Alternative technique of long acting cardioplegia delivery results in less hemodilution

Perfusion ◽  
2020 ◽  
pp. 026765912094672
Author(s):  
Geok Seen Ong ◽  
Goh Si Guim ◽  
Qi Xuan Lim ◽  
Huang Shoo Chay-Nancy ◽  
Nurdiyana Binte Jaafar ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
University Hospital ◽  
Care Group ◽  
Alternative Technique ◽  
Safe Delivery ◽  
Delivery Technique ◽  
National University ◽  
Long Acting

Background: Preparation of del-Nido cardioplegia and its delivery technique can cause significant hemodilution. The resultant effects from hemodilution are largely proportionate to the use of a dual circuit. We opted for a custom-disposable single cardioplegia circuit instead of a dual circuit. Methods: We describe an alternative technique of del-Nido cardioplegia delivery and initial clinical experience with it at National University Hospital, Singapore. This is a retrospective analysis of data from January 2017 to April 2019, comprising of 177 patients of heart surgery and reflecting a single center database survey under the National Health Care Group. Results: Of the 177 patients who underwent surgery with del-Nido cardioplegia, 76 (42.9%) were valve-only procedures and 5 (2.8%) were coronary artery bypass graft–only procedures. Ultrafiltration was utilized in 132 (62.6%) patients, whereas filtrate volume was 2200 [150-9500] mL. The alternative technique of del-Nido cardioplegia delivery adopted by National University Hospital advocates for a single pump, single circuit system. The retrospective institutional data highlighted safe delivery of del-Nido cardioplegia using this technique in a range of procedures. Conclusion: Besides the safe delivery of del-Nido cardioplegia, the National University Hospital Technique reduces hemodilution and provides other technical benefits including a steeper temperature gradient, modification of circuit configuration to deliver another cardioplegia while on bypass, as well as re-configuration of clamps to spike the base solution.

scholarly journals Risk factors for mediastinitis in the post-operative period of heart surgery

2020 ◽  
pp. 971-976
Author(s):  
Debora Ferreira da Cruz ◽  
Elbanir Rosangela Ferreira de Sousa ◽  
Claudia Elizabeth de Almeida
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Rio De Janeiro ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
University Hospital ◽  
Postoperative Risk ◽  
Study Population ◽  
The Relationship

Objectives: The study’s main purpose has been to identify both pre and postoperative risk factors related to the development of mediastinitis among patients who underwent cardiac surgery at a hospital from the Rio de Janeiro city. Furthermore, to characterize the study population and to analyze the relationship between risk factors and the incidence of mediastinitis in patients who underwent cardiac surgery. Methods: It is a descriptive and retrospective study with a quantitative approach, where there were identified the risk factors related to the development of mediastinitis in patients who underwent cardiac surgery at a university hospital from the Rio de Janeiro State. Results: There were obtained a total of 192 patients, mostly males, within the age group from 50 to 69 years old and overweight. Diabetes mellitus and smoking were the most frequent comorbidities, and coronary artery bypass graft surgery was the most performed surgery, 4 patients had mediastinitis. Conclusion: The identification of such factors contributes to the elaboration of prevention strategies for mediastinitis, and the implementation of nursing care in both pre and postoperative periods of cardiac surgeries.

Perioperative management of the high-risk surgical patient: cardiac surgery

2017 ◽  
Author(s):  
Marco Ranucci ◽  
Serenella Castelvecchio ◽  
Andrea Ballotta
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
High Risk Patient ◽  
Advanced Age ◽  
Bleeding Complications ◽  
Surgical Patient ◽  
Number Of Patients

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

A Case of Organic Mania Associated with Open Heart Surgery

1994 ◽  
Vol 7 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Kathryn J. Kotrla ◽  
Ranjit C. Chacko ◽  
Shawn A. Barrett
Keyword(s):  
Heart Surgery ◽  
Single Photon ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Photon Emission ◽  
Open Heart Surgery ◽  
Brain Regions ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Single Photon Emission Computed

Organic mania has been reported to have multiple etiologies. A case is described of a patient who developed mania following a coronary artery bypass graft and mitral valve replacement. Cerebral abnormalities were not detected by computed tomographic or magnetic resonance imaging scans, but an area of dysfunction was found using single photon emission computed tomographic (SPECT) imaging. The lesion resolved when the patient became clinically asymptomatic. The area of decreased cerebral perfusion associated with the patient's mania was in an atypical location, raising questions about which brain regions can result in well-defined psychiatric syndromes.

