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Safety in cardiac surgery

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https://www.readbyqxmd.com/read/28104306/midterm-and-one-year-outcome-of-amphilimus-polymer-free-drug-eluting-stent-in-patients-needing-short-dual-antiplatelet-therapy-insight-from-the-astute-registry-amphilimus-italian-multicenter-registry
#1
Cosmo Godino, Mauro Chiarito, Michael Donahue, Luca Testa, Riccardo Colantonio, Alberto Cappelletti, Alberto Monello, Valeria Magni, Diego Milazzo, Rosario Parisi, Annamaria Nicolino, Shahram Moshiri, Rossella Fattori, Gianfranco Aprigliano, Altin Palloshi, Giuseppe Caramanno, Matteo Montorfano, Francesco Bedogni, Carlo Briguori, Alberto Margonato, Antonio Colombo
BACKGROUND: To assess clinical outcomes of patients needing short dual antiplatelet therapy (S-DAPT) after PCI with Cre8 polymer-free amphilimus eluting-stent (AES). The Cre8-AES with pure i-Carbofilm coating was supposed to induce faster stent endothelialization and reduce device thrombogenicity. METHODS: We performed a sub-analysis of unrestricted consecutive patients treated with Cre8-AES between August 2011 and January 2015. Two groups were formed: 1) patients discharged with S-DAPT (≤3-month), because of high bleeding risk or attending urgent non-cardiac surgery; and 2) patients discharged with Recommended DAPT duration (R-DAPT; ≥6-month)...
January 5, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28100522/intraoperative-dexamethasone-does-not-increase-the-risk-of-postoperative-wound-infection-a-propensity-score-matched-post-hoc-analysis-of-the-enigma-ii-trial-endex
#2
T Corcoran, J Kasza, T G Short, E O'Loughlin, M T V Chan, K Leslie, A Forbes, M Paech, P Myles
BACKGROUND: In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. METHODS: Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. RESULTS: Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8...
February 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28096832/perioperative-care-in-elderly-cardiac-surgery-patients
#3
Ewa Kucewicz-Czech, Katarzyna Kiecak, Ewa Urbańska, Tomasz Maciejewski, Robert Kaliś, Waldemar Pakosiewicz, Tadeusz Kołodziej, Piotr Knapik, Roman Przybylski, Marian Zembala
INTRODUCTION: Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. AIM: To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. MATERIAL AND METHODS: The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009-2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium...
December 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28096826/pol-tavi-polish-registry-of-transcatheter-aortic-valve-implantation-simple-tool-great-value-rationale-and-design
#4
Joanna Zembala-John, Krzysztof Wilczek, Zdzisław Tobota, Piotr Chodór, Daniel Cieśla, Tomasz Jaźwiec, Waldemar Banasiak, Janina Stępińska, Zbigniew Kalarus, Grzegorz Opolski, Marian Zembala
Aortic stenosis (AS) is the most common valvular heart disease in adults in Europe and North America. Management of AS patients depends on accurate diagnosis of the cause and stage of the disease process: the first and definitive therapeutic choice for a growing number of elderly patients with symptomatic AS is surgical treatment. In patients not eligible for surgery, transcatheter aortic valve implantation (TAVI) constitutes a safe and effective alternative. As an innovative, costly method of treatment, it requires however careful monitoring of its course, documenting its early and long-term results, and assessment of its safety and medical-economic cost-effectiveness...
December 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28096823/comparison-of-del-nido-cardioplegia-and-st-thomas-hospital-solution-two-types-of-cardioplegia-in-adult-cardiac-surgery
#5
Prashant Mishra, Ranjit B Jadhav, Chandan Kumar Ray Mohapatra, Jayant Khandekar, Chaitanya Raut, Ganesh Kumar Ammannaya, Harsh S Seth, Jaskaran Singh, Vaibhav Shah
INTRODUCTION: St. Thomas' cardioplegic solution No. 2 (ST), although most widely used in adult cardiac surgery, needs to be given at short intervals, causing additional myocardial injury. AIM: To determine whether del Nido (DN) cardioplegia, with longer periods of arrest, provides equivalent myocardial protection as compared to ST. MATERIAL AND METHODS: The study population comprised 100 patients who underwent elective coronary artery bypass grafting (CABG) or double valve replacement (DVR) surgery between January 2015 and January 2016...
December 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28094478/fluid-management-in-cardiac-surgery-patients-pitfalls-challenges-and-solutions
#6
Elena Bignami, Marcello Guarnieri, Marco Gemma
Fluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality...
