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Cardiac Surgery (cardiac + surgery)
Kinds of Cardiac Surgery Terms modified by Cardiac Surgery Selected AbstractsIS INFORMED CONSENT IN CARDIAC SURGERY AND PERCUTANEOUS CORONARY INTERVENTION ACHIEVABLE?ANZ JOURNAL OF SURGERY, Issue 7 2007Marco E. Larobina Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. Methods: Patients undergoing CABG or PCI at a tertiary hospital were interviewed with questionnaires focusing on the consent process, the patient's understanding of CABG or PCI and associated risks and understanding of medical concepts. Medical staff were questioned on the process of obtaining consent and understanding of medicolegal concepts. Results: Fifty CABG patients, 40 PCI patients and 40 medical staff were interviewed over a 6-month period. No patient identified any of the explained risks as a reason to reconsider having CABG or PCI, but 80% of patients wanted to be informed of all risks of surgery. 80% of patients considered doctors obligated to discuss all risks of surgery. One patient (2%) expressed concern at the prospect of a trainee surgeon carrying out the operation. Stroke (40%) rather than mortality (10%) were the important concerns in patients undergoing CABG and PCI. The purpose of interventions was only partially understood by both groups; PCI patients clearly underestimated the subsequent need for repeat PCI or CABG. Knowledge of medical concepts was poor in both groups: less than 50% of patients understood the cause or consequence of an AMI or stroke and less than 20% of patients correctly identified the ratio equal to 0.5%. One doctor (2.5%) correctly identified the four elements of negligence, eight (20%) the meaning of material risk and four (10%) the meaning of causation. Thirty doctors (75%) believed that all complications of a procedure needed to be explained for informed consent. Less than 10% could recognize landmark legal cases. Conclusion: Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists. [source] News from the Section on Cardiology and Cardiac Surgery of the American Academy of PediatricsCONGENITAL HEART DISEASE, Issue 5 2009Cardiac SurgeryAmerican Academy of Pediatrics, Executive CommitteeSection on Cardiology, MD Chair, Robert Beekman III No abstract is available for this article. [source] Two-dimensional, Non-Doppler Strain Imaging during Anesthesia and Cardiac SurgeryECHOCARDIOGRAPHY, Issue 3 2009F.A.S.E., Nikolaos J. Skubas M.D. Transesophageal echochardiography (TEE) has become an essential intraoperative monitor during general anesthesia for cardiac surgical procedures. In clinical practice, ventricular function is visually evaluated using gray scale and Doppler modes, despite the fact that subjective interpretation is influenced by level of experience and training. Echocardiographic strain imaging measures cardiac deformation and provides objective quantification of regional myocardial function. Non-Doppler strain, which is derived by tracking speckles from two-dimensional (2D) images, bypasses the limitations of Doppler-based strain measurements and evaluates the complex myocardial deformation along three dimensions. As a result, longitudinal shortening, circumferential thinning and radial thickening can be quantified using standard midesophageal and transgastric views, being acquired during a comprehensive TEE examination. Once non-Doppler strain becomes available on "real time," it will have the potential to become a valuable tool for detection of ischemia on the regional level and objective quantification of global ventricular function. [source] Images in Cardiac Surgery: Bullet's Path Creates Ballistic Footprint Within Pulmonary ParenchymaJOURNAL OF CARDIAC SURGERY, Issue 5 2010Ara Ketchedjian M.D. No abstract is available for this article. [source] Usefulness of Intraoperative Real-Time 3D Transesophageal Echocardiography in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 6 2008Thierry V. Scohy M.D. Methods: Preoperative transthoral echocardiography (TTE) revealed: hypertrophic ventricular septum (TTE:19.3 mm), systolic anterior motion (SAM) not causing obstruction and malcoaptation of the anterior mitral valve leaflet (AMVL), and posterior mitral valve leaflet (PMVL) with severe mitral regurgitation. Results: Intraoperative TEE with a x7-2t MATRIX-array transducer (Philips, Andover, MA, USA) with a transducer frequency of x7,2 t mHz, connected to a iE33 (Philips), shows us that the main