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Whiteley J, Toolan C, Shaw M, Perin G, Palmer K, Al-Rawi O, Modi P. Patient-reported outcome measures after mitral valve repair: a comparison between minimally invasive and sternotomy. Interact Cardiovasc Thorac Surg 2021; 32:433-440. [PMID: 33831215 PMCID: PMC8906694 DOI: 10.1093/icvts/ivaa276] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare patient-reported outcome measures of minimally invasive (MI) to sternotomy (ST) mitral valve repair. METHODS We included all patients undergoing isolated mitral valve surgery via either a right mini-thoracotomy (MI) or ST over a 36-month period. Patients were asked to complete a modified Composite Physical Function questionnaire. Intraoperative and postoperative outcomes, and patient-reported outcome measures were compared between 2 propensity-matched groups (n = 47/group), assessing 3 domains: 'Recovery Time', 'Postoperative Pain' (at day 2 and 1, 3, 6 and 12 weeks) and 'Treatment Satisfaction'. Composite scores for each domain were subsequently constructed and multivariable analysis was used to determine whether surgical approach was associated with domain scores. RESULTS The response rate was 79%. There was no mortality in either group. In the matched groups, operative times were longer in the MI group (P < 0.001), but postoperative outcomes were similar. Composite scores for Recovery Time [ST 51.7 (31.8-62.1) vs MI 61.7 (43.1-73.9), P = 0.03] and Pain [ST 65.7 (40.1-83.1) vs MI 79.1 (65.5-89.5), P = 0.02] significantly favoured the MI group. Scores in the Treatment Satisfaction domain were high for both surgical approaches [ST 100 (82.5-100) vs MI 100 (95.0-100), P = 0.15]. The strongest independent predictor of both faster recovery parameter estimate 12.0 [95% confidence interval (CI) 5.7-18.3, P < 0.001] and less pain parameter estimate 7.6 (95% CI 0.7-14.5, P = 0.03) was MI surgery. CONCLUSIONS MI surgery was associated with faster recovery and less pain; treatment satisfaction and safety profiles were similar.
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Affiliation(s)
- Jennifer Whiteley
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Caroline Toolan
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Giordano Perin
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kenneth Palmer
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
- Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Omar Al-Rawi
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
- Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Paul Modi
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
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2
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Zhu S, Sai X, Lin J, Deng G, Zhao M, Nasser MI, Zhu P. Mechanisms of perioperative brain damage in children with congenital heart disease. Biomed Pharmacother 2020; 132:110957. [PMID: 33254442 DOI: 10.1016/j.biopha.2020.110957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/17/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
Congenital heart disease, particularly cyanotic congenital heart disease (CCHD), may lead to a neurodevelopmental delay through central nervous system injury, more unstable central nervous system development, and increased vulnerability of the nervous system. Neurodevelopmental disease is the most serious disorder of childhood, affecting the quality of life of children and their families. Therefore, the monitoring and optimization of nerve damage treatments are important. The factors contributing to neurodevelopmental disease are primarily related to preoperative, intraoperative, postoperative, genetic, and environmental causes, with intraoperative causes being the most influential. Nevertheless, few studies have examined these factors, particularly the influencing factors during early postoperative care. Children with congenital heart disease may experience brain damage during early heart intensive care due to unstable haemodynamics and total body oxygen transfer, particularly early postoperative inflammatory reactions in the brain, blood glucose levels, and other factors that potentially influence long-term neural development. This study analyses the forms of structural and functional brain damage in the early postoperative period, along with the recent evolution of research on its contributing factors.
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Affiliation(s)
- Shuoji Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Xiyalatu Sai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianxin Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Gang Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Mingyi Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - M I Nasser
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
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Abstract
The tremendous and rapid technological advances that humans have achieved in the last decade have definitely impacted how surgical tasks are performed in the operating room (OR). As a high-tech work environment, the contemporary OR has incorporated novel computational systems into the clinical workflow, aiming to optimize processes and support the surgical team. Artificial intelligence (AI) is increasingly important for surgical decision making to help address diverse sources of information, such as patient risk factors, anatomy, disease natural history, patient values and cost, and assist surgeons and patients to make better predictions regarding the consequences of surgical decisions. In this review, we discuss the current initiatives that are using AI in cardiothoracic surgery and surgical care in general. We also address the future of AI and how high-tech ORs will leverage human-machine teaming to optimize performance and enhance patient safety.
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Affiliation(s)
- Roger D Dias
- STRATUS Center for Medical Simulation, Brigham Health, Boston, MA, USA -
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA -
| | - Julie A Shah
- Laboratory of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marco A Zenati
- Laboratory of Medical Robotics and Computer Assisted Surgery (MRCAS), Division of Cardiothoracic Surgery, VA Boston Healthcare System, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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4
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Roy D, Nattel S, Tardif JC. In Memoriam-Martial G. Bourassa (1931-2020). Can J Cardiol 2020; 36:1562-1563. [PMID: 32818558 DOI: 10.1016/j.cjca.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Denis Roy
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
| | - Stanley Nattel
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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Ad N, Luc JGY, Nguyen TC. Cardiac surgery in North America and coronavirus disease 2019 (COVID-19): Regional variability in burden and impact. J Thorac Cardiovasc Surg 2020; 162:893-903.e4. [PMID: 32768300 PMCID: PMC7330597 DOI: 10.1016/j.jtcvs.2020.06.077] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. Methods A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. Results Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high –7.6% vs low –2.6%, P = .195). Conclusions The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
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Affiliation(s)
- Niv Ad
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Adventist White Oak Medical Center, Silver Spring, Md.
