1
|
Ștef A, Bodolea C, Bocșan IC, Vesa ȘC, Pop RM, Cainap SS, Achim A, Antal O, Tintiuc N, Buzoianu AD. Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study. J Clin Med 2024; 13:2242. [PMID: 38673516 PMCID: PMC11051212 DOI: 10.3390/jcm13082242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive-inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = -0.30, p = 0.007) and the length of hospital stay (r = -0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = -0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5-17.7, versus median 15.3, IQR 15.6-20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.
Collapse
Affiliation(s)
- Adrian Ștef
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
- Cardiology Department, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Ioana Corina Bocșan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| | - Simona Sorana Cainap
- Department of Mother and Child, 2nd Pediatric Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Alexandru Achim
- Cardiology Department, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Oana Antal
- Anesthesia and Intensive Care 2 Discipline, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania
| | - Nadina Tintiuc
- Clinical Department of Anesthesia and Intensive Care, Heart Institute “Niculae Stancioiu”, “Iuliu Hatieganu” University of Medicine and Pharmacy, Motilor 19-21, 400001 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babes Nr 8 Street, 400012 Cluj-Napoca, Romania; (I.C.B.); (R.M.P.)
| |
Collapse
|
2
|
Kim CH, Lee JH, Kwon HW, Cho S, Kim WH, Ji SH, Jang YE, Kim JT, Kwak JG. Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs. Cardiol Young 2024; 34:914-918. [PMID: 37981864 DOI: 10.1017/s1047951123003839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUNDS AND OBJECTIVES The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. METHODS We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. RESULTS The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). CONCLUSIONS Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
Collapse
Affiliation(s)
- Chan Hyeong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Pongpanit K, Laosiripisan J, Songsorn P, Charususin N, Yuenyongchaiwat K. Neural respiratory drive assessment and its correlation with inspiratory muscle strength in patients undergoing open-heart surgery: A cross-sectional study. Physiother Res Int 2024; 29:e2073. [PMID: 38284467 DOI: 10.1002/pri.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND PURPOSE Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission-to-discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open-heart surgery. METHODS This cross-sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. RESULTS There was a significant increase in sEMGpara tidal (6.9 ± 3.6 μV, p < 0.001), sEMGpara %max (13.7 ± 11.2%, p = 0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7 ± 286.8%.breaths/min, p < 0.001), while sEMGpara max (-43.6 ± 20.4 μV, p < 0.01) and MIP (-24.4 ± 10.7, p < 0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r = -0.369, p = 0.045), sEMGpara %max (r = -0.646, p = 0.001), and NRDI (r = -0.639, p = 0.001) were significantly associated with a reduction in MIP. DISCUSSION The findings indicate that NRD increases after open-heart surgery, which corresponds to a decrease in inspiratory muscle strength.
Collapse
Affiliation(s)
- Karan Pongpanit
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Jitanan Laosiripisan
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Preeyaphorn Songsorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
| | - Noppawan Charususin
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
| | - Kornanong Yuenyongchaiwat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
4
|
Hämäläinen L, Kohonen M, Laurikka J. Health-related quality of life is improved after coronary artery bypass graft surgery: a 1-year follow-up study. SCAND CARDIOVASC J 2023; 57:2284083. [PMID: 38010887 DOI: 10.1080/14017431.2023.2284083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The purpose of this study was to detect changes in QoL after coronary artery bypass grafting surgeries (CABG) in one year, and to identify the possible predictive factors associated with the change. DESIGN A single-center prospective study of 501 patients was conducted between 2013 and 2018 using the EQ-5D VAS questionnaire for estimating the QoL. The patients filled in a questionnaire preoperatively, at 6 and at 12 months postoperatively. Univariate and multivariable logistic regression analyses were used to find out if certain pre-selected factors or EQ5D dimensions had independent effects on the observed EQ VAS scores. RESULTS QoL improved in all EQ-5D dimensions and in EQ VAS scores at 6 and at 12 months: the greatest changes in the number of reported problems were in the dimensions "mobility" (-34.2%, p<.001), "self-care" (-36.7%, p=.001) and "pain or discomfort" (-31.0%, p<.001). With the multivariable regression model, we could show that normal left ventricle ejection fraction (LVEF) and improvement in mobility and pain/discomfort dimensions were in association with improvement of EQ VAS score at 6 months. At 12 months this association was no longer detectable. CONCLUSIONS CABG procedure can improve patient's QoL when judged with EQ5D dimensions and related overall self-rated health (VAS). This improvement was seen both at 6 and at 12 months postoperatively. Except for LVEF, the other patient-specific risk factors we examined did not seem to affect QoL in the long term.
Collapse
Affiliation(s)
- Laura Hämäläinen
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Mika Kohonen
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Jari Laurikka
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
- Tampere University Hospital Heart Center, Tampere, Finland
| |
Collapse
|
5
|
Ünver S, Yildirim M, Eyı S, Hüseyın S. Pain-related fear among adult patients undergoing open-heart surgery: an interpretative phenomenological analysis. Contemp Nurse 2023; 59:462-477. [PMID: 37608646 DOI: 10.1080/10376178.2023.2249127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND One of the sources of anxiety and fear among patients undergoing open-heart surgery is the possibility of experiencing pain, such as sternotomy-related chest pain. Giving them the chance to express their feelings about the potential pain may be effective in reducing their anxiety and may support their coping strategies. OBJECTIVES To examine pain-related fear among patients undergoing open-heart surgery and to understand the underlying reasons of their fears. METHODS A qualitative interview based on Heidegger's interpretative phenomenological approach was conducted adhering to the COREQ guidelines. Sixteen patients who were undergoing open-heart surgery in the following day were interviewed at the cardiovascular surgery ward of a university hospital. The organization and mapping of the qualitative data was done by using ATLAS.ti 8.0. RESULTS The patients who were afraid of experiencing pain after surgery seemed to be more concerned about open-heart surgery itself (such as pain from sternotomy and chest tubes) and the possibility of prolongation of postoperative pain. To cope with these fears, the patients employed a variety of social and self-coping strategies. Trusting the healthcare team, having a high pain tolerance, and having personal thoughts that take precedence over pain-related fear were the key factors explaining not being afraid of experiencing pain. CONCLUSIONS This study provides a deeper understanding of the underlying reasons and the needs of patients in controlling their pain-related fears before open-heart surgery. Trusting the healthcare professionals is one of the main factors for patients to control their pain-related fears. To develop a supportive sense of trust and to help patients in controlling their pain-related fears, surgical nurses must dedicate enough time for understanding patients' concerns while planning their nursing care plans. Future studies may focus on exploring the role of nursing interventions and multidisciplinary team approaches on the management of preoperative pain-related fear.
Collapse
Affiliation(s)
- Seher Ünver
- Faculty of Health Sciences, Department of Surgical Nursing, Trakya University, Edirne, Turkey
| | - Meltem Yildirim
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Semra Eyı
- Faculty of Health Sciences, Department of Surgical Nursing, Osmangazi University, Eskişehir, Turkey
| | - Serhat Hüseyın
- Medicine Faculty, Department of Cardiovascular Surgery, Trakya University, Edirne, Turkey
| |
Collapse
|
6
|
Sazzad F, Ramanathan K, Moideen IS, Gohary AE, Stevens JC, Kofidis T. A Systematic Review of Individualized Heart Surgery with a Personalized Prosthesis. J Pers Med 2023; 13:1483. [PMID: 37888094 PMCID: PMC10608049 DOI: 10.3390/jpm13101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Personalized surgery is not just a new trend but rather a patient-specific approach to therapy that makes it possible to adopt a targeted approach for a specific patient and closely mirrors the approach of personalized medicine. However, the application of tailored surgery in the context of cardiovascular replacement surgery has not been systematically reviewed. The ability to customize a device is highly dependent on the collection of radiological image data for precise prosthesis modeling. These facts are essential to "tailor-made" device design for precise prosthesis implantation. According to this study, computed tomography (CT) was the most prominent imaging modality; however, transesophageal echocardiography and echocardiography were also found to be helpful. Additionally, a dynamic finite element simulation was also found to be an attractive alternative to the finite element analysis for an in-silico experiment. Nonetheless, there is a paucity of relevant publications and only sporadic evidence. More clinical studies have been warranted, notwithstanding that the derived data and results from this insight into the use of therapeutic interventions may be evidence of multiple directives in clinical practices and beyond. This study may help the integration of personalized devices for better comprehension of predicted clinical outcomes, thus leading towards enhanced performance gains.
