01-01

    Obesity increases oxidative stress, endothelial dysfunction, and inflammation, but the effect of obesity on postoperative AKI is not known. We examined the relationship between body mass index (BMI) and AKI in 445 patients undergoing cardiac surgery and whether oxidative stress (F2-isoprostanes), inflammation (IL-6), or antifibrinolysis (plasminogen activator inhibitor-1 [PAI-1]) contribute to any identified relationship. Overall, 112 (25%) of the 445 patients developed AKI. Higher BMI was independently associated with increased odds of AKI (26.5% increase per 5 kg/m2 [95% confidence interval, 4.3%–53.4%]; P=0.02). Baseline F2-isoprostane (P=0.04), intraoperative F2-isoprostane (P=0.003), and intraoperative PAI-1 (P=0.04) concentrations also independently predicted AKI. BMI no longer predicted AKI after adjustment for the effect of F2-isoprostanes, suggesting that obesity may affect AKI via effects on oxidative stress. In contrast, adjustment for IL-6 or PAI-1 did not substantially alter the association between BMI and AKI. Further, deconstruction of the obesity-AKI relationship into direct (i.e., independent of candidate pathways) and indirect (i.e., effect of BMI on AKI via each candidate pathway) effects indicated that F2-isoprostanes, but not IL-6 or PAI-1, partially mediate the relationship between obesity and AKI (P=0.001). In conclusion, obesity independently predicts AKI after cardiac surgery, and oxidative stress may partially mediate this association. PMID:22626819

  8. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    PubMed Central

    Badenes, Rafael; Lozano, Angels; Belda, F. Javier

    2015-01-01

    Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function. PMID:25705516

  9. Role of nuclear cardiology in advancing cardiac surgery.

    PubMed

    Abidov, Aiden; Hachamovitch, Rory; Berman, Daniel S

    2004-01-01

    Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures [myocardial perfusion SPECT (MPS) and positron emission tomography (PET)] provide the surgeon with objective information that augments standard clinical and angiographic assessments with respect to diagnosis, prognosis, and potential benefit from intervention. Development of the technology and methodology of gated MPS acquisition and interpretation allows assessment of the extent and severity of hypoperfused but viable myocardium, as well as global LVEF and LV volume measurements, diastolic function, and LV geometry. With PET, myocardial metabolism and blood flow reserve can also be measured. This chapter provides insight into the current evidence regarding settings in which nuclear cardiology procedures are helpful to the surgeon in assessment of patients having or being considered for cardiac surgery in the setting of coronary artery disease (CAD). Overall, a risk-benefit approach to MPS results is proposed, with principal focus on identifying patients at risk for major cardiac events who may benefit from a surgical procedure. PMID:15619195

  10. Complex Chronic Conditions Among Children Undergoing Cardiac Surgery.

    PubMed

    Chan, Titus; Di Gennaro, Jane; Wechsler, Stephanie Burns; Bratton, Susan L

    2016-08-01

    Children with complex chronic conditions (CCCs) require a disproportionate amount of inpatient resources and are at increased risk of mortality during hospital admissions. This study examines the impact of non-cardiac, comorbid complex chronic conditions on outcomes in children undergoing congenital heart surgery. All admissions associated with a congenital cardiac surgical procedure in the Kids' Inpatient Database from 1997 to 2012 were examined. Children were classified by the number as well as type (genetic vs. non-genetic) of CCC. Baseline demographics as well as proportion of total inpatient days and total hospitalization charges was assessed. Multivariate regression models examining occurrence of a complication, mortality, prolonged length of stay and high hospitalization charges were constructed. In multivariate models, an increasing number of CCC was associated with increased risk of mortality and complications (mortality: 1 CCC: odds ratio (OR) = 1.17, 95 % CI = 1.03-1.33); ≥2 CCC: OR = 1.54, 95 % CI = 1.26-1.87). Additionally, the presence of a genetic CCC was protective against mortality (OR = 0.71, 95 % CI = 0.56-0.89) while non-genetic CCCs were associated with mortality (OR = 1.62, 95 % CI = 1.41-1.88) and high resource utilization. Over time, the proportion of genetic CCC remained stable while non-genetic CCC increased in prevalence. Complex chronic conditions have a varying association with mortality, morbidity and resource utilization in children undergoing congenital heart surgery. While genetic CCCs were not associated with poor outcomes, non-genetic CCCs were risk factors for morbidity and mortality. These findings suggest that pre-surgical counseling and surgical planning should account for the type of non-cardiac comorbid conditions. PMID:27033243

  11. Hybrid intraoperative pulmonary artery stenting in redo congenital cardiac surgeries

    PubMed Central

    Sridhar, Anuradha; Subramanyan, Raghavan; Premsekar, Rajasekaran; Chidambaram, Shanthi; Agarwal, Ravi; Manohar, Soman Rema Krishna; Cherian, K.M.

    2014-01-01

    Objective Reconstruction of branch pulmonary arteries (PAs) can be challenging in redo congenital heart surgeries. Treatment options like percutaneous stent implantation and surgical patch angioplasty may yield suboptimal results. We present our experience with hybrid intraoperative stenting which may be an effective alternative option. Methods We retrospectively analyzed data of all patients with PA stenosis who underwent intraoperative PA branch stenting in our institution between January 2011 and December 2012. Results Ten patients [6 females, median age 10 (1.4 to 37) years], underwent hybrid stenting of the PA. Primary cardiac diagnoses were pulmonary atresia with ventricular septal defect (VSD) in three patients, pulmonary atresia with intact ventricular septum in two, Tetralogy of Fallot (TOF) in one, Double outlet right ventricle (DORV) with pulmonary stenosis (PS) in one, complex single ventricle in two and VSD with bilateral branch PA stenosis in one patient. Concomitant surgeries were revision/reconstruction of RV-PA conduit in 4, Fontan completion in 4, repair of TOF with conduit placement in 1 and VSD closure in 1 patient. The left PA was stented in 7, the right in 2 and both in 1, with a total of 11 stents. There were no complications related to stent implantation. Two early postoperative deaths were unrelated to stent implantation. At mean follow-up period of 14.8 (12–26) months, stent position and patency were satisfactory in all survivors. None of them needed repeat dilatation or surgical reintervention. Conclusion Hybrid stenting of branch PA is a safe and effective option for PA reconstruction in redo cardiac surgeries. With meticulous planning, it can be safely performed without fluoroscopy. PMID:24581095

  12. Baseline cerebral oximetry values in cardiac and vascular surgery patients: a prospective observational study

    PubMed Central

    2010-01-01

    Aim This study was conducted to evaluate baseline INVOS values and identify factors influencing preoperative baseline INVOS values in carotid endarterectomy and cardiac surgery patients. Methods This is a prospective observational study on 157 patients (100 cardiac surgery patients, 57 carotid endarterectomy patients). Data were collected on factors potentially related to baseline INVOS values. Data were analyzed with student's t-test, Chi-square, Pearson's correlation or Linear Regression as appropriate. Results 100 cardiac surgery patients and 57 carotid surgery patients enrolled. Compared to cardiac surgery, carotid endarterectomy patients were older (71.05 ± 8.69 vs. 65.72 ± 11.04, P < 0.001), with higher baseline INVOS (P < 0.007) and greater stroke frequency (P < 0.002). Diabetes and high cholesterol were more common in cardiac surgery patients. Right side INVOS values were strongly correlated with left-side values in carotid (r = 0.772, P < 0.0001) and cardiac surgery patients (r = 0.697, P < 0.0001). Diabetes and high cholesterol were associated with significantly (P < 0.001) lower INVOS and smoking was associated with higher INVOS values in carotid, but not in cardiac surgery patients. Age, sex, CVA history, Hypertension, CAD, Asthma, carotid stenosis side and surgery side were not related to INVOS. Multivariate analysis showed that diabetes is strongly associated with lower baseline INVOS values bilaterally (P < 0.001) and explained 36.4% of observed baseline INVOS variability in carotid (but not cardiac) surgery. Conclusion Compared to cardiac surgery, carotid endarterectomy patients are older, with higher baseline INVOS values and greater stroke frequency. Diabetes and high cholesterol are associated with lower baseline INVOS values in carotid surgery. Right and left side INVOS values are strongly correlated in both patient groups. PMID:20497559

  13. Bridging antiplatelet therapy in patients requiring cardiac and non-cardiac surgery: from bench to bedside.

    PubMed

    Capodanno, Davide; Tamburino, Corrado

    2014-02-01

    Dual antiplatelet therapy (DAPT) is the mainstay of pharmacotherapy after an acute coronary syndrome or percutaneous coronary intervention. While patients requiring interruption of DAPT at the time of cardiac or noncardiac surgery face an increased risk of thrombotic complications, the opportunity of continuing DAPT in the perioperative period should be balanced against the risk of bleeding. Tailoring antiplatelet therapy on patient- and surgery-specific characteristics mandates a clear understanding of pharmacodynamic and clinical data on using antithrombotic agents in the perioperative period. This is also important given the introduction of novel antiplatelet agents that are already adopted in practice (prasugrel, ticagrelor) or will likely be adopted in the near future (cangrelor). This article explores the theoretical background and rationale for bridging patients on antiplatelet drugs to their surgical procedure, and provides insights on how patient and procedural characteristics translate into different considerations for the use of antithrombotic agents in the surgical setting. PMID:24272832

  14. Apoptosis of circulating lymphocytes during pediatric cardiac surgery

    NASA Astrophysics Data System (ADS)

    Bocsi, J.; Pipek, M.; Hambsch, J.; Schneider, P.; Tárnok, A.

    2006-02-01

    There is a constant need for clinical diagnostic systems that enable to predict disease course for preventative medicine. Apoptosis, programmed cell death, is the end point of the cell's response to different induction and leads to changes in the cell morphology that can be rapidly detected by optical systems. We tested whether apoptosis of T-cells in the peripheral blood is useful as predictor and compared different preparation and analytical techniques. Surgical trauma is associated with elevated apoptosis of circulating leukocytes. Increased apoptosis leads to partial removal of immune competent cells and could therefore in part be responsible for reduced immune defence. Cardiovascular surgery with but not without cardiopulmonary bypass (CPB) induces transient immunosuppression. Its effect on T-cell apoptosis has not been shown yet. Flow-cytometric data of blood samples from 107 children (age 3-16 yr.) who underwent cardiac surgery with (78) or without (29) CPB were analysed. Apoptotic T-lymphocytes were detected based on light scatter and surface antigen (CD45/CD3) expression (ClinExpImmunol2000;120:454). Results were compared to staining with CD3 antibodies alone and in the absence of antibodies. T-cell apoptosis rate was comparable when detected with CD45/CD3 or CD3 alone, however not in the absence of CD3. Patients with but not without CPB surgery had elevated lymphocyte apoptosis. T-cell apoptosis increased from 0.47% (baseline) to 0.97% (1 day postoperatively). In CPB patients with complication 1.10% significantly higher (ANOVA p=0.01) comparing to CPB patients without complications. Quantitation of circulating apoptotic cells based on light scatter seems an interesting new parameter for diagnosis. Increased apoptosis of circulating lymphocytes and neutrophils further contributes to the immune suppressive response to surgery with CPB. (Support: MP, Deutsche Herzstiftung, Frankfurt, Germany)

  15. Comparison of tapentadol with tramadol for analgesia after cardiac surgery

    PubMed Central

    Iyer, Srinivas Kalyanaraman; Mohan, Gokulakrishnan; Ramakrishnan, Sivakumar; Theodore, Sanjay

    2015-01-01

    Background: Tapentadol is a relatively new analgesic. We decided to compare it with tramadol for their various effects after cardiac surgery. Setting: A study in a tertiary care hospital. Materials and Methods: Sixty adults undergoing cardiac surgery were divided into 2 groups of 30 each by computerized random allotment (Group X = tapentadol 50 mg oral and Group Y = tramadol 100 mg oral). Informed Consent and Institutional Ethics Committee approval were obtained. The patients were given either drug X or drug Y after extubation in this single blinded study, wherein the data collectors and analyzers were blinded to the study. All patients received oral paracetamol qds and either drug X or drug Y tds. The pain score was noted on a Visual Analog Scale before each drug dose, 3 h later and on coughing. Heart rate, respiratory rate, and blood pressure were recorded before the drug dose and 3 h later. Postoperative nausea or vomiting (PONV), temperature, and modified Glasgow Coma Scale readings were recorded. The above readings were obtained for 6 doses (up to 48 h after extubation). Statistics: t-test, Pearson Chi-square test, Fisher exact test, and Mantel–Haenszel test were used for statistics. Results: Tapentadol group patients had significantly better analgesia 3 h after the drug and “on coughing” than tramadol group. The difference in their effects on blood creatinine levels, temperature, hemodynamics, oxygen saturation, and respiratory rate were not clinically significant. Tapentadol produced lesser drowsiness and lesser vomiting than tramadol. Conclusions: Tapentadol, due to its norepinephrine reuptake inhibition properties, in addition to mu agonist, is a better analgesic than tramadol and has lesser PONV. PMID:26139740

  16. Myocardial Oxidative Stress in Infants Undergoing Cardiac Surgery.

    PubMed

    Sznycer-Taub, Nathaniel; Mackie, Stewart; Peng, Yun-Wen; Donohue, Janet; Yu, Sunkyung; Aiyagari, Ranjit; Charpie, John

    2016-04-01

    Cardiac surgery for congenital heart disease often necessitates a period of myocardial ischemia during cardiopulmonary bypass and cardioplegic arrest, followed by reperfusion after aortic cross-clamp removal. In experimental models, myocardial ischemia-reperfusion is associated with significant oxidative stress and ventricular dysfunction. A prospective observational study was conducted in infants (<1 year) who underwent elective surgical repair of a ventricular septal defect (VSD) or tetralogy of Fallot (TOF). Blood samples were drawn following anesthetic induction (baseline) and directly from the coronary sinus at 1, 3, 5, and 10 min following aortic cross-clamp removal. Samples were analyzed for oxidant stress using assays for thiobarbituric acid-reactive substances, protein carbonyl, 8-isoprostane, and total antioxidant capacity. For each subject, raw assay data were normalized to individual baseline samples and expressed as fold-change from baseline. Results were compared using a one-sample t test with Bonferroni correction for multiple comparisons. Sixteen patients (ten with TOF and six with VSD) were enrolled in the study, and there were no major postoperative complications observed. For the entire cohort, there was an immediate, rapid increase in myocardial oxidative stress that was sustained for 10 min following aortic cross-clamp removal in all biomarker assays (all P < 0.01), except total antioxidant capacity. Infant cardiac surgery is associated with a rapid, robust, and time-dependent increase in myocardial oxidant stress as measured from the coronary sinus in vivo. Future studies with larger enrollment are necessary to assess any association between myocardial oxidative stress and early postoperative outcomes. PMID:26843460

  17. Saccadic Palsy following Cardiac Surgery: Possible Role of Perineuronal Nets

    PubMed Central

    Roeber, Sigrun; Härtig, Wolfgang; Nair, Govind; Reich, Daniel S.

    2015-01-01

    Objective Perineuronal nets (PN) form a specialized extracellular matrix around certain highly active neurons within the central nervous system and may help to stabilize synaptic contacts, promote local ion homeostasis, or play a protective role. Within the ocular motor system, excitatory burst neurons and omnipause neurons are highly active cells that generate rapid eye movements – saccades; both groups of neurons contain the calcium-binding protein parvalbumin and are ensheathed by PN. Experimental lesions of excitatory burst neurons and omnipause neurons cause slowing or complete loss of saccades. Selective palsy of saccades in humans is reported following cardiac surgery, but such cases have shown normal brainstem neuroimaging, with only one clinicopathological study that demonstrated paramedian pontine infarction. Our objective was to test the hypothesis that lesions of PN surrounding these brainstem saccade-related neurons may cause saccadic palsy. Methods Together with four controls we studied the brain of a patient who had developed a permanent selective saccadic palsy following cardiac surgery and died several years later. Sections of formalin-fixed paraffin-embedded brainstem blocks were applied to double-immunoperoxidase staining of parvalbumin and three different components of PN. Triple immunofluorescence labeling for all PN components served as internal controls. Combined immunostaining of parvalbumin and synaptophysin revealed the presence of synapses. Results Excitatory burst neurons and omnipause neurons were preserved and still received synaptic input, but their surrounding PN showed severe loss or fragmentation. Interpretation Our findings support current models and experimental studies of the brainstem saccade-generating neurons and indicate that damage to PN may permanently impair the function of these neurons that the PN ensheathe. How a postulated hypoxic mechanism could selectively damage the PN remains unclear. We propose that the well

  18. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery.

