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Post cardiac surgery care

Zühre Uz, Can Ince, Philippe Guerci, Yasin Ince, Renata P Araujo, Bulent Ergin, Matthias P Hilty, Thomas M van Gulik, Bas A de Mol
Background: Management of tissue perfusion following cardiac surgery is a challenging task where common clinical parameters do not reflect microcirculatory dysfunction. Heterogeneity in blood flow perfusion and abnormalities in capillary density characterize microcirculatory dysfunction. The restoration of a normal microcirculation may become a novel target for therapy in the future in addition to macrocirculatory parameters. The aim of this study is to determine how the sublingual microcirculatory parameters vary at the bedside in post-cardiac surgery patients which underwent diuretic therapy to correct fluid overload...
2018: Perioperative Medicine
Hatem A El Shora, Ahmed A El Beleehy, Amr A Abdelwahab, Gaser A Ali, Tarek E Omran, Essam A Hassan, Amr A Arafat
BACKGROUND:  Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. MATERIALS AND METHODS:  Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups...
August 16, 2018: Thoracic and Cardiovascular Surgeon
Tanveer Singh Kundra, V Prabhakar, Parminder Kaur, N Manjunatha, Ravi Gandham
OBJECTIVE: To compare the effects of inhaled milrinone and levosimendan on pulmonary and systemic hemodynamics in patients with pulmonary hypertension. DESIGN: Prospective, double-blind, randomized controlled study. SETTING: Tertiary care cardiac institute with 650 beds. PARTICIPANTS: The study comprised 150 adult patients with pulmonary hypertension undergoing mitral valve surgery. INTERVENTIONS: Patients were assigned randomly into 1 of the following 3 groups: milrinone (M), levosimendan (L), or control (C); n = 50 per group...
April 6, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Joseph Philip, Christian Kegg, Dalia Lopez-Colon, Brian J Kelly, Robert M Lawrence, Matthew A Robinson, Ravi S Samraj, Mark S Bleiweis
BACKGROUND: There is no consensus for the length of prophylactic antibiotics after delayed chest closure (DCC) postcardiac surgery in pediatrics. In September 2014, our institution's pediatric cardiac intensive care unit changed the policy on length of prophylactic antibiotics after DCC from 5 days (control) to 2 days (study group). The objective of the study was to determine whether a 2-day course of antibiotics is as effective as a 5-day course in preventing blood stream and sternal wound infections in pediatric DCC...
August 8, 2018: Journal of Intensive Care Medicine
Nicola Moran, Gobnait Byrne
AIMS: to explore cardiothoracic nurses' knowledge and self-reported competence of wound care following cardiac surgery and to ascertain if there were any differences in knowledge between nurses working in public and private hospitals. BACKGROUND: cardiothoracic nurses are the main providers of wound care for patients post cardiac surgery, however, there is a lack of research about their knowledge of wound care. DESIGN: a descriptive, quantitative design was used in the form of a cross-sectional, self-reported questionnaire...
August 9, 2018: British Journal of Nursing: BJN
Annarita Pilleri, Maurizio Giuseppe Abrignani, Fabio Angeli, Paolo Fontanive, Paolo Silvestri, Gian Francesco Mureddu
BACKGROUND: Cardiovascular risk stratification and perioperative management of subjects undergoing non-cardiac surgery have recently been updated in the 2014 European Society of Cardiology guidelines. Nevertheless, and notwithstanding the epidemiological relevance of this condition, an underevaluation of the importance of perioperative risk stratification is a common feeling. METHODS: The ANMCO Cardiovascular Prevention Area organized, last year, a web-based survey with 15 questions to investigate perioperative management and care pathways in non-cardiac surgery and to evaluate guideline adherence of Italian cardiologists...
September 2018: Giornale Italiano di Cardiologia
Heidi Noels, Wendy Theelen, Marieke Sternkopf, Vera Jankowski, Julia Moellmann, Sandra Kraemer, Michael Lehrke, Nikolaus Marx, Lukas Martin, Gernot Marx, Joachim Jankowski, Andreas Goetzenich, Christian Stoppe
Cardiac surgery with cardiopulmonary bypass (CPB) triggers myocardial ischemia/reperfusion injury contributing to organ dysfunction. Preclinical studies revealed that dipeptidyl peptidase (DPP4) inhibition is protective during myocardial infarction. Here, we assessed for the first time the relation of peri-operative DPP4-activity in serum of 46 patients undergoing cardiac surgery with patients' post-operative organ dysfunction during intensive care unit (ICU) stay. Whereas a prior myocardial infarction significantly reduced pre-operative DDP4-activity, patients with preserved left ventricular function showed an intra-operative decrease of DPP4-activity...