Collapse
Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Kollengode Ramanathan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
| | - Irwan Shah Moideen
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Abdulrahman El Gohary
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - John Carey Stevens
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore 119228, Singapore
| |
Collapse
|
7
|
Tang T, Wu C, Wang Z, Wei J, Zhang D, Sheng W. Treatment of syphilitic aortitis with coronary artery bypass grafting and "open" stent placement. J Int Med Res 2023; 51:3000605231204496. [PMID: 37862785 PMCID: PMC10590048 DOI: 10.1177/03000605231204496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/13/2023] [Indexed: 10/22/2023] Open
Abstract
Cardiovascular syphilis manifests many years after primary infection. Here, we report the successful treatment of a patient who developed syphilitic aortitis with bilateral coronary ostial stenosis and aortic insufficiency. The patient underwent right coronary artery bypass grafting, left main coronary ostial "open" stent placement, and mechanical aortic valve placement during open-heart surgery.
Collapse
Affiliation(s)
- Tiansheng Tang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Changjuan Wu
- Department of Pharmacy, Wannan Medical College, No. 22 Wenchang West Road, Wuhu, Anhui, China
| | - Ziao Wang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Jun Wei
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Dafa Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| | - Weiyong Sheng
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Zheshan Road No. 2 Wuhu, China
| |
Collapse
|
8
|
Hosain N, Amin F. Four Decades of Cardiac Surgery in Bangladesh: A Noble Journey That Started with the Help of Japan. JMA J 2023; 6:1-8. [PMID: 36793523 PMCID: PMC9908417 DOI: 10.31662/jmaj.2022-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
The first-ever open-heart operation in Bangladesh was performed on the 18th of September 1981. Although a few cases of finger fracture closed mitral commissurotomies were performed in the country in the 1960s and 1970s, full-fledged cardiac surgical services began only in Bangladesh after the establishment of the Institute of Cardiovascular Diseases at Dhaka in 1978. A Japanese team that includes cardiac surgeons, anesthetists, cardiologists, nurses, and technician came to Bangladesh and played an important role in the initiation of such a Bangladeshi endeavor. Bangladesh is a South Asian country with more than 170 million people living only in an area of 148460 square kilometers. Information was sought from the hospital records, old newspapers, books, and memoirs written by some of the pioneers. Pubmed and Internet search engines were also utilized. The principal author had personal correspondence with the available pioneering team members. The first open-heart operation was performed by visiting Japanese surgeon Dr. Komei Saji along with Bangladeshi surgeon duo Prof. M Nabi Alam Khan and Prof. S R Khan. Since then, cardiac surgery in Bangladesh has made a significant progress although it may not be enough to serve 170 million people. In 2019, twenty-nine centers performed a total of 12926 cases in Bangladesh. Remarkable advancement in cardiac surgery has been made in terms of cost, quality, and excellence in Bangladesh, but the country is lagging behind in the number of operations, affordability, and geographical distribution, which needs to be addressed for a better future.
Collapse
Affiliation(s)
- Nazmul Hosain
- Department of Cardiac Surgery, Chittagong Medical College & Hospital, Chattogram, Bangladesh
| | - Farzana Amin
- Clinical Outcome Department, Northern Health, Prince George, British Columbia, Canada
| |
Collapse
|
9
|
Aksu T, Timur B, Öztürk S, Göde S, İyigün T, Kafa Kulaçoğlu Ü, Sanioğlu S. Outcomes of COVID-19 infection occurring in the recovery period of the open-heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2022; 30:489-94. [PMID: 36605308 DOI: 10.5606/tgkdc.dergisi.2022.22818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 06/29/2022] [Indexed: 01/09/2023]
Abstract
Background In this study, we aimed to examine the effect of novel coronavirus 2019 disease (COVID-19) on the healing process of patients undergoing open-heart surgery. Methods Between October 2020 and May 2021, a total of in 22 patients (14 males, 8 females; mean age: 60±15 years; range, 18 to 82 years) who developed COVID-19 within the first 30 days after open-heart surgery were retrospectively analyzed. Since the study was conducted in the pre-vaccination period, all of the patients were unvaccinated. Demographic, operative, and laboratory data of the patients were analyzed, and morbidity and mortality rates were evaluated. Results Postoperative COVID-19 infection occurred in 22 of 1,171 patients who underwent open-heart surgery. Pneumonia developed in 14 (64%) patients and mechanical ventilation support was required in 50% (n=7) of them. Mortality was seen in eight (36%) patients. Only procalcitonin level (p=0.003) and age (p=0.005) had significant effects on survival. Conclusion Postoperative COVID-19 infection is associated with high pneumonia and mortality rates in unvaccinated patients. Protocols that can prevent false polymerase chain reaction negativity and early contamination can be life-saving.
Collapse
|
10
|
Jiang J, Wang X, Hu J, Wang S. A case report: Anesthetic management for open-heart surgery in a child with congenital insensitivity to pain with anhidrosis. Paediatr Anaesth 2022; 32:1070-1072. [PMID: 35762567 PMCID: PMC9544507 DOI: 10.1111/pan.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disease also known as hereditary sensory and autonomic neuropathy. CIPA is characterized by a lack of pain sensitivity and impaired development of sweat glands. Surgery is required for patients with self-mutilation and skeletal developmental disorders. Due to the disease's rarity and intricacy, anesthesia poses its challenges. Although there have been a few cases of CIPA patients receiving surgery and anesthesia, the number is very limited. Here, we report a case of a child with CIPA who underwent open-heart surgery and discuss the anesthetic considerations. We conclude that patients with CIPA undergoing open-heart surgery require some opioids, that muscle relaxants and volatile anesthetics should be used with extreme caution, and that airway management and temperature control require special attention.
Collapse
Affiliation(s)
- Jialong Jiang
- The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhui230036China
| | - Xuefeng Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhui230036China
| | - Jicheng Hu
- The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhui230036China
| | - Sheng Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhui230036China
| |
Collapse
|
11
|
Kurniawaty J, Setianto BY, Widyastuti Y, Supomo S, Boom CE, Ancilla C. Validation for EuroSCORE II in the Indonesian cardiac surgical population: a retrospective, multicenter study. Expert Rev Cardiovasc Ther 2022; 20:491-496. [PMID: 35579398 DOI: 10.1080/14779072.2022.2078703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2011, the European System for Cardiac Operative Risk (EuroSCORE) II was created as an improvement of the additive/logistic EuroSCORE for the prediction of mortality after cardiac surgery. OBJECTIVE To validate EuroSCORE II in predicting the mortality of open cardiac surgery patients in Indonesia. METHODS We performed a multi-center retrospective study of cardiac surgery patients from three participating centers (Dr. Sardjito Hospital, Kariadi Hospital, and Abdul Wahab Sjahranie Hospital) between January 1st, 2016, and December 31st, 2020. Discrimination and calibration tests were performed. RESULTS The observed mortality rate was 9.5% (73 out of 767 patients). The median EuroSCORE II value was 1.13%. The area under the curve for EuroSCORE II was 0.71 (95% CI: 0.65-0.77), suggesting fair discriminatory power. Calibration analysis suggested that EuroSCORE II underestimated postoperative mortality. Gender, age, chronic pulmonary disease, limited mobility, NYHA, and critical pre-operative state were significant predictors of post-cardiac surgery mortality in our population. CONCLUSION This study suggested that the EuroSCORE II was a poor predictor for postoperative mortality in Indonesian patients who underwent cardiac surgery procedures. Therefore, EuroSCORE II may not be suitable for mortality risk prediction in Indonesian populations, and surgical planning should be decided on an individual basis.