    PubMed

    Zakkar, M; Ascione, R; James, A F; Angelini, G D; Suleiman, M S

    2015-10-01

    Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions. PMID:26116810

  19. Cardiac surgery for children with trisomies 13 and 18: Where are we now?

    PubMed

    Janvier, Annie; Farlow, Barbara; Barrington, Keith

    2016-06-01

    The objective is to examine whether cardiac surgery should be considered for children with trisomy 13 or 18 (T13 or 18).T13 or 18 were previously referred to as "lethal" conditions due to high mortality rates and severe disability among survivors. In the last decade, investigations have revealed these conditions are heterogeneous, with increasing numbers of studies describing interventions for these children. A number of factors makes the interpretation of reported outcomes after cardiac surgery challenging: (1) dissimilarities in practice lead to a wide variation in reported outcomes after cardiac surgery; (2) cardiac surgery is generally offered to older, healthier children; (3) cardiac surgeries of widely varying risks are often lumped together in individual studies, and (4) cases where cardiac surgery has been withheld are generally not included in publications. It is unclear whether withholding cardiac surgery for some children with a ventricular septal defect will lead to death, or the development of pulmonary hypertension, or if death will occur from other causes. In this article, we describe two children with different clinical situations and examine whether cardiac surgery would benefit them and how to communicate with their families. Cardiac surgery may be beneficial to some children with trisomy 13 or 18, but may harm others. Every child should be approached in an individual fashion and the goals of each family should be addressed. Children who are more likely to benefit from surgery may be older, healthier children without respiratory support. Rigorous and transparent research is needed to identify factors that affect survival in trisomy 13 or 18. PMID:26847083

  20. Cardiac rehabilitation outcome following percutaneous coronary intervention compared to cardiac surgery.

    PubMed

    Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro; Hiraki, Koji; Morio, Yuji; Kasahara, Yusuke; Osada, Naohiko; Omiya, Kazuto; Makuuchi, Haruo

    2011-05-01

    To examine differences in objective and subjective outcomes in outpatients undergoing percutaneous coronary intervention (PCI) performed for acute myocardial infarction versus cardiac surgery (CS) following a phase II cardiac rehabilitation (CR). Longitudinal observational study of 437 consecutive cardiac outpatients after 8 weeks of phase II CR. Patients were divided into the PCI group (n = 281) and CS group (n = 156). Handgrip and knee extensor muscle strength, peak oxygen uptake VO₂, upper- and lower-body self-efficacy for physical activity (SEPA), and physical component summary (PCS) and mental component summary (MCS) scores as assessed by Short Form-36 were measured at 1 and 3 months after PCI or CS. All outcomes increased significantly between months 1 and 3 in both groups. However, increases were greater in the CS versus PCI group in handgrip strength (+12.3 % vs. +8.1%, P < 0.01), knee extensor muscle strength (+19.3% vs. +17.5%, P = 0.008), peak VO₂ (+20.9% vs. +16.9%, P < 0.01), upper-body SEPA (+27.7% vs. +9.2 vs. , P = 0.001), and PCS score (+6.5% vs. +4.1%, P = 0.001). Although this relatively short-term phase II CR increased all outcomes for both groups, outcomes showed the recovery process was different between the PCI and CS groups, slightly favoring CS patients. Furthermore, patents in the field of CR are presented. PMID:21513490

  1. Determination of the threshold of cardiac troponin I associated with an adverse postoperative outcome after cardiac surgery: a comparative study between coronary artery bypass graft, valve surgery, and combined cardiac surgery

    PubMed Central

    Fellahi, Jean-Luc; Hedoire, François; Le Manach, Yannick; Monier, Emmanuel; Guillou, Louis; Riou, Bruno

    2007-01-01

    Introduction The objective of the present study was to compare postoperative cardiac troponin I (cTnI) release and the thresholds of cTnI that predict adverse outcome after elective coronary artery bypass graft (CABG), after valve surgery, and after combined cardiac surgery. Methods Six hundred and seventy-five adult patients undergoing conventional cardiac surgery with cardiopulmonary bypass were retrospectively analyzed. Patients in the CABG (n = 225) and valve surgery groups (n = 225) were selected after matching (age, sex) with those in the combined surgery group (n = 225). cTnI was measured preoperatively and 24 hours after the end of surgery. The main endpoint was a severe postoperative cardiac event (sustained ventricular arrhythmias requiring treatment, need for inotropic support or intraaortic balloon pump for at least 24 hours, postoperative myocardial infarction) and/or death. Data are presented as the median and the odds ratio (95% confidence interval). Results Postoperative cTnI levels were significantly different among the three groups (combined surgery, 11.0 (9.5–13.1) ng/ml versus CABG, 5.2 (4.7–5.7) ng/ml and valve surgery, 7.8 (7.6–8.0) ng/ml; P < 0.05). The thresholds of cTnI predicting severe cardiac event and/or death were also significantly different among the three groups (combined surgery, 11.8 (11.5–14.8) ng/ml versus CABG, 7.8 (6.7–8.8) ng/ml and valve surgery, 9.3 (8.0–14.0) ng/ml; P < 0.05). An elevated cTnI above the threshold in each group was significantly associated with a severe cardiac event and/or death (odds ratio, 4.33 (2.82–6.64)). Conclusion The magnitude of postoperative cTnI release is related to the type of cardiac surgical procedure. Different thresholds of cTnI must be considered according to the procedure type to predict early an adverse postoperative outcome. PMID:17888156

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

    PubMed Central

    Reddy, Pingle; Duggar, Brian; Butterworth, John

    2014-01-01

    Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns. PMID:25429332

  3. Gentamicin-impregnated collagen sponge for preventing sternal wound infection after cardiac surgery

    PubMed Central

    Targońska, Sylwia; Stążka, Janusz; Kozioł-Montewka, Maria

    2014-01-01

    The frequency of sternal wound infection (SWI) after cardiac surgery ranges from 0.5% to 8% and is associated with significant morbidity, mortality, and treatment cost. Perioperative antibiotic prophylaxis is not sufficient to fully prevent the contamination of the surgical access site. One of the most effective methods for the prevention of wound infection seems to be the use of gentamicin-impregnated collagen sponge, which is successfully used in abdominal and orthopedic surgery. Surgically implantable topical antibiotics can reduce wound infection in cardiac patients as well, but the efficacy of SWI prevention in cardiac surgery still raises many questions. PMID:26336388

  4. A Reminder of Methylene Blue's Effectiveness in Treating Vasoplegic Syndrome after On-Pump Cardiac Surgery

    PubMed Central

    Brown, Lisa; Tadros, Hany B.; Munfakh, Nabil A.

    2015-01-01

    The inflammatory response induced by cardiopulmonary bypass decreases vascular tone, which in turn can lead to vasoplegic syndrome. Indeed the hypotension consequent to on-pump cardiac surgery often necessitates vasopressor and intravenous fluid support. Methylene blue counteracts vasoplegic syndrome by inhibiting the formation of nitric oxide. We report the use of methylene blue in a 75-year-old man who developed vasoplegic syndrome after cardiac surgery. After the administration of methylene blue, his hypotension improved to the extent that he could be weaned from vasopressors. The use of methylene blue should be considered in patients who develop hypotension refractory to standard treatment after cardiac surgery. PMID:26504450

  5. A Review of Current Analgesic Techniques in Cardiac Surgery. Is Epidural Worth it?

    PubMed Central

    Ziyaeifard, Mohsen; Azarfarin, Rasoul; Golzari, Samad EJ

    2014-01-01

    In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers. PMID:25320659

  6. Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery

    SciTech Connect

    Fiser, W.P.; Thompson, B.W.; Thompson, A.R.; Eason, C.; Read, R.C.

    1983-11-01

    Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. The authors conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.

  7. Deep sternal wound infection after cardiac surgery: Evidences and controversies

    PubMed Central

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-01-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a “bridge” prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  8. Deep sternal wound infection after cardiac surgery: Evidences and controversies.

    PubMed

    Cotogni, Paolo; Barbero, Cristina; Rinaldi, Mauro

    2015-11-01

    Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. PMID:26557476

  9. A quality assurance programme for cell salvage in cardiac surgery.

    PubMed

    Kelleher, A; Davidson, S; Gohil, M; Machin, M; Kimberley, P; Hall, J; Banya, W

    2011-10-01

    At the same time as cell salvage was introduced into our institution for all patients undergoing cardiac surgery with cardiopulmonary bypass, we established a supporting programme of quality assurance to reassure clinicians regarding safety and efficacy. Data collected in patients operated on between 2001 and 2007 included pre- and post-wash heparin concentration, haemoglobin concentration and free haemoglobin concentration. Cell salvage was used in 6826 out of a total of 7243 patients (94%). Post-wash heparin concentration was consistently low (always < 0.4 IU.ml(-1)). There was a significant decrease in post-wash haemoglobin concentration in 2003 compared to 2001, from a median (IQR [range]) of 19.6 (16.7-22.2 [12.9-25.5]) g.dl(-1) to 17.5 (13.6-20.8 [12.6-23.7]) g.dl(-1) (p < 0.015). In addition, there was a significant increase in free plasma haemoglobin in 2006 compared to 2001, from 0.5 (0.3-0.8 [0.1-2.6]) g.l(-1) to 0.8 (0.3-1.4 [0.3-5.2]) g.l(-1) (p < 0.001). This programme led to the detection of a change in operator behaviour in 2003 and progressive machine deterioration resulting in appropriate fleet replacement in 2006. You can respond to this article at http://www.anaesthesiacorrespondence.com. PMID:21883128

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

    PubMed Central

    Shin, Su Rin; Kim, Won Ho; Kim, Dong Joon; Shin, Il-Woo; Sohn, Ju-Tae

    2016-01-01

    The incidence of acute kidney injury after cardiac surgery (CS-AKI) ranges from 33% to 94% and is associated with a high incidence of morbidity and mortality. The etiology is suggested to be multifactorial and related to almost all aspects of perioperative management. Numerous studies have reported the risk factors and risk scores and novel biomarkers of AKI have been investigated to facilitate the subclinical diagnosis of AKI. Based on the known independent risk factors, many preventive interventions to reduce the risk of CS-AKI have been tested. However, any single preventive intervention did not show a definite and persistent benefit to reduce the incidence of CS-AKI. Goal-directed therapy has been considered to be a preventive strategy with a substantial level of efficacy. Many pharmacologic agents were tested for any benefit to treat or prevent CS-AKI but the results were conflicting and evidences are still lacking. The present review will summarize the current updated evidences about the risk factors and preventive strategies for CS-AKI. PMID:27419130

  11. Efficacy of antimicrobial activity of slow release silver nanoparticles dressing in post-cardiac surgery mediastinitis.

    PubMed

    Totaro, Pasquale; Rambaldini, Manfredo

    2009-01-01

    We report our preliminary experience in post-cardiac surgery mediastinitis using a recently introduced silver-releasing dressing claiming prompt antibacterial activity. Acticoat, a silver nanoparticles slow release dressing was used in four patients with documented post-cardiac surgery mediastinitis and persistently positive microbiological cultures despite vacuum-assisted closure (VAC) therapy. In all four patients negative cultures were obtained within a maximum of 72 h and patients were discharged within a maximum of 20 days. PMID:18948308

  12. Alveolar recruitment in patients in the immediate postoperative period of cardiac surgery.

    PubMed

    Padovani, Cauê; Cavenaghi, Odete Mauad

    2011-01-01

    Lung complications during postoperative period of cardiac surgery are frequently, highlighting atelectasis and hypoxemia. Alveolar recruitment maneuvers have an important role in the prevention and treatment of these complications. Thus, this study reviewed and updated the alveolar recruitment maneuvers performance in the immediate postoperative period of cardiac surgery. We noted the efficacy of alveolar recruitment through different specific techniques and the need for development of new studies. PMID:21881720

  13. Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.

    PubMed Central

    Pepi, M; Muratori, M; Barbier, P; Doria, E; Arena, V; Berti, M; Celeste, F; Guazzi, M; Tamborini, G

    1994-01-01

    OBJECTIVE--To evaluate the incidence, characteristics, and haemodynamic consequences of pericardial effusion after cardiac surgery. DESIGN--Clinical, echocardiographic, and Doppler evaluations before and 8 days after cardiac surgery; with echocardiographic and Doppler follow up of patients with moderate or large pericardial effusion after operation. SETTING--Patients undergoing cardiac surgery at a tertiary centre. PATIENTS--803 consecutive patients who had coronary artery bypass grafting (430), valve replacement (330), and other types of surgery (43). 23 were excluded because of early reoperation. MAIN OUTCOME MEASURES--Size and site of pericardial effusion evaluated by cross sectional echocardiography and signs of cardiac tamponade detected by ultrasound (right atrial and ventricular diastolic collapse, left ventricular diastolic collapse, distension of the inferior vena cava), and Doppler echocardiography (inspiratory decrease of aortic and mitral flow velocities). RESULTS--Pericardial effusion was detected in 498 (64%) of 780 patients and was more often associated with coronary artery bypass grafting than with valve replacement or other types of surgery; it was small in 68.4%, moderate in 29.8%, and large in 1.6%. Loculated effusions (57.8%) were more frequent than diffuse ones (42.2%). The size and site of effusion were related to the type of surgery. None of the small pericardial effusions increased in size; the amount of fluid decreased within a month in most patients with moderate effusion and in a few (7 patients) developed into a large effusion and cardiac tamponade. 15 individuals (1.9%) had cardiac tamponade; this event was significantly more common after valve replacement (12 patients) than after coronary artery bypass grafting (2 patients) or other types of surgery (1 patient after pulmonary embolectomy). In patients with cardiac tamponade aortic and mitral flow velocities invariably decreased during inspiration; the echocardiographic signs were less

  14. Respiratory physiotherapy and its application in preoperative period of cardiac surgery.

    PubMed

    Miranda, Regina Coeli Vasques de; Padulla, Susimary Aparecida Trevizan; Bortolatto, Carolina Rodrigues

    2011-01-01

    Cardiac surgical procedures change respiratory mechanics, defecting in lung dysfunction. The physical therapists play an important role in the preparation and rehabilitation of individuals who are undergoing cardiac surgery, as they have a large quantity of techniques. The objective was to evaluate the effectiveness of breathing exercises with and without the use of devices, and respiratory muscle training in preoperative period of cardiac surgery in reducing postoperative pulmonary complications. Although there are controversies as to which technique to use, studies show the effectiveness of preoperative physiotherapy in the prevention and reduction of postoperative pulmonary complications. PMID:22358282

  15. Systemic embolisation as presentation and recurrence of cardiac myxoma two years after surgery.

    PubMed

    Liesting, C; Ramjankhan, F Z; van Herwerden, L A; Kofflard, M J M

    2010-10-01

    Primary cardiac tumours are rare when compared with metastatic involvement. The majority of primary cardiac tumours are benign and in adults the majority of these masses are myxomas. The treatment is surgical removal because of the risk of embolisation and/or cardiovascular complications. We describe a female presenting with systemic embolisation and recurrence of cardiac myxoma after surgery. Recurrence of myxoma is rare after surgery in case of solitary tumours but more frequent in patients with familial myxomas in association with the Carney complex. Genetic analysis revealed a mutation in the PRKAR1A gene that has never been described before. (Neth Heart J 2010;18:499502.). PMID:20978595

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  17. Patient Positioning and Skin Sequelae: Ischemic Epidermal Necrosis from Tight Padding During Cardiac Surgery.

    PubMed

    Sadeghpour, Mona; Au, Jeremiah; Ho, Jonhan; Hyman, Jaime; Patton, Timothy

    2016-05-15

    Careful positioning and padding of pressure points during surgery are recommended to prevent pressure ulcers, vascular injury, and nerve damage in an immobilized patient. However, overpadding may have unintended consequences. We report a case of ischemia-induced full-thickness epidermal necrosis secondary to tight foam padding during a cardiac surgery. PMID:26934606

  18. Cardiac surgery report cards: comprehensive review and statistical critique.

    PubMed

    Shahian, D M; Normand, S L; Torchiana, D F; Lewis, S M; Pastore, J O; Kuntz, R E; Dreyer, P I

    2001-12-01

    Public report cards and confidential, collaborative peer education represent distinctly different approaches to cardiac surgery quality assessment and improvement. This review discusses the controversies regarding their methodology and relative effectiveness. Report cards have been the more commonly used approach, typically as a result of state legislation. They are based on the presumption that publication of outcomes effectively motivates providers, and that market forces will reward higher quality. Numerous studies have challenged the validity of these hypotheses. Furthermore, although states with report cards have reported significant decreases in risk-adjusted mortality, it is unclear whether this improvement resulted from public disclosure or, rather, from the development of internal quality programs by hospitals. An additional confounding factor is the nationwide decline in heart surgery mortality, including states without quality monitoring. Finally, report cards may engender negative behaviors such as high-risk case avoidance and "gaming" of the reporting system, especially if individual surgeon results are published. The alternative approach, continuous quality improvement, may provide an opportunity to enhance performance and reduce interprovider variability while avoiding the unintended negative consequences of report cards. This collaborative method, which uses exchange visits between programs and determination of best practice, has been highly effective in northern New England and in the Veterans Affairs Administration. However, despite their potential advantages, quality programs based solely on confidential continuous quality improvement do not address the issue of public accountability. For this reason, some states may continue to mandate report cards. In such instances, it is imperative that appropriate statistical techniques and report formats are used, and that professional organizations simultaneously implement continuous quality improvement

  19. Robot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience

    PubMed Central

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-01-01

    Background We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Methods Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Results Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Conclusion Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team. PMID:25883892

  20. Does quality of life improve in octogenarians following cardiac surgery? A systematic review

    PubMed Central

    Abah, Udo; Dunne, Mike; Cook, Andrew; Hoole, Stephen; Brayne, Carol; Vale, Luke; Large, Stephen

    2015-01-01

    Objectives Current outcome measures in cardiac surgery are largely described in terms of mortality. Given the changing demographic profiles and increasingly aged populations referred for cardiac surgery this may not be the most appropriate measure. Postoperative quality of life is an outcome of importance to all ages, but perhaps particularly so for those whose absolute life expectancy is limited by virtue of age. We undertook a systematic review of the literature to clarify and summarise the existing evidence regarding postoperative quality of life of older people following cardiac surgery. For the purpose of this review we defined our population as people aged 80 years of age or over. Methods A systematic review of MEDLINE, EMBASE, Cochrane Library, trial registers and conference abstracts was undertaken to identify studies addressing quality of life following cardiac surgery in patients 80 or over. Results Forty-four studies were identified that addressed this topic, of these nine were prospective therefore overall conclusions are drawn from largely retrospective observational studies. No randomised controlled data were identified. Conclusions Overall there appears to be an improvement in quality of life in the majority of elderly patients following cardiac surgery, however there was a minority in whom quality of life declined (8–19%). There is an urgent need to validate these data and if correct to develop a robust prediction tool to identify these patients before surgery. Such a tool could guide informed consent, policy development and resource allocation. PMID:25922099

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

    PubMed Central

    Nielsen, Henning B.

    2014-01-01

    Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established. PMID:24672486

  2. Physical Therapy Management for Adult Patients Undergoing Cardiac Surgery: A Canadian Practice Survey

    PubMed Central

    Anderson, Cathy M.; Jackson, Jennifer; Lucy, S. Deborah; Prendergast, Monique; Sinclair, Susanne

    2010-01-01

    ABSTRACT Purpose: To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery. Methods: A telephone survey was conducted of a selected sample (n=18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery. Results: An average of 21 cardiac surgeries per week (range: 6–42) were performed, with an average length of stay of 6.4 days (range: 4.0–10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50–120 m per session 2–5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb. Conclusions: Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required. PMID:21629599

  3. Quality-of-Life Measures for Cardiac Surgery Practice and Research: A Review and Primer

    PubMed Central

    Tully, Phillip J.

    2013-01-01

    Abstract: Declining mortality and major morbidity rates after cardiac surgery have led to increasing focus on patient quality of life (QOL). Beyond longevity, the impact of cardiac surgery on day-to-day functioning is incredibly salient to patients, their spouses, and families. As such, QOL measures are a welcome and sometimes necessary addition to clinical trials. However, how does one navigate the expansive market of QOL questionnaires, which QOL measures are applicable to cardiac surgery units, and how can they be used meaningfully in clinical practice? Because nearly two decades have passed since QOL measures were reviewed for relevance to cardiac surgery settings, an overview is provided of various generic (Short Form Health Survey [SF-36], Sickness Impact Profile, Nottingham Health Profile) and disease-specific QOL measures (Duke Activity Status Index, Seattle Angina Questionnaire, MN Living with Heart Failure Questionnaire; Heart-QOL) with examples from cardiac surgery studies. Recommendations are provided for the application of QOL measures to clinical trials and the impact on clinical decision-making is discussed. The paucity of methodologically sound QOL studies highlights the necessity for further rigorous empirical data to better inform treatment efficacy studies and clinical decision-making. PMID:23691778

  4. [Preoperative evaluation before non cardiac surgery in subjects older than 65 years].