mechanism and site of regurgitation was an AMVL cleft. We also measured a 24.3-mm thickness of the ventricular septum and analyzing the 3D full volume acquisition revealed that there was no SAM. Conclusion: Intraoperative RT3DTEE permitted comprehensive 3D viewing of the mitral valve revealing the mechanism of mitral valve regurgitation, SAM, and the exact width of the hypertrophic ventricular septum. [source] Predictors and Outcomes Associated with Intraoperative Aortic Dissection in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 5 2008Amber Hurt M.D. The objective of this study was to assess risk factors of aortic dissection and assess outcomes in patients with aortic dissection experience. Methods: A study from a 10-year hospitalization cohort (N = 12,907) with prospective data collection was conducted. Patients without aortic dissection were matched to 33 aortic dissection patients 3:1 on the type of procedure. The study examined 24 potential confounding risk factors and 12 outcome variables. Results: Univariate analysis on potential confounding risk factors revealed two significant risk factors. There was a significant difference between aortic dissection and nonaortic dissection patients with New York Heart Association (NYHA) functional class (p = 0.03). Patients with aortic dissection were more likely to be in Class I or II. Patients with aortic dissection had significantly longer perfusion time (p = 0.008). There was a significant difference between patients with and without aortic dissection on four outcome variables. Patients with an aortic dissection were more likely to need prolonged ventilation (p = 0.046), have renal failure (p = 0.005), require intraaortic balloon pump (IABP) (0.043), and have a higher mortality rate (p < 0.001). Conclusion: Aortic dissection occurs infrequently during coronary artery bypass grafting, but is a devastating complication and greatly increases morbidity. Although few patients dissect intraoperatively, this study attempted to identify predictors that may label a patient as high risk for possible aortic dissection. Although two factors in this study were statistically significant, they are not reliable preoperative predictors of high-risk patients that can be used to screen patients and help prevent aortic dissection and its sequela. [source] Combined Cardiac Surgery and Excision of a Retrosternal Thyroid Mass: A Case ReportJOURNAL OF CARDIAC SURGERY, Issue 3 2006Gilbert H. L. Tang M.D. We describe a combined thyroidectomy, aortic valve replacement, and coronary artery bypass graft surgery on a patient with an asymptomatic retrosternal thyroid mass. [source] The Early History of Cardiac Surgery in StockholmJOURNAL OF CARDIAC SURGERY, Issue 6 2003Kjell Radegran M.D. The portal figure is Clarence Crafoord (1899,1983) who already in 1927 had succeeded with the Trendelenburg pulmonary embolectomy operation. He went on to develop lung surgery in general. With foresight he stimulated the chemists of Karolinska Institute to purify heparin, first for prophylaxis against venous thromboembolism and later for use with the heart-lung machine. In 1944 he became the first surgeon to successfully operate on patients with coarctation of the aorta. With Viking Olov Bjork and Ake Senning the heart-lung machine was improved, finally allowing its clinical use in a patient operated in 1954 for a myxoma of the left atrium, with long-term survival. This was the first successful use of the heart-lung machine in Sweden and the second in the world. He and his coworkers, first at the Sabbatsberg hospital and from 1957 at the Karolinska hospital made major contributions to cardiology and radiology, apart from the progresses in cardiac surgery. Contributions such as pressure recording from the left atrium by needle puncture in 1950, the Senning operation for transposition of the great arteries and the first use of a totally implantable cardiac pacemaker in 1958 are indeed medical history. (J Card Surg 2003;18:564-572) [source] Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac SurgeryJOURNAL OF CARDIAC SURGERY, Issue 1 2001Harald Hausmann M.D. From July 1996 to March 2000, 391 patients with intraoperative cardiac lowoutput syndrome who underwent surgery with heart-lung bypass and had an intre-aortic balloon pump (IABP) Implanted were analyzed in a prospective study. Of these 391 patients, 153 (39%) were operated on in an emergency situation, and 238 (61%) patients had elective surgeries. