Abstract 13691: Factors Affecting Extubation Time Post-Cardiac Surgery

Introduction: Early extubation, defined as extubation within 6 hours post-operation, was found to be safe and associated with decreased complications and costs. Recent enhanced recovery after surgery guidelines recommend early extubation for cardiac surgery patients. This retrospective study aimed to assess our institution’s extubation strategy and identify predictive factors of early extubation in our cardiac surgery patients. Methods: Our study included 13,807 adult patients who underwent cardiothoracic surgery from 2010-2019 at our institution. Forward stepwise multivariable logistic regression analysis was used on patients with complete data (n=10,783) to identify predictors of early extubation. Results: Of the 10,783 patients, 3740 (35%) were extubated within 6 hours post-operation. Early extubated patients were younger, had higher BMI and more likely to be fast track designated. These patients more frequently underwent isolated coronary artery bypass graft (CABG), isolated valve or adult congenital surgery than late extubated patients. Early extubated patients had higher incidence of coronary artery disease (CAD) and anxiety, and were less likely to have difficult intubation or require circulatory support post-surgery. Analysis of 10,783 patients showed BMI >30 (OR=1.840, 95% CI=1.624-2.083), fast track designation (OR=1.338, 95% CI=1.12-1.598) and having CAD (OR=1.107, 95% CI=1.007-1.217) to be predictive of early extubation. Data on patient transfer to the ICU were only available from 2014-2018. Within this sub-group of 7296 patients, variables predictive of early extubation included BMI >30 (OR=1.364, 95% CI=1.195-1.557), dayshift transfer to the ICU (OR=1.680, 95% CI=1.516-1.862), fast track designation (OR=1.397, 95% CI=1.115-1.751) and having isolated procedures such as CABG (OR=1.630, 95% CI=1.413-1.880) and valve surgery (OR=1.506, 95% CI=1.300-1.745). Conclusions: BMI >30, having fast track designation, and having CAD are associated with early extubation. When taking into account patient transfer to the ICU, BMI >30, having fast track designation, dayshift transfer to the ICU, and having isolated procedures such as CABG and valve surgery are associated with early extubation.

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Robotics in cardiac surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.supp2.22 ◽

2018 ◽

Vol 100 (Supplement 7) ◽

pp. 22-33 ◽

Cited By ~ 2

Author(s):

AH Sepehripour ◽

G Garas ◽

T Athanasiou ◽

R Casula

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Coronary Artery Revascularisation

A summary of its uses in mitral valve surgery and coronary artery revascularisation

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Dexmedetomidine Improves Lung Function by Promoting Inflammation Resolution in Patients Undergoing Totally Thoracoscopic Cardiac Surgery

Oxidative Medicine and Cellular Longevity ◽

10.1155/2020/8638301 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Junji Cui ◽

Mintai Gao ◽

Hongqian Huang ◽

Xiaoyan Huang ◽

Qingshi Zeng

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Pulmonary Function ◽

Inflammatory Cytokines ◽

Chest Radiography ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Arterial Blood ◽

Extubation Time ◽

Thoracoscopic Technique

Objective. Totally thoracoscopic cardiac surgery under cardiopulmonary bypass combined with one-lung ventilation has been identified as the trend in cardiac surgery. The aim of this study was to examine the effects of the selective α2 adrenergic receptor agonist dexmedetomidine on the pulmonary function of patients who underwent mitral valve surgery using the totally thoracoscopic technique. Methods. Fifty-seven patients who underwent thoracoscopic mitral valve surgery between July 2019 and December 2019 were selected. The patients were randomly divided into the control (Con) group (n=28) and the dexmedetomidine (DEX) group (n=29) using the random number table method. Arterial blood gas analyses were performed, and the oxygenation (PaO2/FiO2) and respiratory indexes (P(A-a)O/PaO2) were calculated 5 min after tracheal intubation (T1), 2 h after operation (T2), 6 h after operation (T3), and 24 h after operation (T4). Moreover, the serum cytokines interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were detected using the enzyme-linked immunosorbent method at all time points. Chest radiography was performed 24 h after surgery. Peripheral blood samples were collected before and after the operation for a complete hemogram. Additionally, the procalcitonin concentration was measured and recorded when the patients were transported to the intensive care unit (ICU). The postoperative extubation time, length of ICU stay, and pulmonary infection rate were also recorded. Results. Inflammatory reaction after surgery was evident. However, the inflammatory cytokines IL-6, TNF-α, and ICAM-1 in the DEX group were lower than those in the Con group after surgery (T2 to T4; P<0.05). Neutrophil counts and procalcitonin concentration were higher in the Con group than in the DEX group (P<0.05). In addition, in the DEX group, pulmonary exudation on chest radiography was lower, and pulmonary function, as shown by an increase in oxidation index and decrease in the respiratory index, improved after surgery (P<0.05). Moreover, the duration of mechanical ventilation in the Con group was 3.4 h longer than that in the DEX group. Conclusion. Dexmedetomidine has a protective effect on pulmonary function in patients undergoing mitral valve surgery using a totally video-assisted thoracoscopic technique, which may be related to a reduction in the concentration of inflammatory cytokines in the early perioperative period.