    PubMed

    Mureddu, Gian Francesco; Faggiano, Pompilio; Fattirolli, Francesco

    2014-03-01

    Non cardiac surgery is becoming increasingly common in elderly patients; they are usually affected by overt cardiac disease or show multiple risk factors, responsible for a higher incidence of perioperative fatal or nonfatal cardiac events. Of interest, acute myocardial infarction occurring in the perioperative period shows a high mortality rate in people over 65 years old. The cardiovascular risk stratification and perioperative management of subjects undergoing noncardiac surgery have been recently updated in the 2014 European Society of Cardiology Guidelines. However, several critical points still lack of strong evidence and are based on expert opinions only. For example, the use of drugs, such as beta-blockers, before, during and after the surgery, presents many uncertainties regarding the selection of patients more likely to benefit, dosage and duration of therapy, and effects on outcome. Data on elderly patients undergoing non cardiac surgery are scarce. Accordingly, a prospective registry enrolling a large number of aged subjects undergoing non cardiac surgery (particularly at high or intermediate risk) should be able to give us adequate insights on the management strategies currently used, on the incidence of death or cardiovascular events in the postoperative period and on the areas of potential improvement in care. Furthermore, the effects on outcome of structured programs of Guidelines implementation in the clinical practice of cardiologists, anesthesiologists and other health personnel involved in perioperative care, could be positive and should be evaluated. PMID:25481937

  5. Current practice of antiplatelet and anticoagulation management in post-cardiac surgery patients: a national audit.

    PubMed

    Hosmane, Sharath; Birla, Rashmi; Marchbank, Adrian

    2012-04-01

    The Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery recently published a guideline on antiplatelet and anticoagulation management in cardiac surgery. We aimed to assess the awareness of the current guideline and adherence to it in the National Health Service through this National Audit. We designed a questionnaire consisting of nine questions covering various aspects of antiplatelet and anticoagulation management in post-cardiac surgery patients. A telephonic survey of the on-call cardiothoracic registrars in all the cardiothoracic centres across the UK was performed. All 37 National Health Service hospitals in the UK with 242 consultants providing adult cardiac surgical service were contacted. Twenty (54%) hospitals had a unit protocol for antiplatelet and anticoagulation management in post-cardiac surgery. Only 23 (62.2%) registrars were aware of current European Association for Cardio-Thoracic Surgery guidelines. Antiplatelet therapy is variable in the cardiac surgical units across the country. Low-dose aspirin is commonly used despite the recommendation of 150-300 mg. The loading dose of aspirin within 24 h as recommended by the guideline is followed only by 60.7% of surgeons. There was not much deviation from the guideline with respect to the anticoagulation therapy. PMID:22235003

  6. Risks of packed red blood cell transfusion in patients undergoing cardiac surgery.

    PubMed

    Gerber, David R

    2012-12-01

    Packed red blood cell (PRBC) transfusion is common in patients undergoing cardiac surgery. Evidence has accumulated demonstrating that such patients can tolerate relatively low hemoglobins, and an extensive body of literature has developed demonstrating that patients undergoing such surgery who receive PRBC are at risk for several adverse outcomes including increased mortality, atrial fibrillation, and more postoperative infections, as well as numerous other complications. The PubMed database was searched for the English language literature on the topic of PRBC transfusion and outcomes in patients undergoing cardiac surgery, as well as alternatives to this intervention. Data were reviewed to assess the impact of transfusion in patients undergoing cardiac surgery on mortality, cardiac, infectious, and pulmonary, as well as a variety of miscellaneous complications. Patients receiving PRBC were consistently identified as being at higher risk for complications in all categories. The limited prospective data were consistent with the retrospective data, which comprised most of the literature. The preponderance of the literature suggests that patients undergoing cardiac surgery can tolerate lower hemoglobin/hematocrit values than traditionally appreciated. Most published data also indicate that PRBC transfusion should be reserved for patients with an identifiable clinical/physiologic indication fir this intervention, consistent with recent specialty society guidelines. PMID:22762927

  7. Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review

    PubMed Central

    Patel, Nikil; Minhas, Jatinder S.; Chung, Emma M. L.

    2015-01-01

    Modern day cardiac surgery evolved upon the advent of cardiopulmonary bypass machines (CPB) in the 1950s. Following this development, cardiac surgery in recent years has improved significantly. Despite such advances and the introduction of new technologies, neurological sequelae after cardiac surgery still exist. Ischaemic stroke, delirium, and cognitive impairment cause significant morbidity and mortality and unfortunately remain common complications. Postoperative cognitive decline (POCD) is believed to be associated with the presence of new ischaemic lesions originating from emboli entering the cerebral circulation during surgery. Cardiopulmonary bypass was thought to be the reason of POCD, but randomised controlled trials comparing with off-pump surgery show contradictory results. Attention has now turned to the growing evidence that perioperative risk factors, as well as patient-related risk factors, play an important role in early and late POCD. Clearly, identifying the mechanism of POCD is challenging. The purpose of this systematic review is to discuss the literature that has investigated patient and perioperative risk factors to better understand the magnitude of the risk factors associated with POCD after cardiac surgery. PMID:26491558

  8. Postoperative Atrial Fibrillation following Open Cardiac Surgery: Predisposing Factors and Complications

    PubMed Central

    Hashemzadeh, Khosrow; Dehdilani, Mahnaz; Dehdilani, Marjan

    2013-01-01

    Introduction: New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that has substantial effects on outcomes. The aim of this study is to analyze the risk factors in the pre, intra, and postoperative periods, and evaluate its impact on patients’ outcome. Methods: In this prospective study, between March 2007 and February 2011, a total of 1254 patients with preoperative sinus rhythm who underwent open cardiac surgery were included of which 177 (13.6%) had developed POAF. Many clinical variables that are associated with the development of POAF, were evaluated. Results: The study population consisted of 1254 patients that 864 (68.9%) were male and 390 (31.1%) female, and average age was 55.1±15.7 years. POAF occurred in 171 (13.6%) of patients and most of them (68.4%) developed within the first two days after surgery. Multivariate logistic regression analysis was used to identify the following risk factors of POAF: Preoperative risk factors: age>50, smoking, Left ventricular hypertrophy, renal dysfunction, intraoperative risk factors: intraoperative inotrope use, valve surgery, atrial septal defect (ASD) surgery, bicaval cannulation, concomitant cardiac venting of pulmonary and aorta, longer cardiopulmonary time, longer cross-clamp time, postoperative use of inotropic agent after termination of cardiopulmonary bypass. Conclusion: POAF is the most common arrhythmia after cardiac surgery and not only concerted effort should be performed to identify and to reduce the risk factors, but also effective treatment is necessary to prevent mortality and morbidity. PMID:24252985

  9. Impaired Olfaction and Risk for Delirium or Cognitive Decline After Cardiac Surgery

    PubMed Central

    Brown, Charles H.; Morrissey, Candice; Ono, Masahiro; Yenokyan, Gayane; Selnes, Ola A.; Walston, Jeremy; Max, Laura; LaFlam, Andrew; Neufeld, Karin; Gottesman, Rebecca F.; Hogue, Charles W.

    2014-01-01

    Summary Statement Impaired olfaction, identified in 33% of patients undergoing cardiac surgery, was associated with the adjusted risk for postoperative delirium but not cognitive decline. Objectives The prevalence and significance of impaired olfaction is not well characterized in patients undergoing cardiac surgery. Because impaired olfaction has been associated with underlying neurologic disease, impaired olfaction may identify patients who are vulnerable to poor neurological outcomes in the perioperative period. The objective of this study was to determine the prevalence of impaired olfaction among patients presenting for cardiac surgery and the independent association of impaired olfaction with postoperative delirium and cognitive decline. Design Nested prospective cohort study Setting Academic hospital Participants 165 patients undergoing coronary artery bypass and/or valve surgery Measurements Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score < 5th percentile of normative data. Delirium was assessed using a validated chart-review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4–6 weeks after surgery. Results Impaired olfaction was identified in 54 of 165 patients (33%) prior to surgery. Impaired olfaction was associated with increased adjusted risk for postoperative delirium (relative risk [RR] 1.90, 95% CI 1.17–3.09; P=0.009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. Conclusion Impaired olfaction is prevalent in patients undergoing cardiac surgery and is associated with increased adjusted risk for postoperative delirium, but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability for postoperative delirium among patients undergoing cardiac surgery. PMID:25597555

  10. Late Post-Conditioning with Sevoflurane after Cardiac Surgery - Are Surrogate Markers Associated with Clinical Outcome?

    PubMed Central

    Bonvini, John M.; Beck-Schimmer, Beatrice; Kuhn, Sonja J.; Graber, Sereina M.

    2015-01-01

    Introduction In a recent randomized controlled trial our group has demonstrated in 102 patients that late post-conditioning with sevoflurane performed in the intensive care unit after surgery involving extracorporeal circulation reduced damage to cardiomyocytes exposed to ischemia reperfusion injury. On the first post-operative day the sevoflurane patients presented with lower troponin T values when compared with those undergoing propofol sedation. In order to assess possible clinical relevant long-term implications in patients enrolled in this study, we performed the current retrospective analysis focusing on cardiac and non-cardiac events during the first 6 months after surgery. Methods All patients who had successfully completed the late post-conditioning trial were included into this follow-up. Our primary and secondary endpoints were the proportion of patients experiencing cardiac and non-cardiac events, respectively. Additionally, we were interested in assessing therapeutic interventions such as initiation or change of drug therapy, interventional treatment or surgery. Results Of 102 patients analyzed in the primary study 94 could be included in this follow-up. In the sevoflurane group (with 41 patients) 16 (39%) experienced one or several cardiac events within 6 months after cardiac surgery, in the propofol group (with 53 patients) 19 (36%, p=0.75). Four patients (9%) with sevoflurane vs. 7 (13%) with propofol sedation had non-cardiac events (p=0.61). While a similar percentage of patients suffered from cardiac and/or non-cardiac events, only 12 patients in the sevoflurane group compared to 20 propofol patients needed a therapeutic intervention (OR: 0.24, 95% CI: 0.04-1.43, p=0.12). A similar result was found for hospital admissions: 2 patients in the sevoflurane group had to be re-admitted to the hospital compared to 8 in the propofol group (OR 0.23, 95% CI: 0.04-1.29, p=0.10). Conclusions Sevoflurane does not seem to provide protection with regard to the

  11. [Cardiovascular assessment and management before non-cardiac surgery].

    PubMed

    Schwarz, Stefanie; Bernheim, Alain M

    2015-05-01

    The preoperative cardiovascular risk management accounts for patient-related risk factors, the circumstances leading to the surgical procedure, and the risk of the operation. While urgent operations should not be delayed for cardiac testing, an elective surgical intervention should be postponed in unstable cardiac conditions. In stable cardiac situations, prophylactic coronary interventions to reduce the risk of perioperative complications are rarely indicated. Therefore, in most cases, the planned operation can be performed without previous cardiac stress testing or coronary angiography. Preoperative imaging stress testing is recommended for patients with poor functional capacities that are at high cardiovascular risk prior to a high-risk operation. According to the literature, preoperative prophylactic administration of betablockers and aspirin is controversial. Preoperative discontinuation of dual anti-platelet therapy within six months following drug-eluting stent implantation is not recommended. PMID:26098052

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

    PubMed Central

    Ai, Amy L.; Hall, Daniel E.

    2011-01-01

    We examined experiencing divine love as an indicator of affective spiritual growth in a prospective cohort of 200 patients surviving cardiac surgery. These patients previously completed two-wave preoperative interviews when standardized cardiac surgery data were also collected. The information included left ventricular ejection fraction, New York Heart Association Classification, baseline health (physical and mental), optimism, hope, religiousness, prayer coping, religious/spiritual coping, and demographics. We then measured divine love at 900 days postoperatively. Hierarchical linear regression indicated the direct effect of positive religious coping on experiences of divine love, controlling for other key variables. Postoperatively perceived spiritual support was entered at the final step as an explanatory factor, which appeared to mediate the coping effect. None of the other faith factors predicted divine love. Further research regarding divine love and spiritual support may eventually guide clinical attempts to support patients' spiritual growth as an independently relevant outcome of cardiac surgery. PMID:21748012

  13. [Effectiveness of high frequency jet ventilation introduced immediately after cardiac surgery].

    PubMed

    Morishita, A; Hoshino, K; Katahira, S; Tomioka, H

    2008-11-01

    It is important to establish the lung protective strategy strictly for serious respiratory failure after cardiac surgery, because the hemodynamic state is unstable. High frequency jet ventilation (HFJV) was introduced in 5 patients with respiratory failure after cardiac surgery. Two had been diagnosed with acute aortic dissection and 3 with angina pectorlis. Off pump coronary artery bypass grafting was performed in 2 patients. Hemodynamic variables during HFJV were stable, and the duration of HFJV was 9 to 45 hours. Oxygenations improved immediately by the introduction of HFJV in all patients, and no adverse effect was recognized. Therefore, use of HFJV immediately after cardiac surgery might be an effective respiratory therapy of choice for patients with acute lung injury. PMID:19048904

  14. Clinical risk predictors associated with cardiac mortality following vascular surgery in South African patients.

    PubMed

    Biccard, B M; Bandu, R

    2007-01-01

    Clinical risk prediction is important in the prognostication of peri-operative cardiac complications and the management of high-risk cardiac patients for major non-cardiac surgery. However, the current pre-operative clinical risk indices have been derived in European and American patients and not validated in South African patients. The purpose of this study was to evaluate the utility of the clinical risk predictors identified in Lee's revised cardiac risk index and in the African arm of the INTERHEART study, in predicting cardiac mortality following vascular surgery in South African patients. A retrospective cohort study was conducted of all patients undergoing elective or urgent vascular surgery at Inkosi Albert Luthuli Central Hospital over a three-year period. All in-hospital deaths were identified and classified into cardiac or non-cardiac deaths by an investigator blinded to the patients' pre-operative clinical risk predicators. A second investigator blinded to the cause of death identified the following clinical risk predictors: history of ischaemic heart disease, congestive cardiac failure and cerebrovascular accident, presence of diabetes, hypertension and obesity (BMI > 30 kg.m(-2)), elevated serum creatinine (> 180 micromol.l(-1)), positive smoking history and ethnicity. The main finding was that a serum creatinine level of greater than 180 micromol.l(-1) and a positive smoking history were significantly associated with cardiac death (p = 0.012, p = 0.012, respectively). Multivariate analyses using a backward stepwise modeling technique found only a serum creatinine of > 180 micromol.l(-1) and a positive smoking history to be significantly associated with cardiac mortality (p = 0.038, 0.035, respectively) with an odds ratio and 95% confidence interval of 3.02 (1.06-8.59) and 3.40 (1.09-10.62), respectively. All other clinical predictors were not significantly different between the two groups. However, based on the sample size of this study, a type 2 or

  15. Standardized Preoperative Corticosteroid Treatment in Neonates Undergoing Cardiac Surgery- Results From a Randomized Trial

    PubMed Central

    Graham, Eric M.; Atz, Andrew M.; Butts, Ryan J.; Baker, Nathaniel L.; Zyblewski, Sinai C.; Deardorff, Rachael L.; DeSantis, Stacia M.; Reeves, Scott T.; Bradley, Scott M.; Spinale, Francis G.

    2011-01-01

    Objective A heightened inflammatory response occurs following cardiac surgery. The perioperative use of glucocorticoids has been advocated as a method to improve postoperative outcomes. Randomized prospective studies to quantify the effect of methylprednisolone on perioperative outcomes in neonatal cardiac surgery have not been performed. We sought to determine whether pre-operative methylprednisolone would improve postoperative recovery in neonates requiring cardiac surgery. Methods Neonates scheduled for cardiac surgery were randomly assigned to receive either Two Dose (8 hours preoperatively and operatively; n=39) or Single Dose (operatively; n=37) methylprednisolone (30 mg/kg/dose) in a double-blind, placebo-controlled trial. The primary outcome was the incidence of low cardiac output syndrome (standardized score) or death 36 hours postoperatively. Secondary outcomes were death at 30 days, interlukin-6 levels, inotropic score, fluid balance, serum creatinine, and ICU and hospital stay. Results Preoperative plasma levels of the inflammatory cytokine interlukin-6 were reduced by 2-fold (p<0.001) in the Two Dose methylprednisolone group, consistent with the anti-inflammatory effects of methylprednisolone. However, the incidence of low cardiac output syndrome was 46% (17/37) in the Single Dose and 38% (15/39) in the Two Dose methylprednisolone groups (p=0.51). Two Dose methylprednisolone was associated with a higher serum creatinine (0.61±0.18 vs. 0.53±0.12 mg/dL, p=0.03), and poorer postoperative diuresis (−96±49 mL, p=0.05). Inotropic requirement, duration of mechanical ventilation, ICU, and hospital stay did not differ between the 2 groups. Conclusions Combined preoperative and intraoperative use of glucocorticoids in neonatal cardiac surgery does not favorably affect early clinical outcomes, and may exacerbate perioperative renal dysfunction. PMID:21600592

  16. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality.

