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Costa IBSDS, Rochitte CE, Campos CM, Barberato SH, de Oliveira GMM, Lopes MACQ, Nomura CH, Abizaid AA, Cerri G, Kalil R, Hajjar LA. Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection. Arq Bras Cardiol 2020; 115:111-126. [PMID: 32813825 PMCID: PMC8384321 DOI: 10.36660/abc.20200370] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.
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Affiliation(s)
- Isabela Bispo Santos da Silva Costa
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasil Universidade de São Paulo Instituto do Câncer do Estado de São Paulo , São Paulo , SP - Brasil
| | - Carlos Eduardo Rochitte
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
- Hospital do CoraçãoSão PauloSPBrasil Hospital do Coração , São Paulo , SP - Brasil
- Hospital Pró-CardíacoRio de JaneiroRJBrasil Hospital Pró-Cardíaco , Rio de Janeiro , RJ - Brasil
| | - Carlos M. Campos
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração - Hemodinâmica e Cardiologia Intervencionista, São Paulo , SP - Brasil
- Hospital Israelita Albert EinsteinSão PauloSPBrasil Hospital Israelita Albert Einstein - Hemodinâmica e Cardiologia Intervencionista, São Paulo , SP - Brasil
| | - Silvio Henrique Barberato
- CardioEcoCuritibaPRBrasil CardioEco -Centro de Diagnóstico Cardiovascular, Curitiba , PR - Brasil
- Quanta DiagnósticoCuritibaPRBrasil Quanta Diagnóstico – Ecocardiografia, Curitiba , PR - Brasil
| | - Gláucia Maria Moraes de Oliveira
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasil Universidade Federal do Rio de Janeiro – Cardiologia, Rio de Janeiro , RJ - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza WanderleyJoão PessoaPBBrasil Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa , PB - Brasil
- Hospital Metropolitano Dom José Maria PiresJoão PessoaPBBrasil Hospital Metropolitano Dom José Maria Pires , João Pessoa , PB - Brasil
- Sociedade Brasileira de CardiologiaRio de JaneiroRJBrasil Sociedade Brasileira de Cardiologia , Rio de Janeiro , RJ - Brasil
| | - Cesar Higa Nomura
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Alexandre A. Abizaid
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
- Hospital Sírio LibanêsSão PauloSPBrasil Hospital Sírio Libanês , São Paulo , SP - Brasil
| | - Giovanni Cerri
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Roberto Kalil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
| | - Ludhmila Abrahão Hajjar
- Universidade de São PauloInstituto do Câncer do Estado de São PauloSão PauloSPBrasil Universidade de São Paulo Instituto do Câncer do Estado de São Paulo , São Paulo , SP - Brasil
- Universidade de São PauloInstituto do CoraçãoSão PauloSPBrasil Universidade de São Paulo Instituto do Coração , São Paulo , SP - Brasil
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Affiliation(s)
- Bartlomiej Imielski
- Integrated Thoracic Surgery Resident, Division of Cardiac Surgery, Bluhm Cardiovascular Institute of Northwestern University, Chicago, IL, USA.
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Li S, Cui L, Anderson C, Gao C, Yu C, Shan G, Wang L, Peng B. Cardiovascular surgery experience does not significantly improve patients' response to stroke. Brain Behav 2019; 9:e01405. [PMID: 31515973 PMCID: PMC6790311 DOI: 10.1002/brb3.1405] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS. METHODS We performed a cross-sectional community-based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively. RESULTS 0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99-1.98, p = .0572). CONCLUSIONS Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.
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Affiliation(s)
- Shengde Li
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Li‐Ying Cui
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
| | - Craig Anderson
- Neurological and Mental Health DivisionThe George Institute for Global HealthFaculty of MedicineUniversity of New South WalesSydneyAustralia
- The George Institute for Global HealthPeking University Health Science CenterBeijingChina
| | - Chunpeng Gao
- Disease Control and Prevention OfficeDalian Municipal Central HospitalLiaoningChina
| | - Chengdong Yu
- Department of Epidemiology and StatisticsInstitute of Basic Medical SciencesChinese Academy of Medical SciencesBeijingChina
| | - Guangliang Shan
- Department of Epidemiology and StatisticsInstitute of Basic Medical SciencesChinese Academy of Medical SciencesBeijingChina
| | - Longde Wang
- Stroke Control Project CommitteeThe National Health CommissionBeijingChina
| | - Bin Peng
- Department of NeurologyPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijingChina
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Lee JS, Hu HM, Brummett CM, Syrjamaki JD, Dupree JM, Englesbe MJ, Waljee JF. Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA 2017; 317:2013-2015. [PMID: 28510669 PMCID: PMC5815008 DOI: 10.1001/jama.2017.2827] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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] [Indexed: 11/14/2022]
Abstract
This study uses insurance claims and HCAHPS data to investigate correlations between measures of pain and patient satisfaction after hospital discharge and postoperative opioid prescriptions.
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Affiliation(s)
- Jay S. Lee
- Department of Surgery, University of Michigan, Ann Arbor
| | - Hsou M. Hu
- Department of Surgery, University of Michigan, Ann Arbor
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Boku N, Masuda M, Eto M, Nishida T, Morita S, Tominaga R. Risk Evaluation and Midterm Outcome of Cardiac Surgery in Patients on Dialysis. Asian Cardiovasc Thorac Ann 2016; 15:19-23. [PMID: 17244917 DOI: 10.1177/021849230701500105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
The medical charts of 54 patients on maintenance dialysis who underwent cardiovascular surgery (37 elective and 17 urgent/emergency) from 1994 to 2004 were retrospectively analyzed. Thirty patients had coronary artery bypass grafting (17 elective and 13 urgent/emergency), 18 had valve replacement (16 elective and 2 urgent/emergency), and 6 underwent aortic surgery (4 elective and 2 urgent/emergency). The overall early mortality rate was 11.1%, comprising 2 patients (5.4%) who had elective operations and 4 (23.5%) who had urgent or emergency operations ( p = 0.049). The overall 5-year survival rate was 48.4%. The 5-year survival rate was 67.2% for elective surgery and 10.5% for urgent/emergency surgery ( p = 0.0001). The midterm clinical results after elective cardiovascular surgery were acceptable, whereas the results after urgent/emergency surgery were poor. For elective surgery, sufficient and detailed preoperative examinations might have contributed to the better operative outcome. Early diagnosis and consultation to avoid urgent/emergency operations in dialysis patients is recommended.
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Affiliation(s)
- Noriko Boku
- Department of Surgery, Graduate School of Medicine, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Charchian ÉR, Stepanenko AB, Gens AP, Abugov SA, Poliakov RS, Belov IV, Galeev NA. [Clinical management of patients with abdominal aortic aneurysms combined with coronary artery disease and multifocal atherosclerosis]. Kardiologiia 2014; 54:37-41. [PMID: 25102747 DOI: 10.18565/cardio.2014.3.37-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We have analyzed clinical management of 137 patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease treated during last 10 years in the First Cardiac Surgery Department (Surgery of the Aorta and its Branches) of the Petrovsky National Research Center of Surgery. All patients were subjected to surgery involving both vascular regions: in 130 patients (94.9%) the procedures were staged while 7 patients underwent myocardial revascularization simultaneously with the reconstruction of the abdominal aorta from the minimal access. According to our results staged procedures are safer for patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease given the organism's limited capacity due to age and comorbidities. Endovascular repair techniques applied both to the coronary arteries and to the abdominal aorta should be always regarded primarily as a gentle form of intervention. In cases where open surgery is required one should try to avoid blood loss, reduce the duration of the procedure and use minimal access surgery when applicable. The overall mortality rate in patients treated for this disorder over the last 10 years was 2.1%.