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 ,g/kg/min, a left mrial pressure higher then 15 mmHg, output of less than 100 mL/hour, and mixed venous saturation (SvO2) of less then 60% had poor outcomes. Using this data, we developed an IABP score to predict survival early after IABP implantation in cardiac surgery. We conclude that the success or failure of perioperative IABP support can be predicted early after implantation of the balloon pump. In patients with low-output syndrome despite IABP support, implantation of a vantricular assist system should be considered. [source] On "Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac Surgery"JOURNAL OF CARDIAC SURGERY, Issue 1 2001Hooshang Bolooki M.D.Article first published online: 26 JUL 200 No abstract is available for this article. [source] Cardiac Surgery: The Future is Minimal!JOURNAL OF CARDIAC SURGERY, Issue 1 2000Michael J. Mack M.D. No abstract is available for this article. [source] Left Atrial Radiofrequency Ablation During Cardiac Surgery in Patients with Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2003ROBERTO MANTOVAN M.D. Introduction: Intraoperative left atrial radiofrequency (RF) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation (AF). The aim of this study was to verify the outcome of this technique in a controlled multicenter trial. Methods and Results: One hundred three consecutive patients (39 men and 65 women; age 62 ± 11 years) affected by AF underwent cardiac surgery and RF ablation in the left atrium (RF group). The control group consisted of 27 patients (6 men and 21 women; age 64 ± 7 years) with AF who underwent cardiac surgery during the same period and refused RF ablation. Mitral valve disease was present in 89 (86%) and 25 (92%) patients, respectively (P = NS). RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins, a lesion connecting the previous lines, and a lesion connecting the line encircling the left veins to the mitral annulus. Upon discharge from the hospital, sinus rhythm was present in 65 patients (63%) versus 5 patients (18%) in the control group (P < 0.0001). Mean time of cardiopulmonary bypass was longer in the RF group (148 ± 50 min vs 117 ± 30 min, P = 0.013). The complication rate was similar in both groups, but RF ablation-related complications occurred in 4 RF group patients (3.9%). After a mean follow-up of 12.5 ± 5 months (range 4,24), 83 (81%) of 102 RF group patients were in stable sinus rhythm versus 3 (11%) of 27 in the control group (P < 0.0001). The success rate was similar among the four surgical centers. Atrial contraction was present in 66 (79.5%) of 83 patients in the RF group in sinus rhythm. Conclusion: Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation-related complications can occur. During follow-up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1289-1295, December 2003) [source] Ablation of Atypical Atrial Flutter Guided by the Use of Concealed Entrainment in Patients Without Prior Cardiac SurgeryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2000FRANK BOGUN M.D. Ablation of Atypical Atrial Flutter. Introduction: Mapping techniques have not been systematically evaluated with respect to atypical atrial flutter (AF) not involving the inferior vena cava isthmus. The purpose of this study was to assess prospectively the use of concealed entrainment (CE) in mapping of AF and to assess the clinical benefit of ablation of clinically relevant atypical AF. Methods and Results: In seven consecutive patients without prior cardiac surgery presenting with atypical AF, mapping was performed in the right and, if necessary, left atrium. At sites with CE, radiofrequency energy was delivered. In a posthoc analysis, the endocardial activation time, stimulus-flutter wave (F) interval, presence of split potentials and diastolic potentials, and postpacing Interval were assessed, and effective sites were compared to ineffective sites. A total of 22 forms of atypical AE either could be induced or were present at the time of the study. Eleven of the 13 targeted atypical AFs (85%) were successfully ablated. The positive predictive value of CE increased from 45% to 75% in the presence of matching electrogram-F and stimulus-F intervals or if flutter terminated during entrainment pacing, and to 88% in the presence of split atrial electrograms or diastolic potentials. During short-term clinical follow-up, none of the patients had recurrence of the ablated AE. However, the