    PubMed

    D'Agostino, Richard S; Jacobs, Jeffrey P; Badhwar, Vinay; Paone, Gaetano; Rankin, J Scott; Han, Jane M; McDonald, Donna; Shahian, David M

    2016-01-01

    The Society of Thoracic Surgeons Adult Cardiac Database is one of the longest-standing, largest, and most highly regarded clinical data registries in health care. It serves as the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This report summarizes current aggregate national outcomes in adult cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement. PMID:26616408

  17. Current approach to diagnosis and treatment of delirium after cardiac surgery

    PubMed Central

    Evans, Adam S.; Weiner, Menachem M.; Arora, Rakesh C.; Chung, Insung; Deshpande, Ranjit; Varghese, Robin; Augoustides, John; Ramakrishna, Harish

    2016-01-01

    Delirium after cardiac surgery remains a common occurrence that results in significant short- and long-term morbidity and mortality. It continues to be underdiagnosed given its complex presentation and multifactorial etiology; however, its prevalence is increasing given the aging cardiac surgical population. This review highlights the perioperative risk factors, tools to assist in diagnosing delirium, and current pharmacological and nonpharmacological therapy options. PMID:27052077

  18. Intraoperative Embolization and Cognitive Decline After Cardiac Surgery: A Systematic Review.

    PubMed

    Patel, Nikil; Minhas, Jatinder S; Chung, Emma M L

    2016-09-01

    Since the advent of cardiac surgery, complications have existed in many forms. Recent work has focused on the safety of current cardiac surgery with particular emphasis on cognitive outcomes. Cardiopulmonary bypass has improved the safety of operative practice; however, increasing concern surrounds the measurable and immeasurable impact embolization has on the brain. New ischemic lesions have been associated with distant emboli, which intraoperatively enter the cardiovascular system. This has prompted better characterization of the nature of emboli manifesting as cognitive impairment postoperatively. The difficulty in attributing causation relates to the subclinical damage that does not necessarily manifest as clinical stroke. Transcranial Doppler has become an important tool in documenting cerebral emboli during surgery. The purpose of this systematic review is to focus on the current literature to improve our understanding of the impact embolization has on the brain. We also aim to investigate which cardiac interventions hold the greatest burden of embolic load and how previous literature has investigated the impact of emboli on cognition by monitoring emboli during specific cardiac interventions. Significant intraoperative factors such as the cardiopulmonary bypass machine and surgical interventions have been highlighted to summarize the current literature associating cerebral embolization with these factors and postoperative cognitive outcomes. The findings of this review report that the current literature is divided as to whether the impact of embolization during cardiac surgery has any adverse impact on cognition. This review highlights that the ultimate goal of improving cognitive safety will involve further careful consideration of multifactorial events. PMID:26783262

  19. Predictors of in-hospital mortality following redo cardiac surgery: Single center experience

    PubMed Central

    Coskun, Isa; Cayli, Murat; Gulcan, Oner

    2015-01-01

    Purpose Redo cardiac operations represent one of the main challenges in heart surgery. The purpose of the study was to analyze the predictors of in-hospital mortality in patients undergoing reoperative cardiac surgery by a single surgical team. Methods A total of 1367 patients underwent cardiac surgical procedures and prospectively entered into a computerized database. Patients were divided into 2 groups based on the reoperative cardiac surgery (n = 109) and control group (n = 1258). Uni- and multivariate logistic regression analysis were performed to evaluate the possible predictors of hospital mortality. Results Mean age was 56 ± 13, and 46% were female in redo group. In-hospital mortality was 4.6 vs. 2.2%, p = 0.11. EuroSCORE (6 vs. 3; p < 0.01), cardiopulmonary bypass time (90 vs. 71 min; p < 0.01), postoperative bleeding (450 vs. 350 ml; p < 0.01), postoperative atrial fibrillation (AF) (29 vs. 16%; p < 0.01), and inotropic support (58 vs. 31%; p = 0.001) were significantly different. These variables were entered into uni- and multivariate regression analysis. Postoperative AF (OR1.76, p = 0.007) and EuroSCORE (OR 1.42, p < 0.01) were significant risk factors predicting hospital mortality. Conclusions Reoperative cardiac surgery can be performed under similar risks as primary operations. Postoperative AF and EuroSCORE are predictors of in-hospital mortality for redo cases. PMID:26527452

  20. Teamwork, communication, formula-one racing and the outcomes of cardiac surgery.

    PubMed

    Merry, Alan F; Weller, Jennifer; Mitchell, Simon J

    2014-03-01

    Most cardiac units achieve excellent results today, but the risk of cardiac surgery is still relatively high, and avoidable harm is common. The story of the Green Lane Cardiothoracic Unit provides an exemplar of excellence, but also illustrates the challenges associated with changes over time and with increases in the size of a unit and the complexity of practice today. The ultimate aim of cardiac surgery should be the best outcomes for (often very sick) patients rather than an undue focus on the prevention of error or adverse events. Measurement is fundamental to improving quality in health care, and the framework of structure, process, and outcome is helpful in considering how best to achieve this. A combination of outcomes (including some indicators of important morbidity) with key measures of process is advocated. There is substantial evidence that failures in teamwork and communication contribute to inefficiency and avoidable harm in cardiac surgery. Minor events are as important as major ones. Six approaches to improving teamwork (and hence outcomes) in cardiac surgery are suggested. These are: 1) subspecialize and replace tribes with teams; 2) sort out the leadership while flattening the gradients of authority; 3) introduce explicit training in effective communication; 4) use checklists, briefings, and debriefings and engage in the process; 5) promote a culture of respect alongside a commitment to excellence and a focus on patients; 6) focus on the performance of the team, not on individuals. PMID:24779113

  1. [Participation in cardiac rehabilitation after coronary bypass surgery: good news, bad news].

    PubMed

    Henkin, Yaakov

    2012-09-01

    Cardiac rehabilitation programs have the potential to decrease morbidity and mortality and increase quality of life after acute coronary events and coronary bypass surgery (CABG). Unfortunately, the proportion of eligible patients that participate in cardiac rehabilitation remains low, despite coverage of such programs by the Israeli National Health Insurance. A low participation rate is especially prominent in women, elderly, minorities and low socioeconomic classes. In this edition of Harefuah, Gendler et at conducted an interventional study aimed at increasing the participation of patients in cardiac rehabilitation programs after CABG in 5 cardiothoracic wards across Israel. They interviewed 489 patients in the intervention arm and 472 patients in the control arm before surgery and a year later. The intervention included dissemination of information on cardiac rehabilitation to the medical staff and patients. Following the intervention, cardiac rehabilitation increased almost twofold in veteran-Israeli males and females. Although it increased significantly in USSR-born male immigrants, their absolute rate of participation remained low (13.6%). No USSR-born female participated in rehabilitation, either before or after the intervention. The good news is that a simple, inexpensive intervention can increase participation in cardiac rehabilitation after CABG surgery. The bad news is that this potentially lifesaving activity remains unattended by most USSR-born immigrants, and particularly by females. Additional research is required to explore the cultural, social and economic barriers of this phenomenon. PMID:23367745

  2. [Cardiac Surgery in Two Patients with Parkinson's Disease who were Using Deep Brain Stimulation Devices].

    PubMed

    Horiuchi, Kazutaka; Nakata, Shunsuke; Komoda, Satsuki; Yuasa, Takeshi

    2015-09-01

    For the treatment of Parkinson's disease, deep brain stimulation( DBS) devices are implanted for the control of motor symptoms including tremor. We performed cardiac surgery in 2 patients with Parkinson's disease who were using DBS devices. Coronary artery bypass was performed in one patient, and closure of ventricular septal perforation after acute myocardial infarction was performed in the other. There is a risk of injury and electromagnetic interference of DBS devices. No device failure or aggravation of Parkinson's symptom was observed in these cases. In many cases of cardiac surgery, various devices are concomitantly used, and the potential interference with the devices should be carefully examined in perioperative management. PMID:26329628

  3. Usefulness of the Myocardial Infarction and Cardiac Arrest Calculator as a Discriminator of Adverse Cardiac Events After Elective Hip and Knee Surgery.

    PubMed

    Peterson, Brandon; Ghahramani, Mehrdad; Harris, Stephanie; Suchniak-Mussari, Kristen; Bedi, Gurneet; Bulathsinghala, Charles; Foy, Andrew

    2016-06-15

    The 2014 American College of Cardiology and American Heart Association guidelines on perioperative evaluation recommend differentiating patients at low risk (<1%) versus elevated risk (≥1%) for cardiac complications to guide appropriate preoperative testing. Among the tools recommended for estimating perioperative risk is the National Surgical Quality Improvement Program (NSQIP) Myocardial Infarction and Cardiac Arrest (MICA) risk calculator. We investigated whether the NSQIP MICA risk calculator would accurately discriminate adverse cardiac events in a cohort of adult patients undergoing elective orthopedic surgery. We retrospectively reviewed 1,098 consecutive, elective orthopedic surgeries performed at Hershey Medical Center from January 1, 2013, to December 31, 2014. Adverse cardiac events were defined as myocardial infarction or cardiac arrest within 30 days of surgery. The mean estimated risk for adverse cardiac events using the NSQIP MICA risk calculator was 0.54%, which was not significantly different (p = 1) compared with the observed incidence of 0.64% (7 of 1,098 procedures). The c-statistic for discriminating adverse cardiac events was 0.85 (95% CI 0.67 to 1) for the NSQIP MICA risk calculator and 0.9 (95% CI 0.75 to 1) for the Revised Cardiac Risk Index. In conclusion, the NSQIP MICA risk calculator is a good discriminator of adverse cardiac events in patients undergoing elective hip and knee surgery, performing comparably to the Revised Cardiac Risk Index. PMID:27131613

  4. Acute kidney injury following cardiac surgery: current understanding and future directions.

    PubMed

    O'Neal, Jason B; Shaw, Andrew D; Billings, Frederic T

    2016-01-01

    Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30 % of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. Renal ischemia, reperfusion, inflammation, hemolysis, oxidative stress, cholesterol emboli, and toxins contribute to the development and progression of AKI. Preventive strategies are limited, but current evidence supports maintenance of renal perfusion and intravascular volume while avoiding venous congestion, administration of balanced salt as opposed to high-chloride intravenous fluids, and the avoidance or limitation of cardiopulmonary bypass exposure. AKI that requires renal replacement therapy occurs in 2-5 % of patients following cardiac surgery and is associated with 50 % mortality. For those who recover from renal replacement therapy or even mild AKI, progression to chronic kidney disease in the ensuing months and years is more likely than for those who do not develop AKI. Cardiac surgery continues to be a popular clinical model to evaluate novel therapeutics, off-label use of existing medications, and nonpharmacologic treatments for AKI, since cardiac surgery is fairly common, typically elective, provides a relatively standardized insult, and patients remain hospitalized and monitored following surgery. More efficient and time-sensitive methods to diagnose AKI are imperative to reduce this negative outcome. The discovery and validation of renal damage biomarkers should in time supplant creatinine-based criteria for the clinical diagnosis of AKI. PMID:27373799

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

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

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

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

    PubMed Central

    2010-01-01

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

  7. Sensitivity of a modified ACT test to levels of bivalirudin used during cardiac surgery.

    PubMed

    Zucker, Marcia L; Koster, Andreas; Prats, Jayne; Laduca, Frank M

    2005-12-01

    Assessment of anticoagulation status during cardiac surgery can be valuable for novel therapeutics, including direct thrombin inhibitors. The ecarin clotting time (ECT) has been reported to be sensitive for monitoring of bivalirudin in cardiac surgery but is not commercially available. The activated clotting time (ACT), commonly used for heparin monitoring, may display a lack of sensitivity to alternative anticoagulants when used in on-pump cardiac surgery. Both the ACT and ECT have been successfully used for monitoring bivalirudin anticoagulation in off-pump cardiac surgery. A new ACT, the ACTT, was developed to increase the linearity of the clotting time response to bivalirudin at higher concentrations. After Ethics Committee approval, a pilot study was performed to evaluate the feasibility of using bivalirudin for on-pump cardiac surgery and to evaluate dosing of bivalirudin in terms of the pharmacokinetic and safety profile in patients undergoing coronary artery bypass graft (CABG) surgery. Secondary objectives included an assessment of the anticoagulation profile and correlation of the response seen with various ACTs and the ECT with the plasma bivalirudin concentration in the patients' blood. After informed consent, 10 sequential patients presenting for elective cardiac surgery requiring cardiopulmonary bypass received bivalirudin anticoagulation in lieu of heparin. Dosing was fixed (1.0 mg/kg bolus followed by a 2.5 mg/kg/h infusion) and not titrated on the basis of coagulation test results. At baseline and 15-minute intervals, blood samples were collected for ACT (ACTT, Celite, kaolin, ACT+), ECT, and bivalirudin plasma level measurements. Over the range of bivalirudin plasma concentrations in this study, all clot-based systems examined were prolonged according to concentration and showed good correlation with bivalirudin plasma levels. The ACTT and the ECT showed greater sensitivity to bivalirudin (-28.5 sec/microg/ml bivalirudin) compared with the other

  8. Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery.

    PubMed

    Jung, Su-Young; Park, Jung Tak; Kwon, Young Eun; Kim, Hyung Woo; Ryu, Geun Woo; Lee, Sul A; Park, Seohyun; Jhee, Jong Hyun; Oh, Hyung Jung; Han, Seung Hyeok; Yoo, Tae-Hyun; Kang, Shin-Wook

    2016-03-01

    Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23 mEq/L; group 2 (normal levels) 23 to 24 mEq/L; and group 3 (elevated levels) >24 mEq/L. The primary outcome was the predicated incidence of AKI 48 hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48 hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P < 0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective

  9. Cardiac surgery in Germany during 2013: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

    PubMed

    Funkat, A; Beckmann, A; Lewandowski, J; Frie, M; Ernst, M; Schiller, W; Gummert, J F; Cremer, J

    2014-08-01

    On the basis of a voluntary registry of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), data of all cardiac surgical procedures performed in 79 German cardiac surgical units during the year 2013 are presented. In 2013, a total of 99,128 cardiac surgical procedures (implantable cardioverter defibrillator [ICD] and pacemaker procedures excluded) were submitted to the registry. More than 13.8% of the patients were older than 80 years, which remains equal in comparison to the previous year. In-hospital mortality in 40,410 isolated coronary artery bypass grafting procedures (84.5% on-pump and 15.5% off-pump) was 2.9%. In 29,672 isolated valve procedures (including 7,722 catheter-based procedures), an in-hospital mortality of 4.7% was observed. This long-lasting registry of the GSTCVS will continue to be an important tool for quality control and voluntary public reporting by illustrating current facts and developments of cardiac surgery in Germany. PMID:24995534

  10. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

    PubMed

    Beckmann, Andreas; Funkat, Anne-Kathrin; Lewandowski, Jana; Frie, Michael; Schiller, Wolfgang; Hekmat, Khosro; Gummert, Jan F; Mohr, Friedrich Wilhelm

    2014-02-01

    On the basis of a voluntary registry of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), data of all cardiac surgical procedures performed in 79 German cardiac surgical units during the year 2012 are presented. In 2012, a total of 98,792 cardiac surgical procedures (ICD and pacemaker procedures excluded) were submitted to the registry. More than 13.8% of the patients were older than 80 years, which is a further increase in comparison to previous years. In-hospital mortality in 42,060 isolated coronary artery bypass grafting procedures (84.6% on-pump and 15.4% off-pump) was 2.9%. In 28,521 isolated valve procedures (including 6,804 catheter-based procedures), an in-hospital mortality of 4.8% was observed. This long-lasting registry of the GSTCVS will continue to be an important tool for quality control and voluntary public reporting by illustrating current facts and developments of cardiac surgery in Germany. PMID:24323696

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

    PubMed Central

    Akbariasbagh, Parvin; Mirzaghayan, Mohammad Reza; Akbariasbagh, Naseredin; Shariat, Mamak; Ebrahim, Bita

    2015-01-01

    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. PMID:26697086

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

    PubMed Central

    Bignami, Elena; Frati, Elena; Meroni, Roberta; Simonini, Marco; Di Prima, Ambra Licia; Manunta, Paolo; Zangrillo, Alberto

    2015-01-01

    Background: NGAL is one of the most promising AKI biomarkers in cardiac surgery. However, the best timing to dose it and the reference values are still matter of discussion. Aim of the Study: We performed a uNGAL perioperative time course, to better understand its perioperative kinetics and its role in AKI diagnosis. Setting of the Study: San Raffaele University Hospital, cardiac surgery department. Material and Methods: We enrolled in this prospective observational study 19 patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Based on preoperative characteristics, they were divided in low-risk and high-risk patients. uNGAL measurements were collected at pre-defined times before, during, and up to 24 hours after surgery. Statistical Analysis: Data were analysed by use of SAS 1999-2001 program or IBM SPSS Statistics. Results: In low-risk patients, uNGAL had the highest value immediately after general anesthesia induction (basal dosage: uNGAL: 12.20ng×ml-1, IQR 14.00). It later decreased significantly (3.40 ng×ml-1, IQR 4.80; P = 0.006) during CPB, and finally return to its original value 24 hours after surgery. In high-risk patients, uNGAL increased immediately after surgery; it had the highest value on ICU arrival (38,20 ng×ml-1; IQR 133,10) and remained high for several hours. A difference in uNGAL levels between the two groups was already observed at the end of surgery, but it became statistically significant on ICU arrival (P = 0.002). Conclusion: This study helps to better understand the different kinetics of this new biomarker in low-risk and high-risk cardiac patients. PMID:25566710

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

    PubMed Central

    Ozturk, Nilgun Kavrut; Baki, Elif Dogan; Kavakli, Ali Sait; Sahin, Ayca Sultan; Ayoglu, Raif Umut; Karaveli, Arzu; Emmiler, Mustafa; Inanoglu, Kerem; Karsli, Bilge

    2016-01-01

    Background. Parasternal block and transcutaneous electrical nerve stimulation (TENS) have been demonstrated to produce effective analgesia and reduce postoperative opioid requirements in patients undergoing cardiac surgery. Objectives. To compare the effectiveness of TENS and parasternal block on early postoperative pain after cardiac surgery. Methods. One hundred twenty patients undergoing cardiac surgery were enrolled in the present randomized, controlled prospective study. Patients were assigned to three treatment groups: parasternal block, intermittent TENS application, or a control group. Results. Pain scores recorded 4 h, 5 h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block group than in the TENS and control groups. Total morphine consumption was also lower in the parasternal block group than in the TENS and control groups. It was also significantly lower in the TENS group than in the control group. There were no statistical differences among the groups regarding the extubation time, rescue analgesic medication, length of intensive care unit stay, or length of hospital stay. Conclusions. Parasternal block was more effective than TENS in the management of early postoperative pain and the reduction of opioid requirements in patients who underwent cardiac surgery through median sternotomy. This trial is registered with Clinicaltrials.gov number NCT02725229. PMID:27445610

  14. Shifting a Paradigm of Cardiac Surgery: From Minimally Invasive to Micro-Invasive.

    PubMed

    D'Onofrio, Augusto; Gerosa, Gino

    2015-09-01

    The development of new techniques for the treatment of almost all structural heart pathologies that do not require cardiopulmonary bypass and aortic cross-clamping, such as transcatheter aortic valve replacement and transapical mitral chordae implantation, define a new age of our specialty: the micro-invasive (microICS) cardiac surgery era. PMID:26897830

  15. Pacemaker Dependency after Cardiac Surgery: A Systematic Review of Current Evidence

    PubMed Central

    2015-01-01

    Background Severe postoperative conduction disturbances requiring permanent pacemaker implantation frequently occur following cardiac surgery. Little is known about the long-term pacing requirements and risk factors for pacemaker dependency in this population. Methods We performed a systematic review of the literature addressing rates and predictors of pacemaker dependency in patients requiring permanent pacemaker implantation after cardiac surgery. Using a comprehensive search of the Medline, Web of Science and EMBASE databases, studies were selected for review based on predetermined inclusion and exclusion criteria. Results A total of 8 studies addressing the endpoint of pacemaker-dependency were identified, while 3 studies were found that addressed the recovery of atrioventricular (AV) conduction endpoint. There were 10 unique studies with a total of 780 patients. Mean follow-up ranged from 6–72 months. Pacemaker dependency rates ranged from 32%-91% and recovery of AV conduction ranged from 16%-42%. There was significant heterogeneity with respect to the definition of pacemaker dependency. Several patient and procedure-specific variables were found to be independently associated with pacemaker dependency, but these were not consistent between studies. Conclusions Pacemaker dependency following cardiac surgery occurs with variable frequency. While individual studies have identified various perioperative risk factors for pacemaker dependency and non-resolution of AV conduction disease, results have been inconsistent. Well-conducted studies using a uniform definition of pacemaker dependency might identify patients who will benefit most from early permanent pacemaker implantation after cardiac surgery. PMID:26470027

  16. Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Polymeropoulos, Evangelos; Bagos, Pantelis; Papadimitriou, Maria; Rizos, Ioannis; Patsouris, Efstratios; Τoumpoulis, Ioannis

