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Safety in cardiac surgery

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https://www.readbyqxmd.com/read/28427392/percutaneous-intervention-versus-coronary-artery-bypass-graft-surgery-in-left-main-coronary-artery-stenosis-a-systematic-review-and-meta-analysis
#1
Xin-Lin Zhang, Qing-Qing Zhu, Jing-Jing Yang, Yu-Han Chen, Yang Li, Su-Hui Zhu, Jun Xie, Lian Wang, Li-Na Kang, Biao Xu
BACKGROUND: The optimal revascularization technique in patients with left main coronary artery disease (CAD) remains controversial. We aimed to compare the long-term performance of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in treatment of left main CAD. METHODS: PubMed, EMBASE, and the Cochrane Library were searched until November 16, 2016. RESULTS: Six randomized controlled trials and 22 matched observational studies including 22,487 patients and 90,167 patient-years of follow-up were included...
April 21, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28403392/association-of-central-nervous-system-depression-with-topical-brimonidine-when-used-for-hemostasis-a-serious-adverse-event
#2
Devorah R Shagalov, Drew Taylor, Rachel Schleichert, Jonathan Weiss, Eduardo Weiss
Importance: Minor bleeding is the most common complication of dermatologic surgery. Topical brimonidine, 0.33%, gel has been reported for the use of hemostasis in dermatologic surgery. The safety profile and risk of systemic toxic effects when brimonidine is used topically for hemostasis is unknown. Objective: To determine the risk of systemic toxic effects of topical brimonidine, 0.33%, gel when used for hemostasis. Design, Setting, and Participants: In this case series from a private practice (Hollywood Dermatology), 2 patients presented for dermatologic procedures, complicated by persistent bleeding...
April 12, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28398396/-bioresorbable-vascular-scaffolds-clinical-experience-of-the-emilia-romagna-region-italy
#3
Alberto Menozzi, Gianluca Calogero Campo, Vincenzo Guiducci, Gianni Dall'Ara, Andrea Santarelli, Paolo Sbarzaglia, Marco Balducelli, Paolo Magnavacchi, Fabio Sgura, Luciano Losi, Luigi Vignali, Gianni Casella, Luigi Steffanon, Fabio Tarantino, Francesco Saia
BACKGROUND: The bioresorbable vascular scaffold (BRS) technology constitutes the new revolution of the coronary artery disease interventional treatment. Currently, three distinct types of BRSs are available but only one, the Absorb BVS, was on the market in 2013 when the Regional Commission for Medical Devices and the Cardiology and Cardiac Surgery Commission of the Emilia-Romagna Region drew up a technical and scientific essay to provide guidance for the introduction of BRS in public and affiliated health facilities...
February 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28394840/quality-and-safety-in-health-care-part-xxvii-research-and-future-directions-of-the-adult-cardiac-surgery-database
#4
Jay A Harolds
This article discusses some of the most recent research and future directions of the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons. In addition to numerous articles on short-term outcomes from cardiac surgery on adults, there are new initiatives of the Adult Cardiac Surgery Database which will allow long-term outcome analysis and better estimation for each patient on the likely value of the procedure to that individual.
April 7, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28394839/quality-and-safety-in-health-care-part-xxvi-the-adult-cardiac-surgery-database
#5
Jay A Harolds
The Adult Cardiac Surgery Database of the Society of Thoracic Surgeons has provided highly useful information in quality and safety in general thoracic surgery, including ratings of the surgeons and institutions participating in this type of surgery. The Adult Cardiac Surgery Database information is very helpful for writing guidelines and determining optimal protocols and for many research projects. This article discusses the history and current status of this database.
April 7, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28394022/limited-versus-full-sternotomy-for-aortic-valve-replacement
#6
REVIEW
Bilal H Kirmani, Sion G Jones, S C Malaisrie, Darryl A Chung, Richard Jnn Williams
BACKGROUND: Aortic valve disease is a common condition that is easily treatable with cardiac surgery. This is conventionally performed by opening the sternum longitudinally down the centre ("median sternotomy") and replacing the valve under cardiopulmonary bypass. Median sternotomy is generally well tolerated, but as less invasive options have become available, the efficacy of limited incisions has been called into question. In particular, the effects of reducing the visibility and surgical access has raised safety concerns with regards to the placement of cannulae, venting of the heart, epicardial wire placement, and de-airing of the heart at the end of the procedure...
April 10, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28393784/myocardial-revascularization-without-extracorporeal-circulation-why-hasn-t-it-convinced-yet
#7
REVIEW
Efstratios Apostolakis, Nikolaos A Papakonstantinou, Ioanna Koniari
Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump...