majority of patients required either medication for atrial fibrillation or repeated interventions for new forms of AF. Conclusion: Mapping and ablation of atypical AF is feasible if sites with CE can be identified. However, the clinical benefit of successful ablations in patients with atypical flutter appears to be limited. [source] Minimally Invasive Cardiac Surgery, 2nd EditionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2004MARC R. MOON M.D. No abstract is available for this article. [source] Primary Angioplasty Should Become the Standard-of-Care at Qualified Hospitals Without On-Site Cardiac SurgeryJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2000F.A.C.C., THOMAS P. WHARTON JR. [source] Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-UpPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009OFER MERIN M.D. Background: Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent. Methods: We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 ± 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients. Results: Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 ± 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001). Conclusions: Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge. [source] Perioperative Monitoring of Thromboelastograph on Hemostasis and Therapy for Cyanotic Infants Undergoing Complex Cardiac SurgeryARTIFICIAL ORGANS, Issue 11 2009Yongli Cui Abstract This study investigated features and treatments of perioperative coagulopathies in cyanotic infants with complex congenital heart disease (CCHD). Thirty-six infants with cyanotic CCHD were involved and divided into two groups: In group H (n = 20), hematocrit (HCT) > 54%, and in group L (n = 16), HCT < 54%. Blood was sampled at anesthesia induction (T1), rewarming to 36°C (T2), after heparin neutralization (T3), and 4 h after operation (T4). The hemostatic changes were evaluated by thromboelastograph (TEG). After surgery, group H was treated with fibrinogen-combined platelets (PLT), while group L was treated with PLT only. We observed the effect at T4. At T1, the hemostatic function in group H, deteriorating with the increase of HCT (P < 0.01), was obviously lower than that in group L (P < 0.01), but the PLT function was still complete. In group H, the hemostatic function at T2 decreased with a significant drop of PLT function (P < 0.01) and had little change of functional fibrinogen (Ffg) (P > 0.05). At T3, compared with T2, there were improvements in hemostatic function and Ffg (P < 0.01, respectively) without increase of PLT (P > 0.05) in group H. After therapy, PLT function in both groups restored to T1 level (P > 0.05); Ffg at T4 was significantly better than at T1 (P < 0.01) in group H, but Ffg at T4 with still normal function was lower than at T1 in group L (P < 0.01). Whole hemostatic function at T4 was back to normal and had no differences between two groups. So, we proposed that fibrinogen and PLT transfusion in combination should be better for infants with high HCT CCHD, but PLT alone might be enough for low HCT ones. [source] Molecular Adsorbents Recirculating System Dialysis for Liver Insufficiency and Sepsis Following Right Ventricular Assist Device after Cardiac SurgeryARTIFICIAL ORGANS, Issue 8 2004Otrud Vargas Hein Abstract:, We report a case of right heart failure (RHF) and sepsis with liver insufficiency in a 70-year-old patient after coronary artery bypass graft surgery. Three hours after surgery the patient suddenly developed therapy refractory cardiac arrest caused by RHF. He had to have emergency surgery, under which the graft to the right coronary artery was revised and a right ventricular assist device was implanted. Heart function recovered and the assist device was explanted on day 1 after surgery. Thoracic closure was performed on day 5 after surgery. The patient went into septic shock on day 11. Liver dysfunction developed postoperatively and worsened the course of sepsis. Therefore, MARS (molecular adsorbents recirculating system) dialysis was performed once on day 20 after surgery. Liver function improved after MARS therapy and the patient recovered from sepsis. On day 46 the patient was transferred from the ICU of another hospital to one of the peripheral wards, to be finally discharged on day 67. [source] Intensive Imaging Assessment for Successful Minimally Invasive Cardiac SurgeryARTIFICIAL ORGANS, Issue 5 2002Masaya Kitamura Abstract: To clarify special imaging assessment that is