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Post cardiac surgery care

L Vicente-Martínez, R Vicente-Guillen, E Calabuig, F Escribá, A Pajares, P Argente
INTRODUCTION AND OBJECTIVES: Patients undergoing cardiac surgery can have post-operative complications, including infections. The aim of this article was to study the incidence, severity and risk factors of invasive candidiasis in these patients, based on the hypothesis that several factors (multiple transfusions and time on extracorporeal circulation) are related to invasive candidiasis. MATERIAL AND METHODS: The study included a prospective analysis of 669 patients undergoing scheduled cardiac surgery from April 2016 to December 2017...
March 11, 2019: Revista Española de Anestesiología y Reanimación
Xiuling Jin, Liangrong Wang, Liling Li, Xiyue Zhao
Remote ischemic pre-conditioning (RIPC) may have a protective effect on myocardial injury associated with cardiac bypass surgery (CPB). The objective of the present study was to investigate the effect of RIPC on ischemia/reperfusion (I/R) injury and to assess the underlying mechanisms. A total of 241 patients who underwent valve replacement were randomly assigned to receive either RIPC (n=121) or control group (n=120). The primary endpoint was peri-operative myocardial injury (PMI), which was determined by serum Highly sensitive cardiac troponin T (hsTnT)...
March 2019: Experimental and Therapeutic Medicine
Ulrich P Jorde, Aman M Shah, Daniel B Sims, Shivank Madan, Nida Siddiqi, Anne Luke, Omar Saeed, Snehal R Patel, Sandhya Murthy, Jooyoung Shin, Johanna Oviedo, Sade Watts, William Jakobleff, Stephen Forest, Sasa Vukelic, Dimitri Belov, Yoram Puius, Grace Minamoto, Victoria Muggia, Anthony Carlese, Sharon Leung, Marjan Rahmanian, Jonathan Leff, Daniel Goldstein
BACKGROUND: Continuous flow-left ventricular assist devices (CF-LVADS) have revolutionized the management of advanced heart failure. Device complications continue to limit survival, but enhanced management strategies have shown promise. This study compared outcomes for HeartmateII recipients before and after implementation of a multidisciplinary continuous support Heart Team (HTMCS) strategy. METHODS: Between 1/2012-12/2016, 124 consecutive patients underwent primary HeartmateII implantation at our institution...
March 7, 2019: Annals of Thoracic Surgery
Philipp Angleitner, Paul Simon, Alexandra Kaider, Dominik Wiedemann, Kamen Dimitrov, Thomas Schlöglhofer, Maria Angela Rajek, Julia Riebandt, Günther Laufer, Daniel Zimpfer
BACKGROUND: Few reports have described associations between a bleeding revision and outcomes following implantation of a continuous-flow left-ventricular assist device (LVAD). METHODS: We retrospectively analyzed all adult recipients of a continuous-flow LVAD that underwent surgery between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (n = 257; LVAD types: Medtronic [Heartware® ] HVAD® , Abbott [Thoratec® ] Heartmate 2® , Abbott [Thoratec® ] Heartmate 3TM )...
March 6, 2019: Annals of Thoracic Surgery
Elizabeth G Ryan, Ewen M Harrison, Rupert M Pearse, Simon Gates
OBJECTIVE: The traditional approach of null hypothesis testing dominates the design and analysis of randomised controlled trials. This study aimed to demonstrate how a simple Bayesian analysis could have been used to analyse the Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome (OPTIMISE) trial to obtain more clinically interpretable results. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: The OPTIMISE trial was a pragmatic, multicentre, observer-blinded, randomised controlled trial of 734 high-risk patients undergoing major gastrointestinal surgery in 17 acute care hospitals in the UK...
March 7, 2019: BMJ Open
Monira Sharif, Chris Ho Ming Wong, Amer Harky
Sternal wound infection (SWI) is one of the potential complications post cardiac surgery, and despite refined surgical techniques such as smaller incisions, antibiotic therapy, and optimised glycaemic control, the incidence rate is between <1% in elective cases with low risk factors and as high as 25% in patients with extensive risk factors. The presence of SWI will increase the perioperative morbidity and mortality rates and prolong the patient's hospital stay, therefore the prevention and diagnosis with appropriate management of such adverse outcomes at an early stage is important to prevent further progression as it can be fatal when the mediastinal structures are affected...