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Heart surgery in patients on chronic dialysis

Medicinski pregled ◽

10.2298/mpns1302064u ◽

2013 ◽

Vol 66 (1-2) ◽

pp. 64-69 ◽

Cited By ~ 1

Author(s):

Dragana Unic-Stojanovic ◽

Miroslav Milicic ◽

Petar Vukovic ◽

Srdjan Babic ◽

Miomir Jovic

Keyword(s):

Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Artery Bypass ◽

Valve Surgery ◽

Bypass Grafting ◽

End Stage Renal Failure ◽

End Stage

Introduction. Patients on dialysis for end-stage renal failure are subjected to cardiac surgery with increasing frequency. End-stage renal failure is known to be an important risk factor for complications of cardiac operations performed with cardiopulmonary bypass. The aim of this study was to determine the impact of preoperative clinical status and operative variables on perioperative morbidity and mortality in hemodialysis dependent patients subjected to a cardiac surgery. Material and Methods. The following operative variables were examined: urgency, type and duration of surgery and duration of extracorporeal circulation. The study is a retrospective analysis of consecutive patients with end-stage renal failure dependent on maintenance hemodialysis who underwent cardiac surgery during four years. Results. The study included 46 patients. Operations performed included isolated coronary artery bypass grafting (CABG, n = 24), valve surgery alone (n = 6), and combined valve surgery or coronary artery bypass grafting and valve surgery (n = 16). The perioperative mortality rate was 13% with four fatal outcomes in patients who had undergone combined cardiac surgery. We found age > 70 years, preoperative New York Heart Association class IV, preoperative anemia, combined surgery and emergent surgery to be associated with a higher relative risk for perioperative death. Conclusion. Patients on dialysis have an increased morbidity and mortality following cardiac surgery; however, we believe that end-stage renal failure should not be regarded as a contraindication to cardiac surgery or cardiopulmonary bypass.

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Post-operative cardiac implantable electronic devices in patients undergoing cardiac surgery: a contemporary experience

EP Europace ◽

10.1093/europace/euaa241 ◽

2020 ◽

Author(s):

Peter Henry Waddingham ◽

Jonathan M Behar ◽

Neil Roberts ◽

Gurpreet Dhillon ◽

Adam J Graham ◽

...

Keyword(s):

Cardiac Surgery ◽

Left Ventricle ◽

Sinus Node ◽

Electronic Devices ◽

Pacemaker Implantation ◽

High Volume ◽

Patient Characteristics ◽

Valve Surgery ◽

Cardiac Implantable Electronic Devices ◽

Post Surgery

Abstract Aims Optimum timing of pacemaker implantation following cardiac surgery is a clinical challenge. European and American guidelines recommend observation, to assess recovery of atrioventricular block (AVB) (up to 7 days) and sinus node (5 days to weeks) after cardiac surgery. This study aims to determine rates of cardiac implantable electronic devices (CIEDs) implants post-surgery at a high-volume tertiary centre over 3 years. Implant timing, patient characteristics and outcomes at 6 months including pacemaker utilization were assessed. Methods and results All cardiac operations (n = 5950) were screened for CIED implantation following surgery, during the same admission, from 2015 to 2018. Data collection included patient, operative, and device characteristics; pacing utilization and complications at 6 months. A total of 250 (4.2%) implants occurred; 232 (3.9%) for bradycardia. Advanced age, infective endocarditis, left ventricle systolic impairment, and valve surgery were independent predictors for CIED implants (P < 0.0001). Relative risk (RR) of CIED implants and proportion of AVB increased with valve numbers operated (single–triple) vs. non-valve surgery: RR 5.4 (95% CI 3.9–7.6)–21.0 (11.4–38.9) CIEDs. Follow-up pacing utilization data were available in 91%. Significant utilization occurred in 82% and underutilization (<1% A and V paced) in 18%. There were no significant differences comparing utilization rates in early (≤day 5 post-operatively) vs. late implants (P = 0.55). Conclusion Multi-valve surgery has a particularly high incidence of CIED implants (14.9% double, 25.6% triple valve). Age, left ventricle systolic impairment, endocarditis, and valve surgery were independent predictors of CIED implants. Device underutilization was infrequent and uninfluenced by implant timing. Early implantation (≤5 days) should be considered in AVB post-multi-valve surgery.