useful for minimally invasive cardiac surgery (MICS), we examined 141 cases of MICS operations with ministernotomy or minithoracotomy. In the 141 patients, 62 valve, 42 coronary, 37 congenital heart, and 2 other procedures were successfully completed without conversion to full sternotomy. Preoperative chest x-ray, computed tomography, and/or magnetic resonance imaging were necessary for determining the level of ministernotomy, especially in aortic valve operations. Transthoracic echocardiography was useful for selecting procedures of mitral valve or intracardiac repair through the MICS approach. Intraoperative transesophageal echocardiography was essential for continuous monitoring of cardiac function, intracardiac flow, air bubbles, and so forth. The above results suggest that intensive imaging assessment might be very important for successful MICS operations with ministernotomy or minithoracotomy and that extensive indications for this technique exist for various cardiovascular diseases. [source] Prevention of Atrial Fibrillation in Cardiac Surgery: Time to Consider a Multimodality Pharmacological ApproachCARDIOVASCULAR THERAPEUTICS, Issue 1 2010Kwok M. Ho Atrial fibrillation (AF) is very common within the first 5 days of cardiac surgery. It is associated with significant morbidity including stroke, ventricular arrhythmias, myocardial infarction, heart failure, acute kidney injury, prolonged hospital stay, and also short- and long-term mortality. The underlying mechanisms of developing AF after cardiac surgery are multifactorial; risk factors may include advanced age, withdrawal of beta-blockers and angiotensin-converting-enzyme inhibitors, valve surgery, obesity, increased left atrial size, and diastolic dysfunction. There are many pharmacological options in preventing AF, but none of them are effective for all patients and they all have significant limitations. Beta-blockers may reduce the incidence of AF by more than a third, but bradycardia, hypotension, or exacerbation of heart failure often limit their utility postoperatively. Recent evidence suggests that class III antiarrhythmic drugs, sotalol and amiodarone, are more effective than beta-blockers, but they both share similar hemodynamic side effects of beta-blockers. Magnesium, antiinflammatory drugs such as statins, omega fatty acids, and low-dose corticosteroids also have some efficacy and they have the advantages of not causing significant hemodynamic side effects. Data on effectiveness of calcium channel blockers, digoxin, alpha-2 agonists, sodium nitroprusside, and N-acetylcysteine are more limited. Because the pathogenesis of AF is multifactorial, a combination of drugs with different pharmacological actions may have additive or synergistic effect in preventing AF after cardiac surgery. Randomized controlled trials evaluating the effectiveness of a multimodality pharmacological approach in patients at high-risk of AF after cardiac surgery are needed. [source] Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University HospitalCLINICAL CARDIOLOGY, Issue 1 2008Pharm D., Ujjaini Khanderia M.S. Abstract Atrial fibrillation (AF) usually develops within the first 72 h following cardiac surgery, and is often self-limiting. Within 48 h of acute onset of symptoms, approximately 50% of patients spontaneously convert to normal sinus rhythm. Thus, the relative risks and benefits of therapy must be carefully considered. The etiology of AF following cardiac surgery is similar to that in non-surgical patients except that pericardial inflammation and increased adrenergic tone play an increasingly important role. Further, AF after surgery may be associated with transient risk factors that resolve as the patient moves out from surgery, and the condition is less likely to recur compared to AF arising in other circumstances. Immediate heart rate control is important in preventing ischemia, tachycardia-induced cardiomyopathy, and left ventricular dilatation. At our institution, amiodarone is frequently used as a first-line drug for treating AF after cardiac surgery. Inconsistent prescribing practices, variable dosage regimens, and a lack of consensus regarding the appropriate use of amiodarone prompted the need for developing practice guidelines. Multidisciplinary collaboration between the departments of cardiac surgery, pharmacy, and anesthesiology led to the development of a protocol for postoperative AF. We review the clinical evidence from published trials