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Safety in cardiac surgery

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https://www.readbyqxmd.com/read/29781854/salvage-of-threatened-cardiovascular-implantable-electronic-devices-case-series-and-review-of-literature
#1
Andrew M Simpson, W Tyler Rockwell, Roger A Freedman, W Bradford Rockwell
BACKGROUND: The treatment of infected or exposed cardiac pacing and defibrillator devices is controversial. The conservative and widely accepted management calls for removal of the device and leads with immediate or delayed replacement of new components in a new site. Lead extraction carries a 2% major complication risk. In this article, we describe our experience with device salvage techniques and review the current literature. METHODS: This is a retrospective case series of consecutive patients with infected, exposed, or at-risk implanted cardiac devices that were treated with aggressive surgical debridement, local pocket irrigation, and revision...
May 17, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29780728/intimal-re-layering-technique-for-type-a-acute-aortic-dissection-reconstructing-the-intimal-layer-continuity-to-induce-remodeling-of-the-false-channel
#2
Eugenio Neri, Enrico Tucci, Giulio Tommasino, Giulia Guaccio, Carmelo Ricci, Pierleone Lucatelli, Marco Cini, Roberto Ceresa, Antonio Benvenuti, Luigi Muzzi
Background: Residual false channel is common after repair of type A acute aortic dissection (TAAAD). Starting from our recent series of TAAAD patients we carried out a retrospective analysis, regarding the failure of primary exclusion at the time of the initial operation. We classified the location of the principal entry tears perfusing the residual false channel. The proposed technique represents our attempt to correct the mechanism of false channel perfusion during primary repair. We describe a new technique designed to address some limitations of standard hemiarch aortic replacement...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29780726/operative-techniques-for-improving-surgical-exposure-in-basic-cardiac-surgery
#3
Dawn S Hui, Jason M Lizalek, Vikram S Chawa, Richard Lee
Operative exposure is key to ensuring surgical efficiency and patient safety in cardiac surgery. As the population ages and the prevalence of obesity increases, cardiac surgeons will be challenged to consider obese patient physiology and body habitus, surgical exposure and sternotomy closure techniques, and postoperative medical management to ensure optimal outcomes. In this article, we describe techniques to improve operative exposure in both obese and non-obese patients undergoing basic cardiac surgery and highlight the roles of surgical team members to ensure patient safety and provide optimal anesthetic management...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29770294/three-dimensional-modelling-and-three-dimensional-printing-in-pediatric-and-congenital-cardiac-surgery
#4
REVIEW
Laszlo Kiraly
Three-dimensional (3D) modelling and printing methods greatly support advances in individualized medicine and surgery. In pediatric and congenital cardiac surgery, personalized imaging and 3D modelling presents with a range of advantages, e.g., better understanding of complex anatomy, interactivity and hands-on approach, possibility for preoperative surgical planning and virtual surgery, ability to assess expected results, and improved communication within the multidisciplinary team and with patients. 3D virtual and printed models often add important new anatomical findings and prompt alternative operative scenarios...
April 2018: Translational Pediatrics
https://www.readbyqxmd.com/read/29767837/romiplostim-for-the-management-of-perioperative-thrombocytopenia
#5
Hanny Al-Samkari, Ariela L Marshall, Katayoon Goodarzi, David J Kuter
Thrombocytopenic patients requiring invasive surgery have few options to improve their platelet count preoperatively. This is a single-centre, retrospective review of thrombocytopenic patients receiving the thrombopoietin receptor agonist romiplostim perioperatively to allow for surgical interventions. Patient characteristics, romiplostim use, and surgical and safety outcomes (bleeding, thrombosis, transfusions) were collected and analysed. Forty-seven patients underwent 51 surgical procedures (ranging from total hip arthroplasty to open cardiac surgery) with romiplostim support...
May 16, 2018: British Journal of Haematology
https://www.readbyqxmd.com/read/29752218/elevated-international-normalized-ratio-is-not-associated-with-increased-perioperative-morbidity-in-podiatric-limb-salvage-surgery-a-retrospective-analysis
#6
Nalini Vadivelu, Alice M Kai, Feng Dai, Hosni Mikhael, Rima Aouad, Peter Blume
The risk of hemorrhage always exists in anticoagulated patients with an elevated international normalized ratio (INR), a risk that must be measured against the necessity for surgical procedures. The objective of the present retrospective medical record study was to assess the safety with which limb salvage procedures can be conducted in patients with an INR >1.4. The medical records of 231 patients who had undergone limb salvage procedures by 1 surgeon at the Yale New Haven Health System from November 2008 through July 2014 were reviewed...
May 8, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/29748076/comparison-of-levosimendan-and-milrinone-for-ecls-weaning-in-patients-after-cardiac-surgery-a-retrospective-before-and-after-study
#7
Annina Jacky, Alain Rudiger, Bernard Krüger, Markus J Wilhelm, Sebastian Paal, Burkhardt Seifert, Donat R Spahn, Dominique Bettex
OBJECTIVES: Pharmacodynamics suggests that levosimendan might be a valuable inotrope for weaning from extracorporeal life support (ECLS). As there is a paucity of evidence regarding the effectiveness and safety of such an approach, the aim was to report the authors' experiences in ECLS weaning before and after the implementation of levosimendan in clinical practice. DESIGN: Retrospective before-and-after study. SETTING: Cardiac intensive care unit of a university hospital...