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
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Guha A, Dey AK, Omer S, Abraham WT, Attizzani G, Jneid H, Addison D. Contemporary Trends and Outcomes of Percutaneous and Surgical Mitral Valve Replacement or Repair in Patients With Cancer. Am J Cardiol 2020; 125:1355-1360. [PMID: 32171440 DOI: 10.1016/j.amjcard.2020.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
In the era of emerging options for mitral valvular intervention, we sought to characterize the relative utilization, outcomes, and posthospital dispositions of patients referred for transcatheter mitral valve repair (TMVRepair) and surgical mitral valve procedures (SMVP), by cancer-status. Leveraging the National Inpatient Sample, a representative national dataset, ICD-9 codes for all adults >18 years with co-morbid mitral regurgitation, and cancer without metastatic disease admitted from 2003 to 2015 were queried. TMVRepair was performed in 700 hospitalizations from 2012 to 2015, whereas SMVP was utilized during 12,863 hospitalizations from 2003 to 2015. During follow-up, we observed a proportional increase in TMVRepair utilization among cancer patients (vs noncancer), particularly in 2015 (14.2% vs 8.2%, p <0.0001). There was no difference in in-hospital mortality (1.4% vs 1.8%, p = 0.71), ischemic stroke (0.7% vs 0.6%, p = 0.97), major bleeding (8.6% vs 10.9%, p = 0.36), and home discharge (62.1% vs 65.7%, p = 0.45) by cancer-status among patients who underwent TMVRepair; but, cost of care was increased ($52,325 vs $48,832, p <0.0001). Similarly, there was no difference in in-hospital mortality (3.1% vs 3.4%, p = 0.36), ischemic stroke (2.6% vs 3.1%, p = 0.16) as well as the cost-of-care ($58,106 vs $58,844, p = 0.49) among those who underwent SMVP across the same period; but, cancer was associated with increased major bleeding (34.9% vs 30.5%, p <0.0001), and lower likelihood of home discharge (32.8% vs 38.6%, p <0.0001). In conclusion, TMVRepair and SMVP were associated with comparable in-hospital mortality and outcomes in cancer versus noncancer patients. However, cancer patients treated with SMVP experienced more frequent bleeding related complications compared with noncancer patients.
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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Shuab Omer
- Division of Cardiothoracic Surgery Baylor College of Medicine/MEDVAMC, Houston, Texas
| | - William T Abraham
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio
| | - Guilherme Attizzani
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio
| | - Hani Jneid
- Division of Cardiology, Michael E. DeBakey VA Hospital, Baylor College of Medicine, Houston, Texas
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, Ohio; Cancer Control Program, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
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Chen MY, Mundangepfupfu T. Sustained Ventricular Tachycardia Secondary to R-on-T Phenomenon Caused by Temporary Ventricular Epicardial Pacemaker Undersensing after Cardiac Surgery. Anesthesiology 2020; 132:374. [PMID: 31939853 DOI: 10.1097/aln.0000000000002990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle Y Chen
- From the Department of Anesthesiology and Pain Medicine, Division of Critical Care Medicine, University of Washington, Seattle, Washington
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Couffignal C, Amour J, Ait-Hamou N, Cholley B, Fellahi JL, Duval X, Costa De Beauregard Y, Nataf P, Dilly MP, Provenchère S, Montravers P, Mentré F, Longrois D. Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery: A Prospective Cohort Study. Anesthesiology 2020; 132:267-279. [PMID: 31939841 DOI: 10.1097/aln.0000000000003064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. METHODS This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). RESULTS Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. CONCLUSIONS β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.
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Affiliation(s)
- Camille Couffignal
- From the Department of Biostatistics, Bichat-Claude Bernard Hospital, AP-HP.Nord, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (C.C., F.M.) University of Paris, IAME, UMR1137, Paris, France (C.C., X.D., F.M.) INSERM, IAME, UMR 1137, Paris, France (C.C., X.D., F.M.) Clinical Investigation Center, CIC-1425, AP-HP, INSERM, Paris, France (X.D., Y.C.D.B.) Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, APHP, Sorbonne University, UPMC University, Paris 06, UMR INSERM 1166, IHU ICAN, Paris, France (J.A., N.A.-H.) Department of Anesthesia and Intensive Care, Hôpital Européen Georges Pompidou, APHP Paris-Ouest, University of Paris, Paris, France (B.C.) Department of Anesthesia and Intensive Care, Hôpital Cardiologique Louis Pradel, IHU OPERA Inserm U1060/Faculté de Médecine Lyon Est, University Claude Bernard Lyon 1, Lyon, France (J.-L.F.) Department of Cardiac Surgery, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (P.N.) Department of Anesthesia and Intensive Care, Bichat-Claude Bernard Hospital, AP-HP.Nord, APHP, Paris, France (M.-P.D., S.P., P.M., D.L.) University of Paris, Paris, France (P.M., D.L.)
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Murphy GS, Avram MJ, Greenberg SB, Shear TD, Deshur MA, Dickerson D, Bilimoria S, Benson J, Maher CE, Trenk GJ, Teister KJ, Szokol JW. Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery. Anesthesiology 2020; 132:330-342. [PMID: 31939849 DOI: 10.1097/aln.0000000000003025] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures. METHODS Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 μg/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann-Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01. RESULTS Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004). CONCLUSIONS Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.
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Affiliation(s)
- Glenn S Murphy
- From the Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois (G.S.M., S.B.G., T.D.S., M.A.D., D.D., S.B., J.B., C.E.M., G.J.T., K.J.T., J.W.S.) the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (M.J.A.)