Collapse
Affiliation(s)
- Juni Kurniawaty
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Budi Yuli Setianto
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Supomo Supomo
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cindy E Boom
- Harapan Kita National Heart Center Hospital, Jakarta, Indonesia
| | - Cornelia Ancilla
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
12
|
Keles E, Bilen C, Aygun H, Gencpinar T, Catalyurek H. Non-heparin-induced thrombocytopenia in patients after open-heart surgery. Perfusion 2022; 38:781-790. [PMID: 35377248 DOI: 10.1177/02676591221082496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thrombocytopenia (platelet count below 150 x 103/μL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non-heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. MATERIALS AND METHODS In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 103/μL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. RESULTS A total of 501 patients were diagnosed as having non-heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 103 vs.117 x 103/μL; p < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757-46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867-5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638-14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923-64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046-1.420]; p = 0.011). CONCLUSION Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.
Collapse
Affiliation(s)
- Ercan Keles
- Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Cagatay Bilen
- Health Sciences University Dr Behcet Uz Training and Research Hospital, Izmir, Turkey
| | - Hakan Aygun
- Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | | | | |
Collapse
|
13
|
Benak A, Kupo P, Bencsik G, Makai A, Saghy L, Pap R. Is prophylactic ablation of the cavotricuspid and peri-incisional isthmus justified in patients with postoperative atrial flutter after right atriotomy? J Cardiovasc Electrophysiol 2022; 33:1190-1196. [PMID: 35362181 DOI: 10.1111/jce.15481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The two most common postoperative atrial flutter (AFL) circuits after right atriotomy are the cavotricuspid isthmus (CTI) dependent and the lateral, peri-incisional. We investigated whether radiofrequency ablation (RFA) of both circuits results in more favorable long-term outcomes. METHODS Single-center retrospective cohort study of consecutive patients who underwent RFA of AFL after open-heart surgery. The effect of surgery type and RFA strategy on AFL recurrence was evaluated. RESULTS One hundred and forty-two patients (mean age 64.5 ± 12.7 years, 65.% male) were enrolled. Patients with right atrial (RA) flutter (n=124) were divided into two groups based on the index RFA procedure: only one RA circuit was ablated (Group 1, n= 84, 67.7%) or both the CTI and the peri-incisional circuit ablated (Group 2, n= 40, 32.3%). The previous open-heart surgery was categorized based on the extension of the RA incision: limited (Type A) or extended (Type B) atriotomy. After a mean follow-up of 36±28 months, flutter recurrence was not different among patients with limited RA atriotomy (25% vs. 22% in Group 1A and 2A, respectively, p=1.0). However, after type B surgery, ablation of both AFL circuits was associated with a reduced recurrence rate (63% vs. 26% in Group 1B and 2B, respectively, p=0.002). CONCLUSIONS In patients with postoperative RA flutter after extended right atriotomy, ablation of both the CTI and the peri-incisional isthmus significantly reduces the AFL recurrence rate. Prophylactic ablation of both isthmi, even if not proven to support reentry, is reasonable in this population. Keywords This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Attila Benak
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Peter Kupo
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gabor Bencsik
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Attila Makai
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Laszlo Saghy
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Robert Pap
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| |
Collapse
|
14
|
Agwar FD, Tekleab AM. Heart surgery by the locals in resource-limited settings: The experience from Ethiopia. JTCVS Open 2022; 9:98-105. [PMID: 36003472 PMCID: PMC9390689 DOI: 10.1016/j.xjon.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In developing countries, despite its demand is high, heart surgery is not always accessible to the neediest patients. We aimed to describe the early outcomes of heart surgeries that were performed by a local cardiac surgical team in Addis Ababa, Ethiopia. METHODS Data were collected through chart abstraction of patients who underwent heart surgery from the period of June 2017 to July 2021 by the same local cardiac surgical team at 3 centers in Addis Ababa, Ethiopia. Data were analyzed using the Statistical Package for the Social Sciences for Windows version 20.0. RESULTS A total of 290 patients who underwent heart surgery during the specified period were included in the study. Of the total, 192 patients underwent valve surgery (177 were patients with rheumatic valvular disease and 15 were valve surgeries with other causes) with a 30-day mortality rate of 9 (4.7%), 33 patients underwent coronary artery bypass graft with a 30-day mortality rate of 3 (9.1%), 58 patients underwent repair for congenital heart diseases with no 30-day mortality. Specifically, button Bentall was done for 1 patient; maze procedure was done for 2 patients along with mitral valve surgery, and a total of 7 out of 290 (2.4%) underwent redo heart surgery. The overall procedure-related mortality was 4.1%. CONCLUSIONS In addition to operating on a large number of cardiac patients, the local cardiac surgical team was able to do complex surgical procedures such as button Bentall, left maze procedure, redo valve surgeries, and coronary artery bypass graft surgery in a resource-limited setup. The overall patient outcome was comparable to reports from other centers.
Collapse
Affiliation(s)
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics and Child Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
15
|
Peeler A, Moser C, Gleason KT, Davidson PM. Frailty as a Predictor of Postoperative Outcomes in Invasive Cardiac Surgery: A Systematic Review of Literature. J Cardiovasc Nurs 2022; 37:231-47. [PMID: 34016838 DOI: 10.1097/JCN.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Frailty is a syndrome characterized by increased vulnerability and reduced ability to maintain homeostasis after stressful events that results in an increased risk for poor outcomes. Frailty screening could potentially be valuable in cardiac surgery risk assessment. The purpose of this review is to evaluate the current literature linking multicomponent frailty assessment and invasive cardiac surgery outcomes. METHODS We searched PubMed, EMBASE, and CINAHL; 1887 articles met the search criteria, and each was independently reviewed by 2 reviewers. RESULTS The 19 eligible studies assessed 52 291 subjects using 17 different frailty measurements. The most commonly used instruments were the Fried Frailty Phenotype and the Clinical Frailty Scale. Between 9% and 61% of participants were found to be frail in each study. All 19 studies included mortality as an outcome, 12 included surgical complications, 12 included hospital length of stay, 3 included quality of life, and 2 included functional status. Nine found statistically significant differences in survival between frail and nonfrail patients, 6 of 12 found that frail patients had a longer length of stay, 4 of 12 found that frail patients were more likely to experience major complications, and 2 of 2 found that frail patients were more likely to have a decrease in functional status. CONCLUSION Although some studies lacked power, the majority confirmed that frail patients are more likely to experience poor outcomes. Further research is needed to determine which frailty measure provides the best predictive validity and to identify interventions to mitigate the risks that major cardiac surgery poses to frail patients.
Collapse
|
16
|
Shorka D, Yemini N, Ben Shushan G, Tokar L, Benbenishty J, Woloski-Wruble A. Body image and scar assessment: A longitudinal cohort analysis of cardiothoracic, neurosurgery and urology patients. J Clin Nurs 2021; 31:2605-2611. [PMID: 34704299 DOI: 10.1111/jocn.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Scar severity and scar viewing are known to affect body image. The literature is lacking on the relationship between body image and surgical scar assessment. The aims of this study were to compare patients from 3 different surgical departments in terms of body image and scar assessment at discharge, in comparison with nurses' scar assessment, and 3 months post-surgery. In addition, the research examined age and gender in relation to the main variables. METHODS A longitudinal, comparative, correlational study was conducted using an instrument which included a health history, a nurses scar assessment tool and a patient scar assessment tool at hospital discharge, as well as a body image tool used both at discharge and at 3 months' post-surgery. The 10-item body image scale was comprised of affective items, behavioural items and cognitive items. The STROCSS 2019 checklist is used. RESULTS 75 patients were studied who were mostly male (68.0%) with a mean age of 59 and married (77.3%). The sample distribution of departments included 30.7% cardiothoracic, 29.3% neurosurgery and 40% urology. Cardiothoracic patients displayed a significant negative body image pre-surgery compared to post-surgery. Neurosurgical patients' scar assessments were significantly higher than nurses' assessments with no differences found in the other departments. CONCLUSIONS The healthcare team needs to consider engaging patients in post-surgery discussions concerning scarring and body image. The results of this study revealed that expectations in both clinician and patient participants need to be assessed and evaluated for congruency in order to offer a greater patient-focused peri-operative experience.