April 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28393778/safety-and-efficacy-of-ketamine-dexmedetomidine-versus-ketamine-propofol-combinations-for-sedation-in-patients-after-coronary-artery-bypass-graft-surgery
#8
Mona Mohamed Mogahd, Mohammed Shafik Mahran, Ghada Foad Elbaradi
BACKGROUND AND AIMS: Prolonged mechanical ventilation after cardiac surgery is associated with serious complications that increase morbidity and mortality. The present study was designed to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for sedation and analgesia in patients after coronary artery bypass graft (CABG) surgery as regards hemodynamics, total fentanyl dose, time of weaning from mechanical ventilation, time of extubation, and any adverse outcome...
April 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28387790/impact-of-dual-antiplatelet-therapy-after-coronary-artery-bypass-surgery-on-1-year-outcomes-in-the-arterial-revascularization-trial%C3%A2
#9
Umberto Benedetto, Douglas G Altman, Stephen Gerry, Alastair Gray, Belinda Lees, Marcus Flather, David P Taggart
OBJECTIVES: There is still little evidence to boldport routine dual antiplatelet therapy (DAPT) with P 2 Y 12 antagonists following coronary artery bypass grafting (CABG). The Arterial Revascularization Trial (ART) was designed to compare 10-year survival after bilateral versus single internal thoracic artery grafting. We aimed to get insights into the effect of DAPT (with clopidogrel) following CABG on 1-year outcomes by performing a post hoc ART analysis. METHODS: Among patients enrolled in the ART ( n  = 3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone, respectively...
April 6, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28366317/morbidity-and-mortality-in-elective-total-hip-arthroplasty-following-surgical-care-improvement-project-guidelines
#10
Thomas B Bemenderfer, Nigel L Rozario, Charity G Moore, Madhav A Karunakar
BACKGROUND: Following evidence questioning the safety and efficacy of perioperative beta-blocker therapy in noncardiac surgery, the Surgical Care Improvement Project (SCIP) guidelines were retired in 2015. However, perioperative myocardial infarctions and cardiac complications remain leading causes of mortality following noncardiac surgery. The impact of the SCIP guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA) has not been evaluated...
March 9, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28358179/perioperative-cardiac-arrest-in-the-operating-room-environment-a-review-of-the-literature
#11
Jochen Hinkelbein, Janusz Andres, Karl-Christian Thies, Edoardo De Robertis
Cardiac arrest in the operating room (OR) environment is a rare but potentially catastrophic event with mortality rates of more than 50%. Cardiac arrest during anaesthesia and the immediate postoperative period is distinct from non-operative settings or other in-hospital cardiac arrests since it is almost always witnessed and often anticipated. Contributing factors are known, and the event is generally rapidly recognized, as patients are usually under full monitoring. The nature of the cardiac arrest in the OR environment is also different as it is not only related to the patient's conditions but likewise to the anaesthetic and the surgical procedure...
March 28, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28352338/evaluation-of-safety-and-efficacy-of-elective-pci-in-patients-with-cardiac-insufficiency
#12
Jiang-Xin Jing, Xiao-Lan Zhong, Sheng-Guo Chen
We analyzed the safety and the efficacy of the treatment with elective percutaneous coronary intervention (PCI) in patients with coronary heart disease complicated with cardiac insufficiency. We enrolled 217 patients diagnosed with chronic ischemic heart disease complicated with cardiac failure. According to the type of treatment they received, patients were divided into 3 groups: i) The conservative treatment group with 60 patients (they received standard medication); ii) the early PCI group with 82 cases (their condition was stabilized, surgical risk was assessed and PCI was taken as early as possible); and iii) the advanced PCI group with 75 cases (ischemic myocardium was corrected and then elective PCI was applied and for aggravated myocardial ischemia cases, PCI was applied after assessing the risk of surgery)...
February 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28345371/ewma-document-negative-pressure-wound-therapy
#13
Jan Apelqvist, Christian Willy, Ann-Mari Fagerdahl, Marco Fraccalvieri, Malin Malmsjö, Alberto Piaggesi, Astrid Probst, Peter Vowden
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.(1) NPWT has been described as a effective treatment for wounds of many different aetiologies(2,3) and suggested as a gold standard for treatment of wounds such as open abdominal wounds,(4-6) dehisced sternal wounds following cardiac surgery(7,8) and as a valuable agent in complex non-healing wounds...
March 1, 2017: Journal of Wound Care
https://www.readbyqxmd.com/read/28337701/ct-guided-drainage-of-pericardial-effusion-after-open-cardiac-surgery
#14
Nour-Eldin Abdelrehim Nour-Eldin, Mohammed Alsubhi, Tatjana Gruber-Rouh, Thomas J Vogl, Benjamin Kaltenbach, Hazem Hamed Soliman, Wael Eman Hassan, Sherif Maher Abolyazid, Nagy N Naguib
PURPOSE: This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery. MATERIALS AND METHODS: The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion...
