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Adult Cardiac Surgery

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https://www.readbyqxmd.com/read/28091794/the-impact-of-liver-disorders-on-perioperative-management-of-reoperative-cardiac-surgery-a-retrospective-study-in-adult-congenital-heart-disease-patients
#1
Koko Adachi, Hiroaki Toyama, Yu Kaiho, Osamu Adachi, Hiroto Hudeta, Masanori Yamauchi
PURPOSE: We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients. METHODS: This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery. RESULTS: Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%)...
January 16, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28079228/attenuated-recovery-of-contractile-function-in-aging-hearts-following-global-ischemia-reperfusion-role-of-extracellular-hsp27-and-tlr4
#2
Lihua Ao, Yufeng Zhai, Chunhua Jin, Joseph C Cleveland, David A Fullerton, Xianzhong Meng
BACKGROUND: While cardiac functional recovery is attenuated in the elderly following cardiac surgery with obligatory global myocardial ischemia/reperfusion (I/R), the underlying mechanism remains incompletely understood. We observed previously that human and mouse myocardium releases heat shock protein (HSP) 27 during global I/R. Extracellular HSP27 induces myocardial inflammatory response and plays a role in post-ischemic cardiac dysfunction in adult mouse hearts. OBJECTIVE: This study was to determine the role of extracellular HSP27 and Toll-like receptor 4 (TLR4) in the attenuated functional recovery in aging mouse hearts following global I/R...
December 19, 2016: Molecular Medicine
https://www.readbyqxmd.com/read/28077821/ascending-aortic-constriction-promotes-cardiomyocyte-proliferation-in-neonatal-rats
#3
Zhenhua Wang, Sebastian Schmull, Hui Zheng, Jianggui Shan, Rongjiang Zou, Song Xue
Adult heart suffering from increased workload will undergo myocardial hypertrophy, subsequent cardiomyocyte (CM) death, and eventually heart failure. However, the effect of increasing afterload on the neonatal heart remains unknown. We performed ascending aortic constriction (AAC) in neonatal rats 8-12 hours after birth (P0, P indicates postpartum). Seven days after surgery, in vivo heart function was evaluated using cardiac ultrasonography. Haematoxylineosin and Masson staining were used to assess CM diameter and collagen deposition...
January 11, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28074792/remifentanil-prevents-increases-of-blood-glucose-and-lactate-levels-during-cardiopulmonary-bypass-in-pediatric-cardiac-surgery
#4
Tomohiro Chaki, Yuko Nawa, Keishi Tamashiro, Eri Mizuno, Naoyuki Hirata, Michiaki Yamakage
INTRODUCTION: Cardiopulmonary bypass (CPB) can cause stress response that increases levels of cytokine and catecholamine in plasma, resulting in hyperglycemia. In adults, it has been demonstrated that remifentanil infusion during CPB could prevent increases of cytokine, catecholamine, and blood glucose levels, but such effects of remifentanil in children have not been elucidated. AIM: In this study, we investigated the preventive effects of remifentanil on blood glucose and lactate levels during CPB in children...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28072699/prevention-preferable-to-treatment-3-case-reports-of-patients-experiencing-right-sided-heart-failure-after-ebstein-anomaly-correction
#5
Ming Luo, Jing Lin, Zhen Qin, Lei Du
RATIONALE: Ebstein anomaly is a common congenital heart disease that may induce severe tricuspid regurgitation and dilation of the "atrialized" portion of the right ventricle. Patients who undergo surgery to correct Ebstein anomaly are at high risk of postoperative right-sided heart failure, yet little is known about what pre-, peri-, or postoperative procedures may help reduce this risk. PATIENT CONCERNS: Here, we describe 3 cases of adults with Ebstein anomaly who underwent corrective surgery and in whom right-sided heart failure occurred with severe tricuspid regurgitation detected by transesophageal echocardiography...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28066609/association-between-post-sternotomy-tracheostomy-and-deep-sternal-wound-infection-a-retrospective-analysis
#6
Yi-Chin Tsai, Kevin Phan, Andrie Stroebel, Livia Williams, Lisa Nicotra, Lesley Drake, Elizabeth Ryan, James McGree, Peter Tesar, Kiran Shekar
BACKGROUND: Tracheostomy has traditionally been used as a means of facilitated mechanical ventilation in patients requiring respiratory management following cardiac surgery. However in the clinical setting, the advantages of tracheostomy has been questioned by concerns surrounding evidence of its association with increased risk of deep sternal wound infections (DSWI). The present study sought to evaluate retrospectively our experience with post-sternotomy tracheostomy among cardiac surgery patients and association with DSWI...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28063123/minimally-invasive-surgery-should-be-the-standard-of-care-for-paraesophageal-hernia-repair
#7
Francisco Schlottmann, Paula D Strassle, Timothy M Farrell, Marco G Patti
BACKGROUND: It is unclear if minimally invasive surgery (MIS) has been universally embraced for paraesophageal hernia (PEH) repair. The aims of this study were: (a) to assess the national utilization of MIS for PEH repair and (b) to compare the perioperative outcomes between MIS and open procedures METHODS: A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥18 years old) who underwent PEH repair were included...