Collapse
Affiliation(s)
- Dorit Shorka
- Urology Department Co-investigator,, Hadassah Hebrew University Medical Center
| | - Noa Yemini
- Neurosurgery-Open Heart surgery department Co -investigator, Hadassah Hebrew University Medical Center
| | - Gila Ben Shushan
- Neurosurgery-Open Heart surgery department Co -investigator, Hadassah Hebrew University Medical Center
| | - Luba Tokar
- Urology Department Co -investigator, Hadassah Hebrew University Medical Center
| | - Julie Benbenishty
- Academic Consultant Nursing Administration, Hadassah Hebrew University Medical Center
| | | |
Collapse
|
17
|
Nakawatase S, Asae Y, Miyamoto Y, Miyamoto M, Okumoto Y, Mizoguchi H, Sakaki M, Kimura K. A Rare Case of Chronic Expanding Intrapericardial Hematoma with Refractory Right-sided Heart Failure 30 Years after the Surgical Repair of Tetralogy of Fallot. Intern Med 2021; 60:2627-2631. [PMID: 33678745 PMCID: PMC8429310 DOI: 10.2169/internalmedicine.6800-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We herein report the case of a 79-year-old man who presented with right-sided heart failure (HF) 27 years after undergoing surgery for tetralogy of Fallot. The HF did not respond well to oral diuretics. Transthoracic echocardiography and chest X-ray failed to determine the cause of the HF for three years. An intrapericardial mass located just behind the sternum, was finally identified on computed tomography. The mass had compressed the right ventricle, causing right-sided HF. Pre-surgical diagnostic images led to suspicion of a chronic expanding intrapericardial hematoma (CEIH), and the CEIH was surgically removed. The patient's symptoms improved markedly.
Collapse
Affiliation(s)
| | - Yoshinori Asae
- Division of Cardiology, Heart Center, Kinan Hospital, Japan
| | | | | | | | - Hiroki Mizoguchi
- Division of Cardiovascular Surgery, Heart Center, Kinan Hospital, Japan
| | - Masayuki Sakaki
- Division of Cardiovascular Surgery, Heart Center, Kinan Hospital, Japan
| | - Keizo Kimura
- Division of Cardiology, Heart Center, Kinan Hospital, Japan
| |
Collapse
|
18
|
Arslan U, Borulu F, Sarac İ, Prof BE. Chronic intracardiac thrombus, a long-term complication of COVID-19: Case reports. J Card Surg 2021; 36:3939-3943. [PMID: 34309906 PMCID: PMC8446978 DOI: 10.1111/jocs.15836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
Inflammation and thrombogenic effects of coronavirus disease 2019 (COVID‐19) can lead to cardiovascular complications in patients even after recovery from COVID‐19. Intracardiac thrombus is life‐threatening and can cause sudden death. Our study describes two patients who recovered from COVID‐19 and presented with chronic intracardiac thrombus.
Collapse
Affiliation(s)
- Umit Arslan
- Department of Cardiovascular Surgery, Ataturk University, Erzurum, Turkey
| | - Ferhat Borulu
- Department of Cardiovascular Surgery, Ataturk University, Erzurum, Turkey
| | - İbrahim Sarac
- Department of Cardiology, Erzurum State Hospital, Erzurum, Turkey
| | | |
Collapse
|
19
|
Stevens B, Buckley K, Schwartz R, Burkhart H. The Successful Use of an Exchange Transfusion in a Child with Hereditary Spherocytosis Undergoing Congenital Cardiac Surgery. J Extra Corpor Technol 2021; 53:137-9. [PMID: 34194080 DOI: 10.1182/ject-2000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/31/2021] [Indexed: 11/20/2022]
Abstract
Little is reported in the literature regarding hereditary spherocytosis (HS) and cardiopulmonary bypass (CPB). We present a case of a 19-month-old girl child who was referred for an atrioventricular septal defect (AVSD) and HS. The patient underwent surgical repair, and an exchange transfusion was performed at the initiation of CPB. No significant hemolysis or events attributed to HS were observed during or after CPB. The surgical repair of an AVSD in a pediatric patient with HS and total volume exchange transfusion is herein reported.
Collapse
|
20
|
Futamura Y, Watanuki H, Okada M, Sugiyama K, Matsuyama K. The Efficacy and Renal Protective Effect of Tolvaptan in Chronic Kidney Disease Patients after Open-Heart Surgery. Ann Thorac Cardiovasc Surg 2021; 27:317-321. [PMID: 34053960 PMCID: PMC8560536 DOI: 10.5761/atcs.oa.20-00364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose: Unlike loop diuretics, tolvaptan is reported to have a renal protective effect. The purpose of this study was to retrospectively assess the efficacy of tolvaptan administration in chronic kidney disease (CKD) patients following open-heart surgery. Methods: From February 2017 to August 2020, 75 patients with preoperative CKD stages IIIb–V were enrolled in this study and were divided into two groups: the control group (n = 30) and the tolvaptan group (n = 45). All patients routinely received conventional diuretics starting from postoperative day (POD) 1. Tolvaptan at 7.5–15 mg/day was administered if the patients had persistent fluid retention or poor response to conventional diuretics. Results: Tolvaptan administration was initiated at a mean of POD 2.9 ± 2.2, and the mean dosing period was 4.1 ± 3.0 days. The mean time to return to the preoperative body weight in the control and tolvaptan groups was similar. However, estimated glomerular filtration rate (eGFR) was significantly increased at the time when body weight reached the preoperative level and at discharge in the tolvaptan group than in the control group. Conclusion: This study demonstrated the renal protective effect of tolvaptan even in advanced CKD patients after open-heart surgery.
Collapse
Affiliation(s)
- Yasuhiro Futamura
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hirotaka Watanuki
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masaho Okada
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Katsuhiko Matsuyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| |
Collapse
|
21
|
Lee WY, Kwon SJ, Im YM, Kwon BS, Choi ES, Park CS, Yun TJ. Resolution of postnatal shock before open-heart surgery in neonates with prenatal diagnoses. Ann Thorac Surg 2021:S0003-4975(21)00860-2. [PMID: 34019856 DOI: 10.1016/j.athoracsur.2021.04.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The impact of prenatal diagnosis (PreND) for congenital heart disease on outcomes after neonatal open heart surgery is undetermined. We hypothesized that PreND has a positive impact on surgical outcomes in terms of immediate postnatal intensive care, which may lead to a decreased risk of persistent shock before surgery. METHODS Among the 949 neonates who underwent open heart surgery between January 2002 and December 2017, 655 patients (69.0%) were diagnosed prenatally (Group-PreND) and 294 patients (31.0%) were diagnosed postnatally (Group-PostND). Procedural complexity, incidence of postnatal shock (Serum lactate >4.0 mmol/L or pH <7.2), hospitalization timing, duration of shock, resolution of shock, and in-hospital mortality were compared between the two groups. RESULTS In Group-PreND, procedure-dependent comprehensive Aristotle score (10.8 vs. 10.0 P < .001), incidence of extra-cardiac anomalies (13.0% vs. 7.1%, P = .008), heterotaxy syndrome (3.8% vs. 1.0%, P = .021), and postnatal shock (244/655, 37.3% vs. 78/294, 26.5%, P = .001) were higher than in Group-postND. However, patients in Group-PreND were hospitalized earlier after birth (0 day vs 5 days, P < .001), experiencing shorter duration of shock (5.3 hours vs 9.0 hours, P = .01), and, consequently, showing higher incidence of shock resolution (212/244, 87% vs. 52/78, 67%, P < .001). In-hospital mortality was comparable between the two groups (P = .070). CONCLUSIONS Postnatal shock is more frequently observed in Group-PreND. However, prenatal awareness of the disease leads to immediate postnatal initiation of intensive care with shorter exposure to shock, leading to higher probability of shock resolution.
