Leadless pacemaker implant in patients with a history of open heart surgery: experience with the Micra transcatheter pacemaker

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Garweg ◽  
S Iacopino ◽  
M.F El-Chami ◽  
C Veltmann ◽  
N Clementy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Major Complication ◽  
Valve Surgery ◽  
Funding Source ◽  
Open Heart ◽  
Surgery Group ◽  
History Of

Abstract Background The Micra transcatheter pacemaker has demonstrated a favorable safety and efficacy profile relative to transvenous pacing. Patients with a history of open heart surgery have a higher risk of complications with transvenous pacemakers during follow-up. The experience with leadless pacemakers among a large cohort of patients with a history of open heart surgery has not been reported. Objective To report outcomes in patients with a history of open heart surgery undergoing Micra implant. Methods Patients undergoing Micra implant from the Micra Transcatheter Pacing Post-Approval Registry (PAR) were included in the analysis. Baseline and procedural characteristics, major complications, and electrical performance were compared among patients with vs. without history of cardiac surgery. Results A total of 331 out of 1815 (18.2%) patients had a history of open heart surgery, underwent Micra implant, and were followed for 19.4±10.4 months. The mean age was 74.6±13.5 years, 40% were female. The most common cardiac surgery was aortic valve surgery (71%) followed by mitral valve surgery (39%). Patients with prior open-heart surgery were more likely to have contraindications to transvenous pacing, were more likely to be on oral anticoagulants, and had more co-morbidities including atrial fibrillation, heart failure, and coronary artery disease (all p<0.005). Implantation was successful in 327 of 331 patients (98.8%) with a median procedure time of 29 minutes. Mean pacing capture thresholds (PCTs) at implant were 0.66±0.51V and remained stable through follow-up. There were 11 major complications in 10 cardiac surgery patients, with no device or procedure-related infections reported. The major complication rate was 3.1% (Figure) and was not significantly different than that of patients without a history of open heart surgery (HR: 0.85, P=0.640). There was 1 cardiac perforation (with no intervention required) in the open heart surgery group (0.3%) and there were 14 cardiac perforations (0.94%, P=0.332) in the non-open heart surgery group of which 10 required intervention. Conclusion The Micra transcatheter pacemaker can be safely implanted in patients with a history of open heart surgery, with a similar long-term safety profile to patients without a history of open heart surgery. Importantly, there were no device-related infections reported in either group. Risk of Major Complication Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic, Inc.

scholarly journals Influence of biomarkers level during follow-up when operating under cardiopulmonary bypass

2015 ◽  
Vol 18 (3) ◽  
pp. 39
Author(s):  
Yu. I. Petrishchev ◽  
A. L. Levit ◽  
I. N. Leyderman
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Plasma Levels ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Cardiac Surgeons ◽  
The Given ◽  
The Relationship

Systemic inflammatory response was first determined in 1980 and cardiac surgeons turned to it in 1996. At present, there are a lot of publications on this issue, however, the extent of operation and duration of CPB are considered in clinical practice as crucial indicators of severity of patient's condition following cardiac surgery. In our study we tried to look at this problem from a different perspective and draw a parallel between the severity of patient's condition resulting from operational trauma and CPB. We included 48 patients who under-went cardiac surgery under CPB. Plasma levels of procalcitonin (PCT), lactate and interleukin-6 were investigated before the operation, after CPB and at 24 hours. Also revealed was the relationship between the plasma levels of IL-6, lactate and PCT (r = 0.53; p = 0.000 in both cases). The level of PCT at the 3rd stage was found to relate to the duration of CPB (r = 0.4; p = 0.005), ALV (r = 0.44; p = 0.001) and length of stay at ICU (r = 0.53; p = 0.000). We didn't manage to find any relationship between the length of stay at ICU and the duration of CPB. Correlation between the PCT plasma level and the duration of intensive care indicates the importance of dynamics of the given biomarker for early prediction of follow-up course after open-heart surgery.

Psychological Adjustment and Response to Open-Heart Surgery: Some Methodological Considerations

1972 ◽  
Vol 120 (558) ◽  
pp. 491-496 ◽  
Author(s):  
Theodore F. Henrichs ◽  
William F. Waters
Keyword(s):  
Cardiac Surgery ◽  
Psychological Adjustment ◽  
Psychological Factors ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
History Of ◽  
Methodological Considerations ◽  
Psychiatric Complications ◽  
Psychiatric Problems

Psychological factors have long been posited as having a role in determining a person's response to open-heart surgery. As early as 1956 Bolton and Bailey reported a high correlation between a history of psychiatric problems and psychiatric complications following cardiac surgery.