January 6, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28060555/efficacy-of-n-acetylcysteine-in-preventing-acute-kidney-injury-after-cardiac-surgery-a-meta-analysis-study
#8
Mei Mei, Hong-Wen Zhao, Qian-Guang Pan, You-Min Pu, Mao-Zhi Tang, Bing-Bing Shen
PURPOSE: To evaluate whether perioperative N-acetylcysteine (NAC) administration reduces the risk of cardiac surgery associated acute kidney injury (CSA-AKI). MATERIALS AND METHODS: A systematic literature review (Medline, PubMed, Cochrane, Biomedical central, Google Scholar) identified 10 studies (1391 patients; 695 NAC and 696 placebo) that compared the efficacy and adverse effects of perioperative NAC administration for CSA-AKI prevention in adults undergoing elective cardiac surgery...
January 6, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28059837/complications-risk-factors-and-staffing-patterns-for-noncardiac-surgery-in-patients-with-left-ventricular-assist-devices
#9
Michael R Mathis, Subramanian Sathishkumar, Sachin Kheterpal, Matthew D Caldwell, Francis D Pagani, Elizabeth S Jewell, Milo C Engoren
BACKGROUND: Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. METHODS: The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015...
January 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28054177/factors-associated-with-a-low-initial-cerebral-oxygen-saturation-value-in-patients-undergoing-cardiac-surgery
#10
Kensuke Kobayashi, Tadashi Kitamura, Satoshi Kohira, Shinzo Torii, Tetsuya Horai, Mitsuhiro Hirata, Toshiaki Mishima, Koichi Sughimoto, Hirotoki Ohkubo, Yusuke Irisawa, Takuya Matsushiro, Hidenori Hayashi, Yurie Miyata, Yuta Tsuchida, Naoki Ohtomo, Kagami Miyaji
Regional cerebral oximetry using near-infrared spectroscopy device, an INVOS 5100 C (Medtronic, Minneapolis, MN, USA), during cardiac surgery aims to avoid perioperative neurological impairment, especially during cardiopulmonary bypass. However, it is not uncommon to encounter critically low initial cerebral regional oxygen saturation or a low value unresponsive to intervention. Therefore, it is important to identify factors associated with low saturation value other than true cerebral hypoxia. We investigated the relationship between preoperative regional cerebral oxygen saturation and clinical variables during cardiac surgery...
January 4, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28049487/endothelial-microparticles-are-increased-in-congenital-heart-diseases-and-contribute-to-endothelial-dysfunction
#11
Ze-Bang Lin, Hong-Bo Ci, Yan Li, Tian-Pu Cheng, Dong-Hong Liu, Yan-Sheng Wang, Jun Xu, Hao-Xiang Yuan, Hua-Ming Li, Jing Chen, Li Zhou, Zhi-Ping Wang, Xi Zhang, Zhi-Jun Ou, Jing-Song Ou
BACKGROUND: We previously demonstrated that endothelial microparticles (EMPs) are increased in mitral valve diseases and impair valvular endothelial cell function. Perioperative systemic inflammation is an important risk factor and complication of cardiac surgery. In this study, we investigate whether EMPs increase in congenital heart diseases to promote inflammation and endothelial dysfunction. METHODS: The level of plasma EMPs in 20 patients with atrial septal defect (ASD), 23 patients with ventricular septal defect (VSD), and 30 healthy subjects were analyzed by flow cytometry...
January 4, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28044331/cerebral-oximetry-and-its-role-in-adult-cardiac-non-cardiac-surgery-and-resuscitation-from-cardiac-arrest
#12
REVIEW
D W Green, G Kunst
Monitors using near-infra red spectroscopy to assess cerebral oxygenation levels non-invasively in discrete areas of the brain have been used clinically for over 20 years. Interest has intensified recently, especially during cardiac surgery, and there are now five commercially available devices. Despite the attraction of being able to measure oxygen supply/demand in such a critical area, there has been only limited uptake of this technology in overall clinical anaesthetic practice. This narrative review aims to explore not only the rationale for using this technology but also the factors which have restricted its more widespread use...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28043432/early-extubation-a-proposed-new-metric
#13
Todd C Crawford, Jonathan Trent Magruder, Joshua C Grimm, Christopher Sciortino, John V Conte, Bo S Kim, Robert S Higgins, Duke E Cameron, Marc Sussman, Glenn J Whitman
Shorter intubation periods after cardiac surgery are associated with decreased morbidity and mortality. Although the Society of Thoracic Surgeons uses a 6-hour benchmark for early extubation, the time threshold above which complications increase is unknown. Using an institutional Society of Thoracic Surgeons database, we identified 3007 adult patients who underwent 1 of 7 index cardiac operations from 2010-2014. Patients were stratified by the duration of time to extubation after surgery-0-6, 6-9, 9-12, and 12-18 hours...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28043430/prone-positioning-in-cardiac-surgery-for-many-but-not-for-everyone
#14
Che von Wardenburg, Martin Wenzl, Angelo M Dell'Aquila, Axel Junger, Theodor Fischlein, Giuseppe Santarpino
Prone positioning is a therapeutic maneuver to improve arterial oxygenation in patients with acute lung injury that is not implemented in most centers performing adult cardiac surgery. The aim of this study was to review our experience with prone positioning to assess the effects of this maneuver in patients with postoperative acute respiratory failure. From 2010-2014, 127 adult patients with postoperative acute respiratory failure were treated with prone positioning in addition to specific therapy. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with in-hospital mortality...