February 2, 2019: Heart, Lung & Circulation
Abdullah A Alamri, Majed N Alnefaie, Asalh T Saeedi, Abdulaziz F Hariri, Abdulmalik Altaf, Murad M Aljiffry
Introduction: Blood transfusion practices affect both patient's outcomes and utilization of institutional resources. Evidence shows that liberal blood transfusion has a detrimental effect on patient's outcome. A restrictive approach of blood transfusion is recommended by current clinical guidelines. Aim: The aim of this study was to evaluate the attitudes, knowledge, and practices of general surgery (GS) staff and residents regarding peri-operative blood transfusion and anemia management...
December 2018: Medical Archives
Waldemar Elikowski, Małgorzata Małek-Elikowska, Krzysztof Greberski, Stanisław Rzymski, Andrzej Kołowrotkiewicz, Jaromir Furmaniuk, Paweł Bugajski
Takotsubo syndrome (TTS) is rarely diagnosed following valvular and nonvalvular cardiac surgery. Only several such cases, including 12 after mitral valve replacement (MVR) or plasty (MVP) and 2 after coronary artery bypass grafting (CABG) have been reported so far. A CASE REPORT: The authors describe a case of a 75-year-old female in whom TTS occurred on the first postoperative day after elective combined surgery: MVR (with bioprosthesis) and CABG (of the left anterior descending coronary artery)...
January 28, 2019: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Yue-Nan Ni, Yan-Mei Wang, Bin-Miao Liang, Zong-An Liang
BACKGROUND: Studies investigating the role of hyperoxia in critically ill patients have reported conflicting results. We did this analysis to reveal the effect of hyperoxia in the patients admitted to the intensive care unit (ICU). METHODS: Electronic databases were searched for all the studies exploring the role of hyperoxia in adult patients admitted to ICU. The primary outcome was mortality. Random-effect model was used for quantitative synthesis of the adjusted odds ratio (aOR)...
February 26, 2019: BMC Pulmonary Medicine
Corinna Paluszek, Paolo Brenner, Maximilian Pichlmaier, Nikolaus A Haas, Robert Dalla-Pozza, Christian Hagl, Lale Hakami
BACKGROUND: Junctional ectopic tachycardia (JET) is a common arrhythmia causing hemodynamic impairment following corrective cardiac surgery such as tetralogy of Fallot (TOF) repair. METHODS: We report our experience with postoperative JET following surgical repair of TOF. The retrospective study was done from 2003 to 2012 with a total of 105 patients who underwent TOF repair. These patients' clinical and electrocardiographic data (pre-, intra-, and postoperative) were monitored to identify risk factors for the occurrence of JET and to evaluate the outcome of the affected patients...
January 2019: World Journal for Pediatric & Congenital Heart Surgery
Amy Gaskell, Rebecca Pullon, Darren Hight, Jonathan Termaat, Gay Mans, Logan Voss, Matthias Kreuzer, Sebastian Schmid, Stephan Kratzer, Amy Rodriguez, Gerhard Schneider, Paul Garcia, Jamie Sleigh
BACKGROUND: Postoperative delirium may manifest in the immediate post-anaesthesia care period. Such episodes appear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Frontal electroencephalogram (EEG) findings of suppression patterns and low proprietary index values have been associated with postoperative delirium and poor outcomes. However, the efficacy of titrating anaesthesia to proprietary index targets for preventing delirium remains contentious...
February 22, 2019: Trials
Fenny F Shidhika, Christopher T Hugo-Hamman, John B Lawrenson, Henning J Du Toit, Susan M Vosloo, Andre Brooks, Harold S Pribut, Susan R Perkins, Liesl J Zühlke
IntroductionCongenital and acquired heart diseases are highly prevalent in developing countries despite limited specialised care. Namibia established a paediatric cardiac service in 2009 with significant human resource and infrastructural constraints. Therefore, patients are referred for cardiac interventions to South Africa. OBJECTIVES: To describe the diagnoses, clinical characteristics, interventions, post-operative morbidity and mortality, and follow-up of patients referred for care...
February 2019: Cardiology in the Young
Therese Conner, Francesca Cook, Vivian Fernandez, Karen Rascati, Vanessa Rangel-Miller
BACKGROUND: Severe mucopolysaccharidosis type I (also known as Hurler syndrome) is a rare devasting recessive genetic disease caused by the deficiency of an enzyme. Hematopoietic stem cell transplant is the standard of care in the United States, usually conducted before the child is 3 years of age, but little is known about the continued medical and educational needs of the child after transplant. A greater understanding of the burden of illness on the primary caregiver is also needed...