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Lebed' IG, Rudenko NN, Babliak AD, Romaniuk AN, Khanenova VA, Emets IN. [Results of the cardiosurgical care delivery to teenagers and adult patients with inborn heart failures]. Klin Khir 2014:30-33. [PMID: 25252409] [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: 06/03/2023]
Abstract
The results of surgical aid delivery to adult patients, suffering inborn heart failures (IHF), were analyzed for period of 15 yrs. Surgical activity in teenagers and adult patients, suffering IHF, was analyzed with the objective to create a management strategy for such patients. More close dispensary control of teenagers in a pediatrician-cardiologist was noted, while their transfer to the adult clinic it is necessary to follow them thoroughly together with dispensary registration. Progressive enhancement of the patients quantity was registered, in whom more complex and combined inborn anomalies of the heart and the main vessels were diagnosed. Enhancement of the interventions quantity, which are performed on the exit tract of left ventricle and ascending aorta and what is caused by introduction of angiographic interventions, was noted together with total rising of the operations quantity.
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Mach F, Muller O. [Keep a critical mind!]. Rev Med Suisse 2014; 10:1163-1164. [PMID: 24964522] [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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Miltner B, Lancellotti P, Seghaye MC. [European Society of Cardiology guidelines for the management of complex grown-up congenital heart disease]. Rev Med Liege 2014; 69:16-25. [PMID: 24640304] [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: 06/03/2023]
Abstract
The number of patients with Grown-Up Congenital Heart disease (GUCH) consulting adult cardiologists is steadily increasing. These patients have either a non-diagnosed congenital heart disease revealed at adulthood, or a diagnosed congenital heart disease for which one or multiple interventions have possibly been performed during childhood. In this article, we summarize the recommendations of the European Society of Cardiology of 2010 for complex congenital heart disease.
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Zhuraev RK, Zerbino DD. [Marfan syndrome: clinical and pathomorphological restructurings after surgical treatment of aortic aneurysm]. Angiol Sosud Khir 2014; 20:14-20. [PMID: 25490352] [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: 06/04/2023]
Abstract
The authors examined the state of patients suffering from Marfan syndrome (MS) who endured operation for ascending aorta aneurysm with replacement of the ascending aorta and aortic valve (Bentall operation), studying alterations of the skeleton, face, heart and eyes, as well as pathomorphological restructurings in the aortic wall. The study was carried out 7.0 ± 4.2 years after the operation. We examined a total of 39 patients with MS - 27 (69.2%) men and 12 (30.8%) women aged from 22 to 70 years old (average age - 42.1 ± 13.4 years). All patients were operated on for dissecting aneurysm of the ascending aorta accompanied by a considerable degree of aortic valve insufficiency or aortic ostium stenosis. The mean diameter of the aorta at the level of the sinuses of Valsalva amounted to 7.0 ± 1.3 cm (minimal - 5.0 cm, maximal - 12.0 cm), the Z-score prior to operation was 12.7 ± 6.5. The time form making the diagnosis of MS to surgical intervention for aortic aneurysm amounted to 9.6 ± 5.9 years. The condition after operative treatment in all patients was satisfactory, with the haemodynamic indices stable: systolic AP - 133.5 ± 19.1 mm Hg, diastolic AP 85.1 ± 12.9 mm Hg, heart rate 74.8 ± 7.2 bpm. The average systemic score for the symptoms and tests of MS patients amounted to 8.2 ± 3.3 points. Pathohistological alterations of the aorta in patients with Marfan syndrome consisted in pronounced restructuring of the wall with deep irreversible alternative changes. The pathological process extended in the middle aortic layer all alone the length, but not only in the portions of rupture and dissection. The main pathomorphological signs in MS were as follows: focal accumulations of mucoid substances, dystrophic alterations of smooth-muscle cells, ribbon-like anuclear zones, formation of cystlike cavities, alterations of elastic fibres - fragmentation, hyperelastosis, multiplication, thinning and straightening, zones of elastolysis.
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[V Congress of Cardiovascular Surgeons of Ukraine and Poland "Actual Problems of Cardiovascular Surgery", dedicated to the 100th birthday of academician M. M. Amosov]. Klin Khir 2013;:78-9. [PMID: 24283055] [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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Tadros MA, Williams VR, Plourde S, Callery S, Simor AE, Vearncombe M. Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery. Am J Infect Control 2013; 41:509-12. [PMID: 23266384 DOI: 10.1016/j.ajic.2012.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/17/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs. METHODS This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis. RESULTS A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05-52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00-2.21). CONCLUSIONS This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains.
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Affiliation(s)
- Manal A Tadros
- Department of Microbiology, University of Toronto, Toronto, ON, Canada.
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Abstract
Prior studies about the prognosis of syncopal patients shows that the 1-year mortality is consistently higher in cardiogenic than in non-cardiogenic or unexplained syncope. After 10 years, other studies have raised several concerns about this circumstantial evidence, showing that the risk of death is predicted by only the underlying heart disease and not from the syncope itself. This is a prospective cohort study aimed to compare the prognosis of cardiogenic and non-cardiogenic syncope. We studied 200 syncopal patients consecutively admitted to the Emergency Department Observation Unit of the University Hospital of Parma. At 1 month and 1 year after discharge, we compared the incidence of syncopal recurrences, major procedures, cardiovascular events and death for any reason in patients with cardiogenic versus non-cardiogenic syncope. Cardiogenic syncope was associated with the presence of at least one adverse event at short and long term. Despite the significant advances in the treatment of cardiovascular diseases over the past decades, cardiogenic syncope continues to be associated with a significantly worse prognosis when compared with non-cardiogenic syncope.
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Affiliation(s)
- Filippo Numeroso
- Emergency Department, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
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Holemans C, Van Damme H, Defraigne JO. [Should asymptomatic small popliteal artery aneurysms be operated on?]. Rev Med Liege 2012; 67:576-581. [PMID: 23346827] [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 authors recently observed two patients who suffered acute lower limb ischemia secondary to thrombosis of a small (diameter of less than 2 cm) popliteal artery aneurysm. A literature search lead to the conclusion that small popliteal aneurysms, covered with mural thrombus and presenting a distorted neck due to elongation, are prone to thrombosis. Another risk factor is a restrained outflow bed as a result of previous micro-embolisations into the tibial arteries. The authors conclude that small popliteal artery aneurysms are not so innocent as is often presumed.