August 7, 2018: Scientific Reports
Pedro N M P Coelho, Luís M R P C Miranda, Pedro M P Barros, José I G Fragata
OBJECTIVES: Cardiac surgery has little effect on life expectancy in elderly patients. Thus, improving the quality of life should be the main factor affecting therapeutic decisions. Most studies on quality of life in elderly patients undergoing cardiac surgery report improvement but have limitations. Consequently, we assessed improvements in the quality of life of elderly patients undergoing elective cardiac surgery, identified influencing variables and established patterns of mental and physical health variations in the first year postoperatively...
July 31, 2018: Interactive Cardiovascular and Thoracic Surgery
Giuseppe Filiberto Serraino, Federica Jiritano, Michele Rossi, Pasquale Mastroroberto
BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) support has emerged as a valuable rescue therapy in patients with severe acute lung failure. A new bicaval dual-lumen percutaneous cannula can be instituted with a single puncture of the right internal jugular vein under image guidance (fluoroscopy and/or trans-esophageal echocardiography) to support VV-ECMO. However, malpositioning of the dual-lumen catheter can jeopardize the efficacy of the ECMO therapy. CASE REPORT: We report an emergency VV-ECMO instituted at a patient's bedside in the intensive care unit...
June 26, 2018: Heart Surgery Forum
N Subramaniam, D Balasubramanian, P Rka, P Rathod, S Murthy, S Vidhyadharan, S Rajan, J Paul, K Thankappan, S Iyer
OBJECTIVE: Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients. METHODS: In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50-60 years, and univariate analysis was performed...
August 3, 2018: Journal of Laryngology and Otology
Adam A Dalia, Jamel Ortoleva, Amy Fiedler, Mauricio Villavicencio, Ken Shelton, Gaston D Cudemus
OBJECTIVES: At the authors' institution, prior to 2014, patients requiring care in the peri-extracorporeal membrane oxygenation (ECMO) period were treated by intensivists with specific training in ECMO but worked independently. This isolated form of care was addressed in late 2013 with the formal initiation of an ECMO team. The authors wanted to assess the difference in overall mortality for ECMO patients cared for prior to the initiation of a multidisciplinary team compared to after its establishment...
June 20, 2018: Journal of Cardiothoracic and Vascular Anesthesia
A Guerrero Gómez, N González Jaramillo, J A Castro Pérez
INTRODUCTION: The fast track / ultra-fast-track protocols are techniques used to optimise the patient care process and a quick recovery after cardiac surgery. They are one of the mainstays of efficient practice. With their use, the length of hospital and intensive care unit (ICU) stays are reduced, with a direct impact on costs and the quality of the health service. OBJECTIVE: To compare the length of stay in the ICU, length of hospital stay, and post-operative mortality in ultra-fast-track extubated (uFTE) patients and those with conventional extubation (CE) after cardiac surgery...
July 24, 2018: Revista Española de Anestesiología y Reanimación
Ebrahim Shafiei, Mehrzad Bahtoei, Pema Raj, Afshin Ostovar, Daryoush Iranpour, Samad Akbarzadeh, Hooshang Shahryari, Abdorasoul Anvaripour, Rahim Tahmasebi, Thomas Netticadan, Ali Movahed
OBJECTIVES: This study assessed the efficacy of oral consumption of N-acetyl cysteine (NAC) and melatonin (ML) in reducing early reperfusion injury and acute oxidative stress in patients undergoing coronary artery bypass grafting (CABG) with respect to the measurements of cardiac troponin I, lactate, malondealdehyde (MDA), and tumor necrosis factor-α (TNF-α) levels in the blood. METHODS: This study was a randomized, open-label, placebo-controlled trial. Eighty eight patients, aged between 39 to 76 years and eligible for CABG, were recruited and randomly assigned into 3 intervention groups through a simple randomization method and underwent CABG surgery...
