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Adult Cardiac Surgery

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https://www.readbyqxmd.com/read/28320201/analysis-of-never-events-following-adult-cardiac-surgical-procedures-in-the-united-states
#1
Michael P Robich, Brianna M Krafcik, Nishant K Shah, Alik Farber, Denis Rybin, Jeffrey J Siracuse
BACKGROUND: This study was conducted to determine the risk factors, nature, and outcomes of "never events" following open adult cardiac surgical procedures. Understanding of these events can reduce their occurrence, and thereby improve patient care, quality metrics, and cost reduction. METHODS: "Never events" for patients included in the Nationwide Inpatient Sample who underwent coronary artery bypass graft, heart valve repair/replacement, or thoracic aneurysm repair between 2003-2011 were documented...
March 16, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28319507/recombinant-factor-viia-is-associated-with-increased-thrombotic-complications-in-pediatric-cardiac-surgery-patients
#2
Laura Downey, Morgan L Brown, David Faraoni, David Zurakowski, James A DiNardo
BACKGROUND: Recombinant factor VIIa (rFVIIa) is routinely used as an off-label hemostatic agent in children undergoing cardiac surgery. Despite evidence that rFVIIa use is associated with an increased incidence of thrombotic complications in adult cardiac surgery, the safety of rFVIIa as a rescue hemostatic agent in the pediatric cardiac surgical population is less definitively delineated. In this retrospective study, we used propensity score matching to compare the incidence of thrombotic complications between children treated with rFVIIa and their matched controls...
March 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28318659/cardiovascular-and-general-health-status-of-adults-with-trisomy-21
#3
Samuel A Hayes, Shelby Kutty, Joshua Thomas, Joyce T Johnson, Anji T Yetman
BACKGROUND: Patients with Trisomy 21 are now living well into adulthood. Little data exists to assist the cardiologist in the care of these patients. We sought to examine the cardiac and general health status of adults with Trisomy 21 undergoing cardiac evaluation. METHODS & RESULTS: A retrospective review of all affected adults >21years followed at 2 tertiary care institutions was performed. Of 193 patients identified, median age was 31 (range 21.1-60.5) years...
March 10, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28315287/elective-primary-or-secondary-delayed-sternal-closure-improves-outcome-in-severely-compromised-patients
#4
Antonio M Calafiore, Azmat A Sheikh, Juan J Alfonso, Tarek Tantawi, Belgeit Maklouf, Ahmed Shawki, Ahmed Allam, Mohammed O Awadi, Ahmed A Osman, Aly M Habib, Michele Di Mauro
Background Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population. Materials and Methods From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24...
March 17, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28306681/anesthesia-in-adults-with-congenital-heart-disease
#5
Torsten Baehner, Richard K Ellerkmann
PURPOSE OF REVIEW: The current review focuses on patients with congenital heart disease (CHD) with regard to recent trends in global demographics, healthcare provision for noncardiac surgery, as well as anesthetic and perioperative care for these patients. RECENT FINDINGS: About 40 years after milestones of surgical innovation in CHD, the number of adults with CHD (ACHD) now surpasses those of children with CHD. This development leads to the fact that even patients with complex CHD managed for noncardiac surgery are not restricted to highly specialized centers...
March 16, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28303021/age-and-surgical-complexity-impact-on-renoprotection-by-remote-ischemic-preconditioning-during-adult-cardiac-surgery-a-meta-analysis
#6
Chenghui Zhou, Heerajnarain Bulluck, Nengxin Fang, Lihuan Li, Derek J Hausenloy
We aimed to conduct an up-to-date meta-analysis to comprehensively assess the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing adult cardiac surgery. 21 randomized controlled trials (RCTs) with a total of 6302 patients were selected and identified. Compared with controls, RIPC significantly reduced the incidence of acute kidney injury (AKI) [odds ratio (OR) = 0.79; P = 0.02; I(2) = 38%], and in particular, AKI stage I (OR = 0.65; P = 0.01; I(2) = 55%)...