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EuroScore and IL-6 predict the course in ICU after cardiac surgery

European Journal of Medical Research ◽

10.1186/s40001-021-00501-1 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Andreas Bauer ◽

Insa Korten ◽

Gerd Juchem ◽

Isabel Kiesewetter ◽

Erich Kilger ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Valve Surgery ◽

Bypass Grafting

Abstract Background Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU. Methods We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed. Results EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model. Conclusion Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU.

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Clinical application of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block in right-thoracoscopic minimally invasive cardiac surgery: a retrospective cohort study

10.22541/au.164115758.88166074/v1 ◽

2022 ◽

Author(s):

Shenjie Jiang ◽

Xiaokan Lou ◽

Meijuan Yan

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Clinical Application ◽

Fast Track ◽

Minimally Invasive Cardiac Surgery ◽

Cardiac Anesthesia ◽

Opioid Use ◽

Serratus Anterior ◽

Extubation Time ◽

Anterior Plane

Objectives: This study aimed to investigate the effects of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block on the post-operative rehabilitation of patients undergoing right-sided thoracoscopic minimally invasive cardiac surgery, as well as the safety and feasibility of the clinical application of this technique. Background: Regional nerve block has previously been used in cardiac surgery to reduce intraoperative opioid use and promote anesthesia in fast-track and ultra-fast-track cardiac surgery. However, the clinical application of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) in minimally invasive cardiac surgery under thoracoscopy has not been reported. Methods: A total of 102 patients who underwent right-sided thoracoscopic minimally invasive heart valve surgery in our center from January 2021 to August 2021 were enrolled and divided into two groups: an ultrafast channel cardiac anesthesia assisted by serratus anterior plane block (SAPB-GA) group (n=40) and a conventional general anesthesia (GA) group (n=62). The effects of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) on post-operative rapid recovery as well as the safety and feasibility of its clinical application were compared and analyzed. Results: Compared to the GA group, the intraoperative use of sufentanil in the SAPB-GA group was significantly reduced (66.25±1.025, 283.31±11.362, P<0.001); the incidence of postoperative analgesia in ICU was significantly decreased (17%, 48.8%, P<0.001); the incidence of postoperative NRS≥3 in ICU was significantly decreased (15%, 37.1%, P = 0.016); and the postoperative extubation time (1(1-1), 13.84 (10.25-18.36), P<0.001), ICU stay time (28.58±2.838, 61.69±4.125, P<0.001) and postoperative hospital stay (8.08±0.313, 9.74±0.356, P=0.02) were significantly shortened; and the 24 h postoperative thoracic blood drainage was significantly reduced (209.63±25.645, 318.23±20.713, P<0.001). No statistical difference was observed in the incidence of postoperative nausea, vomiting and atelectasis between the two groups (all P>0.05). Both of the groups reported no postoperative cardiovascular events. Conclusions: Ultrafast channel cardiac anesthesia assisted by SAPB could promote the rapid postoperative recovery of patients undergoing minimally invasive cardiac surgery under a thoracoscope. This approach is safe and feasible in the clinic.

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Improved Cost-Effectiveness and Blood Product Utilization From Instituting a Blood Ordering Algorithm for Cardiac Surgical Cases

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218778602 ◽

2018 ◽

Vol 22 (4) ◽

pp. 353-358 ◽

Cited By ~ 1

Author(s):

Kelly Ural ◽

Jay Trusheim ◽

Yamah Amiri ◽

Mariella Gastañaduy

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Cost Savings ◽

Valve Surgery ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

The Creation

Background. Results of a previous study revealed an over-ordering of blood products for cardiac surgery and led to the creation of a new blood ordering algorithm. This follow-up study has been conducted to evaluate improvement in ordering practices. Methods. Retrospective data were collected for 171 patients who underwent coronary artery bypass grafting or valve surgery from March 2015 to March 2016 to determine the crossmatch-to-transfusion ratio (C:tx) and potential cost savings. Results were compared with pre-algorithm values and considered statistically significant if the 95% confidence interval did not include zero. Results. Prior to the algorithm, 100% of patients undergoing cardiac surgery were crossmatched. After instituting the algorithm, this decreased to 15%. The overall C:tx decreased from 7.97 to 2.14. Cost savings were calculated as $114.79 (coronary artery bypass grafting) and $129.05 (valve surgery) per patient. Conclusions. The creation of a new algorithm to guide ordering practices has significantly improved the C:tx, reduced unnecessary crossmatching, and lowered costs.

