Abstract 4092: Initial Experience with Subxiphoid Percutaneous Epicardial Ventricular Tachycardia Ablation in Patients with Prior Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Srijoy Mahapatra ◽  
George M McDaniel ◽  
Pamela K Mason ◽  
Gorav Ailawadi
Keyword(s):  
Cardiac Surgery ◽  
Success Rate ◽  
Nyha Class ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Success Rates ◽  
Ventricular Tachycardia Ablation ◽  
Prior Surgery ◽  
Vt Ablation ◽  
Surgical Group

Introduction: Epicardial ablation via subxiphoid percutaenous access improves VT ablation success rate and is growing in popularity. However, it is unclear if this technique is feasible in patients with prior cardiac surgery because of pericardial adhesions. We describe results in our initial 12 patients with previous cardiac surgery. Methods: A total of 27 patients (11 women) underwent an epicardial VT ablation after failed antiarrhythmic drug therapy and at least one endocardial ablation. Twelve patients had undergone previous cardiac surgery (7 CABG, 3 valve only, 2 combined). The pericardium was accessed using a Tuohy needle. Then a guidewire and an irrigated tip catheter were used to free up adhesions. VT was mapped and ablated. We compared the results in patients with and without prior surgery. Results: There was no difference in the age (62±11 vs 58±13 years, p=ns), percent women (41 vs 40%, p=ns), EF (30±9 vs 27±11, p=ns), NYHA class (2.4±1.0 vs 2.1±0.9, p=ns) or use of beta-blockers (100 vs 93%, p=ns) or ACE inhibtors (100 vs 93%, p=ns) among patients with and without prior cardiac surgery. However, patients with prior surgery were more likely to have CAD (100 vs 66% p=0.02) and be on ASA (100 vs 73%, p=0.04.) The mean procedure (298±90 vs 178±45 min, p=0.01) and fluoroscopy time (106±24 vs 45±11 min, p=0.01) was longer in patients with prior surgery versus without surgery. The entire epicardium was mapped in 15/15 (100%) of the nonsurgical patients but only in 7/11 (64%) of the surgical patients due to adhesions (p=0.02.) The acute success rate, defined as elimination of all clinical VTs, was lower in the surgical group (75 vs 100%, p=0.02). Elimination of all VTs was achieved less often in post-surgical patient than non-surgical patients (58 vs 80%, p=0.04.) There were two occurrences of RV perforation in each group both treated with conservative therapy. There were no other complications. After 7±2 months, 66% of surgical patients and 80% of non-surgical patients were VT free (p=0.04) as monitored by ICD or 1, 3, and 6 month monitor. One patient in non-surgical group died of heart failure. Conclusion: Prior cardiac surgery does not preclude epicardial VT ablation but is associated with longer procedure times and lower success rates.

scholarly journals Dynamic needle tip positioning versus the angle-distance technique for ultrasound-guided radial artery cannulation in adults: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bing Bai ◽  
Yuan Tian ◽  
Yuelun Zhang ◽  
Chunhua Yu ◽  
Yuguang Huang
Keyword(s):  
Success Rate ◽  
Radial Artery ◽  
Posterior Wall ◽  
Surgical Patients ◽  
Arterial Cannulation ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Radial Artery Cannulation ◽  
Artery Cannulation ◽  
First Pass

Abstract Background Ultrasound guidance can increase the success rate and reduce the incidence of complications of arterial cannulation. There are few studies on the utility of the dynamic needle tip positioning (DNTP) technique versus the angle-distance (AD) technique for ultrasound-guided radial arterial cannulation in adult surgical patients. We assessed and compared the success rates and incidences of complications of these two short-axis out-of-plane techniques. Methods A total of 131 adult surgical patients were randomized into DNTP and AD groups to undergo ultrasound-guided radial artery cannulation. The primary outcome was first-pass success without posterior wall puncture. The secondary outcomes included the first-pass success rate, 10-min overall success rate, cannulation time, posterior wall puncture, and the number of skin punctures. Results The first-pass success rates without posterior wall puncture were 53.8% in the DNTP group and 44.6% in the AD group (RR = 1.22, 95% CI: 0.86–1.72; P = 0.26). The cannulation time was significantly longer (P = 0.01) in the DNTP group [79.65 (54.3–109.4) seconds] than in the AD group [47.6 (24.9–103.8) seconds]. The posterior wall puncture rate was significantly lower (P = 0.002) in the DNTP group (29.2%) than in the AD group (56.1%; RR = 0.56, 95% CI: 0.42–0.82). Conclusions There were no significant differences in the first-pass success rate, with or without arterial posterior wall puncture, or in the 10-min overall success rate between the DNTP and AD groups. However, the cannulation time was longer and the posterior wall puncture rate was lower in the DNTP group. Trial registration The trial was registered at www.clinicaltrials.gov (No: NCT03656978). Registered 4 September 2018.