January 17, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28087110/systematic-review-and-meta-analysis-of-randomized-controlled-trials-assessing-safety-and-efficacy-of-posterior-pericardial-drainage-in-patients-undergoing-heart-surgery
#7
Mirosław Gozdek, Wojciech Pawliszak, Wojciech Hagner, Paweł Zalewski, Janusz Kowalewski, Domenico Paparella, Thierry Carrel, Lech Anisimowicz, Mariusz Kowalewski
OBJECTIVES: To investigate the potential beneficial effects of posterior pericardial drainage in patients undergoing heart surgery. METHODS: Multiple online databases and relevant congress proceedings were screened for randomized controlled trials assessing the efficacy and safety of posterior pericardial drainage, defined as posterior pericardiotomy incision, chest tube to posterior pericardium, or both. Primary endpoint was in-hospital/30 days' cardiac tamponade...
December 19, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28077532/modern-hydroxyethyl-starch-and-acute-kidney-injury-after-cardiac-surgery-a-prospective-multicentre-cohort
#8
M Vives, R Callejas, P Duque, G Echarri, D N Wijeysundera, A Hernandez, A Sabate, M Bes-Rastrollo, P Monedero
BACKGROUND: Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients. METHODS: In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals...
October 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28073791/rapid-deployment-aortic-replacement-radar-registry-in-spain-a-protocol
#9
Victor Bautista-Hernandez, Natalia Cal-Purriños, Jose M Arribas-Leal, Manuel Carnero-Alcazar, Jose F Gutierrez-Diez, Jose J Cuenca-Castillo
INTRODUCTION: Rapid deployment valves (RDV) represent a newly introduced approach to aortic valve replacement which facilitates surgical implantation and minimally invasive techniques, shortens surgical times and shows excellent haemodynamic performance. However, evidence on their safety, efficacy and potential complications is mostly fitted with small-volume and retrospective studies. Moreover, no current guidelines exist. To improve our knowledge on this technology, The Rapid Deployment Aortic Replacement (RADAR) Registry will be established across Spain with the aim of assessing RDV outcomes in the real-world setting...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28063271/hybrid-minimally-invasive-approach-for-transvenous-lead-extraction-a-feasible-technique-in-high-risk-patients
#10
Luca Bontempi, Francesca Vassanelli, Manuel Cerini, Gianluigi Bisleri, Alberto Repossini, Laura Giroletti, Lorenza Inama, Francesca Salghetti, Daria Liberto, Daniele Giacopelli, Abdallah Raweh, Claudio Muneretto, Antonio Curnis
INTRODUCTION: Despite the overall safety, transvenous lead extraction (TLE) remains a challenging procedure with inherent risks, where surgery can still be required in elective cases. In this study, we report our experience with a minimally invasive "hybrid" approach, defined as a procedure performed by an electrophysiologist with the support of a cardiac surgeon in the same operative session. METHODS AND RESULTS: We reported 12 cases of planned hybrid lead extraction; minithoracotomy and thoracoscopy were performed on 10 (83%) and 2 (17%) patients, respectively...
January 7, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28054978/hemoglobin-based-blood-substitutes-and-the-treatment-of-sickle-cell-disease-more-harm-than-help
#11
REVIEW
Abdu I Alayash
Intense efforts have been made by both industry and academia over the last three decades to produce viable hemoglobin (Hb)-based oxygen carriers (HBOCs), also known as "blood substitutes". Human trials conducted so far by several manufactures in a variety of clinical indications, including trauma, and elective surgeries have failed and no product has gained the Food and Drug Administration approval for human use. Safety concerns due to frequent incidences of hemodynamic, cardiac events, and even death led to the termination of some of these trials...
January 4, 2017: Biomolecules
https://www.readbyqxmd.com/read/28045369/carotid-endarterectomy-following-thrombolysis-for-acute-ischaemic-stroke
#12
Naz Ahmed, Damian Kelleher, Manmohan Madan, Sarita Sochart, George A Antoniou
BACKGROUND: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. PATIENTS AND METHODS: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points...
January 3, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28043424/phase-of-care-mortality-analysis-a-unique-method-for-comparing-mortality-differences-among-transcatheter-aortic-valve-replacement-and-surgical-aortic-valve-replacement-patients
#13
Todd C Crawford, J Trent Magruder, Joshua C Grimm, Kaushik Mandal, Joel Price, Jon Resar, Matthew Chacko, Rani K Hasan, Glenn Whitman, John V Conte
The objective of this study is based on the phase of care mortality analysis (POCMA), an effective tool to evaluate the root cause of in-hospital mortality in cardiac surgery patients. POCMA has not been used to compare operative mortalities among transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) populations, and may provide insight that could affect patient safety initiatives and improve outcomes in aortic valve surgery. We included patients who underwent TAVR or isolated SAVR between 2011 and March 31, 2015 and did not survive the index hospitalization...