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Affiliation(s)
- Sitaram M Emani
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, MA
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery; Department of Pediatrics Keck School of Medicine of University of Southern California; Heart Institute, Los Angeles, CA, Children's Hospital of Los Angeles, Los Angeles, CA.
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Sorajja P, Cavalcante JL. The revolution in tricuspid regurgitation. Prog Cardiovasc Dis 2019; 62:445-446. [PMID: 31794726 DOI: 10.1016/j.pcad.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
| | - Joao L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN
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12
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Abstract
New developments in transcatheter valve technologies including aortic valve replacement and mitral valve and tricuspid valve interventions are described. Recent studies evaluating the success rate, patient outcomes, and anesthesiologic management of the procedures are discussed.
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Affiliation(s)
- Michael A Ackermann
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany
| | - Jörg K Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Centre Leipzig, Struempellstr 39, Leipzig 04289, Germany.
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13
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Affiliation(s)
- Domingo M Braile
- Faculdade de Medicina de São José do Rio Preto São José do Rio Preto SP Brazil Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
- Universidade de Campinas Campinas SP Brazil Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Meryt Zanini
- Universidade de São Paulo Faculdade de Saúde Pública Postgraduate degree in Health Law São Paulo SP Brazil Postgraduate degree in Health Law from Faculdade de Saúde Pública da Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Fundação Getúlio Vargas MBA in Health Managemen São Paulo SP Brazil MBA in Health Management from Fundação Getúlio Vargas (FGV), São Paulo, SP, Brazil
| | - Camila Sáfadi Alves Gonçalves
- Sociedade Brasileira de Cirurgia Cardiovascular São Paulo SP Brazil Sociedade Brasileira de Cirurgia Cardiovascular, São Paulo, SP, Brazil
| | - Paulo Roberto B Evora
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Ribeirão Preto SP Brazil Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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14
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Jacobs ML, Jacobs JP, Hill KD, O'Brien SM, Pasquali SK, Vener D, Kumar SR, Chiswell K, St Louis JD, Mayer JE, Habib RH, Shahian DM, Fernandez FG. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2019 Update on Research. Ann Thorac Surg 2019; 108:671-679. [PMID: 31336062 PMCID: PMC8104073 DOI: 10.1016/j.athoracsur.2019.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/14/2019] [Indexed: 11/17/2022]
Abstract
As the largest congenital and pediatric cardiac surgical clinical data registry in the world, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) serves as a platform for reporting of outcomes and for quality improvement. In addition, it is an important source of data for clinical research and for innovations related to quality measurement. Each year, several teams of investigators undertake analyses of data in the STS CHSD pertaining to the surgical management of specific diagnostic and procedural groups, or to specific processes of care, and their associations with patient characteristics and outcomes across centers participating in the STS CHSD. Additional ongoing projects involve the development of new or refined metrics for quality measurement and reporting of outcomes and center-level performance. The STS, through its Workforce for National Databases and the STS Research Center and Workforce on Research Development provides multiple pathways through which investigators may propose and perform outcomes research projects based on STS CHSD data. This report reviews research published within the past year.
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Affiliation(s)
- Marshall L Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jeffrey P Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Kevin D Hill
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Sara K Pasquali
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - David Vener
- Department of Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Keck University of Southern California School of Medicine, Los Angeles, California
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - David M Shahian
- Department of Surgery, Division of Cardiac Surgery, and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Felix G Fernandez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Wang S, Wei J, Yuan S, He Y, Han J, Lu J, Cheng W, Huang J. Intraoperative Transesophageal Echocardiography During Cardiovascular Surgery in China. J Cardiothorac Vasc Anesth 2019; 33:1343-1350. [PMID: 30467029 DOI: 10.1053/j.jvca.2018.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To perform a comprehensive nationwide survey of more than 90% of all cardiovascular hospitals in China to assess the current 2018 status of transesophageal echocardiography (TEE) equipment, operating physicians, education, impact on surgery, and reimbursement. DESIGN In this nationwide survey, 716 cardiovascular hospitals in mainland China were included. A 15-question electronic survey was sent to these hospitals and the data were received directly from the questionnaire website for analysis. SETTING Cardiovascular hospitals in mainland China. PARTICIPANTS Departments of anesthesiology in cardiovascular hospitals in mainland China. INTERVENTIONS Answer a 15-question survey. MEASUREMENTS AND MAIN RESULTS About 90% of hospitals have acquired machines to perform TEEs with most of the machines controlled by the ultrasound department. Anesthesiologists performed intraoperative TEEs in 45% of the hospitals, but only 15% of the hospitals have anesthesiologists who have met the basic TEE training requirements. Most anesthesiologists (68%) believed TEE significantly contributed to patient care during cardiovascular surgeries. The overwhelming majority of surveyed hospital staff (93%) stated that they were planning to continue or start intraoperative TEE examinations in the future. CONCLUSION Many hospitals in China have acquired equipment to perform intraoperative TEE examinations during cardiovascular surgeries. However, the number of anesthesiologists who can perform TEEs independently still is not adequate. Standardized trainings, a formal certification process, and governmental payment model changes must be provided to ensure high-quality TEE services and better surgical outcomes in China.
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Affiliation(s)
- Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China; Shantou University Medical College, Shantou, Guangdong Province, China
| | - Su Yuan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi He
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jiange Han
- Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Weiping Cheng
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology, Jewish Hospital and Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY.
