scholarly journals Preoperative oral hygiene recommendation before open-heart surgery: patients’ adherence and reduction of infections: a quality improvement study

2019 ◽  
Vol 8 (2) ◽  
pp. e000512
Author(s):  
Preben Ulrich Pedersen ◽  
Anita Tracey ◽  
Jesper Eske Sindby ◽  
Merete Bjerrum
Keyword(s):  
Oral Hygiene ◽  
Heart Surgery ◽  
Medical Information ◽  
Open Heart Surgery ◽  
Intervention Group ◽  
Open Heart ◽  
Efficient Treatment ◽  
Intention To Treat ◽  
Number Of Patients ◽  
Cost Efficient

AimTo implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced.BackgroundHealthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline.MethodsA quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients’ medical records. Data were reported as intention to treat.ResultsAltogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively.ConclusionsIt was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.

scholarly journals Incidence of Permanent Pacemaker Implantation after Cardiac Surgery: A Single Centre Experience

2019 ◽  
Vol 73 (4) ◽  
pp. 364-367
Author(s):  
Mārtiņš Kalējs ◽  
Edgars Prozorovskis ◽  
Kaspars Kupics ◽  
Ivars Brečs ◽  
Uldis Strazdiņš ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Intervention Group ◽  
Permanent Pacemaker ◽  
Open Heart ◽  
Single Centre ◽  
Permanent Pacemaker Implantation

Abstract Permanent pacemaker implantation (PPI) after open heart surgery is required in 0.4–8.5% of patients. The aim of our study was to determine the incidence of PPI after cardiac surgery at Pauls Stradiņš Clinical University Hospital and to assess its influence on intrahospital outcomes. This was a single-centre retrospective study. We reviewed all patients who underwent either open heart surgery or transcatheter aortic valve implantation (TAVI) between the years 2015 and 2017. Included were all patients with PPI postoperatively before discharge. We compared the patient demographics, and perioperative state, incidence of PPI and intrahospital stay among groups. After cardiac surgery a total of 135 (4.2%) patients received a PPI. The PPI incidence was highest in the tricuspid valve intervention group — 8.8% followed by aortic valve replacement (AVR) patients with 3.3%. After TAVI incidence of PPI was 4.0% after Sapien valve and 8% after CoreValve implantations, respectively. Incidence of PPI after TAVI with the Sapien valve was not significantly higher when compared to conventional AVR, but it was significantly higher after TAVI with CoreValve. Regardless of the initial procedure a need for PPI significantly increased the total length of hospital stay.

P3729The left atrial appendage closure by surgery-2 randomized trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Dominguez ◽  
C V Madsen ◽  
A Irmukhamedov ◽  
C L Carranza ◽  
S Rafiq ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Total Mortality ◽  
Minor Stroke ◽  
Control Group ◽  
Open Heart ◽  
Number Of Patients ◽  
Incomplete Closure ◽  
Laa Closure

Abstract Background Since the left atrium appendage (LAA) is the predilection site for clot formation in patients with atrial fibrillation (AF), closure of the LAA during surgery (LAACS) is often performed but not yet demonstrated to protect against stroke. The recent LAACS trial found that LAA closure protected from strokes and silent brain damages on a moderate (n=187) number of patients. However, results based solely on strokes and cerebral transitory ischemic attacks (TIA) was not significant (18% events in the control group compared to 6% in patients where LAA was closed (p=0.07). Furthermore, incomplete closure of the LAA is of concern, with an increased relative risk for stroke (10–25%). Purpose Determine if LAA closure added to planned open heart surgery protects against post-operative major stroke and minor stroke. Methods Adults scheduled for open-heart surgery who sign informed consent will be included regardless of known AF, provided LAA closure is not previously planned. LAACS-2 is an open, parallel, international multi-center study where patients will be randomized to closure of the LAA (with clip or staple), in addition to planned open-heart surgery. The LAA will remain open in the control group. Randomization will be stratified according to ongoing or expected use of anti-coagulant medication following surgery and classified as coronary artery bypass surgery (CABG) alone, mitral valve surgery or other. The primary endpoint is stroke or TIA occurring over at least two years following surgery. Secondary endpoints are: Total mortality and a combination of stroke, TIA or image of recent cerebral infarction in clinical settings demonstrated post-operatively, until the end follow-up. Occurrence of AF during follow-up will be assessed with prolonged (up to several weeks) monitoring with a three-lead compact sensor. Studies on percutaneous coronary intervention and CABG, estimate a 3.7% pooled incidence of stroke in the first three years following coronary by-pass operations. Using these estimates and those from the previous LAACS study (3.2% strokes on patients with closed LAA vs 11.3% in the control group, p=0.07), we estimate that LAA closure can be demonstrated to protect from strokes, with a significance level of 0.05 and a 90% power, including 1200–1400 patients in an event-driven study. Expecting a cross-over of 10–20%, we plan to enroll 2000 adults. According to the a priori power-calculations, the LAACS-2 trial is powered: 1) to determine if randomization to closure of the LAA in conjunction with planned open-heart surgery, protects patients from post-operative clinical strokes; and 2) if there is an increased thrombogenic effect of incomplete closure or excessive pouch, since such harm can be identified by including between 359 and 1455 patients. Perspective If the LAACS procedure in conjunction with planned open-heart surgery protects against future stroke it should be included in future guidelines. Acknowledgement/Funding Innovation Fund Denmark; NovoNordisk Foundation; Ib Mogens Christiansen; Bispebjerg-Frederiksberg Research Fund

scholarly journals Risk and benefits of temporary pacemaker electrodes in adult open-heart surgery—a systematic review

