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Cardiothoracic surgery

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https://www.readbyqxmd.com/read/28714229/implementing-a-protocol-to-optimize-blood-use-in-a-cardiac-surgery-service-results-of-a-pre-post-analysis-and-the-impact-of-high-volume-blood-users
#1
Juan B Grau, Jacqueline H Fortier, Cyrus Kuschner, Giovanni Ferrari, Mariano E Brizzio, Alex Zapolanski, Richard E Shaw
BACKGROUND: Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests that a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality. STUDY DESIGN AND METHODS: A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit. Over a 5-year period, data were collected on patient characteristics, procedures, utilization of blood products, morbidity, and mortality, and these were compared before and after the protocol was implemented...
July 16, 2017: Transfusion
https://www.readbyqxmd.com/read/28713211/early-extubation-in-pediatric-heart-surgery-across-a-spectrum-of-case-complexity-impact-on-hospital-length-of-stay-and-chest-tube-days
#2
Staci Beamer, Sunita Ferns, Lloyd Edwards, Greer Gunther, Jennifer Nelson
Early extubation is increasingly common in congenital heart surgery, but there are limited outcomes data across the spectrum of case complexity. We performed a retrospective review of 201 pediatric operations using cardiopulmonary bypass between 2012 and 2014. Patients extubated in the operating room or immediately on arrival to the ICU were compared to those extubated by traditional protocols. In-hospital mortality, major complications, need for re-intubation, hospital length of stay, and chest-tube days were compared between groups and by Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) mortality category...
June 2017: Progress in Pediatric Cardiology
https://www.readbyqxmd.com/read/28712521/subclinical-kidney-injury-in-children-receiving-nonsteroidal-anti-inflammatory-drugs-after-cardiac-surgery
#3
Edward Nehus, Ahmad Kaddourah, Michael Bennett, Olivia Pyles, Prasad Devarajan
OBJECTIVE: To investigate the association of nonsteroidal anti-inflammatory drug (NSAID) administration with urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in children following cardiopulmonary bypass (CPB) who did not develop acute kidney injury (AKI). STUDY DESIGN: In this prospective observational study, urinary NGAL levels were investigated in 210 children who underwent cardiothoracic surgery requiring CPB. Children with clinical AKI (defined as an increase in serum creatinine ≥50% from baseline within 72 hours of CPB) were excluded from the analysis...
July 13, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28711585/global-outbreak-of-severe-mycobacterium-chimaera-disease-after-cardiac-surgery-a-molecular-epidemiological-study
#4
Jakko van Ingen, Thomas A Kohl, Katharina Kranzer, Barbara Hasse, Peter M Keller, Anna Katarzyna Szafrańska, Doris Hillemann, Meera Chand, Peter Werner Schreiber, Rami Sommerstein, Christoph Berger, Michele Genoni, Christian Rüegg, Nicolas Troillet, Andreas F Widmer, Sören L Becker, Mathias Herrmann, Tim Eckmanns, Sebastian Haller, Christiane Höller, Sylvia B Debast, Maurice J Wolfhagen, Joost Hopman, Jan Kluytmans, Merel Langelaar, Daan W Notermans, Jaap Ten Oever, Peter van den Barselaar, Alexander B A Vonk, Margreet C Vos, Nada Ahmed, Timothy Brown, Derrick Crook, Theresa Lamagni, Nick Phin, E Grace Smith, Maria Zambon, Annerose Serr, Tim Götting, Winfried Ebner, Alexander Thürmer, Christian Utpatel, Cathrin Spröer, Boyke Bunk, Ulrich Nübel, Guido V Bloemberg, Erik C Böttger, Stefan Niemann, Dirk Wagner, Hugo Sax
BACKGROUND: Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater-cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. METHODS: We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates...
July 12, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28705484/is-it-all-about-the-money-not-all-surgical-subspecialization-leads-to-higher-lifetime-revenue-when-compared-to-general-surgery
#5
Maria Baimas-George, Brian Fleischer, Douglas Slakey, Emad Kandil, James R Korndorffer, Christopher DuCoin
OBJECTIVE: It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered. DESIGN: Data were collected from the Medical Group Management Association's 2015 report of average annual salaries...
July 10, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28696880/performance-of-pediatric-risk-of-mortality-score-among-critically-ill-children-with-heart-disease
#6
Rebecca A Russell, Mallikarjuna Rettiganti, Nancy Brundage, Howard E Jeffries, Punkaj Gupta
OBJECTIVE: To evaluate the performance of the Pediatric Risk of Mortality 3 (PRISM-3) score in critically ill children with heart disease. METHODS: Patients <18 years of age admitted with cardiac diagnoses (cardiac medical and cardiac surgical) to one of the participating pediatric intensive care units in the Virtual Pediatric Systems, LLC, database were included. Performance of PRISM-3 was evaluated with discrimination and calibration measures among both cardiac surgical and cardiac medical patients...