Serial application of the Cardiac Surgery Score (CASUS) to cardiac surgical patients

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
A Badreldin ◽  
M Heldwein ◽  
T Bossert ◽  
K Hekmat
Keyword(s):  
Cardiac Surgery ◽  
Surgical Patients

Entscheidungsprozesse beim Übersetzen: Routine und Reflexion bei Novizen und Berufsübersetzern

Fachsprache ◽  
2017 ◽  
Vol 32 (3-4) ◽  
pp. 100-121
Author(s):  
Friederike Prassl
Keyword(s):  
Decision Making ◽  
Success Rate ◽  
Knowledge Integration ◽  
Popular Science ◽  
Failure Rates ◽  
Science Text ◽  
Success Rates ◽  
Preliminary Results ◽  
Decision Making Processes ◽  
Cognitive Involvement

This article focuses on the decision-making processes involved in research and knowledge integration in translation processes. First, the relevance of decision taking intranslation is discussed. Second, the psychology of decision making as seen by Jungermann et al. (2005) is introduced, who propose a categorization of decision-making processes intofour types: “routinized”, “stereotype”, “reflected” and “constructed”. This classification is then applied to the translations by five professional translators and five novices of five segments occurring in a popular-science text. The analysis reveals that the decision-making types are distributed differently among students and professional translators, which also has to be seen against the background of whether the decisions made were successful or not. The preliminary results of this study show that students resort to reflected decisions in most cases, but with a low success rate. Professionals achieve a higher success rate when making reflected decisions. As expected, they also make more routinized decisions than students. The professionals’ success rates improve with increasing cognitive involvement, while their failure rates are relatively high when making routinized decisions, an aspect worthwhile considering in translation didactics.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jongbeom Shin ◽  
Boram Cha ◽  
Jin-Seok Park ◽  
Weonjin Ko ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Success Rate ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Effective Control ◽  
Success Rates ◽  
Gastrointestinal Tumor ◽  
Bleeding Rate ◽  
Tumor Bleeding ◽  
Hemostatic Powder ◽  
Upper Gastrointestinal

Abstract Background Gastrointestinal tumor bleeding remains a clinical challenge because it is difficult to treat with conventional endoscopic hemostatic options. Recently, an endoscopic hemostatic powder (UI-EWD) was developed and reported to provide effective control of upper gastrointestinal bleeding. The aim of current study was to evaluate the feasibility and efficacy of this novel hemostatic powder in tumor bleeding. Methods A total of 41 consecutive patients with upper gastrointestinal tumor bleeding were included. UI-EWD was applied in all patients as an auxiliary hemostatic method as a salvage therapy or monotherapy during endoscopic treatment. Hemostasis success rates, adverse event related to UI-EWD, and rates of re-bleeding were evaluated. Results In all cases, UI-EWD application was successful at tumor bleeding sites. Immediate hemostasis occurred in 40/41 (97.5%) patients, and re-bleeding within 28 days occurred in 10 of 40 (22.5%) patients that achieved initial hemostasis. The success rate of immediate hemostasis for UI-EWD monotherapy was 100% (23/23). The re-bleeding rate at 28 days after UI-EWD monotherapy was 26.1% (6/23). No adverse events associated with UI-EWD application were encountered. Conclusions The success rate of UI-EWD for immediate hemostasis in cases of GI tumor bleeding was excellent and UI-EWD produced promising results with respect to the prevention of re-bleeding. Based on these results, we suggest that UI-EWD be considered an effective salvage therapy or even monotherapy for GI tumor bleeding.