    2016-01-01

    Purpose: Several studies have investigated the administration of vitamin C (vitC) for the prevention of postoperative atrial fibrillation (AF) after cardiac surgery. However, their findings were inconsistent. The purpose of this meta-analysis was to evaluate the efficacy of vitC as prophylaxis for the prevention of postoperative AF in cardiac surgery. Methods: A systematic search of PubMed, EMBASE, Google Scholar, the Cochrane Library, and clinical trial registries, was performed. 9 studies, published from August 2001 to May 2015, were included, with a total of 1,037 patients. Patients were randomized to receive vitC, or placebo. Results: Cardiac surgery patients who received vitC as prophylaxis, had a significantly lower incidence of postoperative AF (random effects OR=0.478, 95% CI 0.340 – 0.673, P < 10-4). No significant heterogeneity was detected across the analyzed studies (I2=21.7%), and no publication bias or other small study-related bias was found. Conclusion: Our findings suggest that VitC is effective as prophylaxis for the prevention of postoperative AF. The administration of vitC may be considered in all patients undergoing cardiac surgery. PMID:27478787

  17. SvO2 Trigger in Transfusion Strategy After Cardiac Surgery

    ClinicalTrials.gov

    2016-05-18

    Undergoing Nonemergent Cardiac Surgery; Central Venous Catheter on the Superior Vena Cava (to Perform ScVO2 Measure); Anemia (<9g/dL) Requiring Blood Transfusion; Hemodynamic and Respiratory Stability; Bleeding Graded as Insignificant, Mild, Moderate of Universal Definition of Perioperative Bleeding

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

    ERIC Educational Resources Information Center

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

    2002-01-01

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

  19. Nursing assistance at the hospital discharge after cardiac surgery: integrative review

    PubMed Central

    de Jesus, Daniela Fraga; Marques, Patrícia Figueiredo

    2013-01-01

    The study aimed to analyze the available evidence in the literature on nursing care in the hospital post-cardiac surgery. Data were collected from electronic databases LILACS, SciELO, MEDLINE, via DeCS thoracic surgery, hospital, nursing care, in the period 2001 to 2011. Ten articles were selected that showed the need to develop a plan of nursing discharge focusing on prevention of complications and coping with physical limitations resulting from heart surgery. Thus, the discharge should be considered from the time of admission, with carefully planned actions involving patient and family. PMID:24598961

  20. Pro: early extubation in the operating room following cardiac surgery in adults.

    PubMed

    Singh, Karen E; Baum, Victor C

    2012-12-01

    There is growing evidence that the general current approach in many centers of continued mechanical ventilation following cardiac surgery has evolved through historical experience rather than having a strong physiological basis in current practice. There is evidence going back several decades supporting very early (in the operating room [OR]) extubation in pediatric cardiac anesthesia. The authors provide evidence from numerous sources showing that extubation in the OR or shortly after arrival in the ICU is safe and cost-effective and is not prevented by the type of cardiac surgery or the use of cardiopulmonary bypass. They query if the paradigm should not be reversed and very early extubation be the routine unless contraindicated. Like any anesthetic technique, appropriate patient selection is called for, but this technique is widely appropriate. PMID:22798230

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

    PubMed

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

    2016-06-01

    In the present observational study, we measured serum levels of the chemokine stromal cell-derived factor-1α (SDF-1α) in 100 patients undergoing cardiac surgery with cardiopulmonary bypass at seven distinct time points including preoperative values, myocardial ischemia, reperfusion, and the postoperative course. Myocardial ischemia triggered a marked increase of SDF-1α serum levels whereas cardiac reperfusion had no significant influence. Perioperative SDF-1α serum levels were influenced by patients' characteristics (e.g., age, gender, aspirin intake). In an explorative analysis, we observed an inverse association between SDF-1α serum levels and the incidence of organ dysfunction. In conclusion, time of myocardial ischemia was identified as the key stimulus for a significant upregulation of SDF-1α, indicating its role as a marker of myocardial injury. The inverse association between SDF-1α levels and organ dysfunction association encourages further studies to evaluate its organoprotective properties in cardiac surgery patients. PMID:27055858

  2. Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion.

    PubMed

    Toller, W; Heringlake, M; Guarracino, F; Algotsson, L; Alvarez, J; Argyriadou, H; Ben-Gal, T; Černý, V; Cholley, B; Eremenko, A; Guerrero-Orriach, J L; Järvelä, K; Karanovic, N; Kivikko, M; Lahtinen, P; Lomivorotov, V; Mehta, R H; Mušič, Š; Pollesello, P; Rex, S; Riha, H; Rudiger, A; Salmenperä, M; Szudi, L; Tritapepe, L; Wyncoll, D; Öwall, A

    2015-04-01

    In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan. PMID:25734940

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

    PubMed

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

    2015-07-01

    Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. Current evidence suggests that levosimendan enhances cardiac function after cardiopulmonary bypass in patients with both normal and reduced left ventricular function. In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent. PMID:25862519

  4. [Josef Koncz (1916-1988)--pioneer of cardiac surgery].

    PubMed

    Schmitto, J D; Tjindra, C; Kolat, P; Hintze, E; Liakopoulos, O J; Popov, A F; Sellin, C; Dörge, H; Schöndube, F A

    2007-03-01

    Josef Koncz (1916-1988) was until given emeritus status in 1982 director of the Department of Cardiothoracic and Vascular Surgery, which was specifically founded for him in Goettingen, Germany. By the fusion of three different surgical branches the University hospital of Goettingen took over the role of a pacemaker and initiated a standard in the development of this new specialty in Germany. The scientific and clinical work done by the Department of Cardiothoracic and Vascular Surgery was shaped by the personality of the surgeon and scientist Josef Koncz. He was a successful surgeon and innovative pioneer in one person. Already in 1956, he started open-heart surgery and proceeded this technique in an impressing series. In 1965 he was the first in Germany who operated upon the transposition of the great vessels by Mustard's method and developed together with his long-standing assistant, Huschang Rastan, an operation technique to extend the left-ventricular outflow tract combined with tunnel-shaped subvalvular aortic valve stenosis. Another essential element of his work is related to the establishment of the Cardiothoracic and Vascular Surgery as an independent specialty, ending in the foundation of the German Society for Thoracic and Cardiovascular Surgery in 1971. PMID:17458023

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

    PubMed

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

    2016-06-01

    Admission on the day of surgery for elective cardiac and non-cardiac surgery has been established as a prevalent, critical practice. This approach realizes medical, logistical, psychological and fiscal benefits, and its success is predicated on an effective outpatient pre-operative evaluation. The establishment of a highly functional pre-operative clinic with a comprehensive set-up and efficient logistical pathways is invaluable. This notion has been expanded in recent years to include the entire peri-operative period and the concept of a 'peri-operative anesthesia/surgical home' is gaining popularity and support. Evaluating patients prior to admission for surgery, anesthesiologists can place themselves at the forefront of reducing unnecessary pre-operative hospital admissions, excess lab tests, unneeded consultations, and ultimately decrease the cancellations on the day of surgery. Furthermore, by taking a leadership role in the pre-operative clinic, anesthesiologists place themselves squarely at the forefront of the burgeoning movement for the peri-operative surgical home and continue to cement the indispensability of the anesthesiologist during the entire peri-operative course. The authors present this review as a follow-up describing the successful implementation of a pre-operative same-day cardiac surgery clinic and offer these experiences over the last 8 years as a guide to helping other anesthesiologists do the same. PMID:26847740

  6. The Influence of Perioperative Dexmedetomidine on Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Geng, Jun; Qian, Ju; Cheng, Hao; Ji, Fuhai; Liu, Hong

    2016-01-01

    Background The use of dexmedetomidine may have benefits on the clinical outcomes of cardiac surgery. We conducted a meta-analysis comparing the postoperative complications in patients undergoing cardiac surgery with dexmedetomidine versus other perioperative medications to determine the influence of perioperative dexmedetomidine on cardiac surgery patients. Methods Randomized or quasi-randomized controlled trials comparing outcomes in patients who underwent cardiac surgery with dexmedetomidine, another medication, or a placebo were retrieved from EMBASE, PubMed, the Cochrane Library, and Science Citation Index. Results A total of 1702 patients in 14 studies met the selection criteria among 1,535 studies that fit the research strategy. Compared to other medications, dexmedetomidine has combined risk ratios of 0.28 (95% confidence interval [CI] 0.15, 0.55, P = 0.0002) for ventricular tachycardia, 0.35 (95% CI 0.20, 0.62, P = 0.0004) for postoperative delirium, 0.76 (95% CI 0.55, 1.06, P = 0.11) for atrial fibrillation, 1.08 (95% CI 0.74, 1.57, P = 0.69) for hypotension, and 2.23 (95% CI 1.36, 3.67, P = 0.001) for bradycardia. In addition, dexmedetomidine may reduce the length of intensive care unit (ICU) and hospital stay. Conclusions This meta-analysis revealed that the perioperative use of dexmedetomidine in patients undergoing cardiac surgery can reduce the risk of postoperative ventricular tachycardia and delirium, but may increase the risk of bradycardia. The estimates showed a decreased risk of atrial fibrillation, shorter length of ICU stay and hospitalization, and increased risk of hypotension with dexmedetomidine. PMID:27049318

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

    PubMed

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

    2016-05-01

    Acute renal failure (ARF) is associated with increased mortality in pediatric extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of ARF during ECMO in pediatric patients after cardiac surgery. A retrospective study analyzed 42 children (≤15 years) after cardiac surgery requiring venous-arterial ECMO between December 2008 and December 2014 at Fuwai Hospital. ARF was defined as ≥300% rise in serum creatinine (SCr) concentration from baseline or application of dialysis. Multivariate logistic regression was performed to identify the predictors of ARF during ECMO. A total of 42 children (age, interquartile range [IQR], 13.0 [7.2-29.8] months; weight, IQR, 8.5 [6.7-11.0] kg) after cardiac surgery requiring ECMO were included in this study. The total survival rate was 52.4%, and the incidence of ARF was 40.5%. As the result of univariate analysis, ECMO duration, cardiopulmonary resuscitation, maximum free hemoglobin (FHB) during ECMO, lactate level, and mean blood pressure before initiation of ECMO were entered in multiple logistic regression analysis. In multiple logistic regression analysis, FHB during ECMO (OR 1.136, 95% CI 1.023-1.261) and lactate level before initiation of ECMO (OR 1.602, 95% CI 1.025-2.502) were risk factors for ARF during ECMO after pediatric cardiac surgery. There was a linear correlation between maximum SCr and maximum FHB (Pearson's r = 0.535, P = 0.001). Maximum SCr during ECMO has also a linear correlation with lactate level before initiation of ECMO (Pearson's r = 0.342, P = 0.044). Increased FHB during ECMO and high lactate level before initiation of ECMO were risk factors for ARF during ECMO in pediatric patients after cardiac surgery. PMID:26636965

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

    PubMed Central

    Rodrigues, Cristiane Delgado Alves; Moreira, Marcos Mello; Lima, Núbia Maria Freire Vieira; de Figueirêdo, Luciana Castilho; Falcão, Antônio Luis Eiras; Petrucci, Orlando; Dragosavac, Desanka

    2015-01-01

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

  9. Going home after infant cardiac surgery: a UK qualitative study

    PubMed Central

    Tregay, Jenifer; Wray, Jo; Crowe, Sonya; Knowles, Rachel; Daubeney, Piers; Franklin, Rodney; Barron, David; Hull, Sally; Barnes, Nick; Bull, Catherine; Brown, Katherine L

    2016-01-01

    Objective To qualitatively assess the discharge processes and postdischarge care in the community for infants discharged after congenital heart interventions in the first year of life. Design Qualitative study using semistructured interviews and Framework Analysis. Setting UK specialist cardiac centres and the services their patients are discharged to. Subjects Twenty-five cardiologists and nurses from tertiary centres, 11 primary and secondary health professionals and 20 parents of children who had either died after discharge or had needed emergency readmission. Results Participants indicated that going home with an infant after cardiac intervention represents a major challenge for parents and professionals. Although there were reported examples of good care, difficulties are exacerbated by inconsistent pathways and potential loss of information between the multiple teams involved. Written documentation from tertiary centres frequently lacks crucial contact information and contains too many specialist terms. Non-tertiary professionals and parents may not hold the information required to respond appropriately when an infant deteriorates, this contributing to the stressful experience of managing these infants at home. Where they exist, the content of formal ‘home monitoring pathways’ varies nationally, and families can find this onerous. Conclusions Service improvements are needed for infants going home after cardiac intervention in the UK, focusing especially on enhancing mechanisms for effective transfer of information outside the tertiary centre and processes to assist with monitoring and triage of vulnerable infants in the community by primary and secondary care professionals. At present there is no routine audit for this stage of the patient journey. PMID:26826171

  10. [Anesthetic Management for Non-cardiac Surgery in a Patient with Severe Pulmonary Arterial Hypertension].

    PubMed

    Ohno, Sho; Niiyama, Yukitoshi; Murouchi, Takeshi; Yamakage, Michiaki

    2016-05-01

    Severe pulmonary arterial hypertension is a significant risk factor for anesthetic management in patients undergoing even non-cardiac surgery. A 64-year-old female patient with severe pulmonary arterial hypertension was scheduled to undergo inguinal hernioplasty. Preoperative systolic pulmonary arterial pressure was 115 mmHg. We selected monitored anesthesia care with 0.2-0.5 μg x kg(-1) x hr(-1) dexmedetomidine and ultrasound-guided iliohypogastric block. Thereafter, LiDCOrapid was used to acquire the hemodynamic responses during surgery. Continuous iliohypogastric block produced postoperative pain relief and the supplemental analgesic was not needed. The monitored anesthesia care by dexmedetomidine and ultrasound guided continuous iliohypogastric block would be a safe procedure for patients with severe pulmonary arterial hypertension undergoing non-cardiac surgery. LiDCO rapid could be low invasive and useful as a hemodaynamic monitor in such a case. PMID:27319099

  11. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping.

    PubMed

    Zubritskiy, Alexey; Arkhipov, Alexey; Khapaev, Timur; Naberukhin, Yuriy; Omelchenko, Alexander; Gorbatykh, Yuriy; Bogachev-Prokophiev, Alexander; Karaskov, Alexander

    2016-02-01

    Currently, minimally invasive cardiac surgery has found widespread use even in congenital heart surgery. The number of defects, which can be corrected through a small incision or totally endoscopic, is on the rise. Nowadays, surgeons can repair atrial septal defect, ventricular septal defect, patent ductus arteriosus and other congenital heart defects using minimally invasive techniques. In this paper, we report 21 cases of successful repair of supracardiac partial anomalous right upper and middle pulmonary venous connection, using the Warden procedure. It was performed in children through the right-sided midaxillary thoracotomy with direct cardiopulmonary bypass cannulation and induction of ventricular fibrillation. There were no operative or early postoperative deaths or complications. All patients were in sinus rhythm at discharge. According to echocardiography, there were no cases of early SVC or pulmonary veins narrowing. The Warden procedure can be performed safely and efficiently using the minimally invasive cardiac surgery. PMID:26541958

  12. Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery

    PubMed Central

    2014-01-01

    The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia’s safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist. PMID:24791166

  13. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients.

    PubMed

    Beaty, Rachel S; Moffett, Brady S; Hall, Stuart; Kim, Jeffrey

    2015-10-01

    Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating

  14. Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery.

    PubMed

    Heiberg, J; El-Ansary, D; Royse, C F; Royse, A G; Alsaddique, A A; Canty, D J

    2016-10-01

    Transthoracic and transoesophageal echocardiography are increasingly used as tools to improve clinical assessment following cardiac surgery. However, most physicians are not trained in echocardiography, and there is no widespread agreement on the feasibility, indications or effect on outcome of transthoracic or transoesophageal echocardiography for patients after cardiac surgery. We performed a systematic review of electronic databases for focused transthoracic and transoesophageal echocardiography after cardiac surgery which revealed 15 full-text articles. They consistently reported that echocardiography is feasible, whether performed by a novice or expert, and frequently resulted in important changes in diagnosis of cardiac abnormalities and their management. However, most were observational studies and there were no well-designed trials investigating the impact of echocardiography on outcome. We conclude that both transthoracic and transoesophageal echocardiography are useful following cardiac surgery. PMID:27341788

  15. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery.

    PubMed

    Papachristofi, O; Sharples, L D; Mackay, J H; Nashef, S A M; Fletcher, S N; Klein, A A

    2016-02-01

    It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. PMID:26511481

  16. Preoperative extracorporeal membrane oxygenation as a bridge to cardiac surgery in children with congenital heart disease

    PubMed Central

    Bautista-Hernandez, V; Thiagarajan, RR; Fynn-Thompson, F; Rajagopal, SK; Nento, DE; Yarlagadda, V; Teele, SA; Allan, CK; Emani, SM; Laussen, PC; Pigula, FA; Bacha, EA

    2014-01-01

    Background The efficacy of extracorporeal membrane oxygenation (ECMO) in bridging children with unrepaired heart defects to a definitive or palliative surgical procedure has been rarely reported. The goal of this study is to report our institutional experience with ECMO used to provide preoperative stabilization after acute cardiac or respiratory failure in patients with congenital heart disease before cardiac surgery. Methods A retrospective review of the ECMO database at Children's Hospital Boston was undertaken. Children with unrepaired congenital heart disease supported with ECMO for acute cardiac or respiratory failure as bridge to a definitive or palliative cardiac surgical procedure were identified. Data collection included patient demographics, indication for ECMO, details regarding ECMO course and complications, and survival to hospital discharge. Results Twenty-six patients (18 male, 8 female) with congenital heart disease were bridged to surgical palliation or anatomic repair with ECMO. Median age and weight at ECMO cannulation were, respectively, 0.12 months (range, 0 to 193) and 4 kg (range, 1.8 to 67 kg). Sixteen patients (62%) survived to hospital discharge. Variables associated with mortality included inability to decannulate from ECMO after surgery (p = 0.02) and longer total duration of ECMO (p = 0.02). No difference in outcomes was found between patients with single and biventricular anatomy. Conclusions Extracorporeal membrane oxygenation, used as a bridge to surgery, represents a useful modality to rescue patients with failing circulation and unrepaired complex heart defects. PMID:19766826

  17. Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery.

    PubMed

    Rajabali, Naheed; Rolfson, Darryl; Bagshaw, Sean M

    2016-09-01

    Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement. Frailty is common among patients admitted to the intensive care unit and correlates with an increased risk for adverse events, increased resource use, and less favourable patient-centred outcomes. Analogous findings have been described across selected acute cardiology and cardiac surgical settings, in particular those that commonly intersect with critical care services. The optimal methods for screening and diagnosing frailty across these settings remains an active area of investigation. Routine assessment for frailty conceivably has numerous purported benefits for patients, families, health care providers, and health administrators through better informed decision-making regarding treatments or goals of care, prognosis for survival, expectations for recovery, risk of complications, and expected resource use. In this review, we discuss the measurement of frailty and its utility in patients with critical illness and in cardiology and cardiac surgery settings. PMID:27476983

  18. Real-time monitoring of endogenous lipid peroxidation by exhaled ethylene in patients undergoing cardiac surgery

    PubMed Central

    Cristescu, Simona M.; Kiss, Rudolf; te Lintel Hekkert, Sacco; Dalby, Miles; Harren, Frans J. M.; Risby, Terence H.