and discuss our guidelines, defining amiodarone use for AF in the cardiac surgery setting. Copyright © 2007 Wiley Periodicals, Inc. [source] Monitoring of monocyte functional state after extracorporeal circulation: A flow cytometry studyCYTOMETRY, Issue 1 2004Silverio Sbrana Abstract Background Cardiovascular surgery with cardiopulmonary bypass (CPB) induces systemic inflammation and postoperative complications depending on pro- and anti-inflammatory mechanisms. Activated polymorphonuclear cells and monocytes may be responsible for morbidity associated with CPB. Knowledge of the monocyte functional state in particular may help to develop protective interventions. Methods Samples were drawn from venous peripheral blood (basal condition, at 4 and 24 h after CPB) and coronary blood (before and after cardioplegic arrest) of 14 patients undergoing cardiac surgery. The following phenotypic and functional parameters of the monocyte population were studied by flow cytometry: surface molecules expression (CD18, CD11a, CD11b, CD14, CD15, CD45, HLA-DR, and Toll-like receptor [TLR]-4), myeloperoxidase (MPO) content, and intracellular cytokine production (tumor necrosis factor [TNF]-,, interleukin [IL]-1,, IL-6, and IL-8). Results Cardiac surgery with CPB induced down-modulation of surface molecules expression on peripheral monocytes, especially at 24 h after CPB, for CD18, CD11a, and CD11b (P < 0.003) and for the CD15 adhesive cluster (P = 0.0028) and HLA-DR (P < 0.001). At 4 h after CPB, downregulation was observed for CD14 (P = 0.004), CD45 (P = 0.014), and CD15 (P = 0.0056). A loss of MPO was detected in venous peripheral (at 24 h after CPB, P = 0.01) or coronary (at reperfusion, P < 0.02) blood. The CD15 cluster complex exhibited a down-modulation in coronary blood (at reperfusion, P = 0.0003). Spontaneous intracellular production of IL-1,, IL-6, and IL-8 decreased at 24 h after CPB (P < 0.05). Conclusions The down-modulation of integrins and adhesive receptor expression and the loss of MPO suggest a strong activation and shedding reaction of circulating monocyte after CPB, further exacerbated by contact with coronary ischemic vessels. The changes of differentiation antigens may reflect the appearance of a partially immature population immediately after CPB. The reduced proinflammatory cytokine production, observed at 24 h after CPB, suggests a functional polarization of circulating monocytes. © 2003 Wiley-Liss, Inc. [source] Glutamine administration in patients undergoing cardiac surgery and the influence on blood glutathione levelsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009J. M. ENGEL Background: Cardiac surgery with an extracorporeal circulation cardiopulmonary bypass (CPB) is characterized by an oxidative stress response. Glutathione (GSH) belongs to the major antioxidative defense. In metabolic stress, glutamine (GLN) may be the rate-limiting factor of GSH synthesis. Decreased GLN plasma levels were observed after various critical states. We evaluated, in patients undergoing open heart surgery with CPB, the effects of a peri-operative GLN supplementation on GSH in whole blood and assessed their influence on the Sequential Organ Failure Assessment score and the intensive care unit length of stay. Methods: In this prospective, randomized, double-blinded study, we included 60 patients (age older than 70 years, ejection fraction <40% or mitral valve replacement) undergoing an elective cardiac surgery with CPB. We randomly assigned each subject to receive an infusion with either GLN (0.5 g/kg/day, group 1) or an isonitrogeneous, isocaloric, isovolemic amino acids solution (group 2) or saline (group 3). Results: From the first post-operative day GLN plasma levels in group 1 were significantly increased compared with the other groups. With saline GSH the levels decreased significantly post-operatively compared with GLN. We observed a significant correlation between GLN delivery and GSH levels. Conclusions: A peri-operative high-dose GLN infusion increased plasma GLN concentrations and maintained the GSH levels after cardiac surgery with CPB. [source] Open Heart Surgery in Patients 85 Years and OlderJOURNAL OF CARDIAC SURGERY, Issue 1 2004Wellington J. Davis III M.D. Several reports have documented acceptable morbidity and mortality in patients 80 years and older. The results from surgical patients 85 years and older were analyzed. Methods: The records of 89 consecutive patients 85 years and older having