April 6, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29739232/comparison-of-the-coagulation-effect-achieved-by-octaplaslg-versus-fresh-frozen-plasma-in-pediatric-cardiac-surgical-patients
#8
Amanpreet S Kalsi, Omar Al-Azzawi, Ravi Gill
OctaplasLG is indicated for use in patients undergoing cardiac surgery who require replacement of multiple clotting factors. The use of OctaplasLG over single-donor fresh frozen plasma (FFP) may have beneficial effects when considering the transmission of enveloped viruses. Additionally, it has the potential for fewer adverse reactions, reduced disease transmission, and a more homogenous coagulation factor composition. However, its efficacy and safety have not yet been evaluated in the pediatric population...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29735258/outcomes-of-pulmonary-artery-embolization-and-stent-graft-placement-for-the-treatment-of-hemoptysis-caused-by-lung-tumors
#9
Clément Marcelin, Jérome Soussan, Florian Desmots, Jean-Yves Gaubert, Vincent Vidal, Jean Michel Bartoli, Jean Izaaryene
PURPOSE: To evaluate the safety and efficacy of endovascular management of pulmonary artery lesions caused by lung tumors. MATERIALS AND METHODS: Nineteen patients (15 men, 4 women; average age: 60.3 years, range, 51-86 years) treated for massive or recurrent hemoptysis with transarterial pulmonary artery embolization between 2010 and 2016 were included in this multicenter, retrospective study. Inclusion criteria were: patients with lung cancer and at least 1 episode of hemoptysis with a pulmonary artery lesion detected by computed tomography (CT) angiography or after failed bronchial artery embolization...
May 5, 2018: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29733094/safety-profile-of-intraoperative-methadone-for-analgesia-after-major-spine-surgery-an-observational-study-of-1-478-patients
#10
Lauren K Dunn, Sandeep Yerra, Shenghao Fang, Mark F Hanak, Maren K Leibowitz, Salome B Alpert, Siny Tsang, Marcel E Durieux, Edward C Nemergut, Bhiken I Naik
OBJECTIVE: To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery. DESIGN: Retrospective review of perioperative records from March 2011 and February 2016. SETTING: University of Virginia Healthsystem. PATIENTS: Adult patients undergoing elective spinal fusion of two or more levels. MAIN OUTCOME MEASURES: Incidence of respiratory depression, time to extubation, hypotension, hypoxemia, reintubation, cardiac complications, and death...
March 2018: Journal of Opioid Management
https://www.readbyqxmd.com/read/29729267/good-five-year-durability-of-transapical-beating-heart-off-pump-mitral-valve-repair-with-neochordae
#11
Philipp Kiefer, Sabine Meier, Thilo Noack, Michael Andrew Borger, Joerg Ender, Alexandro Hoyer, Friedrich Wilhelm Mohr, Joerg Seeburger
BACKGROUND: Transapical, beating heart, off-pump implantation of neochordae for repair of mitral valve (MV) prolapse is of increasing interest. The aim of this study was to evaluate long term results for MV repair using the NeoChord system. METHODS: Six patients underwent treatment for severe primary mitral regurgitation (MR) using the NeoChord DS1000 system as part of the initial device safety and feasibility Transapical Artificial Chordae Tendinae (TACT) trial at our institution...
May 2, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29727761/systematic-review-and-meta-analyses-of-tranexamic-acid-use-for-bleeding-reduction-in-prostate-surgery
#12
REVIEW
Marcelo A Longo, Bárbara T Cavalheiro, Getúlio R de Oliveira Filho
BACKGROUND: Prostate cancer and benign prostatic hyperplasia have an increased incidence with aging. The most effective treatments are radical prostatectomy and transurethral resection of the prostate. To reduce perioperative bleeding in these surgeries, an approach is the use of tranexamic acid (TXA). Studies show that TXA is effective in reducing the blood loss and the need for transfusion in cardiac, orthopedic, and gynecological surgeries. In prostate surgeries, its efficacy and safety have not been established yet...
May 1, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29726345/mortality-and-morbidity-in-acutely-ill-adults-treated-with-liberal-versus-conservative-oxygen-therapy-iota-a-systematic-review-and-meta-analysis
#13
Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Schünemann, John D Neary, Waleed Alhazzani
BACKGROUND: Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults. METHODS: In the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years)...
April 28, 2018: Lancet
https://www.readbyqxmd.com/read/29722491/-routine-preoperative-testing-in-adults-undergoing-elective-non-cardiothoracic-surgery
#14
REVIEW
N Benahmed, G Briat, K Rondia, J Vlayen
INTRODUCTION: The Belgian Health Care Knowledge Center (KCE) developed a guideline about routine preoperative testing in adults undergoing elective non-cardiothoracic surgery. The guideline is intended for all care providers involved in the preoperative and perioperative management (incl. anesthesiologists, surgeons, cardiologists, lung specialists, radiologists, clinical biologists, general practitioners, etc). METHOD: A recent English guideline published by NICE (National Institute for Health and Care Excellence) was used as a starting point and adapted to the Belgian context...