Collapse
|
22
|
Doğan A, Saritaş S. The effects of neuro-linguistic programming and guided imagery on the pain and comfort after open-heart surgery. J Card Surg 2021; 36:2389-2397. [PMID: 33760270 DOI: 10.1111/jocs.15505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/01/2021] [Accepted: 02/20/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The present study aims to evaluate the effects of neuro-linguistic programming (NLP) and guided imagery on postoperative pain and comfort after open-heart surgery. METHODS In the current, prospective, randomized, single-blind clinical study, the participants received NLP with a new behavior formation technique or the guided imagery relaxation technique using an audio compact disc for a duration of 30 min. RESULTS The patients in the NLP group had significantly lower posttest pain levels, compared to the patients in the guided imagery and control groups. Moreover, the patients in the guided imagery group had significantly higher posttest comfort levels, compared to the patients in the NLP and control groups. CONCLUSION The application of both NLP and guided imagery interventions resulted in reduced postoperative pain and increased postoperative comfort levels after open-heart surgery.
Collapse
Affiliation(s)
- Aysel Doğan
- Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
| | - Serdar Saritaş
- Department of Surgical Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| |
Collapse
|
23
|
Calderon J, Wypij D, Rofeberg V, Stopp C, Roseman A, Albers D, Newburger JW, Bellinger DC. Randomized Controlled Trial of Working Memory Intervention in Congenital Heart Disease. J Pediatr 2020; 227:191-198.e3. [PMID: 32827526 DOI: 10.1016/j.jpeds.2020.08.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy of Cogmed Working Memory Training compared with the standard of care to improve executive function and social outcomes in adolescents with congenital heart disease (CHD) who underwent open-heart surgery in infancy and to identify factors associated with changes in outcomes following the intervention. STUDY DESIGN In a single-center, randomized controlled trial, adolescents (13-16 years) with CHD were randomly assigned to either Cogmed (home-based 45-minutes sessions for 5-8 weeks) or to a control group. The primary outcome was working memory. Secondary outcomes included inhibitory control and cognitive flexibility as well as parent-reported executive function, symptoms of attention deficit hyperactivity disorder, and social outcomes. All measures were assessed at baseline, post-treatment (1-3 weeks post-training) and at 3-month follow-up. Data were analyzed using an intention-to-treat approach. RESULTS Sixty adolescents with CHD participated (28 assigned to Cogmed). No improvement at the post-treatment or 3-month follow-up assessments was found for the primary outcome measure of working memory. Compared with the control group, participants assigned to the intervention demonstrated benefits in inhibitory control and attention at the 3-month follow-up (P = .02) and in parent-reported cognitive regulatory skills at post-treatment and 3-month follow-up (P = .02 and P = .04, respectively). Preterm birth, biventricular CHD, and history of attention deficit hyperactivity disorder diagnosis were associated with improved response to the intervention. CONCLUSIONS Cogmed intervention produced improvements in the self-regulatory control abilities of adolescents with CHD. The training did not enhance other areas of executive function or behavioral outcomes. Further studies are needed to evaluate the longer-term potential benefits to other domains. TRIAL REGISTRATION Clinicaltrials.gov: NCT02759263.
Collapse
Affiliation(s)
- Johanna Calderon
- Department of Psychiatry, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Valerie Rofeberg
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Christian Stopp
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | | | - Daniel Albers
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David C Bellinger
- Department of Psychiatry, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Neurology, Boston Children's Hospital, Boston, MA; Department of Neurology, Harvard Medical School, Boston, MA
| |
Collapse
|
24
|
Khoram B, Yoosefinejad AK, Rivaz M, Najafi SS. Investigating the Effect of Acupressure on the Patients' Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial. J Acupunct Meridian Stud 2020; 13:169-173. [PMID: 33242637 DOI: 10.1016/j.jams.2020.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects. OBJECTIVES The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery. METHOD This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study. RESULTS The results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups. CONCLUSION Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.
Collapse
Affiliation(s)
- Bagher Khoram
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Amin K Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mozhgan Rivaz
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed S Najafi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
25
|
Acheampong D, Boateng P. Colonic diverticulitis following open-heart surgery: a case report of an unusual postoperative gastrointestinal complication. J Surg Case Rep 2020; 2020:rjaa186. [PMID: 32607140 PMCID: PMC7310676 DOI: 10.1093/jscr/rjaa186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/16/2020] [Indexed: 11/14/2022] Open
Abstract
Diverticulitis, though a common gastrointestinal disease, is rare following open-heart surgery. There is insufficient data regarding its incidence and management post-cardiac surgery. Especially in patients with atypical presentation, diagnosis and management can be challenging. This case outlines one such atypical diverticulitis case in which a 57-year-old female patient developed perforated diverticulitis with pelvic abscess accumulation following left ventricular aneurysm (LVA) repair. Diagnosis, appropriate management and treatment approaches are discussed. Cardiac surgeons should consider the possibility of diverticulitis in patients reporting nonspecific abdominal pain following cardiac surgery to ensure early diagnosis and institution of appropriate treatment to prevent associated adverse outcomes.
Collapse
|
26
|
Kartha VM, Rehman M, Nguyen ATH, Amankwah E, Sibinga EMS, Goldenberg NA, Jacobs JP. Post-operative blood loss is higher among African American neonates undergoing open-heart surgery with cardiopulmonary bypass for CHD. Cardiol Young 2020; 30:74-81. [PMID: 31806066 DOI: 10.1017/S1047951119002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neonates are at high risk of bleeding after open-heart surgery. We sought to determine pre-operative and intra-operative risk factors for increased bleeding after neonatal open-heart surgery with cardiopulmonary bypass. METHODS We conducted a retrospective cohort study of neonates (0-30 days old) who underwent open-heart surgery with cardiopulmonary bypass from January, 2009, to March, 2013. Cardiac diagnosis; demographic and surgical data; and blood products, haemostatic agents, and anti-thrombotic agents administered before, during, and within 24 hours after surgery were abstracted from the electronic health record and anaesthesia records. The outcome of interest was chest tube output (in ml/kg body weight) within 24 hours. Relationships between chest tube output and putative associated factors were evaluated by unadjusted and adjusted linear regression. RESULTS The cohort consisted of 107 neonates, of whom 79% had a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Category of 4 or 5. Median chest tube output was 37 ml/kg (range 9-655 ml/kg). Age, African-American race, and longer durations of surgery and cardiopulmonary bypass each had statistically significant associations with increased chest tube output in unadjusted analyses. In multivariable analysis, African-American race retained an independent, statistically significant association with increased chest tube output; the geometric mean of chest tube output among African-American neonates was 71% higher than that of Caucasians (95% confidence interval, 29-125%; p = 0.001). CONCLUSION Among neonates with CHD undergoing open-heart surgery with cardiopulmonary bypass, African-American race is independently associated with greater chest tube output over the first 24 hours post-operatively.
