DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience

Introduction: The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes. Methodology: This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay. Results: There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay. Conclusion: Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.

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Comparative study of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20173894 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3092

Author(s):

Himabindu Bangaru ◽

Varun V. Gaiki ◽

M. V. Ranga Reddy

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Hospital Stay ◽

Prophylactic Antibiotics ◽

Postoperative Hospital Stay ◽

Laparoscopic Appendicectomy ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Preoperative Antibiotics

Background: Antibiotics are being administered both preoperatively and postoperatively even in uncomplicated nonperforated appendicitis. Studies regarding role of postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis are sparse. The aim of the study is therefore to study the efficacy of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in reducing surgical site infection in laparoscopic appendicectomy for uncomplicated nonperforated acute appendicitis.Methods: This is a prospective study done in general surgery department at Malla Reddy institute of medical sciences from September to April 2016.162 patients with nonperforated appendicitis were randomly allocated into two groups. 80 patients in Group A were given single dose of preoperative prophylactic antibiotics. No further antibiotics were given. 82 patients in Group B were given both preoperative and postoperative antibiotics. Postoperative surgical site infection and duration of postoperative hospital stay were compared between both groups. Statistical analysis was done using ANOVA, Fisher’s Exact test and Chi-square test wherever necessary.Results: There was no significant difference in the rate of surgical site infection in both groups. The mean duration of postoperative hospital stay was shorter in preoperative antibiotics only group (Group A). Age and gender had no significant association with surgical site infection. There was no deep incisional or organ space infection in this study.Conclusions: Single dose prophylactic antibiotics would be sufficient in cases of laparoscopic appendicectomy for simple uncomplicated nonperforated acute appendicitis. Postoperative antibiotic administration would not be necessary in these cases.

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Efficacy of Histidine–Tryptophan–Ketoglutarate Solution Versus Blood Cardioplegia in Cardiac Surgical Procedures: A Randomized Controlled | Parallel Group Study

The Heart Surgery Forum ◽

10.1532/hsf.3495 ◽

2021 ◽

Vol 24 (1) ◽

pp. E170-E176

Author(s):

Ihab Ali ◽

Ahmed Hassan ◽

Hoda Shokri ◽

Ramy Khorshed

Keyword(s):

Hospital Stay ◽

Myocardial Protection ◽

Inotropic Support ◽

Time Duration ◽

Blood Cardioplegia ◽

Ventilation Time ◽

Cross Clamp Time ◽

Segmental Wall ◽

Number Of Patients ◽

Significant Difference

Background: In cardiac surgery, myocardial protection is required during cross-clamping followed by reperfusion. The use of cardioplegic solutions helps preserve myocardial energy stores, hindering electrolyte disturbances and acidosis during periods of myocardial ischaemia. This study aimed to compare the efficacy and safety between the histidine–tryptophan–ketoglutarate (HTK) solution and blood cardioplegia in various cardiac surgeries. Methods: Three-hundred-twenty patients aged 30-70 years old undergoing various cardiac surgeries were randomized into the HTK group and the blood cardioplegia group. The ventilation time, total bypass time, cross-clamp time, length of intensive care unit (ICU) or hospital stay, and postoperative complications were analyzed. Results: The total bypass time and cross-clamp time were significantly shorter in the HTK group than in the blood cardioplegia group (P < 0.001). Segmental wall motion abnormalities (SWMA) at postoperative echocardiography were significantly higher in in the blood cardioplegia group (P = 0.008). The number of patients requiring DC Shock was significantly higher in the HTK group (P < 0.001). The number of patients requiring inotropic support was significantly higher in the blood cardioplegia group (P < 0.001). The length of ICU, hospital stay, and ventilation time were significantly longer in the blood cardioplegia group than in the HTK group (P = 0.004, P < 0.001, P < 0.001, respectively). The number of patients requiring prolonged ventilation was significantly higher in the blood cardioplegia group compared with the HTK group (P = 0.022). There was no significant difference between the study groups regarding electrocardiographic changes, 30-day mortality, and 30-day readmission. Conclusion: The use of HTK cardioplegia was associated with significantly shorter cross-clamp time, bypass time, duration of mechanical ventilation, length of ICU stay, and length of hospital stay. It is associated with less incidence of postoperative segmental wall abnormalities and less need for inotropic support than blood cardioplegia. Custodiol cardioplegia is a safe and feasible option that can be used as an effective substitute for blood cardioplegia to enhance myocardial protection.