February 18, 2019: Orphanet Journal of Rare Diseases
Roberta E Redfern, Kevin Fleming, Rebekah L March, Nathan Bobulski, Michael Kuehne, John T Chen, Michael Moront
BACKGROUND: Transfusion of allogenic blood products is associated with significant morbidity and increased risk of mortality. Thrombelastography (TEG) to direct transfusion management during and immediately following cardiothoracic surgery reduced blood product usage in our institution. The goal of this study was to quantify the impact of TEG on postoperative outcomes. METHODS: All patients who underwent cardiac surgery before and after implementation of TEG were retrospectively analyzed...
February 12, 2019: Annals of Thoracic Surgery
Yu A Argunova, S A Pomeshkina, B L Khaes, O L Barbarash
The ever increasing number of the patients presenting with the cardio-surgical problems referred for surgery emphasizes the importance of the treatment of the cases of post-operative complications based on the personalized approach. The present article was designed to report a clinical case of the successful surgical treatment and rehabilitation of a patient presenting with the dysfunction of the bioprosthetic mitral valve and complications of the post-operative course in the form of polyorgan insufficiency with the predominance of respiratory failure...
2019: Voprosy Kurortologii, Fizioterapii, i Lechebnoĭ Fizicheskoĭ Kultury
Gabriele Di Gesaro, Eluisa La Franca, Calogero Falletta, Alessandra Caronia, Sonia Dell'Oglio, Pamela Licata, Cettina Ruperto, Claudia Visconti, Carmelo Cinnirella, Giacomo Chiarandà, Francesco Clemenza
INTRODUCTION: Heart failure (HF) is a main issue of modern healthcare system. Patient affected are continuously growing in number and age; therefore, an integrated management between different parts of healthcare system is crucial to optimize outcome and sustainability. So far, little is known about clinical pathways of HF patients in Sicily. METHODS: On initiative of the Regional HF Group of the Italian Association of Hospital Cardiologists (ANMCO), we decided to census all the Cardiology Unit of Sicily...
January 2019: Recenti Progressi in Medicina
Ludmil Mitrev, Kelly G Speich, Spencer Ng, Albina Shapiro, Talia Ben-Jacob, Majid Khan, Vineeth Nagubandi, John Gaughan
OBJECTIVE: To investigate whether pulse pressure (PP) in anesthetized patients undergoing cardiac surgery before and after cardiopulmonary bypass (CPB) is associated with higher postoperative acute kidney injury (AKI) stage. DESIGN: Retrospective cohort of 597 patients undergoing cardiac surgery. SETTING: Single academic health care center. PARTICIPANTS: Adult patients undergoing cardiac surgery requiring CPB (coronary artery bypass grafting, valve, aortic, or combined surgery)...
January 7, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Lydia K Wright, Jessica H Knight, Amanda S Thomas, Matthew E Oster, James D St Louis, Lazaros K Kochilas
OBJECTIVE: Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by various operative and catheter-based interventions. We aim to understand the long-term transplant-free survival of patients with PA/IVS by treatment strategy. METHODS: Cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional registry with prospectively acquired outcome data after linkage with the National Death Index and the Organ Procurement and Transplantation Network...
February 2, 2019: Heart: Official Journal of the British Cardiac Society
Judson B Williams, Gina McConnell, J Erin Allender, Patricia Woltz, Kathy Kane, Peter K Smith, Daniel T Engelman, William T Bradford
OBJECTIVE: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States. METHODS: The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen...
December 8, 2018: Journal of Thoracic and Cardiovascular Surgery
Alexandre Almeida Guedes, Felipe Ladeira Pereira, Eric Guimarães Machado, Marcello Fonseca Salgado Filho, Leandro Fellet Miranda Chaves, Fernando de Paiva Araújo
BACKGROUND: Trigeminocardiac reflex is a physiological phenomenon that may occur in head and neck surgery, and is usually benign. However, it may present with exaggerated responses with severe morbidity. CASE REPORT: Male patient, 26 years old, candidate for surgical treatment of zygomatic-orbital complex fracture. The surgery with bilateral nasal packing placed at the end of the procedure was uneventful. After being admitted to the post-anesthesia care unity, the patient complained of shortness of breath and nausea...
January 18, 2019: Revista Brasileira de Anestesiologia
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