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Affiliation(s)
- Ch Holemans
- Service de Chirurgie Cardio-vasculaire et Thoracique, CHU de Liège, Belgique
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Noble S, Müller H, Stampfli T, Meier B, Roffi M. [Percutaneous left atrial appendage closure: an alternative in patients with atrial fibrillation and high bleeding risk?]. Rev Med Suisse 2012; 8:1170-1176. [PMID: 22737951] [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
Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence increases with age. AF increases the risk of stroke by a factor of 5 and strokes related to AF are associated with higher mortality and morbidity when compared with strokes in patients with sinus rhythm. Oral anticoagulation is efficient to reduce the risk of stroke in AF patients, but with a substantial risk of bleeding. In clinical practice, 50% of the AF patients with an indication for oral anticoagulation do not receive the treatment. Indeed, many patients do not tolerate oral anticoagulation and this is still true despite the new drugs. Recently, percutaneous left atrial appendage closure for AF patients with high risk of stroke became a valid alternative to oral anticoagulation for stroke prevention.
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Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2009: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2012; 59:636-67. [PMID: 22231795 DOI: 10.1007/s11748-011-0838-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pavie A, Barreda E. [Surgery for infective endocarditis]. Rev Prat 2012; 62:527-529. [PMID: 22641898] [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
Surgical treatment is a cornerstone in the management of infective endocarditis, approximately 50% of patients should be operated in the acute phase. Surgery is indicated in heart failure by acute valvular insufficiency refractory to medica treatment, persistent sepsis despite adequate antibiotic therapy, infections by microorganisms with low response to antibiotics, paravalvular abscess or cardiac fistulas, and for prevention of cerebral embolism when large vegetations are present. Other indication in prosthetic valve endocarditis is prosthesis dysfunction including significant perivalvular leaks or obstruction. In infection of leads of electrophysiological cardiac devices material should always be removed, preferably percutaneously, surgery is indicated when it is not technically possible.
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Affiliation(s)
- Alain Pavie
- Service de chirurgie cardiaque, institut de cardiologie, groupe hospitalier de La Pitié-Salpêtrière, 75651 Paris Cedex 13.
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Samara ET, Aroua A, De Palma R, Stauffer JC, Schmidt S, Trueb PR, Stuessi A, Treier R, Bochud F, Verdun FR. An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres? Radiat Prot Dosimetry 2012; 148:74-82. [PMID: 21335331 DOI: 10.1093/rpd/ncq600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose-area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to patients for procedures of the lower limbs when they were performed in non-academic centres. This may be due to more complex procedures performed in the academic centres. Comparison between the centres showed a great variation in the patient dose for these lower limb procedures.
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Affiliation(s)
- E T Samara
- Institute of Radiation Physics, University Hospital Centre and University of Lausanne, Grand-Pré 1, 1007 Lausanne, Switzerland.
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Sumin AN, Gaĭfulin RA, Bezdenezhnykh AV, Mos'kin MG, Korok EV, Karpovich AV, Ivanov SV, Barbarash OL, Barbarash LS. [Prevalence of multifocal atherosclerosis in different age groups]. Kardiologiia 2012; 52:28-34. [PMID: 22839667] [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: 06/01/2023]
Abstract
Aim of the study was to assess prevalence of lesions in several arterial beds in patients with atherosclerosis of various localization in the clinic of cardiovascular surgery. We examined 1018 patients (825 men and 193 women, aged 31-78 years, mean age 59+/-12 years) in the period of preparation to elective surgical interventions on coronary arteries or other arterial beds. All patients were divided into 4 age groups: group 1 - younger than 60 years (n=542), group 2 - 60-64 years (n=215), group 3 - 65-69 years (n=141), group 4-70 years and older (n=120). All patients were subjected to coronary angiography and Doppler ultrasound investigation (USI) of extracranial arteries. USI of arteries of lower extremities and angiography of peripheral arteries were carried out if indicated. Presence of 50% or greater stenosis was considered a criterion of involvement of an arterial vascular bed. Lesions in 2 or more beds were found in 321 patients (31.5%). Stenoses in 2 and 3 arterial beds were revealed in 24 and 3.5%, respectively, of patients in group 1, and in 31.8 and 10%, respectively, of patients in group 4 (p=0.008). Purposeful diagnostics of multifocal atherosclerosis in patients of the given category apparently should not be limited by older age groups.
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Bokeriia LA, Arakelian VS, Zhane AK, Papitashvili VG, Siradze IV. [Remote results of open interventions in treatment of abdominal aortic aneurysms]. Angiol Sosud Khir 2012; 18:107-115. [PMID: 22929680] [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: 06/01/2023]
Abstract
Analysed herein are the results of treating a total of 471 patients operated on at the Department of Surgical Treatment for Arterial Pathology of the Research Centre of Cardiovascular Surgery named after A. N. Bakulev under the Russian Academy of Medical Sciences for an aneurysm of the infrarenal portion of the abdominal aorta. Complicated forms of AAA were observed in 71 (15.1%) patients. Of these, 13 patients were admitted presenting with a clinical picture of aortic rupture, 56 patients with aortic wall tear (according to ultrasound and/or MSCH findings), and two patients had break of the inferior vena cava. The most frequently encountered accompanying diseases were as follows: CAD noted in 367 (78.2%) patients. Valvular heart defects were revealed in 68 (14.4%) patients. Atherosclerotic alterations of the ascending aorta were diagnosed in 97 (20.6%) patients, and an ascending aortic aneurysm in 14 (2.8%) patients. Operations on the heart were performed in 45 (19.1%) patients. Mitral valve plasty was carried out in 7 patients, and 11 patients had a history of prior interventions on the aortic root and ascending aorta (Bentall-De Bono operation in 3 patients, Carbol operation in 3 patients). 32 patients underwent reconstructive operations on coronary arteries. Transmyocardial laser revascularization of the myocardium was carried out in 4 patients. Endovascular interventions were performed in 32 (6.8%) patients (stenting or transluminal balloon angioplasty of coronary arteries). All patients underwent AAA resection with prosthetic repair. The mentioned operations were combined with the following simultaneous interventions: aortocoronary bypass grafting performed in 31 cases, carotid endarterectomy in 27 cases, and plasty of renal arteries was carried out in 48 patients. Complications in the immediate postoperative period were observed in 79 (16.8%) patients. Hospital mortality amounted to 11 (2.3%) patients. The cumulative survival rate after 1, 5 and 10 years after surgery amounted to 93%, 81% and 44%, respectively, in a complicated course amounting to 91%, 79% and 16%, respectively. The obtained findings of the study demonstrated that the results of the AAA resection should be regarded as fairly good. The main factors influencing the quality of life and surgical outcomes in abdominal aortic aneurysms are as follows: CAD, arterial hypertension, and chronic cerebrovascular diseases. In patients without accompanying diseases, the criteria of quality of life after surgery approximate to those in a healthy population.