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Vervoort D, Meuris B, Meyns B, Verbrugghe P. Global cardiac surgery: Access to cardiac surgical care around the world. J Thorac Cardiovasc Surg 2019; 159:987-996.e6. [PMID: 31128897 DOI: 10.1016/j.jtcvs.2019.04.039] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [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: 11/11/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Cardiovascular disease is the leading cause of death worldwide, responsible for 17.5 million deaths every year, of which 80% occur in low- and middle-income countries. Some 75% of the world does not have access to cardiac surgery when needed because of lack of infrastructure, human resources, and financial coverage. This study aims to map access to cardiac surgery around the world. METHODS A scoping review was done on access to cardiac surgery for an undifferentiated population. Workforce data were collected from the Cardiothoracic Surgery Network database and used to calculate numbers and ratios of adult and pediatric cardiac surgeons to population. RESULTS A total of 12,180 adult cardiac surgeons and 3858 pediatric cardiac surgeons were listed in the Cardiothoracic Surgery Network in August 2017, equaling 1.64 (0-181.82) adult cardiac surgeons and 0.52 (0-25.97) pediatric cardiac surgeons per million population globally. Large disparities existed between regions, ranging from 0.12 adult cardiac surgeons and 0.08 pediatric cardiac surgeons per million population (sub-Saharan Africa) to 11.12 adult cardiac surgeons and 2.08 pediatric cardiac surgeons (North America). Low-income countries possessed 0.04 adult cardiac surgeons and 0.03 pediatric cardiac surgeons per million population, compared with 7.15 adult cardiac surgeons and 1.67 pediatric cardiac surgeons in high-income countries. CONCLUSIONS This study maps the current global state of access to cardiac surgery. Disparities exist between and within world regions, with a positive correlation between a nation's economic status and access to cardiac surgery. Low early mortality rates in low-resource settings suggest the possibility of high-quality cardiac surgery in low- and middle-income countries. There is the need to increase human and physical resources, while focusing on safety, quality, and efficiency to improve access to cardiac surgery for the 4.5 billion people without.
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Affiliation(s)
- Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass.
| | - Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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17
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Wyler von Ballmoos M, Likosky DS, Rezaee M, Lobdell K, Alam S, Parker D, Owens S, Thiessen-Philbrook H, MacKenzie T, Brown JR. Elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery. BMC Nephrol 2018; 19:280. [PMID: 30342486 PMCID: PMC6195960 DOI: 10.1186/s12882-018-1093-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/09/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Previous research suggests that novel biomarkers may be used to identify patients at increased risk of acute kidney injury following cardiac surgery. The purpose of this study was to evaluate the relationship between preoperative levels of circulating Galectin-3 (Gal-3) and acute kidney injury after cardiac surgery. METHODS Preoperative serum Gal-3 was measured in 1498 patients who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery as part of the Northern New England Biomarker Study between 2004 and 2007. Preoperative Gal-3 levels were measured using multiplex assays and grouped into terciles. Univariate and multinomial logistic regression was used to assess the predictive ability of Gal-3 terciles and AKI occurrence and severity. RESULTS Before adjustment, patients in the highest tercile of Gal-3 had a 2.86-greater odds of developing postoperative KDIGO Stage 2 or 3 (p < 0.001) and 1.70-greater odds of developing KDIGO Stage 1 (p = < 0.001), compared to the first tercile. After adjustment, patients in the highest tercile had 2.95-greater odds of developing KDIGO Stage 2 or 3 (p < 0.001) and 1.71-increased odds of developing KDIGO Stage 1 (p = 0.001), compared to the first tercile. Compared to the base model, the addition of Gal-3 terciles improved discriminatory power compared to without Gal-3 terciles (test of equality = 0.042). CONCLUSION Elevated preoperative Gal-3 levels significantly improves predictive ability over existing clinical models for postoperative AKI and may be used to augment risk information for patients at the highest risk of developing AKI and AKI severity after cardiac surgery.
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Affiliation(s)
| | - Donald S. Likosky
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
- Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI USA
| | - Michael Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Shama Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Devin Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | - Sherry Owens
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
| | | | - Todd MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
| | - Jeremiah R. Brown
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH USA
- Department of Biomedical Data Science, HB 7505 Dartmouth-Hitchcock Medical Center, Lebanon, NH NH 03756 USA
- Department of Epidemiology, Geisel School of Medicine, Lebanon, NH USA
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Abstract
For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from "postoperative delirium" to "postoperative cognitive dysfunction or decline." Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Postoperative cognitive dysfunction is not included in the DSM-5 and has been heterogeneously defined, though a recent international nomenclature effort has proposed standardized definitions for it. Here, the authors discuss pathophysiologic mechanisms that may underlie these complications, review the literature on methods to prevent them, and discuss novel approaches to understand their etiology that may lead to novel treatment strategies. Future studies should measure both delirium and postoperative cognitive dysfunction to help clarify the relationship between these important postoperative complications.
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Affiliation(s)
- Miles Berger
- Assistant Professor, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Niccolò Terrando
- Assistant Professor, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - S. Kendall Smith
- Critical Care Fellow, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jeffrey N. Browndyke
- Assistant Professor, Division of Geriatric Behavioral Health, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Mark F. Newman
- Merel H. Harmel Professor of Anesthesiology, and President of the Private Diagnostic Clinic, Duke University Medical Center, Durham, NC
| | - Joseph P. Mathew
- Jerry Reves, MD Professor and Chair, Department of Anesthesiology, Duke University Medical Center, Durham, NC
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19
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Mehran R. The History of Clinical Research Workshop at CIT: A Ten Year Perspective. Catheter Cardiovasc Interv 2018. [PMID: 29542282 DOI: 10.1002/ccd.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others. This update covers several topics of interest to cardiac surgeons and cardiologists, focusing on controversial issues specific to the practice of cardiothoracic surgery: informed consent, relations with hospitals and euthanasia and physician-assisted suicide. The future holds much uncertainty for cardiac surgical practice, research and culture, and we provide an update on ethical issues to serve as a platform for envisioning what is to come.