447 What Age is Best to Perform Myringoplasty?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Wilks ◽  
R Mcleod ◽  
V Unadkat
Keyword(s):  
Systematic Review ◽  
Success Rate ◽  
Meta Analysis ◽  
Paediatric Population ◽  
Cochrane Library ◽  
Clear Correlation ◽  
Success Rates ◽  
Prisma Statement ◽  
Transitional Point ◽  
The Cochrane Library

Abstract Aim This systematic review and meta-analysis aims to assess this relationship and determine the most appropriate age for recommendation of surgery. Method According to the “Preferred Reporting items for systematic review and meta-analysis” (PRISMA) statement, a literature search was performed across Medline, EMBASE and the Cochrane library from 1946-2018. Articles examining a relationship between age and myringoplasty or type 1 tympanoplasty success rates were screened. Results 20 articles encompassing data from 2244 procedures were included. The overall results conveyed a clear correlation between increasing age and rising success rate. A t-test was conducted which demonstrated a significant (P = 0.05) transition at aged 10, whereby success rate below age 10 was 70.6% and above 10 was 86%. Conclusions This systematic review and meta-analysis has uncovered a clear correlation between increasing age and increasing success rate for myringoplasty in the paediatric population. Furthermore, a significant transitional point has been demonstrated at the age of 10 and We hope that knowledge of increased success rates particularly after the age of 10 helps clinicians make more informed decisions about when to operate

Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators

EP Europace ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 598-606
Author(s):  
Ivo Roca-Luque ◽  
Ana Van Breukelen ◽  
Francisco Alarcon ◽  
Paz Garre ◽  
Jose M Tolosana ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Standard Procedure ◽  
False Negative ◽  
False Negative Rate ◽  
Historical Cohort ◽  
Ventricular Tachycardia Ablation ◽  
Vt Ablation ◽  
Lge Cmr

Abstract Aims Ventricular tachycardia (VT) substrate-based ablation has become a standard procedure. Electroanatomical mapping (EAM) detects scar tissue heterogeneity and define conduction channels (CCs) that are the ablation target. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is able to depict CCs and increase ablation success. Most patients undergoing VT ablation have an implantable cardioverter-defibrillator (ICD) that can cause image artefacts in LGE-CMR. Recently wideband (WB) LGE-CMR sequence has demonstrated to decrease these artefacts. The aim of this study is to analyse accuracy of WB-LGE-CMR in identifying the CC entrances. Methods and results Thirteen consecutive ICD-patients who underwent VT ablation after WB-LGE-CMR were included. Number and location of CC entrances in three-dimensional EAM and in WB-LGE-CMR reconstruction were compared. Concordance was compared with a historical cohort matched by cardiomyopathy, scar location, and age (26 patients) with LGE-CMR prior to ICD and VT ablation. In WB-CMR group, 101 and 93 CC entrances were identified in EAM and WB-LGE-CMR, respectively. In historical cohort, 179 CC entrances were identified in both EAM and LGE-CMR. The EAM/CMR concordance was 85.1% and 92.2% in the WB and historical group, respectively (P = 0.66). There were no differences in false-positive rate (CC entrances detected in CMR and absent in EAM: 7.5% vs 7.8% in WB vs. conventional CMR, P = 0.92) nor in false-negative rate (CC entrances present in EAM not detected in CMR: 14.9% vs.7.8% in WB vs. conventional CMR, P = 0.23). Epicardial CCs was predictor of poor CMR/EAM concordance (OR 2.15, P = 0.031). Conclusion Use of WB-LGE-CMR sequence in ICD-patients allows adequate VT substrate characterization to guide VT ablation with similar accuracy than conventional LGE-CMR in patients without an ICD.

scholarly journals Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery - the INFLACOR study.

2018 ◽  
Vol 65 (2) ◽  
pp. 241-250 ◽  
Author(s):  
Maciej Michał Kowalik ◽  
Romuald Lango ◽  
Piotr Siondalski ◽  
Magdalena Chmara ◽  
Maciej Brzeziński ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Genetic Association ◽  
Biochemical Parameters ◽  
Cox Regression ◽  
Association Studies ◽  
Nyha Class ◽  
Genetic Association Studies ◽  
Chronic Obstructive

There is increasing evidence that genetic variability influence patients’ early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFlAmmation in Cardiac OpeRations) cohort.In a series of prospectively recruited 518 adult Polish Caucasians who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFa, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their associations with 30-day and 5-year mortality.The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. The serum levels of IL-6 and ICAM-1 measured three hours after operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance.Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should adjust for the identified chronic and acute postoperative risk factors.

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