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Grisoli D, Chan V, Tran A, Ressler L, Nicholson D, Hynes M, Ruel M, Mesana TG. Frequency and surgical management of complex posterior leaflet prolapse of the mitral valve. J Heart Valve Dis 2010; 19:568-575. [PMID: 21053734] [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: 05/30/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Isolated posterior leaflet prolapse of the mitral valve may present with more complex anatomy than limited middle scallop prolapse (P2). The study aim was to describe the incidence and surgical management of extensive or commissural posterior leaflet prolapse, in addition to long-term outcomes following repair. METHODS Between October 2001 and May 2008, among 481 patients operated on for mitral valve prolapse, 201 consecutive patients underwent mitral valve repair for isolated posterior leaflet prolapse. Of the latter patients, only 81 (40%) had limited P2 prolapse, while the remaining 120 (60%) showed complex posterior leaflet prolapse, including either extensive (n = 105) or commissural (n = 15) prolapse. Extensive leaflet prolapse was treated with aggressive leaflet resection and sliding plasty, combined with a longitudinal annular plication using polytetrafluoroethylene running sutures. Commissural prolapse was repaired with an edge-to-edge technique or commissuroplasty. The clinical and echocardiographic follow up was complete for all patients, and extended up to 6.8 years (mean 2.4 +/- 1.9 years). RESULTS There was no hospital mortality. Repair was successful in 200 patients (99%), who showed no or trivial mitral regurgitation (MR) intraoperatively. The five-year freedom from recurrent MR (grade > 1+) was 91.5 +/- 4.2% in patients with isolated P2 prolapse, compared to 98.8 +/- 1.2% in patients with complex posterior leaflet prolapse (p = 0.07). The repair of complex posterior leaflet prolapse was also similar to that of isolated P2 prolapse with regard to five-year freedom from reoperation (98.9 +/- 5.9% versus 100%; p = 0.4), and survival (92.1 +/- 3.3% versus 88.9 +/- 8.0%; p = 0.9). CONCLUSION In the present series, posterior leaflet prolapse offered more complexity than usually reported, requiring surgical skills beyond simple quadrangular resection. However, the surgical approach, which typically involved extensive leaflet resection and sliding plasty, offered high repair rates and acceptable durability, considering the initial severity of the prolapse anatomy.
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Affiliation(s)
- Dominique Grisoli
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Affiliation(s)
- Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Casanova R, Selman-Houssein E, Palenzuela H, Cárdenas F, Carballés J, Savio A, Naranjo A, Ramiro JC. Cuba's national pediatric cardiology program. MEDICC Rev 2010; 12:6-9. [PMID: 20486407 DOI: 10.37757/mr2010.v12.n2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Esperón A, Kamaid E, Diamant M, Campos HP, Del Carmen Saldías M, Icasuriaga A, Varela C, Delgado D, Alvarez I. Uruguayan experience with cryopreserved arterial homografts. Transplant Proc 2009; 41:3500-4. [PMID: 19857780 DOI: 10.1016/j.transproceed.2009.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/19/2022]
Abstract
INTRODUCTION We analyzed the Uruguayan experience with cryopreserved arterial homografts. We studied 55 medical records in the period from June 9, 2000 to April 7, 2007, including 41 from males and 14 from females, ranging from 36-78 years of age. The clinical indications were as follows: Group 1, revascularization of infrainguinal atherosclerotic occlusive disease by bypass due to the lack of availability of a suitable vein (n = 35); Group 2, substitution of an infected prosthetic grafts (n = 15); and Group 3, arteriovenous fistula (AVF) after failure of previous prosthetic loops by repeated thrombosis and/or infection in the absence of a vein (n = 5). RESULTS Among Group 1, primary and secondary patency rates were 61% and 71%, respectively at 1 year with 15 complications, 3 infections, 8 thromboses, 2 aneurysms, 1 homograft degradation, and 1 death related to surgery. Among Group 2, the primary and secondary patency rates were 71% and 79%, respectively, at 1 year with 6 patients experiencing complications. Group 3 did not have complications with a primary patency rate of 67% at 1 year. CONCLUSIONS The use of cryopreserved arterial homografts is a valid, accessible, and safe alternative in complicated vascular situations. In our country, it is a technology to consider for patients with critical limb ischemia, when the risk of a major amputation is high and it is not possible to have a suitable vein or prosthetic bypass. It can be an excellent alternative for the substitution of infected synthetic bypasses, especially to substitute in situ for an infected aortic graft.
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Affiliation(s)
- A Esperón
- Area de Cirugía Vascular Periférica, Hospital de Clínicas, Instituto Nacional de Donación y Transplante, Ministerio de Salud Pública, Clinica Quirúrgica 1, Hospital Pasteur.
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Zizza A, Pano M, Zaccaria S, Villani M, Guido M. Outcome of acute type A aortic dissection: single-center experience from 1998 to 2007. J Prev Med Hyg 2009; 50:152-158. [PMID: 20411648] [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: 05/29/2023]
Abstract
INTRODUCTION Acute aortic dissection (AAD) is a serious disease of the aorta with high mortality and morbidity, which requires emergency surgical treatment in order to close the site of the dissection and direct blood flow into the true lumen. Improvements in surgical technique have led to better management of patients with reduced operative mortality, although it still remains high. The aim of this study is to evaluate early and late outcomes of the surgical treatment of acute type A aortic dissection at the hospital of Lecce between 1998 and 2007. We also aim to establish a correlation between these outcomes and pre-operative conditions, surgical procedures and location of the site of the tear. METHODS From 1998 to 2007, 100 patients (69 males and 31 females, average age 62.2 +/- 12.3 years, range 22-85 years) underwent surgery for acute AAD at the center. Surgical techniques included replacement of the ascending aorta (Asc Ao) with or without valve replacement (including five patients who underwent the Bentall/De Bono procedure) and replacement of the Asc Ao with or without arch or hemiarch replacement. RESULTS In-hospital mortality was 22%, with different results between surgery for replacement of the aorta and for aorta with valve replacement (respectively, 16% and 23%). Different mortality rates were found between the distal surgical treatments, with rates of 20.8% and 18.2% respectively between replacements of the Asc Ao and of Asc Ao with arch/hemiarch, although they were not statistically significant. A different mortality rate that was subject to the patient's preoperative condition has also been found (33.3% of mortality in patients in unstable or high-risk condition vs 13.8% in patients in stable condition). The peak reached 43.5% mortality in patients taken to the operating room while in shock or cardiac tamponade. The location of the site of the tear is another factor that distinguishes mortality rates, which are 17.8% if localized at the proximal ascending aorta and 22.2% in the aortic arch. Assessment of the outcome (10 years after surgery), has shown that four patients died several years later but for reasons unrelated to the surgery. CONCLUSIONS The surgery of dissection is still an intervention with a relatively high in-hospital mortality risk, and whose outcome, which has been steady in the last 20 years, can be predicted according to the preoperative condition of the patient. This underlines the need to reduce the time of diagnosis indicating immediate surgical treatment.
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Affiliation(s)
- A Zizza
- Institute of Clinical Physiology, National Council of Research, Lecce, Italy.