Collapse
|
27
|
Lomivorotov VV, Moroz G, Ismoilov S, Shmyrev V, Efremov S, Abubakirov M, Batalov V, Landoni G, Lembo R, Bogachev-Prokophiev A, Sapegin A, Bellomo R. Sustained High-dose Thiamine Supplementation in High-risk Cardiac Patients Undergoing Cardiopulmonary Bypass: A Pilot Feasibility Study (The APPLY trial). J Cardiothorac Vasc Anesth 2019; 34:594-600. [PMID: 31558398 DOI: 10.1053/j.jvca.2019.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To test the feasibility and investigate possible cardiovascular effects of a sustained high-dose intravenous thiamine protocol in patients undergoing combined valvular and coronary artery bypass graft surgery. DESIGN Randomized, placebo-controlled, pilot feasibility trial. SETTING Cardiac surgery department of a tertiary hospital. PARTICIPANTS Forty patients undergoing combined valvular and coronary artery bypass surgery. INTERVENTIONS Intravenous thiamine (600 mg on the day of surgery, and 400 mg/day on postoperative days 1, 2, and 3) or placebo. MEASUREMENTS AND MAIN RESULTS The primary feasibility endpoints were recruitment rate and protocol compliance. Secondary endpoints included markers of possible biological and physiological effects. The mean recruitment rate was 8 patients per month and protocol compliance was 97.5%. There were no differences in median peak postoperative lactate (2.7 mmol/L [interquartile range [IQR] 1.4-4.6] for thiamine v 2.5 mmol/L [IQR 1.4-3.6] for placebo; p = 0.53), median peak postoperative creatinine (104 µmol/L [IQR 92.5-129] for thiamine v 99 µmol/L [IQR 86.5-109.5] for placebo; p = 0.53), median nadir postoperative cardiac index (1.8 L/min/m2 [IQR 1.5-2.1] for thiamine v 2.2 L/min/m2 [IQR 1.5-2.5] for placebo; p = 0.25), or the number of patients on vasopressor/inotropic agents (thiamine, 12 [63%]; placebo, 12 [60%]; p = 0.80), or in the total inotrope/vasopressor dose 0.14 µg/kg for thiamine v 0.12 µg/kg for placebo; p = 0.88). CONCLUSIONS A double-blind trial of sustained high-dose intravenous thiamine supplementation in higher-risk cardiac surgery patients was feasible and appeared to be safe. However, such treatment did not demonstrate evidence of biological or physiological effects.
Collapse
Affiliation(s)
- Vladimir V Lomivorotov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Novosibirsk State University, Novosibirsk, Russia.
| | - Gleb Moroz
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | | | - Vladimir Shmyrev
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Sergey Efremov
- Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Marat Abubakirov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vasily Batalov
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrey Sapegin
- E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
28
|
Ertürk EB, Ünlü H. Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery. Int J Health Sci (Qassim) 2018; 12:26-34. [PMID: 30022900 PMCID: PMC6040857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVES Individualized education is important for preparing patients for the operation both physically and psychologically. This study investigated the effects of pre-operative individualized education for open-heart surgery patients on post-operative anxiety and pain severity. METHODS This quasi-experimental study was conducted in a university hospital between January and October 2014 and involved 109 patients. Data were collected through a form developed by the authors, the State-Trait Anxiety Inventory (STAI), and the visual analog scale (VAS). Patients underwent STAI 1 day before the operation to identify their sources of anxiety and educational needs, and then individualized education was given accordingly. 1 day after the operation, STAI was used to measure patients' state anxiety level, and VAS was used to measure their pain level. The effect of demographic variables on differences in anxiety and pain was investigated. RESULTS The average age of the participants was 59.62; 69.7% were male, 92.7% were married, 49.5% graduated from primary school, and the majority (71.6%) had coronary heart disease. The most common sources of anxiety reported the participants included lack of knowledge, being away from family, risk of death, and pain. An analysis of the participants' pre-operative mean scores for state anxiety displayed statistically significant differences (P < 0.05) according to age groups and gender. No significant difference was detected between mean pre- and post-operative state anxiety scores. There was a statistically significant relationship between mean pre- and post-operative state anxiety scores and mean pain scores. CONCLUSIONS The individualized education is given to patients before surgery was found to have potential effects on their post-operative pain levels.
Collapse
Affiliation(s)
- Elif Budak Ertürk
- Department of Nursing, Faculty of Health Sciences, Baskent University, Ankara, Turkey,Address for correspondence: Elif Budak Ertürk, Department of Nursing, Faculty of Health Sciences, Baskent University, Bağlıca Kampüsü Fatih Sultan Mah. Eskisehir Yolu 18. Km, 06790 Etimesgut/Ankara, Turkey. Tel: 0312 246 66 66/15 43. Fax: 0312 2466676. E-mail:
| | - Hayriye Ünlü
- Department of Nursing, Faculty of Health Sciences, Baskent University, Ankara, Turkey
| |
Collapse
|
29
|
Calderon J, Willaime M, Lelong N, Bonnet D, Houyel L, Ballon M, Goffinet F, Khoshnood B. Population-based study of cognitive outcomes in congenital heart defects. Arch Dis Child 2018; 103:49-56. [PMID: 28780508 DOI: 10.1136/archdischild-2016-310830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterise and compare cognitive outcomes in children with operated (open-heart surgery) and non-operated (catheter-based interventions only or no intervention) congenital heart defects (CHD) and to determine associated risk factors. DESIGN This prospective population-based study reports outcomes of 3-year-old children with CHD with or without open-heart surgery. MAIN OUTCOME MEASURES Standardised cognitive scores (mean scores and proportions below normative values) were assessed with the Kaufman Assessment Battery for Children II. We analysed demographic, perinatal and operative variables as predictors of cognitive outcomes. RESULTS 419 children participated (154 with open-heart surgery; 265 without surgery). Global cognitive scores did not differ between the groups. Compared with the non-operated group, children who underwent surgery obtained lower scores in expressive language (p=0.03) and logical reasoning (p=0.05). When compared with test norms, the frequency of global cognitive scores >1 SDs below the expected mean was higher in the surgical group (25% vs 16% in the general population) (p=0.03). A higher-than-expected proportion of children in the non-operated group scored >2 SDs below the expected mean (7% vs 2%) (p=0.05). Being small for gestational age (SGA) significantly increased the risk of cognitive impairment in the surgical group, after adjustments for multiple covariates including maternal education, complexity of the CHD and operative-related variables (adjusted OR=5.9; 95% CI (1.7 to 20.1)). CONCLUSIONS Despite mean scores within the normative range, a high proportion of preschool children with CHD with or without surgery are at early cognitive risk. SGA is a strong predictor of the neurodevelopmental prognosis in CHD.
Collapse
Affiliation(s)
- Johanna Calderon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Inserm, UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | - Marion Willaime
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nathalie Lelong
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Damien Bonnet
- Centre de référence M3C, Necker, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Lucile Houyel
- Service de chirurgie des cardiopathies congénitales, Hôpital Marie Lannelongue, Paris, France
| | - Morgane Ballon
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - François Goffinet
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,Maternité Port Royal, Paris, France
| | - Babak Khoshnood
- Department of Psychiatry, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
30
|
Juhl AA, Hody S, Videbaek TS, Damsgaard TE, Nielsen PH. Deep Sternal Wound Infection after Open-Heart Surgery: A 13-Year Single Institution Analysis. Ann Thorac Cardiovasc Surg 2017; 23:76-82. [PMID: 28163297 DOI: 10.5761/atcs.oa.16-00196] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. METHODS The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. RESULTS A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. CONCLUSION It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.
Collapse
Affiliation(s)
- Alexander Andersen Juhl
- Plastic Surgery Research Unit, Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sofie Hody
- Plastic Surgery Research Unit, Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Senholt Videbaek
- Plastic Surgery Research Unit, Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Engberg Damsgaard
- Plastic Surgery Research Unit, Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Per Hostrup Nielsen
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| |
Collapse
|
31
|
Kasmi L, Bonnet D, Montreuil M, Kalfa D, Geronikola N, Bellinger DC, Calderon J. Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review. Front Pediatr 2017; 5:59. [PMID: 28393063 PMCID: PMC5364136 DOI: 10.3389/fped.2017.00059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/10/2017] [Indexed: 11/17/2022] Open
Abstract
Advances in prenatal diagnosis, perioperative management, and postoperative care have dramatically increased the population of survivors of neonatal and infant heart surgery. The high survival rate of these patients into adulthood has exposed the alarming prevalence of long-term neuropsychological and psychiatric morbidities. Dextro-transposition of the great arteries (d-TGA) is one of the most extensively studied cyanotic congenital heart defect (CHD) with regard to neurodevelopmental outcomes. Landmark studies have described a common neurodevelopmental and behavioral phenotype associated with d-TGA. Children with d-TGA display impairments in key neurocognitive areas, including visual-spatial and fine motor abilities, executive functioning, processing speed, and social cognition. As they grow older, they may face additional challenges with a worsening of deficits in higher order cognitive skills, problems in psychosocial adjustment and a higher-than-expected rate of psychiatric disorders, such as attention-deficit hyperactivity disorder, depression, and anxiety. The aim of this review is to summarize the available recent data on neuropsychological and psychiatric outcomes in individuals with d-TGA after the arterial switch operation. We present findings within a life-span perspective, with a particular emphasis on the emerging literature on adolescent and young adult outcomes. Finally, we propose avenues for future research in the CHD adult neuropsychology field. Among these avenues, we explore the potential mechanisms by which pediatric neurodevelopmental impairments may have lifelong adverse effects as well as alternative interventions that could optimize outcomes.