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Continuous Suture Technique for Aortic Valve Replacement Shortens Cross-Clamp and Bypass Times

Texas Heart Institute Journal ◽

10.14503/thij-16-5886 ◽

2017 ◽

Vol 44 (6) ◽

pp. 390-394 ◽

Cited By ~ 1

Author(s):

Tadashi Kitamura ◽

James Edwards ◽

Kagami Miyaji

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Suture Technique ◽

Paravalvular Leak ◽

Continuous Suture ◽

Surgical Aortic Valve Replacement ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cross Clamp Time

The interrupted noneverting mattress suture technique is typically used in conventional surgical aortic valve replacement. The continuous suture technique, although faster, has been associated with a higher incidence of paravalvular leak. Using a slightly modified technique to minimize this risk, we investigated whether continuous suturing would shorten aortic cross-clamp time in aortic valve replacement in comparison with interrupted suturing. We reviewed the cases and compared the perioperative data of 60 consecutive patients in Japan and Australia (35 men and 25 women; median age, 70 yr) who had undergone aortic valve replacement with or without septal myectomy. The continuous suture technique had been used in 41 patients (Group CS) and the standard interrupted suture technique in 19 (Group IS). The groups were similar in age, sex, pathologic valvular conditions, and operative urgency. In Group CS, aortic cross-clamp time (47 vs 63 min; P=0.0001) and cardiopulmonary bypass time (76 vs 89 min; P=0.04) were significantly shorter. Neither group had early paravalvular leak. Using our continuous suture technique safely shortened aortic cross-clamp time during surgical aortic valve replacement.

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Use of del nido cardioplegia versus St. thomas solution 2 in adult mitral valve replacement surgery at a tertiary care hospital in Kolkata, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201554 ◽

2020 ◽

Vol 8 (5) ◽

pp. 1654

Author(s):

Swarnendu Datta ◽

Ushnish Chakrabarty ◽

Tanmoy Podder ◽

Plaban Mukherjee

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tertiary Care ◽

Care Hospital ◽

Replacement Surgery ◽

Cross Clamp Time ◽

Patient Profiles ◽

Repeated Dosing ◽

Mean Time

Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group.

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Factors influencing the outcome of double valve replacement surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20171994 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1913 ◽

Cited By ~ 1

Author(s):

Manju Gupta ◽

Mohd Shoeb ◽

Pankaj Kumar Mishra ◽

Sunil Dhar ◽

Jagdish Prasad

Keyword(s):

Mortality Rate ◽

Valve Replacement ◽

Statistical Difference ◽

Nyha Class ◽

Surgical Time ◽

Mortality And Morbidity ◽

Cross Clamp Time ◽

Double Valve Replacement ◽

Operative Complications ◽

Class Iv

Background: Data on the influence of surgical variables in mortality and morbidity of patients undergoing double valve replacement (DVR) surgery are scarce. Objective of this study was to identify preoperative, intra operative and post operative factors associated with mortality and morbidity of patients undergoing DVR surgery.Methods: Between 2010 and 2016, patients who underwent double (Mitral and Aortic) valve replacement at our institution were analyzed. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of deaths and the data was analyzed statistically.Results: There were 150 patients, 107 were male (71.3%) and 43 were female (28.6%) Present study revealed a high mortality rate among female patient undergoing DVR surgery than males, which is statically significant at p<0.05. Pre operatively 100 patients (66.6%) were class IV NYHA symptoms. This study finds a significant correlation between preoperative NYHA and hospital mortality with higher mortality rate in NYHA class IV patients with p-value <0.00001 which is significant at p<0.05. Long-term survival was also seen to be significantly dependent on the preoperative LVEF. Among intra operative parameter average total surgical time was 197.70 minutes (3.29 hours); average total cardio pulmonary bypass time was 82.67 minutes (1.37 hours) and average cross clamp time was 67.28 minutes (1.12 hours). Outcome groups (in-hospital death vs. hospital discharge) had a significant statistical difference in relation to variables, respectively: aortic cross clamp time (in minutes) of 77.66 and 67.40 (p=0.001); CPB 95.66 and 84.63 (p=0.006); and total surgical time 208.75 and 186.04 (p=0.002). Among the post operative complications, immediate complications occurring within 7 days of surgery were; low cardiac output syndrome in 9.3% (n=14), bleeding leading to exploration was 8% (n=12), refractory arrhythmias in 3% (n=5), sepsis in 4% (n=6) and acute renal failure in 2% (n=3). Inter mediate post-operative complications (7 to 30 days of surgery) were wound infection in 26 patients (17.3%). There was no incidence of stuck valve or pulmonary thrombo embolism Overall mortality was 8% (12 patients) all within 30 days of operation. There was no statistical difference between the outcome and the types of prostheses used, either biological or metallic (p=0.219).Conclusions: The study results have demonstrated a favourable survival outcome after DVR surgery. An advance age, female sex, a higher NYHA class, poor left ventricular function are associated with poor outcome. The operative mortality in patients undergoing DVR also depends on intra operative factors like total surgical time, CPB time and aortic cross clamped time and has improved remarkably over time, with the improvisation of extracorporeal circulation methods, myocardial protection techniques and postoperative management.