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Affiliation(s)
- Robert M Sade
- Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, 114 Doughty Street, STB 277, MSC 295, Charleston, SC 29425, USA
| | - Minoo N Kavarana
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, 96 Jonathan Lucas Street, CSB 424, MSC 613, Charleston, SC 29425, USA
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21
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Pamukcu O, Tuncay A, Narin N, Baykan A, Korkmaz L, Argun M, Ozyurt A, Sunkak S, Uzum K. Patent Ductus Arteriosus closure in preterms less than 2kg: Surgery versus transcatheter. Int J Cardiol 2017; 250:110-115. [PMID: 29017778 DOI: 10.1016/j.ijcard.2017.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/18/2017] [Revised: 07/23/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND As new devices come into the market, percutaneous techniques improve and interventionalists become more experienced; percutaneous closure gets more common in preterms. In this study we aimed to compare efficacy and safety of Patent Ductus Arteriosus closure surgically versus transcatheter method in preterms <2kg. Best of our knowledge this study is the first one that compares outcomes of surgery and percutaneous Patent Ductus Arteriosus closure in preterms. METHODS & RESULTS Between the dates July 1997 to October 2014 in our center Patent Ductus Arteriosus of 26 patients <2kg were closed percutaneously (Group A) and 31 less than 2kg operated (Group B). Weight of patients in percutaneous Patent Ductus Arteriosus closure group was significantly more than the surgery group. Mean gestational age of the patients in Group A was 30±1.8weeks, in group B was 28.6±3.5weeks. In group A; all cases were closed successfully except 4 cases: device embolization in 2, cardiac tamponade and iatrogenic aortic coarctation were seen. Pneumomediastinum and chylothorax were the major complications of the surgery group. There was no statistically significance between complication and success rates between two groups. CONCLUSION Percutaneous Patent Ductus Arteriosus closure is the candidate for taking the place of surgery in preterms. However, it is not applied routinely; can only be done in fully equipped large centers by experienced interventionalists.
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Affiliation(s)
- Ozge Pamukcu
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye,.
| | - Aydin Tuncay
- Erciyes University School of Medicine, Division of Cardiovascular Surgery, Kayseri, Turkiye
| | - Nazmi Narin
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
| | - Ali Baykan
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
| | - Levent Korkmaz
- Erciyes University School of Medicine, Division of Neonatology, Kayseri, Turkiye
| | - Mustafa Argun
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
| | - Abdullah Ozyurt
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
| | - Suleyman Sunkak
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
| | - Kazim Uzum
- Erciyes University School of Medicine, Division of Pediatric Cardiology, Kayseri, Turkiye
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Doenst T, Essa Y, Jacoub K, Moschovas A, Gonzalez-Lopez D, Kirov H, Diab M, Bargenda S, Faerber G. Cardiac surgery 2016 reviewed. Clin Res Cardiol 2017; 106:851-867. [PMID: 28396989 DOI: 10.1007/s00392-017-1113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 01/09/2023]
Abstract
For the year 2016, more than 20,000 published references can be found in Pubmed when entering the search term "cardiac surgery". Publications last year have helped to more clearly delineate the fields where classic surgery and modern interventional techniques overlap. The field of coronary bypass surgery (partially compared to percutaneous coronary intervention) was enriched by five large prospective randomized trials. The value of CABG for complex coronary disease was reconfirmed and for less complex main stem lesions, PCI was found potentially equal. For aortic valve treatment, more evidence was presented for the superiority of transcatheter aortic valve implantation for patients with intermediate risk. However, the 2016 evidence argued against the liberal expansion to the low-risk field, where conventional aortic valve replacement still appears superior. For the mitral valve, many publications emphasized the significant impact of mitral valve reconstruction on survival in structural mitral regurgitation. In addition, there were many relevant and other interesting contributions from the purely operative arena in the fields of coronary revascularization, surgical treatment of valve disease, terminal heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While this article attempts to summarize the most pertinent publications it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Yasin Essa
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Khalil Jacoub
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - David Gonzalez-Lopez
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Steffen Bargenda
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Affiliation(s)
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Putzu A, Capelli B, Belletti A, Cassina T, Ferrari E, Gallo M, Casso G, Landoni G. Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials. Crit Care 2016; 20:395. [PMID: 27919293 PMCID: PMC5139027 DOI: 10.1186/s13054-016-1560-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients. METHODS Electronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery. Postoperative outcomes were acute kidney injury, atrial fibrillation, myocardial infarction, stroke, infections, and mortality. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using fixed-effects meta-analyses. Primary analysis was restricted to trials with low risk of bias according to Cochrane methodology, and sensitivity analyses examined whether the risk of bias of included studies was associated with different results. We performed trial sequential analysis (TSA) to test the strength of the results. RESULTS We included data from 23 RCTs involving 5102 patients. Meta-analysis of trials with low risk of bias showed that statin therapy was associated with an increase in acute kidney injury (314 of 1318 (23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26 (95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No difference in postoperative atrial fibrillation, myocardial infarction, stroke, infections, or mortality was present. On sensitivity analysis, statin therapy was associated with a slight increase in hospital mortality. Meta-analysis including also trials with high or unclear risk of bias showed no beneficial effects of statin therapy on any postoperative outcomes. CONCLUSIONS There is no evidence that statin therapy in the days prior to cardiac surgery is beneficial for patients' outcomes. Particularly, statins are not protective against postoperative atrial fibrillation, myocardial infarction, stroke, or infections. Statins are associated with a possible increased risk of acute kidney injury and a detrimental effect on hospital survival could not be excluded. Future RCTs should further evaluate the safety profile of this therapy in relation to patients' outcomes and assess the more appropriate time point for discontinuation of statins before cardiac surgery.