cardiac operations between June 1993 and May 1999 were retrospectively reviewed. For purposes of statistical analysis follow-up was considered as a minimum of one office visit to the surgeon, cardiologist, or internist at least 1 month postoperatively. Results: Eighty-seven patients underwent coronary artery grafting and two patients had mitral valve replacement. Follow-up was 100% complete. The operative mortality rate was 12.3%; probability of in-hospital death was 8.2%; risk-adjusted mortality rate was 3.2%. The complication rate was 31.5%. The actuarial 1-, 3-, and 5-year survivals were as follows: 75%, 67%, and 40%. Multivariate predictors of 30-day mortality were preoperative EF, less than 30% (p = 0.029) and postoperative renal failure (p = 0.0039). Conclusions: Cardiac surgery can be performed in patients 85 years and older with good results. There is an associated prolonged hospital stay for elderly patients. Consistent successful outcomes can be expected in this patient population with selective criteria identifying risk factors. (J Card Surg 2004;19:7-11) [source] Increased Interleukin-10 and Cortisol in Long-term Alcoholics after Cardiopulmonary Bypass: A Hint to the Increased Postoperative Infection Rate?ALCOHOLISM, Issue 9 2005Michael Sander Background: Previous studies have shown that 20% of all patients admitted to the hospital abuse alcohol and have increased morbidity after surgery. Long-term alcoholic patients are shown to suffer from immune alterations, which might be critical for adequate postoperative performance. Cardiac surgery with cardiopulmonary bypass (CPB) also leads to pronounced immune alteration, which might be linked with patients' ability to combat infections. Therefore, the aim of our study was to investigate the perioperative levels of TNF-alpha, interleukin-6, interleukin-10, and cortisol in long-term alcoholic and nonalcoholic patients undergoing cardiac surgery to elucidate a possible association with postoperative infections. Methods: Forty-four patients undergoing elective cardiac surgery were included in this prospective study. Long-term alcoholic patients (n= 10) were defined as having a daily ethanol consumption of at least 60 g and fulfilling the Diagnostic and Statistical Manual of Mental Disorders for alcohol abuse. The nonalcoholic patients (n= 34) were defined as drinking less than 20 g ethanol per day. Blood samples were obtained to analyze the immune status upon admission to hospital, the morning before surgery and on admission to the ICU, the morning of days one and three after surgery. Results: Basic characteristics of patients did not differ between groups. Long-term alcoholics had a fourfold increase in postsurgery infection rate and prolonged need for ICU treatment and mechanical ventilation. Postoperative levels of interleukin-10 and cortisol were significantly increased in long-term alcoholic patients compared with nonalcoholic patients. These observations were in line with postoperative interleukin-10 being predictive for postoperative infectious complications. Conclusions: The increased infection rate in long-term alcoholics strengthens the urgent need for interventional approaches providing modulation of the perioperative immune and HPA response in these high-risk patients to counteract their postoperative immune suppression. [source] Cardiac surgery: with or without epidurals?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2006R. Pöyhiä No abstract is available for this article. [source] Laser Polishing in Medical EngineeringLASER TECHNIK JOURNAL, Issue 2 2010Laser Polishing of Components for Left Ventricular Assist Devices Cardiac surgery has made significant progress during the last 50 years. nowadays, almost every congenital or contracted dysfunction of the heart can be treated clinically or at least the etiopathology can be alleviated. During these years, implantable Left Ventricular Assist Devices (LVADs) have proven to be an effective and reliable medical product. In particular, the survival rate of patients with cardiac insufficiency has risen due to these devices. This type of heart-assist device is implanted either to bridge the time until cardiac transplantation or recovery has occurred, or for permanent implantation in the patient's body. Berlin Heart GmbH produces the clinically tested axial pump system INCOR® (Figure 1, above). The INCOR heart-as-sisting pump is a powerful implantable LVAD which has been used in more than 500 