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
#14
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/28040318/transcatheter-mitral-valve-replacement-for-patients-with-symptomatic%C3%A2-mitral%C3%A2-regurgitation-a-global-feasibility-trial
#15
David W M Muller, Robert Saeid Farivar, Paul Jansz, Richard Bae, Darren Walters, Andrew Clarke, Paul A Grayburn, Robert C Stoler, Gry Dahle, Kjell A Rein, Marty Shaw, Gregory M Scalia, Mayra Guerrero, Paul Pearson, Samir Kapadia, Marc Gillinov, Augusto Pichard, Paul Corso, Jeffrey Popma, Michael Chuang, Philipp Blanke, Jonathon Leipsic, Paul Sorajja
BACKGROUND: Symptomatic mitral regurgitation (MR) is associated with high morbidity and mortality that can be ameliorated by surgical valve repair or replacement. Despite this, many patients with MR do not undergo surgery. Transcatheter mitral valve replacement (TMVR) may be an option for selected patients with severe MR. OBJECTIVES: This study aimed to examine the effectiveness and safety of TMVR in a cohort of patients with native valve MR who were at high risk for cardiac surgery...
December 20, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28033074/preoperative-feeding-neonates-with-cardiac-disease
#16
Carly J Scahill, Eric M Graham, Andrew M Atz, Scott M Bradley, Minoo N Kavarana, Sinai C Zyblewski
BACKGROUND: The potential for necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome. METHODS: A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with NEC in neonates requiring cardiac surgery...
January 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28025309/safety-and-efficacy-of-prophylactic-negative-pressure-wound-therapy-following-open-saphenous-vein-harvest-in-cardiac-surgery-a-feasibility-study
#17
Arthur J Lee, Christina E Sheppard, William D T Kent, Holly Mewhort, Khokan C Sikdar, Paul W M Fedak
OBJECTIVES: Surgical site complications following great saphenous vein (GSV) harvest presents a significant risk of morbidity. Negative pressure wound therapy (NPWT) has shown promise in the treatment and prophylaxis of open wounds and surgical incisions but has not been studied following GSV harvest. We performed a feasibility study examining the use of NPWT following GSV harvest for coronary bypass surgery. METHODS: Sixty-four patients were recruited in this single-centre, single-blind, randomized controlled trial...
December 26, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28018097/contraindications-for-video-capsule-endoscopy
#18
REVIEW
Dirk Bandorski, Niehls Kurniawan, Peter Baltes, Reinhard Hoeltgen, Matthias Hecker, Dominik Stunder, Martin Keuchel
Video capsule endoscopy (VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn's disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication...
December 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28007201/incidence-characteristics-predictors-and%C3%A2-outcomes-of-repeat-revascularization-after-percutaneous-coronary-intervention-and-coronary-artery-bypass-grafting-the-syntax-trial-at-5-years
#19
Catalina A Parasca, Stuart J Head, Milan Milojevic, Michael J Mack, Patrick W Serruys, Marie-Claude Morice, Friedrich W Mohr, Ted E Feldman, Antonio Colombo, Keith D Dawkins, David R Holmes, Pieter A Kappetein
OBJECTIVES: The study sought to determine the incidence, predictors, characteristics, and outcomes of repeat revascularization during 5-year follow-up of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) trial. BACKGROUND: Limited in-depth long-term data on repeat revascularization are available from randomized trials comparing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). METHODS: Incidence and timing of repeat revascularization and its relation to the long-term composite safety endpoint of death, stroke, and myocardial infarction were analyzed in the SYNTAX trial (n = 1,800) using Kaplan-Meier analysis...
December 26, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28007199/coronary-artery-bypass-surgery-versus%C3%A2-drug-eluting-stent-implantation-for%C3%A2-left%C3%A2-main-or-multivessel-coronary-artery%C3%A2-disease-a-meta-analysis-of-individual-patient-data
#20
Cheol Whan Lee, Jung-Min Ahn, Rafael Cavalcante, Yohei Sotomi, Yoshinobu Onuma, Pannipa Suwannasom, Erhan Tenekecioglu, Sung-Cheol Yun, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Seong-Wook Park, Patrick W Serruys, Seung-Jung Park
OBJECTIVES: The authors undertook a patient-level meta-analysis to compare long-term outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in 3,280 patients with left main or multivessel coronary artery disease (CAD). BACKGROUND: The relative efficacy and safety of CABG versus PCI with DES for left main or multivessel CAD remain controversial. METHODS: Data were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus Eluting Stent Implantation in the Treatment of Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery vs...
December 26, 2016: JACC. Cardiovascular Interventions
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