July 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28695972/the-incidence-of-postoperative-pneumonia-in-various-surgical-subspecialties-a-dual-database-analysis
#7
Morad Chughtai, Chukwuweike U Gwam, Anton Khlopas, Jared M Newman, Gannon L Curtis, Pedro A Torres, Rafay Khan, Michael A Mont
INTRODUCTION: Pneumonia is the third most common postoperative complication. However, its epidemiology varies widely and is often difficult to assess. For a better understanding, we utilized two national databases to determine the incidence of postoperative pneumonia after various surgical procedures. Specifically, we used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the Nationwide Inpatient Sample (NIS) to determine the incidence and yearly trends of postoperative pneumonia following orthopaedic, urologic, otorhinolaryngologic, cardiothoracic, neurosurgery, and general surgeries...
July 11, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28688940/thoracostomy-tube-removal-implementation-of-a-multidisciplinary-procedural-pain-management-guideline
#8
Lisa M Ring, Anne Watson
OBJECTIVE: Thoracostomy tubes are placed following cardiothoracic surgery for the repair or palliation of congenital heart defects. The aim of this project was to develop and implement a clinical practice guideline for the provision of optimal analgesia during removal of thoracostomy tubes in pediatric postoperative cardiothoracic surgery patients. METHODS: Methods used include a nonexperimental design utilizing chart audits to determine baseline documentation as well as procedure note evaluation to determine both baseline documentation and compliance with the new guideline...
July 6, 2017: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28686356/relaxing-responses-to-hydrogen-peroxide-and-nitric-oxide-in-human-pericardial-resistance-arteries-stimulated-with-endothelin-1
#9
Thomas M Leurgans, Maria Bloksgaard, Akhmadjon Irmukhamedov, Lars P Riber, Jo G R De Mey
In human pericardial resistance arteries, effects of the endothelium-dependent vasodilator bradykinin are mediated by NO during contraction induced by K(+) or the TxA2 analogue U46619 and by H2 O2 during contraction by endothelin-1 (ET-1), respectively. We tested the hypotheses that ET-1 reduces relaxing effects of NO and increases those of H2 O2 in resistance artery smooth muscle of patients with cardiovascular disease. Arterial segments, dissected from the parietal pericardium of 39 cardiothoracic surgery patients, were studied by myography during amplitude-matched contractions induced by K(+) , the TXA2 analogue U46619 or ET-1...
July 7, 2017: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/28681054/establishment-of-a-minimally-invasive-cardiac-surgery-programme-in-singapore
#10
Theo Kofidis, Guohao Chang, Chuen Neng Lee
In Singapore, although minimally invasive cardiac surgery is available, it is not widely practised. Local surgeons have pioneered technologies in Singapore following their launch in the West and introduced them, addressing various heart pathologies. However, the unique position and function of Singapore in the region, the structure and dynamics of cardiothoracic surgery practice in government centres and private practice, and the overall small volume of patients in the country may pose limitations, in spite of all possibilities, in thriving and sharing of such new technologies...
July 6, 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28678115/a-theoretical-model-of-flow-disruptions-for-the-anesthesia-team-during-cardiovascular-surgery
#11
Albert Boquet, Tara Cohen, Fawaaz Diljohn, Jennifer Cabrera, Scott Reeves, Scott Shappell
OBJECTIVES: This investigation explores flow disruptions observed during cardiothoracic surgery and how they serve to disconnect anesthesia providers from their primary task. We can improve our understanding of this disengagement by exploring what we call the error space or the accumulated time required to resolve disruptions. METHODS: Trained human factors students observed 10 cardiac procedures for disruptions impacting the anesthesia team and recorded the time required to resolve these events...
July 3, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28669788/the-effect-of-gender-on-resident-autonomy-in-the-operating-room
#12
Shari L Meyerson, Joel M Sternbach, Joseph B Zwischenberger, Edward M Bender
OBJECTIVE: Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. DESIGN: Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application...
June 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28666929/fluid-responsiveness-after-cardiac-surgery-fracas-a-prospective-observational-study-using-peripheral-near-infrared-spectroscopy
#13
Ethan Butler, John Nguyen, Sajeev Mahendran, Anders Aneman
OBJECTIVES: To describe tissue oxygen saturation (StO2) in response to a vascular occlusion test using thenar eminence and forearm near-infrared spectroscopy (NIRS) and the association with volume responsiveness after cardiac surgery. DESIGN: Single-center, prospective, observational cohort study. SETTING: Cardiothoracic intensive care unit. PARTICIPANTS: Seventy-six post-cardiac surgical adults. INTERVENTIONS: Immediately before and 10 minutes after a 250-to-500 mL fluid bolus, StO2 was measured in response to a vascular occlusion test to calculate tissue deoxygenation (Rdes) and reoxygenation (Rres) rates...