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Evaluation of early extubation (fast-track) after cardiac surgery in a post-anaesthesia recovery unit

European Journal of Anaesthesiology ◽

10.1097/00003643-200406001-00060 ◽

2004 ◽

Vol 21 (Supplement 33) ◽

pp. 23

Author(s):

P. Matute ◽

G. Fita ◽

I. Rovira ◽

C. Gomar ◽

N. Peix ◽

...

Keyword(s):

Cardiac Surgery ◽

Fast Track ◽

Early Extubation ◽

Recovery Unit

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Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery

BMC Pediatrics ◽

10.1186/s12887-019-1832-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Jing Xu ◽

Guanghua Zhou ◽

Yanpei Li ◽

Na Li

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Hospital Stay ◽

Congenital Heart ◽

Fast Track ◽

Adverse Reactions ◽

Icu Stay ◽

Anesthesia Group ◽

Extubation Time

Abstract Background To compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight. Methods One hundred and ninety-four CHD children, aged 6 months to 2 years, weighting 5 to 10 kg, were selected for this study. The 94 boys and 100 girls with the American Society of Anesthesiologists (ASA) physical status III and IV were randomly divided into two groups each consisting of 97 patients, and were subjected to ultra-fast-track and conventional anesthesia for cardiac surgery. For children in UFTA group, sevoflurane was stopped when cardiopulmonary bypass (CPB) started and cis-atracurium was stopped at the beginning of rewarming, and remifentanil (0.3 μg/kg/mim) was then infused. Propofol and remifentanil were discontinued at skin closure. 10 min after surgery, extubation was performed in operating room. For children in conventional anesthesia group, anesthesia was given routinely and they were directly sent to ICU with a tracheal tube. Extubation time, ICU stay and hospital stay after operation were recorded. Sedation-agitation scores (SAS) were assessed and adverse reactions as well as other anesthesia –related events were recorded. Results The extubation time, ICU stay and hospital stay were significantly shorter in UFTA group (P < 0.05) and SAS at extubation was lower in UFTA group than in conventional anesthesia group, but similar in other time points. For both groups, no airway obstruction and other serious complications occurred, and incidence of other anesthesia –related events were low. Conclusions UFTA shortens extubation time, ICU stay and hospital stay for children with CHD and does not increase SAS and incidence of adverse reactions.

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Pleural effusion in patients undergoing coronary artery bypass graft and valve replacement: a population study

Health & Research Journal ◽

10.12681/healthresj.19293 ◽

2018 ◽

Vol 4 (3) ◽

pp. 167

Author(s):

Maria Rossolatou ◽

Dimitris Papageorgiou ◽

Georgia Toylia ◽

Georgios Vasilopoulos

Keyword(s):

Cardiac Surgery ◽

Coronary Artery ◽

Pleural Effusion ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Valve Replacement ◽

Artery Bypass ◽

Bypass Graft ◽

Valve Surgery ◽

Artery Bypass Graft

Introduction: The postoperative pleural effusion (PE) is common in patients who undergo cardiac surgery. Most of these effusions develop as a consequence of the surgical procedure itself and follow a generally benign course. The characteristics of PE and the factors predisposing factors should be documented further.Aim: The aim of this study was to determine the prevalence of PE after cardiac surgery. And also to determine whether this prevale is related to the type of cardiac surgery.Material and Methods: This retrospective study was conducted at a large private hospital in Athens. The sample of the study was all adult patients who undergo coronary artery bypass graft (CABG), valve replacement or a combination of these surgeries. A special form was made to record patients’ demographic and clinical data. Descriptive statistics and correlation studies were performed with the SPSS 22.0, at significant level a=0.05.Results: Among the 118 patients, who included in this study, 42.4% underwent CABG surgery, 29.7% valve surgery, and 28% a combination of two types of surgery. Postoperative pleural effusion was developed in 40% of those who underwent CABG, 42.9% of those who underwent cardiac valve surgery, and 42.4% of those who underwent in both types of surgeries. The mean time development of PE was 6.65 days for the CABG group, 4.8 days for the valve group and 8.7 days for the CABG +valve group. There was no statistically significant difference in the demographic and clinical data of patients with pleural effusion according the type of cardiac surgery.Conclusions: Postoperative PE is a common complication at cardiac surgery and is more common in patients undergoing surgical recuperation of valve.

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