    2014-01-01

    Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (>30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (>10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene. PMID:25128523

  19. Real-time monitoring of endogenous lipid peroxidation by exhaled ethylene in patients undergoing cardiac surgery.

    PubMed

    Cristescu, Simona M; Kiss, Rudolf; Hekkert, Sacco te Lintel; Dalby, Miles; Harren, Frans J M; Risby, Terence H; Marczin, Nandor

    2014-10-01

    Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (> 30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (> 10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene. PMID:25128523

  20. Cardiac Surgery in Germany during 2014: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery.

    PubMed

    Beckmann, Andreas; Funkat, Anne-Kathrin; Lewandowski, Jana; Frie, Michael; Ernst, Markus; Hekmat, Khosro; Schiller, Wolfgang; Gummert, Jan F; Cremer, Joachim Thomas

    2015-06-01

    Based on a voluntary registry of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), data of all heart surgery procedures performed in 78 German cardiac surgical units during the year 2014 are presented. In 2014, a total of 100,398 cardiac surgical procedures (implantable cardioverter-defibrillator and pacemaker procedures excluded) were submitted to the registry. More than 14.2% of the patients were older than 80 years, describing an increase of 0.4% compared with the previous year. The unadjusted in-hospital mortality for 40,006 isolated coronary artery bypass grafting procedures (84.7% on-pump, 15.3% off-pump) was 2.6%. In 31,359 isolated valve procedures (including 9,194 catheter-based procedures), an in-hospital mortality of 4.4% was observed. This annual updated registry of the GSTCVS is published since 1989. It is an important tool for quality assurance and voluntary public reporting by illustrating current standards and actual developments for nearly all cardiac surgical procedures in Germany. PMID:26011675

  1. Readmissions After Cardiac Surgery: Experience of the NIH / CIHR Cardiothoracic Surgical Trials Network

    PubMed Central

    Iribarne, Alexander; Chang, Helena; Alexander, John H.; Gillinov, A. Marc; Moquete, Ellen; Puskas, John D.; Bagiella, Emilia; Acker, Michael A.; Mayer, Mary Lou; Ferguson, T. Bruce; Burks, Sandra; Perrault, Louis P.; Welsh, Stacey; Johnston, Karen C.; Murphy, Mandy; DeRose, Joseph J.; Neill, Alexis; Dobrev, Edlira; Baio, Kim T.; Taddei-Peters, Wendy; Moskowitz, Alan J.; O’Gara, Patrick T.

    2014-01-01

    Background Readmissions are a common problem in cardiac surgery. The goal of this study was to examine the frequency, timing, and associated risk factors for readmission after cardiac surgery. Methods 5,158 adult cardiac surgery patients (5,059 included in analysis) were prospectively enrolled in a 10center cohort study to assess risk factors for infection following cardiac surgery. Data were also collected on all-cause readmissions occurring within 65 days after surgery. Major outcomes included readmission rate stratified by procedure type, cause of readmission, length of readmission stay, and discharge disposition after readmission. Multivariable Cox regression was used to determine risk factors for time to first readmission. Results The overall rate of readmission was 18.7% (number of readmissions=945). When stratified by the most common procedure type, readmission rates were: isolated CABG (14.9%, n=248), isolated valve (18.3%, n=337), CABG + valve (25.0%, n=169). The three most common causes of first readmission within 30 days were: infection (17.1%, n=115), arrhythmia (17.1%, n=115), and volume overload (13.5%, n=91). More first readmissions occurred within 30 days (80.6%, n=672) than after 30 days (19.4%, n=162), and 50% of patients were readmitted within 22 days from index surgery. The median length of stay during the first readmission was 5 days. 15.8% (n=128) of readmitted patients were discharged to a location other than home. Baseline patient characteristics associated with readmission included: female gender, diabetes mellitus on medication, COPD, elevated creatinine, lower hemoglobin, and longer surgery time. In addition, the more complex surgical procedures were associated with increased risk of readmission compared to the CABG group. Conclusions Nearly 1 out of 5 patients who undergo cardiac surgery require readmission, an outcome with significant health and economic implications. Management practices to avert in-hospital infections, reduce post

  2. Brain Monitoring with Electroencephalography and the Electroencephalogram-Derived Bispectral Index During Cardiac Surgery

    PubMed Central

    Kertai, Miklos D.; Whitlock, Elizabeth L.; Avidan, Michael S.

    2011-01-01

    Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider monitoring the brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG Bispectral Index (BIS) decreases the incidence intraoperative awareness compared with standard practice. However there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves “fast-tracking,” decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS monitoring is not superior to a protocol based on end tidal anesthetic concentration monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG monitoring in the cardiac surgical population. PMID:22253267

  3. Use of del Nido Cardioplegia for Adult Cardiac Surgery at the Cleveland Clinic: Perfusion Implications

    PubMed Central

    Kim, Kuna; Ball, Clifford; Grady, Patrick; Mick, Stephanie

    2014-01-01

    Abstract: Cardiac arrest by cardioplegia provides a reproducible and safe method to induce and maintain electromechanical cardiac quiescence. Techniques of intraoperative myocardial protection are constantly evolving. For the past three decades, modified Buckberg cardioplegia solution has been used for adult cardiac surgery at the Cleveland Clinic. This formulation serves as the crystalloid component, which is delivered 4:1 with oxygenated patient’s blood to crystalloid. Meanwhile, our use of the del Nido cardioplegia solution in adult patients, heretofore primarily used in pediatric cardiac surgical centers, has been increasing over the past several years. Single-dose, cold blood del Nido cardioplegia can be delivered antegrade if the duration of the operation will be limited and if there is no significant coronary artery disease or aortic insufficiency that would limit the distribution of cardioplegia. The addition of del Nido cardioplegia to our cardioplegia armamentarium allows us to customize our myocardial protection strategies for different surgical needs. This article aims to provide information on technical aspects of del Nido cardioplegia in adult cardiac surgery and its use at the Cleveland Clinic in the adult surgical population. PMID:26357803

  4. Applying the Gender Lens to Risk Factors and Outcome after Adult Cardiac Surgery

    PubMed Central

    Eifert, Sandra; Guethoff, Sonja; Kaczmarek, Ingo; Beiras-Fernandez, Andres; Seeland, Ute; Gulbins, Helmut; Seeburger, Jörg; Deutsch, Oliver; Jungwirth, Bettina; Katsari, Elpiniki; Dohmen, Pascal; Pfannmueller, Bettina; Hultgren, Rebecka; Schade, Ina; Kublickiene, Karolina; Mohr, Friedrich W.; Gansera, Brigitte

    2014-01-01

    Summary Background Applying the gender lens to risk factors and outcome after adult cardiac surgery is of major clinical interest, as the inclusion of sex and gender in research design and analysis may guarantee more comprehensive cardiovascular science and may consecutively result in a more effective surgical treatment as well as cost savings in cardiac surgery. Methods We have reviewed classical cardiovascular risk factors (diabetes, arterial hypertension, hyperlipidemia, smoking) according to a gender-based approach. Furthermore, we have examined comorbidities such as depression, renal insufficiency, and hormonal influences in regard to gender. Gender-sensitive economic aspects have been evaluated, surgical outcome has been analyzed, and cardiovascular research has been considered from a gender perspective. Results The influence of typical risk factors and outcome after cardiac surgery has been evaluated from a gender perspective, and the gender-specific distribution of these risk factors is reported on. The named comorbidities are listed. Economic aspects demonstrated a gender gap. Outcome after coronary and valvular surgeries as well as after heart transplantation are displayed in this regard. Results after postoperative use of intra-aortic balloon pump are shown. Gender-related aspects of clinical and biomedical cardiosurgical research are reported. Conclusions Female gender has become an independent risk factor of survival after the majority of cardiosurgical procedures. Severely impaired left ventricular ejection fraction independently predicts survival in men, whereas age does in females. PMID:26288584

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

    PubMed

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

    2015-12-15

    A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes. In-hospital mortality rate was 7% for patients who underwent transplantation versus 4% for patients who did not undergo transplantation (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.16 to 2.38). Patients who underwent transplantation were at an increased risk for acute renal failure (OR 1.62, CI 1.36 to 1.94) and blood transfusions (OR 1.63, CI 1.36 to 1.95). Median length of stay was longer (10 vs 9 days), with greater median total charges ($111,362 vs $102,221; both p <0.001). Occurrence of stroke, gastrointestinal complication, infection, and pneumonia was similar between groups. In conclusion, previous solid organ transplantation is an incremental risk factor for postoperative mortality after cardiac surgery. Renal protective strategies and bleeding control should be stressed to mitigate complications. PMID:26520471

  6. [Pre-operative care for cardiac surgery patients with cold antibody disorder, cryoglobulinaemia and cryofibrinogenemia].

    PubMed

    Gumulec, J; Brát, R; Kolek, M; Chrástecký, B; Korístka, M; Cermáková, Z; Nováková, L; Sáchová, L; Chasáková, K; Ranochová, A; Ryzí, M; Návratová, P; Zuchnická, J; Bodzásová, C; Plonková, H; Slezák, P

    2009-03-01

    We present an example of a patient with confirmed cold agglutinin disease who underwent cardiac surgery in hypothermia to illustrate a known fact that, when exposed to cold, cold agglutinins induce haemolysis of erythrocytes and that cryoglobulins and cryofibrinogens may, upon exposition to cold during a surgery under hypothermia, precipitate or gelify and thus increase plasma viscosity and damage microcirculation. Detailed immunological and haematological investigations in all patients awaiting cardiac surgery with a risk of developing hypothermia is not advantageous considering the low number of patients with clinical and laboratory signs of cold agglutinin disease, autoimmune haemolytic anaemia or paroxysmal cold haemoglobinuria and considering that these investigations, in addition, might not detect cryoglobulinaemia and cryofibrinogenemia. Identification of in-risk patients from the warning signs in the medical history, physical or basal laboratory testing who would subsequently undergo confirmatory investigations to verify the presence of these entities and define them accurately might be a potential solution to this clinical issue. Cardiac surgery strategy and peri-operative care should be tailored to the results of these investigations. Well-structured, practiced and functional cooperation between clinicians and laboratory personnel is a prerequisite for success in these circumstances. PMID:19378854

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

    PubMed Central

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  8. Effect of fish oil on monoepoxides derived from fatty acids during cardiac surgery.

    PubMed

    Akintoye, Emmanuel; Wu, Jason H Y; Hou, Tao; Song, Xiaoling; Yang, Jun; Hammock, Bruce; Mozaffarian, Dariush

    2016-03-01

    Our objective was to assess the dynamics of monoepoxides derived from polyunsaturated fatty acids (MEFAs), and their response to n-3 PUFA supplementation, in the setting of acute tissue injury and inflammation (cardiac surgery) in humans. Patients (479) undergoing cardiac surgery in three countries were randomized to perioperative fish oil (EPA + DHA; 8-10 g over 2-5 days preoperatively, then 2 g/day postoperatively) or placebo (olive oil). Plasma MEFAs derived from n-3 and n-6 PUFAs were measured 2 days postoperatively. Based on serial measures in a subset of the placebo group, levels of all MEFAs declined substantially following surgery (at postoperative day 2), with declines ranging from 37% to 63% (P < 0.05 each). Compared with placebo at postoperative day 2, levels of EPA- and DHA-derived MEFAs were 40% and 18% higher, respectively (P ≤ 0.004). The n-3 PUFA supplementation did not significantly alter the decline in n-6 PUFA-derived MEFAs. Both enrollment level and changes in plasma phospholipid EPA and DHA were associated with their respective MEFAs at postoperative day 2 (P < 0.001). Under the acute stress of cardiac surgery, n-3 PUFA supplementation significantly ameliorated the reduction in postoperative n-3 MEFAs, but not n-6 MEFAs, and the degree of increase in n-3 MEFAs related positively to the circulating level of their n-3 PUFA precursors. PMID:26749073

  9. Outcome Reporting in Cardiac Surgery Trials: Systematic Review and Critical Appraisal

    PubMed Central

    Goldfarb, Michael; Drudi, Laura; Almohammadi, Mohammad; Langlois, Yves; Noiseux, Nicolas; Perrault, Louis; Piazza, Nicolo; Afilalo, Jonathan

    2015-01-01

    Background There is currently no accepted standard for reporting outcomes following cardiac surgery. The objective of this paper was to systematically review the literature to evaluate the current use and definition of perioperative outcomes reported in cardiac surgery trials. Methods and Results We reviewed 5 prominent medical and surgical journals on Medline from January 1, 2010, to June 30, 2014, for randomized controlled trials involving coronary artery bypass grafting and/or valve surgery. We identified 34 trials meeting inclusion criteria. Sample sizes ranged from 57 to 4752 participants (median 351). Composite end points were used as a primary outcome in 56% (n=19) of the randomized controlled trials and as a secondary outcome in 12% (n=4). There were 14 different composite end points. Mortality at any time (all-cause and/or cardiovascular) was reported as an individual end point or as part of a combined end point in 82% (n=28), myocardial infarction was reported in 68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered outcomes, such as quality of life and functional classification, were reported in 29% (n=10). Definition of clinical events such as myocardial infarction, stroke, renal failure, and bleeding varied considerably among trials, particularly for postoperative myocardial infarction and bleeding, for which 8 different definitions were used for each. Conclusions Outcome reporting in the cardiac surgery literature is heterogeneous, and efforts should be made to standardize the outcomes reported and the definitions used to ascertain them. The development of standardizing outcome reporting is an essential step toward strengthening the process of evidence-based care in cardiac surgery. PMID:26282561

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

    PubMed

    Nguyen, Nguyenvu; Pezzella, A Thomas

    2015-04-01

    A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas. PMID:25870347

  11. Landiolol for junctional ectopic tachycardia refractory to amiodarone after pediatric cardiac surgery.

    PubMed

    Hasegawa, Tomomi; Oshima, Yoshihiro; Maruo, Ayako; Matsuhisa, Hironori; Kadowaki, Tasuku; Noda, Rei

    2013-06-01

    Postoperative junctional ectopic tachycardia (JET) in children undergoing cardiac surgery is a serious arrhythmia that is associated with considerable morbidity and mortality. We present here a case of successful landiolol therapy for postoperative JET in a 3-month-old infant who underwent ventricular septal defect closure and right pulmonary artery plasty. His left ventricular function was poor postoperatively. The JET was refractory to amiodarone and caused severe hypotension, which was required cardiac massage. Continuous intravenous infusion of low-dose landiolol reduced the persistent JET rate immediately, and restored to sinus rhythm with stable hemodynamics. PMID:22893321

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  13. Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery

    PubMed Central

    Tan, Zhaoxia; Zhou, Li; Qin, Zhen; Luo, Ming; Chen, Hao; Xiong, Jiyue; Li, Jian; Liu, Ting; Du, Lei; Zhou, Jing

    2016-01-01

    Abstract Patients undergoing cardiac surgery often experience abnormal bleeding, due primarily to cardiopulmonary bypass (CPB)-induced activation of platelets. Sevoflurane may inhibit platelet activation, raising the possibility that administering it during CPB may reduce blood loss. Patients between 18 and 65 years old who were scheduled for cardiac surgery under CPB at our hospital were prospectively enrolled and randomized to receive intravenous anesthetics alone (control group, n = 77) or together with sevoflurane (0.5–1.0 vol/%) from an oxygenator (sevoflurane group, n = 76). The primary outcome was postoperative blood loss, the secondary outcome was postoperative need for blood products. Volume of blood loss was 48% lower in the sevoflurane group than the control group at 4 hours after surgery, and 33% lower at 12 hours after surgery. Significantly fewer patients in the sevoflurane group lost >700 mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result, the sevoflurane group received significantly smaller volumes of packed red blood cells (1.25 ± 2.36 vs 2.23 ± 3.75 units, P = 0.011) and fresh frozen plasma (97 ± 237 vs 236 ± 344 mL, P = 0.004). Thus the sevoflurane group was at significantly lower risk of requiring complex blood products after surgery (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17–0.68, P = 0.002). Sevoflurane inhalation from an oxygenator during CPB may reduce blood loss and need for blood products after cardiac surgery. PMID:27124028

  14. Impact of regionalisation of cardiac surgery in Emilia-Romagna, Italy

    PubMed Central

    Nobilio, L; Fortuna, D; Vizioli, M; Berti, E; Guastaroba, P; Taroni, F; Grilli, R

    2004-01-01

    Study objective: Assessment of the impact of the regionalisation of cardiac surgery through the organisational form of a hub&spoke model introduced in the year 2000. Design: Case mix adjusted before (1998–1999)—after (2000–2002) comparison of: (a) in-hospital and 30 days mortality rates; (b) proportion of patients timely (within one day) referred for surgery from spoke to hub centres; (c) patients' waiting times to surgery. Setting: Emilia-Romagna, an Italian region with four million residents. Patients: 16 512 patients aged ⩾18 years and referred to cardiac surgery over the period 1998–2002. Main results:Overall, taking into account differences in case mix across the whole study period, the implementation of the regionalisation policy was associated with a 22% reduction (OR: 0.79, 95%CI: 0.66 to 0.93) in in-hospital mortality rate. The corresponding figure for 30 day mortality was 18% (OR: 0.82: 95%CI: 0.69 to 0.98). The individual centres' volume of cases changed over the study period for all hospitals but two, and the biggest reduction in mortality was seen at the centre with the largest increase in caseload. Conclusions: This study provides additional evidence on the benefit of regionalisation of cardiac surgery interventions. The system allowed each centre to reach the minimum caseload required to assure good quality of care. These findings suggest that policies aimed at increasing cooperation rather than competition among health service providers have a positive impact on quality of care. Timely referrals for surgery increased by 21% (95%CI: 1.12 to 1.31), and mean waiting times were reduced by 7.5 average days (95%CI: -10.33 to -4.71). PMID:14729884

  15. Fast sodium current in cardiac muscle. A quantitative description.

    PubMed Central

    Ebihara, L; Johnson, E A

    1980-01-01

    The voltage and time-dependence of the tetrodotoxin sensitive, fast sodium current in cardiac muscle is described with the Hodgkin-Huxley formalism using two microelectrode, voltage-clamp data obtained by Ebihara et al. (1980, J. Gen. Physiol., 75:437) from small spherical clusters of tissue-cultured 11-d-old embryonic heart cells. The data chosen from that study for quantitative analysis was obtained at 37 degrees C and in standard tissue-culture medium; it was not smoothed, and the capacitive transient was sufficiently brief to make its removal unnecessary. The sodium current, INa, is considered to be given by the following equation: INa = gNa m3h(V - VNa), where gNa is a constant (23 mS), VNa is the sodium equilibrium potential (29 mV), and m and h are independent, first order, dimensionless variables, which can vary between 0 and 1, as defined by the following differential equations, dm/dt = alpha m(1 - m) - beta mm and dh/dt = alpha h(1 - h) - beta hh, where the rate coefficients, alpha m = [0.32 x (V + 47.13)]/[1 - exp(V + 47.13)] and beta m = 0.08 x exp (-V/11). For potentials more positive than -40 mV, alpha h = 0 and beta h = 1/0.13 (exp [(V + 10.66)/ - 11.1] + 1), and for potentials more negative than -40 mV, alpha h = 0.135 x exp [(-80 - V)/6.8] and beta h = 3.56 x exp (0.079V) + 3.1 x 10(5) exp (0.35V). These functions of potential are similar to those of the squid at 15 degrees C, except that their magnitudes are larger (faster). Using these model equations the membrane current in a membrane patch with and without a series resistance was simulated. For the value of series resistance estimated for the preparation from which the analyzed data were obtained, the effects of series resistance on the shape and magnitude of the inward transient current were found to be minimal. It was concluded that their should be no large errors in the data, even in the absence of complete series resistance compensation. PMID:7260301

  16. Massive transfusion and hyperkalaemic cardiac arrest in craniofacial surgery in a child.

    PubMed

    Buntain, S G; Pabari, M

    1999-10-01

    Hyperkalaemia is a recognised complication of massive blood transfusion. We present a case of hyperkalaemic cardiac arrest in a male infant of 12 months, who was undergoing craniofacial surgery for sagittal craniosynostosis. At the time of arrest the patient had received a massive transfusion of predominantly irradiated packed red cells over a two-hour period, and had a measured plasma potassium concentration of 10.1 mmol/l. Cardiopulmonary resuscitation was successful after 15 minutes. On the basis of our laboratory data and a review of the available literature, we recommend the use of fresh, non-irradiated packed red cells whenever possible in paediatric surgery. PMID:10520398

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

    PubMed

    Bhaskar, Pradeep; John, Jiju; Lone, Reyaz Ahmad; Sallehuddin, Ahmed

    2015-01-01

    Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery. PMID:26440256

  18. Racial Disparities in Outcomes After Cardiac Surgery: the Role of Hospital Quality

    PubMed Central

    Vaughan-Sarrazin, Mary; Rosenthal, Gary E.; Girotra, Saket

    2016-01-01

    Patients from racial and ethnic minorities experience higher mortality after cardiac surgery compared to white patients, both during the early postoperative phase as well as long term. A number of factors likely explain poor outcomes in black and minority patients, which include differences in biology, comorbid health conditions, socioeconomic background, and quality of hospital care. Recent evidence suggests that a major factor underlying excess mortality in these groups is due to their over-representation in low-quality hospitals, where all patients regardless of race have worse outcomes. In this review, we examine the factors underlying racial disparities in outcomes after cardiac surgery, with a primary focus on the role of hospital quality. PMID:25894800

  19. Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.