Collapse
Affiliation(s)
- Leila Kasmi
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - Damien Bonnet
- Referral Center for Complex Congenital Cardiac Malformations, Department of Congenital and Pediatric Cardiology, Necker Hospital, University Paris Descartes, Sorbonne Paris Cité , Paris , France
| | - Michèle Montreuil
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David Kalfa
- Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, Columbia University , New York, NY , USA
| | - Nikoletta Geronikola
- Laboratory of Psychopathology and Neuropsychology, Department of Psychology, University Paris 8, Paris Lumières - CNRS , Saint-Denis , France
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Johanna Calderon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School , Boston, MA , USA
| |
Collapse
|
32
|
Aktaş YY, Karabulut N. A Turkish Version of the Critical-Care Pain Observation Tool: Reliability and Validity Assessment. J Perianesth Nurs 2016; 32:341-351. [PMID: 28739066 DOI: 10.1016/j.jopan.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aim was to evaluate the validity and reliability of the Critical-Care Pain Observation Tool in critically ill patients. DESIGN A repeated measures design was used for the study. METHODS A convenience sample of 66 patients who had undergone open-heart surgery in the cardiovascular surgery intensive care unit in Ordu, Turkey, was recruited for the study. The patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (suctioning), and 20 minutes after the procedure while they were conscious and intubated after surgery. FINDING The Turkish version of the Critical-Care Pain Observation Tool has shown statistically acceptable levels of validity and reliability. Inter-rater reliability was supported by moderate-to-high-weighted κ coefficients (weighted κ coefficient = 0.55 to 1.00). For concurrent validity, significant associations were found between the scores on the Critical-Care Pain Observation Tool and the Behavioral Pain Scale scores. Discriminant validity was also supported by higher scores during suctioning (a nociceptive procedure) versus non-nociceptive procedures. The internal consistency of the Critical-Care Pain Observation Tool was 0.72 during a nociceptive procedure and 0.71 during a non-nociceptive procedure. CONCLUSIONS The validity and reliability of the Turkish version of the Critical-Care Pain Observation Tool was determined to be acceptable for pain assessment in critical care, especially for patients who cannot communicate verbally.
Collapse
|
33
|
Hosseini S, Heydari A, Vakili M, Moghadam S, Tazyky S. Effect of lavender essence inhalation on the level of anxiety and blood cortisol in candidates for open-heart surgery. Iran J Nurs Midwifery Res 2016; 21:397-401. [PMID: 27563324 PMCID: PMC4979264 DOI: 10.4103/1735-9066.185582] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Surgery, as a treatment, is a stressful experience. The anxiety is more severe in open-heart surgery patients due to its risk and complications. The present study aimed to determine the effect of lavender essence on the levels of anxiety and blood cortisol in candidates for open-heart surgery. MATERIALS AND METHODS This was a single-blind clinical trial, a random allocation study with a control group conducted on 90 candidates for open-heart surgery in two groups of study and control. The study and control groups inhaled two drops of lavender and distilled water for 20 min, respectively. Spielberger questionnaire was filled by the patients. A 2 ml blood sample was taken to measure the cortisol level and patients' vital signs were recorded before and after intervention. Data were analyzed by chi-square in the form of mean, SD, and frequency distribution, independent t-test, paired t-test, and analysis of covariance (ANCOVA), with a significance level of P = 0.05 to modify the pre-test scores. RESULTS Results showed a significant reduction in mean anxiety score from 56.73 (5.67) to 54.73 (5.42) after intervention in the study group, compared to the control group [1.11 (1.17)] (P < 0.001). There was also a higher difference in cortisol level in the study group compared to the control group [1.88 (0.56) vs. 0.42 (0.45)]. ANCOVA test showed that the 10.8% variance in anxiety score and 69.6% decrease in blood cortisol resulted from inhalation of lavender. CONCLUSIONS Results showed the positive effect of lavender essence on anxiety and blood cortisol level among the patients. Aromatherapy with lavender is suggested to be considered as a nursing intervention in clinical settings.
Collapse
Affiliation(s)
- SeyedAbedin Hosseini
- Departement of ICU Care Nursig, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alemeh Heydari
- Departement of ICU Care Nursig, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - MohammadAli Vakili
- Deputy of Reserch and Technology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Shahram Moghadam
- Departement of Anesthesiology, School of Medecine, Golestan University of Medical Sciences, Gorgan, Iran
| | - SadeghAli Tazyky
- Departement of Psychiatry, School of Medecine, Golestan University of Medical Sciences, Gorgan, Iran
| |
Collapse
|
34
|
Lu J, Meng H, Meng Z, Sun Y, Pribis JP, Zhu C, Li Q. Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials. Int J Clin Exp Pathol 2015; 8:7978-7987. [PMID: 26339364 PMCID: PMC4555692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/29/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery. METHODS A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics. RESULTS Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery. CONCLUSIONS Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.
Collapse
Affiliation(s)
- Jun Lu
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of MedicineShanghai, China
| | - Haoyu Meng
- First Clinical Medical College of Nanjing Medical UniversityNanjing, China
| | - Zhaoyi Meng
- Department of Surgery, Xinyi People’s HospitalXinyi, China
| | - Ying Sun
- First Clinical Medical College of Nanjing Medical UniversityNanjing, China
| | - John P Pribis
- Department of Surgery, University of Pittsburgh Medical CenterPittsburgh, PA, USA
| | - Chunyan Zhu
- Department of Surgery, University of Pittsburgh Medical CenterPittsburgh, PA, USA
| | - Quan Li
- Department of Anesthesiology, Shanghai East Hospital, Tongji University School of MedicineShanghai, China
| |
Collapse
|
35
|
Kumar S, Sudhakar A, Mohan M, Balachandran R, Raj B, Sumangala SG, Kumar RK. Elevated red cell distribution width is associated with delayed postoperative recovery after correction of Tetralogy of Fallot. Ann Pediatr Cardiol 2014; 6:121-5. [PMID: 24688227 PMCID: PMC3957439 DOI: 10.4103/0974-2069.115252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To study the impact of red cell distribution width (RDW) on postoperative recovery after correction of Tetralogy of Fallot (TOF). Background: Increased RDW indicates dysregulated erythropoiesis and predicts survival in critical illnesses that include idiopathic pulmonary artery hypertension and chronic heart failure. Myocardial injury and oxidative stress induced by cardiopulmonary bypass potentially contribute to prolonged recovery in post TOF repair patients. Materials and Methods: Retrospective analysis of data on 94 consecutive children with TOF undergoing corrective repair (January 2010-March 2011) was done. RDW was higher for the study population when compared to acyanotic patients with ventricular septal defect (17.7 ± 3.7 vs. 16.2 ± 4.2; P < 0.001). The mean RDW obtained from 100 separate age-, sex-, and weight-matched TOF patients (17.8) was chosen as a cut-off. Of 93 survivors (median age: 12 (4-204) months, weight: 8.6 (3.2-70) kg), 29 patients with higher RDW (> 17.8) had a longer ICU stay (155.6 ± 71.3 vs. 122.4 ± 61.3 hours, P = 0.02), hospital stay (18.6 ± 10.5 days vs. 13.4 ± 6.5 days, P = 0.01), ventilation time (57.9 ± 41.6 vs. 38.3 ± 30.8 hours, P = 0.01), and more surgical site infection (24.1% vs. 6.2%, P = 0.01). On multivariate analysis only elevated RDW (other variables included age, weight, hemoglobin, hematocrit, and surgical support times) showed a significant association with hospital stay. Conclusions: Elevated RDW appears to be associated with prolonged recovery after TOF repair, the precise underlying mechanisms are worth investigating.