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Wiederkehr D, Ogbonnaya A, Casciano R, Makenbaeva D, Mozaffari E, Corbelli J. Clinical impact of early clopidogrel discontinuation following acute myocardial infarction hospitalization or stent implantation: analysis in a nationally representative managed-care population. Curr Med Res Opin 2009; 25:2327-34. [PMID: 19635046 DOI: 10.1185/03007990903156087] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate the association between discontinuation of clopidogrel therapy and risk of acute myocardial infarction (AMI) hospitalization or cardiac revascularization in a nationally-representative patient population following hospitalization for an AMI or coronary stent insertion. RESEARCH DESIGN AND METHODS This observational cohort study was performed using data on patients from the PharMetrics Anonymous Patient-Centric Database who were hospitalized for an AMI or coronary stent insertion and subsequently treated with clopidogrel. Cox proportional hazard modeling was used to evaluate the association between clopidogrel discontinuation prior to 1 year post-initial AMI hospitalization and the primary endpoint of repeat AMI hospitalization or coronary intervention defined as percutaneous coronary intervention (PCI) with or without stent, or coronary artery bypass graft (CABG). MAIN OUTCOME MEASURES The main outcome for this study was AMI hospitalization or coronary intervention defined as PCI with or without stent placement or CABG. RESULTS A total of 31 835 patients were included in the analyses. Patients were predominantly male and the average patient age was approximately 60 years. After controlling for baseline patient characteristics and follow-up time, discontinuation of clopidogrel was associated with a significantly higher rate of hospitalization for AMI or coronary intervention (HR 1.34, 95% CI 1.22-1.44). CONCLUSION Within a population of ACS patients drawn from a database of 85 US health plans, clopidogrel discontinuation within 1 year following hospitalization for AMI or stent placement is associated with an increased risk of AMI hospitalization or coronary intervention. The results of this study should be interpreted within the context of observational research, which does not address cause and effect relationships.
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Wiederkehr D, Berenson K, Casciano R, Stern L, Makenbaeva D, Mozaffari E, Lamerato L, Corbelli J. Clinical impact of early clopidogrel discontinuation following acute myocardial infarction hospitalization or stent implantation: analysis in a single integrated health network. Curr Med Res Opin 2009; 25:2317-25. [PMID: 19635042 DOI: 10.1185/03007990903156061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the association between the discontinuation of clopidogrel therapy prior to 1 year and the risk of acute myocardial infarction (AMI) hospitalization, coronary intervention or all-cause mortality in a cohort of managed-care patients following AMI hospitalization or stent insertion. RESEARCH DESIGN AND METHODS This observational cohort study included 1152 patients enrolled in the Health Alliance Plan who were hospitalized for AMI, or who underwent coronary stent placement. Clopidogrel use was assessed using pharmacy claims data. The association between discontinuation of clopidogrel prior to 1 year following the initial ACS event and the primary outcome of AMI hospitalization/procedure was assessed using Cox proportional hazards models. Additionally, an analysis was conducted to determine the association of discontinuation prior to 1 year with a secondary composite outcome of AMI hospitalization/coronary stent procedure or all-cause mortality. MAIN OUTCOME MEASURES The primary outcome was AMI hospitalization or procedure. The secondary outcome was a composite of AMI hospitalization/ procedure, or all-cause mortality. RESULTS Discontinuation of clopidogrel in the total cohort of patients was associated with a significantly higher risk of the primary outcome of AMI hospitalization/ coronary intervention (HR 2.712, 95% CI 1.634-4.502). Consistent with this finding, discontinuation of clopidogrel was also associated with a significantly higher risk of the secondary composite endpoint (HR 1.844, 95% CI 1.281-2.653). CONCLUSIONS In patients enrolled in an integrated health network, clopidogrel discontinuation prior to 1 year following AMI hospitalization or stent placement is associated with adverse outcomes including greater risk of death, AMI hospitalization or coronary intervention. These results should be interpreted within the context and limitations of observational research, which cannot attribute causality.
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Stefanadis CI. Expanding the boundaries of interventional cardiology. Hellenic J Cardiol 2009; 50:235-236. [PMID: 19465369] [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: 05/27/2023] Open
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Kinsman LD, Redfern J, Briffa TG. Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry. Med J Aust 2009; 190:162; author reply 162. [PMID: 19203320 DOI: 10.5694/j.1326-5377.2009.tb02324.x] [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] [Received: 06/22/2008] [Accepted: 07/15/2008] [Indexed: 11/17/2022]
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Ejaz AA, Beaver TM, Shimada M, Sood P, Lingegowda V, Schold JD, Kim T, Johnson RJ. Uric acid: a novel risk factor for acute kidney injury in high-risk cardiac surgery patients? Am J Nephrol 2009; 30:425-9. [PMID: 19752530 DOI: 10.1159/000238824] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [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: 06/04/2009] [Accepted: 08/04/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Uric acid has been reported to be a risk factor for the development of chronic kidney disease; however, no study has examined whether uric acid may confer a risk for acute kidney injury. METHODS We investigated the relation between serum uric acid and the incidence of postoperative acute kidney injury in patients undergoing high-risk cardiovascular surgery (cardiac valve and aneurysm surgery). RESULTS Following cardiovascular surgery, 18 of 58 patients (31%) developed acute kidney injury, with 11 of 24 (45.8%) in the elevated uric acid group (defined as >6 mg/dl) and 7 of 34 (20.5%) in the normal uric acid group (p = 0.05). After controlling for baseline renal function, left ventricular ejection fraction, use of nesiritide, type of surgery, and history of previous surgery, an elevated preoperative uric acid conferred a 4-fold risk for acute kidney injury (OR: 3.98, CI: 1.10-14.33, p = 0.035) and longer hospital stay (36.35 vs. 24.66 days, p = 0.009). CONCLUSION This preliminary study suggests that uric acid may be a novel risk factor for acute kidney injury in patients undergoing high-risk cardiovascular surgery.
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Affiliation(s)
- A Ahsan Ejaz
- Division of Nephrology, Hypertension and Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL 32610-0224, USA.
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Tabayashi K. [Comparison of therapeutic strategies for cardiovascular disease between Western countries and Japan]. Nihon Geka Gakkai Zasshi 2008; 109:323-328. [PMID: 19068712] [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: 05/27/2023]
Abstract
A comparative review was performed to clarify the differences in therapeutic strategies and operative results in cardiovascular disease between Western countries and Japan, with the following results. (1) The operative results in the U.S.A. among patients with common cardiovascular diseases were almost the same as among those in Japan, except among those who underwent thoracic descending aortic and thoracoabdominal aortic repair. (2) The number of off-pump coronary artery bypass grafts performed comprises 20% to 30% of all coronary revascularization procedures in Western countries, while in Japan the number exceeds 60%. (3) Total endoscopic coronary artery bypass grafting and percutaneous aortic valve implantation can be performed safely but are currently restricted to only a few indications and are associated with several problems that require further improvement. However, these procedures clearly have the potential for extended indications and improved operative results. In these areas, Western countries are ahead of Japan. (4) Selective cerebral perfusion is a safer method of cerebral protection during aortic arch repair compared with retrograde cerebral perfusion and hypothermic circulatory arrest. Many Japanese cardiovascular surgeons have contributed greatly to advances in this method.