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Affiliation(s)
- Alessandro Putzu
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Bruno Capelli
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milano, Italy
| | - Tiziano Cassina
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Gabriele Casso
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milano, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, Milano, Italy
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Sharif H, Tufail M. Innovations in cardiovascular care: Historical perspective, contemporary practice, recent trends and future directions. J PAK MED ASSOC 2016; 66(Suppl 3):S12-S15. [PMID: 27895342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiovascular diseases continue to be a major cause of mortality and morbidity in the world population. First open heart procedure was performed by Gibbon in 1953, since then many advancements have been introduced to the field of cardiac surgery. Minimally invasive techniques were introduced, which include minimally invasive coronary artery bypass grafting (CABG), off-pump technique, minimally invasive valve surgery or transcatheter techniques to implant stentless or sutureless valves. The hybrid strategy to address coronary disease combines catheterisation procedures with standard surgical techniques. Cardiac imaging has also progressed to provide three-dimensional images of the heart, enabling surgeons to plan procedures with greater accuracy. Left ventricular assist devices can be used in patients suffering from cardiogenic shock or awaiting heart transplantation. Total artificial heart can be used for biventricular mechanical support. As technology becomes increasingly used for patient management, the future surgeon needs to be trained in minimally invasive surgical techniques.
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Affiliation(s)
- Hasanat Sharif
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi
| | - Mayera Tufail
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi
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26
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Lane R. Shengshou Hu: leader of cardiac surgery and health reform in China. Lancet 2016; 388:752. [PMID: 27560267 DOI: 10.1016/s0140-6736(16)31350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Cardiopulmonary (CPB) bypass is 50 years old this year, and has undergone considerable change in that time, particularly with regard to developing technology. However, in recent years the routine application of CPB, as the treatment of choice for patients undergoing reparative heart surgery, has been challenged by new, evolving techniques, particularly Off-Pump Coronary Artery Bypass (OPCAB) and stenting. This paper considers whether CPB still represents a sound investment prospect, with particular emphasis on the biomaterial developments currently taking place. Whilst we accept that routine application of CPB is shrinking under pressure from less invasive techniques, we suggest that this may represent an opportunity to deliever a more highly evolved perfusion to the core of very sick and complex patients who may not be suitable candidates for OPCAB or stenting. These patients will benefit from the application of new technologies currently under development, such as smaller perfusion circuits, improved biomaterial surfaces, smart membranes, and biosensor technology, all aimed at making clinical perfusion a safer and more predictable procedure for the patient. All things conssidered, we feel that CPB, although shrinking in absolute size, still represents a good investment.
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Affiliation(s)
- T Gourlay
- Department of Cardiothoracic Surgery, NHLI, Imperial College London, Faculty of Medicine, London, UK.
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D'Onofrio A, Gerosa G. Shifting a Paradigm of Cardiac Surgery: From Minimally Invasive to Micro-Invasive. J Heart Valve Dis 2015; 24:528-530. [PMID: 26897830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The development of new techniques for the treatment of almost all structural heart pathologies that do not require cardiopulmonary bypass and aortic cross-clamping, such as transcatheter aortic valve replacement and transapical mitral chordae implantation, define a new age of our specialty: the micro-invasive (microICS) cardiac surgery era.
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Vogt P, Mach F. [The war is over -- let us learn to work together]. Rev Med Suisse 2015; 11:1163-1164. [PMID: 26182633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Emontzpohl C, Goetzenich A, Simons D, Kraemer S, Dewor M, Lue H, Hammer L, Jacobs D, Grieb G, Ziegler P, Panse J, Rossaint R, Bernhagen J, Stoppe C. Key role of MIF in the migration of endothelial progenitor cells in patients during cardiac surgery. Int J Cardiol 2015; 181:284-7. [PMID: 25535692 DOI: 10.1016/j.ijcard.2014.11.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/22/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Christoph Emontzpohl
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany; Department of Anesthesiology, University Hospital, RWTH Aachen University, Germany.
| | - Andreas Goetzenich
- Department for Thoracic and Cardiovascular Surgery, University Hospital, RWTH Aachen University, Germany.
| | - David Simons
- German Cancer Research Center (DKFZ), Radiology (E010), Heidelberg, Germany; Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital, RWTH Aachen University, Germany.
| | - Sandra Kraemer
- Department for Thoracic and Cardiovascular Surgery, University Hospital, RWTH Aachen University, Germany.
| | - Manfred Dewor
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany.
| | - Hongqi Lue
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany.
| | - Luise Hammer
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany; Department of Anesthesiology, University Hospital, RWTH Aachen University, Germany.
| | - Denise Jacobs
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany.
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital, RWTH Aachen University, Germany.
| | - Patrick Ziegler
- Department of Oncology, Hematology, Hemostaseology, and Stem Cell Transplantation, University Hospital, RWTH Aachen University, Germany.
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology, and Stem Cell Transplantation, University Hospital, RWTH Aachen University, Germany.