March 18, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28658876/combined-left-recurrent-laryngeal-nerve-and-phrenic-nerve-palsy-a-rare-presentation-of-thoracic-aortic-aneurysm
#14
Pradosh Kumar Sarangi, Pratisruti Hui, H S Sagar, Dinesh Kumar Kisku, Jayashree Mohanty
Hoarseness of voice due to Vocal Cord Palsy (VCP) resulting from aortic aneurysm is a rare entity. Hoarseness due to left Recurrent Laryngeal Nerve (RLN) paralysis caused by identifiable cardiovascular disease has been described as Ortner's syndrome or Cardiovocal syndrome. Very rarely, thoracic aortic aneurysm can cause Phrenic Nerve (PN) palsy causing hemidiaphragm paralysis. But, aortic aneurysm causing both RLN and PN palsy is an extremely rare occasion. Our literature review showed only three cases of combined RLN and PN palsy due to thoracic aortic aneurysm...
May 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28651943/the-nyerorcoverchallenge-what-it-means-for-women-in-cardiothoracic-surgery
#15
EDITORIAL
Mara B Antonoff, Nikki Stamp
No abstract text is available yet for this article.
June 23, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28624014/can-routine-chest-radiography-be-used-to-diagnose-mild-copd-a-nested-case-control-study
#16
A M den Harder, A M Snoek, T Leiner, W J Suyker, L M de Heer, R P J Budde, J W J Lammers, P A de Jong, M J A Gondrie
OBJECTIVES: To determine whether mild stage chronic obstructive pulmonary disease (COPD) can be detected on chest radiography without substantial overdiagnosis. METHODS: A retrospective nested case-control study (case:control, 1:1) was performed in 783 patients scheduled for cardiothoracic surgery who underwent both spirometry and a chest radiograph preoperative. Diagnostic accuracy of chest radiography for diagnosing mild COPD was investigated using objective measurements and overall appearance specific for COPD on chest radiography...
July 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/28616278/management-of-the-vertebral-artery-during-thoracic-endovascular-aortic-repair-with-coverage-of-the-left-subclavian-artery
#17
Jian Zhu, Er-Ping Xi, Shui-Bo Zhu, Gui-Lin Yin, Rong-Ping Wang, Yu Zhang
BACKGROUND: The application of thoracic endovascular aortic repair (TEVAR), a minimally invasive operation, in the aortic arch has been a challenge of cardiovascular surgery in recent years. This study aimed to investigate management of the vertebral artery with coverage of the left subclavian artery (LSA) during TEVAR. METHODS: From January 2007 to September 2014 in the Department of Cardiothoracic Surgery at Wuhan General Hospital of Guangzhou Military Region, 160 patients underwent LSA closure or partial coverage during TEVAR of an aortic lesion near the LSA...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28612281/perioperative-management-of-antiplatelet-treatment-in-patients-undergoing-isolated-coronary-artery-bypass-grafting-in-dutch-cardiothoracic-centres
#18
P W A Janssen, D M F Claassens, L M Willemsen, T O Bergmeijer, P Klein, J M Ten Berg
BACKGROUND: International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). METHODS: A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014...
June 13, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28607827/discrimination-against-female-surgeons-is-still-alive-where-are-the-full-professorships-and-chairs-of-departments
#19
EDITORIAL
Nancy E Epstein
BACKGROUND: Although half of all medical students are now and women are increasingly filling surgical residency positions, few ascend the academic ladder to become chairman of their departments, much less full academic professors. METHODS: We queried PubMed to search for the number of women surgeons in different subspecialties, and asked how many were chairman or full academic professors? RESULTS: Data coming out of largely general or cardiothoracic surgery departments cited no substantial gains for women surgeons over the years; there were few chairmanships or full professorships...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28600373/evaluation-of-a-physiatrist-directed-prehabilitation-intervention-in-frail-patients-with-colorectal-cancer-a-randomised-pilot-study-protocol
#20
Sherman G Wong, Eugene Maida, David Harvey, Natalie Wagner, Ranil Sonnadara, Nalin Amin
INTRODUCTION: Prehabilitation interventions have shown efficacy in the orthopaedic and cardiothoracic surgical populations, but there has been limited evidence for general surgical patients. We present the protocol for a pilot trial of a novel prehabilitation intervention, consisting of a physiatrist-directed preoperative assessment and treatment programme. METHODS AND ANALYSIS: This is a single-centre pilot randomised controlled trial investigating physiatrist-directed prehabilitation for a 4 to 6-week preoperative period...
June 9, 2017: BMJ Open
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