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1269 Five Year Propensity Matched Outcomes of Minimally Invasive vs Conventional Isolated Aortic Valve Surgery

British Journal of Surgery ◽

10.1093/bjs/znab259.255 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Oo ◽

A Khan ◽

J Chan ◽

H Vohra

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Rank Test ◽

Valve Prosthesis ◽

Term Survival ◽

Operative Outcomes ◽

Significant Difference ◽

Aortic Valve Prosthesis

Abstract Aim To analyse the early and mid-term outcomes of the patients undergoing conventional isolated aortic valve replacement (CAVR) versus minimally invasive isolated aortic valve replacement (MIAVR). Method This is a single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement either via CAVR (n = 516) or MIAVR (n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results PM analysis showed the larger sized aortic valve prosthesis were inserted in the MIAVR group (22.8±2.5mm) compared to CAVR group (22.0±2.2mm)(p = 0.010). CPB time was longer with MIAVR (94.4±19.5mins) compared to CAVR (83.1 + 33.3; p = 0.003). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between CAVR and MIAVR groups (17.3±8.2mmHg and13.0±5.1mmHg, respectively; p = 0.001). There was no significant difference between CAVR and MIAVR in the mid-term survival at 3 years. (log-rank test p = 0.314). Conclusions This study found that larger aortic valve sizes with lower mean gradients are being implanted in the MIAVR group. Despite the longer CPB time in the MIAVR group, there was no significant difference in the early complications, mortality, and mid-term survival between MIAVR and CAVR. Further studies will be required to analyse the long-term survival.

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Anatomical circumstances and aortic cross-clamp time in minimally invasive aortic valve replacement

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa251 ◽

2020 ◽

Author(s):

Jure Jug ◽

Zdravko Štor ◽

Borut Geršak

Keyword(s):

Aortic Valve ◽

Linear Regression ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Linear Regression Model ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Cross Clamp Time ◽

The Right

Abstract OBJECTIVES Prolonged operative times, potentially leading to increased morbidity, are a possible drawback of minimally invasive aortic valve replacement. The aim of this study was to assess the impact of anatomical circumstances in the chest on aortic cross-clamp time. METHODS This retrospective study included 68 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve via right-anterior thoracotomy or with ministernotomy. Anatomical variables were measured during preoperative computer tomography scans. RESULTS Aortic cross-clamp time was shorter in those having ministernotomy than in the right-anterior thoracotomy group (41.1 vs 52.3 min; P < 0.001). Cardiopulmonary bypass (CPB) time was not significantly different between groups (P = 0.09). A multivariable linear-regression model (P = 0.018) showed the aortic dextroposition variable to be a significant predictor of the aortic cross-clamp method and CPB times (P = 0.005 and P = 0.003) independent of other anatomical variables in the right thoracotomy group (10 mm deviation from optimal position prolonged the times for 240 and 600 s). For the whole cohort, a correlation between aortic valve dimensions and operative times was found (P = 0.046, P = 0.009). A linear-regression model (P = 0,046) predicted 90 s longer aortic cross-clamp time and 231 s longer CPB time for every 1 mm smaller aortic valve diameter. CONCLUSIONS The anatomical variables are associated with the operative times in minimally invasive aortic valve replacement with sutureless valves. Considering this association, preplanning the procedure is recommended.