March 23, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28336788/transcatheter-treatment-of-severe-tricuspid-regurgitation-with-the-edge-to-edge-mitraclip-technique
#15
Georg Nickenig, Marek Kowalski, Jörg Hausleiter, Daniel Braun, Joachim Schofer, Ermela Yzeiraj, Volker Rudolph, Kai Friedrichs, Francesco Maisano, Maurizio Taramasso, Neil P Fam, Giovanni Bianchi, Francesco Bedogni, Paolo Denti, Ottavio Alfieri, Azeem Latib, Antonio Colombo, Christoph Hammerstingl, Robert Schueler
Background -Current surgical and medical treatment options for severe tricuspid regurgitation (TR) are limited and additional interventional approaches are required. In the present observational study, the safety and feasibility of transcatheter repair of chronic severe TR with the MitraClip system were evaluated. In addition, the effects on clinical symptoms were assessed. Methods -Patients with heart failure symptoms and severe TR on optimal medical treatment were treated with the MitraClip system. Safety, defined as periprocedural adverse events such as death, myocardial infarction, stroke, or cardiac tamponade, and feasibility, defined as successful implantation of one or more MitraClip devices and reduction of TR by at least one grade, were evaluated before discharge and after 30 days...
March 23, 2017: Circulation
https://www.readbyqxmd.com/read/28319580/hospital-characteristics-associated-with-risk-standardized-readmission-rates
#16
Leora I Horwitz, Susannah M Bernheim, Joseph S Ross, Jeph Herrin, Jacqueline N Grady, Harlan M Krumholz, Elizabeth E Drye, Zhenqiu Lin
BACKGROUND: Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. OBJECTIVE: To examine the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). DESIGN: This is a retrospective cross-sectional multivariable analysis...
May 2017: Medical Care
https://www.readbyqxmd.com/read/28319507/recombinant-factor-viia-is-associated-with-increased-thrombotic-complications-in-pediatric-cardiac-surgery-patients
#17
Laura Downey, Morgan L Brown, David Faraoni, David Zurakowski, James A DiNardo
BACKGROUND: Recombinant factor VIIa (rFVIIa) is routinely used as an off-label hemostatic agent in children undergoing cardiac surgery. Despite evidence that rFVIIa use is associated with an increased incidence of thrombotic complications in adult cardiac surgery, the safety of rFVIIa as a rescue hemostatic agent in the pediatric cardiac surgical population is less definitively delineated. In this retrospective study, we used propensity score matching to compare the incidence of thrombotic complications between children treated with rFVIIa and their matched controls...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28316276/levosimendan-in-patients-with-left-ventricular-dysfunction-undergoing-cardiac-surgery
#18
Rajendra H Mehta, Jeffrey D Leimberger, Sean van Diepen, James Meza, Alice Wang, Rachael Jankowich, Robert W Harrison, Douglas Hay, Stephen Fremes, Andra Duncan, Edward G Soltesz, John Luber, Soon Park, Michael Argenziano, Edward Murphy, Randy Marcel, Dimitri Kalavrouziotis, Dave Nagpal, John Bozinovski, Wolfgang Toller, Matthias Heringlake, Shaun G Goodman, Jerrold H Levy, Robert A Harrington, Kevin J Anstrom, John H Alexander
Background Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. Methods In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0...
March 19, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28314534/total-cavopulmonary-connection-with-a-new-bioabsorbable-vascular-graft-first-clinical-experience
#19
Leo A Bockeria, Oleg Svanidze, Alex Kim, Konstantin Shatalov, Vladimir Makarenko, Martijn Cox, Thierry Carrel
OBJECTIVES: To assess safety and clinical performance of a novel bioabsorbable vascular graft in pediatric patients with univentricular cardiac malformation who received surgical correction via an extracardiac cavopulmonary conduit. METHODS: The implanted graft material is designed to attract patient's own cells and proteins, which trigger a cascade of physiological events leading to endogenous tissue restoration. As the graft resorbs progressively after implantation, components of native tissue including collagen, endothelial lining, and capillary blood vessels develop and organize into a natural tissue...
February 7, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28303236/treating-the-critically-ill-with-radiotherapy-lessons-learned-from-a-young-woman-with-cardiac-angiosarcoma
#20
Emma C Fields, Bryan Squires, Harry Lomas
BACKGROUND: Treating patients who are critically ill with radiotherapy (RT) brings a unique set of challenges as it involves treating patients who require mechanical life support, unconventional positioning, and a multidisciplinary team approach to ensure safety. However, when the benefits of such treatment outweigh the risks, the challenges can be overcome, as demonstrated in this unique case of cardiac angiosarcoma. CASE DESCRIPTION: This is a case of a 42-year-old female with a right sided cardiac angiosarcoma who quickly developed cardiac tamponade and respiratory failure related to compression of her right heart by the tumor...
2017: Frontiers in Oncology
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