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Safety in cardiac surgery

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https://www.readbyqxmd.com/read/28645469/transcatheter-mitral-valve-repair-with-mitraclip-for-symptomatic-functional-mitral-valve-regurgitation
#1
REVIEW
Rodrigo Mendirichaga, Vikas Singh, Vanessa Blumer, Manuel Rivera, Alex P Rodriguez, Mauricio G Cohen, William W O'Neill, Sammy Elmariah
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has proved to be safe and effective for high-risk surgical patients with severe symptomatic degenerative mitral regurgitation. There is paucity of data regarding its use in functional mitral regurgitation (FMR). The objective of this study was to evaluate the use of MitraClip in patients with symptomatic moderate or severe FMR and a high surgical risk. Medical libraries were systematically searched for studies assessing the use of MitraClip for patients with symptomatic moderate or severe FMR and a high surgical risk...
May 30, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28637170/neuroprotective-effect-of-pressure-oriented-flow-regulation-and-ph-stat-management-in-selective-antegrade-brain-perfusion-during-total-aortic-arch-repair
#2
Hisato Ito, Toru Mizumoto, Yasuhiro Sawada, Kazuya Fujinaga, Hironori Tempaku, Yasunori Yamamoto, Katsuhiro Tsutsui, Hideto Shimpo
OBJECTIVES: The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump. METHODS: Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28629781/position-paper-for-the-evaluation-and-management-of-oral-status-in-patients-with-valvular-disease-groupe-de-travail-valvulopathies-de-la-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-cardiologie-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-chirurgie-orale-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-parodontologie-et-d-implantologie
#3
REVIEW
Sarah Millot, Philippe Lesclous, Marie-Laure Colombier, Loredana Radoi, Clément Messeca, Mathieu Ballanger, Jean-Luc Charrier, Philippe Tramba, Stéphane Simon, Alain Berrebi, Fabien Doguet, Emmanuel Lansac, Christophe Tribouilloy, Gilbert Habib, Xavier Duval, Bernard Iung
Oral health is of particular importance in patients with heart valve diseases because of the risk of infective endocarditis. Recommendations for antibiotic prophylaxis before dental procedures have been restricted, but the modalities of oral evaluation and dental care are not detailed in guidelines. Therefore, a multidisciplinary working group reviewed the literature to propose detailed approaches for the evaluation and management of buccodental status in patients with valvular disease. Simple questions asked by a non-dental specialist may draw attention to buccodental diseases...
June 16, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28625383/the-assessment-of-the-watchman-device-in-patients-unsuitable-for-oral-anticoagulation-asap-too-trial
#4
David R Holmes, Vivek Y Reddy, Maurice Buchbinder, Kenneth Stein, Myriah Elletson, Martin W Bergmann, Boris Schmidt, Jacqueline Saw
BACKGROUND: Oral anticoagulants (OACs) reduce stroke risks with nonvalvular atrial fibrillation (AF); however, they are underused because of absolute or relative contraindications due to real or perceived risk of bleeding. Although left atrial appendage closure is increasingly performed in OAC-ineligible patients, this has not been studied in a randomized controlled trial. STUDY OBJECTIVES: The ASAP-TOO study is designed to establish the safety and effectiveness of the Watchman left atrial appendage closure device in patients with nonvalvular AF who are deemed ineligible for OAC...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28616214/high-dose-hydroxocobalamin-for-vasoplegic-syndrome-causing-false-blood-leak-alarm
#5
Wisit Cheungpasitporn, John Hui, Kianoush B Kashani, Erica D Wittwer, Robert C Albright, John J Dillon
Blood leak alarms are important safety features in a hemodialysis machine to protect patients from loss of blood through a rupture in the dialyzer membrane (true alarms). A false blood leak alarm can be triggered by air bubbles or detector malfunction (such as deposits of grease or scale). Hydroxocobalamin is an injectable form of vitamin B12 approved by the US Food and Drug Administration for the treatment of confirmed or suspected cyanide toxicity. Due to observations of an increase in arterial pressure after high-dose hydroxocobalamin infusion for the treatment of acute cyanide poisoning, it has recently been reported as an off-label rescue treatment for post-cardiopulmonary bypass vasoplegic syndrome...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28593177/in-hospital-outcomes-and-long-term-follow-up-after-percutaneous-transcatheter-closure-of-postinfarction-ventricular-septal-defects
#6
Ruoxi Zhang, Yong Sun, Meng Sun, Hui Zhang, Jingbo Hou, Bo Yu
Postinfarction ventricular septal defects (VSD) represent a devastating complication of acute myocardial infarction and are associated with high mortality. Percutaneous interventional closure of postinfarction VSD has been proposed as a potential alternative to surgery. The study aimed to evaluate the therapeutic safety and efficacy of percutaneous interventional closure of postinfarction ventricular septal defects (VSD). Each patient was assigned to one of two groups, based on whether they died during hospitalization (death group) or survived (survival group) in this retrospective study...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28580776/do-we-have-enough-evidence-for-minimally-invasive-cardiac-surgery-a-critical-review-of-scientific-and-non-scientific-information
#7
REVIEW
Torsten Doenst, Joseph Lamelas
Reducing surgical trauma by minimizing skin incisions has transformed abdominal surgery resulting in significant improvements in outcome. In cardiac surgery, such efforts have also been made, but similar benefits could not be demonstrated. In addition, any potential benefit comes at the cost of increased cardiopulmonary bypass and clamp times, leading to questions regarding the safety of minimally invasive cardiac surgery (MICS). Nevertheless, outcomes have been equivalent to matched sternotomy cases and there is no doubt that the number of patients undergoing minimally-invasive mitral or aortic procedures is slowly increasing...