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital, RWTH Aachen University, Germany.
| | - Jürgen Bernhagen
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany.
| | - Christian Stoppe
- Institute of Biochemistry and Molecular Cell Biology, University Hospital, RWTH Aachen University, Germany; Department of Anesthesiology, University Hospital, RWTH Aachen University, Germany.
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Quarti A. We have to be pioneers: we owe it to the future generations. J Thorac Cardiovasc Surg 2014; 149:397. [PMID: 25524695 DOI: 10.1016/j.jtcvs.2014.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea Quarti
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Ospedali Riuniti, Ancona, Italy
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D'Ancona G. Transfusion practice in cardiac surgery: ars longa, vita brevis, iudicium difficile (the art is long, life is short, and decision difficult). J Thorac Cardiovasc Surg 2014; 149:303-4. [PMID: 25312224 DOI: 10.1016/j.jtcvs.2014.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/20/2022]
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35
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Jones M. Developing cardiac surgery: "bypassing the limits". Ulster Med J 2014; 83:128. [PMID: 25211787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Carlesimo B, Lo Torto F, Rossi A, Marcasciano M, Ruggiero M. Long-term result of bilateral pectoralis major muscle advancement flap in median sternotomy wound infections. Eur Rev Med Pharmacol Sci 2014; 18:3767-3772. [PMID: 25555865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Deep sternal wound infection (DSWI) is an uncommon but serious complication of open heart surgery being characterized by a high mortality rate and a considerable economic weight. Repair of sternal defects, compromised with infection, can be achieved in several ways. The aim of our study is to report our case load in the management of sternal wound infection. PATIENTS AND METHODS In this study, we will report our twelve-year case load with bilateral pectoralis major advancement flap as the sole treatment modality for deep sternal wound infection. RESULTS This surgical approach has given excellent results in terms of resolution of the infection of the sternum, with few complications and a good cosmetic result. CONCLUSIONS We propose bilateral pectoralis major advancement flap as the first choice treatment for deep sternal wound infection.
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Affiliation(s)
- B Carlesimo
- Department of Plastic and Reconstructive and Aesthetic Surgery, Sapienza University of Rome, Rome, Italy.
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Stefanadis CI. New frontiers in interventional cardiology: from the past to the future. Hellenic J Cardiol 2014; 55:87-88. [PMID: 24491943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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38
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Goldberg SL. The future of innovation in interventional cardiology--have we left the golden era? J Invasive Cardiol 2013; 25:566. [PMID: 24184889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Steven L Goldberg
- The Cardiac Catheterization Laboratory at University of Washington in Seattle, Washington.
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Suri RM, Thompson JE, Burkhart HM, Huebner M, Borah BJ, Li Z, Michelena HI, Visscher SL, Roger VL, Daly RC, Cook DJ, Enriquez-Sarano M, Schaff HV. Improving affordability through innovation in the surgical treatment of mitral valve disease. Mayo Clin Proc 2013; 88:1075-84. [PMID: 24079678 DOI: 10.1016/j.mayocp.2013.06.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 03/20/2013] [Revised: 06/11/2013] [Accepted: 06/21/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether technically innovative cardiac surgical platforms (ie, robotics) deployed in conjunction with surgical process improvement (systems innovation) influence total hospital costs to address the concern that expanding adoption might increase health care expenses. PATIENTS AND METHODS We studied 185 propensity-matched patient pairs (370 patients) undergoing isolated conventional open vs robotic mitral valve repair with identical repair techniques and care teams between July 1, 2007, and January 31, 2011. Two time periods were considered, before the implementation of system innovations (pre-July 2009) and after implementation. Generalized linear mixed models were used to estimate the effect of the type of surgery on cost while adjusting for a time effect. RESULTS Baseline characteristics of the study patients were similar, and all patients underwent successful mitral valve repair with no early deaths. Median length of stay (LOS) for patients undergoing open repair was unchanged at 5.3 days (P=.636) before and after systems innovation implementation, and was lower for robotic patients at 3.5 and 3.4 days, respectively (P=.003), throughout the study. The overall median costs associated with open and robotic repair were $31,838 and $32,144, respectively (P=.32). During the preimplementation period, the total cost was higher for robotic ($34,920) than for open ($32,650) repair (P<.001), but during the postimplementation period, the median cost of robotic repair ($30,606) became similar to that of open repair ($31,310) (P=.876). The largest decrease in robotic cost was associated with more rapid ventilator weaning and shortened median intensive care unit LOS, from 22.7 hours before July 2009 to 9.3 hours after implementation of systems innovations (P<.001). CONCLUSION Following the introduction of systems innovation, the total hospital cost associated with robotic mitral valve repair has become similar to that for a conventional open approach, while facilitating quicker patient recovery and diminished utilization of in-hospital resources. These data suggest that innovations in techniques (robotics) along with care systems (process improvement) can be cost-neutral, thereby improving the affordability of new technologies capable of improving early patient outcomes.