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Affiliation(s)
- Koichi Tabayashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Bokou C, Schreiner-Karoussou A, Breisch R, Beissel J. Changing from image intensifier to flat detector technology for interventional cardiology procedures: a practical point of view. Radiat Prot Dosimetry 2008; 129:83-86. [PMID: 18448437 DOI: 10.1093/rpd/ncn151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A small-scale internal audit has been used to evaluate the impact of the use of a dynamic flat panel detector in the clinical routine in the National Interventional Cardiology Centre in Luxembourg. The parameters tested during commissioning and constancy control of an X-ray system, the introduction of new clinical protocols, the patient and the personal staff dosimetry were considered. The technical parameters tested by the hospital physicist stay the same as for the image intensifier. No innovative protocols have been adopted due to the existence of the flat panel detector. A reduction in dose was noted after the installation of a flat detector, due mostly to the continuing education of the interventional cardiologists as well as the initial calibration of the radiological system. The understanding of the X-ray system and its possibilities is vital for the optimisation of clinical procedures in patient and staff exposure.
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Affiliation(s)
- C Bokou
- Entente des Hôpitaux Luxembourgeois, 13-15 rue J.P. Sauvage, L-2514, Luxembourg.
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Shuvarin MI. [Experience of using coronary surgery in Central Military Clinical Hospital by A.A.Vishnevskiĭ]. Voen Med Zh 2008; 329:41-45. [PMID: 18488487] [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: 05/26/2023]
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Mountford WK, Lackland DT, Soule JB, Hunt KJ, Lipsitz SR, Colwell JA. Racial disparities in trends for cardiovascular disease and procedures among hospitalized diabetic patients. Ethn Dis 2008; 18:131-135. [PMID: 18507262] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
METHODS To determine if racial differences exist for trends in diabetes-related cardiovascular disease (CVD) hospitalization rates, we analyzed data from an inpatient hospital discharge database maintained by the South Carolina Office of Research and Statistics. All hospitalizations involving a diagnosis of diabetes were collected from 1996 through 2003. International Classification of Diseases codes were used to determine diagnosis for diabetes, acute myocardial infraction (AMI), stroke, and other CVD outcomes. Multiple linear regression was performed to model the age-standardized rates during the study period. An interaction parameter for race and discharge year was used in the models to determine if the trend slopes varied between African Americans and Caucasians. RESULTS The diabetes-related hospitalization rates for AMI and stroke declined for both race groups. Although the stroke rates for African Americans were consistently higher than those for Caucasians, the African American trend declined more sharply (P=.027). AMI rates showed sharper declines among Caucasians (P<.001). Rates of CVD procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass graft) were two to three times greater among Caucasians. Cardiomyopathy rates were significantly greater among African Americans and showed a larger increasing trend (P<.001), and findings for congestive heart failure trends were similar (P<.001). CONCLUSIONS Diabetes-related CVD rates and trends vary considerably by race. Rates of AMI and stroke declined in African Americans and Caucasians from 1996 through 2003, while other CVD rates increased. Further research is needed to understand the underlying components of these disparities.
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Affiliation(s)
- William K Mountford
- Department of Biostatistics, Bioinformatics, Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA.
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Valleley MS, Buckley KW, Hayes KM, Fortuna RR, Geiss DM, Holt DW. Are there benefits to a fresh whole blood vs. packed red blood cell cardiopulmonary bypass prime on outcomes in neonatal and pediatric cardiac surgery? J Extra Corpor Technol 2007; 39:168-176. [PMID: 17972451 PMCID: PMC4680727] [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] [Indexed: 05/25/2023]
Abstract
Techniques for pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) have significantly improved over the years. The use of fresh whole blood (FWB) and pre-bypass ultrafiltration (PBUF) has been suggested as means for improving perioperative and postoperative outcomes. It is the intent of this study to show that fresh whole blood along with PBUF will result in balanced CPB prime that can offer a reduction in blood product exposures and blood loss along with improving several measured postoperative outcomes. After institutional review board approval, a retrospective review was conducted on 100 patients to analyze the benefits of FWB and PBUF on outcomes in neonatal and pediatric cardiac surgery. Data analysis included preoperative and CPB data, perioperative inotrope and blood product exposure, and postoperative blood loss and blood product exposure measured for up to a 12-hour period in the intensive care unit (ICU). The three groups compared were FWB prime vs. packed red blood cell (PRBC) prime, < 5 kg FWB prime vs. < 5 kg PRBC prime, and 5+ kg FWB prime and 5+ kg PRBC prime. Cumulative blood product exposures for the FWB prime group found 62% received one blood exposure for the operative and postoperative period (p < .0001). The majority of patients who received a PRBC prime (64%) received three or more cumulative exposures (p < .0003). The < 5 kg FWB group also received significantly less cumulative blood exposure, with 64% receiving just one exposure. Comparatively, 85% of the < 5 kg PRBC patients received three or more blood product exposures perioperatively and postoperatively (p < .0001). Perioperative inotrope and postoperative blood loss did not differ among the groups. Outcomes for intraoperative death, intraoperative extubation, delayed sternal closure, and mediastinal reexploration were also not statistically different. The results of this study found that FWB leads to significantly less blood exposure, specifically in the < 5-kg population. Finally, the use of PBUF is an effective method for achieving a balanced, physiologic prime. Future research would be helpful in determining which specific patient populations would receive the greatest benefit from FWB and PBUF.
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Affiliation(s)
- Melinda S Valleley
- Department of Cardiothoracic Surgery, Children's Hospital of Illinois, Peoria, Illinois Medical, USA.
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Miche E, Knosp J, Pappenroth N, Ennker J, Beinhofer W, Dirschedl P, Radzewitz A. [Integrated case fees in cardiosurgery--a pilot project for fast-track rehabilitation]. Versicherungsmedizin 2007; 59:123-8. [PMID: 17912886] [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: 05/17/2023]
Abstract
BACKGROUND Lengthy recovery and treatment times following cardiosurgical interventions were the motivation for introducing a pilot procedure to integrate acute and rehabilitative treatment structures. The advantage of such a pilot procedure is the medico-economic link between direct transition from acute care to rehabilitation treatment and cutting average case costs. With this in mind, shared case fees for patients following cardiosurgery are being agreed in a pilot project between health insurance companies, acute-care hospitals and rehabilitation clinics. The aim of this study was thus to investigate whether rehabilitation directly after cardiosurgery without prior transferral to an acute-care hospital is comparable with the conventional procedure involving acute care. METHODS A total of 221 patients were included in the investigation. The pilot project group comprised 159 patients (mean age 70 +/- 6 yrs, 117 men and 42 women) who were transferred directly to rehabilitation following cardiosurgery. The control group, comprising 62 patients (mean age = 71 +/- 6 yrs, 42 men and 20 women), was transferred to an acute-care hospital following cardiosurgery before commencing rehabilitation. Sociodemographic and clinical data were comparable between the two groups. RESULTS At the end of rehabilitation, the mean maximum ergometric performance in the pilot group was 96 +/- 33 W, significantly higher than the control group's performance of 81 +/- 31 W. One difference between the two groups related to complications. During rehabilitation, complications occurred more frequently within the pilot group. In the pilot group, compared to the control group, postcardiotomy syndrome occurred in 45.3 versus 25.8% and impaired wound healing in 10.1 versus 4.8% of cases. Despite these results, the pilot group demonstrated a significantly shorter overall hospital stay of 39.5 +/- 7.5 days compared to the control group stay of 45.7 +/- 9.7 days. CONCLUSION Compared to the control group, the pilot group was at no disadvantage with regard to clinical or performance data by the end of rehabilitation. Cardiac complications occur more often during rehabilitation taking place directly after cardiosurgery than with the conventional procedure. These can be viewed, however, as complications occurring directly in temporal conjunction with the operation and as to be expected. Complications attributed directly to fast-track rehabilitation can be excluded. In the pilot group the overall hospital stay was thus shortened. In an environment of legislative restructuring within the healthcare sector, this shows that adequate treatment of cardiosurgical patients is still guaranteed with fast-track rehabilitation.