clinical applications. The main function of the axial pump is to unload the patient's heart by transporting blood from the left ventricle to the aorta. In order to assure high reliability of the pump's operation, the components used for blood transport have to be highly bio- and hemocompatible. [source] Leiomyosarcoma of the pulmonary veinPATHOLOGY INTERNATIONAL, Issue 10 2000Tomoko Okuno A case of a 74-year-old man with leiomyosarcoma of the pulmonary vein is reported. The patient felt transient chest oppression while playing golf 1 week before he visited a clinic with a common cold. He underwent an ultrasonographic examination of the heart, which showed a mass lesion in the left atrium. The preoperative clinical diagnosis was myxoma of the left atrium. Cardiac surgery revealed the mass to be a leiomyosarcoma, probably extending from the left inferior pulmonary vein. The patient underwent a left lower lobectomy of the lung, and the tumor was confirmed to have originated from the wall of the left inferior pulmonary vein. Although the patient had a metastatic lesion in the right axillary lymph node 11 months later, which was excised, he remained free of disease 14 months after the initial operation. Histologically, the tumors were composed of pleomorphic cells with bizarre nuclei and spindle cells with blunt-ended nuclei with 1,4 mitotic figures in 10 high power fields. Immunohistologically, the tumor cells were positive for , -smooth muscle actin and desmin. We reviewed 17 cases of leiomyosarcoma of the pulmonary vein (six males and 11 females with a mean age of 50 years in each group). The present case was the oldest in age and to our knowledge was the first reported case with metastasis in a distant lymph node. [source] Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno,Venous Hemofiltration During Cardiopulmonary BypassARTIFICIAL ORGANS, Issue 8 2009Remo Luciani Abstract Cardiac surgery with cardiopulmonary bypass is associated with a systemic inflammatory response syndrome. The major clinical features of this include a reduction of pulmonary compliance and increased extracellular fluids, with increased pulmonary shunt fraction similar to acute respiratory distress syndrome, thus resulting in prolonged mechanical ventilation time (VAM) and intensive care unit length of stay (ICU STAY). We evaluated the feasibility of an intraoperatory cardiopulmonary bypass (CPB) circuit connected with a monitor for continuous veno,venous hemofiltration (CVVH) to ameliorate pulmonary function after open heart surgery reducing VAM and ICU STAY. Forty patients undergoing elective coronary artery bypass grafting were randomized at the time of surgery into a control group (20 patients who received standard cardiopulmonary bypass) and a study group (20 patients who received CVVH during cardiopulmonary bypass). The analysis of postoperative variables showed a significative reduction of VAM in treated group (CVVH group mean 3.55 h ± 0.85, control group 5.8 h ± 0.94, P < 0.001) and ICU STAY (CVVH group mean 29.5 h ± 6.7, control group 40.5 h ± 6.67, P < 0.001). In our experience, the use of intraoperatory CVVH during cardiopulmonary bypass is associated with lower early postoperative morbidity. [source] Rationale for medical director acceptance or rejection of allogeneic plateletpheresis donors with underlying medical disordersJOURNAL OF CLINICAL APHERESIS, Issue 3 2002Ronald G. Strauss Abstract A survey was completed by 25 medical directors at different institutions performing plateletpheresis. The practices of these 25 physicians were analyzed regarding the acceptance/rejection of plateletpheresis donors with a history of cardiac disease/surgery, seizures/epilepsy, cancer, or autoimmune diseases. Although available medical literature documents little risk of these disorders either to donors (i.e., donation reactions) or to transfusion recipients (i.e., disease transmission), up to 24% of medical directors outright reject some of these potential donors while others accept patients/donors with these illnesses, providing they meet certain medical/health criteria. Acceptance/rejection of individuals with medical disorders has relevance for the availability of the blood supply and blood product shortages because several million Americans, diagnosed with these illnesses, represent a sizable pool of potential blood and platelet donors. J. Clin. Apheresis 17:111,117, 2002. © 2002 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||