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Affiliation(s)
- Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
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Sathananthan J, Ruygrok P. Evolution in the management of postinfarct ventricular septal defects from surgical to percutaneous approach: a single-center experience. J Invasive Cardiol 2013; 25:339-343. [PMID: 23813062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Postinfarction ventricular septal defect (VSD) is an uncommon but serious complication of myocardial infarction associated with high mortality. While traditionally postinfarct VSDs were only closed surgically, percutaneous closure is a newer treatment strategy that has been introduced with success in recent years. We sought to assess trends in treatment choice at our center. METHODS AND RESULTS A single-center, retrospective study design included all patients treated for postinfarction VSDs, either surgically or percutaneously, from January 1992 to December 2012. Percutaneous closure was performed using the self-expandable, double-disc Amplatzer closure device. Over the 20-year study period, a total of 25 patients were treated for postinfarct VSDs, with 18 managed surgically and 7 managed percutaneously. Two patients with an initial surgical repair experienced patch dehiscence and were subsequently treated percutaneously, bringing the number in this group to 9. The use of surgical closure declined over time, with percutaneous closure being the only treatment strategy used from 2004 onward. Mortality rates were 44% and 75% for those with final percutaneous and surgical closure, respectively (P<.13). Mortality rates in patients presenting with and without cardiogenic shock were 80% and 46%, respectively (P<.05). CONCLUSION Percutaneous closure has become the preferred treatment of postinfarct VSDs at our center. Percutaneous closure may be a viable and non-inferior treatment strategy compared to traditional surgical closure.
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Punjabi PP. Evolution of myocardial support: a shifting paradigm. Perfusion 2013; 28:96. [PMID: 23443249 DOI: 10.1177/0267659113478113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tapponnier M, Yarol N, Vincenti G, Hullin R, Schwitter J, Muller O. [Cardiology]. Rev Med Suisse 2013; 9:28-35. [PMID: 23367700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The present review provides a selected choice of clinical research in the field of interventional cardiology, heart failure and cardiac imaging. We also focused on the new guidelines published by the European society of cardiology in 2012.
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Affiliation(s)
- M Tapponnier
- Unité de cardiologie interventionnelle, CHUV, 1011 Lausanne.
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Hoshino J, Fukada Y, Hirota M, Kondo T, Isomura T. [Preserving autologous heart operation for dilated cardiomyopathy]. Kyobu Geka 2013; 66:31-36. [PMID: 23985402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We report non transplant surgical procedure (preserving autologous heart operation) for the patients with dilated cardiomyopathy( DCM), clinical outcomes, and the factor of predict prognosis. PATIENT AND METHOD Since May 2000, 258 patients received surgical procedure for 11 years. SURGICAL PROCEDURES We performed mitral surgery (plasty or replacement) for the patients with more than mild mitral regurgitation (MR). We performed papirally muscule plication since 2005, and we performed 2nd chordal cutting since 2008, for the patients with MR due to mitral tethering. The surgical left ventricular reconstruction( SVR) was performed for the patients with dilated left ventricular. We use spackle tracking echocardiography to decide the type of SVR since 2008. RESULT Hospital death was 18.2%, and late cardiac death was 27.5%.Almost the cause of death was congestive heart failure and ventricular arrhythmia. Five years survival was 58%, 10 years survival was 39%. Preoperative condition, emergent operation, inotropic support, intra aortic balloon pumping(IABP),affect the prognosis. But left ventricular size did not affect it. CONCLUSION Surgical treatment for the patient with DCM should be performed with stable preoperative condition.
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Affiliation(s)
- Joji Hoshino
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
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Maĭstrenko AD, Gurshchenkov AV, Paskar' NS, Pakhomov AV, Sukhova IV, Gordeev ML. [Current state of the problem of surgical treatment of hypertrophic obstructive cardiomyopathy]. Vestn Khir Im I I Grek 2013; 172:82-87. [PMID: 24000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kshettry VR, Aranki SF. Current trends in mitral valve repair techniques in North America. J Heart Valve Dis 2012; 21:690-695. [PMID: 23409346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The current trends in the surgical technique of mitral valve repair (MVR) among North American medical centers participating in the Sorin Valve Repair Registry are described. METHODS A total of 2,314 MVR procedures was performed and documented between 2003 and 2009 at 89 North American medical centers. Surgical procedure characteristics on all mitral valve annuloplasty and valve reconstructions were collected by participating surgeons, and documented in the registry. RESULTS Early in the reporting period (between 2003 and 2007), posterior leaflet resection comprised 60% of all MVR procedures, but the percentage declined systematically through the years 2008 (56.1%) and 2009 (50.4%). A decrease over time was also observed in the frequency of sliding valvuloplasty procedures (from -30% in 2003 to 4.0% in 2009). Proportions of chordal repair techniques tended to increase towards the end of the reporting period, from a low of 15% in 2003 to a peak of 32% in 2008. CONCLUSION This report documents important trends in current MVR techniques among a representative cohort of surgical centers across North America. The data obtained were consistent with a practical shift from the conventional surgical MVR techniques to methods that allow a greater leaflet preservation--and thus less resection--over the latter half of the reporting period.
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Affiliation(s)
- Vibhu R Kshettry
- Minneapolis Heart Institute, Cardiac, Thoracic and Transplant Surgery, 920 East 28th Street, Suite 610, Minneapolis, MN 55407, USA.
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Parcharidis G. Interventional cardiology for structural heart disease. Hellenic J Cardiol 2012; 53:403-404. [PMID: 22995614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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Snyman G, Tucker JEL, Cimini M, Narine K, Fedak PWM. Canadian cardiac surgeons' perspectives on biomedical innovation. Can J Cardiol 2012; 28:607-10. [PMID: 22902159 DOI: 10.1016/j.cjca.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/04/2012] [Accepted: 04/09/2012] [Indexed: 11/18/2022] Open
Abstract
Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada.
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Affiliation(s)
- Gretchen Snyman
- Master of Biomedical Technology Program, Faculty of Graduate Studies, University of Calgary, Calgary, Alberta, Canada
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Ishikawa N, Watanabe G. [Current status and perspective of robot-assisted cardiac surgery]. Nihon Geka Gakkai Zasshi 2012; 113:303-307. [PMID: 22708389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Norihiko Ishikawa
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
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