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Single Versus Multiple Dose Regimen of Prophylactic Antibiotic in Cesarean Section

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v8i2.9771 ◽

2014 ◽

Vol 8 (2) ◽

pp. 50-53 ◽

Cited By ~ 1

Author(s):

K Bhattachan ◽

GN Baral ◽

L Gauchan

Keyword(s):

Single Dose ◽

Hospital Stay ◽

Dose Regimen ◽

Multiple Dose ◽

Prophylactic Antibiotic ◽

Cesarean Deliveries ◽

Cord Clamping ◽

Group I ◽

Significant Difference ◽

Multiple Dose Regimen

Aims: The purpose of this study was to compare the efficacy of single combined dose of Cefotaxime and Metronidazole against conventional regimen of Ampicllin and Metronidazole for five days for the prevention of infectious morbidities in cesarean deliveries. Methods: This study was carried out at Paropakar Maternity and Women’s Hospital, Kathmandu from April to August 2011. Hundred patients, who had cesarean deliveries for various indications, were divided into two groups with fifty on each arm. Patients in group I were treated with intravenous single dose of Cefotaxime and Metronidazole after cord clamping, whereas those patients in group II were treated with Ampicillin and Metronidazole for five days. Efficacy of the treatment was compared in terms of postoperative infectious morbidities, duration of hospital stay and cost of antibiotics. Results: Overall ten cases (10%) had post-operative complications in which eight (8%) had infectious and two (2%) had thrombophlebitis. The infectious morbidities were febrile morbidities in four cases (4%) followed by urinary tract infection in three cases (3%) and wound infection in one case (1%). There was no statistically significant difference among distribution of these morbidities and in the mean duration hospital stay. The cost of single dose regimen was one-eighth of the multiple dose regimens which was statistically significant (p=0.000). Conclusions: Single dose of Cefotaxime and Metronidazole was equally effective as multiple doses of Ampicllin and Metronidazole for five days in prevention of infectious morbidities with benefit of cost.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 50-53 DOI: http://dx.doi.org/10.3126/njog.v8i2.9771

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The Effectiveness of Heart Valve Replacement Surgery in a Non-Referral Regional Hospital: The Analysis of Outcomes after Isolated and Complex Valve Replacement

The Heart Surgery Forum ◽

10.1532/hsf.2373 ◽

2019 ◽

Vol 22 (5) ◽

pp. E343-E351 ◽

Cited By ~ 1

Author(s):

Mehmet Erin Tüysüz ◽

Mehmet Dedemoğlu

Keyword(s):

Renal Failure ◽

Valve Replacement ◽

Heart Valve ◽

Regional Hospital ◽

Heart Valve Replacement ◽

Late Mortality ◽

Replacement Surgery ◽

Double Valve Replacement ◽

Significant Difference ◽

Valve Replacement Surgery

Background: To comprehensively investigate early and late outcomes for all valve replacement surgery patients in a non-referral regional hospital database and to compare these results with the literature. Methods: This was a retrospective study and made up of patients undergoing heart valve replacement in the cardiovascular department of a non-referral regional hospital between May 2008 and February 2018. Inclusion criteria were aortic, mitral and double valve replacement with or without CABG. Results: 212 patients were included in the study. Of the 212 patients, 65 were aortic valve replacement, 119 were mitral valve replacement, 28 were double valve replacement patients. Mean follow-up of all patients was 3.4 ± 2.9 years. There was no significant difference among the groups regarding hospital mortality. The occurrence of acute renal failure and neurological event was the main factors of morbidity-associated mortality. Concomitant CABG procedure was found to be an independent predictor of early mortality after MVR. In the AVR group, there was no significant difference between AVR with CABG and without CABG regarding the 5-year survival rates; whereas in MVR and DVR group, there was a statistically significant difference between the groups. According to Cox proportional hazards model for determining factors related to late mortality, preoperative chronic renal failure and concomitant CABG were factors independently related to late mortality after MVR. Conclusion: We believe that our study will contribute to the development of the outcomes of heart valve replacement surgery in these centers by supporting other non-heart center clinics in working toward acceptable morality rates for complex valve surgeries.

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Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement

Perfusion ◽

10.1177/02676591211045802 ◽

2021 ◽

pp. 026765912110458

Author(s):

Shwe Oo ◽

Amilah Khan ◽

Jeremy Chan ◽

Sanjay Juneja ◽

Massimo Caputo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Rank Test ◽

Term Outcome ◽

Term Survival ◽

Operative Outcomes ◽

Significant Difference

Objective: To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR). Methods: A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR ( n = 516) or MIAVR ( n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results: The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male ( n = 57) and female ( n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female ( n = 54) and 53% male ( n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31). Conclusion: Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.

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