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Affiliation(s)
- E Miche
- Rehabilitationszentrum, Gernsbach
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Martinez LC, Vano E, Gutierrez F, Rodriguez C, Gilarranz R, Manzanas MJ. Patient doses from fluoroscopically guided cardiac procedures in pediatrics. Phys Med Biol 2007; 52:4749-59. [PMID: 17671333 DOI: 10.1088/0031-9155/52/16/003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [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: 11/12/2022]
Abstract
Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm(2) respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.
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Affiliation(s)
- L C Martinez
- Medical Physics and Radiation Protection Service, 12 de Octubre University Hospital, Madrid, Spain.
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Mets O, Spronk PE, Binnekade J, Stoker J, de Mol BAJM, Schultz MJ. Elimination of daily routine chest radiographs does not change on-demand radiography practice in post–cardiothoracic surgery patients. J Thorac Cardiovasc Surg 2007; 134:139-44. [PMID: 17599499 DOI: 10.1016/j.jtcvs.2007.02.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 01/11/2007] [Accepted: 02/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to determine the effect of elimination of daily routine chest radiographs on chest radiographic practice in cardiothoracic surgery patients in the intensive care unit and the post-intensive care unit ward. METHODS We used a prospective, comparative study design with an intervention in a 28-bed intensive care unit/post-intensive care unit ward (including a 4-bed medium-care unit) in a university hospital. Cardiothoracic surgery patients were admitted to the intensive care unit during a period of 6 months (3 months before intervention and 3 months after intervention). Daily routine chest radiographs in the intensive care unit were eliminated; all chest radiographs required a clinical indication. Routine chest radiographs were not performed in the post-intensive care unit ward, both before and after the intervention. RESULTS Before intervention, in the intensive care unit 353 daily routine chest radiographs and 261 on-demand chest radiographs were obtained in 175 patients; after intervention, 275 on-demand chest radiographs were obtained in 163 patients. Before intervention, in the post-intensive care unit ward 413 on-demand chest radiographs were obtained in 167 patients; after intervention, 445 on-demand chest radiographs were obtained in 161 patients. In the intensive care unit the number of chest radiographs per patient day decreased from 1.8 +/- 0.6 to 1.1 +/- 0.6. In the post-intensive care unit ward the number of chest radiographs per patient per day was 0.4 +/- 0.2, both before and after the intervention. Slightly more unexpected abnormalities were found in the on-demand chest radiographs after the intervention. No negative influence on chest radiography timing, length of stay in the intensive care unit and hospital, and readmission rate was seen. CONCLUSIONS Elimination of daily routine chest radiographs led to a decrease of the total number of chest radiographs obtained per patient per day in the intensive care unit and did not change chest radiography practice in the post-intensive care unit ward.
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Affiliation(s)
- Onno Mets
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND This study was aimed at defining clinical and anatomic patterns in cases of surgical endocarditis (SE). METHODS SE cases done between 1981 and 1997 at our metropolitan county hospital were retrospectively analyzed. RESULTS A total of 106 consecutive episodes of SE involving 125 valves in 100 patients were studied. SE included 71 aortic, 42 mitral, and 12 tricuspid valves. The etiologies included intravenous drug abuse (IVDA) in 48 (45%) and dental source in 30 (28%). A congenitally deformed valve was present in 19 (18%). Compared to non-IVDA, IVDA episodes of SE were more often superimposed on previously normal valves (38/48 [79%] vs. 30/58 [52%])**, S. aureus infections (17/43 [40%] vs. 9/54 [17%])*, active endocarditis (38/48 [79%] vs. 32/58 [55%])*, and surgically treated on an urgent basis (10/48 [21%] vs. 4/58 [7%])*. Overall, macroemboli occurred in 53 (50%) of SE and was associated with pseudoaneurysm*, preoperative neurologic dysfunction,** and operative death.** The operative mortality (defined by Society of Thoracic Surgeons) for SE was 5/106 (4.7%). Macroembolism,** aortoventricular discontinuity,** abscesses,* pseudoaneurysm,** and preoperative renal failure* were associated with mortality. Prosthetic valve endocarditis was present in 10 of 106 episodes of SE (9.4%). *p < or = 0.05; **p < or = 0.01. CONCLUSION (1) The aortic valve is most commonly associated with SE, (2) SE of a previously normal valve is more likely to occur with IVDA than other etiologies, (3) macroemboli occur in half of SE and is associated with an increased operative mortality.
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Grilli R, Guastaroba P, Taroni F. Effect of hospital ownership status and payment structure on the adoption and use of drug-eluting stents for percutaneous coronary interventions. CMAJ 2006; 176:185-90. [PMID: 17179220 PMCID: PMC1764787 DOI: 10.1503/cmaj.060385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 12/26/2022] Open
Abstract
BACKGROUND The impact of the use of drug-eluting stents in percutaneous coronary intervention (PCI) on cardiac care is still uncertain. We examined the influence of systemic factors, such as hospital ownership status, organizational characteristics and payment structure, on the use of drug-eluting stents in PCI and the effect on cardiac surgery volume. METHODS We conducted a cross-sectional analysis of drug-eluting stent use in 12 993 patients undergoing PCI with stenting (drug-eluting or bare-metal) and time-series regression analyses of the monthly number of cardiac surgery and PCI procedures performed using data collected from 1998 to 2004 at 13 public and private hospitals in the Emilia-Romagna region of Italy. RESULTS Public hospitals used drug-eluting stents more selectively than private hospitals, targeting the new device to patients at high risk of adverse events. The time-series regression analyses showed that the number of PCI procedures performed per year increased during this period, both in public (slope coefficient 36.4, 95% confidence interval [CI] 30.2 to 43.1) and private centres (slope coefficient 6.4, 95% CI 3.1 to 9.2 ). Concurrently, there was a reduction in the number of isolated coronary artery bypass graft (CABG) surgeries, although the degree of change was higher in public than in private hospitals (coefficient -16.1 v. -6.2 respectively ). The number of CABG procedures associated with valve surgery decreased in public hospitals (coefficient -5.0, 95% CI -6.1 to -3.8) but increased in private hospitals (coefficient 4.1, 95% CI 2.0 to 6.1). INTERPRETATION Public and private hospitals behaved differently in adopting drug-eluting stents and in using PCI with drug-eluting stents as a substitute for surgical revascularization.
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Affiliation(s)
- Roberto Grilli
- Agenzia Sanitaria Regionale, Regione Emilia Romagna, Bologna, Italy.