August 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28580663/autologous-blood-salvage-in-the-era-of-patient-blood-management
#8
REVIEW
R A Sikorski, N A Rizkalla, W W Yang, S M Frank
Almost 150 years after the first autologous blood transfusion was reported, intraoperative blood salvage has become an important method of blood conservation. The primary goal of autologous transfusion is to reduce or avoid allogeneic red blood cell transfusion and the associated risks and costs. Autologous salvaged blood does not result in immunological challenge and its consequences, provides a higher quality red blood cell that has not been subjected to the adverse effects of blood storage, and can be more cost-effective than allogeneic blood when used for carefully selected surgical patients...
June 5, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28578622/modular-minimal-invasive-extracorporeal-circuits-another-step-toward-universal-applicability
#9
Aschraf El-Essawi, Mohammed Morjan, Ingo Breitenbach, Ahmed Bechri, Rene Brouwer, Wolfgang Harringer
INTRODUCTION: Safety concerns have been one of the main reasons opposing a wider acceptance of minimal invasive extracorporeal circuits (MiECC). Following an extensive experience and a multitude of modifications, we have set out to employ a modular MiECC as a universal extracorporeal circuit. METHODS: A total of 129 cardiac surgical procedures were performed by a single surgeon in 2013. Excluding procedures done under circulatory arrest or with the potential need of such, the MiECC was utilized in almost 90% of surgeries...
June 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28567359/non-surgical-extraction-of-right-atrial-mass-by-angiovac-aspiration-device-under-fluoroscopic-and-transesophageal-echocardiographic-guidance
#10
Tariq H Enezate, Arun Kumar, Kul Aggarwal, Sudarshan Balla, Jad Omran
Right-sided cardiac masses are commonly encountered. We present a challenging case of a right atrial thrombus in a patient who had a high surgical risk for open removal. AngioVac aspiration device, under transesophageal echocardiography (TEE) and fluoroscopy guidance, was successfully used to remove the thrombus. The patient tolerated the procedure well and was discharged home. Our case confirms the safety and efficacy of this procedure for treatment of unwanted intracardiac and intravascular masses in patients who are not candidates for conventional therapies of surgery or thrombolytics...
June 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28557569/the-global-end-diastolic-volume-gedv-could-be-more-appropiate-to-fluid-management-than-central-venous-pressure-cvp-during-closed-hyperthermic-intrabdominal-chemotherapy-with-co2-circulation
#11
Francisco Javier Redondo, David Padilla, Pedro Villarejo, Victor Baladron, Patricia Faba, Sergio Sánchez, José Ramón Muñoz-Rodríguez, Natalia Bejarano
BACKGROUND: Closed hyperthermic intraperitoneal chemotherapy (HIPEC) may increase abdominal pressure and effects of hemodynamic changes due to maintenance hyperthermia. Our aim was to analyze the safety and effectiveness of our closed technique with CO2 circulation in management fluid status and hemodynamic parameters by means of cardiac preload control measured by Global End Diastolic Values (GEDV) and a gas exchanger. MATERIAL AND METHODS: A Pilot Clinical Study that included 18 advanced ovarian cancer patients undergoing citoreductive surgery and HIPEC...
May 30, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28552078/comparison-of-the-therapeutic-effects-and-side-effects-of-tadalafil-and-sildenafil-after-surgery-in-young-infants-with-pulmonary-arterial-hypertension-due-to-systemic-to-pulmonary-shunts
#12
Mohammad Reza Sabri, Hamid Bigdelian, Mohsen Hosseinzadeh, Alireza Ahmadi, Mehdi Ghaderian, Mohammad Shoja
Young children with CHD and large systemic-to-pulmonary shunts eventually develop pulmonary hypertension. At present, phosphodiesterase type-5 inhibitors such as sildenafil have been used to control pulmonary pressure before and after cardiac surgery. Recently, tadalafil has been utilised in older children with similar efficacy, but it has been used to a lesser extent in young infants. From April, 2015 to June, 2016, 42 patients aged 3-24 months with a large septal defect and pulmonary arterial hypertension were randomly divided into two equal groups: one group received oral sildenafil (1-3 mg/kg/day every 8 hours), whereas the other group received oral tadalafil (1 mg/kg once a day) from 7-10 days before surgery to 3-4 weeks after surgery...