    PubMed

    Bell, David; Marasco, Silvana; Almeida, Aubrey; Rowland, Michael

    2010-08-01

    With the recent withdrawal of the antifibrinolytic aprotinin from the market, tranexamic acid (TxA) has become more widely used. This change has led to increasing concern about the side-effect profile of TxA, particularly the incidence of postoperative seizures. In this case series, we describe 7 patients over an 18-month period who had open-chamber cardiac surgery and developed seizures in the postoperative period. This incidence is increased compared with that of a cohort of patients in the previous 36 months who did not receive TxA (0.66% versus 0%; P < .05). The exact mechanism of TxA-induced seizures is thought to be via inhibition of gamma-aminobutyric acid receptors in neurons. Data from the neurosurgical literature show a well-established link between this antifibrinolytic and seizures. There is now increasing awareness of this association in cardiac surgery, particularly when high TxA doses are used. PMID:20719731

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

    PubMed Central

    Bhaskar, Pradeep; John, Jiju; Lone, Reyaz Ahmad; Sallehuddin, Ahmed

    2015-01-01

    Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery. PMID:26440256

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

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

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

    PubMed

    Swain, J A; Hartz, R S

    2000-06-01

    The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application. PMID:10866419

  3. Frequency and predictors of return to incentive spirometry volume baseline after cardiac surgery.

    PubMed

    Harton, Suzanne C; Grap, Mary Jo; Savage, Laura; Elswick, R K

    2007-01-01

    Incentive spirometry (IS) is routinely used in most clinical settings, but evaluation of patient efficacy of IS is not standardized. The purpose of this study was to describe the degree and predictors of return to preoperative IS volume after cardiac surgery. IS volumes were documented in 69 subjects (71% men; mean age, 59 years) undergoing cardiac surgery during the preoperative evaluation and twice daily postoperatively. Nineteen percent of subjects achieved their IS preoperative volume by hospital discharge. Based on highest volume achieved, subjects achieved an average of 75% of their preoperative volume by discharge, and only age and number of bypass grafts predicted return to preoperative IS volume. These data may assist nurses and patients to set realistic goals for postoperative IS volume achievement. PMID:17342000

  4. A polymicrobial outbreak of surgical site infections following cardiac surgery at a community hospital in Florida, 2011–2012

    PubMed Central

    Nguyen, Duc B.; Gupta, Neil; Abou-Daoud, Alison; KleKamp, Benjamin G.; Rhone, Chaz; Winston, Tiffany; Hedberg, Trevor; Scuteri, Ana; Evans, Charlotte; Jensen, Bette; Moulton-Meissner, Heather; Török, Thomas; Berríos-Torres, Sandra I.; Noble-Wang, Judith; Kallen, Alexander

    2015-01-01

    We describe an outbreak of 22 sternal surgical site infections following cardiac surgery, including 4 Gordonia infections. Possible operation room environmental contamination and suboptimal infection control practices regarding scrub attire may have contributed to the outbreak. PMID:24679572

  5. [Acute mediastinitis except in a context of cardiac surgery].

    PubMed

    Doddoli, C; Trousse, D; Avaro, J-P; Djourno, X-B; Giudicelli, R; Fuentes, P; Thomas, P

    2010-02-01

    Acute mediastinitis is a life-threatening complication (20 to 40 % of mortality) secondary to oropharyngeal abscesses, neck infections or oesophageal leak spreading into the mediastium. Early diagnosis and optimal therapeutic approach are crucial for patient survival. CT scanning of the cervical and thoracic area is a useful tool for diagnosis and follow-up. Treatment is based on broad-spectrum antibiotherapy, adequate surgery, mediastinal drainage, and treatment of possible organ failure. There is no surgical standardized attitude. Mini-invasive approach could be satisfactory when prompt diagnosis is established and the thoracic drainage is effective. Repeated postoperative CT scanning and close clinical and laboratory monitoring could make an additional thoracotomy a second-line procedure. PMID:20207299

  6. Morphological description of great cardiac vein in pigs compared to human hearts

    PubMed Central

    Alejandro Gómez, Fabian; Ballesteros, Luis Ernesto; Stella Cortés, Luz

    2015-01-01

    Introduction In spite of its importance as an experimental model, the information on the great cardiac vein in pigs is sparse. Objective To determine the morphologic characteristics of the great cardiac vein and its tributaries in pigs. Methods 120 hearts extracted from pigs destined to the slaughterhouse with stunning method were studied. This descriptive cross-over study evaluated continuous variables with T test and discrete variables with Pearson χ square test. A level of significance P<0.05 was used. The great cardiac vein and its tributaries were perfused with polyester resin (85% Palatal and 15% Styrene) and then subjected to potassium hydroxide infusion to release the subepicardial fat. Calibers were measured, and trajectories and relations with adjacent arterial structures were evaluated. Results The origin of the great cardiac vein was observed at the heart apex in 91 (76%) hearts. The arterio-venous trigone was present in 117 (97.5%) specimens, corresponding to the open expression in its lower segment and to the closed expression in the upper segment in the majority of the cases (65%). The caliber of the great cardiac vein at the upper segment of the paraconal interventricular sulcus was 3.73±0.79 mm. An anastomosis between the great cardiac vein and the middle cardiac vein was found in 59 (49%) specimens. Conclusion The morphological and biometric characteristics of the great cardiac vein and its tributaries had not been reported in prior studies, and due to their similitude with those of the human heart, allows us to propose the pig model for procedural and hemodynamic applications. PMID:25859869

  7. Lessons from aviation - the role of checklists in minimally invasive cardiac surgery.

    PubMed

    Hussain, S; Adams, C; Cleland, A; Jones, P M; Walsh, G; Kiaii, B

    2016-01-01

    We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led "threats and errors model" to medical practice and the role of checklists and other strategies aimed at reducing medical errors. PMID:25918039

  8. Role of topical application of gentamicin containing collagen implants in cardiac surgery

    PubMed Central

    2014-01-01

    Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics. However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance. We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward. Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection. PMID:25005533

  9. Current Practice and Utility of Chromosome Microarray Analysis in Infants Undergoing Cardiac Surgery

    PubMed Central

    Buckley, Jason R.; Kavarana, Minoo N.; Chowdhury, Shahryar M.; Scheurer, Mark A.

    2014-01-01

    Objective Traditionally, karyotype and fluorescence in situ hybridization (FISH) were used for cytogenetic testing of infants with congenital heart disease who underwent cardiac surgery at our institution. Recently, chromosome microarray analysis (CMA) has been performed in lieu of the traditional tests. A standardized approach to cytogenetic testing does not exist in this population. The purpose of this study was to assess the utility of CMA based on our current ordering practice. Design We reviewed the records of all infants (< 1 year old) who underwent cardiac surgery at our institution from January 2010 to June 2013. Data included results of all cytogenetic testing performed. Diagnostic yield was calculated as the percentage of significant abnormal results obtained by each test modality. Patients were grouped by classification of congenital heart disease (CHD). Results Two hundred and seventy-five (51%) of 535 infants who underwent cardiac surgery had cytogenetic testing. Of those tested, 154 (56%) had multiple tests performed and at least 18% were redundant or overlapping. The utilization of CMA has increased each year since its implementation. The diagnostic yield for karyotype, FISH and CMA was 10%, 12% and 14% respectively. CMA yield was significantly higher in patients with septal defects (33%, p = 0.01) compared to all other CHD classes. CMA detected abnormalities of unknown clinical significance in 13% of infants tested. Conclusions In our center, redundant cytogenetic testing is frequently performed in infants undergoing cardiac surgery. The utilization of chromosome microarray analysis has increased over time and abnormalities of unknown clinical significance are detected in an important subset of patients. A screening algorithm that risk-stratifies based on classification of CHD and clinical suspicion may provide a practical, data-driven approach to genetic testing in this population and limit unnecessary resource utilization. PMID:25494910

  10. Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery

    PubMed Central

    Goldberg, Joshua; Paugh, Paugh; Dickinson, Timothy A.; Fuller, John; Paone, Gaetano; Theurer, Patty F.; Shann, Kenneth G.; Sundt, Thoralf M.; Prager, Richard L.; Likosky, Donald S.

    2016-01-01

    Background Perioperative red blood cell transfusions (RBC) are associated with increased morbidity and mortality after cardiac surgery. Acute normovolemic hemodilution (ANH) is recommended to reduce perioperative transfusions; however, supporting data are limited and conflicting. We describe the relationship between ANH and RBC transfusions after cardiac surgery using a multi-center registry. Methods We analyzed 13,534 patients undergoing cardiac surgery between 2010 and 2014 at any of the 26 hospitals participating in a prospective cardiovascular perfusion database. The volume of ANH (no ANH, <400mL, 400–799mL, ≥800mL) was recorded and linked to each center’s surgical data. We report adjusted relative risks reflecting the association between the use and amount of ANH and the risk of perioperative RBC transfusion. Results were adjusted for preoperative risk factors, procedure, BSA, preoperative HCT, and center. Results ANH was used in 17% of the patients. ANH was associated with a reduction in RBC transfusions (RRadj 0.74, p <0.001). Patients having ≥800mL of ANH had the most profound reduction in RBC transfusions (RRadj 0.57, p<0.001). Platelet and plasma transfusions were also significantly lower with ANH. The ANH population had superior postoperative morbidity and mortality compared to the no ANH population. Conclusions There is a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH. Our findings suggest the volume of ANH, rather than just its use, may be an important feature of a center’s blood conservation strategy. PMID:26206721

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

    PubMed Central

    Abdollahi, Mohammad-Hasan; Foruzan-nia, Khalil; Behjati, Mostafa; Bagheri, Babak; Khanbabayi-Gol, Mehdi; Dareshiri, Shahla; Pishgahi, Alireza; Zarezadeh, Rafie; Lotfi-Naghsh, Nazgol; Lotfi-Naghsh, Ainaz; Naghavi-Behzad, Mohammad

    2014-01-01

    Background: Post-operative fever is a common complication of cardiac operations, which is known to be correlated with a greater degree of cognitive dysfunction 6 weeks after cardiac surgery. The aim of the present study was to examine efficacy and safety of single dose intravenous Paracetamol in treatment of post-operative fever in children undergoing cardiac surgery. Materials and Methods: In this randomised, double-blind, placebo-controlled clinical trial, 80 children, aged 1-12 years, presenting for open heart surgery were entered in the trial and randomly allocated into two groups: Placebo and Paracetamol. After induction of anaesthesia, 15 mg/kg intravenous Paracetamol solution was infused during 1 h in the Paracetamol group. Patients in placebo group received 15 mg/kg normal saline infusion during the same time. Since the end of operation until next 24 h in intensive care unit, axillary temperature of the two group patients was recorded in 4-h intervals. Any fever that occurred during this period had been treated with Paracetamol suppository (125 mg) and the amount of antipyretic drug consumption for each patient had been recorded. In order to examine the safety of Paracetamol, patients were evaluated for drug complication at the same time. Results: Mean axillary temperature during first 24 h after operation was significantly lower in Paracetamol group compared with placebo group (P = 0.001). Overall fever incidence during 24 h after operation was higher in placebo group compared with Paracetamol group (P = 0.012). Of Paracetamol group patients, 42.5% compared with 15% of placebo group participants had no consumption of antipyretic agent (Paracetamol suppository) during 24 h after operation (P = 0.001). Conclusion: This study suggests that single dose administration of intravenous Paracetamol before paediatric cardiac surgeries using cardiopulmonary bypass; reduce mean body temperature in the first 24 h after operation. PMID:25298601

  12. Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia Increases Delirium After Cardiac Surgery

    PubMed Central

    Saager, Leif; Duncan, Andra E.; Yared, Jean-Pierre; Hesler, Brian D.; You, Jing; Deogaonkar, Anupa; Sessler, Daniel I.; Kurz, Andrea

    2015-01-01

    Background Postoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. We therefore sought to determine the effect of tight intraoperative glucose control using a hyper-insulinemic normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery. Methods We enrolled 198 adult patients having cardiac surgery in this randomized, double-blinded single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp (target blood glucose: 80–110 mg/dL) or standard therapy (conventional insulin administration with blood glucose target < 150 mg/dL). Delirium was assessed using a comprehensive delirium battery. We considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method test was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention), and either 3 (disorganized thinking) or 4 (altered consciousness). Results Patients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26/93 vs. 15/105; Relative Risk (RR), 95% CI: 1.89, 1.06–3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist (ASA) physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy. Conclusions Intraoperative hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac surgery, but not its severity. PMID:25992877

  13. Staged Delayed Sternal Closure Using a Binder Clip After Pediatric Cardiac Surgery.

    PubMed

    Fuchigami, Tai; Nishioka, Masahiko; Akashige, Toru; Higa, Shotaro; Nagata, Nobuhiro

    2016-07-01

    After pediatric cardiac surgery, patients who undergo delayed sternal closure may become hemodynamically unstable. We performed a staged sternal closure technique using a binder clip in 31 consecutive patients to minimize cardiopulmonary instability. Only one patient (3.2%) died of mediastinitis. Thus, our technique may be safe and minimize cardiopulmonary instability. doi: 10.1111/jocs.12767 (J Card Surg 2016;31:464-466). PMID:27277820

  14. Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery

    PubMed Central

    Jung, Su-Young; Park, Jung Tak; Kwon, Young Eun; Kim, Hyung Woo; Ryu, Geun Woo; Lee, Sul A.; Park, Seohyun; Jhee, Jong Hyun; Oh, Hyung Jung; Han, Seung Hyeok; Yoo, Tae-Hyun; Kang, Shin-Wook

    2016-01-01

    Abstract Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23 mEq/L; group 2 (normal levels) 23 to 24 mEq/L; and group 3 (elevated levels) >24 mEq/L. The primary outcome was the predicated incidence of AKI 48 hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48 hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P < 0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a

  15. Has Microsoft® Left Behind Risk Modeling in Cardiac and Thoracic Surgery?

    PubMed Central

    Poullis, Mike

    2011-01-01

    Abstract: This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical results the effects of each of the core components that makes up the care package of a patient’s experiences are examined. The core components examined include: institutional, regional, patient, and surgeon effects. The limitations of current additive (Parsonnet, Euroscore) and logistic (Euroscore, Southern Thoracic Society) regression risk analysis techniques are discussed. The inadequacy of current modeling techniques is demonstrated via the use of known medical formula for calculating flow in the internal mammary artery and the calculation of blood pressure. By examining the fundamental limitations of current risk analysis techniques a new technique is proposed that embraces modern software computer technology via the use of structured query language. PMID:21449233

  16. Preoperative Steroid Treatment Does Not Improve Markers of Inflammation Following Cardiac Surgery in Neonates: Results from a Randomized Trial

    PubMed Central

    Graham, Eric M.; Atz, Andrew M.; McHugh, Kimberly E.; Butts, Ryan J.; Baker, Nathaniel L.; Stroud, Robert E.; Reeves, Scott T.; Bradley, Scott M.; McGowan, Francis X.; Spinale, Francis G.

    2013-01-01

    Objective Neonatal cardiac surgery requiring cardiopulmonary bypass results in a heightened inflammatory response. Perioperative glucocorticoid administration is commonly utilized in attempt to reduce the inflammatory cascade, although characterization of the cytokine response to steroids in neonatal cardiac surgery remains elusive due to highly variable approaches in administration. This randomized trial was designed to prospectively evaluate the effect of specific glucocorticoid dosing protocols on inflammatory markers in neonatal cardiac surgery requiring cardiopulmonary bypass. Methods Neonates scheduled for cardiac surgery were randomly assigned to receive either two-dose (8 hours preoperatively and operatively, n=36) or single dose (operatively, n=32) methylprednisolone at 30mg/kg/dose in a prospective double-blind trial. The primary outcome was the effect of these steroid regimens on markers of inflammation. Secondary analyses evaluated the association of specific cytokine profiles with postoperative clinical outcomes. Results Patient demographics, perioperative variables and preoperative indices of inflammation were similar between the single and two-dose groups. Preoperative cytokine response after the two-dose methylprednisolone protocol was consistent with an anti-inflammatory effect, although this did not persist into the postoperative period. Pre-medication baseline levels of interleukin-6, interleukin-8, interleukin-10 and tumor necrosis factor alpha were predictive of postoperative intensive care unit and hospital length of stay. Only interleukin-8 demonstrated a postoperative response associated with duration of intensive care unit and hospital stay. Conclusions The addition of a preoperative dose of methylprednisolone to a standard intraoperative methylprednisolone dose does not improve markers of inflammation following neonatal cardiac surgery. The routine administration of preoperative glucocorticoids in neonatal cardiac surgery should be

  17. Predictors of Prolonged Stay in the Intensive Care Unit following Cardiac Surgery

    PubMed Central

    Eltheni, Rokeia; Giakoumidakis, Konstantinos; Brokalaki, Hero; Galanis, Petros; Nenekidis, Ioannis; Fildissis, George

    2012-01-01

    The prediction of intensive care unit length of stay (ICU-LOS) could contribute to more efficient ICU resources' allocation and better planning of care among cardiac surgery patients. The aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery ICU-LOS. An observational cohort study was conducted among 150 consecutive patients, who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens, Greece from September 2010 to January 2011. Multivariate regression analysis revealed that patients with increased creatinine levels preoperatively (odds ratio (OR) 3.0, P = 0.049), history of atrial fibrillation (AF) (OR 6.3, P = 0.012) and high EuroSCORE values (OR 2.6, P = 0.017) had a significant greater probability to stay in the ICU for more than 2 days. In addition, intraoperative hyperglycemia (OR 3.0, P = 0.004) was strongly associated with longer ICU-LOS. In conclusion, the high perioperative risk, the history of AF and renal dysfunction, and the intraoperative hyperglycemia are significant predictors of prolonged ICU stay. The early identification of patients at risk could allow the efficient ICU resources' allocation and the reduction of healthcare costs. This would contribute to nursing care planning depending on the availability of healthcare personnel and ICU bed capacity. PMID:22919512

  18. Cerebral oxygenation and hemodynamic changes during infant cardiac surgery: measurements by near infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    du Plessis, Adre J.; Volpe, Joseph J.