July 2018: Medicine (Baltimore)
Jennifer F Gerardin, Michael G Earing
PURPOSE OF REVIEW: Highlight the extracardiac comorbidities that adult congenital heart disease patients and summarize the current recommendations for non-cardiac surgery. RECENT FINDINGS: Adult congenital heart disease patients are living longer, becoming more complex and developing adult comorbidities as they age. These patients have multiorgan involvement including higher prevalence of kidney disease and decreased lung function. Non-cardiac comorbidities can complicate surgery in this patient population...
July 21, 2018: Current Cardiology Reports
Vera Saldien, Tom Schepens, Katrien Van Loock, Gaelle Vermeersch, Davina Wildemeersch, Viviane Van Hoof, Frank De Belder, Johan Bosmans, Marcel Vercauteren, Tomas Menovsky
BACKGROUND: Intraoperative rupture of a cerebral aneurysm during neurosurgery can be a devastating event that increases perioperative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique to obtain flow arrest for short periods of time during dissection or rupture of the aneurysm. OBJECTIVE: To evaluate the neurological and cardiac effects of repetitive periods of RVP during cerebrovascular surgery. METHODS: Data from patients who underwent repetitive RVP during craniotomy for different cerebrovascular disorders were retrospectively analysed from a single-centre medical records database (Cegeka Medical Health Care Systems)...
July 16, 2018: World Neurosurgery
Amy M Shanks, Derek T Woodrum, Sathish S Kumar, Darrell A Campbell, Sachin Kheterpal
BACKGROUND: Perioperative hyperglycemia and its associated increase in morbidity and mortality have been well studied in the critical care and cardiac surgery literature. However, there is little data regarding the impact of intraoperative hyperglycemia on post-operative infectious complications in non-cardiac surgery. METHODS: All National Surgery Quality Improvement Program patients undergoing general, vascular, and urological surgery at our tertiary care center were reviewed...
July 19, 2018: BMC Anesthesiology
Tomas D Tannvik, Audun E Rimehaug, Nils K Skjaervold, Idar Kirkeby-Garstad
This study assesses positional changes in cardiac power output and stroke work compared with classic hemodynamic variables, measured before and after elective coronary artery bypass graft surgery. The hypothesis was that cardiac power output was altered in relation to cardiac stunning. The study is a retrospective analysis of data from two previous studies performed in a tertiary care university hospital. Thirty-six patients scheduled for elective coronary artery bypass graft surgery, with relatively preserved left ventricular function, were included...
July 2018: Physiological Reports
Sergey Karamnov, Ethan Y Brovman, Katherine J Greco, Richard D Urman
PURPOSE: Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post-cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. MATERIALS AND METHODS: In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014...
July 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Fabian B Fahlbusch, Thomas Heinlein, Manfred Rauh, Sven Dittrich, Robert Cesnjevar, Julia Moosmann, Jennifer Nadal, Matthias Schmid, Frank Muench, Michael Schroth, Wolfgang Rascher, Hans-Georg Topf
OBJECTIVES: Coagulation factor XIII (FXIII) plays a key role in fibrin clot stabilization-an essential process for wound healing following cardiothoracic surgery. However, FXIII deficiency as a risk for post-operative bleeding in pediatric cardiac surgery involving cardiopulmonary bypass (CPB) for congenital heart disease (CHD) is controversially discussed. Thus, as primary outcome measures, we analyzed the association of pre-operative FXIII activity and post-operative chest tube drainage (CTD) loss with transfusion requirements post-operatively...
2018: PloS One
Karam Ayoub, Fuad Habash, Ahmed Almomani, Jack Xu, Meera Marji, Allison Shaw-Devine, Hakan Paydak, Srikanth Vallurupalli
Background: New onset post-operative atrial fibrillation (POAF) can complicate both non-cardiac(NCS) and cardiac(CS) surgeries. Long term differences in recurrence of atrial fibrillation (AF) and incidence of ischemic stroke/transient ischemic attack(CVA)between these types of POAFare lacking. Objective: To compare thelong term recurrence rate of AF and incidence of CVAin patients withnew onset POAF after CS and NCS. Methods: All patients who developed POAF between May 2010 and April 2014 were included in this single-center, retrospective study Exclusion criteria included a prior history of atrial tachyarrhythmias and pre-operative use of anti-arrhythmic drugs...
April 2018: Journal of Atrial Fibrillation
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