Collapse
Affiliation(s)
- Shine Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Maitreyi Mohan
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Rakhi Balachandran
- Department of Pediatric Cardiac Anesthesia, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Benedict Raj
- Department of Pediatric CVTS, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
36
|
Abstract
Risk models are widely used to predict outcomes after cardiac surgery. Not only is risk modelling applied in the assessment of the relative impact of specific risk factors on surgical outcomes, but also in patient counselling, the selection of treatment options, comparison of postoperative results, and quality-improvement programmes. At least 19 risk-stratification models exist for open-heart surgery. The focus of risk models was originally on pre-operative prediction of mortality. However, major morbidity is in general more common than mortality and the ability to predict only operative mortality is not an adequate method of determining surgical outcome. Multiple intra- and postoperative variables have been excluded in the majority of models and the possible effect of their future inclusion remains to be seen. The unique patient population of sub-Saharan Africa requires a unique risk model that reflects the patient population and levels of care.
Collapse
Affiliation(s)
- Carla Prins
- Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa.
| | | | | | | |
Collapse
|
37
|
Edwin F, Tettey M, Aniteye E, Tamatey M, Sereboe L, Entsua-Mensah K, Kotei D, Baffoe-Gyan K. The development of cardiac surgery in West Africa--the case of Ghana. Pan Afr Med J 2011; 9:15. [PMID: 22355425 PMCID: PMC3215537 DOI: 10.4314/pamj.v9i1.71190] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/04/2011] [Indexed: 01/08/2023] Open
Abstract
West Africa is one of the poorest regions of the world. The sixteen nations listed by the United Nations in this sub-region have some of the lowest gross domestic products in the world. Health care infrastructure is deficient in most of these countries. Cardiac surgery, with its heavy financial outlay is unavailable in many West African countries. These facts notwithstanding, some West African countries have a proud history of open heart surgery not very well known even in African health care circles. Many African health care givers are under the erroneous impression that the cardiovascular surgical landscape of West Africa is blank. However, documented reports of open-heart surgery in Ghana dates as far back as 1964 when surface cooling was used by Ghanaian surgeons to close atrial septal defects. Ghana's National Cardiothoracic Center is still very active and is accredited by the West African College of Surgeons for the training of cardiothoracic surgeons. Reports from Nigeria indicate open-heart surgery taking place from 1974. Cote D'Ivoire had reported on its first 300 open-heart cases by 1983. Senegal reported open-heart surgery from 1995 and still runs an active center. Cameroon started out in 2009 with work done by an Italian group that ultimately aims to train indigenous surgeons to run the program. This review traces the development and current state of cardiothoracic surgery in West Africa with Ghana's National Cardiothoracic Center as the reference. It aims to dispel the notion that there are no major active cardiothoracic centers in the West African sub-region.
Collapse
Affiliation(s)
- Frank Edwin
- National Cardiothoracic Center, Korle Bu Teaching Hospital, P.O. Box KB 846, Accra, Ghana
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Chan RPC, Galas FRBG, Hajjar LA, Bello CN, Piccioni MA, Auler JOC. Intensive perioperative glucose control does not improve outcomes of patients submitted to open-heart surgery: a randomized controlled trial. Clinics (Sao Paulo) 2009; 64:51-60. [PMID: 19142552 PMCID: PMC2671976 DOI: 10.1590/s1807-59322009000100010] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 10/01/2008] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days). A p-value of <0.05 was considered significant. RESULTS The anthropometric and clinical characteristics of the patients from each group were similar, except for weight and body mass index. The mean glucose level during the protocol period was 126.69 mg/dl in the treated group and 168.21 mg/dl in the control group (p<0.0016). There were no differences between groups regarding clinical outcomes, including the duration of mechanical ventilation, length of stay in the intensive care unit, blood transfusion, postoperative infection, hypoglycemic event, neurological dysfunction or 30-day mortality (p>0.05). CONCLUSIONS In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.
Collapse
|
39
|
Abstract
ABO-incompatible transfusions and transfusion-related lung injury are today the leading transfusion-related causes of death in the developed world. Since anti-A and anti-B antibodies in plasma can give rise to serious, even fatal, transfusion reactions, ABO-identical/compatible plasma is indicated, but presents a logistical challenge and a risk for transfusion of incorrect plasma. In an effort to circumvent these problems, an ABO-independent universally applicable, pathogen-reduced plasma, Uniplas, has been developed and proven safe and efficacious for use in adults through prospective, randomized, controlled open-heart surgery studies and in prospective, parallel group, controlled liver resection studies. The results of these trials are presented and discussed in relation to solvent/detergent (SD) treated plasma, in general. The cost effectiveness of pathogen-reduced plasma is low because of the very low risk for transfusion transmitted viral infections in the developed world (US 2 to 9 million dollars per quality-adjusted life year). However, taking into account the combined safety of Uniplas with regard to transfusion-related lung injury, pathogen reduction and independence of ABO blood groups, the cost per gained life year is reduced to US 40,000 dollars to 100,000 dollars.
Collapse
Affiliation(s)
- Bjarte G Solheim
- Institute of Immunology, Rikshospitalet - Radiumhospitalet Medical Center, University of Oslo, NO-0027 Oslo, Norway.
| |
Collapse
|
40
|
Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Tex Heart Inst J 2002; 29:164-71. [PMID: 12224718 PMCID: PMC124754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
We present a brief summary of the 10 greatest cardiologic developments and discoveries of the 20th century Described are electrocardiography; preventive cardiology and the Framingham Study; "lipid hypotheses" and atherosclerosis; coronary care units; echocardiography; thrombolytic therapy; cardiac catheterization and coronary angiography; open-heart surgery; automatic implantable cardiac defibrillators; and coronary angioplasty. These topics are the personal choices of the authors.
Collapse
|
41
|
Hosotsubo KK, Nishimura M, Nishimura S. Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy. Crit Care 2000; 4:180-7. [PMID: 11056750 PMCID: PMC29041 DOI: 10.1186/cc691] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/1999] [Revised: 02/06/2000] [Accepted: 02/21/2000] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is associated with high mortality. We investigated the incidence of hyperbilirubinaemia after two major types of thoracic surgery: open-heart surgery and oesophagectomy. In order to identify the risk factors associated with hyperbilirubinaemia after major surgery, we compared the incidence after open-heart surgery with that after oesophagectomy. RESULTS Hyperbilirubinaemia was detected in 51% of the open-heart surgery patients (n = 133) and in 64% in the oesophagectomy group (n = 74). The incidence of hyperbilirubinaemia was significantly related to the duration of surgery (P< 0.05). In the open-heart surgery group, duration of surgery was 465 +/- 24 min for the patients without hyperbilirubinaemia and 571 +/- 26 min for the patients with hyperbilirubinaemia. In the oesophagectomy group, the procedure durations were 415 +/- 17 min and 493 +/- 20 min, respectively. The overall mortality rate was 8% in the open-heart surgery group; the rate was 12% in those with hyperbilirubinaemia, but 5% in those without hyperbilirubinaemia. No members of the oesophagectomy group died, with or without hyperbilirubinaemia. Infection significantly affected both the occurrence of hyperbilirubinaemia and mortality in the open-heart surgery group. In the subgroups from the open-heart surgery group, 5% (three out of 65) of those without hyperbilirubinaemia (or evidence of infection) died; of the patients with hyperbilirubinaemia, 3% (one out of 38) of those without infection died and 23% (seven out of 30) with detected infection died. CONCLUSION After open-heart surgery and oesophagectomy, approximately half of the patients studied had higher levels of serum total bilirubin. Time spent in surgery was significantly related to the occurrence of hyperbilirubinaemia. Infection significantly affected mortality and total bilirubin levels after open-heart surgery. Control of infection plays a crucial role in the prevention of hyperbilirubinaemia and in reducing mortality.
Collapse
|