scholarly journals Anxiety, depression, and self-management: a systematic review

2021 ◽  
Author(s):  
Suzanne Fredericks ◽  
Jennifer L. Lapum ◽  
J. Lo
Keyword(s):  
Systematic Review ◽  
Health Care Providers ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Self Management ◽  
Anxiety And Depression ◽  
Care Providers ◽  
Psychological Condition ◽  
Replacement Surgery

The purpose of this article was to address the clinically relevant question: In the presence of anxiety and/or depression, do patients who have had heart surgery engage in self-management behaviours following hospital discharge? A systematic review of 16 studies that examined the psychological condition of patients who had coronary artery bypass graft (CABG) and/or valvular replacement surgery was conducted. Moderate to severe levels of anxiety and depression exist during the first month of home recovery and appear to have an effect on performance of self-management behaviors. As the influence of patients' psychological condition is continued to be examined, it is imperative for health care providers to manage increased rates of anxiety and/or depression following heart surgery. Music and relaxation therapy are presented as evidenced based recommendations for managing anxiety and depression in patients following heart surgery.

Open Heart Surgery in National University Hospital(1959-1993)

1994 ◽  
Vol 24 (6) ◽  
pp. 753
Author(s):  
Kyung Phill Suh ◽  
Joon Ryang Rho ◽  
Yong Jin Kim ◽  
Hyuk Ahn ◽  
Yung Kyoon Lee
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
University Hospital ◽  
Open Heart ◽  
National University

Perioperative management of the high-risk surgical patient: cardiac surgery

2021 ◽  
pp. 1009-1024
Author(s):  
Marco Ranucci ◽  
Serenella Castelvecchio ◽  
Andrea Ballotta
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Oral Anticoagulants ◽  
Treatment Options ◽  
Bypass Graft ◽  
High Risk Patient ◽  
Advanced Age ◽  
Surgical Patient

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify 'the' high-risk patient: 'pre-warned is pre-armed'. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

Significance of Laminar Air Flow Room for the Reverse Isolation in Neutropenic Cancer Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5503-5503
Author(s):  
Ji Hye Lee ◽  
Hae Sook Kim ◽  
Hwi-Joong Yoon ◽  
Kun Soo Lee
Keyword(s):  
Cancer Patients ◽  
Sexual Difference ◽  
Air Flow ◽  
Underlying Disease ◽  
University Hospital ◽  
Care Group ◽  
Reverse Isolation ◽  
National University ◽  
Neutropenic Patients ◽  
Laminar Air Flow

Abstract Infection is one of the most important causes of death in cancer patients. So many physicians make every effort to control the infection, especially in neutropenic cancer patients. The aim of this study is to find out the role of HEPA filter equipped laminar air flow room reverse isolation for the management of chemotherapy induced febrile neutropenic children with cancer. We evaluated febrile neutropenic patients following chemotherapy from January 2003 to April 2006 at the Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea. They were promptly managed by antibiotics and antifungal agents and if possible, they were isolated in the aseptic room. They were allocated to three groups of standard ward care, isolation after onset of fever and isolation before onset of fever. Profiles of infection, clinical courses and survival rate were compared among three groups. One hundred and nine episodes of febrile neutropenia from thirty eight cancer patients were observed. Twenty nine were boys and nine were girls with their median age were 5.5 years. The diagnoses included acute leukemia (36.8%), malignant lymphoma (15.8%), and other solid tumor (47.4%). Fifty five episodes were included to standard ward care, forty four episodes to isolation after onset of fever and thirteen episodes to isolation before onset of fever. We found out that one in thirteen episodes of isolation before onset of fever (8%) and twenty six in ninety six episodes in other groups (27%) were microbiologically or clinically defined infections. Fifty six episodes recovered and only one died of infectious cause both isolation after and before onset of fever group, especially all recovered in isolation before onset of fever group. Forty eight episodes recovered and four died in general ward care group, but there was no statistical difference among three groups (p=0.93). Age, sexual difference, underlying disease, absolute neutrophil count (ANC), duration of ANC recovery and incidence of disseminated intravascular coagulation were no difference among three groups. In early isolated group, duration of fever and antibiotics medication were significantly shorter (p=0.002, 0.009) and CRP level was lower than other two groups (p=0.04). Reverse isolation in laminar air flow room for neutropenic cancer children before onset of fever affect the durations of fever and antibiotics treatment with beneficial effect.

Recent Developments in Myocardial Protection: Retrograde Cardioplegia

1997 ◽  
Vol 5 (1) ◽  
pp. 2-7
Author(s):  
Anthony L Panos ◽  
Salim Aziz
Keyword(s):  
Coronary Sinus ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Ease Of Use ◽  
Blood Cardioplegia ◽  
Catheter Design ◽  
Coronary Sinus Catheter ◽  
Recent Developments

In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.

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