March 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28302746/current-interventional-and-surgical-management-of-congenital-heart-disease-specific-focus-on-valvular-disease-and-cardiac-arrhythmias
#7
Kimberly A Holst, Sameh M Said, Timothy J Nelson, Bryan C Cannon, Joseph A Dearani
Successful outcome in the care of patients with congenital heart disease depends on a comprehensive multidisciplinary team. Surgery is offered for almost every heart defect, despite complexity. Early mortality for cardiac surgery in the neonatal period is ≈10% and beyond infancy is <5%, with 90% to 95% of patients surviving with a good quality of life into the adult years. Advances in imaging have facilitated accurate diagnosis and planning of interventions and surgical procedures. Similarly, advances in the perioperative medical management of patients, particularly with intensive care, has also contributed to improving outcomes...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28302745/current-status-and-future-potential-of-transcatheter-interventions-in-congenital-heart-disease
#8
Damien P Kenny, Ziyad M Hijazi
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28302744/noninvasive-imaging-in-adult-congenital-heart-disease
#9
Luke J Burchill, Jennifer Huang, Justin T Tretter, Abigail M Khan, Andrew M Crean, Gruschen R Veldtman, Sanjiv Kaul, Craig S Broberg
Multimodality cardiovascular imaging plays a central role in caring for patients with congenital heart disease (CHD). CHD clinicians and scientists are interested not only in cardiac morphology but also in the maladaptive ventricular responses and extracellular changes predisposing to adverse outcomes in this population. Expertise in the applications, strengths, and pitfalls of these cardiovascular imaging techniques as they relate to CHD is essential. The purpose of this article is to provide an overview of cardiovascular imaging in CHD...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28302739/changing-landscape-of-congenital-heart-disease
#10
Berto J Bouma, Barbara J M Mulder
Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged...
March 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28302002/preoperative-cardiac-risk-assessment-in-patients-undergoing-liver-transplant-due-to-hepatocellular-carcinoma-should-it-be-different
#11
Haldun Muderrisoglu, Kerem Can Yilmaz, Emir Karacaglar, Ugur Bal, Alp Aydinalp, Gokhan Moray, Mehmet Haberal
OBJECTIVES: Liver transplant is a high-risk surgery for cardiac events. The risk of 30-day major cardiac adverse events is estimated at more than 5%. In this retrospective study, we evaluated our preoperative cardiac risk assessment approach. MATERIALS AND METHODS: We evaluated 58 adult patients who underwent liver transplant between May 2011 and May 2015. Preoperative cardiac risk factors and results of diagnostic tests were noted. Patients were divided into 2 groups: patients with or without hepatocellular carcinoma...
March 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28298666/bivalirudin-as-an-alternative-anticoagulant-for-cardiopulmonary-bypass-during-adult-cardiac-surgery-a-change-in-practice
#12
Peter Gatt, Samuel Anthony Galea, Walter Busuttil, Charles Grima, Jeffrey Muscat, Yvette Farrugia
The referral of patients for open heart surgery, presenting with a history of heparin hypersensitivity instigated a multidisciplinary effort to find an alternative anticoagulant to heparin. The various options mentioned in the literature call for changes in the routine practice of open heart surgery on cardiopulmonary bypass. These changes involve mostly the perfusion setup and conduct on bypass and to a lesser extent the anesthetic and surgical practice. Nevertheless, the different professions involved in the cardiac surgical firm discussed the proposed changes in a multidisciplinary effort...
March 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28292748/unwarranted-variation-in-the-quality-of-care-for-patients-with-diseases-of-the-thoracic-aorta
#13
Alex Bottle, Giovanni Mariscalco, Matthew A Shaw, Umberto Benedetto, Athanasios Saratzis, Silvia Mariani, Mohamad Bashir, Paul Aylin, David Jenkins, Aung Y Oo, Gavin J Murphy
BACKGROUND: Thoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England. METHODS AND RESULTS: Data from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta-analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished...
March 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28287533/isolation-of-endothelial-progenitor-cells-from-healthy-volunteers-and-their-migratory-potential-influenced-by-serum-samples-after-cardiac-surgery
#14
Christoph Emontzpohl, David Simons, Sandra Kraemer, Andreas Goetzenich, Gernot Marx, Jürgen Bernhagen, Christian Stoppe
Endothelial progenitor cells (EPCs) are recruited from the bone marrow under pathological conditions like hypoxia and are crucially involved in the neovascularization of ischemic tissues. The origin, classification and characterization of EPCs are complex; notwithstanding, two prominent sub-types of EPCs have been established: so-called "early" EPCs (subsequently referred to as early-EPCs) and late-outgrowth EPCs (late-EPCs). They can be classified by biological properties as well as by their appearance during in vitro culture...