July 2016: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28043204/safety-of-gelatin-solutions-for-the-priming-of-cardiopulmonary-bypass-in-cardiac-surgery-a-systematic-review-and-meta-analysis
#15
Idris Ghijselings, Dirk Himpe, Steffen Rex
This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit...
December 1, 2016: Perfusion
https://www.readbyqxmd.com/read/28040751/minimally-invasive-endoscopic-surgery-versus-catheter-based-device-occlusion-for-atrial-septal-defects-in-adults-reconsideration-of-the-standard-of-care
#16
Yvonne Schneeberger, Andreas Schaefer, Lenard Conradi, Jens Brickwedel, Hermann Reichenspurner, Rainer Kozlik-Feldmann, Christian Detter
OBJECTIVES: Percutaneous ostium secundum atrial septal defect (ASD II) closure has become the standard of care for treatment of congenital ASD II in adults. Nevertheless, patients are frequently ineligible for this technique due to challenging morphology. In such cases, closure via minimally invasive cardiac surgery (MICS) is an appropriate treatment option. The aim of this study is to compare outcomes of MICS and use of a percutaneous Amplatzer septal occluder (ASO) device for treatment of ASD II in adults...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28034901/body-mass-index-and-mortality-among-adults-undergoing-cardiac-surgery-a-nationwide-study-with-a-systematic-review-and-meta-analysis
#17
Giovanni Mariscalco, Marcin J Woźniak, Alan G Dawson, Giuseppe F Serraino, Richard Porter, Mintu Nath, Catherine Klersy, Tracy Kumar, Gavin J Murphy
BACKGROUND: -In an apparent paradox morbidity and mortality are lower in obese patients undergoing cardiac surgery, although the nature of this association is unclear. We sought to determine whether the obesity paradox observed in cardiac surgery is attributable to reverse epidemiology, bias, or confounding. METHODS: -Data from the National Adult Cardiac Surgery registry for all cardiac surgical procedures performed between April 2002 and March 2013 were extracted...
December 28, 2016: Circulation
https://www.readbyqxmd.com/read/28024933/a-preoperative-multimarker-approach-to-evaluate-acute-kidney-injury-after-cardiac-surgery
#18
Tone B Enger, Hilde Pleym, Roar Stenseth, Guri Greiff, Alexander Wahba, Vibeke Videm
OBJECTIVE: To investigate whether a multimarker strategy combining preoperative biomarkers representing distinct pathophysiologic pathways enhances preoperative risk assessment of acute kidney injury after cardiac surgery (CSA-AKI) and increases knowledge of underlying pathogenesis. DESIGN: Prospective, cohort study. SETTING: Single-center tertiary referral hospital. PARTICIPANTS: The study comprised 1,015 adults undergoing cardiac surgery with cardiopulmonary bypass...
October 11, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28017677/preoperative-renal-resistive-index-predicts-risk-of-acute-kidney-injury-in-patients-undergoing-cardiac-surgery
#19
Daniel Hertzberg, Simon L Ceder, Ulrik Sartipy, Kent Lund, Martin J Holzmann
OBJECTIVE: To investigate whether an elevated preoperative renal resistive index (RRI) predicts acute kidney injury (AKI) in patients undergoing cardiac surgery. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: Cohort of 96 adult cardiac surgical patients. INTERVENTIONS: Resistive index was measurement the day before surgery. MEASUREMENTS AND MAIN RESULTS: Renal Doppler was used to measure the resistive index in renal cortical or arcuate arteries the day before surgery...
October 11, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28007061/the-evolution-of-an-adult-congenital-heart-surgery-program-the-emory-system
#20
REVIEW
Brian Kogon, Joshua Rosenblum, Bahaaldin Alsoufi, Subhadra Shashidharan, Wendy Book
The Emory Adult Congenital Heart (Emory University, Atlanta, GA) program was founded in 2001. In 2004, the surgical component transitioned from a pediatric facility to an adult facility. The aim of this article is characterize the program as a whole, outline changes in the program, and discuss the challenges of the transition process. Between 2001 and 2015, changes in program structure and personnel were evaluated. There has been significant growth of the program between 2001 and 2015. There are currently 19 half-day clinics per week, with 2,700 clinic visits per year...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
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