2018: Revue Médicale de Bruxelles
https://www.readbyqxmd.com/read/29716763/expanding-eligibility-for-the-ross-procedure-a-reasonable-proposition
#15
Aly Ghoneim, Ismail Bouhout, Katie Losenno, Nancy Poirier, Raymond Cartier, Philippe Demers, Michael Tousch, Linruo Guo, Michael W A Chu, Ismail El-Hamamsy
BACKGROUND: Although the Ross procedure offers potential benefits in young adults, technical complexity represents a significant limitation. Therefore, the safety of expanding its use in more complex settings is uncertain. The aim of this study was to compare early outcomes of standard isolated Ross procedures vs expanding elgibility to higher-risk clinical settings. METHODS: From 2011 to 2016, 261 patients (46 ± 12 years) underwent Ross procedures in 2 centres...
January 31, 2018: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29716732/different-nuss-procedures-and-risk-management-for-pectus-excavatum-after-surgery-for-congenital-heart-disease
#16
Chenghao Chen, Xiaofeng Li, Na Zhang, Jie Yu, Dong Yan, Changqi Xu, Qi Zeng, Zhongzhi Li
PURPOSE: In Nuss procedure for pectus excavatum (PE) after surgery for congenital heart disease (CHD), retrosternal adhesion may increase the risk of cardiac injury. This study aimed to explore different Nuss procedures and their implications for reducing the incidence of serious complications and improving surgical safety. METHODS: We retrospectively reviewed 49 cases (29 male and 20 female) of Nuss procedures for PE after surgery for CHD that were performed between April 2003 and December 2016...
April 7, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29703580/nitric-oxide-in-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#17
Salvatore Sardo, Eduardo Atsushi Osawa, Gabriele Finco, Filomena Regina Barbosa Gomes Galas, Juliano Pinheiro de Almeida, Salvatore Lucio Cutuli, Claudia Frassanito, Giovanni Landoni, Ludhmila Abrahao Hajjar
OBJECTIVES: To investigate the efficacy and safety of perioperative administration of nitric oxide in cardiac surgery. DESIGN: Meta-analysis of randomized controlled trials (RCTs). PARTICIPANTS: Cardiac surgery patients. INTERVENTIONS: A search of Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE for RCTs that compared nitric oxide with placebo or other comparators. MEASUREMENTS AND MAIN RESULTS: The primary outcome was intensive care unit (ICU) stay, and secondary outcomes were mortality, duration of mechanical ventilation, and reduction of mean pulmonary artery pressure...
April 24, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29701424/perioperative-family-centered-care-nursing-interventions-that-support-child-and-family-s-emotional-management
#18
Dario Antunes, Paula Diogo
INTRODUCTION: Hospitalization is a negative tonality experience for both child and family, being fear and anxiety their emotional mirror. Concerning the surgical experience, the environment, invasiveness, fear of pain, of not waking up from anaesthesia and parental separation are both causes and enhancers of child and family perioperative distress. A study concerning parent's emotional experience of child's submitted to cardiac surgery, refer guilt for their son's cardiopathy, a roller coaster of emotions, impotence and being seated on pins and needles while waiting during the surgery...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701167/amaze-a-double-blind-multicentre-randomised-controlled-trial-to-investigate-the-clinical-effectiveness-and-cost-effectiveness-of-adding-an-ablation-device-based-maze-procedure-as-an-adjunct-to-routine-cardiac-surgery-for-patients-with-pre-existing-atrial-fibrillation
#19
Linda Sharples, Colin Everett, Jeshika Singh, Christine Mills, Tom Spyt, Yasir Abu-Omar, Simon Fynn, Benjamin Thorpe, Victoria Stoneman, Hester Goddard, Julia Fox-Rushby, Samer Nashef
BACKGROUND: Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. OBJECTIVES: To determine whether or not the maze procedure is safe, improves clinical and patient outcomes and is cost-effective for the NHS in patients with AF. DESIGN: Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised controlled trial...
April 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29699618/cerebrovascular-events-after-cardiovascular-procedures-risk-factors-recognition-and-prevention-strategies
#20
REVIEW
Jasneet K Devgun, Sajjad Gul, Divyanshu Mohananey, Brandon M Jones, M Shazam Hussain, Yash Jobanputra, Arnav Kumar, Lars G Svensson, E Murat Tuzcu, Samir R Kapadia
Stroke has long been a devastating complication of any cardiovascular procedure that unfavorably affects survival and quality of life. Over time, strategies have been developed to substantially reduce the incidence of stroke after traditional cardiovascular procedures such as coronary artery bypass grafting, isolated valve surgery, and carotid endarterectomy. Subsequently, with the advent of minimally invasive technologies including percutaneous coronary intervention, carotid artery stenting, and transcatheter valve therapies, operators were faced with a new host of procedural risk factors, and efforts again turned toward identifying novel ways to reduce the risk of stroke...
May 1, 2018: Journal of the American College of Cardiology
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