February 14, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28284501/cardiopulmonary-exercise-test-in-adults-with-prior-fontan-operation-the-prognostic-value-of-serial-testing
#15
Alexander C Egbe, David J Driscoll, Arooj R Khan, Sameh S Said, Emmanuel Akintoye, Fernando M Berganza, Heidi M Connolly
BACKGROUND: The purpose of the study was to determine the role of cardiopulmonary exercise test (CPET) indices in predicting cardiovascular adverse events (CAEs) in patients with Fontan palliation. CAE was defined as death or cardiac surgery. METHODS: Retrospective review of adult Fontan patients who had treadmill CPET at Mayo Clinic, 1994-2013. Patients with loss of follow-up defined as ≥2years without clinical follow-up were excluded. The results of serial CPETs were reviewed, and patients with CPETs meeting the following criteria were selected for analysis: maximum effort on serial CPETs, minimum of 3-year interval between CPETs, and absence of CAE between CPETs...
February 28, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28277327/lactate-elevation-during-and-after-major-cardiac-surgery-in-adults-a-review-of-etiology-prognostic-value-and-management
#16
Lars W Andersen
Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations...
March 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28270427/contemporary-cardiac-surgery-for-adults-with-congenital-heart-disease
#17
Sylvain Beurtheret, Oktay Tutarel, Gerhard Paul Diller, Cathy West, Evangelia Ntalarizou, Noémie Resseguier, Vasileios Papaioannou, Richard Jabbour, Victoria Simpkin, Anthony J Bastin, Sonya V Babu-Narayan, Beatrice Bonello, Wei Li, Babulal Sethia, Hideki Uemura, Michael A Gatzoulis, Darryl Shore
OBJECTIVE: Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery. METHODS: This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011...
March 7, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28270114/violation-of-prophylactic-vancomycin-administration-timing-is-a-potential-risk-factor-for-rate-of-surgical-site-infections-in-cardiac-surgery-patients-a-prospective-cohort-study
#18
Paolo Cotogni, Cristina Barbero, Roberto Passera, Lucina Fossati, Giorgio Olivero, Mauro Rinaldi
BACKGROUND: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections (SSIs) due to increasing length of stay (LOS), costs and mortality. The antimicrobial prophylaxis is one of the most important tools in the prevention of SSIs. The objective of this study was to investigate the relationship between the timing of antimicrobial prophylaxis administration and the rate of SSIs. METHODS: A prospective cohort study was carried out over 1-year period in all consecutive adult patients undergoing elective cardiac surgery...
March 8, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28267981/healthcare-associated-infections-in-cardiac-surgery-patients-with-prolonged-intensive-care-unit-stay
#19
Michael Mazzeffi, James Gammie, Bradley Taylor, Sarah Cardillo, Nicholina Haldane-Lutterodt, Anthony Amoroso, Anthony Harris, Kerri Thom
BACKGROUND: Healthcare-associated infections (HAIs) are responsible for many deaths of hospitalized patients each year. Patients with prolonged hospitalization are at high risk for HAIs. Increased efforts have been made to decrease these infections, but a recent report from the Centers for Disease Control suggests that some HAIs may be increasing. We hypothesized that HAIs would remain frequent among cardiac surgery patients with prolonged intensive care unit stay and would be associated with increased mortality...
March 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28267688/reduction-of-myocardial-ischemia-reperfusion-injury-by-inhibiting-interleukin-1-alpha
#20
Adolfo G Mauro, Eleonora Mezzaroma, Juan Torrado, Priyanka Kundur, Priyashma Joshi, Kelsey Stroud, Federico Quaini, Costanza A Lagrasta, Antonio Abbate, Stefano Toldo
BACKGROUND: Interleukin-1α (IL-1α) released by dying cells is an alarmin that activates the innate immunity. We hypothesized that after myocardial ischemia-reperfusion (I/R) injury, IL-1α amplifies the myocardial damage by activating the inflammasome and caspase-1. METHODS: Adult male CD1 mice were used. The left anterior descending coronary artery was ligated for 30 minutes, after 24 hours of reperfusion. An IL-1α blocking antibody (15 μg/kg intraperitoneally) or matching vehicle was given after reperfusion...
March 2017: Journal of Cardiovascular Pharmacology
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