Intraoperative Low-volume Acute Normovolemic Hemodilution in Adult Open-heart Surgery

2002 ◽  
Vol 97 (2) ◽  
pp. 367-373 ◽  
Author(s):  
Valter Casati ◽  
Giovanni Speziali ◽  
Cesare D'Alessandro ◽  
Clara Cianchi ◽  
Maria Antonietta Grasso ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Postoperative Bleeding ◽  
Open Heart Surgery ◽  
Valve Surgery ◽  
Control Group ◽  
Open Heart ◽  
Acute Normovolemic Hemodilution ◽  
Normovolemic Hemodilution ◽  
Low Volume

Background Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery. Methods Two hundred four consecutive adult patients undergoing cardiac surgery were prospectively randomized in a nonblinded manner into two groups: ANH group (103 patients), where 5-8 ml/kg of blood was withdrawn before systemic heparinization and replaced with colloid solutions, and a control group, where no hemodilution was performed (101 patients). Procedures included single and multiple valve surgery, aortic root surgery, coronary surgery combined with valve surgery, or partial left ventriculectomy. The purpose of the study was to evaluate the efficacy of ANH in reducing the need for allogeneic blood components. Routine hematochemical evaluations, perioperative blood loss, major complications, and outcomes were also recorded. Results No differences were found between the groups regarding demographics, baseline hematochemical data, and operative characteristics. There was no difference in the amount of transfusions of packed red cells, fresh frozen plasma, platelet concentrates, total number of patients transfused (control group, 36% vs. ANH group, 34.3%; P = 0.88), and amount of postoperative bleeding (control group, 412 ml [313-552 ml] vs. ANH group, 374 ml [255-704 ml]) (median [25th-75th percentiles]); P = 0.94. Further, perioperative complications, postoperative hematochemical data, and outcomes were not different. Conclusions In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding.

scholarly journals Effects of Obesity on Mortality and Morbidity in High-Risk Open Heart Surgery Patients

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hulya Yilmaz Ak ◽  
◽  
Yasemin Ozsahin ◽  
Mehmet Ali Yesiltas ◽  
Ismail Haberal ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Obese Group ◽  
Open Heart ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Risk Patients

Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI <30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p> 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.

scholarly journals Neuropsychomotor development before and after open-heart surgery in infants

2009 ◽  
Vol 67 (2b) ◽  
pp. 457-462 ◽  
Author(s):  
Taís Sica da Rocha ◽  
Ana Guardiola ◽  
Jefferson Pedro Piva ◽  
Cláudia Pires Ricachinevski ◽  
Aldemir Nogueira
Keyword(s):  
Heart Surgery ◽  
Intensive Care Unit Discharge ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Neurodevelopmental Outcomes ◽  
Early Improvement ◽  
Before And After ◽  
Neurological Exam ◽  
Brazilian Studies

There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67 ± 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.

Incidence and Natural History of Phrenic Neuropathy Occurring During Open Heart Surgery

CHEST Journal ◽  
1993 ◽  
Vol 103 (3) ◽  
pp. 850-856 ◽  
Author(s):  
Michael A. DeVita ◽  
Lawrence R. Robinson ◽  
John Rehder ◽  
Brack Hattler ◽  
Catherine Cohen
Keyword(s):  
Natural History ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
History Of ◽  
Phrenic Neuropathy

scholarly journals Case report: Diagnosis and emergency surgery on a young patient with extensive aortic dissection without any risk factors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masoud Shafiee ◽  
Mohsen Shafiee ◽  
Noorollah Tahery ◽  
Omid Azadbakht ◽  
Zeinab Nassari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Aortic Dissection ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Open Heart Surgery ◽  
Rare Condition ◽  
Underlying Disease ◽  
Case Presentation ◽  
History Of

Abstract Background Type A aortic dissection is a very dangerous, fatal, and emergency condition for surgery. Acute aortic dissection is a rare condition, such that many patients will not survive without reconstructive surgery. Case presentation We present a case 24-year-old male who came with symptoms of shortness of breath and cough. The patient underwent ECG, chest radiology, and ultrasound, where the patient was found to have right pleural effusion while his ECG was normal. In the history taken from the patient, he had no underlying disease, no history of heart diseases in his family. For a better diagnosis, ETT and aortic CT angiography was performed on the patient which confirmed the evidence of dissection. Immediately after the diagnosis, necessary arrangements were made for open heart surgery and the patient was prepared for surgery. The patient was admitted in the cardiac surgery ICU for 5 days and his medication was carefully administered. After the conditions were stabilized, the patient was transferred to the post-cardiac surgery ICU ward. The patient was discharged from the hospital one week after the surgery and returned to the office as an OPD one week after his discharge. Conclusion Various risk factors can play a role in creating aortic dissection. Therefore, it is necessary to pay attention to patients’ history for achieving a quick and definitive diagnosis. Therefore, to control the complications of placing the cannula as well as the duration of the surgery, it is very important to reduce the duration of pumping on the patient and to be very careful during the cannula placement.

scholarly journals Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 756
Author(s):  
Praveen Dhaulta ◽  
Vikas Panwar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Variable ◽  
Open Heart ◽  
Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

scholarly journals The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

2021 ◽  
Author(s):  
Murat Aksun ◽  
Saliha Aksun ◽  
Mehmet Ali Çoşar ◽  
Elif Neziroğlu ◽  
Senem Girgin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Experience ◽  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart ◽  
Blood Products ◽  
Product Use ◽  
The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

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