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Malene S. Enevoldsen ◽  
Per Hostrup Nielsen ◽  
J. Michael Hasenkam
Keyword(s):  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Valve Surgery ◽  
Open Heart ◽  
Temporary Pacing ◽  
Number Of Patients ◽  
Temporary Pacemaker ◽  
Pacemaker Electrodes ◽  
Significant Factors

Abstract Background To assess the achieved risk and benefits of inserting temporary epicardial pacemaker electrodes after open-heart surgery for potential treatment of postoperative cardiac arrhythmias, and to investigate the extent of its use in clinical practice. Main text A systematic search was conducted in PubMed and repeated in Embase and Scopus using the PRISMA guidelines. The search identified 905 studies and resulted in 12 included studies, where the type of surgery, study design, total number of included patients, number of patients having temporary pacemaker electrodes inserted, number of patients requiring temporary pacing, primary reason for pacing, significant factors predicting temporary pacing, registered complications and study conclusion were assessed. Eight papers concluded that routine insertion of temporary pacemaker electrodes in all postoperative patients is unnecessary. One paper concluded that they should always be inserted, while three papers concluded that pacing is useful in the postoperative period, but did not recommend a frequency of which they should be inserted. Conclusions The literature suggests that the subgroup of younger otherwise healthy patients without preoperative arrhythmia having isolated coronary artery bypass grafting surgery or single valve surgery should not routinely have temporary pacemaker electrodes inserted.

Blood Products in the Treatment of Acute Bleeding Complications Following Open-Heart Surgery

1979 ◽  
Author(s):  
M. Crow ◽  
T.K. Kaul ◽  
S.M. Rajah
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Bleeding Complications ◽  
Blood Component ◽  
Severe Thrombocytopenia ◽  
Open Heart ◽  
Platelet Concentrates ◽  
Clotting Factors ◽  
Excessive Bleeding ◽  
Number Of Patients

We studied the bleeding patterns in 377 patients undergoing open-heart surgery in the last 18 months. The number of patients with excessive bleeding requiring a coagulation screen was 56 (14.84%), of which 30 (7.95%) had a normal profile, with moderate thrombocytopenia. In 22 of these 30 patients specific bleeding sites were found at re-operation and effective surgical haemostasis was achieved. No specific bleeding sites were found in the remaining 8 (2.12%) and the cause for excessive bleeding was not determined. Treatment with fresh frozen plasma (FFP) gradually controlled the bleeding. Twenty-six (6.89%) had abnormal coagulation findings. Severe thrombocytopenia occurred in 1 patient (0.25%) who was treated with platelet concentrates. Prolonged partial thromboplastin time was recorded in 14 (3.71%) cases and these patients were treated with cryoprecipitate, FFP or fresh blood (depending on the haematocrit and blood volume). The final 11 patients had low levels of all clotting factors, were thrombocytopenic and had significantly raised fibrinogen degradation products, indicating a limited form of intravascular coagulation. These patients were treated with cryoprecipitate, FFP and platelet concentrates. Sixty per cent of the patients with post-operative bleeding required specific blood component therapy besides other medication.

scholarly journals The Effect of Multi-Component Interventions on the Incidence Rate, Severity, and Duration of Post Open Heart Surgery Delirium among Hospitalized Patients

2020 ◽  
Author(s):  
Banafsheh Tehranineshat ◽  
Nima Hosseinpour ◽  
Arash Mani ◽  
Mahnaz Rakhshan
Keyword(s):  
Incidence Rate ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Intervention Group ◽  
Hospitalized Patients ◽  
Control Group ◽  
Open Heart ◽  
Environmental Interventions ◽  
Post Operation ◽  
The Mean

Abstract Background: Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients.Methods: In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and were divided into a control and an intervention group. The interventions included patients’ preoperative education, nurses’ education, and intra-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20.Results: The incidence rate of delirium was 14.6% and 6.2% in the control and intervention groups, respectively (p>0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group (p>0.05). Finally, the mean duration of delirium was 4.5 and 3.25 hours in the two groups, respectively (p>0.05).Conclusions: Since prevention of delirium can play a considerable role in patients’ recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.

scholarly journals A clinical study of normothermic open heart surgery

2017 ◽  
Vol 4 (8) ◽  
pp. 2429
Author(s):  
Ishtiak Ahmed Mir ◽  
Ravinder Kumar ◽  
Madhu Digra ◽  
Dinesh Kumar
Keyword(s):  
Heart Surgery ◽  
Heart Diseases ◽  
Enzyme Level ◽  
Pulmonary Stenosis ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Age Groups ◽  
Open Heart ◽  
Aortic Cross Clamp Time ◽  
Number Of Patients

