Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

This study examined the impact of integrated intensivist consultation in the immediate postoperative period on outcomes for cardiac surgery patients. A retrospective cohort study was conducted in 1711 adult cardiac surgery patients from a single quaternary care center in Minnesota. Outcomes were compared across 2 consecutive 2-year time periods reflecting an elective intensivist model (n = 801) and an integrated intensivist model (n = 910). Patients under the 2 models were comparable with respect to demographics, comorbidities, procedure types, and Society for Thoracic Surgery predicted risk of mortality score; however, patients in the earlier cohort were slightly older and more likely to have chronic kidney disease ( P = .003). Integrated intensivist involvement was associated with reduced postoperative ventilator time, length of stay (LOS), stroke, encephalopathy, and reoperations for bleeding (all P < .01) but was not associated with mortality. Intensivist integration into the postoperative care of cardiac surgery patients may reduce ventilator time, LOS, and complications but may not improve survival.

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The impact of age on outcome of adult cardiac surgery patients

European Journal of Anaesthesiology ◽

10.1097/00003643-200406001-00037 ◽

2004 ◽

Vol 21 (Supplement 33) ◽

pp. 14-15

Author(s):

C. Naughton ◽

J. Roxburgh ◽

R. O. Feneck

Keyword(s):

Cardiac Surgery ◽

The Impact ◽

Adult Cardiac Surgery

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The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.446 ◽

2021 ◽

Author(s):

Nicholas McNamara ◽

Benjamin Robinson ◽

Paul Bannon

Keyword(s):

Cardiac Surgery ◽

The Impact ◽

Adult Cardiac Surgery

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Impact of the Coronavirus Disease 2019 Pandemic on Cardiac Surgical Education in North America

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211011459 ◽

2021 ◽

pp. 155698452110114

Author(s):

Jessica G. Y. Luc ◽

Tom C. Nguyen ◽

Niv Ad

Keyword(s):

Cardiac Surgery ◽

North America ◽

Geographic Distribution ◽

Surgical Education ◽

High Burden ◽

Surgery Training ◽

Virtual Institutions ◽

Licensing Examination ◽

The Impact ◽

Adult Cardiac Surgery

Objective We report the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery trainee education in North America. Methods A survey was sent to participating academic adult cardiac surgery centers in North America. Data regarding the effect of COVID-19 on cardiac surgery training were analyzed. Results Responses were received from 53 academic institutions with diverse geographic distribution. Cardiac surgery trainee re-deployment to alternative clinical duties peaked at the height of the pandemic. We stratified institutions based on high ( n = 20) and low burden ( n = 33) of patients hospitalized with COVID-19. The majority of institutions have converted didactics (high burden 90% vs low burden 73%) and interviews for jobs/fellowships (high burden 75% vs low burden 73%) from in-person to virtual. Institutions were mixed in preference for administration of the licensing examination, with the most common preference for examinations to be held remotely on normal timeline (high burden 45% vs low burden 30%) or in person with more than 3-month delay (high burden 20% vs low burden 33%). Despite the challenges experienced during the COVID-19 pandemic on trainee clinical experience, re-deployment, and decreased operative volume, institutions expected their trainees to graduate on schedule (high burden 95% vs low burden 91%). Conclusions Our study demonstrates that actions taken during the COVID-19 pandemic has led to disruptions in cardiac surgery training with transition of didactics and interviews virtually and re-deployment to alternative duties. Despite this, institutions remain optimistic that their trainees will graduate on schedule.

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Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009927 ◽

2021 ◽

Vol 14 (4) ◽

Author(s):

Alexander A. Brescia ◽

G. Michael Deeb ◽

Stephane Leung Wai Sang ◽

Daizo Tanaka ◽

P. Michael Grossman ◽

...

Keyword(s):

Cardiac Surgery ◽

Aortic Valve ◽

Operative Mortality ◽

Artery Bypass ◽

Paravalvular Leak ◽

Transcatheter Aortic Valve ◽

Risk Of Mortality ◽

Risk Patients ◽

Transcatheter Valve ◽

Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

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Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

10.21203/rs.3.rs-100124/v1 ◽

2020 ◽

Author(s):

Benedict Morath ◽

Andreas Meid ◽

Johannes Rickmann ◽

Jasmin Soethoff ◽

Markus Verch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Kidney Function ◽

Hydroxyethyl Starch ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Kidney Injury ◽

Retrospective Cohort Analysis ◽

The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery

Journal of Anesthesia ◽

10.1007/s00540-011-1287-0 ◽

2011 ◽

Vol 26 (2) ◽

pp. 174-178 ◽

Cited By ~ 34

Author(s):

Alexander Kogan ◽

Sergey Preisman ◽

Alex Bar ◽

Leonid Sternik ◽

Jacob Lavee ◽

...

Keyword(s):

Cardiac Surgery ◽

Postoperative Outcome ◽

The Impact ◽

Adult Cardiac Surgery

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The Impact of Preoperative Frailty on the Clinical and Cost Outcomes of Adult Cardiac Surgery in Alberta, Canada: A Cohort Study

CJC Open ◽

10.1016/j.cjco.2020.09.009 ◽

2020 ◽

Author(s):

Carmel L. Montgomery ◽

Nguyen X. Thanh ◽

Henry T. Stelfox ◽

Colleen M. Norris ◽

Darryl B. Rolfson ◽

...

Keyword(s):

Cardiac Surgery ◽

Cohort Study ◽

The Impact ◽

Cost Outcomes ◽

Adult Cardiac Surgery

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Intraoperative Transoesophageal Echocardiography: Impact on Adult Cardiac Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600310 ◽

1998 ◽

Vol 26 (3) ◽

pp. 287-293 ◽

Cited By ~ 31

Author(s):

D. C. Sutton ◽

R. Kluger

Keyword(s):

Cardiac Surgery ◽

Prospective Observational Study ◽

Case Reports ◽

Transoesophageal Echocardiography ◽

Surgical Patients ◽

Cardiac Pathology ◽

Therapeutic Implications ◽

Multiple Case ◽

The Impact ◽

Adult Cardiac Surgery

Although multiple case reports have demonstrated the capability of transoesophageal echocardiography (TOE) to detect unsuspected cardiac pathology with important therapeutic implications, few studies have examined the effect of real-time interpretation of routine TOE on clinical management of a typical series of cardiac surgery patients. To assess the impact of intraoperative TOE on cardiac surgical management, we conducted a prospective observational study on 238 consecutive patients undergoing intraoperative TOE during adult cardiac surgery. Potentially important new diagnostic information was detected in 39 of 184 (21%) routine and in 53 of 54 requested TOE examinations, and led directly to different surgical procedures in 11 of 184 (6%) routine and in 12 of 54 (22%) requested TOE examinations. Our data suggests that intraoperative TOE may be a valuable tool in the routine management of adult cardiac surgical patients.

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