May 29, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28545585/a-systematic-review-of-left-ventricular-cardio-endoscopic-surgery
#13
REVIEW
Erdinc Soylu, Emaddin Kidher, Hutan Ashrafian, George Stavridis, Leanne Harling, Thanos Athanasiou
Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique...
May 25, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28543216/bridging-with-tirofiban-during-oral-antiplatelet-interruption-a-single-center-case-series-analysis-including-patients-on-hemodialysis
#14
Elizabeth A Walker, William E Dager
INTRODUCTION: Surgical patients requiring an interruption in dual-antiplatelet therapy (DAPT) within 6 months of cardiac stenting are at risk for thrombotic events. Bridging with short-acting intravenous antiplatelet agents has been proposed to minimize the risk of thrombotic and hemorrhagic complications. METHODS: This was a retrospective analysis of a tirofiban bridging strategy that did not use an initial bolus loading dose. Tirofiban infusions were initiated 24to 48 hours after the last oral antiplatelet dose at a rate of 0...
May 23, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28532976/microbiological-problems-and-biofilms-associated-with-mycobacterium-chimaera-in-heater-cooler-units-used-for-cardiopulmonary-bypass
#15
REVIEW
J Walker, G Moore, S Collins, S Parks, M I Garvey, T Lamagni, G Smith, L Dawkin, S Goldenberg, M Chand
The role of heater-cooler units (HCUs) in the transmission of Mycobacterium chimaera during open heart surgery has been recognized since 2013. Subsequent investigations uncovered a remarkable global outbreak reflecting the wide distribution of implicated devices. HCUs are an essential component of cardiopulmonary bypass operations and their withdrawal would severely affect capacity for life-saving cardiac surgery. However, studies have demonstrated that many HCUs are contaminated with a wide range of micro-organisms, including M...
July 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28523181/surgery-after-drug-eluting-stent-implantation-it-s-not-all-doom-and-gloom
#16
EDITORIAL
Francesco Saia
Up to 15-23% of the patients with percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation need a surgical procedure <12 months from PCI. Perioperative risk stratification in these patients is challenging and should take into account many individual clinical and anatomic variables, along with the intrinsic surgical risk for ischemic and bleeding events. The presence of DES has always been considered as a harbinger of doom. In fact, DES are associated with delayed vascular healing and require longer dual antiplatelet treatment...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28514878/anticoagulant-cessation-following-atrial-fibrillation-ablation-limits-of-the-ecg-guided-approach
#17
Matteo Anselmino, Chiara Rovera, Giovanni Marchetto, Federico Ferraris, Davide Castagno, Fiorenzo Gaita
Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management. Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation...
June 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28498903/efficacy-and-safety-of-inhaled-anaesthetic-for-postoperative-sedation-during-mechanical-ventilation-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#18
J Spence, E Belley-Côté, H K Ma, S Donald, J Centofanti, S Hussain, S Gupta, P J Devereaux, R Whitlock
The aim was to evaluate the efficacy and safety of volatile anaesthetic for postoperative sedation in adult cardiac surgery patients through a systematic review and meta-analysis. We retrieved randomized controlled trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials registries, conference proceedings, and reference lists of included articles. Independent reviewers extracted data, including patient characteristics, type of intraoperative anaesthesia, inhaled anaesthetic used, comparator sedation, and outcomes of interest, using pre-piloted forms...
May 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28496931/safety-of-the-direct-oral-anticoagulant-edoxaban-for-atrial-fibrillation-after-cardiac-surgery-pilot-study
#19
Akira Sezai, Shunji Osaka, Hiroko Yaoita, Munehito Arimoto, Hiroaki Hata, Motomi Shiono
Direct oral anticoagulants have recently been recommended for non-valvular atrial fibrillation, but have rarely been studied in the field of cardiac surgery. We prospectively investigated the safety of edoxaban, a novel oral anticoagulant, for use in cardiac surgery patients with postoperative atrial fibrillation (POAF), which is the most common complication of cardiac surgery and can lead to stroke. The subjects were adult cardiac surgery patients with POAF who received oral edoxaban for 2 months in an open-label pilot study...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28492789/single-dose-lignocaine-based-blood-cardioplegia-in-single-valve-replacement-patients
#20
Jaydip Ramani, Amber Malhotra, Vivek Wadhwa, Pranav Sharma, Pankaj Garg, Malkesh Tarsaria, Himani Pandya
OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes...
March 2017: Brazilian Journal of Cardiovascular Surgery
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