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Lambert CR, Bunker S, Garrison LF, Means MD, Pepine CJ, Conti CR, Dewar MA, Goldfarb T. An academic-community cardiovascular service line affiliation: design, implementation, and performance. ACTA ACUST UNITED AC 2006; 4:86-94. [PMID: 16687952 DOI: 10.1111/j.1541-9215.2006.05570.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/29/2022]
Abstract
Both affiliation with an academic medical center and implementation of service line management may be effective management strategies for community health care organizations. The authors describe the design, implementation, and performance of a unique combination of these two distinct strategies for cardiovascular program development in the affiliation of the University of Florida Health Science Center with Health First, a regional community-based integrated delivery system.
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Affiliation(s)
- Charles R Lambert
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, 32610, USA.
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Taylor SL, Fremont A, Jain AK, McLaughlin R, Peterson E, Ferguson TB, Lurie N. Racial and ethnic disparities in care: the perspectives of cardiovascular surgeons. Ann Thorac Surg 2006; 81:531-6. [PMID: 16427845 DOI: 10.1016/j.athoracsur.2005.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 07/31/2005] [Accepted: 08/15/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although racial/ethnic disparities in care are well documented, particularly for cardiac care, we know little about what cardiac surgeons think about them. For educational efforts to be effective in helping physicians address disparities, they must consider providers' knowledge and beliefs about the underlying causes of the disparities. METHODS We conducted a survey in 2004 to assess cardiologists' and cardiac surgeons' knowledge of racial/ethnic disparities in cardiovascular care and their perceptions about the underlying causes. Respondents were recruited from the membership of four cardiovascular professional associations. This paper focuses on cardiovascular surgeons' responses (n = 208). RESULTS Forty-four percent of cardiovascular surgeons thought that, among patients with cardiac risk factors, black patients were not as likely as white patients to receive cardiac diagnostic tests and procedures. Additionally, 30% thought that black patients were not as likely as white patients to receive therapeutic tests and procedures. However, only 13% agreed that cardiac care disparities occur "often" or "somewhat often" based on patients' race/ethnicity, independent of their insurance and education. Only 3% thought disparities were likely to occur in their clinical setting. Respondents appeared more likely to endorse patient factors (eg, health behaviors or treatment adherence) than system or provider (eg, miscommunication or continuity of care) factors as reasons for disparities. CONCLUSIONS Although some surgeons acknowledge that racial/ethnic disparities in cardiac care occur, very few agree that they occur often, independent of patients' characteristics. Educational efforts tailored to local care settings, such as reviewing quality of care data on patients of different races/ethnicities within a clinic/hospital, may effectively inform all physicians of these disparities.
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Affiliation(s)
- Teruhisa Kazui
- First Department of Surgery, Hamamatsu University School of Medicine, Japan
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Richens T. The development of paediatric cardiac services in Scotland. Scott Med J 2006; 51:4-7. [PMID: 16722129 DOI: 10.1258/rsmsmj.51.2.4] [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] [Indexed: 11/18/2022]
Affiliation(s)
- Trevor Richens
- Department of Cardiology, Royal Hospital for Sick Children, Yorkhill Division, Glasgow
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Mortensen PE. [The connection between the volume and the quality within thoracic surgery]. Ugeskr Laeger 2006; 168:1999; author reply 1999-2000. [PMID: 16768909] [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: 05/10/2023]
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Steinbrüchel DA, Ravn JB. [The connection between hospital volume and outcome in thorax surgery]. Ugeskr Laeger 2006; 168:1524-6. [PMID: 16640971] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A review of current literature with respect to a possible correlation among hospital volume, caseload and outcome of thoracic and cardiovascular surgery supports quite convincingly the theory that, from a probability point of view, the combination of high-volume hospitals with high-volume surgeons produces the best results. During the last decade, thoracic and cardiovascular surgery has to a certain degree been centralized in Denmark, reducing the number of public centres to the five university hospitals. None of these centres is low-volume, and two are high-volume hospitals.
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Abstract
We investigated the effect of postoperative administration of colloids on hemostasis in 45 patients after cardiac surgery. Patients were randomized to receive 15 mL kg(-1) of either 4% albumin, 4% succinylated gelatin, or 6% hydroxyethyl starch (molecular weight of 200 kDa/degree of substitution 0.5) as a short-term infusion. There was a comparable decrease in maximum clot firmness of thromboelastometry tracings in gelatin and hydroxyethyl starch groups immediately after completion of the infusion, whereas these values remained unchanged in the albumin group. The impairment in clot strength persisted up to 2 h, although the values partly recovered. Postoperative bleeding correlated inversely with the clot strength in pooled data of the artificial colloids. Fibrin formation (clot formation time, alpha-angle) and fibrinogen-dependent clot strength (maximum clot firmness and shear elastic modulus) were more disturbed in the hydroxyethyl starch group than in the gelatin group. We conclude that after cardiopulmonary bypass surgery, both gelatin and hydroxyethyl starch impair clot strength and fibrin buildup, which may predispose patients to increased blood loss. The greatest impairment in hemostasis was seen after hydroxyethyl starch administration, whereas albumin appeared to have the least effect on hemostatic variables.
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Affiliation(s)
- Tomi T Niemi
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Meilahti Hospital, Helsinki, Finland.
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Trivedi AN, Sequist TD, Ayanian JZ. Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality. J Am Coll Cardiol 2006; 47:417-24. [PMID: 16412871 DOI: 10.1016/j.jacc.2005.08.068] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [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: 04/15/2005] [Revised: 08/03/2005] [Accepted: 08/15/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We assessed use of low-volume hospitals by race and ethnicity for major cardiovascular procedures and determined whether hospital volume is an important factor explaining racial and ethnic differences in post-procedure mortality. BACKGROUND Low hospital volume predicts mortality for cardiovascular procedures and could be a mediator of racial and ethnic differences in procedure outcomes. METHODS We analyzed data from 719,679 hospitalizations for cardiac artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), abdominal aortic aneurysm (AAA) repair, and carotid endarterectomy (CEA) from 1998 to 2001 using the Nationwide Inpatient Sample. We used multivariate logistic regression to assess whether race predicts use of low-volume hospitals and the relative contribution of hospital volume to racial disparity in post-procedure in-hospital mortality. RESULTS Black and Hispanic patients were more likely than white patients to receive cardiovascular procedures in low-volume hospitals. Black patients had greater risk-adjusted mortality than white patients after elective AAA repair (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.20 to 2.84), CABG (OR, 1.19; 95% CI, 1.06 to 1.33), and CEA (OR, 1.56; 95% CI, 1.07 to 2.27), but not PTCA. Hispanic patients did not have higher risk-adjusted mortality than white patients. Adjusting for hospital volume did not substantially reduce the relative risk of death for black patients compared with white patients. CONCLUSIONS Black and Hispanic patients were more likely to receive cardiovascular procedures in low-volume hospitals, but hospital volume did not explain a large proportion of racial differences in post-procedure mortality. Additional research is needed to determine why black patients have increased mortality after cardiovascular procedures and how these mortality rates can be reduced.
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Affiliation(s)
- Amal N Trivedi
- Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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