    1996-10-01

    Despite dramatic advances in the survival rate among infants undergoing cardiac surgery for congenital heart disease, the incidence of brain injury suffered by survivors remains unacceptably high. This is largely due to our limited understanding of the complex changes in cerebral oxygen utilization and supply occurring during the intraoperative period as a result of hypothermia, neuroactive drugs, and profound circulatory changes. Current techniques for monitoring the adequacy of cerebral oxygen supply and utilization during hypothermic cardiac surgery are inadequate to address this complex problem and consequently to identify the infant at risk for such brain injury. Furthermore, this inability to detect imminent hypoxic- ischemic brain injury is likely to become all the more conspicuous as new neuroprotective strategies, capable of salvaging 'insulated' neuronal tissue form cell death, enter the clinical arena. Near infrared spectroscopy is a relatively new, noninvasive, and portable technique capable of interrogating the oxygenation and hemodynamics of tissue in vivo. These characteristics of the technique have generated enormous interest among clinicians in the ability of near infrared spectroscopy to elucidate the mechanisms of intraoperative brain injury and ultimately to identify infants oat risk for such injury. This paper reviews the experience with this technique to date during infant cardiac surgery.

  19. Clinical applications of retrograde autologous priming in cardiopulmonary bypass in pediatric cardiac surgery

    PubMed Central

    Fu, G.W.; Nie, Y.F.; Jiao, Z.Y.; Zhao, W.Z.

    2016-01-01

    Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric cardiopulmonary bypass (CPB). However, this technique is performed in pediatric patients weighing more than 20 kg, and research about its application in pediatric patients weighing less than 20 kg is still scarce. This study explored the clinical application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty pediatric patients scheduled for cardiac surgery were randomly divided into control and experimental groups. The experimental group was treated with CPB using RAP, while the control group was treated with conventional CPB (priming with suspended red blood cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at different perioperative time-points, mechanical ventilation time, hospitalization duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions were significantly lower in the experimental group (P<0.05). There were no significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac between the two groups (P>0.05). Postoperatively, there were no significant differences in Hct (2 h after surgery), mechanical ventilation time, intensive care unit time, or postoperative blood transfusion between two groups (P>0.05). RAP can effectively reduce the hemodilution when using less or not using any banked blood, while meeting the intraoperative perfusion conditions, and decreasing the perioperative blood transfusion volume in pediatric patients. PMID:27119427

  20. General Anesthesia in Cardiac Surgery: A Review of Drugs and Practices

    PubMed Central

    Alwardt, Cory M.; Redford, Daniel; Larson, Douglas F.

    2005-01-01

    Abstract: General anesthesia is defined as complete anesthesia affecting the entire body with loss of consciousness, analgesia, amnesia, and muscle relaxation. There is a wide spectrum of agents able to partially or completely induce general anesthesia. Presently, there is not a single universally accepted technique for anesthetic management during cardiac surgery. Instead, the drugs and combinations of drugs used are derived from the pathophysiologic state of the patient and individual preference and experience of the anesthesiologist. According to the definition of general anesthesia, current practices consist of four main components: hypnosis, analgesia, amnesia, and muscle relaxation. Although many of the agents highlighted in this review are capable of producing more than one of these effects, it is logical that drugs producing these effects are given in combination to achieve the most beneficial effect. This review features a discussion of currently used anesthetic drugs and clinical practices of general anesthesia during cardiac surgery. The information in this particular review is derived from textbooks, current literature, and personal experience, and is designed as a general overview of anesthesia during cardiac surgery. PMID:16117465

  1. The efficacy of post-cardiopulmonary bypass dosing of vancomycin in cardiac surgery.

    PubMed

    Raikhelkar, Jayashree K; Reich, David L; Schure, Rebecca; Varghese, Robin; Bodian, Carol; Scurlock, Corey

    2010-12-01

    Objective. Vancomycin is administered widely to patients undergoing cardiac surgery as prophylaxis against resistant Gram-positive sternal wound and venous donor site infections. The purpose of this study was to determine the efficacy of a standardized prebypass and postbypass dosing regimen of vancomycin by assessing plasma concentrations in the immediate postoperative period and postoperative surgical site infections (SSIs). Design. Retrospective cohort study. Setting . Cardiothoracic surgical intensive care unit in a tertiary care academic medical center. Methods. A total of 34 consecutive adult patients who had undergone cardiac surgery with cardiopulmonary bypass (CPB) were analyzed retrospectively. Each patient received 1000 mg of vancomycin administered over 1 hour around the time of induction of anesthesia and 500 mg after discontinuation of CPB. Trough vancomycin levels were sampled in the intensive care unit 12 hours after the last dose given in the operating room. Along with patient characteristics, postoperative readmission rates and SSIs were recorded for 1 year after surgery. Results. The nadir serum vancomycin level before the next dose was 9.3 ± 4.5 µg/mL (mean ± standard deviation). One superficial SSI was noted. Readmission rate for SSIs was 2.94%. Conclusion . Vancomycin concentrations in the serum were greater than the minimum inhibitory concentration for most staphylococci ranging from 4 to 19.3 µg/mL producing acceptable therapeutic serum concentrations and low rate of infectious complications. Thus postbypass dosing is acceptable in vancomycin cardiac surgical prophylaxis. PMID:20841364

  2. Post cardiac surgery phrenic nerve palsy in pediatric patients.

    PubMed

    Serraf, A; Planche, C; Lacour Gayet, F; Bruniaux, J; Nottin, R; Binet, J P

    1990-01-01

    From January 1978 to December 1988, 109 phrenic nerve paralyses (PNP) occurred in a total of 9149 cardiac operations performed in a population of patients younger than 15 years old (1.2%) whose age varied from 1 day to 15 years old and mean weight was 11.3 +/- 8.7 kg. PNP was diagnosed in 43 patients after closed procedures (1.2% of 3509 procedures) and in 66 patients after open heart operations (1.2% of 5640 operations). PNP was right sided in 49 cases and left sided in 60 cases. Open heart operations that predisposed to PNP were those which needed harvesting of autologous pericardium (P less than 0.0001) and wide exposure of the great vessels. The modified right Blalock-Taussig shunt was the main cause of PNP in closed procedures (P less than 0.02). Small children tolerated PNP less well. They needed longer ventilatory support (P less than 0.0005) and developed more respiratory complications. Seventeen children underwent plication of the affected hemidiaphragm and could be subsequently extubated. It is concluded that for prevention of PNP, a high level of attention should be exercised in neonates and small children, particularly when pericardium is harvested or when exposure needs extensive dissection of the great vessels and thymus resection, or at reoperation. We also prefer to avoid the use of iced slush lavage. PNP, when symptomatic, is best managed by continuous positive airway pressure (CPAP) ventilation. Diaphragmatic plication is recommended when after 2-3 weeks there is no recovery of diaphragmatic function or when there are troublesome respiratory complications. PMID:2171593

  3. Post Cardiac Surgery Acute Kidney Injury: A Woebegone Status Rejuvenated by the Novel Biomarkers

    PubMed Central

    Jayaraman, Rajesh; Sunder, Sham; Sathi, Satyanand; Gupta, Vijay Kumar; Sharma, Neera; Kanchi, Prabhu; Gupta, Anurag; Daksh, Sunil Kumar; Ram, Pranith; Mohamed, Ashik

    2014-01-01

    Background: Acute kidney injury (AKI) is common after cardiac surgery, the incidence varying between 7.7% and 28.1%. It significantly increases morbidity and mortality. Creatinine considerably delays the diagnosis with its own attended demerits. Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality. Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18). Objectives: To find out the incidence of AKI in post-cardiac surgery patients in our hospital, the ability of the two biomarkers in early diagnosis in predicting the severity of AKI based on RIFLE’s criteria and their ability to discriminate pre-renal from intrinsic AKI. Patients and Methods: One-hundred patients who underwent cardiac surgery were selected. Midstream urine samples were collected at 3 time intervals (baseline before surgery, 24 hours and 7 days after surgery). Biomarkers were measured by ELISA using BIORAD processors. Fractional excretion of sodium and urea were used to discriminate pre-renal from intrinsic AKI. Results: Out of 100 patients, 31 had AKI, 11 being pre-renal and 20 intrinsic AKI. Four patients required renal replacement therapy (12.9% among AKI cases and 4% in the overall study cohort). Four among 31 expired in intensive care unit. Identifiable risk factors for AKI included insulin requiring diabetes mellitus, chronic obstructive pulmonary disease, increased cardio-pulmonary bypass time, combined valvular surgery and coronary artery bypass grafting, employment of intra-aortic balloon counter pulsation, left main coronary artery occlusion and an ejection fraction of < 40%. NGAL was extremely sensitive (area under curve-0.96) in detecting intrinsic AKI at 24 hours followed by IL-18 ratio with an area under curve of 0.89. Creatinine at 24 hours was able to detect only 31.6% of intrinsic AKI. None of the pre-renal cases showed rise in the urinary biomarker levels. Patients with

  4. Developing a genetic fuzzy system for risk assessment of mortality after cardiac surgery.

    PubMed

    Nouei, Mahyar Taghizadeh; Kamyad, Ali Vahidian; Sarzaeem, MahmoodReza; Ghazalbash, Somayeh

    2014-10-01

    Cardiac events could be taken into account as the leading causes of death throughout the globe. Such events also trigger an undesirable increase in what treatment procedures cost. Despite the giant leaps in technological development in heart surgery, coronary surgery still carries the high risk of the mortality. Besides, there is still a long way ahead to accurately predict and assess the mortality risk. This study is an attempt to develop an expert system for the risk assessment of mortality following the cardiac surgery. The developed system involves three main steps. In the first step, a filtering feature selection method is applied to select the best features. In the second step, an ad hoc data-driven method is utilized to generate the preliminary fuzzy inference system. Finally, a hybrid optimization method is presented to select the optimum subset of the rules. The study relies on 1,811 samples to evaluate the diagnosis performance of the proposed system. The obtained classification accuracy is very promising with regard to other benchmark classification methods including binary logistic regression (LR) and multilayer perceptron neural network (MLP) with the same attributes. The developed system leads to 100% sensitivity and 84.7% specificity, while LR and MLP methods statistically come up with lower figures (65, 78.6 and 65%, 75.8%), respectively. Now, a fuzzy supportive tool can be potentially taken as an alternative for the current mortality risk assessment system that are applied in coronary surgeries, and are chiefly based on crisp database. PMID:25119238

  5. Pulmonary Protection Strategies in Cardiac Surgery: Are We Making Any Progress?

    PubMed Central

    Al Jaaly, Emad; Zakkar, Mustafa; Fiorentino, Francesca; Angelini, Gianni D.

    2015-01-01

    Pulmonary dysfunction is a common complication of cardiac surgery. The mechanisms involved in the development of pulmonary dysfunction are multifactorial and can be related to the activation of inflammatory and oxidative stress pathways. Clinical manifestation varies from mild atelectasis to severe respiratory failure. Managing pulmonary dysfunction postcardiac surgery is a multistep process that starts before surgery and continues during both the operative and postoperative phases. Different pulmonary protection strategies have evolved over the years; however, the wide acceptance and clinical application of such techniques remain hindered by the poor level of evidence or the sample size of the studies. A better understanding of available modalities and/or combinations can result in the development of customised strategies for the different cohorts of patients with the potential to hence maximise patients and institutes benefits. PMID:26576223

  6. Clinical value of multidetector CT coronary angiography as a preoperative screening test before non‐coronary cardiac surgery

    PubMed Central

    Russo, Vincenzo; Gostoli, Valentina; Lovato, Luigi; Montalti, Maurizio; Marzocchi, Antonio; Gavelli, Giampaolo; Branzi, Angelo; Bartolomeo, Roberto Di; Fattori, Rossella

    2007-01-01

    Objective Myocardial scintigraphy and/or conventional angiography (CA) are often performed before cardiac surgery in an attempt to identify unsuspected coronary artery disease which might result in significant cardiac morbidity and mortality. Multidetector CT coronary angiography (MDCTCA) has a recognised high negative predictive value and may provide a non‐invasive alternative in this subset of patients. The aim of this study was to evaluate the clinical value of MDCTCA as a preoperative screening test in candidates for non‐coronary cardiac surgery. Methods 132 patients underwent MDCTCA (Somatom Sensation 16 Cardiac, Siemens) in the assessment of the cardiac risk profile before surgery. Coronary arteries were screened for ⩾50% stenosis. Patients without significant stenosis (Group 1) underwent surgery without any adjunctive screening tests while all patients with coronary lesions ⩾50% at MDCTCA (Group 2) underwent CA. Results 16 patients (12.1%) were excluded due to poor image quality. 72 patients without significant coronary stenosis at MDCTCA were submitted to surgery. 30 out of 36 patients with significant (⩾50%) coronary stenosis at MDCTCA and CA underwent adjunctive bypass surgery or coronary angioplasty. In 8 patients, MDCTCA overestimated the severity of the coronary lesions (>50% MDCTCA, <50% CA). No severe cardiovascular perioperative events such as myocardial ischaemia, myocardial infarction or cardiac failure occurred in any patient in Group 1. Conclusions MDCTCA seems to be effective as a preoperative screening test prior to non‐coronary cardiac surgery. In this era of cost containment and optimal care of patients, MDCTCA is able to provide coronary vessel and ventricular function evaluation and may become the method of choice for the assessment of a cardiovascular risk profile prior to major surgery. PMID:17164488

  7. Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

    PubMed Central

    2013-01-01

    Background Preoperative risk stratification models have previously been suggested to predict cardiac surgery unit costs. However, there is a lack of consistency in their reliability in this field. In this study we aim to test the correlation between the values of six commonly known preoperative scoring systems and evaluate their reliability at predicting unit costs of cardiac surgery patients. Methods Over a period of 14 months all consecutive adult patients undergoing cardiac surgery on cardiopulmonary bypass were prospectively classified using six preoperative scoring models (EuroSCORE, Parsonnet, Ontario, French, Pons and CABDEAL). Transplantation patients were the only patients we excluded. Total hospital costs for each patient were calculated independently on a daily basis using the bottom up method. The full unit costs were calculated including preoperative diagnostic tests, operating room cost, disposable materials, drugs, blood components as well as costs for personnel and fixed hospital costs. The correlation between hospital cost and the six models was determined by linear regression analysis. Both Spearman’s and Pearson’s correlation coefficients were calculated from the regression lines. An analysis of residuals was performed to determine the quality of the regression. Results A total of 887 patients were operated on for CABG (n = 608), valve (n = 142), CABG plus valve (n = 100), thoracic aorta (n = 33) and ventricular assist devices (n = 4). Mean age of the patients was 68.3±9.9 years, 27.6% were female. 30-day mortality rate was 4.1%. Correlation between the six models and hospital cost was weak (Pearson’s: r < 0.30; Spearman’s: r < 0.40). Conclusion The risk stratification models in this study are not reliable at predicting total costs of cardiac surgical patients. We therefore do not recommend their use for this purpose. PMID:23659251

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

    PubMed Central

    Andrade, Isaac Newton Guimarães; de Araújo, Diego Torres Aladin; de Moraes, Fernando Ribeiro

    2015-01-01

    Objective To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication. Methods Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test. Results The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00) Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001). The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001). The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively. Conclusion The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay. PMID:26313727

  9. The Safety and Efficacy of Antifibrinolytic Therapy in Neonatal Cardiac Surgery

    PubMed Central

    Lin, Chih-Yuan; Shuhaiber, Jeffery H.; Loyola, Hugo; Liu, Hua; del Nido, Pedro; DiNardo, James A.; Pigula, Frank A.

    2015-01-01

    Background Neonates undergoing open-heart surgery are particularly at risk of postoperative bleeding requiring blood transfusion. Aprotinin has attained high efficacy in reducing the requirement for a blood transfusion following a cardiopulmonary bypass, but is seldom studied in the neonatal age group. The aim of this study was to compare the efficacy and adverse effects of aprotinin and tranexamic acid in neonates undergoing open-heart surgery at a single centre. Methods Between October 2003 and March 2008, perioperative data of 552 consecutive neonatal patients undergoing open-heart surgery in Children’s Hospital Boston were reviewed. Among them, 177 did not receive antifibrinolytic therapy (Group A); 100 were treated with tranexamic acid only (Group B); and 275 patients received aprotinin with or without tranexamic acid (Group C). Except for antifibrinolytic therapy, the anaesthesiological and surgical protocols remained identical. Postoperative complications and in-hospital mortality were the primary study endpoints. Results Body weight and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores were statistically comparable among the three groups. No statistically significant differences were observed between the duration of hospitalization, chest tube drainage, reexploration for bleeding, and kidney function impairment. In Group C, less blood was transfused within 24 hours than in GroupB. Operative mortality was similar among the three groups. Conclusion No further risk and kidney injury were observed in the use of aprotinin in neonatal cardiac surgery, aprotinin demonstrated a reduced requirement for blood transfusion compared with tranexamic acid. Our data provide reasonable evidence that aprotinin and tranexamic acid are safe and efficacious as antifibrinolytic modalities in neonatal patients undergoing cardiac surgery. PMID:25954976

  10. Cost-effectiveness analysis of acute kidney injury biomarkers in pediatric cardiac surgery

    PubMed Central

    Petrovic, Stanislava; Lakic, Dragana; Peco-Antic, Amira; Vulicevic, Irena; Ivanisevic, Ivana; Kotur-Stevuljevic, Jelena; Jelic-Ivanovic, Zorana

    2015-01-01

    Introduction Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level). Materials and methods We developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER). Results Analysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of $8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was $5959.35/QALY. Conclusions Our results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery. PMID:26110039