Background: Normothermic open heart surgery is a new approach which is envisaged for better myocardial protection during cardiac surgery based on the concept that chemically arrested heart is perfused continuously with blood and maintained at 37ºC.Methods: This study was conducted in 50 patients at Super Specialty Hospital, Jammu in the Department of CTVS for a period of one year from 2015 to 2016. The patients of all age groups and both sexes were taken up for surgery which included patients of congenital and acquired heart diseases. All patients were undergone thorough history taking, investigations like cardiac enzymes estimation, LFT, RFT, echocardiography, ECG. Cardioplegia used during surgery consisted of warm oxygenated blood, KCL, sodium bicarbonate, hydrocortisone, Mannitol.Results: Majority of patients were in age group of 11-20 years which comprised 30% of all patients. the male and female patients were equal and ratio was 1:1. Per-operative diagnosis was same as pre-operative echocardiographic diagnosis except that one (2%) patient had ASD with partial anomalous pulmonary veins opening into right atrium. One patient (2%) had single ventricle with pulmonary stenosis. Maximum number of patients underwent mitral valve replacement followed by ASD repair. Mean aortic cross-clamp time was 62 patients and mean total CPB was 71.5 minutes. Mean value of volume of blood cardioplegia used was 1100 ml and for priming solution it was 1500 ml. Cardiac enzyme level showed peak rise above normal after 24 hours after surgery in majority of patients.Conclusions: Normothermic open heart surgery can be used in any diverse surgical procedure safely and effectively.

scholarly journals Evaluation of Aminoglycosides Consumption in Open Heart Surgery Based on the Defined Daily Dose Index

2020 ◽  
Author(s):  
Golpar Gholizadeh Shirdarreh ◽  
Gohar Eslami ◽  
Aria Soleimani ◽  
Ebrahim Salehifa
Keyword(s):  
Side Effects ◽  
Creatinine Clearance ◽  
Heart Surgery ◽  
Laboratory Data ◽  
Open Heart Surgery ◽  
Defined Daily Dose ◽  
Open Heart ◽  
Number Of Patients ◽  
Daily Dose ◽  
The Mean

Background: Resistance to antibiotics, including aminoglycosides  (AMG) is one of the problems associated with inappropriate administration of broad-spectrum antibiotics. Objectives: This study aimed to assess the clinical features of aminoglycosides consumption based on the Defined Daily Dose (DDD) index in open heart surgery. Methods: This study was done on 268 patients who underwent heart surgery during 2015 and 2016. Clinical and demographic characteristics, laboratory data, and aminoglycoside-related data such as dose and the total duration of administration were collected through a questionnaire designed by the authors. The patients’ DDD/100 bed-days were calculated, too. Results: Out of 268 patients, 170 patients (63.4%) were male. The Mean±SD age of the patients was 60.65±10.71 years and the Mean±SD duration of hospitalization was 12.19±7.02 days. Ischemic heart disease was the most prevalent cause of hospitalization. The Mean duration of receiving aminoglycosides was 3.61 days. In 134 patients (50%), creatinine clearance was less than 60 mL/min during aminoglycosides administration. In 25 patients (9.32%), a 50% increase in serum creatinine during receiving aminoglycosides was observed. Creatinine clearance had not been calculated for any patient. Conclusion: In this study, monitoring the side effects of aminoglycosides and the serum concentration was not routinely performed. Dose adjustment of aminoglycosides based on renal function test was not considered in a large number of patients and as a result, the dose was inappropriate in many patients. Therefore, it is recommended that the guidelines of drug usage were followed and the patients were monitored more closely for side effects.

scholarly journals The effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Banafsheh Tehranineshat ◽  
Nima Hosseinpour ◽  
Arash Mani ◽  
Mahnaz Rakhshan
Keyword(s):  
Incidence Rate ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Intervention Group ◽  
Hospitalized Patients ◽  
Control Group ◽  
Open Heart ◽  
Environmental Interventions ◽  
Post Operation ◽  
The Mean

Abstract Background Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients. Methods In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and divided into a control and an intervention group. The interventions included the patients’ preoperative education, nurses’ education, and in-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20. Results The incidence rate of delirium was 14.6 and 6.2% in the control and intervention groups, respectively (p > 0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group (p > 0.05). Finally, the mean duration of delirium was 4.5 and 3.25 h in the two groups, respectively (p > 0.05). Conclusions Since prevention of delirium can play a considerable role in the patients’ recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.

The Hemostatic Mechanism after Open-Heart Surgery

1978 ◽  
Vol 39 (02) ◽  
pp. 474-487 ◽  
Author(s):  
E R Cole ◽  
F Bachmann ◽  
C A Curry ◽  
D Roby
Keyword(s):  
Extracorporeal Circulation ◽  
Heart Surgery ◽  
Polyacrylamide Gel Electrophoresis ◽  
Open Heart Surgery ◽  
Coagulation System ◽  
Open Heart ◽  
Time Activity ◽  
Post Surgery ◽  
Plasma Fractions ◽  
The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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