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Safety in cardiac surgery

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https://www.readbyqxmd.com/read/28545585/a-systematic-review-of-left-ventricular-cardio-endoscopic-surgery
#1
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
#2
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
#3
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...
April 26, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28523181/surgery-after-drug-eluting-stent-implantation-it-s-not-all-doom-and-gloom
#4
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
#5
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...
May 18, 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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28492786/the-brazilian-registry-of-adult-patient-undergoing-cardiovascular-surgery-the-bypass-project-results-of-the-first-1-722-patients
#9
Walter J Gomes, Rita Simone Moreira, Alexandre Cabral Zilli, Luiz Carlos Bettiati, Fernando Augusto Marinho Dos Santos Figueira, Stephanie Steremberg Pires D' Azevedo, Marcelo José Ferreira Soares, Marcio Pimentel Fernandes, Roberto Vito Ardito, Renata Andrea Barberio Bogdan, Valquíria Pelisser Campagnucci, Diana Nakasako, Renato Abdala Karam Kalil, Clarissa Garcia Rodrigues, Anilton Bezerra Rodrigues, Marcelo Matos Cascudo, Fernando Antibas Atik, Elson Borges Lima, Vinicius José da Silva Nina, Renato Albuquerque Heluy, Lisandro Gonçalves Azeredo, Odilon Silva Henrique, José Teles de Mendonça, Katharina Kelly de Oliveira Gama Silva, Marcelo Pandolfo, José Dantas de Lima, Renato Max Faria, Jonas Pereira Dos Santos, Rodrigo Pereira Paez, Guilherme Henrique Biachi Coelho, Sergio Nunes Pereira, Roberta Senger, Enio Buffolo, Guido Marco Caputi, José Amalth do Espírito Santo, Juliana Aparecida Borges de Oliveira, Otavio Berwanger, Alexandre Biasi Cavalcanti, Fabio B Jatene
Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1)...
March 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28464769/adult-stem-cell-therapy-for-cardiac-repair-in-patients-after-acute-myocardial-infarction-leading-to-ischemic-heart-failure-an-overview-of-evidence-from-the-recent-clinical-trials
#10
Rygiel Katarzyna
Cardiovascular diseases (CVD) still represent the leading cause of mortality worldwide, despite the remarkable advances in interventional cardiology, cardiac surgery, and modern pharmacotherapy, particularly in the setting of acute myocardial infarction (AMI), chronic ischemic heart failure (HF), cardiomyopathy (CM), and the associated left ventricular (LV) dysfunction. A significant loss of cardiomyocytes that underlies all of these conditions was previously considered irreversible. However, current evidence indicates that the human heart has some potential for repair, and over the past decade, many research studies have been exploring the use of stem cells (SCs) to facilitate restoration of myocardium...
May 1, 2017: Current Cardiology Reviews
https://www.readbyqxmd.com/read/28453629/long-term-outcomes-of-a-rapid-deployment-aortic-valve-data-up-to-5-years%C3%A2
#11
Günther Laufer, Axel Haverich, Martin Andreas, Friedrich W Mohr, Thomas Walther, Malakh Shrestha, Parwis Rahmanian, David Holzhey, Matthias Roth, Christoph Schmitz, René Schramm, Christophe Giot, Thorsten C W Wahlers
OBJECTIVES: Rapid deployment aortic valve replacement (AVR) has been developed to facilitate minimally invasive approaches for cardiac surgery and shorten procedural times. TRITON is a prospectively designed study to assess safety and efficacy of rapid deployment AVR with Edwards INTUITY valve system. This report presents the 5-year outcomes of the TRITON trial. METHODS: A total of 295 patients with aortic valve stenosis were enrolled in the TRITON trial and 287 patients received the study valve...
April 26, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28452912/effects-of-a-brief-team-training-program-on-surgical-teams-nontechnical-skills-an-interrupted-time-series-study
#12
Brigid M Gillespie, Emma Harbeck, Evelyn Kang, Catherine Steel, Nicole Fairweather, Kriengsak Panuwatwanich, Wendy Chaboyer
BACKGROUND: Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. METHODS: Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program...
April 27, 2017: Journal of Patient Safety
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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